THE ROLE OF THE DENTAL ASSISTANT

THE ROLE OF THE DENTAL ASSISTANT

EDUCATIONAL OBJECTIVES

At the end of this course, the student should be able to:

• Master the hygiene measures to be applied in the dental office
• Know the different tasks that a dental assistant performs

Plan

1- Introduction.

hygiene measures in the dental office.

3- The dental assistant.

4- The functions of the dental assistant

4-1-The main tasks.

4-2- Administrative tasks .

4-3-Accessory stains.

4-4-Stains to avoid.

5- Conclusion.

6- Bibliography.

Introduction

Teamwork is the rule in dentistry; indeed, working with four hands in collaboration with the dental assistant will allow the dentist’s time to be used in the most efficient way possible.

• The objectives of hygiene measures in the dental office:

The primary objective of hygiene measures in the dental office is to prevent the transmission of infections from one patient to another patient or to a member of the office team, or to the dental laboratory and vice versa.

• The dental assistant:

3-1 Definition

A dental assistant is a person who assists a dentist in the chair.

She can be trained either by a dentist or by a specialized school for dental assistants.

• DENTAL ASSISTANT FUNCTIONS:

4- 1-The main tasks :

• Reception, hygiene management and surgical assistance:

The main task of the dental assistant is therefore to provide surgical assistance and instrumental assistance to the practitioner after possibly having arranged an appointment in advance and having welcomed the patient into the treatment area.

She must ensure the management of hygiene and asepsis in the office.

Its hygiene functions are:

1. Cleaning the medical area

After each patient, the workstation must be cleaned and disinfected: all surfaces that have been touched by the soiled hands of the practitioner or assistant or on which contaminated instruments have been placed must be washed and disinfected.

To clean and disinfect all these elements, it is preferable to use single-use cloths or paper towels soaked in a detergent and disinfectant solution, then apply an active disinfectant.

• Cleaning other work areas

Attention should be paid to telephone handsets, pens and pencils, as well as equipment located in a so-called “dirty” area (instrumentation processing room, prosthetics laboratory, etc.): faucets, sinks, worktops, shelves, etc.

4-1-2 Instrument processing:

1. Cleaning the instruments

Blood residue or debris decreases the effectiveness of disinfection and sterilization. This is why proper cleaning is important.

For cleaning, manual cleaning, ultrasonic cleaning or floor scrubber can be used .

* For manual cleaning , use a scrubbing brush.

*Ultrasonic cleaning is more efficient and easier to control than manual cleaning. It is better suited for small instrumentation and instruments with complicated shapes.

THE ROLE OF THE DENTAL ASSISTANT

B – Disinfection of instruments

• Thermal disinfection:

Some autoclaves offer the possibility of performing thermal disinfection by contact with boiling water (over 90°C) for 3 to 10 min. When applying this technique, the instruments are placed in an autoclave.

• Chemical disinfection:

The effectiveness of chemical disinfection is determined by the concentration of the product, the temperature, the contact time, the hardness of the water and the number of microorganisms present (degree of contamination).

The ideal disinfectant should be broad spectrum and fast acting. It should also be easy to use, odorless, non-toxic, biodegradable and should not damage equipment.

• Sterilization of instruments
• The hot air sterilizer

Uses dry heat to destroy microorganisms. At a temperature of 160°C, the necessary contact time is 120 minutes. At 170°C, it is 60 minutes and at 180°C, it is 30 minutes.

The advantages : simple and inexpensive technique

The disadvantages

-the duration of a cycle and the results vary depending on the loading technique of the device.

-Handpieces and contra-angles cannot be placed in a hot air sterilizer.

• The saturated water steam sterilizer

In the autoclave , objects are sterilized by means of saturated water vapor. At a temperature of 134°C for 3 minutes. At 121°C, 15 minutes are necessary.

The advantages

-the speed and safety of the sterilization cycle.

-This method can also be used to treat liquids, heavy packaging and linens.

The disadvantages

-resist in the softening of plastic and rubber objects and the rapid onset of corrosion when autoclaving lower quality metal instruments.

