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Essay title - Dental Oral Health

Introduction

Dental nurses are those members of the oral health care team who support the other members of the oral health care team across all different types of dental treatment. The scope of subjects covered in dental nursing is very wide. This wide range of subjects covered in dental nursing touches in detail those areas of specific information and understanding required for a dental nurse to practice effectively. The important factor is applying this knowledge in a practical environment. In general a dental clinic appoints a dental nurse to assist the dentist while the dentist carries treatment for the patients and also to handle patients. Keeping the clinic hygienic and well maintained is the responsibility of dental nurse. Preparing for the surgery, assisting the dentists during surgery by providing the related instruments, maintaining the sterile condition during the surgery process in line with health and safety guidelines are also includes in responsibility of a dental nurse. On top of these functions, a dental nurse is supposed to perform activities like sterilizing dental equipment, preparing materials for filling, taking note of relevant information of each and every patient and controlling consumables in the clinic. A dental nurse is also trained in creating and building good rapport with the patients so that the patients feel relaxed and comfortable during the entire treatment. Some nurses also takes care of the administrative part of the dental clinic including front desk functions which includes attending calls from patients, taking appointments and paperwork handling, which includes financial aspects of the treatment. Dental nurses should be sympathetic, confident and caring at the same time being practical is an added advantage. These qualities help a dental nurse to communicate with the patients and make patients feel comfortable. In many cases, patients who visit dental clinic are frightened, nervous or confusing while they are sitting on the dentist’s chair. It is the skill of dental nurse which can calm patient’s anxiety or make feel the patient normal. While a dental nurse’s approach should be methodical, he or she would be eager to learn continuously about changing techniques and scientific issues related to dental care.

Essay Content

In many cases the first job of the dental nurse in the morning is to set up the surgery so that it is ready for the day. Dental nurse is also responsible for cross infection control and handling dental X-rays. Dental nurse’s come across different types of patients with different needs such as filing, root canal treatment and examinations. The dental nurse keeps all patients cards ready and also the list of patients who have been given appointments for the day. Dental nurse should also make sure that the dental clinic is filled with all the required equipment ready for use and the surgery is clean and tidy. The dental clinic is a busy place and for a dental nurse some times it is very stressful by seeing different patients and different procedures continuously. Most of the times a dental nurse is busy in a dental clinic and only very rarely the clinic will be quite. Dental nurse is also called as someone who is a dental care professional who works as part of a dental team. Along with all pre treatment duties and responsibilities, a dental nurse also tidies the surgery and sterilizes all the instruments used in a treatment once the patient leaves the clinic after the treatment. Sometimes the dental nurses are also employed in general practice, hospitals or the community dental services and can be trained as dental nurse in the armed forces. Just to wok as a trainee/student dental nurse, there is no mandatory requirement of any academic qualifications. However in order to progress one has to study relevant further qualifications. Once someone starts with student/trainee dental nurse, they will be inspired and supported to go for further qualifications. This helps for trainee/student dental nurse for future development of career. Dental hospitals and higher education colleges or institutes run classes on full time and part time basis on dental nursing. For those who want to be a dental hygienist or dental therapist, experience as a dental nurse id generally a requirement. These dental hygienists or dental therapists are also known as oral health practitioners. With more training and further experience dental nurses can also work as orthodontic therapists. In general the skills and knowledge required for a dental nurse are - A keen and genuine interest in the welfare of the patient, good eyesight and practical skills, calm, confident and reassuring nature, ability to respond in a pleasant, helpful and caring manner with children and patients with special needs, positive outlook towards team work, flexibility towards work and excellent organizational skills. There are few specialized dental nursing areas such as Oral health education, Dental sedation nursing, Dental Anesthetic nursing and orthodontic nursing. In general, the services rendered by a nurse are with respect for human dignity and the only one of its kind not influenced by kind of health problems, personal qualities and or by economic or social status. A nurse takes care of patient’s privacy by carefully protecting the information of confidential nature. A nurse is also responsible for taking care of both public and patient when the health and safety is affected by non legal, non competent or non ethical practice by any individual. The nurse owns responsibility and accountability for individual nursing actions and best judgments. A nurse also maintains competence in nursing. A nurse while delegating nursing activities to others or accepting responsibilities and in seeking consultation, discharges informed judgment and individual competence and qualifications as the main criteria. In activities that help to the ongoing continuous development of the profession, a nurse always actively participates. A nurse is also contributes and actively participates in efforts by the profession to introduce and improve standard of nursing. A nurse is also contributes and participate in professions effort to set up and maintain employment conditions which favors high quality nursing care. Participating in the professions effort to safeguard the general public from misinformation and misrepresentation and to maintain the completeness of nursing is also one of the contributions of nurse. And also a nurse interacts with members of the health professions and general public in promoting community and national efforts to fulfill the public health need.

