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Essentials of Dental Assisting
Essentials of
Dental Assisting
P050To order additional copies, call 800.947.4746 or visit adacatalog.org
©2017 Elsevier All rights reserved.
Essentials of Dental AssistingThis practical guide Series, offers everything a dental assistant needs to know and more. With full color photographs and detailed step-by-step instructions, this essential reference focuses on the core clinical skills and the knowledge a practicing dental assistant needs. In addition to covering core clinical skills, it also delves into the “behind-the-scenes” skills of dental assisting, such as legal issues, infection control, common medical emergencies, patient pain and anxiety control, radiography, and more. Essentials of Dental Assisting is ideal for staff training and provides experienced staff members with a comprehensive reference for patient care.
• �Easy-to-follow�organization offers 28 easy-to-read chapters that coverprofession basics and sciences, infection control, chairside treatmentfoundations, patient care, and clinical procedures.
• Step-by-step�procedures�of�skills that dental assistants must master featurea consistent format that includes a goal, equipment, chronological steps, andrationales. Procedure icons indicate what issues/things must be identified whenperforming various core procedures.
• �Specific�chapters�on�specialized�dentistry include periodontics, endodontics,pediatric dentistry, and more.
• �Full-color�artwork focuses on anatomy and physiology; clinical procedures;and dental tools, materials, and equipment. Hundreds of photos, illustrations,and charts make it easy to see exactly how to accomplish tasks.
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Edition 6
Debbie S. RobinsonDoni L. Bird
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Contents
PART ONE The Profession
1 Introduction to Dental Assisting, 1
History of Dentistry, 1African Americans in Dental History, 2Native Americans in Dental History, 3Members of the Dental Health Care Team, 4Overview of the Dental Office, 8
2 Professional and Legal Aspects of Dental Assisting, 11
Characteristics of a Professional Dental Assistant, 11Ethics and Law, 13Types of Law, 13Legal Aspects of Dentistry, 13Levels of Dental Auxiliary Supervision, 15Unlicensed Practice of Dentistry, 15Credentialing of Dental Assistants, 15Risk Management, 15Guidelines for Informed Consent, 16Patient Records, 17Reporting Child Abuse and Neglect, 17Regulatory and Professional Organizations, 17
PART TWO The Sciences
3 Anatomy and Physiology, 20
Directions and Body Planes, 20Organizational Levels of the Body, 21Systems of the Body, 22Structures of the Head and Neck, 24Major Muscles of Mastication and Facial
Expression, 30Blood Supply to the Face and Mouth, 30Lymph Nodes, 30Nerve Supply to the Mouth, 30Structures of the Face and Oral Cavity, 34Procedure 3-1: Identify the Major Landmarks and
Structures of the Face, 39Procedure 3-2: Identify the Major Landmarks, Structures,
and Normal Tissues of the Mouth, 39
4 Dental Anatomy, 41
Anatomic Parts of the Tooth, 41Tissues of the Tooth, 42Types of Teeth, 44
Dental Arches, 44Anterior and Posterior Teeth, 45Tooth Surfaces, 45Anatomic Features of the Teeth, 45Dentition, 48Tooth Numbering Systems, 49Palmer Notation System, 51Procedure 4-1: Identify the Teeth and Name the Tooth
Surfaces, 52Procedure 4-2: Identify the Primary and Permanent
Dentitions Using the Universal National System, the Federation Dentaire Internationale System, and the Palmer Notation System, 52
PART THREE Infection Prevention and Hazardous Materials
