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Dental Operating Room Assistant
PN Awasthi
CHAPTER 1:
Orientation to Dental Profession
THE HISTORY OF DENTISTRY
MEMBERS OF THE DENTAL HEALTH CARE TEAM
The Dentist
Dental Specialist
Dental Specialties Recognized by the Dental Council of India
Dental Assistant
Clinical Dental Assistant
Circulating Assistant
Sterilization Assistant
Business Assistant
Dental Laboratory Technician (Figures 1.5A and B)
OVERVIEW OF THE DENTAL OFFICE
Reception Area
Business or Administrative Office (Figure 1.6)
Nonclinical Areas
Instrument Processing Area
Dental Laboratory (Figure 1.7)
Treatment Rooms (Figure 1.8)
ETHICAL IMPLICATIONS
CHAPTER 2:
Directive Principles of Dental Assistant
ETHICS IN DENTAL ASSISTANCE, ROLE AND RESPONSIBILITY OF DENTAL ASSISTANT
DENTAL ASSISTANT AND SOCIETY
DENTAL ASSISTANT AND CO-WORKERS
DENTAL ASSISTANT AND THE PROFESSION
THE NIGHTINGALE PLEDGE
“THE NIGHTINGALE PLEDGE”
“THE REVISED NIGHTINGALE PLEDGE”
CHAPTER 3:
Duties of the Dental Assistant
OBJECTIVES
STERILIZATION AND INFECTION CONTROL
Operatory Infection Control Barriers
Tray Setup
Personal Protection
Gowns
Eyewear
Masks
Gloves
Postprocedure Sterilization
Surfaces
Instruments
Broken Instruments
Handpieces
Sterilization Equipment
End-of-Day Procedures
Seating, Releasing, and Discussing the Procedure with the Patient
Greeting the Patient
Preprocedure Conversation
Postprocedure Conversation
Dismissal of the Patient
Radiographic Techniques
Preparation of Equipment
Paralleling Technique
Taking Alginate Impressions
Choosing Impression Tray
Preparing the Alginate
Mixing the Alginate
Mandibular Impressions
Maxillary Impressions
Setting Time of the Impression
Boxing, Pouring and Trimming Study Casts
Preparation of the Completed Impression
Boxing the Impression
Pouring the Impression
Separation, Clean-up and Trimming of the Models
Coronal Polish and Oral Hygiene Instruction
Oral Hygiene Instruction
The Coronal Polish
Topical Fluoride Administration
Pit and Fissure Sealant Application
Sealant Procedure
Placement of Topical Anesthetic
Maxillary Placement
Mandibular Placement
Placement of the Dental Dam
Dental Dam Materials
Selection of the Operating Field and Clamp
Placement of the Dental Dam
Removal of the Dental Dam
Evacuation Technique: High-Volume Evacuator and Saliva Ejector
Polishing Amalgam
Instruments
Burs
CHAPTER 4:
Basic Sciences
ANATOMY AND PHYSIOLOGY
Directions in the Body
Planes of the Body
Organizational Levels of the Body
Organs
Body Systems
Systems of the Body
The Digestive System
The Nervous System
The Cardiovascular System
The Endocrine System
The Respiratory System
The Lymphatic System
The Muscular System
Types of Muscle
The Skeletal System
The Urinary System
Integumentary or Skin System
Reproductive System
Types of Bone
Structure of the Head and Neck
OSTEOLOGY OF THE SKULL
1. Brain Case (Calvarium)—8 bones (Figure 4.2)
2. Facial Skeleton—14 bones (Figure 4.3)
Particular Features of Cranial and Facial Bones
Maxilla
Palatine Bones (Figures 4.5 and 4.6)
Zygomatic Bone (Zygoma, Malar Bone) (Figure 4.7)
The Mandible
AGE CHANGES IN MANDIBLE
Paranasal Sinuses
Temporomandibular Joint
