AGM – D11F

M9: Preoperative Requirements

Preoperative requirement:

1. Good Illumination

• While doing a procedure, it is very important to see what you are doing. The
working field should be properly illuminated.

• There are a certain number of equipment in a dental chair that helps you do it.
(Mouth Mirror w/ optical light, Overhead Lamp, High speed hand piece w/ optical
light and Dental Loupe)

2. Systematic Office Arrangement

• It’s a must arrange dental equipment,
materials and etc. in such a way that the
workflow in a dental office would flow in a
smooth matter.

• Proper operatory position, refers to the

dental flow between the dental chair and the
dentist wherein it should have:
o Proper divisions
o Privacy

3. Good architectural and engineering design

▪ Must consider the structural integrity of the building or place that you would be
establishing a dental clinic.

4. Proper operatory equipment position

▪ Advantages:
o Proper positioning promotes convenience for both the dentist and his patient.
o Helps improve work efficiency
o Decreases effort thus conserves energy
o Lessen risk of work-related injury
o Promotes better illumination

▪ Basic operatory positions (McGehee, 1984)

o Position 1 (Right side in front)
o Position 2 (Right side behind)
o Position 3 (Left side behind)

▪ Dentist chairside “clock” positions

Chair position is an important aspect in the success of a dental treatment because it
helps the operator to have a good visibility and accessibility of the oral cavity.
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Proper operator’s position and posture during treatment leads to lesser chance to
get muscle strain, fatigue leading to a more efficient treatment.

o Right-Handed Dentist

a) Right front position (7 o’clock)

▪ Helps in patient’s examination

Working areas:
- Mandibular anterior
- Mandibular right posterior area
- Maxillary anterior teeth
- Patient’s head may be tilted towards operator to increase ease and visibility

b) Right position (9 o’clock)

▪ Operator is on the right side of the patient.

Working areas:
- Facial surfaces of maxillary R posterior teeth
- Facial surfaces of mandibular R posterior teeth
- Occlusal surfaces of mandibular R posterior teeth

c) Right rear position (11 o’clock)

▪ Operator is behind and slightly to the right of the patient.
▪ Preferred position for most dental procedures.
▪ Most areas of the oral cavity are accessible either using direct or indirect
position.

Working areas:
▪ Palatal and incisal (occlusal) surfaces of maxillary teeth
▪ Mandibular teeth using direct vision

d) Direct rear position (12 o’clock)

▪ Operator is directly behind the patient

Working areas:
- Lingual surfaces of mandibular teeth
- This position has limited application.
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o Left-Handed Dentist

a) Left front position (5 o’clock)

b) Left position (3 o’clock)
c) Left rear position (1 o’clock)

▪ Proper dental posture:

o No stooping of shoulders. Dentist shoulder should be erect with both his feet
on the floor about a 1 – 1 ½ feet apart.
o Avoid leaning over the patient.
o Avoid bending the neck when examining or treating patients.
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▪ Position of the patient

5. Proper positioning of dental furniture

Four-handed treatment

• The presence of dental assistant’s two hands assisting a dentist’s two hands, helping to
reduce the amount of time a dental exam or procedure may take.

• The 4 basic tenets of four-handed dentistry

1. Use ergonomically designed equipment to minimize unnecessary motion.

2. Place the patient in supine position.
3. Seat the operating team and patient comfortably in ergonomically designed
equipment.
4. Practice motion economy.
5. Seat the operating team as close to the patient as possible with the legs of the
assistant parallel to the patient chair.
6. Utilize preset trays.
a) Minimize the number of instruments to be used.
b) Place instruments in sequence of use.
c) Place in order from left to right or top to bottom as preferred.
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7. Position equipment, instruments, and materials in advance.

8. The dentist assigns all legally delegable duties to qualified clinical assistants based on
the state’s guidelines.
9. Patient treatment is discussed with the patient and planned in advance in a logical
sequence.

M9: Finger Positions

Key Points in Establishing a Good Finger Position:

Finger Rest

• In dental instrumentation, means the

position assumed by the 3rd and 4th finger
to stabilized the position of the instrument
when the pencil grasp is used or even
different finger positions.

