Group 1 & 2 Operative Dentistry PDF

GROUP 1 Contaminated items and areas may include handpieces, lamp handles, EXPOSURE RISKS AND EFFECT OF INFECTIONS ON DENTISTRY airwater syringe handles, control switches, faucet knobs, and more....

GROUP 1 Contaminated items and areas may include handpieces, lamp handles, EXPOSURE RISKS AND EFFECT OF INFECTIONS ON DENTISTRY airwater syringe handles, control switches, faucet knobs, and more. Effective infection control measures are essential to prevent ENVIRONMENT OF THE DENTAL OPERATORY contamination of these surfaces. These measures include barrier For most of the 20th century, general dentistry was routinely practiced protection of personnel and equipment, instrument sterilization, and without barriers to protect eyes, nose, mouth, and hands. methods to avoid direct contact with contaminated surfaces Not until 1991 were dental personnel required to wear gloves, masks, CROSS -INFECTIONS gowns, and protective eyewear while treating patients. Microbial exposures in the dental operatory include air-borne contamination, and Cross-infections in dentistry are challenging to trace compared to direct and indirect contamination of surfaces. hospital settings because patients might contract infections before or after receiving dental care, making it difficult to pinpoint the source EXPOSURE RICKS AND EFFECT OF INFECTIONS ON DENTISTRY Infection outbreaks in dental settings are typically identified only when clusters of cases are recognized by other health care providers or AIR-BORNE CONTAMINATION through epidemiologic studies and investigative surveys of dental personnel A high-speed handpiece is capable of creating air-borne contaminants from bacterial residents in the dental unit water spray system and from PERSONNEL VULNERABILITY microbial contaminants from saliva, tissues, blood, plaque, and fine debris cut from carious teeth. Since 1971, there have been nine documented cases of dentist-to-patient transmission of hepatitis B (HBV) and one case of HIV. ➔ AEROSOLS However, since the widespread adoption of infection control practices in ◆ ranging from 5 to 50 mm can remain suspended in 1986, no cluster cases of HBV transmission related to dentistry have the air for hours and be inhaled been reported. ➔ MISTS ◆ Visible in a beam of light, mists consist of droplets Patient-to– dental health care worker transmission of occupational estimated to approach or exceed 50 mm that settle disease is low. Without proper immunizations or protective barriers, gradually from the air after 5 to 15 minutes they are more vulnerable to infections like hepatitis B (HBV). However, ➔ SPLATTER the risk of HIV transmission has been minimized due to effective ◆ Larger particles, generally over 50 mm, fall within 3 infection control practices. Continuous attention to epidemiologic data feet of the patient's mouth and can coat the face and on infections like HBV, HCV, and HIV is crucial for improving and garments of dental personnel. maintaining infection control practices, helping to prevent complacency about emerging disease risks Barrier protection, including masks, eyewear, gloves, and gowns, is now a standard requirement for dental procedures. Additionally, EPIDEMIOLOGY OF OTHER INFECTION RICKS pretreatment mouthrinses, rubber dams, and high-velocity air evacuation can reduce microbial exposure. All patients considered infectious Barrier Protection Is Essential DIRECT CONTAMINATION Concerns About Transmissible Infections occurs when there is direct contact with body fluids, posing a major Importance of Immunizations exposure risk for dental personnel. Concerns About Multidrug-Resistant Tuberculosis (MDR-TB) Risks Associated with CMV Infection INDIRECT CONTAMINATION EXPOSURE ASSESSMENT PROTOCOL Indirect contamination occurs when saliva-contaminated hands come into contact with unprotected operatory surfaces during treatment. A. MEDICAL HISTORY Studies have shown that cross-contamination of patients can occur from such surfaces, even when cleaning and disinfecting procedures are used. (1) To detect any unrecognized illness that requires medical diagnosis and care Another study used water-soluble red-fluorescent poster paint as a (2) To identify any infection or high risk that may be important to a visible substitute for saliva to elevate awareness and facilitate problem clinician exposed during examination, treatment, or cleanup procedures solving in infection control (3) To assist in managing and caring for infected patients (4) To reinforce use of adequate infection control procedures  or influenza. This distinction is important when selecting the appropriate B. PERSONAL BARRIER PROTECTION mask for different procedures 1. GLOVES 4. PROTECTIVE BARRIER PROTECTION Single-Use Gloves Proper Glove Dispensing Protective Function Glove Limitations ○ Overgarments are essential for protecting both Puncture-Resistant Utility Gloves clothing and skin from spatter, saliva, and blood during dental procedures. Latex Allergy Concerns Nitrile latex gloves are preferred; they can be washed inside and out, Contamination Risks disinfected, or steam autoclaved, as needed. ○ Operatory clothing frequently becomes contaminated with invisible saliva and traces of When it comes to Allergens it’s important to distinguish these symptoms blood, which can harbor harmful microbes like HBV from physical irritation. for days. Spatter is particularly heavy on the wrists and forearms. the best treatment for latex allergy is to avoid latex products altogether. Sleeve Design Reactions are classified as: ○ sleeves with knit cuffs that fit snugly under gloves delayed hypersensitivity (type IV) – resulting in contact are recommended. This design helps prevent the dermatitis, rhinitis and conjunctivitis. This is the most common transfer of contaminants between patients. hypersensitivity reaction to NRL or accelerating agents. Response occurs between six to 48 hours after exposure Simple and Effective Garments ○ A lightweight garment that covers the arms, chest, immediate hypersensitivity (type I) – asthma, urticaria, and lap when seated is adequate for most dental laryngeal edema and anaphylactic shock/collapse. Response procedures. occurs 15–30 minutes after exposure Avoid Wearing Contaminated Garments Outside the Clinic 2. PERSONAL BARRIER