Cover Page

Contents

Introduction to the Tenth Edition

Introduction to the First Edition

Acknowledgements

Abbreviations

1 Structure of the Dental Profession

The dentist

General Dental Council

The dental team

Dental care professionals

The National Health Service

British Dental Association

2 The Dental Nurse

Personal qualities

The law

Duties of a dental nurse

British Association of Dental Nurses

National Examining Board for Dental Nurses

Registration

3 Outline of Physiology

4 Circulation, Respiration and Digestion

Circulation

Action of the heart

Circulatory system

Respiration

Digestion

5 Medical Emergencies

Faint

Asthma attack

Anaphylaxis

Epileptic fit

Hypoglycaemia and diabetic coma

Angina

Myocardial infarction

Choking

Preparation of the dental team for medical emergencies

6 Microbiology and Pathology

Bacteria

Viruses

Fungi

General effects of disease on the body

Response of the body to pathogen attack

Inflammatory response

Tissue repair

Immunity

Allergy

Dentally related pathology

Oral cancer

Drugs used in dentistry

7 Infection Control and Sterilisation

Sterilisation

Disinfection

Prevention of cross-infection

Occupational hazards

Waste disposal in dental practice

8 Head and Neck Anatomy

Anatomy of the skull

Movements of the jaws

Soft tissues of the mouth

Nerve supply of the head

Blood supply

9 Nerve Supply of the Teeth and Local Anaesthesia

Maxillary nerve

Mandibular nerve

Local anaesthesia

Types of injection

Local anaesthesia for fillings

Preparation for local anaesthesia

10 Dental Anatomy

Structure of the teeth

Tooth morphology

Deciduous teeth

Permanent teeth

Surfaces of the teeth

Charting

Palmer notation

Anatomy of individual teeth

Occlusion of the teeth

11 Dental Caries

Bacterial plaque

Sugar

Acid formation

Sites of caries

Caries and cavity formation

Role of saliva in oral health

Reduced salivary flow

Diagnosis of caries

Prevention of caries

Non-carious tooth surface loss

12 Periodontal Disease

Causes of periodontal disease

Periodontal tissues in health

Chronic gingivitis

Chronic periodontitis

Diagnosis of periodontal disease

Non-surgical treatment of periodontal disease

Surgical treatment of periodontal disease

Other periodontal conditions

13 Assessment and Prevention of Dental Disease

Dental plaque

The role of saliva

Diagnosis of dental disease

Tooth charting

Prevention of dental disease

Effect of general health on oral health

14 Dental Radiography

Effects of ionising radiation on tissues

Uses of radiography

Radiographic changes in disease

X-ray film

Taking intra-oral radiographs

Panoramic radiography

Cephalometric radiography

Digital radiography

Processing

Causes of failure

Quality assurance of films

Dangers of ionising radiation

Legal requirements

Role of the dental nurse

15 Patient Records

Importance of records

Valid consent

Confidentiality of patient details

Patient complaints

GDC standards for dental professionals

Clinical records

NHS records

16 Fillings and Materials

Classification of cavities

Cavity preparation

Moisture control

Instruments

Air abrasion

Temporary filling materials and cavity liners

Permanent filling materials

17 Endodontics

Principles of endodontics

Causes of pulpitis

Choice of treatment

Importance of the medical history

Root filling or pulpectomy

Pulpotomy

Apicectomy

Use of antibiotics in endodontics

18 Inlays, Crowns and Bridges

Gold inlays

Crowns

Bridges

Direct-bonded restorations

Bleaching

19 Dentures and Implants

Denture retention

Denture materials

Patient suitability for dentures

Stages of full denture construction

Prevention of cross-infection

Impressions

Disinfection procedure

Occlusal registration

Trial insertion

Final insertion

After care

Partial dentures

Immediate dentures

Overdentures

Obturators

Soft linings

Implants

20 Extractions and Minor Oral Surgery

Extraction instruments

Care of the patient

Complications of extractions

Accidental extraction

Minor oral surgery

Haemorrhage

The dental nurse’s duty

21 Orthodontics

Aims of treatment

Normal occlusion

Types of malocclusion

Causes of malocclusion

Risks of orthodontic treatment

Treatment of malocclusion

Removable appliances

Fixed appliances

Functional appliances

Surgery procedure

22 Pain and Anxiety Control

General anaesthesia

Conscious sedation

The dental nurse’s duty

Resuscitation

Other forms of anxiety control

Pain control

23 Health and Safety at Work

Role of the dental nurse

Fire precautions

First aid

COSHH

RIDDOR

Waste disposal

Surgery hazards

Infection control

General safety measures

General security measures

Safety signs

24 Patient Management

Reception of patients into the practice

Appointments

Communication skills

Equality of dental care

Patients with special needs

Dental emergencies

Appendix: National Examining Board for Dental Nurses National Certificate Syllabus

Index

Appendix: National Examining Board for Dental Nurses National Certificate Syllabus

(Reproduced with kind permission of the National Examining Board for Dental Nurses (NEBDN))

The syllabus is arranged in the following sections:

1 Health and Safety and Infection Control in the Workplace

2 Emergencies in the Clinical Environment

3 Legal and Ethical Issues in the Provision of Dental Care

4 Anatomical Structures and Systems Relative to Dental Care

5 Oral Diseases and Pathology

6 Patient Care and Management

7 Assessing Patients’ Oral Health Needs and Treatment Planning

8 Oral Health Promotion and Preventive Dentistry

9 Restorative Dentistry

10 Oral Surgery

11 Orthodontic Procedures

12 Dental Drugs, Materials, Instruments and Equipment

13 Pain and Anxiety Control in Dentistry

14 Radiography

15 Communication

HEALTH AND SAFETY AND INFECTION CONTROL IN THE WORKPLACE

1.1 Describe the following aspects of current health and safety legislation and regulation in the workplace in relation to own and other team members’ responsibilities:

