Dental nursing. > Viva 2020. > Flashcards
Viva 2020. Flashcards
Definition of Stroke/ Cerebrovascular Incident. What are the risk factors associated with stroke?
This is a block that occurs in the blood vessels due to a clot which blocks efficient circulation to the tissues. Risk factors include: age, gender, race, diet, habits, exercise.
Signs and Symptoms of stroke.
FAST- face, arms, speech, time.
Management of stroke?
- stop tx. 2. position pt upright. 3. inform SDN. 4. Call ambulance. 5. Get the Zeta pack. 6. Administer O2 is needed. 7. Administer GTN spray sublingually. 8. Administer oral aspirin 300mg. 9. Record in untoward incident report form.
Definition of Myocardial Infarction.
This is a heart attack, where the blood supply is severely reduced to the heart. This can be due to high cholesterol which
Myocardial infarction signs and symptoms.
visibly sweating, clammy skin, distress, denial, faintness, nausea, dyspnea.
Management of myocardial infarction.
- stop tx. 2. sit pt upright. 3. inform SDN. 4. call ambulance. 5. get Zeta pack. 6. Monitor CAB. 7. Administer O2. 8. Administer GTN sublingually. 9. Administer oral aspirin 150-300mg. 10. administer diamorphine 5-10mg IV. 11. Records in untoward incident form.
When should aspirin not be administered?
If pt have certain medical issues: asthma, allergies to aspirin, bleeding disorder, kidney disease, liver disease, peptic ulcers.
Definition of angina pectoris.
A crushing chest pain resulting from moderate inadequacy in coronary circulation to the blood vessels that can be triggered by exertion or stress.
Angina Pectoris signs and symptoms.
Visibly sweating, clammy skin, distress, denial, faintness, nausea, dyspnea, fist to sternum, crushing chest pain.
Management of angina pectoris.
- stop tx. 2. position pt upright. 3. inform SDN and call ambulance. 4. monitor CAB. 5. Get Zeta pack. 6. Administer O2 if necessary. 7. Administer GTN sublingually. 8. if symptoms persist treat as heart attack. 9. Administer oral aspirin 300mg. 10. Record incident in untoward form.
Definition of Cariac Arrest.
When the heart ceases to do its primary function whcih is to circulate blood around the body.
Cardiac arrest signs and symptoms.
pt is collapsed, unconscious, no movement, unresponsive, no pulse.
Management of cardiac arrest.
- stop tx. 2. shake and shout. 3. infrom SDN and call ambulance. 4. check for vital signs, pulse for no more than 10 seconds. 5. assign roles. 6. one gets the AED. 7. one begins compressions. 8. compressions 30:2 with a 1/3 depth of chest. 9. follow the instruction of the AED. 9. When ambulance arrives inform of what was carried out. 10. record in untoward incident report.
What is the chain of survival?
it is a step by step guide used for pt survival. it consists of 5 steps. 1. early access (finding incident and calling 999. 2. early BLS (adequate compressions and depth). 3. early difibrulation (use of AED). 4. early ACLS (adequate cardiovascular life support). 5. integrated post CA care ( transporting to hospital).
Definition of vasovagal syncope?
Loss on consciousness/faint due to internal or external factors eg drop in b/p, excercise, stress.
Vasovagal syncope signs and symptoms.
Visibly sweating, clammy skin, distress, denial, faintness, nausea, dyspnea.
Management of Vasovagal syncope.
- stop tx. 2. position in Trendelenburg position. 3. inform SDN. 4. Get Zeta pack. 5. monitor CAB. 6. Apply cold compress. 7. administer O2. 8. slowely position upright. 9. administer glucose. 10. if symptoms persist, administer Atropine sulfate 0.6mg IV. 11. Record untoward incident report..
What can be found in the Zeta pack?
Glucose, Glucagon, aspirin, medazolam, flumazeline, adrenaline, epipen, salbutamol, GTN spray, saline.
What are the five vital signs?
Vital signs are clinical measurements which indicate the consciousness of a person. Pulse ( 72bpm) temperature (36.6) Oxygen (100%) Blood pressure (120/80) Breathes (12-20 per/m) Skin colour. Level of response (AVPU: Alert, voice, pain, unresponsive)
What are the pulse points?
a rhythmical throbbing of the arteries as blood is propelled through them
Carotid, neck
radial, wrist
brachial, elbow
Definition of Hyperventilation.
Ventilation in excess of that required to maintain normal blood oxygen levels in the arteries. When there is too much oxygen in the blood the b/p rises, the metabolism is disturbed, there are possible convulsions and there is respiratory alkalosis.
Signs and symptoms of hyperventilation.
Visibly sweating, clammy skin, distress, denial, faintness, dyspnea, exasperated breathing, tightness in chest.
Management if hyperventilation.
- stop tx. 2. re-assure pt. 3. inform SDN. 4.Monitor CAB. 5. calm pt down. 6. encourage slow deep breathes. 7. advise pt to cup hands and breath in and out. 8. record untoward incident reports.
Definition of asthma.
A chronic inflammatory disorder that is characterized by the reversible obstruction of the airways. It can be extrinsic (allergic reaction or breathing in allergen) or intrinsic (respiratory infection, occupation stimuli, physical exercise). It is displayed as difficulty breathing.
Signs and symptoms of asthma.
Visibly sweating, clammy skin, distress, dyspnea, wheezing cough, restlessness, difficulty speaking.
Management of Asthma.
- stop tx. 2. position pt upright. 3. Inform SDN. 4. Get Zeta pack. 5. Monitor CAB. 6. If pt has own inhaler let them use it: 2 initially then every min max 10. 7. if no inhaler Administer O2 and Salbutamol nebulizer 2.5mg/2.5ml saline. Salbutamol is meds in mist form which can be inhaled. 8. report in untoward incident report.
