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Dental Assisting
NotesDental Assisting
NotesDental Assistant’s Chairside Pocket Guide
Minas Sarakinakis
Purchase additional copies of this book at your health science bookstore or directly from F. A. Davis by shopping online at www.fadavis.com or by calling 800-323-3555 (US) or 800-665-1148 (CAN)
FA Davis’s Notes Book
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F. A. Davis Company
1915 Arch StreetPhiladelphia, PA 19103www.fadavis.com
Copyright © 2015 by F. A. Davis Company
Copyright © 2015 by F. A. Davis Company. All rights reserved. This product is pro-tected by copyright. No part of it may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without written permission from the publisher.
Printed in China by Imago
Last digit indicates print number: 10 9 8 7 6 5 4 3 2 1
Publisher: Quincy McDonaldDevelopmental Editor: David PayneDirector of Content Development: George W. LangDesign and Illustration Manager: Carolyn O’Brien
Reviewers: Cynthia Baker, DDS, CDA; Kim Best, CDA; Cynthia K. Bradley, CDA, CDPMA, CPFDA, EFDA, BA; Denise Campopiano, CDA, RDH, BS; Alison Collins, CDA, MS; Cynthia S. Cronick, CDA, AAS, BS; DeAnna Davis, CDA, RDA, MEd; Danielle Furgeson, CDA, RDH, EFDA, MS; Vita M. Hoffman, CDA, AS; Ann E. Kiyabu, CDA; Dr. Connie Kracher, PhD, MSD; Aamna Nayyar, BSc, BDS, DDS; Judith E. Romano, RDH, BS, MA; Angela E. Simmons, CDA, CPFDA, BS.
As new scientifi c information becomes available through basic and clinical research, recommended treatments and drug therapies undergo changes. The author(s) and publisher have done everything possible to make this book accurate, up to date, and in accord with accepted standards at the time of publication. The author(s), editors, and publisher are not responsible for errors or omissions or for consequences from application of the book, and make no warranty, expressed or implied, in regard to the contents of the book. Any practice described in this book should be applied by the reader in accordance with professional standards of care used in regard to the unique circumstances that may apply in each situation. The reader is advised always to check product information (package inserts) for changes and new information regarding dose and contraindications before administering any drug. Caution is especially urged when using new or infrequently ordered drugs.
Authorization to photocopy items for internal or personal use, or the internal or personal use of specifi c clients, is granted by F. A. Davis Company for users regis-tered with the Copyright Clearance Center (CCC) Transactional Reporting Service, provided that the fee of $.25 per copy is paid directly to CCC, 222 Rosewood Drive, Danvers, MA 01923. For those organizations that have been granted a photocopy license by CCC, a separate system of payment has been arranged. The fee code for users of the Transactional Reporting Service is: 978-0-8036-3822-8/15 0 + $.25.
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Place 27/8 × 27/8 Sticky Notes herefor a convenient and refi llable note pad
√HIPAA Compliant
√OSHA Compliant
Waterproof and Reusable
Wipe-Free Pages
Write directly onto any page of Dental Assisting Notes with a ballpoint pen. Wipe old entries off
with an alcohol pad and reuse.
INDEXRESOURCEINSTRRADIOLINFECT CONTROL
CHAIR-SIDEMEDSEMERG
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Contacts • Phone/E-Mail
Name
Ph: e-mail:
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Emergency Preparedness
ASA Classifi cations
The American Society of Anesthesiologists (ASA) has introduced a classifi cation system to determine a patient’s physical status.
ASA I
■ Patient is healthy.■ Patient can either climb two fl ights of stairs or walk for two
city blocks without experiencing any shortness of breath.
ASA II
■ Evidence of some mild systemic disease present.■ Patient can climb one fl ight of stairs or walk two city blocks
but may experience some shortness of breath.■ Examples: Epilepsy, asthma, allergies, pregnancy.
ASA III
■ Severe systemic disease that interferes with but does not inhibit daily life.
■ Individual may be able to climb one fl ight of stairs or walk one city block but more than likely would have to stop because of shortness of breath.
■ Examples: Type I diabetes, heart failure, hypertension.
ASA IV
■ Severe systemic disease that inhibits daily activities and can be fatal.
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■ Individual is unable to climb a fl ight of stairs or walk one city block and may even experience shortness of breath at rest.
■ Examples: Uncontrolled, diabetes, heart failure, angina, type two hypertension.
ASA V
■ Patient is rapidly deteriorating and will not survive.
Emergency Kit
Every dental offi ce should maintain a custom designed emer-gency kit ready for use that is easily accessible and portable. Each emergency kit in a dental offi ce should contain at least the following components:
■ Portable oxygen: Used in every medical emergency EXCEPT hyperventilation.
■ Epinephrine: Used in anaphylactic emergencies.■ Nitroglycerin: Used in angina, myocardial infarction (MI),
and congestive heart failure emergencies.■ Diphenhydramine: Used to manage allergic reactions.■ Albuterol: Used in asthma attacks.■ Glucose: Used in patients who are conscious and have
hypoglycemia (low blood sugar).■ Glucagon: Used in unconscious patients with hypoglycemia.
It is administered intramuscularly.■ Lorazepam: Used in emergencies involving seizures
or hyperventilation. It is usually administered intramuscularly.
■ Atropine: Used in low blood pressure emergencies.■ Aspirin: Extremely benefi cial drug in patients with signs
of MI.■ Steroids: Although considered an essential drug due to the
slow onset (1 hour), steroids such as hydrocortisone can be used in managing allergic reactions.
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3Besides the afore mentioned substances, a few items should be included in the emergency kit, such as:
■ One-way valve pocket mask■ Syringes for administering the intramuscular drugs■ Sterile gauze and bandages■ Ice pack■ Automated external defi brillator (AED)
Premedication Guidelines
The American Dental Association (ADA) notes that some indi-viduals may require antibiotic prophylaxis before certain dental procedures. These dental procedures involve manipulation of the gingival tissue, the periapical region of a tooth, or perforation of the oral mucosa.
Only dentists and physicians can prescribe antibiotic prophylaxis.
The two groups of patients for whom antibiotic prophylaxis is
recommended are:
■ Individuals with certain heart conditions that predispose them to infective endocarditis (IE)■ Artifi cial heart valves■ History of having previously contracted IE■ Heart transplant that had complications and valve
problems■ Certain congenital heart conditions such as:
• Unrepaired or incompletely repaired cyanotic congenital heart disease, including those with palliative shunts or conduits
• A completely repaired congenital defect of the heart with prosthetic material or device, whether placed by surgery or by catheter intervention, during the fi rst 6 months after the procedure
• Any repaired congenital heart defect with residual defect at the site or adjacent to the site of a prosthetic patch or a prosthetic device
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Patients should check with their cardiologists if they have any questions about whether they fall into one of these categories.
The recommendations for antibiotic prophylaxis for IE state that the antibiotic should be taken 30 to 60 minutes before the procedure for it to reach adequate levels in the blood. However, if the antibiotic is inadvertently not administered before the pro-cedure, the dosage may be administered up to 2 hours after the procedure.
If a patient who is required to have antibiotic prophylaxis is already taking antibiotics for a separate condition, the dentist must prescribe a different class of antibiotic from the one the patient is already taking.
■ Individuals who have a total joint replacement and run the risk of developing infection at the prosthetic site.
Even though the American Academy of Orthopedic Surgeons (AAOS) recommends antibiotic prophylaxis for all patients with total joint replacement, the ADA and AAOS are in the process of developing evidence-based guidelines to help determine when antibiotic prophylaxis is recommended before a dental proce-dure for patients with orthopedic implants.
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5
Antibiotic Prophylaxis Regimen
Route of
Administration Drug
Dose: One Dose 30–60 Min
Before Appointment
Adult Children
Oral Amoxicillin 2 g 50 mg/kg
Unable to take oral meds
AmpicillinCefazolin
2 g IV or IM1 g IV* or IM
50 mg/kg IV or IM50 mg/kg IV or IM
Unable to take oral meds or allergic to penicillins
CephalexinClindamycinAzithromycin
2 g600 mg500 mg
50 mg/kg20 mg/kg15 mg/kg
Unable to take oral meds or allergic to penicillins
CefazolinClindamycin
1 g IV or IM600 mg IV or
IM
50 mg/kg IV or IM20 mg/kg IV or IM
*IM, intramuscular; IV, intravenous.
Vital Signs
In dentistry, pulse, respiration, and blood pressure are routinely taken to assess the patient’s health before treatment.
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Blood Pressure
Reprinted with permission from: Kantz, S. (Forthcoming). Dental Assisting: A Comprehensive Guide to Current Practice, ed 1. Philadelphia: F.A. Davis Company.
The blood pressure is recorded as a fraction of the systolic blood pressure over the diastolic blood pressure. The force of blood against the blood vessel walls during ventricular contraction is called systolic pressure, and the force of blood against the blood vessel walls during ventricular relaxation is called diastolic pressure.
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Blood Pressure Types In Adults
Systolic (mm Hg) Diastolic (mm Hg)
Normal <120 <80
Prehypertension 120–139 80–89
Hypertension stage 1 140–159 90–99
Hypertension stage 2 ≥160 ≥100
Pulse RateA pulse is the rhythmic dilation of an artery caused by the con-traction and expansion of the arterial wall as blood is pushed out of the heart. It is commonly used to measure one’s heart rate. A person’s pulse can be measured in various areas but is usually felt in the carotid artery in the neck, the brachial artery in the arm, or the radial artery in the wrist. When measuring pulse, one should also assess rhythm and strength. Pulse should be recorded for 1 minute. (In dentistry, it is common to measure the pulse rate for 30 seconds and then multiply by 2.)
Normal Pulse Rates
Pulse Category Heart Rate (bpm)
Adults and children 10 years old and older 60–100
Children younger than 10 years but older than 1 year
60–140
Babies 1 year old and younger 100–160
Adult marathon runners 40–60
bpm, beats per minute.
RespirationDuring respiration, oxygen and carbon dioxide are exchanged in the human body. It is measured by the respiration rate (RR). In an adult at rest, the normal RR is between 12 and 20 breaths/min.
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Normal Respiration Rates
Age Category Respiratory Rate (breaths/min)
Adults 12–20
Children 15–25
Newborns 40–50
Chain of Survival (AHA)
■ Early access: Immediate recognition of cardiac arrest and activate emergency response system (EMS) CALL 911.
■ Begin early CPR: Chest compressions and ventilations.■ Early defi brillation: Use the AED.■ Early advanced care: Provided by EMS personnel.
CPR
Sequence of Steps for CPR: CABBegin the CAB sequence if the person is unresponsive, is not breathing, or has no pulse within 10 seconds.
■ Chest compressions: Perform 30 compressions of the sternum to a depth of at least 2 in. for adults, about 2 in. for children, and about 1½ in. for infants at a rate of 100/min. Allow complete recoil of chest wall.
■ Airway: Ensure that the ability of the victim to breathe is not obstructed by performing a head tilt and chin lift.
■ Breathing: Perform two ventilations.
Reassess CABs after 2 min.
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9Automated External Defi brillator
External defi brillators are becoming vital pieces of equipment in dental offi ces as part of a protocol for managing medical emer-gencies. Early defi brillation saves lives.
■ Turn machine on.■ Follow audio and visual instructions.■ Place pads as directed.■ Follow instructions; stay clear for shock if indicated.■ If machine indicates, continue with CPR.
Obstructed Airway Management (Heimlich Maneuver)Obstructed airways may occur anywhere at any time. A foreign object can become lodged, not allowing the victim to breathe.
If a victim shows the universal sign of choking (grasping the throat with both hands), do the following:
■ Ask whether the person is choking. If she responds, avoid physical contact and encourage her to cough. If she cannot respond, be ready to perform abdominal thrusts.
■ Stand behind the victim, wrap your hands around her waist, and place your fi st, thumb fi rst, above the navel but below the breast bone.
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■ Perform abdominal thrusts using quick upward motions.■ Continue until the foreign object is expelled or until the
victim becomes unconscious due to lack of oxygen in the brain.
■ If the patient becomes unconscious, call 911 and begin CPR.
If, because of pregnancy or the size of the victim, one cannot perform abdominal thrusts, chest thrusts are the best alternative.
Medical Emergencies
Most medical emergencies can be prevented from happening in a dental offi ce by being aware of the patient’s medical health history. Regardless of the precautions taken by the dental staff, however, medical emergencies do happen. Therefore, all dental assistants should have up-to-date credentials on CPR, obstructed airway management, and obtaining vital signs.
Medical emergencies in a dental offi ce are best dealt with as a team. The entire dental team (dentist, assistant, hygienist, and front desk personnel) should practice medical emergency scenarios, so that individual roles are preassigned and duties predetermined.
Angina Pectoris
Lack of oxygen to the heart muscle will lead to myocardial is -chemia with severe chest pain. It has been reported that angina is one of the most frequently encountered medical emergencies in a dental offi ce.
Symptoms & Signs■ Chest pain■ High blood pressure■ High pulse■ Nausea■ Pain radiating to shoulder or even to lower jaw
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11Management■ Administer 100% oxygen.■ Administer nitroglycerin.■ If pain has not subsided 10 minutes after nitroglycerin
administration, call EMS.■ If patient has no known angina condition, call EMS
immediately and follow the fi rst two steps above.
Broken Instrument
By maintaining instruments in good working condition and dis-carding instruments that have become oversharpened and thin, one can prevent broken tips in a patient’s mouth.
In the event that a tip is broken in a patient’s mouth, without alarming the patient, ask him or her not to swallow. Do not rinse because you may dislodge the tip unknowingly. Try to isolate the area, gently dry it out, and locate the tip. If the tip is visible, use a curette or cotton pliers to gently retrieve it. If the tip is not visible, take a radiograph to determine its location. If the tip is deeply lodged, the patient may need to be referred to an oral surgeon for surgical removal.
Diabetic Emergency
Obtaining an accurate medical history in the dental offi ce is extremely important, especially for patients with metabolic dis-orders, such as diabetes. There are three types of diabetes. Type
1 diabetes occurs when the body makes too little or no insulin, also called insulin-dependent diabetes. Type 2 diabetes occurs when the body cannot use the insulin it makes, also called non–insulin-dependent diabetes. Gestational diabetes occurs in preg-nant women.
HypoglycemiaHypoglycemia or insulin shock occurs when blood glucose levels drop signifi cantly.
Symptoms & Signs■ Fast onset■ Irritability
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■ Clammy skin■ Rapid breathing
Management■ Stop all dental procedures and remove all objects from the
mouth.■ If the patient is conscious, give oral glucose.■ Fully recline the patient’s chair.■ If the patient is unconscious, administer glucose
intravenously or glucagon intramuscularly.■ Call EMS.
HyperglycemiaHyperglycemia is less likely to occur in a dental offi ce and is triggered by low insulin levels in the blood.
Symptoms & Signs■ Slow onset■ Dry skin■ Deep breathing■ Nausea■ Vomiting■ Drowsiness
Management■ Determine what type of diabetic emergency is at hand.■ Administration of glucose will not harm a patient with
hyperglycemia, but it will signifi cantly help a hypoglycemic one.
■ Managing hyperglycemia requires administration of precisely the right amount of insulin. Thus, a physician must administer it, so that the patient’s condition will not turn to hypoglycemia because of an overdose of insulin.
■ Call EMS.
Fainting (Syncope or Vasovagal Episode)
Syncope, more commonly known as fainting, is perhaps the most common cause of loss of consciousness in a dental offi ce. It is usually triggered by fear, anxiety, pain, or fasting.
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EMERG
13Symptoms & Signs■ Lightheadedness■ Nausea or vertigo (dizziness)■ Pupil dilation■ Perspiration■ Pallor (paleness)■ Bradycardia (low pulse)■ Loss of consciousness
Management■ Stop all dental procedures and remove all objects from the
mouth.■ Place patient in supine position with head below heart level
to facilitate blood return.■ Administer oxygen (4 L/min).■ Loosen tight clothing.■ Monitor vital signs.■ Keep patient in supine position even after recovery until
ready to be elevated to a seated position.■ If patient is not recovering, call EMS.
Foreign Object Aspiration
Foreign body aspirations in dentistry can be prevented by the use of screens, gauze, or rubber dams. Fixed prostheses should also be secured with fl oss before trying them intraorally. Aspira-tion of a foreign object is a serious, potentially life-threatening situation. If the aspiration leads to the patient choking while in the dental offi ce, follow the instructions for obstructed airway management as described earlier. If the patient becomes uncon-scious, call 911 and begin CPR, as described previously.
Hyperventilation
During hyperventilation, the patient breathes at a much faster rate, consuming more carbon dioxide than is produced, resulting in changes in the pH of the blood. Hyperventilation is triggered by many conditions, including anxiety and fear.
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Symptoms & Signs■ Very fast breathing■ Dizziness■ Heart palpitations■ Muscle spasms■ Tingling of the extremities
Management■ Position the patient in a position in which he or she feels
comfortable (preferably upright).■ Assist in trying to control the patient’s breathing.■ Check vital signs.■ Consider administering lorazepam intramuscularly.■ If condition does not improve, contact EMS.
