Practical class №1

Introduction to dentistry. Goals and objectives of dentistry, its history. Ethics

and deontology. Structure of the specialty, goals and objectives dentistry.
Organization of a dental clinic, department, office. Sanitary and
epidemiological requirements for the organization and equipment of a dental
office. Dental unit. Positions of dentist and assistant during treatment of
maxillary and mandible. Four-handed operation.
Dentistry or Stomatology (Latin) (from the Greek stoma - mouth, logos - teaching) is a
medical discipline dealing with the study of the etiology and pathogenesis of diseases of the
teeth, jaws and other oral cavity organs, their diagnosis, treatment and prevention.
Propaedeutics (from the Greek pro -before, pedia - training) - pre-teaching.
Dentistry. Maxillofacial Surgery
Initially dental services were provided by barbers, bath attendants and artisans.
The history of dentistry as a medical specialty dates back to the late 17 th - early
18th centuries, which is due to the works of the outstanding French physician P. Fochard (fig.
1.1), who rejected the «theory of worms» and began to fill teeth with lead foil.
The development of artificial gold crowns, filling teeth with silver amalgam, and later the
use of arsenic acid for necrotic pulp (1836), and the invention of a drill finally approved the
specialty of Dentistry.
1810 passing of the law granting the right to dental practice to those who received a
doctor's degree.
1836 a law was issued in which the title of «dentist» and the right to independent work
was granted after passing the examinations at the Medical Academy.
1881 in St. Petersburg, V.I. Vanshinsky founded the first Dental school in Russia.
1882 a dental school was organized in Moscow by I.M. Kovarsky.
1883 the first Dentists' scientific society in Russia was organized in St. Petersburg.
 Fig. 1.1. P. Fochard

1885 the publication Dentist's Herald was established.

1889 Moscow Dental Society establishes its own magazine «Odontological review».
1890 official ban on training dentists by apprenticeship.
1892 odontology courses started at the Military Medical Academy in Moscow (headed by
P.F. Fedorov) and at the Higher Women's Courses in St. Petersburg (headed by prof. A.K.
Limberg).
1891 A.K. Limberg presented a thesis in odontology on the topic «Modern prevention
and therapy of dental caries». Limberg Alexander Karlovich (1856-1906), (fig. 1.2) the first
Russian professor of dentistry.

Fig. 1.2. Limberg Alexander

Karlovich (1856-1906)
Since 1900 he was in charge of the first department of dental diseases in Russia located at
the St. Petersburg Women's Medical Institute.
 In 1883 he founded the Petersburg Society of Dentists and Doctors engaged in dentistry.
In 1884 he proposed compulsory higher education for dentists and giving to dentistry a
status equal to other medical specialties.
1910 at the 11th Pirogov Congress it was decided to establish independent departments of
odontology at all departments of medicine with clinics and technical laboratories.
1918 resolution that training of dentists would be part of medical University education.
1920 dentistry departments were organized at departments of medicine of state
universities.
1922 the State Institute of Dentistry was established in Moscow.
1922 Odessa Research Institute for Dentistry was opened.
1990 in the USSR there were 44 dental departments and 2 dental institutes (Moscow,
Poltava).
At present, there are 31 departments of dentistry in Russia.
Over the period 1992-2000, more than 5000 private dental clinics and offices were
organized in the country; in Moscow there are about 1000.
The development of private clinics should lead to competitive medicine; this has a
positive impact on the quality of dental care.