1.1.1 risk assessments and the Health and Safety at Work Act 1974

1.1.2 Fire Precaution (Workplace) Regulations

1.1.3 Health and Safety (First Aid) Regulations

1.1.4 Control of Substances Hazardous to Health Regulations in the workplace (COSHH)

1.1.5 Reporting of Injuries, Diseases and Dangerous Occurrences Regulations (RIDDOR)

1.1.6 Environmental Protection Act

1.1.7 Special Waste and Hazardous Waste Regulations

1.2 Describe own and other team members’ responsibilities in relation to:

1.2.1 avoiding hazards and taking precautions in the dental environment

1.2.2 the safe disposal of clinical waste, sharps and hazardous chemicals

1.2.3 working with hazardous and non-hazardous waste

1.3 Describe infectious diseases, their agents and routes of transmission and methods for preventing cross infection

1.4 Explain:

1.4.1 the principles and methods of sterilisation and disinfection and aseptic techniques

1.4.2 types of micro-organisms, the meaning and significance of the terms pathogens and non pathogens

1.4.3 explain the principles of Universal Precautions

1.5 Explain how personal protection measures are used to control infection

1.6 Explain how the clinical environment should be prepared and maintained prior to, during and after treatment sessions

1.7 Describe and demonstrate the safe disposal of dental instruments, sharps and equipment, and out-of-date drugs and materials

EMERGENCIES IN THE DENTAL SURGERY

2.1 Describe the signs, symptoms and causes of common medical emergencies and explain the actions to be taken should the following particular events occur:

2.1.1 faint

2.1.2 cardiac arrest

2.1.3 respiratory arrest

2.1.4 asthmatic attack

2.1.5 epileptic seizure

2.1.6 diabetic coma

2.1.7 angina/myocardial infarction

2.1.8 dental haemorrhage

2.2 Identify the hazards associated with the use of drugs and their interaction with other medicaments in dentistry

2.3 Describe the records which have to be kept in the event of a health emergency and explain the reasons for this

2.4 Demonstrate knowledge of first aid

LEGAL AND ETHICAL ISSUES IN THE PROVISION OF DENTAL CARE

3.1 Describe the following aspects of current legal and ethical legislation and regulation in the workplace in relation to own and other team members’ responsibilities:

3.1.1 General Dental Council – Standards Guidance

3.1.2 Dentists Act 1984 (Amendment) Order 2005

3.1.3 Access to Health Records

3.1.4 Freedom of Information Act

3.1.5 Department of Health guidance

3.1.6 Data Protection Act

3.1.7 Caldicott Regulations

3.2 Explain what is meant by the term ‘valid consent’ and discuss related issues for different patients

3.3 Explain the reasons for, and methods of, maintaining confidentiality in relation to:

3.3.1 duty of care for patients in relation to records and treatment

3.3.2 colleagues

3.3.3 the employing organisation

3.4 Describe the importance of Data Protection and access to patient records in relation to own and other team members’ responsibilities

3.5 Describe the importance of keeping up-to-date patient records, the medicolegal implications and handling of complaints

3.6 Describe how the practice of dentistry is regulated and how these regulations affect own role and that of other members of the oral health care team in:

3.6.1 responsibility

3.6.2 registration

3.6.3 reporting

3.6.4 delegation

3.6.5 professional relationships

3.7 Demonstrate understanding of dental nurses’ responsibilities in relation to continuing professional development and lifelong learning

ANATOMICAL STRUCTURES AND SYSTEMS RELATIVE TO DENTAL CARE

4.1 Have knowledge of the function and structure of general anatomy as relevant to dental nursing:

4.1.1 the circulatory system

4.1.2 the respiratory system

4.1.3 the digestive system

4.2 Describe:

4.2.1 the basic structure of the oral cavity including the:

nerve and blood supply of the teeth and supporting structures
mandible and maxilla
muscles of mastication
salivary glands

4.2.2 the structure and morphology of deciduous teeth and their eruption dates

4.2.3 the structure and morphology of permanent teeth and their eruption dates

4.2.4 the structure of supporting tissues in the oral cavity

4.2.5 the functions of teeth

ORAL DISEASE AND PATHOLOGY

5.1 Describe the inflammatory process and the effects of the disease process in all patients including elderly people and children on:

5.1.1 hard dental tissues

5.1.2 supporting dental tissues

5.1.3 other areas of the oral cavity

5.2 Describe the aetiology and progression of:

5.2.1 dental caries

5.2.2 periodontal disease

5.2.3 other oral diseases including tooth surface loss, such as erosion, attrition and abrasion

5.3 Describe micro-organisms and their role in the disease process, especially those associated with:

5.3.1 dental caries

5.3.2 periodontal disease

5.3.3 other oral diseases

5.4 Know the aetiology in the progression of oral cancer

PATIENT CARE AND MANAGEMENT

6.1 Describe and demonstrate effective ways of providing chairside support in all clinical procedures to:

6.1.1 patients

6.1.2 other members of the oral health team

6.2 Describe the special care needs which different patients may have and how these needs can be met effectively:

6.2.1 young patients

6.2.2 elderly patients

6.2.3 patients with medical problems

6.2.4 patients with disabilities

6.3 Understand the social, cultural, environmental and psychological factors that can affect patient management

6.4 Explain effective ways of dealing with anxious and vulnerable patients

6.5 Describe and demonstrate effective ways of providing emergency dental care

6.6 Be familiar with the problems of drug abuse and its effects in dentistry

ASSESSING PATIENTS’ ORAL HEALTH NEEDS AND TREATMENT

7.1 Describe the reasons for recording personal details of patients and effective methods of doing this

7.2 Demonstrate effective methods of recording medical, dental, and relevant social details of patients:

7.2.1 UK – National Health Service Chart

7.2.2 International Dental Federation (FDI)

7.2.3 information technology

7.2.4 other international charts

7.3 Demonstrate effective methods of recording soft tissue conditions using periodontal charts

7.4 Describe the importance of discussing, explaining and recording different treatment options with the patient, including the cost implications and the patient’s NHS or other welfare entitlement

