Dental Assistant Instruction Pack 3 PDF

Dental Assistant Instruction Pack 3 Lessons 17-21 0204551LB03A-14 Dental Assistant Instruction Pack 3 Lesson 17—Pediatric Dentistry Lesson 18—Orthodontics Lesson 19—Oral Pathology Lesson 20—Medical Emergencies Lesson 21—Oral and Maxillofacial Surgery 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. 0204551LB03A-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 17: Pediatric Dentistry Step 1: Learning Objectives............................................................................................................................................. 1 Step 2: Lesson Preview..................................................................................................................................................... 1 Step 3: What Is Pediatric Dentistry?.............................................................................................................................. 2 Breaking Down the Definition........................................................................................................................ 2 Getting to Know the Pediatric Dentist and Dental Assistant...................................................................... 2 Setting................................................................................................................................................................. 4 Step 4: The Stages of Childhood..................................................................................................................................... 5 Infancy................................................................................................................................................................ 5 Toddlerhood....................................................................................................................................................... 5 Preschool............................................................................................................................................................ 6 Early Elementary School.................................................................................................................................. 7 Elementary, Junior High and Senior High School........................................................................................ 7 Behavior Management...................................................................................................................................... 8 Step 5: Patients with Special Needs.............................................................................................................................. 11 Intellectual Disability...................................................................................................................................... 12 Down Syndrome.............................................................................................................................................. 13 Autism Spectrum Disorders........................................................................................................................... 13 Cerebral Palsy................................................................................................................................................... 15 Step 6: Practice Exercise 17-1....................................................................................................................................... 16 Step 7: Review Practice Exercise 17-1.......................................................................................................................... 19 Step 8: The Pediatric Dental Exam............................................................................................................................... 20 Medical and Dental History........................................................................................................................... 21 Extraoral Exam................................................................................................................................................ 21 Intraoral Soft Tissue Exam............................................................................................................................. 21 Dental Exam and Teeth Charting.................................................................................................................. 22 Radiographic Exam......................................................................................................................................... 22 Step 9: Preventive Measures.......................................................................................................................................... 23 Rubber Cup Prophylaxis................................................................................................................................. 23 Oral Hygiene.................................................................................................................................................... 26 Diet.................................................................................................................................................................... 26 Dental Assistant Step 10: Common Pediatric Procedures...................................................................................................................... 27 Fluoride Treatment.......................................................................................................................................... 27 Sealant Application.......................................................................................................................................... 29 Step 11: Other Common Practices............................................................................................................................... 31 Preventive Orthodontia.................................................................................................................................. 32 Crown Cementation........................................................................................................................................ 32 Pulp Therapy.................................................................................................................................................... 33 Step 12: Practice Exercise 17-2..................................................................................................................................... 33 Step 13: Review Practice Exercise 17-2........................................................................................................................ 34 Step 14: Treatment of Traumatic Injuries.................................................................................................................... 37 Fractured Anterior Teeth................................................................................................................................ 37 Avulsed Teeth................................................................................................................................................... 38 Extrusion and Lateral Luxation Injuries....................................................................................................... 39 Preventing Mouth Trauma............................................................................................................................. 40 Dealing with Abuse......................................................................................................................................... 41 Step 15: Practice Exercise 17-3..................................................................................................................................... 42 Step 16: Review Practice Exercise 17-3........................................................................................................................ 43 Step 17: Why This Matters............................................................................................................................................ 45 Step 18: Summary........................................................................................................................................................... 45 Step 19: Journal Entry.................................................................................................................................................... 46 Step 20: Quiz 17.............................................................................................................................................................. 46 Endnotes........................................................................................................................................................... 46 Lesson 18: Orthodontics Step 1: Learning Objectives............................................................................................................................................. 1 Step 2: Lesson Preview..................................................................................................................................................... 1 Step 3: What Is Orthodontics?........................................................................................................................................ 2 Occlusion............................................................................................................................................................ 2 Malocclusion...................................................................................................................................................... 3 Moving the Teeth to Correct Malocclusions.................................................................................................. 4 Step 4: The Orthodontic Office...................................................................................................................................... 6 Physical Layout of the Office........................................................................................................................... 6 The Orthodontic Team..................................................................................................................................... 6 Step 5: Who Needs Orthodontic Treatment?............................................................................................................... 