PROTECTION ○ Wearing contaminated overgarments outside the Remove Jewelry Before Handwashing clinical area can pose a risk to family members and Proper Handwashing Technique others, especially young children, who may come Handwashing When Changing Gloves into contact with the soiled clothing. Surgical Hand Scrub Special Cleansing for Surgery or Leaks Handling and Laundering of Used Garments ○ when a glove leaks, or if the clinician experiences an ○ After use, overgarments should be removed with injury, a 4% chlorhexidine cleanser may be used for minimal handling and placed directly into a laundry its broader activity. However, caution is necessary as bag. it can be hazardous to eyes Use of Alcohol Rubs C. DISPOSAL OF CLINICAL WASTE 3. PROTECTIVE EYEWEAR, MASKS AND HAIR PROTECTION Liquid Clinical Waste Disposal ○ heavy metals like mercury or silver should never be Protective Eyewear disposed to the basin. Proper Use and Handling of Eyewear and Masks Safe Disposal of Contaminated Materials Mask Replacement Regulated Sharps and Pathologic Waste Avoiding Cross-Contamination Proper Bagging of Medical Waste Mask Fit for Aerosol ○ HIV and HBV can survive in wet conditions for several Protection Hair Protection days, making careful handling of medical waste vital to preventing infection. HIGH FILTRATION MASKS Masks with the highest filtration, like rectangular, folded types, are Compliance with Federal and Local Regulations - recommended for surgeries. Domeshaped masks provide adequate The disposal of blood-contaminated waste is regulated by federal protection against spatter and some infections (e.g., HBV and HIV) but agencies like the EPA, as well as local environmental protection agencies. are not sufficient against aerosol-borne respiratory viruses like measles These regulations primarily apply once the waste leaves the dental office or clinic. Compliance with local, county, and state regulations is Rationale: essential, as they may have stricter requirements than federal guidelines Protecting operational surfaces with disposable covers prevents cross-contamination and reduces cleaning time and costs. Covers D. NEEDLE DISPOSAL eliminate the need for frequent cleaning and are more protective. (1) dispose of needles in a hard-walled, leak-proof, and sealable Materials: container White Paper Sheets: For workbenches and surfaces with dry materials. (2) locate the needle-disposal container in the operatory close to where Paper/Plastic Covers: For dental unit trays, including edges. the needle will be used; and Clear Plastic Bags: Fit chair backs, control units, and x-ray equipment. (3) avoid carrying unsheathed contaminated needles or containers in a Plastic Silverware Bags: Fit suction handles and air-water syringe manner that could endanger others or would allow the needles to be handles. accidentally spilled Methods: E. PRECAUTIONS TO AVOID INJURY EXPOSURE Cover Surfaces: Use disposable barriers to protect frequently touched or soiled surfaces. Minimize Transmission Risks Dispose and Replace: After each appointment, discard and replace ○ Pointed instruments without hollow lumens, like covers. used burs, wires, and sharp tools, have a low Check Covers: If covers are damaged or dislodged, clean and disinfect capacity for transmitting infected blood the underlying equipment before re-covering. Safe Passing of Instruments Resheathing Needles Safely Semi Critical Item: Handling Burs and Handpieces Items that contact mucosa or are used intraorally, such as air-water ○ Burs should be removed from handpieces after use. syringe tips, suction tips, prophy angles, and handpieces. If left in a handpiece, ensure that the bur is pointed away from hands and body Noncritical Items: Environmental surfaces and supporting equipment not touched during OVERVIEW OF ASEPTIC TECHNIQUES treatments, like chairs, floors, and walls. Asepsis aims to prevent cross-contamination in clinical settings. Items Disinfectants Selection: touched with saliva-coated hands must be cleaned of contaminants Use EPA-approved disinfectants effective against Mycobacterium, before use with another patient. polioviruses, common respiratory viruses, and hospital pathogens. Alcohols (70-79% ethyl) are effective but may harden dried blood. Contamination Awareness Touch Only What’s Necessary Controlling Contamination: STERILIZATION 1.Cleaning and sterilizing 2.Using Disposable Covers Method of instrument recycling that can be monitored and documented 3.Handling Equipment to show that conditions for control of disease transmission were 4.Disinfecting Noncritical Surfaces established. Kinds and sizes of sterilization equipment depend on the treatment GOOD ASEPSIS PRACTICE instrumentation used in the practice. Good asepsis practices help minimize the need to clean or disinfect STAINLESS STEEL INSTRUMENTS ANY STERILIZATION METHOD non-operatory areas by preventing contamination in the first place. Commonly found contaminated items in dental offices include HIGH SPEED AND LOW SPEED BEST AUTOCLAVED telephones, faucet handles, switches, cabinet handles, radiography HANDPIECES controls, lamp handles, door handles, charts, and pens. BURS Dry heat, chemiclave, gas sterilizer (may rust or corrode if TO AVOID CROSS CONTAMINATION, CLINICIAN SHOULD: not protected from steam -Minimize Contact -Handle Objects Carefully Metal Impression Trays Any method Dry heat: greater -Protect Surfaces than 345°F may remove soldered -Regular Cleaning handles Orthodontic Plier(Stainless Steel) High Quality: resist corrosion in  Routine biological spore tests are needed to confirm autoclave sterilization, especially for heavy packs. Low Quality: must be sterilized Only manufacturer-approved fluid can be used. by dry heat or chemical vapor Instruments must be dry before loading, and the door gasket must be checked for leaks to prevent sterilization failures. STEAM PRESSURE STERILIZATION DRY HEAT STERILIZATION Performed in steam autoclave. Achieved at temperatures above 320°F (160°C) LIGHT LOAD: 250°F(121°C), 15 minutes minimum at 15lb of pressure Professional dry heat ovens with gravity convection Instruments spaced 1 cm apart Individual can be reduced to 7 mins. -> Increase the temperature to approximately Instruments: Heat at 320°F (160°C) for 30 minutes, or longer 273°F (134°C) to give 30 lb of pressure. for