Finger Guard

• A position assumed by the finger of a

nonoperating hand in order to protect the
part being work upon injury and lessen
the vibration of the tooth being worked
on. In general, guards make the area
steadier.

Commonly used Finger Position:

1. Pen grasp
• It is common grasp that is used in dentistry wherein it is
similar to the manner in which one holds a pen in
writing.

• Thumb, index and middle fingers contact the instrument

while the tips of the ring and little fingers are placed on
the working tooth as a rest.

• Applied usually in mandibular arch

o Dental Explorer and Mouth Mirror
o *Dental High Speed; almost all of the instruments

2. Inverted pen grasp

• The instrument is directed upward or inward toward the operator.

• It is usually used on the lingual and labial surfaces of anterior teeth.

 AGM – D11F

3. Palm and thumb grasp

• Is a powerful grasp in comparison to the pen grasp
but the pen grasp is more stable.

• Shaft of the instrument is grasped by all the four

fingers, while the thumb is free of the instrument and
rest on the nearby tooth of the same arch to
somehow stabilize the instrument.

4. Position where no rest is used

• All fingers grasp the instrument.

• This is commonly used in the surgery department or dental surgery.

• eg. In using forceps, cotton pliers etc.

M9: Dental Clinic Assistant

Responsibilities of a Dental Clinic Assistant:

• Multi-skilled member

• Provides support

• Operator's extra hands.

• Provide more efficient dental treatment.

Requirements for Dental Assistant

• Dental assistants usually learn their skills on the job.

• High school students interested in a future career as a dental assistant should take courses
in biology, chemistry, health, and office practices.

• Dental assistants must be reliable, work well with others, and have good manual dexterity.

• In some states, dental assistants must be licensed or registered.

Tasks of a Dental Assistant

• Keeps all the instrument in proper working order.

• Sterilization and preparation of instruments.

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• Makes patient comfortable

• Develops radiographs

• Taking impressions of teeth for study models

• Prepares materials for temporary fillings and other tasks under the direction of the dentist
or hygienist.

• May also be present during a dentistry procedure.

The assistant may also perform any the following tasks:

• seating patients in the treatment area

• providing assistance in the office

• ordering supplies

• serve as office manager or receptionist manage the business aspect of dentistry manage
patient records, filing, and recall systems.

Dental/Oral Hygienist
• is a licensed dental professional, specializes in preventive oral health.

• some are licensed to administer local anesthesia.

• typically focusing on techniques in oral hygiene.

Common procedures performed by hygienists:

*It may differ from one country to another as it depends on their dental law.

• Oral Prophylaxis

• Taking of prescribed radiographs

• Administration of Fluoride

• Providing instructions for proper oral hygiene and care.

• Dental Sealants
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• Scaling and Root Planing

o Scaling is a type of cleaning wherein plaque and tartar around and below the gum
line are removed.

o Root planing involves scraping and smoothing the root surfaces of the teeth. Gum
tissue can firmly reattach to roots that are clean and smooth.

Guidelines of Maintaining Dental Equipment

 Dental Chair

o Clean and polish the upholstered parts, including crevices.

o Put on clean headrest covers.

o Bring the chair to lowest and basic position.

• Dental Unit

o Clean and polish with non-abrasive material.

o The waste trap in cuspidor should be empty and clean.

o Clean and polish bright the cuspidor.

o Put off the electric switch.

o Put out the Bunsen Burner.

o Put off the supply to the cuspidor.

o Put off compressed air, if the unit is fitted with cut-off valve.

• Room in General

o Clean towels

o gauze and cotton rolls should be ready for the next day.

o Put off the heat radiators, electric fans, and air-conditioners.

o Doors and windows should be locked.

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o Must be cleaned.

o All electric gas, adequate switches must be put off.

• Reception Room and Appointment Desk

o Furniture and fixtures should be clean and polish

o Drinking fountain should be clean

o Typewriter or Computer should be covered after use

o The time of the clock must be set

o Ashtrays should be emptied and cleaned

o Keep lavatories clean

• Prosthetic Laboratory

o Put off the burn-furnaces, water baths, vascular, boil-out tanks, lathes and dental
engines

o Put off and polish the lathe blower

o Close the air and gas valves

o Check and fill the plastic artificial stone and investment bin

o Clean and store the crucible ring and flasks.

o Tools, mounted stones and other small gadgets should be cleaned and returned to
instrument drawer.

o Clean the boil-out tank and remove the wax residue.

o Release tension on casting machine.

o Eliminate waxes from casting ovens.

