Unit 17 Dental Assistant Skills

JANET J. NELSON RN, CMA

Labial frenulum

Uvula

Lingual frenulum

Palatine tonsil

ORAL ANATOMY

Labia

Salivary Glands

Parotid glands drain through Stenson’s Duct (Parotid duct)

Submandibular glands run under the mucosa on either side of the midline of the mouthn by the Whartons ducts (Submandibular ducts).

Sublingual drain into the floor of the mouth by the Sublingual or Rivinus ducts.

Identifying the Structures and Tissues of a Tooth

• Dentations: sets of teeth• Primary or deciduous dentition (baby teeth)

• 20 teeth• Age 6month-2 years

• Permanent or Secondary (succedaneous) dentition• 32 teeth• Age 5-20

• Mixed Dentition both primary and permanent teeth present Age 5-12

The Tooth

MAIN SECTIONS OF A TOOTH

• Crown: Visible part• Root: Below gingiva• Cervix: Neck• Apex: Tip of root

Main tooth tissues• Enamel: Covering of

crown• Cementum: Covering of

root• Dentin: Living hard tissue

under enamel and cementum

• Pulp: Soft tissue located in pulp canal & pulp chamber.

Periodontium

• Structures that surround and support teeth

• Alveolar process or ridge

• Periodontal ligament• Gingiva or gums

7:2 Identifying the Teeth• Incisors: Anterior

teeth (used for cutting food)

• Cuspids: Cuspids or eyeteeth (for tearing food)

• Bicuspids: Premolars (NOT present in deciduous dentition)

• Molars: Posterior teeth (largest and strongest)

Primary or Deciduous Teeth

• First set of teeth – called “baby” teeth

• 20 teeth• Naming of teeth• There are NO Bicuspids

(premolars)

Permanent or Secondary Teeth

• Second or permanent set of teeth

• 32 teeth• NOTICE: Patient’s

right and left. Also named based on maxillary or mandibular

17:3 Identifying TeethUsing Numbering Systems

• Universal Numbering System• Federation Dentaire

International System• Primary teeth are identified

by letters A to T.• Start at the right maxillary 2nd

molar (A) and proceed to the right mandibular 2nd molar (T).

• Simplifies charting

Universal Method with Permanent Teeth

• Permanent teeth are identified with numbers 1 to 32

• Right 3rd Maxillary molar is #1 and the right 3rd mandibular molar is #32

• Always remember: • It is the patient’s right and

not yours. • The mouth is divide into

four quadrants.

Federation Dentaire International (FDI) System

• Used mostly in Europe and Canada.

• Each quadrant is numbered. Right maxillary is 5, Left maxillary is 6, Left mandibule is 7 and right mandible is 8

• The teeth are numbered from 1-5 starting with central incisor and ending with the second molar.

FDI System

Permanent Teeth Deciduous teeth

17:4 Identifying the Surfaces of the Teeth

• Begins with location of tooth as anterior or posterior.

• Which permanent teeth are anterior teeth?• Central and lateral

incisors & cuspids• Which permanent teeth

are posterior teeth?• Bicuspids• Molars

ANTERIOR TOOTH SURFACES

FACIAL orLABIAL

MIDLINE

MESIAL

INCISAL

DISTAL

The inside or tonguesurface of an anterior tooth iscalled” lingual”.

POSTERIOR TOOTH SURFACES

MIDLINE MESIAL

BUCCAL

OCCLUSAL

DISTAL

LINGUAL

ABBREVIATIONS

• Buccal : B• Distal: D• Incisal: I• Facial: F

(Labial:La)• Lingual: L• Mesial: M• Occlusal: O

Mrs. Nelson has lots to smile about.

How would you chart this cavity?

• Many surfaces are involved.

• “Line angle” describes two surfaces involved

• “Point angle” describes when more than two surfaces are involved.

• This example is a cavity of the a mesiofaciolingual caries.

Rules for line and point angles

• Drop the “al” of the words and replace with “o”

• Use mesial & distal as the FIRST part of the word

• Use incisal & occlusal as the LAST part of the word

• Exception: Mesioocclusodistal. (Yes there are two O’s and two C’s)

• Abbreviated MOD

.