9 Angle’s Classification of Malocclusions.......................................................................................................... 9 VI 0204551LB03A-14 Table of Contents Step 6: Practice Exercise 18-1....................................................................................................................................... 12 Step 7: Review Practice Exercise 18-1.......................................................................................................................... 14 Step 8: Types of Orthodontia........................................................................................................................................ 15 Preventive Orthodontia.................................................................................................................................. 15 Corrective Orthodontia.................................................................................................................................. 15 Step 9: The Orthodontic Treatment Process............................................................................................................... 16 Preliminary Examination............................................................................................................................... 16 The Treatment Plan and Case Presentation................................................................................................. 18 Orthodontic Treatment.................................................................................................................................. 18 Periodic Visits.................................................................................................................................................. 19 Completing Treatment.................................................................................................................................... 20 Removal of Appliances.................................................................................................................................... 20 Retention.......................................................................................................................................................... 20 Step 10: Practice Exercise 18-2..................................................................................................................................... 20 Step 11: Review Practice Exercise 18-2........................................................................................................................ 21 Step 12: Specialized Instruments.................................................................................................................................. 22 Step 13: Virtual Flashcard Tutorial............................................................................................................................... 25 Step 14: Orthodontic Appliances................................................................................................................................. 25 Fixed Appliances.............................................................................................................................................. 25 Auxiliary Attachments.................................................................................................................................... 27 Removable Appliances.................................................................................................................................... 28 Step 15: Virtual Flashcard............................................................................................................................................. 31 Step 16: Orthodontic Procedures................................................................................................................................. 32 Place Separators............................................................................................................................................... 32 Place Posterior Bands...................................................................................................................................... 33 Cement Anterior Brackets.............................................................................................................................. 34 Place Arch Wire............................................................................................................................................... 34 Tie Ligatures and Elastics............................................................................................................................... 35 Step 17: The Latest in Orthodontics............................................................................................................................ 36 The Damon System......................................................................................................................................... 36 Smart Brackets................................................................................................................................................. 37 Step 18: Practice Exercise 18-3..................................................................................................................................... 39 Step 19: Review Practice Exercise 18-3........................................................................................................................ 40 Step 20: Why this Matters.............................................................................................................................................. 41 Step 21: Summary........................................................................................................................................................... 42 0204551LB03A-14 VII Dental Assistant Step 22: Journal Entry.................................................................................................................................................... 42 Step 23: Quiz 18.............................................................................................................................................................. 42 Endnotes........................................................................................................................................................... 42 Lesson 19: Oral Pathology Step 1: Learning Objectives............................................................................................................................................. 1 Step 2: Lesson Preview..................................................................................................................................................... 1 Step 3: What Is Oral Pathology?..................................................................................................................................... 1 Step 4: Clinical Signs of Diseases and Disorders: Part 1............................................................................................. 2 Sign Number 1: Inflammation......................................................................................................................... 3 Sign Number 2: Lesions.................................................................................................................................... 3 Sign Number 3: Caries...................................................................................................................................... 6 Step 5: Virtual Flashcards................................................................................................................................................ 8 Step 6: Practice Exercise 19-1......................................................................................................................................... 8 Step 7: Review Practice Exercise 19-1............................................................................................................................ 9 Step 8: Clinical Signs of Diseases and Disorders: Part 2........................................................................................... 10 Sign Number 4: Diseases of the Soft Tissues............................................................................................... 10 Sign Number 5: Conditions of the Tongue.................................................................................................. 14 Sign Number 6: Temporomandibular Disorders......................................................................................... 16 Sign Number 7: Bruxism................................................................................................................................ 16 Step 9: Virtual Flashcards.............................................................................................................................................. 16 Step 10: Practice Exercise 19-2..................................................................................................................................... 17 Step 11: Review Practice Exercise 19-2........................................................................................................................ 17 Step 12: Cancer: The Disease, Treatments and Effects.............................................................................................. 18 Oral Cancer...................................................................................................................................................... 18 Effects of Medical Treatments on the Mouth............................................................................................... 19 Step 13: HIV/AIDS: The Disease, Treatments and Effects....................................................................................... 21 Hyperplastic Candidiasis................................................................................................................................ 21 Cervical Lymphadenopathy........................................................................................................................... 21 HIV Gingivitis.................................................................................................................................................. 21 Lesions.............................................................................................................................................................. 