Dental Assistant Instruction Pack 1 PDF

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YTI Career Institute

Margaret Graham, M.Ed., Sheila D. McCray, M.S., CCS, CCS-P, Martha Roden, B.S., Celeste Yeik, AAS

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dental assistant training dental assisting dental office procedures dental health

Summary

This instruction pack provides lessons on dental assisting, covering topics such as the role of the dental assistant, preventive dentistry, welcoming patients, dental equipment, instruments, materials, and examinations. It details the history of dentistry, career choices for dental assistants, and outlines a day in the life of a dental assistant.

Full Transcript

Dental Assistant Instruction Pack 1 Lessons 1-8 0204551LB01A-14 Dental Assistant Instruction Pack 1 Lesson 1—Welcome to the World of Dentistry Lesson 2—The Role of the Dental Assistant Lesson 3—Preventive Dentistry and Nutrition Lesson 4—Welcoming the Dental Pati...

Dental Assistant Instruction Pack 1 Lessons 1-8 0204551LB01A-14 Dental Assistant Instruction Pack 1 Lesson 1—Welcome to the World of Dentistry Lesson 2—The Role of the Dental Assistant Lesson 3—Preventive Dentistry and Nutrition Lesson 4—Welcoming the Dental Patient Lesson 5—Dental Equipment Lesson 6—Dental Instruments Lesson 7—Dental Materials Lesson 8—The Dental Examination No part of this document may be reproduced or transmitted in any form or by any means, electronic or mechanical, for any purpose, without the express written permission of U.S. Career Institute. Copyright © 2009-2024, U.S. Career Institute. All Rights Reserved. 0204551LB01A-14 Acknowledgments Margaret Graham, M.Ed., Author Sheila D. McCray, M.S., CCS, CCS-P, Author Martha Roden, B.S., Author Celeste Yeik, AAS, Subject Matter Expert Editorial Staff Janet Perry, B.A., Vice President of Academics and Compliance Brenda Blomberg, B.A., CPC, Curriculum Department Manager Christopher Pimental, B.A., Project Manager Julia Bauernfeind, B.S., Editorial Assistant Jane Bullinger, Editorial Assistant Jessica Babb-Raymundo, B.A., Graphic Designer U.S. Career Institute Fort Collins, CO 80525 www.uscareerinstitute.edu Biographies Margaret Graham, M.Ed. Margaret Graham is an experienced educational writer and editor with more than 30 years of experience. Sheila D. McCray, M.S., CCS, CCS-P Sheila McCray is an experienced instructional designer, writer and medical coder. Sheila earned her master’s degree Instructional and Performance Technology from Boise State and a bachelor’s in Journalism from Temple University. Martha Roden, B.S. With a bachelor’s degree in Nutrition and Natural Resources, Martha Roden started her career as a nutritionist, explaining vitamins, nutrition and diet to her clients. A chance conversation with a client led her to a job as an engineering assistant and a technical writer. Next, she moved into technical training to get firsthand feedback from people regarding her explanation skills. However, teaching people to use software made her realize how difficult it was to use, so Martha moved into the usability profession—helping design software that was intuitive and easy-to-use. She’s definitely had a dynamic career, but everything she’s done has focused on helping people “find what they need and understand what they read.” Celeste Yeik, AAS Celeste graduated from Laramie County Community College in 2006 with her AAS degree in Dental Hygiene. She serves as the SME of dental assisting with U.S. Career Institute. Celeste also works as a full time clinical hygienist for Peak Dental Services where she acts as a Lead Hygiene Mentor. Celeste resides in Colorado and enjoys spending time outdoors with her husband Dustin and their three daughters. Table of Contents Lesson 1: Welcome to the World of Dentistry Step 1: Learning Objectives............................................................................................................................................. 1 Step 2: Lesson Preview..................................................................................................................................................... 1 Step 3: Welcome to Your Career as a Dental Assistant................................................................................................ 3 Promising Work Outlook................................................................................................................................. 3 Job Variety.......................................................................................................................................................... 4 Value.................................................................................................................................................................... 5 Dental Professionals Are Caregivers............................................................................................................... 5 Behind the Scenes in the Dentist’s Office....................................................................................................... 6 Step 4: The Future of Dental Assisting.......................................................................................................................... 7 Career Choices................................................................................................................................................... 7 The Expanded Function Dental Assistant..................................................................................................... 8 The Dental Hygiene Assistant.......................................................................................................................... 9 Dental Assistants Are the Future..................................................................................................................... 9 Step 5: Dentistry: A Brief History................................................................................................................................ 10 Ancient Dental Practices................................................................................................................................ 10 Two Frenchmen of the Renaissance.............................................................................................................. 11 A Revolutionary Discovery............................................................................................................................ 11 Dentistry Arrives in the United States.......................................................................................................... 12 Step 6: Practice Exercise 1-1.......................................................................................................................................... 12 Step 7: Review Practice Exercise 1-1............................................................................................................................ 14 Step 8: A Day in the Life of a Dental Assistant........................................................................................................... 14 A Nice Way to Start the Day.......................................................................................................................... 15 Duties, Responsibilities and Pride................................................................................................................. 16 Cruising Through the Afternoon.................................................................................................................. 16 The Day Winds Down.................................................................................................................................... 17 Step 9: Practice Exercise 1-2.......................................................................................................................................... 17 Step 10: Review Practice Exercise 1-2.......................................................................................................................... 18 Step 11: Why this Matters.............................................................................................................................................. 18 Step 12: Summary........................................................................................................................................................... 18 Step 13: Journal Entry.................................................................................................................................................... 19 Step 14: Quiz 1................................................................................................................................................................ 19 Endnotes........................................................................................................................................................... 19 Dental Assistant Lesson 2: The Role of the Dental Assistant Step 1: Learning Objectives............................................................................................................................................. 1 Step 2: Lesson Preview..................................................................................................................................................... 1 Step into the Dental Office............................................................................................................................... 3 Step 3: More Than One Kind of Dental Assistant........................................................................................................ 3 Clinical Assistant............................................................................................................................................... 4 Sterilization Assistant........................................................................................................................................ 5 Expanded Function Dental Assistant............................................................................................................. 5 Business Assistant.............................................................................................................................................. 5 Step 4: Other Professionals in the Dental Office.......................................................................................................... 6 The Dentist......................................................................................................................................................... 6 The Dental Hygienist........................................................................................................................................ 6 The Dental Laboratory Technician................................................................................................................. 7 Office Staff.......................................................................................................................................................... 9 Step 5: Practice Exercise 2-1............................................................................................................................................ 