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Taylor Brewer

Dental Materials
Spring 2016

Office Visitation
The office that I chose to go visit and observe two separate procedures was
Natures Way Dentistry located in Moscow, Idaho. The first procedure I
observed was a composite filling and the second procedure I observed was a
crown preparation.

Procedure 1:

The first procedure I observed at Dr. Werners office was a composite filling. I
met with the assistant, Hailey, prior to the procedure and she gave me a
HIPPA form to fill out for their personal records and security purposes. She
then took me to the back office and showed me where they were doing the
procedure and introduced me to the dentist.

Before the patient was brought to the back room, Hailey showed me all of
the materials that they would be using in order to complete the procedure.
The materials consisted of Etch Burkhart Percision+, Optibond Solo Plus,
Venus Diamond Composite, burrs with finishing strips and a One Gloss
disposable polishing cup. The two different types of burrs that Dr. Warner
used to drill out the cavity, shape and prep the tooth was an 11-57 and a
variety of diamond burrs. Hailey also showed me the type of suction that
they use in their office, which was new to me and something that I have not
seen before. The suction was called an Isolite suction with a block attached
so the patient could rest their jaw during the procedure.

The patient was then brought back into the room after being greeted and
checked in at the front desk and prepped for the procedure by Hailey. The
patient was an obvious regular to the office and was very comfortable with
being at the dentist for his procedure; showing no signs of anxiousness or
fear before the procedure. Hailey and the patient talked about the new
things that has happened in his life since the last visit and she also asked
about his previous dental procedures that they have completed in his mouth;
the patient showed no sign of concern with his previous restorations.

The patient was then further prepped for the procedure with an application
of 20% Benzocaine topical that was placed in the patients vestibule right
below tooth #22; which was the tooth that was being filled for the day due to
decay. The application was placed in the mouth for about 5 minutes before
Hailey went and informed the dentist that he was ready for anesthetic.
Dr. Werner came into the room shortly after and started talking with the
patient about the procedure that he was completing today. Doctor had the
radiographs from previous visits pulled up on the screen as he gave a brief
description to the patient to further help patient education on the procedure.
Dr. Warner then gave one carp of Lidocaine HCL 2% to the patient right
below the point of interest next to the front mandibular lateral. Doctor
retracted the lip with his left hand and gave gentle shakes to the cheek the
whole time the anesthetic was given to help the process; which took about
one minute to complete. The needle was then recapped using the proper on
handed scoop technique and placed back onto the tray. The patient was then
left to sit in the room to get numb for about 5 minutes.

Dr. Werner soon returned to the room to asked if the patient felt numb
enough for the procedure; the patient stated he was so the process was then
started. The patient was leaned back into the chair and the Isolite suction
was placed into his mouth for further isolation of the tooth and better
suction; Hailey is also using the slow suction for further retraction and
suction of the water from the high speed. Dr. Werner started off by drilling
out the cavity with a diamond burr with the high speed hand piece. Once the
cavity was all drilled out, Doctor did some final smoothing and shaping to the
tooth with another diamond burr and an 11-57 burr. A wedge was then
placed between tooth #22 and 23 so that the material did not seep into the
contact and interproximal space. Once the tooth was to his satisfaction,
Doctor filled the cavity with the etch (Burkhart Percision+) which was soon
rinsed and suctioned for about 10 seconds. Next, the bond (Optibond Solo
Plus) was placed with the light being turned away from point of interest so it
did not set so quickly; the tooth was then cured for 10 seconds. The
composite (Venus Diamond) was then placed with an explorer and shaped to
liking before it was cured for 15 seconds. The wedge was removed from the
mouth and a finishing strip was used to test the contacts of the tooth on both
the mesial and the distal surfaces ensuring there was no interproximal
blockage. The composite was good and the contact was open so the
procedure was finished by polishing with the One Gloss disposable cup; this
was used on the slow speed.

Dr. Warner then evaluates his work and has the patient occlude to see if the
composite feels high or feels like he is hitting on his tooth. The patient said
that everything felt great, but Doctor still checked occlusion with the
articulating paper. Once placed in the mouth, the patient is instructed to
tap, tap, tap and grind his teeth together. The articulating paper was
removed and Doctor further inspects for any high areas that may be present.
The tooth looked great and the occlusion was good so doctor then asked if
the patient had any further questions regarding the procedure. The patient
said no and thanked Dr. Warner for his work and then was brought to the
front desk for dismissal by the assistant Hailey.
The instruments were taken to the sterilization room and properly bagged
and prepped. The slow and fast speeds were wiped with alcohol and bagged
for sterilization. The room was broken down and wiped down with CaviWipes
and re-bagged in preparation for a new patient.