22 Lymphoma........................................................................................................................................................ 23 HIV Periodontitis............................................................................................................................................ 23 Tongue Changes............................................................................................................................................... 23 Oral Health Care for Patients with HIV/AIDS............................................................................................ 23 VIII 0204551LB03A-14 Table of Contents Step 14: Virtual Flashcards............................................................................................................................................ 23 Step 15: Practice Exercise 19-3..................................................................................................................................... 24 Step 16: Review Practice Exercise 19-3........................................................................................................................ 25 Step 17: Why This Matters............................................................................................................................................ 26 Step 18: Summary........................................................................................................................................................... 26 Step 19: Journal Entry.................................................................................................................................................... 26 Step 20: Quiz 19.............................................................................................................................................................. 26 Lesson 20: Medical Emergencies Step 1: Learning Objectives............................................................................................................................................. 1 Step 2: Lesson Preview..................................................................................................................................................... 1 Step 3: What Is a Medical Emergency?.......................................................................................................................... 2 Step 4: Medical Emergency Assessment and Response............................................................................................... 2 Step 5: Emergency Preparedness.................................................................................................................................... 3 Formalized Plan................................................................................................................................................. 3 Employees’ Roles and Duties........................................................................................................................... 3 Emergency Supplies.......................................................................................................................................... 4 Step 6: Practice Exercise 20-1......................................................................................................................................... 4 Step 7: Review Practice Exercise 20-1............................................................................................................................ 6 Step 8: Common Medical Emergencies......................................................................................................................... 7 Breathing Difficulties: Airway Obstructions................................................................................................. 7 Breathing Difficulties: Asthma........................................................................................................................ 8 Syncope............................................................................................................................................................... 8 Allergic Reaction............................................................................................................................................... 9 Diabetes............................................................................................................................................................ 10 Step 9: Practice Exercise 20-2....................................................................................................................................... 13 Step 10: Review Practice Exercise 20-2........................................................................................................................ 14 Step 11: Other Emergency Situations.......................................................................................................................... 16 Myocardial Infarction..................................................................................................................................... 16 Epileptic Seizure.............................................................................................................................................. 17 Cerebrovascular Accident.............................................................................................................................. 18 Step 12: Practice Exercise 20-3..................................................................................................................................... 20 Step 13: Review Practice Exercise 20-3........................................................................................................................ 21 Step 14: Why This Matters............................................................................................................................................ 22 Step 15: Summary........................................................................................................................................................... 23 Step 16: Journal Entry.................................................................................................................................................... 23 0204551LB03A-14 IX Dental Assistant Step 17: Quiz 20.............................................................................................................................................................. 23 Endnotes........................................................................................................................................................... 23 Lesson 21: Oral and Maxillofacial Surgery Step 1: Learning Objectives............................................................................................................................................. 1 Step 2: Lesson Preview..................................................................................................................................................... 1 Step 3: What Is Oral and Maxillofacial Surgery?.......................................................................................................... 2 The Oral and Maxillofacial Surgeon’s Office................................................................................................. 2 The Role of the Surgical Dental Assistant...................................................................................................... 3 Step 4: Practice Exercise 21-1......................................................................................................................................... 5 Step 5: Review Practice Exercise 21-1............................................................................................................................ 6 Step 6: Specialized Instruments in Oral and Maxillofacial Surgery.......................................................................... 7 Instruments Used in Oral and Maxillofacial Surgery................................................................................... 7 Extraction Forceps............................................................................................................................................. 9 Hemostat........................................................................................................................................................... 10 Mouth Prop...................................................................................................................................................... 10 Needle Holder.................................................................................................................................................. 10 Retractor........................................................................................................................................................... 11 Rongeur............................................................................................................................................................. 11 Scalpel............................................................................................................................................................... 12 Surgical Burs.................................................................................................................................................... 12 Surgical Curette................................................................................................................................................ 13 Surgical Handpiece.......................................................................................................................................... 13 Surgical and Suture Scissors........................................................................................................................... 14 Surgical Personal Protective Equipment...................................................................................................... 15 Step 7: Virtual Flashcards.............................................................................................................................................. 15 Step 8: Practice Exercise 21-2....................................................................................................................................... 