GOALS AND OBJECTIVES OF ETHICS AND DEONTOLOGY IN DENTISTRY

Medical Ethics (Latin ethics, from the Greek ethice, study of morality), or medical
deontology (Greek deon, duty, the term «deontology» has been widely used in the domestic
literature of recent years) means the totality of ethical norms and principles of behavior of
medical practitioners in the performance of their professional duties.
According to modern ideas, medical ethics includes the followin g sides.
► Scientific aspect: the division of medical science, which studies the ethical and moral
aspects of the activity of medical practitioners.
► Practical aspect: the field of medical practice, whose objectives include formation and
implementation of ethical norms and rules in professional medical activities.
Historical reference
► Ancient sources of medical ethics and deontology: «Oath» and «Law» of Hippocrates
(V-IV BC).
► The term «ethics» as an «idea of human moralit » was proposed by Aristotle (384-322
BC).
► Middle Ages: «The Canon of Medical Science» and «Ethics» by Ibn Sina (Avicenna,
X-XI century).
► Jeremiah Bentham (English philosopher, lawyer, priest, 1748-1832) introduced the
concept of deontology as «... the doctrine of proper human behavior to achieve its goal» (XVIII
century).
► Russian medicine: «A word on the piety and moral qualities of the Hip-pocratic
doctor» and «A word on the way to teach and learn practical medicine» by Matvey Mudrov
(1776-1831), «Letters from Heidelberg» and «Diary of an old doctor» by Nikolai Pirogov (1810-
1881).
► The Nuremberg Trial of 1947: the Nazi Medical Sentence -the Nuremberg Code -
postulates not only legal, but also moral and ethical provisions for medical experiments.
► 1947: the World Medical Association was established. Its basic documents are the
Geneva Declaration - the oath of a doctor (1948), the
International Code of Medical Ethics (1949), the Helsinki Declaration of Human Rights
(1964), the Helsinki-Tokyo Declaration (1975), the International Declaration on Human Rights
(1983). Medical ethics studies and determines solutions to various problems of interpersonal
relationships in three mai n areas:
► medical practitioner - patient;
 ► medical practitioner - relatives of the patient;
► medical practitioner - medical practitioner.
Any practitioner in the medical field should have such qualities as compassion, kindness,
sensitivity and responsiveness, caring and attentive attitude towards the patient. Of great
importance is the word, which implies not only culture of speech, but also a sense of tact, the
ability to enliven the patient's spirits, not to injure him with an imprudent statement.
Of particular importance in the medical profession are such universal norms of
communication as: the ability to respect and listen carefully to the interlocutor, to show interest
in the subject matter of the conversation and the patient's opinion, correct and clear turn of
speech. Neat external appearance of medical personnel is also important: a clean dressing gown
and cap, clean shoe covers, well-groomed hands with short-cut nails. It must always be
remembered that a heavily perfumed and made-up doctor is unacceptable. Strong, heady odors
can cause unwanted reactions from nervous irritation of the patient and various manifestations of
his allergy, to an acute attack of bronchial asthma.
Primum non nocere (lat.) First of all, do no harm - this statement is the main ethical
principle in medicine.
The moral responsibility of the medical worker implies compliance with all the principles
of medical ethics. Incorrect diagnosis, treatment, behavior of a doctor, representatives of middle
and junior medical personnel can lead to physical and mental suffering of patients. Such actions
of the medical practitioner as violating the patient's privacy, denial of medical care, violation of
privacy, etc. are unacceptable.
Iatrogenic condition
Violation of the deontological principles of communication with the patient can result in
development of so-called iatrogenic conditions (Greek - iatros, doctor, geneps, generated,
arising). Iatrogenic condition (iatrogenia) refers to a patient's pathological condition caused by
careless statements or actions of a doctor or other medical practitioner that gives the person an
idea of having a disease or certain severity of his condition.
In addition to psychogenic iatrogenia (iatropsychogenia), the following conditions are
distinguished
► Iatropharmacogeny: a consequence of drug exposure to the patient; for example, side
effects of drugs.
► Manipulation of iatrogenia: adverse effects in the patient during exploratory
procedures; e.g. complications after coronary angiography.
► Combined iatrogenia: a combined effect of several factors.
► The so-called dumb iatrogenia is a consequence of inaction of a medical worker.
Medical secrecy
Deontological issues of caring for patients also include the need to preserve medical
secrecy. Medical practitioners have no right to disclose deeply personal, intimate information
about the patient. However, this requirement does not apply to situations that pose a threat to
other people: venereal disease, infection, carrying the human immunodeficiency virus (HIV),
poisoning, etc. In such cases, health workers are required to immediately inform the relevant
organizations about the information received.

