Dental Assisting Notes Dental Assistants Chairside Pocket Guide

• F. A.
Davis Company
Always at your side ...
Dental Assisting
Notes
Dental Assistant’s Chairside Pocket Guide
Minas Sarakinakis
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FA Davis’s Notes Book
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F. A. Davis Company
1915 Arch Street

Philadelphia, PA 19103
www.fadavis.com
Copyright © 2015 by F. A. Davis Company
Copyright © 2015 by F. A. Davis Company. All rights reserved. This product is pro-
tected by copyright. No part of it may be reproduced, stored in a retrieval system,
or transmitted in any form or by any means, electronic, mechanical, photocopying,
recording, or otherwise, without written permission from the publisher.
Printed in China by Imago
Last digit indicates print number: 10 9 8 7 6 5 4 3 2 1
Publisher: Quincy McDonald

Developmental Editor: David Payne
Director of Content Development: George W. Lang
Design and Illustration Manager: Carolyn O’Brien
Reviewers: Cynthia Baker, DDS, CDA; Kim Best, CDA; Cynthia K. Bradley, CDA,
CDPMA, CPFDA, EFDA, BA; Denise Campopiano, CDA, RDH, BS; Alison Collins, CDA,
MS; Cynthia S. Cronick, CDA, AAS, BS; DeAnna Davis, CDA, RDA, MEd; Danielle
Furgeson, CDA, RDH, EFDA, MS; Vita M. Hoffman, CDA, AS; Ann E. Kiyabu, CDA;
Dr. Connie Kracher, PhD, MSD; Aamna Nayyar, BSc, BDS, DDS; Judith E. Romano,
RDH, BS, MA; Angela E. Simmons, CDA, CPFDA, BS.
As new scientific information becomes available through basic and clinical research,
recommended treatments and drug therapies undergo changes. The author(s) and
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in accord with accepted standards at the time of publication. The author(s), editors,
and publisher are not responsible for errors or omissions or for consequences from
application of the book, and make no warranty, expressed or implied, in regard to
the contents of the book. Any practice described in this book should be applied by
the reader in accordance with professional standards of care used in regard to the
unique circumstances that may apply in each situation. The reader is advised always
to check product information (package inserts) for changes and new information
regarding dose and contraindications before administering any drug. Caution is
especially urged when using new or infrequently ordered drugs.
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Place 27/8 × 27/8 Sticky Notes here
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Write directly onto any page of Dental Assisting

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CHAIR- INFECT RADIOL

EMERG MEDS INSTR RESOURCE INDEX
SIDE CONTROL
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Contacts • Phone/E-Mail
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1
Emergency Preparedness
ASA Classifications
The American Society of Anesthesiologists (ASA) has introduced
a classification system to determine a patient’s physical status.
ASA I
■ Patient is healthy.
■ Patient can either climb two flights of stairs or walk for two
city blocks without experiencing any shortness of breath.
ASA II
■ Evidence of some mild systemic disease present.

■ Patient can climb one flight of stairs or walk two city blocks
but may experience some shortness of breath.
■ Examples: Epilepsy, asthma, allergies, pregnancy.
ASA III
■ Severe systemic disease that interferes with but does not

inhibit daily life.
■ Individual may be able to climb one flight of stairs or walk
one city block but more than likely would have to stop
because of shortness of breath.
■ Examples: Type I diabetes, heart failure, hypertension.
ASA IV
■ Severe systemic disease that inhibits daily activities and can

be fatal.
EMERG
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■ Individual is unable to climb a flight of stairs or walk one

city block and may even experience shortness of breath
at rest.
■ Examples: Uncontrolled, diabetes, heart failure, angina, type
two hypertension.
ASA V
■ Patient is rapidly deteriorating and will not survive.
Emergency Kit
Every dental office should maintain a custom designed emer-
gency kit ready for use that is easily accessible and portable.
Each emergency kit in a dental office should contain at least the
following components:
■ Portable oxygen: Used in every medical emergency EXCEPT
hyperventilation.
■ Epinephrine: Used in anaphylactic emergencies.
■ Nitroglycerin: Used in angina, myocardial infarction (MI),
and congestive heart failure emergencies.
■ Diphenhydramine: Used to manage allergic reactions.
■ Albuterol: Used in asthma attacks.
■ Glucose: Used in patients who are conscious and have
hypoglycemia (low blood sugar).
■ Glucagon: Used in unconscious patients with hypoglycemia.
It is administered intramuscularly.
■ Lorazepam: Used in emergencies involving seizures
or hyperventilation. It is usually administered
intramuscularly.
■ Atropine: Used in low blood pressure emergencies.
■ Aspirin: Extremely beneficial drug in patients with signs
of MI.
■ Steroids: Although considered an essential drug due to the
slow onset (1 hour), steroids such as hydrocortisone can be
used in managing allergic reactions.
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Besides the afore mentioned substances, a few items should be
included in the emergency kit, such as:
■ One-way valve pocket mask
■ Syringes for administering the intramuscular drugs
■ Sterile gauze and bandages
■ Ice pack
■ Automated external defibrillator (AED)
Premedication Guidelines
The American Dental Association (ADA) notes that some indi-
viduals may require antibiotic prophylaxis before certain dental
procedures. These dental procedures involve manipulation of the
gingival tissue, the periapical region of a tooth, or perforation of
the oral mucosa.
Only dentists and physicians can prescribe antibiotic
prophylaxis.
The two groups of patients for whom antibiotic prophylaxis is
recommended are:
■ Individuals with certain heart conditions that predispose
them to infective endocarditis (IE)
■ Artificial heart valves
■ History of having previously contracted IE
■ Heart transplant that had complications and valve
problems
■ Certain congenital heart conditions such as:
• Unrepaired or incompletely repaired cyanotic congenital
heart disease, including those with palliative shunts or
conduits
• A completely repaired congenital defect of the heart with
prosthetic material or device, whether placed by surgery
or by catheter intervention, during the first 6 months
after the procedure
• Any repaired congenital heart defect with residual defect
at the site or adjacent to the site of a prosthetic patch or
a prosthetic device
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Patients should check with their cardiologists if they have any

questions about whether they fall into one of these categories.
The recommendations for antibiotic prophylaxis for IE state
that the antibiotic should be taken 30 to 60 minutes before the
procedure for it to reach adequate levels in the blood. However,
if the antibiotic is inadvertently not administered before the pro-
cedure, the dosage may be administered up to 2 hours after the
procedure.
If a patient who is required to have antibiotic prophylaxis is
already taking antibiotics for a separate condition, the dentist
must prescribe a different class of antibiotic from the one the
patient is already taking.
■ Individuals who have a total joint replacement and run the
risk of developing infection at the prosthetic site.
Even though the American Academy of Orthopedic Surgeons
(AAOS) recommends antibiotic prophylaxis for all patients with
total joint replacement, the ADA and AAOS are in the process of
developing evidence-based guidelines to help determine when
antibiotic prophylaxis is recommended before a dental proce-
dure for patients with orthopedic implants.
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Antibiotic Prophylaxis Regimen
Route of Dose: One Dose 30–60 Min
Administration Drug Before Appointment
Adult Children
Oral Amoxicillin 2g 50 mg/kg
Unable to take Ampicillin 2 g IV or IM 50 mg/kg IV or IM
oral meds Cefazolin 1 g IV* or IM 50 mg/kg IV or IM
Unable to take Cephalexin 2g 50 mg/kg
oral meds or Clindamycin 600 mg 20 mg/kg
allergic to Azithromycin 500 mg 15 mg/kg
penicillins
Unable to take Cefazolin 1 g IV or IM 50 mg/kg IV or IM
oral meds or Clindamycin 600 mg IV or 20 mg/kg IV or IM
allergic to IM
penicillins
*IM, intramuscular; IV, intravenous.
Vital Signs
In dentistry, pulse, respiration, and blood pressure are routinely
taken to assess the patient’s health before treatment.
EMERG
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Blood Pressure
Reprinted with permission from: Kantz, S. (Forthcoming).

Dental Assisting: A Comprehensive Guide to Current Practice,
ed 1. Philadelphia: F.A. Davis Company.
The blood pressure is recorded as a fraction of the systolic blood

pressure over the diastolic blood pressure. The force of blood
against the blood vessel walls during ventricular contraction is
called systolic pressure, and the force of blood against the blood
vessel walls during ventricular relaxation is called diastolic
pressure.
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Blood Pressure Types In Adults
Systolic (mm Hg) Diastolic (mm Hg)
Normal <120 <80
Prehypertension 120–139 80–89
Hypertension stage 1 140–159 90–99
Hypertension stage 2 ≥160 ≥100
Pulse Rate
A pulse is the rhythmic dilation of an artery caused by the con-
traction and expansion of the arterial wall as blood is pushed out
of the heart. It is commonly used to measure one’s heart rate. A
person’s pulse can be measured in various areas but is usually
felt in the carotid artery in the neck, the brachial artery in the
arm, or the radial artery in the wrist. When measuring pulse, one
should also assess rhythm and strength. Pulse should be
recorded for 1 minute. (In dentistry, it is common to measure the
pulse rate for 30 seconds and then multiply by 2.)
Normal Pulse Rates

Pulse Category Heart Rate (bpm)
Adults and children 10 years old and older 60–100
Children younger than 10 years but older 60–140
than 1 year
Babies 1 year old and younger 100–160
Adult marathon runners 40–60
bpm, beats per minute.
Respiration
During respiration, oxygen and carbon dioxide are exchanged in
the human body. It is measured by the respiration rate (RR). In
an adult at rest, the normal RR is between 12 and 20 breaths/min.
EMERG
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Normal Respiration Rates

Age Category Respiratory Rate (breaths/min)
Adults 12–20
Children 15–25
Newborns 40–50
Chain of Survival (AHA)

■ Early access: Immediate recognition of cardiac arrest and
activate emergency response system (EMS) CALL 911.
■ Begin early CPR: Chest compressions and ventilations.
■ Early defibrillation: Use the AED.
■ Early advanced care: Provided by EMS personnel.
CPR
Sequence of Steps for CPR: CAB

Begin the CAB sequence if the person is unresponsive, is not
breathing, or has no pulse within 10 seconds.
■ Chest compressions: Perform 30 compressions of the
sternum to a depth of at least 2 in. for adults, about 2 in. for
children, and about 1½ in. for infants at a rate of 100/min.
Allow complete recoil of chest wall.
■ Airway: Ensure that the ability of the victim to breathe is not
obstructed by performing a head tilt and chin lift.
■ Breathing: Perform two ventilations.
Reassess CABs after 2 min.
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Automated External Defibrillator
External defibrillators are becoming vital pieces of equipment in

dental offices as part of a protocol for managing medical emer-
gencies. Early defibrillation saves lives.
■ Turn machine on.
■ Follow audio and visual instructions.
■ Place pads as directed.
■ Follow instructions; stay clear for shock if indicated.
■ If machine indicates, continue with CPR.
Obstructed Airway Management
(Heimlich Maneuver)
Obstructed airways may occur anywhere at any time. A foreign
object can become lodged, not allowing the victim to breathe.
If a victim shows the universal sign of choking (grasping the
throat with both hands), do the following:
■ Ask whether the person is choking. If she responds, avoid
physical contact and encourage her to cough. If she cannot
respond, be ready to perform abdominal thrusts.
■ Stand behind the victim, wrap your hands around her waist,
and place your fist, thumb first, above the navel but below
the breast bone.
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■ Perform abdominal thrusts using quick upward motions.

■ Continue until the foreign object is expelled or until the
victim becomes unconscious due to lack of oxygen in the
brain.
■ If the patient becomes unconscious, call 911 and begin CPR.
If, because of pregnancy or the size of the victim, one cannot
perform abdominal thrusts, chest thrusts are the best
alternative.
Medical Emergencies
Most medical emergencies can be prevented from happening in
a dental office by being aware of the patient’s medical health
history. Regardless of the precautions taken by the dental staff,
however, medical emergencies do happen. Therefore, all dental
assistants should have up-to-date credentials on CPR, obstructed
airway management, and obtaining vital signs.
Medical emergencies in a dental office are best dealt with
as a team. The entire dental team (dentist, assistant, hygienist,
and front desk personnel) should practice medical emergency
scenarios, so that individual roles are preassigned and duties
predetermined.
Angina Pectoris
Lack of oxygen to the heart muscle will lead to myocardial is-
chemia with severe chest pain. It has been reported that angina
is one of the most frequently encountered medical emergencies
in a dental office.
Symptoms & Signs
■ Chest pain
■ High blood pressure
■ High pulse
■ Nausea
■ Pain radiating to shoulder or even to lower jaw
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Management
■ Administer 100% oxygen.
■ Administer nitroglycerin.
■ If pain has not subsided 10 minutes after nitroglycerin
administration, call EMS.
■ If patient has no known angina condition, call EMS
immediately and follow the first two steps above.
Broken Instrument
By maintaining instruments in good working condition and dis-
carding instruments that have become oversharpened and thin,
one can prevent broken tips in a patient’s mouth.
In the event that a tip is broken in a patient’s mouth, without
alarming the patient, ask him or her not to swallow. Do not rinse
because you may dislodge the tip unknowingly. Try to isolate the
area, gently dry it out, and locate the tip. If the tip is visible, use
a curette or cotton pliers to gently retrieve it. If the tip is not
visible, take a radiograph to determine its location. If the tip is
deeply lodged, the patient may need to be referred to an oral
surgeon for surgical removal.
Diabetic Emergency
Obtaining an accurate medical history in the dental office is
extremely important, especially for patients with metabolic dis-
orders, such as diabetes. There are three types of diabetes. Type
1 diabetes occurs when the body makes too little or no insulin,
also called insulin-dependent diabetes. Type 2 diabetes occurs
when the body cannot use the insulin it makes, also called non–
insulin-dependent diabetes. Gestational diabetes occurs in preg-
nant women.
Hypoglycemia
Hypoglycemia or insulin shock occurs when blood glucose levels
drop significantly.
Symptoms & Signs
■ Fast onset
■ Irritability
EMERG
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■ Clammy skin
■ Rapid breathing
Management
■ Stop all dental procedures and remove all objects from the
mouth.
■ If the patient is conscious, give oral glucose.
■ Fully recline the patient’s chair.
■ If the patient is unconscious, administer glucose
intravenously or glucagon intramuscularly.
■ Call EMS.
Hyperglycemia
Hyperglycemia is less likely to occur in a dental office and is
triggered by low insulin levels in the blood.
Symptoms & Signs
■ Slow onset
■ Dry skin
■ Deep breathing
■ Nausea
■ Vomiting
■ Drowsiness
Management
■ Determine what type of diabetic emergency is at hand.
■ Administration of glucose will not harm a patient with
hyperglycemia, but it will significantly help a hypoglycemic
one.
■ Managing hyperglycemia requires administration of
precisely the right amount of insulin. Thus, a physician must
administer it, so that the patient’s condition will not turn to
hypoglycemia because of an overdose of insulin.
■ Call EMS.
Fainting (Syncope or Vasovagal Episode)

Syncope, more commonly known as fainting, is perhaps the
most common cause of loss of consciousness in a dental office.
It is usually triggered by fear, anxiety, pain, or fasting.
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Symptoms & Signs
■ Lightheadedness
■ Nausea or vertigo (dizziness)
■ Pupil dilation
■ Perspiration
■ Pallor (paleness)
■ Bradycardia (low pulse)
■ Loss of consciousness
Management
■ Stop all dental procedures and remove all objects from the
mouth.
■ Place patient in supine position with head below heart level
to facilitate blood return.
■ Administer oxygen (4 L/min).
■ Loosen tight clothing.
■ Monitor vital signs.
■ Keep patient in supine position even after recovery until
ready to be elevated to a seated position.
■ If patient is not recovering, call EMS.
Foreign Object Aspiration