Seizures
Seizures result from abnormal electrical activity in the brain.Risk factors include genetic predisposition and systemic imbal-
ances caused by metabolic disorders, use of certain drugs, infec-tions, cancer, and trauma.
Symptoms & SignsBecause of the various types of seizures, the symptoms may vary slightly. However, common symptoms include the following:■ Convulsions■ Heavy breathing■ Muscle contraction■ Loss of consciousness■ Frothy mouth
Management■ Stop treatment immediately and make sure you remove all
objects from the patient’s mouth to avoid injury.■ Place the patient in a supine position on his or her left side
to avoid aspiration.■ Loosen tight clothing.■ Protect the patient from injury by gentle restraint and do not
attempt to move to the fl oor.
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15■ Administer oxygen.■ If the patient becomes unconscious, call EMS and begin CPR.
Dental Emergencies
Management procedures described in the following are to be performed only by licensed dentists or, in some cases, by dental hygienists.
Abscess
PeriodontalSymptoms & Signs■ Pain■ Swelling■ Pus■ Bleeding gums
Management■ Débridement of the periodontal pocket, root planing, and
scaling if indicated and clinically possible■ Local delivery of antimicrobial solutions and placement of
antibiotics■ If pocket is deep (>6–7 mm), referral to periodontist may be
appropriate for surgical resolution and reduction of the pocket depth.
Tooth RelatedSymptoms & Signs■ Pain (can be severe).■ Swelling.■ Pus.■ Bad taste and odor.■ Pain on tapping.■ No temperature sensitivity.■ Many times a parulis is visible on the gingival margin apical
to the abscessed tooth.■ Fever.
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Management■ Drain the abscess to relieve the pressure.■ Prescribe systemic antibiotics.■ Prescribe mild pain control medication.■ Perform root canal or extraction depending on tooth
condition and patient preference.
Alveolar Osteitis (Dry Socket)Symptoms & Signs■ Radiating pain (can be severe)■ Visible bone■ Bad breath■ Foul taste■ Bleeding from the extraction site■ Gray tissue surrounding the extraction site
Management■ Administer local anesthesia.■ Clean and irrigate socket.■ Place medicaments in the socket.■ Stress postoperative instructions.■ Prescribe antibiotics and perhaps pain medication.■ Replace medicaments if necessary.■ Evaluate in a few days.
Avulsed ToothSymptoms & Signs■ Tooth completely out of the socket■ Pain■ Swelling
Management■ Obtain a radiograph of the area to rule out bone fragments
in the socket or socket fracture and collapse.■ If the tooth is temporary (deciduous), do nothing; let the
permanent tooth erupt.■ If the tooth is permanent (succedaneous) and is preserved
without excessive manipulation, attempt to reinsert it back to the socket and splint it to adjacent teeth.
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17■ If reimplantation is successful, root canal treatment and
crown restoration will be necessary.■ If reimplantation fails, discuss alternative restorative options
with the patient.
Broken ToothSymptoms & Signs■ Caused by trauma or decay■ Temperature sensitivity
Management■ Obtain a radiograph to evaluate root integrity.■ Restore (restorations will vary depending on the amount of
the broken tooth and the condition of the remaining tooth structure).
■ Root canal or extraction may be necessary.■ Discuss alternative restorative options.
Cracked Tooth Syndrome (CTS)Symptoms & Signs■ Caused by trauma or decay■ Temperature sensitivity
Management■ Obtain a radiograph to evaluate root integrity.■ Confi rm CTS with bite stick (bite and release test).■ Restore (restorations will vary depending on the amount of
the broken tooth and the condition of the remaining tooth structure).
■ Root canal or extraction may be necessary.■ Discuss alternative restorative options.
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18
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intm
ent
Card
ura
Do
xazosin
mesylate
Dry m
ou
th/M
on
itor vital sig
ns, p
rovid
e a stress-free ap
po
intm
ent
Celeb
rexC
elecoxib
Dry m
ou
th
Celexa
Citalo
pram
Dry m
ou
th, p
ostu
ral hyp
oten
sion
Cialis
Tad
alafi lD
ry mo
uth
Claritin
Loratad
ine
Dry m
ou
th
Clo
zarilC
lozap
ine
Dry m
ou
th
Co
ntin
ued
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20
MEDS
Co
mm
on
ly Prescrib
ed M
edicatio
ns T
hat A
ffect the M
ou
th
and
Teeth
—co
nt’d
Tra
de
Na
me
Ge
ne
ric N
am
eD
en
tal E
ffects
/Ma
na
ge
me
nt
Co
mb
ivent
Alb
utero
l–ipratro
piu
mD
ry mo
uth
, teeth m
ay app
ear disco
lored
Co
ncerta
Meth
ylph
enid
ate HC
lD
ry mo
uth
/Use vaso
con
strictors w
ith cau
tion
Co
rtefH
ydro
cortiso
ne
Can
did
a
Co
um
adin
Warfarin
Co
ntact p
hysician
befo
re perfo
rmin
g a p
roced
ure
in w
hich
bleed
ing
is expected
Darvo
cetP
rop
oxyp
hen
e–acetam
ino
ph
enS
tom
atitis
Deltaso
ne
Pred
niso
ne
Delayed
healin
g, C
and
ida
Dem
erol
Mep
eridin
eH
ypo
tensio
n (p
ostu
ral)
Den
avirP
enciclo
virA
ffects taste
Dep
akote
Valp
roic A
cidD
ry mo
uth
Desyrel
Trazo
do
ne
Dry m
ou
th, h
ypo
tensio
n
Detro
lT
oltero
din
eD
ry mo
uth
Difl u
canFlu
con
azole
Affects taste b
ud
s
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MEDS
21C
om
mo
nly P
rescribed
Med
ication
s Th
at Affect th
e Mo
uth
an
d T
eeth—
con
t’d
Tra
de
Na
me
Ge
ne
ric N
am
eD
en
tal E
ffects
/Ma
na
ge
me
nt
Dilan
tinP
hen
ytoin
sod
ium
Gin
gival h
yperp
lasia
Dilau
did
Hyd
rom
orp
ho
ne
Dry m
ou
th
Du
ragesic
Fentan
yl (transd
ermal)
Hyp
oten
sion
, dry m
ou
th
Effexo
rV
enlafaxin
e HC
lD
ry mo
uth
Elavil
Am
itriptylin
e HC
LD
ry mo
uth
, hyp
oten
sion
/Do
no
t use
vasoco
nstricto
rs
En
brel
Etan
ercept
Alters taste
En
do
cetO
xycod
on
e–acetamin
op
hen
Dry m
ou
th
Fosam
axA
lend
ron
ate sod
ium
Rare cases o
f osteo
necro
sis
Halcio
nT
riazolam
Dry m
ou
th, sto
matitis
Hald
ol
Halo
perid
ol
Dry m
ou
th
Hyzaar
Losartan
–hyd
roch
loro
thiazid
eD
ry mo
uth
Imitrex
Su
matrip
tanD
ry mo
uth
Ind
eralP
rop
rano
lol H
CL
Dry m
ou
th
Co
ntin
ued
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22
MEDS
Co
mm
on
ly Prescrib
ed M
edicatio
ns T
hat A
ffect the M
ou
th
and
Teeth
—co
nt’d
Tra
de
Na
me
Ge
ne
ric N
am
eD
en
tal E
ffects
/Ma
na
ge
me
nt
Isord
ilIso
sorb
ide d
initrate
Hyp
oten
sion
Lamictal
Lamo
trigin
eD
ry mo
uth
LasixFu
rosem
ide
Dry m
ou
th, h
ypo
tensio
n
Libriu
mC
hlo
rdiazep
oxid
eD
ry mo
uth
, som
etimes co
ated to
ng
ue is n
oted
Lod
ine
Eto
do
lacD
ry mo
uth
Lop
ressor
Meto
pro
lol
Dry m
ou
th
Lorab
idLo
racarbef
Can
did
a, affects con
traceptive m
easures
Lotrel
Am
lod
ipin
e–ben
azepril
Dry m
ou
th, g
ing
ival hyp
erplasia
Loven
ox
En
oxap
arin so
diu
mC
on
tact ph
ysician b
efore p
erform
ing
a pro
cedu
re in
wh
ich b
leedin
g is exp
ected
Lun
estaE
szop
iclon
eD
ry mo
uth
Luvo
xFlu
voxam
ine m
aleateD
ry mo
uth
LyricaP
regab
alinD
ry mo
uth
Med
rol
Meth
ylpred
niso
lon
eC
and
ida, d
elayed h
ealing
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MEDS
23C
om
mo
nly P
rescribed
Med
ication
s Th
at Affect th
e Mo
uth
an
d T
eeth—
con
t’d
Tra
de
Na
me
Ge
ne
ric N
am
eD
en
tal E
ffects
/Ma
na
ge
me
nt
Mevaco
rLo
vastatinD
ry mo
uth
, hyp
oten
sion
Mirap
exP
ramip
exole d
ihyd
roch
lorid
eD
ry mo
uth
Mircette
Eth
inyl estrad
iol–d
esog
estrelG
ing
ival chan
ges
Neco
nE
thin
yl estradio
l–n
oreth
ind
ron
eG
ing
ival chan
ges
Neu
ron
tinG
abap
entin
Dry m
ou
th
No
rvascA
mlo
dip
ine
Dry m
ou
th, g
ing
ival hyp
erplasia
No
rvirR
iton
avirC
and
ida
Orth
o-n
ovu
mN
oreth
ind
ron
e–ethin
yl estrad
iol
Gin
gival ch
ang
es
OxyC
on
tinO
xycod
on
eD
ry mo
uth
, hyp
oten
sion
Pam
elor
No
rtriptylin
e HC
lH
ypo
tensio
n/D
o n
ot u
se vasoco
nstricto
rs
Patan
ol
Olo
patad
ine H
Cl
Dry m
ou
th
Paxil
Paro
xetine
Dry m
ou
th
Pep
cidFam
otid
ine
Dry m
ou
th
Co
ntin
ued
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24
MEDS
Co
mm
on
ly Prescrib
ed M
edicatio
ns T
hat A
ffect the M
ou
th
and
Teeth
—co
nt’d
Tra
de
Na
me
Ge
ne
ric N
am
eD
en
tal E
ffects
/Ma
na
ge
me
nt
Pen
icillin V
KP
enicillin
Can
did
a, hairy to
ng
ue, red
uces co
ntracep
tive actio
n
Plavix
Clo
pid
og
relC
on
tact ph
ysician b
efore p
erform
ing
a pro
cedu
re in
wh
ich b
leedin
g is exp
ected
Pro
ton
ixP
anto
prazo
leE
xcessive salivation
Pro
ventil
Alb
utero
lD
ry mo
uth
, teeth d
iscolo
ration
Pro
zacFlu
oxetin
eD
ry mo
uth
, hyp
oten
sion
Req
uip
Ro
pin
irole
Dry m
ou
th, h
ypo
tensio
n
Resto
rilT
emazep
amD
ry mo
uth
, taste alteration
s
Serax
Oxazep
amD
ry mo
uth
, coated
ton
gu
e
Sereven
tS
almetero
lC
and
ida
Sero
qu
elQ
uetiap
ine
Dry m
ou
th
Teg
retol
Carb
amazep
ine
Dry m
ou
th, sto
matitis
Ten
orm
inA
teno
lol
Dry m
ou
th, affects taste
Tim
op
ticT
imo
lol m
alateD
ry mo
uth
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MEDS
25C
om
mo
nly P
rescribed
Med
ication
s Th
at Affect th
e Mo
uth
an
d T
eeth—
con
t’d
Tra
de
Na
me
Ge
ne
ric N
am
eD
en
tal E
ffects
/Ma
na
ge
me
nt
Trivo
ra-28Levo
no
rgestrel–eth
inyl
estradio
lG
ing
ival chan
ges
To
franil
Imip
ramin
e HC
LD
ry mo
uth
, hyp
oten
sion
/ Do
no
t use
vasoco
nstricto
rs
To
pam
axT
op
iramate
Dry m
ou
th
Trilep
talO
xcarbazep
ine
Dry m
ou
th
Ultram
Tram
ado
lD
ry mo
uth
, hyp
oten
sion
Valiu
mD
iazepam
Dry m
ou
th
Versed
Mid
azolam
Increased
salivation
Wellb
utrin
Bu
pro
pio
n H
CL
Dry m
ou
th
Xan
axA
lprazo
lamD
ry mo
uth
Zith
rom
axA
zithro
mycin
Can
did
a, hairy to
ng
ue, red
uces co
ntracep
tive actio
n
Zo
mig
Zo
lmitrip
tanA
ffects taste
Zyp
rexaO
lanzap
ine
Dry m
ou
th, h
ypo
tensio
n
Th
e med
ication
s in g
reen are th
ose o
ften p
rescribed
by d
entists. T
ext in red
ind
icates imp
lication
s for th
e den
tal visit.
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26
CHAIR-SIDE
Dentition
Tooth Eruption Tables
Deciduous (Primary) Dentition
Teeth Age of Eruption (months)
Central incisors 6–8
Lateral incisors 7–9
Canines 15–20
First molars 12–16
Second molars 20–30
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27
CHAIR-SIDE
Permanent (Adult) Dentition
Arch Teeth
Age of Eruption
(years)
Maxillary Central incisors 7–9
Lateral incisors 8–9
Canines 11–13
First premolars 10–11
Second premolars 10–13
First molars 6
Second molars 12–14
Third molars (wisdom teeth) 17–21
Mandibular Central incisors 6–7
Lateral incisors 7–8
Canines 8–9
First premolars 10–12
Second premolars 11–13
First molars 6
Second molars 12–14
Third molars (wisdom teeth) 17–21
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28
CHAIR-SIDE
Tooth Numbering
Tooth numbering systems provide a consistent method for iden-tifying teeth for charting and descriptive purposes.
Universal System
1
Permanent dentition
Permanent dentition
Maxillary
Maxillary
Mandibular
Mandibular
Primary dentition
A B C D E F G H I J
T S R Q P O N M L K
2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
32 31 30 29 28 27 26 25 24 23 22 21 20 19 18 17
Reprinted with permission from: Prajer, R., & Grosso, G. (2011). DH Notes: Dental Hygienist’s Chairside Pocket Guide, ed 1. Philadelphia: F.A. Davis Company; p. 28.
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29
CHAIR-SIDE
Universal System (Permanent Dentition)
Tooth Number Tooth Name
1 Maxillary right third molar
2 Maxillary right second molar
3 Maxillary right fi rst molar
4 Maxillary right second premolar
5 Maxillary right fi rst premolar
6 Maxillary right canine
7 Maxillary right lateral incisor
8 Maxillary right central incisor
9 Maxillary left central incisor
10 Maxillary left lateral incisor
11 Maxillary left canine
12 Maxillary left fi rst premolar
13 Maxillary left second premolar
14 Maxillary left fi rst molar
15 Maxillary left second molar
16 Maxillary left third molar
17 Mandibular left third molar
18 Mandibular left second molar
19 Mandibular left fi rst molar
20 Mandibular left second premolar
21 Mandibular left fi rst premolar
22 Mandibular left canine
23 Mandibular left lateral incisor
24 Mandibular left central incisor
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30
CHAIR-SIDE
Universal System (Permanent Dentition)—cont’d
Tooth Number Tooth Name
25 Mandibular right central incisor
26 Mandibular right lateral incisor
27 Mandibular right canine
28 Mandibular right fi rst premolar
29 Mandibular right second premolar
30 Mandibular right fi rst molar
31 Mandibular right second molar
32 Mandibular right third molar
Begin counting from the upper right third molar as #1 to the upper left third molar as #16, then move to the lower left third molar as #17, and fi nish at the lower right third molar as #32.
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31
CHAIR-SIDE
Universal System (Primary Dentition)
Tooth Number Tooth Name
A Primary maxillary right second molar
B Primary maxillary right fi rst molar
C Primary maxillary right canine
D Primary maxillary right lateral incisor
E Primary maxillary right central incisor
F Primary maxillary left central incisor
G Primary maxillary left lateral incisor
H Primary maxillary left canine
I Primary maxillary left fi rst molar
J Primary maxillary left second molar
K Primary mandibular left second molar
L Primary mandibular left fi rst molar
M Primary mandibular left canine
N Primary mandibular left lateral incisor
O Primary mandibular left central incisor
P Primary mandibular right central incisor
Q Primary mandibular right lateral incisor
R Primary mandibular right canine
S Primary mandibular right fi rst molar
T Primary mandibular right second molarBegin counting from the upper right second molar as #A to the upper left second
molar as #J, then move to the lower left second molar as #K, and fi nish at the lower right second molar as #T.
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32
CHAIR-SIDE
Palmer Notation SystemIn the Palmer notation system, all quadrants are given their own bracket. Teeth are noted within each bracket based on their rela-tion to the midline. The orientation of the bracket notes the quadrant. Letters are used for deciduous teeth.
