13/04/15' Saving your natural teeth. 77 Stud Rd Dandenong!!!!!!!! Saving your natural teeth. 77 Stud Rd Dandenong!!!!!!!!

Transcription

1 Saving your natural teeth Phillippe O Zimet Associate Professor in Endodontics School of Dentistry and Oral Health La Trobe University 77 Stud Rd Dandenong Saving your natural teeth Phillippe O Zimet Associate Professor in Endodontics School of Dentistry and Oral Health La Trobe University 77 Stud Rd Dandenong 1'

2 What is stress? That is a matter of opinion Stress is when your expectations are not met or exceeded 2'

3 Opinions matter more than facts Is it: the facts that matter or a matter of fact Consistent communication matters Quality Assurance: Positive approach on how to do it right Risk management: Negative approach on how to avoid problems Is your practice positive or negative? ' ' What is great day? It is a stress free day.where everyone's expectations are met or exceeded 3'

4 All Players must be on the same page Each can be a source of stress Need a whole of practice approach We must all be primed to know what to expect A GOOD RESTAURANT REQUIRES: Good service/food Good atmosphere Efficiency 4'

5 A GOOD DENTAL SURGERY REQUIRES: Good service/treatment Good atmosphere Efficiency How do we FullPhill the expectations? By creating them How do we create the perfect day? 5'

6 Use the double PLAN method: Patient centred Prepared and protocol driven Language appropriate Learn from mistakes Affable Available Note everything Nothing is too much trouble Saving your natural teeth Phillippe O Zimet Associate Professor in Endodontics School of Dentistry and Oral Health La Trobe University 77 Stud Rd Dandenong Be prepared: Have well documented guidelines and protocols Urgency and emergency Trauma 6'

7 Be consistent: Implementation of systems: The telephone protocol Logical Efficacious Step by step Be correct: Yes No Language should not be emotive Infected tooth Dead tooth Discomfort Pain Fair prognosis Compromised Pulp or root canal Nerve Number 15 Scalpel Saving your natural teeth Phillippe O Zimet Associate Professor in Endodontics School of Dentistry and Oral Health La Trobe University 77 Stud Rd Dandenong 7'

8 Be prepared: Have well documented guidelines and protocols so each staff member is aware of their responsibility Be consistent: Implementation of systems: The infection control manual Logical Efficacious Step by step ' Be consistent: Implementation of systems: Procedure monitors 8'

9 Be correct: Establish routines' Saving your natural teeth Phillippe O Zimet Associate Professor in Endodontics School of Dentistry and Oral Health La Trobe University 77 Stud Rd Dandenong Be prepared: Have well documented guidelines and protocols so each staff member is aware of their responsibility What MUST dentist do? What SHOULD/CAN DA do? What SHOULD/CAN reception do? What interaction is possible to facilitate treatment? 9'

10 Be prepared: Have well documented guidelines and protocols so each staff member is aware of their responsibility FILE FLARE TREATMENT STEPS Set up kit ready for treatment Seat the patient Place blue gown and give the patient dark glasses Set up local anaesthetic in the Wand Blue Lignospan Gold Articaine POZ usually uses 1 gold for all upper. He will usually use 1 blue and 1 gold for lower molars. Rub patient shoulder Ask POZ how many holes and what clamp for rubber dam and set up with appropriate clamp and rubber dam clamp forceps Comfort patient rub shoulder - while giving local anaesthetic Offer patient a rinse and rinse using suction and triple syringe Pass POZ rubber dam and rubber dam frame Pass POZ Glick and floss and take dirty mirror All go on the white (dirty) tray Pass POZ hypochlorite swab and mirror Move light away and adjust microscope ' Be consistent: Establish routines se/ng'up'surgery'from'la'trobe'video' Be consistent: Implementation of systems: Use intuitive record keeping treatment sheet notes to create a differential diagnosis and treatment plan 10'

11 Be Correct: Delegate tasks based legal requirements and training Set up kit ready for treatment Seat the patient Place blue gown and give the patient dark glasses Set up local anaesthetic in the Wand Blue Lignospan Gold Septanest POZ usually uses 1 blue for all upper teeth and all lowers except for molars. He will usually use 1 blue and 1 gold for lower molars Ask POZ how many holes and what clamp for rubber dam and set up with appropriate clamp and rubber dam clamp forceps Comfort patient while giving local anaesthetic Offer patient a rinse and rinse using suction and triple x syringe Pass POZ rubber dam and rubber dam frame Pass POZ glick and floss and take dirty mirror All go on the white (dirty) tray Pass POZ oraseal Pass POZ hypochlorite swab and mirror Move light away and adjust microscope High Speed handpiece with appropriate bur to access the tooth with suction #2 Bur Anterior teeth and premolars #4 Bur Molar teeth Slow Speed handpiece with Pulp Bur Suction in access as necessary POZ will then begin using K & H hand files POZ will use Apex Locator to check canal lengths Be correct: Language and message should prevent confusion Communication should be consistent What is the cost of a confused message or complaint? Protocol driven Staff know what to expect Be correct: Where is down time? 10 x 30 secs/ day = cup of coffee Put protocols in bite size chunks so both dentist and DA can anticipate treatment progression: Step 1: Pre-exam questionnaire and interview including: Presenting complaint Medical History Dental history Examination Diagnosis Treatment planning Step 2: Pain control What LA? Rubber dam (what clamp?) and interim restoration Step 3: Access and length determination Step 4: Mechanical instrumentation of the root canal system Irrigation Step 5: Medication Temporization Step 6: Obturation Step 7: Restoration (post/no post) Step 8: Recall, assess disease control and maintenance 11'