GOALS AND OBJECTIVES OF DENTAL PROPAEDEUTICS

The purpose of propaedeutics of dental diseases is to prepare students for further in-depth
dental training in clinical practice.
Objectives of the course propaedeutics of dental diseases:
► studying the organization and work of the dental therapeutic office at a dental clinic,
equipment and instruments, their design and purpose.
► studying the safety precautions and first aid.
► studying the terms of ergonomics and medical ethics in dentistry.
► studying embryology, histology and anatomy of teeth.
 ► mastering the basic principles of preparation of carious cavities.
► studying the physico-chemical properties of filling materials of various groups,
methods of their preparation and application, techniques of filling cavities of various types.
► mastering the methods of working with various types of endodontic instruments and
the technique of endodontic treatment of various teeth .
► studying indications for prosthetic dental treatment and the main clinical and
laboratory stages of prosthetic appliances.
► studying the indications for surgical dental treatment, mastering the technique working
with various types of surgical instruments, mastering the technique of performing surgical
treatment of dental diseases.
ORGANIZATION OF DENTAL CLINIC
Organization and extent of care provided depend on the type of health care institutions.
The structure of urban and rural health care is different; it is associated with such factors as
administrative division into districts, density of population, etc.
In the city, provision of medical and preventive care is based primarily on the territorial
or occupational principle (people can register with a clinic at their place of residence or work).
At present there is a diverse network of dental institutions:
► independent dental clinics distributed in regions, cities, and districts, including
children's clinics;
► dental offices in the territorial (multidisciplinary) polyclinics of cities, central district
hospitals, medical and sanitary units of enterprises;
► dental offices in hospitals (including rural, regional and district hospitals),
dispensaries, women's consultations, at schools, health centers of industrial enterprises and in
outpatient clinics in rural areas;
► fee-for-service clinics, private offices;
► dental departments in regional, city and district hospitals, clinics of medical
universities, as well as at the Institute for Advanced Training of Doctors.
The main objectives of the dental clinic are:
► carrying out measures for the prevention of diseases of the maxillofacial area among
the population in organized collectives;
► organization and implementation of activities aimed at early detection of diseases of
the maxillofacial area;
► provision of qualified outpatient dental care.

Structure of the dental clinic is, roughly, as follows:

