- Created by: Aman
- Created on: 14-04-15 19:54
What does a Dental Hygienist do?
Hygienist either provides treatment directly to a patient or under prescription from a dentist.
Helps patient maintain oral health
- Preventing + treating periodontal (gum) disease
- Promoting good oral health practice
Key terms - hygienist
Radiograph: Image made on a sensitive plate/ film by X-rays/gamma rays or similar radiation.
Dental caries: Tooth decay
Tooth wear: Loss of tooth substance through something unrelated to tooth caries/trauma
Supragingival: Located on surface of tooth not surrounded by gingiva
Subgingival: Occurring beneath gums, between gums and the neck and root of the teeth
Gingival: Concerned with gums (gingival tissue)
Debridement: Removal of damaged tissue. foreign object from a wound
Topical treatment: Rub-on treatment
Fissure: Split/crack creating a narrow opening
Fissure sealant: Plastic material placed in pits + fissures of molars (preventative treatment)
Key terms - hygienist 2
Anti-microbial: Active against microbes
Intra/Extra-oral: Inside/outside mouth
Analgesia: Inability to feel pain/ medicine which acts to relieve pain
Inferior dental block analgesia: Nerve block of the inferior alveolar/intra-oral mandibular will anaesthetise:
- floor of mouth
- lower portion of ramus (lower jaw)
- ALL mandibular teeth (all lower teeth)
- Anterior (front) 2/3 of tongue
- Body of mandible (jaw)
Key terms - hygienist 3
Contemporaneous: Existing/ occurring at the same time - I am contemporaneous w. Arjan
Pathology: Science of the causes and effects of disease
Peri-implant tissues: Soft and hard gum tissues surrounding a dental implant
Rubber dam: Isolates a single tooth during endodontic procedures, gives better visibility of tooth crown.
Dental pulp: Part in centre of tooth made up of living tissue and cells. It's part of the dentin-pulp complex.
Main roles - hygienist
- Provide hygiene treatment to a wide variety of individuals
- Conduct supragingival and subgingival scaling and root surface debridement using manual/powered tools
- Provide patient advice + delivery of care for patient
- Take, process + interpret films used by GDP
- Obtain dental history from patient and evaluate medical history
- Prescribe radiographs
- Carry out clinical examination - within their competence --> diagnoses and treatment
- Complete periodontal examination and charting using indices + screen + monitor periodontal disease
- Preventative oral care to patients + liase with dentist over their treatment (caries, peridontal disease + tooth wear)
- Use anti-microbial therapy to manage plaque related disease
- Adjust restored surfaces in relation to periodontal treatment
- Apply topical treatments and fissure sealants
Main roles - hygienist 2
- Give patients advice on how to stop smoking
- Take impressions
- Place rubber dam
- Take intra/extra oral photographs
- Give infiltration and inferior (lower) dental block analgesia (anaesthetic for lower mouth)
- Place temporary dressings and re-cement crowns with temporary cement
- Take care of implants and peri-implant tissues
- Oral-cancer screening
- Identify anatomical features, recognise abnormalities + interpret common pathology (causes and effects of disease)
- Referral if necessary - to other healthcare professionals (cancer)
- Keep full, accurate + contemporaneous dental records
- working on prescription; vary the detail but not the direction of the precription (number of surfaces to be restored or material to be used )
Extra work - hygienist
Tooth whitening - by dentist prescription
Administer inhalation sedation
Remove sutures (stitches) after wound has been checked by dentist
- EXTRACT TEETH
- RESTORE TEETH (FILLINGS/CROWNS)
- ADJUST UNRESTORED SURFACES
- CARRY OUT PULP TREATMENT
What does a Therapist do?
exactly the same stuff as a hygienist +
- carry out direct restorations on primary + secondary teeth (fillings)
- carry out pulpotomies on primary teeth
- extract primary teeth
- place pre-formed crowns on primary teeth
- working on prescription; vary the detail but not the direction of the precription (number of surfaces to be restored or material to be used )
Extra work - therapist
- Tooth whitening to prescription of dentist
- Administer inhalation sedation
- Remove sutures after wound has been checked by dentist
Types of dentistry
Sedation - odontophobia
Endodontic therapy - root canal
- Pulp (nerve and blood supply) of tooth is infected either by trauma or decay - leading to pain and infections
- Area is anaesthetised
- Dam may be used to keep tooth safe from contamination from other bacteria in the mouth + improve visibility of affected tooth.