What is Asphyxia?
It is a complete blockage of the airways causing difficulty in breathing due to the lack of O2.
Signs and symptoms of asphyxia.
Visibly sweating, distress, dyspnea, restlessness, wheezing cough, difficulty breathing.
Management of asphyxia.
- stop tx. 2. remove tight clothing. 3. remove cause of asphyxia. 4. treat arising conditions. 5. monitor CAB. 6. can be treated with CPR. 7. call ambulance. 8. record untoward incident form.
Management of Unknown cause of LOC.
- stop tx. 2. re-assure patient. 3. inform SDN. 4. Monitor CAB. 5. administer O2. 6. (unconsious pt= glucagon IM. conscious= glucose.) 7. administer hydrocortisone sodium succinate 200mg as it is an anti-inflammatory. 8. report untoward incident form.
What to do in an occurancy of an eyesplash?
If dental liquid or material gets into the eye tx must stop immediately. Re-assure pt and inform SDN. Get an eyewash from wash station. Administer Diphoterine 50ml in the first 10sec and then 10ml/10sec. Dress in eyepatch. Refer to Eye+ear hospital. Report.
Skin burn cause and management.
This can occur when there is a flame or chemicals used during tx. stop tx. inform SDN. Place skin under cold running water. Remove any constricting items which can cause swelling. Apply burn shield gel which can relieve pain and is non-toxic. Apply non-cotton dressing. If severe transfer to hospital. report.
Stainless steel and hall crowns.
A stainless steel crown (SSC) is a pre-formed metal crown used for the restoration of severely decayed deciduous teeth. Stainless steel crowns are used on paeds patients who have excessive caries, worn enamel or not properly formed dentition. Definition of caries is it is a localised desolation of tooth surface brought about by metabolic activity in a microbial deposit on the tooth surface. Worn enamel can be due to genetic dental anomalies. SS crowns are usually placed on posterior primary teeth. SS crowns are made from nickel and chrome. Using hall crown technique is a less invasive and less time consuming method of treating decayed primary molars. The teeth are treated by removing the caries and filling appropriately with operator preferences materials. The crown is placed over the top to prevent natural teeth from decaying further while still maintaining a good biting surface for the patient. The instruments I would prepare for this tx would include howie pliers, crimping pliers, cup jaw pliers, festooning crown scissors, nylon band seater, mitchells trimmer and floss.
Fissure sealants.
This is a material which creates a barrier between pits and fissures of teeth and protects against decay forming bacteria from accumulating and forming caries. It is applied to posterior permanent teeth as they erupt in children and in adults. Fissure sealant material in DDUH contains fluoride which is an agent which has anti-cariogenic properties. When applying fissure sealants you need acid etchant, bond, light cure and good moisture control. Fissure sealants can last up to 10 years if the patient doesn’t have any bruxism habits.
Orthodontic archwire: NiTi and SS.
An archwire is a piece of metal wire which is used in orthodontic fixed treatment as a source of force to correct malocclusion and misaligned dentition. There are two types of materials which archwires are made from. Nickle Titanium (NiTi) is usually used at the early stages of othodontic tx as it possessed superelasticity and shape memory. The shape of NiTi archwires are round and are measured by the cross-sectional circumferance. Stainless Steel archwire is usually used after the NiTi archwire. They key properties SS archwire possessed is that it is rigid, it is low friction and formable (it can be bended). The SS archwire cross section is square. For this tx, I would prepare a distal end cutter, ligature cutter, ligature tucker, weingart pliers, mosquito artery forcepts.
Pre-operative instructions for IV sedation.
IV sedation is a type of conscious sedation that uses drugs intravenously to produce a state of depression on the CNS which enables the tx to be carried out without the patient being fully asleep. The pre-operative instructions that are given to pt are: 1)not to consume food 2 hours before treatment. 2) have an escort bringthe pt home after tx and look after them for 24h. 3) take medication as usual. 4) ensure there is no nail varnish or false nails on the day. 5) explain the post-operative instructions also eg. no operating machinery, no signing legal documents.
Behavioural management techniques for paeds.
The aim of behaviour management techniques is to find methods which can help the pt to proceed with tx with no anxieties and increased comfort. It is important to understand and know what the behavioral management techniques are as it can be vital for pt in receiving oral care in general. 1) communication: the tone and words that are used during tx is important as they pt needs to feel at ease. loud noises can make them feel at danger and complex vocabulary can confuse them. 2)tell-show-do is a method which combines verbal and non verbal explaination to pt. 3)positive reinforcement: is a method of explaining desirable behavior and achieving appropriate feedback and to reinforce desirable behaviour. 4)introduce one procedure at a time to aclimatize them to having dental tx done.
Behavioural management techniques for special care dentistry.
The aim of behaviour management techniques is to find methods which can help the pt to proceed with tx with no anxieties and increased comfort. It is important to understand and know what the behavioral management techniques are as it can be vital for pt in receiving oral care in general. 1) communication: the tone and words that are used during tx is important as they pt needs to feel at ease. loud noises can make them feel at danger and complex vocabulary can confuse them. 2)tell-show-do is a method which combines verbal and non verbal explaination to pt. 3)positive reinforcement: is a method of explaining desirable behavior and achieving appropriate feedback and to reinforce desirable behaviour. 4)introduce one procedure at a time to acclimatize them to having dental tx done. this method helps build up trust in the dental team for the pt.
Different types of brushing techniques.