Permanent Teeth
Upper Right
8┘ 7┘ 6┘ 5┘ 4┘ 3┘ 2┘ 1┘
8┐ 7┐ 6┐ 5┐ 4┐ 3┐ 2┐ 1┐
Lower Right
Upper Left
└1 └2 └3 └4 └5 └6 └7 └8
┌1 ┌2 ┌3 ┌4 ┌5 ┌6 ┌7 ┌8
Lower Left
Deciduous Teeth (Baby Teeth)
Upper Right Upper Left
E┘ D┘ C┘ B┘ A┘ └A └B └C └D └E
E┐ D┐ C┐ B┐ A┐ ┌A ┌B ┌C ┌D ┌E
Lower Right Lower Left
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33
CHAIR-SIDE
Cavity (Caries) Classifi cation
Cavities (caries) are perhaps the most common dental disease. Caries is defi ned as an infectious bacterial disease that affects the tooth and the surrounding structures. G.V. Black has intro-duced a system classifying the various types of caries found on teeth based on location and tooth surfaces affected.
Class I■ Pit and fi ssure caries
Reprinted with permission from: Prajer, R., & Grosso, G. (2011). DH Notes: Dental Hygienist’s Chairside Pocket Guide, ed 1. Philadelphia: F.A. Davis Company; p. 33.
Class II■ Interproximal caries in posterior teeth (mesial, distal)
Reprinted with permission from: Prajer, R., & Grosso, G. (2011). DH Notes: Dental Hygienist’s Chairside Pocket Guide, ed 1. Philadelphia: F.A. Davis Company; p. 34.
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34
CHAIR-SIDE
Class III■ Interproximal caries in anterior teeth with no incisal edge
involvement
Reprinted with permission from: Prajer, R., & Grosso, G. (2011). DH Notes: Dental Hygienist’s Chairside Pocket Guide, ed 1. Philadelphia: F.A. Davis Company; p. 34.
Class IV■ Interproximal caries in anterior teeth with incisal edge
involvement
Reprinted with permission from: Prajer, R., & Grosso, G. (2011). DH Notes: Dental Hygienist’s Chairside Pocket Guide, ed 1. Philadelphia: F.A. Davis Company; p. 34.
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35
CHAIR-SIDE
Class V■ Caries in the gingival third of anterior and posterior teeth
Reprinted with permission from: Prajer, R., & Grosso, G. (2011). DH Notes: Dental Hygienist’s Chairside Pocket Guide, ed 1. Philadelphia: F.A. Davis Company; p. 35.
Class VI■ Caries on incisal edge of anterior teeth or cusps of posterior
teeth due to defects
Reprinted with permission from: Prajer, R., & Grosso, G. (2011). DH Notes: Dental Hygienist’s Chairside Pocket Guide, ed 1. Philadelphia: F.A. Davis Company; p. 35.
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36
CHAIR-SIDE
Charting
Charting of existing and diagnosed procedures is important to maintain an accurate record of the patient’s oral status.
Color Coding
Color Meaning
Red Treatment pending
Blue or black Existing restorations
Tooth Surface Abbreviations
Abbreviation Meaning
M Mesial
D Distal
La Labial
B Buccal
L Lingual
I Incisal
O Occlusal
DO Disto-occlusal
MO Mesio-occlusal
MOD Mesio-occlusal-distal
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37
CHAIR-SIDE
Dental Abbreviations
Abbreviation Meaning
Abs Abscess
ADA American Dental Association
ADAA American Dental Assistant Association
Adj Adjustments
AM or Amal Amalgam
Anes Anesthesia
Ant Anterior
BOP Bleeding on probing
Br Bridge
BWX Bitewing radiograph
C or Com Composite
Cem Cement
CLD or FLD Complete lower denture or full lower denture
Consult Consultation
CPR Cardiopulmonary resuscitation
CRN or Cr Crown
CUD or FUD Complete upper denture or full upper denture
Deci Deciduous
Del Delay
Dent Denture
Dx or Diag Diagnosis
Epi Epinephrine
Ex or Exam Examination
EXT Extraction
Continued
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38
CHAIR-SIDE
Dental Abbreviations—cont’d
Abbreviation Meaning
FGC Full gold crown
Fl Fluoride
FMX Full mouth radiographic series
FPD Fixed partial denture (i.e., bridge)
FX Fracture
Fx Function
HIPAA Health Insurance Portability and Accountability Act
Hist History
HP Handpiece
I & D or I/D Incise and drain
MSDS Manufacturer’s safety data sheet
NKA No known allergies
NKDA No known drug allergies
NSAIDS Nonsteroidal anti-infl ammatory drugs
PA Periapical radiograph
PANO Panoramic radiograph
Perm Permanent
PFM Porcelain fused to metal crown
PFS Pits and fi ssure sealants
PLD Partial lower denture
Pre-Med Premedication
PRN As needed
PSR Periodontal Screening Record
PUD Partial upper denture
Px Prognosis
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39
CHAIR-SIDE
Dental Abbreviations—cont’d
Abbreviation Meaning
PX or P Prophylaxis
RCT Root canal therapy
RPD Removable partial denture
Rx Prescription
TMJ Temporomandibular joint
Tx Treatment
Tx Pl Treatment plan
UCR Usual, customary, and reasonable
Xylo Xylocaine
ZOE Zinc oxide eugenol
Occlusion
The relationship of the maxillary teeth with the mandibular teeth when they come together is described as occlusion.
The ideal occlusion occurs when maxillary and mandibular teeth contact at maximum level.
Class I Occlusion Molar RelationshipClass I occlusion molar relationship is defi ned as the type of occlusion in which the mesiobuccal cusp of the maxillary fi rst molar contacts the buccal grove of the mandibular fi rst molar.
Class I Occlusion Canine RelationshipClass I occlusion canine relationship is defi ned as the type of occlusion in which the maxillary canine contacts the distal half of the mandibular canine and the mesial half of the mandibular fi rst premolar.
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Reprinted with permission from: Prajer, R., & Grosso, G. (2011). DH Notes: Dental Hygienist’s Chairside Pocket Guide, ed 1. Philadelphia: F.A. Davis Company; p. 29.
Class II Occlusion Molar RelationshipClass II occlusion molar relationship is defi ned as the type of occlusion in which the mesiobuccal cusp of the maxillary fi rst molar occludes in the space between the mandibular second premolar and the mandibular fi rst molar.
Class II Occlusion Canine RelationshipClass II occlusion canine relationship is defi ned as the type of occlusion in which the distal surface of the maxillary canine is located mesially to the distal surface of the mandibular canine.
Class II Division 1The molar relationships are like that of Class II, and the anterior teeth are protruded.
Reprinted with permission from: Prajer, R., & Grosso, G. (2011). DH Notes: Dental Hygienist’s Chairside Pocket Guide, ed 1. Philadelphia: F.A. Davis Company; p. 30.
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Class II Division 2The molar relationships are Class II, but the central teeth are retroclined, and the lateral teeth are seen overlapping the centrals.
Reprinted with permission from: Prajer, R., & Grosso, G. (2011). DH Notes: Dental Hygienist’s Chairside Pocket Guide, ed 1. Philadelphia: F.A. Davis Company; p. 30.
Class III Occlusion Molar RelationshipClass III occlusion molar relationship is defi ned as the type of occlusion in which the buccal groove of the mandibular fi rst molar occludes mesial to the mesiobuccal cusp of the maxillary fi rst molar.
Class III Occlusion Canine RelationshipClass III occlusion canine relationship is defi ned as the type of occlusion in which the distal surface of the mandibular canine occludes mesially from the mesial surface of the maxillary canine.
Reprinted with permission from: Prajer, R., & Grosso, G. (2011). DH Notes: Dental Hygienist’s Chairside Pocket Guide, ed 1. Philadelphia: F.A. Davis Company; p. 30.
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Misalignment or Malocclusion
Teeth and arches can be positioned in such a way that can cause problems with occlusion, aesthetics, and function. Some exam-ples of misaligned teeth are described.
CrossbiteIdeally, the maxillary teeth should occlude facially or buccally to the mandibular teeth. Deviations from this norm, such as the maxillary incisors being lingual to mandibular incisors or maxil-lary or mandibular posterior teeth being excessively lingual or buccal to the norm, will result in what is called crossbite.
Reprinted with permission from: Prajer, R., & Grosso, G. (2011). DH Notes: Dental Hygienist’s Chairside Pocket Guide, ed 1. Philadelphia: F.A. Davis Company; p. 31.
Reprinted with permission from: Prajer, R., & Grosso, G. (2011). DH Notes: Dental Hygienist’s Chairside Pocket Guide, ed 1. Philadelphia: F.A. Davis Company; p. 31.
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End to EndCusp-to-cusp or incisal edge-to-incisal edge contact.
Reprinted with permission from: Prajer, R., & Grosso, G. (2011). DH Notes: Dental Hygienist’s Chairside Pocket Guide, ed 1. Philadelphia: F.A. Davis Company; p. 31.
Reprinted with permission from: Prajer, R., & Grosso, G. (2011). DH Notes: Dental Hygienist’s Chairside Pocket Guide, ed 1. Philadelphia: F.A. Davis Company; p. 32.
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OverbiteAn excessive overlap in a vertical direction between maxillary and mandibular incisors.
Overbite
Reprinted with permission from: Prajer, R., & Grosso, G. (2011). DH Notes: Dental Hygienist’s Chairside Pocket Guide, ed 1. Philadelphia: F.A. Davis Company; p. 33.
OverjetAn excessively buccal positioning of the maxillary incisors in relation to mandibular incisors.
Overjet
Reprinted with permission from: Prajer, R., & Grosso, G. (2011). DH Notes: Dental Hygienist’s Chairside Pocket Guide, ed 1. Philadelphia: F.A. Davis Company; p. 32.
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Open BiteAnterior teeth do not occlude when the posterior teeth are in occlusion.
Reprinted with permission from: Prajer, R., & Grosso, G. (2011). DH Notes: Dental Hygienist’s Chairside Pocket Guide, ed 1. Philadelphia: F.A. Davis Company; p. 32.
Anesthesia
One of the primary responsibilities of a dentist is to eliminate dental disease as painlessly as possible. Science and chemistry have provided the dental profession with several agents to achieve topical, local, and general anesthesia so the patient can be as comfortable and pain free as possible during dental procedures.
Topical Anesthetics
Topical anesthetics are administered to achieve terminal nerve ending anesthesia. It is short lasting and can be used for a variety of reasons:
■ Before local anesthetics■ To manage patient’s gag refl ex■ Before suture removal or removal of loosely attached
primary teeth
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Most Common Topical Anesthetics
Benzocaine 20% Concentration
Cetacaine 14% Benzocaine2% Tetracaine
Lidocaine 5% In liquid form
Oraqix (mostly used in dental hygiene procedures)
2.5% Prilocaine2.5% Lidocaine
Local Anesthetics
Local anesthetics are used before treatment to provide tempo-rary anesthesia (no feeling) to the teeth and soft tissue. The mode of action is to block nerves that identify pain from sending impulses to the brain. Local anesthetics vary in the duration of their effect:
■ Short acting (30 minutes)■ Intermediate acting (60 minutes)■ Long acting (90 minutes)
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Most Common Local Anesthetics
Generic Name Trade Name
Vaso-
constrictor
Vasoconstrictor
Concentration
2% Lidocaine with epinephrine
Xylocaine Octocaine
Yes 1 : 100,000
2% Mepivicaine with levonordefrin
Carbocaine Yes 1 : 20,000
3% Mepivicaine plain
Carbocaine No N/A
4% Articaine Septocaine Yes 1 : 100,0001 : 200,000
Prilocaine Citanest Forte Yes 1 : 100,000
Bupivacaine Marcaine Yes 1 : 200,000
2% Lidocaine Xylocaine No N/A
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Anesthesia Color Coding
Anesthetic Color
2% Lidocaine with epinephrine 1 : 100,000
2% Lidocaine with epinephrine 1 : 50,000
Lidocaine plain
Mepivacaine 2% with levonordefrin 1 : 20,000
Mepivacaine 3%
Prilocaine 4% with epinephrine 1 : 200,000
Prilocaine 4%
Bupivacaine 4% with epinephrine
Articaine 4% with epinephrine
Preparation for Injection
■ Review medical history.■ Wipe injection site with 2 × 2 gauze to remove excess saliva.■ Apply topical anesthetic and let it remain for 2 to 3 minutes.■ Assemble and hand anesthetic syringe to doctor for
injection.■ Most commonly used needles:
■ 30-gauge short (blue cap) for infi ltrations and maxillary blocks
■ 27-gauge long (yellow cup) for mandibular blocks
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Injection Types
Maxillary Injections
Maxillarynerve
Ophthalmic nerve
Mandibularnerve
Anterior superior alveolar nerve
Middlesuperior alveolar nerve
Posterior superior alveolar nerve
Greater and lesser palatine nerves
Dental plexus
Trigeminalganglion
Reprinted with permission from: Prajer, R., & Grosso, G. (2011). DH Notes: Dental Hygienist’s Chairside Pocket Guide, ed 1. Philadelphia: F.A. Davis Company; p. 111.
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Posterior Superior Alveolar (PSA)■ Infi ltration injection is used for maxillary posterior molars.■ Use a 27-gauge short needle.
Reprinted with permission from: Prajer, R., & Grosso, G. (2011). DH Notes: Dental Hygienist’s Chairside Pocket Guide, ed 1. Philadelphia: F.A. Davis Company; p. 115.
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Middle Superior Alveolar (MSA)■ Infi ltration injection is used for maxillary premolars.■ Use a 27-gauge short needle.
Reprinted with permission from: Prajer, R., & Grosso, G. (2011). DH Notes: Dental Hygienist’s Chairside Pocket Guide, ed 1. Philadelphia: F.A. Davis Company; p. 116.
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Anterior Superior Alveolar (ASA)■ Infi ltration injection is used for maxillary anterior teeth.■ Use a 27-gauge short needle.
Reprinted with permission from: Prajer, R., & Grosso, G. (2011). DH Notes: Dental Hygienist’s Chairside Pocket Guide, ed 1. Philadelphia: F.A. Davis Company; p. 117.
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Greater Palatine Block■ Block injection.■ Anesthetizes posterior portion of hard palate.■ Use a 27-gauge short needle.
Reprinted with permission from: Prajer, R., & Grosso, G. (2011). DH Notes: Dental Hygienist’s Chairside Pocket Guide, ed 1. Philadelphia: F.A. Davis Company; p. 120.
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Nasopalatine Block■ Block injection.■ Anterior portion of hard palate between canines.■ Use a 27-gauge short needle.
Reprinted with permission from: Prajer, R., & Grosso, G. (2011). DH Notes: Dental Hygienist’s Chairside Pocket Guide, ed 1. Philadelphia: F.A. Davis Company; p. 122.
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Mandibular Injections
Inferior alveolar nerve
Lingual nerve
Mylohyoid nerve
Reprinted with permission from: Prajer, R., & Grosso, G. (2011). DH Notes: Dental Hygienist’s Chairside Pocket Guide, ed 1. Philadelphia: F.A. Davis Company; p. 122.
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Inferior Alveolar Nerve Block■ Block injection.■ Unilateral effect to the midline.■ Use a 30-gauge long needle.
Reprinted with permission from: Prajer, R., & Grosso, G. (2011). DH Notes: Dental Hygienist’s Chairside Pocket Guide, ed 1. Philadelphia: F.A. Davis Company; p. 124.
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Buccal Nerve Block■ Block injection.■ Soft tissue buccal to fi rst molars.■ Use a 30-gauge long needle.
Reprinted with permission from: Prajer, R., & Grosso, G. (2011). DH Notes: Dental Hygienist’s Chairside Pocket Guide, ed 1. Philadelphia: F.A. Davis Company; p. 126.
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Mental Nerve Block■ Block injection.■ Premolars, canines, incisors.■ Use a 30-gauge long needle.
Reprinted with permission from: Prajer, R., & Grosso, G. (2011). DH Notes: Dental Hygienist’s Chairside Pocket Guide, ed 1. Philadelphia: F.A. Davis Company; p. 127.
Nitrous Oxide Sedation
Nitrous oxide is the most commonly used sedative in dentistry. It is commonly used in oral and periodontal surgery, in patients with high levels of apprehension and anxiety, in children, and in patients with developmental and behavioral conditions.
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Indications
■ To reduce fear and anxiety■ Used in children to eliminate negative experience of
restraining■ Used in patients with special needs■ Used in patients with high gag refl ex■ Used in patients who have diffi culty reaching profound local
anesthesia■ To enhance the action of local anesthesia■ To prevent triggering other medical conditions (e.g., stress
may increase blood pressure, trigger angina incidents)
Contraindications
■ Patients unable to breathe adequately through their nose due to respiratory infections, blocked sinuses
■ Patients who have undergone eye or ear surgery■ Patients with hypoxia or chronic obstructive pulmonary
disease (COPD)■ Patients with history of drug addiction■ Patients taking sleep medications or antidepressants■ Pregnant women during fi rst trimester even though their
physicians should be contacted if N2O-O2 is considered for their treatment
■ Patients treated with bleomycin sulfate treatment for neoplasm in which fi brosis of the lungs is often found
■ Patients with sickle cell anemia■ Patients who have congestive heart failure (CHF)
Medical Assessment of the Patient Before Administration
Patients who are considered candidates for N2O-O2 inhalation sedation should complete a detailed medical history form to be reviewed by the dentist. If at any moment there is a doubt about their suitability for nitrous oxide, the physician should be con-sulted, and if necessary, the appointment should be rescheduled.
