Providing Chairside Support for Dental Extractions and Surgery

This report delves into the critical aspects of providing chairside support for tooth extractions and minor oral surgery, focusing on the responsibilities of a dental nurse. It emphasizes the importance of maintaining accurate patient records, including patient history, clinical examinations, and treatment details, adhering to GDC guidelines. The report explores the selection of appropriate equipment, instruments, and materials for both simple and surgical extractions of erupted teeth, as well as various minor oral surgeries such as apicectomy, fraenectomy, biopsy, and the removal of impacted teeth and buried roots. It highlights the necessity of confirming patient compliance with pre-operative instructions and reporting any non-compliance. Furthermore, the report underscores the crucial role of the dental nurse in providing the operator with the necessary equipment and materials during surgical procedures to ensure smooth and efficient operations. It provides insights into the importance of sterilization, hygiene, and patient support throughout the processes.

Providing chairside support for the extraction of teeth and minor oral surgery
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Providing chairside support for the extraction of teeth and minor oral surgery
Student’s Name:
Instructor’s Name:
Date:

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Providing chairside support for the extraction of teeth and minor oral surgery
The general dental council (GDC) sets out the duties of the dental profession in the legislation
and it is the governing body for dentistry under the National Health Service (NHS) of United
Kingdom [1]. The primary aim of the GDC is to encourage high standards of education and
quality along with professional conduct in dentists and dental care professionals (DCPs) [1]. The
following assignment provides insight on unit 311 in dental nursing that deals with various
aspects of providing chairside support for the extraction of teeth and minor oral surgery [1].
1.1. Why do you need to provide records, charts, and images to the operator for planned
treatment?
Dental records comprise all documents dealing with the patient history, history of current illness
or presentation, clinical examination details, clinical diagnosis, treatment carried out, disease
follow-up and prognosis [1, 2]. For a dental care professional, it is of utmost importance to
maintain records of the patient. Its applications lie in the forensic area [2]. Additionally, these
reports hold legal importance in the aspects of consumerism and insurance [2]. A patient record
typically consists of various elements including handwritten notes, study models, consultation
reports, radiographs and images, referrals, clinical images and photographs, drug prescriptions,
special investigation results, laboratory prescriptions, information for patient identification,
complete medical history, and history of illness [2]. The information recorded in the report must
be easy to access and must be recorded in a typical clinical nature [2]. The record keeping and
maintenance of information is an important prerogative of the dental nurse and dental care
professional [2]. Whilst providing chairside support to the dentist, the dental nurse has the

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responsibility of maintaining the records meticulously [2]. The clinical information recorded
should be legible, clear, and devoid of excessive abbreviations and ambiguity [2]. The GDC of
NHS provides ample guidelines for the record keeping for dental patients [2]. These guidelines
detail the type of information that needs to be maintained in the record, the colour coding, and
filing in an open shelf method [2]. The dental record is alternatively referred to as a patient chart.
The patient chart is an official document that records information of diagnostics, notes of clinical
nature, treatments provided, and communications related to the patients as progressed in the
office of the dentist [2]. The patient-related communication must include the instructions given
to the patient for home-based care and consent obtained for treatment [2].
I have realised the importance of patient record-keeping in most instances while providing
chairside support to dentists and health care providers. In each instance, the patient details have
to be explicit and legible. I believe that recording the patient-related communication entailing the
verbatim references is vital in record keeping. The protection of health information is of utmost
importance and the record keeping must be done in a diligent and comprehensive manner for
several reasons such as:
 Patient care: The patient chart is a documentation of the course of treatment and may
additionally provide data that aids evaluation and improvement of the quality of patient
care [2]. I practice the documentation of treatment course starting with the initial
diagnosis and all follow-up prescriptions.
 Patient communication: The patient record documents the patient-related communication
that occurs in the dental office between the dentist and the patient [2]. Along with this,
the communication between the dental professionals who care for the patient. The records