7.5 Describe the maintenance of study models and diagnostic reports

7.6 Be familiar with how referral procedures work locally

ORAL HEALTH PROMOTION AND PREVENTIVE DENTISTRY

8.1 Describe how diet may affect oral health, including non carious tooth surface loss

8.2 Describe how the dental team can help a patient to improve their oral condition

8.3 Describe and demonstrate methods/aids that can be used in maintaining oral hygiene

8.4 The prevention and control of periodontal diseases and dental caries covers:

observing/monitoring the hard and soft tissues
applying fissure sealants
the use of antimicrobial agents
scaling (hand and ultrasonic)
polishing
topical and systemic fluorides

For each of the above:

8.4.1 identify the instruments and equipment used in the procedure, and describe their use and order of use during the procedure

8.4.2 describe the different stages undertaken during the procedure

8.4.3 identify the materials used during the procedure and demonstrate their use

8.4.4 explain the pre- and post-operative care of patients

RESTORATIVE DENTISTRY

9.1 Cavity preparation

Explain why cavities are restored and the different ways this may be done:

provisional restorations
amalgam restorations
composite, glass ionomer restorations and compomers
inlays – gold/porcelain
veneers

For each of the above:

9.1.1 identify the instruments and equipment used in the procedure, and describe their use and the order of use during the procedure

9.1.2 describe the preparation of a cavity prior to restoration

9.1.3 identify the materials used during the procedure and demonstrate their use

9.1.4 explain the pre- and post-operative care of patients

9.2 Endodontics

Explain the reasons for endodontic treatment and the different procedures that may be used:

conventional root canal treatment
apicectomy and retrograde root filling
pulpotomy/pulpectomy/pulp capping

For each of the above:

9.2.1 identify the instruments and equipment used in the procedure, and describe their use and the order of their use during the procedure

9.2.2 describe the different stages during the procedure and the reasons these are undertaken

9.2.3 identify the materials used during the procedure and demonstrate their use

9.2.4 explain the pre- and post-operative care of patients

9.3 Fixed prostheses

Explain the reasons for providing fixed prostheses and the different procedures that may be used:

crowns and bridges, both permanent and temporary
dental implants

For crowns and bridges:

9.3.1 describe their types and uses

9.3.2 identify the instruments and equipment used in the procedure, and describe their use and the order of use during the procedure

9.3.3 describe the preparation of a tooth prior to construction of a fixed prosthesis

9.3.4 describe the laboratory stages required to construct a fixed prosthesis

9.3.5 identify the materials used during the procedure and demonstrate their use

9.3.6 explain the pre- and post-operative care of patients

9.4 Removable prostheses

Explain the reasons for providing removable prostheses and the different types that may be used:

full dentures
partial dentures (metal base and acrylic base)
immediate dentures
repairs, relines and additions

For each of the above:

9.4.1 describe their types and uses

9.4.2 identify the instruments and equipment used in the procedure, and describe their use and the order of their use during the procedure

9.4.3 describe the surgery procedures required to construct a removable prosthesis

9.4.4 describe the laboratory stages required to construct a removable prosthesis and the need for effective communication with the dental laboratory

9.4.5 identify the materials used during the procedure and demonstrate their use

9.4.6 explain the pre- and post-operative care of patients

9.5 Periodontal surgery

Explain why periodontal surgery may be necessary and give details in simple terms of the different types of procedures:

gingivectomy
flap operations

For each of the above:

9.5.1 describe the procedure in simple terms

9.5.2 identify the instruments and equipment used in the procedure

9.5.3 identify the materials used during the procedure

9.5.4 explain the pre- and post-operative care of patients

ORAL SURGERY

Explain why teeth need to be extracted and the complications that may arise during each procedure:

10.1 Extraction of deciduous and permanent teeth

10.1.1 identify the instruments and equipment used in the procedure, and describe their use and the order of their use during the procedure

10.1.2 describe the post-operative problems which may occur and explain how they are treated

10.1.3 explain the pre- and post-operative care of patients

10.2 Minor oral surgical procedures

extraction of erupted and partially erupted teeth
extraction of buried and impacted teeth and roots
removal of roots
investigation of hard tissue lesions
investigation of soft tissue lesions
intraoral suturing

For each of these areas:

10.2.1 describe the different minor oral surgery procedures and the different stages within them

10.2.2 identify the instruments and equipment used in the procedure, and describe their use and order of use during the procedure

10.2.3 explain the pre- and post-operative care of patients

ORTHODONTIC PROCEDURES

11.1 Describe the major orthodontic classifications of teeth and jaws

11.2 For removable, fixed and functional orthodontic appliances:

11.2.1 be aware of each of their different uses

11.2.2 accurately record and provide chairside support during assessments

11.2.3 provide chairside support during fitting of appliances, including instrument selection