12 Be correct: Where is down time? 10 x 30 secs/ day = cup of coffee Objective guidelines for treatment planning: Requires making a differential diagnosis and treatment plan e.g. post placement Staff can prepare Larry'Brown'230408'post'if' more'than'1/3'ideal'is' missing' Be correct: Objective guidelines for use of each material, instrument or equipment: Each instrument has a defined purpose. Each kit must be identical. Minor variation creates confusion Where is down time? 10 x 30 secs/ day = cup of coffee Saving your natural teeth Phillippe O Zimet Associate Professor in Endodontics School of Dentistry and Oral Health La Trobe University 77 Stud Rd Dandenong 12'

13 1. Mirror 2. Endo Probe 3. Glick 4. Hypo with monojet tip 5. Tweezers 6. File cleaner with mtwos (#10-#35) 7. Dappen Dish 8. File Stand 9. Thumb Ruler 10. Topical on cotton bud, floss 1 piece of gauze File container 12. Bur Stand 13. Cotton Pallets Blue Cloth 2. Tweezers 3. Spatula 4. Glick 5. Artery forceps 6. Syringe 7. 5/7 Plugger 8. Blacks Plugger 9. Spoon Escavator 10. Perio Probe 11. Glass Slab 12. Rubber Dam Forceps Heat Tip 14. Scissors 15. Gauze 15 *PLEASE NOTE* Suction, rubber, hook and raypex cord get put on at start of treatment 1. Implementation of systems: Poor practice results from ignorance and misunderstanding a stated practice policy. Establishing systems allows us to coordinate our direction. " Set Standard The Audit Cycle implement change French GL J Hosp Infect 1993;24, Compare with standard verificagon' 1. performance monitor Observe Practice 2.performance measurement 1. Implementation of systems:' Provide the minimum expectation 1. Moral responsibility 2. Ethical responsibility 3. Legal responsibility 4. Practical advantages 1. Implementation of systems:' Kit Setup OPERATOR SIDE DA S SIDE How to train staff: Video Manual Reminder pictures: -how to set up kits -hand hygiene 13'

14 1. Implementation of systems: Provides systems which: Improve image Improve efficiency Improve predictability Improve communication Allows change to occur seamlessly Allows consistency, documentation, transparency and accountability In summary it fulfils predictability, consistency and effectiveness " Set Standard The Audit Cycle implement change French GL J Hosp Infect 1993;24, Compare with standard verificagon' 1. performance monitor Observe Practice 2.performance measurement 2. Implementation of zoning and containment: ' Zoning confines the microorganisms limiting the spread of microorganisms which allows easier control, management, decontamination or elimination of microorganisms. Sterile Clean Dirty Zoning' TOOTH MOUTH DIRTY picture' DIRTY STERILE CLEAN STERILE TIPPED TRANSFER TWEEZERS Floor Dirty 2. Implementation of zoning and containment: ' It is up to the dentist and DA to ensure all kits are tidy on the bracket tables to ensure efficiency Know where your instruments are 14'

15 3. Personal Protective Equipment high personal hygiene: CDC and other sources state that "80% of all infections are transmitted by hands hand-hygiene-respiratory-viruses-and-sarswing Alcohol-based hand rubs are more effective against most bacteria and many viruses than either medicated or nonmedicated soaps 4. Have a routine Set up clinical room Manage hand hygiene Gown Hat Mask Glasses Manage hand hygiene Gloves At the beginning of each day delegate clear designated roles Based on Hand hygiene sequence based on AUSTRALIAN GUIDELINES FOR THE PREVENTION AND CONTROL OF INFECTION IN HEALTHCARE 2010 in word Unpack the clinical room Remove gloves Manage hand hygiene Remove glasses Remove gown Remove mask Manage hand hygiene 4. Have a routine In the surgery In the halls In the IRC In the administrative areas Be efficient not officious Patient centred 15'

16 5. Work smarter not harder Time is a valuable commodity that can t be bought or sold but it can be managed Placing'file'in'the'hanpiece' 6. Prevent the oops factor All the staff must be anticipating the next move. Hands and minds should never be still Edited-by:-Herluf-Skovsgaard' Videos are available _ La Trobe Endodontics: Clinical videos: ' Clinical video part 1: Clinical video part 2: Clinical video part 3: Clinical video part 4: How to lance: Placing a composite core: The text with the following videos provides the instruction required; Preclinical root canal instruments: Preclinical root canal treatment: Access preparation upper central incisor: Access preparation upper premolar tooth: Access preparation upper molar tooth: Access preparation lower molar tooth: 16'

17 My thanks to all my co-workers who ensure a stress free and patient focused day everyday 17'