A dentist working alone spends 80% of the time doing what could be done by trained auxiliary. In order to even approach meeting the increased demand for dental services, it is imperative that good dental auxiliary be trained and allowed to perform these functions that they can carry out with quality satisfactorily equal to the dental practitioner. We feel that the program we have structured in the Department of Pediatric Dentistry allows the student to gain this knowledge and the motivation to use it. The presentation of such principles is accomplished by:

It is with these principles in mind that this manual was written and structured.

General policies of the Department, along with such items as time management, the use of equipment and supplies, seminar participation, grading, treatment plans, ethics,

use of departmental library, conduct, and professional development have been covered in the Department of Pediatric Dentistry section in the General Clinic Manual. They will not be repeated here so that it behooves you to review these items at the time of your block assignment.

Prevention of oral disease should be the ultimate goal of any practice that includes

children as patients. There are numerous components to a successful preventive practice. These include routine examinations beginning as early as one year old, oral hygiene instructions for patients and parents, fluoride supplementation, proper sealant placement, proper diet analysis, occlusion, and early restorative treatment. We realize that many of these areas are not needed by all patients. However, it our hope that this manual will be a valuable resource during your Pediatric Dentistry rotation, and as you begin your practice.

As you will note, at many points during your clinical procedures you will have the instructor come to your chair to check your progress. Before the instructor arrives, pass all instruments back to the assistant. Then she will get the instructor. The student is to remain with the patient. This is a good time to get to know the patient better through conversation and/or patient education.

When the instructor approaches the chair, rise and allow him to use the operator's stool. Introduce him to your patient. Then move to the 7:00 position to the instructor's right and state specifically what you want. For instance: "Dr. Smith, this is Billy Jones, would you please check a step-by-step M.O. preparation on Tooth K." The same instructor that gave the chair check for a procedure must continue as the instructor for that procedure until it is completed.

Listen to what the instructor has to say and feel free to ask any questions. After the instructor is finished, move to the 11:00 position and allow the instructor to exit. The be seated and proceed with your operation. If a grade or signature is required, be sure the instructor accomplishes this before leaving your work area.

The dental assistant will always get the instructor for you. While she is gone, always stay with the patient. NEVER leave the child alone in the chair.

While the child is being seated, conversation and your approach should be in an easy-going everyday manner. Kindness, patience, a sense of humor, an air of confidence, and a smile make the child feel at ease. Much of the patient's fear can be overcome by this type of approach.

Remember that during your contact with the child patient, you will be acting in the role of a teacher as well as a practitioner. One of your prime objectives is to teach the child to accept a new situation and follow instructions. Remember the patient is not a miniature adult and this situation may be entirely foreign to the child. Work to establish good communication and stress the fact that the dentist and assistant are interested in helping him/her. A review of your text and lecture notes on this subject can help make your stay in the Department of Pediatric Dentistry a successful one.

The dental situation and its associated objects, sounds, and procedures are all new to the young patient during the first visit. The oral cavity that we deal with has been a "security area" for the child in early years. On top of this, subjective fears may have been formed in the child from careless parents, relatives, or playmates. Therefore, it is imperative that the child be introduced to the dental setting in a manner conducive to a future of happiness as a dental patient.

The most successful manner in which this has been achieved is to show and tell the child what is going to be done before you do it, in words and a manner that the child will understand. Do not lie to the child; honesty is the best policy when dealing with children. Quick, jerky, sudden movements should be avoided.

It is generally best to introduce the patient to less painful procedures on the initial appointment. The prophylaxis and radiographic examination provide a good means of initiating them to treatment in a pleasant manner. Again, an air of friendliness and confidence on the part of the operator and the assistant will form the basis of successful treatment.

Patient management may be accomplished by any operator who remembers and employs several principles which have proven to be successful when dealing with children and guiding child behavior.

1. Always call the patients by their first name or nickname.

2. Direct the conversation toward the child when possible.

3. Approach the child in an easy-going manner.

4. Display kindness, patience, firmness, concern, and a calm

sense of confidence in your words and in your manner.

5. Talk at the child's level so that you will achieve good communication with the patient. Do not talk above or below the patient's level of understanding and be especially careful not to use "baby talk."

6. Talk to the child about activities and things that are enjoyable.

7. Keep appointments as brief as possible, yet accomplishing as much as possible. This spells efficiency.

8. When performing procedures, avoid quick, sudden movements.

9. Let the patient know you care, but that you are in control.

10. Avoid fear-promoting words: "stick," "hurt," "drill," etc. Be honest, but use more comforting language.

11. Do not attempt to bribe or shame a patient into good behavior.

12. Do admire and praise good behavior whenever you can; this enhances its repetition.

13. Short, concise commands are better in telling the patient what to do than questions or suggestions.

14. The operator must at all times keep his own self-control. A child's

ill-behavior is probably due to many things such as innate and subjective fear, and poor parental control. Losing your temper doesn't help.

An organized approach is essential during the examination procedure to insure collection of adequate data. At the time of the first visit this involves:

1) a complex medical and dental history; 2) parent consultation; 3) an orthodontic evaluation; 4) collection of radiographic data; 5) a clinical exam; 6) topical fluoride treatment; 7) dismissal of the patient. The pattern to be followed in the Children's Clinic is as follows:

2. Parent Consultation: There are specific times when you must consult with the

parents. These occur twice during the first appointment, before the initiation of

treatment at each visit, and at the final appointment.

To insure a complete examination and to perform it efficiently, a set routine should be followed consistently. The pattern which we follow is:

a. The examination will proceed starting with the upper right most posterior tooth, progressing around the upper arch. Then the lower left most posterior area is examined and continue around the arch to finish up with the lower right posterior area.

b. Examine and dictate the permanent teeth present, the missing primary teeth, and the primary teeth present in the sequence as outlined in #1.

c. Examine and dictate all restorations present in the same manner.

* d. Examine and dictate all carious lesions in the same manner.

e. Assimilate and coordinate this information logically in your mind to be able to discuss this child's problems and any questions you might have about them at the time of the instructor's check.

* When making both the clinical and radiographic examinations, the following definition of an area on the tooth to observe and the relevant factors involved must be considered. Also to be considered is that pits and fissures cannot be stoned or smoothed, but they can be sealed.

Observe - an incipient lesion that does not penetrate the enamel, and by taking all relevant factors into consideration, it is determined that the tooth can best (or properly) be left unrestored.

a. Patient's age

b. Time period that this tooth has been in the mouth (how long has it taken for this decalcification to proceed this far) or how much longer will this tooth be in the mouth.

c. Patient's hygiene

d. Caries index

e. Whether working on the same tooth or same general area

f. Can tooth be left unrestored for the same period of six months, and if caries progress, not significantly damage the tooth or adjacent tooth, or affect pulp.

g. Calcification level of that tooth.

h. If patient is dentally reliable (recalls)

6. Instructor's Check: The instructor will check your findings and prophylaxis and discuss them with you. The instructor will check the quality of your radiographs.