15 Step 9: Review Practice Exercise 21-2.......................................................................................................................... 17 Step 10: Types of Oral Surgery Procedures and Assisting........................................................................................ 18 Prepare a Sterile Field..................................................................................................................................... 18 Oral Surgery Procedures................................................................................................................................. 19 Extractions........................................................................................................................................................ 19 Alveoplasty....................................................................................................................................................... 21 Removal of Impacted Teeth........................................................................................................................... 23 Biopsy................................................................................................................................................................ 25 X 0204551LB03A-14 Table of Contents Step 11: Practice Exercise 21-3..................................................................................................................................... 29 Step 12: Review Practice Exercise 21-3........................................................................................................................ 32 Step 13: Why This Matters............................................................................................................................................ 34 Step 14: Summary........................................................................................................................................................... 34 Step 15: Journal Entry.................................................................................................................................................... 35 Step 16: Quiz 21.............................................................................................................................................................. 35 0204551LB03A-14 XI Dental Assistant XII 0204551LB03A-14 Lesson 17 Pediatric Dentistry Step 1: Learning Objectives When you have completed the instruction in this lesson, you will be trained to: Compare a pediatric dental office to a general dentistry office. Explain the characteristics of each stage of childhood to adolescence and describe each stage’s common behaviors. Demonstrate successful communication and behavior management skills to address childhood stages. Explain the special needs of certain patients regarding dental visits. Outline the components of the pediatric dental exam and how to educate children and parents about diet and caries. List and explain how to perform common preventive pediatric procedures. Summarize common procedures such as preventive orthodontia, cementing crowns and pulp therapy. Explain the methods to treat the most common traumatic injuries. Explain the dental assistant’s role in cases of suspected child abuse. Step 2: Lesson Preview Children’s needs differ from adults’. Pediatric dental practices must accommodate the unique needs of children, as well as children and adults with special needs. In this lesson, you’ll learn the stages of childhood and the needs of disabled patients. You’ll explore how to successfully communicate with pediatric patients. You’ll also learn common pediatric procedures. You’ll even have an opportunity to examine how dentists treat traumatic injuries. Most importantly, you’ll learn the role you’ll play as a dental assistant dealing with all facets of pediatric dentistry. So, let’s get going! Dental Assistant Step 3: What Is Pediatric Dentistry? Pediatric dentists are concerned about the overall well-being of children. Here’s how the ADA defines pediatric dentistry: An age-defined specialty that provides primary and comprehensive preventive and therapeutic oral health care for infants and children through adolescence, including those with special healthcare needs.1 ONLINE LEANRING Build on what you’re learning by reading the article at: https://bluecloudpsc.com/ patient-resources/pediatric-dentistry/#:~:text=Pediatric%20Dentistry%20is%20an%20 age,with%20special%20health%20care%20needs. Breaking Down the Definition This section breaks down the parts of pediatric dentistry’s definition. Term Details Age-defined Pediatric dentists (specifically) provide care for a specific age group of patients, from infancy through adolescence. They also provide all types of treatment. Primary and comprehensive Pediatric dentists are primary providers. No need for a care referral from another dentist. Parents choose a pediatric dentist the same as they would a pediatrician. Special healthcare needs Pediatric dentists’ training and experience allows them to evaluate and treat medically compromised patients. This includes special needs patients, regardless of age. This includes patients with hemophilia, leukemia and congenital syndromes, such as Down syndrome and autism. Pediatric dentists and dental assistants must love children. They must also have the energy to keep up with the high volume of daily patients. Patience and compassion are also key—for dentists and DAs, especially regarding children and special needs patients. If you have those characteristics, you’ll do well in pediatric dentistry. Keep in mind, though, pediatric dentistry presents several differences from general dentistry. Keep reading to explore comparisons. Getting to Know the Pediatric Dentist and Dental Assistant Pediatric dentists continue their education for three additional years after dental school in an accredited pediatric program. These dentists have great understanding and respect for children. Dental assistants in pediatric offices take a more active role in preventive dental care than in general dentistry. You’ll perform all legal procedures, such as coronal polishing and impression taking. Your state’s regulations will guide you regarding limits. 17-2 0204551LB03A-17-14 Pediatric Dentistry Pediatric dentists and their assistants make a great team for kids. The Pediatric Dental Assistant’s Role You’ll play an important role in establishing initial contact with children. This includes introducing them to the office and the equipment. Talking to young patients is important. Once the dentist enters the operatory, you prepare the child for the introduction. From there, the dentist will converse with the patient. However, before—and even during—you must help the patient understand: The dentist is in charge. This way, your patient follows the dentist’s instructions. For clingy patients, you can gently remind them to listen. Children work well with a single set of instructions during procedures. However, once the procedure ends, you take over. You’ll talk to the child about the experience, escort him back to his parents, where you’ll review any take-home instructions. In reality, your role will vary depending on your workplace—and your dentist. So, use these suggestions as guidelines but talk to your dentist to clearly define your role. 0204551LB03A-17-14 17-3 Dental Assistant Setting The first thing children see is the office. A pediatric dental office must appear cheerful and non-threatening to children. Pleasant music helps. It distracts children when they’re waiting and while they’re receiving treatment. Décor—Children are sensitive to their physical environment. The décor matters. It’s why many pediatric dental offices use jungle, space or cartoon themes to set children at ease. Appearance—Appearance matters to children too, not just adults. White uniforms could scare children who might have lingering anxiety from negative doctor visits. Colored or printed uniforms help put them at ease. Room arrangement—Unlike adult dental offices, with one chair per bay, pediatric practices often feature several dental chairs arranged in one large area. Why? Children feel reassured when they see other children receiving dental care. Additionally, children might be less likely to show their fear or misbehave with other children behaving near them. However, there’s always the chance that one child who misbehaves sets off the other young patients. So, some pediatric practices have a quiet room—an isolated area where the anxious, angry or frightened child can sit. Equipment, Instruments and Materials A pediatric office’s equipment differs from a general dental office’s, too. Dental chairs are often smaller than those for adults. Other offices can opt for full-size dental chairs—but with booster cushions. Pediatric dentists use the same instruments as general dentists. However, the dental materials in the pediatric office may vary. For example, pediatric dentists use more glass ionomers for fillings. They’re easy to place, and they release fluoride. Pediatric dentists tend to use stainless steel crowns instead of porcelain fused to metal. Steel is strong, inexpensive and dentists can place them in one appointment. Pediatric dentists also use space maintainers to keep a space between teeth when primary teeth are lost prematurely. Pediatric dental chairs may be a little smaller to accommodate young children. 