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Chapter 19 Dental Assistant Skills Copyright © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 19:1 Identifying the Structures and Tissues of a Tooth • Odontology – Study of anatomy, growth, and diseases of teeth • Teeth are accessory organs of the digestive tract • Teeth aid in mastication (chewing) of food Copyright © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 19:1 Identifying the Structures and Tissues of a Tooth (continued) • Dentitions: sets of teeth • Primary or deciduous dentition – 20 teeth • Permanent or succedaneous dentition – 32 teeth Copyright © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 19:1 Identifying the Structures and Tissues of a Tooth (continued) • Crown – Visible in the mouth, protected by enamel • Root – Below the gum line, covered on the outside by cementum Copyright © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 19:1 Identifying the Structures and Tissues of a Tooth (continued) • Cervix – Where crown meets cementum covering the root • Apex – Tip of the root – Apical foramen, where nerves and blood enter tooth Copyright © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 19:1 Identifying the Structures and Tissues of a Tooth (continued) • Tissues (refer to Figure 19-2 in Text) – Enamel: hardest body tissue, covers the crown – Cementum: covers outside of the root – Dentin: main bulk of tooth, located under the enamel and cementum of the root – Pulp: soft inner area of tooth Copyright © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 19:1 Identifying the Structures and Tissues of a Tooth (continued) • Periodontium – Structures that surround and support teeth – Alveolar process or ridge: surrounds roots and has sockets – Periodontal ligament: supports tooth in the socket – Gingiva or gums: surrounds the cervix Copyright © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 19:1 Identifying the Structures and Tissues of a Tooth (continued) • Disease can affect the teeth and supporting structures • Dental care – Preventing and treating dental disease – Preserving and prolonging the life of the teeth Copyright © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 19:2 Identifying the Teeth • Incisors – Front and center of the mouth – Used to cut or bite food • Cuspids – At angles of lips, also called canines or eyeteeth – Used to tear food Copyright © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 19:2 Identifying the Teeth (continued) • Bicuspids – Before the molars, also called premolars – Used to pulverize or grind food • Molars – Back of the mouth; largest, strongest teeth – Used to chew and grind food Copyright © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 19:2 Identifying the Teeth (continued) • Primary or deciduous teeth – First set of teeth, called “baby” teeth – 20 teeth – Naming of teeth by quadrant (maxillary and mandibular) • Refer to Figure 19-3 in Text Copyright © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 19:2 Identifying the Teeth (continued) • Permanent or succedaneous teeth – Second or permanent set of teeth – 32 teeth • 16 maxillary and 16 mandibular Copyright © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 19:3 Identifying Teeth Using the Universal/National Numbering System and the Federation Dentaire International (FDI) System • Universal/National Numbering System – Primary teeth identified using letters from A to T – Permanent teeth identified by numbers 1 to 32 • Refer to Figure 19-4 in Text Copyright © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 19:3 Identifying Teeth Using the Universal/National Numbering System and the Federation Dentaire International (FDI) System (continued) • Federation Dentaire International (FDI) System – Two-digit code to identify the quadrant and the tooth – Mouth is divided into four quadrants • Refer to Figure 19-5 in Text Copyright © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 19:4 Identifying the Surfaces of the Teeth • Anterior (toward the front) teeth – Incisors and cuspids • Posterior (toward the back) teeth – Bicuspids and molars • Refer to Figure 19-6 in Text Copyright © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 19:4 Identifying the Surfaces of the Teeth (continued) • Crown surfaces of anterior teeth – Labial – Lingual – Incisal —Mesial —Distal • Refer to Figure 19-7 in Text Copyright © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 19:4 Identifying the Surfaces of the Teeth (continued) • Crown surfaces of posterior teeth – Buccal – Lingual – Occlusal —Mesial —Distal • Refer to Figure 19-8 in Text • Abbreviations for crown surfaces vary by doctor Copyright © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 19:4 Identifying the Surfaces of the Teeth (continued) • Line angles – Form where two crown surfaces meet • Point angles – Form where three crown surfaces meet Copyright © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 19:4 Identifying the Surfaces of the Teeth (continued) • Anterior tooth has eight line angles and four point angles – Suggested abbreviations • Posterior tooth has eight line angles and four point angles – Suggested abbreviations Copyright © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 19:5 Charting Conditions of the Teeth • Conditions of teeth are often charted on dental charts or insurance forms • Forms, symbols used, abbreviations, and other factors vary by dental office • Dental charts are legal records Copyright © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 