Advanced Dental Nursing Advanced Dental Nursing SECOND EDITION Edited by Robert S. Ireland BDS, MPhil, MFGDP(UK) Associate Clinical Professor Postgraduate Dental Education Unit The University of Warwick A John Wiley & Sons, Ltd., Publication This edition fi rst published 2010 © 2010 Blackwell Publishing Ltd Blackwell Publishing was acquired by John Wiley & Sons in February 2007. Blackwell’s publishing programme has been merged with Wiley’s global Scientifi c, Technical, and Medical business to form Wiley-Blackwell. Registered offi ce John Wiley & Sons Ltd, The Atrium, Southern Gate, Chichester, West Sussex PO19 8SQ, United Kingdom Editorial offi ces 9600 Garsington Road, Oxford OX4 2DQ, United Kingdom 2121 State Avenue, Ames, Iowa 50014-8300, USA For details of our global editorial offi ces, for customer services and for information about how to apply for permission to reuse the copyright material in this book please see our website at www.wiley.com/ wiley-blackwell. 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This publication is designed to provide accurate and authoritative information in regard to the subject matter covered. It is sold on the understanding that the publisher is not engaged in rendering professional services. If professional advice or other expert assistance is required, the services of a competent professional should be sought. Library of Congress Cataloging-in-Publication Data Advanced dental nursing / edited by Robert S. Ireland. – 2nd ed. p. ; cm. Includes bibliographical references and index. ISBN 978-1-4051-9267-5 (pbk. : alk. paper) 1. Dental assistants–Outlines, syllabi, etc. 2. Dental assistants–Vocational guidance–Great Britain. I. Ireland, Robert, MFGCP. [DNLM: 1. Dental Assistants–Outlines. WU 18.2 A245 2010] RK60.5.A38 2010 617.6′0233–dc22 2009049784 A catalogue record for this book is available from the British Library. Set in 9.5/12 pt Palatino by Toppan Best-set Premedia Limited Printed in Singapore 1 2010 Contents Author Profi les, ix Preface, xiii Acknowledgements, xiv 1 Career Development Pathways, 1 Introduction, 2 Governing bodies and professional associations, 3 Continuing professional development (CPD), 5 Further activities and resources for CPD, 7 Career opportunities, 11 Interprofessional development, 20 Teaching and training, 23 References and further reading, 25 2 Oral Health Education, 26 Promoting oral health, 27 Care of appliances and advanced restorations, 63 Dental public health, 65 Planning and setting up a preventive dental unit, 69 Planning and preparing an exhibition or display, 71 References and further reading, 76 3 Special Care Dentistry, 77 Introduction, 78 Legislative framework, 81 Working principles, 83 A practical approach, 85 Learning disability, 91 Physical impairment, 95 Cardiovascular system, 107 Cancer of the head and neck region, 117 v vi Contents Respiratory disorders, 118 Endocrine disorders, 121 Gastrointestinal and related disorders, 128 Neurological and psychiatric disorders, 138 References and further reading, 158 4 Sedation, 159 Management of anxiety, 160 Patient assessment, 168 Applied physiology and anatomy, 174 Monitoring, 183 Pharmacology, 189 Sedation techniques: practical considerations, 204 Medical emergencies, 224 Medico-legal issues, 234 References and further reading, 243 5 Orthodontic Dental Nursing, 245 Anatomical structures relevant to orthodontics, 246 Biology of tooth movement, 258 Classifi cation of occlusion and malocclusion, 261 Indications for orthodontic treatment, 265 Orthodontic treatment, 267 Orthodontic assessment, 275 Orthodontic appliances and treatment options, 293 Timing of orthodontic treatment, 320 Cleft lip and palate, 321 Infection control, 325 Laboratory skills, 326 Oral health and care of appliances, 328 Orthodontic stock control, 331 Medico-legal aspects, 332 Occlusal indices, 338 References and further reading, 347 6 Dental Implantology, 349 Introduction, 350 Management of the missing tooth, 350 Applied anatomy, 360 Patient assessment, 367 Implant treatment, 373 Types of surgical procedure, 377 Implant-retained prostheses, 379 Maintenance and monitoring of dental implants, 382 Contents vii Implant stock control, 385 Medico-legal aspects, 388 References and further reading, 390 7 The Future, 391 Future developments in training and education, 391 Information technology development, 393 Clinical governance, 394 Research in primary care, 398 References and further reading, 402 Abbreviations, 404 Index, 409 Author Profi les Editor Robert S. Ireland BDS, MPhil, MFGDP(UK) Associate Clinical Professor Postgraduate Dental Education Unit The University of Warwick