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Modern Dental Assisting 11th Edition Bird Test Bank

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ISBN-10 ‏ : ‎ 1455774510
ISBN-13 ‏ : ‎ 978-1455774517
Author: Debbie S. Robinson

Prepare for a successful career as a dental assistant! Modern Dental Assisting is the leading text in dental assisting — the most trusted, the most comprehensive, and the most current. Using an easy-to-understand approach, this resource offers a complete foundation in the basic and advanced clinical skills you must master to achieve clinical competency. It describes dental assisting procedures with photographs and clear, step-by-step instructions. Along with the textbook, this complete learning package includes a companion Evolve website replete with learning exercises and games and video clips of dental assisting procedures plus animations and review questions. Written by Doni Bird and Debbie Robinson, two well-known and well-respected dental assisting educators, this edition is also available as a Pageburst e-book.

Table contents:

Who Will Benefit from This Book?
Organization
The Learning Package
The Student Package Includes:
The Faculty Package Includes All Student Resources, Plus:
New to This Edition
Textbook
Evolve Web Site
For Instructors
For Students
Student Workbook
Dental Assisting Online
Support
The Learning Package
Textbook
Evolve Web Site
Student Site
Plus The Interactive Dental Office Online!
Faculty Site
Plus TEACH Instructor Resources
Student Workbook
Dental Assisting Online for Modern Dental Assisting
How To Use Modern Dental Assisting
Icon Key
Dedication
Part One The Dental Assisting Profession
The Dental Assisting Profession
Interactive Review – Modern Dental Assisting
Interactive Review – Part 1
1 History of Dentistry
Electronic Resources
Learning Outcomes
Key Terms
Early Times
The Egyptians
The Greeks
FIGURE 1-1 Ancient Etruscan gold-banded bridge with built-in calf’s tooth.
TABLE 1-1 Highlights in the History of Dentistry
The Chinese
The Romans
The Renaissance
FIGURE 1-2 Pierre Fauchard, the “Father of Modern Dentistry.”
Early America
FIGURE 1-3 John Greenwood, dentist to George Washington, was the second son of Isaac Greenwood, who is regarded as the first native-born American dentist. John Greenwood served in the colonial army at age 14 during the Revolutionary War and later became a dentist.
Educational and Professional Development in the United States
FIGURE 1-4 G.V. Black, the “Grand Old Man of Dentistry.”
FIGURE 1-5 Black’s dental treatment room, as reconstructed in a Smithsonian exhibit.
FIGURE 1-6 W.C. Roentgen discovered the early potential of a radiograph beam in 1895.
FIGURE 1-7 Dental instrument kit belonging to Nellie E. Pooler Chapman. She practiced dentistry in Nevada City, California. She died in 1906.
Women in Dental History
FIGURE 1-8 Lucy B. Hobbs-Taylor, the first female graduate of dental school.
FIGURE 1-9 Dr. Faith Sai So Leong, The first female graduate at College of Physicians and Surgeons (now the University of Pacific Arthur A. Dugoni School of Dentistry).
TABLE 1-2 Highlights of Women in Dentistry
African Americans in Dental History
FIGURE 1-10 Robert Tanner Freeman, the first African American graduate of Harvard School of Dental Medicine.
History of Dental Assisting
FIGURE 1-11 C. Edmund Kells and his “working unit,” about 1900. Assistant on the left is keeping cold air on the cavity, while assistant on the right mixes materials, and “secretary” records details.
TABLE 1-3 Highlights of African Americans in Dentistry
FIGURE 1-12 Hazel O. Torres, CDA, RDAEF, MA, founding coauthor of the Modern Dental Assisting textbook, shown here with her husband, Carl.
History of Dental Hygiene
FIGURE 1-13 Ann Ehrlich, CDA, MA, founding coauthor of the Modern Dental Assisting textbook.
FIGURE 1-14 Dental hygienist during the 1960s working in a standing position.
Dental Accreditation
FIGURE 1-15 Dental students at University of California San Francisco, School of Dentistry, treat patients in the dental clinic in the early 1900s.
FIGURE 1-16 Modern dental-assisting students practicing chairside skills with their instructor in an accredited dental-assisting program.
National Museum of Dentistry
FIGURE 1-17 Dr. Samuel D. Harris National Museum of Dentistry.
▪ Legal and Ethical Implications
▪ Eye to the Future
▪ Critical Thinking
Pageburst Integrated Resources
2 The Professional Dental Assistant
Electronic Resources
Learning Outcomes
Key Terms
FIGURE 2-1 The dental assistant is an important member of the dental healthcare team.
Characteristics of a Professional Dental Assistant
Professional Appearance
FIGURE 2-2 The professional dental assistant’s attire may vary depending on the duties performed. Left, Scrubs are acceptable at times. Center, Full personal protective wear is indicated for chairside procedures. Right, Surgical gowns may be indicated for surgery or hospital dentistry.
Knowledge and Skills
Guidelines for a Professional Appearance
Teamwork
Attitude
Dedication
Responsibility and Initiative
Confidentiality
Personal Qualities
Educational Requirements
Types of Programs
Career Opportunities
Employment Settings
Other Career Opportunities
Salaries
Professional Organizations
American Dental Assistants Association
FIGURE 2-3 Juliette A. Southard, founder of the American Dental Assistants Association (ADAA).
FIGURE 2-4 The seal of the American Dental Assistants Association (ADAA).
Benefits of Membership
Many Roles of Dental Assistants
Chairside Dental Assistant
Expanded-Functions Dental Assistant
Administrative Assistant
Check Your Personal Qualities as a Dental Assistant
Mission Statement of the American Dental Assistants Association (ADAA)
Where to Obtain More Information: ADAA
Dental Assisting National Board
Certified Dental Assistant
FIGURE 2-5 Official logo of the Dental Assisting National Board (DANB).
FIGURE 2-6 Official certificate of the certified dental assistant (CDA).
Certified Dental Assistant (CDA) Examination.
Certified Orthodontic Assistant (COA) Examination.
Certified Preventive Functions Dental Assistant (CPFDA).
Where to Obtain More Information: DANB
Benefits of DANB Certification
▪ Eye to the Future
▪ Critical Thinking
Pageburst Integrated Resources
3 The Dental Healthcare Team
Electronic Resources
Learning Outcomes
Key Terms
Dentist
Roles and Responsibilities of Dental Healthcare Team Members
Dentist or Dental Specialist
Clinical Dental Assistant (Chairside Assistant, Circulating Assistant)
Expanded-Functions Dental Assistant (EFDA)
Dental Hygienist
Business Assistant (Administrative Assistant, Secretarial Assistant, Receptionist)
Dental Laboratory Technician
Dental Specialist
Registered Dental Hygienist
Dental Specialties Recognized by the American Dental Association
FIGURE 3-1 Dental hygienist performing an oral prophylaxis.
Dental Assistant
FIGURE 3-2 Dentist and chairside dental assistant working together.
FIGURE 3-3 Chairside dental assistant supported by a circulating dental assistant.
Clinical Dental Assistant
Chairside Assistant
Circulating Assistant
FIGURE 3-4 Dental assistants find volunteering at community dental health events very rewarding.
Community Work
Mobile Dental Facilities
Sterilization Assistant
Expanded-Functions Dental Assistant
FIGURE 3-5 A, Mobile dental van. B, Treatment area inside the dental van.
FIGURE 3-6 A sterilization assistant is an important member of the team.
FIGURE 3-7 Expanded-functions dental assistant (EFDA) removing excess cement.
FIGURE 3-8 A patient is greeted by the business assistant before meeting the dental hygienist.
Business Assistant
FIGURE 3-9 Dental laboratory technicians working in a large commercial dental laboratory.
FIGURE 3-10 Laboratory cases are stored in work pans. The dentist’s written laboratory prescription is posted on each work pan.
Dental Laboratory Technician
Supporting Services
▪ Legal and Ethical Implications
FIGURE 3-11 A, Entrance to the treatment areas of a modern dental spa–type office. B, Reception area of a general dentistry office with a spa-like atmosphere.
▪ Eye to the Future
▪ Critical Thinking
Pageburst Integrated Resources
4 Dental Ethics
Electronic Resources
Learning Outcomes
Key Terms
Sources for Ethics
Basic Principles of Ethics
TABLE 4-1 Basic Ethical Principles
Regard for Self-Determination (Autonomy)
To “Do No Harm” (Nonmaleficence)
Promotion of Well-Being (Beneficence)
Regard for Justice
Veracity
Confidentiality
FIGURE 4-1 Patients have the right to expect confidentiality regarding their conversations in the dental office.
Privacy
Continuing Education
Professional Code of Ethics
Applying Ethical Principles
American Dental Assistants Association (ADAA): Principles of Ethics and Code of Professional Conduct
Ethical Dilemmas
Case Example
Steps for Solving Ethical Dilemmas
▪ Legal and Ethical Implications
▪ Eye to the Future
▪ Critical Thinking
Pageburst Integrated Resources
5 Dentistry and the Law
Electronic Resources
Learning Outcomes
Key Terms
Statutory Law
Criminal Law
FIGURE 5-1 “Lady Justice.” Justitia was the Roman goddess of justice and is the figure depicted in statues across the world, often holding both scales and a sword. Her scales imply the weighting of justice, and the blindfold represents the impartiality of justice.
Civil Law
Contract Law
Tort Law
State Dental Practice Act
Contents of a Typical Dental Practice Act
Board of Dentistry
Expanded Functions and Supervision
Unlicensed Practice of Dentistry
Expanded Functions Delegated to Qualified Dental Assistants*
Dentist-Patient Relationship
Duty of Care/Standard of Care
FIGURE 5-2 Witnesses must be credible and tell the truth on the stand in court to avoid charges of perjury.
Dentist’s Duty of Care to the Patient
Abandonment
Patient Responsibilities
Due Care
Malpractice
Acts of Omission and Commission
Doctrine of Res Ipsa Loquitur
Risk Management
Avoiding Malpractice Lawsuits
“Silence Is Golden”
FIGURE 5-3 An important role of the dental assistant is to facilitate good communication with the patient.
Guidelines for Informed Consent
Informed Patient Consent
Informed Refusal
Guidelines for Informed Consent
Exceptions to Disclosure
Informed Consent for Minors
Documenting Informed Consent
Clinical Situations that Require Written Informed Consent
Content of Informed Consent Forms
Patient Referral
Failure to Refer
Guarantees
Contributory Negligence
Patient Records
Ownership of Dental Records and Radiographs
FIGURE 5-4 Patient records must be handled with care.
Guidelines for Charting Entries in Clinical Records
Reporting Abuse and Neglect
Child Abuse
FIGURE 5-5 This boy was a victim of child abuse.
Domestic Violence
Elder Abuse
Indicators of Child Abuse and Neglect
Behavioral Indicators
Dental Neglect or Abuse
Other Indicators
Dental Neglect
Immunity
HIPAA
Purpose of HIPAA
HIPAA: Summary of the Health Insurance Portability and Accountability Act of 1996
Privacy Standards
Patients’ Rights
Administrative Requirements
▪ Legal and Ethical Implications
▪ Eye to the Future
▪ Critical Thinking
Pageburst Integrated Resources
Part Two Sciences in Dentistry
Sciences in Dentistry
Interactive Review – Part 2
6 General Anatomy
Electronic Resources
Learning Outcomes
Key Terms
Planes and Body Directions
TABLE 6-1 Directional Terms for the Human Body
FIGURE 6-1 Body in anatomical (anatomic) position.
FIGURE 6-2 Organizational levels of the body. The human body develops from the simplest to the most complex forms.
Structural Units
Cells
Stem Cells
Stem Cells in Medicine
FIGURE 6-3 Basic human cell.
FIGURE 6-4 The evolution of a stem cell.
Cell Membrane
Cytoplasm
Nucleus
Visualizing the Semipermeable Function of the Cell
Tissues
TABLE 6-2 Types of Tissues and Functions in the Body
Organs
Body Systems
Body Cavities
Body Regions
FIGURE 6-5 Spaces within the body that house specific organs are referred to as body cavities.
▪ Legal and Ethical Implications
▪ Eye to the Future
▪ Critical Thinking
Pageburst Integrated Resources
7 General Physiology
Electronic Resources
Learning Outcomes
Key Terms
Physiology and Dental Assisting
Physiology and the Dental Assistant
Body Systems
Skeletal System
Bone
TABLE 7-1 Major Body Systems
TABLE 7-2 Disorders of the Skeletal System
FIGURE 7-1 The skeletal system.
FIGURE 7-2 The structure of bone.
Cartilage
FIGURE 7-3 A, Cortical bone (arrows) appears hard and dense. B, Cancellous bone forms trabeculae (arrow).
Joints
Muscular System
Striated Muscle
FIGURE 7-4 Types of joints. A, Ball-and-socket. B, Hinge. C, Gliding. D, Pivot. E, Saddle. F, Gomphosis.
TABLE 7-3 Disorders of the Muscular System
FIGURE 7-5 Muscles of the body, anterior view.
Smooth Muscle
Cardiac Muscle
FIGURE 7-6 Muscles of the body, posterior view.
Muscle Function
Cardiovascular System
Circulatory System
Heart
Heart Chambers
Heart Valves
TABLE 7-4 Disorders of the Heart
TABLE 7-5 Disorders of the Lymphatic System
FIGURE 7-7 The heart and great vessels.
FIGURE 7-8 Coronary vessels.
Blood Flow Through the Heart
Blood Vessels
FIGURE 7-9 Arteries carry blood from the heart to the body.
Blood and Blood Cells
FIGURE 7-10 Hematocrit.
Blood Typing and Rh Factor
Lymphatic System
Lymph Vessels
Lymph Nodes
Lymph Fluid
Lymphoid Organs
Tonsils.
Spleen.
Nervous System
FIGURE 7-11 Lymphatic system.
Neurons
FIGURE 7-12 The tonsils.
Central Nervous System
Brain
TABLE 7-6 Disorders of the Nervous System
FIGURE 7-13 Bell’s palsy. Paralysis of the facial muscles on the patient’s left side. A, The patient is trying to raise his eyebrows. B, The patient is attempting to close his eyes and smile.
Spinal Cord
Peripheral Nervous System
Respiratory System
Structures
Nose
Pharynx
FIGURE 7-14 The central nervous system.
Epiglottis
Larynx
Trachea
Lungs
TABLE 7-7 Disorders of the Respiratory System
FIGURE 7-15 Structure of the respiratory system.
Digestive System
TABLE 7-8 Disorders of the Digestive System
Digestive Process
Structures
Mouth
FIGURE 7-16 Major structures of the digestive system.
Pharynx
Esophagus
Stomach
Small Intestine
Large Intestine
Liver, Gallbladder, and Pancreas
Endocrine System
FIGURE 7-17 Endocrine glands.
TABLE 7-9 Disorders of the Endocrine System
Urinary System
TABLE 7-10 Disorders of the Urinary System
FIGURE 7-18 The urinary system.
Integumentary System
Skin Structures
Epidermis
Dermis
Subcutaneous Fat
TABLE 7-11 Disorders of the Integumentary System
FIGURE 7-19 The three most common forms of skin cancer. A, Squamous cell. B, Basal cell. C, Malignant melanoma.
Skin Appendages
Hair
Nails
Glands
Reproductive System
Female
Male
Interaction Among the Ten Body Systems
TABLE 7-12 Disorders of the Female Reproductive System
TABLE 7-13 Disorders of the Male Reproductive System
▪ Legal and Ethical Implications
▪ Eye to the Future
▪ Critical Thinking
Pageburst Integrated Resources
8 Oral Embryology and Histology
Electronic Resources
Learning Outcomes
Key Terms
Oral Embryology
Prenatal Development
FIGURE 8-1 Periods and structures in prenatal development. Note that the size of the structures is neither accurate nor comparative.
FIGURE 8-2 Sperm fertilizes the ovum and unites with it to form the zygote after the process of meiosis and during the first week of prenatal development. Chromosomes from the ovum and sperm join to form a zygote—a new individual.
FIGURE 8-3 A fetus at various weeks of development.
Embryonic Development of the Face and Oral Cavity
Primary Embryonic Layers
TABLE 8-1 Developmental Disturbances
Structures Formed by Specialized Cells of Primary Embryonic Layers
Ectoderm (Outer Layer)
Mesoderm (Middle Layer)
Endoderm (Inner Layer)
Early Development of the Mouth
Branchial Arches
FIGURE 8-4 Scanning electron micrograph of the head and neck of an embryo at 4 weeks shows development of the brain, face, and heart. Note the stomodeum (ST), or “primitive mouth,” and the developing eye.
FIGURE 8-5 A human embryo during the fifth week of development.
Hard and Soft Palates
Facial Development
FIGURE 8-6 Adult palate and developmental divisions.
FIGURE 8-7 A, An infant with a left unilateral complete cleft lip and palate. B, The infant after corrective surgeries are performed.
Tooth Development
Developmental Disturbances
Genetic Factors
Environmental Factors
Known Teratogens Involved in Congenital Malformations
Facial Development After Birth
TABLE 8-2 Stages of Tooth Development
TABLE 8-3 Dental Developmental Disturbances
Tooth Movement
Life Cycle of a Tooth
Growth Periods
FIGURE 8-8 Changes in facial contours from birth to adulthood.
FIGURE 8-9 The mandible grows by displacement, resorption, and deposition. Note how space is created to accommodate the third molar.
Bud Stage.
Cap Stage.
FIGURE 8-10 Process of orthodontic tooth movement.
BELL Stage.
Calcification
Pits and Fissures.
Eruption of Primary Teeth
Shedding of Primary Teeth
Eruption of Permanent Teeth
Oral Histology
Crown
FIGURE 8-11 A, Chronologic order of eruption of the primary dentition. B, Permanent dentition.
Root
FIGURE 8-12 Stages in the process of tooth eruption. A, Oral cavity before the eruption process begins. Reduced enamel epithelium covers the newly formed enamel. B, Fusion of the reduced enamel epithelium with the oral epithelium. C, Disintegration of central fused tissue, leaving a tunnel for tooth movement. D, Coronal fused tissues peel back from the crown during eruption, leaving the initial junctional epithelium near the cementoenamel junction.
FIGURE 8-13 Radiograph shows normal resorption of the roots of a mandibular primary molar before it is shed.
Enamel
FIGURE 8-14 Examples of mixed dentition with eruption of primary and permanent teeth.
FIGURE 8-15 Anterior (top or front) tooth and posterior (bottom or back) tooth show the dental tissues.
FIGURE 8-16 A, The anatomical crown is the portion of the tooth that is covered with enamel and remains the same. B, The clinical crown is the portion of the tooth that is visible in the mouth and may vary because of changes in the position of the gingiva.
FIGURE 8-17 Enamel rod, the basic unit of enamel. A, Relationship of the rod to enamel. B, Scanning electron micrograph of enamel shows head (H) and tail (T).
Dentin
FIGURE 8-18 Scanning electron micrograph of dentinal tubules.
Cementum
Pulp
FIGURE 8-19 The dental pulp.
Periodontium
Attachment Apparatus
Alveolar Process.
FIGURE 8-20 Periodontium of the tooth with its components identified.
Periodontal Ligament.
Supportive and Protective Functions.
Sensory Function.
Nutritive Function.
Formative and Resorptive Functions.
FIGURE 8-21 Anatomy of the alveolar bone. A, Mandibular arch of a skull with the teeth removed. B, Portion of the maxilla of a skull with the teeth removed. C, Cross-section of the mandible with the teeth removed.
Periodontal Ligament Fiber Groups.
Periodontal Fiber Groups.
FIGURE 8-22 The alveolar crest as it appears on a radiograph.
Transseptal Fiber Groups.
Gingival Fiber Groups.
FIGURE 8-23 Periodontal fiber groups.
FIGURE 8-24 Some of the fiber subgroups of the gingival fiber group: circular, dentogingival, alveologingival, and dentoperiosteal ligaments.
Gingival Unit
Lining Mucosa.
Masticatory Mucosa.
FIGURE 8-25 A, A dense masticatory type of mucosa makes up the gingiva. B, The delicate lining type of mucosa covers the vestibule.
Specialized Mucosa.
▪ Legal and Ethical Implications
▪ Eye to the Future
▪ Critical Thinking
Pageburst Integrated Resources
9 Head and Neck Anatomy
Electronic Resources
Learning Outcomes
Key Terms
Regions of the Head
Bones of the Skull
Bones of the Cranium
Parietal Bones
FIGURE 9-1 Regions of the head: frontal, parietal, occipital, temporal, orbital, nasal, infraorbital, zygomatic, buccal, oral, and mental.
TABLE 9-1 Bones of the Skull
Frontal Bone
Occipital Bone
Temporal Bones
TABLE 9-2 Terminology of Anatomical Landmarks of Bones
Sphenoid Bone
FIGURE 9-2 Lateral view of the skull. 1.Anterior lacrimal crest2.Anterior nasal spine3.Body of mandible4.Condyle of mandible5.Coronal suture6.Coronoid process of mandible7.External acoustic meatus of temporal bone8.External occipital protuberance (inion)9.Fossa for lacrimal sac10.Frontal bone11.Frontal process of maxilla12.Frontozygomatic suture13.Glabella14.Greater wing of sphenoid bone15.Inferior temporal line16.Lacrimal bone17.Lambdoid suture18.Mastoid process of temporal bone19.Maxilla20.Mental foramen21.Mental protuberance22.Nasal bone23.Nasion24.Occipital bone25.Orbital part of ethmoid bone26.Parietal bone27.Pituitary fossa (sella turcica)28.Posterior lacrimal crest29.Pterion (encircled)30.Ramus of mandible31.Squamous part of temporal bone32.Styloid process of temporal bone33.Superior temporal line34.Tympanic part of temporal bone35.Zygomatic arch36.Zygomatic bone37.Zygomatic process of temporal bone
FIGURE 9-3 Frontal view of the skull. 1.Anterior nasal spine2.Body of mandible3.Frontal bone4.Frontal notch5.Frontal process of maxilla6.Glabella7.Greater wing of sphenoid bone8.Infraorbital foramen9.Infraorbital margin10.Inferior nasal concha11.Inferior orbital fissure12.Lacrimal bone13.Lesser wing of sphenoid bone14.Maxilla15.Mental foramen16.Mental protuberance17.Middle nasal concha18.Nasal bone19.Nasal septum20.Nasion21.Orbit (orbital cavity)22.Ramus of mandible23.Superior orbital fissure24.Supraorbital foramen25.Supraorbital margin26.Zygomatic bone
FIGURE 9-4 Posterior view of the skull. 1.External occipital protuberance (inion)2.Highest nuchal line3.Inferior nuchal line4.Lambda5.Lambdoid suture6.Occipital bone7.Parietal bone8.Parietal foramen9.Sagittal suture10.Superior nuchal line
Ethmoid Bone
Auditory Ossicles
FIGURE 9-5 View of external base of the skull. 1.Apex of petrous part of temporal bone2.Articular tubercle3.Carotid canal4.Condylar canal (posterior)5.Edge of tegmen tympani6.External acoustic meatus7.External occipital crest8.External occipital protuberance9.Foramen lacerum10.Foramen magnum11.Foramen ovale12.Foramen spinosum13.Greater palatine foramen14.Horizontal plate of palatine bone15.Hypoglossal (anterior condylar) canal16.Incisive fossa17.Inferior nuchal line18.Inferior orbital fissure19.Infratemporal crest of greater wing of sphenoid bone20.Jugular foramen21.Lateral pterygoid plate22.Lesser palatine foramina23.Mandibular fossa24.Mastoid foramen25.Mastoid notch26.Mastoid process27.Medial pterygoid plate28.Median palatine (intermaxillary) suture29.Occipital condyle30.Occipital groove31.Palatine grooves and spines32.Palatine process of maxilla33.Palatinovaginal canal34.Petrosquamous fissure35.Petrotympanic fissure36.Pharyngeal tubercle37.Posterior border of vomer38.Posterior nasal aperture (choana)39.Posterior nasal spine40.Pterygoid hamulus41.Pyramidal process of palatine bone42.Scaphoid fossa43.Spine of sphenoid bone44.Squamotympanic fissure45.Squamous part of temporal bone46.Styloid process47.Stylomastoid foramen48.Superior nuchal line49.Transverse palatine (palatomaxillary) suture50.Tuberosity of maxilla51.Tympanic part of temporal bone52.Vomerovaginal canal53.Zygomatic arch
FIGURE 9-6 Anterior view of the facial bones and overlying facial tissue.
Bones of the Face
Zygomatic Bones
Maxillary Bones
FIGURE 9-7 Bones and landmarks of the hard palate.
Palatine Bones
Nasal Bones
Lacrimal Bones
Vomer
Nasal Conchae
Mandible
FIGURE 9-8 The mandible. A, From the front. B, From behind and above. C, From the left and front. D, Internal view from the left. 1.Alveolar part2.Angle3.Anterior border of ramus4.Base5.Body6.Coronoid process7.Digastric fossa8.Head9.Inferior border of ramus10.Lingula11.Mandibular foramen12.Mandibular notch13.Mental foramen14.Mental protuberance15.Mental tubercle16.Mylohyoid groove17.Mylohyoid line18.Neck19.Oblique line20.Posterior border of ramus21.Pterygoid fovea22.Ramus23.Sublingual fossa24.Submandibular fossa25.Superior and inferior mental spines (genial tubercles)
Hyoid Bone
Postnatal Development
Fusion of Bones
Development of the Facial Bones
Mandible.
Maxilla.
Differences Between Male and Female Skulls
Temporomandibular Joints
Capsular Ligament
Articular Space
FIGURE 9-9 The fetal skull. A, Anterior view. B, Lateral view. C, Posterior view.
Jaw Movement
Hinge Action
FIGURE 9-10 Stages of postnatal development of the human skull. A, Anterior view. B, Lateral view.
FIGURE 9-11 Lateral view of the joint capsule of the temporomandibular joint and its lateral temporomandibular ligament. Note on the inset that the capsule has been removed to show the upper and lower synovial cavities and their relationship to the articular disc.
FIGURE 9-12 Hinge and gliding actions of the temporomandibular joint.
Gliding Movement
Temporomandibular Disorders
TABLE 9-3 Categories of Temporomandibular Disorders (TMDs)
FIGURE 9-13 Palpation of the patient during movements of both temporomandibular joints.
Symptoms
Pain.
Joint Sounds.
Limitations in Movement.
Causes
Muscles of the Head and Neck
Major Muscles of the Neck
TABLE 9-4 Major Muscles of the Neck
TABLE 9-5 Major Muscles of Facial Expression
Major Muscles of Facial Expression
Major Muscles of Mastication
Muscles of the Floor of the Mouth
Muscles of the Tongue
FIGURE 9-14 Palpation of the sternocleidomastoid muscle by having the patient turn the head to the opposite side.
Muscles of the Soft Palate
FIGURE 9-15 Major muscles of mastication include the temporalis and masseter muscles shown here.
Salivary Glands
TABLE 9-6 Major Muscles of Mastication
TABLE 9-7 Muscles of the Floor of the Mouth
TABLE 9-8 Extrinsic Muscles of the Tongue
TABLE 9-9 Major Muscles of the Soft Palate
FIGURE 9-16 View from above the floor of the oral cavity showing the origin and insertion of the geniohyoid muscle.
FIGURE 9-17 Extrinsic muscles of the tongue.
Minor Salivary Glands
Major Salivary Glands
FIGURE 9-18 The salivary glands.
FIGURE 9-19 Sialoliths. A, Occlusal radiograph showing a sialolith (arrow) in Wharton’s duct. B, Sialolith (arrow) in a minor salivary gland on the floor of the mouth.
Blood Supply to the Head and Neck
Major Arteries of the Face and Oral Cavity
External Carotid Artery
Facial Artery
Lingual Artery
Maxillary Artery
TABLE 9-10 Major Arteries to the Face and Oral Cavity
FIGURE 9-20 Major arteries and veins of the face and oral cavity.
Major Veins of the Face and Oral Cavity
Clinical Considerations: Facial Paralysis
Nerves of the Head and Neck
FIGURE 9-21 Facial paralysis resulting from damage to lower motor neurons of the facial nerve (cranial nerve VII).
Cranial Nerves
Innervation of the Oral Cavity
Maxillary Division of Trigeminal Nerve
Mandibular Division of Trigeminal Nerve
Lymph Nodes of the Head and Neck
Structure and Function
Superficial Lymph Nodes of the Head
Deep Cervical Lymph Nodes
Lymphadenopathy
FIGURE 9-22 The twelve cranial nerves.
