Essentials of minimally invasive operative dentistry

All members of the oral healthcare team have a part to play in patient management, and the team is comprised of the lead dentist (plus other colleagues in the dental practice), the dental nurse, hygienist, receptionist, laboratory technician, and possibly a dental therapist. In the UK, registered dental nurses can take further qualifications in teaching, oral health education, and radiography, and can specialize in other aspects of dentistry, including orthodontics, oral surgery, sedation, and special care. If the dentist wishes to have a second specialist opinion regarding a difficult diagnosis, formulating a care plan or even executing it, they may refer the patient to a specialist dentist working in another practice, or to a hospital-based consultant specialist in restorative dentistry. These specialists have undergone further postgraduate clinical and academic training and gained qualifications enabling them to be registered as specialists with the General Dental Council (GDC) in the UK in their specific trained fields (e.g. endodontics, periodontics, prosthodontics), or have further specialist training in restorative dentistry. The lead dentist will act as a central hub in the coordinating wheel of patient management, possibly outsourcing different aspects of work to relevant specialist colleagues, as spokes of that wheel. This is the clinical environment in which patients are diagnosed and treated. This room has traditionally been known as the ‘dental surgery’, but a more appropriate modern description might be the ‘dental clinic’, as much of the more holistic care offered to patients within its four walls will be non-surgical in the first instance. The operator and nurse must work closely together. To be successful, each must build up an understanding of how the other works. The clinic consists of a dental operating chair with an attached or mobile bracket table carrying the rotary instruments and 3-1 air/water syringe (and possibly the light-cure unit and ultrasonic scaler), work surfaces (which should be as clutter-free as possible for good-quality infection control; see later), cupboards for storage, and two sinks, one for normal hand washing and another for decontaminating soiled instruments prior to sterilization. Often the surgery will also house an X-ray unit for taking intra-oral radiographs. Most clinics are designed to accommodate right-handed practitioners, in terms of the location of many of the instruments and controls.