NJXDG EXAM All Expected Q uestions A nd Answers 1. Applying topical fluoride gel or foam (efda): Selecting the tray 1) Select a disposable tray that is of the appropriate size for the patient's mouth. The tray must be long and sufficiently deep to cover all erupted teeth co mpletely without extending beyond the distal surface of the most posterior tooth. Trays are available in sizes to fit primary, mixed, and adult dentition. If the patient's mouth can accommodate it, you may use a double -arch tray. This saves time by treatin g both arches at the same time. Remember, trays are discarded after a single use & if you try a tray in the mouth but do not use it that tray must be discarded. Preparing the teeth 2) Check to see whether calculus is present; if it is not, no preparation is required. Fluoride diffuses easily through the acquired pellicle and bacterial plaque. 3) If calculus is present, request that the dentist or dental hygienist remove it. The presence of plaque will not affect the uptake of fluoride. Applying the topical fluoride 4) Seat the patient in an upright position and explain the procedure. Having the pt upright prevents gel from going into the throat. 5) Instruct the pt not to swallow the fluoride. 6) Select the appropriate tray, and load it with a minimal amount of fluoride, following guidelines according to the patient's age. 7) Dry the teeth using air from the air water syringe. For fluoride to be maximally effective, the teeth must be dry when the fluoride is applied. 8) Insert the tray, and place cotton rolls between the arches. Ask the patient to bite up and down gently on the cotton rolls, to squeeze the fluoride over all tooth surfaces. 9) promptly place the saliva ejector, and tilt the patient's head forward. 10) Set the timer for the appropriate amount of time in accordance with the manufacturer's instructions. During this time, do not leave the patient unattended. 11) On completion, remove the tray, but do not allow the pt to rinse or swallow. Promptly use the saliva ejector or the high -volume oral evaluator tip to close the lips tightly around the saliva ejector. Removing excess saliva and fluoride solution will make the pt more comfortable and less likely to rinse with water. 12) Instruct and the pt not to rinse, eat, drink, or brush the teeth for at least 30 minutes. These activities could disturb the action of the fluoride. Documentation - date NJXDG EXAM All Expected Q uestions A nd Answers - "applied APF fluoride get. Instructed pt not to eat for 30 min.) - operator 2. Applying fluoride varnish (EFDA): 1) Obtain informed consent from the pt, or parent/legal guardian in the case of a minor patient. Informed consent is a legal requirement for the provision of any dental treatment. 2) Gather supplies and single -unit dose for application. Once you begin the proce - dure, you will not be able to stop in your the middle to get something you forgot. 3) Recline the pt to an ergonomically correct position for better access to the oral cavity & be in a comfortable position. 4) Wipe the teeth to be varnished with the gauze or cotton roll & insert the saliva ejector. The varnish is not moisture sensitive and can be applied in the presence of saliva, the saliva ejector is for pt comfort only. 5) Using a cotton tip applicator, brush or syringe applicator, apply 0.3 to 0.5 ml of varnish (unit dose) to clinical crown of teeth; application time is 1-3 minutes. Refer to manufacturer's instructions for specific application time. 6) Dental floss may be used to draw the varnish inter -proximally. 7) allow pt to rinse after the procedure has been completed to remove any residual taste. 8) Remind the pt to avoid eating hard foods, drinking hot or alcoholic beverages, brushing, and flossing for at least 4-6 hours, or preferably until the next day after the application. Drink through a straw for the first few hours after application. Documentation - date - "applied 0.3 ml of 5% sodium fluoride varnish (insert brand name) on facial and lingual surfaces of teeth #s 6 -14, and 19-30. - operator 3. Assisting patient with dental floss (EFDA): Preparing the floss 1) Cut a piece of floss about 18 inches long. Wrap the excess floss around the middle or index fingers of both of your hands, leaving 2-3 inches of working space exposed. 2) Stretch the floss tightly between your fingers, and use your thumb and index finger to guide the floss into place. 3) Hold the floss tightly between the thumb and forefinger of each hand. These fingers control the floss and they should be no farther away than 1/2 inch apart. Flossing the teeth 4) Pass the floss gently between the patient's teeth, using a sawing motion. Guide the floss to the gumline. Do not force or snap the floss past the contact area. The NJXDG EXAM All Expected Q uestions A nd Answers floss may cut or injure the tissue. 