7. Topical Fluoride Treatment: All new patients, and recall patients, will receive a topical fluoride treatment at this time. See the step-by-step treatment procedure sheet for details.

8. Patient Dismissal: The student will remove the napkin, set the patient upright, let the patient get a prize, and conduct the patient through the door and hall and present the patient to the parent . The student will at this time tell the parent any needed information about the preceding or succeeding appointment, such as what foods to eat, carefully observing the patient while the anesthetic is still effective, and the fact that it is very important to polish alloys. The student will remember to use language that the parent can comprehend. When the future appointment is being made, let the receptionist do it. Do not interfere!

Recall appointments are made for those patients which have been treated to completion in the Department. Priority is given to those children who have space maintenance appliances in the mouth.

When a patient is seen on recall, the procedure is to treat the patient as though he were a new patient. Charting will be completed on a new chart completing both the orthodontic evaluation side and the clinical examination side. The oral hygiene program will be conducted as though the patient were a new patient.

Radiographic examination shall be at the instructor's discretion.

When any patient has a fixed appliance in place, the appliance shall be removed prior to radiographic examination. The removal of the appliance is a preventive measure against demineralization and caries process occurring under the bands. The banded teeth are cleaned of their cement and checked for abnormalities.

After charting, the operator has the instructor consultation check to evaluate his findings. The effectiveness of the appliance, if one has been in place, may also be discussed at this time.

The operator then performs the fluoride treatment on both arches of the patient. If there is an appliance which will be replaced, it is recemented at this time. An instructor should check the appliance after it has been recemented.

Observance of the above procedure will be modified only when approved by the instructor.

I. First Visit:

B. Parent to waiting room and patient, student, and assistant to operatory for orthodontic examination.

C. Instructor review of medical history and x-ray check.

D. Patient, student, and assistant to x-ray area for film survey.

E. Patient, student, and assistant to operatory for clinical examination.

F. Instructor - new patient check out.

G. Prophylaxis is given.

H. Patient, student, and assistant - fluoride placed by disposable tray method and left in contact with the teeth for three minutes. Contacts are then flossed to assure exposure of these areas to fluoride.

I. Patient and student to waiting room. Short discussion with parent to be sure the parent will be present at the next appointment.

II. Second Visit

A. Patient, parent, student, and assistant to consultation room.

1. Assistant discloses all of the patient's teeth and student answers parent's questions about cleaning the child's teeth.

2. Student examines and scores the plaque index.

B. Total score:

1. Below four:

a. Student shows patient and parent any areas that were missed.

b. Patient and assistant to operatory.

c. Student presents treatment recommendations and fees to parent.

2. Four or above:

a. Student shows patient and parent the plaque and stresses the need for the removal of it (explains consequences, and lost time) and instructs in plaque removal.

b. Patient's age:

1. Under eight - parent removes All plaque. Floss required.

2. Eight or older - patient removed All plaque. Floss required. (parent aid may be required.)

c. Patient brushes fluoride on teeth.

d. Patient: and assistant to operatory

e. Student presents treatment recommendations and fees to parents.

Parent to Waiting Room

C. Student to Operatory for First Appointment Treatment.

III. All Subsequent Treatment Appointments

A. Patient, student, and assistant to operatory

1. Assistant discloses all areas of all of patient's teeth.

2. Student scores plaque index.

B. Total Score:

1. Below four: Student tells patient (or parent) to concentrate on areas that were missed (at end of appointment if parent needs to be informed.) Then carries out scheduled operative treatment.

2. Four or above - get instructor's confirmation:

a. Patient under eight years:

1. Patient and student to consultation room; assistant to waiting room to get parent and brings parent to consultation room.

2. Parent moves all plaque. Floss required.

3. Patient brushes fluoride on teeth.

4. Parent to waiting room; patient, student, and assistant to operatory to begin scheduled treatment.

b. Patient eight or older:

1. Student shows patient plaque.

2. Patient removes All plaque. Floss required. Assistant

informs parent that plaque is present on teeth.

3. Patient brushes fluoride on teeth.

PATIENT'S NAME___________________________________________AGE_______

TOOTH SURFACES SCORED:

1. Buccal surface of maxillary right posterior molar

2. Labial surface of maxillary right central incisor

3. Lingual surface of mandibular left posterior molar

4. Labial surface of mandibular left central incisor

5. Proximal areas (over-all impression)

COMMENTS:

____________________________________________________________

____________________________________________________________

____________________________________________________________

____________________________________________________________

____________________________________________________________

____________________________________________________________

____________________________________________________________

I. Treatment plan on a new patient or a recall patient: The following steps are to be followed when working up a treatment plan on a new patient or a recall patient:

B. Be sure that the intra-oral x-rays are checked by an instructor before the patient is dismissed to determine if retakes are necessary. If retakes are performed, these are also to be checked and signed by an instructor.

C. Between the first and second appointments, the student is to make an x-ray diagnosis and write up his treatment plan on a separate sheet of paper which is attached to the grade sheet. Any needed consultation sheets are also to be written and ready to discuss with the instructor.

1. The treatment plan must be completed, and signed by an instructor before any operative procedures are started.

a. If the student fails to get this accomplished before the day that the patient returns for the second visit, he is given an automatic "zero" for his treatment plan.

2. The instructor is to go over the x-ray diagnosis and charting with the student.

3. Then the instructor is to examine the student's treatment plan and make any necessary changes. There are two separate boxes in which to write the treatment plan. Be sure that you fill out all information at the top of the treatment plan sheet. Be neat and use your accepted abbreviations in your write-up. When the instructor sees your treatment plan, he will sign the box with his initials, date, and the fact that it has been "seen." Go to the same instructor, if possible, to grade it again. If acceptable, the instructor will initial the box with the date and the fact that it is now "OK."

4. The instructor is then to:

a. Initial x-ray diagnosis on the grade sheet.

b. Grade the student on x-ray diagnosis and their quality and treatment plan in the appropriate space on the student grade.

c. The student will receive a 2 or less if his films are mounted improperly for the x-ray diagnosis.

5. The assistant is then instructed to transfer the approved treatment plan to the record sheet and fill out the estimate sheet. When this is accomplished, the assistant is to place the record sheet and the original initialed treatment plan slip on the appropriate place to be checked and filed.

II. Considerations for Radiographic Diagnosis:

A. Be sure films are mounted properly.

B. Correspond films with clinical charting while diagnosing.

C. Completing the following steps in order will aid in securing a comprehensive diagnosis:

1. Examine the quality of the bony structure.

2. Examine the number of teeth present.

3. Examine the stage of development and eruption.

4. Examine the position of the teeth.

The completion of patients' treatment will be a separate appointment and should include the procedures listed below. Each of these steps will be examined carefully by instructor and a grade for the appointment will be given.

