6610 NE 181st Street, Suite #1, Kenmore, WA 98028 www.northshoredentalacademy.com425.408.9400

CLASS SYLLABUS

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READ CHAPTER 25 Ergonomics (p.392-398) No Key Terms No Recall Questions

READ CHAPTER 33 Delivering Dental Care (p.513-527) No Key Terms Recall Questions: 1 through 10

READ CHAPTER 34 Dental Hand Instruments (p.528-539) No Key Terms Recall Questions: 4, 6, 9, 10, 11 and 12

READ CHAPTER 35 Dental Hand-pieces and Accessories (p.540-553) No Key Terms No Recall Questions

READ CHAPTER 36 Moisture Control (p.554-573) Key Terms: Beveled, Bow, Exposed, Invert, Septum Recall Questions: 1 through 10

READ CHAPTER 37 Anesthesia and Pain Control (p.574-593) No Key Terms Recall Questions: 1, 7, 11 and 14

READ CHAPTER 48 General Dentistry (p.824-844) No Key Terms No Recall Questions

READ CHAPTER 49 Matrix System for Restorative Dentistry (p.845-855) No Key Terms No Recall Questions

DAY 6

FOR NEXT WEEK’S TEST: - Read your assigned chapters

- Study your recall questions

- Know your key terms

- Be able to diagram your handouts and X-ray diagram

- Know your sealant, amalgam and composite steps

- Practice Restorative and Perio. Charting

Subject to change

BE PREPARED

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MAXILLARY

MANDIBULAR

Figure 12A

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The treatment of carious lesion known as cavities and fractured teeth. The goal with restorative dentistry is to restore the tooth to its normal function and appearance. There are two types of materials commonly used in restorative dentistry: 1. Amalgam 2. Composite

Amalgam RestorationsStrong, durable alloy of several metals, including Mercury. These metals are triturated in an amalgamator just before use. Amalgam restorations are used mainly on posterior teeth because of its silver color. It is not esthetically pleasing for use on anterior teeth. Freshly mixed, the soft amalgam is condensed into the prepared tooth. Amalgam is pliable and easily shaped and carved. Once it hardens, it is a very strong restoration that can withstand biting forces.

Composite RestorationsAlso know as resin restorations, it is composed mainly of organic resin matrix and inorganic filler. Composite is the tooth color. Its used mainly on anterior teeth, though it is readily used on posterior by some practitioners. Composites do not have the strength that amalgam has, however, it is available in different formulas to meet specific needs of an anterior and posterior restoration. There are two types of composite: 1. Self-Cured - hardens through a chemical reaction soon after its mixed. 2. Light-Cured - hardens after it has been exposed to curing light.

Matrix and ToffelmierAn assembly of two pieces, Matrix and Toffelmier acts as a wall to hold filling material in place as it is placed into the prepared cavity.

MatrixA metal or plastic band used to replace the missing wall of a tooth during placement of the restorative material.

ToffelmierHolds the matrix band and may be adjusted to expand or reduce circle of the matrix band. The matrix band is placed into Toffelmier so the small circle is on the same side as the slot in the Toffelmier. The slot of the Toffelmier is always placed toward the gum line.

WedgesTriangle-shapes made of wood or plastic and placed into the embrasure space to hold the matrix tightly against the margin of preparation. Wedges can also be used to slightly separate teeth in some situations.

Matrix and ToffelmierAn assembly of two pieces, Matrix and Toffelmier acts as a wall to hold filling material in place as it is placed into the prepared cavity.

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PAIN CONTROL

Possible complications with local Anesthesia •Hemotoma-bruisingandswelling •Parestheia-numbnessthatlastsformanyhoursordays.Itmaybearesultofirritationofthenerveduringinjection •Trismus-spasmofthemusclesofmastication.Itmayresultinsorenessanddifficultyopeningthemouth •Soft-tissuetrauma-thepatientbitesorchewstheliportonguewhileanesthetized •Tissuessloughing-alayerofepitheliumislost •Infectedarea-canbedifficulttoanesthetize,solutionsarenotaseffectiveinareasofinfection •Injectionintobloodvessel-theoperatorcanaspirateasyringetoseeiftheneedleisinthebloodvessel

Methods of injection 1. Infiltration - depositing anesthetic into tissues near the apex of the tooth to be treated. Can be used everywhere in the mouth when soft tissue procedures are performed. 2. Field block - injecting anesthetic near large terminal nerve branches, away from the side of the dental treatment. Used very commonly in the maxillary arch because the bone is less dense solution can penetrate bone and contact nerve branches that innervate the teeth. Used in lower anterior area as well, the posterior bone is to dense for field block anesthesia. 3. Nerve block - anesthetic is deposited close to a main nerve trunk, often at some distance from the treatment area. Use often in the lower arch, it will typically numb half of the mandible, and half of the patients’ tongue.

