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Mahoney
5/2/15
DH 132
Procedure #1
I
went
to
observe
two
office
procedures
at
Riverbend
Dental
located
in
springfield
with
Dr.
Allison
Cadaret.
The
first
procedure
I
observed
was
a
cementation
of
a
permanent
crown
on
tooth
#5.
When
I
first
arrived,
the
dental
assistant
was
the
once
who
greeted
me,
showed
me
around,
and
brought
back
the
patient.
The
patient
had
a
polycarbonate
temporary
crown
placed
over
tooth
number
#5,
which
had
severe
MODBL
decay,
about
two
weeks
prior.
Dr.
cadaret
said
she
chose
this
particular
temporary
material
because
it
is
suitable
for
premolars.
At
the
previous
appointment,
Dr.
Cadaret
used
Tempbond
to
place
the
temporary
crown,
in
order
to
achieve
retention
for
the
following
two
weeks
while
also
still
being
able
to
remove
the
temporary
crown
once
the
final
product
returned
from
the
laboratory.
The
assistant
performed
the
removal
of
the
temporary
crown,
but
she
had
difficulty
removing
it
without
causing
discomfort
to
the
patient.
She
used
forceps
to
grasp
the
crown,
but
the
Tempbond
was
not
budging.
She
then
applied
some
topical
anesthetic
to
the
surrounding
tissue
and
chatted
with
the
patient
in
order
to
give
it
time
to
absorb
into
the
gingiva-and
after
about
5
mins
she
was
able
to
successfully
remove
it
without
causing
harm
to
the
patient.
They
had
used
Luxatemp
as
the
impression
material
when
obtaining
an
impression
to
be
sent
off
to
the
laboratory.
After
two
weeks
the
lab
sent
back
a
porcelain
crown-they
chose
porcelain
for
aesthetic
purposes.
The
assistant
then
placed
the
crown
and
took
an
x-ray
to
check
that
the
crown
prep
and
the
tooth
fit
together
properly.
The
premolar
projection
showed
proper
placement.
Next,
she
used
articulating
paper
to
check
the
bite
with
the
crown
on
(upper
arch
vs.
lower
arch).
It
was
specifically
shim
stock
articulating
paper,
which
is
super
thin.
The
assistant
then
used
a
carbide
polishing
burr
(coarse
grit)
attached
to
high
speed
handpiece
to
file
down
the
occlusal
surfaces
that
were
interfering
with
the
normal
bite.
At
this
point,
the
dentist
entered
the
room.
She
used
floss
interproximally
to
check
placement
of
crown.
Where
the
contact
was
too
tight,
the
floss
would
get
caught,
so
she
used
the
same
carbide
polishing
burr
to
file
down
the
sides
in
order
to
make
sure
the
contact
spaces
were
not
too
crowded.
It
was
now
time
to
cement
the
crown
using
3M
Luting
Agent.
The
assistant
combined
1
scoop
powder
with
1
drop
of
liquid
on
a
mixing
pad.
While
she
was
doing
this,
the
dentist
applied
a
viscous
ferxy
sulfate-
which
is
a
hemostatic
agent-
to
the
tissue
to
minimize
bleeding.
She
then
proceeded
to
apply
gluma
to
the
tooth
surface,
which
is
a
desensitizing
agent
to
numb
the
nerve
ending
in
the
dentin
tubules.
While
the
dentist
was
doing
all
of
this,
the
assistant
applied
the
luting
agent
inside
the
crown.
The
dentist
then
placed
the
crown
onto
the
tooth
and
they
waited
two
minutes
in
order
to
let
it
set.
She
then
used
floss
to
remove
excess
cement
interproximally.
Procedure
#2
The
second
procedure
I
observed
was
performed
right
after
the
first,
in
the
room
adjacent.
It
was
an
MO
composite
on
tooth
#
4.
The
dentist
used
Dentrix
specifically.
She
said
she
preferred
composite
for
aesthetic
purposes
as
well
as
that
fact
that
it
doesnt
expand/contract
over
time.
The
dentist
began
by
administering
local
anesthetic
(after
topical
was
placed).
It
was
specifically
a
PSA
injection
and
they
allowed
about
five
minutes
for
numbness
to
occur.
She
used
Endo-ICE
on
the
end
of
a
cotton
swab
to
test
the
area-once
the
patient
confirmed
no
feeling
she
proceeded.
A
bite
block
and
a
dri
tip
were
placed
in
the
patients
mouth.