I. EVALUATION OF THE STUDENT'S TECHNICAL AND DIAGNOSTIC ABILITIES

1. Maintenance and management of comprehensive, confidential patient records.
1. Competency in more demanding procedures.
2. Number of poor clinical grades (2 or below) obtained rather than the average of all grades.
3. Productivity and time usage.

The student will be evaluated in the four major areas with regard to the new patient examination.

A. Patient's Systemic Health Evaluation

1. Patient's name

2. Existing health problems or drug idiosyncrasies

3. Drugs or medicines being taken by the patient

4. Hereditary dental traits that the parent is aware of

NOTE: All questions on the medical history must be answered. A Medical Alert stamp must be placed on the cover of the chart, the medical history form, and the treatment plan sheet (before the x-ray check).

The medical summary must be complete, including drug amounts and dosages, details of past medical problems (when they occurred, and resolution, etc.)

5. Patient's diet habits

6. Number of siblings and the child's relationship, with respect to age, to them

7. Patient's and parent's dental IQ

B. Soft Tissue Evaluation

1. Oral hygiene

2. Gingiva, mucosa, etc.

3. Floor of the mouth

4. Tongue

5. Throat

C. Orthodontic Evaluation

1. Skeletal and soft tissue relationships (retrusive, prognathic, normal)

2. Habits and muscular imbalances

3. Tooth size to arch length relationship

4. Eruption sequence

5. Dental relationship

a. Molar e. Open-bites

b. Cuspid f. Overbite, overjet

c. Intercuspation g. Midline relationship

d. Cross-bites

6. Summary of orthodontic relationships and recommendations for treatment:

a. Mixed dentition analysis d. Consultation

b. Study models e. Referral

c. Cephalometrics

D. Dental Evaluation:

1. Teeth present or absent

2. Existing restorations

3. Presence of dental decay

4. Fractures

5. Developmental anomalies

Failure to:

1. Be familiar with the health questionnaire = a grade of "O"

2. Recognize - skeletal and soft tissue relationship = a grade of "2" or less

3. Recognize - molar relationship, obvious presence of a habit, pathology of soft or hard tissue (not including pit caries) = grade of no more than "2".

4. Properly summarize the data and make proper recommendations for treatment = a grade of no more than "3".

5. Recognize apparent dental caries including pits and fissures and defective restorations = a grade of "3" or below.

Prophylaxis:

The students are evaluated on their ability to recognize and remove bacterial plaques, stains, and calculus from the teeth and gingival crevices of their patients with a minimum of trauma to the surrounding tissues.

Failure to:

1. Floss the contact areas of the teeth = a grade of "2" or below

2. Recognize the presence of calculus = a grade of "2" or below

3. Remove all the calculus that is present = a grade of 2 or less

4. Remove supra-crevicular plaque = a grade of 2 or less

5. Remove crevicular plaque = a grade of 2 or less

6. Avoid unnecessary trauma to surrounding tissues = a grade of 2 or less

7. Have assistant remove debris from the oral cavity following the prophylaxis = a grade of 3 or less

The students are evaluated in the following major areas of diagnosis and treatment planning.

1. Recognition and recording of non-pathological structures:

a. Primary teeth that are present

b. Permanent teeth that are present though not necessarily erupted

c. Existing restorations

2. Recognition and recording of pathology

a. bony abnormalities

b. periapical or furcation involvement

c. supernumeraries

d. missing teeth

e. dental caries

f. ectopic eruption

g. hereditary or other anomalies of tooth development

3. Incorporation of needed orthodontic treatment into the treatment plan.

4. Formation of an organized treatment plan.

a. utilization of the quadrant approach (no bilateral mandibular blocks)

b. logical order of treatment

c. emergency procedures treated first

d. any contra-indicated drugs or treatment are mentioned to the instructor

e. if no emergency exists, a minor treatment is done initially to introduce the patient to restorative treatment

f. any tests or information-gaining procedures that are needed are done early in the treatment

g. all treatment has been completed in an arch before any appliance is seated

h. any referrals are incorporated in the treatment plan

i. any management adjuncts that may be required are listed (Nitrous Oxide, premedication, etc.)

j. completion films are listed if required

Failure to:

1. Mark teeth that are present = 2 if a junior, 2 or less if a senior

2. Recognize obvious pathology = 2 or less

3. Incorporate recommended orthodontic procedures in their proper place = 2 or less

4. Utilize the quadrant approach = 2 or less

5. Note contra-indicated treatment or drugs = 0

6. Formulate an organized, logical sequence of treatment: initial attempt = 3; second attempt = 2; other = 0

Cavity Preparation:

When grading the student's cavity preparations, the five major items listed below will be evaluated in a systematic manner for each preparation:

1. Removal of all decay

2. Depth of cavity preparation (particularly occlusal portion)

a. too shallow - not through enamel; no retention

b. too deep - exposure or unnecessary depth which will jeopardize the health of the pulp or weaken the structure of the tooth

c. inconsistent depth for no apparent reason

d. proper depth and contour of axial wall

3. Proper extension (for prevention), outline and convenience form

b. Occlusal aspect - proper extension into all fissures prevents recurrent decay. Excessive extension may weaken marginal ridges and cusps

c. Proper width of Isthmus

d. Proper depth and contour of the gingival seat

In grading the placement, carving, and polishing of the silver amalgam, the following criteria will be taken into account:

1. Marginal integrity: All margins should be completely restored and closed with no excess

2. Anatomical carving: The cusp plane inclinations should be restored and in proper occlusal relationship. The alloy should conform to the contour of the original natural surface of the tooth including the marginal ridge.

3. Contact: The size of the contact area and the location should be properly restored. The contact with the adjacent tooth should be sufficiently tight.

4. Condensations: The surface should be smooth and homogeneous

5. Polish: All margins and surfaces should be smoothed and polished with no scratches or roughness. The entire surface should have a high uniform sheen.