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Upon verifying the patient’s suitability, an informed consent should be signed and all details, and potential side effects should be explained to the patient. Before the actual administration of the gas, the patient’s vital signs must be measured and recorded and an examination of the airway should take place. The patient or the parent (if a minor) must also have been informed before the appointment to eat light to avoid vomiting. In children, special attention should also be paid for enlarged adenoids and tonsils. After the procedure, detailed records of the time, fl ow, and oxygenation procedures should be recorded.
Pharmacological and Physiological Effects of Nitrous Oxide
When ammonium nitrate is heated to high temperatures, it yields nitrous oxide and water. Nitrous oxide is a colorless, “sweet”-tasting gas, and it is the only inorganic gas that is used for seda-tion in humans. Nitrous oxide affects the central nervous system (CNS) by dulling the perception of painful stimuli and creating a more relaxed, carefree attitude in the patient. The exact mecha-nism is not completely known; it is believed, however, that this drug increases the release of endorphins in the body, which in turn block opioid receptors in the CNS, thus elevating the pain threshold. It is a relatively safe drug and has no effect on the cardiovascular system except minor vasodilatation. The pulse and heart rate remain unaffected, and there is no effect on the skeletal muscle system.
Nitrous oxide has an onset time of 2 to 5 minutes and is metabolized and excreted by the lungs. Because of its high dif-fusion rate (34 times higher than nitrogen), it is contraindicated for patients with medical conditions listed earlier, and it should never be administered without a scavenging system because it can accumulate, displacing oxygen, and overcome health care personnel. When inhaled, nitrous oxide reaches the lungs and travels via the circulatory system to the brain (limbic system) and the rest of the body. The patient experiences the following symptoms:
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■ A tingling sensation, especially in the extremities■ A warm feeling■ A feeling of well-being and euphoria■ In deeper sedation states, inability to keep the eyes open■ Nausea and vomiting (only if oversedated)
Notable: Nitrous oxide/oxygen has a fast onset and recovery.
Management of Complications and Medical Emergencies
Even though nitrous oxide has a great safety record, medical emergencies may occur while the patient is under its infl uence. The best way to manage such emergencies is to prevent them. Perform a thorough examination of the prospective recipient’s medical history to not only ensure that the patient is a “good” candidate, but also to learn of any medical condition.
Oversedation can lead to nausea and vomiting during the pro-cedure. If such an event occurs, do the following:
1. Turn the patient to his or her side to avoid aspiration. 2. Stop administering nitrous oxide immediately. 3. Give the patient 100% oxygen. 4. When the risk of vomiting has subsided, move the patient to
a contamination-free area where he or she can breathe fresh air. Measure the patient’s vital signs.
High concentrations of the gas can lead to dizziness, deep breath-ing, and eventually unconsciousness because of a lack of oxygen. In such cases, do the following:
1. Immediately stop the gas supply. 2. Give the patient 100% oxygen. 3. Measure and record vital signs. 4. Evaluate voluntary breathing and pulse. 5. Initiate cardiopulmonary resuscitation while informing the
emergency services.
REMEMBER: Nitrous oxide does not kill brain cells, but lack of oxygen does.
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Chairside Concepts
Four-Handed Dentistry
■ Minimizes stress and fatigue for dentist and assistant.■ Provides effi cient care to the patient.
Seating zones: Visualize the patient as a clock with his head on 12 o’clock and his feet on 6 o’clock and use the zones shown in the following chart to determine the appropriate seating for the dentist and the assistant.
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12
1
2
3
4
56
7
8
9
10
Operator’szone
Right-handed dentist
Left-handed dentist
Operator’szone
Static zone
Static zone
Assistant’szone
Assistant’szone
Transfer zone
Transfer zone
11
12
1
2
3
4
56
7
8
9
10
11
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Right-Handed DentistDentist’s zone 7–12Assistant’s zone 2–4Transfer zone 4–7Static zone 122
Positioning
■ Sit all the way back on the stool.■ Rest your feet on the stool base.■ Keep your legs parallel to the patient’s dental chair.■ Keep your eye level about 6 inches above the operator.
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Motions
■ Class I: Movement of the fi ngers only
■ Class II: Movement of the wrist and fi ngers
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■ Class III: Movement of the wrist, fi ngers, and elbow
■ Class IV: Movement of the arm and shoulder
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■ Class V: Movement of the entire torso
Basic Principles
■ The operator is able to maintain vision on the operative fi eld, thus reducing eyestrain.
■ The team conserves time and motion during instrument transfers.
■ There is a reduction in stress and strain on the operating team because of the uninterrupted fl ow of the procedure without the delays associated with locating and delivering instruments.
■ When instrument transfer is used in conjunction with the oral evacuator and the air/water syringe, the operative site will always be clean and the next instrument will be ready for use.
■ Percutaneous injuries associated with use of dental instruments can be minimized using a prescribed transfer technique.
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Instrument Transfer
■ Pen grasp: The position commonly used to hold a pen or pencil and is widely used for most operative instruments.
■ Modifi ed pen grasp: Similar to the pen grasp except the operator uses the pad of the middle fi nger on the handle of the instrument. Adds stability to the transfer.
■ Palm grasp: Hold the instrument on the palm. Used for bulky instruments such as forceps.
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■ Palm/thumb grasp: Hold the instrument in the palm and guide with the thumb. Used in holding the high volume evacuation (HVE), it provides more vertical freedom in the movement of the instrument.
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Infection Control and Instruments
Instrument Classifi cation Based on Need for Infection Control
Critical■ Touch bone and/or penetrate soft tissue.■ Heat sterilize between uses or use sterile single-use,
disposable devices.■ Examples: surgical instruments, scalpel blades, periodontal
scalers, and surgical dental burs.
Semicritical■ Touch mucous membranes.■ Heat sterilize or high-level disinfect.■ Examples: Dental mouth mirrors, amalgam condensers, and
dental handpieces.
Noncritical■ Contact with intact skin.■ Clean and disinfect using a low- to intermediate-level
disinfectant.■ Examples: X-ray head, pulse oximeter, blood pressure cuff.
Instrument Processing
■ Transport
■ Transport contaminated instruments to processing and sterilization area.
■ Use a designated processing area to control quality and ensure safety.
■ Divide processing area into work areas.■ Cleaning: Use an ultrasonic cleaner.■ Packaging
■ Wrap or package instruments for sterilization.■ Wrap or place critical and semicritical items that will be
stored in containers before heat sterilization.■ Open and unlock hinged instruments.
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■ Place a chemical indicator inside the pack.■ Wear heavy-duty, puncture-resistant utility gloves.
■ Sterilization: Load and operate sterilizer according to the manufacturer’s guidelines.
■ Storage: Store instruments in such a way as to maintain integrity of the package.
■ Delivery to procedure site: Deliver instruments to procedure site maintaining integrity and opening before procedure.
■ Quality control: Implement quality control test to assure sterilization effi ciency.
Instrument Sterilization
Sterilization Methods■ Steam Autoclave (steam under pressure)
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■ Four cycles (heat up, sterilization, depressurization, drying).
■ Short time.■ Corrosive (may rust non–stainless steel instruments).■ Use distilled water ONLY.
■ Chemical Vapor
■ Special chemical compound■ Short time
■ Rapid Heat Transfer
■ Very short time■ Noncorrosive
■ Dry Heat
■ Long time■ Noncorrosive
■ Liquid Chemical Sterilant/Disinfectants
■ Only for heat-sensitive critical and semicritical devices.■ Powerful, toxic chemicals raise safety concerns.■ Heat-tolerant and disposable alternatives are available.
Sterilization Monitoring: Types of Indicators■ Mechanical: Measure time, temperature, pressure■ Chemical: Change in color when physical parameter is
reached
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Reprinted with permission from: Henry, R., & Perno, M.G. (Forthcoming). Dental Hygiene: Applications to Clinical Practice, ed 1. Philadelphia: F.A. Davis Company.
■ Biological (spore tests): Use biological spores to assess the sterilization process directly
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CDC Guidelines for Infection Control
Chain of Infection
CDC Guidelines for Infection Control
Chain ofInfectionHost Source
Pathogen
Entry
For an infection to occur, four conditions must be present:
■ A germ must be present (e.g., bacteria, virus, parasite).■ The germ must have a place to live and multiply such as
human, food, soil, or water.■ A susceptible host must be present.■ There must be a way for the germ to enter the host, such as
direct contact or air droplets.
Standard Precautions
Application■ Apply to all patients■ Integrate and expand Universal Precautions to include
organisms spread by blood and the following:■ Body fl uids, secretions, and excretions except sweat,
whether or not they contain blood■ Nonintact (broken) skin■ Mucous membranes
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Elements■ Hand washing■ Use of personal protective equipment (PPE) (gloves, masks,
eye protection, gowns)■ Patient care equipment■ Environmental surfaces■ Injury prevention
Bloodborne Pathogens
Examples■ Hepatitis B virus (HBV)■ Hepatitis C virus (HCV)■ Human immunodefi ciency virus (HIV)
Characteristics■ Are transmissible in health care settings■ Can produce chronic infection■ Are often carried by persons unaware of their infection
Exposure Prevention Strategies
■ Engineering controls: Isolate or remove the hazard■ Work practice controls: Change the manner of performing
tasks■ Administrative controls: Policies, procedures, and
enforcement measures
Postexposure Management Program
■ Clear policies and procedures■ Education of dental health care personnel (DHCP)■ Rapid access to clinical care■ Postexposure prophylaxis (PEP)■ Testing of source patients and health-care personnel (HCP)■ Wound management■ Exposure reporting■ Assessment of infection risk■ Type and severity of exposure
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■ Bloodborne status of source person■ Susceptibility of exposed person
Hand Hygiene
■ Hands are the most common mode of pathogen transmission.
■ Reduce spread of antimicrobial resistance.■ Prevent health care–associated infection.
Reprinted with permission from: Henry, R., & Perno, M.G. (Forthcoming). Dental Hygiene: Applications to Clinical Practice, ed 1. Philadelphia: F.A. Davis Company.
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Terms and Defi nitions
■ Hand washing: Washing hands with plain soap and water■ Antiseptic hand wash: Washing hands with water and soap
or other detergents containing an antiseptic agent■ Alcohol-based hand rub: Rubbing hands with an alcohol-
containing preparation■ Surgical antisepsis: Washing hands with an antiseptic soap
or an alcohol-based hand rub before operations by surgical personnel
Guidelines
■ Use hand lotions to prevent skin dryness.■ Consider compatibility of hand care products with gloves.■ Keep fi ngernails short.■ Avoid artifi cial nails.■ Avoid hand jewelry that may tear gloves.
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Personal Protective Equipment
■ A major component of Standard Precautions■ Protects the skin and mucous membranes from exposure to
infectious materials in spray or spatter■ Should be removed when leaving treatment areas
Masks and Face Shield
■ Wear a surgical mask and either eye protection with solid side shields or a face shield to protect mucous membranes of the eyes, nose, and mouth.
■ Change masks between patients.■ Use clean, reusable face protection between patients; if
visibly soiled, clean and disinfect.
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Clothing
■ Wear gowns, lab coats, and uniforms that cover skin and personal clothing likely to become soiled with blood, saliva, or infectious material.
■ Change if visibly soiled.■ Remove all barriers before leaving the work area.
Gloves
■ Minimize the risk of HCP acquiring infections from patients.■ Prevent microbial fl ora from being transmitted from HCP to
patients.■ Reduce contamination of the hands of HCP by microbial
fl ora that can be transmitted from one patient to another.■ Are not a substitute for hand washing.
Sterile Glove Donning TechniquePeel open the outer pack from the corners. The inner pack is sterile.
■ Pick up the cuff of the right glove with your left hand. Slide your right hand into the glove until you have a snug fi t over the thumb joint and knuckles. Your bare left hand should only touch the folded cuff; the rest of the glove remains sterile.
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■ Slide your right fi ngertips into the folded cuff of the left glove. Pull out the glove and fi t your left hand into it.
■ Unfold the cuffs down over your gown sleeves. Make sure your gloved fi ngertips do not touch your bare forearms or wrists.
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All photos in the gloving sequence are reprinted with permission from: Johansson, C., & Chinworth, S. A. (2012). Mobility in Context: Principles of Patient Care Skills, ed 1. Philadelphia: F.A. Davis Company; pp. 102–103, Fig. 4-12.
Environmental Surfaces
■ May become contaminated■ Do not require as stringent decontamination procedures
Categories■ Clinical contact surfaces
■ High potential for direct contamination from spray or splatter or by contact with DHCP’s gloved hand
■ Housekeeping surfaces■ Do not come into contact with patients or devices■ Limited risk of disease transmission
Recommendations■ Use barrier precautions (e.g., heavy-duty utility gloves,
masks, protective eyewear) when cleaning and disinfecting environmental surfaces.
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■ Physical removal of microorganisms by cleaning is as important as the disinfection process.
■ Follow manufacturer’s instructions for proper use of Environmental Protection Agency (EPA)–registered hospital disinfectants.
■ Do not use sterilants or high-level disinfectants on environmental surfaces.
Clinical Contact Surfaces■ Risk of transmitting infections is greater than for
housekeeping surfaces.■ Surface barriers can be used and changed between patients.
OR
■ Clean and then disinfect using an EPA-registered low- (HIV/HBV claim) to intermediate-level (tuberculocidal claim) hospital disinfectant.
Water LinesProblem: Contamination of Water Supply■ Microbial biofi lms form in small-bore tubing of dental units.■ Biofi lms serve as a microbial reservoir.■ Primary source of microorganisms is municipal water
supply.
Solutions to the Problem■ Independent reservoir.■ Chemical treatment.■ Filtration.■ Combinations.■ Sterile water delivery systems.■ Use sterile saline or sterile water as a coolant or irrigator
when performing surgical procedures.■ Use devices designed for the delivery of sterile irrigating
fl uids.■ Clean and heat sterilize intraoral devices that can be
removed from air and waterlines.■ Follow manufacturer’s instructions for cleaning, lubrication,
and sterilization.■ Do not use liquid germicides or ethylene oxide.■ Use barriers and change between uses.
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■ Clean and disinfect at an intermediate level the surface of devices if visibly contaminated.
■ Do not advise patients to close their lips tightly around the tip of the saliva ejector.
Medical Waste Management
Reprinted with permission from: Henry, R., & Perno, M.G. (Forthcoming). Dental Hygiene: Applications to Clinical Practice, ed 1. Philadelphia: F.A. Davis Company.
■ Properly label containment to prevent injuries and leakage.■ Medical wastes are “treated” in accordance with state and
local EPA regulations.■ Processes for regulated waste include autoclaving and
incineration.
Program Evaluation
■ Develop standard operating procedures.■ Evaluate infection control practices.■ Document adverse outcomes.■ Document work-related illnesses.■ Monitor health care–associated infections.
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Introduction to Radiology
Dental radiology is one of the most important factors contribut-ing to quality and reliable diagnosis and treatment of patients. Dental assistants must understand the concepts behind the physics of radiology and must be competent in exposing accu-rate, diagnostic, and quality radiographs and images.
Brief History
In 1895, Wilhelm C. Roentgen discovered x-rays by accident while he was experimenting with the production of cathode rays. Many other scientists continued to research these new rays, and in 1896, Edmund Kells, a dentist, recorded the fi rst practical use of x-rays in dentistry. Throughout the years, several devel-opments and improvements have been implemented in dental radiology, such as the panoramic concept, high-speed fi lms (F-speed), digital radiography, and 3-D cone imaging.
Uses of Dental Radiology
■ Diagnostic: Identify disease in the teeth and the surrounding hard tissue.
■ Qualitative: Evaluate quality and clinical functionality of placed restorations.
■ Legal: Document and record conditions at a specifi c time frame.
■ Forensic: Help identify deceased individuals.
Types of Dental Radiology
■ Intraoral: Procedures in which the fi lm or digital devices that record images are placed inside the patient’s mouth. Examples of intraoral x-rays are periapical (PA) x-rays and bitewing (BW) x-rays.
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■ Extraoral: Procedures in which the fi lm or digital devices that record images are located outside the patient’s mouth. Examples of extraoral x-rays are panoramic, cephalometric, and lateral skull.
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Dental Radiology Equipment
Intraoral X-Ray Unit
Components■ Control panel: Contains all setting adjustments buttons,
master switch, indicator light, and exposure button. It can be located in the x-ray area only if a remote exposure button is available to limit the operator’s exposure to radiation or outside the x-ray area.■ Exposure button: Controls the fl ow of electricity to
generate x-rays.■ Kilovoltage selector (kVp): Controls the penetrating power
of the x-ray beam. Normal kVp range is between 70 and 90 kVp.