M10: Clinical Attire

Proper Attire

• Dentist must wear a comfortable clean attire when treating his patients. This also applies to
all the dental staff and in some cases even the attire of the patient.
 AGM – D11F

Attire of a dental clinician

• Head cap

• Scrub Suit

• Disposable mask

• Flat comfortable shoes

• Clean gloves/ sterile gloves

o Types of Gloves
a) Latex

• Face shield/ Eye protector

b) Nitrile

• White Coat/Gown
 AGM – D11F

c) Vinyl
- uses as an over glove
- prevents cross contamination
while recording dental records
and etc.

PPEs Equipment that are used in an Operating Room:

• Procedures that are done to be complex and surgical in nature.

o Sterile Gloves
o Sterile Shoe Covers

o Sterile Gown

Patient’s attire

• Head Cap
• Eye shield/ Dental Protective glasses
• Gown
• Disposable bib
o “polybib”
o “dry-back

Take note that:

• Cleansers - Cleansing physically is the removal of dirt and debris. i.e. brushing, sweeping.
In this procedure: water, soap and detergent are used. It is advisable to cleanse any object
intended for sterilization
 AGM – D11F

• Detergent - A cleansing agent, as water, soap or a soluble or liquid preparation (soap less)
synthetic.

• Soap - Made usually by action of alkali on fat or fatty acids. both soap and detergent has
emulsifying oil that holds dirt in suspension.

M11: Dental Records

The Patient’s Role

• The Patient’s Complaint

• Present complain of the patient and the reason for his visit to the dentist without being
asked.

1. Preventive- A patient visits his dentist once or twice a year for a checkup and
prophylaxis

2. Curative- The reason for every patient to visit a dentist

3. Cosmetics- The patient is motivated for consultation to improve his facial esthetics.

The Dentist’s Role

• Pre-treatment Consideration
o The dentist is responsible for evaluating the conditions or symptoms of the case.

• Case of Exigency
o In case of exigency where only one plan of treatment is possible, the denial or delay
would surely destroy the patient’s heath, and it is necessary to perform the operation at
once.

• Voluntary Consent
o When a patient decides to go to the clinic and sits on the dental chair of his own accord,
it is considered as enough consent.

o The patient can choose among the number of possible plans of treatments.

Priority data

1. Full name of the patient.

2. Address
3. By whom referred, if at all
4. Date of admittance
5. Age of the patient
6. Sex
7. Laboratory findings
8. The payments
9. The condition of the mouth
 AGM – D11F

Conditions of the mouth given attention during oral examination:

1. Missing teeth

2. Supernumerary teeth

3. Development defects on tooth

4. Caries

5. Attrition, abrasion, erosion

6. Deformities of the jaws, teeth, malposition of teeth, condition of occlusion

7. Firmness of the gums, their texture, and also the tongue and floor of the mouth

8. Inflammation of visible soft tissues

9. Pain

10. Calculus, stains

11. Condition of the bone, alveolar

12. Teeth filled or restored

13. Any other deviation from the normal condition of the mouth

14. The condition of the pulps

Dental charts

• It contains record of a patient's dental history and treatment. It’s a simplified graphic
representation of the teeth on which clinical, radiologic, and forensic information may be
recorded.
 AGM – D11F

Local and Systemic Conditions

• If there are clinical and laboratory findings pertaining to the structures in the oral cavity
where the diagnosis cannot be very well brought about or instituted, systemic findings
might aid in the assessment of the local data.

• Diseases occur because the mouth is also an essential constituent of the human body.
There is a mouth-body connection wherein any condition which affects the system will also
affect the mouth.

• Dentists are expected to be able to recognize some of the manifestations of certain

pathologies in the body or in the mouth of their patients. Cases that are suspected of
systemic nature should be referred to physicians.

Routine Examinations

• The General Physical Build - "Dentist's Appraisal “

• The mouth - examination of the soft tissues, the teeth, radiographs of the alveolar tissues,
the occlusion, etc.

