Delivering Dental Care
Chapter 33
Copyright © 2005 by Elsevier Inc. All rights reserved.
Introduction
The clinical assistant assumes the
important responsibility of preparing
the treatment areas, assisting the dentist
in procedures, and completing
expanded functions.
Copyright © 2005 by Elsevier Inc. All rights reserved.
Preparing for Your Patient
• Review Patient Record
– Administrative Staff
• Review any changes in personal information.
– Clinical Staff
• Review for any health problems that may alter dental
treatment.
• Medical Alerts.
• Review progress notes planned for treatment of the day.
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Preparing the Treatment Area
• Treatment room clean, disinfected, and ready
for the next patient.
• Patient records, radiographs, and laboratory
results in place.
• Sterile preset tray and other supplies in place.
• Dental chair positioned to seat the patient.
• Equipment moved out of the way for the patient
and dental team.
Copyright © 2005 by Elsevier Inc. All rights reserved.
Admitting the Patient
• Pleasantly greet patient in the reception
area by name.
• Escort patient to the treatment area.
• Place the patient’s personal items in a
safe place out of the way of the procedure.
• Initiate conversation with the patient.
• Ask if there are any questions that you
can answer about treatment for the day.
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Seating the Patient
• Seat patient from side of the dental chair.
• Lower or slide the chair arm into position.
• Place patient napkin.
• Inform the patient before adjusting the chair.
• Position operating light.
• Complete treatment room preparations.
• Wash hands and place on personal
protective equipment.
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Team Dentistry
• Goals of Work Simplification
– Decrease number of instruments.
– Sequence instruments on a tray by their use.
– Follow correct positioning of the patient, dentist,
and assistant.
– Use appropriate moisture control techniques.
– Transfer instruments and dental materials as
necessary.
– Use the least amount of motion.
– Allow assistant to perform expanded functions.
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Fig. 33-1 Concept of 4-handed dentistry
(Courtesy A-dec.)
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Principles of Team Positioning
Positioning the Patient
• Criteria
– Patient is lowered to supine position.
– Patient slides up in chair so head is even
with top of headrest.
– Final adjustments made by the operator.
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Principles of Team Positioning-cont’d
Positioning the Operator
• Criteria
– Seated as far back as possible.
– Thighs parallel to the floor, or knees slightly
lower than the hips.
– Feet kept flat on the floor.
– Backrest of the chair positioned to support
the lower portion or small of the back.
– Operator’s forearms bent at the elbow and
parallel to the floor.
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Fig. 33-3 Position of the operator
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Principles of Team Positioning-cont’d
Positioning the Dental Assistant
• Criteria
– Seated back on the stool.
– Feet on the base or foot ring of the stool.
– Positioned as close as possible to the
dental chair.
– Legs parallel to the patient’s chair.
– Eye level 4 to 6 inches above the eye
level of the operator.
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Fig. 33-4 Position of the Dental Assistant
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Operating Zones
Basic concept required for
practicing efficient and comfortable
team dentistry
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Fig. 33-5 Operating zones for a right-handed operator
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Fig. 33-6 Operating zones for a left-handed operator
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Four-Handed Dentistry
An ergonomically sound way to
practice dentistry using the skills of
the dental assistant, while including
work simplification techniques.
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Instrument Transfer and Exchange
• Benefits
– Standardized operating sequence
– Reduces the amount of time in the
dental chair for the patient
– Increases productivity
– Less fatigue and stress
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Operator’s Grasp
• Three Basic Grasps
– Pen Grasp: The instrument is held in the same
manner as a pen.
– Palm Grasp: The instrument is held securely in the
palm of the hand.
– Palm-thumb Grasp: The instrument is held in the
palm of the hand, and the thumb is used to
stabilize and guide the instrument.
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Fig. 33-7 Basic Instrument Grasps
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Principles of Instrument Transfer
• Understand the sequence of procedure and anticipate
when an instrument transfer is required.
• Transfer dental instruments and dental materials with
left hand.
• Transfer of instruments should be accomplished with
a minimum of motion involving only the fingers, wrist,
and elbow.
• Instruments transferred in position of use.
• Instrument is transferred so dentist can grasp the
instrument for its appropriate use.
• Instrument being transferred must be positioned in
the dentist's hand firmly.
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Instrument Transfer and Exchange-cont’d
• Variations in Instrument Transfer
– Mirror and explorer
– Cotton pliers
– Handpiece
– Instruments with hinges
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The Expanded-Function Dental Assistant
• Expanded Function refers to specific intraoral
procedures or part of a procedure by the clinical dental
assistant that have been delegated by the dentist.
• Advantages
– Increases productivity
– Lessens stress on dentist
– More patients are seen
– Increases job satisfaction
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Working as the Operator
• Understand dental anatomy
• Follow guidelines for operator positioning
• Develop intraoral mirror skills
• Use an intraoral fulcrum
• Understand cavity preparations
• Adapt instrumentation
• Application of dental materials
• Evaluation of the expanded function
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