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Showing posts with label Dental. Show all posts
Showing posts with label Dental. Show all posts

Wednesday, September 19, 2018

Dental- Scope of Services


Dental- Scope of Services


Dental hospital or clinic facilities include:
        State of the art Dental Units.
        Digital X—Ray machines (RVG) assigned to every dental units.
        Intra Oral camera.
        Self sustained autoclave for sterilization.
        Latest instruments, equipments and materials of high quality.

       Complete management of Dental patients, i.e evaluation, diagnosis, treatment plan, procedure and follow up.
        Routine treatment of Out Patients with dental problems.
        Routine dental check up of Patients from Wellness Assessment Center.
        Referred patients from other specialties.
        Referrals from other hospitals and clinics in Pune.
 Attending to the emergency trauma patients involving maxilla and mandible(Trauma Management)
        Procedures like cosmetic and esthetic dentistry, which include Smile Design and maintenance of smile line, Full Mouth Rehabilitation etc.  are carried out.
     Routine Procedures such as extraction, direct and indirect fillings, root canal treatment, crown and bridges, Metal Free Restoration (full ceramic such as Procera, Lava, Czar etc) cosmetic and esthetic dentistry, Inlay, Onlay, Dentures both complete and partial (using high quality imported material and latest technology), scaling etc. are carried out.
 Specialized procedure such as orthodontic treatment. Oral and Maxillofacial surgery, Specialized   Periodontal (GUM) Surgery etc are carried out by the specialists of the respective fields.
        An well equipped children’s clinic looks after the child patient by a competent Paedodontist.
        Dental Implantology using very high quality Implants.
     Besides above we are having Stem cell Banking facilities particularly taking advantage of stem cells available in the tooth, which is an entirely new concept in India.



Dental Technician- Job Description


Job Description

Job Title: Dental Technician
Qualification: Graduate / Diploma

Skills: Technical and analytical skills.

Roles, Responsibilities & Authorities:
        Assist in dental procedures.
        Sterilization of instruments.
        Indenting the Dental and Medical store.
        Maintenance of stores
        Maintenance of documents of medical and dental stores.
        Overall maintenance of sterilization of the procedure room.
        Assist in departmental administration..
        Management of patients before and after procedure.

Junior Dental Surgeon -Job Description

Job Description


Job Title: Junior Dental Surgeon
Qualification: BDS
Skills: Technical, analytical and communication skills.

Roles, Responsibilities & Authorities:
           All such procedural work under the guidance of the Consultants as applicable to a junior Dentist (which include minor prosthetic work, scaling etc.)
           Assist the Consultant in carrying out the procedure.
           Management of the wellness patients.
           Assist in the departmental administration.
           Entire documentation of the department.
           Management of the patients before and after the procedure.
           Management of the Dental lab work which is outsourced, which include documentation, receive and dispatch of lab jobs.
           Overlooking the indenting and maintenance of dental and medical stores, sterilization of the entire Department.

Orthodontist Job Description

JOB DESCRIPTION

Job Title:Orthodontist 
Qualification: BDS, MDS
Experience: 10+ years.

Skills: Technical, analytical and communication skills.

  • Provide treatment for various forms of malocclusion and teeth irregularity
  • Perform diagnostic tests using x-rays and plaster molds to locate the position of a dental problem
  • Fit braces, brackets, and other teeth appliances in patients’ mouth to correct teeth positioning
  • Schedule routine check-ups to track treatment progress and adjust dental appliances as required
  • Proffer recommendations to patients on proper dental care and hygiene necessary
  • Work with orthodontist assistant to ensure patients receive adequate teeth care
  • Perform dentofacial orthopedics to improve the general appearance of patients
  • Determine if applied braces are due to be removed
  • Assist patients in resolving dental or oral problems such as speech impairments and gum disease
  • Develop treatment plans to address individual patient problem
  • Design and model teeth appliances such as retainers, lingual arch wires, and brackets
  • Liaise with other orthodontists and health care professionals to coordinate orthodontic services for patients
  • Provide patients with proposed treatment plans and cost estimates.
  • Study patients’ dental records and medical history to determine type and severity of teeth condition
  • Provide patients with cost estimates and details of a treatment plan
  • Inspect dental equipment and appliances to ensure they function normally.
  • Examine patients to assess abnormalities of jaw development, tooth position, and other dental-facial structures.
  • Design and fabricate appliances, such as space maintainers, retainers, and labial and lingual arch wires.