safety Medium Loads: 60-90 minutes at 335°F (168°C) to 345°F ADVANTAGES (174°C) Most rapid and effective method for sterilizing cloth surgical Use a range of temperatures; calibrate with a pyrometer packs and towel packs. Use FDA-reviewed equipment to avoid liability AUTOMATED MODELS: Easier operation, must be evaluated Gravity convection ovens need careful calibration to avoid with a biologic spore test monitoring system failures DISADVANTAGES ADVANTAGES Temperature sensitivity Rust and Corrosion Rust and Corrosion Capacity and Cost Efficiency STERILIZATION OF BURS IN AUTOCLAVES Burs can be protected by keeping them submerged in a small DISADVANTAGES amount of 2% sodium nitrite solution. Damage to HeatSensitive Items Longer Cycles at Lower Mix 20 g (2/3 oz) of sodium nitrite with 1 L of pure water. Temperatures Ineffectiveness with Heavy Loads Timing Issues Store the solution in a tightly sealed container. Calibration and Error Risks Rinse burs, place in a beaker with sodium nitrite solution, and sterilize. Discard solution, transfer burs with sterile forceps, store dry, and remove residue if needed. ETOX (ETHYLENE OXIDE STERILIZATION) CHEMICAL VAPOR PRESSURE STERILIZATION (CHEMICLAVING) Best method for sterilizing complex instruments and delicate materials. TYPES: 1. Automatic Devices: Sterilize items in several hours and operate at Chemical vapor pressure sterilization, or chemiclaving, is performed in a elevated temperature. chemiclave and operates at 270°F (131°C) with 20 lb of pressure, 2. Less Expensive Devices: Operate overnight at room temperature. achieving sterilization in approximately 30 minutes. Similar to steam sterilizers BUT uses a prescribed chemical that must be properly labeled Porous and Plastic Materials: Absorb gas and require 24 hours to meet OSHA’s Chemical Hazard Communication Standard. Newer or more of aeration before contact with skin or tissues. models effectively manage aldehyde vapors, while older ones require Chamber Sizes: Larger chambers hold more instruments but proper venting. are more expensive. Some designs accommodate stacks of trays. ADVANTAGES Consultation: Seek detailed information from manufacturers or Corrosion Resistance: Effectively sterilizes carbon steel and infection control texts and dental product distributors. other corrosionsensitive instruments without rust or corrosion. DISADVANTAGES BOILING WATER Items sensitive to high temperatures may be damaged. Instruments must be lightly packaged in specific bags from the Boiling water does not kill spores and cannot sterilize sterilizer manufacturer. instruments. Effective for killing blood-borne pathogens in Heavy cloth wrappings, like towels, may not allow full areas inaccessible to room-temperature sterilants and penetration for effective sterilization. disinfectants.  Used as a temporary measure when sterilization is not possible, such as during sterilizer breakdown. Clean items thoroughly. Submerge items completely and boil at 98°C to 100°C (at sea level) for 10 minutes. Simple steaming is unreliable. Pressure cooking is preferred and necessary at high altitudes for effective disinfection. GROUP 2 PATIENT ASSESSMENT, EXAMINATION AND DIAGNOSIS, AND TREATMENT D. PHYSIOLOGICAL CHANGES ASSOCIATED WITH AGING PLANNING PATIENT ASSESSMENT Delayed Healing: Older adults may experience slower wound healing, which can complicate recovery from dental procedures, necessitating INFECTION CONTROL careful planning and post-operative care. During patient assessments it is essential to prevent the spread of infections among patients, protect vulnerable individuals, and ensure Medication Interactions: Many older adults take multiple medications the safety of healthcare workers. By following proper protocols, that can interact with dental treatments or anesthetics. healthcare facilities can reduce healthcare associated infections, comply with regulations, prevent outbreaks, and maintain public trust in the healthcare system Osteoporosis: Age-related decrease in bone density can affect the jawbone, making it more prone to fractures during extractions or other CHIEF COMPLAINT invasive procedures. Identifying and documenting the patient's chief complaint is essential before treatment, as it guides the need for diagnostic tests and helps Dry mouth (Xerostomia) which increases the risk of dental decay, oral determine the cause and appropriate treatment of the issue. infections, and difficulties in wearing dentures. Adequate saliva is essential for maintaining oral health, and reduced saliva can complicate MEDICAL REVIEW A comprehensive medical review form is the focus of the patient dental procedure interview. This form helps the practitioner identify conditions that may affect dental treatment or require referral to a physician. E. SOCIOLOGIC AND PHYSIOLOGIC REVIEW A. COMMUNICABLE DISEASES During initial dental visits, clinicians should evaluate the patient's attitudes, priorities, expectations, and motivations concerning dental Detection and treatment of oral infections are especially vital for care. Understanding the patient's commitment to dental health, which immunocompromised patients, who are at higher risk for severe includes their appreciation for dental care, habits, background, illnesses. Immunocompromised individuals, due to conditions like occupation, and financial situation, is important for successful leukemia or HIV, or through immunosuppressive treatments, may treatment. Maintaining and updating records of these discussions and develop serious oral infections that can spread to vital organs. Effective findings is essential, as it informs the dentist's recommendations and examination and treatment of oral lesions in these patients are essential. treatment planning. B. ALLERGIES AND MEDICATION F. DENTAL HISTORY Sometimes patients report that they are"sensitive" or allergic to local The dental history review involves assessing the patient's previous anesthetic. They often refer to having had a reaction after the injection dental experiences and current issues. This review helps understand past of "Novocaine. " These alleged reactions are often attributable to problems and treatments, which can indicate the patient's future excessive anesthetic deposited over too short a time or, more likely, to behavior and tolerance towards