9 Step 6: Review Practice Exercise 2-1............................................................................................................................ 11 Step 7: The Patient.......................................................................................................................................................... 12 Confidentiality................................................................................................................................................. 12 Pay Attention to Your Peers: Standard of Care............................................................................................ 13 Abandonment and Due Care......................................................................................................................... 14 Patient Responsibilities................................................................................................................................... 14 Step 8: Personal Characteristics of a Successful Dental Assistant............................................................................ 15 Appearance Matters......................................................................................................................................... 15 Knowledge and Skills...................................................................................................................................... 16 Attitude............................................................................................................................................................. 16 Step 9: Practice Exercise 2-2.......................................................................................................................................... 17 Step 10: Review Practice Exercise 2-2.......................................................................................................................... 19 Step 11: Why This Matters............................................................................................................................................ 19 Step 12: Journal Entry.................................................................................................................................................... 20 Step 13: Summary........................................................................................................................................................... 20 Step 14: Quiz 2................................................................................................................................................................ 21 Endnotes........................................................................................................................................................... 21 VI 0204551LB01A-14 Table of Contents Lesson 3: Preventive Dentistry and Nutrition Step 1: Learning Objectives............................................................................................................................................. 1 Step 2: Lesson Preview..................................................................................................................................................... 1 Step 3: Preventive Dentistry............................................................................................................................................ 2 Battling Plaque................................................................................................................................................... 2 Calculus.............................................................................................................................................................. 3 Out-of-Control Plaque: Periodontal Disease................................................................................................. 4 Step 4: Basic Preventive Care at Home.......................................................................................................................... 4 Tooth Brushing—General................................................................................................................................ 5 Tongue Cleaning.............................................................................................................................................. 10 Show Patients Their Plaque............................................................................................................................ 10 Extra Protection: Mouthwashes..................................................................................................................... 11 Step 5: Advanced Preventive Care: Interdental Care................................................................................................. 11 Types of Floss................................................................................................................................................... 12 Beyond Flossing: Other Plaque-fighting Tools............................................................................................ 12 Step 6: Practice Exercise 3-1.......................................................................................................................................... 15 Step 7: Review Practice Exercise 3-1............................................................................................................................ 17 Step 8: Fluoride Treatment............................................................................................................................................ 18 Where Does Fluoride Come From?.............................................................................................................. 19 Who Needs Fluoride?...................................................................................................................................... 19 Risk Factors and Fluoride Care...................................................................................................................... 19 Controversy Regarding Fluoride................................................................................................................... 19 Fluorosis............................................................................................................................................................ 20 Home Fluoride Treatment.............................................................................................................................. 21 Step 9: Ages and Stages.................................................................................................................................................. 21 Children............................................................................................................................................................ 21 Toddlers and Preschoolers............................................................................................................................. 21 The Primary Ages—Five through Eight....................................................................................................... 22 Pre-adolescents—Ages Nine through 12...................................................................................................... 22 Teens.................................................................................................................................................................. 22 Adults................................................................................................................................................................ 22 Senior Citizens................................................................................................................................................. 22 Patients with Special Needs............................................................................................................................ 23 Step 10: Dental Prevention and Sealants..................................................................................................................... 24 Dental Assistants Can Help with Sealants.................................................................................................... 25 0204551LB01A-14 VII Dental Assistant Step 11: Practice Exercise 3-2....................................................................................................................................... 25 Step 12: Review Practice Exercise 3-2.......................................................................................................................... 28 Step 13: Nutrition and Oral Health.............................................................................................................................. 29 What Does Healthy Eating Look Like?......................................................................................................... 30 Best Foods for Dental Health......................................................................................................................... 30 Vitamins, Minerals, Supplements and Water............................................................................................... 30 Sugar’s Role in Dental Disease....................................................................................................................... 31 Eating Disorders and Oral Health................................................................................................................. 32 Step 14: Practice Exercise 3-3....................................................................................................................................... 33 Step 15: Review Practice Exercise 3-3.......................................................................................................................... 35 Step 16: Why This Matters............................................................................................................................................ 35 Step 17: Summary........................................................................................................................................................... 36 Step 18: Journal Entry.................................................................................................................................................... 36 Step 19: Quiz 3................................................................................................................................................................ 37 Endnotes........................................................................................................................................................... 37 Lesson 4: Welcoming the Dental Patient Step 1: Learning Objectives............................................................................................................................................. 1 Step 2: Lesson Preview..................................................................................................................................................... 