1. Delivering Dental Care
Chapter 33
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2. Chapter 33 Lesson 33.1
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3. Learning Objectives Define and spell the Key Terms.
Discuss the importance of preparing a dental treatment room for a procedure.
Describe how to prepare the dental treatment area for a patient’s arrival.
Demonstrate admitting and seating the patient.
(Cont’d)
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4. Learning Objectives
(Cont’d)
Describe how the operator is positioned during treatment.
Describe how the assistant is positioned during treatment.
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5. Introduction
The clinical assistant assumes the important responsibility of preparing treatment areas, assisting the dentist in procedures, and carrying out expanded functions.
What is four-handed dentistry? (Process by which the operator and assistant work together to perform clinical procedures in an ergonomically structured environment.)
List and discuss various advance preparation procedures a dental assistant can complete to increase the smooth flow of patient care throughout the day. (Obtain the patient record, know the upcoming procedure[s], and have the supplies and equipment ready.)
What might result from a failure to meet standards for these tasks? (Loss of productivity for the dentist, inconvenience or discomfort for the patient, and unnecessary stress for everyone.)
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6. Preparing for Your Patient
Review patient record
Administrative staff
Check for changes in personal information.
Clinical staff
Check for health problems that may alter dental treatment.
Look for medical alerts.
Review progress notes for planned for treatments of the day.
What is the best way to know your patients and to be better prepared for their presence in the reception area? (Have a brief meeting or review the day’s schedule before the patient arrives.)
Some of the issues that should be discussed by the dental team include changes in patients’ dental histories, additional supplies or equipment that may be needed, preparations for the apprehensive patient, and assignments of expanded functions.
What are some of the tasks that should be completed during preparation for the apprehensive patient? (Scheduling a longer appointment, using premedication, and using pain-control measures such as nitrous oxide.)
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7. Preparing the Treatment Area
Treatment room clean, disinfected, and ready for the next patient
Patient records, radiographs, and laboratory results in place
Sterile preset tray and other supplies in place
Dental chair positioned to seat the patient
Equipment moved out of the way for the patient and dental team      
Is the use of personal protective equipment (PPE) recommended for the cleaning and disinfection of the treatment room? (Yes.)
List the appropriate PPE. (Safety eyewear, lab jacket with long cuffed sleeves, gloves, face mask.)
Where should radiographs be placed? (Illuminated view box.)
When should the sterile preset tray be opened? (After the patient is seated and before treatment.)
What is the proper position of the dental chair for receiving the patient? (Upright and at the lowest height.)
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8. Admitting the Patient
Pleasantly greet the patient by name in the reception area.
Escort the patient to the treatment area.
Place the patient’s personal items in a safe place, out of the way of the procedure.
Initiate conversation with the patient.
Ask whether the patient has any questions about the treatment for the day that you might be able to answer.
The patients must be greeted in a courteous manner. Remember to establish eye contact and smile, call the patient by his or her last name, and introduce yourself.
Where is the best place to put the patient’s personal items?
Why would you keep such items within the patient’s sight?
Why is initiating conversation with the patient important?
Why should you ask the patients whether they have any questions or need further information about the treatment?
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9. Seating the Patient
Seat the patient from the side of the dental chair.
Lower or slide the arm into position.
Place the patient’s napkin.
Inform the patient before adjusting the chair.
Position the operating light.
Complete treatment-room preparations.
Wash hands and don personal protective equipment.
Ask the patient to swing his or her legs onto the chair after he or she has been seated from the side of the chair, then place the patient napkin over the patient’s chest and clasp the corners with the use of a napkin chain.
Why should you inform the patient before adjusting the chair?
Move the chair slowly until the patient is in the right position.
Turn on the light after positioning it so that it is aimed at the patient’s chest.
Does the PPE for treatment setup differ from the PPE used during treatment procedures?
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10. Team Dentistry Components of work simplification
Decreased number of instruments.
Sequencing of instruments on the tray by their use
Correct positioning of the patient, dentist, and assistant
Use of appropriate moisture-control techniques.
Transfer of instruments and dental materials as necessary
Use of the least possible amount of motion
Performance of expanded functions by the assistant
What are the main goals of this concept? (To deliver the best and most effective care to the patient and to increase productivity.)
How does ergonomics play a role in team dentistry?
How do the appropriate moisture-control techniques simplify work? (Visibility of the work field in the mouth is increased.)
Expanded functions allow the dentist to use time more effectively and efficiently.
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11. Fig The concept of four-handed dentistry is shown in the positioning of the patient and dental team. (Courtesy of A-dec.)