FIGURE 9-23 Maxillary and mandibular innervation.
FIGURE 9-24 Palatal, lingual, and buccal innervation.
Clinical Considerations: Toothache and Sinus Pain
FIGURE 9-25 A, Superficial lymph nodes of the head and associated structures. B, Deep cervical lymph nodes and associated structures.
FIGURE 9-26 The paranasal sinuses.
Paranasal Sinuses
▪ Eye to the Future
▪ Critical Thinking
Pageburst Integrated Resources
10 Landmarks of the Face and Oral Cavity
Electronic Resources
Learning Outcomes
Key Terms
Landmarks of the Face
Regions of the Face
Features of the Face
Skin
FIGURE 10-1 Regions of the face. A, At rest. B, Smiling. See Regions of the Face on p. 131 for which regions correspond to each number.
FIGURE 10-2 Features of the face.
Lips
FIGURE 10-3 Frontal view of the lips.
Clinical Considerations: Lips
The Oral Cavity
The Vestibule
Labial and Other Frenula
FIGURE 10-4 Vestibule and vestibular tissue of the oral cavity.
FIGURE 10-5 Buccal vestibule and buccal mucosa of the cheek. The opening of the parotid duct is seen opposite the second maxillary molar.
FIGURE 10-6 View of gingivae and associated anatomical landmarks.
FIGURE 10-7 Linea alba (arrow).
FIGURE 10-8 A, Clinically normal gingivae in light-skinned individual. B, Clinically normal pigmented gingivae in a dark-skinned individual.
Gingiva
Unattached Gingiva
Interdental Gingiva
Gingival Groove
FIGURE 10-9 Close-up view of gingivae and associated anatomical landmarks.
Attached Gingiva
The Oral Cavity Proper
Hard Palate
Soft Palate
Tongue
FIGURE 10-10 A, Surface features of the hard palate. B, Surface features of the soft palate.
Clinical Considerations: Gag Reflex
FIGURE 10-11 Dorsum of the tongue.
FIGURE 10-12 Sublingual aspect of the tongue.
Clinical Considerations: Lingual Frenula
Taste Buds
Teeth
▪ Eye to the Future
▪ Critical Thinking
Pageburst Integrated Resources
11 Overview of the Dentitions
Electronic Resources
Learning Outcomes
Key Terms
Dentition Periods
Primary Dentition
Mixed Dentition
Clinical Considerations: Nasmyth’s Membrane
TABLE 11-1 Dentition Periods and Clinical Considerations
TABLE 11-2 Primary Dentition in Order of Eruption
Permanent Dentition
FIGURE 11-1 A, Example of the dentition in a 9-month-old child. B, Example of the complete primary dentition.
FIGURE 11-2 An example of the oral cavity during the mixed dentition period.
FIGURE 11-3 Facial and buccal view of a permanent dentition.
Dental Arches
Quadrants
TABLE 11-3 Permanent Dentition in Order of Eruption
Sextants
Anterior and Posterior Teeth
FIGURE 11-4 A, Primary dentition separated into quadrants. B, Permanent dentition separated into quadrants.
FIGURE 11-5 Permanent dentition separated into sextants.
Types and Functions of Teeth
Incisors
Canines
FIGURE 11-6 A, Occlusal view of the permanent dentition. Types of teeth are identified through the Universal/National System. B, Occlusal view of the primary dentition.
Premolars
Molars
Tooth Surfaces
FIGURE 11-7 Surfaces of the teeth and their relationships to other oral cavity structures, to the midline, and to other teeth.
Anatomic Features of Teeth
Contours
FIGURE 11-8 Tooth contours. A, Normal contour. B, Inadequate contour. C, Overcontouring.
Facial and Lingual Contours
Mesial and Distal Contours
Contacts
Height of Contour
FIGURE 11-9 Example of a permanent anterior tooth with the contact area and the height of contour identified.
Embrasures
Clinical Considerations: Anatomical Features of the Teeth
Angles and Divisions of Teeth
FIGURE 11-10 Embrasures may diverge facially, lingually, occlusally, or apically.
Line and Point Angles
FIGURE 11-11 Line and point angles.
Divisions Into Thirds
Occlusion and Malocclusion
FIGURE 11-12 An anterior tooth and a posterior tooth, with designations for crown and root thirds.
FIGURE 11-13 Lingual view of the teeth in centric occlusion.
Angle’s Classification
Class I
TABLE 11-4 Angle’s Classifications of Malocclusion
Class II
Division 1.
Division 2.
Class III
Stabilization of the Arches
Closure
Curve of Spee
Curve of Wilson
FIGURE 11-14 Radiograph shows the mesial drift of the mandibular second molar after the first molar has been lost.
FIGURE 11-15 Curves noted in the dental arch. A, Curve of Spee. B, Curve of Wilson.
Tooth-Numbering Systems
Universal/National System
International Standards Organization System
Palmer Notation System
TABLE 11-5 Tooth Designation Systems
Example of Palmer Notation System
FIGURE 11-16 Palmer Notation System.
▪ Legal and Ethical Implications
▪ Eye to the Future
▪ Critical Thinking
Pageburst Integrated Resources
12 Tooth Morphology
Electronic Resources
Learning Outcomes
Key Terms
FIGURE 12-1 Stainless steel crowns are available in a variety of sizes for each tooth.
Anterior Permanent Dentition
FIGURE 12-2 Attractive teeth are important for a nice smile at any age.
FIGURE 12-3 Various views of a newly erupted permanent maxillary incisor show its features.
Permanent Incisors
Maxillary Central Incisors
FIGURE 12-4 Various views of a permanent maxillary right central incisor.
FIGURE 12-5 Mamelons are the rounded portions of the incisal edge of the lower central incisors.
Maxillary Lateral Incisors
FIGURE 12-6 Various views of a permanent maxillary right lateral incisor.
FIGURE 12-7 Pegged maxillary lateral incisor. Note the conical shape. The maxillary third molars differ from the other teeth considerably in terms of size, contour, and relative position.
Mandibular Incisors
Mandibular Central Incisors.
Mandibular Lateral Incisors.
Clinical Considerations: Incisors
FIGURE 12-8 Various views of a permanent mandibular right central incisor.
Permanent Canines
FIGURE 12-9 Various views of a permanent mandibular right lateral incisor.
Maxillary Canines
Mandibular Canines
FIGURE 12-10 Views of permanent mandibular and maxillary canines. A, Labial view. B, Lingual view.
FIGURE 12-11 Various views of a permanent maxillary right canine.
FIGURE 12-12 Various views of a permanent mandibular right canine.
Clinical Considerations: Canines
Posterior Permanent Dentition
FIGURE 12-13 Occlusal surface on a permanent posterior tooth and its features.
Clinical Considerations: Posterior Teeth
Permanent Premolars
Maxillary First Premolars
FIGURE 12-14 Other features of the occlusal table on a permanent posterior tooth, including the central groove.
Clinical Considerations: Premolars
FIGURE 12-15 Various views of a permanent maxillary first premolar.
Maxillary Second Premolars
Mandibular First Premolars
FIGURE 12-16 Various views of a permanent maxillary right second premolar.
FIGURE 12-17 Various views of a permanent mandibular right first premolar.
Mandibular Second Premolars
FIGURE 12-18 Various views of a permanent mandibular second premolar.
FIGURE 12-19 Occlusal views of a permanent mandibular second premolar. A, U-type. B, H-type. C, Y-type.
Permanent Molars
Maxillary Molars
FIGURE 12-20 A, Maxillary first molar. B, Mandibular first molar.
Clinical Considerations: Maxillary Molars
Maxillary First Molars.
FIGURE 12-21 Various views of a permanent maxillary right first molar.
Maxillary Second Molars.
Maxillary Third Molars.
FIGURE 12-22 Various views of a permanent maxillary right second molar.
Mandibular Molars
FIGURE 12-23 Buccal views of permanent maxillary right molars. A, First molar. B, Second molar. C, Third molar. Notice how the roots tend to be located closer together when the molars are farther distally. Third molar roots are often fused.
FIGURE 12-24 Various views of permanent maxillary right third molars.
Clinical Considerations: Mandibular Molars
Mandibular First Molars.
FIGURE 12-25 Various views of a permanent mandibular right first molar.
Mandibular Second Molars.
Mandibular Third Molars.
FIGURE 12-26 Various views of a permanent mandibular right second molar.
FIGURE 12-27 Various views of the permanent mandibular right third molar.
Primary Dentition
FIGURE 12-28 Buccal views of permanent mandibular right molars. A, First molar. B, Second molar. C, Third molar. Note that the roots are closer together and become shorter from the first molar to the third molar. Third molar roots are often fused.
FIGURE 12-29 A, Primary mandibular molar. B, Permanent mandibular molar.
Clinical Considerations: Primary Teeth
FIGURE 12-30 Various views of a primary maxillary right central incisor.
Primary Incisors
Maxillary Central Incisors
Maxillary Lateral Incisors
FIGURE 12-31 Various views of a primary maxillary lateral incisor.
FIGURE 12-32 Various views of a primary mandibular central incisor.
Mandibular Central Incisors
Mandibular Lateral Incisors
FIGURE 12-33 Various views of a primary mandibular lateral incisor.
Primary Canines
Maxillary Canines
Mandibular Canines
FIGURE 12-34 Various views of a primary maxillary canine.
FIGURE 12-35 Various views of a primary mandibular canine.
Primary Molars
Maxillary First Molars
FIGURE 12-36 Various views of a primary maxillary first molar.
FIGURE 12-37 Various views of a primary maxillary second molar.
Maxillary Second Molars
Mandibular First Molars
FIGURE 12-38 Various views of a primary mandibular first molar.
FIGURE 12-39 Various views of a primary mandibular second molar.
Mandibular Second Molars
▪ Eye to the Future
▪ Critical Thinking
Pageburst Integrated Resources
Part Three Oral Health and Prevention of Dental Disease
Oral Health and Prevention of Dental Disease
Interactive Review – Part 3
13 Dental Caries
Electronic Resources
Learning Outcomes
Key Terms
Bacterial Infection
Dental Plaque
FIGURE 13-1 Dental plaque made visible with a disclosing agent.
Enamel Structure
The Caries Process
Stages of Caries Development
FIGURE 13-2 Factors involved in the formation of carious defects.
How to Control Tooth Decay
FIGURE 13-3 Demineralization and remineralization of the tooth.
Secondary (Recurrent) Caries
FIGURE 13-4 A, Early carious lesion, or white spot of demineralization. B, Overt carious lesion. C, Rampant caries.
FIGURE 13-5 Severely decayed molar on a child.
FIGURE 13-6 Decay on the lingual surface of a maxillary lateral incisor.
FIGURE 13-7 Radiograph shows recurrent decay (arrows) under an amalgam restoration.
Root Caries
FIGURE 13-8 Root surface caries.
Prevention of Root Caries
Early Childhood Caries
Risk Factors
FIGURE 13-9 Rampant early childhood caries.
FIGURE 13-10 Child suffering an abscess.
Risk Factors for Early Childhood Caries
How Children Get Early Childhood Caries
The Importance of Saliva
FIGURE 13-11 Children with untreated dental decay.
Saliva’s Beneficial Actions
Caries Diagnosis
FIGURE 13-12 Milk or formula will remain on babies’ teeth if they are put to sleep with a bottle.
Dental Explorer
Radiographs
Visual Appearance
Indicator Dyes
FIGURE 13-13 Special types of dyes, when applied to a preparation, can indicate with color any areas of decay and thus aid in earlier caries detection.
Caries Detection Devices
Laser Caries Detector
FIGURE 13-14 Spectra Fluorescence Caries Detection Aid System. A, Lightweight handpiece with high resolution, auto-exposure CCD sensor connects to a computer. B, Doppler radar-like images provide both color and numerical indicators; in active mode carious regions appear red, healthy enamel appears green.
FIGURE 13-15 A and B, The DIAGNOdent directs a laser beam into the occlusal surface. C, The DIAGNOdent pen is an even newer device that provides the same early caries detection in a more portable handheld device. D, The dental treatment sequence.
FIGURE 13-16 Visual and radiographic appearance of seemingly intact molar.
Calibration of the Tip
CAMBRA
CAMBRA Techniques
FIGURE 13-17 Cross-section of molar shows decay.
TABLE 13-1 Correlation of DIAGNOdent Values With Possible Course of Action
FIGURE 13-18 Preventive measures against caries. A, Fluoride rinse. B, Chlorhexidine rinse. C, Xylitol gum.
Methods of Caries Intervention
Caries Risk Assessment Tests
Dental Assistant’s Role in Caries Risk Assessment
Risk Factors for Future Dental Caries
Who Should Be Tested for Caries Risk?
▪ Legal and Ethical Implications
▪ Eye to the Future
▪ Critical Thinking
Procedure 13-1 Performing Caries Detection Using the KaVo DIAGNOdent Caries Detection Device (Expanded Function)
Prerequisites for Performing This Procedure
Equipment and Supplies
Procedural Steps
Establish Zero Base Line
Scanning Procedure
Documentation
Procedure 13-2 Performing Caries Risk Assessment (Expanded Function)
Prerequisites for Performing This Procedure
Equipment and Supplies
Procedural Steps
A, Compare the density of the mutans streptococci (MS) colonies. B, Compare the density of the lactobacilli (LB) colonies.
Documentation
Pageburst Integrated Resources
14 Periodontal Diseases
Electronic Resources
Learning Outcomes
Key Terms
Definition and Prevalence of Periodontal Disease
TABLE 14-1 Structures of the Periodontium
FIGURE 14-1 Anatomical relationship of the normal gingivae. Gingival tissues include the alveolar mucosa, mucogingival junction, attached gingiva, free gingiva, and interdental papilla.
Periodontal Disease and Systemic Health
Cardiovascular Disease
Box 14-1 Potential Associations Between Periodontal Infection and Systemic Health
Preterm/Low Birth Weight
Respiratory Disease
Causes of Periodontal Disease
Dental Plaque
Calculus
FIGURE 14-2 Clinical photo of 10-day-old supragingival plaque. The first symptoms of gingival inflammation (arrows) are becoming visible.
FIGURE 14-3 Heavy calculus deposits on the lingual surfaces of the lower anterior teeth.
Supragingival Calculus
Subgingival Calculus
Tooth Deposits
Other Risk Factors
Types of Periodontal Disease
TABLE 14-2 Common Risk Factors for Periodontal Disease
Signs and Symptoms
Gingivitis
FIGURE 14-4 Gingivitis type I.
TABLE 14-3 Clinical Gingival Characteristics in Health and Disease
Box 14-2 Characteristics of Plaque-Induced Gingival Disease
I Dental Plaque–Induced Gingivitis*
II Plaque-Induced Gingival Disease Modified by Systemic Factors
Endogenous Sex Steroid Hormone Gingival Disease
Diabetes Mellitus–Associated Gingivitis
Hematologic (Leukemic) Gingival Disease
Drug-Influenced Gingival Enlargement
Gingival Disease Associated With Nutrition
FIGURE 14-5 Medication-induced gingivitis.
FIGURE 14-6 Gingival inflammation and enlargement associated with orthodontic appliance and poor oral hygiene.
Periodontitis
FIGURE 14-7 Cross-section of a tooth and associated anatomical structures. A, Illustrates the depth of a normal gingival sulcus. B, Illustrates a periodontal pocket.
Description of Periodontal Disease
FIGURE 14-8 Generalized chronic periodontitis in a 38-year-old woman with a 20-year history of smoking at least one pack of cigarettes per day. A, Clinical view shows minimal plaque and inflammation. Probing produced negligible bleeding, which is common with smokers. Patient reported spacing between the right maxillary incisors, which was associated with advanced attachment bone loss. B, Radiographs show severe, generalized, horizontal pattern of bone loss. Maxillary and mandibular molars have already been lost through advanced disease and furcation involvement.
Box 14-3 Characteristics of Periodontitis
I Chronic Periodontitis*
II Aggressive Periodontitis†
III Necrotizing Periodontal Disease‡
Credit for perioscopy: state-of-the-art technology.
▪ Legal and Ethical Implications
▪ Eye to the Future
▪ Critical Thinking
Pageburst Integrated Resources
15 Preventive Dentistry
Electronic Resources
Learning Outcomes
Key Terms
Partners in Prevention
FIGURE 15-1 The mother lifts the child’s lip to look for early signs of decay.
Early Dental Care
Pregnancy and Dental Care
TABLE 15-1 Comprehensive Preventive Dentistry Program
Patient Education Guidelines
Disclosing solution shows heavy plaque formation throughout the mouth.
Dental Care for 0 to 5 Years
Dental Sealants
Oral Health and Aging
FIGURE 15-2 A, Toothbrushing should begin as soon as the first tooth appears. B, This is the first dental visit for this 15-month-old boy. The dental assistant is showing the mother how to brush her son’s teeth.
FIGURE 15-3 This molar is protected from decay with the use of a dental sealant.
Age-Related Dental Changes
Age-Related Dental Changes
Age-Related Pathology-Related Conditions
Age-Related Pathology Conditions
Fluoride
Oral Health Educational Materials and Web Sites
How Fluoride Works
Preeruptive Development
Posteruptive Development
FIGURE 15-4 Topical fluoride gels for professional application.
FIGURE 15-5 A, Mild fluorosis. B, Moderate fluorosis.
Safe and Toxic Levels
Precautions
Fluoride Needs Assessment
Sources of Fluoride
Fluoridated Water
Fluoride Needs Assessment
Bottled Water
Sources of Systemic Fluoride
Foods and Beverages
Prescribed Dietary Supplements
Sources of Topical Fluoride
FIGURE 15-6 Fluoride can be dispensed by the dentist in tablet form.
Toothpastes
Mouth Rinses
FIGURE 15-7 Examples of 0.4% stable stannous fluoride gels and pastes, and 1.1% sodium fluoride prescription toothpastes.
TABLE 15-2 Types of Professionally Applied Fluorides
FIGURE 15-8 Training toothpaste for young children.
Gels
FIGURE 15-9 Various chemotherapeutic products available to consumers.
Varnish
TABLE 15-3 Fluoride Therapies for Home Use
FIGURE 15-10 Example of fluoride varnish product for high-risk individuals of all ages.
Professional Applications
Nutrition and Dental Caries
Sugar Substitutes
FIGURE 15-11 Sugar-free sodium bicarbonate gum containing xylitol.
Xylitol
Dietary Analysis
Steps for Analyzing a Food Diary
Hard Facts About Soft Drinks
Plaque Control Program
FIGURE 15-12 Children younger than 8 years of age should be supervised while brushing to ensure that all areas of the teeth have been thoroughly cleaned.
FIGURE 15-13 The “finger brush” should be used as soon as teeth appear in the baby’s mouth.
Toothbrushes and Toothbrushing
Baby Toothbrushes
Manual Toothbrushes
FIGURE 15-14 Examples of manual toothbrushes.
Automatic Toothbrushes
Toothbrushing
FIGURE 15-15 Worn out toothbrush.
FIGURE 15-16 Positioning the toothbrush head and bristle tips so that they reach the gingival margin is critical for achieving the most effective cleaning results. A, Straight head placement. B, Round head placement.
FIGURE 15-17 Bass method. A, Place the toothbrush so that the bristles are angled at approximately 45 degrees from the tooth surfaces. B, Start at the most distal tooth in the arch, and use a vibrating, back-and-forth motion to brush.
Toothbrushing Precautions
Toothbrushing for Unusual Conditions
TABLE 15-4 Examples of Powered Toothbrushes
FIGURE 15-18 Observing toothbrushing technique.
FIGURE 15-19 Improper brushing techniques can result in abrasion of the tooth surface and can cause gingival recession.
Dental Floss or Tape
When to Floss
TABLE 15-5 Powered Toothbrushes: General Modes of Action
FIGURE 15-20 The dental assistant helps the patient with flossing.
Interdental Aids
End-Tuft Brushes
FIGURE 15-21 Interproximal cleaning devices include wooden tips (A and B), interproximal brushes (C-F), and rubber-tipped stimulators (G).
FIGURE 15-22 An interdental hygienic aid. A, Anterior teeth. B, Cleaning the posterior interproximal areas that are difficult to reach.
FIGURE 15-23 A bridge threader is used as an aid to clean under a fixed bridge.
Bridge Threaders
Automatic Flossers
Perio-Aid
FIGURE 15-24 This battery-powered flossing device enables single-handed flossing with a disposable nylon flexible tip, which offers convenience for some patients.
Dentures
Toothpaste
FIGURE 15-25 A, Toothpick placed at the gingival margin. B, Gentle up-and-down motion keeping tip on tooth.
FIGURE 15-26 Denture and denture brush.
Mouth Rinses
FIGURE 15-27 Toothpaste for children.
Oral Irrigation Devices
FIGURE 15-28 Mouth rinses. A, Two prerinses (left) and several alcohol-free mouth rinses (right). B, Familiar brands of mouth rinses contain alcohol in amounts ranging from 8 percent to 27 percent.
TABLE 15-6 Types of Toothpastes
FIGURE 15-29 Waterpik Water Flosser. This unit also comes with six tips or attachments: the classic tip, a subgingival tip, an orthodontic tip, the Plaque Seeker tip, a toothbrush tip, and a tongue cleaner.
FIGURE 15-30 The American Dental Association Seal of Acceptance.
General Guidelines for Home Care Products
▪ Patient Education
The dental assistant uses the intraoral camera to assist with patient education.
▪ Legal and Ethical Implications
▪ Critical Thinking
Procedure 15-1 Applying Topical Fluoride Gel or Foam (Expanded Function)
Prerequisites for Performing This Procedure
Equipment and Supplies
Procedural Steps
Selecting the Tray
Preparing the Teeth
Applying the Topical Fluoride
Documentation
Procedure 15-2 Applying Fluoride Varnish (Expanded Function)
Prerequisites for Performing This Procedure
Equipment and Supplies
Procedural Steps
Documentation
Procedure 15-3 Assisting the Patient with Dental Floss (Expanded Function)
Prerequisites for Performing This Procedure
Equipment and Supplies
Procedural Steps
Preparing the Floss
Flossing the Teeth
Documentation
Pageburst Integrated Resources
16 Nutrition
Electronic Resources
Learning Outcomes
Key Terms
Nutrition and the Dental Assistant
Healthy People 2020 Report
FIGURE 16-1 The dental assistant discusses dental health with her patient.
Nutrient Recommendations
Box 16-1 Functions of Five Major Nutrients
Carbohydrates
Proteins
Fats/Lipids
Vitamins
Minerals
Box 16-2 Healthy People 2020 Report: An Overview
Vision
Mission
Overarching Goals
Dietary Reference Intakes (DRIs)
Recommended Dietary Allowances (RDAs)
Dietary Guidelines for Americans
MyPlate
USDA MyPlate Resources
Six Key Nutrients
FIGURE 16-2 MyPlate.
Canada’s Food Guide
Carbohydrates
Sources of Carbohydrates
Foods That Cause Tooth Decay
FIGURE 16-3 Eating Well with Canada’s Food Guide.
TABLE 16-1 Dietary Fiber in Some Common Foods
Proteins
TABLE 16-2 Diet Recommendations for Common Dental Conditions
Sources of Protein
Fats (Lipids)
Cholesterol
Antioxidants
TABLE 16-3 Common Sources of Fats and Cholesterol
Sources of Antioxidants
Vitamins
Minerals
TABLE 16-4 Vitamins: Best Sources, Primary Functions, Deficiency Symptoms, and Toxicity
Water
TABLE 16-5 Minerals: Best Sources, Primary Functions, Deficiency Symptoms, and Toxicity
Diet Modification
Dietary Analysis
Reading Food Labels
FIGURE 16-4 Food diary. Typically used for 1 to 7 days. (A customizable version is available on Evolve.)
Product Label Information
Labeling Ingredients
FIGURE 16-5 Nutrition facts label.
Label Claims
Organic Foods
Box 16-3 Food Label Terminology
Calories
Fat
Cholesterol
Sodium
Fiber
Sugar
Healthy
Eating Disorders
TABLE 16-6 Common Diet-Related Disorders
Bulimia
Anorexia Nervosa
Female Athlete Triad
Management of Eating Disorders
Healthy Habits
▪ Patient Education
▪ Legal and Ethical Implications
▪ Eye to the Future
▪ Critical Thinking
Pageburst Integrated Resources
17 Oral Pathology
Electronic Resources
Learning Outcomes
Key Terms
Making a Diagnosis
Historical Diagnosis
Clinical Diagnosis
FIGURE 17-1 Dentinogenesis imperfecta.
FIGURE 17-2 Melanin pigmentation.
FIGURE 17-3 Fissured tongue.
Radiographic Diagnosis
Microscopic Diagnosis
Laboratory Diagnosis
Therapeutic Diagnosis
FIGURE 17-4 A, Clinical appearance of bilateral mandibular tori. B, Clinical appearance of lobulated torus palatinus.
Surgical Diagnosis
Differential Diagnosis
FIGURE 17-5 Median rhomboid glossitis (arrow).
FIGURE 17-6 Periapical pathology.
FIGURE 17-7 Internal resorption (arrow).
FIGURE 17-8 Horizontal impaction of the third molar.
FIGURE 17-9 The arrow points to a white lesion on the anterior floor and ventral surface of the tongue.
FIGURE 17-10 The arrow points to angular cheilitis.
FIGURE 17-11 The arrow points to a traumatic bone cyst.
FIGURE 17-12 The arrow points to static bone cyst.
Acute/Chronic Inflammation
Classic Signs of Inflammation
Oral Lesions
Lesions Extending Below Mucosal Surface
FIGURE 17-13 Radiographs of dentigerous cysts around the crown of an unerupted bicuspid (A) and an impacted third molar (B).
Lesions Extending Above Mucosal Surface
Lesions Even With Mucosal Surface
Raised or Flat Lesions
Diseases of the Oral Soft Tissues
Leukoplakia
Lichen Planus
FIGURE 17-14 Leukoplakia.
FIGURE 17-15 Lichen planus on the buccal mucosa.
Candidiasis
Pseudomembranous Candidiasis
FIGURE 17-16 Pseudomembranous candidiasis.
FIGURE 17-17 Chronic hyperplastic candidiasis. The white appearance of the tongue did not wipe off, and it disappeared with antifungal treatment.
Hyperplastic Candidiasis
Atrophic Candidiasis
Aphthous Ulcers
FIGURE 17-18 Minor aphthous ulcer.
Cellulitis
FIGURE 17-19 Cellulitis. Swelling is caused by increased local edema associated with a dental infection. The patient was hospitalized for treatment of the swelling.
Conditions of the Tongue
FIGURE 17-20 Black hairy tongue.
FIGURE 17-21 Geographic tongue.
FIGURE 17-22 Fissured tongue and attrition of the teeth.
FIGURE 17-23 Pernicious anemia. Angular cheilitis and depapillation of the tongue in a patient with pernicious anemia.
Oral Cancer
FIGURE 17-24 Clinical appearance of squamous cell carcinoma of the lower lip.
TABLE 17-1 Appearance of Early Cancer
Oral Cancer Warning Signs
Leukemia
FIGURE 17-25 Left side of a panoramic radiograph shows destruction of the mandible by squamous cell carcinoma.
Smokeless Tobacco
Therapy for Oral Cancer
FIGURE 17-26 Leukemia.
FIGURE 17-27 Tobacco chewer’s white lesion. Note the rough texture of the surface.
Dental Implications of Radiation Therapy
FIGURE 17-28 A and B, Radiation mucositis. C, Postradiation xerostomia.
Xerostomia
Radiation Caries
Osteoradionecrosis
Dental Implications of Chemotherapy
Human Immunodeficiency Virus and Acquired Immunodeficiency Syndrome
TABLE 17-2 Dental Implications of Chemotherapy
Oral Manifestations
HIV Gingivitis
HIV Periodontitis
Oral Lesions Associated With Hiv Infection
Cervical Lymphadenopathy
FIGURE 17-29 Atypical periodontal disease in a patient with human immunodeficiency virus (HIV) infection.
Candidiasis
Lymphoma
FIGURE 17-30 Lymphadenopathy (arrow).
FIGURE 17-31 Candidiasis in a patient with human immunodeficiency virus (HIV) infection. Removable plaques are present on the mucosa of the soft palate.
Hairy Leukoplakia
FIGURE 17-32 Intraoral lymphoma (arrow) in a patient with acquired immunodeficiency syndrome (AIDS).
