OH8.2012 Provide chairside support during the extraction of teeth and minor oral surgery

Overview

This standard is intended for those who provide close support during the extraction of erupted teeth, the extraction of unerupted teeth or roots, and bone removal. You will need to ensure that the patient is properly prepared for the procedure and monitor them at all stages of the treatment, reporting any problems or concerns to the operator. You will also need to anticipate the operator's requirements to ensure that there is no unnecessary delay during the procedure. Managing the prevention and control of infection is also a key requirement. You will need to know about the different types of extraction and minor surgical procedures including the reasons for carrying them out, and the instruments, materials, equipment and medicaments involved. 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 equipment, instruments, materials and medicaments which are used in the following procedures:
   1. extraction of erupted teeth
   2. extraction of unerupted teeth and roots
   3. local and regional anaesthesia
4. the purpose and correct methods of preparing and handling the range of equipment, instruments, materials and medicaments
5. the use of equipment, instruments, materials and medicaments for the different procedures and the order in which they are likely to be required
6. recognised forms of valid consent and their application before any treatment is undertaken
7. the different forms of pain and anxiety control that are available in dentistry
8. the reasons why the extraction of teeth may be necessary
9. the purpose of removing roots and unerupted teeth, the different forms which this may take and its relationship to other forms of dental treatment
10. the purpose and reasons for raising mucoperiosteal flaps and your role in providing chairside support for this procedure
11. the purpose and reason for tooth sectioning or bone removal and your role in providing chairside support for this procedure
12. the potential risks and complications that may arise during and after extractions including nerve damage, haemorrhage, oro-antral fistulas
13. health and safety regulations and national policies and procedures
14. standard precautions and quality standards of infection prevention and control, including personal protective equipment and your role in maintaining them
15. what is and is not a sterile field and how the correct level of cleanliness may be maintained for the patient's condition, the treatment and the setting
16. the ergonomics of dental practice including seating, positioning of the patient and team, instrument passing, suction tip placement
17. methods of working which will complement the work of the operator and the reasons for this
18. the reasons for continually observing the operator during the procedure
19. methods of protecting and retracting the soft tissues
20. methods of aspirating during treatment
21. your role in assisting haemostasis, including assisting the placement and cutting of sutures, preparing packs
22. the legal and organisational policies relating to the disposal of waste and spillage from clinical treatments and investigations
23. how to monitor, support and reassure the patient throughout treatment including identifying anxiety
24. how to recognise and respond to actual or potential emergencies
25. why the patient should be confirmed as fit prior to leaving the surgery
26. methods of communicating information clearly and effectively
27. 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
28. the different types of 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
29. the importance of keeping full contemporaneous records and the legislation and guidelines relating to patients' records and confidentiality
30. methods of effective team working in oral health care

Performance Criteria

You must be able to:

1. retrieve and make available the correct patient's charts, records and images and identify correctly the planned treatment
2. check with the patient that they have followed the prescribed pre-treatment instructions and report any non-compliance promptly to the appropriate member of the team
3. apply standard precautions for infection prevention and control and take other appropriate health and safety measures
4. provide appropriate support during the administration of local or regional analgesia
5. anticipate, select and arrange the equipment, instruments, materials and medicaments in their most likely order of use and easy reach of the chairside in a manner that minimises the possibility of damage and cross-infection
6. suitably protect the patient's soft tissues using instruments and materials appropriate to the procedure, irrigate and aspirate the treatment area and maintain a clear field of operation
7. continuously monitor and reassure the patient, identify any complications and take the necessary actions without delay
8. assist the operator in the placement and cutting of sutures if used, record the sutures correctly and prepare an appropriate post-operative dressing
9. dispose of waste, spillage promptly and in a safe manner and place
10. provide post-operative instructions or information to the patient on care of the mouth, post-extraction haemorrhage and suture removal if required, and how to access to emergency care and advice
11. support the patient appropriately throughout and confirm with the operator that the patient is fit to leave the surgery prior to them doing so
12. 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