Brushing your teeth is a cleaning method that is done to remove any debris and plaque that builds up on the tooth surface. Plaque is a firmly adherent biofilm which is a mass of living, dying and dead bacteria and their products in a mucopollysacharide matrix. It is quite important as it helps reduce the formation of decay forming bacteria as well as bacteria which causes gingivitis/periodontitis. Brushing should be done with a soft bristle brush and fluoridated toothpaste with 1450F ppm twice a day. Before giving the pt brushing advice it is important to ask them to demonstrate how they brush their teeth. There are four brushing techniques: Modified bass- 45degree at the gingival margin in circular motions. modified stillmans- repeating MB but then cleaning the tooth downwards to remove debris. Fones- circular motions all around. Charters- Placing the brush at a 45degree downwards and doin g circular motions.
Vitality testing.
Vitality testing is done to determine if the nerve of a tooth is alive or dead. Vitality of a tooth is tested when there has been trauma, pain, discolouration. types of diagnostics for vitality testing: radiographs- allows to see if the nerve is infected. TTP- tenderness to percussion is gentle tapping on the tooth surface to see if the pt feels any pain of not. ETP- is an electric pulp test/ thermal test used to determine if the pt can feel hot sensations. Cold test- endofrost is used to determine if the nerve can be stimulated with a cold. sensation. It is at a -50degrees temperature.
Classifications of malloclussion.
Classifications of malocclusion are used to determine the position that the jaw is positioned at. It is important to know what the classification of malocclusion is to determine how it is going to be tx. There are two types of classifications: molar and incisal relatonship and they are catogarised into class1,2 (DIV1&2) and 3.
Class 1- When the mesiobuccal cusp occludes in the mid buccal groves of the lower 6s. Lower incisal edge lies in or just below the cingulum plateau of the upper incisors. This is considered the ideal occlusion.
Class 2- When the mesiobuccal cusps occlude anterior of the mid buccal grooves of the lower 6s. The lower incisal edge lies posterior of the cingulum plateau of the upper incisors. There is severe over bite and overjet.
Class 3- When the mesiobuccal cusps occlude posterior of the mid buccal grooves of the lower 6s. The lower incisal edge lies anterior of the cingulum plateau of the upper incisors. There is an underbite.
Mother/carer calls to make appointment for SCD pt. What questions would you ask?
It is important that when guardians and carers call to make an appointment that a good tone and enthusiasm is heard over the phone as it projects a good environment for a special care pt to be treated in which is essentially how we want the pt to feel. Asking the right questions before tx can create the difference between a pt complying with the treatment. 1)What type of disability is it? is it mild or severe? 2) is the pt verbal/non-verbal? 3) The pt overall med hx, any concerns we should be aware off? Family doc/consultants. 4) How does the pt usually react to doctors, the environment, getting tx done? 5) What time suits the pt most due to their lifestyle being made up off routine. 6) What dental concerns are there currently? 7) If they are unaware of where the clinic is to give them good details and descriptions. Make them aware of parking facilities.
What are the types of conscious sedation?
Conscious sedation is the use of drugs intravenously to produce a state of depression on the CNS which enables the tx to be carried out without the patient being fully asleep. It is used for pts who are anxious about tx, paediatric pt and to enable more complex tx. Conscious sedation allows the pt feel more at ease in the dental chair and more cooperation, less gagging and allows the tx time to be increased. There are 3 types of CS used in dentistry: oral, inhalation/nasal and IV.
Oral- This is given to pt in capsule form. The pill is usually taken an hour before tx to relax the pt. It is not as common as the absorption levels aren’t as accurate/ reliable.
Nasal- The gas that is used is called nitrous oxide. It is used to bring a patient into a state of ease and relaxation of the anxious patient to undergo treatment. This is also beneficial for pt who have a fear of needles. It reduces anxiety and gagging also. The disadvantages of this CS is the cost of all the equipment, the pollution that is emmited and that it is not potent enough. Also pregnant women, pt with respiratory and emotional disorders are recommended this type of CS.
IV- With this type of sedation the veins are cannulated to administer drug into the bloodstream. This is the most affective method of conscious sedation as the drugs go directly into the blood. The drug that is most commonly used is called medazolam and its reversal drug is known as flumazeline.
It is important to emphasise the importance of pre-operative and post-operative instructions to pts.
Post operative instruction following sedation.
Giving the pt as well as their escort the correct instruction is very important. The instructions given must be given before treatment starts and after it is finished in a language that it understood by all parties. 1) a responsible escort must take the pt home after tx and take care of them for 24hrs.
2) no operating any sort of machinery for a minimum of 24hrs.
3) no signing any legal documents as the pt would not be in their full conscious state to make important decisions.
4) not to consume any alcohol 24hrs after tx as they may not remember how much they had as well as it may disturb the clotting process.
5) not to consume any hot foods/liquids.
Pre-operative instructions for sedation.
As sedation provides a state of depression to the CNS it is important to explain to the pt beforehand what needs to be done. Before any tx is done the pt must have their baseline vitals checked and recorded. This includes b/p, pulse,temperature,o2 levels. The pt must be advised that they should remove any false nails or nailpolish before tx. Food must not be consumed 2 hours before tx as it can cause pt to gag and potentially vomit during tx. The pt needs to be informed about having organised an escort who can take them home and look after them. If the pt needs to take medication on a daily basis they may continue to do so before the tx.
What are the different categories of special care dentistry?
SCD is a branch of dentistry that is concerned with providing oral health tx to those who have any form of disability. These disabilities can include intellectual, physical or psychological. It is an important branch in dentistry as this group of pts are very underserved and usually have higher levels of oral diseases. The reason for this may be that they rely on other individuals to take care of them, they don’t understand that their oral diseases need to be treated or for non-verbal pt they may not be able to let anyone know of their problems.
Types of intellectual disabilities include- down syndrome, pt with autism, ADHD.