Foreign body aspirations in dentistry can be prevented by the
use of screens, gauze, or rubber dams. Fixed prostheses should
also be secured with floss before trying them intraorally. Aspira-
tion of a foreign object is a serious, potentially life-threatening
situation. If the aspiration leads to the patient choking while in
the dental office, follow the instructions for obstructed airway
management as described earlier. If the patient becomes uncon-
scious, call 911 and begin CPR, as described previously.
Hyperventilation
During hyperventilation, the patient breathes at a much faster
rate, consuming more carbon dioxide than is produced, resulting
in changes in the pH of the blood. Hyperventilation is triggered
by many conditions, including anxiety and fear.
EMERG
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Symptoms & Signs

■ Very fast breathing
■ Dizziness
■ Heart palpitations
■ Muscle spasms
■ Tingling of the extremities
Management
■ Position the patient in a position in which he or she feels
comfortable (preferably upright).
■ Assist in trying to control the patient’s breathing.
■ Check vital signs.
■ Consider administering lorazepam intramuscularly.
■ If condition does not improve, contact EMS.
Seizures
Seizures result from abnormal electrical activity in the brain.
Risk factors include genetic predisposition and systemic imbal-
ances caused by metabolic disorders, use of certain drugs, infec-
tions, cancer, and trauma.
Symptoms & Signs
Because of the various types of seizures, the symptoms may vary
slightly. However, common symptoms include the following:
■ Convulsions
■ Heavy breathing
■ Muscle contraction
■ Loss of consciousness
■ Frothy mouth
Management
■ Stop treatment immediately and make sure you remove all
objects from the patient’s mouth to avoid injury.
■ Place the patient in a supine position on his or her left side
to avoid aspiration.
■ Loosen tight clothing.
■ Protect the patient from injury by gentle restraint and do not
attempt to move to the floor.
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■ Administer oxygen.
■ If the patient becomes unconscious, call EMS and begin CPR.
Dental Emergencies
Management procedures described in the following are to be
performed only by licensed dentists or, in some cases, by dental
hygienists.
Abscess
Periodontal
Symptoms & Signs
■ Pain
■ Swelling
■ Pus
■ Bleeding gums
Management
■ Débridement of the periodontal pocket, root planing, and
scaling if indicated and clinically possible
■ Local delivery of antimicrobial solutions and placement of
antibiotics
■ If pocket is deep (>6–7 mm), referral to periodontist may be
appropriate for surgical resolution and reduction of the
pocket depth.
Tooth Related
Symptoms & Signs
■ Pain (can be severe).
■ Swelling.
■ Pus.
■ Bad taste and odor.
■ Pain on tapping.
■ No temperature sensitivity.
■ Many times a parulis is visible on the gingival margin apical
to the abscessed tooth.
■ Fever.
EMERG
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Management
■ Drain the abscess to relieve the pressure.
■ Prescribe systemic antibiotics.
■ Prescribe mild pain control medication.
■ Perform root canal or extraction depending on tooth
condition and patient preference.
Alveolar Osteitis (Dry Socket)
Symptoms & Signs
■ Radiating pain (can be severe)
■ Visible bone
■ Bad breath
■ Foul taste
■ Bleeding from the extraction site
■ Gray tissue surrounding the extraction site
Management
■ Administer local anesthesia.
■ Clean and irrigate socket.
■ Place medicaments in the socket.
■ Stress postoperative instructions.
■ Prescribe antibiotics and perhaps pain medication.
■ Replace medicaments if necessary.
■ Evaluate in a few days.
Avulsed Tooth
Symptoms & Signs
■ Tooth completely out of the socket
■ Pain
■ Swelling
Management
■ Obtain a radiograph of the area to rule out bone fragments
in the socket or socket fracture and collapse.
■ If the tooth is temporary (deciduous), do nothing; let the
permanent tooth erupt.
■ If the tooth is permanent (succedaneous) and is preserved
without excessive manipulation, attempt to reinsert it back
to the socket and splint it to adjacent teeth.
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■ If reimplantation is successful, root canal treatment and
crown restoration will be necessary.
■ If reimplantation fails, discuss alternative restorative options
with the patient.
Broken Tooth
Symptoms & Signs
■ Caused by trauma or decay
■ Temperature sensitivity
Management
■ Obtain a radiograph to evaluate root integrity.
■ Restore (restorations will vary depending on the amount of
the broken tooth and the condition of the remaining tooth
structure).
■ Root canal or extraction may be necessary.
■ Discuss alternative restorative options.
Cracked Tooth Syndrome (CTS)
Symptoms & Signs
■ Caused by trauma or decay
■ Temperature sensitivity
Management
■ Obtain a radiograph to evaluate root integrity.
■ Confirm CTS with bite stick (bite and release test).
■ Restore (restorations will vary depending on the amount of
the broken tooth and the condition of the remaining tooth
structure).
■ Root canal or extraction may be necessary.
■ Discuss alternative restorative options.
EMERG
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Commonly Prescribed Medications That Affect the Mouth
and Teeth
Trade Name Generic Name Dental Effects/Management
Accupril Quinapril Hypotension/Monitor vital signs, allow patient to
sit up for a couple of minutes
Aciphex Rabeprazole Dry mouth, potentially gingivitis
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Adderall Amphetamine/dextro- Dry mouth/Monitor vital signs, keep
amphetamine appointments short
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Advil Ibuprofen Potential postoperative bleeding
Aggrenox Dipyridamole–ASA Contact physician before performing a procedure
in which bleeding is expected
Aldactone Spironolactone Dry mouth
Allegra Fexofenadine HCl Dry mouth
Ambien Zolpidem tartrate Dry mouth
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Amoxil Amoxicillin Compromised contraception
Ativan Lorazepam Dry mouth
Augmentin Penicillin–clavulanate Candida, compromised contraception
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and Teeth—cont’d
AZT Zidovudine Bleeding of the gums
Boniva Ibandronate Potential necrosis of jaw bone
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Buspar Buspirone Dry mouth
Calan Verapamil HCl Dry mouth/Monitor vital signs, provide a
stress-free appointment
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Cardura Doxazosin mesylate Dry mouth/Monitor vital signs, provide a

stress-free appointment
Celebrex Celecoxib Dry mouth
Celexa Citalopram Dry mouth, postural hypotension
Cialis Tadalafil Dry mouth
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Claritin Loratadine Dry mouth
MEDS
Clozaril Clozapine Dry mouth
Continued
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Combivent Albuterol–ipratropium Dry mouth, teeth may appear discolored
Concerta Methylphenidate HCl Dry mouth/Use vasoconstrictors with caution
Cortef Hydrocortisone Candida
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Coumadin Warfarin Contact physician before performing a procedure
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Darvocet Propoxyphene– Stomatitis
acetaminophen
Deltasone Prednisone Delayed healing, Candida
Demerol Meperidine Hypotension (postural)
Denavir Penciclovir Affects taste
Depakote Valproic Acid Dry mouth
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MEDS
Desyrel Trazodone Dry mouth, hypotension

Detrol Tolterodine Dry mouth
Diflucan Fluconazole Affects taste buds
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Dilantin Phenytoin sodium Gingival hyperplasia
Dilaudid Hydromorphone Dry mouth
Duragesic Fentanyl (transdermal) Hypotension, dry mouth
Effexor Venlafaxine HCl Dry mouth
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Elavil Amitriptyline HCL Dry mouth, hypotension/Do not use
vasoconstrictors
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Enbrel Etanercept Alters taste

Endocet Oxycodone–acetaminophen Dry mouth
Fosamax Alendronate sodium Rare cases of osteonecrosis
Halcion Triazolam Dry mouth, stomatitis
Haldol Haloperidol Dry mouth
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Hyzaar Losartan–hydrochlorothiazide Dry mouth
MEDS
Imitrex Sumatriptan Dry mouth
Inderal Propranolol HCL Dry mouth
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Isordil Isosorbide dinitrate Hypotension
Lamictal Lamotrigine Dry mouth
Lasix Furosemide Dry mouth, hypotension
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Librium Chlordiazepoxide Dry mouth, sometimes coated tongue is noted
Lodine Etodolac Dry mouth
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Lopressor Metoprolol Dry mouth
Lorabid Loracarbef Candida, affects contraceptive measures
Lotrel Amlodipine–benazepril Dry mouth, gingival hyperplasia
Lovenox Enoxaparin sodium Contact physician before performing a procedure
Lunesta Eszopiclone Dry mouth
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MEDS
Luvox Fluvoxamine maleate Dry mouth

Lyrica Pregabalin Dry mouth
Medrol Methylprednisolone Candida, delayed healing
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Mevacor Lovastatin Dry mouth, hypotension
Mirapex Pramipexole dihydrochloride Dry mouth
Mircette Ethinyl estradiol–desogestrel Gingival changes
Necon Ethinyl estradiol– Gingival changes
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norethindrone
Neurontin Gabapentin Dry mouth
23
Norvasc Amlodipine Dry mouth, gingival hyperplasia

Norvir Ritonavir Candida
Ortho-novum Norethindrone–ethinyl Gingival changes
estradiol
OxyContin Oxycodone Dry mouth, hypotension
Pamelor Nortriptyline HCl Hypotension/Do not use vasoconstrictors
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MEDS
Patanol Olopatadine HCl Dry mouth
Paxil Paroxetine Dry mouth
Pepcid Famotidine Dry mouth
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Penicillin VK Penicillin Candida, hairy tongue, reduces contraceptive
action
Plavix Clopidogrel Contact physician before performing a procedure
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Protonix Pantoprazole Excessive salivation
Proventil Albuterol Dry mouth, teeth discoloration
24
Prozac Fluoxetine Dry mouth, hypotension
Requip Ropinirole Dry mouth, hypotension
Restoril Temazepam Dry mouth, taste alterations
Serax Oxazepam Dry mouth, coated tongue
Serevent Salmeterol Candida
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Seroquel Quetiapine Dry mouth
MEDS
Tegretol Carbamazepine Dry mouth, stomatitis

Tenormin Atenolol Dry mouth, affects taste
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Timoptic Timolol malate Dry mouth
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Trivora-28 Levonorgestrel–ethinyl Gingival changes
estradiol
Tofranil Imipramine HCL Dry mouth, hypotension/Do not use
vasoconstrictors
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Topamax Topiramate Dry mouth
Trileptal Oxcarbazepine Dry mouth
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Ultram Tramadol Dry mouth, hypotension

Valium Diazepam Dry mouth
Versed Midazolam Increased salivation
Wellbutrin Bupropion HCL Dry mouth
Xanax Alprazolam Dry mouth
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Zithromax Azithromycin Candida, hairy tongue, reduces contraceptive
MEDS
action
Zomig Zolmitriptan Affects taste
Zyprexa Olanzapine Dry mouth, hypotension
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The medications in green are those often prescribed by dentists. Text in red indicates implications for the dental visit.
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Dentition
Tooth Eruption Tables
Deciduous (Primary) Dentition

Teeth Age of Eruption (months)
Central incisors 6–8
Lateral incisors 7–9
Canines 15–20
First molars 12–16
Second molars 20–30
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Permanent (Adult) Dentition
Age of Eruption
Arch Teeth (years)
Maxillary Central incisors 7–9
Canines 11–13
First premolars 10–11
Second premolars 10–13
First molars 6
Third molars (wisdom teeth) 17–21
Mandibular Central incisors 6–7
Canines 8–9
First premolars 10–12
Second premolars 11–13
First molars 6
Third molars (wisdom teeth) 17–21
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Tooth Numbering
Tooth numbering systems provide a consistent method for iden-
tifying teeth for charting and descriptive purposes.
Universal System
Permanent dentition Maxillary
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
A B C D E F G H I J
Primary Maxillary
dentition
Mandibular
T S R Q PO N M L K
32 31 30 29 28 27 26 25 24 23 22 21 20 19 18 17
Permanent dentition Mandibular
Reprinted with permission from: Prajer, R., & Grosso, G.

(2011). DH Notes: Dental Hygienist’s Chairside Pocket Guide,
ed 1. Philadelphia: F.A. Davis Company; p. 28.
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Universal System
(Permanent Dentition)
Tooth Number Tooth Name
1 Maxillary right third molar
2 Maxillary right second molar
3 Maxillary right first molar
4 Maxillary right second premolar
5 Maxillary right first premolar
6 Maxillary right canine
7 Maxillary right lateral incisor
8 Maxillary right central incisor
9 Maxillary left central incisor
10 Maxillary left lateral incisor
11 Maxillary left canine
12 Maxillary left first premolar
13 Maxillary left second premolar
14 Maxillary left first molar
15 Maxillary left second molar
16 Maxillary left third molar
17 Mandibular left third molar
18 Mandibular left second molar
19 Mandibular left first molar
20 Mandibular left second premolar
21 Mandibular left first premolar
22 Mandibular left canine
23 Mandibular left lateral incisor
24 Mandibular left central incisor
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Universal System
(Permanent Dentition)—cont’d
25 Mandibular right central incisor
26 Mandibular right lateral incisor
27 Mandibular right canine
28 Mandibular right first premolar
29 Mandibular right second premolar
30 Mandibular right first molar
31 Mandibular right second molar
32 Mandibular right third molar
Begin counting from the upper right third molar as #1 to the upper left third molar
as #16, then move to the lower left third molar as #17, and finish at the lower
right third molar as #32.
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Universal System (Primary Dentition)
A Primary maxillary right second molar
B Primary maxillary right first molar
C Primary maxillary right canine
D Primary maxillary right lateral incisor
E Primary maxillary right central incisor
F Primary maxillary left central incisor
G Primary maxillary left lateral incisor
H Primary maxillary left canine
I Primary maxillary left first molar
J Primary maxillary left second molar
K Primary mandibular left second molar
L Primary mandibular left first molar
M Primary mandibular left canine
N Primary mandibular left lateral incisor
O Primary mandibular left central incisor
P Primary mandibular right central incisor
Q Primary mandibular right lateral incisor
R Primary mandibular right canine
S Primary mandibular right first molar
T Primary mandibular right second molar
Begin counting from the upper right second molar as #A to the upper left second
molar as #J, then move to the lower left second molar as #K, and finish at the
lower right second molar as #T.
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Palmer Notation System

In the Palmer notation system, all quadrants are given their own
bracket. Teeth are noted within each bracket based on their rela-
tion to the midline. The orientation of the bracket notes the
quadrant. Letters are used for deciduous teeth.
Permanent Teeth
Upper Right
8┘ 7┘ 6┘ 5┘ 4┘ 3┘ 2┘ 1┘
8┐ 7┐ 6┐ 5┐ 4┐ 3┐ 2┐ 1┐
Lower Right
Upper Left
└1 └2 └3 └4 └5 └6 └7 └8
┌1 ┌2 ┌3 ┌4 ┌5 ┌6 ┌7 ┌8
Lower Left
Deciduous Teeth (Baby Teeth)
Upper Right Upper Left