Bob has been a part - time lecturer at the University of Liverpool and a senior partner in a group dental practice for 30 years. In 1995, he was appointed Professor of Primary Dental Care and Director of the Dental Therapy Course at the University of Liverpool. He has produced three educational videos for the dental team and has been extensively involved in hospital and practice dental nurse training. He is the editor of A Clinical Textbook for Dental Hygiene and Therapy . He is currently a presiding examiner for the National Examining Board for Dental Nurses (NEBDN) and formerly external examiner for dental nursing at Trinity College, Dublin. Mary Cameron RDN, DipDHE, FEATC, Cert Health Education, Licentiateship in Dental Nursing Oral Health Co - ordinator/Educational Advisor – Community Dental Service NHS Greater Glasgow & Clyde Mary qualifi ed as a dental nurse in 1978. She has worked in general practice and hospitals and, in 1998, moved to the Community Dental Service. In her previous role within the CDS she led a team of oral health educators, with a remit to deliver and evaluate oral health programmes throughout Glasgow. She now leads and advises on DCP training programmes. In 1992, she became a part - time tutor delivering the post - qualifi cation certifi cate in oral health education in Scotland. She is currently an examiner with the NEBDN and former chairperson of the Oral Health Committee. She continues her role as an external verifi er for City & Guilds and the Scottish Qualifi cations Authority. Ulpee Darbar BDS, MSc, FDS (Rest Dent)RCS, FHEA Consultant in Restorative Dentistry Eastman Dental Hospital and Institute, London ix x Author Profi les Ulpee is a full time Consultant in Restorative Dentistry and is also on the specialist lists in Restorative Dentistry, Periodontology and Prosthodontics. She was appointed as Clinical Director of the Eastman Dental Hospital in 2006. Her clinical focus lies in the management of patients with complex and multidisciplinary problems including tooth loss and its replacement with dental implants. She is extensively involved in education and training at postgraduate level for dentists and dental care professionals. She has been proactive in running successful training courses for dental nurses in different implant systems and has written the fi rst book on dental implants for dental nurses. She lectures extensively in these areas both nationally and internationally and is on the Specialist Advisory Board for the Royal College of Surgeons (Edinburgh) Implant Dentistry Diploma and is also an examiner for this exam. Janet Goodwin BA(Hons), RDN, LCGI Qualifi cations Manager National Examining Board for Dental Nurses Janet has worked as a dental nurse in general dental practice, dental hospital and the Community Dental Service as an oral health educator. In 1985 she started teaching oral health and the NEBDN National Certifi cate in local colleges. In 1988, she was appointed as a training offi cer in a large youth training scheme primarily for underprivileged teenagers. She then returned to Leeds Dental Institute to take up the position of tutor, before being appointed principal dental nurse in 1991, while also working as an external verifi er for City & Guilds. Janet is currently qualifi cations manager for the National Examining Board for Dental Nurses, and a member of the GDC Council. She is on the editorial board of the journal Team in Practice and was involved in the C hild Protection and the Dental Team handbook. Tina Gorman RDN, FAETC Director of Nursing Dublin Dental School and Hospital Tina trained at Belfast Dental Hospital and qualifi ed in 1990. She was awarded the Kilner McCourt prize for the highest mark in Ireland in the National Examination. She was the fi rst person in Northern Ireland to obtain the post - certifi cate in conscious sedation. She moved to work for Homefi rst Community Dental Service in 1999, where she assisted in the set - up of a new sedation and general anaesthetic service for adults with physical and learning disabilities. She is an NEBDN examiner for the National Certifi cate and Conscious Sedation qualifi cations. She also introduced the West Midlands Special Care Dental Nursing Course in 2001 whilst she was a dental nurse tutor. She is currently based in Dublin Dental Hospital managing the Nursing Department. She is the dental nursing representative on the British Society for Disability and Oral Health, member of the edito- rial board of the Journal of Disability and Oral Heath and is the fi rst non - dentist president of the Irish Society for Disability and Oral Health (2008 – 2010). Author