■ Milliamperage selector (mA): Controls the number of electrons produced. Higher mA increases the number of electrons.
■ Extension arm: Positions the tubehead during x-ray procedures and contains wiring that connects the tubehead and the control panel. It is easily adjustable and folds for effi cient storage.
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Reprinted with permission from: Henry, R., & Perno, M. G. (Forthcoming). Dental Hygiene: Applications to Clinical Practice, ed 1. Philadelphia: F.A. Davis Company.
■ Tubehead: Metal housing of the x-ray tube. It also contains transformers, oil that prevents overheating for the production of x-rays, and aluminum or lead glass.■ Important components in the tubehead are the collimator,
aluminum disc (which restricts the size of the x-ray beam before exiting the tubehead), and aluminum fi lters (which fi lter out low-wavelength x-rays).
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Reprinted with permission from: Henry, R., & Perno, M. G. (Forthcoming). Dental Hygiene: Applications to Clinical Practice, ed 1. Philadelphia: F.A. Davis Company.
■ X-ray tube: Located inside the tubehead and is the device where the x-rays are produced. It contains the following:■ Anode: A positive electrode composed of the tungsten
target embedded in a copper housing. The tungsten target acts as a focal spot and transforms the electron waves into x-rays.
■ Cathode: A negative electrode made of a tungsten fi lament embedded in molybdenum housing. The tungsten fi lament is where electrons are produced.
The x-ray tube is in a vacuum state (no air is present).
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Extraoral X-Ray Unit
Panoramic machines have similar components and produce x-rays under the same principles as the intraoral units.
X-Ray Processor
■ Manual: Rarely used today because of extended period of time to develop and process radiographs.
■ Automatic: Faster and more effi cient with controlled temperature and time.
Automatic processors house a roller transport system that carries radiographs through the developer and fi xer solutions and through a rinse and air dry cycle.
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Processing Solutions■ Developing solution: Reacts with exposed silver halide
crystals forming black metallic silver and softens emulsion of the fi lm.
■ Fixer solution: Removes all unexposed silver halide crystals and hardens emulsion.
Both of these solutions are available in powder, liquid concen-trate, and ready-to-use liquid forms.
Duplicating
Duplication of radiographs must occur in a dark room.Procedure for duplication:
■ Open duplicating machine.■ Place duplicating fi lm on the glass top of the machine with
the emulsion facing up.■ Place fi lms to be duplicated on the top and close the lid.■ Turn on exposing light of the duplicating machine for the
manufacturer’s recommended time.■ Remove duplicating fi lm and process as normal.
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Dental Radiology Film Types
Dental radiology fi lm is made of a semifl exible acetate fi lm base that is coated with an emulsion of silver halide, silver bromide, and silver iodide crystals.
Intraoral Film
Speed■ D speed■ E speed■ F speed (the fastest fi lm available, which means it requires
less amount of radiation)
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93Size■ #0, smallest fi lm used in pediatric patients■ #1, used in pediatric patients and often for lower anterior
PAs■ #2, most commonly used for adult BW and PA x-rays■ #4, used in occlusal exposures
Extraoral Film
■ Is placed outside the mouth.■ Requires a cassette to protect it.■ Requires intensifying screens.■ Green sensitive (rare earth–intensifying screens).■ Blue sensitive (calcium tungstate–intensifying screens).
Duplicating Film■ Sensitive to light.■ Emulsion only in one side.■ Side with emulsion appears dull.■ Available in all sizes, including 8-in x 10-in sheets.
Characteristics of Radiographic Beam
Contrast
■ Radiographic images appear in a range of shades from black to white with several shades of gray in between.
■ Higher kVp produces lower contrast.
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Density
■ Density is the overall darkness or blackness of the fi lm.■ Density is controlled by mAs (milliampere seconds).
Factors Infl uencing Contrast and Density
Factor Effect
Milliamperage (mA)
Decreased Decreased density
Increased Increased density
Kilovoltage (kVp)
Increased Increased density, low contrast
Decreased Decreased density, high contrast
Time (sec)
Decreased Decreased density
Increased Increased density
Radiation Effects
X-rays are a type of ionizing radiation that is harmful and causes biologic changes in living tissue.
Exposure to radiation has a cumulative effect, meaning that tissue undergoes damage and changes over a period of time.
Acute Radiation Exposure
Acute radiation exposure occurs when large amounts of radia-tion are absorbed by tissue over a short period of time (i.e., exposure to nuclear fallout).
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95Chronic Radiation Exposure
Chronic radiation exposure occurs when small amounts of radia-tion are absorbed by tissue over an extended period of time. During chronic exposure, symptoms of damage may not be noticeable until years after the original exposure.
Critical Organs
Organs that are more susceptible to radiation exposure during dental procedures are:
■ Skin■ Thyroid gland■ Bone marrow■ Lens of the eye
Maximum Permissible Dose
According to the National Council on Radiation Protection and Measurements (NCRP), the maximum permissible dose (MPD) is the highest amount of radiation that the human body can receive without enduring any injury.
■ MPD for occupational exposure: 5.0 rem/year.■ MPD for non-occupational exposure: 0.1 rem/year.
Patient Protection
■ Lead apron and thyroid collar.■ High-speed fi lm or use of digital systems.■ Proper technique that minimizes the number of retakes.■ Exposure factors such as kVp and mA to minimum levels,
allowing diagnostic quality radiographs.■ Use of aiming devices to avoid patient holding the fi lm or
digital sensors.
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Operator Protection
■ Monitoring: use of monitoring devices such as badges.■ Proper equipment operation.■ Knowledge of safety regulation.■ ADA and FDA guidelines state that pregnant operators must
use a lead apron during exposure of dental radiographs. The embryo or fetus will not receive detectable amounts of radiation if a lead apron is used.
ALERT: Keep radiation exposure to as low as reasonably achievable.
Errors Due to Temperature, Solutions, Contamination, and Film Handling
■ Underdeveloped fi lm: Appears light; indicates not enough developing time.
■ Overdeveloped fi lm: Appears dark; indicates excessive developing time.
■ Fixer spots: White spots; indicate fi xer came into contact with fi lm prior to developing.
■ Developer spots: Dark spots; indicate developer came into contact with fi lm prior to developing.
■ Brown or yellow stains: Indicate inadequate chemicals.■ Fingerprint: Indicates fi lm touched by fi ngers.■ Overlapping: Indicates fi lms are in contact during
processing.■ Developer/fi xer cutoff: Indicates inadequate chemical levels.■ Light lean in the dark room: Film appears black.■ Fogged fi lm: Indicates inappropriate safe light.
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Most Common Types of Dental Radiographs
Intraoral
Periapical (PA)A PA radiograph captures the entire tooth and its surrounding structures. It is used primarily to identify periapical pathology. Exposure techniques include the paralleling (aiming devices) and bisecting the angle techniques. PA radiographs are taken in both the anterior and posterior teeth.
Bitewing (BW)A BW radiograph captures the posterior upper and lower teeth, mainly the crown portion. There are two types of BW radio-graphs. Premolar BWs include the fi rst and second premolars and mesially extend up to and distal to the canines. Molar BWs
include the fi rst and second molars. Exposure techniques include BW tabs or the use of aiming devices.
Intraoral SeriesA full-mouth survey (FMX) is a series of usually 18 fi lms: 14 PA and 4 BW x-rays. An FMX survey is necessary to perform a comprehensive dental examination.
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Exposing TechniquesParalleling Technique■ Place the fi lm/sensor parallel to the long axis of the tooth of
interest.■ Direct the central x-ray beam perpendicular to the long axis
of the tooth and the fi lm.■ Direct the central x-ray beam through the contact areas
between the teeth.■ Use fi lm size #1 or #2.
Film
X-rays
Tube
The use of XCP (extension cone paralleling) devices is recom-mended for the paralleling technique for more accurate and operator-free errors.
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99Bisecting Technique■ Bisecting technique is not an ideal technique but is useful in
special situations, such as in children and patients with shallow, narrow mouths or fl at palates.
■ Place the fi lm against the tooth of interest.■ Aim the central beam perpendicular to the imaginary
bisector of the angle formed between the long axis of the tooth and the fi lm.
■ Use fi lm size #1 or #2.
Plastic bite blocks, aiming rings, and Eezee-Grip (Rinn) holders can be used with the bisecting techniques.
Film
X-rays
Tube
Imaginaryline
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Occlusal Technique■ Occlusal technique is used to examine large areas of the
upper or lower jaw.■ Use fi lm size #4.■ It is often used in children.■ Place fi lm on the occlusal surface of the teeth with the white
portion facing the arch to be examined. Ask the patient to gently bite on the fi lm.
Recommended Sequence of Exposing an FMXNote: This is just a recommendation and is based on providing the patient with the most comfortable experience while at the same time ensuring that all teeth have been exposed with no double takes and minimal aiming device modifi cation.
Teeth to expose, by number:
■ 6, 7■ 8, 9■ 10, 11■ 22, 23■ 24, 25■ 26, 27■ 4, 5■ 1, 2, 3■ 20, 21
Extraoral
PanoramicPanoramic exposures provide a complete picture of the entire oral cavity and surrounding structures.
In a panoramic x-ray, both the fi lm and the tubehead rotate around the patient’s head, producing individual images that, when combined in a single fi lm, produce an image of the upper and lower jaw and surrounding structures.
■ 17, 18, 19■ 12, 13■ 14, 15, 16■ 28, 29■ 30, 31, 32■ R premolar BW■ R molar BW■ L premolar BW■ L molar BW
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101Procedure■ Explain to the patient the procedure.■ Ask the patient to remove all metal objects from the neck
up.■ Place a lead apron with no thyroid collar on the patient.■ Position the patient while standing “as tall as possible,” with
the midsagittal* plane perpendicular to the fl oor and the Frankfort** plane parallel to the fl oor.
■ Instruct the patient to bite on the bite stick located on the machine to focus on the focal trough***.
■ Ask the patient to swallow, place the tongue on the roof of the mouth, and remain still during exposure.
*Midsagittal plane: Imaginary line that divides the patient’s face into left and right sides
**Frankfort plane: Imaginary line that passes from the bottom of the eye socket to the upper portion of the ear canal
***Focal trough: An imaginary three-dimensional zone in which the panoramic images appear clear
CephalometricCephalometric examination is mostly used in orthodontics during the treatment planning phase. In addition, it is often used to identify trauma, disease, and developmental abnormalities.
Cephalometric and other extraoral examination follow the pan-oramic guidelines mentioned previously.
Other Extraoral Examinations■ Reverse Towne projection: Identifi es fractures in the ramus
and condyle of the mandible.■ Submentovertex projection: Identifi es zygomatic arch
fractures and presents the base of the skull.■ Waters projection: Evaluates the sinus area.■ Cone-beam computed tomography (commonly referred to
by the acronym CBCT) is a medical imaging technique consisting of x-ray computed tomography in which the x-rays are divergent, forming a cone.
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CBCT has become increasingly important in treatment planning and diagnosis in implant dentistry, as well as in orthodontics and endodontics.
Digital Radiography
Reprinted with permission from: Kantz, S. (Forthcoming). Dental Assisting: A Comprehensive Guide to Current Practice, ed 1. Philadelphia: F.A. Davis Company.
■ The use of digital radiography is increasing rapidly.■ It uses a sensor rather than a fi lm to record electron
impulses and then digitizes the image through a computer, producing a diagnostic image.
■ It requires much less radiation exposure to produce diagnostic quality images (50%–80% less radiation).
■ The same intraoral x-ray units may be used.■ It is applied both in intraoral and extraoral examinations.■ Several systems are available.■ The same positioning principles apply as for traditional
radiography.■ Start-up costs for this technology are expensive.
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103Types of Digital Radiography
Direct Digital Imaging■ A sensor is placed in the patient’s mouth, and it is exposed
to x-rays.■ The sensor can be wired or wireless.■ The sensor captures the exposed image and transfers it to
the computer.
Indirect Digital Imaging■ An already existing radiograph.■ A CCD (charge coupled device).■ A computer.■ Existing radiograph is digitized using the CCD device and
transferred to the computer using a scanner.■ Inferior quality as the result is a copy and not the original
image.
Storage Phosphor Imaging■ Wireless.■ A reusable phosphor plate is used instead of a sensor.■ Acts as an intensifying screen.■ Image is captured and then via a laser scanner is transferred
to the computer.
Advantages versus Disadvantages
Advantages■ Up to 80% less radiation exposure.■ Great tool in patient education.■ Apart from initial investment, lower cost because of the lack
of developing solutions and fi lm.
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Disadvantages■ High initial start-up cost.■ Sensor size being bulky creates problems to some patients.■ Because sensors cannot be sterilized, special attention must
be paid to infection control.
Infection Control Sites
Areas of radiography equipment that are likely to be contami-nated are as follows:
■ Tubehead■ PID■ Control panel■ Dental chair■ Lead apron■ Counter surfaces■ Darkroom equipment■ Computer hardware (e.g., mouse, keyboard)■ Sensor protective sleeves■ Holding and aiming devices■ Film
Infection Control Checklist
Prior to Exposure■ Cover or disinfect
■ X-ray machine■ Work area■ Lead apron■ Dental chair
■ Wash hands (operator)■ Put on gloves (operator)
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RADIOL
105During Exposure■ Dry and wipe the exposed fi lm with a paper towel.■ Place fi lm in a disposable container.
After Exposure■ Dispose of all contaminated items.■ Place fi lm-holding devices in designated area for
contaminated objects.■ Remove gloves.■ Wash hands.■ Remove lead apron.
Infection control checklist modifi ed from: Ianucci, J., & Jansen Howerton, L. (2011). Dental Radiography: Principles and Techniques, ed 4. St Louis: Saunders.
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106
INSTR
General Dentistry Instruments
Acorn Burnisher
■ To burnish permanent and temporary fi lling materials
Reprinted with permission from: Kantz, S. (Forthcoming). Dental Assisting: A Comprehensive Guide to Current Practice, ed 1. Philadelphia: F.A. Davis Company.
Amalgam Carrier
■ To carry amalgam■ Single or double ended■ Various sizes depending on size of the cavity preparation
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INSTR
107
Reprinted with permission from: Kantz, S. (Forthcoming). Dental Assisting: A Comprehensive Guide to Current Practice, ed 1. Philadelphia: F.A. Davis Company.
Amalgam Well
■ To hold amalgam after trituration and before placing into the cavity
■ Made in various sizes and from different materials
Reprinted with permission from: Kantz, S. (Forthcoming). Dental Assisting: A Comprehensive Guide to Current Practice, ed 1. Philadelphia: F.A. Davis Company.
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INSTR
108
Anesthetic Syringe
■ To deliver anesthetic solution■ Aspirating capabilities to avoid injection of anesthetic
directly in a blood vessel■ Various types
Reprinted with permission from: Kantz, S. (Forthcoming). Dental Assisting: A Comprehensive Guide to Current Practice, ed 1. Philadelphia: F.A. Davis Company.
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INSTR
109Articulating Paper Holder
■ To hold articulating paper in place during occlusion checks
Reprinted with permission from: Kantz, S. (Forthcoming). Dental Assisting: A Comprehensive Guide to Current Practice, ed 1. Philadelphia: F.A. Davis Company.
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INSTR
110
Cement Spatula
■ To mix temporary and permanent cements as well as various fi lling materials
Reprinted with permission from: Kantz, S. (Forthcoming). Dental Assisting: A Comprehensive Guide to Current Practice, ed 1. Philadelphia: F.A. Davis Company.
Chisel
■ To smooth and plane enamel within the cavity preparation
Reprinted with permission from: Kantz, S. (Forthcoming). Dental Assisting: A Comprehensive Guide to Current Practice, ed 1. Philadelphia: F.A. Davis Company.
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INSTR
111Composite Instrument
■ To carry and place composite material in the cavity preparation
Reprinted with permission from: Kantz, S. (Forthcoming). Dental Assisting: A Comprehensive Guide to Current Practice, ed 1. Philadelphia: F.A. Davis Company.
Condenser
■ To condense permanent and temporary fi lling materials in the cavity preparation
Reprinted with permission from: Kantz, S. (Forthcoming). Dental Assisting: A Comprehensive Guide to Current Practice, ed 1. Philadelphia: F.A. Davis Company.
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INSTR
112
Cotton Forceps
■ To carry objects in and out of the mouth■ Locking type available■ Various sizes
Reprinted with permission from: Kantz, S. (Forthcoming). Dental Assisting: A Comprehensive Guide to Current Practice, ed 1. Philadelphia: F.A. Davis Company.
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INSTR
113Dental Dam Clamps
■ To stabilize dental dam■ Various shapes and sizes to accommodate various teeth
Reprinted with permission from: Kantz, S. (Forthcoming). Dental Assisting: A Comprehensive Guide to Current Practice, ed 1. Philadelphia: F.A. Davis Company.