E┘ D┘ C┘ B┘ A┘ └A └B └C └D └E
E┐ D┐ C┐ B┐ A┐ ┌A ┌B ┌C ┌D ┌E
Lower Right Lower Left
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Cavity (Caries) Classification
Cavities (caries) are perhaps the most common dental disease.
Caries is defined as an infectious bacterial disease that affects
the tooth and the surrounding structures. G.V. Black has intro-
duced a system classifying the various types of caries found on
teeth based on location and tooth surfaces affected.
Class I
■ Pit and fissure caries

Class II
■ Interproximal caries in posterior teeth (mesial, distal)

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Class III
■ Interproximal caries in anterior teeth with no incisal edge
involvement

Class IV
■ Interproximal caries in anterior teeth with incisal edge
involvement

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Class V
■ Caries in the gingival third of anterior and posterior teeth

Class VI
■ Caries on incisal edge of anterior teeth or cusps of posterior
teeth due to defects

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Charting
Charting of existing and diagnosed procedures is important to
maintain an accurate record of the patient’s oral status.
Color Coding
Color Meaning
Red Treatment pending
Blue or black Existing restorations
Tooth Surface Abbreviations

Abbreviation Meaning
M Mesial
D Distal
La Labial
B Buccal
L Lingual
I Incisal
O Occlusal
DO Disto-occlusal
MO Mesio-occlusal
MOD Mesio-occlusal-distal
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Dental Abbreviations
Abs Abscess
ADA American Dental Association
ADAA American Dental Assistant Association
Adj Adjustments
AM or Amal Amalgam
Anes Anesthesia
Ant Anterior
BOP Bleeding on probing
Br Bridge
BWX Bitewing radiograph
C or Com Composite
Cem Cement
CLD or FLD Complete lower denture or full lower denture
Consult Consultation
CPR Cardiopulmonary resuscitation
CRN or Cr Crown
CUD or FUD Complete upper denture or full upper denture
Deci Deciduous
Del Delay
Dent Denture
Dx or Diag Diagnosis
Epi Epinephrine
Ex or Exam Examination
EXT Extraction
Continued
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Dental Abbreviations—cont’d
FGC Full gold crown
Fl Fluoride
FMX Full mouth radiographic series
FPD Fixed partial denture (i.e., bridge)
FX Fracture
Fx Function
HIPAA Health Insurance Portability and
Accountability Act
Hist History
HP Handpiece
I & D or I/D Incise and drain
MSDS Manufacturer’s safety data sheet
NKA No known allergies
NKDA No known drug allergies
NSAIDS Nonsteroidal anti-inflammatory drugs
PA Periapical radiograph
PANO Panoramic radiograph
Perm Permanent
PFM Porcelain fused to metal crown
PFS Pits and fissure sealants
PLD Partial lower denture
Pre-Med Premedication
PRN As needed
PSR Periodontal Screening Record
PUD Partial upper denture
Px Prognosis
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Dental Abbreviations—cont’d
PX or P Prophylaxis
RCT Root canal therapy
RPD Removable partial denture
Rx Prescription
TMJ Temporomandibular joint
Tx Treatment
Tx Pl Treatment plan
UCR Usual, customary, and reasonable
Xylo Xylocaine
ZOE Zinc oxide eugenol
Occlusion
The relationship of the maxillary teeth with the mandibular teeth
when they come together is described as occlusion.
The ideal occlusion occurs when maxillary and mandibular
teeth contact at maximum level.
Class I Occlusion Molar Relationship
Class I occlusion molar relationship is defined as the type of
occlusion in which the mesiobuccal cusp of the maxillary first
molar contacts the buccal grove of the mandibular first molar.
Class I Occlusion Canine Relationship
Class I occlusion canine relationship is defined as the type of
occlusion in which the maxillary canine contacts the distal half
of the mandibular canine and the mesial half of the mandibular
first premolar.
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Class II Occlusion Molar Relationship

Class II occlusion molar relationship is defined as the type of
occlusion in which the mesiobuccal cusp of the maxillary first
molar occludes in the space between the mandibular second
premolar and the mandibular first molar.
Class II Occlusion Canine Relationship
Class II occlusion canine relationship is defined as the type of
occlusion in which the distal surface of the maxillary canine is
located mesially to the distal surface of the mandibular canine.
Class II Division 1
The molar relationships are like that of Class II, and the anterior
teeth are protruded.

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Class II Division 2
The molar relationships are Class II, but the central teeth are
retroclined, and the lateral teeth are seen overlapping the
centrals.

Class III Occlusion Molar Relationship

Class III occlusion molar relationship is defined as the type of
occlusion in which the buccal groove of the mandibular first
molar occludes mesial to the mesiobuccal cusp of the maxillary
first molar.
Class III Occlusion Canine Relationship
Class III occlusion canine relationship is defined as the type of
occlusion in which the distal surface of the mandibular canine
occludes mesially from the mesial surface of the maxillary
canine.

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Misalignment or Malocclusion
Teeth and arches can be positioned in such a way that can cause
problems with occlusion, aesthetics, and function. Some exam-
ples of misaligned teeth are described.
Crossbite
Ideally, the maxillary teeth should occlude facially or buccally to
the mandibular teeth. Deviations from this norm, such as the
maxillary incisors being lingual to mandibular incisors or maxil-
lary or mandibular posterior teeth being excessively lingual or
buccal to the norm, will result in what is called crossbite.


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End to End
Cusp-to-cusp or incisal edge-to-incisal edge contact.


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Overbite
An excessive overlap in a vertical direction between maxillary
and mandibular incisors.
Overbite

Overjet
An excessively buccal positioning of the maxillary incisors in
relation to mandibular incisors.
Overjet

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Open Bite
Anterior teeth do not occlude when the posterior teeth are in
occlusion.

Anesthesia
One of the primary responsibilities of a dentist is to eliminate
dental disease as painlessly as possible. Science and chemistry
have provided the dental profession with several agents to
achieve topical, local, and general anesthesia so the patient can
be as comfortable and pain free as possible during dental
procedures.
Topical Anesthetics
Topical anesthetics are administered to achieve terminal nerve
ending anesthesia. It is short lasting and can be used for a variety
of reasons:
■ Before local anesthetics
■ To manage patient’s gag reflex
■ Before suture removal or removal of loosely attached
primary teeth
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Most Common Topical Anesthetics

Benzocaine 20% Concentration
Cetacaine 14% Benzocaine
2% Tetracaine
Lidocaine 5% In liquid form
Oraqix (mostly used in dental hygiene 2.5% Prilocaine
procedures) 2.5% Lidocaine
Local Anesthetics
Local anesthetics are used before treatment to provide tempo-
rary anesthesia (no feeling) to the teeth and soft tissue. The mode
of action is to block nerves that identify pain from sending
impulses to the brain. Local anesthetics vary in the duration of
their effect:
■ Short acting (30 minutes)
■ Intermediate acting (60 minutes)
■ Long acting (90 minutes)
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Most Common Local Anesthetics
Vaso- Vasoconstrictor
Generic Name Trade Name constrictor Concentration
2% Lidocaine with Xylocaine Yes 1 : 100,000
epinephrine Octocaine
2% Mepivicaine Carbocaine Yes 1 : 20,000
with
levonordefrin
3% Mepivicaine Carbocaine No N/A
plain
4% Articaine Septocaine Yes 1 : 100,000
1 : 200,000
Prilocaine Citanest Forte Yes 1 : 100,000
Bupivacaine Marcaine Yes 1 : 200,000
2% Lidocaine Xylocaine No N/A
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Anesthesia Color Coding

Anesthetic Color
2% Lidocaine with epinephrine
1 : 100,000
2% Lidocaine with epinephrine
1 : 50,000
Lidocaine plain
Mepivacaine 2% with
levonordefrin 1 : 20,000
Mepivacaine 3%
Prilocaine 4% with epinephrine
1 : 200,000
Prilocaine 4%
Bupivacaine 4% with
epinephrine
Articaine 4% with epinephrine
Preparation for Injection

■ Review medical history.
■ Wipe injection site with 2 × 2 gauze to remove excess saliva.
■ Apply topical anesthetic and let it remain for 2 to 3 minutes.
■ Assemble and hand anesthetic syringe to doctor for
injection.
■ Most commonly used needles:
■ 30-gauge short (blue cap) for infiltrations and maxillary
blocks
■ 27-gauge long (yellow cup) for mandibular blocks
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Injection Types
Maxillary Injections
Ophthalmic
Maxillary nerve
nerve
Trigeminal
ganglion
Anterior superior
alveolar nerve
Middle
superior
alveolar
nerve
Posterior
superior
alveolar
nerve
Dental plexus
Mandibular
nerve
Greater and lesser

palatine nerves

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Posterior Superior Alveolar (PSA)

■ Infiltration injection is used for maxillary posterior molars.
■ Use a 27-gauge short needle.

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Middle Superior Alveolar (MSA)
■ Infiltration injection is used for maxillary premolars.

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Anterior Superior Alveolar (ASA)

■ Infiltration injection is used for maxillary anterior teeth.

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Greater Palatine Block
■ Block injection.
■ Anesthetizes posterior portion of hard palate.

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Nasopalatine Block
■ Anterior portion of hard palate between canines.

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Mandibular Injections
Lingual nerve
Inferior alveolar nerve
Mylohyoid nerve

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Inferior Alveolar Nerve Block

■ Unilateral effect to the midline.
■ Use a 30-gauge long needle.

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Buccal Nerve Block
■ Soft tissue buccal to first molars.

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Mental Nerve Block

■ Premolars, canines, incisors.

Nitrous Oxide Sedation

Nitrous oxide is the most commonly used sedative in dentistry.
It is commonly used in oral and periodontal surgery, in patients
with high levels of apprehension and anxiety, in children, and in
patients with developmental and behavioral conditions.
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Indications
■ To reduce fear and anxiety
■ Used in children to eliminate negative experience of
restraining
■ Used in patients with special needs
■ Used in patients with high gag reflex
■ Used in patients who have difficulty reaching profound local
anesthesia
■ To enhance the action of local anesthesia
■ To prevent triggering other medical conditions (e.g., stress
may increase blood pressure, trigger angina incidents)
Contraindications
■ Patients unable to breathe adequately through their nose
due to respiratory infections, blocked sinuses
■ Patients who have undergone eye or ear surgery
■ Patients with hypoxia or chronic obstructive pulmonary
disease (COPD)
■ Patients with history of drug addiction
■ Patients taking sleep medications or antidepressants
■ Pregnant women during first trimester even though their
physicians should be contacted if N2O-O2 is considered for
their treatment
■ Patients treated with bleomycin sulfate treatment for
neoplasm in which fibrosis of the lungs is often found
■ Patients with sickle cell anemia
■ Patients who have congestive heart failure (CHF)
Medical Assessment of the Patient

Before Administration
Patients who are considered candidates for N2O-O2 inhalation
sedation should complete a detailed medical history form to be
reviewed by the dentist. If at any moment there is a doubt about
their suitability for nitrous oxide, the physician should be con-
sulted, and if necessary, the appointment should be rescheduled.
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Upon verifying the patient’s suitability, an informed consent

should be signed and all details, and potential side effects should
be explained to the patient. Before the actual administration of
the gas, the patient’s vital signs must be measured and recorded
and an examination of the airway should take place. The patient
or the parent (if a minor) must also have been informed before
the appointment to eat light to avoid vomiting. In children,
special attention should also be paid for enlarged adenoids and
tonsils. After the procedure, detailed records of the time, flow,
and oxygenation procedures should be recorded.
Pharmacological and Physiological Effects of

Nitrous Oxide
When ammonium nitrate is heated to high temperatures, it yields
nitrous oxide and water. Nitrous oxide is a colorless, “sweet”-
tasting gas, and it is the only inorganic gas that is used for seda-
tion in humans. Nitrous oxide affects the central nervous system
(CNS) by dulling the perception of painful stimuli and creating a
more relaxed, carefree attitude in the patient. The exact mecha-
nism is not completely known; it is believed, however, that this
drug increases the release of endorphins in the body, which in
turn block opioid receptors in the CNS, thus elevating the pain
threshold. It is a relatively safe drug and has no effect on the
cardiovascular system except minor vasodilatation. The pulse
and heart rate remain unaffected, and there is no effect on the
skeletal muscle system.
Nitrous oxide has an onset time of 2 to 5 minutes and is
metabolized and excreted by the lungs. Because of its high dif-
fusion rate (34 times higher than nitrogen), it is contraindicated
for patients with medical conditions listed earlier, and it should
never be administered without a scavenging system because it
can accumulate, displacing oxygen, and overcome health care
personnel. When inhaled, nitrous oxide reaches the lungs and
travels via the circulatory system to the brain (limbic system) and
the rest of the body. The patient experiences the following
symptoms:
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■ A tingling sensation, especially in the extremities
■ A warm feeling
■ A feeling of well-being and euphoria
■ In deeper sedation states, inability to keep the eyes open
■ Nausea and vomiting (only if oversedated)
Notable: Nitrous oxide/oxygen has a fast onset and recovery.
Management of Complications and

Medical Emergencies
Even though nitrous oxide has a great safety record, medical
emergencies may occur while the patient is under its influence.
The best way to manage such emergencies is to prevent them.
Perform a thorough examination of the prospective recipient’s
medical history to not only ensure that the patient is a “good”
candidate, but also to learn of any medical condition.
Oversedation can lead to nausea and vomiting during the pro-
cedure. If such an event occurs, do the following:
1. Turn the patient to his or her side to avoid aspiration.
2. Stop administering nitrous oxide immediately.
3. Give the patient 100% oxygen.
4. When the risk of vomiting has subsided, move the patient to
a contamination-free area where he or she can breathe fresh
air. Measure the patient’s vital signs.
High concentrations of the gas can lead to dizziness, deep breath-
ing, and eventually unconsciousness because of a lack of oxygen.
In such cases, do the following:
1. Immediately stop the gas supply.
2. Give the patient 100% oxygen.
3. Measure and record vital signs.
4. Evaluate voluntary breathing and pulse.
5. Initiate cardiopulmonary resuscitation while informing the
emergency services.
REMEMBER: Nitrous oxide does not kill brain cells, but lack of
oxygen does.
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Chairside Concepts
Four-Handed Dentistry
■ Minimizes stress and fatigue for dentist and assistant.
■ Provides efficient care to the patient.
Seating zones: Visualize the patient as a clock with his head on
12 o’clock and his feet on 6 o’clock and use the zones shown in
the following chart to determine the appropriate seating for the
dentist and the assistant.
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Right-handed dentist 12
11 1
Static zone
10
2
Operator’s
zone
9 3
Assistant’s
zone
8 4
Transfer zone
7 5
6
Left-handed dentist 12
11 1
Static zone Operator’s
zone
10 2
Assistant’s
zone
9 3
8 4
Transfer zone 7 5
6
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Dentist’s zone 7–12
Assistant’s zone 2–4
Transfer zone 4–7
Static zone 122
Positioning
■ Sit all the way back on the stool.
■ Rest your feet on the stool base.
■ Keep your legs parallel to the patient’s dental chair.
■ Keep your eye level about 6 inches above the operator.
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Motions
■ Class I: Movement of the fingers only
■ Class II: Movement of the wrist and fingers
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■ Class III: Movement of the wrist, fingers, and elbow
■ Class IV: Movement of the arm and shoulder
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■ Class V: Movement of the entire torso
Basic Principles
■ The operator is able to maintain vision on the operative
field, thus reducing eyestrain.
■ The team conserves time and motion during instrument
transfers.
■ There is a reduction in stress and strain on the operating
team because of the uninterrupted flow of the procedure
without the delays associated with locating and delivering
instruments.
■ When instrument transfer is used in conjunction with the
oral evacuator and the air/water syringe, the operative site
will always be clean and the next instrument will be ready
for use.
■ Percutaneous injuries associated with use of dental
instruments can be minimized using a prescribed transfer
technique.
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Instrument Transfer
■ Pen grasp: The position commonly used to hold a pen or
pencil and is widely used for most operative instruments.
■Modified pen grasp: Similar to the pen grasp except the

operator uses the pad of the middle finger on the handle
of the instrument. Adds stability to the transfer.
■ Palm grasp: Hold the instrument on the palm. Used for
bulky instruments such as forceps.
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■ Palm/thumb grasp: Hold the instrument in the palm and
guide with the thumb. Used in holding the high volume
evacuation (HVE), it provides more vertical freedom in the
movement of the instrument.
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Infection Control and Instruments

