Patient description:

● Age -9y 11m

● Sex -female
● Medical history -fit and healthy, no allergies

Procedure being carried out: Adjustment of tongue guard with bilateral expansion screws
Clinical area preparation:
- I turned on all needed equipment -PC, dental chair, mixer
- I disinfected all the clinical surfaces and contact points with isopropyl alcohol and
placed contamination barriers on surfaces to be used
- I double checked the consent form, risk of orthodontic treatment and FP17 had been
signed at the initial appointment and their scannings are saved in the patient records
- I prepared a few items to hand out to the patient at the end of the appointment -
leaflets on topics such as : a card with the practice contact details and working hours
to call in case of orthodontic emergencies and their white slip with details of the next
appointment to be filled in at the end for them to hand to reception.
- I checked the medical history, paying particular attention to allergies to nickel,
stainless steel or acrylic as these elements are present in a removable appliance
- I made available the patient’s clinical notes
- I set up: for the clinician: a treatment tray with a mouth mirror, right angle
probe,College tweezers, Adams’ pliers, spring forming pliers, ruler and dividers,
screw key; on the nurse side: Maun’s heavy wire cutters, slow handpiece and acrylic
trimming burs of various grittiness, patient hand mirror, screw key.
- PPE for the patient - goggles and bib
- PPE for the clinician and myself (mask, visor, gloves, plastic apron)

Assistance given to orthodontist:

- I updated the patient’s notes with a new medical history check and with details of
today’s appointment as requested by the clinician
- I invited the patient to remove the appliance and place it on the treatment tray, paying
attention to whether the appliance looks worn, how their thumb looks and how easy
is for the patient to remove the appliance
- I handed the clinician the ruler, slow hand piece and acrylic trimming bur, Adams’
pliers, screw key
- I held the patient mirror for the clinician to demonstrate to the patient and for the
patient to practice how to turn the screw ¼ turn each week following the yellow arrow
imbedded in the baseplate

Assistance given to the patient:

- I invited and welcomed the patient and their parent in the surgery and seated them
both (I provided a chair for the parent)
 - I ensured the patient is wearing their PPE and are comfortably seated in the chair,
adjusting their head rest to support their neck and adjusting the light angle to protect
their eyes
- I double checked with the patient, prior to treatment, if there are any changes in their
medical history
- I asked the patient if there are any difficulties wearing the guard and when they can’t
wear it
- I reassured the patient when the appliance was tightened and I helped them to see
themselves in the mirror
- I reminded the patient the appliance is only to be removed for cleaning after meals
and during contact sports , swimming or playing mouth instruments and during this
time it is to be kept in its storage box only, not in paper tissue as they can be
discarded by mistake, also to avoid letting it within dogs’ reach as they will chew on
them.
- I advised patient and parent to consider having a mouthguard made for contact
sports
- I gave patient a lot of positive feedback on how it looks
- I checked with the patient whether they still have the screw key .I reminded the
patient to associate the screw turning with another thing they do on a certain day in
the week perhaps, like the LFD test or to set a reminder on their phone, that way they
won't forget to turn it, also not to be impatient and to only turn it 0.25mm (¼ turn).
- I reminded the patient when the next appointment will be (8-10 weeks) and I briefly
explained what it will consist of ( adjustment of the metal parts of the appliance as it
will become a bit loose, turning the screw a bit more).
- I accompanied them into reception and said farewell after I invited them to have a sit
for a minute and indicated to them the receptionist that will book their next
appointment.

After the procedure: I ensured all the patient’s notes were saved, then I performed the
surgery turnaround and instrument reprocessing as per HTM 01-05.

Aim of procedure: the adjustment is a stage in the process of correcting class II

malocclusion and deterring thumb sucking; the active components ( the loop and screw) are
checked and tightened, the passive components are checked for signs of compliant wear
and adjusted as well. The aim is to make sure the movements are happening consistently
and the patient has no issues with compliance - that the anterior open bite is closing and that
the posterior teeth are being tilted buccally.

Role and Reflective account:

● Strengths - I managed the patient quite well and I had all the documentation ready
for this procedure.
● Weaknesses - I should have reiterated the tips on how to avoid thumb sucking while
the appliance is out of the mouth as the right thumb still looked much cleaner than
the left one.
● Role - during this procedure my role was to assist both the clinician and the patient ,
handing instruments while ensuring the patient is at ease and comfortable at all times
while ensuring the standards of infection control are met according to regulations; it
also involved communication with members of the dental team - clinician, receptionist
and also with the patient and their parent