5 Disease Transmission, 54
Pathogens, 54Bacteria, 54Chain of Infection, 56Viral Diseases of Major Concern to Dental Health Care
Workers, 59Bacterial Diseases of Major Concern to Dental Health
Care Workers, 62
6 Infection Control and Management of Hazardous Materials, 65
Roles and Responsibilities of the CDC and OSHA, 66Osha’s Bloodborne Pathogens Standard, 66Handwashing and Hand Care, 69Personal Protective Equipment, 70Medical Waste Management, 74Osha’s Hazard Communication Standard, 75Procedure 6-1: First Aid After an Exposure Incident, 79Procedure 6-2: Handwashing Before Gloving, 80Procedure 6-3: Applying Alcohol-Based Hand
Rubs, 82Procedure 6-4: Putting on Personal Protective
Equipment (PPE), 83Procedure 6-5: Removing Personal Protective
Equipment, 84
7 Surface Disinfection and Treatment Room Preparation, 87
Surface Barriers, 87Precleaning and Disinfection, 88
Contents ix
Classifications of Instruments, Equipment, and Surfaces, 92
Additional Aseptic Techniques, 93Cleaning and Disinfection of the Laboratory Area, 94Cleaning and Disinfecting the Radiology Area, 95Procedure 7-1: Placing and Removing Surface
Barriers, 96Procedure 7-2: Performing Treatment Room Cleaning
and Disinfection, 96Procedure 7-3: Disinfecting an Alginate Impression, 97
8 Instrument Processing, 99
Sterilization Center, 99Precleaning and Packaging Instruments, 102Methods of Sterilization, 105Sterilization Monitoring, 107Procedure 8-1: Operating the Ultrasonic Cleaner, 110Procedure 8-2: Autoclaving Instruments, 111Procedure 8-3: Sterilizing Instruments With Chemical
Vapor, 112Procedure 8-4: Sterilizing Instruments With Dry
Heat, 113Procedure 8-5: Sterilizing Instruments With Chemical
Liquid, 113Procedure 8-6: Performing Biologic Monitoring, 114
PART FOUR Dental Treatment
9 Clinical Dentistry, 116
Clinical Area, 116Standard Procedure Routine, 116Instrument Transfer, 121Expanded Functions for the Dental Assistant, 124Procedure 9-1: Admitting and Seating the Patient, 125Procedure 9-2: Transferring Instruments Using the
Single-Handed Technique, 126Procedure 9-3: Transferring Instruments Using the
Two-Handed Technique, 126
10 Moisture Control, 128
Mouth Rinsing, 128Oral Evacuation Methods, 128Isolation Techniques, 130Dental Dam, 131Procedure 10-1: Performing a Mouth Rinse, 136Procedure 10-2: Positioning the High-Volume Evacuator
During a Procedure, 136Procedure 10-3: Placing and Removing Cotton Rolls, 137Procedure 10-4: Preparation, Placement, and Removal of
the Dental Dam (Expanded Function), 139
PART FIVE Patient Care
11 The Dental Patient, 142
Patient Record, 143Vital Signs, 148
Procedure 11-1: Registering a New Patient, 155Procedure 11-2: Obtaining a Medical-Dental Health
History, 155Procedure 11-3: Taking an Oral Temperature Reading
With a Digital Thermometer, 155Procedure 11-4: Taking a Patient’s Pulse, 156Procedure 11-5: Measuring a Patient’s
Respiration, 156Procedure 11-6: Taking a Patient’s Blood
Pressure, 156
12 The Dental Examination, 159
Components of the Dental Examination, 159Oral Examination, 162Soft Tissue Examination, 162Recording Dental Treatment, 170Procedure 12-1: Soft Tissue Examination (Expanded
Function), 171Procedure 12-2: Charting of Teeth, 174Procedure 12-3: Recording the Completed Dental
Treatment, 175
13 Medical Emergencies in the Dental Office, 177
Preventing Emergencies, 177Legal Responsibilities, 178Emergency Preparedness, 178Patient Assessment, 179Emergency Responses, 179Documentation of an Emergency, 182Procedure 13-1: Performing Cardiopulmonary
Resuscitation (CPR) (One Person), 182Procedure 13-2: Responding to a Patient with an