1 Step 3: Common Communication Modes.................................................................................................................... 2 Visual-based Communicators.......................................................................................................................... 2 Auditory-based Communicators..................................................................................................................... 3 Kinesthetic-based Communicators................................................................................................................. 3 Key Words and Phrases.................................................................................................................................... 4 Step 4: Active Listening................................................................................................................................................... 4 Paying Attention................................................................................................................................................ 5 Show You Are Listening.................................................................................................................................... 5 Paraphrase.......................................................................................................................................................... 5 Listening Errors................................................................................................................................................. 6 Self-Analysis....................................................................................................................................................... 7 Nonverbal Cues.................................................................................................................................................. 8 Step 5: Professional Communication Skills................................................................................................................ 11 General Rules of Professional Communication.......................................................................................... 11 Communication Barriers................................................................................................................................ 12 Step 6: Practice Exercise 4-1.......................................................................................................................................... 12 Step 7: Review Practice Exercise 4-1............................................................................................................................ 14 VIII 0204551LB01A-14 Table of Contents Step 8: Greeting New Patients....................................................................................................................................... 15 Greeting Patients............................................................................................................................................. 16 Meet—Get to Know Patients.......................................................................................................................... 16 Complete Intake Forms.................................................................................................................................. 16 Step 9: Create the Patient Record................................................................................................................................. 16 Step 10: The Patient Registration Form....................................................................................................................... 17 Insurance Information.................................................................................................................................... 18 Step 11: Medical Health History................................................................................................................................... 18 Conditions........................................................................................................................................................ 19 Diseases............................................................................................................................................................. 19 Allergic Reactions............................................................................................................................................ 20 Review of the Medical History....................................................................................................................... 20 Step 12: Practice Exercise 4-2....................................................................................................................................... 21 Step 13: Review Practice Exercise 4-2.......................................................................................................................... 23 Step 14: Dental Health History..................................................................................................................................... 24 Review of the Dental Health History............................................................................................................ 25 Step 15: Informed Consent........................................................................................................................................... 25 Implied Consent.............................................................................................................................................. 25 Written Consent.............................................................................................................................................. 25 Right to Refuse................................................................................................................................................. 26 Minor Patients and Consent.......................................................................................................................... 27 Situational Consent Requirements................................................................................................................ 27 Additional Requirements............................................................................................................................... 27 Step 16: Additional Forms............................................................................................................................................. 27 Step 17: Financial Arrangement Sheet......................................................................................................................... 28 Step 18: Progress Notes.................................................................................................................................................. 28 Step 19: Health Insurance Portability and Accountability Act................................................................................ 29 HIPAA and Dental Assistants........................................................................................................................ 29 Step 20: Practice Exercise 4-3....................................................................................................................................... 29 Step 21: Review Practice Exercise 4-3.......................................................................................................................... 32 Step 22: Why This Matters............................................................................................................................................ 33 Step 23: Summary........................................................................................................................................................... 33 Step 24: Journal Entry.................................................................................................................................................... 34 Step 25: Quiz 4................................................................................................................................................................ 34 Endnotes........................................................................................................................................................... 34 0204551LB01A-14 IX Dental Assistant Lesson 5: Dental Equipment Step 1: Learning Objectives............................................................................................................................................. 1 Step 2: Lesson Preview..................................................................................................................................................... 1 About the Steps to Take and Virtual Labs...................................................................................................... 1 Step 3: Dental Equipment................................................................................................................................................ 1 Sanitary Categories............................................................................................................................................ 2 Dental Chair....................................................................................................................................................... 2 Dental Stools...................................................................................................................................................... 3 The Dental Unit and Associated Equipment................................................................................................. 4 Step 4: Practice Exercise 5-1.......................................................................................................................................... 12 Step 5: Review Practice Exercise 5-1............................................................................................................................ 17 Step 6: More Equipment................................................................................................................................................ 18 X-ray Equipment............................................................................................................................................. 18 X-ray View Box................................................................................................................................................ 19 Dental Curing Equipment.............................................................................................................................. 20 Other Non-patient Centered Equipment..................................................................................................... 20 Step 7: Virtual Flashcard Tutorial................................................................................................................................. 22 About the Flashcards....................................................................................................................................... 