In many instances dental nurses, because of feelings of lack of control and being undervalued have expressed dissatisfaction with their work. Some of the most likely reasons for job dissatisfaction based on pilot study conducted in general dental practice are outlined below: One of the most important groups within the dental team is nurses. Dental nurse acts as advocates for patients and as dentist’s clinics integral part while they help dentist entire day. For a successful dental practice, the role of dental nurse is very critical. The main reason for many dental nurses dissatisfaction is that of being taken for granted without giving them the deserved credit. How a dental nurse feels their work is rated by the dentist is the main factor taken for granted perception. This is the feeling by a nurse when her supportive role to a dentist is considered as not very important. To give an example as narrated by a dental nurse about her experience with a dentist for whom she was working, In the process of a treatment she had arranged all required instruments required for the treatment at the place it was supposed to be placed. She was very well aware of the dentists way of treatment and had knew exactly which is the instrument the dentists needs first and subsequently till he finishes his treatment. However the dentists performed his treatment as if there was no presence of the dental nurse at all during the treatment process except for requests such as asking for a periodontal probe which was already arranged. However when the dentist needed a pair of scissors while the nurse was busy, the dentist responded as if the dental nurse is slow in her work. The second category is four-handedness. In a surgery, with her dentistry for the surgery environment the dental nurse shares her responsibility. This is like the working process between the dentist and dental nurse is like a joint venture. This way of thinking makes the dental nurse’s role within a dental clinic as a joint venture with responsibility towards the patient care is shared by both dentist and the dental nurse. The concept of ‘four-handedness represents this line of thinking. Dental nurse acts as an extra pair of hands between patient and the dentist and this makes her an integral part of daily routine of a dental clinic. This shared clinical experience makes it clear that a dentals nurse’s activities and responses within a dental clinic are also dependent upon dentists and patients treatment needs. Some dental nurses are of the opinion that clinical work is the most beneficial part of being a dental nurse. This clinical work gives a dental nurse feeling of self satisfaction and decreases her feelings of isolation and being disenchanted. The below statement by a dental nurse makes it clear how clinical work of a dental nurse is of very high value. However at times even clinical work also becomes not worthy if dental nurse starts feeling being disenchanted with the work. Another dental nurse commented as below -The third category is economic dependence. In the event of one person livelihood or daily earning is dependent on the income of another individual, she is economically dependent on that individual. When a dental nurse’s entire income is only from one source which is her role as dental nurse, her entire income is completely dependent on the earning power of the dentist with who the dental nurse is employed with. The economic well-being and financial viability of the nurse is completely dependent upon dentists earning level. This may sound same in the case of a female secretary who works in small companies. However in the dental practice, the income level of the practice is determined solely on the dentists own presence and physical worth , where as in the case of a small business, irrespective of the owners physical presence or owners absence, the income can increase. Many women have expressed their views on a dentals nurse’s economic position. Some have also expressed views on differences of hospital service and general practice. In dental practice there is no one to turn to and the only option is to leave. The forth category is surgery working which may be considered a parallel work in the home which may be of low nature and routine. The needs of others determine the dental nurse’s daily routine. If a dental nurse makes sure the dental surgery is running smoothly, he or she is enabling the dentist to provide effective and result oriented care to the patients. Dental treatment provided and the throughput of patients determines the surgery working. Dental treatment provided and throughput of patients influences the level to which the dental nurse feels his or her work as being important. Job satisfaction may get reduced if there is increased throughput of patients. One of the nurse commented on this as - Quote “After dentist finishes with a patient, I am the one who does the cleaning away, wiping down the surfaces and putting the instrument in the sink. Then it’s changing your gloves and putting a fresh tray on the bracket table - its non stop. The only variation is the treatment the patient requires. These days I don’t even have time to say hello.” Unquote. The explanations above explain to some extend the issues why dental nurses have low job satisfaction. The above analysis also helps to understand the complicated process which is involved in dental nurse’s working experiences. It is advocated that in general practice the dental nurse’s work could be explained as a process of dental nursing which is characterized by feelings of taken for granted, economic dependence, four-handedness and surgery working. The reasons for dental nurse’s low job satisfaction may be understood as a dynamic underplay between these various categories or elements which details the dental nursing process.