Instrument Classification Based on Need
for Infection Control
Critical
■ Touch bone and/or penetrate soft tissue.
■ Heat sterilize between uses or use sterile single-use,
disposable devices.
■ Examples: surgical instruments, scalpel blades, periodontal
scalers, and surgical dental burs.
Semicritical
■ Touch mucous membranes.
■ Heat sterilize or high-level disinfect.
■ Examples: Dental mouth mirrors, amalgam condensers, and
dental handpieces.
Noncritical
■ Contact with intact skin.
■ Clean and disinfect using a low- to intermediate-level
disinfectant.
■ Examples: X-ray head, pulse oximeter, blood pressure cuff.
Instrument Processing
■ Transport
■ Transport contaminated instruments to processing and
sterilization area.
■ Use a designated processing area to control quality and
ensure safety.
■ Divide processing area into work areas.
■ Cleaning: Use an ultrasonic cleaner.
■ Packaging
■ Wrap or package instruments for sterilization.
■ Wrap or place critical and semicritical items that will be
stored in containers before heat sterilization.
■ Open and unlock hinged instruments.
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■ Place a chemical indicator inside the pack.
■ Wear heavy-duty, puncture-resistant utility gloves.
■ Sterilization: Load and operate sterilizer according to the
manufacturer’s guidelines.
■ Storage: Store instruments in such a way as to maintain
integrity of the package.
■ Delivery to procedure site: Deliver instruments to procedure
site maintaining integrity and opening before procedure.
■ Quality control: Implement quality control test to assure
sterilization efficiency.
Instrument Sterilization
Sterilization Methods
■ Steam Autoclave (steam under pressure)
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■ Four cycles (heat up, sterilization, depressurization,
drying).
■ Short time.
■ Corrosive (may rust non–stainless steel instruments).
■ Use distilled water ONLY.
■ Chemical Vapor
■ Special chemical compound
■ Short time
■ Rapid Heat Transfer
■ Very short time
■ Noncorrosive
■ Dry Heat
■ Long time
■ Noncorrosive
■ Liquid Chemical Sterilant/Disinfectants
■ Only for heat-sensitive critical and semicritical devices.
■ Powerful, toxic chemicals raise safety concerns.
■ Heat-tolerant and disposable alternatives are available.
Sterilization Monitoring: Types of Indicators

■ Mechanical: Measure time, temperature, pressure
■ Chemical: Change in color when physical parameter is
reached
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Reprinted with permission from: Henry, R., & Perno, M.G.

(Forthcoming). Dental Hygiene: Applications to Clinical
Practice, ed 1. Philadelphia: F.A. Davis Company.
■ Biological (spore tests): Use biological spores to assess the

sterilization process directly
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CDC Guidelines for Infection Control

Chain of Infection
CDC Guidelines for Infection Control
Pathogen
Chain of
Host Infection Source
Entry
For an infection to occur, four conditions must be present:

■ A germ must be present (e.g., bacteria, virus, parasite).
■ The germ must have a place to live and multiply such as
human, food, soil, or water.
■ A susceptible host must be present.
■ There must be a way for the germ to enter the host, such as
direct contact or air droplets.
Standard Precautions
Application
■ Apply to all patients
■ Integrate and expand Universal Precautions to include
organisms spread by blood and the following:
■ Body fluids, secretions, and excretions except sweat,
whether or not they contain blood
■ Nonintact (broken) skin
■ Mucous membranes
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Elements
■ Hand washing
■ Use of personal protective equipment (PPE) (gloves, masks,
eye protection, gowns)
■ Patient care equipment
■ Environmental surfaces
■ Injury prevention
Bloodborne Pathogens
Examples
■ Hepatitis B virus (HBV)
■ Hepatitis C virus (HCV)
■ Human immunodeficiency virus (HIV)
Characteristics
■ Are transmissible in health care settings
■ Can produce chronic infection
■ Are often carried by persons unaware of their infection
Exposure Prevention Strategies

■ Engineering controls: Isolate or remove the hazard
■ Work practice controls: Change the manner of performing
tasks
■ Administrative controls: Policies, procedures, and
enforcement measures
Postexposure Management Program

■ Clear policies and procedures
■ Education of dental health care personnel (DHCP)
■ Rapid access to clinical care
■ Postexposure prophylaxis (PEP)
■ Testing of source patients and health-care personnel (HCP)
■ Wound management
■ Exposure reporting
■ Assessment of infection risk
■ Type and severity of exposure
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■ Bloodborne status of source person

■ Susceptibility of exposed person
Hand Hygiene
■ Hands are the most common mode of pathogen
transmission.
■ Reduce spread of antimicrobial resistance.
■ Prevent health care–associated infection.

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Terms and Definitions
■ Hand washing: Washing hands with plain soap and water
■ Antiseptic hand wash: Washing hands with water and soap
or other detergents containing an antiseptic agent
■ Alcohol-based hand rub: Rubbing hands with an alcohol-
containing preparation
■ Surgical antisepsis: Washing hands with an antiseptic soap
or an alcohol-based hand rub before operations by surgical
personnel
Guidelines
■ Use hand lotions to prevent skin dryness.
■ Consider compatibility of hand care products with gloves.
■ Keep fingernails short.
■ Avoid artificial nails.
■ Avoid hand jewelry that may tear gloves.
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Personal Protective Equipment

■ A major component of Standard Precautions
■ Protects the skin and mucous membranes from exposure to
infectious materials in spray or spatter
■ Should be removed when leaving treatment areas
Masks and Face Shield

■ Wear a surgical mask and either eye protection with solid
side shields or a face shield to protect mucous membranes
of the eyes, nose, and mouth.
■ Change masks between patients.
■ Use clean, reusable face protection between patients; if
visibly soiled, clean and disinfect.
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Clothing
■ Wear gowns, lab coats, and uniforms that cover skin and
personal clothing likely to become soiled with blood, saliva,
or infectious material.
■ Change if visibly soiled.
■ Remove all barriers before leaving the work area.
Gloves
■ Minimize the risk of HCP acquiring infections from patients.
■ Prevent microbial flora from being transmitted from HCP to
patients.
■ Reduce contamination of the hands of HCP by microbial
flora that can be transmitted from one patient to another.
■ Are not a substitute for hand washing.
Sterile Glove Donning Technique
Peel open the outer pack from the corners. The inner pack is
sterile.
■ Pick up the cuff of the right glove with your left hand. Slide
your right hand into the glove until you have a snug fit over
the thumb joint and knuckles. Your bare left hand should
only touch the folded cuff; the rest of the glove remains
sterile.
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■ Slide your right fingertips into the folded cuff of the left
glove. Pull out the glove and fit your left hand into it.
■ Unfold the cuffs down over your gown sleeves. Make sure
your gloved fingertips do not touch your bare forearms or
wrists.
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All photos in the gloving sequence are reprinted with

permission from: Johansson, C., & Chinworth, S. A. (2012).
Mobility in Context: Principles of Patient Care Skills, ed 1.
Philadelphia: F.A. Davis Company; pp. 102–103, Fig. 4-12.
Environmental Surfaces
■ May become contaminated
■ Do not require as stringent decontamination procedures
Categories
■ Clinical contact surfaces
■ High potential for direct contamination from spray or
splatter or by contact with DHCP’s gloved hand
■ Housekeeping surfaces
■ Do not come into contact with patients or devices
■ Limited risk of disease transmission
Recommendations
■ Use barrier precautions (e.g., heavy-duty utility gloves,
masks, protective eyewear) when cleaning and disinfecting
environmental surfaces.
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■ Physical removal of microorganisms by cleaning is as
important as the disinfection process.
■ Follow manufacturer’s instructions for proper use of
Environmental Protection Agency (EPA)–registered hospital
disinfectants.
■ Do not use sterilants or high-level disinfectants on
environmental surfaces.
Clinical Contact Surfaces
■ Risk of transmitting infections is greater than for
housekeeping surfaces.
■ Surface barriers can be used and changed between patients.
OR
■ Clean and then disinfect using an EPA-registered low-
(HIV/HBV claim) to intermediate-level (tuberculocidal claim)
hospital disinfectant.
Water Lines
Problem: Contamination of Water Supply
■ Microbial biofilms form in small-bore tubing of dental units.
■ Biofilms serve as a microbial reservoir.
■ Primary source of microorganisms is municipal water
supply.
Solutions to the Problem
■ Independent reservoir.
■ Chemical treatment.
■ Filtration.
■ Combinations.
■ Sterile water delivery systems.
■ Use sterile saline or sterile water as a coolant or irrigator
when performing surgical procedures.
■ Use devices designed for the delivery of sterile irrigating
fluids.
■ Clean and heat sterilize intraoral devices that can be
removed from air and waterlines.
■ Follow manufacturer’s instructions for cleaning, lubrication,
and sterilization.
■ Do not use liquid germicides or ethylene oxide.
■ Use barriers and change between uses.
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■ Clean and disinfect at an intermediate level the surface of

devices if visibly contaminated.
■ Do not advise patients to close their lips tightly around the
tip of the saliva ejector.
Medical Waste Management

■ Properly label containment to prevent injuries and leakage.
■ Medical wastes are “treated” in accordance with state and
local EPA regulations.
■ Processes for regulated waste include autoclaving and
incineration.
Program Evaluation
■ Develop standard operating procedures.
■ Evaluate infection control practices.
■ Document adverse outcomes.
■ Document work-related illnesses.
■ Monitor health care–associated infections.
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Introduction to Radiology
Dental radiology is one of the most important factors contribut-
ing to quality and reliable diagnosis and treatment of patients.
Dental assistants must understand the concepts behind the
physics of radiology and must be competent in exposing accu-
rate, diagnostic, and quality radiographs and images.
Brief History
In 1895, Wilhelm C. Roentgen discovered x-rays by accident
while he was experimenting with the production of cathode rays.
Many other scientists continued to research these new rays, and
in 1896, Edmund Kells, a dentist, recorded the first practical
use of x-rays in dentistry. Throughout the years, several devel-
opments and improvements have been implemented in dental
radiology, such as the panoramic concept, high-speed films
(F-speed), digital radiography, and 3-D cone imaging.
Uses of Dental Radiology

■ Diagnostic: Identify disease in the teeth and the surrounding
hard tissue.
■ Qualitative: Evaluate quality and clinical functionality of
placed restorations.
■ Legal: Document and record conditions at a specific time
frame.
■ Forensic: Help identify deceased individuals.
Types of Dental Radiology

■ Intraoral: Procedures in which the film or digital devices that
record images are placed inside the patient’s mouth.
Examples of intraoral x-rays are periapical (PA) x-rays and
bitewing (BW) x-rays.
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■ Extraoral: Procedures in which the film or digital devices

that record images are located outside the patient’s mouth.
Examples of extraoral x-rays are panoramic, cephalometric,
and lateral skull.
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Dental Radiology Equipment
Intraoral X-Ray Unit
Components
■ Control panel: Contains all setting adjustments buttons,
master switch, indicator light, and exposure button. It can be
located in the x-ray area only if a remote exposure button is
available to limit the operator’s exposure to radiation or
outside the x-ray area.
■ Exposure button: Controls the flow of electricity to
generate x-rays.
■ Kilovoltage selector (kVp): Controls the penetrating power
of the x-ray beam. Normal kVp range is between 70 and
90 kVp.
■ Milliamperage selector (mA): Controls the number of
electrons produced. Higher mA increases the number of
electrons.
■ Extension arm: Positions the tubehead during x-ray
procedures and contains wiring that connects the tubehead
and the control panel. It is easily adjustable and folds for
efficient storage.
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Reprinted with permission from: Henry, R., & Perno, M. G.

■ Tubehead: Metal housing of the x-ray tube. It also contains

transformers, oil that prevents overheating for the
production of x-rays, and aluminum or lead glass.
■ Important components in the tubehead are the collimator,
aluminum disc (which restricts the size of the x-ray beam
before exiting the tubehead), and aluminum filters (which
filter out low-wavelength x-rays).
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Reprinted with permission from: Henry, R., & Perno, M. G.

■ X-ray tube: Located inside the tubehead and is the device

where the x-rays are produced. It contains the following:
■ Anode: A positive electrode composed of the tungsten
target embedded in a copper housing. The tungsten target
acts as a focal spot and transforms the electron waves
into x-rays.
■ Cathode: A negative electrode made of a tungsten
filament embedded in molybdenum housing. The tungsten
filament is where electrons are produced.
The x-ray tube is in a vacuum state (no air is present).
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Extraoral X-Ray Unit

Panoramic machines have similar components and produce
x-rays under the same principles as the intraoral units.
X-Ray Processor
■ Manual: Rarely used today because of extended period of
time to develop and process radiographs.
■ Automatic: Faster and more efficient with controlled
temperature and time.
Automatic processors house a roller transport system that
carries radiographs through the developer and fixer solutions
and through a rinse and air dry cycle.
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Processing Solutions
■ Developing solution: Reacts with exposed silver halide
crystals forming black metallic silver and softens emulsion
of the film.
■ Fixer solution: Removes all unexposed silver halide crystals
and hardens emulsion.
Both of these solutions are available in powder, liquid concen-
trate, and ready-to-use liquid forms.
Duplicating
Duplication of radiographs must occur in a dark room.
Procedure for duplication:
■ Open duplicating machine.
■ Place duplicating film on the glass top of the machine with
the emulsion facing up.
■ Place films to be duplicated on the top and close the lid.
■ Turn on exposing light of the duplicating machine for the
manufacturer’s recommended time.
■ Remove duplicating film and process as normal.
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Dental Radiology Film Types

Dental radiology film is made of a semiflexible acetate film base
that is coated with an emulsion of silver halide, silver bromide,
and silver iodide crystals.
Intraoral Film
Speed
■ D speed
■ E speed
■ F speed (the fastest film available, which means it requires
less amount of radiation)
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Size
■ #0, smallest film used in pediatric patients
■ #1, used in pediatric patients and often for lower anterior
PAs
■ #2, most commonly used for adult BW and PA x-rays
■ #4, used in occlusal exposures
Extraoral Film
■ Is placed outside the mouth.