Failure to:

1. Remove all excess alloy from the margins = a grade of 3 or less

2. Restore the margin completely (open margin) = a grade of 2 or less

3. Restore the occlusal surface = a grade of 2 or less

4. Restore the contact = a grade of 2 or less

5. Condense correctly = a grade of 2

6. Polish the restoration well = a grade of 2 or less

Chrome Crown:

A. Preparation - The Chrome crown preparation will be evaluated for the following:

1. Complete caries removal

2. The tooth should be restored to approximate normal configuration

3. Proximal slices

a. Should be as parallel in both directions as possible

b. Should not have damaged adjacent teeth or restorations

c. No ledging

d. Gingival margin should be below tissue but no deeper than is required to cover the pathology that exists

e. Should have a minimal amount of reduction (only enough to break contact and seat crown)

4. Occlusal reduction

a. 1 to 1 1/2 mm reduction

b. General anatomy of the occlusal portion of the tooth should be retained

c. Occlusal table has been narrowed by reducing it buccally and lingually from its original width

5. All angles should be rounded.

Failure to:

1. Completely remove caries = a grade of 2 or less

2. Avoid damage to adjacent teeth or restorations = a grade of 2 or less

3. Carry out as described any of the other steps in the crown preparation = a grade of 3 or less

B. Adaptation - The student will be evaluated in regard to the following:

1. Proper size of crown

C. Tissue Condition - The student will be evaluated in regard to subjecting the patient to unnecessary tissue trauma

Failure to:

1. Select the proper size crown = 3 or less

2. Properly trim the chrome crown (too long or too short) = 2 or less

3. Properly crimp the chrome crown - 3 or less

4. Properly remove cement from the chrome crown = 2 or less

5. Adequately polish the chrome crown = 3 or less

Pulp Treatment: (formocreosol pulpotomies)

The student will be evaluated in the following areas regarding pulp treatment:

A. First Step

1. Proper evaluation of the tooth, (teeth), in regard to pulp treatment

2. Complete removal of caries

3. Proper opening for access. All pulp horns are uncovered and are readily accessible.

4. Complete removal of the coronal pulp tissue (into the canals to a diameter of a #4 round bur). The chamber should be clean of any debris.

5. Hemorrhage control.

Failure to:

1. Properly interpret the tooth (teeth) to be treated = 2 or less

2. Remove all decay = 2 or less

3. Gain proper access opening = 2 or less

4. Properly remove pulp tissue or other debris = 2 or less

5. Control hemorrhage = 3 or less

B. Second Step

1. Proper removal of ZOE temporary

2. Proper tissue fixation

Failure to:

1. Remove all temporary filling material that is required for proper access = 3 or less

2. Remove formocreosol pellets = 2 or less

3. Gain proper tissue fixation = 2 if not recognized. If recognized, no reduction of grade should be made if the student knows to place formocreosol again.

Composite Restorations:

The student will be evaluated in the following areas in regard to placement of composite restorations.

1. Cavity preparation

a. Complete caries removal

b. Adjacent teeth or restorations are not damaged

c. Proper access

d. Proper retention and extension

e. Sufficient etching of acid-etch technique is required

f. Placement of base and/or liner

Failure to:

1. Remove caries = 2 or less

2. Avoid damage to adjacent teeth or restorations = 2 or below

3. Gain proper access = 3 or below

4. Gain proper extension = 3 or below

5. Properly carry out both 3 or 4 above = 2 or below

6. Properly etch or prevent contamination of acid etch prep = 2 or below

2. Placement

a. No contamination

b. No voids

3. Finishing

a. Proper contour including contact if applicable

b. Flash removed and synthetic finished to margin

c. Metal particles polished out

d. Uniform smoothness

e. Proper occlusion

f. Proper shade

Failure to:

1. Prevent contamination of the material, to prevent voids or to use enough = 2 or below

2. Attain proper contour = 3 or less

3. Finish to margin or to remove metal or gain uniform smoothness = 3 or less

4. Attain proper occlusion = 2 or less

5. Attain proper shade = 3 or less

Tooth Brushing Instruction: (TBI)

The student will be evaluated in this area mainly on how clean the teeth are and if they have been flossed.

If the student's presentation can be observed by an instructor, the student can be evaluated in this area at the instructor's discretion.

Failure to:

1. Remove all plaque = a grade of "P"

2. Floss all contacts and remove plaque = a grade of "P"

3. Properly evaluate and score the plaque index (in other words, deliberately misscore) at a treatment appointment will result in a reduction in prep grades.

Senior Clinical Re-Entry Examination:

Senior students are given a written examination during the first day of the rotation, which counts 20% toward the final course (block) grade. In the event of a failing grade, the student will be given a make-up examination. Failure on the retake examination may result in automatic course failure and repeat of the course. In no case will an improved grade on the retake examination be counted toward the 20% of the final grade. In this event, the highest grade attainable is a "D".

The reason the entry examination is given is to promote improved patient care by insuring that the senior students review clinically pertinent material. This has been found to be necessary since most senior students have not had pediatric dental didactic or clinical experiences for several months prior to entering their senior block.

The re-entry examination will cover all Pediatric Dentistry and Orthodontic classes freshman through junior year, including material given in labs, seminars, and reading assignments from the textbook, Dentistry for the Child and Adolescent by McDonald and Avery, and the Pediatric Dentistry-Orthodontic Clinical Procedure Manual.

The main concept behind "sit -down" dentistry is to apply the principles of motion economy regarding body posture, body motion, and arrangement of the work area so as to increase productivity and reduce stress and strain during normal operative procedures. To apply this concept, we must be totally aware of the essential role that the D.A. performs during these procedures.

I. DOCTOR'S POSITION

II. ASSISTANT'S POSITION

A. Step-by-Step Treatment Procedures:

B. Instrument Passage:

3. General Considerations Regarding Exchange of Instruments:

III. STEP-BY-STEP TREATMENT PROCEDURES

Seating of the dental team and patient

Patient in upright position

INSTRUCTOR CHECK AND PARENT CONSULT (If not already done earlier in the appointment)

Pick up disclosing solution bud on

gauze square.

Receives bud and square, R BUD AND SQUARE, L To R

Moistens bud and applies disclosing

solution to teeth to demonstrate debris

BUD, GAUZE SQUARE, R to L___________ HAND MIRROR, L To R

Uses mirror to show patient neglected

brushing areas

____________________

*Complete tooth brushing instruction and patient oral hygiene education is completed at

this time. When the instruction is complete, the patient is placed in the reclining position. ____________________

Picks up scaler L

HAND MIRROR, R to L MIRROR, R to L, SCALER, L to R

Scales necessary areas Pick up slow speed with prophy angle

in place

SCALER, R to L SLOW SPEED, L to R

Uses prophy angle and prophy paste Pick up prophy paste L,

to complete prophylaxis Suction R.

Use suction as necessary

Signal when through with prophy paste Replace prophy paste L

Replace suction R

Pick up dental floss

Mirror, L to R

SLOW SPEED, R to L DENTAL FLOSS, Both hands to both

hands (Thumb and forefinger)

Use dental floss between all Pick up suction R. Triplex L.

proximals Wash field when flossing is completed

Hang up suction, triplex.

Pick up explorer L. Mirror R

DENTAL FLOSS, R to L EXPLORER, L R, MIRROR, R L

Checks sulcus and other areas for Disposes of dental floss

cleanliness.

