DLA 1203- Exam 1

1. Preparation for Patient Care
Chapter 13

2. Patient Record
 For effective treatment to take place, dental assistants must get a
complete and accurate patient history.
 This includes personal information, such as:
 Name
 Address
 Phone numbers
 Emergency contacts
 Social security number
 Insurance information.

3. Patient Record- Medical History
 A medical history is also obtained, including:
 information on past surgeries
 Gall bladder removal or heart valve replacement
 Diseases
 Hypertension or diabetes
 Injuries
 Back injuries or broken bones
 Allergies
 Medications or latex
 current medication use
 Medical information relates to anything the patient is experiencing physically or mentally that
impacts the patient’s overall health status.

4. Patient Record- Dental History
Dental information is also obtained, such as:
Patient concerns
Date of last exam
Dental information is related to the patient’s oral health and
the reasons for the patient’s visit to the practice.
This includes the patient’s attitude toward dentistry and quality
of previous care of the oral cavity and teeth.

5. Clinical Observations
 Clinical observation is then done to determine deviations from normal, such as:
 Gait
 Speech
 Behavioral problems
 Eyes
 Dilated
 Facial symmetry
 Droopy eyelids
 Clinical observation relates to any deviations from normal that the dental assistant may note while
speaking to and observing the interactions he or she is having with the patient.

6. Clinical Setting
 Signing of consent forms
 If a patient is going to have a general anesthetic or an invasive procedure performed, it
is necessary for the patient to sign a consent form.
Patient gives formal permission for tx
Implied consent is given if the patient is coming in for an initial exam
 Referral information
 If a patient is referred from another dentist for tx, then a referral form is needed.
 Radiographs, if necessary
 Before tx is started, radiographs must be taken to ensure proper tx

7. Clinical Examination
Mouth and lips
Cracking or ulceration
Smile line
Vermillion border
Commissures
External floor of mouth
Lymph nodes

8. Key Terms
 Palpate
 Feeling with the fingers or hand
 Smile Line
 Where the lips are when the patient smiles
 Vermillion Border
 The line around the lip
 Commissures
 The corners of the lip

9. Examine the Lips
A: Smile Line
B: Vermillion Border
C: Commissures of the
Lip

10. Examine External Tissues of the Mandible
and Floor of Mouth
 Examine the external floor of the mouth
and the cervical lymph nodes
 The floor of the mouth is examined with
the patient’s mouth closed
 The DA palpates the soft tissues in the
area with the fingers, checking for any
abnormalities

11. Examine the Cervical Lymph Nodes
Have the patient turn their
head to the side.
The DA gently feels the chain
of lymph nodes from the ear
to the collar bone.
This is done on the opposite
side of the neck as well.

12. Examine the Temporomandibular Joint (TMJ)
 The DA sits behind the patient’s head to palpate
the joint as the patient opens and closes his or
her mouth
 The DA also places a finger from each hand just
anterior to the tragus of each ear and has the
patient open and close his or her mouth.
 The operator listens for any noise from the TMJ
 Clicking
 Feels for any catching as the patient opens
 Any symptoms, pain, or tenderness is noted on
the patient’s chart

13. Intraoral Exam
The operator will do a quick visual assessment looking
for any obvious problems.
Problems could include:
Lesions in the mouth
Abscessed teeth
Color changes in oral mucosa

14. Intraoral Examination of Floor of Mouth
Support the mandible with
one hand while gently
palpating with fingers of the
other hand on the ventral
sides of the tongue and floor
of mouth

15. Examine the Oral Mucosa and Frenum
The mucosa and the frena of
the upper and lower lips are
examined by gently pulling the
lips out and inspecting the
area.