■ Requires a cassette to protect it.
■ Requires intensifying screens.
■ Green sensitive (rare earth–intensifying screens).
■ Blue sensitive (calcium tungstate–intensifying screens).
Duplicating Film
■ Sensitive to light.
■ Emulsion only in one side.
■ Side with emulsion appears dull.
■ Available in all sizes, including 8-in x 10-in sheets.
Characteristics of Radiographic Beam

Contrast
■ Radiographic images appear in a range of shades from black
to white with several shades of gray in between.
■ Higher kVp produces lower contrast.
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Density
■ Density is the overall darkness or blackness of the film.
■ Density is controlled by mAs (milliampere seconds).
Factors Influencing Contrast and Density

Factor Effect
Milliamperage (mA)
Decreased Decreased density
Increased Increased density
Kilovoltage (kVp)
Increased Increased density, low contrast
Decreased Decreased density, high contrast
Time (sec)
Decreased Decreased density
Increased Increased density
Radiation Effects
X-rays are a type of ionizing radiation that is harmful and causes
biologic changes in living tissue.
Exposure to radiation has a cumulative effect, meaning that
tissue undergoes damage and changes over a period of time.
Acute Radiation Exposure

Acute radiation exposure occurs when large amounts of radia-
tion are absorbed by tissue over a short period of time (i.e.,
exposure to nuclear fallout).
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Chronic Radiation Exposure
Chronic radiation exposure occurs when small amounts of radia-
tion are absorbed by tissue over an extended period of time.
During chronic exposure, symptoms of damage may not be
noticeable until years after the original exposure.
Critical Organs
Organs that are more susceptible to radiation exposure during
dental procedures are:
■ Skin
■ Thyroid gland
■ Bone marrow
■ Lens of the eye
Maximum Permissible Dose

According to the National Council on Radiation Protection and
Measurements (NCRP), the maximum permissible dose (MPD) is
the highest amount of radiation that the human body can receive
without enduring any injury.
■ MPD for occupational exposure: 5.0 rem/year.
■ MPD for non-occupational exposure: 0.1 rem/year.
Patient Protection
■ Lead apron and thyroid collar.
■ High-speed film or use of digital systems.
■ Proper technique that minimizes the number of retakes.
■ Exposure factors such as kVp and mA to minimum levels,
allowing diagnostic quality radiographs.
■ Use of aiming devices to avoid patient holding the film or
digital sensors.
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Operator Protection
■ Monitoring: use of monitoring devices such as badges.
■ Proper equipment operation.
■ Knowledge of safety regulation.
■ ADA and FDA guidelines state that pregnant operators must
use a lead apron during exposure of dental radiographs. The
embryo or fetus will not receive detectable amounts of
radiation if a lead apron is used.
ALERT: Keep radiation exposure to as low as reasonably
achievable.
Errors Due to Temperature, Solutions,

Contamination, and Film Handling
■ Underdeveloped film: Appears light; indicates not enough
developing time.
■ Overdeveloped film: Appears dark; indicates excessive
developing time.
■ Fixer spots: White spots; indicate fixer came into contact
with film prior to developing.
■ Developer spots: Dark spots; indicate developer came into
contact with film prior to developing.
■ Brown or yellow stains: Indicate inadequate chemicals.
■ Fingerprint: Indicates film touched by fingers.
■ Overlapping: Indicates films are in contact during
processing.
■ Developer/fixer cutoff: Indicates inadequate chemical levels.
■ Light lean in the dark room: Film appears black.
■ Fogged film: Indicates inappropriate safe light.
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Most Common Types of Dental
Radiographs
Intraoral
Periapical (PA)
A PA radiograph captures the entire tooth and its surrounding
structures. It is used primarily to identify periapical pathology.
Exposure techniques include the paralleling (aiming devices) and
bisecting the angle techniques. PA radiographs are taken in both
the anterior and posterior teeth.
Bitewing (BW)
A BW radiograph captures the posterior upper and lower teeth,
mainly the crown portion. There are two types of BW radio-
graphs. Premolar BWs include the first and second premolars
and mesially extend up to and distal to the canines. Molar BWs
include the first and second molars. Exposure techniques include
BW tabs or the use of aiming devices.
Intraoral Series
A full-mouth survey (FMX) is a series of usually 18 films: 14 PA
and 4 BW x-rays. An FMX survey is necessary to perform a
comprehensive dental examination.
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Exposing Techniques
Paralleling Technique
■ Place the film/sensor parallel to the long axis of the tooth of
interest.
■ Direct the central x-ray beam perpendicular to the long axis
of the tooth and the film.
■ Direct the central x-ray beam through the contact areas
between the teeth.
■ Use film size #1 or #2.
Tube
X-rays
Film
The use of XCP (extension cone paralleling) devices is recom-

mended for the paralleling technique for more accurate and
operator-free errors.
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Bisecting Technique
■ Bisecting technique is not an ideal technique but is useful in
special situations, such as in children and patients with
shallow, narrow mouths or flat palates.
■ Place the film against the tooth of interest.
■ Aim the central beam perpendicular to the imaginary
bisector of the angle formed between the long axis of the
tooth and the film.
■ Use film size #1 or #2.
Plastic bite blocks, aiming rings, and Eezee-Grip (Rinn) holders
can be used with the bisecting techniques.
Tube
Imaginary
line
X-rays
Film
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Occlusal Technique
■ Occlusal technique is used to examine large areas of the
upper or lower jaw.
■ Use film size #4.
■ It is often used in children.
■ Place film on the occlusal surface of the teeth with the white
portion facing the arch to be examined. Ask the patient to
gently bite on the film.
Recommended Sequence of Exposing an FMX
Note: This is just a recommendation and is based on providing
the patient with the most comfortable experience while at the
same time ensuring that all teeth have been exposed with no
double takes and minimal aiming device modification.
Teeth to expose, by number:
■ 6, 7 ■ 17, 18, 19
■ 8, 9 ■ 12, 13
■ 10, 11 ■ 14, 15, 16
■ 22, 23 ■ 28, 29
■ 24, 25 ■ 30, 31, 32
■ 26, 27 ■ R premolar BW
■ 4, 5 ■ R molar BW
■ 1, 2, 3 ■ L premolar BW
■ 20, 21 ■ L molar BW
Extraoral
Panoramic
Panoramic exposures provide a complete picture of the entire
oral cavity and surrounding structures.
In a panoramic x-ray, both the film and the tubehead rotate
around the patient’s head, producing individual images that,
when combined in a single film, produce an image of the upper
and lower jaw and surrounding structures.
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Procedure
■ Explain to the patient the procedure.
■ Ask the patient to remove all metal objects from the neck
up.
■ Place a lead apron with no thyroid collar on the patient.
■ Position the patient while standing “as tall as possible,” with
the midsagittal* plane perpendicular to the floor and the
Frankfort** plane parallel to the floor.
■ Instruct the patient to bite on the bite stick located on the
machine to focus on the focal trough***.
■ Ask the patient to swallow, place the tongue on the roof of
the mouth, and remain still during exposure.
*Midsagittal plane: Imaginary line that divides the patient’s face into left and right
sides
**Frankfort plane: Imaginary line that passes from the bottom of the eye socket to
the upper portion of the ear canal
***Focal trough: An imaginary three-dimensional zone in which the panoramic
images appear clear
Cephalometric
Cephalometric examination is mostly used in orthodontics
during the treatment planning phase. In addition, it is often used
to identify trauma, disease, and developmental abnormalities.
Cephalometric and other extraoral examination follow the pan-
oramic guidelines mentioned previously.
Other Extraoral Examinations
■ Reverse Towne projection: Identifies fractures in the ramus
and condyle of the mandible.
■ Submentovertex projection: Identifies zygomatic arch
fractures and presents the base of the skull.
■ Waters projection: Evaluates the sinus area.
■ Cone-beam computed tomography (commonly referred to
by the acronym CBCT) is a medical imaging technique
consisting of x-ray computed tomography in which the
x-rays are divergent, forming a cone.
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CBCT has become increasingly important in treatment

planning and diagnosis in implant dentistry, as well as in
orthodontics and endodontics.
Digital Radiography

■ The use of digital radiography is increasing rapidly.

■ It uses a sensor rather than a film to record electron
impulses and then digitizes the image through a computer,
producing a diagnostic image.
■ It requires much less radiation exposure to produce
diagnostic quality images (50%–80% less radiation).
■ The same intraoral x-ray units may be used.
■ It is applied both in intraoral and extraoral examinations.
■ Several systems are available.
■ The same positioning principles apply as for traditional
radiography.
■ Start-up costs for this technology are expensive.
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Types of Digital Radiography
Direct Digital Imaging
■ A sensor is placed in the patient’s mouth, and it is exposed
to x-rays.
■ The sensor can be wired or wireless.
■ The sensor captures the exposed image and transfers it to
the computer.
Indirect Digital Imaging
■ An already existing radiograph.
■ A CCD (charge coupled device).
■ A computer.
■ Existing radiograph is digitized using the CCD device and
transferred to the computer using a scanner.
■ Inferior quality as the result is a copy and not the original
image.
Storage Phosphor Imaging
■ Wireless.
■ A reusable phosphor plate is used instead of a sensor.
■ Acts as an intensifying screen.
■ Image is captured and then via a laser scanner is transferred
to the computer.
Advantages versus Disadvantages

Advantages
■ Up to 80% less radiation exposure.
■ Great tool in patient education.
■ Apart from initial investment, lower cost because of the lack
of developing solutions and film.
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Disadvantages
■ High initial start-up cost.
■ Sensor size being bulky creates problems to some patients.
■ Because sensors cannot be sterilized, special attention must
be paid to infection control.
Infection Control Sites

Areas of radiography equipment that are likely to be contami-
nated are as follows:
■ Tubehead
■ PID
■ Control panel
■ Dental chair
■ Lead apron
■ Counter surfaces
■ Darkroom equipment
■ Computer hardware (e.g., mouse, keyboard)
■ Sensor protective sleeves
■ Holding and aiming devices
■ Film
Infection Control Checklist

Prior to Exposure
■ Cover or disinfect
■ X-ray machine
■ Work area
■ Lead apron
■ Dental chair
■ Wash hands (operator)
■ Put on gloves (operator)
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During Exposure
■ Dry and wipe the exposed film with a paper towel.
■ Place film in a disposable container.
After Exposure
■ Dispose of all contaminated items.
■ Place film-holding devices in designated area for
contaminated objects.
■ Remove gloves.
■ Wash hands.
■ Remove lead apron.
Infection control checklist modified from: Ianucci, J., & Jansen Howerton, L. (2011).
Dental Radiography: Principles and Techniques, ed 4. St Louis: Saunders.
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General Dentistry Instruments

Acorn Burnisher
■ To burnish permanent and temporary filling materials

Amalgam Carrier
■ To carry amalgam
■ Single or double ended
■ Various sizes depending on size of the cavity preparation
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Amalgam Well
■ To hold amalgam after trituration and before placing into
the cavity
■ Made in various sizes and from different materials

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Anesthetic Syringe
■ To deliver anesthetic solution
■ Aspirating capabilities to avoid injection of anesthetic
directly in a blood vessel
■ Various types

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Articulating Paper Holder
■ To hold articulating paper in place during occlusion checks

INSTR
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Cement Spatula
■ To mix temporary and permanent cements as well as
various filling materials

Chisel
■ To smooth and plane enamel within the cavity preparation

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Composite Instrument
■ To carry and place composite material in the cavity
preparation

Condenser
■ To condense permanent and temporary filling materials in
the cavity preparation

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Cotton Forceps
■ To carry objects in and out of the mouth
■ Locking type available
■ Various sizes

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Dental Dam Clamps
■ To stabilize dental dam
■ Various shapes and sizes to accommodate various teeth

INSTR
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Dental Dam Forceps

■ To place and remove clamp

Dental Dam Frame

■ To hold and support dental dam

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Dental Dam Punch
■ To punch holes in the dental dam for teeth involved

Discoid-Cleoid
■ To create occlusal anatomy in permanent and temporary
filling materials

INSTR
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Explorer

Gingival Margin Trimmer

■ To create bevels in the gingival margins of the preparation

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Hatchet
■ To remove unsupported enamel rods
Hoe
■ To smooth the cavity preparation

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Hollenback Carver
■ To contour anatomy in interproximal areas in permanent
and temporary restorative materials

Liner Placement Instrument

■ To mix and place various types of liners into the cavity
preparation

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Matrix Band Retainer (Tofflemire)
■ To hold and support the matrix band during restorations

Mouth Mirror
■ To retract soft tissue
■ To provide indirect vision
■ To reflect light
■ Disposable or not
■ Single or double sided
■ Various sizes and styles
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Periodontal Probe
■ To measure pocket depths
■ Various measuring increments
■ Various types and shapes

Spoon Excavator
■ To remove decay
■ Multiple secondary functions
■ Single or double ended
■ Various size and shapes
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Friction Grip Burs
Diamond

INSTR
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Fissure: Cross-Cut Straight

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Fissure: Cross-Cut Tapered

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Fissure: Plain Straight

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Fissure: Plain Tapered

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Inverted Cone

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Pear Shape

Round

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Basic Endodontic Instruments

Broach
■ To remove pulp tissue from the canal
Endodontic Condenser (plugger)

■ To assist in vertical condensation of the gutta percha
■ Can also be used to condense the final filling of the root
canal
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Endodontic Explorer
■ To locate access openings of canal during endodontic
treatment.
Endodontic Spreader
■ To assist in the lateral condensation of the gutta percha
■ Can also be used to condense the final filling of the root
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Endodontic Stand
■ To hold for easy access of files and burs
File (K-Type)
■ To contour and shape the root canals before obturation
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Gates Glidden
■ To enlarge the pulp chamber
■ Attaches to slow speed (latch type)
Gutta-Percha
■ To fill root canal during the obturation process
■ Various sizes
■ Pliable when heated
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Paper Points
■ To dry root canals before obturation
■ Various sizes
Sodium Hypochlorite Syringe
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Basic Oral Surgery Instruments
Anterior Mandibular Forceps
■ To remove anterior mandibular teeth
Bone File
■ To smooth alveolar bone following tooth extraction
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Chisel and Mallet

■ To assist in splitting tooth or bone
Cryer Elevators (East and West)

■ To assist in elevating roots when crown portion of tooth is
broken
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Hemostat
■ To hold on to tissue or bone pieces
■ Various sizes and shapes
■ Longer beaks
Reprinted with permission from: Bidwell, J., & Grafft, D.

(Forthcoming). Surgical Procedures for Surgical Technology
and Surgical Assisting, ed 1. Philadelphia: F.A. Davis
Company.
INSTR
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Mandibular Molar Universal Forceps (Cowhorn)

■ To remove lower molar teeth
Mandibular Universal Forceps (151)

■ To remove all lower teeth
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Maxillary Left Forceps (88L)
■ To remove trifurcated maxillary left first and second molars
Maxillary Right Forceps (88R)

■ To remove trifurcated maxillary right first and second
molars
INSTR
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Maxillary Universal Forceps (150)

■ To remove all upper arch teeth
Mouth Props
■ To hold patient’s mouth open
■ Various shapes and sizes
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Needle Holder
■ To hold on to the suture needle
■ Short beaks with indentation to hold on to the needle
securely
Periosteal Elevator
■ To separate tissue from bone and/or tooth
INSTR
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Rongeurs
■ To smooth and contour alveolar bone after tooth extraction
■ Hinged forceps
Root Tip Picks

■ To remove broken root tips
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Scalpel Handle with Blades
■ To cut tissue
■ Can be disposable
■ Blades come in various shapes and sizes
Straight Elevator
■ To luxate and elevate the tooth from its socket
INSTR
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Surgical Curette
■ To remove abscessed or granulation tissue
■ Various sizes
■ Can be single or double ended
Suture Scissors
■ To cut off sutures
■ Rounded or straight end
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Tissue Scissors
■ To cut excess tissue
Reprinted with permission from: Bidwell, J., & Grafft, D.