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have to be precise and comprehensive to aid any other dental care provider without any
prelude to the patient [2]. The maintenance of patient records is an utterly challenging
aspect of the nurse handling chairside support. I have found the aspect of remembering
and recording all related communication points challenging.
 Defence against malpractice allegations: The medicolegal implications of the dental
report are of prime importance [2]. The court of law utilises the patient records for
information on diagnostics and patient-related communication along with medical history
[2]. In my perspective, the medicolegal aspect of patient record-keeping is of an
extremely meticulous nature.
 Identification of the patient: Dental records aid in providing information to the legal
authorities that help in identification of missing or dead patients [2].
Patient charts may be of paper-based, electronic, or radiographic nature. It is important to
retain patient information [2]. For children, it is essential to retain the information till they
turn major in age. This information may even be scanned and stored electronically [2].
Electronic storage is fast developing recently and this method saves storage space. The
diagnostic and treatment casts are sometimes photographed and stored [2]. Whilst converting
the records to any of these forms, a consultation with the solicitor and liability insurance
company is essential [2]; The regulations of NHS indicate that dental charts must be
maintained for a period of two years along with treatment photographs, study models etc.
must be retained till the completion of the course of treatment [2]. The records have to follow
the basic code of confidentiality [2]. Therefore, it is essential to provide the patient records to
the operator during planned treatment [2].

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In my experience, patient records have to be provided well in advance to the operator as a
fair amount of preparation is essential. The treatment, although planned, can involve several
steps of multitasking and can present several unanticipated challenges. Thus, as a chairside
support nurse during a dental surgery, I believe in early preparation of record keeping and
handing it over to the operator in due time.
1.2. Why do you need to select equipment, instruments, and materials required for:
a. The extraction of erupted teeth
The process of extraction of erupted teeth consists of the removal of the tooth from the bone on
which it has developed [3]. Based on the position where the tooth is present, the equipment that
is used for extraction differs [3]. If the removal involves the extraction of a tooth which is
visible, it is termed simple extraction. Local anaesthesia is administered followed by the surgery
[3]. For simple extractions, the instruments commonly used are: 1. Extraction forceps 2.
Periosteal elevator. Both these instruments have unique purposes [3]. The periodontal ligament is
weakened and the tooth is broken off from it. The extraction forceps aid in holding the tooth
present just above the gum [3]. The pressure is maintained by the forceps whilst the periosteal
elevator pulls the tooth by digging it out of the socket where it has developed [3]. The other type
of extraction is the surgical extraction [3]. The type of extraction is determined by the sturdiness
quotient of the tooth crown, and the tooth root curvature [3]. Surgical extraction is employed for
teeth broken above the gumline, decayed beyond use of forceps etc. The surgical procedure is
similar to simple extraction; however, it requires incision into the gingiva and the gumline [3]. A
surgical flap is created by making an incision in the gumline gaining access to the root via

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gingiva. The tool ‘periotome’ is then used to probe the gumline to separate the tooth from the
ligament [3]. After severing the tooth from the ligament, the dental drill may be used for
segmentation if necessary. A tool namely ‘elevator’ or forceps is used to rock the teeth within the
socket. The tooth is finally extracted with forceps [3].
As a chairside nurse, I am required to have all the above listed equipments in handy during the
course of the operation. In my experience, I have found that there can be several unanticipated
instances of sudden bleeding from the gingival regions. There needs to be a fair amount of
preparation for such events.
b. Minor oral surgery:
a) The role of a dental nurse is much crucial during the dental implant procedure [4]. The
procedure called antiseptic handscrubbing is carried out by the nurse [4]. The other
duties include PPE (wearing surgical sterilised accessories). The nurse must ensure all
the surgical items are ready, open the pre-wrapped sterile implant material. However,
they must open it only when the dentist is ready to carry out implantation to avoid
contamination [4]. As a chairside dental nurse, I feel that the maintenance of hygiene and
sterility whilst handling the surgical equipment is of absolute importance. It can also be a
tricky aspect due to lack of time or experience.
b) Apicectomy: Apicectomy is a surgical procedure carried out in those with infection of
the root [4]. The dental nurse is as essential in the scene as the rest of the surgeries [4].
The nurse will have to prepare the clinical environment and the surgical procedure
equipment [4]. The sterilization of equipment has to be maintained at all times [4]. I