11.2.4 pre-treatment care and post-operative instructions

DENTAL DRUGS, MATERIALS, INSTRUMENTS AND EQUIPMENT

12.1 Describe the drugs and materials commonly used in dentistry and explain their use

12.2 Demonstrate the correct manipulation of materials commonly used in dentistry

12.3 Describe the hazards associated with materials commonly used in dentistry and explain how to minimise the risks associated with these materials

12.4 Describe the actions to be taken in the case of mercury spillage

12.5 Demonstrate methods of recording, labelling and storing drugs and materials

12.6 Describe the legislation applicable to drugs and materials in dentistry (including their safe disposal) in relation to their own and other team members’ responsibilities

12.7 Describe and demonstrate the care and maintenance of instruments and equipment used in dentistry

PAIN AND ANXIETY CONTROL IN DENTISTRY

13.1 Be familiar with the management of different forms of facial pain and anxiety control

13.2 Describe:

13.2.1 the different types of local anaesthetic agent and the contents of a local anaesthetic cartridge

13.2.2 the methods of administering local anaesthetic agents

13.2.3 the hazards associated with local anaesthesia

13.2.4 how to treat emergencies associated with local anaesthesia

13.3 Be familiar with:

13.3.1 the differences between conscious sedation and general anaesthesia

13.3.2 the regulations which govern the administration of conscious sedation and general anaesthesia

13.3.3 other techniques of anxiety control in dentistry, such as hypnosis

RADIOGRAPHY

14.1 Describe the following aspects of current radiography legislation and regulation in relation to own and the clinical team’s responsibilities

14.2 Describe:

14.2.1 the use of radiography in assessing oral health needs

14.2.2 the hazards associated with radiation in the dental surgery

14.2.3 the precautions taken to limit radiation hazards

14.2.4 principles and techniques of taking dental radiographs (including digital) and demonstrate the processing, recording and maintenance of dental radiographs

14.2.5 faults that can occur in processing radiographs

14.2.6 how dental radiographic films and chemicals can be stored safely, and demonstrate the care of dental radiographic equipment

14.2.7 the regulations which govern the taking of dental radiographs

COMMUNICATION

15.1 Describe and discuss methods of communicating clearly and effectively with patients and colleagues

15.2 Discuss the reception of patients into the dental environment and the role of the dental nurse in this procedure

15.3 Explain how dental appointments can be organised effectively

15.4 Discuss working in a team environment and the role of the dental nurse

15.5 Provide evidence of using information technology

Index

Abbreviations

Abdomen

Abrasion

Abscess

Aciclovir

Acid etching

Acrylic

Actinomyces

Acupuncture

Acute necrotising ulcerative gingivitis

Adrenaline

AIDS

Air abrasion

Airway

ALARA

Alginate

Allergy

Alveolar abscess

Alveolar process

Alveoli

Alveolectomy

Amalgam

Amalgamator

Ameloblast cells

Amelodentinal junction

Amoxicillin

Amphotericin

Anaemia

Anaesthesia

General

Local

Anaesthetic drugs

Local

Surface

Analgesia

Analgesics

Anaphylactic shock

Angina pectoris

Angle's classification

Antibiotics

Antibodies

Anticoagulants

Antigens

Antitoxins

Antrum

Aorta

Apical foramen

Apicectomy

Appointments

Artery

Articular eminence

Articulating paper

Articulator

Asepsis

Aspirator

Aspirin

Asthma

Asystole

Atrium

Attrition

Autoclave

Bacillusfusiformis

Bacteraemia

Bacteria

Bacterial endocarditis

Baseplate

Basic life support

Bile

Biopsy

Black’s classification

Bleaching

Blood

Bonding agents

Bone

Borrdia vincmti

Bridge

British Association of Dental Nurses

Broach Bronchi

Bronchitis

Brook airway

Bruxism

Buccal sulcus

Buffer action

Bulimia

Burs

Business Services Authority

Calcium hydroxide

Calculus Cancer

Candida albicans

Cannula

Capillary

Carbohydrate

Carbon dioxide

Cardiac arrest

Caries

Cartilage

Cassette

Cavity

classification

lining

preparation

Cell

Cellulitis

Cementum

Cermet

Certificates

National

Vocational

Charting

Chewing gum

Chisel

Chlorhexidine

Choking

Chrome-cobalt

Cingulum

Circulation

Circulatory system

Cleft palate

Clindamycin

Clinical audit

Clinical governance

Collapse

Communication

Compomer

Composite

Compoule

Computer

Condyle

Confidentiality

Coning

Conscious sedation

Consent

Contact point

Continuing Professional Development,

Coronary artery disease

Coronary thrombosis

Coronoid process

Corticosteroid

COSHH

Creutzfeld-Jakob disease

Crohn’s disease

Cross-infection

Crown

Curette

Cusp of

Carabelli

Cyanosis

Cyst

Data Protection Act

Demineralization

Dental Care Professional

Dental Practice Board

Dental Practitioner’s Formulary

Dentine

Dentine pins

Dentists Act

Dentures

Denture stomatitis

Developer

Diabetes

Diaphragm

Diazepam

Digestion

Digestive system

Disclosing agents

Discrimination

Disinfection

Dislocation

DMF count

DNA

Dry socket

Duodenum

Elastomer

Elevator

Elongation

Emergency kit

Enamel

Endocrine glands

Endocrine system

Endodontics

Enzymes

Epiglottis

Epileptic fit

Epinephrine (see Adrenaline)