Types of physical impairments- loss of hearing, loss of sight, immobile (wheelchair users), spina bifida, cerebral palsey, muscular distrophy.
Psychological disabilities may include- emotional disorders like anxiety, depression, eating disorders, schizophrenia, and bipolar disorder.
For this part of dentistry it is important to acknowledge the pt responses and behaviour to the environment and tx. I may be useful to follow behavioural management techniques to create a more optimum environment for the pt.
Conscious sedation monitoring equipment
Baseline vital signs must be taken and recorded before any sedation is carried out. Monitoring equipment must be used during sedation as it allows to monitor the pt vital signs throughout the treatment and it permits the dental team to detect any adverse reactions due to the drugs being used. Early detection of these adverse reactions allow the dental team to provide the corrective measures to prevent serious complications from occurring.
Pulse oxymeter - This is a non invasive method used to measure and monitor a pt oxygen saturation levels. The oxygen levels must be from 95-100%.
Blood pressure cuff- this is used to measure the pt b/p which is the systolic/diastolic pressure exerted on the arteries. The average rate 120/80.
Pulse rate- the heart rate allows us to ensure that the heart is functioning normally by circulating the blood around the body. a normal pulse is 72 bpm.
During sedation the vital signs are checked together by a vital sign monitor that is attached to the pt via the finger and the upper arm. The monitor is activated every 15 minutes to check the vital signs.
Paediatric eruption dates.
Tooth development begins in week 6-7 of prenatal life. This is called initiation. The tooth bud rises and connects to the oral epithelium. A paediatric pt, when the dentition is full, has 20 teeth, 10 in each arch. Deciduious teeth are less mineralised, easily worn and more opaque as they reflect light more. Paediatric pt do not have any premolars.
Central incisors- 6-10m… exfoliation-6-7yrs
Lateral incisors-7-10m.. exfoliation-7-8yrs
Canine-16m… exfoliation- 9-12yrs
First Molar- 12m… exfoliation- 9-11yrs
Second Molar- 20-32m… exfoliation- 10-12yrs
Bleeding disorders.
This is a disorder which affects the coagulability of the blood. Blood disorders can affect the main components of red blood cells (anemia), white blood cells (leukemia) as well as platelets (von Willebrand disease, VWF is a substance that allows platelets to stick together and form clots). A diagnosis can be made from a series of tests such as blood test, urine test, bone marrow biopsy. Some signs that a pt has a blood disorder may include: excessive bleeding from cuts, easy bruising, chronic infections, fatigue, nosebleeds. It is important to acknowledge that pt with BD should not be taking certain medication so checking mx hx is vital. These medications include aspirin, non steroidal anti-inflammatory, some antibiotics.
Orthodontic Retainers
Orthodontic retainers are worn by pt who underwent orthodontic tx. It is worn to maintain the positioning of the pt teeth after they have been moved into the correct occlusion. It can take up to 6 months for the teeth to remain in the new position that they have been moved to. If the pt does not wear their retainer the teeth can move and shift back which called relapse. Retainers can be fixed or removable.
Lingual retainer- This is a fixed retainer that is bonded to the lingual surface of the teeth. It is made from a metal wire which is a composition of nickle, titanium and/or copper. Some pros include that it is not visible to others, you cannot be misplaced, cant be damaged easily and lasts a long time. Some cons include that it may be difficult to maintain good oral hygiene and to clean it, can irritate the tongue, and is not proven to be capable of maintaining correct occlusion on it’s own.
Essix retainer- This is a removable retainer. It is made from plastic/polyurethane. It can last up to a year, depending on how the pt takes care of it. To keep it clean the pt must clean it once a day with a soft bristle brush and water and keep it safe in a container when not using it. The pt must wear the retainer all day everyday for the first 4-6 months. After that they can switch to only wearing them at night everyday. Some pros include: they are clear so they are less noticable, easy to remove when eating. Some cons include: can get easily worn due to bruxism during the night, may need replacing often, can cause a lisp, can cause excessive saliva production.
Hawley retainer- This is also a removable retainer and is made from metal. Due to its material it can last the pt for years. To maintain it the pt can clean it with a soft bristle brush and water. Just as with the essix retainer the hawley should be worn as instructed. Some pros include: lasts a very long time, easy to clean, can be adjusted easily,does not stain easily. Some cons include it is obvious and visible, can be lost or damaged, can cause excessive saliva production and can have bacteria living on it.
Personal information in Dental practices.
Private personal information, pt information must not be given out to any personnel who is seeking any information. This comes under the GDPR policies and the dental council regulations under the scope of dental nurses in regards to recording and maintaining patient records. There are circumstances where the information can be disclosed which is to parents/legal guardians of pt under the age of 16, by patient consent or through 1)by law, 2) court of law 3)necessary the interest of the pt or public interest.
Legislation to health and safety.
Work and healthy safety act 2005, employee and employer duties/responsibilities.
GDPR is so ppl have their data confidential in any workplace.
GDPR
GDPR is a legal framework that sets guidelines for the collection and processing of personal information from individuals who live in the European Union. Patients need to give consent for their information being given out. there are 7 key parts of GDPR. 1)lawfullness,fairness and transperancy. 2)purpose limitation 3)data minimisation 4)Accuracy 5)storage limitation 6)integrity and confidentiality 7)accountability and compliance
Consent
Consent is a process of giving someone permission to execute an action, eg a dental procedure. Consent is an important part of any treatment as it allows the dental team to acknowledge that the pt understands and wants to have work done. Before getting a pt consent, the must completely understand every part of the procedure (reason, benefit, risks, alternative methods, procedure steps). This has to be completed in a language that is comprehended by the pt. A good way to understand if the pt understands everything is to have them say it back if necessary. The pt must also be capable to give consent. This means the pt has their own mental ability (capacity) to agree to undergo treatment. This means they cant be under the influence, of age to give their own consent and must voluntarily do it themselves. There are different types of consent: assent, which is given by a parent/guardian/career of a pt who does not have capacity to give their own consent, verbal and written.