Obstructed Airway, 184Procedure 13-3: Responding to the Unconscious
Patient, 184Procedure 13-4: Responding to the Patient with
Breathing Difficulty, 185Procedure 13-5: Responding to the Patient Experiencing
a Seizure, 186Procedure 13-6: Responding to the Patient Experiencing
a Diabetic Emergency, 186Procedure 13-7: Responding to the Patient with Chest
Pain, 187Procedure 13-8: Responding to the Patient Experiencing
a Cerebrovascular Accident (Stroke), 187Procedure 13-9: Responding to the Patient Experiencing
an Allergic Reaction, 187
14 Pain and Anxiety Control, 189
Topical Anesthesia, 189Local Anesthesia, 190Vasoconstrictors, 190Health Status of the Patient, 190Local Anesthesia Techniques, 190Preparing the Anesthetic Syringe, 191Local Anesthetic Cautions, 193Pain and Anxiety Control Methods, 194
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Documentation of Anesthesia and Pain Control, 196Procedure 14-1: Applying a Topical Anesthetic
Ointment, 197Procedure 14-2: Assembling the Local Anesthetic
Syringe, 197Procedure 14-3: Assisting in the Administration of Local
Anesthesia, 199Procedure 14-4: Assisting in the Administration and
Monitoring of Nitrous Oxide–Oxygen Sedation (Expanded Function), 200
PART SIX Dental Imaging
15 Radiation Safety and Production of X-Rays, 202
Radiation Physics, 203Properties of X-Ray Beams, 203Types of Radiation, 204Radiation Measurement, 205Radiation Exposure, 205Absorbed Dose, 205Dose Equivalence, 205Radiation Hazards and Protection, 205Biologic Effects of Radiation, 206Patient Protection, 207Protection of the Operator, 210Dental X-Ray Machine, 210Image Characteristics, 212Radiographic Quality, 212
16 Oral Radiography, 215
Intraoral Views, 216Film-Based Radiography, 216Care of Dental Films, 217Film Care During Exposure, 217Infection Control in Dental Radiography, 217Intraoral Radiography Techniques, 218Full-Mouth Radiographic Survey, 223Occlusal Technique, 224Exposure and Technique Errors, 224Processing Radiographs, 224Processing Solutions, 224Manual Processing, 226Automatic Film Processing, 226Processing Errors, 227Duplicating Radiographs, 227Mounting Radiographs, 227Digital Radiography, 229Types of Digital Imaging Systems, 229Common Errors, 233Radiation Safety and Protection, 233Extraoral Radiography, 233Informed Consent, 235Documentation, 235Ownership of Dental Radiographs, 235Procedure 16-1: Practicing Infection Control During Film
Exposure, 236
Procedure 16-2: Assembling Extension-Cone Paralleling (XCP) Instruments, 237
Procedure 16-3: Producing a Full-Mouth Radiographic Survey Using the Paralleling Technique, 239
Procedure 16-4: Producing a Four-Film Radiographic Survey Using the Bite-Wing Technique, 248
Procedure 16-5: Producing Maxillary and Mandibular Radiographs Using the Occlusal Technique, 250
Procedure 16-6: Practicing Infection Control in the Darkroom, 251
Procedure 16-7: Practicing Infection Control With the Use of the Daylight Loader, 252
Procedure 16-8: Manual Processing of Dental Radiographs, 253
Procedure 16-9: Automatic Processing of Dental Radiographs Using the Daylight Loader, 254
Procedure 16-10: Mounting Dental Radiographs, 255Procedure 16-11: Preparing the Equipment for Panoramic
Radiography, 256Procedure 16-12: Preparing the Patient for Panoramic
Radiography, 257Procedure 16-13: Positioning the Patient for Panoramic
Radiography, 257Procedure 16-14: Practicing Infection Control With Digital
Sensors, 258Procedure 16-15: Practicing Infection Control With
Phosphor Storage Plates, 259
PART SEVEN Preventive Dentistry
17 Preventive Care, 262