Epstein-Barr virus

Erosion

Eruption

Erythromycin

Ethyl chloride

Excavator

Excretion

Exocrine glands

External cardiac compression

External oblique ridge

External respiration

Extraction

Fainting

Filling

Fire precautions

Fissure

Fissure sealants

Fistula, Fixer

Floss

Fluconazole

Fluoride

Fluorosis

Foramen

greater palatine

incisive

infra-orbital

magnum

mandibular

mental

Forceps bone

Cheatle

dissecting

extraction

Miller

mosquito

Spencer Wells

Foreshortening

Frenectomy

Frenum

Fungi

Gall bladder

Gamma rays

General Dental Council

Gingiva

Gingival crevice

Gingivectomy

Gingivitis

Glass ionomer cement

Gleanoid fossa

Gold

Granulation tissue

Gutta percha

Haemoglobin

Haemophilia

Haemorrhage

Haemostasis

Halitosis

Handpiece

HBV (see Hepatitis B)

HCV (see Hepatitis C)

Health and Safety at Work

Heart

Heimlich manoeuvre

Hepatitis

Herpes

Homeostasis

Hormone

Human immunodeficiency virus

Hydrocortisone

Hydroxyapatite

Hygienist

Hyoid bone

Hypertension

Hypnosis

Hypodontia

Hypoglycaemia

Hypoxia

Iatrogenic factors

Ibuprofen

Immune system

Immunity

Impaction

Implants

Impression paste

Impressions

Infection

Infective endocarditis

Inferior vena cava

Inflammation

Injection

Inlay

Inoculation injury

Integumentary system

Intensifying screen

Internal respiration

Interprismatic substance

Intestine

Jaws

Junctional epithelium

Kidney

Lactobacillus

Lamina dura

Laryngoscope

Larynx

Laser

Leukaemia

Lidocaine

Lignocaine (see Lidocaine)

Lining cavity

soft

Liver

Local Rules

Lungs

Malocclusion

Mandible

Mastication

Matrix outfit

Maxilla

Meniscus

Mercury

Mercury poisoning

Metronidazole

Miconazole

Midazolam

Mitral valve

Moisture control

Monitoring

Mouth pack

Mucous membrane

Mucus

Muscles of facial expression

Muscles of mastication

Musculoskeletal system

Mylohyoid ridge

Myocardial infarction

National Health Service

Needle

Needle holders

Needlestick injury (see Inoculation injury)

Nerve block

Nerves

Nervous system

Nitrous oxide

Non-milk extrinsic sugars

Nystatin

Obturator

Occlusal registration,

Occlusal rests, Occlusion

Occlusion rims

Odontoblasts

Oesophagus

Operculectomy

Oro-antral fistula

Oropharyngeal (Guedel) airway

Orthodontics

Overbite

Overdenture

Overjet

Oxygen

Pace maker

Palate

Pancreas

Paper point

Paracetamol

Parachute chain

Paramyxovirus

Peer review

Penicillin

Pericoronitis

Periodontal disease

Periodontal ligament

Periodontitis

Peristalsis

Personal Development Plan

Personal Protective Equipment

Pharynx

Plaque

Plasma

Plaster

Plastic instrument

Platelets

Polycarboxylate cement

Porcelain

Porphyromonas gingivalis

Portal vein

Post dam

Pregnancy

Prescription

Preventive dentistry

Prevotella

Prilocaine

Prion

Primary Care Trust

Probe

Prop

Protozoa

Ptyalin

Pulmonary artery

Pulmonary vein

Pulp

Pulpitis

Pulpotomy

Pulse

Pulse oximeter

Pus

Radiation

Radiation Protection Adviser

Radiation Protection Supervisor

Radiography

Reamer

Records

Record of Experience

Rectum

Red cells

Registration

Regurgitation

Relative analgesia

Remineralisation

Rescue breathing

Resorption

Respiration

Artificial

expired air

failure of

Respiratory system

Resuscitation

Reye’s syndrome

Rheumatic fever

RIDDOR

Rongeurs

Root canal

Rubber dam

Rubella

Saliva

Salivary glands

Scaling

Scalpel

Sedation

Shimstock

Sigmoid notch

Sinus

Skin

Skull

Smoking

Social cleaning

Sodium hypochlorite

Soft lining

Sphygmomanometer

Spirochaetes

Splint

Spores

Squamous cell carcinoma

Stagnation areas

Stainless steel

Staphylococci

Sterilisation

Sternum

Stethoscope

Stomach

Streptococcus

Superior vena cava

Sutures

Swallowing

Syringe

Taste buds

Technician

Teeth

Anatomy

Crowded

Deciduous

Functions

Missing

Permanent

Structure

Supernumerary

surfaces of

Temperature

Temporo-mandibular joint

Tetracycline

Therapist

Tissue conditioner

Tongue

Toothbrushing

Toxins

Trachea

Trans-illumination

Treponema vincenti

Tricuspid valve

Trismus

Tuberosity

Tumour

Ulcer

Ulcerative colitis

Ultrasonic bath

Universal Precautions

Urinary system

Vaccination

Varnish

Vasoconstrictor

Vein

Venepuncture

Ventilation

Ventricle

Virus

Vitamin

Warfarin

Xerostomia

Washer disinfector

Waste disposal

Wax knife

White cells

White spot lesion

Willis bite gauge

Wood sticks

Xerostomia

Zinc oxide and eugenol cement

Zinc phosphate cement

White spot lesion

Zoning

1 Structure of the Dental Profession

The dentist

Dentists undergo five years of undergraduate training at a university dental school. On passing their final examinations, students are awarded the degree of Bachelor of Dental Surgery (BDS). But they cannot use the title of dentist or practise the profession until their names have been entered in The Dentists Register.

The register is kept by the General Dental Council (GDC) and contains the name, address and qualification(s) of every person legally entitled to practise dentistry in the United Kingdom. Such persons may describe themselves as dentist, dental surgeon or dental practitioner. There is no difference between these titles. Dentists may also use the courtesy title of Doctor but must not imply that they are anything other than dentists. Following qualification all dentists are legally required to continue their professional education until their retirement from practice, in order to maintain and update their skills.