Capsular Ligament
Articular Space
Movements of the Temporomandibular Joint
MAJOR MUSCLES OF MASTICATION AND FACIAL EXPRESSION
BLOOD SUPPLY TO THE FACE AND MOUTH
LYMPH NODES
The Muscles of Mastication and Facial Expression
Major Arteries to the Face and Mouth
NERVES SUPPLY TO THE MOUTH
Maxillary Innervations
Mandibular Innervations
STRUCTURE OF THE FACE AND ORAL CAVITY
Landmarks of the Face
Regions of the Face
Features of the Face
The Oral Cavity
The Tongue
The Frenum
The Salivary Glands
The Hard and Soft Palate
The Gingivae
The Teeth
DENTAL (TOOTH) ANATOMY
Terminology
Groups of Teeth
Maxillary or Mandibular
Right or Left
Anteriors or Posteriors (Figure 4.10)
Names of the Teeth (Figure 4.11)
Anteriors
Posteriors
Number Substitutes for Names of Teeth (Figure 4.12)
STRUCTURE OF THE TEETH AND SUPPORTING TISSUES (Figure 4.13)
Teeth
Supporting Structures of the Teeth
Crown Morphology (Contours)
Tooth Surfaces (Figure 4.14)
Anterior Tooth Point Angles
Posterior Tooth Point Angles
Distinctive Crown Convexities and Concavities
Convexities
Crown Concavities
Proximal Surface Contact Characteristics
Contact Points or Areas (Figure 4.40)
Embrasure (Figure 4.41)
Occlusal Surface Outlines of Posterior Teeth (Figure 4.42)
Circular Rounded in Outline
Rectangular
Trapezoid
Rhomboidal
Descriptions of Individual Teeth
Overview
Maxillary Central Incisor
Maxillary Lateral Incisor
Maxillary Cuspid
Maxillary First Bicuspid
Maxillary Second Bicuspid
Maxillary First Molar
Mandibular First Bicuspid
Mandibular Second Bicuspid
Mandibular First Molar
BASIC MICROBIOLOGY
Bacteria
Fungi
Viruses
MICROBES IN THE MOUTH
TRANSMISSION ROUTES FOR INFECTIONS
DEFENSE MECHANISMS OF THE BODY
TYPES OF DISEASE TRANSMITTED
CHAPTER 5:
Pharmacology
ANTIMICROBIAL
ANTIBIOTICS
ANTIVIRALS
ANTIFUNGALS
ANTIPARASITICS
NONPHARMACEUTICAL ANTIMICROBIALS
Essential Oils
Cations and Elements
Microorganisms that Produce Antibiotics
Characteristics of Antibiotics
Classification of Antibiotics
According to Chemical Structure
According to Mechanism of Action
According to Spectrum of Activity
According to Mode of Action
According to Source
Age of the Patient
Renal Function
Hepatic Function
Local Factors
Drug Allergy
Impaired Host Defence
Pregnancy
Genetic Factors
Indications for Antibiotic Prophylaxis
If Allergic
If Nil Orally
Kinds of Antimicrobial Agents and their Primary Modes of Action
Some Classes of Antibiotics and their Properties
Adult Dosage of Commonly Used Antibiotics in Dental Office
ANALGESICS
Classification of Analgesics
Mild Analgesics
Moderate Analgesia
Others
Uses
Side Effects
Relatively Recent Additions
Strong Analgesics
Morphine Sulfate
Other Strong Analgesics
Commonly Used Non-narcotic Analgesics and Antipyretic Dosage
Acetaminophen (Tylenol)
Ibuprofen (Brufen)
Naproxen Sodium (Anaprox)
Indomethacin (Indocin)
Tolmetin Sodium (Tolectin)
Sulindac (Clinoril)
Diclofenac Sodium (Voveran)
Phenylbutazone (Butazolidine)
Natural Products
Oil of Evening Primrose (Primula officinalis)
COX-2 Inhibitors
Narcotic Antagonists
Naloxone (Narcan)
B. Naltrexone (ReVia)
Adding to Analgesia
ANTISEPTICS AND DISINFECTANTS
Desirable Properties
Alcohols
Aldehydes
