Dental Operating Room Assistant PN Awasthi
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Orientation to Dental ProfessionCHAPTER 1

In the modern clinical dentistry, dental assistant is an important member of the oral health care team. He plays a key role in delivering patient care in the contemporary dental surgery room. Part of becoming a good team player is learning the skills and qualification necessary to assist the doctor.
This chapter will take you through the important milestones in the fascinating history of dentistry. The two main dental scourges of mankind, i.e. dental caries and pyorrhea alveolaris, have influenced the evolution and progress of the art and science of dentistry. You will also know how the first dental assistant, Lady in attendance evolved into the highly skilled dental health professional recognised today as the dental assistant.
Although the fate deemed it otherwise, dentistry should have been the first specialty of medicine. Chapin and Harris, two physicians opened the first school of dentistry in Baltimore, USA in1884. Other physicians soon joined the faculties of other dental schools and thus the profession of dentistry emerged, rather than a specialty of medicine.
Our ancient literature (Table 1.1) lays lot of stress on freshening of mouth, which implies the wide spread prevalence of pyorrhea alveolaris. Foul breath itself has been mentioned as a separate disease entity in the books. Datun from Babool or Neem trees receives special mention for cleaning of teeth and maintaining oral health.
Table 1.1   Important milestones in the history of dentistry
3000-2151 BC
Hesi-Re is earliest dentist known by name.
900-300 BC
Teeth receive attention for religious reasons or self-adornment.
460-322 BC
Hippocrates and Aristotle write about tooth decay.
166-201 AD
Restore decayed teeth with gold crowns.
Use Siwak as a primitive toothbrush.
Ambroise Pare
Writes extensively about dentistry, including extractions.
Pierre Fauchard
Becomes “Father of Modern Dentistry”.
John Hunter
Performs first scientific study of teeth.
Horace Wells
Uses nitrous oxide for relief of dental pain.
American Dental Association is founded.
C Edmund Kells
Employs first dental assistant.
GV Black
Becomes “Grand Old Man of Dentistry” and perfects amalgam.
WC Roentgen
Discovers X-rays.
Frederick McKay
Discovers that fluoride is connected with prevention of dental caries.
Alfred C Fones
Establishes first dental hygiene school Bridgeport, Conn.
The purpose of the dental health care team is to provide quality oral care for the patients in the practice. Each member of the team plays a very important role, but always remembers that the most important person in the dental office is the patient. The roles and responsibilities of each team member are listed in Table 1.2. The dental health care team consists of the following:
  • Dentist (general dentist or specialist)
  • Dental Assistant (clinical, expanded functions, business)
  • Dental Hygienist
  • Dental Laboratory Technician
The Dentist
The dentist is the individual who is legally and ultimately responsible for the care of the patients and the supervision of all other members of the team. The dentist is often referred to as the leader of the team. The dentist trained in India must graduate from a dental college approved by the Dental Council of India and Ministry of Health and Family Welfare Government of India. Dental education programs usually last 5 academic years. When dentists graduate from a dental college, they are awarded either the Bachelor of Dental Surgery (BDS). Before going into practice, all dentists must register with Dental Council of India, state branch, the state in which they choose to practice. Dentists have a variety of practice options available to them. Some will choose to practice alone, some may choose to have a practice partner, and others may enter a large group practice. Other options for dentists include the military, public health, community clinics, research, teaching, or returning to school for specialty training.3
Table 1.2   Roles and responsibilities of dental health care team members
Dentist or dental specialist
Registered dental hygienist
Is legally responsible for the care of the patient.
Assesses the patient's oral health needs as related to physical and emotional well-being.
Uses up-to-date diagnostic skills.
Uses current techniques and skills in all aspects of patient care.
Provides legally required supervision for dental auxiliaries.
Assesses the periodontal status of patients, including measurement of the depth of periodontal pockets and conditions of the oral tissues.
Performs dental prophylaxis (e.g. removal of plaque from crowns and root surfaces).
Performs scaling and root-planning procedures.
Exposes, processes, and evaluates the quality of radiographs. Performs additional procedures, such as administration of local anesthetic and administration of nitrous oxide if allowed by the state.
Clinical dental assistant (chair side assistant, circulating assistant)
Business assistant (administrative assistant, secretarial assistant, receptionist)
Seats and prepares patients.
Maintains and prepares treatment rooms and instruments.
Assists dentist at chairside during patient treatment.
Prepares and delivers dental materials.
Provides postoperative patient instructions.
Oversees infection control program.
Performs radiographic procedures.
Performs basic laboratory procedures. (e.g. pouring impressions to create diagnostic casts)
Provides assurance and support for the patient.
Greets patient and answers the phone.
Makes and confirms appointments.
