The role of the dental assistant
- 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 dental practice is to prevent the transmission of infections from one patient to another patient or to a member of the practice 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.
- THE FUNCTIONS OF THE DENTAL ASSISTANT:
4- 1-The main tasks :
- Reception, hygiene management and surgical assistance:
The main task of the dental assistant is therefore to provide surgical and instrumental assistance to the practitioner after possibly having arranged an appointment in advance and welcomed the patient into the treatment area.
She must ensure the management of hygiene and asepsis in the office.
Its hygiene functions are:
A- Cleaning of workstations and premises:
a. 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.
b. Cleaning of 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, work surfaces, shelves, etc.
4-1-2 Instrument processing:
A. Instrument Cleaning: Blood residue or debris reduces the effectiveness of disinfection and sterilization. This is why proper cleaning is important.
For cleaning, manual cleaning, ultrasonic cleaning or scrubber-dryer 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 instruments and instruments with complicated shapes.
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 minutes. 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, temperature, contact time, water hardness 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 non-damaging to equipment.
C Sterilization of instruments:
- The hot air sterilizer
uses dry heat to destroy microorganisms. At a temperature of 160°C, the required 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 device loading technique.
-Handpieces and contra-angles cannot be placed in a hot air sterilizer.
- The saturated steam sterilizer
In the autoclave , objects are sterilized using saturated steam. At a temperature of 134°C for 3 minutes. At 121°C, 15 minutes are required.
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
-residing in the softening of plastic and rubber objects and the rapid onset of corrosion when autoclaving lower quality metal instruments
- The unsaturated chemical steam sterilizer
In the chemiclave , sterilization is carried out using unsaturated chemical vapors. The vapor is a mixture of formaldehyde, acetone, and alcohols. At a temperature of 132°C, the required contact time is 20 minutes.
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 outside of the instrument, either with a brush and detergent or in a scrubber-dryer. 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 any traces of oil and clean the optical fibers with alcohol.
5. Pack.
6. Sterilize. Both a conventional autoclave and a chemiclave can be used.
The hot air sterilizer is not suitable due to the length of the sterilization cycle and the high temperature.
7. Before using the instrument again, operate 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 enhance internal cleaning and drain the instrument.
-Sterilization: There are autoclaves specifically designed for rotary instruments. Their sterilization cycle is shortened, which saves time.
4-2-Administrative tasks:
The common secretarial tasks that can be performed by a versatile 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 prosthetics laboratories;
*manages the stock of small equipment and consumables and ensures their traceability;
*ensures written orders for supplies and their follow-up.
4-3-Accessory tasks:
Maintenance work: Only the maintenance of dental furniture and equipment related to care is the exclusive responsibility of the dental assistant. While a dental assistant is not a cleaning lady, a practitioner cannot be prevented from offering his assistant an increase in salary by performing, if and only if she wishes, additional cleaning hours, in place of 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 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 Tätigkeitund ihre Prophylaxe.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 J.Practical Infection Control in Dentistry. Williams & Wilkins, Daltimore 2nd Ed.
The role of the dental assistant
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