Biguanides
Halogen-Releasing Agents
Chlorine-Releasing Agents
Iodine and Iodophors
Silver Compounds
Peroxygens
Hydrogen Peroxide
Peracetic Acid
Phenols
Bis-Phenols
Triclosan
Hexachlorophene
Halophenols
Quaternary Ammonium Compounds
Vapor-Phase Sterilants
ASTRINGENTS
Definition
Metallic Astringents
Zinc Chloride and Zinc Sulphate
Alum
Copper Sulphate
Ferric Chloride
Lead Acetate
Silver Nitrate
Vegetable Astringents
OBTUNDANTS
MOUTHWASHES
Mode of Action
PREPARATION OF SOLUTIONS IN DIFFERENT PERCENTAGES USED IN DENTAL PRACTICE
CHAPTER 6:
Infection Control and Management of Biomedical Waste
CHAPTER 7:
Diagnostic Aids
INTRODUCTION
Visual and Tactile Inspection
Radiography
Electric Pulp Testing
Thermal Testing
Anesthetic Testing
Test Cavity
CHAPTER 8:
Radiology
PHYSICS OF RADIATION
Radiology
Roentgenology
TYPES OF RADIATION
Corpuscular Radiation
Electromagnetic Radiations
PROPERTIES OF X-RAYS
BIOLOGICAL EFFECTS OF RADIATION
PROTECTION OF THE PATIENT AND THE OPERATOR
RADIATION DETECTION AND MEASUREMENT
Personal Monitoring
Advantages
Disadvantages
Radiation Protection
Shielding
Distance
Time
X-Ray Films
Base
Emulsion
Intraoral Films
Extraoral Films
Screened
Nonscreened
DENTAL RADIOLOGY
INTRAORAL RADIOGRAPHY
TYPES OF INTRAORAL RADIOGRAPHIC FILM AND THEIR PURPOSES
PLACEMENT OF FILM PACKETS
PERIAPICAL RADIOGRAPHIC TECHNIQUES
Intraoral Parallel Technique
Principle
Comments
Introduction
Principle
BITE-WING (INTERPROXIMAL) EXPOSURE TECHNIQUES
General
OCCLUSAL EXPOSURE TECHNIQUES
General
EXTRAORAL RADIOGRAPHS
Extraoral Supplemental Views
THE PANORAMIC RADIOGRAPH
General
Advantages of the Panoramic Radiograph
Disadvantages of the Panoramic Radiograph
Uses of the Panoramic Radiograph
FULL MOUTH RADIOGRAPHS
DIGITAL RADIOGRAPHY
Introduction
Phosphorus Sensor
CCD/CMOS Sensor
MANUAL PROCESSING
AUTOMATIC PROCESSOR
FAULTY RADIOGRAPHS
General
UNDEREXPOSED IMAGE
OVEREXPOSED IMAGE
BLURRED IMAGE
PARTIAL IMAGE
DISTORTED IMAGE
FOGGED FILM
STAINED OR STREAKED FILM
BLEACHED IMAGE
LEAD-FOIL IMAGE
NO IMAGE
RETICULATION
CHAPTER 9:
Dental Assistance in Specialty Practice
MAXILLOFACIAL SURGERY
Informed Consent
Patient Record Keeping
Detailed Medical History
Recording of Vital Signs
PREPARATION OF PATIENT FOR LOCAL AND GENERAL ANESTHESIA
Patient Counseling/Psychological Preparation
PREMEDICATION
General Preoperative Preparation
Routine Orders
Diagnosis
Diet
Activity
Vital Signs
Sedation
Specific Orders
Anesthetic Premedication
Blood and Blood Products
Preparation of the Field
CARDIOPULMONARY RESUSCITATION (CPR)
Single Rescue for Adults
Recognization of Unconsciousness
CPR Performed by 2 Rescuers
Brushing Technique
The Bass Method
Modified Stillman's Method
Charters' Method
LIST OF OPERATIVE INSTRUCTIONS
NUTRITION AND FEEDING OF MAXILLOFACIAL TRAUMA CASES
DENTAL EMERGENCIES AND THEIR MANAGEMENT
Occasional Toothache
Acute Pulpitis
Periapical Abscesses
Periodontal Abscess
Pericoronitis
Postoperative Hemorrhage
Dry Socket
Assistance in Management of Trauma Patient
Control of Bleeding
Control of Pain
DRUGS FOR EMERGENCY KITS
Preparation of Drugs for Parenteral Administration
Intramuscular Administration
Intravenous Administration