Procedure 2:

The second procedure I observed was at the same office, Natures Way, with
the same dentist and assistant; Hailey and Dr. Werner. This procedure
involved a crown prep on tooth #18. I met with the assistant Hailey again
prior to the procedure and she explained to me and showed me all the
materials that the dentist would need. This included one carpel of Lidocaine
HCL 2%, 20% Benzocaine topical, cord dux dental gingikit with two sizes: 1a
and 0a, diamond and 11-57 burrs, Etch Burkhart Percision+, Optibond Solo
Plus, CompCore AF syringe mix stack core material build up, CorrectSet fast
set and normal set impression material, articulating paper and a basic
restorative set up.

The patient was greeted at the front and brought back to the dental chair by
the assistant. He seemed to have known the staff well and felt comfortable in
the environment considering they immediately picked up on past
conversations. Hailey told him she was going to prepare him to get numb
and put 20% Benzocaine topical in the buccal vestibule in the mandible
below #18. The patient was then instructed to wait 5 minutes while Dr.
Werner preps for the injection to further get him numb. Five minutes later Dr.
Werner comes and greets the patient asking him how he has been and
explains the procedure and asks if he has any concerns. The patient says he
has no concerns and Dr. Werner prepares to start the injection. He used one
carpel of Lidocaine HCL 2% and did an inferior alveolar nerve block injection.
Dr. Werner explains that the patient will feel a slight pitch and lots of jiggling
as he vibrates his cheek during the injection. Once finished, he uses the one
handed scoop technique and places the syringe back onto the tray. He
instructs the patient that they are going to wait 5 minutes for the anesthetic
to start working and leaves the room.

Dr. Werner returns to the room after about 5 minutes and asks the patient if
he is feeling numb on the left side of his mouth, the patient responds that
yes he is numb and doctor starts preparing for the procedure. An impression
was taken with the CorrectSet regular impression material to make a quick
temporary crown and to see the patients bite registration. The impression is
removed after about 2 minutes and is set on the tray for later use. Dr.
Werner first grabs his high speed hand piece to take out the temporary build
up material that was previously placed in the patients mouth with a
diamond burr. Hailey was using the high suction to pick up the excess build
up along with the Isolite suction block that was placed in the mouth prior to
the procedure. Once all of the excess material was removed, the patient is
given a quick rinse and the tooth is dried in preparation for the etch. Etch
Burkhart Percision+ was placed on the surface with a cotton applicator for 10
seconds and then was rinsed thoroughly with water. Optibond Solo Plus was
then placed, air dried and light cured for 10 seconds. This was evaluated and
then covered with the syringe mix stack core material build up. On top of
that, the Optibond Solo Plus was placed again and light cured for 10 seconds.
Dr. Werner then grabs the high speed and starts to smooth the build up
around the tooth with a diamond burr. Next, graded floss (size 0a) was
tucked around the tooth to protect the gums and margin in preparation for
the fine tuning; this was done with a cord packer. Fine tuning of the margin
was then done with the high speed. Next, a picture was taken of the tooth
with an intraoral camera for records. Dr. Werner then checked the patients
occlusion with articulating paper placing it in the mouth and instructing to
tap, tap, tap and grind their teeth. The occlusion looked good and the
graded floss was removed from the margin and replaced with impression
cord; the excess was removed with a pair of straight quimby gum scissors.
The assistant then tested in the impression tray to ensure it was the right fit
for the patients mouth. When the tray size was confirmed that it was the
correct size, the impression was taken. Dr. Werner placed the fast set
impression material onto the tooth as the assistant proceeded to remove the
impression cord with a pair of forceps. The tray full of regular set material
was then placed in the patients mouth after completion. The patient was
instructed that this had to sit in the mouth for 5 minutes and he was set up
in the dental chair; the impression material that was used for this procedure
was Burkhart impression material. Once the impression material was set up,
it was removed from the mouth and the temporary crown was then made
from this impression. Dr. Werner then left and the assistant completed the
remaining of the procedure. To do this, the temporary crown bridge material
was placed into the original impression tray and then set in the patients
mouth for 3 minutes to set up. After 3 minutes, the temporary crown was
removed and trimmed with an acrylic burr by the assistant. After many
attempts of trying in the crown and removing excess with the burr, the crown
finally became a perfect fit within the patients mouth. The crown was then
placed into the mouth and checked with articulating paper to ensure the
patient was not hitting and the occlusion was in good contact. The assistant
called in doctor to check her work on occlusion and fitting of the crown. Dr.
Werner said that the crown looked good and she was okay to cement it on.
The temporary crown was then set in the mouth with Temp-Bond NE until the
final crown was made and set on a later date. The patient was then
dismissed from the chair and walked to the front desk to set up his next
appointment.