17-4 0204551LB03A-17-14 Pediatric Dentistry Additionally, pediatric dentists may use nitrous oxide more often to calm anxious patients. Special needs patients, as well as children, may benefit from the effects of nitrous oxide and its ability to decrease anxiety. It may also help to relax the muscles to make the procedures easier for the pediatric dentist. Step 4: The Stages of Childhood If you plan to be a dental assistant at a pediatric dental office, you probably like and want to understand children. This means understanding them in terms of their chronological, mental and emotional ages. Here’s a brief overview of each: 1. Chronological age—Child’s age in years and months 2. Mental age—Child’s level of intellectual development 3. Emotional age—Child’s level of emotional maturity These ages could differ in a child. A child with a chronological age of six may have a mental age of eight (functioning at the intellectual level of an average eight-year-old). At the same time, her emotional age might reflect five (functioning at the emotional level of an average five-year-old). Now let’s look at the guidelines for the average child’s development at certain ages. These guidelines will help you successfully work with children from infancy through adolescence. A child who differs widely from these guidelines may have a physical or emotional problem. Infancy Infancy refers to birth through age two. During this time, children learn to sit, stand, walk and run. Vocally, they progress from babbling to using simple sentences. Socially, they learn to identify faces, are generally afraid of strangers and fear separation from their parents. Communication and Behavior Because infants remain “attached” to their parents and afraid of strangers, parents should be present during dental exams. Typically, the parent holds the infant on his lap, with the infant facing the dental assistant who sits facing the parent and child. Since an infant cannot answer questions or clearly communicate, the parents, dentist and assistant must monitor and interpret the child’s responses. It’s especially important to watch for any gagging since infants have sensitive gag reflexes. Intraoral probing could stimulate gagging. The dental staff must clearly explain the exam and the treatment to the parents. When the exam ends, the staff must explain post-operative instructions as well. Toddlerhood Toddlerhood runs from ages two to three. At two years old, toddlers depend on tone of voice and facial expressions to comprehend situations. Sudden movements and sounds tend to startle them. However, by three years old, toddlers learn independence, have lessened their fear of strangers and ask several “how” and “why” questions. 0204551LB03A-17-14 17-5 Dental Assistant Communication and Behavior Toddlers can generally follow simple instructions. This means they play an active role in the treatment experience by sitting still, keeping their hands at their sides and opening their mouths wide. You help by maintaining a constant and upbeat verbal conversation with the patient by using warm facial expressions. Special hint: Explain changes in chair position, sounds and other activities so the toddler doesn’t startle. Also, during exams, answer toddlers’ questions patiently, honestly and sincerely. If they ask too many questions, mention you’ll answer anything after you finish the treatment. Toddlers are more willing to be examined without their parents present. They still like a parent nearby for reassurance, though. This equates to less fear, crying and withdrawal. To help further motivate toddlers, use phrases like: “Open your mouth wide.” “Keep your hands by your sides.” “No talking, please.” Preschool Preschool-age refers to ages four to five years. Here, children gain a greater sense of self and want more autonomy—independence and freedom of choice. Still, they respond well to a controlled and structured environment. You’ll note that this group can, and often does, interact with others through speech and physical activity. They enjoy discussing possessions, accomplishments and themselves. They might act less cooperative, more assertive, aggressive or resistant. But they generally have no problem being examined without their parents present. Communication and Behavior Communicate at a level preschoolers understand—but avoid baby talk. Center conversations on recent activities and accomplishments. Preschoolers love to talk about themselves! Give them choices that support their need for autonomy. Ask what flavor fluoride they want or what color toothbrush they prefer. This is the age when children may become overly resistant. So, allowing them to make choices gives them a feeling of some control of the situation. This makes everyone’s job easier. When you work with a preschooler, consider using phrases like: “Which tooth do you want to start with?” “What flavor fluoride do you like?” “What’s your favorite color toothbrush?” 17-6 0204551LB03A-17-14 Pediatric Dentistry Early Elementary School Early elementary school-age refers to ages five to seven. These ages reflect socialization and recognition of authority figures other than their parents and teachers. They tend to respond well to older adults. They also feel the pressure of their own peers. Communication and Behavior Talk to the patient about the role of the dentist and the dental assistant. From there, establish “the rules.” It helps if the child observes other well-behaved children receiving dental care. When you work with an early elementary school-age child, consider phrases like: “I’m putting the mirror in your mouth. Open wide and count to ten.” “I’m tapping your tooth with my instrument. Does anything hurt?” Elementary, Junior High and Senior High School Elementary school age refers to ages eight to eleven. Here, children learn the rules and regulations of society and are able to accept them. At this age, children have learned to overcome fears of objects and situations that bothered them when they were younger. They’ve learned that situations are generally less frightening than they imagined. Junior high and senior high school-age refers to ages twelve to eighteen. Communication and Behavior When you work with children and adolescents eight years and above, you can use direct phrases that tell them why you want them to perform a certain action, such as: 1. “I need to pull floss through to make sure the contacts aren’t too tight. Otherwise, you won’t be able to floss well.” 2. “Your gums may feel a little tender. Make sure to brush lightly so you don’t irritate them.” You speak to them, in many ways, as you would an adult. Speak to children eight and above as you would an adult. 0204551LB03A-17-14 17-7 Dental Assistant Behavior Management Do you remember your first dental visit? What about the first time you had a cavity filled? Was the experience good or bad? It’s important to remember that a child’s first experience with a dentist may determine the way she views dentistry and dental health for the rest of her life! So, aim to make each visit as positive as possible. This involves a certain amount of behavior management. General Guidelines Building trust between parent, child and dentist is essential for effective dental patient care. Here are various ways to build trust with patients. Learning these ideals will help the dental team successfully perform procedures on all pediatric patients. Building trust with child patients Component Details Be honest Ensure what you say is true from the child’s point of view. Consider the child’s point Put yourself in the child’s shoes. Adjust your language level to of view the age of the child. Use words that make sense to the child. For example, it’s better to say, “You might feel a pinch,” instead of “You might feel a mosquito bite.” Most children know what a pinch feels like. Raise the child’s chair to eye-level so you don’t tower over him. Use tell-show-do Tell the child what you plan to do. Show the child what you plan to do. Do exactly what you’ve told and shown. Use positive reinforcement Reinforce and reward appropriate behavior. Don’t punish undesirable behavior. Never reward it either. Give your full attention From the time the child arrives, direct your conversation toward the child. Select topics that she might enjoy such as pets, favorite stories, television shows, toys and the clothes she’s wearing. Deal appropriately with Some children talk when they’re anxious or as a way to delay talkative ones treatment. Watch your talkative patients to see if this is the case. If it is, answer some of the questions, but then tell the child you have to start work. He can ask all he wants once the procedure ends. Establishing trust means paying attention to your patient’s behavior. This means reading her verbal and non- verbal cues to determine how she’s dealing with the visit. You must assess the patient’s behavior so you can figure out how to respond to it and develop good rapport. 17-8 0204551LB03A-17-14 Pediatric Dentistry How to Measure Behavior The Frankel Scale for Behaviors is an excellent way to interpret a child’s behavior when he visits the dentist. Frankel Scale for Pediatric Dental Patient Behavior Rating Definition Patient Behavior 1 Definitely negative Refuses treatment Cries forcefully Acts fearfully Demonstrates other evidence of extreme negativism 2 Negative Acts reluctant to receive treatment Uncooperative Shows evidence of a negative attitude—without sudden withdrawal 3 Positive Accepts treatment Acts cautious at times Willing to comply, sometimes with reservation, but always follows directions 4 Definitely positive Demonstrates good rapport with the dentist Interested in dental procedures Laughs and enjoys the situation Specific Behavior Management Techniques Now, time to get specific. This next section will show you how to apply the earlier general behavior guidelines to specific situations—according to the child’s behavior rating. This table lists some of the techniques recommended by the American Academy of Pediatric Dentistry: Behavior Management Techniques Management Description Objectives When to Use (or not) Technique Tell-show-do Explain the situationReduce fears. Use for all patients who can at the patient’s level. Shape patient’s communicate, regardless of Demonstrate and responses. communication method. perform the actual Give expectations of procedure. behavior. Voice control Change your voice Gain patient’s Use for uncooperative or volume, tone or pace attention. inattentive child. to influence and Prevent negative Do NOT use for children direct the patient’s or avoidance who cannot understand behavior. behaviors. due to age, disability, Establish authority. medication or emotional immaturity. Positive Give appropriately Reinforce desired Use for all patients. reinforcement timed feedback. behavior. Praise and facial expressions. 