22 Step 8: Practice Exercise 5-2.......................................................................................................................................... 22 Step 9: Review Practice Exercise 5-2............................................................................................................................ 23 Step 10: Why This Matters............................................................................................................................................ 24 Step 11: Summary........................................................................................................................................................... 24 Step 12: Journal Entry.................................................................................................................................................... 25 Step 13: Quiz 5................................................................................................................................................................ 25 Endnotes........................................................................................................................................................... 25 Lesson 6: Dental Instruments Step 1: Learning Objectives............................................................................................................................................. 1 Step 2: Lesson Preview..................................................................................................................................................... 1 Step 3: Hand Instruments................................................................................................................................................ 1 Common Chairside Instruments.................................................................................................................... 2 Black’s Formula: Angles and Dimensions...................................................................................................... 3 Examination....................................................................................................................................................... 4 Tooth Preparation.............................................................................................................................................. 5 Restorative.......................................................................................................................................................... 7 Accessory............................................................................................................................................................ 9 X 0204551LB01A-14 Table of Contents Step 4: Virtual Flashcards.............................................................................................................................................. 13 Step 5: Practice Exercise 6-1.......................................................................................................................................... 13 Step 6: Review Practice Exercise 6-1............................................................................................................................ 17 Step 7: Dental Rotary Instruments............................................................................................................................... 19 Burs.................................................................................................................................................................... 19 Abrasive Rotary Instruments......................................................................................................................... 22 Step 8: Tray Systems....................................................................................................................................................... 23 Plastic or Metal Trays and Tubs..................................................................................................................... 23 Cassette System................................................................................................................................................ 24 Step 9: Virtual Flashcards.............................................................................................................................................. 25 Step 10: Practice Exercise 6-2...................................................................................................................................... 25 Step 11: Review Practice Exercise 6-2.......................................................................................................................... 30 Step 12: Why This Matters............................................................................................................................................ 31 Step 13: Summary........................................................................................................................................................... 32 Step 14: Journal Entry.................................................................................................................................................... 32 Step 15: Quiz 6................................................................................................................................................................ 32 Endnotes........................................................................................................................................................... 32 Lesson 7: Dental Materials Step 1: Learning Objectives............................................................................................................................................. 1 Step 2: Lesson Preview..................................................................................................................................................... 1 Step 3: Introduction to Dental Materials....................................................................................................................... 1 Mechanical Properties...................................................................................................................................... 2 Thermal Changes............................................................................................................................................... 2 Electrical Properties.......................................................................................................................................... 3 Corrosive Properties......................................................................................................................................... 3 Solubility............................................................................................................................................................. 3 Application Properties...................................................................................................................................... 3 Amalgams........................................................................................................................................................... 4 Composite Resins.............................................................................................................................................. 5 Glass Ionomers................................................................................................................................................... 5 Compomers........................................................................................................................................................ 6 Cements.............................................................................................................................................................. 6 Etchants and Bonding Agents.......................................................................................................................... 8 Bleaching Products............................................................................................................................................ 8 Sealants............................................................................................................................................................... 9 0204551LB01A-14 XI Dental Assistant Step 5: Virtual Flashcards.............................................................................................................................................. 10 Step 6: Practice Exercise 7-1.......................................................................................................................................... 10 Step 7: Review Practice Exercise 7-1............................................................................................................................ 13 Step 8: Laboratory Materials......................................................................................................................................... 14 Impression Materials....................................................................................................................................... 14 Gypsum Materials........................................................................................................................................... 16 Dental Waxes.................................................................................................................................................... 17 Processing Waxes............................................................................................................................................. 18 Bite Registration Waxes.................................................................................................................................. 18 Materials for Provisional Restorations.......................................................................................................... 19 Step 9: Virtual Flashcards.............................................................................................................................................. 20 Step 10: Practice Exercise 7-2....................................................................................................................................... 20 Step 11: Review Practice Exercise 7-2.......................................................................................................................... 21 Step 12: Why This Matters............................................................................................................................................ 22 Step 13: Summary........................................................................................................................................................... 22 Step 14: Journal Entry.................................................................................................................................................... 22 Step 15: Quiz 7................................................................................................................................................................ 