FIGURE 17-33 Hairy leukoplakia (arrow) on the lateral borders of the tongue.
Kaposi’s Sarcoma
FIGURE 17-34 Kaposi’s sarcoma (arrows) in a patient with acquired immunodeficiency syndrome (AIDS). A, Skin. B, Gingivae.
FIGURE 17-35 Herpes simplex ulceration of the hard palate in a patient with human immunodeficiency virus (HIV) infection. Arrows point to the periphery of the ulcer.
Herpes Simplex
Herpes Zoster
Human Papillomavirus
FIGURE 17-36 Papillary lesion (arrows) of the upper lip caused by human papillomavirus in a patient with human immunodeficiency virus (HIV) infection.
Developmental Disorders
Genetic Factors
TABLE 17-3 Dental Developmental Disturbances
Environmental Factors
Known Teratogens Involved in Congenital Malformations
Drugs
Chemicals
Infections
Radiation
Disturbances in Jaw Development
FIGURE 17-37 Discoloration of teeth caused by tetracycline ingestion.
Disturbances in Lip, Palate, and Tongue Development
FIGURE 17-38 A newborn with bilateral complete cleft lip and palate. Note severe angulation of the premaxillary segment.
FIGURE 17-39 Ankyloglossia. Restriction of movement of the tongue due to a lingual frenum that is abnormally short or is attached too close to the tip of the tongue.
FIGURE 17-40 Partial anodontia.
Disturbances in Tooth Development and Eruption
FIGURE 17-41 Radiograph shows unerupted supernumerary teeth.
FIGURE 17-42 Dens in dente.
FIGURE 17-43 Hutchinson’s incisors.
FIGURE 17-44 A, Clinical picture of fusion involving a permanent lateral incisor. B, Fusion of mandibular molars.
FIGURE 17-45 Note loss of enamel in these teeth in a patient with hypocalcified amelogenesis imperfecta.
Disturbances in Enamel Formation
Disturbances in Dentin Formation
Abnormal Eruption of the Teeth
Premature Eruption
Ankylosis
Impaction
FIGURE 17-46 A radiograph of ankylosis of a deciduous molar.
FIGURE 17-47 Impactions in mixed dentition visible on a dental radiograph.
FIGURE 17-48 Abrasion at the cervical area of mandibular premolars caused by toothbrushing.
Miscellaneous Disorders
Abrasion
Attrition
Bruxism
FIGURE 17-49 A, Attrition of adult dentition. B, Attrition of adult dentition (incisal view).
FIGURE 17-50 Attrition of the mandibular anterior teeth resulting from bruxism.
Bulimia
FIGURE 17-51 Pierced tongue with jewelry.
Orofacial Piercings
Meth Mouth
Some Common Meth Ingredients
FIGURE 17-52 Meth mouth.
Signs and Symptoms of Meth Use
Early Meth Use
Continued Meth Use
Advanced Meth Use
Meth Overdose
▪ Patient Education
▪ Legal and Ethical Implications
▪ Eye to the Future
▪ Critical Thinking
Pageburst Integrated Resources
Part Four Infection Prevention in Dentistry
Infection Prevention in Dentistry
Interactive Review – Part 4
18 Microbiology
Electronic Resources
Learning Outcomes
Key Terms
Pioneers in Microbiology
FIGURE 18-1 Colonies of bacteria are growing in the culture medium in this Petri plate.
Koch’s Postulates
FIGURE 18-2 Discovery of rabies vaccine by Louis Pasteur, 1885.
Major Groups of Microorganisms
FIGURE 18-3 Louis Pasteur is honored at the Sorbonne.
Bacteria
Shape
Gram-Positive and Gram-Negative Bacteria
Need for Oxygen
Capsules
Spores
FIGURE 18-4 Three basic shapes of bacteria.
FIGURE 18-5 Colonies of streptococci growing on agar medium are diagnostic for strep throat.
FIGURE 18-6 Golden-yellow colonies of staphylococci.
FIGURE 18-7 Gram-positive stain.
FIGURE 18-8 Gram-negative stain.
Rickettsiae
Algae
Protozoa
Fungi
Prions
FIGURE 18-9 A, Multiple white plaques of pseudomembranous candidiasis (thrush) in an individual infected with human immunodeficiency virus (HIV). B, Candida-associated denture stomatitis with the edentulous maxillary arch.
Prion Diseases
Future Research
Viruses
Specificity
Latency
TABLE 18-1 Primary Types of Hepatitis
Treatment of Viral Diseases
Transmission of Viral Diseases
Viruses in the Environment
Viral Diseases
Viral Hepatitis
Hepatitis A
Hepatitis B
Hepatitis B Immunization.
Questions Frequently Asked About Viral Hepatitis
Who Should Get the HBV Vaccine?
Hepatitis C
Hepatitis D
Hepatitis E
Tips for Remembering Types of Hepatitis
Human Immunodeficiency Virus
Herpesviruses
Herpes Simplex Virus Type 1
Primary Herpes.
TABLE 18-2 Types of Human Herpesviruses
Recurrent Herpes Labialis.
Herpes Simplex Virus Type 2
FIGURE 18-10 Herpes labialis. A, 12 hours after onset. B, 48 hours after onset.
Herpes Zoster Virus
Cytomegalovirus
Epstein-Barr Virus
Herpes Transmission
West Nile Virus
H1N1 Flu Virus (Swine Flu)
FIGURE 18-11 A colonized transmission electron micrograph (TEM) image showing the presence of a number of novel H1N1 virus virons in a tissue sample.
TABLE 18-3 Types of Influenza
Bacterial Diseases
Tuberculosis
FIGURE 18-12 Bacteria in biofilm taken from dental unit waterlines.
Legionnaires’ Disease
Tetanus
FIGURE 18-13 A, Chancre on tongue seen in primary syphilis. B, Chancre on lip.
Syphilis
Methicillin-Resistant Staphylococcus Aureus (MRSA)
Pandemic Diseases
FIGURE 18-14 A, Magnified 20,000×, the colorized scanning electron micrograph (SEM) depicts a grouping of methicillin-resistant Staphylococcus aureus (MRSA) bacteria. B, MRSA-caused skin infection depicting a cutaneous abscess on the back of the shoulder.
▪ Legal and Ethical Implications
▪ Eye to the Future
▪ Critical Thinking
Pageburst Integrated Resources
19 Disease Transmission and Infection Prevention
Electronic Resources
Learning Outcomes
Key Terms
The Chain of Infection
Overview of the CDC Infection Control Recommendations for Dentistry
Infectious Agent
Reservoir
FIGURE 19-1 At least one part must be removed to break the chain of infection.
Portal of Entry
Susceptible Host
Types of Infections
Acute Infection
Chronic Infection
Latent Infection
Opportunistic Infection
Modes of Disease Transmission
FIGURE 19-2 Pathogens can be transferred from staff to patient, patient to staff, and patient to patient through contaminated equipment.
Primary Modes of Disease Transmission in Dentistry
Direct Transmission
Indirect Transmission
Airborne Transmission
Aerosol, Spray, or Spatter
FIGURE 19-3 Aerosol from an ultrasonic scaler.
Parenteral Transmission
Blood-Borne Transmission
Food and Water Transmission
Fecal-Oral Transmission
The Immune System
FIGURE 19-4 Acquired immunity.
Naturally Acquired Immunity
Artificially Acquired Immunity
Disease Transmission in the Dental Office
Patient to Dental Team
Dental Team to Patient
Patient to Patient
Dental Office to Community
Box 19-1 Rare Case of Hepatitis B Patient-to-Patient Transmission in a Dental Office
Box 19-2 Patient-To-Patient Transmission of Hepatitis C in Dentist’s Office
Community to Dental Office to Patient
Roles and Responsibilities of the CDC and OSHA in Infection Control
Guidelines for Infection Control in Dental Healthcare Settings (CDC)
FIGURE 19-5 CDC Guidelines for Infection Control in Dental Healthcare Settings—2003.
OSHA Blood-Borne Pathogens Standard
CDC Rankings of Evidence
Exposure Control Plan
Standard and Universal Precautions
Written Exposure Control Plan Required by OSHA
Overview of CDC Guidelines for Infection Control in Dental Healthcare Settings—2003
Standard Precautions
OSHA Blood-Borne Pathogens Standard Training Requirements
Categories of Employees
TABLE 19-1 Occupational Exposure Determination
Postexposure Management
Management of an Exposure Incident*
Follow-Up Measures for Exposed Worker
Employee Training
Hepatitis B Immunization
Employee Medical Records
FIGURE 19-6 Standard hepatitis B virus (HBV) informed refusal.
Postvaccine Testing
Requirements for Employee Medical Records
Managing Contaminated Sharps
FIGURE 19-7 A puncture-resistant sharps disposal container should be located as close as possible to the area where the disposal of sharps takes place.
FIGURE 19-8 UltraSafety Plus XL aspirating syringe. A, Ready for injection. B, Needle sheathed to prevent needle-stick injury.
Guidelines for Needles
Preventing Needle Sticks
FIGURE 19-9 ProTector disposable needle guard.
Infection Control Practices
Hand Hygiene
Handwashing Guidelines
FIGURE 19-10 Areas of the hand not thoroughly washed because of poor handwashing technique.
FIGURE 19-11 Sensing device automatically turns the water on and off with hands-free operation.
Alcohol-Based Hand Rubs
FIGURE 19-12 Alcohol-based hand rub agents are available for refillable wall-mounted containers, in counter size, and in purse size.
Hand Care Recommendations
Personal Protective Equipment
Hand Hygiene in Dental Healthcare Settings
Overview of 2002 CDC Hand Hygiene Guidelines
Method for Decontaminating Hands
General Recommendations for Hand Hygiene
Special Considerations for Hand Hygiene
Hand Care Products
FIGURE 19-13 Water-based hand products will not break down latex gloves.
FIGURE 19-14 Appropriate clinical attire consists of long-sleeved gowns, gloves, and eyewear.
FIGURE 19-15 Depending on the task, the dental assistant’s attire might consist of scrubs, lab coats, or surgical gowns. A, Dental assistant in scrubs. B, Dental assistant in lab coat. C, Dental assistant in surgical gown.
Protective Clothing
Protective Clothing Requirements
FIGURE 19-16 Containers of contaminated laundry must be labeled with the universal biohazard symbol.
Handling Contaminated Laundry
Guidelines for the Use of Protective Clothing
FIGURE 19-17 Fluid-impervious gown.
Protective Masks
Protective Eyewear
FIGURE 19-18 Flat (A) and dome-shaped or molded (B) types of face masks.
FIGURE 19-19 Face masks should never be worn below the nose or on the chin.
FIGURE 19-20 A, Face mask and safety glasses. B, Face mask and disposable face shield.
Guidelines for the Use of Protective Masks
Face Shields
FIGURE 19-21 Face shields provide adequate eye protection, but a face mask is still required when one is assisting with aerosol-generating procedures.
Patient Eyewear
Gloves
FIGURE 19-22 A, Patients should be provided with protective eyewear. B, Combination patient protective eyewear and mask.
Guidelines for the Use of Gloves
Box 19-3 Types of Gloves in Dentistry
Patient Care Gloves
Utility Gloves
Other Gloves
Gloves
Gloves Damaged During Treatment
Gloves Damaged by Dental Materials
Examination Gloves
Overgloves
FIGURE 19-23 Nonsterile examination gloves.
FIGURE 19-24 Overglove worn over an examination glove.
Guidelines for the Use of Overgloves
Sterile Surgical Gloves
Sterile Surgeon’s Gloves
Utility Gloves
FIGURE 19-25 Utility gloves are used when instruments are prepared for sterilization.
FIGURE 19-26 Latex-free nitrile gloves.
Non–Latex-Containing Gloves
Maintaining Infection Control While Gloved
Opening Drawers and Cabinets
Opening Containers
High-Tech Equipment
Examples of High-Tech Equipment
Latex Allergies
FIGURE 19-27 Computer keyboard with a smooth surface that allows for effective cleaning and disinfection.
Box 19-4 Infection Control Considerations for High-Tech Equipment
Box 19-5 Care of Patients With Latex Allergies
CDC Guidelines for Contact Dermatitis and Latex Hypersensitivity
FIGURE 19-28 Irritant dermatitis.
Irritant Dermatitis
Type IV Allergic Reaction
Type I Allergic Reaction
Treatment
Latex-Sensitive Patients
Waste Management in the Dental Office
Classification of Waste
TABLE 19-2 Classification of Waste
CDC Guidelines for Regulated Medical Waste
General Waste
Contaminated Waste
Hazardous Waste
Infectious or Regulated Waste (Biohazard)
Handling Extracted Teeth
CDC Guidelines for Handling Extracted Teeth
Handling Contaminated Waste
Handling Medical Waste
Infectious Waste
FIGURE 19-29 Waste is separated into clearly marked containers. Left, Unregulated waste. Right, Regulated waste.
Disposal of Medical Waste
Additional Infection Control Practices
OSHA Blood-Borne Pathogens Standard
CDC Guidelines: Special Considerations
Saliva Ejectors
Saliva Ejector
Dental Laboratory
FIGURE 19-30 Pouch for lab cases with the biohazard label.
FIGURE 19-31 This denture has large amounts of calculus adhering to it.
FIGURE 19-32 Impression trays are heat-sterilized in individual bags.
CDC Guidelines for Dental Laboratories
Preprocedural Mouth Rinses
Mycobacterium tuberculosis
CDC Guidelines for Mycobacterium tuberculosis
Creutzfeldt-Jakob Disease and Other Prion Diseases
Creutzfeldt-Jakob Disease
Laser/Electrosurgery Plumes or Surgical Smoke
Laser/Electrosurgery Plumes/Surgical Smoke
▪ Legal and Ethical Implications
▪ Eye to the Future
▪ Critical Thinking
Procedure 19-1 Applying First Aid After an Exposure Incident
Goal
Equipment and Supplies
Procedural Steps
Procedure 19-2 Handwashing Before Gloving
Goal
Equipment and Supplies
Procedural Steps
Procedure 19-3 Applying Alcohol-Based Hand Rubs
Goal
Equipment and Supplies
Procedural Steps
Procedure 19-4 Putting on Personal Protective Equipment
Goal
Equipment and Supplies
Procedural Steps
Procedure 19-5 Removing Personal Protective Equipment
Goal
Equipment and Supplies
Procedural Steps
Eyewear
Masks
Protective Clothing
Procedure 19-6 Disinfecting an Alginate Impression
Goal
Equipment and Supplies
Procedural Steps
Pageburst Integrated Resources
20 Principles and Techniques of Disinfection
Electronic Resources
Learning Outcomes
Key Terms
Environmental Infection Control
Rankings of Evidence
Clinical Contact Surfaces
CDC Recommendations for Environmental Infection Control
General Recommendations
Clinical Contact Surfaces
Housekeeping Surfaces
FIGURE 20-1 Touch surfaces (A); transfer surfaces (B); and splash, spatter, and droplet surfaces (C).
TABLE 20-1 Comparison of Surface Barriers and Precleaning/Disinfection
Surface Contamination
Surface Barriers
FIGURE 20-2 Smooth surfaces are easily sprayed and wiped.
FIGURE 20-3 An example of water on a fluid-resistant material.
FIGURE 20-4 Surfaces touched during patient care should be covered with protective barriers. If not protected, they should be cleaned and disinfected at the end of the procedure.
Surfaces Typically Protected with Barriers*
FIGURE 20-5 Rolls of plastic tubing that can be cut to the desired length.
FIGURE 20-6 Tube socks provide barrier protection for difficult-to-clean areas.
Clinical Contact Surfaces
Single-Use (Disposable) Items
Single-Use (Disposable) Devices
Disposable or Not?
Always Single-Use-Only Items
Either Disposable or Reusable
Precleaning and Disinfection
Personal Protective Equipment (PPE)
Precleaning.
TABLE 20-2 Chemical Classification of Disinfectants
Disinfection.
Disinfectants
FIGURE 20-7 Disposable premoistened wipes with tuberculocidal activity.
Ideal Surface Disinfectant.
Disinfectant Precautions
FIGURE 20-8 Decreasing order of resistance of microorganisms to germicidal chemicals.
TABLE 20-3 OSAP Surface Disinfectant Reference Chart—2010
TABLE 20-4 EPA-Registered Surface Disinfectants for Dentistry
Iodophors.
Synthetic Phenol Compounds.
FIGURE 20-9 Iodophor surface disinfectant.
FIGURE 20-10 Synthetic phenol disinfectant.
Sodium Hypochlorite.
Alcohol.
Immersion Disinfectants.
Glutaraldehyde
Chlorine Dioxide
Ortho-Phthalaldehyde
TABLE 20-5 FDA-Cleared Instrument-Immersion Disinfectants for Dentistry
FIGURE 20-11 Covered instrument tray for use with immersion disinfectants.
Evacuator System
Traps
Housekeeping Surfaces
FIGURE 20-12 A, ProE-Vac liquid evacuation system cleaner. B, Convenient closed container for transporting solution between units.
Carpeting and Cloth Furnishings
Spills of Blood and Body Substances
Carpeting
Managing Spills
Greener Infection Control
Greener Infection Control
Green Resources
Paper
Radiology
Personal Protective Attire
Surface Barriers and Precleaning/Disinfection
▪ Legal and Ethical Implications
▪ Eye to the Future
▪ Critical Thinking
Procedure 20-1 Placing and Removing Surface Barriers
Goal
Equipment and Supplies
Procedural Steps
Procedure 20-2 Performing Treatment Room Cleaning and Disinfection
Goal
Equipment and Supplies
Procedural Steps
Pageburst Integrated Resources
21 Principles and Techniques of Instrument Processing and Sterilization
Electronic Resources
Learning Outcomes
Key Terms
Rankings of Evidence
Classification of Patient Care Items
TABLE 21-1 Seven Steps for Instrument Processing
CDC Guidelines for Sterilization and Disinfection of Patient Care Items
General Recommendations
Critical Instruments
Semicritical Instruments
Noncritical Instruments
TABLE 21-2 CDC Classification of Instruments and Procedures
Personal Protective Equipment
Transporting and Processing Contaminated Patient Care Items
Instrument-Processing Area
FIGURE 21-1 Personal protective equipment (PPE) must be worn while instruments are prepared for sterilization.
CDC Guidelines for Receiving, Cleaning, and Decontamination Procedures
CDC Guidelines for Instrument-Processing Area
Terms Used in Instrument Processing
Workflow Pattern
Contaminated Area
Preparation and Packaging Area
Precleaning and Packaging Instruments
Holding Solution
FIGURE 21-2 Instrument-processing areas. A, Linear. B, U-shaped.
FIGURE 21-3 Waste items are properly discarded.
FIGURE 21-4 A modern sterilization center.
Hand Scrubbing
FIGURE 21-5 Commercial holding solutions are available for use in precleaning.
Ultrasonic Cleaning
FIGURE 21-6 Ultrasonic cleaning system.
FIGURE 21-7 It is important to keep the ultrasonic cleaner covered while in use to reduce spatter and contaminated aerosols.
FIGURE 21-8 A commercial all-purpose ultrasonic cleaner.
FIGURE 21-9 An enzyme ultrasonic cleaner in tablet form.
Ultrasonic Cleaning Solutions
FIGURE 21-10 Special tartar and stain remover ultrasonic solution.
Care of the Ultrasonic Cleaner
Testing the Ultrasonic Cleaner
Automated Washers/Disinfectors
Drying, Lubrication, and Corrosion Control
FIGURE 21-11 A Miele thermal disinfector provides safe and thorough instrument cleaning, disinfecting, and drying. Instruments must be packaged and sterilized after the cycle.
Packaging Instruments
CDC Guidelines for Preparation and Packaging
Packaging Materials
TABLE 21-3 Packaging Materials and Types of Sterilization
FIGURE 21-12 Self-seal packages provide an excellent wrap for sterilized materials.
Sterilization of Unwrapped Instruments
CDC Guidelines for Sterilization of Unwrapped Instruments
Methods of Sterilization
Steam Autoclave
TABLE 21-4 Advantages and Disadvantages of Sterilization Methods
TABLE 21-5 Sterilization and Disinfection Guide for Common Dental Items
FIGURE 21-13 Steam autoclave.
FIGURE 21-14 STATIM G4 autoclave.
FIGURE 21-15 Vacuum-type autoclave.
Packaging Instruments
TABLE 21-6 Typical Steam Temperatures in Sterilizing Cycle
Flash Sterilization
Unsaturated Chemical Vapor Sterilization
FIGURE 21-16 Chemical vapor sterilant solution.
Advantages
Disadvantages
Filtration and Monitoring of Chemical Vapors
Packaging
Pressure, Temperature, and Time
Dry Heat Sterilization
Static Air Sterilizers
Forced Air Sterilizers
Ethylene Oxide Sterilization
FIGURE 21-17 Forced-heat (rapid heat transfer) sterilizer.
FIGURE 21-18 SPOROX II is a high-level disinfectant/sterilizer used for instruments that cannot tolerate heat sterilization.
Liquid Chemical Sterilants
Liquid Chemical Sterilants/High-Level Disinfectants
Sterilization Failures
Sterilization Monitoring
TABLE 21-7 Results of Sterilization Errors
CDC Guidelines for Sterilization Monitoring
Physical Monitoring
Chemical Monitoring
Process Indicators
Process Integrators
FIGURE 21-19 A, Unprocessed instruments. B, Wrapped instruments after processing. Note the color change in the tape.
FIGURE 21-20 Integrator strips used inside packs to monitor time, temperature, and pressure.
FIGURE 21-21 The dental assistant inserts the integrator strip into the sterilization pouch with the instruments.
Limitations
Biologic Monitoring
FIGURE 21-22 Use of a mail-in service is a convenient method of biologic monitoring.
FIGURE 21-23 In-office biologic monitoring system.
Additional Reasons for Biologic Monitoring
Handpiece Sterilization
Flushing Techniques
Sterilizing Techniques
Storage Area for Sterilized Items and Clean Dental Supplies
Instruments and supplies stored in a closed cabinet.
▪ Legal and Ethical Implications
▪ Eye to the Future
▪ Critical Thinking
Procedure 21-1 Operating the Ultrasonic Cleaner
Goal
Equipment and Supplies
Procedural Steps
Procedure 21-2 Autoclaving Instruments
Goal
Equipment and Supplies
Procedural Steps
Load the Autoclave
Operate the Autoclave
Reassemble and Store the Trays
Procedure 21-3 Sterilizing Instruments with Unsaturated Chemical Vapor
Goal
Equipment and Supplies
Procedural Steps
Wrap the Instruments
Load and Operate the Chemical Vapor Sterilizer
Procedure 21-4 Sterilizing Instruments with Dry Heat
Goal
Equipment and Supplies
Procedural Steps
Wrap Instruments
Load and Operate the Dry Heat Sterilizer
Procedure 21-5 Sterilizing Instruments with Liquid Chemical Sterilants
Goal
Equipment and Supplies
Procedural Steps
Prepare the Solution
Use the Solution
Maintain the Solution
Procedure 21-6 Performing Biologic Monitoring
Goal
Equipment and Supplies
Procedural Steps
Procedure 21-7 Sterilizing the Dental Handpiece
Goal
Equipment and Supplies
Procedural Steps
Pageburst Integrated Resources
Part Five Occupational Health and Safety
Occupational Health and Safety
Interactive Review – Part 5
22 Regulatory and Advisory Agencies
Electronic Resources
Learning Outcomes
Key Terms
Associations and Organizations
American Dental Association
American Dental Assistants Association
ADAA Creed for Dental Assistants
TABLE 22-1 Professional Organizations
FIGURE 22-1 ADA Seal of Acceptance.
American Dental Hygienists’ Association
Organization for Safety, Asepsis and Prevention
State and Local Dental Societies
Government Agencies
Centers for Disease Control and Prevention
Food and Drug Administration
TABLE 22-2 Government Agencies
FIGURE 22-2 Overview of a dental operatory showing items (arrows) regulated by the U.S. Food and Drug Administration (FDA).
Environmental Protection Agency
Occupational Safety and Health Administration
OSHA Inspections
National Institutes of Health
National Institute of Dental and Craniofacial Research
National Institute for Occupational Safety and Health
Duties of NIOSH
Public Health Agency of Canada
Roles of the PHAC
▪ Legal and Ethical Implications
▪ Eye to the Future
▪ Critical Thinking
Pageburst Integrated Resources
23 Chemical and Waste Management
Electronic Resources
Learning Outcomes
Key Terms
Hazardous Chemicals
Exposure to Chemicals
How Chemicals Enter the Body
FIGURE 23-1 Chemical hazard warning labels.
Acute and Chronic Chemical Toxicity
Hand Protection
FIGURE 23-2 Clean room nitrile gloves provide protection and dexterity when handling chemicals.
Eye Protection
Protective Clothing
Inhalation Protection
FIGURE 23-3 Dental assistant wearing chemical goggles.
FIGURE 23-4 Disposable respirator has tapered angle to fit facial contours around nose and chin to protect against dusts and chemical mists.
Control of Chemical Spills
FIGURE 23-5 Mercury spill kit, with aspirator to pick up larger drops of mercury, labeled bottle for recovered mercury, base/activator product to absorb small amounts of mercury, product to absorb mercury vapors, gloves, scoop, sponge, mixing cups, spatulas, and labeled polyethylene bag for disposal.
Eyewash Units
Precautions When Working With Mercury
Ventilation
General Precautions for Storing Chemicals
FIGURE 23-6 A, Countertop eyewash and eye/face washes provide water to the face and eyes to gently wash away contaminants. B, A wall-mounted style of eyewash station with a card attached on which to record inspection dates.
Follow Instructions
Avoid Exposure to Light
Check Expiration Date
Rotate Inventory
Guidelines for Minimizing Exposure to Chemical Hazards in the Dental Office
Disposal of Empty Containers
Hazardous Waste Disposal
Hazard Communication Program
Revision of the HCS Standard
FIGURE 23-7 Globally Harmonized System of Classification and Labeling of Chemicals.
Major Changes to the Hazard Communication Standard
Hazard Classification
Labels
Safety Data Sheets
Information and Training
Phase-In Period
Written Program
Responsibilities of Dental Assistant As Coordinator of Hazard Communication Program
Chemical Inventory
FIGURE 23-8 A, Hazard Communication Standard pictograms. B, Sample label.
TABLE 23-1 Summary of the Phase-In Dates Required Under the Revised Hazard Communication Standard (HCS)
Safety Data Sheets
FIGURE 23-9 Example of a material safety data sheet binder.
Employee Training
TABLE 23-2 Sections of Material Safety Data Sheet (MSDS)
TABLE 23-3 Sections of Hazard Communication Safety Data Sheets (SDS)
Box 23-1 Required Format of the New Safety Data Sheets
Guide for Hazard Communication Employee Training Program
Labeling of Chemical Containers
FIGURE 23-10 Chemical disinfectants not in their original container must be clearly labeled.
National Fire Protection Association Labels
Exemptions to Labeling Requirements
Dental Office Waste Management
Dental Materials That May Be Regulated
TABLE 23-4 Types of Dental Waste
Classification of Waste
FIGURE 23-11 Classification of dental waste.
Extracted Teeth
Sharps
FIGURE 23-12 Biohazard bag and biohazard sharps containers.
Scrap Amalgam
Photochemical Waste
Radiographic Fixer
FIGURE 23-13 Radiographic solutions in holding containers.
Radiographic Developer
Lead Contamination
Lead Foil
Disinfectants
Nonhazardous Waste Management
Waste Disposal
▪ Legal and Ethical Implications
▪ Eye to the Future
▪ Critical Thinking
Procedure 23-1 Creating an Appropriate Label for a Secondary Container
Goal
Equipment and Supplies
Procedural Steps
Pageburst Integrated Resources
24 Dental Unit Waterlines
Electronic Resources
Learning Outcomes
Key Terms
Microorganisms in Dental Unit Waterlines
Background
FIGURE 24-1 Close-up of dental tube opening.
Sources of Microorganisms
TABLE 24-1 Sample Amounts of Bacteria in Dental Unit Water at Various U.S. Sites
FIGURE 24-2 A, Magnification of biofilm formation on the walls of the tube. B, Magnification of cross-section of biofilm formation in DUWL.
Biofilm
FIGURE 24-3 Bacteria in biofilm taken from DUWLs.
Biofilm in Dental Waterlines
Growth-Promoting Factors
FIGURE 24-4 Bacteria in biofilm dropping into waterlines. Some bacteria are planktonic and enter directly from the municipal water supply.