5) Curve the floss into a C shape against one tooth. Slide it gently into the space between the gingiva and the tooth. Use both hands to move the floss up and down on one side of the tooth. 6) Repeat these steps on each side of all teeth in both arches; including the posterior surface of the last tooth in each quadrant. 7) As the floss becomes frayed or soiled, move a fresh area into the working position. Documentation - date - "provided flossing demonstration and instruction. Patient practiced technique and did well. - operator 4. Using an instrument intraorally (EFDA): 1) Seat and place the pt in the supine position. 2) Position yourself as the operator. 3) Adjust the dental light to illuminate the oral cavity. 4) Using a pen grasp, pick up the mirror with your nondominant hand and the explorer with your dominant hand. 5) Instruct your pt to open his/her mouth and turn toward or away from you, depending on the location of the mouth. 6) Establish a fulcrum close to the area that you will be exploring with your instrument. 7) Adapt the explorer to the most posterior tooth in the upper right quadrant. A well-adapted instrument prevents damage to the tooth and surrounding tissue. 8) Follow around the tooth with the mirror and the explorer, and examine all surfaces through visualization and touch. 5. Preparing, placing, and removing the dental dam (EFDA): Patient prepara - tion 1) Check the pt's record for contrainidications, and identify the area to be isolated. Inform the pt of the need to place a dental dam, and explain the steps involved. 2) Assist the dentist in the administration of local anesthetic. The dentist will determine which teeth are to be isolated and will note whether any malposed teeth must be accommodated. 3) Apply lubricating ointment to the pt's lip with a cotton roll or cotton -tipped applicator. Pt's comfort is a matter of concern throughout placement and removal of the dental dam. 4) Place yourself in the operator's position, and adjust your pt for easier access. NJXDG EXAM All Expected Q uestions A nd Answers 5) Use the mouth mirror and the explorer to examine the site where the dam is to be placed. It should be free of plaque and debris. If the dam is placed in an area with plaque and debris, the dam could push the plaque and debris into the sulcus and irritate the gingival tissues. If debris and plaque is present, selective coronal polish ing is performed on these teeth before dam is applied. 6) Floss all contacts involved in placement of the dental dam. Any tight contacts may tear the dam. Punching the dental dam 7) Use a template or stamp to mark on the dam the teeth to be isolated. 8) Correctly punch the marked dam according to the teeth to be isolated. Be sure to use the correct size of punch hole for the specific tooth. 9) If teeth have tight contacts, lightly lubricate the holes on the tooth surface (undersurface) of the dam. This eases placement of dam. Placing the clamp and the frame 10) Select the correct size of the clamp. 11) Secure the clamp by tying a ligature of dental tape on the bow of the clamp. 12) Place the beaks of the dental dam forceps into the holes of the clamp. Grasp the handles of the dental dam forceps, and squeeze to open the clamp. Turn upward, and allow the locking bar to slide down to keep the forceps open for placement. 13) Retrieve the dental dam forceps. Position the lingual jaws of the clamp first, then the facial jaws. Duri ng placement, keep an index finger on the clamp to prevent the clamp from coming off before it has been stabilized on the tooth. Check the clamp for fit. Lingual jaw placement serves as a fulcrum for placement of the facial jaws. 14) Transfer the dental dam to the site; stretch the punch hole for the anchor tooth over the clamp. 15) Use cotton pliers to retrieve the ligature and pull it through so that it is exposed and easy to grasp if necessary. 16) Position the frame over the dam, and slightly pull the dam, allowing it to hook onto the projections of the frame to ensure a smooth and stable fit. 17) Fit the last hole of the dam over the last tooth to be exposed at the opposite end of the anchor tooth. This stabilizes the dam and aids in locating the remaining punch holes for the teeth to be isolated. 18) Using the index fingers of both hands, stretch the dam on the lingual and facial surfaces of the teeth so that the dam slides through each contact area. 19) With a piece of dental tape or waxed floss, floss through the contacts, pushing the dam below the proximal contacts of each tooth to be isolated. Slide the floss through the contact rather than pulling it back through the contact. This will keep