Aromatic Ammonia
PAIN AND ANXIETY CONTROL
Management of Pain
NSAIDs RECOMMENDED FOR POSTOPERATIVE PAIN
ADMISSION PROCEDURE
History
Examination
CREATE THE ENVIRONMENT FOR THE SURGERY
Responsibilities of Dental Operating Room Assistant
INSTRUMENTS USED IN SURGERY
Operating Theater Techniques and Present Concepts in Assistance
Definition
Purpose
Description or Environment
Operating Room Equipment
Life Support and Emergency Resuscitative Equipment
Patient Monitoring Equipment
Diagnostic Equipment
Other Operating Room Equipment
New Surgical Techniques
CREATING ENVIRONMENT FOR SURGERY
SCRUBBING UP
GOWNING
GLOVING
THE OPERATION SITE SHAVING
DRAPING
SWABS AND PACKS
CLEANING THE THEATER
CLEANING INSTRUMENTS
FORCEPS EXTRACTION
Indications
Contraindications
Systemic Contraindications
Forceps Extraction
Anesthesia
Position of the Patient
Preparation and Draping
Position of the Left Hand
Forceps Extraction
Postextraction Procedure
Multiple Extractions
Order of Extraction
SURGICAL EXODONTIA
Raising a Flap
Bone Removal
Sectioning Teeth
Removal of Tooth/Fragments
Wound Toilet
Primary Closure
Preprosthetic Surgery
Extraction of Remaining Teeth
Retained Roots and Bone Sequestrae
Small Bony Irregularities
Fibrous (Flabby) Ridges
Fibrous Bands and Irritation Hyperplasia
Tori
Muscle Attachments
Ridge Augmentation
Sulcus Deepening
Suture Placement
Closure of Skin Lacerations
Types of Suture
Types of Stitch
Simple Interrupted Suture
Horizontal Mattress Suture
Vertical Mattress Suture
Continuous Suture
IMMEDIATE POSTOPerative CARE
Importance of Postoperative Anesthetic Care
Preparation of Splint
Acrylic Splint
Cast Cap Silver Splint
MINOR ORAL SURGERY
Apicectomies
Indications
Assessment
Access and Flap Design
Root Apex Resection
The Retrograde Root Filling
Flap Closure
Biopsy
Types of Biopsy
What Should be Biopsied?
Special Considerations
Technique
Biopsy and Oral Cancer
Samples
FIRST AID
1. Dressing the Wound (Figure 9.1)
2. Covering the Bandage (Figure 9.2)
3. Securing the Bandage (Figure 9.3)
4. Checking the Circulation (Figure 9.4)
FRACTURES OF THE MANDIBLE AND MAXILLA CHARACTERISTICS
FRACTURE MANDIBLE
Pathophysiology
Classification of Mandibular Fractures
Classification by Anatomic Region
Clinical History
Clinical Examination
Indications
Indications for Closed Reduction
Indications for Open Reduction
Absolute Indications
Relative Indications
Fracture Middle Third of Face
Etiology
Pathophysiology
Clinical History
Physical Examination
Le Fort I Fractures (Figure 9.6)
Le Fort II Fractures (Figure 9.6)
Le Fort III Fractures (Figure 9.6)
Postoperative Details
History of the Procedure
Pathophysiology
Classification of Mandibular Fractures
Classification by Anatomic Region
Clinical History
Clinical Examination
Indications
Indications for Closed Reduction
Indications for Open ReductioN
Absolute Indications
Relative Indications
PREPARATION OF ARCH BAR AND WIRING (see Figures 9.7A to E)
FRACTURES WITH DISPLACEMENT BUT NO TISSUE LOSS
FRACTURES WITH SEVERE TISSUE LOSS
INTERDENTAL EYELET WIRING FOR MANDIBULAR FRACTURES
ALTERNATIVE METHOD OF EYELET WIRING USING HOOKS AND RUBBER BANDS
RISDON WIRING FOR A FRACTURED MANDIBLE