NOTES

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MOST COMMONLY USED ANESTHETICS

Lidocaine (Xylocaine) 2% with Epinephrine 1:100,000 (widely used) •Fastacting,short-lasting,hasavasoconstrictor •GoodforinfiltrationbutusewithSeptocaineforablockonthemandibular •Greattouseforsmallerproceduressuchasfillingsandcrownseats

Lidocaine with more Epinephrine 1:500,000 (widely used) •Long-lasting,hasavasoconstrictor •Alsousedasavasoconstrictor

Carbocaine (Mepivacaine) 3% with no Epinephrine (widely used) •Fastacting,long-lasting.SimilartoLidocaine,butlastslonger •Greattouseforsmallerproceduressuchasfillingsandcrownseats •GoodtouseforpatientswhoarenotabletouseEpinephrineandpatientswhoareonmedicationsthatmay have an adverse reaction to epinephrine. For example, blood pressure medications, antidepressants (Carbocaine can be found with a vasoconstrictor as a 2% 1:200,000)

Citanest (Priolcaine) 4% with no Epinephrine (widely used) •Fastacting,short-lasting •Greatforsmallerproceduresandisalsousedforpatientswhocan’tuseEpiniphrine •SimilaraffectasLidocainebutdoesn’tlastaslong

Marcaine (Bupivacaine) .5% with no Epinephrine 1:200,000 (widely used) •Delayedonsetofaction.Longest-lasting,canlastforupto8hours •Usedalotinoralsurgeryduetoitslonglastingeffect.Itpreventspost-oppainaftersurgicalprocedures and decreases the need for post-op medications

Septocaine (Articaine) 4% with no Epinephrine 1:100,000 (widely used) •Moderatetolong-lasting •Goodforinfiltrationsforlonger-lastingproceduressuchasoralsurgery,rootcanals,orlongerappointments where multiple fillings are being replaced •CanbeusedwithLidocaineforanerveblock

NOTES

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CARBOCAINE 3% (WITHOUT NEO-COBEFRIN)

If patients cannot tolerate Lidocaine 2% (with Epinephrine), the best alternative is Carbocaine 3% (without neo-cobefrin). Carbocaine (without Neo-Cobefrin), often abbreviated as Carbocaine 3%, is a very safe anesthetic. The disadvantages of Carbocaine 3% are: •Ittakeslongertotakeeffect •Ithasashortduration,sometimesonly15to30minutes •ThelevelofanesthesiaisnotalwaysasdeepasitiswithLidocaine2%(withEpinephrine).Sometimesanother injection is required

READ THE LABELS!

Local anesthetics are distributed in glass vials called carpules. The type of anesthetic is tabled on the carpules and it is color-coded also. The color-coding standard is used by all manufacturers: •Lidocaine2%withEpinephrine1:100,000isalwayslabeledwithabrickredring •LidocainewithEpinephrine1:50,000isalwayslabeledwithagreenring •Carbocaine3%(withoutNeo-Cobefrin)isalwayslabeledwithawhitering

NOTES

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COMPOSITE STEPS AND INSTRUMENTS (Gold Knife and Woodson are used in this procedure)

Procedure Instruments

1. Assistant will hand to the Doctor. Mirror and explorer

2A. Assistant applies topical. 2x2, cotton swab and topical anesthetic

2B.Doctorwillanesthetize. Anestheticsyringe,carpule,needle,needleshield (NOTE: when grabbing a needle, remember for Maxillary - blue, Mandibular - yellow. Also, look at the patient’s health history for which type of carpule you will use. Should you use a vasoconstrictor?)

3. Doctor or assistant will pick the shade. Shade guide

4. Assistant places rubber dam. Rubber dam, rubber dam scissors, rubber dam clamp, rubber dam forceps, rubber dam punch, floss and rubber dam frame (NOTE: when punching anterior teeth, go canine to canine, no rubber dam clamp needed)

5A. Doctor will prep the tooth. High-speed hand-piece, slow-speed hand-piece and burs

5B. Doctor will remove soft decay Spoon excavator (NOTE: have a 2x2 handy to wipe off . soft decay when Doctor is working on the tooth)

6. Doctor will smooth and bevel the enamel walls Hatchet, hoe and gingival margin trimmer as well as the floor of the prepped tooth. (NOTE: grab only one of the above instruments)