Bacterial Characteristics
Methods for Reducing Bacterial Contamination
Self-Contained Water Reservoirs
FIGURE 24-5 Self-contained dental water unit.
Box 24-1 Methods to Reduce Bacterial Contamination of Dental Unit Waterlines (DUWLS)
Microfiltration Cartridges
FIGURE 24-6 Reservoir water bottles and lines in self-contained water systems must be cleaned and disinfected according to the manufacturer’s instructions. The container under the water bottle will catch any solution drips. Note: The dental assistant is careful not to touch and contaminate the neck of the bottle.
FIGURE 24-7 The DentaPure (blue) cartridge is attached to the tube in the unit that draws the water from the bottle. As the water is drawn from the bottle and passes through the cartridge, 2 to 6 parts per million of iodine are released into the water. Then the water that is delivered to the handpiece, three-way water syringe, and ultrasonic scaler is treated.
FIGURE 24-8 A-dec ICX waterline treatment tablets help protect waterlines from contamination.
Chemical Agents
Infection Control and Dental Unit Water
Using the Proper Water
FIGURE 24-9 Water spray from ultrasonic scaler tip.
Flushing Waterlines
Minimizing Aerosol
Using Protective Barriers
Recommendations for Dental Unit Waterlines, Biofilm, and Water Quality
Monitoring Water Quality
Use of Saliva Ejectors
FIGURE 24-10 Low-volume saliva ejectors can cause backflow to occur.
Recommendations for Dental Handpieces and Other Devices Attached to Air and Waterlines
▪ Legal and Ethical Implications
▪ Eye to the Future
▪ Critical Thinking
Procedure 24-1 Testing Dental Unit Waterlines
Goal
Equipment and Supplies
Confirm Dental Unit Waterline Testing Service.
Procedural Steps
Pageburst Integrated Resources
25 Ergonomics
Electronic Resources
Learning Outcomes
Key Terms
Ergonomics in the Dental Office
Ergonomic Chairside Tips
FIGURE 25-1 Ergonomic factors in dentistry.
FIGURE 25-2 A, Dental assistant in poor position. B, Dental assistant in proper position.
Posture
Optimal Dental Assistant Positioning
Optimal Operator Positioning
FIGURE 25-3 Configuration of spine in seated dental assistant.
Neutral Position
Deviations and Problems
FIGURE 25-4 Small pieces of equipment should be kept in a location that does not require twisting or bending.
Reaching Movements
Repetition and Force
Carpal Tunnel Syndrome
FIGURE 25-5 Repetitive stress on the bend in the wrist over long periods can lead to carpal tendon injury. This dental assistant should periodically change her grasp on the oral evacuator to straighten out her wrist. She also should use the back support on her chair.
Gloves
Properly Fitting Gloves
FIGURE 25-6 A, Cross-section of the wrist. B, Schematic view of the carpal tunnel.
FIGURE 25-7 A, Arrow indicates the location of the thenar eminence on a gloved hand. B, Glove is too tight. C, Glove is too loose.
Muscle-Strengthening Exercises
▪ Legal and Ethical Implications
▪ Eye to the Future
FIGURE 25-8 Hand exercises. A, and B, Slowly open and close the hands from a completely open position to a completely closed position, ending with the fingers tucked into the palms. C, Press the palms of the hands together and then relax. D, Gently pull on and relax each finger on each hand separately. E, Cross the wrists and gently stretch and relax.
FIGURE 25-9 Full back release. Let the head move down slowly, allow the arms and head to fall between the knees, hold for a few seconds, and then raise slowly by contracting the stomach muscles and rolling up. Bring the head up last.
FIGURE 25-10 Shoulder shrugging.
▪ Critical Thinking
Pageburst Integrated Resources
Part Six Patient Information and Assessment
Patient Information and Assessment
Interactive Review – Part 6
26 The Patient Record
Electronic Resources
Learning Outcomes
Key Terms
Patient Compliance
Permanent Record
Privacy
Quality Assurance
FIGURE 26-1 Example of the patient record.
FIGURE 26-2 Business assistant instructing a patient on completing the forms.
FIGURE 26-3 Notice of privacy practices form.
FIGURE 26-4 Example of an electronic form on screen. This is from the Eagle Soft practice management program.
Risk Management
Research
Patient Record Forms
Patient Registration
Medical-Dental Health History
Medical History
Dental History
Medical Alert
Medical-Dental Health History Update
FIGURE 26-5 Example of a patient registration form.
FIGURE 26-6 Example of a two-sided medical-dental health history form. A, Medical history. B, Dental history.
FIGURE 26-7 Examples of medical alert sticker.
Clinical Examination
FIGURE 26-8 Example of the medical-dental health history update form.
FIGURE 26-9 A, Example of a clinical examination form. B, Example of a recall examination form.
Treatment Plan
Informed Consent
Progress Notes
Entering Data in a Patient Record
▪ Legal and Ethical Implications
▪ Eye to the Future
FIGURE 26-10 Example of a treatment plan form.
FIGURE 26-11 Example of the informed consent form.
FIGURE 26-12 Example of a progress notes form.
Standards and Criteria for Data Entered in a Clinical Record
▪ Critical Thinking
Procedure 26-1 Registering a New Patient
Equipment and Supplies
Procedural Steps
Procedure 26-2 Obtaining a Medical-Dental Health History
Equipment and Supplies
Procedural Steps
Procedure 26-3 Entering Treatment in a Patient Record
Equipment and Supplies
Procedural Steps
Procedure 26-4 Correcting a Chart Entry
Goal
Procedural Steps
Pageburst Integrated Resources
27 Vital Signs
Electronic Resources
Learning Outcomes
Key Terms
Factors That Affect Vital Signs
Temperature
Temperature Readings
Types of Thermometers
Digital
FIGURE 27-1 A digital thermometer.
Tympanic
Glass
FIGURE 27-2 A tympanic thermometer.
FIGURE 27-3 A glass thermometer showing the mercury bulb.
Pulse
Radial Artery
Brachial Artery
FIGURE 27-4 Location of the radial artery.
FIGURE 27-5 Location of the brachial artery.
FIGURE 27-6 Location of the carotid artery.
Carotid Artery
Pulse Characteristics
Pulse Readings
Respiration
Respiration Characteristics
FIGURE 27-7 Respiration patterns. Bradypnea is an abnormally slow respiratory rate. Tachypnea is excessively short, rapid breaths, and hyperventilation is excessively long, rapid breaths.
Respiration Readings
Blood Pressure
TABLE 27-1 Blood Pressure Classification for Adults
Blood Pressure Equipment
FIGURE 27-8 Types of sphygmomanometers. A, Aneroid (without liquid) dial system. B, Aneroid floor model.
FIGURE 27-9 Stethoscope.
TABLE 27-2 Five Phases of Korotkoff Sounds in Blood Pressure Measurement
FIGURE 27-10 Automated electronic blood pressure devices. A, Arm-cuff model. B, Wrist-cuff model.
Blood Pressure Readings
Medical Considerations
FIGURE 27-11 Pulse oximetry.
Advanced Monitoring Procedures
Pulse Oximetry
Electrocardiogram
FIGURE 27-12 Chest leads for ECG.
FIGURE 27-13 Recording of ECG.
TABLE 27-3 The Cardiac Cycle
▪ Patient Education
▪ Legal and Ethical Implications
▪ Eye to the Future
▪ Critical Thinking
Procedure 27-1 Taking an Oral Temperature Reading with a Digital Thermometer
Equipment and Supplies
Procedural Steps
Procedure 27-2 Taking a Patient’s Pulse
Equipment and Supplies
Procedural Steps
Procedure 27-3 Taking a Patient’s Respiration
Equipment and Supplies
Procedural Steps
Procedure 27-4 Taking a Patient’s Blood Pressure
Equipment and Supplies
Procedural Steps
Procedure 27-5 Taking a Patient’s Pulse Oximetry (Expanded Function)
Equipment and Supplies
Procedural Steps
Procedure 27-6 Taking a Patient’s ECG (Expanded Function)
Equipment and Supplies
Procedural Steps
Pageburst Integrated Resources
28 Oral Diagnosis and Treatment Planning
Electronic Resources
Learning Outcomes
Key Terms
Examination and Diagnostic Techniques
Visual Evaluation
Palpation
Instrumentation
FIGURE 28-1 Detecting decay.
Detection
Probing
Radiography
Intraoral Imaging
FIGURE 28-2 Using a periodontal probe to measure the sulcus.
FIGURE 28-3 Example of a bitewing intraoral radiograph.
Photography
FIGURE 28-4 Example of a panoramic extraoral radiograph.
FIGURE 28-5 An intraoral imaging system is used to evaluate the condition and educate the patient.
Recording the Dental Examination
FIGURE 28-6 Photographs are taken to provide a visual evaluation of the patient.
Tooth Diagrams
FIGURE 28-7 Example of an anatomic diagram for charting conditions of the mouth.
FIGURE 28-8 Example of a geometric diagram for charting conditions of the mouth.
FIGURE 28-9 Electronic charting.
Tooth-Numbering Systems
Universal Numbering System
International Standards Organization System/Fédération Dentaire Internationale System
Palmer Notation System
Color Coding
Black’s Classification of Cavities
FIGURE 28-10 A, Universal numbering system. B, International Standards Organization System/Fédération Dentaire Internationale numbering system. C, Palmer notation system. See Interactive Resources Box for linking to labeling exercises.
Abbreviations
TABLE 28-1 Black’s Classification of Cavities
Charting
Symbols
Clinical Examination of the Patient
TABLE 28-2 Commonly Used Charting Symbols
Soft Tissue Examination
Examination and Charting of the Teeth
Examination and Charting of the Periodontium
Box 28-1 Description of Probing Scores
Box 28-2 Classification of Furcations
Box 28-3 Classification of Dental Mobility
The Treatment Plan
Types of Treatment Plans
Level I: Emergency Care
Level II: Standard Care
Level III: Optimum Care
Treatment Plan Presentation
▪ Patient Education
▪ Legal and Ethical Implications
▪ Eye to the Future
▪ Critical Thinking
FIGURE 28-11 Treatment plan form presented following treatment plan presentation.
FIGURE 28-12 Financial arrangements form.
Procedure 28-1 Extraoral and Intraoral Photography (Expanded Function)
Equipment and Supplies
Procedural Steps
Readying Your Camera
Readying Your Patient
Taking Photographs
Procedure 28-2 The Soft Tissue Examination (Expanded Function)
Equipment and Supplies
Procedural Steps
Patient Preparation
Extraoral Features
Cervical Lymph Nodes
Temporomandibular Joint
Indications of Oral Habits
Interior of the Lips
Oral Mucosa and Tongue
Floor of the Mouth
Procedure 28-3 Charting of Teeth
Equipment and Supplies
Procedural Steps
Patient Preparation
Examination of the Teeth and Occlusion
Procedure 28-4 Periodontal Screening: Examination of the Gingival Tissues
Equipment and Supplies
Procedural Steps
Pageburst Integrated Resources
29 The Special Needs and Medically Compromised Patient
Electronic Resources
Learning Outcomes
Key Terms
Role of the Dental Assistant
The Aging Population
Stages of Aging
Oral Health of the Aging
Oral Health Conditions
Xerostomia
FIGURE 29-1 Aging person.
Periodontal Disease
Tooth Decay
Dark and Brittle Teeth
Bone Resorption
The Special Needs Patient
FIGURE 29-2 Example of a medication profile for a patient.
FIGURE 29-3 Periodontal conditions of an older patient.
FIGURE 29-4 Root caries of a tooth in an older patient.
FIGURE 29-5 Darkened teeth associated with secondary dentin and aging.
FIGURE 29-6 Bone resorption with loss of teeth and alveolar ridge.
Assistance From Organizations
Specific Disorders of the Medically Compromised Patient
Developmental Disorders
Intellectual Disability
Down Syndrome
Autism
Cerebral Palsy
Physical Disorders
Vision Impairment
Clinical Considerations for Visually Impaired Patients
Hearing Impairment
FIGURE 29-7 Escorting a vision-impaired patient.
Clinical Considerations for Hearing-Impaired Patients
The Patient in a Wheelchair
FIGURE 29-8 Handicapped sticker.
Neurologic Disorders
Alzheimer’s Disease
Clinical Considerations for Alzheimer’s Disease
Seizures
Petit Mal Seizures.
Grand Mal Seizures.
Clinical Considerations for Seizures
Multiple Sclerosis
Clinical Considerations for Multiple Sclerosis
Stroke
FIGURE 29-9 Effects of a cerebrovascular accident (stroke).
Clinical Considerations for a Patient with History of Stroke
Neuromuscular Disorders
Clinical Considerations for Neuromuscular Disorders
Muscular Dystrophy
Parkinson’s Disease
Amyotrophic Lateral Sclerosis (ALS)
Arthritis
Rheumatoid Arthritis (RA).
Osteoarthritis.
FIGURE 29-10 Effects of rheumatoid arthritis on the body.
Clinical Considerations for Arthritis
Cardiovascular Disorders
Clinical Considerations for Cardiovascular Disorders
Congestive Heart Failure
Hypertension
Angina
Endocarditis
Pulmonary Disorders
Allergies
FIGURE 29-11 Effects of increased blood pressure.
Clinical Considerations for Allergies
Bronchial Asthma
Clinical Considerations for Bronchial Asthma
Chronic Obstructive Pulmonary Disease
Clinical Considerations for COPD
FIGURE 29-12 Appearance of a patient with chronic obstructive pulmonary disease (COPD).
Blood Disorders
Clinical Considerations for Blood Disorders
Endocrine Disorders
Hyperthyroidism
Clinical Considerations for Hyperthyroidism
Hypothyroidism
Diabetes Mellitus
Clinical Considerations for Diabetes Mellitus
Behavioral and Psychiatric Disorders
Clinical Considerations for Behavioral and Psychiatric Disorders
▪ Legal and Ethical Implications
▪ Eye to the Future
▪ Critical Thinking
Procedure 29-1 Transferring a Patient from a Wheelchair
Equipment
Procedural Steps
Pageburst Integrated Resources
30 Principles of Pharmacology
Electronic Resources
Learning Outcomes
Key Terms
Overview of Drugs
Dispensing of Drugs
Controlled Substance Act
Schedule I Drugs
Schedule II Drugs
Schedule III Drugs
Schedule IV Drugs
Schedule V Drugs
Prescriptions
Prescription Terminology
TABLE 30-1 Common Prescription Abbreviations
Recording Prescriptions
Telephone Guidelines
FIGURE 30-1 Example of a prescription pad.
Drug Reference Materials
Package Inserts
Drug Dosage
Administration of Medications
Stages of Drug Action in the Body
Drugs Commonly Prescribed in Dentistry
Analgesics
Antibiotics
TABLE 30-2 Routes of Drug Administration
Antibiotic Prophylaxis
Antifungal Agents
Antiviral Agents
Antianxiety Agents
Drugs Commonly Prescribed in Medicine
TABLE 30-3 American Heart Association Antibiotic Recommendations for a Dental Procedure
Cardiovascular Drugs
Respiratory Drugs
Gastrointestinal Drugs
Neurologic Drugs
Psychoactive Drugs
Endocrine/Hormonal Drugs
Adverse Drug Effects
Common Adverse Effects of Medications
Drug Complications
▪ Patient Education
▪ Legal and Ethical Implications
▪ Eye to the Future
▪ Critical Thinking
Pageburst Integrated Resources
31 Assisting in a Medical Emergency
Electronic Resources
Learning Outcomes
Key Terms
Preventing a Medical Emergency
Emergency Preparedness
FIGURE 31-1 It is important to have open communication with emergency personnel.
Assigned Roles
Routine Drills
Emergency Telephone Numbers
FIGURE 31-2 Preparing oxygen for an emergency.
FIGURE 31-3 The dental assistant has repositioned the patient and is assessing vital signs.
FIGURE 31-4 Poster shows the most common number to be dialed for emergency services—911.
FIGURE 31-5 Emergency medical services personnel on the scene.
Recognizing a Medical Emergency
Signs and Symptoms
Emergency Care Standards
Basic Life Support
Cardiopulmonary Resuscitation
Choking
Automated External Defibrillator
Emergency Equipment and Supplies
Oxygen
FIGURE 31-6 Standardized color-coded basic emergency kit.
Emergency Responses
TABLE 31-1 Drugs Used in Medical Emergencies
FIGURE 31-7 Examples of an oxygen cylinder.
Common Medical Emergencies Experienced in the Dental Office
Syncope
Postural Hypotension
The Pregnant Patient
Cardiac Emergencies
Angina
Acute Myocardial Infarction
Cerebrovascular Accident
Hyperventilation
Asthma Attack
Allergic Reaction
Epileptic Seizure
Diabetes Mellitus
Hyperglycemia
Hypoglycemia
Documentation of an Emergency
▪ Patient Education
▪ Legal and Ethical Implications
▪ Eye to the Future
▪ Critical Thinking
Emergency Procedure 31-1 Performing Cardiopulmonary Resuscitation (One Person)
Equipment and Supplies
Procedural Steps for Adult, Child, Infant CPR
Determine Unresponsiveness
Initiate Assistance
Initiate Compressions
Airway and Ventilation
Emergency Procedure 31-2 Responding to the Patient with an Obstructed Airway
Signs and Symptoms
Procedural Steps
Care of the Patient
Responding to the Conscious Seated Patient
Emergency Procedure 31-3 Operating the Automated External Defibrillator
Equipment and Supplies
Procedural Steps
Emergency Procedure 31-4 Preparing the Oxygen System
Equipment and Supplies
Procedural Steps
Emergency Procedure 31-5 Responding to the Unconscious Patient
Syncope (Fainting)
Signs and Symptoms
Response Steps
Postural Hypotension
Signs and Symptoms
Response Steps
Emergency Procedure 31-6 Responding to the Patient with Chest Pain
Angina Attack
Signs and Symptoms
Response Steps
Acute Myocardial Infarction (Heart Attack)
Signs and Symptoms
Response Steps
Emergency Procedure 31-7 Responding to the Patient Who Is Experiencing a Cerebrovascular Accident (Stroke)
Signs and Symptoms
Response Steps
Emergency Procedure 31-8 Responding to the Patient with a Breathing Problem
Hyperventilation
Signs and Symptoms
Response Steps
Asthma Attack
Signs and Symptoms
Response Steps
Emergency Procedure 31-9 Responding to the Patient Who Is Experiencing an Allergic Reaction
Localized Rash
Signs and Symptoms
Response Steps
Anaphylaxis
Signs and Symptoms
Response Steps
Emergency Procedure 31-10 Responding to the Patient Who Is Experiencing a Convulsive Seizure
Grand Mal Seizure
Signs and Symptoms
Response Steps
Petit Mal Seizure
Signs and Symptoms
Response Steps
Emergency Procedure 31-11 Responding to the Patient Who Is Experiencing a Diabetic Emergency
Hyperglycemia
Signs and Symptoms
Response Steps
Hypoglycemia
Signs and Symptoms
Response Steps
Pageburst Integrated Resources
Part Seven Foundation of Clinical Dentistry
Foundation of Clinical Dentistry
Interactive Review – Part 7
32 The Dental Office
Electronic Resources
Learning Outcomes
Key Terms
Design of the Dental Office
FIGURE 32-1 Design of the dental office varies depending on the need.
FIGURE 32-2 Reception area of a dental office.
FIGURE 32-3 Part of a reception area designed for children.
Reception Area
Administrative Area
Treatment Area
Central Sterilization
FIGURE 32-4 Organization and design of the business area.
FIGURE 32-5 Typical office dental treatment area.
Dental Laboratory
Dentist’s Private Office
Dental Staff Lounge
Office Environment
Temperature and Air Exchange
Lighting
Wall and Floor Coverings
FIGURE 32-6 Traffic control.
Traffic Control
Sound Control
Privacy
FIGURE 32-7 Patient dental chair.
Clinical Equipment
Patient Dental Chair
FIGURE 32-8 Design of the headrest on a dental chair.
FIGURE 32-9 Different parts of the unit may be controlled by buttons on a dental chair.
FIGURE 32-10 Upright position of a patient in a dental chair.
Operator’s Stool
Dental Assistant’s Stool
FIGURE 32-11 Patient in a supine position in a dental chair.
FIGURE 32-12 Left, Dental assistant’s stool. Right, Operator’s stool.
Dental Unit
FIGURE 32-13 Dental unit.
Delivery Systems
Rheostat
Waterlines
FIGURE 32-14 A, Diagram showing front delivery system. B, Diagram showing side delivery system. C, Diagram showing rear delivery system.
FIGURE 32-15 A rheostat controls the handpieces of the dental unit.
FIGURE 32-16 Air-water syringe.
Air-Water Syringe
Operating Light
FIGURE 32-17 Operating light.
FIGURE 32-18 Oral evacuation system that contains a saliva ejector, a high-volume evacuator, and an air-water syringe.
Oral Evacuation System
Curing Light
FIGURE 32-19 A cordless curing light is used to harden dental materials.
Amalgamator
Dental Radiography Unit
FIGURE 32-20 Amalgamator.
FIGURE 32-21 Radiography unit.
View Box for Radiographs
FIGURE 32-22 View box.
Care of Dental Equipment
Central Vacuum Compressor
Central Air Compressor
FIGURE 32-23 Disposable traps must be changed weekly to ensure proper functioning of the vacuum system.
Morning and Evening Routines for Dental Assistants
▪ Patient Education
▪ Eye to the Future
▪ Critical Thinking
Procedure 32-1 Performing the Morning Routine (Opening the Office)
Procedural Steps
Procedure 32-2 Performing the Evening Routine (Closing the Office)
Procedural Steps
Pageburst Integrated Resources
33 Delivering Dental Care
Electronic Resources
Learning Outcomes
Key Terms
Knowing Your Patients
Reviewing the Patient Record
Preparing the Treatment Area
Greeting and Seating the Patient
Team Dentistry
Principles of Team Positioning
Positioning the Patient
FIGURE 33-1 The concept of four-handed dentistry is shown in the positioning of the patient and dental team members.
Positioning the Operator
FIGURE 33-2 Distance from the operator’s face to the patient’s face when positioned correctly.
FIGURE 33-3 Position of the operator when seated correctly.
FIGURE 33-4 Position of the dental assistant when seated correctly.
Positioning the Dental Assistant
Motion Economy
Classification of Motions
Operating Zones
Operator’s Zone
Transfer Zone
FIGURE 33-5 Operating zones for a right-handed operator.
FIGURE 33-6 Operating zones for a left-handed operator.
Assistant’s Zone
Static Zone
Instrument Transfer
Objectives of Efficient Instrument Transfer
Grasping an Instrument
Transfer Technique
FIGURE 33-7 Basic instrument grasps. A, Pen grasp. B, Palm grasp. C, Palm-thumb grasp.
Variations in Instrument Exchange
Mirror and Explorer
Cotton Pliers
FIGURE 33-8 The dentist prepares to receive the mirror and explorer by positioning the hand on either side of the patient’s head.
FIGURE 33-9 The assistant transfers the cotton pliers, ensuring that the ends are together so as not to drop the item.
FIGURE 33-10 Transferring the handpiece.
FIGURE 33-11 Transferring scissors so the dentist can grasp them correctly.
Handpiece
Instruments with Hinges
Expanded Functions
Dental Supervision
Working as the Operator
Operator Positioning
Developing Mirror Skills
TABLE 33-1 Suggested Positioning of the Operator and the Patient According to Areas of the Mouth Being Treated
FIGURE 33-12 Positioning the mirror to correctly reflect the image of the teeth.
Establish a Working Position.
Establish Preferred Mirror-to-Tooth Position.
Using a Fulcrum
FIGURE 33-13 Using a fulcrum to stabilize the hand and the instrument.
Understanding Dental Anatomy
Understanding Cavity Preparations
Adapting Instrumentation
Applying Dental Materials
Evaluation of Expanded Functions
▪ Patient Education
▪ Legal and Ethical Implications
▪ Eye to the Future
▪ Critical Thinking
Procedure 33-1 Admitting and Seating of the Patient
Procedural Steps
Procedure 33-2 Transferring Instruments with the Single-Handed Technique
Procedural Steps
Procedure 33-3 Transferring Instruments with the Two-Handed Technique
Procedural Steps
Procedure 33-4 Using the Dental Mirror Intraorally
Equipment and Supplies
Procedural Steps
Procedure 33-5 Using an Instrument Intraorally (Expanded Function)
Equipment and Supplies
Procedural Steps
Pageburst Integrated Resources
34 Dental Hand Instruments
Electronic Resources
Learning Outcomes
Key Terms
Identifying Hand Instruments
Instrument Number
Instrument Design
Handle
Shank
FIGURE 34-1 Catalog or call number associated with Howe pliers.
FIGURE 34-2 The three parts of a dental hand instrument.
Working End
Black’s Instrument Formula
FIGURE 34-3 Black’s instrument formula.
TABLE 34-1 Numbers in G.V. Black’s Instrument Formula
Instrument Classification
FIGURE 34-4 Tray setup showing appropriate sequence of instruments. 1, Examination instruments. 2, Hand cutting instruments. 3, Restorative instruments. 4, Accessory instruments.
Instrument Sequence
Examination Instruments
Basic Setup
TABLE 34-2 Examination Instruments
FIGURE 34-5 Basic setup that includes mouth mirror, explorer, and cotton forceps (pliers).
Hand Cutting Instruments
FIGURE 34-6 Uses for the mouth mirror. A, Indirect vision allows the operator to see areas of the mouth that are not visible on direct vision. B, Light reflection directs light into areas of the mouth that are not directly accessible with the operating light. C, Retraction maintains a clear operating field by keeping the tongue or cheek out of the way during a procedure. D, Tissue protection helps guard the tongue or cheek against accidental injury caused by a dental bur.
Restorative Instruments
FIGURE 34-7 Transferring mirror and explorer simultaneously to the operator.
Accessory Instruments and Items
TABLE 34-3 Hand (Manual) Cutting Instruments
TABLE 34-4 Restorative Instruments
TABLE 34-5 Accessory Instruments and Items
Preset Cassettes (Trays)
FIGURE 34-8 Cassette for a preventive procedure.
Storage Tubs
FIGURE 34-9 Preset restorative tray.
FIGURE 34-10 Storage tub holding additional items needed for a procedure.
Color-Coding Systems
▪ Legal and Ethical Implications
FIGURE 34-11 Color-coding system for instruments.
▪ Eye to the Future
▪ Critical Thinking
Procedure 34-1 Identifying Examination Instruments
Equipment and Supplies
Procedural Steps
Procedure 34-2 Identifying Hand (Manual) Cutting Instruments
Equipment and Supplies
Procedural Steps
Procedure 34-3 Identifying Restorative Instruments
Equipment and Supplies
Procedural Steps
Procedure 34-4 Identifying Accessory Instruments and Items
Equipment and Supplies
Procedural Steps
Pageburst Integrated Resources
35 Dental Handpieces and Accessories
Electronic Resources
Learning Outcomes
Key Terms
Evolution of Rotary Equipment
Dental Handpieces
Low-Speed Handpiece
FIGURE 35-1 Low-speed handpiece with straight attachment.
FIGURE 35-2 Low-speed handpiece with contra-angle attachment. 1. Contra-angle attachment, 2. Slow-speed motor
FIGURE 35-3 Prophy Slow-speed handpiece motor.
FIGURE 35-4 Straight attachment slides onto the slow-speed motor.
Uses of the Low-Speed Handpiece
Clinical
Laboratory
Straight Attachment
FIGURE 35-5 Contra-angle attachment on the low-speed handpiece.
FIGURE 35-6 Disposable prophy cup and brush.
Contra-Angle Attachment
Prophylaxis Angle
FIGURE 35-7 High-speed handpiece.
High-Speed Handpiece
Uses of the High-Speed Handpiece
Water Coolant System
Bur Adaptation
FIGURE 35-8 Different styles of securing burs in the handpiece.
FIGURE 35-9 A fiber optic light provides better illumination of an area for the operator.
Fiber Optic Lighting
Ultrasonic Handpiece
FIGURE 35-10 Ultrasonic handpiece.
FIGURE 35-11 Soft tissue diode laser.
Laser Handpiece
Precautions in the Care and Handling of Laser Handpieces
Air Abrasion Handpiece
FIGURE 35-12 Air abrasion handpiece.