MIRROR, EXPLORER, BOTH IN L to L Receives and replaces on tray

Proceed to appropriate procedure

__OPERATOR__________________ ASSISTANT

Seating of Dental Team and Patient

INSTRUCTOR CHECK AND PARENT CONSULT (if not already done earlier in the appointment)

Completion of Prophylaxis

or

Completion of TBI

Pick up fluoride tray, L

Receives fluoride tray, R FLUORIDE TRAY, L to R

Tries in tray for size

FLUORIDE TRAY, R to L Receives and places rubber cushion

and liner in tray.

Place solution into liner

Retracts cheeks for drying Picks up triplex R, tray L

Dries arch with air

Receives tray, R FLUORIDE TRAY, L to R

Places tray over dried arch and Replaces triplex R

has patient bite moderately heavy Picks up suction L

for three minutes Places suction over end of tray

handle. Times the three minutes

Removes fluoride tray, R Suctions excess fluid

FLUORIDE TRAY, R to L Receives tray L (thumb and forefinger)

Hangs up suction, L

Replaces liner and places fluoride

in liner

*Repeat steps with opposite arch

Picks up unwaxed dental floss

Receives floss L to R FLOSS L TO L & R

Floss all contact areas to insure

interproximals have received fluoride

Floss L to L RECEIVES FLOSS L

INSTRUCTOR CHECK AND PARENT CONSULT (if not already done earlier in the appointment)

__OPERATOR__________________ ASSISTANT

Receives mirror and explorer MIRROR, R to L, EXPLORER, L to R

Examine tooth and surrounding teeth Pick up 2 x 2 gauze.

MIRROR, EXPLORER, Both in L to L 2 x 2 GAUZE, L to R

L. Retracts cheek

R, Swabs injection area Picks up topical swab stick, L

Receives swab stick, R TOPICAL SWAB STICK, L to R

L. Retracts cheek

R, Applies topical for thirty seconds Picks up syringe in R

2 x 2 GAUZE, TOPICAL SWAB STICK Receives topical swab stick &

R to L 2 x 2 gauze

Receives syringe, R and passes SYRINGE, R to R

below patient's vision

L. Retracts cheek Retains needle cover and extending

R. Injection made L arm over patient's arms. After exchange, R arm over patient's left arm

SYRINGE, R to L Receives syringe, replaces needle cover, replaces on tray

Passes below patient's vision at

left of chair Picks up suction R. triplex L

Washes injection area and child's

mouth

__________

* At the end of each procedure requiring local anesthetic, a cotton roll is placed in the patient's mouth on the proper side, a caution sticker is placed on their shirt and a pink caution slip is given to the parent.

INSTRUCTOR CHECK AND PARENT CONSULT (If not already done earlier in the appointment)

__OPERATOR__________________ ASSISTANT

Application: Assistant punches appropriate

areas and applies lubricant to

undersurface

Has waxed floss on clamp

Clamp on forceps, pick up with

L hand.

Receives clamp forceps and clamp CLAMP FORCEPS AND CLAMP L to R

and places clamp on appropriate tooth

Maintains control of floss with

R hand

Picks up rubber dam on frame L

CLAMP FORCEPS R to L RUBBER DAM ON FRAME L to R

Places rubber dam over clamp and Replace forceps on tray

appropriate teeth

Picks up dental floss L

Receives dental floss L and R DENTAL FLOSS L To L & R

Flosses between proximals, flossing

tooth to be ligated last, and leaving floss

to be tied if necessary for moisture control

_____________________________________________________________________

On patient's

LEFT

Receives large spoon R and holds

on lingual of tooth LARGE SPOON, L To R

Ties ligature

LARGE SPOON, R to L Receives and places on tray

_____________________________________________________________________

On Patient's

RIGHT

Ties ligature - if necessary Holds large excavator on lingual of tooth

_____________________________________________________________________

Secures floss over button on frame Picks up water L and suction R

Washes operative field and dries

INSTRUCTOR CHECK

Receives explorer EXPLORER, L to R

Loosens ligature with explorer

Pulls from interproximal Cuts floss with scissors R

Picks up clamp forceps L

EXPLORER, R To L CLAMP FORCEPS, L To R

Removes clamp, locking forceps to prevent

loss of clamp during exchange

CLAMP FORCEPS, R to L Receives clamp forceps, L

Holds rubber dam with L Cuts rubber dam interproximals with R

Removes rubber dam Picks up 2 x 2 gauze, L

RUBBER DAM, Both Hands to R Receives rubber dam with R

Receives 2 x 2 gauze, R 2 x 2 GAUZE, L to R

Cleans debris with 2 x 2 gauze Picks up water L and suction R

Washes field

2 x 2 GAUZE R to L Receives 2 x 2 gauze

Checks patient's face for cleanliness

__OPERATOR__________________ ASSISTANT

Seating of the Dental Team and Patient

Secure Local Anesthesia

Placement of Rubber Dam

#4 round is in the slow speed

245 is in the high speed handpiece

Receives high speed and mirror HIGH SPEED , L to R, MIRROR, R to L

Prepares cavity Picks up triplex L, suction R

Outline form, resistance and retention Keeps field clean

forms, and convenience form Dries field at end of procedure

Triplex to R, hangs up suction

HIGH SPEED, R to L Receives and replaces high speed L

Changes button on unit to slow speed R

Picks up slow speed L

Receives slow speed, R SLOW SPEED, L to R

Performs caries removal Using air syringe, keep field clean

Performs caries removal Hangs up triplex

SLOW SPEED, R to L

MIRROR, L to R Receives mirror and slow speed and

replaces on tray.

INSTRUCTOR'S CHECK

Operator may correct and complete preparation

using previously used Instrumentation

Receives mirror and explorer MIRROR R to L, EXPLORER L to R

Checks preparation if necessary Turns on amalgamator R

Places cotton in cotton forceps with Copalite

EXPLORER R to L COTTON FORCEPS L to R

Uses Copalite in preparation Dries Copalite with triplex in R

COTTON FORCEPS Receives and replaces on tray

Empties amalgam into cloth and

loads carrier L

Receives amalgam carrier AMALGAM CARRIER L to R

Places amalgam Picks up condenser L.

