DDC 101

Preparing for Your Patient

• Review patient record
  • Administrative staff
    • Check for changes in personal information.
  • Clinical staff
    • Check for health problems that may alter dental treatment.
    • Look for medical alerts.
    • Review progress notes for planned for treatments of the day.

What is four-handed dentistry? (Process by which the operator and assistant work together to perform clinical procedures in an ergonomically structured environment.)

List and discuss various advance preparation procedures a dental assistant can complete to increase the smooth flow of patient care throughout the day. (Obtain the patient record, know the upcoming procedure[s], and have the supplies and equipment ready.)

What might result from a failure to meet standards for these tasks? (Loss of productivity for the dentist, inconvenience or discomfort for the patient, and unnecessary stress for everyone.)

What is the best way to know your patients and to be better prepared for their presence in the reception area? (Have a brief meeting or review the day’s schedule before the patient arrives.)

Some of the issues that should be discussed by the dental team include changes in patients’ dental histories, additional supplies or equipment that may be needed, preparations for the apprehensive patient, and assignments of expanded functions.

What are some of the tasks that should be completed during preparation for the apprehensive patient? (Scheduling a longer appointment, using premedication, and using pain-control measures such as nitrous oxide.) 

Preparing the Treatment Area

• Treatment room clean, disinfected, and ready for the next patient
• Patient records, radiographs, and laboratory results in place
• Sterile preset tray and other supplies in place
• Dental chair positioned to seat the patient
• Equipment moved out of the way for the patient and dental team      

Is the use of personal protective equipment (PPE) recommended for the cleaning and disinfection of the treatment room? (Yes.)

List the appropriate PPE. (Safety eyewear, lab jacket with long cuffed sleeves, gloves, face mask.)

Where should radiographs be placed? (Illuminated view box.)

When should the sterile preset tray be opened? (After the patient is seated and before treatment.)

What is the proper position of the dental chair for receiving the patient? (Upright and at the lowest height.)

Admitting the Patient

• Pleasantly greet the patient by name in the reception area. 
• Escort the patient to the treatment area.
• Place the patient’s personal items in a safe place, out of the way of the procedure.
• Initiate conversation with the patient.
• Ask whether the patient has any questions about the treatment for the day that you might be able to answer.   

The patients must be greeted in a courteous manner. Remember to establish eye contact and smile, call the patient by his or her last name, and introduce yourself.

Where is the best place to put the patient’s personal items? 

Why would you keep such items within the patient’s sight?

Why is initiating conversation with the patient important?

Why should you ask the patients whether they have any questions or need further information about the treatment?

Seating the Patient

• Seat the patient from the side of the dental chair.
• Lower or slide the arm into position.
• Place the patient’s napkin.
• Inform the patient before adjusting the chair.
• Position the operating light.
• Complete treatment-room preparations.
• Wash hands and don personal protective equipment.       

Ask the patient to swing his or her legs onto the chair after he or she has been seated from the side of the chair, then place the patient napkin over the patient’s chest and clasp the corners with the use of a napkin chain.

Why should you inform the patient before adjusting the chair? 

Move the chair slowly until the patient is in the right position.

Turn on the light after positioning it so that it is aimed at the patient’s chest.

Does the PPE for treatment setup differ from the PPE used during treatment procedures?

Team Dentistry

• Components of work simplification
  • Decreased number of instruments.
  • Sequencing of instruments on the tray by their use
  • Correct positioning of the patient, dentist, and assistant
  • Use of appropriate moisture-control techniques.
  • Transfer of instruments and dental materials as necessary
  • Use of the least possible amount of motion 
  • Performance of expanded functions by the assistant       

What are the main goals of this concept? (To deliver the best and most effective care to the patient and to increase productivity.)

How does ergonomics play a role in team dentistry? 

How do the appropriate moisture-control techniques simplify work? (Visibility of the work field in the mouth is increased.)

 Expanded functions allow the dentist to use time more effectively and efficiently.

The concept of four-handed dentistry is shown in the positioning of the patient and dental team.
(Courtesy of A-dec.)

How does four-handed dentistry affect ergonomics and the concept of team dentistry? (The use of proper four-handed procedures enhances the treatment process by reducing stress and fatigue of both dentist and dental assistant. Four-handed dentistry also better uses the time of the dental team, increasing productivity.)

Principles of Team Positioning

• Patient
  • Lowered to the supine position
  • Head even with the top of the headrest
  • Final adjustments made by the operator
  • Operator positioning
  • Seated as far back as possible.
  • Thighs parallel to the floor or knees slightly lower than the hips
  • Feet flat on the floor
  • Backrest of the chair positioned to support the lower portion or small of the back
  • Operator’s forearms bent at the elbow and parallel to the floor

Why is correct positioning of the dental team essential in the clinical area? (Correct positioning allows access and visibility to all areas of the patient’s mouth while providing maximum comfort and support to the dentist and dental assistant.)

What occurs when the dentist or dental assistant stretches to reach an instrument or gain access to the patient’s mouth? (Accumulated stress contributes to circulatory problems, lower-back pain, and other muscle aches and pain.)

What can you ask the patient to do to make access to specific areas of the mouth easier? (Turn his or her head to the left or right.)

What are the most essential requirements for the operator? (Access and vision.)

Position of the operator when seated correctly. 

Is this operator positioned correctly (Yes.)

Note the neutral elbow position.

Note how the weight of the operator is supported by the straight back and feet that are flat on the floor.

• Dental assistant
• Seated back on the stool
• Feet on the base or foot ring of the stool
• Positioned as close as possible to the dental chair
• Legs parallel to the patient’s chair
• Eye level 4 to 6 inches above the eye level of the operator   

The dental assistant has to anticipate the needs of the dentist during treatment and maintain access to the area of concentration. 

Position of the dental assistant when seated correctly.

Is the dental assistant positioned correctly? (Yes.)

This position will allow the dental assistant to sit 4 to 6 inches above the clinician to allow the assistant to have access to the concentration area.

Note the neutral elbow position.

Note how the feet are supported by the ring at the base of the stool.