Registered dentists have a wide choice of opportunities within the profession: general practice, community dental service, hospital service, university teaching and research, industrial dental service and the armed forces. They may also take additional higher qualifications and become specialists in a particular branch of dentistry. Some examples of such qualifications are:

Fellowship in Dental Surgery (FDS)
Master of Science (MSc) in a specialty
Master of Dental Surgery (MDS)
Master of Clinical Dentistry (M Clin Dent)
Membership in General Dental Practice (MGDP)
Membership in the Joint Dental Faculties (MJDF)
Membership in Orthodontics (MOrth)
Membership in Clinical Community Dentistry (MCCD)
Membership in Restorative Dentistry (MRD)
Membership in Paediatric Dentistry (M Paed Dent)
Membership of the Faculty of Dental Surgery (MFDS)
Diploma in Dental Public Health (DDPH)
Diploma in Dental Radiology (DDR)
Diploma in General Dental Practice (DGDP)
Diploma in Orthodontics (DOrth)

These qualifications are provided by the faculties of dental surgery, and the faculty of general dental practitioners, of the royal colleges of surgery.

Having obtained the relevant higher qualifications, dentists may join the Specialist Lists for their particular specialty. The following lists are included in the Dentists Register:

Oral and maxillofacial surgery
Surgical dentistry
Dental and maxillofacial radiology
Dental public health
Oral medicine
Oral microbiology
Oral pathology
Orthodontics
Periodontics
Prosthodontics
Restorative dentistry

General Dental Council

The GDC is the governing body of the dental profession and its duties are set out in legislation. These duties are to promote high standards of professional education and professional conduct among dentists, and dental care professionals (DCPs), throughout their entire practising career. It thereby ensures that the status of the profession in the community is upheld and that a proper code of conduct is maintained for the protection of the public. In essence, its remit is to protect patients and to regulate the dental team.

In performance of these duties the GDC must be satisfied that courses of study at dental schools and the qualifying examinations are adequate, and the same applies to postgraduate education.

It is the policy of the GDC for all dentists, after qualification, to serve one year of vocational training before starting independent practice. Such training schemes are already in force in National Health Service (NHS) general practice, the community and hospital services, and also on a voluntary basis in non-NHS practice. As soon as adequate resources and facilities are available, it will be mandatory for all dentists to undergo vocational training after qualification.

The GDC is empowered to remove or suspend from the register any dentist or DCP who has been convicted of a criminal offence or is guilty of serious professional misconduct. It may also suspend any dentist whose fitness to practise is seriously impaired because of physical or mental conditions.

Apart from registered dentists, the only other persons permitted to undertake dental treatment are dental hygienists and dental therapists. The GDC is responsible for these DCPs in much the same way as for dentists. After qualification they must be enrolled by the GDC in the DCP register. The limited range of dental treatment which they are permitted to undertake is laid down in the Dental Auxiliaries Regulations.

The dental team

Dentists’ training enables them to undertake, without assistance, all treatment necessary for patients, including construction of their dentures, crowns and bridges, etc. Except for the actual treatment performed within the mouth, much of the work which a dentist is qualified to do can be performed by others. For example, a chairside dental nurse provides an extra pair of hands for preparing and mixing filling and impression materials, and for helping with suction, retraction and illumination to keep the operative field clear and dry for the dentist and comfortable for the patient. A dental technician can make dentures, crowns and bridges ready for the dentist to fit, while dental hygienists and therapists are permitted to undertake limited forms of dental treatment.

By utilising all this assistance, a dentist becomes the leader of a team which can practise in the most efficient way. Dentists carry out all the treatment which they alone can perform, while the other members of the team – hygienist, therapist, dental nurses and technician – perform all the work which a dentist can delegate. Compared with a single-handed dentist, the dental team can provide far more treatment each day with less effort and fatigue for all concerned, and thereby give a better total service to the patient and the community.

This description of a clinical dental team, consisting of a dentist, dental nurse and dental auxiliaries (hygienist and therapist), is no longer valid for the new millennium. An enlarged team of dentist and DCPs is superseding it. This new group of team members will eventually comprise:

Dental nurses
Dental hygienists
Dental therapists
Orthodontic therapists
Dental technicians
Clinical dental technicians
Maxillofacial prosthetists and technologists

All the above will be registered by the GDC and have specific training programmes, extended duties and professional responsibilities for continuing professional development and professional conduct similar to those of dentists. Further information is available from: General Dental Council, 37 Wimpole Street, London W1G 8DQ; tel: 020 7887 3800; fax: 020 7224 3294; e-mail: information@gdc-uk.org; website: www.gdc-uk.org.

Dental care professionals

This section introduces the new dental team of dentist and GDC registered DCPs for the new millennium.

Dental hygienist

After two years’ training at a dental hospital, or in the armed forces, hygienists are awarded a Diploma in Dental Hygiene. They can then become registered by the GDC and use the title of Enrolled Dental Hygienist (EDH). They are permitted to undertake a number of dental procedures prescribed by a dentist, and for which they have been trained. These duties include:

Scaling and polishing teeth
Use of local anaesthesia
Application of fluorides and fissure sealants
Treating patients under conscious sedation, provided that a dentist is present in the room
Emergency replacement of dislodged crowns, using temporary cement
Removal of excess cement
Application of a temporary filling if one becomes dislodged while under treatment
Taking impressions

Apart from their treatment role, hygienists are also trained to be proficient dental health educators.

