PER4.
1b
Range: amalgam – adult
Procedure
Class I Amalgam Restoration for Upper left permanent first molar (UL6)
Clinical area
mixed private and NHS practice, the surgery is divided into 2 areas: on the right
clean zone for decontaminated area which is marked with a GREEN sign and left
contaminated zone which is marked with a RED sign.
the patient
The patient is a 48-year-old male, regular attendee, fit and healthy patient, no
medical issues disclosed. The patient had an occlusal surface of UL6. All options
were explained by the dentist and the patient took amalgam filling and have the tooth
restored. Class I cavities are those involving a single surface, in a pit or fissure, so a
class I filling could be an occlusal, a buccal or a lingual filling, for example.
*Patient gave consent a trainee nurse to be in the room and assist the dentist.
Preparation of the surgery
I washed my hands with antibacterial soap according to HTM 01-05 Hand washing
technique poster above the designated sink.
Changed into uniform, removed jewellery, hair up
PPE: eye visor, mask, gloves, uniform, closed shoes
I switched on decontamination room light, switched on Autoclave (type B&S), started
helix/B&D test (I do this every day before first cycle of sterilisation and vacuum test
once per week, which are installed in autoclave settings), and filled up autoclave with
demineralised water. All record of the test and cycle reports are saved automatically
inside the sterilizer's memory in PDF format. Once a week, I download it through the
front USB port and save on computer for record.
I disinfected the clinical area using virucidal disinfectant wipes with alcohol (surfaces,
dental light and handles, spittoon, bracket table) and alcohol-free wipes for dental
chair. I do this before the first patient, between patients and at the end of the day. I
filled the water bottle with distilled water mixed with Alpron and i connected it to the
dental chair, flushed waterlines for 2 minutes at the start of the day, and I flush for 30
second before each patient.
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Prepared the dirty box for instruments (I bring it from decontamination room in my
surgery)
*I am aware that the best practice to prevent cross infection is to place plastic
barriers in the: dental chair head rest, control panel, chair light handles, Suction
hoses, light cure tip, X-ray machine collimator and control panel, Computer
keyboard. However, in my workplace we don’t use them.
When the surgery was decontaminated I prepared for the procedure to carry out:
- I removed my full PPE
- I washed my hands with the 8 steps recommended by the HTM 01-05
- I printed the day list
- I checked medical history
-I checked if I have all the stock needed
i Switched on all equipment and ensure that everything is in working order:
- switch on the compressor
- switch on power to the surgery
- X-ray scanner
- dental light
- dental chair
- aspiration equipment
- amalgamator
Washed my hands with antibacterial hand wash (before and after activity)
Cleaned and disinfected all working surfaces and other dental equipment with
alcohol wipes.
Preparation of Patient Records on the computer:
- medical history
- X-ray or photo (relevant for a treatment)
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- treatment plan
- consent form (written or verbal consent)
*as this is an AGP (Aerosol Generating Procedure) , I provided PPE for the dentist:
Non latex gloves (Nitrile)
face mask: Stealth P3 respirator
disposable gown
Visor
-I provided PPE for the patient
Disposable bib
Protective glasses
-I had set the following PPE for me
Nitrile gloves
face mask: Stealth P3 respirator
disposable gown
Visor
i Set up instruments, materials and equipment required for the procedure, includes:
For the administration of Local Anaesthetics
- topical anaesthetic paste
- cotton wool roll
- appropriate local anaesthetic syringe (lidocaine)
- appropriate local anaesthetic cartridge (aspirating)
- appropriate local anaesthetic needle (short for infiltration)
- needle guard
For placement of Rubber Dam:
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- rubber dam sheet
- rubber dam punch
- clamp
- clamp forceps
- rubber dam frame and dental floss
For placement of an Amalgam restoration:
- mouth mirror
- probe
- tweezers
- 3-in-1 tip
- high and slow speed handpieces
- amalgam plugger
- carver
- burnisher
- flat plastic
- cotton wool rolls
- aspirator tip
- saliva ejector
- amalgamator
- disposable amalgam capsule
- plastic amalgam carriers
- amalgam well
- dental floss
- millers forceps and articulating paper (to check the bit)
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- mouthwash (for the patient)
- tissues (for the patient)
The dentist called the patient in to the surgery
Assisting the patient
- i greeted the patient by name in a friendly manner
- sat the patient in the dental chair and provided the patient with bib and safety
glasses
- helped the patient to feel comfortable and relaxed during the visit
- monitored the patient during the treatment
- reassured the patient throughout treatment
- removed the bib and safety glasses
- at the end of the visit ensure that the patient is clean and tidy after the treatment
(face and clothing)
- ensure that the patient has the post-operative instructions - verbal or written
Assisting the clinician
- prepared the patient records (medical history, previous radiographs if necessary,
treatment plan and consent form)
- set up instruments and materials
- passed instruments and materials as required
- maintain a clear and dry field
- assisted with placement of Rubber Dam
- monitored the patient during the treatment in order to predict any complications
such as fainting or sickness
- assist the patient after the procedure, ensured that the patient leave clean and tidy
after the treatment.
