OH6.2012 Provide chairside support during the provision of fixed and removable prostheses

Overview

This standard concerns the provision of chairside support during the preparation and fitting of fixed and removable prostheses. Fixed prostheses include crowns and supported/adhesive bridges, inlays, veneers, temporary bridges, and temporary crowns. Removable prostheses include metal, acrylic and immediate prostheses. The procedures include first impression, second impression, occlusal registration, try-in, and fitting. You will need to prepare and mix a wide range of materials which, if not carried out correctly, can affect the success of treatment. Therefore you will need to know about the purposes of the different materials, their use, their relationship to other materials, methods and amounts for mixing, the effects of temperature, and the correct handling. This standard is applicable to members of the oral health care team providing chairside assistance for the preparation and fitting of fixed or removable prostheses including orthodontic appliances. Users of this standard will need to ensure that practice reflects up to date information and policies. Version No 2

Knowledge and Understanding

You will need to know and undertand:

1. the structure and function of teeth and periodontium including the number of roots
2. regional anatomy of the head and neck and dental anatomy
3. the options available for replacing missing teeth and the relative benefits of each, including:
   1. fixed prostheses
   2. removable prostheses
   3. implants
4. the purpose of crown, bridge, inlay and veneer preparation techniques
5. the purpose of temporary crowns and bridges and their construction
6. recognised forms of valid consent and their application before any treatment is undertaken
7. the equipment and instruments used in preparing teeth for fixed prostheses
8. the equipment, instruments and materials for gingival retraction before impression taking
9. selecting and preparing impression trays and mixing and loading the appropriate impression material
10. preparing and planning temporary crowns and bridges, including cements
11. shade taking and the use of shade guides
12. methods of taking occlusal registrations and why these are necessary
13. the instruments and materials required for:
    1. the removal of temporary prostheses
    2. the checking and adjusting of fixed prostheses before final fitting
14. different types of cements and correct methods of mixing and the methods of isolation during cementation
15. the use of impression materials in making study models or working casts for the construction of the appliance and of the opposing arch or tooth
16. the different forms which impression materials take and the relationship of these to the treatment being undertaken
17. the preparation, application, storage and after-care of impressions to preserve the accuracy of the impression
18. why impression materials should be disinfected prior to the attachment of a laboratory prescription
19. the different stages in making complete and partial removable prostheses, relines, rebases and additions
20. the purpose of:
    1. pre-prosthetic surgery
    2. tooth preparation prior to partial denture constructions
    3. using obturators
    4. tissue conditioners
    5. using spoon dentures
21. the equipment, instruments, and materials which are used in taking primary and secondary impressions
22. the equipment, instruments, and materials which are used:
    1. in taking occlusal registrations
    2. in try-ins
    3. at the fitting of removable prostheses
    4. in the fitting, monitoring and adjusting of orthodontic appliances
23. the range of orthodontic treatments available and the different type of appliances used
24. the role of the dental technician in the oral health care team and purpose of close liaison with technical staff and the dental laboratory in relation to materials and timing of dental appointments
25. the relevance and importance of the dental laboratory prescription in relation to the regulation of custom made medical devices
26. the type of support which patients may need when obtaining new removable prostheses and the worries which they may have
27. how to care for removable prostheses
28. aftercare for immediate dentures
29. the ergonomics of dental practice including seating, positioning of the patient and team, instrument passing, suction tip placement
30. methods of protecting and retracting the soft tissues
31. methods of aspirating during treatment
32. methods of working which will complement the work of the operator and the reasons for this
33. the reasons for continually observing the operator during the procedure
34. the equipment used in the administration of local and regional anaesthesia
35. how to monitor, support and reassure the patient throughout treatment including identifying anxiety
36. health and safety regulations and national policies and procedures
37. standard precautions and quality standards of infection prevention and control, including personal protective equipment and your role in maintaining them
38. the legal and organisational policies relating to the disposal of waste and spillage from clinical treatments and investigations
39. the importance of communicating information clearly and effectively
40. how to modify information and communication methods for individuals, including patients with special needs, patients from diverse social and ethnic backgrounds, children and the elderly and where necessary, provide representation for them
41. the different types of charts and records used in the organisation including medical history, personal details, dental charts, radiographs/photographs and study models for assessment and treatment planning and their purpose
42. the importance of keeping full contemporaneous records and the legislation and guidelines relating to patients' records and confidentiality
43. methods of effective team working in oral health care

Performance Criteria

You must be able to:

1. apply standard precautions for infection prevention and control and take other appropriate health and safety measures
2. make available a selection of potentially suitable trays for the operator and once they have selected one, prepare it ready for use compatible with the material and tray being used
3. correctly select the appropriate impression materials and prepare them:
   1. to the correct quantity in relation to the size of the tray
   2. to the correct consistency
   3. within the handling and setting time relative to the material and ambient temperature
   4. using the correct technique
4. load impression materials correctly on to the impression tray using a method which allows a complete and accurate impression to be taken
5. offer patients appropriate support while impressions are in their mouths
6. disinfect impressions, bite blocks and try-ins appropriately on removal and record accurate, legible and complete details of stages, shades and requirements on the laboratory prescription and attach it securely to the packaging
7. prepare the correct equipment and materials for recording the:
   1. occlusal registration
   2. try-in
   3. denture fit
   4. denture adjustment
8. provide appropriate support during the administration of local or regional analgesia
9. prepare any equipment and materials required for a tooth to be prepared before the impression is to be taken
10. work in a way which will complement the work of the operator including aspirating and protecting and retracting the soft tissues
11. correctly mix and prepare the appropriate materials when temporary crowns are being prepared and fitted
12. correctly assess the amount and type of adhesive material required for fixed prostheses and prepare it:
    1. to the correct consistency
    2. using a technique appropriate to the material
    3. at the time required by the operator
13. offer the correct instruments and materials for trimming, cleaning and checking the final adjustment of the fitting when they are required
14. dispose of waste, spillage promptly and in a safe manner and place
15. continuously monitor and reassure the patient, identify any complications and take the necessary actions without delay
16. offer patients advice and instruction in a manner appropriate to them
17. ensure that all records and other appropriate documents are complete, accurate and legible following the procedure

Additional Information

This standard links with the following dimension within the NHS Knowledge and Skills Framework (October 2004): Dimension: HWB7 Interventions and treatments