A dental nurse upon completion of her dental nursing course should be able to display consistent, sound and practical skills within the context of dental nursing. A dental nurse upon completion if her dental nursing study, should know the clinical procedure connected with a wide range of dental treatment including the appraisal of oral health, treatment planning, restorative dentistry, pediatric dentistry, orthodontics, preventive dentistry, oral surgery, oral medicine, gerodontology, pain and anxiety control, dental accidents and emergency dental care. They should also understand the principles on which these subjects are based. Restorative dentistry is concerned with the taking care of the plaque related diseases, tooth loss and tooth wears. A dental nurse should also know to take are of these situations, including preventive, non operative care and also restoration of teeth using the best prevailing techniques of conservative dentistry which may include crowns and endodontics, the replacement of the teeth by prosthess and implants and treatment and maintenance of the support of the teeth by the periodontology procedures. Pediatric dentistry is taking care of normal growth and development of child and the advancement of maintenance of child’s oral health. A dental nurse should know and understand how children are handled as dental patients and the needs of patients with special needs. Orthodontics is development and growth of occlusion and face, the level of normal variation in function and form of both the soft and hard tissues of the face and mouth in particularly the ways in which these variations produces the differences in occlusion. Dental nurses should also know the different kinds of orthodontic treatment and their role in providing support in assessment and treatment of a patient’s occlusion by a dentist. A dental nurse also should be capable of providing dentist and the patient both, the effective support in a surgical procedure and in particularly that are conveniently called as ‘minor oral surgery’ which may include the extraction of teeth, removal of roots, raising mucoperiosteal flaps, extraction of buried and impacted teeth, bone removal, tooth sectioning and intraoral suturing. A dental nurse should also know the area of oral medicine which may include the diagnosis and management of diseases of the oral mucosa, diseases of other oral tissues, diseases of the salivary glands and the facial bones and joints. Oral manifestations of systemic diseases and the diagnosis and management of facial pain of dental and non dental origin also should be known and understood by a dental nurse. Gerodontology is another area which the dental nurse should be aware of. This is the effects of ageing upon the oral tissues and the needs of the elderly dental patient. The pain and anxiety control is the basic requirement for dentistry practice. A dental nurse should understand the different types of pain and anxiety control that are there in dentistry including conscious sedation. Dental nurse should be capable to reassure the anxious patient and provide required chair side support during the local and regional analgesia for operation and procedures of a patients tooth. The basics of oral pathology and oral microbiology should be understood by a dental nurse who includes the process underlying the main oral diseases which may include both malignant and potentially malignant lesions along with a description of the kinds for their diagnosis, management and prevention. Preventive dentistry and dental public health which is the successes and limitations of preventive dentistry and scope for further progress should be known to a dental nurse. A dental nurse should be well versed with the practice of preventive care including oral health education and oral health promotion. Dental nurse should be able to instruct, inform and advice patients on the ways and skills to control dental plaque. Dental nurse should know basic understanding of cultural, social and environmental factors which determines the health and illness. Dental Radiography is another area which a dental nurse should be familiar with where the dental nurse should be clear on principles which are the foundation of dental radiography techniques, the instruments used and the types of processing films and the practice of digital radiography. Dental nurse should know the dangers of ionizing radiation and understand the relevant regulations pertaining to those dangers so that the dental nurse can perform proper radiation protection measures for other dental staff, patients and for themselves. Dental nurse should also know to prepare equipment, materials and patients for dental radiology, processing and mounting dental radiographs and quality assurance needs in processing dental radiographs. A dental nurse should be competent with sound theoretical knowledge and understanding of the subject along with required experience of the clinical environment to be capable of resolving problems encountered independently. A dental nurse should be knowledgeable with sound theoretical knowledge of the subject along with limited clinical/practical experience. A dental nurse should be familiar with basic understanding of the subject but not necessary to have direct clinical experience or to be expected to carry out procedures independently on her own. Dental nurse should have knowledge of biomedical sciences and oral biology with the knowledge of oral physiology and craniofacial, oral and dental anatomy relevant to dental nursing. Familiarity with those aspects of general anatomy, physiology and biochemistry relevant to dental nursing is also an area which a dental nurse should be aware of. Behavioral sciences, communication skills and health informatics are also very important issues which a dental nurse should have knowledge. She should be competent at using information technology and communication with patients, their families, other members of dental team and relevant healthcare professionals. Dental nurse should have knowledge of dealing with patients of different social and ethnic backgrounds and knowledge of working as part of dental team and familiarity with relevant psychological and social issues which are relevant for the care of patient. Under human disease, a dental nurse should have knowledge of scientific sterilization principles, antisepsis and disinfection. Dental nurse should also familiar with relationships between oral health and human diseases and disorders to enable them to promote oral health in the circumstances of a patient’s general health. With regard to medical emergencies, a dental nurse should be competent in carrying out resuscitation techniques successfully and have knowledge to identify that a medical emergency has created and to provide support for the person who is in emergency and the people who are providing immediate handling of the emergency.