Dental therapist

Dental therapists undertake a two-year course at a dental hospital. They are awarded a Diploma in Dental Therapy and having obtained GDC registration, they may use the title of Enrolled Dental Therapist (EDT). They are permitted to carry out the same treatment as hygienists and can also undertake a wider range of procedures such as:

Simple fillings
Pulp treatment of deciduous teeth
Extraction of deciduous teeth
Fitting preformed crowns on deciduous teeth

Hygienists and therapists are required to have prior experience as a dental nurse and a National Certificate or NVQ for admission to dental hospital training courses. Some of these courses provide for dual qualification as hygienist and therapist, and many include training in dental radiography. As with hygienists, an important part of the dental therapist’s role is dental health education.

Dental technician

Dental technicians are highly skilled craftsmen who construct dentures, crowns, bridges, inlays, orthodontic appliances, splints and replacements for fractured or diseased parts of the face and jaws. They work to the dentist’s prescription in a dental laboratory. Training consists of a full-time course in a dental hospital or technical college, or an apprenticeship with part-time attendance at a technical college. From July 2008, only registered clinical dental technicians will be able to carry out laboratory work as they become recognised as another category of DCP by the GDC.

Dental nurse

The role of dental nurses, their duties and training facilities are covered in Chapter 2.

The National Health Service

Dental treatment in the United Kingdom is provided either privately or through the NHS. Private patients obtain treatment from a practitioner of their choice and pay a fee to the practitioner for professional services given.

NHS dental treatment differs from private practice in the range of treatment provided and the method of payment for such treatment. Certain types of treatment available in private practice are restricted in the NHS. Payments to the dentist are controlled by the NHS, with patients’ contributions ranging from nil to a set maximum.

Currently, NHS treatment available to the public is split into three bands, as follows:

Band 1 – simple treatments such as examinations, radiographs, scalings
Band 2 – routine treatments such as fillings, extractions, root treatments
Band 3 – complex treatments involving laboratory work such as crowns, bridges, dentures

A set fee is charged to the patient for each of the bands, regardless of the amount of treatment carried out, so for instance the same fee is paid for one filling or 10 fillings, if provided during the same course of treatment.

The cost of the NHS is borne by the state, and the government department responsible for it is the Department of Health. The Department of Health delegates operational management of the service to the NHS Executive. For administrative purposes the country is divided into a number of large strategic health authorities for overall planning. These are subdivided at a local level into a large number of smaller authorities called NHS trusts for hospital services and primary care trusts (PCTs) for community clinics and general practitioner services. PCTs have the responsibility of deciding the level of need for NHS dentistry in their area, as well as providing emergency out-of-hours dental care to the public.

Community dental service

The community dental service was formerly called the school dental service, providing examination and treatment for children and expectant and nursing mothers. It still meets the same needs but has acquired additional responsibilities. These vary according to local demand but can include: treatment for special needs patients of all ages; treatment of older people; provision for general anaesthesia; conscious sedation and orthodontic treatment for patients of general practitioners; and dental health programmes for the community at large.

The community dental service is administered by an NHS trust or PCT and co-operates with hospital staff and general practitioners in planning and coordinating all dental services in the district. Salaried community dental officers provide treatment in clinics with equipment and materials supplied by the trust or PCT.

Hospital dental service

Hospitals are administered by an NHS trust. Dental services are provided by the consultant oral surgeon and consultant orthodontist. They provide specialist advice and treatment to patients referred by practitioners outside the hospital and to patients referred from other departments of the hospital. They are also in overall charge of dental care for long-stay inpatients. In addition, most consultants provide postgraduate courses and part-time training posts for general practitioners.

General dental service

This is the general practitioner service which provides a significant share of all dental treatment in the United Kingdom. It is administered by the local PCT which holds dentists’ contracts and is responsible for NHS disciplinary procedures.

The Dental Practice Division of the Business Services Authority (previously the Dental Practice Board) authorises payment of treatment fees to practitioners. It can also arrange for patients to be examined by its dental reference officers (DROs).

General practitioners set up and equip their practices at their own expense and can treat private patients as well as NHS patients.

New legislation (Health and Social Care Act) will, over the next few years, introduce major changes to improve NHS dental services, for patients and the practices providing it.

Clinical governance

Clinical governance requires every NHS practice principal to have a quality assurance system for the practice, in order to ensure a consistent quality of care. It must cover:

Infection control (see Chapter 7)
All legal obligations of health and safety law in the practice (see Chapter 23)
All legal obligations for radiation protection (see Chapter 14)
Compliance with GDC requirements for continuing professional development (see Chapter 2)

The practice must:

Appoint a member of the staff to be responsible for operating the system
Display a written practice quality policy for patients
Provide the PCT with an annual report on the quality assurance system

Clinical audit and peer review

Clinical audit is an essential feature of clinical governance that came into force for NHS dentists in 2001. Its purpose is to ensure that individual dentists assess different aspects of their practice, make changes where needed, and thereby improve service and care for their patients.

Peer review is an optional alternative to clinical audit for dentists who prefer to undertake their practice assessments within a group of other dentists, and thereby share the benefit of the group’s combined experience.

Whichever option is chosen for implementing these requirements, it is subject to approval by a local assessment panel, and submission of a report on completion.

British Dental Association

The British Dental Association (BDA) is the professional body representing the majority of dentists in the United Kingdom. It publishes the British Dental Journal (BDJ) and negotiates for the profession with the government and other bodies where dental interests are concerned. Membership of the BDA is voluntary and open to all dentists.