Oral & Maxillofacial Surgeon Job Description


JOB DESCRIPTION

Job Title: Oral & Maxillofacial Surgeon

Qualification: BDS, MDS
Experience: 10+ years.
Skills: Technical, analytical and communication skills.

- Collaborate with other professionals such as restorative dentists and orthodontists in order to plan treatment.
- Perform surgery on the mouth and jaws in order to treat conditions such as cleft lip and palate and jaw growth problems.
- Perform surgery to prepare the mouth for dental implants, and to aid in the regeneration of deficient bone and gum tissues.
- Provide emergency treatment of facial injuries including facial lacerations, intra-oral lacerations, and fractured facial bones.
- Remove impacted, damaged, and non-restorable teeth.
- Remove tumors and other abnormal growths of the oral and facial regions, using surgical instruments.
- Treat infections of the oral cavity, salivary glands, jaws, and neck.


Process Flow of Dental Department

SOP of Dispatch & Receipt of Prosthetic Job


SOP of Dispatch & Receipt of Prosthetic Job

        Once the impression is taken, clean it thoroughly in water or follow manufacturer’s instructions to clean it and keep it aside.

        If alginate impression has been taken then prepare the model immediately.

        Then the lab prescription form to be filled with the detail of the job.

        Keep the impression /job ready along with the lab prescription at the reception.

        Once the delivery man from the dental laboratory arrives fill up the requisite register at the front desk and dispatch the packet containing the job.

        Once the job arrives back from the Dental lab check it, then receive it and fill the requisite register at the front desk and keep it ready for the doctor’s inspection and procedure thereafter.


SOP of Equipment Care


SOP of Equipment Care

        Hand piece
          Wipe air rotor and Micromotor hand piece with alcohol & cotton in between the use.
          Do not use water to clean the hand piece.
          After  the day’s  work  is over,  remove  the  hand  piece  from  the attachment,  thoroughly wipe it & clean with  alcohol alternatively we can use disinfective spray to remove blood clot etc.
          Then lubricate the handpiece as per instruction before sending it for autoclaving.
          Then put it in the pouch ready for autoclaving.
          The hand piece is ready for use.
          NEVER DROP the hand piece or the cartage will be damaged.

        Small Dental instruments like reamers, files, and  burs.
          Put the small instrument their such as burs completely dipped in alcohol immediately after use. DO NOT USE WATER to clean them.
          Root canal instruments such as reamers, files and broachers should be cleared with the aid of wire  wash  and or dipped in 5%  Sodium  Hypochlorite  to remove the  debris  ( by  efflorescence)  immediately after use.
          In between procedure sterilize the root canal instrument by means of glass bead sterilizer and keep them ready for use.
          At the end of the day burs can be autoclaved after following the ultrasonic cleaning method.
          Do not use water to clean them.
          If you find any fine instruments with damaged tips, keep them aside and DO NOT USE Them.

        Hand instruments
          Wipe them thoroughly clean using alcohol immediately after use.
          Then clean them with detergent and brush as mentioned in SOP 2
          Then put them in a tray containing multienzyme.
          Then put them in a ultrasonic cleaner.
          Then autoclave them 
          Store them ready for use.
          Take special care for mirror tops. Do not put them in water for prolonged time or they will loose their property (the silver surface  will be damaged)

        X-ray censor
          Wrap the x-ray censor with fresh cling film after every patient.
          Take optimum care NEVER TO drop it to the ground.
          Always put it attached to its designated place i.e. the x-ray box.






SOP of Periodic Check Of Autoclaves


SOP of Periodic Check Of Autoclaves

Periodical check of the autoclave
        It is to be carried out on weekly basis.
        Biological indicator for steam autoclave is used for the same which is kept with the load. At the end of the sterilisation process, the vial is sent to the microbiology department for necessary testing.
   The perfect working condition of the autoclave will be confirmed if the indicator after incubation does not change its colour.
Replacement of the bio-x Filter
The filter of the sterile air emitted into the autoclave chamber to be replaced once or year as per manufacture’s instructions.

Cleanings of the sterilizing chamber 
        Disconnect the power and ensure that the chamber is cold.
        Rinse thoroughly with water using a soft cloth soaked in water.
        Then dry carefully and thoroughly taking care not to damage the protective layer.
Cleanings of the front panel
          Disconnect  the power.
          Use a soft cloth damped with alcohol to clean the front panel.