The
dentist
used
a
carbide
330
burr
attached
to
high
speed
handpiece
to
remove
the
decayed
pieces
of
tooth
structure.
She
used
a
dark
substance
called
Sable
Seek,
which
is
a
caries
indicator
dye
which
stains
denatured
collagen.
The
next
five
minutes
consisted
of
her
using
the
dye,
drilling
for
a
bit,
and
so
on
until
all
decayed
portions
were
removed.
Next,
she
placed
a
matrix
band
around
tooth
to
build
a
wall
for
the
contact
on
the
mesial
side.
The
material
she
used
to
place
the
restoration
was
Base
Bitrabond,
which
is
a
glass
ionomer
that
bonds
well
to
dentin-sealing
it
off.
This
particular
product
cures
in
the
mouth.
The
dentist
then
applied
Prime
&
Bond
and
light
cures
for
30
seconds
with
matrix
band
on,
and
for
an
additional
30
seconds
after
removing
the
band.
Dr.
Cadaret
used
a
composite
polishing
tip,
which
was
made
of
rubber
impregnated
with
diamonds,
to
achieve
the
true
shape
of
first
premolar.
She
used
articulating
paper
several
times,
both
on
the
occlusal
surfaces
and
interproximally
to
determine
what
needed
to
be
filed
off.
Finally,
she
flossed
interproximally
to
remove
any
excess
product.
Client
Record
Procedure
#1
The
particular
office
I
observed
preferred
that
I
did
not
look
over
their
chart
notes
for
HIPAA
purposes.
The
assistants
fill
out
the
chart
notes
during
the
day,
and
at
the
end
of
day
the
Dr.
looks
over
them
to
make
sure
they
are
sufficient.
There
is
a
different
template
for
each
procedure.
For
the
crown
cementation,
the
assistant
specifies
which
particular
tooth
the
procedure
is
performed
on,
the
material
used,
if
anesthetic
was
used
(injectable
or
topical),
and
included
documentation
of
the
x-ray.
Additional
comments
may
be
made
and
PARQ
is
listed
above
the
electronic
signature
from
the
doctor.
Procedure
#2
The
template
is
somewhat
similar
for
a
composite
restoration.
It
includes
the
specific
surfaces
of
decay,
all
the
materials
used
in
the
process,
and
the
anesthetic
is
used
(which
particular
injections).
Additional
comments,
PARQ,
and
electronic
signature
from
Dr.
follow.
Infection
Control
Procedures
I
was
honestly
very
surprised
how
much
their
office
protocols
differed
from
LCC.
Given
it
was
a
much
smaller
office,
but
their
sterilization
room
literally
looked
like
a
galley
kitchen
to
me.
It
was
open
on
both
sides
so
patients
were
able
to
observe
the
entire
area-even
from
the
reception
area
which
I
found
strange.
I
also
found
it
strange
that
although
the
assistants
removed
the
trays
and
contaminated
items
from
the
treatment
rooms,
they
only
carried
them
to
sterilization
room-where
the
receptionist
placed
instruments
in
the
ultrasonic
and
sterilizers.
She
was
wearing
gloves,
but
no
protective
eyewear
or
mask.
Personally
I
thought
their
outfits
were
very
cute,
but
they
did
not
look
like
scrub.
They
wore
capris
and
flats!
I
was
pretty
sure
that
was
against
OSHA
protocol.
There
were
not
any
barriers
placed
over
the
chairs
or
on
the
handpieces,
though
they
did
disinfect
them.
I
also
observed
the
assistant
touching
the
computer
and
x-ray
equipment
(which
had
minimal
barriers)
with
her
dirty
gloves
that
had
been
in
the
patients
mouth.
Overall,
they
seemed
to
be
more
laid
back
in
their
infection
control
protocols
as
compared
to
LCC.
General
Impressions
I
thought
that
the
overall
atmosphere
of
the
office
was
very
pleasant.
It
was
small,
quaint,
and
quiet
(which
I
liked).
I
also
enjoyed
the
fact
that
all
women
worked
there-
one
dentist,
two
hygienists,
and
three
assistants.
The
patients
seemed
to
know
the
doctor
on
a
more
personal
level
and
they
were
able
to
chat
when
time
permitted.
The
part
that
fascinated
me
most
was
the
x-ray
machine
pulled
out
from
a
cabinet
chairside!
This
seemed
to
help
the
clinician
use
time
much
more
effectively.
Actually,
overall
I
was
very
surprised
at
how
fast
the
procedures
took.
I
would
say
they
only
took
about
twenty
minutes
a
piece;
time
was
always
used
effectively.