AMALGAM CARRIER R to L CONDENSER L TO R

Condenses amalgam Loads carrier L

_____________________________________________________________________

Repeat steps until ready to over pack

AMALGAM CARRIER R to L Mechanical Condenser with rubber

Over Pack L to R

Picks up Walls Carver L

MECHANICAL AMALGAM CONDENSER

To L WALLS CARVER L to R

Assistant writes up record for procedures accomplished

Carves with Walls to desired anatomy Picks up discoid if requested by

operator

WALLS CARVER R to L DISCOID L To R

Completes carving using discoid if

necessary Picks up cotton swab stick

DISCOID CARVER R to L BALL BURNISHER L to R

Smoothes alloy

BALL BURNISHER R to L WET COTTON BUD L to R

Smoothes and cleans alloy

May use discoid or explorer to remove flash if necessary

MIRROR, WET COTTON BUD L to L Receives and places on tray

Picks up suction R and triplex L

Washes and dries field

_____________________________________________________________________

Receives explorer, R EXPLORER, L To R

Loosens ligature with explorer Cuts floss with scissors R

Pulls from interproximal Picks up clamp forceps L

EXPLORER, R to L CLAMP FORCEPS, L to R

Removes clamp, locking forceps

to prevent loss of clamp during exchange

CLAMP FORCEPS, R to L Receives clamp forceps, L

Holds rubber dam with L Cuts rubber dam interproximals with R

Removes rubber dam with both hands Picks up 2 x 2 gauze, L

RUBBER DAM, Both hands to R Receives rubber dam with R

Receives 2 x 2 gauze, R 2 x 2 GAUZE, L To R

Clean debris with 2 x 2 gauze Picks up water L, and suction R

Washes field

Picks up cotton forceps with articulation paper L

2 x 2 GAUZE, R to L MIRROR, R to L, FORCEPS WITH

PAPER, L To R

Checks occlusion of restoration Picks up discoid L

FORCEPS WITH PAPER, R to L DISCOID CARVER, L TO R

Uses discoid if necessary to correct

occlusion

DISCOID CARVER, MIRROR, L to L Receives discoid and mirror and

replaces on tray

Use of cotton roll on anesthetized size

Warning Sticker applied

Dismissal of Patient

__OPERATOR__________________ ASSISTANT

Seating of the Dental Team and Patient

Secure Local Anesthesia

Placement of Rubber Dam

4 round is in the slow speed

245 is in high speed

HIGH SPEED, L to R

Receives high speed and mirror MIRROR, R to L

Prepares cavity in tooth: Picks up suction R and triplex L

Outline form to keep field clean

Resistance and retention forms

convenience form

Hangs up suction, switches triplex

to R

HIGH SPEED, R to L Receives and replaces high speed L

Changes handpiece control with R slow

Picks up slow speed, L

Receives slow speed, R SLOW SPEED WITH #4 BUR, L to R

Caries removal performed Uses air to clean field

Picks up hatchet, L

SLOW SPEED, R to L HATCHET, L to R

Planes enamel walls Picks up HOE, L

HATCHET, R to L HOE, L to R

Planes enamel walls Replaces hatchet

HOE, R To L Explorer, L to R

Examines preparation Replaces hoe

_____________________________________________________________________

Triplex, L, Suction R washes

and dries field

MIRROR, EXPLORER, BOTH in L to L Receives mirror and explorer and

replaces on tray

Operator may correct and complete preparation

using previously used instrumentation

Receives mirror and explorer MIRROR, R to L, EXPLORER, L To R

Places cotton in cotton forceps with

copalite

Checks preparation if necessary

EXPLORER, R to L COTTON FORCEPS, L To R

Picks up matrix band and Howe Plier,

Places copalite in preparation L

COTTON FORCEPS R to L MATRIX BAND AND HOWE, L To R

Receives cotton forceps, L

Places band on tooth and draws material

to seam with Howe

HOWE PLIER AND BAND, R to L Receives Howe Plier and Band L

Spot welds band, cuts excess

bends down tab with 114 plier

MIRROR, L to R MATRIX BANK IN 114 PLIER, L to R

Receives band and 114 plier, R

Contours band with 114 plier

114 PLIER, R to L Receives 114 Plier, L

Places hand on tooth Picks up mirror, R

Receives mirror, L MIRROR, R to L

Picks up wedge and cotton forceps, L

Places wedge in proximal

_____________________________________________________________________

COTTON FORCEPS, MIRROR, Both in L to L Receives and replaces on tray

Turns on amalgamator with R

Empties amalgam into cloth

Loads carrier L

Receives carrier AMALGAM CARRIER L to R

Places amalgam Picks up condenser L

AMALGAM CARRIER R to L CONDENSER L to R

Condenser amalgam Loads carrier L

Repeat until ready to over pack

Picks up mechanical condenser L

AMALGAM CARRIER R to L MECHANICAL CONDENSER WITH

RUBBER OVER PACK L to R

Picks up explorer L

MECHANICAL CONDENSER R to L EXPLORER L to R

Carves with explorer Picks up Walls carver

EXPLORER R to L WALLS CARVER L to R

Carves with Walls Replaces explorer

Breaks band seam with Walls Picks up cotton forceps L

WALLS CARVER R to L COTTON FORCEPS L to R

Remove wedge

WEDGE R to L Receives wedge and places it on tray

Removes matrix band Picks up Hollenbeck L

COTTON FORCEPS, MATRIX BAND R to L HOLLENBECK L to R

Carves proximals with Hollenbeck end R hand suctions area as necessary

and dictates operation to assistant for to remove debris. Assistant writes

charting. Carves occlusal with Walls end up record for procedure accomplished

Picks up Discoid L

WALLS CARVER R to L DISCOID CARVER L to R

Carves as necessary with Discoid Picks up moist cotton swab

_____________________________________________________________________

DISCOID CARVER R to L BALL BURNISHER L to R

Smoothes alloy surface

BALL BURNISHER R to L WET COTTON BUD L to R

Smoothes and cleans surface

May use discoid or explorer to remove flash if necessary

MIRROR, WET CONTROL, L to L Receives and places on tray

Picks up Suction R and triplex L

Washes and dries field

Receives explorer EXPLORER L to R

Loosens ligature with explorer

Pulls from interproximal Cuts floss with scissors R

Picks up clamp forceps L

EXPLORER R to L CLAMP FORCEPS L to R

Removes clamp, locking forceps to prevent

loss of clamp during exchange

CLAMP FORCEPS R to L Receives clamp forceps L

Holds rubber dam with L Cuts rubber dam interproximals with R

Replaces clamp forceps L

Removes rubber dam Picks up 2 x 2 gauze L

RUBBER DAM, Both hands to R 2 x 2 GAUZE L to R

Cleans debris with 2 x 2 gauze Pick up water L and suction R

Washes field

Picks up cotton forceps with

articulating paper L

2 x 2 GAUZE R to L MIRROR R to L

FORCEPS WITH PAPER L to R

_____________________________________________________________________

Checks occlusion of restoration Picks up Discoid L

Forceps with paper R to L DISCOID CARVER L to R `

Uses discoid to correct occlusion

as necessary

DISCOID CARVER, MIRROR L to L Receives discoid and mirror and

replaces on tray

Use of cotton roll on anesthetized side

Warning sticker applied

Dismissal of patient

__OPERATOR__________________ ASSISTANT

Seating of Dental Team and Patient

Secure Local Anesthesia

Placement of Rubber Dam

2 is in the slow speed

245 is in the high speed

Receives mirror and high speed HIGH SPEED, L to R, MIRROR, R to L

Enters tooth preparing approximate outline Picks up triplex L, Suction R

form Keeps field clean

Dries field at end of procedure

Hangs up suction and triplex

HIGH SPEED, R to L Replaces high speed L

Changes button on unit to slow R