Cleaning and Emptying the load tank .
The load tank to be emtied and cleaned at least once in a year.

Emptying of the discharge tank
        Insert the end of the tube into the water discharge tap, while the other end opens into a container to receive the discharged water.
        Open the tap fully to the discharge.


SOP of Basic Tray Set-up


SOP of Basic Tray Set-up

Desired outcome
To have sterilized instruments arranged in order of use on the tray, to facilitate quick and efficient dental treatment.

Measurement
        Consistency of tray set up arrangement.
        Number of times you must leave the chair to get something you have forgotten.
Set up
        Mouth mirror
        Explorer
        Perio probe
        Twizer
        Guaze  (2*2)
        Hand mirror
        Excavator







SOP of Medical Emergencies


SOP of Medical Emergencies
Introduction
Medical emergencies do occur in dental practice. Fortunately these are rare. But none the less this can be potentially life threatening when occur. So the dental team must be adequately prepared and equipped to deal with common life threatening conditions. We must remember
             Medical emergencies can occur at any time.
             All the staff member need to know their role in the event of a medical emergency.
             The entire staffs need to be trained in dealing with such an emergency.
Preparations for emergencies
The number of emergencies that arise in a dental office is inversely proportional to the preventive measures taken by the dental surgeon.
        A comprehensive medical history: Must be recorded for all the patients and updated regularly.
        Training:  All staff in the dental department should be adequately trained, and /or well organized treatment plan should be worked and rehearsed.
        Equipments and Drugs: An emergency tray containing all the necessary drugs should be readily available.
        Inj Adrenalin (1:1000, 1 mg/ml)
        Inj. Atropine
        Inj. Hydrocortison Sodium Succinate
        Inj. Avil
        GTN spray or tablets
        Salbutamol inhaler
        Inj. Dextrose 25%
        Inj. Pause (tranxemic acid)
        Oral Glucose powder
        5% Dextrose
Equipment :
        Sthethoscope
        Blood pressure recording instrument.
        Oxygen delivery system for delivering high flow of oxygen (5-10 litres / min)
        Syringes and Needles
        Bag mask device with oxygen reservoir.
        Basic airway adjunct (Oropharygneal and naso pharyngeal airways)
        Spacer device to deliver salbutamol.
EMERGENCY SITUATIONS AND SPECIFIC RESPONSE
1. Allergy
(a) Anaphylaxis (Type -1 Hypersensitivity)
It is a potentially life threatening immune reactions to foreign material and develop quickly.
Presentation
        Urticaria
        Angioedema
        Hypotension
        Tachycardia
        Bronchospasm 
Management
It is depended on the severity of presentations. 
        Stop administration of drug
        Assess the degree of cardiovascular collapse (from pulse and blood pressure)
        Assess the degree of airway obstructions (upper – angioedema Lower – bronchospasm)
        Activate CODE BLUE or arrange evacuation  to A&E.
        Put patient in supine position
        Assess breathing difficulty (stridor, wheeze, can’t speak) and administer oxygen.
        Monitor consciousness, airway, breathing, circulation, pulse, BP.
        If in shock it may be angioedema or bronchospasm.
        If B.P. is low put patient in trendelenberg position. 
(Drugs to be administered)
        Inj. Hydrocortison Sodium Succinate 100 mg IV with sterile water
        Inj. Avil 50 mg IM/IV 
        Inj. Adrenaline 2 mg IV
        Start IV fluid and maintain IV link
(b)Delayed reaction
Most drugs at one time or other can have allergic reaction.
Presentation
        Swellings at the site of injections
        Angio-neurotic oedema
        Pruritus
        Urticaria
Management   
Inj. Avil IV/IM
(2) Asthma
Assess the patient
        Acute / severe
        Patient unable to speak in complete sentences
        Pulse  > 110/min
        RR      > 45
 Life threatening  asthma
        Silent chest
        Cyanosis
        Sweating
        Hypercarbic flush
        Bradycardia
        hypotension
        confusion, agitation           
Management
 If any of the above is present transfer to A& E, otherwise
        High flow of oxygen
        Salbutamol inhalation
        Activate CODE BLUE or evacuate to A&E.
(3) Chest pain(Angina) / Myocardial Infarction
Presentation
        Persistent central chest pain, with possible radiation to the left or right arms, jaw or neck.
        Nausea, vomiting
        A sense of impending doom
        Restlessness
        Shortness of breath
        Pallor, Cold and clammy skin
        Hypotension, Tachycardia
Management
If Angina or acute MI is suspected:
        Reassure the patient.
