Download continued - cloudfront.net

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.