Professionalism.
This is the conduct, aims, or qualities that characterize or mark a profession or a professional person. Professionalism in a dental practice would include time keeping, relationship with staff and patients, and having the correct knowledge to carry out the duties and responsibilities of that profession and the manner in which you deal with difficult situations such as complaints.
Displacement of a tooth.
Displacement of a tooth is when a tooth has been dislodged to a different position in the mouth, buccaly, lingually, ect. This usually occurs due to trauma like falling or due to sports. Due to its unnatural displacement, the tooth may become loose. In some causes the gingiva and the oral tissue may become inflammed. An avulsed tooth is a tooth that is completely displaced out of its socket. It is important to test if the tooth is still vital after the trauma by TTP, ETP, cold test and radiographs. To prevent the loose tooth from falling out completely, the dentist can splint the loose tooth by bonding it to the adjacent teeth to help stabilize it while the underlying bone and gums heal. Sometimes if the trauma was extreme and irritated the pulp, the operator might have to preform a RCT. If the tooth is not savable, the tooth may be extracted and prosthodontic work would need to be done.
Benefits and risks of orthodontic treatment.
Orthodontics is a branch of dentistry concerned with the growth, the development, the correction and prevention of irregularities and malocclusion of teeth. Malocclusion is an appreciable deviation from an ideal occlusion. This would include an overjets, overbite, underbite, cross bites and irregular eruption of the teeth. The benefits or orthodontic treatment are correction of severe malocclusion, aesthetic end result, aesthetics, function and alteration of the soft tissue environments. There are also some disadvantages and risks of ortho. Disadvantages include the cost, frequent dental appointments, discomfort, change in diet. The risks of orthodontic treatment would include decalcification of enamel, inhalation/swallowing of small auxillaries during tx, gingivitis/periodontitis and relapse.
OHI for pt wearing braces?
Having good OH is very important for pt who are undergoing orthodontic tx. OH is a process of removing plaque buildup from the tooth surface, gingiva as well as brackets and archwires. Failure to do so may result in gingivitis/periodontitis and/or a failed treatment. There is an array of auxiliaries that can be used to have the optimum OH. As a dental nurse I would be able to list and explain good OHI. The pt can use interdental brushes, single tufted brushes, soft bristle brushes, regular floss, superfloss. It is important to emphasis to the pt the correct ways to use each cleaning option to receive good results.
Placing a split after a trauma has occurred.
After a trauma has resulted, the tooth may become displaced into a different position and become loose. This can cause the pt pain and discomfort. To prevent the loose tooth from falling out completely, the dentist can splint the loose tooth by bonding it to the adjacent teeth using a stainless steel wire to help stabilize it while the underlying bone and gums heal.
Reasons and indications for orthodontic tx.
Orthodontics is a branch of dentistry concerned with the growth, the development, the correction and prevention of irregularities and malocclusion of teeth. Malocclusion is an appreciable deviation from an ideal occlusion. Some reasons for getting orthodontic tx done would be missing teeth, an overbite which is where the maxilla excessively protrudes over the mandible, an overjet which is where the incisors procline, underbite which is where the mandible protrudes under the maxilla, displacement of teeth, crossbite and function which have an affect on the pt everyday life eg. eating/speeking (lisp)
Biopsy
This is a surgical tx where a sample of tissue is removed from the body in order to complete histological examinations to receive definitive diagnosis. As this is a surgical procedure the working fields and environment must be aseptic. the instruments which I would set up would be opened by another nurse using an aseptic technique which is away from herself onto the sterile working field. Another important step to take is to ensure that all the instruments are sterile by checking their packaging for sterile colour changes as an indicator that the package has been steam penetrated. As I would have conducted a surgical hand wash and have the correct surgical PPE on, I would arrange the instruments as needed, taking into account to be cautious of the sharps on the surgical field. The instruments which would be prepared are Kilner cheek retracter, toothed forcepts, biopsy punch, sutures, suture scissors, mitchells trimmer, scalpel handle, blade, mayo needle holder/castro viejo needle holders and a surgical suction. During the tx one of my main roles would include maintaining moisture control as well as providing a clean vision for the operator by retracting of the soft tissues depending on where in the oral cavity the biopsy is being done.
What to do in the case of a percutaneous injury?
A percutaneous injury is one where the skin is penetrated with a sharp object such as a needle or a scalpel blade. If this injury occurs, it can cause the spread of blood borne viruses from pt to healthcare workers. Steps to take in case of a PE:
1) stop tx asap. 2) inform the operator and the CNM. 3) encourage the wound to bleed, 4)clean the wound in running water and soap. 5) Carefully dry the wound and place a waterproof dressing. 6) Report the incident in a untoward incident report form. 7) Check the pt med hx to see if there is any history of blood borne viruses that may have been contracted. 8) a full report must be conducted as to how the injury occurred.
What are the IPC policies and their topics?
An IPC policy guarantees that care is provided in a clean and safe environment which minimizes the risk of transmitted healthcare associated infections like Hep. The IPC policy outlines the standard protocols and guidelines in a dental field which minimizes that infection from pt to staff from occurring. The topics which would be included in the policy would include:
1) Healthcare associated infections- This topic discusses the immune status that employees need to have before commencing work. This entails receiving the mandatory vaccinations for Heb B, Tuberculosis, Varicella, Influenza, Measles, Mumps and Rubella. This topic also has information about blood borne viruses, including what actions to take when you are exposed.