(Forthcoming). Surgical Procedures for Surgical Technology
and Surgical Assisting, ed 1. Philadelphia: F.A. Davis
Company.
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Basic Orthodontics Instruments

Band Pusher
■ To push bands into place during orthodontic procedures
Bird Beak
■ To bend and contour wire
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Bands and Brackets
Bracket Placement Pliers

■ To carry and place brackets on tooth for cementation or
bonding
INSTR
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Bracket Remover
■ To remove brackets upon completion of orthodontic
treatment
Distal End Cutter

■ To cut distal end of arch wire after placement in brackets
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Elastic Placement Pliers
■ To place elastics around brackets and wires
Elastics
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Ligature-Tying Pliers
■ To tie ligatures onto arch wire
Three-Prong Bender
■ To bend and contour wire
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Weingart Pliers
■ To place and remove arch wire or brackets
Wire
INSTR
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Wire Cutter
■ To cut wire
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Dental Assistant Profession
The American Dental Assistant’s Association (ADAA) has defined
a Code of Ethics for Dental Assistants that delineates the profes-
sion (www.adda.org).
Profession Preservation
The concept of profession preservation encourages the dental
assistant to assume the obligation of maintaining and enriching
the profession based on the needs of the individuals the profes-
sion of dentistry is committed to serve. This concept can be
achieved as follows.
Professionalism
The dental assistant should at all times:
■ Maintain confidentiality.
■ Perform only duties allowed by state law.
■ Prove competency in allowed duties.
■ Show respect for dentists.
Professional Development
The dental assistant should constantly strive to enrich his or her
knowledge of the profession and to upgrade and perfect hand
and technical skills for the benefit of the employer and the human
beings he or she serves.
Involvement
Every dental assistant should exhibit a commitment to the pro-
fession by being involved with professional associations in a
local, state, or national level to better the profession via construc-
tive feedback and recommendation.
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Common Dental Terminology

Abscess: Acute or chronic, localized inflammation with a
concentration of pus, associated with tissue destruction and
frequently swelling, usually secondary to infection.
Abscess, periapical: Acute or chronic inflammation and pus

formation at the end of a tooth root in the alveolar bone
secondary to infection.
Abscess, periodontal: Abscess of the gingiva or periodontal

tissue as a result of periodontal infection.
Abutment: A tooth or implant used to support a fixed

prosthesis.
Acid etching: Use of an acid, most commonly phosphoric acid,

to prepare the tooth enamel or dentin surface to provide
retention for bonding.
Adhesive: Any chemical substance that joins or creates close

adherence of two or more surfaces.
Alveolar: Referring to the bone surrounding the tooth.
Alveoloplasty: Surgical procedure for soothing and

recontouring alveolar bone, usually in preparation for a
prosthesis.
Amalgam: An alloy used in direct dental restorations.
Analgesia: Loss of pain sensations without loss of

consciousness.
Anterior teeth: The teeth and tissues located toward the front
of the mouth; the maxillary and mandibular incisors and
canines.
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Anxiolysis: Reduction of anxiety using a pharmacologic agent
such as a benzodiazepine or nitrous oxide.
Apicoectomy: Amputation of the apex of a tooth.
Avulsion: Separation of tooth from its socket due to trauma.
Benign: The nonmalignant character of a neoplasm.
Bicuspid: A tooth with two cusps.
Bilateral: Pertaining to the right and left sides.
Biopsy: Removal of tissue for histologic evaluation.
Bitewing radiograph: Interproximal view radiograph of the

coronal portion of the tooth.
Bonding: Process by which two or more components are made

integral by mechanical or chemical adhesion at their
interface.
Bruxism: Abnormal grinding of the teeth.
Buccal: Pertaining to or around the cheek.
Calculus: Hard mineralized material adhering to crowns or

roots of teeth.
Canal: Space inside the root portion of a tooth containing pulp

tissue.
Caries: Commonly used term for tooth decay.
Cavity: Decay in tooth caused by caries; also referred to as

carious lesion.
Cement base: Material used under a filling to replace lost tooth

structure.
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Cementum: Hard connective tissue covering the tooth root.
Cephalometric radiograph: A radiographic head film used in

the scientific study of the measurements of the head with
relation to specific reference points.
Cleft palate: Congenital deformity resulting in lack of fusion of

the soft or hard palate (or both), either partial or complete.
Clenching: The clamping and pressing of the jaws and teeth

together in centric occlusion frequently associated with
psychological stress or physical effort.
Composite: A dental restorative material made up of disparate

or separate parts (e.g., resin and quartz particles).
Coronal: The clinical crown of a tooth.
Curettage: Scraping and cleaning the walls of a cavity or

gingival pocket.
Cyst: Pathological cavity, usually lined with epithelium,

containing fluid or soft matter.
Cyst, odontogenic: Cyst derived from the epithelium of

odontogenic tissue (developmental, primordial).
Cyst, periapical: Cyst at the apex of a tooth with a nonvital

pulp.
Débridement: Removal of subgingival or supragingival plaque

and calculus that obstructs the ability to perform an
evaluation.
Decay: The lay term for carious lesions in a tooth;

decomposition of tooth structure.
Deciduous: Having the property of falling off or shedding; a

name used for the primary teeth.
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Dental prophylaxis: Scaling and polishing procedure performed
to remove coronal plaque, calculus, and stains.
Dentin: That part of the tooth that is beneath enamel and

cementum.
Dentition: The teeth in the dental arch.
Denture: An artificial prosthesis for natural teeth and adjacent

tissues.
Denture base: The part of a denture that makes contact with

soft tissue and retains the artificial teeth.
Diagnostic cast: Plaster or stone model of teeth and adjoining

tissues; also referred to as study model.
Diastema: A space, such as one between two adjacent teeth in

the same dental arch.
Direct restoration: A restoration fabricated inside the mouth.
Displaced tooth: A partial evulsion of a tooth.
Distal: Toward the back of the dental arch (or away from the
midline).
Dry socket: Localized inflammation of the tooth socket after

extraction caused by infection or loss of blood clot; alveolitis.
Edentulous: Without teeth.
Enamel: Hard calcified tissue covering dentin of the crown of a

tooth.
Evaluation, comprehensive: Typically used by a general dentist

or specialist when evaluating a patient comprehensively. It is
a thorough evaluation and recording of the extraoral and
intraoral hard and soft tissues. It may require interpretation
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of information acquired through additional diagnostic

procedures. This would include the evaluation and recording
of the patient’s dental and medical history and a general
health assessment.
Evaluation, limited oral: A problem-focused evaluation limited

to a specific oral health problem. This may require
interpretation of information acquired through additional
diagnostic procedures. Definitive procedures may be
required on the same date as the evaluation.
Evaluation, periodic oral: An evaluation performed on a patient

of record to determine any changes in the patient’s dental
and medical health status since a previous comprehensive or
periodic evaluation.
Excision: Surgical removal of bone or tissue.
Exostosis: Overgrowth of bone.
Extraoral: Outside the mouth.
Exudate: A material usually resulting from inflammation or

necrosis that contains fluid, cells, or other debris.
Facial: The surface of a tooth directed toward the face

(including the buccal and labial surfaces) and opposite the
lingual surface. Facial surface equals buccal surface in the
posterior or the labial in the anterior.
Filling: A term used for the restoration of lost tooth structure

by using materials such as metal, alloy, plastic, or porcelain.
Fixed partial denture: A prosthetic replacement of one or more

missing teeth cemented or attached to the abutment teeth or
implant abutments adjacent to the space.
Foramen: Natural opening into or through bone.
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Fracture: The breaking of a part, especially of a bony structure;
breaking of a tooth.
Frenum: Muscle fibers covered by a mucous membrane that

attaches the cheek, lips, or tongue to associated dental
mucosa.
Furcation: The anatomic area of a multirooted tooth where the

roots diverge.
General anesthesia: A controlled state of unconsciousness,

accompanied by a partial or complete loss of protective
reflexes, including loss of ability to independently maintain
airway and respond purposefully to physical stimulation or
verbal command, produced by a pharmacologic or
nonpharmacologic method or combination thereof.
Gingiva: Soft tissues overlying the crowns of unerupted teeth

and encircling the necks of those that have erupted.
Gingivectomy: The excision or removal of gingiva.
Gingivitis: Inflammation of gingival tissue without loss of

connective tissue.
Gingivoplasty: Surgical procedure to reshape gingiva.
Glass ionomer: Material in which the solid powdered phase is

a fluoride-containing glass powder. The material is
translucent and can be used as a restoration, a liner, and a
luting agent.
Graft: A piece of tissue or alloplastic material placed in contact

with tissue to repair a defect or supplement a deficiency.
Hemisection: Surgical separation of a multirooted tooth.
Implant: Material inserted or grafted into tissue; a device

especially designed to be place surgically within or on the
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mandibular or maxillary bone as a means of providing for

dental replacement.
Incisal: Pertaining to the biting edges of the incisor and cuspid

teeth.
Indirect pulp cap: Procedure in which the nearly exposed pulp

is covered with a protective dressing to protect the pulp from
additional injury and to promote healing and repair via
formation of secondary dentin.
Indirect restoration: A restoration fabricated outside the

mouth.
Inlay: An indirect intracoronal restoration; a dental restoration

made outside the oral cavity to correspond to the form of the
prepared cavity, which is then luted into the tooth.
Interproximal: Between the adjoining surfaces of adjacent teeth

in the same arch.
Intracoronal: Referring to “within” the crown of a tooth.
Intraoral: Inside the mouth.
Intravenous sedation or analgesia: A medically controlled state

of depressed consciousness while maintaining the patient’s
airway, protective reflexes, and the ability to respond to
stimulation or verbal commands. It includes intravenous
administration of sedative or analgesic agent(s) (or both) and
appropriate monitoring.
Labial: Pertaining to or around the lip.
Lesion: An injury or wound; area of diseased tissue.
Lingual: Pertaining to or around the tongue; surface of the

tooth directed toward the tongue; opposite of facial.
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Local anesthesia: The loss of pain sensation over a specific
area of the anatomy without loss of consciousness.
Maintenance, periodontal: Therapy for preserving the state of

health of the periodontium.
Malignant: Having the properties of dysplasia, invasion, and

metastasis.
Malocclusion: Improper alignment of biting or chewing

surfaces of upper and lower teeth.
Maryland bridge: Fixed partial denture feature conservative

retainers that are resin bonded to abutments.
Maxilla: The upper jaw.
Mesial: Toward the midline of the dental arch; opposite of

distal.
Molar: Teeth posterior to the premolars (bicuspids) on either

side of the jaw.
Mucous membrane: Lining of the oral cavity as well as other

canals and cavities of the body; also called mucosa.
Nonintravenous conscious sedation: A medically controlled

state of depressed consciousness while maintaining the
patient’s airway, protective reflexes, and ability to respond to
stimulation or verbal commands.
Occlusal: Pertaining to the biting surfaces of the premolar and

molar teeth or contacting surfaces of opposing teeth or
opposing occlusion rims.
Occlusal radiograph: An intraoral radiograph made with the

film being held between the occluded teeth.
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Occlusion: Any contact between biting or chewing surfaces of

maxillary (upper) and mandibular (lower) teeth.
Odontoplasty: Adjustment of tooth length, size, or shape;

includes removal of enamel projections.
Onlay: An indirect restoration made outside the oral cavity that

overlays a cusp or cusps of the tooth, which is then luted to
the tooth.
Oral pathology: The specialty of dentistry and pathology

concerned with recognition, diagnosis, investigation, and
management of diseases of the oral cavity, jaws, and
adjacent structures.
Orthognathic: Functional relationship of the maxilla and

mandible.
Osteoplasty: Surgical procedure that modifies the configuration

of bone.
Osteotomy: Surgical cutting of bone.
Overdenture: A removable prosthetic device that overlies and

may be supported by retained tooth roots or implants.
Palate: The hard and soft tissues forming the roof of the mouth
that separates the oral and nasal cavities.
Palliative: Action that relieves pain but is not curative.
Panoramic radiograph: An extraoral radiograph on which the

maxilla and mandible are depicted on a single film.
Partial denture: Usually refers to a prosthetic device that

replaces missing teeth; see fixed partial denture or
removable partial denture.
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Periapical radiograph: A radiograph made by the intraoral
placement of film for disclosing the apices of the teeth.
Periodontal: Pertaining to the supporting and surrounding

tissues of the teeth.
Periodontal disease: Inflammatory process of the gingival

tissues or periodontal membrane of the teeth, resulting in an
abnormally deep gingival sulcus, possibly producing
periodontal pockets and loss of supporting alveolar bone.
Periodontal pocket: Pathologically deepened gingival sulcus; a

feature of periodontal disease.
Periodontitis: Inflammation and loss of the connective tissue of

the supporting or surrounding structure of teeth with loss of
attachment.
Periradicular: Surrounding a portion of the root of the tooth.
Plaque: A soft, sticky substance that accumulates on teeth

composed largely of bacteria and bacterial derivatives.
Pontic: An artificial tooth on a fixed partial denture (bridge).
Post: An elongated projection fitted and cemented within the

prepared root canal, serving to strengthen and retain
restorative material or a crown restoration.
Posterior: Refers to teeth and tissues toward the back of the

mouth (distal to the canines); the maxillary and mandibular
premolars and molars.
Premedication: The use of medications before dental

procedures.
Primary dentition: The first set of teeth; see deciduous.
RESOURCE
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Prophylaxis: Scaling and polishing procedure performed to

remove coronal plaque, calculus, and stains.
Prosthesis: Artificial replacement of any part of the body. A

dental prosthesis is any device or appliance replacing one or
more missing teeth and, if required, associated structures.
(This is a broad term that includes abutment crowns and
abutment inlays and onlays, bridge, dentures, obturators,
and gingival prostheses.)
Prosthesis, fixed: Nonremovable tooth or implant-borne dental

prosthesis attached to abutment teeth or roots or implants.
Prosthesis, interim: A provisional prosthesis designed for use

over a limited period of time, after which it will be replaced
by a more definitive restoration.
Prosthesis, removable: Dental prosthesis designed to be

removed and reinserted by the patient.
Provisional: Formed or preformed for temporary purposes or

used over a limited period; a temporary or interim solution;
usually refers to a prosthesis or individual tooth restoration.
Pulp: Connective tissue that contains blood vessels and nerve

tissue that occupies the pulp cavity of a tooth.
Pulp cavity: The space within a tooth that contains the pulp.
Pulpectomy: Complete removal of vital and nonvital pulp

tissue from the root canal space.
Pulpitis: Inflammation of the dental pulp.
Pulpotomy: Surgical removal of a portion of the pulp with the

aim of maintaining the vitality of the remaining portion by
means of an adequate dressing; pulp amputation.
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Quadrant: One of the four equal sections into which the dental
arches can be divided; begins at the midline of the arch and
extends distally to the last tooth.
Rebase: Process of refitting a denture by replacing the base

material.
Reline: Process of resurfacing the tissue side of a denture with

new base material.
Reimplantation: The return of a tooth to its alveolus.
Removable partial denture: Prosthetic replacement of one or

more missing teeth that can be removed by the patient; a
removable bridge.
Retainer, orthodontic: Appliance to stabilize teeth after

orthodontic treatment.
Retainer, prosthodontic: A part of a fixed partial denture that

attaches a pontic to the abutment tooth, implant abutment,
or implant.
Retrograde filling: A method of sealing the root canal by

preparing and filling it from the root apex.
Root: The anatomic portion of the tooth that is covered by

cementum and is located in the alveolus (socket) where it is
attached by periodontal ligaments.
Root canal: The portion of the pulp cavity inside the root of a
tooth; the chamber within the root of the tooth that contains
the pulp.
Root canal therapy: The treatment of disease and injuries of

the pulp and associated periradicular conditions.
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Root planing: A procedure designed to remove microbial flora,

bacterial toxins, calculus, and diseased cementum or dentin
on the root surfaces and in the pocket.
Scaling: Removal of plaque, calculus, and stains from teeth.
Splint: A device used to support, protect, or immobilize oral

structures that have been loosened, replanted, fractured, or
traumatized.
Stomatitis: Inflammation of the membranes of the mouth.
Study model: Plaster or stone model of teeth and adjoining

tissues; also referred to as diagnostic cast.
Suture: Stitch used to repair incision or wound.
Temporomandibular joint (TMJ): The connecting hinge

mechanism between the base of the skull (temporal bone)
and the lower jaw (mandible).
Temporomandibular joint dysfunction: Abnormal functioning

of the temporomandibular joint; also refers to symptoms
arising in other areas secondary to the dysfunction.
Tissue conditioning: Material intended to be placed in contact

with tissues for a limited period with the aim of assisting the
return to a healthy condition.
Torus: A bony elevation or protuberance of bone; see

exostosis.
Trismus: Restricted ability to open the mouth, usually caused

by inflammation or fibrosis of the muscles of mastication.
Unerupted: Refers to a tooth or teeth that have not penetrated

the oral cavity.
Unilateral: One sided; pertaining to or affecting only one side.

