Basic Guide to Dental Procedures
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About this ebook
Written as an introductory guide for the whole dental team, it makes no attempt to explain the theory and clinical technique behind each procedure in detail. Rather, with the aid of ‘before and after’ colour illustration it offers sufficient overview to enable the reader to understand and explain procedures to their patient with confidence.
Each section is clearly structured to cover the reasoning behind the treatment described, the relevant dental background, the basics of how each procedure is carried out and if applicable, aftercare information.
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Basic Guide to Dental Procedures - Carole Hollins
SECTION 1
PREVENTIVE TECHNIQUES
Application of Fissure Sealants
Application of Topical Fluorides
REASON FOR PROCEDURE
Preventive techniques are aimed at preventing the onset of dental caries in teeth, so that they maintain the dental health of a patient.
The two procedures to be discussed are:
Application of fissure sealants
Application of topical fluorides
APPLICATION OF FISSURE SEALANTS
Background information of procedure
Any surface area of a tooth that cannot be cleaned easily by the patient can allow food debris and, ultimately, plaque to accumulate there, and can allow caries to develop by acting as a stagnation area.
The usual sites are the occlusal pits and fissures of posterior teeth, and especially the first permanent molars which erupt at around 6 years of age.
These teeth are particularly prone to caries because:
They are the least accessible teeth for cleaning, being at the back of a young patient’s mouth
They erupt at an age when a good oral hygiene regime is unlikely to have been developed, and so may be cleaned poorly
Younger patients often have a diet containing more sugars than an adult diet, as the concept of dietary control will not be appreciated
Details of procedure
The occlusal pit or fissure needs to be eliminated to prevent it acting as a stagnation area, and this is achieved by closing the inaccessible depths with a sealant material.
The materials used are either composites or glass ionomer cements, or a combination of the two (known as a compomer).
Technique
The tooth is kept isolated from saliva contamination, as materials will not adhere to the tooth
Occlusal fissures and pits are chemically roughened with acid etch to allow microscopic bonding of the material to the enamel
Etch is washed off and the tooth is dried; the etched surface will appear chalky white
Unfilled resin is run into the etched areas to seal the fissures or pits, and then locked into the enamel structure by setting with a curing lamp
APPLICATION OF TOPICAL FLUORIDES
Background information of procedure
Other areas of the teeth which are very difficult to clean are the points at which they contact with each other in the dental arch – the interproximal (interdental) areas.
There are certain oral health products available specifically for the cleaning of these areas, such as dental floss, but they require a certain amount of dexterity and determination by the patient to be used effectively.
All fluoridated toothpastes provide some protection of these areas from caries, but some patients require additional fluoride protection by the application of topical fluoride.
They are:
Children with high caries rates
Disabled patients who are unable to achieve a good level of oral hygiene
Medically compromised patients in whom tooth extractions are too dangerous to be carried out (haemophiliacs, those suffering from some heart defects)
Details of procedure
A high concentration of fluoride is required to be applied to the interproximal areas; it should be sufficiently viscous so that it is not washed away quickly by saliva and can be taken into the enamel structure of the tooth to make it more resistant to caries.
Technique
The teeth are polished to remove any plaque present and to allow maximum tooth contact with the fluoride
Polish is washed off thoroughly and the teeth are dried
Viscous fluoride gel is placed into a special applicator tray (one for each arch) and the trays are inserted into the patient’s mouth to fully cover the teeth
The trays are kept in situ for several minutes to allow the maximum penetration of the gel into the interproximal areas
The trays are removed and the patient is instructed not to rinse his or her teeth, or to eat or drink for up to 1 h
SECTION 2
ORAL HYGIENE INSTRUCTION
Use of Disclosing Agents
Toothbrushing
Interdental Cleaning
REASON FOR PROCEDURE
Oral hygiene instruction is given to patients to ensure that they are maximising their efforts to remove plaque from their teeth in order to minimise the damage caused by periodontal disease and caries.
Dietary advice is also given to help patients to avoid foods and drinks that are particularly damaging to their teeth – those high in refined sugars and those that are acidic.
When the advice is correctly followed on a regular basis, patients can enjoy a well cared for and pain-free mouth, as well as avoiding the expense of reparative dental treatment.
The procedures to be discussed are:
Use of disclosing agents
Toothbrushing
Interdental cleaning
USE OF DISCLOSING AGENTS
Background information of procedure
Disclosing agents are vegetable dyes supplied in liquid or tablet form and in various colours, usually red or blue.
They act by staining any plaque on the tooth surface to their own colour, thus making it far easier to show the presence and location of the plaque to the patient, as plaque is normally a creamy white colour and may be difficult to see otherwise (see Figure 2.1a, b).
Once stained, suitable oral hygiene instruction can be given to remove the plaque effectively. The dyes do not stain the teeth themselves, or any restorations.
Figure 2.1 (a) Plaque on teeth. (b) Same teeth after disclosing to show plaque more obviously
Details of procedure
The agents can initially be used at the practice by the oral health team, so that the correct problem areas can be identified and suitable cleaning advice given. The patient can then use the agents at home to check his or her progress on a regular basis. The most common agents are disclosing tablets.
Technique
A protective bib is placed over the patient so that his or her clothing is not inadvertently marked
The patient is given one disclosing tablet and asked to chew it for about 1 min
The patient spits out the chewed tablet and saliva, but does not rinse out
Using a patient mirror, any stained plaque is pointed out by the oral health team and the worst areas are noted (very often the gingival margins)
Detailed advice is then given on improved brushing techniques to eliminate the plaque from these areas
The patient can follow these instructions immediately, so that