Ashley

Mahoney

5/2/15

DH 132

Procedure #1

I went to observe two office procedures at Riverbend Dental located in springfield with Dr.
Allison Cadaret. The first procedure I observed was a cementation of a permanent crown on
tooth #5.

When I first arrived, the dental assistant was the once who greeted me, showed me around,
and brought back the patient. The patient had a polycarbonate temporary crown placed over
tooth number #5, which had severe MODBL decay, about two weeks prior. Dr. cadaret said she
chose this particular temporary material because it is suitable for premolars. At the previous
appointment, Dr. Cadaret used Tempbond to place the temporary crown, in order to achieve
retention for the following two weeks while also still being able to remove the temporary
crown once the final product returned from the laboratory.

The assistant performed the removal of the temporary crown, but she had difficulty removing it
without causing discomfort to the patient. She used forceps to grasp the crown, but the
Tempbond was not budging. She then applied some topical anesthetic to the surrounding tissue
and chatted with the patient in order to give it time to absorb into the gingiva-and after about 5
mins she was able to successfully remove it without causing harm to the patient.

They had used Luxatemp as the impression material when obtaining an impression to be sent
off to the laboratory. After two weeks the lab sent back a porcelain crown-they chose porcelain
for aesthetic purposes. The assistant then placed the crown and took an x-ray to check that the
crown prep and the tooth fit together properly. The premolar projection showed proper
placement.

Next, she used articulating paper to check the bite with the crown on (upper arch vs. lower
arch). It was specifically shim stock articulating paper, which is super thin. The assistant then
used a carbide polishing burr (coarse grit) attached to high speed handpiece to file down the
occlusal surfaces that were interfering with the normal bite.

At this point, the dentist entered the room. She used floss interproximally to check placement
of crown. Where the contact was too tight, the floss would get caught, so she used the same
carbide polishing burr to file down the sides in order to make sure the contact spaces were not
too crowded.

It was now time to cement the crown using 3M Luting Agent. The assistant combined 1 scoop
powder with 1 drop of liquid on a mixing pad. While she was doing this, the dentist applied a
viscous ferxy sulfate- which is a hemostatic agent- to the tissue to minimize bleeding. She then
proceeded to apply gluma to the tooth surface, which is a desensitizing agent to numb the
nerve ending in the dentin tubules.

While the dentist was doing all of this, the assistant applied the luting agent inside the crown.
The dentist then placed the crown onto the tooth and they waited two minutes in order to let it
set. She then used floss to remove excess cement interproximally.

Procedure #2
The second procedure I observed was performed right after the first, in the room adjacent. It
was an MO composite on tooth # 4. The dentist used Dentrix specifically. She said she preferred
composite for aesthetic purposes as well as that fact that it doesnt expand/contract over time.

The dentist began by administering local anesthetic (after topical was placed). It was specifically
a PSA injection and they allowed about five minutes for numbness to occur. She used Endo-ICE
on the end of a cotton swab to test the area-once the patient confirmed no feeling she
proceeded. A bite block and a dri tip were placed in the patients mouth.
The dentist used a carbide 330 burr attached to high speed handpiece to remove the decayed
pieces of tooth structure. She used a dark substance called Sable Seek, which is a caries
indicator dye which stains denatured collagen. The next five minutes consisted of her using the
dye, drilling for a bit, and so on until all decayed portions were removed.

Next, she placed a matrix band around tooth to build a wall for the contact on the mesial side.
The material she used to place the restoration was Base Bitrabond, which is a glass ionomer
that bonds well to dentin-sealing it off. This particular product cures in the mouth. The dentist
then applied Prime & Bond and light cures for 30 seconds with matrix band on, and for an
additional 30 seconds after removing the band.

Dr. Cadaret used a composite polishing tip, which was made of rubber impregnated with
diamonds, to achieve the true shape of first premolar. She used articulating paper several
times, both on the occlusal surfaces and interproximally to determine what needed to be filed
off. Finally, she flossed interproximally to remove any excess product.

Client Record
Procedure #1
The particular office I observed preferred that I did not look over their chart notes for HIPAA
purposes. The assistants fill out the chart notes during the day, and at the end of day the Dr.
looks over them to make sure they are sufficient. There is a different template for each
procedure. For the crown cementation, the assistant specifies which particular tooth the
procedure is performed on, the material used, if anesthetic was used (injectable or topical), and
included documentation of the x-ray. Additional comments may be made and PARQ is listed
above the electronic signature from the doctor.

Procedure #2
The template is somewhat similar for a composite restoration. It includes the specific surfaces
of decay, all the materials used in the process, and the anesthetic is used (which particular
injections). Additional comments, PARQ, and electronic signature from Dr. follow.
Infection Control Procedures
I was honestly very surprised how much their office protocols differed from LCC. Given it was a
much smaller office, but their sterilization room literally looked like a galley kitchen to me. It
was open on both sides so patients were able to observe the entire area-even from the
reception area which I found strange. I also found it strange that although the assistants
removed the trays and contaminated items from the treatment rooms, they only carried them
to sterilization room-where the receptionist placed instruments in the ultrasonic and sterilizers.
She was wearing gloves, but no protective eyewear or mask.

Personally I thought their outfits were very cute, but they did not look like scrub. They wore
capris and flats! I was pretty sure that was against OSHA protocol.

There were not any barriers placed over the chairs or on the handpieces, though they did
disinfect them. I also observed the assistant touching the computer and x-ray equipment (which
had minimal barriers) with her dirty gloves that had been in the patients mouth.

Overall, they seemed to be more laid back in their infection control protocols as compared to
LCC.

General Impressions
I thought that the overall atmosphere of the office was very pleasant. It was small, quaint, and
quiet (which I liked). I also enjoyed the fact that all women worked there- one dentist, two
hygienists, and three assistants. The patients seemed to know the doctor on a more personal
level and they were able to chat when time permitted. The part that fascinated me most was
the x-ray machine pulled out from a cabinet chairside! This seemed to help the clinician use
time much more effectively. Actually, overall I was very surprised at how fast the procedures
took. I would say they only took about twenty minutes a piece; time was always used
effectively.