2) Standard precautions- are the minimum infection prevention practices that apply to all patient care, regardless of suspected or confirmed infection status of the patient, in any setting where health care is delivered. Some actions which practice standard precautions include: hand hygiene, coughing etiquette, use of ppe, having sterile instruments, sharps safety.
3) Decontamination of dental instruments- This topic discusses the local decontamination unit (ldu) and the methods used to effectively sterilising dental instruments. In this policy it emphasizes the contaminated and non contaminated zones that should be provided and used to ensure and prevent cross contamination from occurring. It also details the processes of decontamination in the LDU which include: transportation of instruments, cleaning and disinfection, inspection, sterilization and storage.
4) Waste disposal- In the policy it informs about the different types and maintenance of non risk and risk waste. Non risk waste would include packaging of dental instruments and materials which do not contain blood or saliva. Risk waste would include contaminated waste which would be covered in bodily fluids. This can also include sharp boxes and amalgam waste systems as they hold risk and can harm when coming in contact with it.
5) training and education- this would discuss how all employees need to receive training on the dental surgeries IPC policies.
Discuss the musculoskeletal strains and injuries that can be received in a dental surgery. How can they be avoided?
Musculoskeletal disorders are soft tissue injuries that affect the muscles, tendons, nerves, ligaments, joints and/or blood vessels. The most common areas which can suffer from musculoskeletal strains in a dental surgery are the lower back, neck, shoulders, wrists and hands. The main reasons for this pain and strain is overstretching, twisting and reaching repeatedly over a long period of time. This actions are quite common in the dental work field which is a prime reason why musculoskeletal disorders are so prominent. It is important to find methods which reduce the disorder as much as possible for dental healthcare workers to improve day to day activity. This can be achieved by adapting ergonomics. Ergonomics is the methods which allow the HCP to achieve optimum work done while removing risk factors that lead to musculoskeletal injuries and allows for improved human performance and productivity. Actions that can increase ergonomics would be: sitting while working, sitting 10cm above the operator, sitting in swivel chairs, having their back straight and their feet flat.
Early childhood caries.
Caries is the localised desolution of tooth surface brought about by a metabolic activity in a microbial deposit. Caries can effect anyone but it can effect children of a younger age more significantly if they follow routines that causes them to be apart of the risk group. Children who are in the risk group would include those who: snack throughout the day rather than consume full meals, go to bed with a milk bottle, and consume high sugar in their diet. By doing this, the natural pH of the oral cavity and teeth falls below 5.5 which cause the teeth to begin demineralisation. This is also called an acid attack. If a child snacks often through out the day, the pH of the teeth falls below this critical level often, not allowing the dentition to follow up with a remineralisation phase. This results in the formation of caries.
Steps involved to process contaminated instruments for re-use.
1) Acquiring dental instruments- This is gathering the instruments from the clinical area after use.
2) cleaning- This is a process of physically removing soiling, including a large number of microorganisms and organic material on which they thrive.
3) Disinfecting- This is a process that eliminated many or all pathogenic microorgansms with the exceptions of bacterial spores. The washer disinfector is the most reliable cleaning process as it requires little human contact with instruments. The loads are all validated and can be tracked. The washer disinfector requires staff training and regular servicing. There are 5 stages in each cycle: Cold rinse, Warm wash, Rinse, Disinfecting rinse, Drying.
4) Inspecting- This process allows for manual inspection of the dental instrument to ensure that no materials or natural biological matter has been left behind.
5) Packaging- The instrument is placed into disposable packaging in order to prevent any risk of infection. This packaging has sterilisation indicators which allow to assess if steam has penetrated the instruments.
6) Sterilisation- This is a physical and chemical process that completely kills or destroys all forms of viable microorganisms from an object, including spores. RIMD are all sterilised by steam in an autoclave. The autoclave requires a few tests to ensure the cycle has passed, these include: vacuum seal test and bowie and dick test (steam penetration). The cycle must reach 134 degrees celsius for 3 minutes minimum.
7) Transport- The sterilised instruments are brought out onto clinics to be used.
8) Storage- the location where instruments are stored should be dry and cool drawers. The instruments should not be kept in the drawers for over 30 days.
9) Use- The instrument is used for treatment.
10) transport- The whole process begins again.
Discuss IPC Procedure: zoning, Standard precautions and barriers.
IPC is an evidence-based practices and procedures that, when applied consistently in health care settings, can prevent or reduce the risk of transmission of microorganisms to health care providers, clients, patients, residents and visitors
Standard precautions are the minimum infection prevention practices that apply to all patient care, regardless of suspected or confirmed infection status of the patient, in any setting where health care is delivered. This includes hand hygiene, cough etiquette, wearing ppe, disinfection instruments, ect.
Zoning is a practice which helps prevent cross contamination from occurring. It provides designated areas to be allocated from clean instruments and contaminated. This is a method which prevents the unnecessary exposure of clean instruments in a contaminated environment.
The use of barriers is another way to reduce cross contamination. Examples of barrier is the use of PPE as well as barrier shields which are placed onto surfaces to minimise cross contamination during treatment. The locations where I would place barrier shields would be on the headlight, back of the dental chair, the console. They are taken off and replaced after each pt. It is important to wear PPE during treatment as it protects the dental team from harming themselves and also prevents cross contamination. PPE includes face masks, gloves, safety glasses and gowns.
Hand hygiene.
Hand Hygiene is a simple and very effective method of helping to prevent the spread of healthcare associated infection. It can be done using antimicrobial hand soap or alcohol hand sanitiser. Alcohol hand rubs are recommended and are preferable in the healthcare setting for social and antiseptic hand hygiene. Alcohol hand sanitisers should not be used if the hands are visibly soiled. Hand hygiene should be carried out with no hand jewelry on. On wet hands, soap should be applied and the first step is carried out. 1) rub palm to palm. 2) Rub back to hands. 3) rub intertwining the fingers. 4) Rub back of fingers. 5) Rub both thumbs. 6) rub both wrists.