- Access hole drilled
- Necrotic tissue and dying tissue is removed from canal
- Tooth is disinfected
- Root canal is shaped so that gutta-percha can be used to fill canal
- The hole is filled using gutta-percha (thermoplastic) which moulds into the shape of the canal
- Access hole is filled with temporary filling, if tooth is too weak to hold filling, a post (metal/strong plastic) is put in place
- Antibiotics may be prescribed and then a permanent restoration (filling/crown) will be put in place to prevent tooth from breaking due to its brittle nature.
Types of treatment
Dental crowns - used to cover damaged, chipped or cracked teeth and when cemented into place will cup the portion of the tooth which sits above and at the gum line. It is made from porcelain and metal or metal. It can also be fitted to just make the tooth look better and the old tooth will need to be drilled down
Crown + bridgework - impression taken from surrounding teeth and bridge anchors to neighbouring teeth and replaces one or more missing teeth. The prosthetic is held together by teeth on either side of the missing one. Made from precious /semi-precious metals or porcelain.
Fillings - Fillings are most commonly fitted to fill a hole caused by dental caries and return tooth's form and function as close as possible to it's original. Also because of tooth grinding, nail biting or opening cans with teeth. Amalgam fillings no longer as popular because they expand and contract and also contain mercury which is toxic - silver, composite = tooth-coloured and gold. They are, however strong + set and harden quickly.
How to identify tooth decay
Acids in the mouth dissolve the outer layer of the tooth leading to a cavity (hole)
- bad breath
- grey/bornw/black spots on teeth
- unpleasant taste in mouth
Can lead to dental abscecces (collection of pus at end of tooth/gums) OR gum disease.
CAUSE: First stage fluoride varnish, 2nd stage filling, 3rd stage root canal, 4th stage extirpation
Bacteria combine with food particles and saliva to form plaque
Sugary drinks are high in carbs, bacteria turn carbs into energy - they produce acids at the same time. Acid can break down the outer surface and enter the dentin (softer part)
Types of treatment 2
Scale + polish - teeth cleaned by hygienist, removal of deposits that build up on teeth
Orthodontic treatment - Straighten/ move teeth to improve their appearance, improve bite, close gaps or overcrowding. Made of metal/plastic or ceramic. Can be removable or fixed
Wisdom tooth removal - Grow at back of mouth + are usually the last teeth to come out (late teens/twenties) They can sometimes come out at an angle and only emerge partially and so are called IMPACTED. These impacted teeth can be extracted.
Dental implants: Fixed alternative to removable dentures. If mouth has shrunk due to loss of teeth they may be the only option. They can be used to replace one or several teeth (bridge for more than one) Titanium screws (bio-compatible) are drilled into jaw-bone to support crown/bridge/denture.
Dentures - Fitted in place of natural teeth. Can get full or part-set and are custom-made from impressions taken from your gums (metal or plastic). They're removable so you can clean them, however part-set dentures can be cleaned with other teeth. Full-set dentures must be removed and seaoked in cleaning solution
Types of treatment 3
Broken/knocked out tooth -
Chipped - tooth can be smoothed down and filled or crowned
Broken/knocked out - emergency and an implant/bridge or implant may need to be fitted
Tooth whitening - Teeth bleached to make the, lighter. It can't make them brilliant white, however can brighten them by several shades. Mouthguard containing bleaching gel must be worn and takes a couple of months. Laser whitening/power whitening is faster and done within 1 hour.
Veneers: New facings for discoloured rather than damaged teeth. Front of tooth is drilled away, impression taken and thin layer of porcelain applied to front of tooth - similar to the application of a false fingernail.
Although not everybody likes to go and see their dentist, in order to keep teeth clean, it makes up an important part of maintenance of good oral hygiene.
needed to provide dental care to patients and become a vital member of the team
Values they look for combine that of the NHS Constitution and the university's own values.