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Veneer: In the construction of crowns or pontics, a layer of
tooth-colored material, usually, but not limited to, composite,
porcelain, ceramic, or acrylic resin, attached to the surface by
direct fusion, cementation, or mechanical retention.
Vestibuloplasty: Any of a series of surgical procedures

designed to increase relative alveolar ridge height.
Xerostomia: Decreased salivary secretion that produces a dry

and sometimes burning sensation of the oral mucosa or
cervical caries.
X-ray: A radiograph.
Spanish Terms
Medical Questions
The Spanish Terms section is reprinted with permission from:
Prajer, R., & Grosso, G. (2011). DH Notes: Dental Hygienist’s
Chairside Pocket Guide, ed 1. Philadelphia: F.A. Davis Company;
pp. 202–204.
What are your physician’s name and phone number?

¿Qué es el nombre de su médico y el número de teléfono?
Are you taking any medications? If so, what?

¿Toma medicina? ¿Si eso es el caso, qué?
Do you have any heart problems?

¿Tiene algúnos problemas cardíacso?
Do you have high blood pressure?

¿Tiene la hipertensión?
Do you have diabetes?

¿Tiene la diabetes?
RESOURCE
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Do you have any allergies?

¿Tiene algunas alergias?
Are you allergic to any medications?

¿Es alérgico a medicina?
Do you have to take antibiotics before dental treatment?

¿Tiene que tomar antibióticos antes de tratamiento dental?
Have you recently been hospitalized?

¿Ha sido hospitalizado recientemente?
Dental Questions
When was your last dental visit?
¿Cuándo fue su última visita dental?
Are you having any problems with your teeth?

¿Tiene cualquier problemas con los dientes?
Do you have any pain?

¿Tiene dolor?
How often do you brush?

¿Con qué frecuencia se cepilla?
How often do you floss?

¿Con qué frecuencia se limpia con hilo dental?
Do your gums bleed when you brush, floss, or eat?

¿Sangran sus gomas cuando se cepilla, limpia con hilo dental
o come?
When were your last dental x-rays?

¿Cuándo fueron sus últimas radiografías dentales?
Is there anything that you would like to discuss with the

dentist?
¿Hay algo que usted querria discutir con el dentista?
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Treatment Directives
Open your mouth.
Abra la boca.
Close your mouth.

Cierre la boca.
Swish and spit.

Mueva y escupa.
Swallow.
Trague.
Close your teeth together.

Cierre los dientes juntos.
Bite down.
Muerda hacia abajo.
Chin up.
El mentón arriba.
Web References
American Dental Association
http://www.ada.org
American Heart Association
http://www.americanheart.gov
Centers for Disease Control and Prevention
http://www.cdc.gov
Dental Assistant National Board
http://www.danb.org
Medline Plus
http://www.nlm.nih.gov
National Institute for Occupational Safety and Health
http://www.cdc.gov/niosh
RESOURCE
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U.S. Department of Labor Occupational Safety and Health

http://www.osha.gov
References
American Dental Association. (2011). Radiography/Xrays.
Retrieved October, 18, 2011, from http://www.ada.org/prf/
resources/topics/topics_radiography_chart.pdf.
American Heart Association. (2011). Endocarditis Prophylaxis
Information. Retrieved June 22, 2011, from http://
wwwamericanheart.org/presenter.jhtml?identifier = 1108.
American Society of Anesthesiologists. (2009). ASA Physical
Status Classification System. Retrieved August 9, 2011, from
http://www..asahg.org/clinical/physicalstatus.htm.
Bird, D., & Robinson, D. (2009). Modern Dental Assisting, ed 9. St
Louis: Saunders Elsevier.
Brunick, A., & Clark, M. (2008). Handbook of Nitrous Oxide and
Oxygen. St Louis: Mosby/Elsevier.
CDC. Guidelines for environmental infection control in health-care
facilities: recommendations of CDC and the Healthcare Infection
Control Practices Advisory Committee (HICPAC). MMWR
2003;52(No. RR-10).
Chesnutt, I., & Gibson, J. (2002). Clinical Dentistry. Edinburgh:
Harcourt Publishers Limited/Churchill Livingstone.
Dofka, C. (2007). Dental Terminology, ed 2. Thompson Delmar
Learning.
F.A. Davis Company. (2009). Taber’s Cyclopedic Medical
Dictionary, ed 21. Philadelphia: F.A. Davis Company.
Food and Drug Administration. Guidance for Industry and FDA
Reviewers: Content and Format of Premarket Notification
[510(k)] Submissions for Liquid Chemical Sterilants/High Level
Disinfectants. Rockville, MD: US Department of Health and
Human Services, Food and Drug Administration, 2000.
Available at http://www.fda.gov/cdrh/ode/397.pdf.
168
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Grimes, E. (2009). Medical Emergencies. Upper Saddle River, NJ:
Pearson Prentice Hall.
Ianucci, J., & Jansen Howerton, L. (2006). Dental Radiography
Principles and Techniques, ed 3. St Louis: Saunders.
Kohn, W.G., Collins, A.S., Cleveland, J.L., et al. (2003). Centers for
Disease Control and Prevention. Guidelines for infection control
in dental health-care settings—2003. MMWR Recomm Rep
52(RR-17):1–61.
Little, J., Falace, D., Miller, C., & Rhodus, N. (2008). Dental
Management of the Medically Compromised Patient, ed 7. St
Louis: Elsevier/Mosby.
Malamed, S. (2004). Handbook of Local Anesthesia, ed 5. St
Louis: Elsevier/Mosby.
Malamed, S. (2007). Medical emergencies in the Dental Office, ed
6. St Louis: Elsevier/Mosby.
Mauriello, S., Overman, V., & Platin, E. (1995). Radiographic
Imaging for the Dental Team. Philadelphia: J.B. Lippincott.
Miles DA, Van Dis ML, Jensen CW, et al.: Radiographic Imaging
for Dental Auxiliaries, 3rd Ed. Philadelphia, W.B. Saunders,
1999.
Miller, C.H., & Palenik, C.J. (2004). Infection Control &
Management of Hazardous Materials for the Dental Team, ed 3.
St Louis: Mosby-Year Book; 260–275.
Mosby. (2012). Dental Drug Reference, ed 10. St Louis: Mosby.
Mosby. (2004). Spanish terminology for the Dental Team. St
Louis: Mosby
Organization for Safety & Asepsis Procedures. (2004). From Policy
to Practice: OSAP’s Guide to the Guidelines. Annapolis, MD:
OSAP; 45–62.
Organization for Safety & Asepsis Procedures. (2005). Surface
disinfectants for dentistry: tools for selecting and using surface
disinfectants in dental settings. Infection Control In Practice.
Vol 4:1.
RESOURCE
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Pickett, F., & Gurenlian, J. (2010). Preventing Medical

Emergencies: Use of Medical History, ed 2. Philadelphia:
Lippincott Williams & Wilkins.
Turley, S. (2010). Understanding Pharmacology for Health
Professionals, ed 4. Upper Saddle River, NJ: Pearson.
U.S. Department of Labor, Occupational Safety and Health
Administration. (2001). 29CFR Part 1910.1030. Occupational
Exposure to Bloodborne Pathogens; Needlesticks and Other
Sharps Injuries; Final Rule. Fed Reg 66:5317–5325. As amended
from and includes 29 CFR Part 1910.1030. U.S. Department of
Labor, Occupational Safety and Health Administration. (1991).
Occupational exposure to bloodborne pathogens; final rule. Fed
Reg 56:64174–64182. Available at http://www.osha.gov/SLTC/
dentistry/index.html.
Williams & Wilkins. (1997). Stedman’s Concise Medical Dictionary
for the Health Professions, ed 3.Baltimore, MD: Williams and
Wilkins.
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INDEX
A Anesthesia/anesthetics, 45–58
Abscess(es), 15–16 152 color coding, 48
Abutment, 152 general, 157
Acid etching, 152 injections, 48–58
Acorn burnisher, 106 local, 46–47, 159
Acute radiation exposure, 94 syringe, 108
Adhesive, 152 topical, 45–46
Airway(s), obstructed, 9–10 Angina pectoris, 10–11
Albuterol, 24 Anode, 89
Albuterol–ipratropium, 20 Anterior mandibular forceps,
Alcohol-based hand wash, 133
77 Anterior superior alveolar
Alendronate sodium, 21 (ASA) injection, 52
Alprazolam, 25 Anterior teeth, 152
Alveolar, 152 Antibiotic prophylaxis regimen,
Alveolar osteitis, 16 5
Alveoloplasty, 152 Antisepsis, surgical, 77
Amalgam, 152 Antiseptic hand wash, 77
Amalgam carrier, 106–107 Anxiolysis, 153
Amalgam wall, 107 Apicoectomy, 153
American Dental Assistant’s Articaine, 47
Association (ADAA) Articulating paper holder, 109
Code of Ethics for Dental Aspiration, foreign body, 13
Assistants of, 151 Atenolol, , 24
American Society of Automated external
Anesthesiologists (ASA) defibrillator, 9
classification system for Avulsed tooth, 16–17
physical status, 1–2 Avulsion, 153
Amiodipine, 23 Azithromycin, 25
Amitriptyline HCl, 21
Amlodipine–benazepril, 22 B
Amoxicillin, 18 Band(s), orthodontic, 145
Amphetamine/ Band pusher, orthodontic, 144
dextroamphetamine, 18 Benign, 153
Analgesia, 152 Benzocaine, 46
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Bicuspid, 153 Celecoxib, 19

Bilateral, 153 Cement base, 153
Biopsy, 153 Cement spatula, 110
Bird beak, orthodontic, 144 Cementum, 154
Bisecting technique, 99 Centers for Disease Control and
Bite, open, 45 Prevention (CDC)
Bitewing (BW) radiograph, 97, infection control guidelines
153 of, 74–76
Blood pressure, 6–7 Cephalometric radiograph, 101,
Blood pressure types, in adults, 154
7 Cetacaine, 46
Bloodborne pathogens, 75 Chain of survival, 8
Bonding, 153 Chairside, 26–69
Bone file, 133 anesthesia, 45–58
Bracket(s), orthodontic, 145 basic principles, 67
Bracket placement pliers, 145 concepts, 62–69
Bracket remover, 146 dentist positioning, 64
Bridge(s), Maryland, 159 dentition, 26–45
Broach, 128 four-handed dentistry, 62–64
Broken instrument, 11 instrument transfer, 68
Broken tooth, 17 motions, 65–67
Bruxism, 153 nitrous oxide sedation,
Buccal, 153 58–61
Buccal nerve block, 57 Charting, 36
Bupivacaine, 47 Chisel, 110, 134
Bupropion HCl, 25 Chlordiazepoxide, 22
Buspirone, 19 Citalopram, 19
Clamp(s), dental dam, 113
C Class I occlusion, 39
CAB of CPR, 8 Class II occlusion, 40–41
Cabamazepine, 24 Class III occlusion, 41
Calculus, 153 Cleft palate, 154
Canal, 153 Clenching, 154
Cardiopulmonary resuscitation Clinical contact surfaces, 83
(CPR), 8–10 Clopidogref, 24
Caries, 153 Clozapine, 19
Cathode, 89 Code of Ethics for Dental
Cavity, 153 Assistants
Cavity classification, 33–35 of ADAA, 151
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Color coding, 36 cephalometric, 101
for anesthesia, 48 exposing techniques, 98–100
for charts, 36 extraoral series, 100–102
Composite, 154 FMX, 97
Composite instrument, 111 intraoral series, 97–100
Comprehensive evaluation, occlusal technique, 100
155–156 PA, 97
Computed tomography (CT), panoramic, 100–101
101–102 paralleling technique, 98
Condenser (plugger), 111 types of, 97–102
endodontic, 128 Dental terminology, 152–165
Cone beam computed Dentin, 155
tomography (CBCT), 101–102 Dentition, 26–45
Coronal, 154 cavity classification, 33–35
Cotton forceps, 112 charting, 36
Cowhorn forceps, 136 deciduous, 26
Cracked tooth syndrome (CTS), defined, 155
17 dental abbreviations, 37–39
Crossbite, 42 misalignment/malocclusion,
Cryer elevators (east and west), 42–45
134 occlusion, 39–41
Curettage, 154 permanent, 27
Cyst(s), 154 primary, 31, 161
tooth eruption tables, 26–27
D tooth numbering, 28–32
Debridement, 154 tooth surface abbreviations,
Decay, 154 36
Deciduous, 154 Denture, 155, 160, 163
Deciduous dentition, 26 Denture base, 155
Dental abbreviations, 37–39 Diabetic emergency, 11–12
Dental dam clamps, 113 Diagnostic cast, 155
Dental dam forceps, 114 Diastema, 155
Dental dam frame, 114 Diazepine, 25
Dental dam punch, 115 Digital radiography, 102–104
Dental emergencies, 15–17 Dipyridamole–ASA, 18
Dental prophylaxis, 155 Direct restoration, 155
Dental radiographs. Discoid-cleoid, 115
bisecting technique, 99 Displaced tooth, 155
BW, 97 Distal, 155
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Distal end cutter, orthodontic, Enoxaparin sodium, 22