How does four-handed dentistry affect ergonomics and the concept of team dentistry? (The use of proper four-handed procedures enhances the treatment process by reducing stress and fatigue of both dentist and dental assistant. Four-handed dentistry also better uses the time of the dental team, increasing productivity.)
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12. Principles of Team Positioning
Patient
Lowered to the supine position
Head even with the top of the headrest
Final adjustments made by the operator
(Cont’d)
Why is correct positioning of the dental team essential in the clinical area? (Correct positioning allows access and visibility to all areas of the patient’s mouth while providing maximum comfort and support to the dentist and dental assistant.)
What occurs when the dentist or dental assistant stretches to reach an instrument or gain access to the patient’s mouth? (Accumulated stress contributes to circulatory problems, lower-back pain, and other muscle aches and pain.)
What can you ask the patient to do to make access to specific areas of the mouth easier? (Turn his or her head to the left or right.)
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13. Principles of Team Positioning
(Cont’d)
Operator positioning
Seated as far back as possible.
Thighs parallel to the floor or knees slightly lower than the hips
Feet flat on the floor
Backrest of the chair positioned to support the lower portion or small of the back
Operator’s forearms bent at the elbow and parallel to the floor
What are the most essential requirements for the operator? (Access and vision.)
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14. Fig. 33-3 Position of the operator when seated correctly.
Is this operator positioned correctly (Yes.)
Note the neutral elbow position.
Note how the weight of the operator is supported by the straight back and feet that are flat on the floor.
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15. Principles of Team Positioning
(Cont’d)
Dental assistant
Seated back on the stool
Feet on the base or foot ring of the stool
Positioned as close as possible to the dental chair
Legs parallel to the patient’s chair
Eye level 4 to 6 inches above the eye level of the operator
The dental assistant has to anticipate the needs of the dentist during treatment and maintain access to the area of concentration.
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16. Fig. 33-4 Position of the dental assistant when seated correctly.
Is the dental assistant positioned correctly? (Yes.)
This position will allow the dental assistant to sit 4 to 6 inches above the clinician to allow the assistant to have access to the concentration area.
Note the neutral elbow position.
Note how the feet are supported by the ring at the base of the stool.
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17. Operating Zones
Basic concept required for the efficient, comfortable practice of team dentistry
Operating zones are based on the “clock” concept. This concept is the best way to identify the working position of the dental team, dental equipment, and supplies needed to perform a procedure.
What affects the operator’s position within the operating zone?
The operator’s zone is the zone in which the clinician is positioned.
The transfer zone is the zone in which instruments and dental materials are exchanged between the clinician and the dental assistant.
The assistant’s zone is the area in which the assistant is positioned.
The static zone is directly behind the patient. This is the area with rear delivery or a unit that holds the handpieces, air-water syringe, and additional counter space.
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18. Fig. 33-5 Operating zones for a right-handed operator.
What is the operator zone for a right-handed clinician? (12 o’clock to 5 o’clock.)
What is the transfer zone for a right-handed clinician? (4 o’clock to 7 o’clock.)
What is the assistant’s zone for a right-handed clinician? (2 o’clock to 4 o’clock.)
What is the static zone for a right-handed clinician? (12 o’clock to 2 o’clock.)
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19. Fig. 33-6 Operating zones for a left-handed operator.
What is the operator zone for a left-handed clinician? (5 o’clock to 8 o’clock.)
What is the transfer zone for a left-handed clinician? (5 o’clock to 8 o’clock.)
What is the assistant’s zone for a left-handed clinician? (8 o’clock to 10 o’clock.)
What is the static zone for a left-handed clinician? (10 o’clock to 12 o’clock.)
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20. Four-Handed Dentistry
An ergonomically sound way to practice dentistry using the skills of the dental assistant while including work simplification techniques
What is the key term that describes the focus of four-handed dentistry?
Instrument transfer or instrument exchange takes place in which zone?
What is the role of the dental assistant in four-handed dentistry?
Who benefits from a standardized operating sequence?
How do the patient and the dental team benefit?
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21. Chapter 33 Lesson 33.2
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22. Learning Objectives Explain instrument transfer.
Demonstrate instrument transfer using a selection of instruments.
Specify three grasps used by the operator.
Demonstrate the correct grasp and use of hand instruments.
Transfer instruments using the single-handed technique.
(Cont’d)
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23. Learning Objectives
(Cont’d)
Transfer instruments using the two-handed technique.
Identify five areas in which the assistant must have competency when practicing expanded functions.
Demonstrate the proper use of a dental mirror.
Demonstrate the intraoral use of a dental instrument.