2 The Dental Nurse

Employers requiring a dental nurse look for the following attributes:

Ability to communicate
Intelligence
Ability to show initiative
Friendliness
Sense of loyalty and responsibility
Awareness that the first priority in a practice is the patient

Of the above attributes, the ability to communicate and show initiative is more likely to be regarded as important than academic knowledge, since all dental nurses have to be qualified or in training to be able to work in practice, so an accepted level of intelligence is mandatory anyway. However, a command of written and spoken English is essential as poor grammar, spelling and speech reflect badly on a practice, as well as creating communication difficulties.

Although the duties of a dental nurse vary from practice to practice, according to its size and number of staff employed, they may be classified under the headings of surgery and office duties. To perform these efficiently, dental nurses must possess certain personal qualities and a knowledge of the law and dental ethics.

Personal qualities

The dental nurse is usually the first person to receive a patient. This is an important occasion as a patient’s confidence in the practice may well be influenced by the appearance and manner of the dental nurse.

Appearance

A dental nurse should be smartly dressed without going to extremes of fashion. Attention to personal hygiene is essential, not only as it affects appearance, but also to ensure good results and prevent cross-infection in the surgery. Hair should be short, or secured away from the face, to prevent contact with working areas or equipment during close chairside assistance. Similarly, jewellery and wrist watches should not be worn as they can be unhygienic or liable to damage surgical gloves.

Personality

A calm, courteous and sympathetic manner, combined with a cheerful and friendly disposition, is an obvious necessity when dealing with anxious patients. It will gain their confidence, and allow the dental nurse to keep cool under all conditions and cope with any emergency which may arise. Handling patients in a busy practice can be trying and requires much patience and tact.

Speech

The voice must be calm to inspire confidence, and clear enough to be understood on the telephone. Instructions to patients should be given in simple language to avoid misunderstanding.

Concentration

Concentration requires an alert mind and attention to detail. Mistakes must not be made in patients’ records, appointments, telephone messages, assisting with treatment or dealing with emergencies.

Punctuality

The smooth running of a busy practice depends on the staff and patients keeping appointments on time. Dental nurses must set an example by observing strict punctuality on duty.

The law

All nurses are affected directly or indirectly by two enactments: the Dentists Act (see below), and the Health and Safety at Work Act, which is covered in Chapter 23.

Dentists Act

Under the Act, the General Dental Council is given the important function of maintaining high standards of professional conduct among dentists and DCPs, with responsibility to their patients as the first priority. Anyone found guilty of a criminal offence or serious professional misconduct is liable to be removed or suspended from the register kept by the GDC, and is thereby legally forbidden to practise. This now applies to dental nurses and other DCPs, and requires them to be registered with the GDC and their adherence to standards of professionalism similar to those already applying to dentists, hygienists and dental therapists. These standards are set out in the GDC’s ‘Standards Guidance’ booklets, which are available to all dental professionals. The key points are covered in Chapter 15.

Ethical practice

All members of the dental team are required to:

Put patients’ interests first
Respect patients’ dignity and choices
Protect patients’ confidential information
Co-operate with other members of the dental team and other healthcare colleagues in the interests of patients
Maintain their professional knowledge and competence
Be trustworthy

Applying ethical principles

The practical application of these ethical principles requires you to:

Apply them in your work as a dental professional, whether or not you routinely treat patients
Understand that you are professionally responsible for your actions and must be able to account for them
Put patients’ interests before your own or those of your colleagues
Apply these principles when handling queries and complaints from patients and in all other aspects of non-clinical professional service
Maintain your GDC registration and work only within the limits of your knowledge, professional competence and physical capability
Take effective action to protect patients if you believe they are being put at risk by: your health, behaviour or professional performance; or those of a colleague; or by any aspect of the practice clinical environment
If in doubt, obtain advice from senior staff, appropriate professional body or the GDC
Treat patients with respect, courtesy and awareness of their dignity and rights
Understand and promote patients’ responsibility for making decisions about their bodies, their priorities and their care, and obtain their consent before any treatment is undertaken
Provide all the information, including the risks, benefits, costs and alternative options, upon which they can make their decision
Ensure that there is no discrimination against patients regarding their race, ethnic origin, age, sex, disability, special needs, sexuality, lifestyle, beliefs and economic status
Treat all information about patients as confidential, and for use only for the purposes for which it was provided
Ensure that such material is kept securely to prevent any accidental or unauthorised access to it

GDC registration completes the first stage of your professional career. Thereafter:

Compliance with your legal obligations, knowledge, skills and professional competence must be maintained and updated by verifiable continuous professional development
Justify your professional status, and the trust of your patients and colleagues, by honesty and fairness in all your professional and personal activities
Apply all these ethical principles to clinical and professional relationships, and to any commercial or business dealings in which you may be involved
Maintain proper standards of personal behaviour in all aspects of your life, and thereby promote patients’ confidence in you and public confidence in the dental profession

It is illegal at present for dental nurses and technicians to carry out any work in a patient’s mouth. Dental nurses are not allowed to take X-rays unless they have been specially trained for this purpose. Further details are given in this chapter and in Chapter 14.

A dentist may delegate to a dental nurse the responsibility for giving patients instruction in oral hygiene, provided that:

1 The dentist is satisfied that the dental nurse is fully competent to do so.

2 Suitable and documented training has been given in this area, showing that the dental nurse has been deemed competent by more senior colleagues.

3 It is understood that the dentist is personally responsible for whatever instruction is given.

Continuing professional development

Continuing professional development (CPD) and lifelong learning are now statutory requirements for the continuing registration of DCPs, and will become compulsory for dental nurses from July 2008. It aims to guide an individual in updating their skills and education throughout their working life, to ensure that they stay abreast of all the changes and updates in their chosen career. This should then ensure that they provide the best care and service as is possible to patients.