Manage patient records, payroll, insurance billing and financial arrangements.
Ensure that patient privacy measures are in place and followed.
Oversees patient relations.
Expanded-functions dental assistant (EFDA)
Dental laboratory technician
Performs only those intraoral (inside mouth) procedures that are legal in the state in which the EFDA practices. Check with your state board of dentistry for a current listing of dental assistant duties.
Performs laboratory work only under licensed dentist's prescription.
Constructs and repairs prosthetic devices (e.g. full and partial dentures).
Constructs restorations (e.g. Crowns, bridges, inlays, and veneers)
Although a general dentist is trained and legally permitted to perform all dental procedures, many dentists prefer to refer more difficult cases to specialists who have advanced training in certain areas. Most dentists are members of their professional organization, the Indian Dental Association (IDA)
Dental Specialist
The DCI recognizes nine dental specialties. To become a specialist one has to go through 3 years postgraduate course (MDS) offered by one of the DCI recognized colleges. Most dentists who are specialists will also belong to a professional organization for their specialty in addition to membership in the IDA. The nine dental specialties recognized by the Indian Dental Association are listed as under.4
Dental Specialties Recognized by the Dental Council of India
  1. Public Health Dentistry involves developing policies at country, state, and national levels for programs to control and prevent disease. Examples include dental public helath professionals involved with fluoridation issues, community oral health education, and head start programs. Dental public health also includes dental screenings within a community to assess the needs of the community. In dental public health, the community is the patient rather than an individual.
  2. Conservative and Endodontics involve the cause, diagnosis, prevention, and treatment of diseases and injuries of the pulp and associated structures. The common term for much of the treatment is root canal. The specialist is an endodontist.
  3. Oral Medicine and Radiology. The dental radiologist uses new and oral medicine aspect not mentioned sophisticated imaging techniques to locate tumors and infectious diseases of the jaws, head and neck and assists in the diagnosis of patients with trauma and temporomandibular disorders.
  4. Oral and Maxillofacial Surgery involve the diagnosis and surgical treatment of diseases, injuries and defects of the oral and maxillofacial regions. It involves much more than tooth extractions. The specialist is an oral and maxillofacial surgeon.
  5. Oral Pathology, Microbiology and Forensic Odontology involve the nature of diseases affecting the oral cavity and adjacent structures. A major function is to perform biopsies and work closely with oral surgeons to provide a diagnosis. The specialist is an oral pathologist.
  6. Orthodontics and Dentofacial Orthopedics involve the diagnosis, treatment, and prevention of malocclusions of the teeth and associated structures. This specialty entails much more than fitting of braces. The specialist is an orthodontist.
  7. Pediatric and Preventive Dentistry involve the oral health care of children from birth to adolescence. The pediatric dentist often treats children with emotional and behavioral problems.
  8. Periodontology involves the diagnosis and treatment of diseases of the oral tissues supporting and surrounding the teeth. The specialist is a periodontist.
  9. Prosthodontics and Crown and Bridge involve the restoration and replacement of natural teeth with artificial constructs, such as crowns, bridges, and dentures. The specialist is a prosthodontist.
Dental Assistant
As an educationally qualified dental assistant, you will be able to assume many activities that do not require the professional skill and judgment of the dentist.
Although not all states require formal education for dental assistants, minimal standards for schools accredited by the Commission on Dental Accreditation require a program of approximately 1 academic year in length, conducted in a post-high 5school educational institution. The curriculum must include didactic, laboratory and clinical content. Dental assistants may also receive training at vocational schools or proprietary schools accredited through the state's board of denistry.
As modern dentistry changes and procedures and techniques become more complex the role of the dental assistant will continue to evolve. Many important and varied roles are available within dentistry for dental assistants. Each dental practice is unique and has specific needs, and the educationally qualified dental assistant is quick to adapt to new situations as the need arises (Figure 1.1).
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Figure 1.1: Chairside and circulating dental assistants
Clinical Dental Assistant
The clinical dental assistant is directly involved in patient care. The role of the clinical dental assistant is usually defined as chairside or circulating assistant (Figure 1.2).
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Figure 1.2: Clinical dental assistant
Circulating Assistant
The circulating assistant serves as an extra pair of hands where needed throughout the clinical areas of the practice. This is referred to as six-handed dentistry (Figure 1.1). In many practices, the circulating assistant is responsible for seating and dismissing patients, and preparing and caring for instruments and treatment rooms.
Sterilization Assistant
In many offices, the responsibility for sterilization procedures is delegated to a specific individual.
In other offices, all dental assistants share this important responsibility. The sterilization assistant efficiently and safely processes all instruments and manages biohazardous waste.
Other responsibilities include weekly monitoring of sterilizers and maintenance of sterilization monitoring reports (Figure 1.3). The sterilization assistant is also responsible for the selection of infection control products and performing quality assurance procedures.