Laboratory Handpiece
Handpiece Maintenance
FIGURE 35-13 Lubrication system.
Handpiece Sterilization
General Considerations for Handpiece Sterilization
Sterilization Procedure Sheets.
Rotary Cutting Instruments
FIGURE 35-14 Bur parts and types of shanks. A, Long straight lab. B, Latch-type. C, Friction-grip.
Shank Types
Neck
Head
Dental Burs
Bur Shapes
Diamond Rotary Instruments
TABLE 35-1 Burs for Restorative Dentistry
Box 35-1 Indications for Using Diamond Burs
Finishing Rotary Instruments
FIGURE 35-15 Finishing burs.
Abrasive Rotary Instruments
FIGURE 35-16 Accessory attachments for rotary instruments. A, Silicon carbide produces a moderately rough surface. It is available in wheels, points, and stones, and the color varies from gray-green to black. It is used for polishing metal restorations. B, Rubber points come in varying colors, depending on their abrasiveness. The brown is the most abrasive, with green having less abrasiveness, and then white a polishing point. C, Cuttlebone is most often adhered to discs and points. It is used for final finishing and polishing of the restoration. D, Sandpaper discs refer to sand particles adhered to flexible paper discs or strips as a medium abrasive. They are used for finishing and polishing a restoration. 1, Snap on metal center. 2, Screw on. E, Carborundum particles adhered to disc. As with carborundum on burs, it is used to cut or separate one structure from another.
Accessories
Laboratory Rotary Instruments
FIGURE 35-17 Types of mandrels.
FIGURE 35-18 Varying shapes of laboratory acrylic burs.
▪ Legal and Ethical Implications
▪ Eye to the Future
▪ Critical Thinking
Procedure 35-1 Identifying and Attaching Dental Handpieces
Equipment and Supplies
Procedural Steps
Procedure 35-2 Identifying and Attaching Burs for Rotary Cutting Instruments
Equipment and Supplies
Procedural Steps
Pageburst Integrated Resources
36 Moisture Control
Electronic Resources
Learning Outcomes
Key Terms
Oral Evacuation Systems
Saliva Ejector
High-Volume Evacuator
FIGURE 36-1 Saliva ejector.
FIGURE 36-2 Saliva ejector placed under the tongue for a procedure.
Suction Tips
FIGURE 36-3 High-volume evacuator (HVE) tips. A, Stainless steel evacuator tip. B, Plastic evacuator tip.
FIGURE 36-4 Stainless steel (top) and plastic (bottom) surgical evacuation tips.
FIGURE 36-5 Grasps used for operating the high-volume evacuator (HVE). Top, Thumb-to-nose grasp. Bottom, Pen grasp.
Grasping the Evacuator
FIGURE 36-6 High-volume evacuator (HVE) tip positioned on a posterior tooth closest to you.
Positioning the Evacuator
Daily Maintenance of the Evacuation System
FIGURE 36-7 High-volume evacuator (HVE) tip positioned on anterior tooth opposite of handpiece placement.
Rinsing the Oral Cavity
Limited-Area Rinsing
Full-Mouth Rinsing
FIGURE 36-8 Air-water syringe with multiple tips. A, Disposable plastic syringe tip for single use. B, Metal syringe tip.
Air-Water Syringe
Isolation of Teeth
Cotton Roll Isolation
Advantages
Disadvantages
FIGURE 36-9 Cotton roll isolation in the mandibular quadrant.
Cotton Roll Holders
Dry-Angle Isolation
FIGURE 36-10 Cotton roll holder.
FIGURE 36-11 Placement of dry angle in the buccal mucosa.
The Dental Dam
Dental Dam Equipment
Dental Dam Material
FIGURE 36-12 Dental dam material.
Size
Color
Thickness
Dental Dam Frame
FIGURE 36-13 Dental dam frames.
Dental Dam Napkin
Lubricants
Dental Dam Punch
FIGURE 36-14 Dental dam punch.
Size of Holes on the Punch Plate.
Dental Dam Stamp and Template
Dental Dam Forceps
FIGURE 36-15 Sizes of holes for punching the dental dam and coordinating teeth with the sizes of punched holes.
FIGURE 36-16 Dental dam stamp.
Dental Dam Clamps
Parts of the Dental Dam Clamp.
FIGURE 36-17 Dental dam forceps.
FIGURE 36-18 Positioning the beaks of the dental dam forceps into the clamp properly.
Fitting the Dental Dam Clamp.
FIGURE 36-19 Parts of the dental dam clamp.
Ligatures on Clamps.
Dental Dam Stabilizing Cord
FIGURE 36-20 Types of dental dam clamps.
FIGURE 36-21 Ligature placed on the bow of the clamp for protective reasons.
Dental Dam Preparation
FIGURE 36-22 Punching the dam for a maxillary application.
FIGURE 36-23 Punching the dam for a mandibular application.
Maxillary Arch Application
Mandibular Arch Application
Curve of the Arch
Malaligned Teeth
Teeth to Be Isolated
FIGURE 36-24 Punching the dam for a malaligned tooth.
Keypunch Hole
Hole Sizing and Spacing
Troubleshooting Hole Sizing and Spacing.
Dental Dam Placement and Removal
FIGURE 36-25 Maxillary anterior dam application.
Special Applications for the Dental Dam
Anterior Teeth
Stabilizing the Cervical Clamp.
FIGURE 36-26 Compound wax used to stabilize anterior clamp.
Fixed Bridge
▪ Patient Education
▪ Legal and Ethical Implications
▪ Eye to the Future
▪ Critical Thinking
Procedure 36-1 Positioning the High-Volume Evacuator During a Procedure
Equipment and Supplies
Procedural Steps
Posterior Placement
Anterior Placement
Procedure 36-2 Performing a Mouth Rinse
Equipment and Supplies
Procedural Steps
Limited-Area Mouth Rinse
Full-Mouth Rinse
Procedure 36-3 Placing and Removing Cotton Rolls
Equipment and Supplies
Procedural Steps
Maxillary Placement
Mandibular Placement
Cotton Roll Removal
Procedure 36-4 Preparing, Placing, and Removing the Dental Dam (Expanded Function)
Prerequisites for the Expanded-Functions Dental Assistant (EFDA) When Performing This Function
Equipment and Supplies
Procedural Steps
Patient Preparation
Punching the Dental Dam
Placing the Clamp and the Frame
Inverting the Dam
Removing the Dam
Pageburst Integrated Resources
37 Anesthesia and Pain Control
Electronic Resources
Learning Outcomes
Key Terms
Topical Anesthesia
Local Anesthesia
Characteristics of Local Anesthetics
FIGURE 37-1 Topical anesthetic.
FIGURE 37-2 Topical gel patch.
Method of Action
Chemical Composition of Anesthetics
Time Span of Anesthetics
Vasoconstrictors in Anesthetics
TABLE 37-1 Commonly Used Dental Anesthetics
Contraindications to Vasoconstrictors
Injection Techniques
Maxillary Anesthesia
Palatal Anesthesia
Mandibular Anesthesia
FIGURE 37-3 Maxillary injections. A, Local infiltration. B, Field block. C, Nerve block.
FIGURE 37-4 Palatal injections. A, Greater palatine. B, Nasopalatine nerve block.
Periodontal Ligament Injection
Local Anesthesia Setup
Anesthetic Syringe
FIGURE 37-5 Mandibular injections. A, Inferior alveolar. B, Buccal nerve block. C, Incisive nerve block.
FIGURE 37-6 Periodontal ligament injection.
FIGURE 37-7 Anesthetic syringe.
FIGURE 37-8 Anesthetic cartridges.
Anesthetic Cartridges
Color-Coding of Local Anesthetic Cartridges.
FIGURE 37-9 Local anesthetic cartridges packaged in blister packs.
Guidelines for Handling Anesthetic Cartridges
Disposable Needle
FIGURE 37-10 Anesthesia color codes.
FIGURE 37-11 Outer covering for the needle.
FIGURE 37-12 Sterile needle. 1, cartridge end of needle; 2, needle hub; 3, injection end of needle; 4, protective cap; 5, seal on cap; 6, need guard.
Complications and Precautions
Injection Into a Blood Vessel
Infected Areas
Toxic Reactions
Localized Reactions.
Systemic Reactions.
Temporary Numbness
Paresthesia
Electronic Anesthesia
FIGURE 37-13 Electronic anesthesia showing electrode placement for mandibular procedures. A, Anterior and premolar teeth. B, Posterior teeth.
Inhalation Sedation
Advantages of N2O Use
Disadvantages of N2O Use
FIGURE 37-14 Portable N2O system unit.
Contraindications to N2O Use
Pregnancy
Nasal Obstruction
Emphysema and Multiple Sclerosis
Emotional Instability
Chemical Makeup
Equipment
FIGURE 37-15 N2O and O2 cylinders are stored away from the clinical setting.
FIGURE 37-16 Nasal masks used for inhalation.
FIGURE 37-17 Scavenger system attached to mask and evacuation unit to redirect unused N2O gas.
Scavenger System
Reducing Exposure to N2O
Patient Assessment and Monitoring
Patient Education
Administration
Antianxiety Agents
Intravenous Sedation
General Anesthesia
Four Stages of Anesthesia
Patient Preparation
Patient Education
Patient Recovery
Documentation of Anesthesia and Pain Control
▪ Patient Education
▪ Legal and Ethical Implications
▪ Eye to the Future
▪ Critical Thinking
Procedure 37-1 Applying a Topical Anesthetic
Equipment and Supplies
Procedural Steps
Preparation
Placement
Procedure 37-2 Assembling the Local Anesthetic Syringe
Equipment and Supplies
Procedural Steps
Selecting the Anesthetic
Loading the Anesthetic Cartridge
Placing the Needle on the Syringe
Procedure 37-3 Assisting in the Administration of Local Anesthesia
Equipment and Supplies
Procedural Steps
Procedure 37-4 Assisting in the Administration and Monitoring of Nitrous Oxide/Oxygen Sedation (Expanded Function)
Prerequisites for the Efda and the Rda
Equipment and Supplies
Procedural Steps
Administration
Oxygenation
Pageburst Integrated Resources
Part Eight Radiographic Imaging
Radiographic Imaging
Interactive Review – Part 8
38 Foundations of Radiography, Radiographic Equipment, and Radiation Safety
Electronic Resources
Learning Outcomes
Key Terms
Uses of Dental Images
Discovery of X-Radiation
Pioneers in Dental Radiography
FIGURE 38-1 A, Wilhelm Conrad Roentgen (1845–1923), the discoverer of x-rays. B, A Crookes tube, which Roentgen worked with at the time of his discovery of x-rays in 1895.
FIGURE 38-2 First radiograph of the human body, showing the hand of Roentgen’s wife.
Radiation Physics
TABLE 38-1 Highlights in the History of Dental Radiography
Atomic Structure
Nucleus
FIGURE 38-3 A, Diagrammatic representation of an oxygen atom. B, A molecule of water (H2O) consists of two atoms of hydrogen connected to one atom of oxygen.
Electrons
Bremsstrahlung Radiation
Ionization
Properties of X-Rays
FIGURE 38-4 Bremsstrahlung radiation. This radiation occurs in the target anode material. The incoming electron (from the cathode) slows as it is drawn to the nucleus of the atom. Some of the energy lost in the deceleration is emitted as an x-ray photon with energy equal to that lost by the electron.
FIGURE 38-5 Ionization occurs when an electron is removed from the orbital shell of the electronically stable atom.
FIGURE 38-6 Electromagnetic spectrum, showing the various wavelengths of radiation typically used.
Box 38-1 Characteristics of X-Rays
FIGURE 38-7 A, A wavelength is the distance between the crest (peak) of one wave and the crest of the next. B, Frequency is the number of wavelengths that pass a given point in a certain amount of time. The shorter the wavelength, the higher the frequency will be, and vice versa.
The Dental X-Ray Machine
Tubehead
FIGURE 38-8 Dental x-ray machine. A, Tubehead. B, Position indicator device. C, Extension arm. D, Control panel.
X-Ray Tube
Cathode
FIGURE 38-9 Diagram of the dental x-ray tubehead.
FIGURE 38-10 X-ray tube.
FIGURE 38-11 This x-ray tubehead has a round position indicator device.
FIGURE 38-12 Federal regulations require that the diameter of a collimated x-ray beam be restricted to 2.75 inches at the patient’s skin. PID, Position indicator device.
Anode
FIGURE 38-13 A and B, Rectangular collimation.
FIGURE 38-14 The arrows point to the position indicator device.
Position Indicator Device
Extension Arm
Control Panel
Master Switch and Indicator Lights
FIGURE 38-15 A, Heliodent intraoral x-ray machine. B, GX-770 intraoral x-ray machine.
FIGURE 38-16 The operator stands at the control panel located outside the x-ray room.
Exposure Button
Milliamperage Selector
Kilovoltage Selector
X-Ray Production
FIGURE 38-17 The production of dental images occurs in the x-ray tube. 1, When the filament circuit is activated, the filament heats up, and thermionic emission occurs. 2, When the exposure button is activated, the electrons are accelerated from the cathode to the anode. 3, Electrons strike the tungsten target, and their kinetic energy is converted to x-rays and heat.
Types of Radiation
FIGURE 38-18 Types of radiation interaction with the patient: primary, secondary, and scatter.
Radiolucent and Radiopaque Characteristics
FIGURE 38-19 Bitewing radiograph showing radiopaque (white, a area of amalgam reatoration and radiolucent (black, b) area of air and cheek tissue.
Characteristics of X-Ray Beam
Quality
Quantity
FIGURE 38-20 Kilovoltage peak (kV0) and milliamperage (mA) controls are located on the dental x-ray machine.
Intensity
Contrast
FIGURE 38-21 A, Diagnostic radiograph. B, Increase in kilovoltage results in an image that exhibits increased density; the image appears darker.
FIGURE 38-22 A, Diagnostic radiograph. B, Decrease in kilovoltage results in an image that exhibits decreased density; the image appears lighter.
TABLE 38-2 Influence of X-Ray Beam Factors on Density and Contrast of Images
Density
FIGURE 38-23 A, Image produced with lower kilovoltage exhibits high contrast; many light and dark areas are seen, as is demonstrated by the use of a stepwedge. B, Image produced by higher kilovoltage exhibits low contrast; many shades of gray are seen instead of black and white.
Geometric Characteristics
FIGURE 38-24 Sign indicating a radiation hazard area.
Radiation Effects
Tissue Damage
TABLE 38-3 Disorders of Critical Organs Resulting from Cumulative Radiation Exposure
Ionization
Biologic Effects
Cumulative Effects
Acute and Chronic Radiation Exposure
Genetic and Somatic Effects
TABLE 38-4 Relative Radiation Sensitivity of Cells and Tissues
Critical Organs
FIGURE 38-25 Comparison of somatic and genetic effects of radiation.
Radiation Measurement
TABLE 38-5 Units Of Radiation Measurement
Maximum Permissible Dose
Radiation Safety
Dentist’s Responsibilities for Dental Imaging
Protective Devices
Aluminum Filtration
Collimator
TABLE 38-6 Radiation Sources and Whole Body Exposure
TABLE 38-7 Examples of Selection Criteria for Prescribing Radiographs
Position Indicator Device
Patient Protection
Lead Apron and Thyroid Collar
Fast-Speed Film
FIGURE 38-26 The longer (16-inch) position indicator device (PID) is preferred to the short (8-inch) PID because it produces less divergence of the x-ray beam.
FIGURE 38-27 A, The lead apron and the thyroid collar must be large enough to cover the seated patient from the neck to above the knees. B, Examples of lead aprons designed specifically for children.
FIGURE 38-28 The patient’s fingers are unnecessarily exposed to radiation when film/sensor holders are not used.
Image Receptor-Holding Devices
Exposure Factor
Proper Technique
Pregnancy
FIGURE 38-29 For safety, the dental assistant must stand out of the path of the primary beam.
Operator Protection and Monitoring
Radiation Monitoring
FIGURE 38-30 A radiation monitoring badge is used to monitor the amount of radiation that reaches the dental radiographer.
Rules of Radiation Protection
Equipment Monitoring
FIGURE 38-31 Child sitting on parent’s lap for dental x-ray.
Pediatric Patients
ALARA Concept
▪ Patient Education
▪ Legal and Ethical Implications
▪ Eye to the Future
▪ Critical Thinking
Pageburst Integrated Resources
39 Digital Imaging, Dental Film, and Processing Radiographs
Electronic Resources
Learning Outcomes
Key Terms
Digital Radiography
FIGURE 39-1 A rear-mounted computer monitor allows the dental team to refer to the images and the patient record. A flat screen computer monitor is mounted from the ceiling, so patients can watch videos of their choice during dental treatment.
FIGURE 39-2 Digital images of a patient chart and digital panoramic image on a computer.
Types of Digital Imaging Systems
Direct Digital Imaging
Indirect Digital Imaging
Phosphor Storage Imaging
Digitizing Images
FIGURE 39-3 Dexis Platinum Sensor: 1, Sensor housing. 2, Integrated electronics to maximize the imaging area. 3, Scatter guard to prevent x-ray back-scatter. 4, The x-ray beam is converted into visible light. 5, Fiber optics transmit light to the sensor for clear images. 6, High-resolution sensor brings out the smallest details.
FIGURE 39-4 A, Cable-type sensor. B, Wireless sensor.
FIGURE 39-5 Barrier envelope for phosphor plate.
FIGURE 39-6 Front and back sides of phosphor plate.
FIGURE 39-7 The desktop scanner scans the radiographs and digitizes the images to be viewed on a computer.
Digital Imaging Software Programs
X-Ray Film and Film Processing
Positioning Instruments
FIGURE 39-8 Example of how images can be manipulated with the software program. A, Changed contrast. B, Pseudocolor alteration. C, Inversion of image.
FIGURE 39-9 A, Snap-a-Ray Xtra Film and phosphor plate holder for the bisecting technique. B, Eezee-Grip Digital Sensor Holder for the bisecting technique.
Box 39-1 Advantages and Disadvantages of Digital Radiography
Advantages
Immediate Viewing of Images
Less Radiation
No Chemicals
Ability to Enhance Images
Communication With Other Dentists
No More Lost Films
Remote Consultation Capability
Disadvantages
Cost
Converting Previous Records to Digital
Learning the Computer Software
Thickness and Rigidity of Sensors
Infection Control
Beam Alignment Devices
FIGURE 39-10 Plastic- and styrofoam-type disposable bite-block film holders.
FIGURE 39-11 The EndoRay is designed to be used for images of teeth with endodontic instruments in them.
Dental Film
Film Composition
Latent Image
Film Speed
FIGURE 39-12 A, Rinn sensors suitable for Gendex, VisualiX, USB/GX, Cygnus, and Visiodent systems. B, Digital sensor holding device.
FIGURE 39-13 Cross-sectional diagram of film base and emulsion.
FIGURE 39-14 Scanning electron micrograph of unprocessed emulsion of pre-2006 Kodak Ultra-Speed dental film (5000× magnification). Note white-appearing, unexposed silver bromide grains.
FIGURE 39-15 Insight is the F-speed film available from Kodak.
Types of Film
FIGURE 39-16 Contents of a dental film packet: lead foil, radiograph film, and black paper.
Intraoral Film
Film Packet
Packet Information.
Wrapper and Lead Sheet.
FIGURE 39-17 The lead foil insert in this package has a raised diamond pattern across both ends.
FIGURE 39-18 A radiograph that was positioned backward in the mouth will have a herringbone pattern on it.
Package Positioning.
Package Disposal.
FIGURE 39-19 The white side of the film packet faces the tube. A, Size #4 occlusal film. B, Size #2 film. C, Size #1 film.
Outer Packet
Tube Side.
Label Side.
Film Sizes
FIGURE 39-20 Panoramic x-ray film.
FIGURE 39-21 Cephalometric radiograph.
Extraoral Film
Film Packaging
FIGURE 39-22 Boxes of extraoral x-ray film.
Film Cassette
FIGURE 39-23 The dental assistant removes a film from a flexible film cassette.
FIGURE 39-24 Rigid-type film cassette with an intensifying screen.
Intensifying Screen
Film Types
Duplicating Film
FIGURE 39-25 Example of a film duplicator.
Film Storage
Film Processing
TABLE 39-1 Developer Composition
Five Steps in Processing
TABLE 39-2 Fixer Composition
FIGURE 39-26 Concentrated solutions of film developer and fixer.
Processing Solutions
The Darkroom
Requirements for a Film Processing Darkroom
Lighting
Room Lighting.
Safelighting.
FIGURE 39-27 A distance of at least 4 feet must separate the safelight from the working area.
Processing Tanks
FIGURE 39-28 Processing tanks show developing and fixing tank inserts in bath of running water.
TABLE 39-3 Processing Temperatures and Times
Automatic Processor
FIGURE 39-29 A, A typical automatic film processor used in the dental office. B, A daylight loader, which may be attached to the top of an automatic processor.
FIGURE 39-30 Component parts of the automatic processor.
Components
Processing Solutions
Processing Errors
Box 39-2 Preventing Problems in Automatic Processors
TABLE 39-4 Time and Temperature Errors and Solutions for Manual Processing
TABLE 39-5 Chemical Contamination Errors and Solutions for Manual Processing
TABLE 39-6 Film Handling Errors and Solutions for Manual Processing
TABLE 39-7 Lighting Errors and Solutions
FIGURE 39-31 Radiograph processing errors. A, Overdevelopment. B, Developer splash. C, Scratched film. D, Water spots. E, Solution too low. F, Roller marks. G, Fingerprints. H, Overlapped films. I, Underdeveloped. J, Reticulation. K, Fixer spots. L, Developer cutoff. M, Number of errors. N, Fixer cutoff. O, Air bubbles. P, Black fingerprint. Q, Static electricity. R, Exposure to light. S, Fogged film.
▪ Legal and Ethical Implications
▪ Eye to the Future
▪ Critical Thinking
Procedure 39-1 Duplicating Dental Radiographs
Goal
Equipment and Supplies
Procedural Steps
Procedure 39-2 Processing Dental Films Manually
Goal
Equipment and Supplies
Procedural Steps
Preparation
Processing
Procedure 39-3 Processing Dental Films in an Automatic Film Processor
Equipment and Supplies
Procedural Steps
Pageburst Integrated Resources
40 Legal Issues, Quality Assurance, and Infection Prevention
Electronic Resources
Learning Outcomes
Key Terms
Legal Considerations
Federal and State Regulations
Licensure Requirements
Risk Management
Informed Consent
Liability
Patient Records
Ownership of Dental Radiographs
Digital Files Security
Patient Refusal
Patient Education
FIGURE 40-1 The dental assistant explains the importance of radiographs and answers the patient’s questions regarding the safety of dental x-rays.
Quality Assurance in the Dental Office
Quality Control Tests
Types of Quality Control Tests
Dental X-Ray Machines
X-Ray Machine Quality Control Steps
Dental X-Ray Film
Phosphor Storage Plates
Screens and Cassettes
View Boxes
FIGURE 40-2 View box with clean Plexiglas and new bulb.
Darkroom Lighting
Safelight Test.
Film Processing
FIGURE 40-3 A, Unexposed film with coin on it. B, Radiograph showing outline of coin.
Manual Processing.
Automatic Processing.
Processing Solutions.
Developer Strength.
Reference Radiograph.
Stepwedge Radiograph.
FIGURE 40-4 Radiograph of a stepwedge.
Fixer Strength.
Quality Administration Procedures
Administrative Quality Control Steps
Description
Monitoring
Maintenance
Evaluation
Training
Infection Control
Centers for Disease Control and Prevention Guidelines
Guidelines for Dental Radiology
The Radiography Operatory
X-Ray Machine
Lead Apron
Dental Chair
FIGURE 40-5 X-ray exposure control with barriers in place.
Work Area
Checklist for Infection Control in Dental Radiography
Before Exposure
Treatment Area (Covered or Disinfected)
Equipment and Supplies (Prepared Before Seating Patient)
Patient Preparation (Performed Before Putting on Gloves)
Operator Preparation (Completed Before Exposure)
During Exposure
Film/PSP Handling
Positioning Devices
After Exposure
Before Glove Removal
After Glove Removal
FIGURE 40-6 Radiography operatory with barriers in place.
Surfaces Likely to Be Contaminated During X-Ray Procedures
Equipment and Supplies
Film and Phosphor Storage Plates
Film.
FIGURE 40-7 A, A plastic surface barrier is placed over the work surface. B, After each exposure, the dental assistant wipes the film dry using a paper towel and then places the exposed film into a plastic bag that has been taped to the wall.
FIGURE 40-8 Protective barrier on x-ray film.
FIGURE 40-9 Steps to open a size 2 film packet without contaminating the film. A, Method for removing films from packet and not touching them with contaminated gloves. Open tab, and slide lead foil and black interleaf paper from wrapping. B, Rotate contaminated film packet away from black paper and foil and discard. C, Peel back paper wrapping away from film. D, Allow film to fall into a clean cup.
PSPs.
Digital Sensors
Image Receptor Positioning Instruments
Procedures During and After X-Ray Exposure
Operator Preparation
FIGURE 40-10 Protective packet barrier over phosphor storage plate (PSP).
FIGURE 40-11 FDA-cleared sensor and cable barriers.
FIGURE 40-12 Disposable film positioner.
Drying of Exposed Film or PSP
FIGURE 40-13 After placing the lead apron and assembling materials, the dental assistant will put on her gloves and, if necessary, a face mask.
Collection of Contaminated Films and PSPs
Positioning Instruments
Disposal of Contaminated Items
Handwashing
Surface Disinfection
Procedures During X-Ray Film Processing
Transporting Film
Infection Control Steps in Dental Imaging
Treatment Area
Preparation of Patient and Operator
Exposure of Image
After Exposure of Images
▪ Legal and Ethical Implications
▪ Eye to the Future
▪ Critical Thinking
Procedure 40-1 Practicing Infection Control During Film Exposure
Goal
Equipment and Supplies
Procedural Steps
Procedure 40-2 Practicing Infection Control in the Darkroom
Goal
Equipment and Supplies
Procedural Steps
Procedure 40-3 Practicing Infection Control with Use of Daylight Loader
Goal
Equipment and Supplies
Procedural Steps
Procedure 40-4 Practicing Infection Control with Digital Sensors
Goal
Equipment and Supplies
Procedural Steps
Procedure 40-5 Practicing Infection Control with Phosphor Storage Plates (PSPs)
Goal
Equipment and Supplies
Procedural Steps
Exposures
Preparing PSPs for Scanning
Scanning the PSP
Pageburst Integrated Resources
41 Intraoral Imaging
Electronic Resources
Learning Outcomes
Key Terms
Full-Mouth Survey
FIGURE 41-1 Steps to quality dental images.
FIGURE 41-2 Bitewing radiograph. Note that only the crowns and the alveolar ridge are visible, but not the entire root.
Intraoral Imaging Techniques
Paralleling Technique
Five Basic Rules
FIGURE 41-3 A, Anterior periapical. B, Posterior periapical. Note that the entire tooth and surrounding bone are visible on the radiograph.
FIGURE 41-4 A, Full-mouth survey using digital sensor. B, Mounted full-mouth series with eight anterior films using the paralleling technique.
FIGURE 41-5 Intraoral x-ray techniques. A, Bisecting angle technique. B, Paralleling technique.
FIGURE 41-6 A, Parallel lines are always separated by the same distance and do not intersect. B, Intersecting lines cross one another. C, Perpendicular lines intersect one another to form right angles. D, Right angle measures 90 degrees and is formed by two perpendicular lines.
FIGURE 41-7 A, Long axis of maxillary incisor divides the tooth into two equal halves. B, Long axis of mandibular premolar divides the tooth into two equal halves.
Patient Preparation
FIGURE 41-8 Position of the film sensor, teeth, position indicator device (PID), and central ray of the x-ray beam in the paralleling technique. The film sensor and the long axis of the tooth are parallel. The central ray (CR) is perpendicular to the tooth and the film sensor. An increased distance (16 inches) is required.
FIGURE 41-9 In this diagram, x-rays pass through the contact areas of the premolars because the central ray is directed through the contacts and perpendicular to the film. If the central ray (CR) is not directed through the contacts, overlap of the premolar contacts occurs.
Exposure Sequence for Image Receptor Placement
Anterior Exposure Sequence
FIGURE 41-10 This radiograph demonstrates a cone cut, that is, a clear unexposed area on the film. The position indicator device was positioned too far distally, so the anterior portion of the film received no exposure.