0204551LB03A-17-14 17-9 Dental Assistant Behavior Management Techniques Management Description Objectives When to Use (or not) Technique Distraction Divert the patient’s Reduce the Use for all patients. attention from likelihood of a perceived an unpleasant unpleasant perception by the procedure. patient. Nonverbal Reinforce and guide Improve Use for most patients. communication behaviors through effectiveness of Do NOT use for Aspergers physical contact, other behavior sufferers (high level autism). posture and facial management They cannot “read” your expressions. techniques. facial expression, body Gain or maintain the language or tone of voice. patient’s attention Instead, use direct verbal and cooperation. instructions in simple, straight-forward language. Hand-over-mouth Place hand over Gain patient’s Use only at the (HOM) patient’s mouth while attention so you can recommendation of the explaining behavior communicate. child’s parent or guardian expectations. Eliminate and with written informed Remove hand when inappropriate consent. patient behaves avoidance For a healthy child who correctly. responses. is able to understand Reapply if necessary. Improve child’s self- and cooperate, but who confidence during displays defiant or hysterical treatment. avoidance behaviors. Ensure child’s Do NOT use on a child who safety during the is unable to understand procedure. due to age, disability, medications or emotional immaturity. Physical restraint Partially or Reduce or Use only at the completely eliminate unwanted recommendation of the immobilize the movement. child’s parent or guardian patient’s body or Protect patient and and with written informed parts of it (head, staff from injury. consent. arms, body or legs). Use for a patient who Successfully deliver care. cannot cooperate due to immaturity, mental or physical disability. Use when all other techniques fail or when the safety of the patient or dental team is at risk. Do NOT use for a cooperative patient or for a patient with medical conditions that would be negatively impacted by restraints. 17-10 0204551LB03A-17-14 Pediatric Dentistry Restraints may be necessary in certain situations. Sometimes a child remains uncooperative even when the dental team has used every possible positive approach. When this happens, it can be very challenging for the dentist, dental assistant, parents and child. Restraints can help. Restraints are either pharmacological or physical. Pharmacological restraints are drugs that calm or sedate the patient. Nitrous oxide is common. The child becomes relaxed and when the procedure is over, the gas wears off rapidly with minimal side effects. A physical restraint can be as simple as the dental assistant holding the child’s hands. This is especially important if the child reaches for the dentist’s arm, syringe or handpiece. However, when things get out of hand with head shaking, arm waving and kicking, you may need to use a papoose board. A papoose board is a device that gently “hugs” the child during a procedure. It has Velcro straps that fasten over the child and restrain the hands, arms and legs. This device is also great for sedated, younger children who have less control over their movements. Dentists might use gentle restraints with children. Note: Use restraints only after receiving written, informed consent from the child’s parent or guardian. Step 5: Patients with Special Needs By now you should have a good idea how children of different ages think and behave and how best to communicate with them and manage their behavior. But what about children and adults with special needs? You’ll need to learn to work with them as well. Children with intellectual disability—Down syndrome, autism or cerebral palsy—require special daily physical needs, including dental hygiene. A pediatric dental office may offer a better environment for patients with special needs. However, it’s important for the dental team to review and evaluate the patient’s medical and social history. This will help determine whether treatment should occur in the pediatric dental office or in a hospital setting. Let’s look at the various disabilities special needs patients might have—and how to work with those patients. 0204551LB03A-17-14 17-11 Dental Assistant Intellectual Disability Intellectual disability is defined as a condition where an individual has limited mental and adaptive skills. There are four levels of intellectual disability: mild, moderate, severe and profound. Mild Intellectual Disability Individuals with mild intellectual disability have intelligence quotients (IQs) ranging from 50 to 70. People with mild intellectual disability: 1. Develop social and communication skills during preschool years 2. Have little or no motor skill problems 3. Are often indistinguishable from other children until a later age. When working with a patient with mild intellectual disability, treat the patient as you’d treat other patients. However, you may need to be more patient, understanding and reassuring because the patient’s comprehension is slower. Moderate Intellectual Disability Individuals with moderate intellectual disability have IQs ranging from 35 to 55. They learn to communicate during preschool years but rarely academically progress beyond second-grade level. They may benefit from vocational training later in life. They generally need supervision and guidance under stress and typically live in supervised group homes where they can care for themselves. When working with a patient with moderate intellectual disability, you may need to administer pre- treatment medication or use restraints. Severe Intellectual Disability Individuals with severe intellectual disability have IQs ranging from 20 to 40. They display poor motor skills during the preschool period and rarely develop communication skills. As adults, they may be able to perform simple tasks under close supervision. Working with a patient with a severe intellectual disability will require specialized dental treatment. This typically involves general anesthesia. Profound Intellectual Disability Individuals in this group have IQs below 20. During their early years, these children showed minimal motor skills. Throughout life, they require a highly structured environment with constant aid and supervision. Individuals with profound intellectual disability require specialized dental care, usually in an institutional setting. 17-12 0204551LB03A-17-14 Pediatric Dentistry Down Syndrome Patients with Down syndrome have a defect in their chromosomes that results in mental difficulties and noticeably different physical characteristics. Mental difficulties range from mild to moderate intellectual disability. Obvious physical characteristics include: Flattened back of head Slanted eyes Slightly jutting jaw Reduced muscle strength and tone Slightly depressed nose bridge Heart Problems The physical problems often contribute to abnormal dental development. Teeth erupt late, with primary incisors not erupting until after one year of age. Teeth are small and peg-shaped. Malocclusion and misalignment are common. Because of the forward position of the mandible and underdeveloped nasal and maxillary bones, the tongue rarely has enough space. This causes people with Down syndrome to keep their mouths open—with their tongue slightly protruding. The misaligned teeth, malocclusion and mouth breathing generally lead to periodontal problems. When you work with patients with Down syndrome, treat them according to their mental age and abilities. Autism Spectrum Disorders Autism spectrum disorders (ASDs) are brain disorders that begin in early childhood and persist throughout adulthood. They affect three crucial areas of development: communication, social interaction and creative or imaginative play. It’s important to understand the basic characteristics of ASD so you know how to work with a patient with autism. People with ASD have great difficulty with social interaction and communication. They are unable to use or interpret nonverbal behaviors. This means that social behaviors, like using or interpreting appropriate tone of voice or facial expression, are beyond them. Additionally, they exhibit no interest in sharing experiences with others or forming relationships with others. To the casual observer, they appear emotionally immature with no empathy. Interestingly, people with autism struggle with understanding the emotions of others. They may be unable to gauge their own stress levels and have difficulty expressing pain. Although they might lack interest in others, they show an extreme interest and preoccupation with objects. New experiences, strange smells and loud sounds particularly affect people with ASD. It’s important to prepare the patient for a visit. This might involve the parent explaining what a dentist is, why it’s important to visit the dentist and what a dental office looks like. Or it might involve the patient making several visits to the dentist: one visit to meet the dentist, one visit to get used to the chair and the procedures in the operatory and one for an exam and treatment. Some dentists and dental assistants rely on story books or visual aides to walk the patient through the process before he ever sits in the chair. 0204551LB03A-17-14 17-13 Dental Assistant When working with a patient with autism, you must be patient, repetitive and clear. Remember, voice and facial expressions mean little to them—they focus solely on your words. They do not understand imaginative sentences involving sarcasm or word play. So, stick with the facts and repeat, repeat, repeat. Dr. David Tesini, a pediatric dentist, has developed the “D-Termined Program of Repetitive Tasking and Familiarization in Dentistry,” a method he successfully uses with his patients who have ASD. It involves five steps. Testimonials of academics and private practitioners, support DTP as successful in encouraging other dental professionals to open their practices to children with Autistic Spectrum Disorder.2 1. Divide the skill. Break down the procedure into short steps. For example: a) walk into the operatory, b) get into the chair, c) put your legs out straight, d) put your hands on your tummy, e) open your mouth wide and f) count to ten. 2. Demonstrate the skill. The dental assistant demonstrates the skill. 3. Drill the skill. Have the patient practice each step of the skill and repeat it as many times as necessary until moving to the next step. Repetition helps patients with autism learn. 4. Delight the learner. Make it fun for the patient by giving lots of positive reinforcement such as “it’s okay,” “good girl” or “good boy” and “very good.” 5. Delegate the skill. Make sure the parents or caregivers practice the skills with the patient at home so things get easier with each visit. This is a time-consuming approach that requires patience. Throughout the process, both you and the dentist must give clear instructions and reinforcing feedback. When working with a patient with ASD: Make eye contact with the patient to require him to pay attention. This establishes a relationship. Example, “Look at me.” Describe and model the behavior you expect. For example, “Legs out straight” or “Open wide.” Perform the procedure exactly as you described it. Use counting to help the child remain still for longer periods. Dentist can perform procedures in a series of timed increments. Example, “Open wide while I count. 