• The systemic conditions – It is necessary if an ailment of the mouth has apparent or possible
complications elsewhere in the body or if an ailment of another organ manifests in the
mouth.

Body Temperature

• The body temperature is the balance between heat production and heat loss in the body.

o Normal Temperature
1. Health’s normal temperature: approximately 98.6ºF or 37ºC.
2. Rectal/ear temperature: about a degree higher than oral
3. Oral temperature
- Lower than rectal
4. Axillary temperature:
- Lower than oral

o Fever
- Also called Pyrexia
- A high abnormal temperature of the body.

Fever may be present in:

1. Severe infections;
2. Reactions to post-surgical operations;
3. Neurogenic fever from injury of the central nervous centers.
4. Fever may be present in dehydration, due to reduction of blood water.
5. Fever may be produced by drugs and other chemical substances.
 AGM – D11F

Thermometer

• Used to measure the temperature of the human body.

• Mercury thermometer
o Very toxic if released into the environment and can cause serious health problems for
humans and wildlife.
o Affects fetal and child development by preventing the brain and nervous system from
developing normally.

Different types of thermometers:

1. Multi-purpose thermometers 4. Armpit (axillary) thermometer

2. Oral thermometers
5. Eardrum thermometers

3. Rectal thermometers

6. Forehead thermometer (forehead

strip thermometer)
 AGM – D11F

7. Pacifier thermometer 8. Disposable thermometer

Special Considerations

• Record ought to show vital information such as:

1. Adverse drug reactions

2. Prescription issued

3. Treatments in the past or present whether systemic or dental, emergency or not.

4. Health conditions when the patient was still a child.

5. Behavior problems.

Laboratory findings and other pertinent matters.

• Dental records also include:

o plaster casts and impression of the teeth
o old dentures
o photographs
o pertinent reports from family members
o prognosis from colleague consultants

M12: The Dental Office

What are the things to think through when setting up a dental office?

• Must be able to support financially- from rental fee of the space, dental materials, complete
Instrumentation

• Site location
o Analyze the community and patients
o Parking
o Size of the clinic – reception, business office, operatory/treatment room, restroom,
staff’s area, x-ray room, sterilization area

General Consideration

1. Financial
2. Convenience/Environment
3. Aesthetics/Beauty
 AGM – D11F

Interior design consideration

1. Lighting
2. Color
3. Flooring
4. Walls
5. ceilings

Fundamental Compartments of an Ideal Dental Office

1. Reception area/Receiving area

2. Treatment Room/Operating Room

3. Laboratory area
4. Lavatory facility

Optional Compartments

1. Business/secretarial office

2. Recovery room

3. Dark room

4. Store room

Features of a Reception room

1. Telephone, television, WiFi

2. Magazines/newspapers
 AGM – D11F

3. Lavatory

4. Basic living room furniture

5. Proper interior decoration

6. Pieces of art

7. Digital frame with sample cases

8. Informational material

Basic Features of the Operating Room

• Diagnostic equipment/s
• Dental chair
• For specialists, appropriate equipment – pedodontics, periodontics, endodontics, surgery,
• Sterilizer/Autoclave
• Dental Instruments
• Dental Materials

Dental Chair

• Josiah Flagg created the first ever head rest for dental chairs that would keep the head in
a fixed position during the dental procedure. (1790)

• James Beall patented the first dental chair. (1867)

 AGM – D11F

Parts of a Dental Chair

1. Cuspidor/Spitoon 8. Dental light

2. Saliva ejector 9. Operator’s chair

3. Hi-vacuum ejector 10. Assistant’s chair

4. Tumbler/cup holder 11. Headrest

5. Bracket table 12. Backrest

6. 3-way syringe – air, water, air & water 13. Footrest

7. Handpiece – low-speed and high speed 14. Armrest

Adjunct tools

1. Intra-oral Camera 2. Peri-apical radiograph machine

 AGM – D11F

3. Light cure machine

5. Amalgamator

6. Panoramic/Cephalometric radiograph
machine
4. Ultra-sonic scalers

M13: Introduction to Dental Materials

Science ff Dental Materials

• Is defined as, “The Study of composition and properties of dental materials and the manner
in which they interact with the environment they are placed”.

