-1 INTRODUCTION TO ORAL PROPHYLAXIS
The goal of preventive dentistry is to assist the patient in either establishing control of his or her dental
disease or in continuing to maintain good oral health. Preventive dentistry includes all clinical tests, treatments, and patient education for the purpose of preventing oral disease and supporting the effectiveness of treatment aimed at caries and periodontitis. All patients will receive a careful assessment of their oral health needs and be provided with an individualized preventive dentistry treatment plan.
Some of the duties of a preventive dentistry assistance are as follows:
Completes a thorough dental health questionnaire review
Performs supragingival scalings with hand and sonic instruments
Performs oral prophylaxis
Provides nutrition/diet counseling
Applies topical anticariogenic agents
Places pit and fissure sealants
Delivers pre-operative oral antimicrobial rinses
Sharpens and demonstrates proper care of periodontal instruments
Demonstrates proper patient instruction in the use of home care devices
The term prophylaxis means prevention of disease. When you apply its broadest interpretation to the oral cavity, it includes all measures to prevent oral disease. For our purposes, we define oral prophylaxis as the clinical procedures that you perform for your patients. Our discussion will include evaluation of records, the seating of the patient, instruments, examinations, and contraindications to prophylaxis. We will begin with the evaluation of the patient's dental health record.
PREPARATION FOR ORAL PROPHYLAXIS
Before the patient enters the dental treatment room, evaluate his or her dental record for completeness. The folder should contain the patient's dental records, current radiographs, and any other applicable forms. Check the past medical and dental history of the patient. Check the recommendations that were made during previous oral prophylaxis appointments and the recent dental examinations. If the patient has had radiographs taken since the previous oral prophylaxis, evaluate them for subgingival calculus and restoration margin overhangs. Subgingival calculus can appear on a radiograph as a "spur" or deposit between the teeth, below the gingival margin.
NOTE: Subgingival calculus and overhangs can only be removed by a dentist or dental hygienist.
If you find any subgingival calculus during the patient examination or treatment, contact a dentist or hygienist who will remove it either during your appointment with the patient or at a later time. A preventive dentistry technician should only treat patients with supragingival calculus who are scheduled for routine oral prophylaxis. Patients with subgingival calculus will be appointed with a dentist or dental hygienist. The dental treatment plan will indicate who will treat the patient to ensure proper scheduling.
CONTRAINDICATIONS TO PROPHYLAXIS
Evaluate the medical history of dental patients before treatment begins. Some patients have medical conditions, such as a heart murmur, that require antibiotic treatment 1 hour before you can treat them. If the medical history indicates the patient has or had a heart murmur, ask the patient if he or she has taken any antibiotic medicine.
PATIENT AND OPERATOR POSITIONING
Correct operator and patient positioning helps to accomplish the following: Prevents operator and patient fatigue and discomfort Permits the operator to gain a clear view of the tooth being worked on Allows easy access of instruments to the teeth Saves time
. Position the back of the patient's chair at about a 15° angle (slightly raised above the parallel position) to the floor (fig. 3-1) .
The patient's heels should be even or slightly higher than the head. The top of the patient's head must be even with the end of the headrest for you to see and reach the patient's mouth. If possible, position the bracket tray out of the patient's direct vision. Ask the patient if he or she is in a comfortable position.
. To properly position yourself in the seated operator position, adjust the chair so that you are comfortable and your posture is correct. To maintain good working posture (fig. 3-2 ), position your feet flaton the floor, thighs parallel to the floor, back and head straight, and arms at waist level. Keep your body weight evenly distributed.
Figure 3-1. -- Positioning of the patient.
Figure 3-2 - Seated operator position.
Your unit light is kept at arms length above or in front of the patient. The light should be easy to reach but not near the patient's or operator's head. Illumination of the treatment area becomes more difficult when the light is positioned too close to the patient. In addition the light generates a large amount of heat. Direct the unit light from above the patient as shown in figure 3-3.
Figure 3-3 - Unit light placement.
The position of the bracket table should be low enough to permit a clear view of the instruments. It should also be a reasonable distance above and to the side of the patient.
The patient's open mouth should be level with your waist. This will enable you to reach the patient's mouth while maintaining your arms at waist level. For mandibular instrumentation, the patient will have his or her mouth open in a chin-down position. Position your legs under the back of the chair. The back of the dental chair should touch the top of your legs, or you may straddle the back of the chair with your legs.
Now you are ready to learn how to position yourself around your patient in relation to the treatment areas of the mouth. Operating positions for right-handed and left-handed technicians are usually identified in relation to a 12-hour clock (figs. 3-4 and 3-5).
Figure 3-4 - Operating positions-right-handed operator.
Figure 3-5 - Operating positions-left-handed operator.
As you try various positions, notice how they afford you a clear view of the treatment area. You will not be able to obtain a clear view of the teeth surfaces in the mouth through operator and patient positioning alone. The use of the mouth mirror will assist you to obtain a complete view.
Before you begin any scaling procedures, make a thorough appraisal of the condition of the patient’s mouth. This examination serves three purposes:
Determines the needs of the patient Determines the sequence in which these needs must be met Provides you with useful information for conducting the dental health counseling The screening examination has two phases:
Observation of the entire oral mucosa Examination of the teeth and gingival tissues Look for ulcers or sores on the lips, skin, or intraoral mucosa. These may be the result of viral or other infections, which could preclude your treatment of the patient. You can also ask the patient if he or she has any sensitive or painful teeth or areas in the mouth about which you should know. If you see something during your examination that you do not recognize as a normal feature of the anatomy, check with a dentist before proceding.
Plaque is nearly transparent and difficult to see without the use of a stain or disclosing agent to highlight its presence. These agents color the plaque, but they do not color clean tooth surfaces. The coloring agent used in disclosing is a harmless red food dye and comes in the form of tablets or liquid. Follow the manufacturer's instructions for use. After your initial examination of the patient, apply a disclosing agent to reveal the presence of plaque before the prophylaxis procedures. This will help you and the patient identify what must be cleaned and will assist in patient education.
assisting dental fundamentals