With regard to specific legal, ethical and professional responsibility, a dental nurse should be competent at maintaining complete accurate clinical records, knowledge of consent responsibilities, duty of care and confidentiality, knowledge of patient’s rights and how to handle complaints, competency range of other members of the dental team, familiarity with the ethical and legal obligations of registered members of the dental team, knowledge of obligation to practice in the best interest of patients at all times, familiar with the need for lifelong learning and professional development and familiarity with law as it applies with records. With regard to health and safety and infection control the dental nurse should be competent with implementing and performing satisfactory infection control and preventing physical chemical and microbiological contamination in the clinic and the laboratory, competent in arranging and using the working clinical and laboratory environment in the safe and efficient manner, knowledge of health and safety legislation as it affects clinical and laboratory practice. With regard to dental biomaterials science, a dental nurse should be competent at the required chair side manipulation of the dental biomaterials commonly utilized in clinical dentistry, have knowledge of the science that underpins the dental biomaterials utilized by the dental nurse, have knowledge of the limitations such as dental biomaterial and familiar with those aspects of biomaterials safety which relates to the work of the dental nurse. With regard to chair side support, a dental nurse should be competent at providing support for the operator and patient during dental procedures, competent at preparation and maintenance of the dental surgery before, during and after treatment, knowledge of clinical procedures related to restorative dentistry, pediatric dentistry, orthodontics, preventive dentistry, oral surgery, oral medicine and gerodontology, familiar with the mechanics of dental equipments such as autoclaves, hand pieces and suction apparatus in order to provide routine maintenance. With regard to pain and anxiety control, dental nurse should be competent at re-assuring the anxious patient, provision of chair side support during the analgesia which includes both local and regional, knowledge of manifestations of anxiety and pain and the common methods available for their control and management. With regard to preventive dentistry, dental nurse should be competent in performing methods of maintaining oral hygiene, competent at demonstrating methods of caring for dentures and orthodontics appliances, familiarity with social, cultural and environmental factors which contribute to health. With regard to dental radiography, a dental nurse should be competent at preparing equipment, materials and patients for dental radiography, competent at processing and mounting dental radiographs, knowledge of principles which underpin dental radiographic techniques, dangers of radiation and required regulations, familiarity with the needs of chemicals used in processing. The capability of a nurse to involve in ethical practice in day to day work and deal with ethical problems, concerns and situations can be the outcome of decisions taken at different levels such as organizational, regional, individual, provincial, national and international. The ethical code offers guidance for providing care that is corresponding with the ethical practice and for actively influencing and participating in development of policy, review and revision at all different levels of decision making. The ethical and legal dimension is a complex issue in nursing practice. A law compatible with ethics is an ideal system of law where adherence to law should not require violation of ethics. In the event of a law which is not incompatible with ethics, then that may be a situation where nurses need to take collective action to change the law. The code covers only ethical responsibility where as the domain of ethics and law still remains distinct. In their day to day practice nurses constantly come across situations involving ethics. These can be explained in many ways. In ethical decision making, the code of ethics for nurses is structured surrounding eight primary values that are critical to ethical nursing practice which are safe, competent and ethical care, health and well being, choice, dignity, confidentiality, justice, accountability and quality practice environments.

Specific responsibility statements are provided with each value. How a particular value or responsibility applies in a particular context is ethical reflection which begins with a review of ones own ethics and judgment. Belief or attitude about importance of a goal, an object, a principle or a behavior is value.

The capability to render safe, ethical and competent care which allows nurses to fulfill nurse’s professional and ethical obligations towards the people they serve is valued by nurses. Nurses also value health promotion and comfort and helping others to achieve their highest level of health in situations of normal health, injury, illness, disability or at the end of life. With respect to choice, nurses respect and promote the autonomy of individuals and help them to convey their health needs and values and to secure desired information and services so that informed decisions can be made. With regard to dignity as a nursing value, nurses respect and recognize the existing and essential worth of each person and advocate for respectful treatment of each and every individual. With regard to confidentiality, nurses protect information obtained in the context of a professional relationship of a nurse and patient and make sure that these information is shared outside the health care team only with the prior approval of the patient or in the event required to be disclosed due to legal issues or where the non disclosure would result in substantial harm. With regard to justice as value, nurses uphold principles of fairness and equality to help persons in receiving a portion of health services and resources needed to their needs and in promotion of social justice. Accountability as a value, nurses are answerable for their practice and they perform acts in a manner in line with their professional practice standard and professional responsibilities. Lastly the quality practice environments as value, nurses value and advocate for practice surroundings that process organizational structures and resources required to make sure support, respect and more importantly safety for all individuals in the work place. Job action by dental nurses in many cases directed towards obtaining conditions of employment which helps safe, ethical and legal care of patients including current and future patients. Individual dental nurses or group of dental nurse’s takes care of patients in implementing and planning any action. Members of the public have a right to claim information on the steps taken to take care of the safety of the patients in any action by a nurse.

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