dental procedures. Identifying an intravascular deposition. Patients may be allergic to preservatives in difficulties with previous treatments, such as areas of pain or broken topical and injectable local anesthetics. restorations, can guide adjustments to treatment or environment to prevent complications. Knowing the date and type of existing C. SYSTEMIC DISEASES AND CARDIAC ABNORMALITIES radiographs is also important to determine if new radiographs are necessary and to avoid unnecessary radiation. The FDA guidelines provide recommendations for the appropriate type and frequency of Infection Risk: Certain systemic diseases, particularly those involving radiographs based on the patient's condition and risk factors. immune compromise (like diabetes or HIV), increase the risk of infections. Invasive dental procedures can introduce bacteria into the bloodstream, leading to potentially serious infections like endocarditis in G. RISK ASSESSMENT patients with cardiac abnormalities involves evaluating multiple factors— behavioral, sociodemographic, Cardiac Risks: Patients with heart conditions are at risk of developing environmental, physical, microbiologic, and host-related—that infective endocarditis, an infection of the heart valves or lining caused by contribute to the likelihood of disease. Since most diseases result from a bacteria entering the bloodstream. The American Heart Association combination of these factors, assessing individual risk can be complex. recommends prophylactic antibiotics for certain patients before dental For dental caries, patients with several risk factors are considered high procedures to prevent this. risk and should receive proactive treatment to manage these risks. Conversely, patients with fewer risk factors may only need regular condition based on the examination. Treatment monitoring Planning: Outlines necessary dental procedures. II. EXAMINATION AND DIAGNOSIS Examination Process: Oral Hygiene: Ensures a clean, dry, and well-lit mouth for accurate examination. Instrumentation: Uses This section describes the examination and diagnosis of problems with essential tools like a mirror, explorer, and periodontal probe. orofacial soft tissues, teeth, restorations, periodontium, and occlusion. Systematic Approach: Follows a consistent charting order, Special considerations for evaluating a patient presenting with pain also starting from the upper right quadrant. are reviewed. In practice, each tooth is evaluated individually by using a combination of clinical and radiographic examinations and appropriate MAGNIFICATION IN OPERATIVE DENTISTRY adjunctive tests. Clinical dentistry often requires the viewing and evaluation of small details in teeth, intraoral and perioral tissues, restorations, and study GENERAL CONSIDERATION casts. Benefits of Magnification Importance of observation: Dentists must be attentive to subtle details ○ Improved Accuracy: Magnification allows for a more to identify potential health issues. precise diagnosis and treatment plan. Infection control: Strict adherence to universal precautions is essential ○ Enhanced Visualization: Dentists can see details that would otherwise be invisible. throughout the examination. Initial assessment: A general overview of the patient's overall health ○ Reduced Eye Strain: Magnification helps to prevent and oral condition is conducted. eye strain and fatigue. Preliminary tooth alignment check: A basic evaluation of the bite is performed to inform subsequent examinations. Types of Magnification ○ Loupes: These are magnifying glasses mounted on a frame that the dentist wears. CHARTING AND RECORDS ○ Dental Microscope: This provides higher magnification and better illumination than loupes. Content of Dental Records: Records should include patient information, medical history, dental history, clinical exam findings, diagnosis, EXAMINATION OF OROFACIAL SOFT TISSUES treatment plan, informed consent documentation, progress notes, and A comprehensive orofacial soft tissue examination is a critical completion notes. component of a complete dental evaluation. The process involves a systematic inspection and palpation of various areas, including: Qualities of Good Records: Records should be uncomplicated, comprehensive, accessible, and current. This ensures clear Extraoral Examination: Submandibular glands and cervical nodes communication, complete information, and ongoing updates. Benefits of Masticatory muscles Good Records: Maintaining thorough records benefits patients and dentists in several ways: Intraoral Examination: Cheeks, vestibules, mucosa Lips, lingual and Proper Care: Records guide accurate treatment planning. facial alveolar mucosa Palate, tonsillar areas, tongue, and floor of the Communication: Records facilitate communication with insurance mouth companies. Quality Assurance: Records serve as a foundation for evaluating the EXAMINATION OF TEETH AND RESTORATIONS quality of care provided. Legal Matters: Records serve as legal evidence in malpractice cases. CLINICAL EXAMINATION FOR CARIES Electronic Records: Electronic records are increasingly used and offer advantages like incorporating digital X-rays and photos Visual examination: Observing changes in tooth color or texture. PREPARATION FOR CLINICAL EXAMINATIONS Tactile examination: Using an explorer to detect rough spots or cavities. Role of the Chairside Assistant: Radiographs: Identifying caries through X-rays. ○ Initial Assessment: Conducts a preliminary examination of teeth and existing restorations using Transillumination: Shining light through teeth to detect hidden decay. dental terminology and charting symbols. Clinical Examination for Caries Recent advancements have introduced new technologies for more accurate and early detection of caries: Dentist's Role: Laser-induced fluorescence (LIF): Detects changes in tooth fluorescence ○ Confirmation: Verifies the assistant's charting. caused by caries. Diagnosis: Determines the patient's oral health Digital imaging fiberoptic transillumination (DIFOTI): Uses light to If a restoration is defective, the dentist may fix it by identify caries by analyzing tooth structure. reshaping it , smoothing it out , fixing the problem area , or removing and replacing the restoration entirely. Quantitative light-induced fluorescence (QLF): Measures