7. Doctor will evaluate for pins, liners and posts. Dycal paper pad, Dycal mix (2), Dycal applicator (NOTE: necessary if there is not enough tooth structure)

8. Assistant will place Toffelmier, matrix and wedges Cotton pliers, matrix Toffelmier and wedges (NOTE: don’t forget if you are working on an anterior tooth (NOTE: remember that the wedges are placed with cotton you will not need a toffelmier or matrix, just a clear mylar strip. pliers in an inverted-triangular shape) If you are working on posterior teeth you will need a Toffelmier and Matrix band)

9. Doctor will apply etch, prime and bond. Then cure. L-pop, orange paddle, curing light (NOTE: cure for 10-seconds)

10. Doctor will place composite material. Woodson

11. Assistant will cure composite. UV curing light and orange paddle (NOTE: done for 30-seconds)

12. Doctor will remove Toffelmier, matrix and wedges Cotton pliers if working in a posterior tooth, if working on an anterior Doctor will remove mylar strip.

13A. Doctor will shape the restoration. High-speed hand-piece and finishing burs

13B. Doctor will remove any flashing. Gold knife

13C. Doctor will finish restoration. Slow-speed hand-piece, polishing disc and finishing strip

14. Doctor will check contact points. Dental floss

15. Assistant will remove rubber dam. Rubber dam clamp, rubber dam frame, forceps and rubber dam scissors (NOTE: never just pull the rubber dam off, this shows a lack of care)

16A. Doctor will check the occlusion. Articulating ribbon and articulating ribbon forceps

16B. Doctor will adjust if necessary . High-speed hand-piece and burs

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AMALGAM STEPS AND INSTRUMENTS (Condensers, Discloid/Cleoid, IPC or Hollenback and a Burnisher are used)

Procedure Instruments

1. Assistant will hand to the Doctor. Mirror and explorer

2A. Assistant applies topical. 2x2, cotton swab and topical anesthetic

2B.Doctorwillanesthetize. Anestheticsyringe,carpule,needle,needleshield (NOTE: when grabbing a needle, remember for Maxillary - blue, Mandibular - yellow. Also, look at the patient’s health history for which type of carpule you will use. Should you use a vasoconstrictor?)

3. Assistant places rubber dam. Rubber dam, rubber dam scissors, rubber dam clamp, rubber dam forceps, rubber dam punch, floss and rubber dam frame (NOTE: when punching anterior teeth, go canine to canine, no rubber dam clamp or forceps for anterior teeth only needed for posterior teeth)

4A. Doctor will prep the tooth. High-speed hand-piece, slow-speed hand-piece and burs (NOTE: no rubber dam forceps composite)

4B. Doctor will remove soft decay. Spoon excavator (NOTE: have a 2x2 handy to wipe off soft decay when Doctor is working on the tooth)

5. Doctor will smooth and bevel the enamel walls Hatchet, hoe and gingival margin trimmer as well as the floor of the prepped tooth. (NOTE: grab only one of the above instruments)

6. Doctor will evaluate for pins, liners and posts. Dycal paper pad, Dycal mix (2), Dycal applicator (NOTE: necessary if there is not enough tooth structure)

7. Assistant will place Toffelmier, matrix and wedges. Cotton pliers, matrix Toffelmier and wedges (NOTE: remember that the wedges are placed with cotton pliers in an inverted-triangular shape)

8. Assistant will triturate the amalgam and place in the amalgam well. Triturator and amalgam well

9. Doctor will deliver the amalgam to prepped area. Amalgam carrier (NOTE: hand to Doctor with larger side first)

10. Doctor will condense the amalgam into prepped area. Condensers

11. Doctor will clear matrix. Explorer

12. Doctor will carve the Occlusal surface. Discloid/Cleoid

13. Doctor will remove the Toffelmier, matrix and wedges. Cotton pliers

14A. Doctor will carve Interproximal. IPC or Hollenback

14B. Doctor will finish carving the Occlusal surface. Discoid/Cleoid

15. Doctor will polish the Occlusal surface. Burnisher

16. Doctor will check contact points. Dental floss

17. Doctor or assistant will remove rubber dams. Rubber dam clamp, rubber dam frame, forceps and rubber dam scissors (NOTE: never just pull the rubber dam off, this shows a lack of care)

18A. Doctor will check the occlusion/bite. Articulating ribbon and articulating ribbon forceps

18B. Doctor will adjust if necessary . If the amalgam is soft we will use a discoid/Cleoid if hard we will use a highspeed handpiece with a bur