The 5 moments of hand hygiene includes: 1)before touching a pt. 2) before an asceptic procedures. 3) after touching the pt. 4) after touching pt surrounding. 5) after exposure to bodily fluids.
Oral hygiene for pt with cancer.
Cancer is a condition in which the body’s cells multiply without control, destroying healthy tissues and endangering life. Some aetiologies include: alcohol, smoking, occupation, dietary deficiencies, immunosuppressants and viruses. From a dental team point of view, we can help the pt by helping with lubrication by having water for them and preventing cancer from rapidly growing can be done by doing biopsy tx, radiographs, and blood tests. Good Oral hygiene is very important for pt who underwent cancer tx as they can have an increase in infections and caries formation. Using materials that have high fluoride content can help with the health of their teeth also. Dentists can prescribe high fluoridated toothpaste to the pt which contains 5000ppm fl. Education and reiteration is helpful to allow the pt to receive the best advice possible.
What is cross contamination and the chain of infection.
cross-contamination is “the process by which bacteria or other microorganisms are unintentionally transferred from one substance or object to another, with harmful effect”. Examples of this would include hand shakes, touching contaminated surfaces like a counter or a door knob. Cross contamination causes pathogenic material to spread and cause infections and illnesses to arise. cross-contamination can occur if someone touches an object with the virus. Other ways that cross-contamination can occur is during treatment when medical instruments are not correctly cleaned, disinfected and sterilised. Due to this timeline it is important to acknowledge practices which can cease the chain of infection. In order for an infection to grow and transmit from people to people/objects, it requires six events to occur. These six events include; infectious agent, reservoir, portal of exit, modes of transport, portal of entry and a host. If one of these elements are broken, the disease will not be transmitted. What do these elements mean? Reservoir is where bacteria lives, grows and multiplies. The portal of exit,as the name suggests, is the path by which a disease leaves its host. Modes of transmission are the ways in which bacteria spreads. This can be direct (contact) and indirect (airborne) transmissions. Portal of entry is the way a disease enters the body. The host is any person where a disease can live. Disease can be more dangerous to hosts that are susceptible. A susceptible host becomes such due to genetic factors eg. weak immunity. By interrupting the chain of infection stops germs from spreading. Methods which interrupt the chain of infection include standard precautions eg hand washing, cough etiquette, vaccinations and sterilisation of medical equipment.
To conclude, it is important to acknowledge what surfaces we come in contact with on a regular basis to minimise cross-contamination.
Discuss all the validation procedures involved for ensuring sterilization of dental instruments.
This is a physical and chemical process that completely kills or destroys all forms of viable microorganisms from an object, including spores. This is an essential step in the reprocessing of reusable dental instruments that have become contaminated, or are potentially contaminated, with saliva, blood or other biological fluids. The aim of sterilization is to break the chain of potential cross-infection between patients by killing micro-organisms. Sterilization using a steam sterilizer is recommended as this is the most efficient, cost effective and safe method of sterilizing dental instruments. To kill microorganisms, the instruments need to be exposed to steam at a specified temperature for a specific holding time which is is 134–137°C for a minimum of 3 minutes. The autoclave requires a few tests to ensure the cycle has passed, these include: vacuum seal test and bowie and dick test (steam penetration). Air Leakage Test (to ensure the autoclave is sealed for optimum sterilisation.) helix test (Daily steam penetration test for autoclaves). Other tests include checking packaging indication for colour changes.
Blood borne viruses.
Blood borne viruses is one that can be spread through contamination by blood or other body fluids through direct and indirect contact. Blood borne viruses can cause severe disease in certain people. Examples of blood borne viruses in dental practices include HIV, HPV, Hep. Transmission of BBV can occur through percutaneous injury from any sharps.
Discuss: i) Routes of Infection ii) the types of infection iii) Chain of Infection.
An infection is the invasion of an organism’s body tissues by disease-causing agents, their multiplication, and the reaction of host tissues to the infectious agents and the toxins they produce. The types of infections are bacterial, fungal and viral. The routes of transmission is how the infection spreads. There are five route of infection. 1)Direct contact- transmission of infection from direct b objects or surfaces.5) Vector borne transmission- Vectors are living organisms that can transfer pathogenic microorganisms to other animals or locations and include arthropod vectors (e.g., mosquitoes, fleas, ticks) and rodents or other vermin. 6) Zoonotic transmission- Diseases transmitted between animals and humans. The chain of infection is a series of events that has to happen to enable germs (when we speak of germs in this section, this refers to bacteria, fungi and viruses) to cause infections in a person. If we can break a link at any part of the chain, we can stop infection arising. The chain of infection includes six parts: 1) reservoir, 2)The portal of exit, 3)The mode of transmission, 4) The portal of entry, 5)The susceptible host, 6)The infectious agent.
Discuss the management and policies associated with the safe disposal of all types of healthcare waste.
Safe disposal is important in a dental practice as it allows prevention of injury and harm of others. It is essential that all waste produced within the Dental Practice is placed into its correct container for disposal. There are multiple types of waste that can be found in a dental practice: Regular, contaminated, sharp, chemical waste. The different types of waste also has to be colour coded: Regular/uncontaminated waste (black thick bin liners), contaminated (yellow thick bin liners), Sharps (in a thick plastic yellow bin with a blue lid), chemical waste (thick yellow plastic bins with purple lids. There also is a seperate disposal method for amalgam filling material. All the bin liners and bins are created to be puncture proof.