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INSTR
114
Dental Dam Forceps
■ To place and remove clamp
Reprinted with permission from: Kantz, S. (Forthcoming). Dental Assisting: A Comprehensive Guide to Current Practice, ed 1. Philadelphia: F.A. Davis Company.
Dental Dam Frame
■ To hold and support dental dam
Reprinted with permission from: Kantz, S. (Forthcoming). Dental Assisting: A Comprehensive Guide to Current Practice, ed 1. Philadelphia: F.A. Davis Company.
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INSTR
115Dental Dam Punch
■ To punch holes in the dental dam for teeth involved
Reprinted with permission from: Kantz, S. (Forthcoming). Dental Assisting: A Comprehensive Guide to Current Practice, ed 1. Philadelphia: F.A. Davis Company.
Discoid-Cleoid
■ To create occlusal anatomy in permanent and temporary fi lling materials
Reprinted with permission from: Kantz, S. (Forthcoming). Dental Assisting: A Comprehensive Guide to Current Practice, ed 1. Philadelphia: F.A. Davis Company.
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INSTR
116
Explorer
Reprinted with permission from: Kantz, S. (Forthcoming). Dental Assisting: A Comprehensive Guide to Current Practice, ed 1. Philadelphia: F.A. Davis Company.
Gingival Margin Trimmer
■ To create bevels in the gingival margins of the preparation
Reprinted with permission from: Kantz, S. (Forthcoming). Dental Assisting: A Comprehensive Guide to Current Practice, ed 1. Philadelphia: F.A. Davis Company.
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INSTR
117Hatchet
■ To remove unsupported enamel rods
Hoe
■ To smooth the cavity preparation
Reprinted with permission from: Kantz, S. (Forthcoming). Dental Assisting: A Comprehensive Guide to Current Practice, ed 1. Philadelphia: F.A. Davis Company.
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INSTR
118
Hollenback Carver
■ To contour anatomy in interproximal areas in permanent and temporary restorative materials
Reprinted with permission from: Kantz, S. (Forthcoming). Dental Assisting: A Comprehensive Guide to Current Practice, ed 1. Philadelphia: F.A. Davis Company.
Liner Placement Instrument
■ To mix and place various types of liners into the cavity preparation
Reprinted with permission from: Kantz, S. (Forthcoming). Dental Assisting: A Comprehensive Guide to Current Practice, ed 1. Philadelphia: F.A. Davis Company.
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INSTR
119Matrix Band Retainer (Toffl emire)
■ To hold and support the matrix band during restorations
Reprinted with permission from: Kantz, S. (Forthcoming). Dental Assisting: A Comprehensive Guide to Current Practice, ed 1. Philadelphia: F.A. Davis Company.
Mouth Mirror
■ To retract soft tissue■ To provide indirect vision■ To refl ect light■ Disposable or not■ Single or double sided■ Various sizes and styles
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INSTR
120
Periodontal Probe
■ To measure pocket depths■ Various measuring increments■ Various types and shapes
Reprinted with permission from: Kantz, S. (Forthcoming). Dental Assisting: A Comprehensive Guide to Current Practice, ed 1. Philadelphia: F.A. Davis Company.
Spoon Excavator
■ To remove decay■ Multiple secondary functions■ Single or double ended■ Various size and shapes
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INSTR
121
Friction Grip Burs
Diamond
Reprinted with permission from: Kantz, S. (Forthcoming). Dental Assisting: A Comprehensive Guide to Current Practice, ed 1. Philadelphia: F.A. Davis Company.
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INSTR
122
Fissure: Cross-Cut Straight
Reprinted with permission from: Kantz, S. (Forthcoming). Dental Assisting: A Comprehensive Guide to Current Practice, ed 1. Philadelphia: F.A. Davis Company.
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INSTR
123Fissure: Cross-Cut Tapered
Reprinted with permission from: Kantz, S. (Forthcoming). Dental Assisting: A Comprehensive Guide to Current Practice, ed 1. Philadelphia: F.A. Davis Company.
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INSTR
124
Fissure: Plain Straight
Reprinted with permission from: Kantz, S. (Forthcoming). Dental Assisting: A Comprehensive Guide to Current Practice, ed 1. Philadelphia: F.A. Davis Company.
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INSTR
125Fissure: Plain Tapered
Reprinted with permission from: Kantz, S. (Forthcoming). Dental Assisting: A Comprehensive Guide to Current Practice, ed 1. Philadelphia: F.A. Davis Company.
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INSTR
126
Inverted Cone
Reprinted with permission from: Kantz, S. (Forthcoming). Dental Assisting: A Comprehensive Guide to Current Practice, ed 1. Philadelphia: F.A. Davis Company.
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INSTR
127Pear Shape
Reprinted with permission from: Kantz, S. (Forthcoming). Dental Assisting: A Comprehensive Guide to Current Practice, ed 1. Philadelphia: F.A. Davis Company.
Round
Reprinted with permission from: Kantz, S. (Forthcoming). Dental Assisting: A Comprehensive Guide to Current Practice, ed 1. Philadelphia: F.A. Davis Company.
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INSTR
128
Basic Endodontic Instruments
Broach
■ To remove pulp tissue from the canal
Endodontic Condenser (plugger)
■ To assist in vertical condensation of the gutta percha■ Can also be used to condense the fi nal fi lling of the root
canal
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INSTR
129Endodontic Explorer
■ To locate access openings of canal during endodontic treatment.
Endodontic Spreader
■ To assist in the lateral condensation of the gutta percha■ Can also be used to condense the fi nal fi lling of the root
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INSTR
130
Endodontic Stand
■ To hold for easy access of fi les and burs
File (K-Type)
■ To contour and shape the root canals before obturation
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INSTR
131Gates Glidden
■ To enlarge the pulp chamber■ Attaches to slow speed (latch type)
Gutta-Percha
■ To fi ll root canal during the obturation process■ Various sizes■ Pliable when heated
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INSTR
132
Paper Points
■ To dry root canals before obturation■ Various sizes
Sodium Hypochlorite Syringe
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INSTR
133
Basic Oral Surgery Instruments
Anterior Mandibular Forceps
■ To remove anterior mandibular teeth
Bone File
■ To smooth alveolar bone following tooth extraction
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INSTR
134
Chisel and Mallet
■ To assist in splitting tooth or bone
Cryer Elevators (East and West)
■ To assist in elevating roots when crown portion of tooth is broken
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INSTR
135Hemostat
■ To hold on to tissue or bone pieces■ Various sizes and shapes■ Longer beaks
Reprinted with permission from: Bidwell, J., & Grafft, D. (Forthcoming). Surgical Procedures for Surgical Technology and Surgical Assisting, ed 1. Philadelphia: F.A. Davis Company.
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INSTR
136
Mandibular Molar Universal Forceps (Cowhorn)
■ To remove lower molar teeth
Mandibular Universal Forceps (151)
■ To remove all lower teeth
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INSTR
137Maxillary Left Forceps (88L)
■ To remove trifurcated maxillary left fi rst and second molars
Maxillary Right Forceps (88R)
■ To remove trifurcated maxillary right fi rst and second molars
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INSTR
138
Maxillary Universal Forceps (150)
■ To remove all upper arch teeth
Mouth Props
■ To hold patient’s mouth open■ Various shapes and sizes
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INSTR
139Needle Holder
■ To hold on to the suture needle■ Various shapes and sizes■ Short beaks with indentation to hold on to the needle
securely
Periosteal Elevator
■ To separate tissue from bone and/or tooth■ Various shapes and sizes
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INSTR
140
Rongeurs
■ To smooth and contour alveolar bone after tooth extraction■ Hinged forceps
Root Tip Picks
■ To remove broken root tips■ Various shapes and sizes
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INSTR
141Scalpel Handle with Blades
■ To cut tissue■ Can be disposable■ Blades come in various shapes and sizes
Straight Elevator
■ To luxate and elevate the tooth from its socket■ Various shapes and sizes
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INSTR
142
Surgical Curette
■ To remove abscessed or granulation tissue■ Various sizes■ Can be single or double ended
Suture Scissors
■ To cut off sutures■ Rounded or straight end
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INSTR
143Tissue Scissors
■ To cut excess tissue■ Various shapes and sizes
Reprinted with permission from: Bidwell, J., & Grafft, D. (Forthcoming). Surgical Procedures for Surgical Technology and Surgical Assisting, ed 1. Philadelphia: F.A. Davis Company.
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INSTR
144
Basic Orthodontics Instruments
Band Pusher
■ To push bands into place during orthodontic procedures
Bird Beak
■ To bend and contour wire
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INSTR
145Bands and Brackets
Bracket Placement Pliers
■ To carry and place brackets on tooth for cementation or bonding
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INSTR
146
Bracket Remover
■ To remove brackets upon completion of orthodontic treatment
Distal End Cutter
■ To cut distal end of arch wire after placement in brackets
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INSTR
147Elastic Placement Pliers
■ To place elastics around brackets and wires
Elastics
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INSTR
148
Ligature-Tying Pliers
■ To tie ligatures onto arch wire
Three-Prong Bender
■ To bend and contour wire
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INSTR
149Weingart Pliers
■ To place and remove arch wire or brackets
Wire
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INSTR
150
Wire Cutter
■ To cut wire
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RESOURCE
151
Dental Assistant Profession
The American Dental Assistant’s Association (ADAA) has defi ned a Code of Ethics for Dental Assistants that delineates the profes-sion (www.adda.org).
Profession Preservation
The concept of profession preservation encourages the dental assistant to assume the obligation of maintaining and enriching the profession based on the needs of the individuals the profes-sion of dentistry is committed to serve. This concept can be achieved as follows.
Professionalism
The dental assistant should at all times:
■ Maintain confi dentiality.■ Perform only duties allowed by state law.■ Prove competency in allowed duties.■ Show respect for dentists.
Professional Development
The dental assistant should constantly strive to enrich his or her knowledge of the profession and to upgrade and perfect hand and technical skills for the benefi t of the employer and the human beings he or she serves.
Involvement
Every dental assistant should exhibit a commitment to the pro-fession by being involved with professional associations in a local, state, or national level to better the profession via construc-tive feedback and recommendation.
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RESOURCE
152
Common Dental Terminology
Abscess: Acute or chronic, localized infl ammation with a concentration of pus, associated with tissue destruction and frequently swelling, usually secondary to infection.
Abscess, periapical: Acute or chronic infl ammation and pus formation at the end of a tooth root in the alveolar bone secondary to infection.
Abscess, periodontal: Abscess of the gingiva or periodontal tissue as a result of periodontal infection.
Abutment: A tooth or implant used to support a fi xed prosthesis.
Acid etching: Use of an acid, most commonly phosphoric acid, to prepare the tooth enamel or dentin surface to provide retention for bonding.
Adhesive: Any chemical substance that joins or creates close adherence of two or more surfaces.
Alveolar: Referring to the bone surrounding the tooth.
Alveoloplasty: Surgical procedure for soothing and recontouring alveolar bone, usually in preparation for a prosthesis.
Amalgam: An alloy used in direct dental restorations.
Analgesia: Loss of pain sensations without loss of consciousness.
Anterior teeth: The teeth and tissues located toward the front of the mouth; the maxillary and mandibular incisors and canines.
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RESOURCE
153Anxiolysis: Reduction of anxiety using a pharmacologic agent
such as a benzodiazepine or nitrous oxide.
Apicoectomy: Amputation of the apex of a tooth.
Avulsion: Separation of tooth from its socket due to trauma.
Benign: The nonmalignant character of a neoplasm.
Bicuspid: A tooth with two cusps.
Bilateral: Pertaining to the right and left sides.
Biopsy: Removal of tissue for histologic evaluation.
Bitewing radiograph: Interproximal view radiograph of the coronal portion of the tooth.
Bonding: Process by which two or more components are made integral by mechanical or chemical adhesion at their interface.
Bruxism: Abnormal grinding of the teeth.
Buccal: Pertaining to or around the cheek.
Calculus: Hard mineralized material adhering to crowns or roots of teeth.
Canal: Space inside the root portion of a tooth containing pulp tissue.
Caries: Commonly used term for tooth decay.
Cavity: Decay in tooth caused by caries; also referred to as carious lesion.
Cement base: Material used under a fi lling to replace lost tooth structure.
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RESOURCE
154
Cementum: Hard connective tissue covering the tooth root.
Cephalometric radiograph: A radiographic head fi lm used in the scientifi c study of the measurements of the head with relation to specifi c reference points.
Cleft palate: Congenital deformity resulting in lack of fusion of the soft or hard palate (or both), either partial or complete.
Clenching: The clamping and pressing of the jaws and teeth together in centric occlusion frequently associated with psychological stress or physical effort.
Composite: A dental restorative material made up of disparate or separate parts (e.g., resin and quartz particles).
Coronal: The clinical crown of a tooth.
Curettage: Scraping and cleaning the walls of a cavity or gingival pocket.
Cyst: Pathological cavity, usually lined with epithelium, containing fl uid or soft matter.
Cyst, odontogenic: Cyst derived from the epithelium of odontogenic tissue (developmental, primordial).
Cyst, periapical: Cyst at the apex of a tooth with a nonvital pulp.
Débridement: Removal of subgingival or supragingival plaque and calculus that obstructs the ability to perform an evaluation.
Decay: The lay term for carious lesions in a tooth; decomposition of tooth structure.
Deciduous: Having the property of falling off or shedding; a name used for the primary teeth.
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155Dental prophylaxis: Scaling and polishing procedure performed
to remove coronal plaque, calculus, and stains.
Dentin: That part of the tooth that is beneath enamel and cementum.
Dentition: The teeth in the dental arch.
Denture: An artifi cial prosthesis for natural teeth and adjacent tissues.
Denture base: The part of a denture that makes contact with soft tissue and retains the artifi cial teeth.
Diagnostic cast: Plaster or stone model of teeth and adjoining tissues; also referred to as study model.
Diastema: A space, such as one between two adjacent teeth in the same dental arch.
Direct restoration: A restoration fabricated inside the mouth.
Displaced tooth: A partial evulsion of a tooth.
Distal: Toward the back of the dental arch (or away from the midline).
Dry socket: Localized infl ammation of the tooth socket after extraction caused by infection or loss of blood clot; alveolitis.
Edentulous: Without teeth.
Enamel: Hard calcifi ed tissue covering dentin of the crown of a tooth.
Evaluation, comprehensive: Typically used by a general dentist or specialist when evaluating a patient comprehensively. It is a thorough evaluation and recording of the extraoral and intraoral hard and soft tissues. It may require interpretation
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156
of information acquired through additional diagnostic procedures. This would include the evaluation and recording of the patient’s dental and medical history and a general health assessment.
Evaluation, limited oral: A problem-focused evaluation limited to a specifi c oral health problem. This may require interpretation of information acquired through additional diagnostic procedures. Defi nitive procedures may be required on the same date as the evaluation.
Evaluation, periodic oral: An evaluation performed on a patient of record to determine any changes in the patient’s dental and medical health status since a previous comprehensive or periodic evaluation.
Excision: Surgical removal of bone or tissue.
Exostosis: Overgrowth of bone.
Extraoral: Outside the mouth.
Exudate: A material usually resulting from infl ammation or necrosis that contains fl uid, cells, or other debris.
Facial: The surface of a tooth directed toward the face (including the buccal and labial surfaces) and opposite the lingual surface. Facial surface equals buccal surface in the posterior or the labial in the anterior.
Filling: A term used for the restoration of lost tooth structure by using materials such as metal, alloy, plastic, or porcelain.
Fixed partial denture: A prosthetic replacement of one or more missing teeth cemented or attached to the abutment teeth or implant abutments adjacent to the space.
Foramen: Natural opening into or through bone.
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157Fracture: The breaking of a part, especially of a bony structure;
breaking of a tooth.
Frenum: Muscle fi bers covered by a mucous membrane that attaches the cheek, lips, or tongue to associated dental mucosa.
Furcation: The anatomic area of a multirooted tooth where the roots diverge.
General anesthesia: A controlled state of unconsciousness, accompanied by a partial or complete loss of protective refl exes, including loss of ability to independently maintain airway and respond purposefully to physical stimulation or verbal command, produced by a pharmacologic or nonpharmacologic method or combination thereof.
Gingiva: Soft tissues overlying the crowns of unerupted teeth and encircling the necks of those that have erupted.
Gingivectomy: The excision or removal of gingiva.
Gingivitis: Infl ammation of gingival tissue without loss of connective tissue.
Gingivoplasty: Surgical procedure to reshape gingiva.
Glass ionomer: Material in which the solid powdered phase is a fl uoride-containing glass powder. The material is translucent and can be used as a restoration, a liner, and a luting agent.
Graft: A piece of tissue or alloplastic material placed in contact with tissue to repair a defect or supplement a defi ciency.
Hemisection: Surgical separation of a multirooted tooth.
Implant: Material inserted or grafted into tissue; a device especially designed to be place surgically within or on the
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158
mandibular or maxillary bone as a means of providing for dental replacement.
Incisal: Pertaining to the biting edges of the incisor and cuspid teeth.