        Put the patient in comfortable position.
        Give Nitrogyclerine Tablets (Isosorbide Nitrate Tablet) to put it sublingually.
        Give high flow of oxygen
        In the meantime activate CODE BLUE
(4)Diabetes 
 The most common diabetics related emergencies are:-
        Hypoglycaemia  – due to low blood sugar.
        Hyperglycaemia (diabetic keto acidosis) – due to high blood sugar
Hyperglycaemia and Ketoacidosis
Presentation
        Dehydration
        Progressive reduction in the level of consciousness
        hypotension
        Coma
Management
        Primary assessment
                Resuscitation followings ABC line of management i.e. securing airway breathing and circulation.
                Immediate activation of CODE BLUE or evacuation to the A&E.
Hypoglycaemia
Presentation
        Sweating
        Hunger
        Tremor
        Agitation
        Progressive drowsiness
        Confusion
        Coma
Managements
        Glucose powder neat or dissolved in water.
        If the patient improves it is followed up with food (Carbohydrate)
        If the patient is unconscious follow ABC line of management and activate CODE BLUE OR evacuate to A&E.
Note :
Any diabetic with impaired consciousness will be assumed to have hypoglycaemia until proven otherwise.
(5)Epilepsy
Presentation
        Sudden spasm of muscles producing rigidity (tonic phase)
        Jerking movements of head. arms, and legs may occur (Chronic clonic phase)
        May become unconscious
        May have noisy or spasmodic breathing, salivation and urinary incontinence
Managements
           Inj. Diazepam IV 5-10 mg.
           Mouth gag placement to prevent self inflicted bite injury.
           Put the patient on the floor.
           Remove all objects from patients mouth (denture etc ).
           Loosen  tight clothing
           Turn victim to stable side position as soon as seizure stops. Maintain clear airway, avoid aspirations.
           Shift to A&E.
(6)   Upper airway obstructions due to foreign body
 During dental procedure teeth or other small objects might inadvertently  get displaced and enter into the oropharynx, larynx, trachea or oesophagus.
Prevention
           Gauze screen should always be placed to block off oropharynx from mouth.
Presentation
        Distress
         Chocking
         Coughing
         Apnea
         Cyanosis
         Altered sences or loss of consciousness
Managements
           Put the chair in upright position
           Patient instructed to hold perfectly still and not swallow until the object can be retrieved
           Encourage the patient to cough up.
If the above procedure fails, and the patient shows increased respiratory distress,
Then manage as follows:-
           Put the patient in upright position, turn patient side on in chair. Support chest with one hand and deliver five sharp back blows between the shoulder blades with the other hand supporting the chest.
           If back flow fails give five abdominal thrust (Heimlich procedure)
           If the victim is unconscious commence CPR and activate CODE BLUE .
           If the patient shows no sign of respiratory distress, the foreign body might have been swallowed.
           Confirm position by radiograph and manage accordingly.
(7) Vasovagal syncope
It is transient loss of consciousness due to Vagal stimulation
Presentation
           Patient feels light headed and dizzy
           Nauseous, uncomfortable or agitated
           Cold and Clammy skin
           Thready , slow pulse
           Hypotension
           Transient loss of posture.
Managements
        Put the patient in trendelenberg (lying posture) position (left lateral position for pregnant patient)
        Reassure the patient
        Loosen the clothing
        Maintain airway (follow ABC line of management)
        Administer oxygen if respiratory distress present.
        Mild respiratory stimulus like spirit of ammonia can be used or sensory stimulus like pinching of ear lobule can help.
        Patients usually recover soon then slowly raise him to seated position.
        If the patient has H/o significant medical problem or syncope is prolonged, then evacuate immediately.
 (8) Toxic reaction to local anaesthetics
Presentation
        Initial excitatory phase followed by marked depression.
        Patient may be talkative and anxious
        Nausea, vomiting may be there
        Convulsion may be there but rare.
Management
        Most reactions are of minor nature and can be treated palliatively.
        Any sign of reaction noted during injection of LA, needle should be withdrawn immediately.
        Inj. Hydrocortison 100mg IV and Inj. Avil 25mg.
        Administer oxygen.
        If convulsion occur and becomes intensive give diazepam intravenously.
        In case of severe CNS stimulation / depression activate CODE BLUE.