Discuss Ethics, the principles of Ethics and the Hippocratic Oath.
Ethics are moral principles that govern a person’s behaviour. There are four principles of ethics which are: autonomy (The duty to respect and promote individuals´ choices to achieve whats in their best interest), non maleficence (The duty to do not harm), beneficence (The duty always to act in the best interests of the patient), justice (Treating everyone fairly and equally). The hippocratic oath is one of the oldest binding documents in history and is still held sacred by physicians. It states that all physicians must treat the ill to the best of one’s ability, to preserve a patient’s privacy, to teach the secrets of medicine to the next generation, and so on.
Bruxism.
This is a habit of clenching the jaw and grinding the teeth. It most often occurs unconsciously at night during sleep. Bruxism is typically associated with stress but it can also be triggered by abnormal occlusion. Some symptoms of bruxism may include headaches, sore facial muscles, sensitive teeth. This habit can be extremely damaging to the dentition. I causes enamel loss, flattened tooth surface, loosing of the teeth. If bruxism is not resolved it may lead to tooth loss and jaw dysfunction.
Discuss the four main types of Health and Safety Hazards and the different hazards that are specific to the dental surgery.
Health and safety are regulations that intended to prevent accident or injury in workplaces or public environments. There are different types of hazards that can be found in a dental surgery which can include: 1) biological hazards- examples include blood, saliva, tooth fractures, clinical waste, sharps. 2) Chemical hazards- Examples of these would be different types of disinfectants or materials which can harm physically by irritation/burning eg, amalgam, latex, gasses. 3)physical hazards- eg. musculoskeletal, which can be a result of straining the body by not implementing ergonomics into the working field or by accidents. 4)psycological hazards- work related stress.
To protect these hazards from occuring, the health, safety and welfare act was created. This act contains the actions employers and employees are responsible for to minimise and prevent accidents from occuring.
Management and storage of chemicals.
Correct handling of chemical substances is extremely important in dental surgeries. It should be done with extreme care and caution. Anyone who is handeling chemicals should be wearing full PPE including glasses, mask and gloves to protect the face and hands from being exposed to accidental spillages. It is also very important that any surgery that is handeling chemicals is equipt with the correct emergency kits if any accidents do occur. All employees should be made aware of where these kits are and how they are used. All chemicals should be stored in leak proof durable containers which would not be susceptible to chemical erosion. All containers should be labeled with the chemical details such as name, use, expiration dates. Chemicals should be stored in ventilated cabinets, in compatible cupboards.
Types of microbes and the differences between each type.
Microbes are microscopic organisms that exist as unicellular, multicellular, or cell clusters. There are seven types of microorganisms: 1) bacteria- this is a unicellular organism that is described to be prokaryotic as it lacks a nuclei, there are 4 different shapes which include a coccus, a bacillus, spirrila and vibrio. Bacteria is either gram-possitive or gram-neg. 2) archaea- differ from bacteria due to the cell wall structure as well as the lack peptidoglycans. Archaeans use different energy sources like hydrogen gas, carbon dioxide, and sulphur, 3) fungi- are eukaryotic cells with a wall made from chitin. fungi reproduce by releasing spores. 4) protozoa- are unicelluare aerobic eukaryotes. They make up the largest group of organisms in the world in terms of numbers, biomass, and diversity. Their cells are made of cellulose. 5) algae- are unicellular or multicellular eukaryotes that obtain nourishment by photosynthesis. 6) viruses- Viruses are noncellular entities that consist of a nucleic acid core (DNA or RNA) surrounded by a protein coat. Viruses are not considered to be living organisms. They can not metabolize on their own. 7) multicellular animal parasites- A group of eukaryotic organisms consisting of the flatworms and roundworms, which are collectively referred to as the helminths. They are different to other microorganisms as they can be seen by the naked eye.
Headgear.
Headgear is an orthodontic appliance that is used to correct bite support and jaw alignment support. It is most commonly worn by children as their jaws are still developing. Headgear is worn extra-orally unlike other orthodontic appliances. It corrects severe malocclusion which is an applicable deviation from an ideal occlusion. Headgear aids to correct class 2 and 3 malocclusion. There are many different parts to a headgear which include a head cap (which provides anchorage), a fitting cap, facebow, elastic bands, hooks and tubes and the chin cup. It is important to follow orthodontists instructions when wearing headgear. The success of the headgear appliance depends on the amount of time it is worn for which is recommended for 12-15 hours a day. The use of this appliance depends on the patient, it can be anywhere from 9mon-2yrs. Pt need to remove the appliance when eating, drinking through a straw is recommended. the different parts of the headgear should be cleaned with warm water.
Discuss the decontamination of dental chair unit waterlines (DUWs), Biofilm and Legionella.
The dental chair unit waterlines can become contaminated if the water in the waterlines becomes stagnate when the equipment is not being used. Some of the bacteria found in dental unit water are known to cause disease in humans, of particular concern is Legionella. Legionella the bacterium which causes legionnaires’ disease which is a type of pneumonia. The most efficient means of maintaining good quality DUW output water is regular disinfection with a disinfectant or biocide that removes biofilm from the waterlines resulting in output water of potable quality
Dry socket.
This is an infection in the exposed alveolar bone after an extraction treatment which is due to the blood clot disintegration. Pt find this to be extremely painful when it occurs. It often occurs in smokers, female pt due to their use of the oral contraceptive pill and vigorous rinsing after the extraction. the blood clot at the site of the tooth extraction fails to develop, or it dislodges or dissolves before the wound has healed causing pain and discomfort. The tx of a dry socket would be to clean out the socket from the infection present with saline or chlorhexadine rinse. Afterwards the operator would place a medication into the socket and may prescribe over the counter painkillers.