19:5 Charting Conditions of the Teeth (continued) • Dental charts include – Personal patient information – Medical history – Charting area – Treatment section – Radiographic history – Remarks Copyright © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 19:5 Charting Conditions of the Teeth (continued) • Notation methods for dental charting vary – In most offices, colored pencils are used • Symbols for anatomic diagrams can also vary • All treatments or services are also recorded • Use of computerized dental charting Copyright © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 19:6 Operating and Maintaining Dental Equipment • Follow manufacturer’s recommendations for operation of equipment • Infection control is essential • Follow standard precautions before, during, and after procedures • Refer to Procedure 19:6 in Text Copyright © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 19:6 Operating and Maintaining Dental Equipment (continued) • Occupational Safety and Health Administration (OSHA) requirements • Use personal protective equipment (PPE) • Protective barriers for dental equipment Copyright © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 19:6 Operating and Maintaining Dental Equipment (continued) • Equipment includes – Dental lights – Dental chair – Air compressor – Oral-evacuation system – Assistant’s cart • Tri-flow or air–water syringe • Saliva ejector • High-velocity oral evacuator (HVE) • Cuspidor Copyright © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 19:6 Operating and Maintaining Dental Equipment (continued) • Equipment includes (continued) – Doctor’s cart • Rheostats • Low-speed handpiece – Contra angle for cutting and polishing – Prophylaxis angle for holding cups, etc. • High-speed handpiece (ultraspeed) Copyright © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 19:7 Identifying Dental Instruments and Preparing Dental Trays • Methods for setting up dental trays vary • Organization of trays in proper sequence • Main parts of a dental hand instrument – Blade, nib, or point – Shank – Shaft Copyright © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 19:7 Identifying Dental Instruments and Preparing Dental Trays (continued) • Standard instruments – Mouth mirror – Explorer – Cotton pliers – Scalers – Periodontal probes – Excavator – Chisels Copyright © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 19:7 Identifying Dental Instruments and Preparing Dental Trays (continued) • Standard instruments (continued) – Amalgam instruments – Burnisher – Plastic composite instruments – Surgical instruments – Cleoid-discoid carver – Plastic filling instrument (PFI) Copyright © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 19:7 Identifying Dental Instruments and Preparing Dental Trays (continued) • Examples of tray setups – Prophylactic, or general exam – Amalgam restoration – Composite, or esthetic – Surgical extraction • Refer to Procedure 19:7 in Text Copyright © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 19:8 Positioning a Patient in the Dental Chair • • • • • • Correct positioning increases efficiency Supine position in four-handed dentistry Explain all chair movements Protective drape and safety glasses on patient Position light 30–50 inches from mouth Principles of seating patient in dental chair Copyright © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 19:9 Demonstrating Brushing and Flossing Techniques • Correct brushing and flossing techniques are essential in preventing dental disease – Prevention of carious lesions – Removal of plaque – Prevention of halitosis Copyright © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 19:9 Demonstrating Brushing and Flossing Techniques (continued) • Bass method of brushing • Five surfaces on each tooth – Chewing or biting surface – Facial surface – Lingual surface – Side, or interproximal, surfaces (two per tooth) Copyright © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 19:9 Demonstrating Brushing and Flossing Techniques (continued) • Toothbrushes vary in size, shape, and texture • Toothpastes or dentifrices – Clean teeth, freshen breath – Fluoride to prevent decay • Dental floss – Removes plaque and bacteria Copyright © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 19:10 Taking Impressions and Pouring Models • Impression – Negative reproduction of a tooth, several teeth, or a dental arch – Taken to form a model of an area for restoration treatment that will take place outside of the mouth – Common materials used to take impressions Copyright © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 19:10 Taking Impressions and Pouring Models (continued) • Model – Also called a cast – Positive reproduction of the arches or teeth created from the negative impression – Common materials are plaster or stone Copyright © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Alginate • Irreversible hydrocolloid impression material, cannot be returned from gel to original state • Advantages – Simple, economical, easily removed from tissues • Disadvantages – Not good for fine detail, shrinks, tears/breaks easily when wet Copyright © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Alginate (continued) • Alginate powder – Follow manufacturer’s recommended directions • Storage of alginate material – Cool, dry location – Avoid moisture contamination • Premixed alginate with dispensing unit • Refer to Procedure 19:10A Copyright © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Rubber Base (Polysulfide) • Elastomeric impression material that is elastic and rubbery in nature • Two tubes of paste mixed manually – Base and catalyst • Three types are produced • Can be used for any type of dental impression Copyright © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Rubber Base (Polysulfide) (continued) • Not as subject to size changes as alginate • Models should be poured promptly if possible • Disadvantages – Sulfur-like odor, taste, long setting time, causes permanent stains • Refer to Procedure 19:10B in Text Copyright © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Silicones • Polysiloxane or polyvinylsiloxane • Available in light, medium, and heavy versions • Supplied in two tubes – Base and catalyst Copyright © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Silicones (continued) • Advantages – Not affected by fluids in oral cavity – Impression retains shape and size for a long time • Disadvantages – Latex gloves may inhibit setting – More expensive than rubber-base or polysulfide materials Copyright © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Gypsum Materials • Two main products used to form models – Plaster, stone • Principles for use of gypsum • Refer to Procedures 19:10C and 19:10D in Text • Follow CDC guidelines for infection control when taking impressions and pouring models Copyright © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 19:11 Making Custom Trays • Impression trays that are made to fit a particular patient’s mouth – Model of the patient’s mouth – Impression taken – Stone or plaster model as base for custom tray • Refer to Procedure 19:11 in Text Copyright © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 19:11 Making Custom Trays (continued) • Materials used to produce trays – Acrylic resins are most popular and are self-curing or light-curing • Custom trays are for exclusive use with one patient • Clean and replace all equipment Copyright © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 19:12 Maintaining and Loading an Anesthetic Aspirating Syringe • Anesthesia is used to control pain/discomfort • Types of anesthesia – General anesthesia – Analgesia or sedation – Local anesthesia – Topical anesthesia Copyright © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 19:12 Maintaining and Loading an Anesthetic Aspirating Syringe (continued) • Refer to Procedures 19:12A and 19:12B in Text • Two main kinds of injections for used for local anesthesia – Block – Infiltration or field Copyright © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 19:12 Maintaining and Loading an Anesthetic Aspirating Syringe (continued) • Types of medications used for local anesthesia – Anesthetic carpules (cartridges) – Aspirating syringes • Computer-controlled local anesthetic delivery systems • Use standard precautions Copyright © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 19:13 Mixing Dental Cements and Bases • Cements and bases used in variety of dental procedures – Liner – Base – Cement – Temporary Copyright © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 19:13 Mixing Dental Cements and Bases (continued) • Products include – Varnish – Zinc oxide eugenol (ZOE) – Calcium hydroxide – Zinc phosphate – Polycarboxylate • Some require light curing Copyright © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 19:14 Preparing Restorative Materials—Amalgam and Composite • Restoration – Process of replacing a diseased portion of a tooth or a lost tooth by artificial means • May include filling material, crown, bridge, denture, partial denture, implant • Cavity requires restoration Copyright © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Amalgam • Restorative material used mostly on posterior teeth • Contains four main metals – Silver – Tin – Copper – Zinc Copyright © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Amalgam (continued) • Mercury is added to other metals to form amalgam – Must be handled with care due to toxicity – Use PPE – Follow manufacturer’s recommendations Copyright © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Amalgam (continued) • • • • • • Amalgamation Trituration Amalgam alloy Dental amalgam alloy Use of amalgam bonding agents Refer to Procedure 19:14A in Text Copyright © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Composite • Restorative material used primarily for repair of anterior teeth – Self-curing (chemical-curing) or light-curing • Various shades to blend with teeth • Follow manufacturer’s instructions • Refer to Procedure 19:14B in Text Copyright © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 19:15 Developing and Mounting Dental Radiographs (X-Rays) • Dental radiographs – Radiolucents – Radiopaque • Types of dental radiographs • Developing films • Mounting X-rays Copyright © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 19:15 Developing and Mounting Dental Radiographs (X-Rays) (continued) • Types of dental radiographs – Bite-wings —Occlusal films – Periapical films —Panoramics – Pedodontic (child) films • Developing films, mounting radiographs – Refer to Procedures 19:15A and 19:15B in Text Copyright © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 19:15 Developing and Mounting Dental Radiographs (X-Rays) (continued) • Digital dental radiography – Becoming more common – Eliminates need for X-ray film/developing – Reduces radiation exposure 80–90 percent – Can be printed or stored in a patient’s HER – Cost is a disadvantage Copyright © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.