23 Endnotes........................................................................................................................................................... 23 Lesson 8: The Dental Examination Step 1: Learning Objectives............................................................................................................................................. 1 Step 2: Lesson Preview..................................................................................................................................................... 1 Step 3: The Dental Treatment Room............................................................................................................................. 2 In the Operatory................................................................................................................................................ 2 Seating the Patient............................................................................................................................................. 2 Step 4: Positioning the Dental Patient........................................................................................................................... 3 Upright................................................................................................................................................................ 3 Supine.................................................................................................................................................................. 3 Sub-supine.......................................................................................................................................................... 4 Step 5: Operator’s Stool and Positioning....................................................................................................................... 4 Step 6: Assistant’s Stool and Positioning........................................................................................................................ 5 Step 7: Operating Zones.................................................................................................................................................. 6 Static Zone.......................................................................................................................................................... 7 Operator’s Zone................................................................................................................................................. 7 Assistant’s Zone.................................................................................................................................................. 7 Transfer Zone..................................................................................................................................................... 8 XII 0204551LB01A-14 Table of Contents Step 8: Practice Exercise 8-1............................................................................................................................................ 8 Step 9: Review Practice Exercise 8-1............................................................................................................................ 10 Step 10: Components of the Dental Examination...................................................................................................... 11 New Patients..................................................................................................................................................... 11 Established Patients......................................................................................................................................... 11 Step 11: Dental Exam Overview................................................................................................................................... 11 Dental Exam—Part 1: Visual Examination.................................................................................................. 11 Dental Exam—Part 2: Radiographs.............................................................................................................. 12 Dental Exam—Part 3: Impressions for Diagnostic Casts........................................................................... 12 Dental Exam—Part 4: Soft Tissue Examination.......................................................................................... 12 Step 12: Practice Exercise 8-2....................................................................................................................................... 17 Step 13: Review Practice Exercise 8-2.......................................................................................................................... 19 Step 14: Dental Exam—Part 5: Periodontal Examination........................................................................................ 19 Patient History Review................................................................................................................................... 20 Radiographs...................................................................................................................................................... 20 Bite Evaluation................................................................................................................................................. 20 Mobility............................................................................................................................................................. 20 Gingival Evaluation......................................................................................................................................... 21 Periodontal Probing........................................................................................................................................ 21 Periodontal Charting...................................................................................................................................... 22 Step 15: Dental Exam—Part 6: Examination of the Teeth (Instrumentation)....................................................... 22 Step 16: Dental Exam—Part 7: Photographs (Extraoral and Intraoral).................................................................. 23 Step 17: Dental Exam—Part 8: Radiography.............................................................................................................. 23 Extraoral Radiography.................................................................................................................................... 23 Intraoral Radiography..................................................................................................................................... 23 Step 18: Dental Exam—Part 9: Orthodontic Assessment......................................................................................... 24 Malocclusion.................................................................................................................................................... 24 Malalignment................................................................................................................................................... 25 Step 19: Dental Exam—Part 10: Head and Neck Cancer Examination.................................................................. 26 Step 20: Practice Exercise 8-3....................................................................................................................................... 27 Step 21: Review Practice Exercise 8-3.......................................................................................................................... 30 Step 22: Introduction to Vital Signs............................................................................................................................. 31 Taking Vital Signs............................................................................................................................................ 31 Step 23: Temperature..................................................................................................................................................... 31 Measuring Temperature.................................................................................................................................. 32 Assess and Document Temperature.............................................................................................................. 33 0204551LB01A-14 XIII Dental Assistant Step 24: Pulse.................................................................................................................................................................. 34 Measuring Pulse............................................................................................................................................... 34 Assess and Document Pulse Rate.................................................................................................................. 36 Step 25: Respiration........................................................................................................................................................ 37 Assess and Document Respiration................................................................................................................ 38 Step 26: Blood Pressure................................................................................................................................................. 39 Blood Pressure Instruments........................................................................................................................... 39 Assess and Document Blood Pressure.......................................................................................................... 40 Step 27: Smoking History.............................................................................................................................................. 42 Step 28: Practice Exercise 8-4....................................................................................................................................... 43 Step 29: Review Practice Exercise 8-4.......................................................................................................................... 45 Step 30: Why This Matters............................................................................................................................................ 46 Step 31: Summary........................................................................................................................................................... 47 Step 32: Journal Entry.................................................................................................................................................... 47 Step 33: Quiz 8................................................................................................................................................................ 47 Endnotes........................................................................................................................................................... 