Dental assistant


Dental assistants are members of the dental team. They support a dental operator in providing more efficient dental treatment. Dental assistants are distinguished from other groups of dental auxiliaries by differing training, roles and patient scopes.

History

The first dental assistant

, a pioneering dentist operating from New Orleans, enlisted the first dental assistant, . The dental field was initially dominated by males, but after this first addition of a female, it was then acceptable for women to seek dental treatment without their husbands. This led to dental assistants of that era also being known as "Ladies in Attendance". Thanks to the addition of women to dentistry, the profession flourished with more and more women seeking treatment and more patients overall receiving care.

The first association

It was not until almost four decades later that in 1923 the first dental assistant association was founded by Juliette Southard, named the and it is still in practice now. It began with just five members, now reaching more than 10,000.

Roles

The dental assistant's role is often thought to be to support the dental operator by typically passing instruments during clinical procedures. However, in fact, their role extends much further to include: providing patients help with their oral hygiene skills, preparing the patient for treatment, sterilising instruments, assisting during general anaesthetic dental procedures, positioning suction devices, exposing dental radiographs, taking dental impressions, recording patient notes and administration roles such as scheduling appointments, ensuring compliance with OSHA and CDC standards, maintaining sterilization logs, and conducting regular operatory disinfection.

Infection control

It was customary for oral health care workers and dental assistants in the 1980s to practice oral health care without wearing gloves, masks or eye protection. This was at a crucial time due to the human immunodeficiency virus spreading rapidly at a global rate. At the time, the transmission risks associated with bloodborne pathogens like HIV and hepatitis B were not fully understood, and personal protective equipment was not yet standard in most clinical settings. However, the increased awareness and understanding of these infectious diseases by the late 1980s and early 1990s led to significant changes in infection control protocols across health care fields, including dentistry. However, in 2018 gloves, masks and eye protection have become part of the standard infection control guidelines which has been implemented in all oral health care settings as a means of preventing the spread of infectious disease. Infection control in oral health care not only protects the patient but it also protects the oral health care workers. This includes: dentists, dental specialists, oral health therapists, dental hygienists and dental assistants.
Dental assistants play a crucial role in maintaining high levels of infection control in the oral health care setting. The dental assistant is the major link between oral health care workers and the patient. To perform infection control responsibilities well, the dental assistant must have the appropriate education, training and work experience. Examples of infection control protocols that the dental assistant needs to follow in an oral health setting include:

Hand hygiene

aims to reduce the number of microorganisms on hands. Antimicrobial agents such as alcohol-based hand rub or antimicrobial soap and water are effective agents to remove most antimicrobial bacteria on hands in dental settings.

Personal protective equipment (PPE)

Gloves, gown, hair net and eye protection are essential barrier protection items that enable the dental assistant to reduce the transmission of infectious diseases to themselves, other dental co-workers and patients. Gloves and masks need to be disposed after each patient, eyewear can be disposable or reusable and gowns need to be replaced if visibly soiled. Lastly, footwear must include leather closed toe shoes; this minimises the risk of sharps injury.

Surgical procedures and aseptic technique

It is crucial to wear sterile gloves when the dental assistant is assisting in surgery with the oral health care clinician. Hand hygiene using antimicrobial soap and water is imperial to maintaining adequate infection control in this setting, as this minimises the risk of infection.

Management of sharps injury

It is crucial that sharp instruments which include: needles, scalers, scalpels, burs, orthodontics bands and endodontic files need to be handled with care and appropriate techniques to minimise any potential sharps injury. Sharps also need to be disposed accordingly into the sharps containers, separate from other disposable bins. The dental assistant needs to be aware of what is required to go into the sharps containers and what is not. This minimises the chance of spreading infectious diseases.

Management of clinical waste

It is imperative that when performing change over, that the dental assistant is able to distinguish the difference between medical related waste compared to contaminated waste. Contaminated waste needs to be placed in a leak proof thick yellow bag with a biohazard symbol label.

Environment

The dental assistant should put on utility gloves when cleaning working surfaces during the changeover between patients. Each person in the dental office needs to have his or her own pair/s of utility gloves. They must also be able to distinguish between clean and dirty zones as this minimises the spread of infectious diseases between co-workers and patients. Additionally, plastic barriers are placed on: instruments such as; hand pieces connected to the chair, overhead lights, amalgamators, x-ray machines, mixing materials and other miscellaneous dental instruments, materials or appliances. One of the roles that the dental assistant participates in is changing these plastic barriers after each patient has left that surgery. This ensures that the surgery is set up ready for the next patient.
  • These infection control procedures and protocols not only apply to the dental assistant, but to all co-workers in the oral health care setting. However, the dental assistant is the major connection between the patient and the oral health care clinician. Therefore, it is imperative that they follow these guidelines to minimise the risk of spreading possible infectious diseases to co-workers, patients and themselves.

    Sterilisation, disinfectant and antiseptic

Dental assistants play a large role in ensuring that the reusable dental instruments used daily in dental practices are sterilized adequately after each use. Sterilization is an essential part of the infection control protocol. This can be defined as free of all life forms where the elimination of considerable number of the most heat resistant spores is the basic criteria sterilization. Sterilization process consists of
  1. Autoclaving where moist heat kills bacteria by denaturation of high protein- containing bacteria at 250F for 15 to 20 minutes or 270 F for 3 minutes. Biological monitors and Process indicators are 2 methods used to ensure the effectiveness of sterilization process.
  2. # Biological monitor where bacterial spores are placed in strips or envelops along with the instruments. This method shows that the microorganisms have been eradicated and must be conducted weekly.
  3. # Process indicators; where the load has reached a certain temperature, the indicators change their colour.
  4. Dry heat sterilization which requires a higher temperature and longer time than steam autoclave, therefore, only glass or metal objects can be steamed by dry heat.
  5. Chemiclave by using Ethylene oxide at relatively low temperature for 2–3 hours.
  6. Cold/ chemical test which can be done by soaking instruments in a specific chemical solution such as 2% glutaraldehyde for 10 hours in order to kill bacterial spores. However, this method does not destroy hepatitis viruses and spores.
Disinfectant is also one of the major roles of dental assistant where chemicals applied to inanimate surfaces such as lab tops, counter tops, headrests, light handles, etc. This is to make sure that germicide and/or microbiostatic are achieved. Antiseptic chemical agents similar to disinfectants but they may be applied safely to living tissue, is another task for dental assistant where Alcohol is the most commonly used.

Health promotion

Dental assistants make a difference in the community by participating in health promotion activities and programs. These programs may take place at schools, preschools, immunisation events or at maternal health clinics. Dental operators may also be supported by dental assistants during pre-school or school screenings.
Dental assistants can extend their scope to provide oral health promotion to patients in Australia by completing the Certificate IV in Dental Assisting. The dental assistant will have the ability to implement an individualised oral health promotion program and oral hygiene program. After the appropriate training the dental assistant may;
  1. Promote the dental team concept in achieving good oral health and promoting good oral hygiene habits
  2. Assist in making dental treatment accessible and affordable to the community
  3. Perform health promotion activities by promoting good oral health to the community
  4. Support and educate on oral health promotion to allied health professionals
Dental assistants help other dental and allied health professionals in health promotion. These dental assistants implement oral health programs by providing resources and presentation promoting oral health messages to several target groups and community settings. These settings include:
Dental assistant can educate the community and schools by advising on:
  • Oral diseases
  • Diet analysis and counselling
  • Oral hygiene strategies
  • Preventive strategies
  • Care of fixed & removable prosthesis and fixed appliances
  • Smoking cessation
  • Preventing sports injuries