Posterior Exposure Sequence
FIGURE 41-11 Anterior periapical film placement shows structures visible on the radiograph. A, Maxillary canine exposure. B, Maxillary incisor exposure. C, Mandibular canine exposure. D, Mandibular incisor exposure.
FIGURE 41-12 Posterior periapical film placement showing structures visible on the radiograph. A, Maxillary premolar exposure. B, Maxillary molar exposure. C, Mandibular premolar exposure. D, Mandibular molar exposure.
Guidelines for Film Placement
Guidelines for Sensor Placement
Film Placement
FIGURE 41-13 A, A diagram of an anterior tooth with the central ray perpendicular to the “imaginary” bisector of the angle between the long axis of the tooth and the film plane. B, A posterior tooth using the bisecting angle concept.
Bisecting Technique
Image Receptor Holders
FIGURE 41-14 EeZee-Grip (Dentsply Rinn) sensor holder for both anterior and posterior digital images.
Angulation of Position Indicator Device
FIGURE 41-15 The arrows indicate movement in a horizontal direction.
FIGURE 41-16 Correct horizontal angulation.
Horizontal Angulation
Correct Horizontal Angulation.
Incorrect Horizontal Angulation.
FIGURE 41-17 Incorrect horizontal angulation.
FIGURE 41-18 Overlapped contact areas.
Vertical Angulation
Correct Vertical Angulation.
FIGURE 41-19 Vertical angulation of the position indicator device (PID) refers to PID placement in an up-and-down (head-to-toe) direction.
FIGURE 41-20 A, If the vertical angulation is too steep, the image on the film is shorter than the actual tooth. B, Foreshortened image.
TABLE 41-1 Recommended Vertical Angulation Ranges for Bisecting Technique
Incorrect Vertical Angulation.
Foreshortened Images.
Elongated Images.
Image Receptor Size and Placement
FIGURE 41-21 A, If the vertical angulation is too flat, the image on the film is longer than the actual tooth. B, Elongated image.
Patient Positioning
Beam Alignment
FIGURE 41-22 Vertical angulation of +10 degrees is used to compensate for the slight bend of the upper portion of the film and the tilt of the maxillary teeth.
Bitewing Technique
Image Receptor Holder and Bitewing Tab
FIGURE 41-23 Bitewing tab and film holder.
Angulation of Position Indicator Device
Exposure for Image Receptor Placement
Occlusal Technique
Patients with Special Medical Needs
Guidelines for Dental Treatment of Patients with Disabilities
FIGURE 41-24 X-rays can be taken with a patient sitting in his or her wheelchair.
Vision Impairment
Hearing Impairment
Mobility Impairment
Developmental Disabilities
Patients with Special Dental Needs
Edentulous Patient
FIGURE 41-25 Mixed occlusal-periapical edentulous survey.
Pediatric Patient
Guidelines for Dental Radiography of Pediatric Patients
Endodontic Patient
FIGURE 41-26 Extension-cone paralleling (XCP) instruments can be used for the pediatric patient. Exposure time is reduced because of the size of the patient. Follow the recommendations of the manufacturer.
FIGURE 41-27 The EndoRay II film holder is designed for use during endodontic procedures when x-rays must be taken while instruments are in the canal.
Gagging Patient
Guidelines to Reduce Gag Reflex in Dental Patients
Exposure Sequencing
Image Receptor Placement
Avoid the Palate.
Demonstrate Image Receptor Placement.
Extreme Cases
Dental Imaging Technique Errors
Mounting Dental Radiographs
Recognizing Anatomic Landmarks
Selecting the Mount
Methods of Mounting
Guidelines for Mounting Radiographs
FIGURE 41-28 Radiographic exposure errors. A, Clear. B, Black. C, Dark. D, Light. E, No apices. F, Overlapped contacts. G, Foreshortened image. H, Elongated image. I, Cone cut. J, Distorted image with dark lines on corners. K, Double image. L, Blurred image. M, Light image with herringbone pattern. XCP, Extension-cone paralleling; PID, position indicator device.
FIGURE 41-29 Radiographic landmarks of normal anatomy. A, Structures of the tooth. B through D, Maxillary structures. Radiographic landmarks of normal anatomy. E through G, Maxillary structures. H through L, Mandibular structures.
FIGURE 41-30 With the labial mounting method, radiographs are viewed as if the dental radiographer were looking directly at the patient.
▪ Legal and Ethical Implications
▪ Eye to the Future
▪ Critical Thinking
Procedure 41-1 Preparing the Patient for Dental Imaging
Goal
Equipment and Supplies
Procedural Steps
Procedure 41-2 Assembling the XCP (Extension-Cone Paralleling) Instruments
Goal
Equipment and Supplies
Extension-cone paralleling (XCP) instruments for film.
Extension-cone paralleling (XCP-DS) instruments for digital sensors.
Procedural Steps
Anterior Assembly
Posterior Assembly
Procedure 41-3 Producing Full-Mouth Radiographic Survey Using Paralleling Technique
Goal
Equipment and Supplies
Procedural Steps
Preparation Before Seating Patient
Additional Preparation Requirements for Digital Technologies
Positioning Patient
Maxillary Canine Exposure
Maxillary Central/Lateral Incisor Exposure
Mandibular Canine Exposure
Mandibular Incisor Exposure
Maxillary Premolar Exposure
Maxillary Molar Exposure
Mandibular Premolar Exposure
Mandibular Molar Exposure
Documentation
Procedure 41-4 Producing Full-Mouth Radiographic Survey Using Bisecting Technique
Goal
Equipment and Supplies
Procedural Steps
Preparation Before Seating Patient
Maxillary Canine Exposure
Maxillary Incisor Exposure
Mandibular Canine Exposure
Mandibular Incisor Exposure
Maxillary Premolar Exposure
Maxillary Molar Exposure
Mandibular Premolar Exposure
Mandibular Molar Exposure
Documentation
Procedure 41-5 Producing Four-View Radiographic Survey Using Bitewing Technique
Goal
Equipment and Supplies
Procedural Steps
Premolar Bitewing Exposure
Molar Bitewing Exposure
Procedure 41-6 Producing Maxillary and Mandibular Radiographs Using Occlusal Technique
Goal
Equipment and Supplies
Procedural Steps
Maxillary Occlusal Technique
Mandibular Occlusal Technique
Procedure 41-7 Mounting Dental Radiographs
Goal
Equipment and Supplies
Procedural Steps
Pageburst Integrated Resources
42 Extraoral Imaging
Electronic Resources
Learning Outcomes
Key Terms
Panoramic Imaging
FIGURE 42-1 This diagram outlines some of the structures that can be visualized on a panoramic image.
FIGURE 42-2 A, Open contacts on a bitewing film. B, The posterior contacts are closed on this panoramic film.
FIGURE 42-3 A specialized program in the digital software allows this type of “panoramic bitewing” projection. Note that the interproximal contacts are opened. This set of bitewings also displays the periapical regions of all posterior teeth.
Types of Panoramic Units
Basic Concepts
TABLE 42-1 Advantages and Disadvantages of Panoramic Imaging
Focal Trough
Equipment
FIGURE 42-4 A, Film-based panoramic unit. B, Digital panoramic unit.
FIGURE 42-5 The film and x-ray tubehead move around the patient in opposite directions in panoramic radiography.
FIGURE 42-6 Schematic representation of the focal trough, or image layer, of a panoramic machine. Structures in the middle of the layer (darkest area) will be sharply depicted; those toward the periphery will be less sharply depicted. All structures outside the layer will be blurred and magnified.
FIGURE 42-7 Exposure control of a digital panoramic unit.
Tubehead
Head Positioner
FIGURE 42-8 Head positioner (notched bite-block, forehead rest, and lateral head support) is used to align the patient’s teeth in the focal trough.
Exposure Controls
Film and Intensifying Screens
Common Errors
Patient Preparation Errors
Ghost Images.
FIGURE 42-9 Large hoop earrings (1) and “ghost” images (2). The ghost image of the earring appears on the opposite side of the film and is enlarged and laterally distorted.
FIGURE 42-10 On a panoramic radiograph, a lead apron artifact (arrows) appears as a large cone-shaped radiopacity that obscures the mandible.
Solution.
Lead Apron Artifact.
Solution.
Patient Positioning Errors
Lips and Tongue.
Solution.
FIGURE 42-11 If the tongue is not placed on the roof of the mouth, a radiolucent shadow (arrows) will be superimposed over the apices of the maxillary teeth.
FIGURE 42-12 “Reverse smile line” is seen on a panoramic film when the patient’s chin is tipped upward.
Chin Too High (Positioning of Frankfort Plane).
Solution.
Chin Too Low.
Solution.
Posterior to Focal Trough.
Solution.
Anterior to Focal Trough.
FIGURE 42-13 “Exaggerated smile line” is seen on a panoramic film when the patient’s chin is tipped downward.
FIGURE 42-14 Frankfort and midsagittal planes. The Frankfort plane passes through the floor of the orbit and the external auditory meatus. The midsagittal plane divides the face in half into right and left sides.
FIGURE 42-15 Patient is biting too far back on the bite stick.
FIGURE 42-16 Anterior teeth appear widened and blurred on a panoramic film when the patient is positioned too far back on the bite-block.
FIGURE 42-17 Anterior teeth appear narrowed and blurred on a panoramic film when the patient is positioned too far forward on the bite-block.
FIGURE 42-18 If the patient is not standing erect, superimposition of the cervical spine (arrows) may be seen at the center of the panoramic film.
Solution.
Spine Not Straight.
Solution.
Tips for Success When Exposing Panoramic Images
Three-Dimensional Digital Imaging
Cone Beam Computed Tomography (CBCT)
How CBCT Works
FIGURE 42-19 Next-generation i-CAT dental imaging system. Cone beam computed tomography (CBCT) machines have a small footprint and are equivalent to a digital Panorex. The patient is comfortably seated within the machine and does not feel claustrophobic, as in conventional hospital computed tomography (CT) scans.
FIGURE 42-20 Examples of various sizes of the field of view.
FIGURE 42-21 A sample of the types of views offered by software modules. Most have settings to customize contrast and to select only the area of interest.
Advantages of Three-Dimensional Views
Common Uses of CBCT
Uses for CBCT
FIGURE 42-22 A, Soft-tissue anatomy captured using cone beam computed tomography (CBCT) technology (i-CATVision software). B, Skeletal anatomy captured from CBCT data and superimposed on a digital photograph (InVivo Dental 3-D Imaging Software). This allows the practitioner to see how dental and skeletal changes will alter facial soft tissue.
FIGURE 42-23 Digital images allow for custom coloring of soft tissues to assess airway anatomy and sinus morphology (InVivo Dental 3-D Imaging Software). They provide information on the entire maxillofacial region.
Advantages and Disadvantages of CBCT
Advantages
Disadvantages
Specialized Extraoral Imaging
Equipment
Film and Intensifying Screens
Grid
FIGURE 42-24 A, Impacted mandibular third molars (tooth #17 in green; tooth #32 in pink. Note the roots of #17 surrounding the mandibular canal. B, Teeth #17 and 32 positioned facial to the mandibular canal. C, Transparent mandible showing full view of the location of the mandibular
FIGURE 42-25 Examples of cone-beam computed tomography machines. A, CS 9000D 3D Extraoral Imaging System. B, Planmeca Promax 3D. C, i-CAT FLX Cone Beam 3D system. D, Comfort 3D Imaging System. E, NewTom VGi.
FIGURE 42-26 Panoramic images being taken on a patient. Note, the head positioner in place.
FIGURE 42-27 A grid decreases the amount of scatter radiation that reaches the extraoral film.
Procedures
Skull Radiography
Lateral Cephalometric Projection
Posteroanterior Projection
FIGURE 42-28 A, For the lateral cephalometric projection, proper patient and film positioning is shown as viewed from the front, side, and top of the patient. CR, Central ray; FP, Frankfort plane; MSP, midsagittal projection. B, Lateral cephalometric radiograph.
FIGURE 42-29 For the posteroanterior skull projection, proper patient and film positioning is shown as viewed from the side, back, and top of the patient. CR, Central ray; FP, Frankfort plane; MSP, midsagittal projection.
Temporomandibular Joint Radiography
FIGURE 42-30 Temporomandibular joint (TMJ) pathology viewed from three dimensions. Cone beam imaging can be used in diagnosing a variety of conditions within the maxillofacial region, such as TMJ disorder, airway problems, tumors, and cysts.
▪ Legal and Ethical Implications
▪ Eye to the Future
▪ Critical Thinking
Procedure 42-1 Preparing Equipment for Panoramic Imaging
Goal
Equipment and Supplies for Film-Based Units
Procedural Steps
Procedure 42-2 Preparing the Patient for Panoramic Imaging
Goal
Equipment and Supplies
Procedural Steps
Procedure 42-3 Positioning the Patient for Panoramic Imaging
Goal
Procedural Steps
Pageburst Integrated Resources
Part Nine Dental Materials
Dental Materials
Interactive Review – Part 9
43 Restorative and Esthetic Dental Materials
Electronic Resources
Learning Outcomes
Key Terms
Standardization of Dental Materials
FIGURE 43-1 ADA Council on Dental Materials seal.
Criteria for a New Dental Material
Properties of Dental Materials
Mechanical Properties
Types of Stress and Strain
Ductility and Malleability
Thermal Change
Contraction and Expansion
Electrical Properties
FIGURE 43-2 Types of stress and strain. A, Tensile stress. B, Compressive stress. C, Shear stress.
FIGURE 43-3 A galvanic action can occur when different types of metals touch each other.
FIGURE 43-4 Corrosion can occur on certain metals.
Corrosive Properties
Hardness
FIGURE 43-5 Dental materials must withstand the solubility of saliva in the oral cavity.
Solubility
Application Properties
Flow
Adhesion
Retention
Curing
FIGURE 43-6 Light-curing of a composite resin.
Direct Restorative and Esthetic Materials
Amalgam
FIGURE 43-7 Example of class II amalgam restoration.
Indications for Using Dental Amalgam
Contraindications to the Use of Dental Amalgam
Composition of Dental Amalgam
FIGURE 43-8 The mercury and alloy powder are in their purest form before trituration.
High-Copper Alloys
FIGURE 43-9 Microscopic view of alloy powder particles. A, Irregular. B, Spherical. C, Mixed.
TABLE 43-1 Composition and Classification of Dental Amalgam Alloy Powders
Mercury-to-Alloy Ratios
Nonmercury Alloys
Controversial Issues in Mercury
The Application of Dental Amalgam
Preparation.
Trituration.
FIGURE 43-10 Sources of mercury hazards in the dental operatory.
Box 43-1 Best Management Practices for Mercury Amalgam
Non-Contact (Scrap) Amalgam
Amalgam Capsules
Disposable Chairside Traps
Reusable Chairside Traps
Vacuum Pump Filters
Amalgam Separators
Line Cleaners
FIGURE 43-11 Precapsulated amalgam.
FIGURE 43-12 Activator used to break the separating membrane in the capsule.
TABLE 43-2 Amalgamation Time
Condensation.
Carving and Finishing.
Composite Resins
Commercial Examples of Composite Resins
FIGURE 43-13 Increments of amalgam placed.
FIGURE 43-14 Carving an amalgam restoration.
Indications for Using Composite Resins
Contraindications for Using Composite Resins
Composition of Composite Resins
Resin Matrix.
Filler.
FIGURE 43-15 Class IV composite restoration showing before (A) and after (B).
FIGURE 43-16 Effect of particle size on surface finish of composite.
Coupling Agent.
FIGURE 43-17 Summary of the historical evolution of dental composites, curing methods, and accompanying bonding systems.
Pigments.
Application of Composites
Shade Selection.
Tips When Choosing a Shade
Application.
Polymerization
FIGURE 43-18 Use of a shade guide for color matching.
FIGURE 43-19 Composite resin kit.
Finishing and Polishing
Steps in Finishing a Composite Resin
Glass Ionomers
Resin Modified
Metal Reinforcement
Fabrication and Application
FIGURE 43-20 Setup for mixing glass ionomer liquid and powder.
FIGURE 43-21 Glass ionomers are supplied in capsules, cartridges, and individual powder and liquid bottles.
Cautions for Placing Glass Ionomers
Temporary Restorative Materials
Intermediate Restorative Materials
FIGURE 43-22 Placement of intermediate restorative material (IRM) into a molar.
Provisional Restorative Materials
FIGURE 43-23 Example of provisional coverage material.
FIGURE 43-24 Acrylic resin is supplied as liquid/powder, tubes, and automix cartridges.
Tooth-Whitening Materials
Composition of Whitening Materials
Methods of Tooth Whitening
FIGURE 43-25 Before and after the use of a whitening product.
Indirect Restorative Materials
Commercial Examples of Bleaching Products
FIGURE 43-26 Gold crown.
Gold–Noble Metal Alloys
Ceramic Castings
Porcelain
FIGURE 43-27 Porcelain crown.
▪ Patient Education
▪ Legal and Ethical Implications
▪ Eye to the Future
▪ Critical Thinking
Procedure 43-1 Mixing and Transferring Dental Amalgam
Equipment and Supplies
Procedural Steps
Procedure 43-2 Preparing Composite Resin Materials
Equipment and Supplies
Procedural Steps
Procedure 43-3 Mixing Intermediate Restorative Materials (IRM)
Equipment and Supplies
Procedural Steps
Procedure 43-4 Preparing Acrylic Resin for the Fabrication of Provisional Coverage
Equipment and Supplies
Procedural Steps
Pageburst Integrated Resources
44 Dental Liners, Bases, and Bonding Systems
Electronic Resources
Learning Outcomes
Key Terms
Prepared Tooth Structures
Pulpal Responses
Types of Pulpal Stimuli
TABLE 44-1 Supplementary Dental Materials and Application in Order of Use
Dental Liners
Calcium Hydroxide
Examples of Commercial Dental Liners
Application
FIGURE 44-1 Placement of a liner.
Varnish
Application
FIGURE 44-2 Microscopic view of dentin structure with exposed dentinal tubules. A, Showing one layer of varnish. B, Two layers of varnish sealing the dentinal tubules.
FIGURE 44-3 Location for placement of cavity varnish.
Examples of Commercial Varnishes
Fluoride Varnish
FIGURE 44-4 An example of a fluoride varnish product.
Desensitizer
Application
Dental Bases
Types of Materials Used
Examples of Commercial Cement Bases
Zinc Oxide–Eugenol
Zinc Phosphate
Polycarboxylate
Glass Ionomer
Resin-Modified Glass Ionomer
Application
FIGURE 44-5 Location for placement of a base.
Dental Etchant
Application
FIGURE 44-6 Microscopic view of enamel tags after etching.
FIGURE 44-7 Example of etchant material.
Dental Bonding
Dentin Bonding
FIGURE 44-8 Microscopic view in various stages of etching. A, Unetched dentin with smear layer. B, Overetched dentin.
FIGURE 44-9 Process of bonding. A, Enamel rods unetched. B, Enamel rods etched. C, Bonding agent mechanically bonding to tooth. D, Resin chemically bonding to bonding agent.
Enamel Bonding
Application
Guidelines for Clinical Application of Bonding Products
▪ Patient Education
▪ Legal and Ethical Implications
▪ Eye to the Future
▪ Critical Thinking
Procedure 44-1 Applying Calcium Hydroxide (Expanded Function)
Prerequisites for Performing This Procedure
Equipment and Supplies
Procedural Steps
Procedure 44-2 Applying Dental Varnish (Expanded Function)
Prerequisites for Performing This Procedure
Equipment and Supplies
Procedural Steps
Procedure 44-3 Applying a Desensitizer (Expanded Function)
Prerequisites for Performing This Procedure
Equipment and Supplies
Procedural Steps
Procedure 44-4 Mixing and Placing Zinc Oxide–Eugenol Cement as a Base (Expanded Function)
Prerequisites for Performing This Procedure
Equipment and Supplies
Procedural Steps
Procedure 44-5 Mixing and Placing Zinc Phosphate Cement as a Base (Expanded Function)
Prerequisites for Performing This Procedure
Equipment and Supplies
Procedural Steps
Procedure 44-6 Mixing and Placing Polycarboxylate Cement as a Base (Expanded Function)
Prerequisites for Performing This Procedure
Equipment and Supplies
Procedural Steps
Procedure 44-7 Applying an Etchant Material (Expanded Function)
Prerequisites for Performing This Procedure
Equipment and Supplies
Procedural Steps
Procedure 44-8 Applying a Bonding System (Expanded Function)
Prerequisites for Performing This Procedure
Equipment and Supplies
Procedural Steps
Pageburst Integrated Resources
45 Dental Cements
Electronic Resources
Learning Outcomes
Key Terms
Classification of Dental Cements
Permanent Cements
FIGURE 45-1 Casting ready to be cemented.
Temporary Cements
Variables Affecting Final Cementation
Mixing Time
Guidelines for Mixing Dental Cements
Automix System
FIGURE 45-2 Hold the bottle upright when dispensing the liquid of a cement.
Humidity
Powder-to-Liquid Ratio
Temperature
Types of Cement
Glass Ionomer Cement
Chemical Makeup of Glass Ionomer Cement
Application
FIGURE 45-3 Premeasured capsules of glass ionomer permanent cement.
Examples of Commercial Glass Ionomer Cement
Composite Resin Cement
FIGURE 45-4 Examples of composite resin cements supplied in variable systems.
Chemical Makeup of Composite Resin Cement
Application
Commercial Resin Cements
Zinc Oxide–Eugenol Cement
FIGURE 45-5 TempBond NE, a type I temporary cement.
FIGURE 45-6 ZOE type II cement for permanent cementation.
Chemical Makeup of Zinc Oxide–Eugenol Cement
Application
Examples of Commercial ZOE Cement
Polycarboxylate Cement
Chemical Makeup of Polycarboxylate Cement
FIGURE 45-7 Powder and calibrated syringe of polycarboxylate cement.
Application
Examples of Commercial Polycarboxylate Cement
FIGURE 45-8 Zinc phosphate type I cement for permanent cementation.
Zinc Phosphate Cement
Chemical Makeup of Zinc Phosphate Cement
Application
Examples of Commercial Zinc Phosphate Cement
Cement Removal
FIGURE 45-9 Excess cement must be removed after the setting process.
▪ Patient Education
▪ Legal and Ethical Implications
▪ Eye to the Future
▪ Critical Thinking
Procedure 45-1 Mixing Glass Ionomer for Permanent Cementation
Equipment and Supplies
Procedural Steps
Procedure 45-2 Mixing Composite Resin for Permanent Cementation
Equipment and Supplies
Procedural Steps
Procedure 45-3 Mixing Zinc Oxide–Eugenol for Temporary Cementation
Equipment and Supplies
Procedural Steps
Procedure 45-4 Mixing Zinc Oxide–Eugenol for Permanent Cementation
Equipment and Supplies
Procedural Steps
Procedure 45-5 Mixing Polycarboxylate for Permanent Cementation
Equipment and Supplies
Procedural Steps
Procedure 45-6 Mixing Zinc Phosphate for Permanent Cementation
Equipment and Supplies
Procedural Steps
Preparing the Mix
Placing Cement in the Casting
Procedure 45-7 Removing Cement from Permanent or Temporary Cementation (Expanded Function)
Prerequisites for Performing This Procedure
Equipment and Supplies
Procedural Steps
Pageburst Integrated Resources
46 Impression Materials
Electronic Resources
Learning Outcomes
Key Terms
Classification of Impressions
Preliminary Impressions
Final Impressions
Bite Registrations
Impression Trays
Stock Trays
Selection
FIGURE 46-1 Types of stock trays. A, Metal perforated tray used most often for preliminary impressions. B, Metal water coolant tray used most often with reversible hydrocolloid impressions. C, Plastic perforated tray used for preliminary and final impressions. D, Bite tray used for final impressions and bite registrations. E, Triple tray designed to eliminate steps by taking final impressions and bite registration at the same time.
Characteristics
Adaptation
FIGURE 46-2 Examples of quadrant, section, and full-arch impression trays.
FIGURE 46-3 Extending impression tray with utility wax.
Custom Trays
Tray Adhesives
FIGURE 46-4 Impression tray with adhesive applied.
Hydrocolloid Materials
Irreversible Hydrocolloid: Alginate
Composition and Chemistry
Physical Phases
Strength
Packaging and Storage
Types of Setting
Altering Setting Time
FIGURE 46-5 Packaging of alginate.
Water-to-Powder Ratio
Mixing Techniques
FIGURE 46-6 A plastic scoop and a plastic cylinder are supplied with alginate.
Taking an Alginate Impression
Explain Procedure to Patient
FIGURE 46-7 Example of an alginator.
FIGURE 46-8 How an impression must appear.
Evaluating Alginate Impression
Impressions of Edentulous Arches
Reversible Hydrocolloid
FIGURE 46-9 Conditioning bath for reversible hydrocolloid.
Tray Material
Syringe Material
FIGURE 46-10 Reversible hydrocolloid tray material.
Application of Reversible Hydrocolloid Impression Material
FIGURE 46-11 Example of a final impression.
Elastomeric Materials
Characteristics
Forms of Materials
Light-Bodied Material
Regular and Heavy-Bodied Materials
Basic Impression Technique
Curing Stages and Types
Mixing of Materials
Paste System
Automix System
Mixing Unit System
Putty System
Types of Elastomeric Materials
FIGURE 46-12 Mixing unit for final impression material.
TABLE 46-1 Properties Of Final Impressions Materials
FIGURE 46-13 Polysulfide material.
Polysulfide
Chemical Makeup and Mixing Guidelines for Polysulfide Impression Material
Chemical Makeup
Guidelines for Using Material
Polyether
Chemical Makeup and Mixing Guidelines for Polyether Impression Material
Chemical Makeup
Guidelines for Using Material
Silicone
FIGURE 46-14 Impregum F polyether impression material.
Chemical Makeup and Mixing Guidelines for Silicone Impression Material
Chemical Makeup
Guidelines for Using Material
Polysiloxane
FIGURE 46-15 Silicone material.
FIGURE 46-16 Polysiloxane (polyvinyl siloxane) material.
Chemical Makeup and Mixing Guidelines for Polysiloxane Impression Material
Chemical Makeup
Guidelines for Using Material
Occlusal (Bite) Registration
Wax Bite Registration
Polysiloxane Bite Registration Paste
FIGURE 46-17 Example of a bite registration.
FIGURE 46-18 Wax bite registration.
Zinc Oxide–Eugenol Bite Registration Paste
▪ Patient Education
▪ Legal and Ethical Implications
▪ Eye to the Future
▪ Critical Thinking
Procedure 46-1 Mixing Alginate Impression Material
Equipment and Supplies
Procedural Steps
Procedure 46-2 Taking a Mandibular Preliminary Impression (Expanded Function)
Prerequisites for Performing This Procedure
Equipment and Supplies
Procedural Steps
Preparation
Loading the Mandibular Impression Tray
Seating the Mandibular Impression Tray
Removing the Mandibular Impression
Procedure 46-3 Taking a Maxillary Preliminary Impression (Expanded Function)
Prerequisites for Performing This Procedure
Equipment and Supplies
Procedural Steps
Preparation
Loading the Maxillary Impression Tray
Seating the Maxillary Impression Tray
Removing the Maxillary Impression
Caring for Alginate Impressions
Before Dismissing the Patient
Procedure 46-4 Mixing a Two-Paste Final Impression Material
Equipment and Supplies
Procedural Steps
Preparing Light-Bodied Syringe Material
Preparing Heavy-Bodied Tray Material
Procedure 46-5 Preparing an Automix Final Impression Material
Equipment and Supplies
Procedural Steps
Procedure 46-6 Taking a Wax Bite Registration (Expanded Function)
Prerequisites for Performing This Procedure
Equipment and Supplies
Procedural Steps
Procedure 46-7 Mixing Polysiloxane Material for a Bite Registration
Equipment and Supplies
Procedural Steps
Procedure 46-8 Mixing Zinc Oxide–Eugenol Bite Registration Material
Equipment and Supplies
Procedural Steps
Pageburst Integrated Resources
47 Laboratory Materials and Procedures
Electronic Resources
Learning Outcomes
Key Terms
Safety in the Dental Laboratory
FIGURE 47-1 Commercial dental laboratory.
Laboratory Rules
Physical Safety
Chemical Safety
Biohazards
Dental Laboratory Equipment
Heat Sources
Model Trimmer
FIGURE 47-2 Dental laboratory within a dental office.