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For administration of Local Anaesthetic:
- checked all relevant patient records were available
- set up instruments and materials
- passed syringe and LA cartridge as required
- reassured the patient throughout treatment
- provided adequate aspiration and tissue retraction
- monitored the patient during the administration of local anaesthetic in order to
predict any complications such as fainting or sickness
For placement of Rubber Dam:
- set up instruments and materials
- monitored the patient during the treatment in order to predict any complications
such as fainting or sickness
- provided adequate aspiration and tissue retraction
- assisted with placement of Rubber Dam
For placement of an Amalgam restoration:
- i switched on and adjusted the chair light
- the dentist started removing all caries from the cavity using fast handpiece and
round bur then slow handpiece and rose head bur burs and excavators
- Then the dentist created cavity undercuts by inverted cone diamond bur to make
sure that the amalgam restoration does not fall out.
- i assisted by providing adequate soft tissue retraction with aspirators without
causing trauma to the patient.
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- on request, i mixed calcium hydroxide 2 pastes system (Dycal) on a mixing paper
pad and the dentist placed it on the floor of the dry cavity to protect the pulp.
- then i inserted the amalgam capsule on the amalgamator and mixed for 10
seconds, i carefully opened the capsule and put the mixed amalgam on an amalgam
well.
- on dentist request i filled and passed the plastic amalgam carrier to the dentist who
placed amalgam into the cavity in increments
- Each increment was fully pushed and condensed into the cavity, using the amalgam
plugger.
- Once filled, any excess amalgam was carved off the tooth and the surface of the
restoration was shaped by a carver
- The edges of the amalgam were smoothed and adapted fully to the tooth surface
by use of a ball ended burnisher
- i assisted by suctioning all excess amalgam from the mouth by high volume
suction.
- The occlusion is checked by articulating paper and millers forceps and adjusted using
fast handpiece and a polishing bur
Postoperative instructions (written and verbal):
- after receiving a local anaesthetic, numbness might last for several hours after the
procedure
- avoid any chewing until the numbness has completely worn off (to avoid damage to
your tongue and lips)
- gum tissue could have been irritated during the procedure and may be sore for a
few days together with the anesthetic injection site
- do not chew hard or sticky foods or chew directly on the new fillings for the first 24
hours (it takes this long for the silver to reach its maximum strength), if possible,
chew only on the opposite side of your mouth
- new silver fillings can be sensitive to hot and cold liquids and other foods
- give an emergency telephone number for care and advice if problem occur.
Aim of the procedure
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- restore the function of the tooth, for adequate mastication
- alleviate discomfort or pain
- Amalgam fillings are widely used in the U.K. for permanently filling posterior teeth.
Although amalgam is not aesthetically the best filling material, it does have some
advantages, it is a very strong and long-lasting material, and compared to other
filling materials is easy to use.
Reflective account
Strength: I made sure we used the amalgam within the time recommended before it
sets.
Weakness: I forgot some of the instruments for the tray.
Action: I asked our head nurse to help me set up the tray, to make sure I don’t forget
anything
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