1…2…3…” Throughout the procedure, it’s wise to remind the patient that the visit has a time limit. It will end. Visual timers can help the patient realize the visit is not forever. This can reduce anxiety. ONLINE LEARNING Build on what you’re learning by reading the article at: https://reader.mediawiremobile.com/ accessibility/issues/206518/articles/5fb3f64f8a5a6cc128451ed1/reader. 17-14 0204551LB03A-17-14 Pediatric Dentistry Cerebral Palsy Cerebral palsy describes a group of neural disorders caused from brain damage before the central nervous system reaches maturity. This occurs within the first few years after birth. The brain damage can cause paralysis, muscle weakness, lack of coordination and other motor skill disorders. This affects the patient’s ability to move and maintain posture and balance. Depending on the location of the brain injury and its severity, other problems could result. This includes intellectual disability, seizures, language disorders, learning disabilities and vision and hearing problems. Medical professionals typically categorize cerebral palsy by the type of motor disturbance: Spasticity Refers to increased muscle tension or stiffness that causes exaggerated stretch reflexes. Often, the position of the head triggers abnormal positions of the whole body. The stiffness often increases when the child is upset or excited, or when the body is in certain positions. Athetosis Refers to uncontrollable, involuntary, uncoordinated movements of the body, face and extremities. The arms and legs may seem jumpy and move nervously, or the hands or toes may move for no reason. When the child does move by choice, the body parts typically move too fast and too far. Pre-treatment medication can relax patients with disabilities. Because of the lack of physical coordination in the patient, you and the dentist will typically use pre- treatment medication to relax and control the patient. This makes routine dental hygiene possible. In some cases, the dentist may need to use general anesthesia. Routine dental hygiene is important because the physical limitations of cerebral palsy make it almost impossible for patients to brush their teeth. Some patients can use an electric toothbrush with special adaptations to the handle. 0204551LB03A-17-14 17-15 Dental Assistant However, in most cases, the patient’s caregiver performs her twice-daily oral hygiene tasks. Now that you’ve had a chance to learn about the pediatric dental office, the age groups it serves and special needs patients, it’s time to review with a Practice Exercise. Step 6: Practice Exercise 17-1 Select the best answer from the choices provided. 1. This age characteristic reflects infants. a. Learn rules and regulations of society, generally not afraid of unknown situations b. Startled by sudden movements and sounds, want independence, but need structure and control of their environment c. Very attached to parents and afraid of strangers 2. This age characteristic reflects preschool. a. Recognize authority figures other than parents and teachers, respond to peer pressure and older adults b. Startled by sudden movements and sounds, want independence, but need structure and control of their environment c. Want autonomy and freedom of choice 3. This age characteristic reflects early elementary school. a. Recognize authority figures other than parents and teachers, respond to peer pressure and older adults b. Learn rules and regulations of society, generally not afraid of unknown situations c. Want autonomy and freedom of choice 4. This age characteristic reflects elementary, junior high and high school. a. Recognize authority figures other than parents and teachers, respond to peer pressure and older adults b. Learn rules and regulations of society, generally not afraid of unknown situations c. Want autonomy and freedom of choice 5. This best characterizes a definitely negative patient. a. Has good rapport with the dentist, is interested in the dental procedures, laughs and enjoys the situation b. Accepts treatment, occasionally acts cautious, is willing to comply, sometimes with reservation but always follows directions c. Acts reluctant to receive treatment, is uncooperative, shows some negative attitude, but no sudden withdrawal d. Refuses treatment, cries forcefully, acts fearfully, demonstrates extreme negativism 17-16 0204551LB03A-17-14 Pediatric Dentistry 6. This best characterizes a negative patient. a. Has good rapport with the dentist, is interested in the dental procedures, laughs and enjoys the situation b. Accepts treatment, occasionally acts cautious, is willing to comply, sometimes with reservation but always follows directions c. Acts reluctant to receive treatment, is uncooperative, shows some negative attitude, but no sudden withdrawal d. Refuses treatment, cries forcefully, acts fearfully, demonstrates extreme negativism 7. This best characterizes a positive patient. a. Has good rapport with the dentist, is interested in the dental procedures, laughs and enjoys the situation b. Accepts treatment, occasionally acts cautious, is willing to comply, sometimes with reservation but always follows directions c. Acts reluctant to receive treatment, is uncooperative, shows some negative attitude, but no sudden withdrawal d. Refuses treatment, cries forcefully, acts fearfully, demonstrates extreme negativism 8. This best characterizes a definitely positive patient. a. Has good rapport with the dentist, is interested in the dental procedures, laughs and enjoys the situation b. Accepts treatment, occasionally acts cautious, is willing to comply, sometimes with reservation but always follows directions c. Acts reluctant to receive treatment, is uncooperative, shows some negative attitude, but no sudden withdrawal d. Refuses treatment, cries forcefully, acts fearfully, demonstrates extreme negativism 9. This best describes a treatment approach for a patient with a mild intellectual disability. a. Administer pre-medication, use specialized dental treatment and possibly use general anesthesia b. Treat as a normal patient, but be more patient and reassuring c. Treat in an institutional setting d. Use specialized dental treatment and general anesthesia 10. This best describes a treatment approach for a patient with a moderate intellectual disability. a. Administer pre-medication, use specialized dental treatment and possibly use general anesthesia b. Treat as a normal patient, but be more patient and reassuring c. Treat in an institutional setting d. Use specialized dental treatment and general anesthesia 0204551LB03A-17-14 17-17 Dental Assistant 11. This best describes a treatment approach for a patient with a severe intellectual disability. a. Administer pre-medication, use specialized dental treatment and possibly use general anesthesia b. Treat as a normal patient, but be more patient and reassuring c. Treat in an institutional setting d. Use specialized dental treatment and general anesthesia 12. This best describes a treatment approach for a patient with a profound intellectual disability. a. Administer pre-medication, use specialized dental treatment and possibly use general anesthesia b. Treat as a normal patient, but be more patient and reassuring c. Treat in an institutional setting d. Use specialized dental treatment and general anesthesia Answer as directed. 13. Explain the “tell-show-do” method. 14. Name four ways to gain trust from a pediatric patient. 15. List three qualities of a good pediatric dental assistant. 16. Name a piece of equipment in a pediatric dental office that may differ from that in a standard dental office. 17. List three typical characteristics of a pediatric dental office. 18. Nonverbal communication is a behavior management technique that does not work with what type of patient? Why? 19. What is the name of a typical restraint and when might you use it? 20. What is cerebral palsy and what does it affect? 21. Name at least four characteristics of a patient with Down syndrome. 22. Autism spectrum disorders are brain disorders that affect what three crucial areas of development? 23. Explain the difference in schooling between a traditional dentist and a pediatric dentist. 24. What patients does a pediatric dentist serve? 17-18 0204551LB03A-17-14 Pediatric Dentistry Step 7: Review Practice Exercise 17-1 Review the answers to the Practice Exercise and use this as a study tool when preparing for your Quiz. 1. This age characteristic reflects infants. c. Very attached to parents and afraid of strangers 2. This age characteristic reflects preschool. b. Startled by sudden movements and sounds, want independence, but need structure and control of their environment 3. This age characteristic reflects early elementary school. a. Recognize authority figures other than parents and teachers, respond to peer pressure and older adults 4. This age characteristic reflects elementary, junior high and high school. b. Learn rules and regulations of society, generally not afraid of unknown situations 5. This best characterizes a definitely negative patient. d. Refuses treatment, cries forcefully, acts fearfully, demonstrates extreme negativism 6. This best characterizes a negative patient. c. Acts reluctant to receive treatment, is uncooperative, shows some negative attitude, but no sudden withdrawal 7. This best characterizes a positive patient. b. Accepts treatment, occasionally acts cautious, is willing to comply, sometimes with reservation but always follows directions 8. This best characterizes a definitely positive patient. a. Has good rapport with the dentist, is interested in the dental procedures, laughs and enjoys the situation 9. This best describes a treatment approach for a patient with a mild intellectual disability. b. Treat as a normal patient, but be more patient and reassuring 10. This best describes a treatment approach for a patient with a moderate intellectual disability. a. Administer pre-medication, use specialized dental treatment and possibly use general anesthesia 11. This best describes a treatment approach for a patient with a severe intellectual disability. d. Use specialized dental treatment and general anesthesia 12. This best describes a treatment approach for a patient with a profound intellectual disability. c. Treat in an institutional setting 13. Explain the “tell-show-do” method. First, tell the child what you plan to do. Then, show the child what you plan to do. Last, do exactly what you’ve told and shown. 