Indirect pulp cap: Procedure in which the nearly exposed pulp is covered with a protective dressing to protect the pulp from additional injury and to promote healing and repair via formation of secondary dentin.
Indirect restoration: A restoration fabricated outside the mouth.
Inlay: An indirect intracoronal restoration; a dental restoration made outside the oral cavity to correspond to the form of the prepared cavity, which is then luted into the tooth.
Interproximal: Between the adjoining surfaces of adjacent teeth in the same arch.
Intracoronal: Referring to “within” the crown of a tooth.
Intraoral: Inside the mouth.
Intravenous sedation or analgesia: A medically controlled state of depressed consciousness while maintaining the patient’s airway, protective refl exes, and the ability to respond to stimulation or verbal commands. It includes intravenous administration of sedative or analgesic agent(s) (or both) and appropriate monitoring.
Labial: Pertaining to or around the lip.
Lesion: An injury or wound; area of diseased tissue.
Lingual: Pertaining to or around the tongue; surface of the tooth directed toward the tongue; opposite of facial.
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159Local anesthesia: The loss of pain sensation over a specifi c
area of the anatomy without loss of consciousness.
Maintenance, periodontal: Therapy for preserving the state of health of the periodontium.
Malignant: Having the properties of dysplasia, invasion, and metastasis.
Malocclusion: Improper alignment of biting or chewing surfaces of upper and lower teeth.
Maryland bridge: Fixed partial denture feature conservative retainers that are resin bonded to abutments.
Maxilla: The upper jaw.
Mesial: Toward the midline of the dental arch; opposite of distal.
Molar: Teeth posterior to the premolars (bicuspids) on either side of the jaw.
Mucous membrane: Lining of the oral cavity as well as other canals and cavities of the body; also called mucosa.
Nonintravenous conscious sedation: A medically controlled state of depressed consciousness while maintaining the patient’s airway, protective refl exes, and ability to respond to stimulation or verbal commands.
Occlusal: Pertaining to the biting surfaces of the premolar and molar teeth or contacting surfaces of opposing teeth or opposing occlusion rims.
Occlusal radiograph: An intraoral radiograph made with the fi lm being held between the occluded teeth.
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160
Occlusion: Any contact between biting or chewing surfaces of maxillary (upper) and mandibular (lower) teeth.
Odontoplasty: Adjustment of tooth length, size, or shape; includes removal of enamel projections.
Onlay: An indirect restoration made outside the oral cavity that overlays a cusp or cusps of the tooth, which is then luted to the tooth.
Oral pathology: The specialty of dentistry and pathology concerned with recognition, diagnosis, investigation, and management of diseases of the oral cavity, jaws, and adjacent structures.
Orthognathic: Functional relationship of the maxilla and mandible.
Osteoplasty: Surgical procedure that modifi es the confi guration of bone.
Osteotomy: Surgical cutting of bone.
Overdenture: A removable prosthetic device that overlies and may be supported by retained tooth roots or implants.
Palate: The hard and soft tissues forming the roof of the mouth that separates the oral and nasal cavities.
Palliative: Action that relieves pain but is not curative.
Panoramic radiograph: An extraoral radiograph on which the maxilla and mandible are depicted on a single fi lm.
Partial denture: Usually refers to a prosthetic device that replaces missing teeth; see fi xed partial denture or removable partial denture.
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161Periapical radiograph: A radiograph made by the intraoral
placement of fi lm for disclosing the apices of the teeth.
Periodontal: Pertaining to the supporting and surrounding tissues of the teeth.
Periodontal disease: Infl ammatory process of the gingival tissues or periodontal membrane of the teeth, resulting in an abnormally deep gingival sulcus, possibly producing periodontal pockets and loss of supporting alveolar bone.
Periodontal pocket: Pathologically deepened gingival sulcus; a feature of periodontal disease.
Periodontitis: Infl ammation and loss of the connective tissue of the supporting or surrounding structure of teeth with loss of attachment.
Periradicular: Surrounding a portion of the root of the tooth.
Plaque: A soft, sticky substance that accumulates on teeth composed largely of bacteria and bacterial derivatives.
Pontic: An artifi cial tooth on a fi xed partial denture (bridge).
Post: An elongated projection fi tted and cemented within the prepared root canal, serving to strengthen and retain restorative material or a crown restoration.
Posterior: Refers to teeth and tissues toward the back of the mouth (distal to the canines); the maxillary and mandibular premolars and molars.
Premedication: The use of medications before dental procedures.
Primary dentition: The fi rst set of teeth; see deciduous.
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162
Prophylaxis: Scaling and polishing procedure performed to remove coronal plaque, calculus, and stains.
Prosthesis: Artifi cial replacement of any part of the body. A dental prosthesis is any device or appliance replacing one or more missing teeth and, if required, associated structures. (This is a broad term that includes abutment crowns and abutment inlays and onlays, bridge, dentures, obturators, and gingival prostheses.)
Prosthesis, fi xed: Nonremovable tooth or implant-borne dental prosthesis attached to abutment teeth or roots or implants.
Prosthesis, interim: A provisional prosthesis designed for use over a limited period of time, after which it will be replaced by a more defi nitive restoration.
Prosthesis, removable: Dental prosthesis designed to be removed and reinserted by the patient.
Provisional: Formed or preformed for temporary purposes or used over a limited period; a temporary or interim solution; usually refers to a prosthesis or individual tooth restoration.
Pulp: Connective tissue that contains blood vessels and nerve tissue that occupies the pulp cavity of a tooth.
Pulp cavity: The space within a tooth that contains the pulp.
Pulpectomy: Complete removal of vital and nonvital pulp tissue from the root canal space.
Pulpitis: Infl ammation of the dental pulp.
Pulpotomy: Surgical removal of a portion of the pulp with the aim of maintaining the vitality of the remaining portion by means of an adequate dressing; pulp amputation.
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163Quadrant: One of the four equal sections into which the dental
arches can be divided; begins at the midline of the arch and extends distally to the last tooth.
Rebase: Process of refi tting a denture by replacing the base material.
Reline: Process of resurfacing the tissue side of a denture with new base material.
Reimplantation: The return of a tooth to its alveolus.
Removable partial denture: Prosthetic replacement of one or more missing teeth that can be removed by the patient; a removable bridge.
Retainer, orthodontic: Appliance to stabilize teeth after orthodontic treatment.
Retainer, prosthodontic: A part of a fi xed partial denture that attaches a pontic to the abutment tooth, implant abutment, or implant.
Retrograde fi lling: A method of sealing the root canal by preparing and fi lling it from the root apex.
Root: The anatomic portion of the tooth that is covered by cementum and is located in the alveolus (socket) where it is attached by periodontal ligaments.
Root canal: The portion of the pulp cavity inside the root of a tooth; the chamber within the root of the tooth that contains the pulp.
Root canal therapy: The treatment of disease and injuries of the pulp and associated periradicular conditions.
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164
Root planing: A procedure designed to remove microbial fl ora, bacterial toxins, calculus, and diseased cementum or dentin on the root surfaces and in the pocket.
Scaling: Removal of plaque, calculus, and stains from teeth.
Splint: A device used to support, protect, or immobilize oral structures that have been loosened, replanted, fractured, or traumatized.
Stomatitis: Infl ammation of the membranes of the mouth.
Study model: Plaster or stone model of teeth and adjoining tissues; also referred to as diagnostic cast.
Suture: Stitch used to repair incision or wound.
Temporomandibular joint (TMJ): The connecting hinge mechanism between the base of the skull (temporal bone) and the lower jaw (mandible).
Temporomandibular joint dysfunction: Abnormal functioning of the temporomandibular joint; also refers to symptoms arising in other areas secondary to the dysfunction.
Tissue conditioning: Material intended to be placed in contact with tissues for a limited period with the aim of assisting the return to a healthy condition.
Torus: A bony elevation or protuberance of bone; see exostosis.
Trismus: Restricted ability to open the mouth, usually caused by infl ammation or fi brosis of the muscles of mastication.
Unerupted: Refers to a tooth or teeth that have not penetrated the oral cavity.
Unilateral: One sided; pertaining to or affecting only one side.
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165Veneer: In the construction of crowns or pontics, a layer of
tooth-colored material, usually, but not limited to, composite, porcelain, ceramic, or acrylic resin, attached to the surface by direct fusion, cementation, or mechanical retention.
Vestibuloplasty: Any of a series of surgical procedures designed to increase relative alveolar ridge height.
Xerostomia: Decreased salivary secretion that produces a dry and sometimes burning sensation of the oral mucosa or cervical caries.
X-ray: A radiograph.
Spanish Terms
Medical Questions
The Spanish Terms section is reprinted with permission from: Prajer, R., & Grosso, G. (2011). DH Notes: Dental Hygienist’s Chairside Pocket Guide, ed 1. Philadelphia: F.A. Davis Company; pp. 202–204.
What are your physician’s name and phone number?
¿Qué es el nombre de su médico y el número de teléfono?
Are you taking any medications? If so, what?
¿Toma medicina? ¿Si eso es el caso, qué?
Do you have any heart problems?
¿Tiene algúnos problemas cardíacso?
Do you have high blood pressure?
¿Tiene la hipertensión?
Do you have diabetes?
¿Tiene la diabetes?
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166
Do you have any allergies?
¿Tiene algunas alergias?
Are you allergic to any medications?
¿Es alérgico a medicina?
Do you have to take antibiotics before dental treatment?
¿Tiene que tomar antibióticos antes de tratamiento dental?
Have you recently been hospitalized?
¿Ha sido hospitalizado recientemente?
Dental Questions
When was your last dental visit?
¿Cuándo fue su última visita dental?
Are you having any problems with your teeth?
¿Tiene cualquier problemas con los dientes?
Do you have any pain?
¿Tiene dolor?
How often do you brush?
¿Con qué frecuencia se cepilla?
How often do you fl oss?
¿Con qué frecuencia se limpia con hilo dental?
Do your gums bleed when you brush, fl oss, or eat?
¿Sangran sus gomas cuando se cepilla, limpia con hilo dental o come?
When were your last dental x-rays?
¿Cuándo fueron sus últimas radiografías dentales?
Is there anything that you would like to discuss with the
dentist?
¿Hay algo que usted querria discutir con el dentista?
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167Treatment Directives
Open your mouth.
Abra la boca.
Close your mouth.
Cierre la boca.
Swish and spit.
Mueva y escupa.
Swallow.
Trague.
Close your teeth together.
Cierre los dientes juntos.
Bite down.
Muerda hacia abajo.
Chin up.
El mentón arriba.
Web References
American Dental Association http://www.ada.orgAmerican Heart Association http://www.americanheart.govCenters for Disease Control and Prevention http://www.cdc.govDental Assistant National Board http://www.danb.orgMedline Plus http://www.nlm.nih.govNational Institute for Occupational Safety and Health http://www.cdc.gov/niosh
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U.S. Department of Labor Occupational Safety and Health http://www.osha.gov
References
American Dental Association. (2011). Radiography/Xrays. Retrieved October, 18, 2011, from http://www.ada.org/prf/resources/topics/topics_radiography_chart.pdf.
American Heart Association. (2011). Endocarditis Prophylaxis Information. Retrieved June 22, 2011, from http://wwwamericanheart.org/presenter.jhtml?identifi er = 1108.
American Society of Anesthesiologists. (2009). ASA Physical Status Classifi cation System. Retrieved August 9, 2011, from http://www..asahg.org/clinical/physicalstatus.htm.
Bird, D., & Robinson, D. (2009). Modern Dental Assisting, ed 9. St Louis: Saunders Elsevier.
Brunick, A., & Clark, M. (2008). Handbook of Nitrous Oxide and Oxygen. St Louis: Mosby/Elsevier.
CDC. Guidelines for environmental infection control in health-care facilities: recommendations of CDC and the Healthcare Infection Control Practices Advisory Committee (HICPAC). MMWR 2003;52(No. RR-10).
Chesnutt, I., & Gibson, J. (2002). Clinical Dentistry. Edinburgh: Harcourt Publishers Limited/Churchill Livingstone.
Dofka, C. (2007). Dental Terminology, ed 2. Thompson Delmar Learning.
F.A. Davis Company. (2009). Taber’s Cyclopedic Medical Dictionary, ed 21. Philadelphia: F.A. Davis Company.
Food and Drug Administration. Guidance for Industry and FDA Reviewers: Content and Format of Premarket Notifi cation [510(k)] Submissions for Liquid Chemical Sterilants/High Level Disinfectants. Rockville, MD: US Department of Health and Human Services, Food and Drug Administration, 2000. Available at http://www.fda.gov/cdrh/ode/397.pdf.
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169Grimes, E. (2009). Medical Emergencies. Upper Saddle River, NJ:
Pearson Prentice Hall.
Ianucci, J., & Jansen Howerton, L. (2006). Dental Radiography Principles and Techniques, ed 3. St Louis: Saunders.
Kohn, W.G., Collins, A.S., Cleveland, J.L., et al. (2003). Centers for Disease Control and Prevention. Guidelines for infection control in dental health-care settings—2003. MMWR Recomm Rep 52(RR-17):1–61.
Little, J., Falace, D., Miller, C., & Rhodus, N. (2008). Dental Management of the Medically Compromised Patient, ed 7. St Louis: Elsevier/Mosby.
Malamed, S. (2004). Handbook of Local Anesthesia, ed 5. St Louis: Elsevier/Mosby.
Malamed, S. (2007). Medical emergencies in the Dental Offi ce, ed 6. St Louis: Elsevier/Mosby.
Mauriello, S., Overman, V., & Platin, E. (1995). Radiographic Imaging for the Dental Team. Philadelphia: J.B. Lippincott.
Miles DA, Van Dis ML, Jensen CW, et al.: Radiographic Imaging for Dental Auxiliaries, 3rd Ed. Philadelphia, W.B. Saunders, 1999.
Miller, C.H., & Palenik, C.J. (2004). Infection Control & Management of Hazardous Materials for the Dental Team, ed 3. St Louis: Mosby-Year Book; 260–275.
Mosby. (2012). Dental Drug Reference, ed 10. St Louis: Mosby.
Mosby. (2004). Spanish terminology for the Dental Team. St Louis: Mosby
Organization for Safety & Asepsis Procedures. (2004). From Policy to Practice: OSAP’s Guide to the Guidelines. Annapolis, MD: OSAP; 45–62.
Organization for Safety & Asepsis Procedures. (2005). Surface disinfectants for dentistry: tools for selecting and using surface disinfectants in dental settings. Infection Control In Practice. Vol 4:1.
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170
Pickett, F., & Gurenlian, J. (2010). Preventing Medical Emergencies: Use of Medical History, ed 2. Philadelphia: Lippincott Williams & Wilkins.
Turley, S. (2010). Understanding Pharmacology for Health Professionals, ed 4. Upper Saddle River, NJ: Pearson.
U.S. Department of Labor, Occupational Safety and Health Administration. (2001). 29CFR Part 1910.1030. Occupational Exposure to Bloodborne Pathogens; Needlesticks and Other Sharps Injuries; Final Rule. Fed Reg 66:5317–5325. As amended from and includes 29 CFR Part 1910.1030. U.S. Department of Labor, Occupational Safety and Health Administration. (1991). Occupational exposure to bloodborne pathogens; fi nal rule. Fed Reg 56:64174–64182. Available at http://www.osha.gov/SLTC/dentistry/index.html.
Williams & Wilkins. (1997). Stedman’s Concise Medical Dictionary for the Health Professions, ed 3.Baltimore, MD: Williams and Wilkins.