47 XIV 0204551LB01A-14 Lesson 1 Welcome to the World of Dentistry Step 1: Learning Objectives When you have completed the instruction in this lesson, you will be trained to: Identify the major contributors to the field of dentistry throughout the ages. Create a timeline identifying the years and major contributions or changes in the field of dentistry. Describe the growth factors that are causing increased employment opportunities in the dentistry field. Summarize a day in the life of a dental practice. List and define the nine specialties of dentistry. Step 2: Lesson Preview Welcome and congratulations on taking the first step toward a career in dental assisting! You chose an exciting field with lots of room for advancement—especially now. The U.S. Bureau of Labor Statistics projects employment opportunities for dental assistants to grow seven percent between 2022 and 2032.1 The number of jobs will increase and will rival other fields.2 Your studies here will start you on that path. Welcome to the world of dental assistance! Dental Assistant Dental assistants play a vital role in human wellness. When you complete this course, you’ll have the knowledge that will lead you toward success in the field. When you’re ready to find that job, you’ll be well cared for, too. Graduate assistance is available to every student that completes these courses. This includes helping you market yourself and preparing you to enter that new career. You’re ready to learn, and your instructor is ready to teach you. From the first page to graduation and on into the working world, you have an entire team dedicated to your success! Before you begin, take a moment to review how this course organizes its material. Your learning material comes as a series of packs, each divided into lessons. Each lesson covers skills that you’ll master on your way to completion. The lessons are easy to follow. They offer step-by-step instruction to make learning simple—even fun! Each new lesson will begin with Learning Objectives and a Lesson Preview. The Learning Objectives tell you what you should learn by the end of the lesson. The Lesson Preview supplies a brief description of what’s coming. Next, you’ll read new material. Each lesson might have several reading segments and Practice Exercises with questions. This format lets you apply what you learn. It also helps you retain the information. Finally, you’ll take a graded Quiz after each lesson. Quizzes highlight what’s important in the course. You’ll answer many of the items on the Quiz without having to look back at the lesson material. If you’re unsure of an answer, you can return to the information in your lesson to locate and verify your answer. All your Quizzes are open book. It’s always better to refer to your resources to review, rather than to memorize. If you have questions about any part of the course, feel free to contact an instructor. The instructor is available to help make this course rewarding. Your course materials provide Online Learning opportunities for you to discover more about certain topics. While you will not be tested on the information provided, you are encouraged to participate in the Online Learning to get the most out of this course. At the time of publication, all external websites listed in this course were verified as accurate. However, a website sponsor may change their link. These learning opportunities provide extra material to enhance your course and are not required to complete the coursework itself. If you have any questions or need to report a broken link, please message your instructor. In this first lesson, you’ll familiarize yourself with the essentials of dental assisting. You’ll also explore key traits and abilities that will help you succeed. To that, you’ll soon discover how important the dental assistant is and get a glimpse at office operations and patient care. As a dental assistant, you’ll work on the front line of the healthcare industry. Soon, you’ll become part of a team that delivers vital care in prevention and treatment. Dentists are often the first healthcare providers to detect disease—from hypertension to oral cancer. 1-2 0204551LB01A-01-14 Welcome to the World of Dentistry The skills you’ll get here will help you join one of the most flexible workforces in health care. Your ability to work in various settings will make you a valuable employee. Doors will open for you to become a respected and vital member of a medical team. As a dental assistant, you’ll be qualified to apply for jobs in small offices, group practices, dental clinics, hospitals and a myriad of other healthcare facilities. This course will prepare you to get there. So, keep reading! Step 3: Welcome to Your Career as a Dental Assistant You’ve chosen wisely, selecting dental assisting for your next career move. The industry continues to grow. These sections hint at why. Promising Work Outlook Dental practices around the United States continue to emerge. The U.S. Bureau of Labor and Statistics cites diverse reasons. Here are overviews of a few. The population in the United States is expanding. More people means more teeth of all ages—which will require preventive care and treatment. The U.S. Bureau of Labor Statistics expects 25,700 openings for dental assistants each year from 2022 to 2032.3 Baby Boomers are approaching their senior years. Lifelong, quality dental care has left this generation with more of their natural teeth than their parents’ generation. Today, this demographic visits the dental office regularly. Over the decades, the dental field has broadened its outreach and improved preventive care measures. This has yielded more long-term, loyal clients than in previous generations. This group of patients reflects a demographic that visits dentists at an earlier age than did previous generations. That means their children will start early as well. As older dentists retire, recent dental graduates either take over those practices or form their own. The new breed of dentists tend to see more value in dental assistants than did their retiring counterparts. So, they’ll be looking for well-prepared candidates to join their teams. Dental assistants multitask. This frees dentists to perform more complex procedures in a shorter time. So, they recognize the value dental assistants bring toward their income and stress relief. With strong growth opportunities in the field, many dental assistants advance within their practices or join others. Some retire or others transfer to different industries. This creates new openings each year. The U.S. Bureau of Labor and Statistics backs this up. 0204551LB01A-01-14 1-3 Dental Assistant Job Variety Dental assistance reflects variety. According to the American Dental Association, dental assistants’ duties rate among the most comprehensive and varied in the dental office.4 Throughout each day, you may be handling any of these tasks: Tasks Detail Treatment procedures Assist dentists during procedures: passing instruments, maneuvering suction hoses, matrix bands and lighting. Provide post-surgery instructions for oral care and follow-up. X-rays and more Specially trained dental assistants take x-rays of teeth and the surrounding areas. They do so by following all relevant safety procedures. Then, they ensure that the images are clear.5 Intake and evaluate Gather and record patient’s medical history. Assess vital signs. Provide comfort, details and instructions before, during and after procedures. Infection control Some dental assistants develop, teach and maintain infection control protocols and procedures. Prep work Prepare and sterilize equipment. Organize and sterilize instruments and workstations. Instruct Teach patients effective oral care and hygiene strategies. Models and casts Perform lab tasks, such as taking impressions of a patient’s teeth—under the direction of a dentist. Prepare materials for dental impressions or temporary crowns.6 Front office Perform computer and scheduling tasks. Communicate with clients in person, online or via phone. Check and order supplies. Payment File claims, obtain payments, contact insurers. Create and send invoices, pay bills, bookkeeping. As you advance in your field, you’ll expand your knowledge as well as your growth potential. You conquer more duties and make yourself even more valuable. ONLINE LEARNING Build on what you’re learning by reading the article at: https://www.schoolofdentalassisting-vancouver.com/dental-assistant-traits/. 1-4 0204551LB01A-01-14 Welcome to the World of Dentistry Value Dentists recognize the value dental assistants bring to their practices. Dental assistants provide an extra set of eyes and ears at the dental chair. They offer quality customer care, which keeps patients coming back. Finally, they handle critical functions in the office, including laboratory and administrative work. In addition to excellent job prospects, dental assistants can enjoy flexible schedules. Often, they can determine whether a full or part-time schedule suits them. Dental assistants often have flexibility in setting their schedules. Nearly 74 percent work between 31 to 40 hours a week. Approximately 10 percent work more than 40 hours a week.7 Work hours can range from early morning into the evening and weekends. Your dental assistant credential will position you to find many openings and schedules. Dental Professionals Are Caregivers People often take their teeth for granted—until something goes wrong. Dental healthcare professionals, on the other hand, promote a daily care view to help patients prevent problems. To that end, as a dental assistant, you will join an army of caring people. You’ll fight on behalf of your patients—to help them keep happy, healthy teeth. As a dental assistant, you’ll help screen patients for health issues beyond tooth decay—often for the first time. For example, many dental care professionals are first to detect eating disorders. They might also discover signs of child abuse or neglect. Oral cancers and anxiety issues often come to focus during dental exams. They often spot signs of poor diet, malnutrition and other red flags. Essentially, your job matters at a fundamental level for everyone who walks into your office. So, as you continue through this course, remember that you’re training to stand on the front line of health care. You’re stepping into a position where you can make an important difference for everyone, young and old. Dental assistants help protect the young and old. 0204551LB01A-01-14 1-5 Dental Assistant Behind the Scenes in the Dentist’s Office As a staff member, you’ll have access to all office areas. You’ll get to use some of the amazing equipment. Read on to get familiar with some areas. Location Description Reception area Characterized by comfortable seating, warm lighting. Toys and books, perhaps, for children. Other amenities, too, depending on target patients. Administrative area Overlooks the reception area. An assistant controls this space. The bridgeway to check in or talk to patients. Common equipment: Phone systems, file cabinets, computers and more. Treatment areas Characterized by dental