14. Name four ways to gain trust from a pediatric patient. Any four of these: Be honest with the child; consider the child’s point of view; use “tell-show-do”; give positive reinforcement; give the child your full attention; deal appropriately with talkative patients. 15. List three qualities of a good pediatric dental assistant. Any three of these: Loves children; is patient with children; understands children; is patient and compassionate toward special needs patients; is able to deal with a high-volume office. 0204551LB03A-17-14 17-19 Dental Assistant 16. Name a piece of equipment in a pediatric dental office that may differ from that in a standard dental office. Dental chairs are often smaller or have a “booster” cushion. 17. List three typical characteristics of a pediatric dental office. Any three of these: Cheerful or theme- oriented décor; large, open rooms for multiple patients; dentists and dental assistants wear colored or patterned uniforms; there is a quiet room. 18. Nonverbal communication is a behavior management technique that does not work with what type of patient? Why? Patients with autism (especially Aspergers syndrome) cannot “read” facial expressions, body language or tone of voice. They need direct, simple instructions. 19. What is the name of a typical restraint and when might you use it? Restraints can be pharmacological or physical. Pharmacological restraints are medications that calm or sedate a patient who is fearful or is unable to control his movements. Physical restraints, such as holding hands, blocking arm movement or using a papoose board, are used for younger, sedated children or patients who are reacting in a dangerous manner. 20. What is cerebral palsy and what does it affect? Cerebral palsy is a group of neurological disorders resulting from brain damage before or within a few years of birth. The damage impacts different parts of the brain and affects the ability to move and maintain posture and balance, muscle weakness and lack of coordination. 21. Name at least four characteristics of a patient with Down syndrome. Any four of these: Flattened back of head; slanted eyes; slightly depressed bridge of nose; slightly jutting jaw; reduced muscle strength and tone; heart problems; mild to moderate intellectual disability. 22. Autism spectrum disorders are brain disorders that affect what three crucial areas of development? Communication—they cannot interpret nonverbal behaviors such as tone of voice or facial expressions; Social interaction—they appear emotionally immature or with no empathy; Creative or imaginative play—they cannot use or interpret creative use of words, such as sarcasm, humor or word play. 23. Explain the difference in schooling between a traditional dentist and a pediatric dentist. A pediatric dentist requires three more years of dental school than a traditional dentist. 24. What patients does a pediatric dentist serve? A pediatric dental practice serves children and patients with special needs or disabilities. Step 8: The Pediatric Dental Exam You’ve likely seen pictures of a child’s first birthday—the hand in the cake, the frosting on the face and a big smile. But what about the child’s first dental visit? Not such a happy affair. A child’s first dental visit can be pleasant when the child and parents come in well-prepared. Recall that dental professionals often recommend that infants see the dentist as soon as the first tooth appears. However, this isn’t always the case. Presume, for this section, the first dental appointment for a child occurs at about two years of age. 17-20 0204551LB03A-17-14 Pediatric Dentistry This appointment allows the dental staff to collect information, introduce themselves to the child and help the child feel comfortable with dentistry. It also gives the team a chance to educate the parents about pediatric dental care. This part of the lesson overviews this first exam, step-by-step. As a dental assistant, you’ll be involved with each step. Medical and Dental History When you meet the parents, you must collect background information about the child’s general medical and dental health. This information typically includes: Medical History Weight at birth Level of learning according Past hospitalizations and to parents procedures under general anesthesia Date of last visit to physician Past medications Daily Medications and current treatment Negative reactions to Allergies, prescription or Any problems at or since medicine store bought birth Dental History Primary concern about Bleeding gums with Fluoride and toothbrush child’s dental health brushing habits Satisfaction with Finger, thumb or pacifier Inherited family dental appearance of teeth habits characteristics After reviewing the information with the parent and child, the dentist will proceed to the exams: extraoral, intraoral, dental and possibly radiographic. Extraoral Exam Similar to adults, the pediatric extraoral exam evaluates the patient’s facial profile to determine skeletal characteristics. Characteristics such as asymmetry of the eyes, ears or nose may indicate an undiagnosed syndrome. If the dentist notices abnormalities, she can refer the child to an appropriate professional for a complete evaluation. Intraoral Soft Tissue Exam Similar to adults, the pediatric intraoral exam evaluates the child’s gingiva and periodontium. The dentist or hygienist examines the base of the teeth for plaque and calculus. They also check for gingival inflammation and bleeding. 0204551LB03A-17-14 17-21 Dental Assistant Dental Exam and Teeth Charting Most of the exam time is spent examining and charting teeth. This involves a mouth mirror and explorer. However, when working with very young children, you may only be able to use your fingers. Young children are often afraid to have any type of instrument in their mouths. During the exam, the dentist examines and charts primary and mixed dentition. Based on age and eruption sequences for primary and permanent dentition, the dentist can determine any spacing or crowding issues. Radiographic Exam A radiographic exam is necessary for a complete diagnosis. However, young children might find this problematic. A child must be able to handle the size of the film in his mouth and sit still throughout the entire procedure. If the child isn’t ready for the procedure, you’ll have to postpone it. If the child is ready, follow these steps: Use words like “camera” and “taking a picture” when you explain the process. Use the “tell-show-do” concept when you position the film and the x-ray unit. This also gives you a chance to see if the child can sit still long enough without actually exposing the child to radiation. Match the size of the film to the level of comfort for the child’s mouth. If necessary, bend the anterior corners of the film for bite-wing placement to make it fit better. Expose the easiest films first—the ones that are most comfortable for the child. These are usually the occlusal projections. Be aware of triggering a child’s gag reflex. Radiographic exam Children generally require radiographs more often than adults. They’re growing, so their teeth, mouth and jaws continually change. The American Academy of Pediatric Dentistry recommends radiographic exams every six months for children with a high risk of tooth decay and less frequently for children at low risk.3 Once the exam is over, it’s important for the dental team to explain preventive care to children and their parents. 17-22 0204551LB03A-17-14 Pediatric Dentistry Step 9: Preventive Measures As a dental assistant, you’ll help your young patients develop and maintain good dental habits. You must educate, encourage and persuade patients toward positive attitudes and behaviors that favor good oral health. The dental assistant and the rest of the dental team spend a great deal of time educating patients, parents and the community about preventive dental care. This includes outreach programs to schools and community organizations. As a dental assistant, you’ll be part educator and part public relations agent for your office. Here are the types of preventive care you’ll be explaining and demonstrating. Rubber Cup Prophylaxis Rubber cup prophylaxis refers to a procedure for removing stains and plaque from the teeth. It also involves polishing coronal surfaces. A rubber polishing cup attaches by a prophy angle to a slow-speed handpiece. It slowly rotates to polish the teeth, using a slightly abrasive polishing agent. The rubber cup is less likely to cut the gingiva than a bristle brush. So, it’s a better choice for children. The rate of abrasion is affected by: 1. The amount of abrasive agent 2. The amount of pressure 3. The rotation speed Rubber cup prophylaxis Let’s learn how to perform a rubber cup prophylaxis by entering the Virtual Lab. 0204551LB03A-17-14 17-23 Dental Assistant Virtual Lab: Rubber Cup Prophylaxis To view this Virtual Lab, go to the Student Site and select Resources. At this time, you will select Rubber Cup Prophylaxis to watch the instructional video. Review this procedure and watch the Virtual Lab until you can explain the procedure without reading the steps or watching the lab. Equipment needed: PPE, disposable prophy angle, prophy paste, HVE tip or saliva ejector, dental floss, air-water syringe, disposable or sterile tip, paper disposable bibs for patient 1. Before the patient arrives, check her medical history to review any contraindications to the procedure. Any concerns should be discussed with the dentist before the patient arrives. 2. Check that proper barriers are in place. 3. Greet the patient and walk her to the operatory area. 4. Drape the seated patient with a waterproof napkin. Make sure patient has no prosthetic, (removable devices, particularly orthodontic retainers in the pediatric patient) in her mouth and give the patient protective eyewear unless she has her own eyewear. 5. Explain the procedure to the patient and answer any questions. 6. Remember to use “tell-show-do” method. 7. Use proper hand hygiene and wear proper PPE—

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