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believe that apicectomy is especially challenging due to the inherent infection. The
maintenance of sterility is essential and I practice mindfulness during the event.
c) Fraenectomy: the procedure of fraenectomy is the removal of a small tissue fold that
prevents the dislocation of the organ [4]. This fold is known as frenulum [4]. In
dentistry, it is a much important procedure and the nurse will have to prepare the
environment and equipment for the procedure [4].
d) Biopsy: Biopsy is a minute incision carried out for examination of the tissue [4]. The
dental nurse has the role of maintaining the sterilization of the equipment [4]. It is
essential to provide a clear vision during the entire procedure [4].
e) Removal of impacted teeth: Impacted teeth result in painful extraction [3, 4]. Along
with the normal procedure, it is essential to provide support to the patient and assist in
anaesthesia administration along with other duties [3].
f) Removal of buried roots: the role of the dental nurse involves assessment of the
appropriate anaesthesia along with the equipment [3]. Buried roots are especially painful
to palpation and extraction and thus, the provision of the appropriate support as in
normal surgeries is essential [3].
1.3. Why do you need to confirm the patient has followed the prescribed pre-operative
treatment instructions and report any non-compliance to the appropriate member of staff?
It is essential for the dental nurse to confirm from the patient charting and record to see if the
patient has gone through all the pre-operative procedures [3]. In case of non-compliance, the
surgery or dental extraction procedure will be much painful and the unprepared patient will run
the risk of nerve damage, trauma, tissue tear, and in severe cases, collapse [3]. Therefore, if the

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dental nurse observes any discrepancy, the appropriate member of staff needs to be informed to
avoid any untoward accidents [3].
In a certain instance, I experienced an event where the presence of mind in terms of observing
discrepancies in patient details is critical. I noticed that one of the patients, Mrs. Kimberly (name
changed), was repeatedly complaining of a ‘prickly sensation’ in her lower gums whilst being
prepared for the surgery. Upon inspection, I noticed a minor tissue tear (suspected) and informed
the dental team at site and the operator for due assistance to the patient.
OUTCOME 2
2.1. Why must you provide the operator with equipment, instruments, and materials
during extractions and minor oral surgery?
The operator or the dentist needs to be supported whilst performing the dental surgery [4]. The
materials and equipments need to be provided to the operator immediately as the procedures
need to be carried out in a planned procedure [4]. Since minor surgeries require the
administration of anaesthesia, the further steps in the surgical incisions need to proceed smoothly
[4]. Thus, for the facilitation of the surgical procedure, the dental nurse and/or the dental team
needs to be of constant support in providing the necessary equipment to the operator in due time;
also, it may be essential to choose the equipment based on the condition, the position of tooth
etc. I have repeatedly felt the need to be well-informed of the probable instruments for the
suggested dental operation and be prepared with the entire sterilised set of equipment. Since the
surgery is crucial and dexterous, the operator faces the challenge of being focused in the surgical

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procedure to ensure minimal pain to the patient; thus, the chairside nurse’s support in providing
equipment in time and in the best conditions of sterility is of crucial importance.
2.2. Why must you support the patient during the administration of local anaesthesia?
a. Adults: Dental nurses are the most important people in the dental team. They have several
extended duties in the dental office especially at the time of oral surgeries [5]. They are essential
in assisting the dentist, dental hygienist, and the dental therapist by providing chairside support
during the time of surgery [5]. They provide for additional dexterity and help during the surgery
by supplying the required equipments to the operator in due time [5]. They are expected to
provide emotional and physical support to patients. The most important duty of dental nurses is
to manage patients during cases of dental anxiety or phobia [5]. The most commonplace
occurrence is when the administration of anaesthesia is made to the patients [5]. Both the
occurrences of fear and anxiety lead to physical and emotional responses in the patients and
hence the dental nurse must be well equipped in skill to handle the patients [5].
b. Children: In children, it is especially true that the prospect of administration of anaesthesia
leads to a rapid response of fear and anxiety [5]. Minor patients react in an altered behavioural or
emotional manner. They need to be reassured and provided immense emotional support at the
time of dental anxiety or phobia [5]. In case of occurrence of anxiety or phobia in children, it can
lead to several physiological damages whilst anaesthesia is administered [5].
As a chairside nurse, I have seen that the time of administration of anaesthesia is the most
challenging of all situations. The patient feels threatened, anxious, and deeply distressed. As a