Vacuum Former
Vibrator
FIGURE 47-3 Model trimmer.
FIGURE 47-4 Vacuum former.
FIGURE 47-5 Vibrator.
FIGURE 47-6 Sandblaster.
Laboratory Handpiece
Sandblaster
Articulator
FIGURE 47-7 Articulator.
Face Bow
Dental Lathe
Specialized Spatulas and Bowls
FIGURE 47-8 Dental lathe.
FIGURE 47-9 Wax spatula.
FIGURE 47-10 Different sizes of rubber flexible bowls.
Wax Spatulas
Mixing Spatulas
Rubber Bowls
FIGURE 47-11 Dental models.
Dental Models
Gypsum Products
Chemical Properties
Setting Reactions
Forms
Dental Plaster.
Dental Stone.
High-Strength Stone.
Powder-to-Water Ratio
Pouring Dental Models
Double-Pour Method
Box-and-Pour Method
FIGURE 47-12 Anatomic and art portions of a dental model.
FIGURE 47-13 Examples of pouring methods. Upper left, boxed; upper right, inverted; lower middle, double-pour.
Inverted-Pour Method
Trimming and Finishing Dental Models
Anatomic and Art Portions
Polishing Plaster Models
Custom Impression Trays
Criteria for Creating Custom Impression Trays
Guidelines and Terminology for Creating a Custom Impression Tray
Acrylic Resin Tray Materials
Light-Cured Resin Tray Materials
Vacuum-Formed Thermoplastic Resin
Dental Waxes
Classification of Waxes
FIGURE 47-14 Inlay casting wax.
Pattern Waxes
Inlay Casting Wax.
Casting Wax.
Baseplate Wax.
FIGURE 47-15 Use of inlay wax on the die.
FIGURE 47-16 Baseplate wax.
Processing Wax
Boxing Wax.
FIGURE 47-17 Boxing wax.
FIGURE 47-18 Utility wax.
Utility Wax.
Sticky Wax.
Impression Waxes
Corrective Impression Wax.
FIGURE 47-19 Bite registration wax.
Bite Registration Wax.
▪ Patient Education
▪ Legal and Ethical Implications
▪ Eye to the Future
▪ Critical Thinking
Procedure 47-1 Taking a Face-Bow Registration (Expanded Function)
Equipment and Supplies
Procedural Steps
Procedure 47-2 Mixing Dental Plaster
Equipment and Supplies
Procedural Steps
Procedure 47-3 Pouring Dental Models Using the Inverted-Pour Method
Equipment and Supplies
Procedural Steps
Preparing the Impression
Pouring the Mandibular Model and Base
Pouring the Maxillary Cast
Separating the Cast from the Impression
Procedure 47-4 Trimming and Finishing Dental Models
Equipment and Supplies
Procedural Steps
Preparing the Model
Trimming the Maxillary Model
Trimming the Mandibular Model
Finishing the Model
Procedure 47-5 Constructing an Acrylic Resin Custom Tray
Equipment and Supplies
Procedural Steps
Preparing the Model
Mixing the Acrylic Resin
Forming the Tray
Creating the Handle
Finishing the Tray
Procedure 47-6 Creating a Light-Cured Custom Tray
Equipment and Supplies
Procedural Steps
Procedure 47-7 Constructing a Vacuum-Formed Custom Tray
Equipment and Supplies
Procedural Steps
Pageburst Integrated Resources
Part Ten Assisting in Comprehensive Dental Care
Assisting in Comprehensive Dental Care
Interactive Review – Part 10
48 General Dentistry
Electronic Resources
Learning Outcomes
Key Terms
Cavity Preparation
Terminology
Initial Preparation
FIGURE 48-1 Outline form of a cavity preparation.
FIGURE 48-2 Resistance form of a cavity preparation.
Box 48-1 Terminology Related to Cavity Preparation
Tooth Preparation Walls
Tooth Preparation Angles
FIGURE 48-3 Retention form placed in the cavity preparation.
FIGURE 48-4 Convenience form used for easy access to tooth decay.
Final Preparation
Standardized Plan for a Restorative Procedure
Dental Assistant’s Role in a Restorative Procedure
Permanent Restorations
Class I Restorations
Tooth Preparation
FIGURE 48-5 Class I restorations. A, Occlusal pits and fissures of premolar/molar. B, Buccal pits and fissures of mandibular molars. C, Lingual pits and fissures of maxillary molars. D, Lingual pits of maxillary incisors.
Special Considerations
Class II Restorations
Tooth Preparation
FIGURE 48-6 A, Typical class I tooth preparation for amalgam on maxillary premolar. B, Schematic representation illustrates tooth preparation walls: facial (f), mesial (m), distal (d), pulpal floor (p), and lingual (l).
FIGURE 48-7 Class II restorations. A, Two-surface restoration. B, Three-surface restoration. C, Multisurface restoration.
FIGURE 48-8 A, Typical class II MO conventional tooth preparation for amalgam on maxillary molar. B, Schematic representation illustrates tooth preparation walls: molar (a), facial (f) of proximal and incisal portions, gingival (g), and lingual (l) of proximal and incisal portions.
Special Considerations
Class III and IV Restorations
Tooth Preparation
FIGURE 48-9 A, Class III conventional tooth preparation on maxillary central incisor. B, Schematic representation illustrates tooth preparation walls: axial (a), facial (f) of proximal and incisal portions, gingival (g), and lingual (l) of proximal and incisal portions.
Special Considerations
FIGURE 48-10 A, Class IV conventional tooth preparation of maxillary canine. B, Schematic representation illustrates tooth preparation walls: axial (a), facial (f) of proximal and incisal portions, gingival (g), lingual (l) of proximal and incisal portions, and mesial (m).
Class V Restorations
Tooth Preparation
FIGURE 48-11 Class IV composite restoration with decay affecting the distal-incisal surfaces.
Special Considerations
Complex Restorations
FIGURE 48-12 A, Class V conventional tooth preparation of maxillary canine. B, Schematic representation illustrates tooth preparation walls: axial (a), facial (f), distal (d), gingival (g), incisal (i), and mesial (m).
Retention Pins
FIGURE 48-13 Retention (retentive) pins placed in tooth structure for retaining and supporting a restoration.
Intermediate Restorations
Veneers
FIGURE 48-14 Veneers placed on tooth #8 and tooth #9 to reduce discoloration and cover stain. A, Before placement. B, After placement.
FIGURE 48-15 Veneers placed to close diastema.
Tooth Whitening
FIGURE 48-16 Before and after photos of tooth whitening used for extrinsic stains.
FIGURE 48-17 Before and after photos of tooth whitening used for intrinsic stains.
FIGURE 48-18 Custom-fitted tray for bleaching procedure.
Treatment Options
In-Office Treatment
At-Home Treatment
Over-the-Counter Options
Brush-on Whitening.
FIGURE 48-19 Loading peroxide gel into custom-fitted tray.
Whitening Strips.
Trays with Bleaching Gels.
Abuse of Whitening Products
Adverse Effects of Tooth Whitening
Thermal Hypersensitivity
Tissue Irritation
Dental Assistant’s Role in Tooth Whitening
Patient Instructions for Tooth Whitening
▪ Patient Education
▪ Legal and Ethical Implications
▪ Eye to the Future
▪ Critical Thinking
Procedure 48-1 Assisting in a Class I Restoration
Equipment and Supplies
Procedural Steps
Preparing the Tooth
Preparing the Cavity
Placing Dental Materials
Placing Permanent Material
Final Carving or Finishing
Occlusal Adjustment
Postoperative Instructions
Documentation
Procedure 48-2 Assisting in a Class II Amalgam Restoration
Equipment and Supplies
Procedural Steps
Preparing the Tooth
Preparing the Cavity
Placing the Base and Cavity Liner (Expanded Function)
Placing the Matrix Band and Wedge (Expanded Function)
Placing the Bonding Agent (Expanded Function)
Mixing the Amalgam
Placing and Condensing the Amalgam
Initial Carving
Final Carving
Occlusal Adjustment
Postoperative Instructions
Documentation
Procedure 48-3 Assisting in a Class III or IV Restoration
Equipment and Supplies
Procedural Steps
Preparing the Tooth
Preparing the Cavity
Etching, Bonding, and Composite Placement
Finishing the Restoration
Documentation
Procedure 48-4 Assisting in a Class V Restoration
Equipment and Supplies
Procedural Steps
Preparing the Tooth
Preparing the Cavity
Placing Dental Materials
Placing Permanent Material
Final Carving or Finishing
Documentation
Procedure 48-5 Placing and Carving an Intermediate Restoration (Expanded Function)
Prerequisites for Performing This Procedure
Equipment and Supplies
Procedural Steps
Carving Stage
Documentation
Procedure 48-6 Assisting in the Placement of a Veneer
Equipment and Supplies
Procedural Steps
Documentation
Pageburst Integrated Resources
49 Matrix Systems for Restorative Dentistry
Electronic Resources
Learning Outcomes
Key Terms
Posterior Matrix Systems
Universal Retainer
FIGURE 49-1 Tooth preparation with mesial and distal proximal walls missing.
Matrix Band
Contouring
Wedges
Components of a Universal Retainer
FIGURE 49-2 Most commonly used posterior matrix bands.
FIGURE 49-3 Contouring the band assists in the restoration process.
FIGURE 49-4 Wedge correctly positioned interproximally.
FIGURE 49-5 Assortment of precontoured wedges.
Criteria for Placing the Posterior Matrix Retainer and Band
Anterior Matrix Systems
FIGURE 49-6 A and B, The diagrams show the correct and incorrect position when using a round toothpick wedge. C and D, The diagrams show the correct and incorrect position when using a triangular wedge.
FIGURE 49-7 A clear matrix system.
FIGURE 49-8 Contouring a plastic matrix band.
FIGURE 49-9 AutoMatrix system.
Alternative Matrix Systems
AutoMatrix System
Sectional Matrices
FIGURE 49-10 Sectional matrix system. A variety of sizes and shapes accommodate composite and amalgam restorative materials: 1, pediatric band; 2, small band; 3, extended small band; 4, standard band; 5, large band; 6, tension rings.
FIGURE 49-11 Copper T-band used for primary molars.
Matrix Systems for Primary Teeth
T-Band
FIGURE 49-12 Spot welder used for primary molars.
Spot-Welded Band
▪ Patient Education
▪ Legal and Ethical Implications
▪ Eye to the Future
▪ Critical Thinking
Procedure 49-1 Assembling a Matrix Band and Universal Retainer
Equipment and Supplies
Procedural Steps
Procedure 49-2 Placing and Removing a Matrix Band and Wedge for a Class II Restoration (Expanded Function)
Prerequisites for Performing This Procedure
Equipment and Supplies
Procedural Steps
Preparing the Band Size
Placing Matrix Band and Universal Retainer
Placing the Wedge
Removing Universal Retainer, Matrix Band, and Wedge
Procedure 49-3 Placing a Plastic Matrix for a Class III or Class IV Restoration (Expanded Function)
Prerequisites for Performing This Procedure
Equipment and Supplies
Procedural Steps
Pageburst Integrated Resources
50 Fixed Prosthodontics
Electronic Resources
Learning Outcomes
Key Terms
Plan of Care
Considerations for Prescribing Fixed Prosthodontics
Indications
Contraindications
Indirect Restorations
Inlays and Onlays
Veneers
Porcelain Veneers
FIGURE 50-1 Inlay cast restoration fabricated from porcelain.
FIGURE 50-2 Onlay cast restoration fabricated from gold.
Crowns
FIGURE 50-3 Porcelain veneers placed to cover hypocalcification defects.
FIGURE 50-4 VITA Easyshade device.
FIGURE 50-5 Posterior gold crown.
FIGURE 50-6 Anterior porcelain-fused-to-metal (PFM) crown.
Fixed Bridge
Components of a Fixed Bridge
Unit.
Pontic.
Abutment.
Resin-Bonded Bridge
FIGURE 50-7 Four-unit porcelain-fused-to-metal (PFM) anterior fixed bridge.
FIGURE 50-8 Three-unit PFM bridge.
FIGURE 50-9 Resin-bonded bridge.
Role of the Dental Laboratory Technician
Laboratory Prescription
FIGURE 50-10 Laboratory prescription.
Box 50-1 Laboratory Steps in Creating an Indirect Restoration
Laboratory Working Days
Overview of a Crown Procedure
Shade Selection
FIGURE 50-11 Shade guide, used to match the exact color of teeth.
Preparation
Retention Aids for Crowns
Core Buildup
FIGURE 50-12 Prepared tooth structure showing height and contour.
FIGURE 50-13 Prepared tooth structures showing different designs of the margin.
FIGURE 50-14 An existing amalgam restoration is prepared for the core buildup designed to support the crown.
Retention Pins
Post and Core
Gingival Retraction and Tissue Management
FIGURE 50-15 Tooth #5 was restored using a cast post and core. A, Prepared tooth. B, Cemented cast post and core.
FIGURE 50-16 Types of retraction cords.
Gingival Retraction Cord
Retraction Cord Packing
Surgical Retraction
FIGURE 50-17 Gingival retraction cord instrument.
Mechanical Retraction
Final Impression and Bite Registration
Provisional Coverage
Delivery Appointment
Provisional Placement of a Permanent Casting
Overview of a Bridge Procedure
Preparation Appointment
Try-In and Cementation Appointment
FIGURE 50-18 Bridge cemented in place.
Patient Instructions
Computer-Assisted Restorations
FIGURE 50-19 CEREC CAD/CAM device.
FIGURE 50-20 Molar prepared and readied for the scanning portion of the procedure.
FIGURE 50-21 A series of ceramic blocks in varying sizes and shades used to prepare the indirect restoration.
▪ Patient Education
▪ Legal and Ethical Implications
▪ Eye to the Future
▪ Critical Thinking
Procedure 50-1 Placing and Removing Gingival Retraction Cord (Expanded Function)
Prerequisites for Performing This Procedure
Equipment and Supplies
Procedural Steps
Preparation
Placement
Removal
Documentation
Procedure 50-2 Assisting in a Crown and Bridge Preparation
Equipment and Supplies
Procedural Steps
Preliminary Steps
Tooth Preparation
Documentation
Procedure 50-3 Assisting in the Delivery and Cementation of a Cast Restoration
Equipment and Supplies
Procedural Steps
Documentation
Procedure 50-4 Assisting in a CAD/CAM Procedure (Expanded Function)
Equipment and Supplies
Procedural Steps
Preliminary Steps
Tooth Preparation
Documentation
Pageburst Integrated Resources
51 Provisional Coverage
Electronic Resources
Learning Outcomes
Key Terms
Types of Provisional Coverage
Custom Provisional
FIGURE 51-1 Custom provisional coverage.
Prefabricated Crowns
FIGURE 51-2 Preformed polymer crown.
FIGURE 51-3 Preformed polycarbonate crowns.
FIGURE 51-4 Stainless steel crown.
Criteria for Provisional Fabrication
FIGURE 51-5 The provisional should resemble the natural tooth in its appearance, contour, contact, and occlusion.
Custom Provisional Coverage
Preformed Crowns
FIGURE 51-6 Different forms of acrylic and composite provisional materials.
Criteria for Cementation
FIGURE 51-7 Polycarbonate provisional crown.
Troubleshooting When Fabricating a Provisional
Questions to Think About When Selecting a Temporary Cement
Home Care Instructions
FIGURE 51-8 Provisional crown–removing forceps.
Removal of the Provisional Crown or Bridge
▪ Patient Education
▪ Legal and Ethical Implications
▪ Eye to the Future
▪ Critical Thinking
Procedure 51-1 Fabricating and Cementing a Custom Acrylic Provisional Crown (Expanded Function)
Prerequisites for Performing This Procedure
Equipment and Supplies
Procedural Steps
Procedure 51-2 Fabricating and Cementing a Custom Acrylic Provisional Bridge (Expanded Function)
Prerequisites for Performing This Procedure
Equipment and Supplies
Procedural Steps
Procedure 51-3 Fabricating and Cementing a Preformed Provisional Crown (Expanded Function)
Prerequisites for Performing This Procedure
Equipment and Supplies
Procedural Steps
Pageburst Integrated Resources
52 Removable Prosthodontics
Electronic Resources
Learning Outcomes
Key Terms
Factors Influencing the Choice of a Removable Prosthesis
Extraoral Factors
Physical Health
FIGURE 52-1 Partial denture.
FIGURE 52-2 Full denture.
Mental Health
Patient Motivation
Age
Dietary Habits
Social and Economic Factors
Occupation
Intraoral Factors
Musculature
Salivary Flow
Residual Alveolar Ridge
Oral Mucosa
Oral Habits
Tori
Removable Partial Denture
Box 52-1 Considerations for Prescribing a Removable Partial Denture
Indications For a Removable Partial Denture
Contraindications to a Removable Partial Denture
Components of a Partial Denture
Framework
Connectors
FIGURE 52-3 Components of a partial denture.
FIGURE 52-4 Different types of clasps. A, I-bar clasp. B, C-clasp.
Retainer
Rest
Artificial Teeth
FIGURE 52-5 Artificial teeth.
Appointment Sequencing for a Partial Denture
Appointment One: Records
Appointment Two: Preparation
Appointment Three: Try-In
Appointment Four: Delivery
Appointment Five: Postdelivery Check
FIGURE 52-6 Laboratory prescription.
Home Care Instructions
Full (Complete) Denture
Components of a Full Denture
Base
Box 52-2 Considerations for Prescribing a Full Denture
Major indications for a full denture include the following:
Contraindications to a full denture include those listed here:
Flange
Post Dam
Artificial Teeth
FIGURE 52-7 Components of a full denture: base, flange, post dam, and artificial teeth.
Appointment Sequencing for a Full Denture
Appointment One: Records
Appointment Two: Final Impression
FIGURE 52-8 Final impression for a full denture.
Essentials of a Final Impression for Dentures
Appointment Three: Try-In of Baseplate and Occlusal Rim
Artificial Teeth.
FIGURE 52-9 Recording made from the baseplate–occlusal rim assembly: vertical dimensions, occlusal relationship, smile line, and canine eminence.
Occlusal Registration.
Functionally Generated Path Technique.
Appointment Four: Try-In
Appointment Five: Delivery
Appointment Six: Postdelivery
Home Care Instructions
FIGURE 52-10 Wax setup within the articulated cast.
What To Expect the First Month
FIGURE 52-11 Denture and denture brush.
Immediate Dentures
Construction
Surgical Template
Placement
Overdentures
Denture Adjustment and Relining
Tissue Conditioners
Impression
Delivery
FIGURE 52-12 Broken denture.
Denture Repairs
Denture Duplication
▪ Patient Education
▪ Legal and Ethical Implications
▪ Eye to the Future
▪ Critical Thinking
Procedure 52-1 Assisting in the Delivery of a Partial Denture
Equipment and Supplies
Procedural Steps
Procedure 52-2 Assisting in a Wax Denture Try-In
Equipment and Supplies
Procedural Steps
Procedure 52-3 Assisting in the Delivery of a Full Denture
Equipment and Supplies
Procedural Steps
Procedure 52-4 Repairing a Fractured Denture (Expanded Function)
Equipment and Supplies
Procedural Steps
Pageburst Integrated Resources
53 Dental Implants
Electronic Resources
Learning Outcomes
Key Terms
Indications for Implants
FIGURE 53-1 Dental implant.
Contraindications to Implants
The Dental Implant Patient
Psychological Evaluation
Dental Examination
Medical History and Evaluation
Specialized Radiographs and Imaging
FIGURE 53-2 Custom stent used to aid the dentist in placing an implant.
Diagnostic Casts and Surgical Stents
Preparation for Implants
Informed Consent
Surgical Preparation
Types of Dental Implants
Endosteal Implant
FIGURE 53-3 Second-stage surgery whereby two single endosseous units were placed for tooth #18 and tooth #19.
FIGURE 53-4 Diagram showing the types of endosteal implants.
Subperiosteal Implant
Transosteal Implant
FIGURE 53-5 Diagram showing the position of the subperiosteal implant.
Maintenance of Dental Implants
Home Care
FIGURE 53-6 Subperiosteal implant with full-arch denture prosthesis.
FIGURE 53-7 Diagram showing the position of the transosteal implant.
FIGURE 53-8 Peri-implantitis, showing redness and inflammation of tissue around the implant caused by plaque.
Routine Office Visits
FIGURE 53-9 Implant sites should be cleaned daily.
▪ Patient Education
▪ Legal and Ethical Implications
▪ Eye to the Future
▪ Critical Thinking
Procedure 53-1 Assisting in an Endosteal Implant Surgery
Equipment and Supplies
Procedural Steps
Stage I Surgery: Implant Placement
Osseointegration Period
Stage II Surgery: Implant Exposure
Pageburst Integrated Resources
54 Endodontics
Electronic Resources
Learning Outcomes
Key Terms
Pulpal Damage
Causes
Symptoms
FIGURE 54-1 Abscess (arrow) associated with mandibular first molar resulting from extensive decay into the pulp.
FIGURE 54-2 Radiograph of a necrotic tooth resulting from trauma.
Endodontic Diagnosis
Percussion and Palpation
FIGURE 54-3 Percussion test.
FIGURE 54-4 Palpation test.
Thermal Sensitivity
FIGURE 54-5 Ice used for testing thermal sensitivity.
Electric Pulp Testing
Radiographic Imaging
FIGURE 54-6 Pulp tester.
FIGURE 54-7 Good-quality radiographs are necessary for endodontic evaluation. Left, Showing good contrast around the apex; right, showing poor contrast around the apex.
Requirements of Endodontic Images
Diagnostic Conclusions
Endodontic Procedures
Pulp Capping
Pulpotomy
FIGURE 54-8 Endodontic explorer.
FIGURE 54-9 Endodontic spoon excavator.
Pulpectomy
Instruments and Accessories
Hand Instruments
Explorer
Endodontic Spoon Excavator
Spreaders and Pluggers
FIGURE 54-10 Spreader (top) and plugger (bottom) used to obturate the canal.
Glick Number 1
Hand-Operated Files
FIGURE 54-11 Glick Number 1.
FIGURE 54-12 K-type files.
FIGURE 54-13 Hedstrom files.
TABLE 54-1 Color Coding and Sizing of Hand-Operated Files
K-Type File
Hedstrom File
Reamer File
FIGURE 54-14 Reamer files.
FIGURE 54-15 Dental broach.
Broaches
Rotary-Operated Files and Burs
FIGURE 54-16 Rotary handpiece used for endodontics.
Ancillary Instruments
Rubber Stops
Paper Points
FIGURE 54-17 Gates-Glidden burs.
FIGURE 54-18 Peso files.
FIGURE 54-19 Rubber stops.
Medicaments and Dental Materials in Endodontics
Irrigation Solutions
Root Canal Filling Materials
FIGURE 54-20 Paper points.
FIGURE 54-21 Materials needed for preparation and obturation of the pulpal canal. Top, Sterile irrigating solution. Bottom, Sterile paper points and syringe used with irrigating solution. Left, Files. Right, Gutta-percha.
Root Canal Sealers
FIGURE 54-22 A, Gutta-percha in varying sizes. B, The Obtura Max is a heated gutta-percha delivery system used to deliver warm gutta-percha to the root canal system for obturation.
Overview of Root Canal Therapy
Anesthesia and Pain Control
Isolation and Disinfection of the Operating Field
Access Preparation
Estimated Working Length
Electronic Apex Locator
FIGURE 54-23 Two types of devices for stop setting and measuring.
FIGURE 54-24 Electronic apex locator.
Debridement and Shaping of the Canal
Obturation
Surgical Endodontics
FIGURE 54-25 The apex of this mesiofacial root has been surgically removed.
Apicoectomy and Apical Curettage
Retrograde Restoration
FIGURE 54-26 Root end filling is completed on a central incisor.
Root Amputation and Hemisection
▪ Patient Education
▪ Legal and Ethical Implications
▪ Eye to the Future
▪ Critical Thinking
FIGURE 54-27 A, Periodontal loss involving the mesial root. B, Root amputation. C, Hemisection.
Procedure 54-1 Assisting in Electric Pulp Vitality Test
Equipment and Supplies
Procedural Steps
Procedure 54-2 Assisting in Root Canal Therapy
Equipment and Supplies
Procedural Steps
Preparing the Field of Operation
Removing the Pulp
Cleaning and Shaping the Canal
Preparing to Fill the Canal
Filling the Canal
Posttreatment Instructions and Follow-Up
Pageburst Integrated Resources
55 Periodontics
Electronic Resources
Learning Outcomes
Key Terms
The Periodontal Examination
FIGURE 55-1 Computer generated periodontal chart.
FIGURE 55-2 A periodontal chart on a computer screen. This periodontist can easily refer to the chart as he treats the patient.
Medical and Dental History
Dental Examination
Mobility
FIGURE 55-3 Mobility is detected with the blunt ends of two instruments.
TABLE 55-1 Dental Conditions That Contribute to Periodontal Disease
TABLE 55-2 Periodontal Examination of Gingiva and Supporting Tissues
Oral Tissues and Supporting Structures
Periodontal Probing
Early Signs of Periodontal Disease
Bleeding Index
FIGURE 55-4 Cross-section of a tooth, gingiva, and bone. The A side shows normal sulcus depth. The B side shows a periodontal pocket.
Occlusal Adjustment
FIGURE 55-5 Diagram shows probing of the periodontal pocket depth. The millimeter measurement indicates the distance from the gingival margin to the base of the pocket.
FIGURE 55-6 Six probing depths are taken for each tooth: B, Buccal; DB, distobuccal; DL, distolingual; L, lingual; MB, mesiobuccal; ML, mesiolingual.
Radiographic Analysis
FIGURE 55-7 Bone loss in periodontal disease: a, Vertical bone defect. b, Crestal ridge at near-normal height. c, Alveolar crest. d, Severe vertical defect.
Periodontal Instruments
Periodontal Probes
FIGURE 55-8 A, Molar vertical bitewing. B, Premolar vertical bitewing.
Explorers
FIGURE 55-9 Working end of a periodontal probe.
FIGURE 55-10 Furcation probe.
Scalers and Files
Curettes
FIGURE 55-11 Various styles of periodontal explorers. A, EXC 11/12 AF explorer allows access to pockets deeper than 5 mm for evaluating root surfaces. B, Elongated design is useful for exploring the furcation area.
FIGURE 55-12 Curved sickle scaler.
FIGURE 55-13 Hoes. A, Mesial/distal hoe. B, Buccal/lingual hoe.
FIGURE 55-14 Interdental file.
Surgical Knives
Pocket Markers
FIGURE 55-15 A, Anterior curette. B, Posterior curette.
FIGURE 55-16 Comparison of the end of a scaler (pointed) and the end of a curette (rounded).
Hand Scaling and Ultrasonic Scaling
Advantages of Hand Scaling and Ultrasonic Scaling
Advantages of Hand Scaling
Advantages of Ultrasonic Scaling
Ultrasonic Scaler
FIGURE 55-17 Universal curette. Note the cutting edge on each side of the blade.
FIGURE 55-18 Assorted Gracey curettes.
FIGURE 55-19 Gingivectomy knives. A, Kirkland knife. B, Orban interdental knives.
FIGURE 55-20 Peritomes.
FIGURE 55-21 Periodontal pocket marker makes pinpoint perforations that indicate the line for a surgical incision.
Indications
Contraindications
FIGURE 55-22 A series of ultrasonic tips designed to reach every area of the mouth.
FIGURE 55-23 A, Positioning of the ultrasonic scaler. B, Ultrasonic scaler with water source turned on.
Precautions for Children
Nonsurgical Periodontal Treatment
Dental Prophylaxis
Scaling and Root Planing
FIGURE 55-24 A Gracey currette is used during scaling and root planing.
Gingival Curettage
Antimicrobial and Antibiotic Agents
Locally Delivered Antibiotics
FIGURE 55-25 This irrigation tip is designed for low-pressure delivery of antimicrobial agents. The soft rubber tip is placed below the gingival margin and is ideal for cleaning periodontal pockets and furcations. It can be incorporated easily into a patient’s self-care routine.
Surgical Periodontal Treatment
Advantages and Disadvantages
Remaining Bone
Excisional Surgery
Gingivectomy
FIGURE 55-26 Prognosis based on amount of bone loss. A, When some bone is present, it may be safe to postpone surgery and take a wait-and-see approach. An additional bone loss of 2 mm may not alter the prognosis of the tooth. B, When half the bone has been lost, an additional 2 mm loss can seriously jeopardize the tooth; therefore, surgery is highly recommended. C, With advanced bone loss, surgery may be performed in an effort to save the tooth, but the prognosis is poor.