chairs, assistants’ stools and cabinets. X-ray viewers and a sink are also common. Common equipment: Roll-trays, rheostat, waterlines and hoses, air and water syringes, saliva ejector and more. Sterilization center Usually tucked back in the office—between or near operatories and treatment areas. Dental laboratory Area to pour dental impressions, prepare diagnostic models, create custom impression trays. Spacious, it often includes workbenches and storage accessories. Private offices Dentists’ private areas. Common equipment: Desks, personal items, chairs and an array of adornments. Dental unit 1-6 0204551LB01A-01-14 Welcome to the World of Dentistry Step 4: The Future of Dental Assisting Many dental practices provide care for specific insurance companies. This attracts large numbers of patients. Because of this relationship, insurance companies can command lower rates for services than dentists normally charge. One way that dentists can make up for this lost income is by hiring dental assistants. Why? Dental assistants’ vast skills allow them perform procedures and paperwork that free the dentist to see more patients in less time. When a dental practice can treat more patients, it earns more income. This is because of you! Career Choices Dentists can focus their practices in areas other than general dentistry—and you can join them. The American Dental Association recognizes nine dental specialties: Specialty Details 1 Dental public health A policy-making area of dentistry. Rarely works with patients. The community, and its well-being, is the focus. Tends to work with government officials/ agencies to set policy. An example: Should a local government add fluoride to the water? 2 Endodontics These dentists specialize in performing root canals. They also treat diseases and injuries to tooth pulp and mandibular structures. Dental assistant duties: Chairside assistance during surgeries, x-ray processing, patient interactions, among others. 3 Oral & maxillofacial radiology Dentists focus on advanced x-ray techniques toward treating patients with face, jaw and neck trauma. Dental assistant duties: Include helping to locate tumors and technical support to assist dentist diagnose infectious diseases. 4 Oral & maxillofacial surgery Dentists focus on wisdom tooth removal. They also treat facial injuries, perform reconstructive and dental implant surgery and treat patients with mandibular cysts. Dental assistant duties: Participation in pain control and anesthesia assistance. 5 Oral pathology Dentists conduct biopsies and other diagnostic procedures to uncover causes of diseases and other ailments. Dental assistant duties: Varied specialized assistance responsibilities. 0204551LB01A-01-14 1-7 Dental Assistant 6 Orthodontics Dentists specialize in straightening teeth and jaw alignment. Dental assistant duties: Key responsibilities involve working with youths and adolescents. 7 Pediatric dentistry Dentists work with children, from birth to adolescence. They treat tooth decay, provide mouthguards and a myriad of other duties. Dental assistant duties: Include varied specialized assistance responsibilities, which also include working with special needs patients. 8 Periodontics Periodontal translates to “around the tooth.” Dentists work on gums and provide services to support alveolar bone health. Dental assistant duties: Include varied specialized treatment and prevention support techniques. 9 Prosthodontics Dentists insert crowns, cosmetic veneers and implants. They restore smiles and help maintain healthy teeth. Dental assistant duties: Include varied specialized to support dentists’ practices and needs. Clearly, you have a range of options regarding dental specialization in your career. Opportunities abound to pick your area of interest and follow it. There are ample openings in most of these specialties. The Expanded Function Dental Assistant This title reflects an expanded credential for dental assistants. After receiving additional training, expanded function dental assistants (EFDA) can perform more challenging patient procedures. While dentists are ultimately responsible for all patient services and results, dental assistants are proving capable and savvy in expanded areas—but under supervision. Two categories dictate the supervision EFDAs undergo to perform these expanded tasks: Direct supervision—The dentist is required to be in the same treatment area while the EFDA is performing the service. Indirect supervision—The EFDA may handle the task while the dentist is in the office, available to evaluate the EFDA if needed. Throughout this course, you’ll receive instruction in expanded functions. Take note, though, that states determine what defines an EFDA. So, qualifications might vary among regions. In one location, for instance, dental assistants without additional training may place restorative material in a patient’s mouth. While in another, only EFDAs may perform that task. 1-8 0204551LB01A-01-14 Welcome to the World of Dentistry In general, though, EFDAs are authorized to perform these procedures: Place matrix bands Perform coronal polishes Remove excess cement Take impressions Make temporary crowns In some states, all you’ll need is proof that you’ve successfully completed this course in order to qualify as an EFDA. Other states might require you to take an exam before you can call yourself an EFDA. Professional organizations like the American Dental Assistants Association (ADAA) provide information on statewide regulations and policies. The Dental Hygiene Assistant Today, dental assistants often work chairside with dental hygienists. In some offices, they handle certain hygienist tasks on their own. This represents a shift from the old ways of doing things in the field, which springs from three sources: Economic advantage for the office. That is, practices can service more patients in the same amount of time. Effort to relieve overworked hygienists. Desire to deliver what several dentists call “red carpet treatment” to their patients. You’ll learn more about the different roles dental assistants play in the next lesson. For now, know that one of the emerging areas where dental assistants spread their magic is with dental hygienists. Dental Assistants Are the Future You’ve read about the federal government’s projections of the growing demand for dental assistants. You recognize that dental assistants offer great value to the offices where they work. You know the money they help save, the stress they relieve and the services they offer. You are joining a group of people in a field with excellent job prospects, access to a variety of schedules, good pay and benefits—and above all, a way to make an important impact on people’s health. Dental assistance is a dynamic field that holds many opportunities. It will engage your mind, add variety to your life and bring you many rewarding interactions with colleagues and your patients. 0204551LB01A-01-14 1-9 Dental Assistant Step 5: Dentistry: A Brief History Remember Paul Revere and his famous midnight ride? He warned early colonists that the British were coming! Did you know that Paul Revere was also a dentist in Boston? His name appears as the first documented forensic dentist. He earned this title after he identified one of his deceased patient’s dental work—which he had placed in the soldier’s mouth! Ancient Dental Practices This historical anecdote, written by Seth Borenstein, appeared as an Associated Press article on April 5, 2006. “April 5, 2006—WASHINGTON—Proving prehistoric man’s ingenuity and ability to withstand and inflict excruciating pain, researchers have found that dental drilling dates back 9,000 years. Primitive dentists drilled nearly perfect holes into live but undoubtedly unhappy patients between 5500 BC and 7000 BC, an article in Thursday’s issue of the journal Nature reports. Researchers carbon-dated at least nine skulls with 11 drill holes found in a Pakistan graveyard. That means dentistry is at least 4,000 years older than first thought—and far older than the useful invention of anesthesia.” Dental history abounds with fascinating stories. Some date to more than 9,000 years ago in a small farming town in what is now Pakistan. They tell of drilling teeth using a small bow, flint drill tips and no pain relief! Experts within the scientific community wonder about the purpose of the drilling. Some suggest it was to alleviate the pain caused by cavities or to release evil spirits. Hesy-Re: History’s First Dentist What historians do know, however, is this: Hesy-Re, a physician to ancient Egyptian royals around 2600 BC, was the first documented dentist. Aristocrats of the time were concerned with oral health. So, dentists held high regard. In fact, Hesy-Re’s epitaph refers to him as “the greatest of those who dealt with teeth (chief toother), and of the physicians.”8 The Ebers Papyrus, believed to date back to 1700-1550 BC, refers to diseases of the teeth and various toothache remedies.9 1-10 0204551LB01A-01-14 Welcome to the World of Dentistry Greek and Roman Dentists Hippocrates, a Greek who lived in the 5th century BC, became known as the Father of Medicine. His writings covered medical and dental diseases. He developed early forms of toothpaste and mouthwash. The famous Hippocratic Oath, still the foundation of medical and dental ethics, sprang from his work. Similarly, Claudius Galen, a 2nd century doctor, taught patients to use a file to remove decayed portions of their teeth. During this era, if you were on the guest list for an upper-class Roman dinner party, you might have received a gold toothpick as a party favor. Why? To clean your teeth between dinner courses. Ancient Romans also made early versions of toothpaste from eggshells, bones and oyster shells mixed with honey.10 Two Frenchmen of the Renaissance Ambroise Paré lived during in the 1500s—when barbers also served as dentists. Basic internet research reveals that Paré earned the title “Father of Modern Surgery” because he worked with many wounded soldiers. He was the first to use artificial eyes, hands and legs, too. Additionally, he wrote about extracting teeth and reimplanting them. Two-hundred years later, Pierre Fauchard entered the picture. The internet lauds him as the Father of Modern Dentistry. At a time when most physicians guarded their discoveries, Fauchard shared his. A Funny Story History shows that Fauchard committed a notable faux pas. He recommended people rinse their mouths in the morning with several spoonsful of their urine! He balanced this odd advice, however, by dispelling several myths of his time. One included the fact that a tooth worm caused tooth decay—a myth that dated back to the Sumerians in 5000 BC. He also realized that scaling teeth could help minimize gum disease. Plus, he removed caries from teeth and filled the cavities with lead or tin. Fauchard also used animal teeth to make dentures. Most importantly, Fauchard published a book that is widely credited with allowing dentistry to break from medicine into its own specialty.11 A Revolutionary Discovery In 1895, Wilhelm Conrad Roentgen, a Bavarian physicist, discovered the x-ray. This forever changed dentistry and medicine. Since you will likely operate x-ray machines, his influence touches you, even today. You’ll learn much more about radiology, or the use of x-ray, in coming lessons. 