146 Environmental surfaces
Doxazosyn mesylate, 19 infection control related to,
Dry socket, 16, 155 82–84
Epinephrine, lidocaine with,
E 47
Edentulous, 155 Eszopiclone, 22
Elastic placement pliers, Etanercept, 21
orthodontic, 147 Ethinyl estradiol–desogestrel,
Emergency kit, 2–3 23
Emergency preparedness, Ethinyl estradiol–norethindrone,
1–10 23
antibiotic prophylaxis Etodolac, 22
regimen, 5 Evaluation(s), 155–156
ASA classification system, Excision, 156
1–2 Exostosis, 156
chain of survival, 8 Explorer, 116, 129
CPR, 8–10 Extraoral, 156
dental emergencies, 15–17 Extraoral x-ray unit, 90
emergency kit, 2–3 Exudate, 156
medical emergencies, 10–15
premedication guidelines, F
3–4 Face shield, infection control,
vital signs, 5–8 78
Enamel, 155 Facial, 156
End to end, 43 Fainting, 12–13
Endodontic instruments, Famotidine, 23
128–132 Fentanyl (transdermal), 21
broach, 128 Fexoenadine HCl, 18
condenser (plugger), 128 File(s)
explorer, 129 bone, 133
file (K-type), 130 K-type, 130
Gates Gidden, 131 Filling, 156
Gutta-Percha, 131 Fixed partial denture, 156
paper points, 132 Fixed prosthesis, 162
sodium hydrochloride Fluconazole, 20
springs, 132 Fluoxetine, 24
spreader, 129 Fluvoxamine maleate, 22
stand, 130 Foramen, 156
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Forceps Graft, 157
anterior mandibular, 133 Greater palatine block, 53
cotton, 112 Gutta-Percha, 131
dental dam, 114
mandibular molar universal H
(Cowhorn), 136 Haloperidol, 21
mandibular universal (151), Hand hygiene, 76–77
136 Hand washing, 77
maxillary left (88L), 137 Hatchet, 117
maxillary right (88R), 137 Heimlich maneuver, 9–10
maxillary universal (150), 138 Hemisection, 157
Foreign body aspiration, 13 Hemostat, 135
Four-handed dentistry, 62–64 Hoe, 117
Fracture, 157 Hollenback carver, 118
Frenum, 157 Hydrocortisone, 20
Friction grip burs, 121–127 Hydromorphone, 21
diamond, 121 Hyperventilation, 13–14
fissure: cross-cut straight, 122
fissure: cross-cut tapered, 123 I
fissure: plain straight, 124 Ibandronate, 19
fissure: plain tapered, 125 Ibuprofen, 18
inverted cone, 126 Imipramine HCl, 25
pear shape, 127 Implant, 157–158
round, 127 Incisal, 158
Full-mouth survey (FMX), 97 Indirect digital imaging, 103
Furcation, 157 Indirect pulp cap, 158
Furosemide, 22 Indirect restoration, 158
Infection(s), chain of, 74
G Infection control, 70–84
Gabapentin, 23 bloodborne pathogens, 75
Gates Gidden, 131 CDC guidelines for, 74–76
General anesthesia, 157 clinical contact surfaces–
Gingival margin trimmer, 116 related, 83
157 environmental surfaces–
Gingivectomy, 157 related, 82–84
Gingivitis, 157 exposure prevention
Gingivoplasty, 157 strategies in, 75
Glass ionomer, 157 hand hygiene in, 76–77
Gloves, infection control, 79–82 instruments and, 70–73
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classification based on gingival margin trimmer, 116

need for, 70 hatchet, 117
medical waste management hoe, 117
in, 84 Hollenback carver, 118
personal protective in infection control, 70–73
equipment (PPE) in, 78–84. classification based on
postexposure management need for infection control,
program in, 75–76 70
program evaluation, 84 liner placement, 118
radiography-related, 104–105 matrix band retainer
standard precautions, 74–75 (Tofflemire), 119
water lines–related, 83–84 mouth mirror, 119
Inferior alveolar nerve block, 56 oral surgery, 133–143
Injection(s), 48–58 orthodontic, 144–150
mandibular, 55–58. periodontal probe, 120
maxillary, 49–58. spoon excavator, 120
preparation for, 48 sterilization of, 71–73
types of, 49–58 transfer of, 68
Inlay 158 Interim prosthesis, 162
Instrument(s), 106–150 Interproximal, 158
acorn burnisher, 106 Intracoronal, 158
amalgam carrier, 106–107 Intraoral, 158
amalgam wall, 107 Intraoral x-ray unit, components
anesthetic syringe, 108 of, 87–89
articulating paper holder, 109 Intravenous sedation/analgesia,
broken, 11 158
cement spatula, 110 Isosorbide dinitrate, 22
chisel, 110
composite, 111 K
condenser, 111 K-type file, 130
cotton forceps, 112 Kells, E., 85
dental dam clamps, 113
dental dam frame, 114 L
dental dam punch, 115 Labial, 158
discoid-cleoid, 115 Lamotrigine, 22
endodontic, 128–132. Lesion 158
explorer, 116 Levonordefrin, 47
friction grip burs, 121–127 Levonorgestrel–ethinyl
general dentistry, 106–120 estradiol, 25
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Lidocaine, 46, 47 MSA, 51
Ligature-tying pliers, nasopalatine block, 54
orthodontic, 148 PSA, 50
Limited oral evaluation, 156 Maxillary left forceps (88L),
Liner placement instrument, 137
118 Maxillary right forceps (88R),
Lingual, 158 137
Local anesthetics, 46–47, 159 Maxillary universal forceps
Loracarbef, 22 (150), 138
Loratadine, 19 Medical emergencies, 10–15
Lorazepam, 18 Medical waste management, in
Losartan–hydrochlorothiazide, infection control, 84
21 Medication(s), 18–25
Lovastatin, 23 Mental nerve block, 58
Meperidine, 20
M Mepivicaine with levonordefrin,
Maintenance, periodontal, 47
159 Mesial, 159
Malignant, 159 Methylprednisolone, 22
Mallet, 134 Methylprenidate HCl, 20
Malocclusion, 42–45, 159 Metoprolol, 22
Mandibular injections, 55–58 Midazolam, 25
buccal nerve block, 57 Middle superior alveolar (MSA)
inferior alveolar nerve block, injection, 51
56 Mirror, mouth, 119
mental nerve block, 58 Misalignment, 42–45
Mandibular molar universal Molar, 159
forceps (Cowhorn), 136 Motion(s), in chairside
Mandibular universal forceps dentistry, 65–67
(151), 136 Mouth, medications effects on,
Maryland bridge 159 18–25
Mask(s), in infection control, Mouth mirror, 119
78 Mouth props, 138
Matrix band retainer Mucous membrane,
(Tofflemire), 119 159
Maxilla, 159
Maxillary injections, 49–5 N
ASA, 52 Nasopalatine block, 54
greater palatine block, 53 Needle holder, 139
INDEX
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Process CyanProcess
YellowProcess Black
INDEX
Nerve block(s) Cryer elevators (east and

buccal, 57 west), 134
inferior alveolar, 56 hemostat, 135
mental, 58 mallet, 134
Nitrous oxide sedation, 58–61 mandibular molar universal
complications of, 61 forceps, 136
contraindications to, 59 mandibular universal forceps
indications for, 59 (151), 136
medical assessment of maxillary left forceps (88L),
patient prior to, 59–60 137
medical emergencies maxillary right forceps (88R),
associated with, 61 137
pharmacological and maxillary universal forceps
physiological effects of, (150), 138
60–61 mouth props, 138
Nonintravenous conscious needle holder, 139
sedation, 159 periosteal elevator, 139
Norethindrone–ethinyl estradiol, rongeurs, 140
23 root tip picks, 140
Nortriptyline HCl, 23 scalpel handle with blades,
141
O straight elevator, 141
Obstructed airway management surgical curette, 142
,9–10 suture scissors, 142
Occlusal, 159 tissue scissors, 143
Occlusal radiographs, 159 Oraqix, 46
Occlusion, 39–41, 160 Orthodontic instruments,
Odontogenic cyst, 154 144–150
Odontoplasty, 160 band(s), 145
Olopatidine HCl, 23 band pusher, 144
Onlay, 160 bird beak, 144
Open bite, 45 bracket placement pliers, 145
Oral pathology, 160 bracket remover, 146
Oral surgery instruments, brackets, 145
133–143 distal end cutter, 146
anterior mandibular forceps, elastic placement pliers, 147
133 ligature-tying pliers, 148
bone file, 133 three-prong bender, 148
chisel, 134 Weingart pliers, 149
178
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Process CyanProcess
YellowProcess Black
179
wire, 149 Periapical (PA) radiograph, 97,
wire cutter, 150 161
Orthodontic retainer, 163 Periodic oral evaluation, 156
Orthognathic, 160 Periodontal, 161
Osteitis, alveolar, 16 Periodontal abscess, 15, 152
Osteoplasty, 160 Periodontal disease, 161
Osteotomy, 160 Periodontal maintenance, 159
Overbite, 44 Periodontal pocket, 161
Overdenture, 160 Periodontal probe, 120
Overjet, 44 Periodontitis, 161
Oxazepam, 24 Periosteal elevator, 139
Oxcarbazepine, 25 Periradicular, 161
Oxycodone, 23 Permanent dentition, 27
Oxycodone–acetaminophen, Personal protective equipment
21 (PPE), 78–82
Phenytoin sodium, 21
P Plaque, 161
Palate, 160 Pliers
Palliative, 160 bracket placement, 145
Palm grasp, instrument-related, elastic placement, 147
68 ligature-tying, 148
Palm/thumb grasp, instrument- Weingart, 149
related, 69 Pontic, 161
Palmer notation system, in Positioning in chairside
tooth numbering, 32 dentistry, 64
Panoramic radiograph, 100–101, Post, 161
160 Posterior, 161
Pantoprazole, 24 Posterior superior alveolar
Paper points, endodontic, 132 (PSA) injection, 50
Paralleling technique, in Pramipexole dihydrochloride,
intraoral radiography, 98 23
Paroxetine, dental effects of, 23 Prednisone, 20
Partial denture, 160, 163 Pregabalin, 22
Pen grasp, 68 Premedication, 161
Penciclovir, 20 Premedication guidelines, 3–4
Penicillin, 24 Prilocaine, 47
Penicillin–clavulanate, 18 Primary dentition, 31, 161
Periapical (PA) abscess, 152 Probe, periodontal, 120
Periapical (PA) cyst, 154 Prophylaxis, 162
INDEX
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Process CyanProcess
YellowProcess Black
INDEX
Propoxyphene–acetaminophen, extraoral, 86
20 film types, 92–93
Propranolol HCl, 21 history of, 85
Prosthesis(es), 162 infection control sites, 104–105
Prosthodontic retainer, 163 intraoral, 85
Provisional, 162 introduction to, 85–86
Pulp cavity, 162 radiation effects, 94–96
Pulpectomy, 162 radiographic beam
Pulpitis, 162 characteristics, 93–94
Pulpotomy, 162 types of, 85–86
Pulse rate, 7 uses of, 85
Rebase, 163
Q Reimplantation, 163
Quadrant, 163 Reline, 163
Quetiapine, 24 Removable partial denture,
Quinapril, 18 163
Removable prosthesis, 162
R Respiration, 7–8
Rabeprazole, 18 Restoration, 155, 158
Radiation exposure Resuscitation, cardiopulmonary,
acute, 94 8–10.
chronic, 95 Retainer(s), 163
maximum permissible dose, Retrograde filling, 163
95 Reverse Towne projection, 101
operator protection from, 96 Ritonavir, 23
patient protection from, 95 Roentgen, W.C., 85
Radiograph(s). See specific Rongeurs, 140
types Root, 163
Radiographic beam Root canal, 163
characteristics, 93–94 Root canal therapy, 163
Radiology, 85–105 Root planing, 164
dental radiographs, 97–102. Root tip picks, 140
digital, 102–104. Ropinirole, 24
equipment, 87–93
duplicating-related, 91–92 S
extraoral x-ray unit, 90 Salmeterol, 24
intraoral x-ray unit, 87–89 Scaling, 164
x-ray processor, 90–91 Scalpel handle with blades, 141
errors due to, 96 Scissors, 142–143
180
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Process CyanProcess
YellowProcess Black
181
Sedation Tissue conditioning, 164
nitrous oxide, 58–61 Tissue scissors, 143
nonintravenous conscious, Tofflemire retainer, 119
159 Tolterodine, 20
Seizures, 14–15 Tooth (teeth)
Sodium hydrochloride springs, anterior, 152
132 avulsed, 16–17
Spanish terms, 165–167 broken, 17
Spatula(s), cement, 110 displaced, 155
Spironolactone, 18 medication effects on, 18–25
Splint, 164 Tooth eruption tables, 26–27
Spoon excavator, 120 Tooth numbering, 28–32
Spreader, endodontic, 129 Palmer notation system, 32
Stand, endodontic, 130 universal system, 28–31
Steam autoclave, 71–72 Tooth surface abbreviations,
Sterile glove donning 36
technique, 79–82 Topical anesthetics, 45–46
Sterilization, instrument, 71–73 Topiramate, 25
Stomatitis, 164 Torus, 164
Storage phosphor imaging, 103 Tramalol, 25
Straight elevator, 141 Trazodone, 20
Study model, 164 Triazolam, 21
Submentovertex projection, 101 Trismus, 164
Sumatriptan, 21
Surgical antisepsis, 77 U
Surgical curette, 142 Unerupted, 164
Suture, 164 Unilateral, 164
Suture scissors, 142 Universal system, 28–31
Syncope, 12–13 permanent dentition, 29–30
primary dentition, 31
T
Tadalafil, 19 V
Temazepam, 24 Valproic acid, 20
Temporomandibular joint Vasovagal episode, 12–13
(TMJ), 164 Veneer, 165
Terminology, 152–165 Ventafaxine HCl, 21
Three-prong bender, Verapamil HCl, 19
orthodontic, 148 Vestibuloplasty, 165
Timolol malate, 24 Vital signs, 5–8
INDEX
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Process CyanProcess
YellowProcess Black
INDEX
W X
Warfarin, 20 X-ray, 165
Water lines, 83–84 X-ray processor, 90–91
Water supply, contamination of,
83–84 Z
Waters projection, 101 Zidovudine, 19
Web references, 167–168 Zolpidem tartrate, 18
Weingart pliers, 149
Wire(s), orthodontic, 149
Wire cutter, orthodontic, 150
182
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Process CyanProcess
YellowProcess Black

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FA Davis’s Notes Book

3822_FM_i-iv.indd i 9/5/2014 2:58:59 PM

1915 Arch Street

Copyright © 2015 by F. A. Davis Company

Printed in China by Imago

Last digit indicates print number: 10 9 8 7 6 5 4 3 2 1

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Waterproof and Reusable

Write directly onto any page of Dental Assisting

CHAIR- INFECT RADIOL

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3822_IFC_IFC2{IFC}.indd IFC2 9/5/2014 2:58:47 PM

■ Evidence of some mild systemic disease present.

■ Severe systemic disease that interferes with but does not

■ Severe systemic disease that inhibits daily activities and can

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■ Individual is unable to climb a flight of stairs or walk one

■ Patient is rapidly deteriorating and will not survive.

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Patients should check with their cardiologists if they have any

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Reprinted with permission from: Kantz, S. (Forthcoming).

The blood pressure is recorded as a fraction of the systolic blood

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Normal Pulse Rates

bpm, beats per minute.

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Normal Respiration Rates

Chain of Survival (AHA)

Sequence of Steps for CPR: CAB

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External defibrillators are becoming vital pieces of equipment in

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■ Perform abdominal thrusts using quick upward motions.

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Fainting (Syncope or Vasovagal Episode)

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Foreign Object Aspiration

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Symptoms & Signs

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Cardura Doxazosin mesylate Dry mouth/Monitor vital signs, provide a

Desyrel Trazodone Dry mouth, hypotension

Enbrel Etanercept Alters taste

Luvox Fluvoxamine maleate Dry mouth

Norvasc Amlodipine Dry mouth, gingival hyperplasia

Tegretol Carbamazepine Dry mouth, stomatitis

Ultram Tramadol Dry mouth, hypotension

Deciduous (Primary) Dentition

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Reprinted with permission from: Prajer, R., & Grosso, G.

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