16. Examine the Palate and the Posterior of the
Tongue using Mouth Mirror
Examine maxillary and
mandibular buccal area
Examine the palate and the
posterior of the tongue

17. Examine the Tongue
 Last area to be examined
 A gauze sponge is needed to grasp the
tongue
 Place the gauze around the tip of the
tongue and pull to the side to visually
inspect the posterior area on each side.
 Lift the tongue to examine under
 Ask the patient to say “ah-ah” so you
can examine the uvula and the tissues
of the oropharynx

18. After the Extraoral and Intraoral Exam
 Each tooth is evaluated by the dentist and the findings are noted on the
dental chart portion of the dental record
 Periodontal charting is completed to establish the health of the gum and
bone tissue
 The dentist may order additional diagnostic items such as:
 Study models
 Bite registration
 X-rays
 These will aid in giving the patient a complete diagnosis

19. Diagnosis and Tx Plan
The dentist will evaluate the information obtained from the
patient, x-rays, models, bite registration, and examination and
come up with a diagnosis.
A decision or conclusion reached by the dentist that identifies any dental
problems or concerns for the patient.
The treatment will be identified in a treatment plan.
 Where the dentist records the plan of care for the patient
 It will list all problems that were identified
 The dentist or the DA will present the treatment plan, and answer any of the patient’s
questions

20. The Treatment Plan
Tx plan may have to be completed in stages
It may also have to be revised to meet the patient’s budget
and insurance concerns
Discussion between the dentist and/or DA and the patient can
occur at the tx plan appt.
Informed Consent and the scheduling of appointments usually
occurs at this time.

21. Treatment Notes
 The DA and the dentist will review medical and dental history each time the patient visits and update the
information.
 Tx notes are entered on the patient’s record and begin with the current date, the tooth number and the
specific treatment that occurred.
 This record should show:
 the anesthetic given and any reactions
 the dental treatment
 What was done and used during tx
 All entries should be very precise, clear and legible.
 Entries should be in ink, unless entered on the computer
 Each time the patient is in for dental treatment, the record is updated and the procedure followed.
 Also updated if the patient calls the office or the office calls them with the reason for the call

22. Vital Signs
Vital signs are the basic signs of life
They include:
Body temperature
Pulse
Blood pressure
Respiration rate
Initial measurement of vital signs are baseline vital signs.
Should be completed on every patient, before starting any treatment

23. Vital Signs
Give the operator specific information a bout the physical
and emotional condition of the patient
They may point out previously undetected abnormalities
Vital signs, along with overall patient health information
and any pain that the patient reports to the dentist, aid in
planning the patient’s dental tx and are essential during
emergency tx.

24. Body Temperature
 A thermometer is used to measure body temperature
 Compared to the normal body temperature range, and if higher or lower, must
be further investigated.
 A range is used when identifying the normal body temperature, because
temperature varies from person to person and throughout the day.
 Temperature rises during workouts, emotional excitement, and even eating.
 Temperature in young children and infants will vary more than in adults

25. Body Temperature
Normal Range in
Fahrenheit:
99.5º
98.6º Average
36.0º
Normal Range in
Celsius:
37.5º
37.0º Average
35.5º

26. Body Temperature
The patient has a fever is he or she is above the normal range.
An antipyretic (used to reduce fever) could include:
Cold packs
Alcohol rubs
Acetaminophen
Nonsteroidal anti-inflammatory OTC drugs
Aspirin

27. Body Temperature
A patient is said to be hypothermic if the body
temperature is below normal (96º)
Hypothermia could be caused by:
Prolonged exposure to cold
Over dose of antipyretic drugs such as aspirin.

28. Body Temperature
Tympanic thermometer: ear thermometer
Infrared signal is bounced off the tympanic membrane or ear drum.
Contraindication would be too much ear wax
Could cause inaccurate reading
Dental offices do not routinely take a temperature unless the
situation arises where the information is needed; however it is always
beneficial to have the knowledge and understanding of
temperature, the role it plays in health, and the normal ranges.

29. Pulse
 Intermittent beating sensation felt when fingers are pressed against an artery.
 Pulse rate is determined by palpation
 Do not use thumb to palpate.
 Why?
 Pulse can be palpated on one of several arteries:
 Radial
 Carotid
 Temporal
 The DA usually most commonly uses the radial artery.