fluorescence intensity to assess caries activity. One of the main concerns with anterior teeth is esthetics For front teeth, how the restoration looks is important. CLINICAL EXAMINATION FOR AMALGAM RESTORATIONS If a tooth-colored restoration has dark marginal staining or is discolored The process involves a systematic examination using various tools and to the extent that it is esthetically displeasing and the patient is unhappy techniques: with the appearance, the restoration should be judged defective If the restoration has dark stains around the edges or if its Visual inspection: Observing the restoration for any abnormalities, such color has changed in a way that makes it look unattractive. as discoloration, cracks, or voids. CLINICAL EXAMINATION FOR ADDITIONAL DEFECTS Tactile examination: Using an explorer to check for rough edges, overhangs, or fractures. Localized Hard White Areas During a dental exam, dentists might find hard white spots on Dental floss: Detecting overhangs and improper proximal contacts. the teeth, often due to nonhereditary issues like childhood fever, trauma, or fluorosis Radiographic interpretation: Identifying hidden issues like recurrent caries or fractures. Hypocalcification condition occurs when the enamel doesn't develop properly, 11 distinct conditions may be encountered when amalgam restorations leading to opaque, discolored, and hard surfaces. are evaluated: Chemical Erosion: 1.Amalgam“blues, ” Acid exposure, whether from diet or internal sources like acid 2.Proximal overhangs reflux, can cause significant tooth damage. 3.Marginal ditching 4.Voids 5.Fracture lines RADIOGRAPHIC EXAMINATION OF TEETH AND RESTORATIONS 6. Lines indicating the interface between abutted restorations 7.Improper anatomic contours Types of X-Rays 8.Marginal ridge incompatibility bite-wing X-rays are great for finding cavities between teeth 9.Improper proximal contacts 10.Recurrent caries periapical X-rays are better for checking roots and surrounding bone. 11. Improper occlusal contacts Common Misinterpretations CLINICAL EXAMINATION OF CASTS RESTORATIONS certain features, like normal shadows, can be confused with Cast restorations should be evaluated clinically in the same manner as cavities, leading to incorrect diagnoses. amalgam restorations. If any aspect of the restoration is not satisfactory or is causing tissue harm, it should be classified as defective and Combining X-Rays with Other Exams considered for recontouring, repair, or replacement most accurate diagnoses come from using both X-rays and physical examinations together. CLINICAL EXAMINATION OF COMPOSITE AND OTHER TOOTH-COLORED RESTORATIONS Bite-Wing Radiographs: effective for assessing bone levels around teeth Bone Loss Assessment: adiographs help identify whether bone loss is Tooth-colored restorations should be evaluated clinically in the same localized or generalized and whether it is vertical or horizontal manner as amalgam and cast restorations Crown-Lengthening Procedures procedures involve surgically removing When examining tooth-colored restorations the dentist uses gingiva to create a longer clinical crown for better restoration placement the same criteria as when checking metal fillings or crowns. and retention Corrective procedures include recontouring, polishing, repairing, or replacing  ADJUNCTIVE AIDS FOR EXAMINING TEETH AND RESTORATIONS EXAMINATION OF OCCLUSION Percussion Test.Static Occlusion Analysis This test involves gently tapping the tooth to check for pain, check for missing teeth, midline alignment, spacing, fractured which could indicate inflammation in the surrounding tissues or an issue teeth. with the pulp Dynamic Occlusion Analysis Palpation assess dynamic occlusion by observing the mandible’s By pressing on the gums around the tooth, a dentist can movements (right, left, forward, and various excursions). detect tenderness or swelling, which may indicate an abscess or other infection EXAMINATION OF A PATIENT IN PAIN Thermal Tests MEDICAL HISTORY AND CHIEF COMPLAINT Cold or hot substances are applied to the tooth to assess pulp CLINICAL EXAMINATION health. RADIOGRAPHIC EXAMINATION Electrical Pulp Test DIAGNOSTIC TECHNIQUE A mild electric current is used. to test if the tooth pulp is MANAGEMENT AND TREATMENT alive. Study Casts TREATMENT PLANNING These are models of a patient’s teeth that help the dentist General Considerations A treatment plan is a systematic approach to plan treatment, especially for complex cases control etiologic factors, repair damage, and maintain dental health. It relies on thorough evaluation, dentist expertise, understanding of indications, and accurate prognosis. REVIEW OF PERIODONTIUM Treatment Plan Sequencing Treatment plan sequencing is crucial for successful treatment plans, Evaluation Before Treatment ensuring logical order of procedures and coordination between Before starting any dental procedures, it's essential to assess treatments. Complex plans should be sequenced in phases like urgent, the condition of the periodontium. This includes the gums, bone, and control, re-evaluation, definitive, and maintenance other structures around the teeth. Urgent Phase Importance of Accurate Diagnosis The urgent phase of care commences with a comprehensive examination A thorough understanding of the periodontal health is vital of the patient's medical condition and history. because the success of any dental treatment depends on the health of these supporting tissues. Control Phase The control phase of treatment aims to eliminate active diseases like Clinical Examination caries and inflammation, prevent maintenance conditions, eliminate Gingival Color and Texture potential disease causes, and initiate preventive dentistry activities Assessing the gingiva helps determine periodontal health. Re-evaluation Phase Tooth Mobility Occlusal Relationship Restoration Contouring This phase, also known as the holding phase, is a period between the Assess tooth mobility and classify it as: definitive and control phases that facilitates inflammation resolution and - Class 1 (slight movement) healing. - Class 2 (moderate movement) - Class 3 (severe movement Definitive Phase The patient undergoes the corrective phase of treatment, which includes Occlusal Relationship endodontic, periodontic, orthodontic, oral