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chairside nurse, I believe that I am required to act with utmost empathy and integrity at these
circumstances.
2.3. Why do you need to aspirate, irrigate, and protect the patient’s soft tissues and
airway?
The incidence of dental emergencies is common in most cases. One example of such an
emergency is pericoronitis [6]. In this condition, there is typically an inflammation in the soft
tissues that surround the crown of the tooth [6]. In most cases, the tooth is erupted. The most
common occurrence of such kind is in wisdom teeth [6]. The occurrence of pericoronitis is
preceded by accumulation of bacterial plaque and/or debris, food etc underneath the flap of the
gum that covers the site of partial eruption in the tooth [6]. There may the presence of
inflammation and oedema and if this is accompanied by trauma of the tooth, the flap is also
inflammated. In such cases, there may be pus beneath the flap accompanied by a bad taste [6]. A
common occurrence in these cases is the presence of regional lymphadenopathy and trismus. In
severe instances, there may a compromise in the oral airway [6]. In such cases, aspiration and
saline (warm) irrigation under the flap may provide systemic relief. This is mostly true if the
condition is localized [6]. The airway blockade or laboured air reception is one of the most
critical times in oral surgery. As a chairside nurse, I have found that aspiration and irrigation
greatly ease the operation.
2.4. Why must you monitor the patient during the clinical procedure?
The most crucial team in the dental office is that of the dental nurses. In most cases, the
occurrence of dental emergencies is highly commonplace [7]. Thus, it is most essential to

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monitor the patients in the clinical setting [7]. The dental nurses play a vital role in monitoring
the patients during the entire procedure [7]. The patients are mostly under dental anxiety, fear, or
phobia [7]. These may result in the occurrence of physiological, emotional, or behavioural
changes [7]. In order to eliminate the anxiety or any physiological consequences, often
cardiologic monitoring is carried out during the surgical procedure [7]. The dental nurse has the
highest degree of responsibility in eliminating the stress caused to the patient [7]. The concept of
monitoring also involves the detail record of the patient interactions [7] and treatments provided
[7]. These records are of medicolegal significance and they have to be meticulously carried out
[7]. The most crucial responsibility of the dental nurse is to also monitor the vital notes during
the clinical procedure [7]. The process of monitoring begins since the commencement of the case
i.e. even before the physical arrival of the patient [7]. The dental nurse prepares for the patient
visit and carries out the general protocol of patient care regulation and preparation for the dental
appointment in terms of equipment, office space, hygiene, and routine regulations [7]. This then
extends to the monitoring of the patient-related communication during the clinical procedure and
consultation [7]. The process of monitoring is termed as ‘monitoring vital signs’ [7]. In fact, the
administration of local anaesthetic can lead to anxiety and stress in the patient [7]. Such distress
additionally occurs whilst performing the dental procedures which are extensive in nature [8].
These anxieties and distresses may lead to systemic and/or physiological changes [8]. These
disturbances may turn out to be of much potential harm to the patients and thus have to be
strictly avoided [8]. The dental nurses have the crucial responsibility to monitor the patients in
order to avoid serious repercussions in the patients [8]. The medically challenged patients have
to be monitored continuously during the procedure [8]. There are three primary benefits to the

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process of monitoring [8]. Firstly, it aids the detection of acute medical emergencies that may
demand immediate reaction and medical attention [8]. The second advantage is that it unveils
deleterious trends that may be impending [8]. The process of monitoring also helps to evaluate
the efficiency of the preventive and emergency care measures currently being undertaken [8].
I believe that supporting and monitoring patients during the course of the surgery is vital to the
success of the surgery. Several unforeseen complications and events arise during the course
making it essential for us to be vigilant at all times.
2.5. Identify the complications and what actions would the dental nurse take
a. Nerve damage: During the course of dental treatment and surgical procedure, there are
chances of incidence of damage to the nerve [9]. The most common nerves that could be under
the risk of damage during dental surgery are the lingual nerves [9]. The lingual nerve is a branch
of the mandibular nerve branched out of the trigeminal nerve [9]. These nerves are connected to
the sensory nerves of the tongue and the damage to them causes pain in the tongue [9]. The teeth
present on the mucosa near the tongue also become painful [9]. An injury to the lingual nerve
may be caused whilst injecting anaesthesia before the oral surgery [9]. During the oral surgery
procedure of dental implants, it is common to encounter nerve damages [9]. The first symptoms
of nerve damage include a tingling sensation and may cause numbness in the area of damage [9].
There may be occurrences of numbness in the jawline and even the neck [9]. There may be a
needle prick-like sensation in the area and it will have to be examined immediately [9]. If the
damage is of suspected neuropathic nature, then neuropathic treatment will have to be
undertaken [9]. The first line of treatment for neuropathy of nerves is by medication for e.g.