30. Pulse- Radial Pulse Site
Located on the radial artery, on the
thumb side of the wrist
It can be found approximately one
inch above the base of the thumb
Most common site for obtaining
pulses in the dental office

31. Pulse- Carotid Pulse Site
Located on the carotid artery in the
neck, just below the angle of the
mandible
Normally large and therefore easy to
locate

32. Pulse- Temporal Pulse Site
Over the smaller temporal artery
located in the temporal fossa
Slight depression just in front of the eat
at about the level of the eyebrow
More difficult to locate than radial
or carotid

33. Pulse
Pulse rate: beats per minute
Pulse rhythm: notes regular expansion and contraction of an artery
caused by the heart pumping blood through the body
Irregular
Slow
Rapid
Pulse Volume: strength of the pulse
Strong
Weak

34. Pulse
Number of beats per minute varies depending on:
Patients age
Sex
Physical and mental conditions
It is expressed in a range without an absolute number

35. Pulse
Tachycardia: Abnormally rapid resting pulse rate
Bradycardia: Abnormally slow resting heart rate
Arrhythmia: Irregular heartbeat patterns

36. Pulse
 Ensure patient is positioned with arm level or lower than the heart
 Ensure arm is supported and extended
 Most operators take the pulse for 30 seconds and then double that
number
 Anything less than 30 seconds will not allow the operator to determine any
arrhythmia

37. Pulse
Normal Pulse Rates for
Adults
60 to 100 beats per
minute (BPM)
Normal Pulse Rates for
Children
70 to 100 beats per
minute (BPM)

38. Respiration
Inhalation: one breath taken in
Exhalation: one breath let out
Count the breaths taken in and out for one
minute

39. Respiration
It is best to assess respiration when the patient is not aware of
what you are doing.
Count the respirations after obtaining a pulse.
The patient will still think you are taking a pulse while you
count respirations.

40. Respiration
Tachypnea: abnormally rapid resting respiratory rate
Bradypnea: abnormally slow resting respiratory rate
Generally, children have a more rapid respiration rate,
as with pulse rate
The younger the child, the faster the rate

41. Respiration
Respiratory rhythm: breathing pattern
Respiration depth: amount of air that is inhaled and exhaled
shallow or deep
Other notations about the breath sounds that are heard should be
noted in the chart
Raspy
Wheezy

42. Respiration
Normal Respiration
Rate in Adults
12 to 18
Normal Respiration
Rate in Children
20 to 40
Respirations per minute (RPM)

43. Blood Pressure
An important indicator of the health of the patient’s cardiovascular
system
The patient may have heart disease and still feel good and look
outwardly healthy.
The fear of dental treatment may be stressful enough, though, to
induce a heart attack, so we must take and record BP before
treatment
It is not done in all dental offices, because not all dental assistants
have been trained to perform this skill.

44. Blood Pressure
Some dental offices have an
automated blood pressure
machine
These can be placed on the upper
forearm or on the wrist

45. Blood Pressure
 Blood pressure is measured by placing a
sphygmomanometer around the brachial
artery
 Cloth-covered inflatable rubber bladder used
to control the flow of blood in the artery
 The brachial artery is palpated
 Located at the inside of the elbow in the
antecubital space (indented area) as the arm is
stretched straight.

46. Blood Pressure
 Position the arm at the patient’s heart height
 After brachial artery is located, the cuff can be placed one inch above
the bend in the elbow and secured.
 The DA then uses a stethoscope
 Instrument used to hear and amplify the sounds produced by the heart
 Has two ear pieces that must be placed in the ears in a forward position
 At the end piece is a diaphragm which amplifies and sends sound up the tubing to
the ears
 The DA pumps up the cuff, which closes off the blood in the artery, and
the slowly lets the air escape.