FITTING ARCH BARS FOR MANDIBULAR FRACTURES
Nutrition, Feeding and Transportation of Trauma Patients
Energy Requirements
Vitamin Requirements
Nutritional Assessment
Postoperative Recommendation for Specific Conditions
Tooth Extraction
Infection
Resection of Cyst/Benign Tumor
Resection of Malignant Lesion
Bone Grafting
Jaw Immobilization
Feeding
Oral Feeding
Nasogastric Feeding
Parenteral Nutrition
Transportation
Preparation of Trolley for Different Surgical Procedure
Preparation of Trolley for Difficult Surgical Procedure
ENDODONTICs
Endodontic Instruments and Equipment
INSTRUMENT TROLLY FOR ENDODONTIC TREATMENT (Figures 9.21A and B)
Basic Set-up
Endodontic Filling—Tray Set-up
DENTAL MEDICAMENTS IN ENDODONTICS
Essential Oils
1. Eugenol
2. Phenolic Compounds
3. Halogens
4. Quaternary Ammonium Compounds
Radiographs in Endodontics
Radiographic Technical Requirements
ROOT CANAL TREATMENT
APICECTOMY
Complications
SURGICAL PACK (Figure 9.32)
Advantages
Care Following Endodontic Surgery
Diet
Be Gentle
Sutures
INFECTION CONTROL IN PROSTHODONTIC LABORATORY
Disinfection
Sterilization
Classification of Sterilization Agents
Exposure
Goals/Actions
Preventing Cross-Contamination
Mask/Protective Eyewear/Clothing (Figure 9.34)
Chemical Disinfectants
Disinfecting Impressions (Figures 9.35A and B)
PROSTHODONTICS
Impression Materials
Ideal Properties of an Impression Material
Classification of Various Impression Materials
RIGID IMPRESSION MATERIALS
Impression Plaster (Figure 9.36)
Limitations
Impression Compound (Figure 9.37)
Composition
Flow
Softening Impression Compound
Uses
Advantages
Disadvantages
Zinc Oxide Eugenol Paste (Figure 9.38)
Composition
Tube 1 (Base Materials)
Tube 2
Manipulation (Figures 9.39A and B)
Uses
Advantages
Disadvantages
ELASTIC IMPRESSION MATERIALS
Irreversible Hydrocolloid Impression Materials (Figure 9.40)
Composition
Manipulation and Properties
Control of Setting Time Alginate (Figure 9.41)
Uses
Advantages
Disadvantages
Reversible Hydrocolloid Impression Materials (Figure 9.42)
Agar Hydrocolloid
Composition
Manipulation
CONDITIONER UNIT CONSISTS OF
WATER COOLED RIM LOCK TRAYS (Figure 9.43)
Uses
Advantages
Disadvantages
ELASTOMERS
Polysulfide Impression Materials (Figure 9.44)
Manipulation
Uses
Advantages
Disadvantages
Condensation Silicones (Figure 9.45)
Base Paste
Catalyst Paste
Manipulation
Uses
Advantages
Disadvantages
Addition Silicon Impression Materials (Figure 9.46)
Base Paste
Catalyst Paste
Uses
Advantages
Disadvantages
Polyether Impression Materials (Figure 9.47)
Base Paste
Catalyst Paste
Uses
Advantages
Different Methods of Making Impressions with Elastomers
1. Single Mix or Mono-phase Technique
2. Multiple Mix Technique
3. Reline Technique (Two-Stage Putty-Wash Technique) (Figure 9.48)
Advantages
FINAL IMPRESSION MATERIALS
Plaster of Paris (Figure 9.50)
Advantages
Disadvantages
Zinc Oxide Eugenol (Figure 9.51)
Advantages
Disadvantages
Irreversible Hydrocolloid (Figure 9.52)
Advantages
Disadvantages
Tissue Conditioning Materials (Figure 9.53)
Elastomers (Figure 9.54)
IMPRESSION TRAYS
Definition
REQUIREMENTS FOR IMPRESSION TRAYS
IMPRESSION TRAY MATERIALS (Figures 9.55 and 9.56)