0204551LB01A-01-14 1-11 Dental Assistant Dentistry Arrives in the United States Isaac Greenwood was the first American dentist born on U.S. soil. His second son, John, joined the army at age 14. He later became one of George Washington’s dentists. Fast forward to 1844, when Horace Wells alleviated patients’ pain by using nitrous oxide during dental surgery—instead of brute force, rum or opium. Dental Assisting’s Roots Dental assisting started in 1885, in New Orleans, when C. Edmund Kells hired a “lady in attendance.” He did this to adhere to the social standard of the time, which mandated that women must be accompanied when entering a dentist’s office. In 1924, Juliette Southard started the American Dental Assistants Association. In 1948, the certifying board of the ADAA emerged, though it’s now called the Dental Assisting National Board (DANB). In the early 1900s, Frederick S. McKay linked fluoride to stronger teeth when residents of Colorado Springs left his dental office with very few cavities. He credited natural fluoride in the local drinking water. One final milestone in the dental industry appeared in the 1990s: diligence in using protective gloves and other gear. This began in 1990, after a woman contracted AIDS from her Florida dentist. The modern gowns, face masks, gloves and eyewear that you will use to protect yourself and your patients tracks back to that incident. There you have it, a brief look at dental history. From here forward, you’ll be part of its new history. Now, take a moment to review what you’ve just learned with a Practice Exercise. Step 6: Practice Exercise 1-1 Select the correct answer from the choices provided. 1. The U.S. Bureau of Labor Statistics expects approximately _____ openings for dental assistants each year from 2022 to 2032. a. 15,000 b. 27,000 c. 35,000 d. 56,000 2. Which is a factor in the high growth rate in the dental assisting field? a. Dental assistants can now do everything that a dentist can do. b. Newer dentists tend to hire more dental assistants. c. As baby boomers age, they will visit the dentist less frequently. d. The government plans to use dental assistants in the military. 1-12 0204551LB01A-01-14 Welcome to the World of Dentistry 3. Which is a TRUE statement? a. Older dentists seem to hire more dental assistants to do their work. b. Younger dentists see more value in dental assistants than older dentists. c. Dental assistants can do complex procedures to free up the dentist’s time. 4. This is one of the many responsibilities you’ll have as a dental assistant. a. Take and develop x-rays b. Give blood transfusions c. Write condolences for the dentist d. Visit patient’s homes to collect payments 5. How often do dental assistants work? a. Full-time, including some evenings and weekends b. Part-time, usually during evening hours c. Full-time or part-time, depending on when you want to work d. Full-time only, but usually during regular business hours 6. What might you be the first to do as a part of a professional dental healthcare team? a. Notice an important health issue, such as an eating disorder or oral cancer b. Ask the patient her height and weight c. Tell a patient not to worry when she has a bad check-up d. Schedule the dentist’s itinerary for a training seminar 7. You’ll pour impressions, among other activities, in this area. a. Reception area b. Sterilization and supply center c. Treatment room d. Laboratory 8. EFDA stands for this. a. Excellent fluoride delivery for all b. Expanded function dental assistant c. Every full-time dentist’s assistant d. Education for dental assistants 9. This is one reason dental assistants are becoming important as support for dental hygienists. a. Dentists want to take more days off. b. Dental hygienists need on-site instructions. c. Dentists want to deliver red carpet treatment to their patients. d. Dental hygienists are assistants in training. 0204551LB01A-01-14 1-13 Dental Assistant 10. Why did C. Edmund Kells hire a “lady in attendance?” a. To keep him company during a long, hard day b. To allow men to visit with her during treatments c. To allow women to visit the dentist unaccompanied d. To keep the office tidy Step 7: Review Practice Exercise 1-1 Review the answers to the Practice Exercise and use this as a study tool when preparing for your Quiz. 1. The U.S. Bureau of Labor Statistics expects approximately b. 27,000 openings for dental assistants each year from 2022 to 2032. 2. Which is a factor in the high growth rate in the dental assisting field? b. Newer dentists tend to hire more dental assistants. 3. Which is a TRUE statement? b. Younger dentists see more value in dental assistants than older dentists. 4. This is one of the many responsibilities you’ll have as a dental assistant. a. Take and develop x-rays 5. How often do dental assistants work? c. Full-time or part-time, depending on when you want to work 6. What might you be the first to do as a part of a professional dental healthcare team? a. Notice an important health issue, such as an eating disorder or oral cancer 7. You’ll pour impressions, among other activities, in this area. d. Laboratory 8. EFDA stands for this. b. Expanded function dental assistant 9. This is one reason dental assistants are becoming important as support for dental hygienists. c. Dentists want to deliver red carpet treatment to their patients. 10. Why did C. Edmund Kells hire a “lady in attendance?” c. To allow women to visit the dentist unaccompanied Step 8: A Day in the Life of a Dental Assistant At 7:00 a.m., Sabrina unlocks the door to the Morgan Family Dental Clinic. She’s worked there for three years. This morning, she’s the first to arrive. She flips on the lights, heads to the staff lounge and brews coffee for the crew. Sabrina loves the office atmosphere. It’s relaxed but professional. Everyone works hard, and the staff genuinely cares about each other. Sabrina is part of a good team. Drs. Mark and Karen Morgan, dentists, started the dental clinic 12 years ago, after getting married. They understand that each staff member plays an important role in keeping the office running smoothly—and that each member merits respect. “Care for the Patient and the Provider” is their motto. 1-14 0204551LB01A-01-14 Welcome to the World of Dentistry With the coffee brewed, Sabrina turns on the computers. She glances at the day’s schedule and patient charts. Rashad, the office manager, printed them last night. Sabrina left early yesterday to watch her daughter’s third grade spelling bee. She came early to catch up some. This morning will be busy: a composite resin placement, a crown preparation and a denture realignment; followed by a reprieve. The office always closes from 11:30 a.m. to 1:00 p.m., so everyone can take a break or get lunch in the real world. Today, lunch will be at the Mexican restaurant around the corner. It’s the office’s monthly staff meeting. The team will discuss concerns, policies, birthdays and even share social updates. After lunch, it’s back at it. The afternoon’s appointments include a crown cementation, a primary tooth extraction and a postoperative visit from a recent root canal patient. After 4:00 p.m., the schedule remains open to accommodate patient emergencies. A Nice Way to Start the Day Sabrina smiles when she sees that one of her favorite patients, Juan Carlos, will come in today. He just had a third surgery to repair his cleft palate. Even though Dr. Mark didn’t perform the surgery, he wants to keep track of young Juan Carlos’s progress. Sabrina gets to assist during the check-up. She’s glad she wore her scrubs with the dinosaurs on them. Children respond to positive energy. Sabrina heads down the hall to pull the instruments she’ll need to set up at each operatory. The sterilizer sits ready in the sterile prep room. Sabrina puts on her gloves and sets up materials for the two dental hygienists and the two dentists. She turns on the central air compressor and vacuum units that will work hard throughout the day. As she hears the rest of the staff trickle in, she puts on her personal protective equipment to prepare for her first client. This includes safety glasses, a face mask and a long-sleeved protective gown. 0204551LB01A-01-14 1-15 Dental Assistant Duties, Responsibilities and Pride By 8:00 a.m., Sabrina’s already taken two sets of x-rays. Radiography with a digital system is simple. She views the finished x-rays in the appropriate operatory, chatting with patients and staff as she moves through the office. One new patient worries about the extent of work that she’ll need. She’s also concerned about the possible expense. Sabrina spends a few extra minutes listening and reassuring her with helpful information. Between patients, Sabrina cleans each operatory, hands out toothbrushes, toothpaste and floss and explains instructions for certain procedures. It’s important that each patient follows at-home care precisely. So, she always takes her time to ensure they understand. On certain occasions, Sabrina sets up the DVD player for a new patient to watch the video about the practice and services. She’s proud to appear in the video, explaining x-ray procedures. “It’s part of my 15 minutes of fame,” she tells her family. Soon, she’ll assist Dr. Karen with a crown. So, she spends extra time with Terrell, setting up a rubber dam around his tooth. He can’t reply to her questions, but Sabrina has learned through experience how to carry on a one-sided conversation. This keeps Terrell relaxed and focused on something other than the procedure. Before everyone breaks for lunch, Sabrina ensures that the dentists’ notes on the morning’s patients are current. The office has laptops at each station so she can input information about each treatment as Dr. Karen or Dr. Mark dictates details. She also inserts her own notes, listing x-rays and other services that she provided. This helps Rashad prepare accurate invoices. Cruising Through the Afternoon After lunch, Sabrina answers billing questions for Rashad. Then, she checks the operatories to ensure everything is set for the afternoon. Her next patient will arrive at 2:00 p.m. This gives her time to catch up on policy work. Sabrina stays on top of government regulations that affect the office. The task sounds harder than it is. She receives email updates from OSHA (the federal Occupational Safety and Health Administration). Once she’s clear on the details, she updates the staff about any changes or concerns. By 2:15 p.m., Sabrina has administered a topical anesthetic on her next patient. He’s ready when Dr. Karen comes to place a crown—which Sabrina slips away to prepare. Her last appointment is with Juan Carlos. His smile charms the entire staff. It’s a smile that has improved after each surgery to repair his cleft palate. Specialist at a nearby hospital do his surgeries. (They grafted bone from his hip to the roof of his mouth.) Dr. Mark sees Juan

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