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Figure 1.3: Sterilization assistant
Business Assistant
Business assistants, also known as administrative assistants, or secretarial assistants, or receptionists, are primarily responsible for the smooth and efficient operation of the business office (Figure 1.4). Two or more assistants may work in the business area of a dental office. The duties of a business assistant include controlling appointments, communicating on the phone, coordinating financial arrangements with patients, and handling dental insurance claims.7
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Figure 1.4: Business assistant
It is not uncommon for a chairside dental assistant to move into a business office position. It is very helpful when the individual at the desk has an excellent understanding of how the clinical practice functions.
Dental Laboratory Technician (Figures 1.5A and B)
The dental laboratory technician usually does not work in the dental office with the other team members, although some dental offices have “in-house” laboratories. Many dental technicians choose to be employed in private laboratories, and others choose to own and operate their own laboratory. In either case, the dental laboratory technician may legally perform only those tasks specified by the written prescription of the dentist. Dental technicians make crowns, bridges, and dentures from impressions taken by the dentist and sent to the dental laboratory. The dental assistant often communicates with the dental laboratory technician regarding the length of time needed to return a case, or to relay special instructions from the dentist about a case. It is important to have a good working relationship with the dental laboratory.
Dental laboratory technicians can receive their training through apprenticeship, commercial schools, or ADA-accredited programs. Many have received their training in ADA-accredited programs that are 2 years in length. Dental laboratory technicians have extensive knowledge of dental anatomy and materials and also excellent manual dexterity.
To become a Certified Dental Technician (CDT), the dental laboratory technician must pass a written examination. Dental technicians may be members of their professional organization.8
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Figures 1.5A and B: Dental technicians
The types and sizes of dental offices vary greatly, and the interior design and décor usually reflect the dentist's personal style. However, certain areas are found in every dental office, these include the reception area, business office, nonclinical areas, and instrument processing area, dental laboratory, and treatment rooms.
Reception Area
The reception area is where patients are received, greeted pleasantly, and made to feel welcome. This should not be a “waiting room”, with proper scheduling; patients can be seen on time for their appointments.
Patients often judge the quality of their care by the appearance of the office, so all the areas of dental office must be kept neat and clean at all times.
Business or Administrative Office (Figure 1.6)
This area is the hub for the management of business aspect of the dental practice, and it includes a scheduling area where patients can make future appointments, an area where patients can make financial arrangements, and an area for a record storage where patient records can be safeguarded and privacy maintained. It is not unknown for a dental office to have two or more staff members working in this important area.
Nonclinical Areas
The dentist will usually have a private office for his/her personal use. Other staff members should respect the privacy of this area. The consultation room is where a dentist discusses the proposed treatment plans with the patient. When there is no consultation area, the dentist's private office is used for this purpose.9
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Figure 1.6: Patients waiting area
The staff lounge is an area where the staff may rest, eat, and hold meetings. Contaminated clothing or items must not be brought into this area. Staff members are responsible for keeping this clean and neat at all time.
Instrument Processing Area
The instrument processing area is where contaminated instruments are cleaned, packaged, sterilized, and stored for reuse.
Dental Laboratory (Figure 1.7)
The dental laboratory within the dental office is used by the staff to pour impressions, prepare study models, and polish removable items, such as denture or space maintainers. It is important to wear safety goggles whenever you are using laboratory equipment. In addition, the entire lab must be kept neat and clean at all times. There should never be food or drink in the laboratory area because this is considered an area of potential contamination. Major equipment in the dental laboratory usually includes a laboratory hand pieces for tasks such as trimming custom trays or temporary restorations. Laboratory work pans for storing together all the parts of individual cases. A model trimmer is used for trimming diagnostic casts and study models. A vacuum former used to create custom trays, bleaching trays, mouth guards, etc.
A dental lathe is to grind metals, polish dentures and precious metal crowns.
Treatment Rooms (Figure 1.8)
Dental treatment rooms, also known as operatories, are the heart of the clinical area of the dental practice. These are the rooms where the patients receive treatment.10
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Figure 1.7: Pouring of impression
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Figure 1.8: Treatment rooms
Most practices have several treatment rooms. There is usually at least one treatment room for the dental hygienist. In some practices, separate treatment rooms serve as an extra room for emergencies or short procedures, such as a check-up following surgery.
Dental assisting is a wonderful career. It offers you a wide range of professional opportunities. You have the opportunity to pursue a career in general dentistry. Specialty practices, public health clinics, or dental schools. Some day, you may even choose to become a dental assisting educator. Always remember to maintain an attitude of professionalism and cooperative teamwork with other staff members, and never forget that the most important person in the office is the patient.