Picks up slow speed L, triplex R

Receives and finishes caries

removal and outline, retention SLOW SPEED WITH #2 BUR, L to R

and convenience forms

Uses air as necessary

The use of a 1/2 round bur is usually necessary for retention

Picks up explorer, L

SLOW SPEED, L to R EXPLORER, L to R

Checks preparation for outline

form, caries removal and retention

MIRROR, EXPLORER, BOTH L to L Receives and replaces on tray

Operator may use previously used

instrumentation to complete preparation

_____________________________________________________________________

Receives mirror and explorer MIRROR R to L, EXPLORER L to R

Checks preparation if necessary Place cotton in cotton forceps with

Copalite

EXPLORER R to L COTTON FORCEPS L to R

Uses Copalite in preparation Dries Copalite with triplex in R

COTTON FORCEPS R to L Receives and replaces on tray

Use of matrix band may be implemented as necessary

to adequately condense for margins and contour

Turns on amalgamator with R

Empties amalgam into cloth

Loads carrier L

Receives amalgam carrier AMALGAM CARRIER L to R

Places amalgam Picks up condenser L

AMALGAM CARRIER R to L CONDENSER L to R

Condenses amalgam Loads carrier L

Repeat steps until ready to over pack

Picks up mechanical condenser L

AMALGAM CARRIER R to L MECHANICAL CONDENSER WITH

RUBBER OVER PACK L to R

MECHANICAL AMALGAM CONDENSER

R to L HOLLENBECK L to R

Carves proximal areas and smoothes surface Picks up Discoid Carver L

margins Writes up record for procedure

accomplished

HOLLENBECK R to L discoid carver L to R

Carves labial or lingual dovetail Picks up wet cotton bud L

surface as necessary

DISCOID CARVER R to L BALL BURNISHER L to R

Smoothes alloy Picks up explorer L

BALL BURNISHER R to L WET COTTON BUD L to R

Smoothes and cleans alloy

_____________________________________________________________________

WET COTTON BUD, R to L EXPLORER L to R

Removes excess flash and checks

gingival of proximal

MIRROR, EXPLORER, L to L Receives and replaces on tray

Picks up suction R, triplex L

Washes and dries field

Receives explorer EXPLORER, L to R

Loosens ligature

Pulls from interproximal Cuts floss with scissors, R

Picks up clamp forceps, L

EXPLORER, R to L CLAMP FORCEPS, L to R

Removes clamp, locking forceps to

prevent loss of clamp during exchange

CLAMP FORCEPS, R to L Receives clamp forceps, L

Holds rubber dam, L

Removes rubber dam Picks up 2 x 2 gauze, L

RUBBER DAM, Both hands to R Receives rubber dam with R

Receives 2 x 2 gauze 2 x 2 GAUZE, L to R

Cleans debris with 2 x 2 gauze Picks up water L, suction R

Washes field

Picks up forceps with articulating

paper, L, mirror, R

MIRROR, R to L

2 x 2 GAUZE, R to L FORCEPS WITH PAPER, L to R

_____________________________________________________________________

Checks occlusion Picks up discoid if necessary

FORCEPS WITH PAPER, R to L DISCOID, L to R

MIRROR, DISCOID, BOTH in L to L Receives and replaces on tray

Use of cotton roll on anesthetized side

Warning Sticker applied

Dismissal of patient

__OPERATOR__________________ ASSISTANT

Receives mirror and explorer MIRROR, R to L, EXPLORER, L to R

Checks preparation if necessary Places cotton in cotton forceps with

Copalite

EXPLORER, R to L COTTON FORCEPS, L to R

Uses Copalite in preparation Dries Copalite with triplex in R

COTTON FORCEPS, R to L Receives and replaces on tray

__OPERATOR__________________ ASSISTANT

Picks up matrix band and Howe Plier, L

MIRROR AND COTTON FORCEPS,

BOTH IN L to R MATRIX BAND AND HOWE, L to R

Places band on tooth and draws

material to seam with Howe

HOWE PLIER & BAND, R to L Receives band and plier, L

Spot welds band, cuts excess,

bend down tab with 114 plier

Receives band and 114 plier, R MATRIX BAND IN 114 PLIER L to R

Contours band with 114

114 PLIER, R to L Receives 114 plier, L

Places hand on tooth Picks up mirror, R

Receives mirror, L MIRROR, R to L

Receives cotton forceps, R COTTON FORCEPS WITH WEDGE,

L to R

Places wedge in proximal

COTTON FORCEPS, MIRROR, Both in L to L Receives and replaces on tray

__OPERATOR__________________ ASSISTANT

Instructor CHECK and Parent Consult;(If not done earlier in the appointment)

Seating of Dental Team and Patient

Medium finishing bur in C.A.

HANDPIECE, L to R

Receives slow speed and mirror MIRROR, R to L

Smoothes and finishes amalgam surfaces Picks up triplex, L and

defining margins Suction R

Uses continuously

Hangs up triplex and suction

SLOW SPEED, R to L Receives and using both hands

changes bur to small round

finishing bur if necessary

Receives slow speed SLOW SPEED, L to R

Smoothes and finishes areas not accessible Picks up triplex L and suction R

by the medium bur as necessary Uses continuously

Hangs up triplex and suction

SLOW SPEED, R to L Receives slow speed

Receives and using both hands

changes bur to interproximal

finishing bur if applicable

Receives slow speed SLOW SPEED, L to R

Smoothes and finishes proximal margins Picks up triplex L and suction R

margins and surfaces Using continuously

Hangs up triplex and suction

SLOW SPEED, R to L Receives slow speed

Receives and using both hands

changes bur to green polishing stone

Receives slow speed SLOW SPEED, L to R

Polishes surfaces of the restoration

SLOW SPEED, R to L Receives and replaces

INSTRUCTOR CHECK

__OPERATOR__________________ ASSISTANT

Seating of the Dental Team and Patient

Secure Local Anesthesia

Selects Proper Shade of Material

Placement of Rubber Dam

2 is the slow speed

245 is in the high speed

Receives high speed and mirror HIGH SPEED, L to R, MIRROR, R to L

Enters tooth preparing approximate outline Picks up triplex L, Suction R

form Keeps field clean

Hangs up suction, switches triplex to R

HIGH SPEED, R to L Receives and replaces high speed L

Changes button on unit to slow R

Picks up slow speed, L

Receives and finishes caries removal SLOW SPEED WITH #2 BUR, L to R

and outline, retention, and convenience forms

Uses air as necessary

The use of 1/2 round bur is usually necessary for retention

Picks up explorer, L

SLOW SPEED, L to R EXPLORER, L to R

Checks preparation for outline form caries

removal, and retention

MIRROR, EXPLORER, Both L to L Receives and replaces on tray

Operator may use previously used instrumentation

to complete preparation

_____________________________________________________________________

Receives mirror and explorer MIRROR R to L, EXPLORER, L to R

Checks preparation if necessary Picks up matrix L

EXPLORER R to L MATRIX L to R

Places matrix in desired position, if Picks up cotton plier and cotton

necessary pellet and dips in etching solution

**Receives cotton pliers and etches COTTON PLIERS L to R

cavo surface of preparation

COTTON PLIERS R to L Receives cotton pliers

Washes and dries tooth

Receives bonding agent applicator BONDING AGENT APPLICATOR L to R

Makes Bonding Agent available to operator

Places bonding agent on cavosurface of Prepares composite material

preparation

Picks up composite instrument

BONDING AGENT APPLICATOR R to L COMPOSITE INSTRUMENT

Place composite in cavity over fill very slightly Make composite available to operator

If used, draw matrix to contour.

