1. 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. Chapter 19 Dental Assistant Skills

2. 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

3. 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

4. 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

5. 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

6. 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

7. 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

8. 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

9. 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

10. 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

11. 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

12. 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

13. 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

14. 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

15. 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

16. 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—Mesial – Lingual—Distal – Incisal Refer to Figure 19-7 in Text

17. 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—Mesial – Lingual—Distal – Occlusal Refer to Figure 19-8 in Text Abbreviations for crown surfaces vary by doctor

18. 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

19. 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

20. 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

21. 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

22. 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

23. 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

24. 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

25. 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

26. 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)

27. 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

28. 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

29. 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)

30. 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

31. 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

32. 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

33. 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)

34. 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

35. 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

36. 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

37. 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

38. 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

39. 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

40. 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

41. 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

42. 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

43. 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

44. 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

45. 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

46. 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

47. 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

48. 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

49. 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

50. 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

51. 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

52. 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

53. 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

54. 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

55. 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

56. 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

57. 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

58. 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