THE ROLE OF THE DENTAL ASSISTANT

• The unsaturated chemical steam sterilizer

In the chemiclave, sterilization is ensured by unsaturated chemical vapors. The vapor is a mixture of formaldehyde, acetone and alcohols. At a temperature of 132°C, the necessary contact time is 20 minutes.

An advantage :An important advantage of chemiclave is the less frequent occurrence of corrosion.

The disadvantages

– are the cost price of purchasing and consuming products

-the release of toxic vapors.

D- Hygienic treatment of contra-angles , handpieces and turbines

• Standard treatment:

As with any sterilizable instrument, it is recommended to clean and sterilize rotating instruments after each use, following a specific procedure:

1. Run the instrument empty with its spray for about ten seconds to rinse the fluid pipes.

2. Wash the external face, either with a brush and detergent or in a floor scrubber . Washing in an ultrasonic device is not suitable: it would damage the instrument.

3. Inject the lubricant recommended by the manufacturer, following its instructions.

4. Remove traces of oil and clean the optical fibers with alcohol.

5. Pack.

6. Sterilize. Both the classic autoclave and the chemiclave can be used.

The hot air sterilizer is not suitable because of the length of the sterilization cycle and the high temperature.

7. Before using the instrument again, run it for a few seconds empty, with its spray.

• Additional specific means:

-Disinfection – Lubrication:

Disinfection and lubrication of rotating instruments can be improved by the use of automatic devices which:

* rotate the internal parts during the injection of the products and therefore irrigate them better,

*inject an effective disinfectant before the classic lubricant,

*spray the disinfectant also on the external face,

*inject pressurized air after injecting the disinfectant and lubricant to improve internal cleaning and drain the instrument.

-Sterilization: There are autoclaves designed specifically for rotating instruments. Their sterilization cycle is shortened, which saves time.

4-2-Administrative tasks

The common secretarial tasks that can be performed by a multi-skilled dental assistant are in fact very limited.

*writes quotes, treatment sheets and fee notes due by patients ;

*ensures collections and records payments,

*coordinates the liaison with the prosthetics laboratories;           

*manages the stock of small equipment and consumable products and ensures their traceability;

*ensures written orders for supplies and their follow-up .

4-3-Accessory spots

Maintenance work: Only the maintenance of dental furniture and equipment related to care is the exclusive responsibility of the dental assistant. Of course, a dental assistant is not a cleaning lady; however, a practitioner cannot be prevented from offering his assistant an increase in her salary by doing, if and only if she wishes, additional hours of cleaning, in place of a cleaning staff…

4-4-Stains to avoid

-The dental assistant exercises a clinical support profession, and as such is certainly not a contract or account manager.

-It is not possible, for example, to ask your dental assistant to present a treatment plan independently (the recommendation of therapeutic solutions is the sole and entire responsibility of the practitioner)

– A dental assistant is not a statistician either.

5- Conclusion

Although one sometimes becomes a dental assistant by chance, few continue their practice without passion.

In all cases, the dental assistant who continues has a strong propensity for the medical and social care of the patient and places compliance with basic rules of hygiene and asepsis as a primary requirement.

6- Bibliographies

1.Block SS Disinfection, Sterilization , and Preservation. 4thed., Lea & Felbiger , Philadelphia/ London ( 1991).

2.Borneff M.Infektionsprobleme der zahnärztlichen Effectiveness her Prophylaxis.Heidelberger Verlagsanstalt , Heidelberg (1993).

3.Centers for Disease Control and Prevention: Recommended infection-control practices for dentistry , 1993.

4.MMWR 42 (No. RR-8): 1–12 (1993 ).Cottone JA, Molinari JA

5.State-of-the-art. Infection control in dentistry. JADA 123:33–41 (1991 ).Cottone JA, Terezhalmy GT, Molinari JDPractical Infection Control in Dentistry.Williams & Wilkins, Daltimore 2nd Ed.

THE ROLE OF THE DENTAL ASSISTANT