Profi les xi Jayne Harrison BDS, FDS(Orth), RCPS, MDentSci, MOrthRCS, PhD Consultant Orthodontist Liverpool University Dental Hospital Jayne qualifi ed from Cardiff Dental School in 1985 and subsequently underwent general dental and then orthodontic training in Merseyside and North Wales. She gained her FDS in 1989, MOrth and MDentSci in 1993, FDS(Orth) in 1998 and PhD in 2002. She was appointed as a consultant orthodontist at Liverpool University Dental Hospital in 1998, where she is also programme director for the orthodontic nursing course. She is on the editorial board of the journal of Orthodontics and Cochrane Oral Health Group and has had several papers published on orthodontic subjects and evidence - based dentistry. Patricia Heap RDN, FETC, Dip DHE, MRSH Principal Dental Nurse University Dental Hospital of Manchester Pat qualifi ed as a dental nurse in 1963 at the University Dental Hospital of Manchester. Since then she has been employed in all sections of dentistry and in 1972 she returned to the Dental Hospital as senior dental nurse in periodontology, then tutor dental nurse and fi nally in 1985 to the post of principal dental nurse. She has since gained the City & Guilds Further Education Teachers certifi cate with credit, RSH Diploma in Oral Health Education, Dental Sedation Nursing Post Qualifi cation certifi cate and BTEC Safety in Healthcare certifi cate. She is on the Board of Examiners for NEBDN and is an examiner for both the national and sedation examinations. She currently sits on the sub - committees for Sedation and the independent assessment for the Oral Healthcare NVQ programme. Lesley Longman BSc, BDS, FDS RCS(Edin), PhD Consultant in Restorative Dentistry Liverpool University Dental Hospital Lesley was appointed lecturer in restorative dentistry at the University of Liverpool Dental School in 1984 and gained her FDS (Ed) in the same year. She was awarded a PhD in 1991 and appointed consultant in restorative dentistry in 1997. She is on the specialist register for prosthodontics and restorative dentistry. She has responsibility for organising the teaching of sedation to dental undergraduates. She currently lectures on postgraduate dental courses in sedation and is course director for the University of Liverpool Certifi cate in Conscious Sedation. She is also currently programme director for the certifi cate course in sedation for dental nurses. June Nunn BDS, MA, PhD, FDS RCS(Edin), DDPHRCS, FDS RCS Professor of Special Care Dentistry and Head of Department Dental School and Hospital Trinity College Dublin, Ireland xii Author Profi les June moved from her post as consultant/senior lecturer in child dental health in the School of Dentistry, University of Newcastle - upon - Tyne to the Chair in Special Care Dentistry at Trinity College Dublin in October 2001. She is past president of both the British Society for Disability and Oral Health, and the International Association for Disability and Oral Health, and in 2003 was the President of the Irish Society for Disability and Oral Health. June edits the Journal of Disability and Oral Health and edited the IADH textbook on D isability and Oral Care . She has been an examiner at the Royal Colleges of Surgeons of England and Edinburgh for the M Paed Dent, MSCD and DSCD, as well as external examiner for both undergraduate and postgraduate students in a number of UK and overseas dental schools. She is codirector for the Postgraduate Diploma in Conscious Sedation in Trinity College Dublin. Kathleen O ’ Donovan FAETC, RDN Dental Nurse Manager Liverpool University Dental Hospital Kath qualifi ed as a dental nurse in 1973 and has since gained the Certifi cate in Oral Health Education (Nottingham University) and the NEBDN Certifi cate in Dental Sedation Nursing. She is currently organising the Certifi cate in Orthodontic Nursing at Liverpool University Dental Hospital. She is on the Board of Examiners for the NEBDN and is an examiner for the Certifi cate in Dental Sedation and NVQ. She is involved in teaching on dental nurse courses for dental sedation, orthodontic nursing and oral health care. She was formerly Chairman of Council for the British Association of Dental Nurses. Mike Wanless BDS, DipPH, DGDP(UK), MSc, PhD Head and Clinical Director Greater Manchester School for Dental Care Professionals Mike is head and clinical director of the Greater Manchester School for Dental Care Professionals (DCPs), based in Salford. He is also an educational programme director for North Western Deanery and is a director of NEBDN, for whom he has examined since 1986. He lectures widely on communicating with dental patients.