17:5 Charting Conditions of the TeethThere are two parts to a dental chart. Personal history, medical history, insurance history is located in one section.The second section includes a “treatment area” with a narrative description of treatment. Also included is an anatomic diagram section.

Anatomic ChartingForm

Geographic charting form

DENTAL CHARTING SYMBOLS

• Cavity = • Amalgam = • Composite restoration = • Missing tooth = X

• To be extracted = /• Has been extracted = //• RCT done = • Fracture = VVV• Impacted (entire tooth) = • Gold crown (entire tooth) = Ө• Esthethic crown (entire crown) =

o

In the pulp canal

Charting Abbreviations

• AM or Amal = amalgam restoration• Anes = anesthetic• BWXR = bitewing X-rays• Com or Ant = composite restoration• Cr or CR = crown• Ex or Clin = exam or clinical exam• Ext = extraction• FMXR = full mouth X-rays• Imp = impression• Pro or Prophy = prophylaxis• RCT or Endo = root canal or endodontic

17:6 Operating and Maintaining Dental Equipment

• Follow manufacturer’s recommendations for operation of equipment

• Infection control - PPE, barriers for equipment, etc• Dental light - 30-50 inches from pt, barriers on handles• Chair- safety, cleaning after each patient, barrier on head rest,

Drape patient with plastic side down• Air compressor-use to operate handpieces and air syringes …

usually 100#• Oral evacuation system or central vacuum system – debris

is caught in a trap and needs to be cleaned (provides suction for other tools)

17:6 continued

• Assistant’s cart – instruments and supplies for dental assistant.

• Tri-flow or air-water syringe – air & water injector• Saliva ejector – low suction for saliva, disposable tips• High-velocity oral evacuator - high suction,• Cavitron - ultrasonic scaling technology

• Doctor’s cart – handpieces, air-water syringe, other supplies for dentist

17:6 continued• Low-speed handpiece (conventional-speed)

• Contra-angle• Prophylaxis angle

• High-speed handpiece (ultraspeed)• Maintenance of low-speed and high-speed

handpieces – clean, lubricate, • Burs – “drill bit”

Summary

• Responsibilities for care and maintenance of dental equipment will vary

• Dental assistant should learn exactly what maintenance is expected as a part of the job

• Read specific manufacturer’s instructions for equipment you will handle

17:7 Identifying Dental Instruments

• Mouth mirror• Explorer: examine teeth,caries• Cotton Pliers• Scalers:removes calculus

• Hoes: clean anterior caries • Hatchets: remove hard caries

Instruments continued

• Cleiod-Discoid: cleiod is cutting edge in claw shape and discoid is cutting edge but oval shaped. Used to carve amalgam.

• Amalgam carrier

• Condensor-Plugger

• Composite Restoration: Plastic tools

17:8 Positioning a Patientin the Dental Chair

• Designed to position patient comfortably while providing doctor and assistant easy access to oral cavity

• Headrest needs covering• Chair controls: up/down; recline; chair lock• Cleaning chair with wipes between patients• Principles of seating patient in dental chair• Apply drape with plastic down

17:9 Demonstrating Brushing and Flossing Techniques

• Using correct brushing and flossing techniques is essential to prevent dental disease

• May be responsible for teaching patients• Correct brushing and flossing is one method of

prophylactic care

• http://www.ada.org/public/games/animation/index.asp

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Brush and Floss cont.

• Purposes: prevent decay, plaque, halitosis • Demonstrations: • 45 o degree angle, methodical, • Five surfaces on each tooth• Toothbrushes change Q6M• Toothpastes or dentifrices• Dental floss

17:14 Amalgam Preparation

• CR = “Silver fillings”• Amalgam is mixture of mercury, silver, tin copper

and zinc

• Titruration: method of shaking capsule to mix metals.

• Must be used immediately after mixing• Use carrier, squeeze cloth & plugger• Instruct patient to use soft diet & no pressure for

24 hours

17:14 Composite Restoration Prep

• CR: “Tooth colored filling”

• Various choices for accurate tooth color

• Self curing or light-cured

• Etching solution first …bonding solution…composite

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