Table Of Content• F. A. Davis Company
Always at your side ...
DDeennttaall AAssssiissttiinngg
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Dental Assistant’s Chairside Pocket Guide
Minas Sarakinakis
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F. A. Davis Company
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Philadelphia, PA 19103
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Copyright © 2015 by F. A. Davis Company
Copyright © 2015 by F. A. Davis Company. All rights reserved. This product is pro-
tected by copyright. No part of it may be reproduced, stored in a retrieval system,
or transmitted in any form or by any means, electronic, mechanical, photocopying,
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Printed in China by Imago
Last digit indicates print number: 10 9 8 7 6 5 4 3 2 1
Publisher: Quincy McDonald
Developmental Editor: David Payne
Director of Content Development: George W. Lang
Design and Illustration Manager: Carolyn O’Brien
Reviewers: Cynthia Baker, DDS, CDA; Kim Best, CDA; Cynthia K. Bradley, CDA,
CDPMA, CPFDA, EFDA, BA; Denise Campopiano, CDA, RDH, BS; Alison Collins, CDA,
MS; Cynthia S. Cronick, CDA, AAS, BS; DeAnna Davis, CDA, RDA, MEd; Danielle
Furgeson, CDA, RDH, EFDA, MS; Vita M. Hoffman, CDA, AS; Ann E. Kiyabu, CDA;
Dr. Connie Kracher, PhD, MSD; Aamna Nayyar, BSc, BDS, DDS; Judith E. Romano,
RDH, BS, MA; Angela E. Simmons, CDA, CPFDA, BS.
As new scientifi c information becomes available through basic and clinical research,
recommended treatments and drug therapies undergo changes. The author(s) and
publisher have done everything possible to make this book accurate, up to date, and
in accord with accepted standards at the time of publication. The author(s), editors,
and publisher are not responsible for errors or omissions or for consequences from
application of the book, and make no warranty, expressed or implied, in regard to
the contents of the book. Any practice described in this book should be applied by
the reader in accordance with professional standards of care used in regard to the
unique circumstances that may apply in each situation. The reader is advised always
to check product information (package inserts) for changes and new information
regarding dose and contraindications before administering any drug. Caution is
especially urged when using new or infrequently ordered drugs.
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Place 27/ × 27/ Sticky Notes here
8 8
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CHAIR- INFECT
EMERG MEDS RADIOL INSTR RESOURCE INDEX
SIDE CONTROL
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Contacts (cid:129) Phone/E-Mail
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Emergency Preparedness
ASA Classifi cations
The American Society of Anesthesiologists (ASA) has introduced
a classifi cation system to determine a patient’s physical status.
ASA I
■ Patient is healthy.
■ Patient can either climb two fl ights of stairs or walk for two
city blocks without experiencing any shortness of breath.
ASA II
■ Evidence of some mild systemic disease present.
■ Patient can climb one fl ight of stairs or walk two city blocks
but may experience some shortness of breath.
■ Examples: Epilepsy, asthma, allergies, pregnancy.
ASA III
■ Severe systemic disease that interferes with but does not
inhibit daily life.
■ Individual may be able to climb one fl ight of stairs or walk
one city block but more than likely would have to stop
because of shortness of breath.
■ Examples: Type I diabetes, heart failure, hypertension.
ASA IV
■ Severe systemic disease that inhibits daily activities and can
be fatal.
EMERG
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■ Individual is unable to climb a fl ight of stairs or walk one
city block and may even experience shortness of breath
at rest.
■ Examples: Uncontrolled, diabetes, heart failure, angina, type
two hypertension.
ASA V
■ Patient is rapidly deteriorating and will not survive.
Emergency Kit
Every dental offi ce should maintain a custom designed emer-
gency kit ready for use that is easily accessible and portable.
Each emergency kit in a dental offi ce should contain at least the
following components:
■ Portable oxygen: Used in every medical emergency EXCEPT
hyperventilation.
■ Epinephrine: Used in anaphylactic emergencies.
■ Nitroglycerin: Used in angina, myocardial infarction (MI),
and congestive heart failure emergencies.
■ Diphenhydramine: Used to manage allergic reactions.
■ Albuterol: Used in asthma attacks.
■ Glucose: Used in patients who are conscious and have
hypoglycemia (low blood sugar).
■ Glucagon: Used in unconscious patients with hypoglycemia.
It is administered intramuscularly.
■ Lorazepam: Used in emergencies involving seizures
or hyperventilation. It is usually administered
intramuscularly.
■ Atropine: Used in low blood pressure emergencies.
■ Aspirin: Extremely benefi cial drug in patients with signs
of MI.
■ Steroids: Although considered an essential drug due to the
slow onset (1 hour), steroids such as hydrocortisone can be
used in managing allergic reactions.
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Besides the afore mentioned substances, a few items should be
included in the emergency kit, such as:
■ One-way valve pocket mask
■ Syringes for administering the intramuscular drugs
■ Sterile gauze and bandages
■ Ice pack
■ Automated external defi brillator (AED)
Premedication Guidelines
The American Dental Association (ADA) notes that some indi-
viduals may require antibiotic prophylaxis before certain dental
procedures. These dental procedures involve manipulation of the
gingival tissue, the periapical region of a tooth, or perforation of
the oral mucosa.
Only dentists and physicians can prescribe antibiotic
prophylaxis.
The two groups of patients for whom antibiotic prophylaxis is
recommended are:
■ Individuals with certain heart conditions that predispose
them to infective endocarditis (IE)
■ Artifi cial heart valves
■ History of having previously contracted IE
■ Heart transplant that had complications and valve
problems
■ Certain congenital heart conditions such as:
• Unrepaired or incompletely repaired cyanotic congenital
heart disease, including those with palliative shunts or
conduits
• A completely repaired congenital defect of the heart with
prosthetic material or device, whether placed by surgery
or by catheter intervention, during the fi rst 6 months
after the procedure
• Any repaired congenital heart defect with residual defect
at the site or adjacent to the site of a prosthetic patch or
a prosthetic device
EMERG
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Patients should check with their cardiologists if they have any
questions about whether they fall into one of these categories.
The recommendations for antibiotic prophylaxis for IE state
that the antibiotic should be taken 30 to 60 minutes before the
procedure for it to reach adequate levels in the blood. However,
if the antibiotic is inadvertently not administered before the pro-
cedure, the dosage may be administered up to 2 hours after the
procedure.
If a patient who is required to have antibiotic prophylaxis is
already taking antibiotics for a separate condition, the dentist
must prescribe a different class of antibiotic from the one the
patient is already taking.
■ Individuals who have a total joint replacement and run the
risk of developing infection at the prosthetic site.
Even though the American Academy of Orthopedic Surgeons
(AAOS) recommends antibiotic prophylaxis for all patients with
total joint replacement, the ADA and AAOS are in the process of
developing evidence-based guidelines to help determine when
antibiotic prophylaxis is recommended before a dental proce-
dure for patients with orthopedic implants.
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