How to identify tooth decay 2
Visual examination: Cavity in tooth will show that there may be decay
White lesions: Caused by tooth de-mineralisation (cavity formed). They cause the tooth to lose its shien and they start to look chalky. If the decay isn't very bad, re-minaeralisation can occur if the patient starts to brush and floss more effectively. If not a filling or bonding may need to be conducted to fill th cavity. They show up on x-rays becuse the ray can penetrate the softened enamel as it isn't as hard anymore.
Black lesions: Means the speed of decay has stopped or is slowing down.
Probing: If gum bleeds on probing, it means there is gum-inflammation present.
Physical test: Soft + sticky area means there may be decay present.
To start treatment as soon as is reasonably possible.
Inform you of services available to you, from helping you decide on better lifestyle decisions (stop smoking, drinking) to practical help - treatment
Promises to treat patients in a clean and safe environment based on national best practice
Expect you to:
Take responsibility for your own health + care
Register with dental practice
Treat professionals with respect
Giving feedback - neg or pos
Keeping hospital appointements, or if you must cancel, doing so in good time
Followin courses of treatment you've agreed to.
NHS Constitution values
- working together for patients: patients come first in everything and they should be included in every decision as well as put before organisational boundaries + speak up when things go wrong
- respect + dignity: We respect their aspirations and commitmnet in life, and seek to understand their priorities, needs abilities and time limits. We take what patients have to say seriously and are open and honest about what we think and can + cannot do.
- everyone counts: Maximise resources for community and make sure nobody is discriminated against or left behind. We understand that some individuals need more help than others and that when we waste resources, we waste opportunities for others.
- commitment to quality of care: Earn trust by insisting on quality + striving to achieve good quality of care. the basic of quality are safety, effectiveness + patient experience, and we aim to get these right every time. We encourage feedback from patients and use this to improve our service.
- compassion: respond to distress with compassion and humanity. Search for thins we can do, however small to relive that person of anxiety or stress + we find time for patients and families before needing to be asked.
- improving lives: Strive to improve people's wellbeing and their view of our service and realise we all have a part to play in improvement.
Portsmouth + NHS values
Improving lives - Social responsibility + personal responsibility and accountability; taking part in activities + organisations for the greater good. Engage in sense of community
Respect + dignity: Respect equal opportunity and academic freedom of staff
Compassion: ethical + responsible behavior: uphold highest standards of academic + professional standards. We are honest + trustworthy in what we do + say. Encourage extra-curricular activities for students to develop personally + socially.
Everyone counts: Equality, openess, tolerance + respect and inclusivity: rescpect and celebrate diversity with an inclusive culture.
Working together for patients + commitment to quality of care: Commitment to highest quality care and embedding professional standards: uphold the highest academic + professional standards, support research, exploit university's potential for research in order to find a solution to problems + promote the impact and value of research Inspire students to meet challenges of society
Connect with patient - information they give should be taken on board
Empathise - try and understand how they are feeling + listen
Exploration of the patient's ideas - ask them why they're nervous, and how you can help
Signal - tell the patient to just raise their hand if they feel they need a break
Explaining - explain the treatment, and benefits in detail and summarise what you'll be doing
- if the patient is very scared, they can be sent to special NHS clinic sdesigned for nervous patients
Simple inhalation sedation: similar to gas and air, but it is given through a nosepiece
Intravenous sedation: Injection given through arm or hand and has such calming affects, you probably won't remember much of what happened. It won't send you to sleep though.
Facilities at portsmouth
Newly built envioronment:
- two clinics (44 dental treatment bays)
- two individual surgeries
- a phantom head room
- decontamination suite
- radiography suite
- four radiography booths
Teamwork: King's college come and train there
Library: Over 400,000 books.
What interests me:
Patient interaction + ability to work with individuals with poor oral health to those who need help maintaining oral health. Seeing how your work has an impact on not only an individual's oral health, but also their general health as poor oral hygiene is linked to cardiovascular disease and increased chances of stroke.
Year 1: pre-clinical practice (starts with patients straight away) + learning about behavioral and human sciences
Year 2: Professional development + team work + radiography and advancing on your sciences as well as clinical practice
Year 3: oral surgery + medicine + clinical practice in wider community.
Roles: ARMED FORCES