surgical, and operative Evaluate how teeth come together during chewing to prevent trauma procedures before fixed or removable prosthodontic treatment. to the periodontium. Maintenance Phase Restoration Contouring The maintenance phase involves regular recall examinations to identify Ensure restorations are properly contoured to avoid trapping plaque potential adjustments for future breakdowns and to reinforce home care Interdisciplinary Considerations in Operative Treatment Planning During control or definitive phases of an operative procedure, there are general guidelines for when operative treatment should occur compared to other forms of care. ENDODONTICS All teeth undergoing large or cast restorations should undergo a pulpal/periapical evaluation. PERIODONTICS Periodontal treatment should precede operative care, as improved oral hygiene, initial scaling, and root planing procedures can create a more favorable environment for operative treatment. ORTHODONTICS Orthodontic therapy involves extrusion or realignment of teeth for optimal interdental spacing, stress distribution, function, and esthetics, ensuring caries-free teeth before orthodontic banding. ORAL SURGERY Most cases require the removal of impacted, unerupted, and hopelessly involved teeth before undergoing operative treatment. OCCLUSION The occlusion should be evaluated and adjusted if necessary to achieve a static anatomic occlusion with stable maximum intercuspation, nearly coincident with the retruded contact position FIXED AND REMOVABLE PROSTHODONTICS Before placing cast restorations, it's advisable to complete restorations. Sometimes, a large amalgam or composite restoration is used as a foundation for improved crown retention. TREATMENT CONSIDERATIONS FOR ELDERLY PATIENTS As the lifespan increases, elderly individuals face increasingly complex medical, mental, emotional, and social conditions that impact their ability to care for their dentition and periodontium. The conditions mentioned are crucial to consider when deciding on dental treatment. Efficient patient and operator positions are beneficial for the welfare of General Considerations: The operator should not hesitate to rotate the both individuals. patient’s head backward or forward or from side to side to accommodate the demands of access and visibility of the operating field. Positions that create unnecessary curvature of the spine or slumping of When operating in the maxillary arch, the maxillary occlusal surfaces the shoulders should be avoided. should be oriented approximately perpendicular to the floor. When operating in the mandibular arch, the mandibular occlusal surfaces Back and chest should be in an upright position should be oriented approximately 45 degrees to the floor. The face of the operator should not come in close proximity to that of the patient. Modern dental chairs Designed to provide total body support in any The ideal distance, similar to that for reading a book chair position Available chair accessory: Adjustable head rest cushion / articulating headrest attached to the chair back Contoured or lounge- Minimize body contact with the patient From most positions, the left type chair Provides the patient support and comfort. hand should be free to hold the mouth mirror to reflect light onto the operating field to view the tooth preparation indirectly or to retract the Patient positioning cheek or tongue. When operating for an extended period, a certain The patient should have direct access to the chair. The chair height amount of rest and muscle relaxation can be obtained for the operator should be low, the backrest upright, and the armrest adjusted to allow by changing operating positions. the patient to get into the chair. After the patient is seated, the armrest is returned to its normal position. The headrest cushion is positioned to Important things that your operating stools should have support the head and elevate the chin slightly away from the chest. In Casters this position, neck muscle strain is minimal, and swallowing is facilitated. Well padded and smooth cushion edges The chair is adjusted to place the patient in a reclining position. Backrest Foot ring The most common patient positions for operative dentistry are almost Foot rest (Operators don’t have it) supine or reclined 45 degrees The operator should not be balanced on the stool, using it as a The choice of patient position varies with the operator, the type of third leg of a tripod. The operator should sit back on the procedure, and the area of the mouth involved in the operation. In the cushion, using the entire seat and not just the front edge. The almost supine position, the patient’s head, knees, and feet are upper body should be positioned so that the spinal column is approximately the same level. The patient’s head should not be lower straight or bent slightly forward and supported by the backrest than the feet; the head should be positioned lower than the feet only in of the stool. an emergency, as when the patient is in syncope. When the operation is Some operator and assistant stools have backrests with curved completed, the chair should be placed in the upright position so that the extensions that offer additional body support. The thighs patient can leave the chair easily and gracefully, preventing undue strain should be parallel to the floor, and the lower legs should be or loss of balance. perpendicular to the floor. If the seat is too high, its front edge can cut off circulation to the user’s legs. Feet should be flat on RIGHT FRONT POSITION/ 7 O CLOCK It is for the examination of the floor. mandibular anterior and posterior teeth and maxillary anterior teeth. The seated work position for the assistant is essentially the You can tilt the head of the patient towards you for better work same as for the operator except that thestool is 4 to 6 inches higher for maximal visual access. It is important that the stool Right position/ 9 o’clock This position is used to operate the facial for the assistant have an adequate footrest so that a parallel surfaces of the maxillary and mandibular right posterior teeth and the thigh position can be maintained with good foot support. occlusal surfaces of the mandibular right posterior teeth. Right Rear Position / 11 o’ clock It is the position of choice