B

OH6 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 their correct handling.

This standard is applicable to any member 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 1

Knowledge and Understanding

You will need to know and understand:

  1. Dental anatomy in relation to the mandible and maxilla
  2. Jaw movements of the temporo-mandibular joint
  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 techniques
  5. The purpose of temporary crowns and bridges and their construction
  6. The equipment and instruments used in preparing teeth for fixed prostheses
  7. The equipment, instruments and materials for retraction before impression taking
  8. Selecting and preparing impression trays and mixing and loading the appropriate impression material
  9. Preparing and planning temporary crowns and bridges, cements, and hand instruments (such as flat plastics)
  10. Shade taking (such as shade guides)
  11. Methods of taking occlusal registrations and why these are necessary
  12. The instruments and materials required for:
    1. the removal of temporary prostheses
    2. the checking and adjusting of fixed prostheses before final fitting
    3. protecting and retracting the soft tissues (such as rubber dams)
  13. Different types of cements and correct methods of mixing and the methods of isolation during cementation
  14. 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
  15. The different forms which impression materials take (alginates, reversible hydrocolloid, puttys), the relationship of these to the treatment being undertaken
  16. The preparation, application, storage and after-care of impressions to preserve the accuracy of the impression
  17. Why impression materials should be disinfected prior to the attachment of a laboratory ticket
  18. The different stages in making complete and partial removable prostheses, relines, rebases and additions
  19. 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
  20. The options available for replacing missing teeth and their relative benefits
  21. The equipment, instruments, and materials which are used in taking initial and second impressions
  22. The equipment, instruments, and materials which are used taking occlusal registrations (such as wax occlusal rims, additional sheets of pink wax, heat source, markers, shade guides and mould guides)
  23. The equipment, instruments, and materials which are used in try-ins (such as the waxed-up removable prostheses, heat source, shade guides, wax knife, LeCron carver, sheet wax, mirrors)
  24. The equipment, instruments, and materials which are used at the fitting of removable prostheses (such as individual mirror, handpiece, polymeric stone, polymeric trimming burs, pressure relief paste, articulating papers)
  25. The differences between constructing dentures for adults, children and the elderly
  26. The range of orthodontic treatments available and the different type of appliances used
  27. The equipment, instruments, and materials which are used in the fitting, monitoring and adjusting of orthodontic appliances
  28. 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 timing, materials etc
  29. The relevance and importance of laboratory work tickets and record cards
  30. The type of support which patients may need when obtaining new removable prostheses and the worries which they may have
  31. How to care for removable prostheses
  32. Aftercare for immediate dentures
  33. Methods of protecting and retracting the soft tissues
  34. Methods of aspirating during treatment
  35. The importance of communicating information clearly and effectively
  36. Methods of modifying information and communication methods for different individuals including patients from different social and ethnic backgrounds, children (including those with special needs), and the elderly
  37. The purpose, method of use and function of protective wear and the reason for their use
  38. Standard precautions and quality standards of cross infection control and your role in maintaining them
  39. The reasons for monitoring continuously the patient and the operator
  40. 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
  41. Confidentiality in relation to patient records
  42. Methods of effective team working in oral health care

Performance Criteria

You must be able to do the following:

  1. apply standard precautions for infection control and take other appropriate health and safety measures
  2. provide appropriate support during the administration of local or regional analgesia
  3. thoroughly clean any removable prosthesis which is to be relined, added to or adjusted and prepare the relevant area of the prostheses for the work to be undertaken
  4. 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
  5. prepare any equipment and materials required for a tooth to be prepared before the impression is to be taken
  6. 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
  7. load impression materials correctly on to the impression tray using a method which allows a complete and accurate impression to be taken
  8. offer patients appropriate support while impressions are in their mouths
  9. disinfect impressions appropriately on removal and record accurate, legible and complete all details of stages, shades and requirements on the laboratory ticket and attach it securely to the packaging
  10. correctly mix and prepare the appropriate materials when temporary crowns are being prepared and fitted
  11. prepare the correct equipment and materials for recording the occlusal registration
  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. continuously monitor the patient, identify any complications and take the necessary actions without delay
  15. offer patients advice and instruction in a manner appropriate to them

Additional Information

This National Occupational Standard was developed by Skills for Health.

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

Dimension: HWB7 Interventions and treatments
OH6 Provide chairside support during the provision of fixed and removable prostheses
Final version approved June 2010 © copyright Skills For Health
For competence management tools visit tools.skillsforhealth.org.uk
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