Modified Stock Tray (Individual Tray)
Robert R. Renner's Technique
Technique
Modification of the Tray to make it Adhesive
Advantages over Custom Tray
Advantages over Conventional Use of Stock Stray
Disadvantages of Stock Tray
Types of Special Custom Trays
Border Molded—Modeling Compound Special Trays
Method
Knife Trimming
Making Space in the Tray
Transparent Acrylic Trays
Autopolymerizing Resin Impression Trays
Sprinkle-on Method
Procedure
Finger Adapted Dough Method
Procedure
Vacuum-adapted Method
Procedure
Shellac Method
Procedure
SPECIAL TRAYS FOR IMPLANT PLACEMENT (Figure 9.57)
Advantages of the Implant Border-Lock Impression Tray
IMPRESSION TECHNIQUES (Figure 9.58)
Mucostatic Impression Technique
Advantages
Disadvantages
Mucocompressive Impression Technique
Advantages
Disadvantages
Selective Impression Technique
Advantages
Disadvantages
DIAGNOSTIC CAST
Definition
Requirements
Procedure for Pouring Alginate Preliminary Impressions
BEADING AND BOXING
PREPARATION OF DENTULOUS DIAGNOSTIC CASTS
BITE REGISTRATION
Introduction
Form of Occlusal RIM
Factors Controlling the Form of an Occlusion Rims
RELATIONSHIP OF THE NATURAL TEETH WITH THE ALVEOLAR BONE
RELATIONSHIP OF THE OCCLUSION RIM TO THE EDENTULOUS RIDGE
DIMENSION USED TO FABRICATE A STANDARD OCCLUSION RIM
Maxillary Occlusal Rim
ANDIBULAR OCCLUSAL RIM
CLINICAL GUIDELINES FOR DETER MINING THE SHAPE OF THE OCCLUSION RIM
MATERIALS USED TO FABRICATE OCCLUSAL RIMS
FABRICATION OF OCCLUSION RIMS
Maxillary Occlusion Rims (Figures 9.59A to C)
Mandibular Occlusion Rim (Figures 9.60A to C)
SHADE SELECTION IN CD, FPD, RPD
Natural Teeth
Aids for Selection of Shade
Skin Color
Age and Tooth Color
Dentogenic Concept
Requirements for Shade Selection
Color and Shade Selection for FPD and RPD
Hue
Value
Chroma
Shade Selection Guidelines
Shade Guides (Figures 9.61A to C)
INStRUMENT TROLLY FOR IMPLANTS (Figures 9.62A to E)
Basic Instruments
Add-on Components
IMMEDIATE DENTURE
Interim Immediate Denture
Convention Immediate Denture
Advantages
Disadvantages
Indications
Clinical Procedures
Preimpression Procedures
Clinical Technique
PostinsertioN Instructions
RELINING OF DENTURES
Introduction
Indications for Relining
Contraindications for Relining
Advantages
Disadvantages
Relining Procedures (Figure 9.63)
Clinical Procedures
Denture Preparation
PERIODONTAL DISEASES
Bone Loss associated with Periodontal Disease
INSTRUMENTATION FOR PERIODONTICS
Periodontal Probe
Explorers
Scalers
Curettes
Ultrasonic Scalers
PERIODONTAL SURGICAL INSTRUMENTS
Periodontal Knives
PERIODONTAL TREATMENT PROCEDURES
Oral Prophylaxis
Scaling
Root Planing
Gingival Curettage
Postoperative Instructions after Scaling and Curettage
MATERIALS USED IN PERIODONTICS
Sutures for Periodontal Flaps
Periodontal Surgical Dressings
PERIODONTAL SURGERY
Excisional Periodontal Surgery
Incisional Periodontal Surgery
Osteoplasty
Substractive Osseous Surgery
Additive Osseous Surgery
Periodontal Plastic Surgery
INSTRUCTIONS AFTER PERIODONTAL SURGERY
RECENT ADVANCES IN PERIODONTICS
Periodontal Microsurgery
Lasers in Periodontics
Implants and Periodontics
INDEX
TOC
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