in most of dental operations Most areas of the mouth are accessible The lingual and incisal (occlusal) surfaces of the maxillary teeth are viewed in the mouth mirror Direct vision may be used on mandibular teeth, particularly on the left side, but the use of a mouth mirror is advocated for visibility, light reflection, and retraction. Direct Rear Position/ 12 o’clock Has limited application Primarily used for Lingual Surfaces of the anterior teeth Directly behind of the patient, looks down over patient’s head B. INTRUMENTS EXCHANGE Hemostasis. The term hemostasis, as used in operative dentistry, refers All instrument exchanges between the operator and assistant should to the temporary reduction in blood flow and volume in tissue occur in the exchange zone below the patient’s chin and several inches (ischemia) where a vasoconstrictor is used. above the patient’s chest. During proper instrument exchange, the operator should not need to remove his or her eyes from the operating Operator Efficiency. Local anesthesia greatly benefits the dentist and the field. The operator should rotate the instrument handle forward to cue patient and is beneficial for successful tooth preparation and restoration the assistant to exchange instruments. During the procedure, the operator should anticipate and inform the assistant of the next 3) ADMINISTRATION instrument required; this allows the instrument to be brought into the Psychology. Patients have varying degrees of concern about receiving an exchange zone for a timely exchange. The assistant should take the intraoral injection. A concentrated effort by the dentist and dental instrument from the operator, rather than the operator dropping it into assistant is required to make the procedure more acceptable, and a the assistant’s hand, and vice versa. positive approach is desirable with all patients during this phase of treatment. Each instrument should be used completely before proceeding to the next instrument; this minimizes the number of instrument exchanges Technique Steps and Principles. Profound, painless anesthesia of the necessary for each procedure. teeth and contiguous soft tissues is so important in operative dentistry, salient features of a recommended technique for infiltration anesthesia MAGNIFICATION Another key to the success of clinical operative of a maxillary canine are presented. dentistry is visual acuity. Disposable Needle. The sheath covers the needle and the cap covers The operator must be able to see clearly to attend to the details of each the reverse end (cartridge end) of the disposable needle, For each procedure. Because of aging the human eye sight is starting to loss its patient (appointment), the dental assistant selects a sheathed, capped, function After the age 40 the operator may require to use magnifying new disposable needle of the desired length and gauge. lenses Magnifying lenses have a fixed focal length that often requires the operator to maintain a proper working distance, which ensures good Prop/Guard Card. The dental assistant inserts the sheathed needle end posture Several types of magnification devices are available, including into the prop/guard card and removes the cap on the reverse end of the bifocal eyeglasses, loupes, and surgical telescopes The use of eyeglasses needle. also provides some protection from eye injury. Anesthetic Cartridge. Using a new cartridge for each patient is PAIN CONTROL imperative. Because some ingredients do not have an extended shelf 1) PATIENT FACTORS life, the anesthetic cartridge should not be more than 18 months past the date of manufacture. Cardiovascular System. Before administering any drug, the condition of the cardiovascular system (heart and blood vessels) must be assessed. At Anesthetic Solution. The weakest solution of anesthetic that will be minimum, blood pressure, heart rate, and rhythm should be evaluated effective should be used. Lidocaine 2% with epinephrine is commonly and recorded for all patients. used in operative dentistry and is generally recommended; 1 mL (half a cartridge) provides infiltration anesthesia for 40 to 60 minutes for Central Nervous and Respiratory Systems. The central nervous system anterior teeth. (CNS) is more easily affected by an overdose of injected anesthetic drugs than the cardiovascular system. Anesthetic Syringe. Includes a rod (or piston) that has a harpoon (or barb) on the cartridge end and a thumb ring on the other end. Assembly Allergy. Malamed stated that documented, reproducible allergy is an of Syringe. To assemble the syringe, the assistant or operator picks up absolute contraindication for administration of local anesthetic the syringe and, while holding the piston fully retracted, inserts the cartridge. 2) BENEFITS Cooperative Patient. When a local anesthetic appropriate for the Topical Anesthetic. Before needle entry, the mucosa at the injection site procedure is properly administered, patient anxiety and tension should should be wiped free of debris and saliva by a sterile gauze. be minimal. Injection Site. If in place, the needle sheath should be removed in a Salivation Control. Saliva control is a primary reason for desiring one-person procedure with the hand protected by the shield. Injection. profound anesthesia for most patients. Knowing the injection site and with the needle directed properly, two things are done simultaneously in preparation for the injection. Disposal of Needle and Cartridge. Proper disposal of the needle and cartridge is crucial. Removal and disposal of the sheathed, used needle is Here's the corrected and organized text: done by the dental assistant, whose shield-protected hand carefully Rubber Dam Isolation unscrews the sheathed needle from the syringe and moves it away from the syringe. The rubber dam is used to define the operating field by isolating one or more teeth from the oral environment. It eliminates saliva 4) EMERGENCY PROCEDURE from the operating site and retracts the soft tissue, reducing The importance of taking pretreatment vital signs cannot be interruptions to replace cotton rolls for maintaining isolation. overemphasized.The patient’s pretreatment blood pressure and pulse Advantages: rate should be recorded in the chart. These vital signs are useful to uncover previously unknown cardiovascular problems