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24. Instrument Transfer and Exchange
Benefits
Standardized operating sequence
Reduced amount of time in the dental chair for the patient
Increases productivity
Less fatigue and stress
Instruments should be exchanged with class I, class II, and class III motions. These motions only involve the fingers, wrist and elbows.
Describe a class I motion and give an example. (Movement of fingers only.)
Describe a class II motion and give an example. (Movement of wrist and fingers.)
Describe a class III motion and give an example. (Movement of fingers, wrist, and elbow.)
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25. Operator’s Grasp Three basic grasps
Pen grasp: The instrument is held in the same manner as a pen.
Palm grasp: The instrument is held securely in the palm of the hand.
Palm-thumb grasp: The instrument is held in the palm of the hand and the thumb is used to stabilize and guide the instrument.
Can you define the term “grasp”? (Grasp is the correct way an instrument or handpiece is held.)
What affects the manner in which the operator grasps and holds an instrument? (The instrument type, the way it is used, and the area of the mouth in which it is being used.)
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26. Fig. 33-7 Basic instrument grasps. A, Pen grasp. B, Palm grasp
Fig Basic instrument grasps. A, Pen grasp. B, Palm grasp. C, Palm-thumb grasp.
Can you identify the grasps pictured on the slide? (A, pen grasp; B, palm grasp; C, palm-thumb grasp.)
Can you identify when each grasp would be used? (Pen grasp, explorer; palm grasp, surgical forceps; palm-thumb grasp, cotton pliers.)
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27. Principles of Instrument Transfer
Understand the sequence of procedures and anticipate when an instrument transfer is required.
Transfer dental instruments and dental materials with the left hand.
Transfer of instruments should be accomplished with a minimum of motion, involving only the fingers, wrist, and elbow.
Instruments are transferred in their position of use.
An instrument is transferred so that the dentist can grasp the instrument for its appropriate use.
An instrument being transferred must be positioned in firmly in the dentist's hand.
(Cont’d)
If transfer of dental instruments is done with the dental assistant’s left hand, what is the function of the dental assistant’s right hand? (The right hand is kept free to provide suction and ready the next materials and instruments.)
When instruments are being transferred, the working end or the position of use is pointed downward for mandibular areas or upward for maxillary areas.
Why is it important to transfer instruments to the dentist in their position for use? (So the dentist does not have to reposition the instrument in his or her hands before use.)
Assistant transfer technique is usually a single-handed technique.
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28. Principles of Instrument Transfer
(Cont’d)
Variations in instrument transfer
Mirror and explorer
Cotton pliers
Handpiece
Instruments with hinges
Why are different instrument-exchange procedures necessary? (Because of variations in instrument design.)
The dental assistant delivers the mirror and explorer simultaneously, using a two-handed exchange.
What signal is used by the dentist to indicate the need for the mirror and explorer? (The dentist places one hand on each side of the patient’s mouth in a position ready to receive the instrument.)
The dental assistant delivers the pliers to the dentist while pinching the “beaks” to avoid dropping the item being held in the pliers.
Take care to avoid tangling the hoses during handpiece transfer.
Rubber dam forceps, surgical forceps, orthodontic pliers, and scissors should be transferred with care. Hold the instrument at the hinge and transfer by directing their handles into the dentist’s palm (Scissors are placed over the dentist’s fingers.)
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29. The Expanded-Function Dental Assistant
“Expanded function” refers to specific intraoral procedures or part of a procedure by the clinical dental assistant that have been delegated by the dentist.
Advantages
Increased productivity
Less stress on the dentist
More patients seen
Increased job satisfaction
Expanded-function dental assistants (EFDAs) must be credentialed in accordance with state guidelines. Most states require formal education before a dental assistant can legally perform expanded-function duties.
What are approved educational training programs? (Accredited dental-assisting programs, programs approved by the state dental board but not accredited, specific course[s] approved by the state dental board.)
Who or what dictates whether the expanded function must be under the direct or indirect supervision of the dentist? (The dental practice act for that state.)
What is direct supervision? (The dentist must be in the same treatment area as the EFDA for the EFDA to perform the function.)
What is indirect supervision? (The dentist must be in the dental office area, but not specifically in the same treatment room, as the EFDA and must be available to evaluate the EFDA’s expanded function.)
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30. Working as the Operator
Understand dental anatomy.
Follow guidelines for operator positioning.
Develop intraoral mirror skills.
Use an intraoral fulcrum.
Understand cavity preparations.
Adapt instrumentation.
Apply dental materials.
Evaluate the expanded function.
A dental assistant carrying out an expanded function assumes the role of an operator.
It is imperative that the EFDA become knowledgeable and competent in the areas listed on this slide.
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