FIGURE 55-27 Gingivectomy surgery to treat gingival enlargement. A, Enlarged gingivae. B, Initial incision with a Kirkland knife. C, Interproximal tissue removed with an Orban knife. D and E, Gingivoplasty performed with tissue nippers and a round diamond bur. F, Surgery completed. G, Periodontal pack placed. H, Surgical area 3 months after surgery.
Gingivoplasty
Incisional Surgery
Osseous Surgery
Osteoplasty
Ostectomy
Crown Lengthening
Soft Tissue Grafts
Pedicle Graft
Free Gingival Soft Tissue Graft
Postsurgical Patient Instructions
FIGURE 55-28 Instruments often used in osseous surgery. A, Rongeurs. B, Carbide round burs. Left to right: Friction grip, surgical-length friction grip, and slow-speed handpiece. C, Diamond burs. D, Interproximal files: Schluger and Sugarman. E, Back-action chisels. F, Ochsenbein chisels.
Patient Instructions After Periodontal Surgery
FIGURE 55-29 Reduction of bony ledges by osteoplasty. A, Buccal preoperative photograph showing two crowns and exostoses. B, Flap retracted to show a facial exostosis. C, After osseous surgery; the bulk of the bony removal was performed by osteoplasty, with minor ostectomy between the two molars. D, Postoperative photograph at 6 weeks.
FIGURE 55-30 Surgical crown lengthening has provided these otherwise unrestorable mandibular molars with improved retention and restorative access for successful restorations. A, Before crown lengthening. B, Crown lengthening surgery completed. C, Buccal view after surgery. D, Final restoration.
FIGURE 55-31 A, Gingival recession around #22 before soft tissue graft. B, After soft tissue graft.
Periodontal Surgical Dressings
Zinc Oxide–Eugenol Dressing
FIGURE 55-32 Zinc oxide powder and liquid eugenol are mixed in advance.
FIGURE 55-33 Paste for noneugenol dressing is ready to be mixed.
Noneugenol Dressing
FIGURE 55-34 A and C, Presurgical recession of gingival tissues. B and D, Healed tissues after gingival graft surgery.
Esthetic and Plastic Periodontal Surgery
Lasers in Periodontics
Types of Periodontal Plastic Surgery
Advantages of Laser Surgery
Laser Safety
FIGURE 55-35 Laser unit.
FIGURE 55-36 Preoperative (A) and immediate postoperative (B) views of a gingivectomy performed to gain access for restorative prognosis.
FIGURE 55-37 Immediate postoperative view of a frenectomy. Note the lack of bleeding.
FIGURE 55-38 Laser removal of excess tissue caused by cyclosporine-induced gingival hyperplasia.
FIGURE 55-39 A and B, A lesion of the lower lip. C and D, Incision is performed using a laser. E, Complete removal of the lesion. F and G, At 10 days, sutures have been removed; note the favorable esthetic result.
FIGURE 55-40 To prevent injury to the eyes of persons who are not wearing special light filter glasses, warning signs must be placed in areas where lasers are used.
FIGURE 55-41 Matte-finished laser instruments.
▪ Patient Education
▪ Legal and Ethical Implications
▪ Eye to the Future
▪ Critical Thinking
Procedure 55-1 Assisting with a Dental Prophylaxis
Goal
Equipment and Supplies
Procedural Steps
Procedure 55-2 Assisting with Gingivectomy and Gingivoplasty
Goal
Equipment and Supplies
Typical series of periodontal surgical instruments, divided into two cassettes. A, From left, Mirrors, explorer, probe, series of curettes, needle holder, rongeurs, and scissors. B, From left, Series of chisels, Kirkland knife, Orban knife, scalpel handles with surgical blades (#15C, #15, #12D), periosteal elevators, spatula, tissue forceps, cheek retractors, mallet, and sharpening stone.
Procedural Steps
Role of the Dental Assistant
Role of the Dentist
Procedure 55-3 Preparing and Placing a Noneugenol Periodontal Dressing*
Goal
Equipment and Supplies
Procedural Steps
Mixing the Material
Placing the Dressing
Documentation
Procedure 55-4 Removing a Periodontal Dressing*
Goal
Equipment and Supplies
Procedural Steps
Pageburst Integrated Resources
56 Oral and Maxillofacial Surgery
Electronic Resources
Learning Outcomes
Key Terms
Indications for Oral and Maxillofacial Surgery
Members of the Oral and Maxillofacial Surgical Team
The Oral Surgeon
The Surgical Assistant
The Surgical Setting
Box 56-1 Surgical Assistant’s Role in Oral Surgery
Advanced Preparation
Treatment Room Preparation
Patient Preparation
During Surgery
After Surgery
Surgical Preparation
Private Practice
Operating Room
Specialized Instruments and Accessories
FIGURE 56-1 The operating room.
Elevators
Forceps
FIGURE 56-2 Periosteal elevators.
FIGURE 56-3 Straight elevator.
FIGURE 56-4 Root tip picks.
Surgical Curette
Rongeur
Bone File
Scalpel
Hemostat
Needle Holder
Surgical and Suture Scissors
Retractors
FIGURE 56-5 Types of extraction forceps. A, Maxillary molar extraction forceps. B, Maxillary anterior extraction forceps. C, Mandibular molar extraction forceps. D, Mandibular anterior extraction forceps. E, Root tip extraction forceps.
FIGURE 56-6 Surgical curettes.
FIGURE 56-7 Rongeurs.
FIGURE 56-8 Bone files.
FIGURE 56-9 Scalpel handles and blades. 1, Disposable handle. 2, Bard Parker handle. 3, #12 blade. 4, #15 blade.
Mouth Props
Chisel and Mallet
Rotary Instruments
FIGURE 56-10 Hemostats.
FIGURE 56-11 Needle holders.
FIGURE 56-12 Surgical scissors.
FIGURE 56-13 Tissue retractors.
FIGURE 56-14 Cheek and tongue retractor.
FIGURE 56-15 Mouth props.
FIGURE 56-16 Chisel and mallet.
Surgical Asepsis
Sterile Field
FIGURE 56-17 Surgical handpiece.
Surgical Scrub
Proper Gloving
Surgical Procedures
Forceps Extraction
Multiple Extractions and Alveoplasty
Removal of Impacted Teeth
Biopsy
Incisional Biopsy
Excisional Biopsy
Oral Brush Biopsy
FIGURE 56-18 Brush used to gather surface cells.
Biopsy Results
Sutures
FIGURE 56-19 An example of suture material labeled according to size, type, length, and type of needle.
FIGURE 56-20 A, Figure-eight suture. B, Simple loop suture. C, Horizontal/mattress suture. D, Continuous locking suture.
Suture Placement
Suture Removal
Postoperative Care
Control of Bleeding
Control of Swelling
Diet
Postsurgical Complications
Alveolitis
▪ Patient Education
▪ Legal and Ethical Implications
▪ Eye to the Future
▪ Critical Thinking
Procedure 56-1 Preparing a Sterile Field for Instruments and Supplies
Procedural Steps
Procedure 56-2 Performing a Surgical Scrub
Equipment and Supplies
Procedural Steps
Procedure 56-3 Performing Sterile Gloving
Procedural Steps
Procedure 56-4 Assisting in Forceps Extraction
Equipment and Supplies
Procedural Steps
Procedure 56-5 Assisting in Multiple Extractions and Alveoplasty
Equipment and Supplies
Procedural Steps
Procedure 56-6 Assisting in Removal of an Impacted Tooth
Equipment and Supplies
Procedural Steps
Surgical Preparation
Removing the Impacted Tooth
Procedure 56-7 Assisting in Suture Placement
Equipment and Supplies
Procedural Steps
Procedure 56-8 Performing Suture Removal (Expanded Function)
Prerequisites for Performing This Procedure
Equipment and Supplies
Procedural Steps
Procedure 56-9 Assisting in the Treatment of Alveolitis
Equipment and Supplies
Procedural Steps
Pageburst Integrated Resources
57 Pediatric Dentistry
Electronic Resources
Learning Outcomes
Key Terms
The Pediatric Dental Team and Office
The Pediatric Dentist
FIGURE 57-1 Patient at a pediatric dental office.
The Pediatric Dental Assistant
The Pediatric Dental Office
FIGURE 57-2 Example of pleasing, patient-friendly reception area of a pediatric dental office.
FIGURE 57-3 Clinical assistants should dress professionally but in a nonthreatening manner for the pediatric dental patient.
The Pediatric Patient
Erikson’s Stages of Development
Learning Basic Trust
Learning Autonomy
Play Age
FIGURE 57-4 During the period in which children are developing autonomy, conflicts with siblings, peers, and parents can seem never-ending.
School Age
Adolescence
Behavior Management
FIGURE 57-5 Adolescence is an extremely complex stage of development because of the many new opportunities and challenges thrust upon the teenager.
TABLE 57-1 Frankl Scale for Pediatric Dental Patient Behavior
Guidelines for Child Behavior
Examples of Ways to Include a Young Child in a Procedure
The Challenging Patient
FIGURE 57-6 The papoose board provides a way of holding the arms and legs still to prevent patients from injuring themselves or others.
Patients with Special Needs
Mentally Challenged
Down Syndrome
Autism
Cerebral Palsy
Diagnosis and Treatment Planning
Medical and Dental History
Specific Information Noted in the Pediatric Medical and Dental History
Medical History
Dental History
Initial Clinical Examination
Radiographic Imaging
Extraoral Examination
Intraoral Soft Tissue Examination
Examination and Charting of Teeth
Preventive Dentistry for Children
Oral Hygiene
FIGURE 57-7 Example of dental report card used for recall appointments.
Fluorides
Fluoride Varnish
Diet
Sealants
Orofacial Development
FIGURE 57-8 Space maintainer used to “reserve” the space until the permanent tooth erupts.
FIGURE 57-9 An appliance is placed to interfere with the finger position during thumb sucking.
FIGURE 57-10 The lower permanent premolars erupted lingual to the primary teeth.
FIGURE 57-11 Example of fixed appliance used to correct cross-bite.
FIGURE 57-12 Palatal expansion appliance used to widen the maxillary arch.
Sports Safety
FIGURE 57-13 Under Armour mouth guard.
Sports for Which Use of a Mouth Guard Is Recommended
Pediatric Procedures
Restorative Procedures
Instrument Size
Matrix System
Endodontic Procedures
Pulp Therapy
Pulpotomy
FIGURE 57-14 A deep calcium hydroxide pulpotomy completed on the central incisor.
Prosthodontic Procedures
Stainless Steel Crown
Types of Crowns
Dental Trauma
FIGURE 57-15 Traumatized maxillary incisor.
Fractured Anterior Teeth
Traumatic Intrusion
Extrusion and Lateral Luxation Injuries
Avulsed Teeth
FIGURE 57-16 Flyer describing actions to take in a dental emergency as distributed to school personnel.
FIGURE 57-17 Fracture of an anterior tooth.
FIGURE 57-18 Avulsion of maxillary central incisors.
Replanting an Avulsed Tooth
Child Abuse
What to Include When Reporting Child Abuse
▪ Patient Education
▪ Legal and Ethical Implications
▪ Eye to the Future
▪ Critical Thinking
Procedure 57-1 Assisting in Pulpotomy of a Primary Tooth
Equipment and Supplies
Procedural Steps
Procedure 57-2 Assisting in Placement of a Stainless Steel Crown
Equipment and Supplies
Procedural Steps
Preparing the Tooth
Selecting and Sizing the Stainless Steel Crown
Trimming and Contouring the Crown
Cementation
Pageburst Integrated Resources
58 Coronal Polishing
Electronic Resources
Learning Outcomes
Key Terms
Coronal Polishing
FIGURE 58-1 A, Bristle brush. B, Rubber polishing cup. C, Reusable prophy angle. D, Disposable prophy angle.
Box 58-1 Indications for and Contraindications to Coronal Polishing
Indications
Contraindications
Benefits of Coronal Polishing
Selective Polishing
Dental Stains
Types of Stains
Box 58-2 Possible Damaging Effects of Coronal Polishing
Tooth Surfaces
Gingival Tissues
Restorations
FIGURE 58-2 Endogenous developmental stain: tetracycline. Note how the stained area corresponds to the period of tooth development and the time the drug was taken.
FIGURE 58-3 Endogenous developmental stain: enamel hypoplasia.
FIGURE 58-4 Endogenous developmental stain: dental fluorosis.
FIGURE 58-5 Endogenous developmental stain: secondary caries.
FIGURE 58-6 Exogenous stain: amalgam restoration.
FIGURE 58-7 Staining of Nasmyth’s membrane after eruption of the teeth. The entire crown area of the primary dentition is affected.
TABLE 58-1 Extrinsic Stains
Tooth Stains
Methods of Removing Plaque and Stains
Air Polishing
Rubber Cup Polishing
TABLE 58-2 Intrinsic Stains
Box 58-3 Indications for and Contraindications to Air Polishing Use
Indications
Contraindications
Handpieces and Attachments for Coronal Polishing
Polishing Cups
FIGURE 58-8 Air polisher unit (left) and magnetostive scaler (right).
Bristle Brushes
Bristle-Brush Polishing Stroke
Prophylaxis Angle and Handpiece
Grasping the Handpiece
FIGURE 58-9 Close-up of hand with handpiece and proper grasp.
Handpiece Operation
The Fulcrum and Finger Rest
Polishing Agents
Polishing Esthetic Restorations
FIGURE 58-10 Prophy pastes and equipment. A, Finger ring that holds the individual container of prophy paste. B, Mild grit. C, Medium grit. D, Coarse grit. E, Soft polishing paste for esthetic restorations.
TABLE 58-3 Commonly Used Abrasives
Factors That Influence the Rate of Abrasion
Polishing Tips
Coronal Polishing Steps
Polishing Stroke
FIGURE 58-11 A, It can be difficult to detect esthetic restorations. Two of these teeth have crowns. B, Note the opaque white line of cement on teeth #8 and #9, which shows that these teeth have porcelain crowns.
FIGURE 58-12 Use overlapping strokes to ensure complete coverage of the tooth.
FIGURE 58-13 Stroke from the gingival third with just enough pressure to cause the cup to flare.
Positioning the Patient and Operator
Positioning the Patient
FIGURE 58-14 For the mandibular arch, the patient’s head is positioned so the lower jaw is parallel to the floor when the mouth is open.
FIGURE 58-15 For access to the maxillary arch, position the patient’s head with the chin up.
Positioning the Operator
FIGURE 58-16 The right-handed operator is seated at the nine o’clock position.
Sequence of Polishing
Flossing After Polishing
Evaluation of Polishing
▪ Patient Education
▪ Legal and Ethical Implications
▪ Eye to the Future
▪ Critical Thinking
Procedure 58-1 Rubber Cup Coronal Polishing (Expanded Function)
Prerequisites for Performing This Procedure
Equipment and Supplies
Procedural Steps
Maxillary Right Posterior Quadrant, Buccal Aspect (Eleven O’Clock or Twelve O’Clock Position May Be Used)
Maxillary Right Posterior Quadrant, Lingual Aspect (Eleven O’Clock or Twelve O’Clock Position May Be Used)
Maxillary Anterior Teeth, Facial Aspect
Maxillary Anterior Teeth, Lingual Aspect
Maxillary Left Posterior Quadrant, Buccal Aspect
Maxillary Left Posterior Quadrant, Lingual Aspect
Mandibular Left Posterior Quadrant, Buccal Aspect (Eleven O’Clock or Twelve O’Clock Position May Be Used)
Mandibular Left Posterior Quadrant, Lingual Aspect
Mandibular Anterior Teeth, Facial Aspect
Mandibular Anterior Teeth, Lingual Aspect
Mandibular Right Quadrant, Buccal Aspect
Mandibular Right Quadrant, Lingual Aspect
Mandibular Right Quadrant, Lingual Aspect (Eleven O’Clock or Twelve O’Clock Position May Be Used)
Documentation
Pageburst Integrated Resources
59 Dental Sealants
Electronic Resources
Learning Outcomes
Key Terms
How Sealants Work
FIGURE 59-1 Section of tooth showing long, narrow fissure containing debris. A sealant is present and covers the opening of the fissure.
Dental Caries and Sealants
FIGURE 59-2 Micrograph showing toothbrush bristle in a groove.
FIGURE 59-3 Molar with a properly placed sealant.
Indications for Sealants
FIGURE 59-4 Enamel without significant fissures (well coalesced).
Indications for Sealant Placement
Contraindications to Sealants
Contraindications to Sealant Placement
Types of Sealant Materials
Method of Polymerization
TABLE 59-1 Troubleshooting Problems with Sealants
FIGURE 59-5 Helioseal Clear sealant material.
Color
Fillers
Working Time
Box 59-1 Advantages and Disadvantages of Chemical-Cured and Light-Cured Sealants
Chemical-Cured (Self-Cured or Auto-Polymerizing) Sealants
Advantages
Disadvantages
Light-Cured Sealants
Advantages
Disadvantages
Placement Technique
Preventing Problems with Sealants
Etching
Remineralization of Etched Unsealed Enamel
Bite Interference by Sealant
Failures
Blocked Contacts
Fluoride Release
FIGURE 59-6 Excess sealant blocking the contact area.
Microabrasion
Precautions for Dental Personnel and Patients
Etchant Precautions
FIGURE 59-7 Air abrasion tip.
Sealant Precautions
Storage and Use
Manufacturer’s Instructions
Factors in Sealant Retention
▪ Legal and Ethical Implications
▪ Eye to the Future
▪ Critical Thinking
Procedure 59-1 Application of Dental Sealants (Expanded Function)
Prerequisites for Performing this Procedure
Equipment and Supplies
Procedural Steps
Pageburst Integrated Resources
60 Orthodontics
Electronic Resources
Learning Outcomes
Key Terms
Benefits of Orthodontic Treatment
Psychosocial Problems
Oral Malfunction
Dental Disease
The Orthodontic Team and Office
The Orthodontist
The Orthodontic Assistant
The Orthodontic Office
Understanding Occlusion
Developmental Causes
Genetic Causes
Environmental Causes
Birth Injuries
Injury Throughout Life
Habits
TABLE 60-1 Habits That Affect the Dentition
Malocclusion
Class I Malocclusion
Class II Malocclusion
Class III Malocclusion
Malaligned Teeth
FIGURE 60-1 Angle’s classification of malocclusion.
FIGURE 60-2 Crowding of teeth in the mandibular arch.
FIGURE 60-3 Excessive protrusion of the maxillary incisors creates an overjet.
FIGURE 60-4 Complete coverage of the lower anterior teeth is caused by an overbite.
FIGURE 60-5 An open bite is created when the patient’s anterior teeth make an opening.
FIGURE 60-6 An example of a cross-bite showing improper alignment of the maxillary and mandibular teeth.
Management of Orthodontic Problems
Corrective Orthodontics
Orthodontic Records and Treatment Planning
Medical and Dental History
Physical Growth Evaluation
FIGURE 60-7 An example of a form used to acquire information about the perception of a person’s teeth.
Social and Behavioral Evaluation
Clinical Examination
Analysis of Facial Proportions
Evaluation of Oral Health
Evaluation of Jaw and Occlusal Function
Diagnostic Records
Photographs
Radiographs
Cephalometric Analysis
FIGURE 60-8 Facial analysis from the frontal and profile views.
FIGURE 60-9 Standard extraoral photographs.
FIGURE 60-10 Intraoral photographs showing a patient’s front view in occlusion (A), the maxillary occlusal view (B), and the right buccal view (C).
FIGURE 60-11 A panoramic radiograph showing the eruption process.
Cephalometric Landmarks and Points
Diagnostic Casts
FIGURE 60-12 A, Cephalometric radiograph. B, Cephalometric landmarks and points. C, Cephalometric analysis.
FIGURE 60-13 Diagnostic cast that has been digitally produced from a laser scan of the cast and displayed for space analysis.
Case Presentation
Financial Arrangements
FIGURE 60-14 Full braces.
Specialized Instruments and Accessories
Orthodontic Treatment
Fixed Appliances
Sequence of Appointments for the Orthodontic Patient
TABLE 60-2 Intraoral Instruments
TABLE 60-3 PLIERS
Separators
Orthodontic Bands
Fitting Molar Bands
FIGURE 60-15 Molar band showing the attachments of tubes and cleats to hold the arch wire and head gear.
Cementation of Orthodontic Bands
Bonded Brackets
Auxiliary Attachments
FIGURE 60-16 The band pusher is used to seat the band interproximally.
FIGURE 60-17 Example of bonding on tooth #9.
FIGURE 60-18 Auxiliary attachment on a molar band. A, Band. B, Tubing. C, Brackets.
Arch Wire
FIGURE 60-19 An example of how an arch wire is adapted to each tooth in the process of straightening teeth.
Types of Arch Wires
Shapes of Arch Wires
FIGURE 60-20 Examples of types of ligature ties. A, Wire ligature tie. B, Elastic ligature tie.
Ligating the Arch Wire
Power Products
FIGURE 60-21 An example of different power products used for movement.
New Treatment Options
Adjustment Visits
Checking the Appliance
Oral Hygiene and Dietary Instructions
Toothbrushing Instructions
Headgear
Face Bow
Traction Devices
Completed Treatment
TABLE 60-4 Dietary Habits and Orthodontics
FIGURE 60-22 A, High-pull headgear. The high-pull traction device is a caplike device that fits around the top of the patient’s head and hooks perpendicular to the occlusal plane. It can be used in controlling the growth of the maxilla or in retraction of the anterior teeth. B, Cervical traction. The cervical traction device fits around the patient’s neck. The exerted force is parallel to the occlusal plane of the patient’s teeth. This type of traction is used when the maxillary first molars are stabilized or moved distally. C, Combination headgear. A combination traction device combines the features of high-pull and cervical traction devices. It exerts a force along the occlusal plane and upward. D, Chin cap. The chin cap traction device is a combination of a high-pull strap and a chin cup that fits on the mandible. This helps to control growth of the mandible in patients with class III malocclusion.
Retention
Orthodontic Positioner
FIGURE 60-23 An orthodontic positioner.
FIGURE 60-24 Examples of Hawley retainers.
Hawley Retainer
FIGURE 60-25 The lingual retainer is bonded into place.
Lingual Retainer
▪ Patient Education
▪ Legal and Ethical Implications
▪ Eye to the Future
▪ Critical Thinking
Procedure 60-1 Placing and Removing Steel Separating Springs (Expanded Function)
Prerequisites for Performing this Procedure
Equipment and Supplies
Procedural Steps
Placing Steel Separating Springs
Removing Steel Separating Springs
Procedure 60-2 Placing and Removing Elastomeric Ring Separators (Expanded Function)
Prerequisites for Performing this Procedure
Equipment and Supplies
Procedural Steps
Placing Elastomeric Ring Separators
Removing Elastomeric Ring Separators
Procedure 60-3 Assisting in the Fitting and Cementation of Orthodontic Bands (Expanded Function)
Equipment and Supplies
Procedural Steps
Preparation
Mixing and Placing the Cement
Removing Excess Cement
Documentation
Procedure 60-4 Assisting in the Direct Bonding of Orthodontic Brackets
Equipment and Supplies
Procedural Steps
Preparing the Teeth
Bonding the Brackets
Documentation
Procedure 60-5 Placing Arch Wires (Expanded Function)
Prerequisites for Performing This Procedure
Equipment and Supplies
Procedural Steps
Measuring the Arch Wire
Positioning the Arch Wire
Procedure 60-6 Placing and Removing Ligature Ties (Expanded Function)
Prerequisites for Performing This Procedure
Equipment and Supplies
Procedural Steps
Placing Wire Ligatures
Removing Ligature Ties
Procedure 60-7 Placing and Removing Elastomeric Ties (Expanded Function)
Prerequisites for Performing This Procedure
Equipment and Supplies
Procedural Steps
Placing Elastomeric Ties
Removing Elastomeric Ties
Pageburst Integrated Resources
Part Eleven Dental Administration and Communication Skills
Dental Administration and Communication Skills
Interactive Review – Part 11
61 Communication in the Dental Office
Electronic Resources
Learning Outcomes
Key Terms
Understanding Human Behavior
Significant People in Psychology
Social Attitudes
Peer Pressure
Cultural Diversity
FIGURE 61-1 Maslow’s Hierarchy of Needs.
Basic Dental Terms in Spanish
Communication Pathways
Verbal Communication
Words Are Important
Box 61-1 Effective Words
Voice Quality
Asking Questions
Nonverbal Communication
TABLE 61-1 Nonverbal Communication
Listening Skills
Communicating with Colleagues
FIGURE 61-2 Team meeting.
Being a Team Member
Stress in the Dental Office
Causes
Methods of Stress Reduction
Conflict Among Coworkers
Box 61-2 Conflict Resolution
Communicating with Patients
FIGURE 61-3 Communication is the most important tool in a practice.
Patient Needs
Psychological Needs
Anxiety and Fear of Pain
Dental-Phobic Patients
Patient’s Responses
Physical and Mental Needs
Financial Needs
Meeting Patient Needs
Positive Atmosphere
Sincerity
Showing Respect
Respecting the Patient’s Time
Resolving Complaints and Misunderstandings
Remaining Approachable
Respecting Patient Confidentiality
Phone Skills
Etiquette
FIGURE 61-4 The business assistant answers the phone.
Incoming Calls
Working with Difficult Callers
Placing a Caller on Hold
On-Hold Message Systems
Callers Wanting to Speak to the Dentist
Taking Messages
FIGURE 61-5 An example of a printed form for taking messages.
Phone Message Systems
Answering Service
Answering Machine
FIGURE 61-6 A multipurpose phone system with multiple lines and answering machine.
Voice Mail
Emailing
Automatic Dialing Services
Text Messaging
Patient’s Preferred Method of Communication
FIGURE 61-7 The office assistant using a headset system.
Phone Equipment
Headsets
Pager
Facsimile (“Fax”) Machine
FIGURE 61-8 A facsimile (fax) machine.
Written Communications
Equipment
FIGURE 61-9 Business equipment is set up within the office management area.
FIGURE 61-10 A desktop computer system used in the dental office.
Business Letters
FIGURE 61-11 Copier, printer, scanner, and fax machine all in one.
Types of Business Letters
Letters to Colleagues
Letters to Insurance Carriers
Format of a Business Letter
Anatomy of a Business Letter
Preparing Envelopes for Mailing
FIGURE 61-12 A full-blocked business letter.
FIGURE 61-13 A semi-blocked business letter.
FIGURE 61-14 Anatomy of a business letter.
Marketing Your Dental Practice
Goals of Practice Marketing
Logistics of Marketing
The Plan
Marketing Budget
Tracking Responses
Types of Practice Marketing
Practice Newsletter
FIGURE 61-15 An example of a dental practice brochure for marketing.
Patient Education Materials
▪ Patient Education
▪ Eye to the Future
▪ Legal and Ethical Implications
▪ Critical Thinking
Procedure 61-1 Answering the Phone
Equipment and Supplies
Procedural Steps
Procedure 61-2 Composing a Business Letter
Equipment and Supplies
Procedural Steps
Pageburst Integrated Resources
62 Business Operating Systems
Electronic Resources
Learning Outcomes
Key Terms
Operating Procedure Manual
HIPAA Compliance
HIPAA Privacy Compliance List
Personnel Manual
Computer Applications in the Dental Office
FIGURE 62-1 A, Computer keyboard. B, Computer system.
Characteristics of the Computer
Record Keeping
Types of Records and Files
Patient Dental Records
Patient Financial Records
Practice Business Records
FIGURE 62-2 Patient ledger.
Filing Systems
FIGURE 62-3 Anatomy of an electronic ledger.
Basic Filing Methods
Alphabetic
Color Coding
Numeric
FIGURE 62-4 An example of a software program to show the business side of a practice.
FIGURE 62-5 Keep filing systems simple.
Chronologic
Electronic
Guidelines for Efficient Filing
TABLE 62-1 Indexing* Rules for Alphabetic† Filing
FIGURE 62-6 File showing color coding.
FIGURE 62-7 Chronological filing.
Active and Inactive Files
Purge Tabs
FIGURE 62-8 Computerized filing.
FIGURE 62-9 Use an outguide.
Record Protection and Confidentiality
HIPAA Electronic Safeguards
Protecting Electronic Files
Protecting Paper Files
Appointment Scheduling

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