• Science of dental materials is a basic science which deals with physical, mechanical and
biological properties of dental materials. The study of Science of dental materials gives the
operator a basic knowledge about the materials. This help to choose a material and allow
him/her to effectively manipulate it.
 AGM – D11F

“Why are we studying this field?”

6. for the knowledge to make optimal selection of materials

7. To understand the behavior of the materials, use, handling, manipulation
8. Safety considerations of the materials
9. Patient education regarding dental restoratives
10. Recognition of materials – proper care of prostho/restorations
11. Understand the professional literature

History of Dental Materials:

• Dating as early as 500 B.C. - present

o Metals – gold  Plaster and wax models
o Prosthetics of bone, ivory, wax, metals
o Porcelains – late 1700’s
o Amalgam – early 1800’s
o Acrylics – 1940’s
o Adhesive dentistry – 1970’s – present

* Ancient Egyptian Bridge

- Gold wire used to hold pontic crowns.

Oral Environment

• Very demanding.
• There can be

1. Temperature variations.

o Normal temperature of oral cavity (32℃ to 37℃).

o On intake of a cold/hot food or drink temperature range increases (0℃ to 70℃).

2. pH Variations.

o pH of saliva is neutral (7.0)

o On intake of acidic fruit juices or alkaline medicaments, pH may vary from 2.0 to
11.0

3. Variations in Masticatory forces

o Muscles of Mastication apply forces to the dentition.

o Masticatory forces vary from tooth to tooth.
o Average force applied by the tooth increases from anterior to posteriors.
 AGM – D11F

Tooth Average force (N)

Second molar 800
First molar 390
Bicuspids 288
Cuspids 208
Incisors 155

Characteristics of Ideal Materials:

• Biocompatible
o Non-toxic, nonirritating, non-allergenic

• Mechanically stable & durable

o Strong, resistant to fracture

• Resistant to Corrosion
o does not deteriorate over time

• Dimensionally Stable
o Little change by temperature & solvents

• Minimal conduction
o Insulates against thermal/electrical change

• Esthetic
o Looks like oral tissue

• Easy to manipulate
o Minimal/reasonable effort & time needed

• Adheres to tissues
o Retains onto, and seals, tooth structure

• Tasteless and Odorless

o Not unpleasant to patient

• Cleanable/Repairable
o Easily maintained or fixed

• Cost-effective
o Affordability vs. benefits/disadvantages

Classification of Dental materials

All dental materials fall under 4 main groups:

• Polymers.
o Chemical compound consisting of large organic molecules formed by the union of
many smaller monomer units is called a “POLYMER”
 AGM – D11F

o Chemical reaction in which low molecular weight monomers are converted into high
molecular weight polymer chains “POLYMERIZATION”

• Metals.
o An opaque lustrous chemical substance that is a good conductor of heat and electricity,
and when polished is a good reflector of light”.

• Ceramics
o “An inorganic compound with nonmetallic properties, typically composed of metallic
(or semi- metallic) and nonmetallic elements.”

• Composites
o Composite materials (also called composition materials or shortened to composites)
are materials made from two or more constituent materials with significantly different
physical or chemical properties, that when combined, produce a material with
characteristics different from the individual components.

Classification of Dental Materials

Dental materials can be classified as:

• Preventive dental materials

o Basic aim is to provide resistance to the progression of an active carious lesion.
o Carious lesion causes the demineralization of the dental enamel.
o These include:
a. Chemotherapeutic agents like Dentifrices, Mouthwashes and cavity varnishes.
b. Pit and fissure sealants.
c. Fluoride releasing cements.

o Preventive dental materials can also serve as Restorative materials.

o Can be either,
1. Short time periods.
2. Moderately long time period.
3. Longest time periods.

• Restorative dental materials.

o Help to repair or replace defected tooth structure. These include:
1. Amalgam.
2. Bonding agents.
3. Resin based composites.
4. Compomers.
5. Ceramics.
6. Liners.
7. Cement bases.
8. Dental polymers.

a. Direct restorative dental materials.

- Used intraorally.
- fabricate restorations / prosthetic devices directly on the teeth or tissues.
 AGM – D11F

b. Indirect restorative dental materials.