Cures composite as appropriate. COMPOSITE CURING LIGHT L to R

MATRIX R to L Receive and discard

COMPOSITE LIGHT R to L Receive and replace

Trim all excess flash

Place 12 fluted bur in R.A. handpiece round

Write up procedure

_____________________________________________________________________

Receives slow speed SLOW SPEED L to R

Use 12 fluted round bur with air, contour Pick up triplex L, Suction R

and finish lingual

Keep field clean for finishing and

polishing

Hang up triplex, suction

SLOW SPEED, R to L Receives and changes to garnet and/or

fine sand and/or fine cuttle fish disk

Receives slow speed SLOW SPEED, L to R

Use disk with air to finish, Pick up zirconium strip

contour, and polish

SLOW SPEED R to L ZIRCONIUM STRIP R to L

Uses zirconium strips as necessary to

finish proximal Triplex L, suction R

Keep field wet

Hang up triplex, suction

Pick up explorer, L

SLOW SPEED, R to L EXPLORER, L to R

Check finished restoration Replaces slow speed

MIRROR, EXPLORER, Both in L to L Receives and replace

Receives explorer EXPLORER, L TO R

Loosens ligature with explorer

Pulls from interproximal Cuts floss with scissors, R

Picks up clamp forceps, L

EXPLORER, R to L CLAMP FORCEPS, L to R

Removes clamp, locking forceps to prevent

loss of clamp during exchange

CLAMP FORCEPS, R to L Receives clamp forceps

Holds rubber dam with L Cuts rubber dam interproximals with R

Removes rubber dam Picks up 2 x 2 gauze, L

RUBBER DAM, Both hands to R Receives rubber dam with R

Receives 2 x 2 gauze 2 x 2 GAUZE, L to R`

Clean debris with 2 x 2 gauze Picks up water L and suction R

Washes field

2 x 2 GAUZE, R to L Receives and dispose of gauze

Use cotton roll on anesthetized side

Warning sticker applied

__OPERATOR__________________ ASSISTANT

Seating of the Dental Team and Patient

Instructor CHECK and Parent Consult;

Secure Local Anesthesia

Placement of the Rubber Dam

6 round is in slow speed

245 is in the high speed

Receives high speed and mirror HIGH SPEED, L to R

MIRROR, R to L

Prepare conservative alloy Suction R, triplex L

outline form if possible Keep field clean

Hang up suction, R

Triplex to R

Pick up slow speed, L

HIGH SPEED, R to L SLOW SPEED, L to R

Removal of gross caries

Proceed to either all caries

removed or exposure is produced

SLOW SPEED, MIRROR, Both to L to L Receives slow speed and mirror

Receives mirror and slow speed Suction R, triplex L

Keeps field clean

Triplex to R

SLOW SPEED, R to L Receives slow speed

Replaces slow speed L

Picks up high speed L

Receives high speed HIGH SPEED, L to R

Removes chamber ceiling with 245 Suction R triplex back to L

Keeps field clean

Hangs up suction and triplex

HIGH SPEED, R to L Receives and replaces L

Change button on unit to slow

Receives slow speed SLOW SPEED, L to R

Removes overhanging chamber Triplex L suction R

walls, removes pulpal tissue Keep field clean

and prepares seat for ZOE in canals

(Small spoon may be used in addition to slow speed for removal of pulp)

Wash field at end of pulp removal

Hang up suction, triplex

Pick up dry cotton pellets with cotton

forceps

SLOW SPEED, R to L COTTON IN COTTON FORCEPS L to R

Place cotton in chamber to control hemorrhage

and keep chamber dry for instructor check Write up procedure

COTTON FORCEPS, MIRROR, Both L to L Receive and replace on tray

(Instructor will check for cleanliness of chamber, direct access and vision,

caries removal, obturating seat for paste, and hemorrhage control) Then it will be determined if a five-minute formocreosol pulpotomy or a two step formocreosol pulpotomy will be completed.

Pick up mirror R, cotton forceps with

formocreosol moistened cotton, L

Receive mirror and cotton forceps MIRROR, R to L, COTTON FORCEPS,

L to R

Place cotton pellets with formocreosol over

pulpal stamps

Place large dry cotton pellets Prepare ZOE to be ready to mix

over formocreosol pellets to absorb

excess formocreosol. Leave formocreosol

pellets on pulp stumps for five minutes

Remove all cotton pellets and inspect pulp

tissue for adequate fixation.

COTTON PELLET IN FORCEPS, R to L Receives cotton forceps discards pellets

Mix ZOE to base consistency

Place up plastic instrument, L

Receives plastic instrument PLASTIC INSTRUMENT, L to R

Place ZOE base in tooth

Picks up explorer, L

PLASTIC INSTRUMENT, R to L EXPLORER, L to R

Receives explorer and carves

excess cement to margin of opening

Loosens ligature with explorer

Pulls from interproximal Cuts floss with scissors, R

Picks up clamp forceps, L

MIRROR, EXPLORER, Both in L to L CLAMP FORCEPS, L to R

Removes clamp, locking forceps to prevent

loss of clamp during exchange

CLAMP FORCEPS, R to L Receives clamp forceps, L

Holds rubber dam with L Cuts rubber dam interproximals with R

Removes rubber dam Picks up 2 x 2 gauze, L

RUBBER DAM, Both hands to R Receives rubber dam with R

Receives 2 x 2 gauze Picks up water L and suction R

Cleans debris with 2 x 2 gauze Washes field

Receives and places in receptacle

Check of occlusion of cement

Continue on to Crown Procedure

or

Use of cotton roll on anesthetized side

Warning sticker applied

Pick up mirror R, cotton forceps with

formocreosol moistened cotton, L

Receive mirror and cotton forceps MIRROR, R to L, COTTON FORCEPS,

L to R

Place cotton pellets with formocreosol over

pulpal stamps

Place large dry cotton pellets Prepare ZOE to be ready to mix

over formocreosol pellets to absorb

excess formocreosol