48. Blood Pressure
 Before taking the patient’s blood pressure, the assistant should estimate the
systolic pressure using the “palpate, inflate, obliterate, deflate” method.
 While listening with the stethoscope, the assistant places the cuff on the
patient’s arm above the antecubital space and palpates the radial pulse.
 Then, the DA slowly inflates the cuff just until the pulse is obliterated,
memorizes the number (mm Hg), and releases the pressure in the bulb.
 Add 30 mm Hg to the number representing the obliteration point.
 This is the estimated systolic pressure and gives a target point to inflate the cuff

49. Blood Pressure
The DA listens to the first pulsation sound and notes where the
needle is indicating on the pressure gauge.
The first sound heard indicates systolic blood pressure
Created when the heart contracts and forces blood through the arteries.
Systolic blood pressure is the TOP number when recording BP

50. Blood Pressure
Once the systolic blood pressure is determined,
listen carefully and watch the pressure gauge until
the pulsation sound disappears. This is noted on the
gauge as the diastolic blood pressure.
Created as the arteries return to their original state
when the hear relaxes between contractions.
Diastolic blood pressure is the BOTTOM number when
recording BP

51. Blood Pressure
 Korotkoff sounds are sounds heard when medical personnel listen through a stethoscope while
they are taking blood pressure.
 They are not audible if the patient is without arterial disease, or if the cuff is inflated above the
systolic blood pressure because that would mean that the blood flow is occluded
 Like pinching a rubber hose closed so that water is not allowed to flow through it
 As the blood begins to flow in spurts it results in turbulence that produces an audible sound
 As the pressure in the cuff becomes less, thumping sounds continue to be heard, and then as the
cuff pressure continues to go down the sounds change, becoming more muted and then
disappearing altogether. That is when the diastolic pressure is noted.
 The cuff is no longer restricting the flow of blood

52. Blood Pressure
 The first Korotkoff sound is the snapping sound first heard at the systolic pressure.
 Clear, repetitive, tapping sounds for at least two consecutive beats are considered the systolic pressure
 The second sounds are the murmurs heard for most of the area between the systolic and diastolic
pressures
 The third sound was described as loud, crisp, tapping sound
 The fourth sound, at pressures within 10 mm Hg above the diastolic blood pressure
 Thumping and muting
 The fifth Korotkoff sound is silence as the cuff pressure drops below diastolic blood pressure.
 The disappearance of sound is considered the diastolic blood pressure, 2 mm Hg above the last sound heard.
 The second and third Korotkoff sounds have no known clinical significance

53. Recording Blood Pressure
 Two measurements are always recorded when taking blood pressure
 Recoded as a fraction
 Systolic/diastolic
 Recorded in even numbers (the gauge only has even numbers)
 There is no absolute number for normal blood pressure, it is a range like
other vital signs
 Children normally have lower pressure, and as adults age, the blood
pressure goes up

54. Blood Pressure
Normal Systolic
Pressure
100 to 140 mm Hg
Normal Diastolic
Pressure
60 to 90 mm Hg

55. Blood Pressure
Hypertension: Higher-than-normal blood pressure
Hypotension: Lower-than-normal blood pressure
An increase in diastolic pressure is more significant
than an increase in systolic pressure, because it
indicates that the heart is working harder.

56. Normal Blood Pressure Readings
Child 10 years of age:
100/66
Adolescent 16 years of age:
118/76
Adult
Systolic below 140, but above 100
Diastolic below 90, but above 60

57. Blood Pressure
 Place the head of the stethoscope directly over the palpated pulse, making sure not to touch the bladder cuff, as it
would create extraneous sounds.
 Close the valve on the bulb, and rapidly inflate the cuff to 30 above the palpated systolic pressure.
 Open the valve, slowly deflating the cuff.
 Note that the pressure should drop at 2 to 3 per second.
 With your eyes directly in line of the dial, note the reading at which you hear the first beat, or the systolic pressure.
 Allow the pressure to lower steadily until you note a change in the sound to a softer, more muffled sound.
 This can be noted as the diastolic pressure.
 Continue to release the pressure until all sound disappears, which may also indicate the diastolic pressure.
 Check with your physician for which reading they prefer.
 Remove the stethoscope from your ears, and finish deflating the cuff, and release the remaining air by squeezing the
cuff between your hands.