and to serve as a Dry, Clean Operating Field: The rubber dam is the baseline if an adverse reaction occurs during treatment preferred method for obtaining a dry, clean field for most procedures. It allows the operator to perform B.)Analgesia (Inhalation Sedation) The most appropriate method of procedures like caries removal, tooth preparation, and preventing pain is by blocking the nerve pathways capable of conducting nerve impulses. For patients who have a low threshold of pain and are insertion of restorative materials with minimal apprehensive (hyperresponders), raising the threshold by inhalation contamination, reducing the risk of postoperative sedation is an aid to be coupled with anesthesia by injection problems. Access and Visibility: The rubber dam provides maximal C.)Hypnosis The fear of pain associated with dental procedures access and visibility by controlling moisture and sometimes can be controlled by hypnosis. Hypnosis is not a way to retracting the soft tissue. eliminate all other accepted means of minimizing dental pain or Improved Properties of Dental Materials: It prevents discomfort, but it may be a valuable adjunct in improving accepted moisture contamination of restorative materials during procedures insertion, promoting better properties in dental Operative dentistry cannot be executed properly unless the moisture in materials. the mouth is controlled. Moisture control refers to excluding sulcular Protection of the Patient and Operator: The rubber fluid, saliva, and gingival bleeding from the operating field. It also refers dam protects the patient from aspirating or swallowing to preventing the handpiece spray and restorative debris from being small instruments or debris. It is also considered an swallowed or aspirated by the patient. The rubber dam, suction devices, effective infection control barrier in the dental office. and absorbents are variously effective in moisture control. The goals of Operating Efficiency: Using the rubber dam increases operating field isolation are moisture control, retraction, and harm operating efficiency and productivity by discouraging prevention. Local anesthesia also is important in moisture control, excessive patient conversation and aiding in maintaining mouth opening with the rubber dam retainer. “Goals ofIsolation” Retraction and Access An axiom taught to every member of the health profession is "Do no harm, " and an important Disadvantages: consideration of isolating the operating field is preventing the patient from being harmed during the operation. 17,20 Excessive saliva and handpiece spray can alarm the patient. Small instruments and Low Usage Among Practitioners: Rubber dam usage is restorative debris can be aspirated or swallowed. Soft tissue can be low among private practitioners due to time damaged accidentally. As with moisture control and retraction, a rubber consumption and patient objections. Some patients, like dam, suction devices, absorbents, and occasional use of a mouth prop those with asthma, may find it difficult to tolerate the contribute not only to harm prevention, but also to patient comfort and rubber dam, especially if nasal breathing is challenging. operator efficiency. Harm prevention is provided as much by the manner Rare cases involve psychological intolerance or latex in which these devices are used as by the devices themselves. “Goals allergies. ofIsolation” Harm Prevention Local anesthetics play a role in eliminating Oral Conditions That Preclude Use: Certain conditions the discomfort of dental treatment and controlling moisture. Use of may prevent rubber dam use, such as teeth that have these agents reduces sali-vation, apparently because the patient is more comfort-able, less anxious, and less sensitive to oral stimuli, reducing not erupted enough to support a retainer, some third salivary flow. Local anesthetics incoporating a vasoconstrictor also molars, and extremely malpositioned teeth. reduce blood flow, helping to control hemorrhage at the operating site. Cotton Roll Isolation and Cellulose Wafers Cotton Roll Isolation: Cotton roll isolation involves placing absorbent cotton rolls around the tooth to keep it dry, retract the cheek, and provide additional absorbency. After positioning the cotton rolls or cellulose wafers, the saliva ejector may be used. When removing these absorbents, it may be necessary to moisten them with the air-water syringe to prevent inadvertent removal of the epithelium from the cheeks, floor of the mouth, or lips. Several commercial devices are available for holding cotton rolls in place. However, it is usually necessary to remove the holding appliance to change the cotton rolls. In selected situations, cotton roll isolation can be as effective as rubber dam isolation. When combined with profound anesthesia, absorbents provide acceptable moisture control for most clinical procedures. Cellulose Wafers: Cellulose wafers serve a similar purpose as cotton rolls by helping to keep the area dry and retract soft tissues. They are often used when rubber dam application is impractical or impossible. Other Isolation Techniques Throat Shields: When a rubber dam is not used, throat shields are recommended to prevent the aspiration or swallowing of small objects. High-Volume Evacuators and Saliva Ejectors: High-volume evacuators are preferred for suctioning water and debris from the mouth due to their higher capacity, whereas saliva ejectors remove water slowly and are less effective at picking up solids. Mirror and Evacuator Tip Retraction: A secondary function of the mirror and evacuator tip is to retract the cheek, lip, and tongue during procedures. Mouth Props: Mouth props relieve the patient from the responsibility of maintaining mouth opening, allowing for added relaxation during the procedure. Retraction Cord: Retraction cords can be used for isolation and retraction in direct procedures involving accessible subgingival areas or in indirect procedures involving gingival margins. Drugs: The use of drugs to control salivation is rarely indicated in restorative dentistry, with atropine being one of the few exceptions. However, atropine is contraindicated for nursing mothers and patients with glaucoma, and the operator should be familiar with its indications, contraindications, and side effects.