Process of Dental Disease, 263Tooth Brushing, 264Flossing, 265Home Care Techniques, 266Fluoride, 267Topical Fluoride, 269Nutrition, 270Preventive Dental Care, 274Procedure 17-1: Assisting the Patient With Dental Floss
(Expanded Function), 275Procedure 17-2: Applying a Topical Fluoride Gel or Foam
(Expanded Function), 276Procedure 17-3: Applying Fluoride Varnish (Expanded
Function), 278
18 Coronal Polishing and Dental Sealants, 281
Coronal Polishing, 281Stains of the Teeth, 281Equipment for Rubber-Cup Coronal Polishing, 284Rubber-Cup Coronal Polishing, 285Pit and Fissure Sealants, 287Precautions for Dental Personnel and Patients, 289Procedure 18-1: Rubber-Cup Coronal Polishing
(Expanded Function), 290Procedure 18-2: Application of Dental Sealants
(Expanded Function), 293
Contents xi
PART EIGHT Restorative Dentistry
19 Instruments, Handpieces, and Accessories, 297
Hand Instruments, 297Rotary Instruments, 300Dental Burs, 308Abrasive Rotary Instruments, 308Procedure 19-1: Identifying Examination
Instruments, 312Procedure 19-2: Identifying Hand (Manual) Cutting
Instruments, 312Procedure 19-3: Identifying Restorative
Instruments, 313Procedure 19-4: Identifying Accessory Instruments and
Items, 313Procedure 19-5: Identifying and Attaching the Dental
Handpiece, 313Procedure 19-6: Identifying and Attaching Burs for Rotary
Cutting Instruments, 314
20 Restorative and Esthetic Dental Materials, 316
Characteristics of Dental Materials, 317Properties Affecting a Dental Material, 317Amalgam, 317Composite Resins, 318Dental Liners, 320Dental Bases, 321Etching Systems, 321Bonding Systems, 321Temporary Restorative Materials, 321Dental Cements, 321Tooth-Whitening Materials, 322Procedure 20-1: Mixing and Transferring Dental
Amalgam, 323Procedure 20-2: Preparing Composite Resin
Materials, 324Procedure 20-3: Application of Calcium Hydroxide
(Expanded Function), 325Procedure 20-4: Application of Dental Varnish (Expanded
Function), 326Procedure 20-5: Applying an Etchant Material (Expanded
Function), 327Procedure 20-6: Applying a Bonding System (Expanded
Function), 327Procedure 20-7: Mixing Intermediate Restorative
Material, 328Procedure 20-8: Mixing Zinc Oxide–Eugenol for a Base,
Temporary Cementation, and Permanent Cementation, 329
Procedure 20-9: Mixing Glass Ionomer for Permanent Cementation, 330
Procedure 20-10: Mixing Zinc Phosphate for a Base and Permanent Cementation, 330
Procedure 20-11: Mixing Polycarboxylate for a Base and Permanent Cementation, 332
21 Restorative Procedures, 334
Cavity Preparation, 335Matrix Systems, 335Permanent Restoration, 337Complex Restorations, 338Veneers, 338Vital Bleaching, 338Procedure 21-1: Assembling a Matrix Band and Universal
Retainer, 339Procedure 21-2: Placing a Plastic Matrix for a Class III or
Class IV Restoration (Expanded Function), 340Procedure 21-3: Placing and Removing a Matrix Band
and Wedge for a Class II Restoration (Expanded Function), 341
Procedure 21-4: Assisting in a Class II Amalgam Restoration, 342
Procedure 21-5: Assisting in a Class III or IV Composite Restoration, 345
22 Impression Materials and Laboratory Procedures, 348
Impression Trays, 348Impression Materials, 349Bite Registration, 353Laboratory Procedures, 354Diagnostic Casts, 354Procedure 22-1: Mixing Alginate Impression
Material, 356Procedure 22-2: Taking a Mandibular Preliminary
Impression (Expanded Function), 357Procedure 22-3: Taking a Maxillary Preliminary
Impression (Expanded Function), 358Procedure 22-4: Mixing a Two-Paste Final Impression
Material, 359Procedure 22-5: Preparing an Automix Final Impression
Material, 360Procedure 22-6: Mixing Dental Plaster, 362Procedure 22-7: Pouring Dental Models Using the