- used extra orally.
- Formed indirectly over a cast or models.

• Auxiliary dental materials.

o Materials used in the process of fabricating dental prosthesis. These include:
1. Impression materials.
2. Dental waxes.
3. Gypsum casts and model materials.
4. Finishing and polishing abrasives.
5. Acrylic resins for impressions.
6. Acid etching solutions.

• Temporary Restorative Dental Materials

o Sub category of restorative materials. Intended to be used to restore the tooth
temporarily. These include:
a. Orthodontic wires.
b. Cements used as temporary liners.
c. Cements used as temporary filling materials.
d. Acrylic resins used for inlays, inlays, crowns and fixed partial dentures.

Selection of Dental Materials

• Analysis of the problem

o Basic and very important step.
o Incorrect analysis may lead to wrong treatment plan.
o Poor prognosis and failure of treatment. e.g. Selection of a filling material.

• Consideration of the available requirements

o Enlist the requirements that a material must meet.
o Requirements of a material are dependent upon the situation

• Consideration of the available materials and their properties

o Clear concept about the properties.
o In case of immediate problem, must choose from the materials in hand.
o Dentist must be up to date with the advancements.
*Thorough comparison of Properties of the available materials with requirements.

• Choice of a suitable material

o Final step.
o Narrowing the range of choice.
o Factors:

1. Availability.

2. Ease of handling.

3. Cost effectiveness.
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Identification of Restorations:

• Dental Restoration” –
o Restores function & appearance of oral structure lost by pathology, injury, or is
congenitally missing

Examples:

1. Pathology – caries: filling

2. Injury – broken tooth: crown

3. Congenitally Missing: prosthetic (i.e. bridge)

o Direct Restoration – A restoration that is created and placed directly into the prep site
of the tooth (i.e. amalgam filling, composite filling)

o Indirect Restoration – A restoration that is created outside of the mouth on a model of

the prepped tooth and later fixed into the mouth (i.e. gold crown, denture)

Direct Fillings:

• Usually made of amalgam (“silver” metal) or composite (acrylic) materials

• For caries of various degrees; anterior or posterior teeth

Posterior amalgam fillings Anterior Composite Filling Posterior Composite Filling

Crown:

• Indirect restoration to replace missing crown of tooth, or protect remaining crown of

tooth
• Caries, fractures, teeth with RCT, esthetics
• Made of porcelain, metals, or both

Porcelain-Fused-to-Metal (PFM) Crown

Bridge:

• An indirect restoration; to replace one or more missing teeth

• “fixed” – not removable; cemented to existing teeth
• Made of porcelain, metals, or both
• Abutment – the existing tooth/teeth supporting the bridge
• Pontic – the replacement tooth
 AGM – D11F

Missing tooth – area to be restored

Anterior bridge on model
Pontic

Abutments Anterior bridge before cementation

Before Treatment After Bridge Cementation

Indirect Restorations:

• Inlay – A fabricated restoration made of metal or porcelain that replaces missing tooth
structure; does NOT include the restoration of any cusps
• Onlay – A fabricated restoration (as above) that DOES include the restoration of at least
one cusp
 AGM – D11F

Veneers:

• All-porcelain or acrylic facing for tooth

• Primarily used for esthetic reasons
• Can alter shape & color of existing tooth

Denture:

• The removable dental prosthetic used to replace all of the teeth on an arch; patient is
edentulous.
o Made of acrylic (teeth may be porcelain)

• “Partial denture”- replaces some teeth in the arch; patient is partially edentulous.
o Made of acrylic usually with metal substructure and clasps

metal clasp for

retention

Removable Partial Denture Full Upper and Lower Denture

Endodontic Restorations:

• “Endodontic” – “inside” the tooth; root canal treatment (RCT)

o Gutta percha – used to fill the canal
o Post and Core – The post is a metal piece that is screwed into and cemented into the
root canal
o The core is built-up around the post to create more available tooth structure
 AGM – D11F

Pediatric Restorations:

• Stainless Steel Crown (SSC):

o Prefabricated
o Cemented

• Space Maintainer:
o Holds space where primary tooth was prematurely lost
o Stainless steel band/crown with loop
o Fabricated outside of the mouth; cemented