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171
INDEX
A
Abscess(es), 15–16 152Abutment, 152Acid etching, 152Acorn burnisher, 106Acute radiation exposure, 94Adhesive, 152Airway(s), obstructed, 9–10Albuterol, 24Albuterol–ipratropium, 20Alcohol-based hand wash,
77Alendronate sodium, 21Alprazolam, 25Alveolar, 152Alveolar osteitis, 16Alveoloplasty, 152Amalgam, 152Amalgam carrier, 106–107Amalgam wall, 107American Dental Assistant’s
Association (ADAA)Code of Ethics for Dental
Assistants of, 151American Society of
Anesthesiologists (ASA)classifi cation system for
physical status, 1–2Amiodipine, 23Amitriptyline HCl, 21Amlodipine–benazepril, 22Amoxicillin, 18Amphetamine/
dextroamphetamine, 18Analgesia, 152
Anesthesia/anesthetics, 45–58color coding, 48general, 157injections, 48–58local, 46–47, 159syringe, 108topical, 45–46
Angina pectoris, 10–11Anode, 89Anterior mandibular forceps,
133Anterior superior alveolar
(ASA) injection, 52Anterior teeth, 152Antibiotic prophylaxis regimen,
5Antisepsis, surgical, 77Antiseptic hand wash, 77Anxiolysis, 153Apicoectomy, 153Articaine, 47Articulating paper holder, 109Aspiration, foreign body, 13Atenolol, , 24Automated external
defi brillator, 9Avulsed tooth, 16–17Avulsion, 153Azithromycin, 25
B
Band(s), orthodontic, 145Band pusher, orthodontic, 144Benign, 153Benzocaine, 46
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Bicuspid, 153Bilateral, 153Biopsy, 153Bird beak, orthodontic, 144Bisecting technique, 99Bite, open, 45Bitewing (BW) radiograph, 97,
153Blood pressure, 6–7Blood pressure types, in adults,
7Bloodborne pathogens, 75Bonding, 153Bone fi le, 133Bracket(s), orthodontic, 145Bracket placement pliers, 145Bracket remover, 146Bridge(s), Maryland, 159Broach, 128Broken instrument, 11Broken tooth, 17Bruxism, 153Buccal, 153Buccal nerve block, 57Bupivacaine, 47Bupropion HCl, 25Buspirone, 19
C
CAB of CPR, 8Cabamazepine, 24Calculus, 153Canal, 153Cardiopulmonary resuscitation
(CPR), 8–10Caries, 153Cathode, 89Cavity, 153Cavity classifi cation, 33–35
Celecoxib, 19Cement base, 153Cement spatula, 110Cementum, 154Centers for Disease Control and
Prevention (CDC)infection control guidelines
of, 74–76Cephalometric radiograph, 101,
154Cetacaine, 46Chain of survival, 8Chairside, 26–69
anesthesia, 45–58basic principles, 67concepts, 62–69dentist positioning, 64dentition, 26–45four-handed dentistry, 62–64instrument transfer, 68motions, 65–67nitrous oxide sedation,
58–61Charting, 36Chisel, 110, 134Chlordiazepoxide, 22Citalopram, 19Clamp(s), dental dam, 113Class I occlusion, 39Class II occlusion, 40–41Class III occlusion, 41Cleft palate, 154Clenching, 154Clinical contact surfaces, 83Clopidogref, 24Clozapine, 19Code of Ethics for Dental
Assistantsof ADAA, 151
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173Color coding, 36
for anesthesia, 48for charts, 36
Composite, 154Composite instrument, 111Comprehensive evaluation,
155–156Computed tomography (CT),
101–102Condenser (plugger), 111
endodontic, 128Cone beam computed
tomography (CBCT), 101–102Coronal, 154Cotton forceps, 112Cowhorn forceps, 136Cracked tooth syndrome (CTS),
17Crossbite, 42Cryer elevators (east and west),
134Curettage, 154Cyst(s), 154
D
Debridement, 154Decay, 154Deciduous, 154Deciduous dentition, 26Dental abbreviations, 37–39Dental dam clamps, 113Dental dam forceps, 114Dental dam frame, 114Dental dam punch, 115Dental emergencies, 15–17Dental prophylaxis, 155Dental radiographs.
bisecting technique, 99BW, 97
cephalometric, 101exposing techniques, 98–100extraoral series, 100–102FMX, 97intraoral series, 97–100occlusal technique, 100PA, 97panoramic, 100–101paralleling technique, 98types of, 97–102
Dental terminology, 152–165Dentin, 155Dentition, 26–45
cavity classifi cation, 33–35charting, 36deciduous, 26defi ned, 155dental abbreviations, 37–39misalignment/malocclusion,
42–45occlusion, 39–41permanent, 27primary, 31, 161tooth eruption tables, 26–27tooth numbering, 28–32tooth surface abbreviations,
36Denture, 155, 160, 163Denture base, 155Diabetic emergency, 11–12Diagnostic cast, 155Diastema, 155Diazepine, 25Digital radiography, 102–104Dipyridamole–ASA, 18Direct restoration, 155Discoid-cleoid, 115Displaced tooth, 155Distal, 155
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INDEX
174
Distal end cutter, orthodontic, 146
Doxazosyn mesylate, 19Dry socket, 16, 155
E
Edentulous, 155Elastic placement pliers,
orthodontic, 147Emergency kit, 2–3Emergency preparedness,
1–10antibiotic prophylaxis
regimen, 5ASA classifi cation system,
1–2chain of survival, 8CPR, 8–10dental emergencies, 15–17emergency kit, 2–3medical emergencies, 10–15premedication guidelines,
3–4vital signs, 5–8
Enamel, 155End to end, 43Endodontic instruments,
128–132broach, 128condenser (plugger), 128explorer, 129fi le (K-type), 130Gates Gidden, 131Gutta-Percha, 131paper points, 132sodium hydrochloride
springs, 132spreader, 129stand, 130
Enoxaparin sodium, 22Environmental surfaces
infection control related to, 82–84
Epinephrine, lidocaine with, 47
Eszopiclone, 22Etanercept, 21Ethinyl estradiol–desogestrel,
23Ethinyl estradiol–norethindrone,
23Etodolac, 22Evaluation(s), 155–156Excision, 156Exostosis, 156Explorer, 116, 129Extraoral, 156Extraoral x-ray unit, 90Exudate, 156
F
Face shield, infection control, 78
Facial, 156Fainting, 12–13Famotidine, 23Fentanyl (transdermal), 21Fexoenadine HCl, 18File(s)
bone, 133K-type, 130
Filling, 156Fixed partial denture, 156Fixed prosthesis, 162Fluconazole, 20Fluoxetine, 24Fluvoxamine maleate, 22Foramen, 156
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INDEX
175Forceps
anterior mandibular, 133cotton, 112dental dam, 114mandibular molar universal
(Cowhorn), 136mandibular universal (151),
136maxillary left (88L), 137maxillary right (88R), 137maxillary universal (150), 138
Foreign body aspiration, 13Four-handed dentistry, 62–64Fracture, 157Frenum, 157Friction grip burs, 121–127
diamond, 121fi ssure: cross-cut straight, 122fi ssure: cross-cut tapered, 123fi ssure: plain straight, 124fi ssure: plain tapered, 125inverted cone, 126pear shape, 127round, 127
Full-mouth survey (FMX), 97Furcation, 157Furosemide, 22
G
Gabapentin, 23Gates Gidden, 131General anesthesia, 157Gingival margin trimmer, 116
157Gingivectomy, 157Gingivitis, 157Gingivoplasty, 157Glass ionomer, 157Gloves, infection control, 79–82
Graft, 157Greater palatine block, 53Gutta-Percha, 131
H
Haloperidol, 21Hand hygiene, 76–77Hand washing, 77Hatchet, 117Heimlich maneuver, 9–10Hemisection, 157Hemostat, 135Hoe, 117Hollenback carver, 118Hydrocortisone, 20Hydromorphone, 21Hyperventilation, 13–14
I
Ibandronate, 19Ibuprofen, 18Imipramine HCl, 25Implant, 157–158Incisal, 158Indirect digital imaging, 103Indirect pulp cap, 158Indirect restoration, 158Infection(s), chain of, 74Infection control, 70–84
bloodborne pathogens, 75CDC guidelines for, 74–76clinical contact surfaces–
related, 83environmental surfaces–
related, 82–84exposure prevention
strategies in, 75hand hygiene in, 76–77instruments and, 70–73
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INDEX
176
classifi cation based on need for, 70
medical waste management in, 84
personal protective equipment (PPE) in, 78–84.
postexposure management program in, 75–76
program evaluation, 84radiography-related, 104–105standard precautions, 74–75water lines–related, 83–84
Inferior alveolar nerve block, 56Injection(s), 48–58
mandibular, 55–58.maxillary, 49–58.preparation for, 48types of, 49–58
Inlay 158Instrument(s), 106–150
acorn burnisher, 106amalgam carrier, 106–107amalgam wall, 107anesthetic syringe, 108articulating paper holder, 109broken, 11cement spatula, 110chisel, 110composite, 111condenser, 111cotton forceps, 112dental dam clamps, 113dental dam frame, 114dental dam punch, 115discoid-cleoid, 115endodontic, 128–132.
explorer, 116friction grip burs, 121–127general dentistry, 106–120
gingival margin trimmer, 116hatchet, 117hoe, 117Hollenback carver, 118in infection control, 70–73
classifi cation based on need for infection control, 70
liner placement, 118matrix band retainer
(Toffl emire), 119mouth mirror, 119oral surgery, 133–143orthodontic, 144–150periodontal probe, 120spoon excavator, 120sterilization of, 71–73transfer of, 68
Interim prosthesis, 162Interproximal, 158Intracoronal, 158Intraoral, 158Intraoral x-ray unit, components
of, 87–89Intravenous sedation/analgesia,
158Isosorbide dinitrate, 22
K
K-type fi le, 130Kells, E., 85
L
Labial, 158Lamotrigine, 22Lesion 158Levonordefrin, 47Levonorgestrel–ethinyl
estradiol, 25
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INDEX
177Lidocaine, 46, 47Ligature-tying pliers,
orthodontic, 148Limited oral evaluation, 156Liner placement instrument,
118Lingual, 158Local anesthetics, 46–47, 159Loracarbef, 22Loratadine, 19Lorazepam, 18Losartan–hydrochlorothiazide,
21Lovastatin, 23
M
Maintenance, periodontal, 159
Malignant, 159Mallet, 134Malocclusion, 42–45, 159Mandibular injections, 55–58
buccal nerve block, 57inferior alveolar nerve block,
56mental nerve block, 58
Mandibular molar universal forceps (Cowhorn), 136
Mandibular universal forceps (151), 136
Maryland bridge 159Mask(s), in infection control,
78Matrix band retainer
(Toffl emire), 119Maxilla, 159Maxillary injections, 49–5
ASA, 52greater palatine block, 53
MSA, 51nasopalatine block, 54PSA, 50
Maxillary left forceps (88L), 137
Maxillary right forceps (88R), 137
Maxillary universal forceps (150), 138
Medical emergencies, 10–15Medical waste management, in
infection control, 84Medication(s), 18–25Mental nerve block, 58Meperidine, 20Mepivicaine with levonordefrin,
47Mesial, 159Methylprednisolone, 22Methylprenidate HCl, 20Metoprolol, 22Midazolam, 25Middle superior alveolar (MSA)
injection, 51Mirror, mouth, 119Misalignment, 42–45Molar, 159Motion(s), in chairside
dentistry, 65–67Mouth, medications effects on,
18–25Mouth mirror, 119Mouth props, 138Mucous membrane,
159
N
Nasopalatine block, 54Needle holder, 139
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178
Nerve block(s)buccal, 57inferior alveolar, 56mental, 58
Nitrous oxide sedation, 58–61complications of, 61contraindications to, 59indications for, 59medical assessment of
patient prior to, 59–60medical emergencies
associated with, 61pharmacological and
physiological effects of, 60–61
Nonintravenous conscious sedation, 159
Norethindrone–ethinyl estradiol, 23
Nortriptyline HCl, 23
O
Obstructed airway management ,9–10
Occlusal, 159Occlusal radiographs, 159Occlusion, 39–41, 160Odontogenic cyst, 154Odontoplasty, 160Olopatidine HCl, 23Onlay, 160Open bite, 45Oral pathology, 160Oral surgery instruments,
133–143anterior mandibular forceps,
133bone fi le, 133chisel, 134
Cryer elevators (east and west), 134
hemostat, 135mallet, 134mandibular molar universal
forceps, 136mandibular universal forceps
(151), 136maxillary left forceps (88L),
137maxillary right forceps (88R),
137maxillary universal forceps
(150), 138mouth props, 138needle holder, 139periosteal elevator, 139rongeurs, 140root tip picks, 140scalpel handle with blades,
141straight elevator, 141surgical curette, 142suture scissors, 142tissue scissors, 143
Oraqix, 46Orthodontic instruments,
144–150band(s), 145band pusher, 144bird beak, 144bracket placement pliers, 145bracket remover, 146brackets, 145distal end cutter, 146elastic placement pliers, 147ligature-tying pliers, 148three-prong bender, 148Weingart pliers, 149
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INDEX
179wire, 149wire cutter, 150
Orthodontic retainer, 163Orthognathic, 160Osteitis, alveolar, 16Osteoplasty, 160Osteotomy, 160Overbite, 44Overdenture, 160Overjet, 44Oxazepam, 24Oxcarbazepine, 25Oxycodone, 23Oxycodone–acetaminophen,
21
P
Palate, 160Palliative, 160Palm grasp, instrument-related,
68Palm/thumb grasp, instrument-
related, 69Palmer notation system, in
tooth numbering, 32Panoramic radiograph, 100–101,
160Pantoprazole, 24Paper points, endodontic, 132Paralleling technique, in
intraoral radiography, 98Paroxetine, dental effects of, 23Partial denture, 160, 163Pen grasp, 68Penciclovir, 20Penicillin, 24Penicillin–clavulanate, 18Periapical (PA) abscess, 152Periapical (PA) cyst, 154
Periapical (PA) radiograph, 97, 161
Periodic oral evaluation, 156Periodontal, 161Periodontal abscess, 15, 152Periodontal disease, 161Periodontal maintenance, 159Periodontal pocket, 161Periodontal probe, 120Periodontitis, 161Periosteal elevator, 139Periradicular, 161Permanent dentition, 27Personal protective equipment
(PPE), 78–82Phenytoin sodium, 21Plaque, 161Pliers
bracket placement, 145elastic placement, 147ligature-tying, 148Weingart, 149
Pontic, 161Positioning in chairside
dentistry, 64Post, 161Posterior, 161Posterior superior alveolar
(PSA) injection, 50Pramipexole dihydrochloride,
23Prednisone, 20Pregabalin, 22Premedication, 161Premedication guidelines, 3–4Prilocaine, 47Primary dentition, 31, 161Probe, periodontal, 120Prophylaxis, 162
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180
Propoxyphene–acetaminophen, 20
Propranolol HCl, 21Prosthesis(es), 162Prosthodontic retainer, 163Provisional, 162Pulp cavity, 162Pulpectomy, 162Pulpitis, 162Pulpotomy, 162Pulse rate, 7
Q
Quadrant, 163Quetiapine, 24Quinapril, 18
R
Rabeprazole, 18Radiation exposure
acute, 94chronic, 95maximum permissible dose,
95operator protection from, 96patient protection from, 95
Radiograph(s). See specifi c types
Radiographic beam characteristics, 93–94
Radiology, 85–105dental radiographs, 97–102.digital, 102–104.equipment, 87–93
duplicating-related, 91–92extraoral x-ray unit, 90intraoral x-ray unit, 87–89x-ray processor, 90–91
errors due to, 96
extraoral, 86fi lm types, 92–93history of, 85infection control sites, 104–105intraoral, 85introduction to, 85–86radiation effects, 94–96radiographic beam
characteristics, 93–94types of, 85–86uses of, 85
Rebase, 163Reimplantation, 163Reline, 163Removable partial denture,
163Removable prosthesis, 162Respiration, 7–8Restoration, 155, 158Resuscitation, cardiopulmonary,
8–10.Retainer(s), 163Retrograde fi lling, 163Reverse Towne projection, 101Ritonavir, 23Roentgen, W.C., 85Rongeurs, 140Root, 163Root canal, 163Root canal therapy, 163Root planing, 164Root tip picks, 140Ropinirole, 24
S
Salmeterol, 24Scaling, 164Scalpel handle with blades, 141Scissors, 142–143
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INDEX
181Sedation
nitrous oxide, 58–61nonintravenous conscious,
159Seizures, 14–15Sodium hydrochloride springs,
132Spanish terms, 165–167Spatula(s), cement, 110Spironolactone, 18Splint, 164Spoon excavator, 120Spreader, endodontic, 129Stand, endodontic, 130Steam autoclave, 71–72Sterile glove donning
technique, 79–82Sterilization, instrument, 71–73Stomatitis, 164Storage phosphor imaging, 103Straight elevator, 141Study model, 164Submentovertex projection, 101Sumatriptan, 21Surgical antisepsis, 77Surgical curette, 142Suture, 164Suture scissors, 142Syncope, 12–13
T
Tadalafi l, 19Temazepam, 24Temporomandibular joint
(TMJ), 164Terminology, 152–165Three-prong bender,
orthodontic, 148Timolol malate, 24
Tissue conditioning, 164Tissue scissors, 143Toffl emire retainer, 119Tolterodine, 20Tooth (teeth)
anterior, 152avulsed, 16–17broken, 17displaced, 155medication effects on, 18–25
Tooth eruption tables, 26–27Tooth numbering, 28–32
Palmer notation system, 32universal system, 28–31
Tooth surface abbreviations, 36
Topical anesthetics, 45–46Topiramate, 25Torus, 164Tramalol, 25Trazodone, 20Triazolam, 21Trismus, 164
U
Unerupted, 164Unilateral, 164Universal system, 28–31
permanent dentition, 29–30primary dentition, 31
V
Valproic acid, 20Vasovagal episode, 12–13Veneer, 165Ventafaxine HCl, 21Verapamil HCl, 19Vestibuloplasty, 165Vital signs, 5–8
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182
X
X-ray, 165X-ray processor, 90–91
Z
Zidovudine, 19Zolpidem tartrate, 18
W
Warfarin, 20Water lines, 83–84Water supply, contamination of,
83–84Waters projection, 101Web references, 167–168Weingart pliers, 149Wire(s), orthodontic, 149Wire cutter, orthodontic, 150
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