The instruments were taken to the sterilization room and properly bagged
and prepped. The slow and fast speeds were wiped with alcohol and bagged
for sterilization. The room was broken down and wiped down with CaviWipes
and re-bagged in preparation for a new patient.
Client Record:
HX-History
EX-Exam
DX-Diagnosis
TX-Treatment
I unfortunately did not get to personally watch the client record being
imported into the system after treatment because I was told that they are
filled out by the dentist; he was busy after the treatment with another
patient. However, I was told how the basic charting was done by the
assistant Hailey. Within the chart, the medical history (HX-history) of the
patient and the current status of their health is noted, the procedure (EX-
exam) and specifics to what tooth, side of the mouth and surface that is
being treated is noted along with the reasoning (DX-diagnosis) behind the
treatment for that patient, the treatment (TX-treatment) and the specifics of
the procedure being performed; such as the type of materials and anesthetic
used is explained, the next appointment for the patient is noted, and the
dentist who performed the treatment is stated. Within the chart, it also
states patient consent to treatment and that the patient was knowledgeable
about the procedure; meaning it was explained and any questions or
concerns were answered. Overall, the charting was simple, short and easy to
decipher.

Infection Control Procedures:

The sterilization was done by the assistant who was helping the dentist
during the procedure. The instruments, used or unused, were taken to the
sterilization room and put into the ultrasonic for 15 minutes prior to being
bagged appropriately and put into the autoclave for sterilization. This was
done fairly quickly after the procedure ended so that the office staff would
not get confused on which instruments were sterile and unsterile and which
rooms were dirty and clean. The office was fairly busy throughout the day, so
a fast response to dirty materials, rooms and instruments was a must to keep
things running smoothly and to keep minimal confusion between staff
members. The rooms were wiped with CaviWipes after the barriers were
removed and thrown away in the appropriate trash. Anything that contained
blood was placed into the biohazard trash and anything that was sharp, such
as the needles for anesthetic, was placed into the sharps container. The
sterilization room was located behind all the procedure rooms so that the
patients could see that the process was being done consistently and
continually throughout the day; ensuring them that their room was clean and
that the instruments being used on them were sterile. Overall, their
sterilization process was pretty similar to ours in the clinic. The sterilization
room they had was bigger and more spacious than the one we have in the
clinic, but the disinfection process was fairly similar to ours.

General Impression:

My general impression of the office I chose to visit was that it was very small
and located in a weird spot. The location was inside of a complex that had
many businesses around it and it was located on the second floor of this
building. office had scentsy going in the waiting room that was a very
calming and comforting smell and made for a good first impression upon
arrival. It was a very nice office and the staff members were very friendly,
kind and inviting when I arrived and to their patients. The office also offered
the scentsy smell in a variety of lotions and creams at the front desk that the
patient could buy; the smell was made to make the patient feel calm. Both
procedures were in the morning, so the office was not too busy when I
arrived. The office was very well maintained and looked fairly new. The staff,
especially the dentist, was very open to all of my questions and ensured me
to ask if I had any throughout the day/procedure. The office also had a
massage room located in the back that was open to patients who wanted;
which was a new thing for me to see in a dental office. Overall, both visits
were fairly laid back and the staff seemed to handle their procedure and
days very well. The office was very organized with both procedures and
everything ran very smooth. The office was a very comforting environment
and the staff made me feel very welcome. The only thing that I disliked
about the office was the location; making it difficult and confusing to find for
newcomers.