Inverted-Pour Method, 362Procedure 22-8: Trimming and Finishing Dental
Models, 364
23 Prosthodontics and Dental Implants, 367
Fixed Prosthodontics, 367Removable Prosthodontics, 372Partial Dentures, 374Full Dentures, 376Relining of a Partial or Complete Denture, 378Immediate Dentures, 379Dental Implants, 379Types of Dental Implants, 379Maintenance of Dental Implants, 381Procedure 23-1: Placing and Removing the Gingival
Retraction Cord (Expanded Function), 382Procedure 23-2: Fabricating and Cementing a Custom
Acrylic Provisional Crown, 383
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Procedure 23-3: Assisting in a Crown and Bridge Restoration, 384
Procedure 23-4: Assisting in the Delivery and Cementation of a Cast Restoration, 385
Procedure 23-5: Assisting in the Delivery of a Partial Denture, 386
Procedure 23-6: Assisting in the Delivery of a Full Denture, 387
Procedure 23-7: Assisting in an Endosteal Implant Surgery, 388
PART NINE Specialized Dentistry
24 Periodontics, 392
Periodontal Diseases, 392Periodontal Examination, 395Periodontal Surgical Instruments, 401Periodontal Treatment Procedures, 401Ultrasonic Scaler, 403Scaling, Root Planing, and Gingival Curettage, 403Antimicrobial and Antibiotic Agents, 404Periodontal Surgery, 405Postperiodontal Surgery, 406Procedure 24-1: Assisting with a Dental
Prophylaxis, 408Procedure 24-2: Assisting with Gingivectomy and
Gingivoplasty, 409Procedure 24-3: Preparing and Placing Noneugenol
Periodontal Dressing, 411Procedure 24-4: Removing a Periodontal Dressing, 412
25 Endodontics, 414
Endodontic Diagnosis, 414Use of Radiographic Imaging in Endodontics, 415Diagnostic Conclusions, 415Instruments in Endodontics, 416Microscopic Endodontics, 416Medication and Filling Materials in Endodontics, 420Pulp Therapy, 421Overview of Root Canal Therapy, 421Surgical Endodontics, 423Procedure 25-1: Assisting in Electric Pulp Vitality
Testing, 423Procedure 25-2: Assisting in Root Canal Therapy, 424
26 Oral and Maxillofacial Surgery, 428
Surgical Environment, 428Oral Surgery Instruments, 428Surgical Asepsis, 429Surgical Procedures, 429Types of Surgical Procedures, 432Suture Placement, 433Immediate Postoperative Care, 433Alveolitis (Dry Socket), 433Procedure 26-1: Performing a Surgical Scrub, 434Procedure 26-2: Performing Sterile Gloving, 435
Procedure 26-3: Assisting in a Forceps Extraction, 436Procedure 26-4: Assisting in Multiple Extraction and
Alveoloplasty, 437Procedure 26-5: Assisting in the Removal of an Impacted
Tooth, 438Procedure 26-6: Assisting in Suture Placement, 440Procedure 26-7: Performing Suture Removal (Expanded
Function), 441
27 Pediatric Dentistry, 443
Pediatric Dental Office, 443Examination of the Pediatric Patient, 445Pediatric Procedures, 445Procedure 27-1: Assisting in Pulpotomy of a Primary
Tooth, 450Procedure 27-2: Assisting in the Placement of a
Stainless Steel Crown, 450
28 Orthodontics, 454
Angle Classifications of Malocclusion, 454Indications for Orthodontic Treatment, 454Records Visit and Treatment Planning, 456Case Presentation, 457Orthodontic Treatment, 457Instruments for Orthodontics, 460Fixed Orthodontic Appliances, 460Oral Hygiene and Dietary Instructions, 465Adjustment Visits, 465Completed Treatment, 466Procedure 28-1: Placing and Removing Elastomeric Ring
Separators (Expanded Function), 467Procedure 28-2: Assisting in the Fitting and Cementation
of Orthodontic Bands, 468Procedure 28-3: Assisting in the Direct Bonding of
Orthodontic Brackets, 469Procedure 28-4: Placing Arch Wires (Expanded
Function), 470Procedure 28-5: Placing and Removing Ligature Ties
(Expanded Function), 471