► Chief dentist (deputy head physician for clinical practice);
► Department of Therapeutic Dentistry;
► 2-nd department (office) (for the treatment of periodontal diseases and oral mucosa);
► Department of Surgical Dentistry;
► Department of Orthopedic Dentistry with Dental Laboratory;
► physiotherapy office;
► X-ray room;
► registry;
► administrative and economic department;
► accounting department.
In dental clinics and dental offices, patients are treated differentially for therapeutic,
surgical and orthopedic conditions. In dental offices that make up the outpatient clinics, health
centers of enterprises, hospitals, dentists see patients with therapeutic and surgical diseases, i.e.,
they provide a mixed type of dental care.
The number of nursing staff is worked out at the rate of 1 nurse per 1 dental surgeon, 2
therapeutic dentists, children's and orthodontist dentist, and 3 prosthodontists.
 These objectives are aimed at the following:
► routine preventive examinations in organized groups with simultaneous treatment of
identified patients;
► complete dental prophylaxis among the pre-conscription and recruitment populations;
► emergency care for patients with acute conditions and injuries of the maxillofacial
area;
► follow-up of populations of patients with certain dental profiles;
► provision of qualified outpatient dental care with timely hospitalization of persons in
need of inpatient treatment;
► examination of temporary incapacity for work of patients, issuance of sick leave
certificates and recommendations for employment;
► the entire complex of rehabilitative treatment of patients with dento-maxillary disease,
dental prosthetics and orthopedic treatment first of all;
► analysis of the incidence of dental diseases, including diseases with temporary
disability, among workers and employees of industrial enterprises located on the territory of the
served area; as well as developing measures for reduction and elimination of the causes
contributing to the occurrence of diseases and complications;
► introduction of up-to-date methods of diagnosis and treatment, new medical
equipment and medicines;
► health education among the population involving the mass media (periodicals,
television, radio, etc.);
► measures to improve the skills of doctors and nurses. Organization of dental
department or office
► Requirements for the location of the building of a dental clinic.
• Taking into account the hygienic conditions of the terrain (relief, nature and
contamination of the soil, wind rose, groundwater elevation).
• Accessibility of the clinic by public transport.
• Proximity of large industrial facilities that pollute the environment.
• Windows should face north, north-west, east (if the terrain is north of 55° N); windows
facing south-west and west are unacceptable on the grounds of possible overheating of the
premises and direct sunlight.
• Separate entrance to the children's and adult departments, with a separate wardrobe and
bathroom.
► Organization of a dental clinic (department).
• Registry (registration of primary patients, storage of patients' records). Patients' records
are classified as sensitive information.
• X-ray room with special protection of walls (lead protection).
• Office for functional diagnostics and physiotherapy.
• Dental technicians.
► Features of the dental office.
• The area of the office is 14 m2 per one chair, + 7 m2 for each additional chair.
• Wall height should be no less than 3 meters (3.3 m on average).
• Depth under natural light should be no more than 6 m.
• Heating with the possibility of regulating the temperature in the office (the temperature
in the office should be 18-23 °C).
• Forced and exhaust ventilation, + easily opened windows and transoms, fume hoods.
• Water supply and sewerage; when connecting water to the installation, there must be an
additional valve for shutdown; 2 sinks: one for washing the tools and one for washing the hands.
• Inside the office everything should be easy to clean with disinfectants.
• On the walls there should be tiles to a height of not less than 1.8 meters (in surgical
rooms the tiles go to the ceiling), above the tiling there should be water-based, oil or glue paint;
ceilings should be covered with metal or plastic panels, paint; floors - with linoleum or tile;
windows should have metal or plastic shutters.
• The wall color should be in yellow-green-blue scale to prevent distortion of color of
teeth, skin, mucous membrane; reflectivity of finishing materials should be not less than 40%
(0.4).
• Natural lighting; chairs should be preferably arranged in 1 row (in 2 rows at most); light
ratio (the ratio of the area of windows to the floor area) of 1:4 or 1:5; artificial lighting should be
general and local; the most preferable types of lamps are fluorescent lamps of cold natural light
and fluorescent lamps with corrected color rendition; sources of general lighting should have an
even number of lamps (to prevent pulsation of the light flux); the standard artificial lighting is at
200 lux, general lighting - at 500 lux; brightness of local lighting should not exceed the
brightness of general lighting by more than tenfold; the color parameters of the sources of
general and local lighting must coincide.
• Bactericidal (quartz lamps) are needed during surgery and for disinfection of the room
between alternating teams.
► Features of finishing when working with amalgam:
• adding sulfur to plaster to bind mercury vapor;
• special processing of floor tiles;
• linoleum covering the walls to a height of 10 cm;
• an exhaust hood is mandatory;
• sinks should have special siphons for mercury retention (cleaning once every 3-4
months);
• a metal box for storing mercury containing waste.
 Dentistry is a branch of medicine that consists of the study, diagnosis, prevention, and
treatment of diseases, disorders, and conditions of the oral cavity, commonly in the dentition but
also the oral mucosa, and of adjacent and related structures and tissues, particularly in the
maxillofacial (jaw and facial) area.
Dentistry consists of different branches such as
-Therapeutic dentistry is a branch of medicine dealing with the diagnosis and treatment
of diseases of teeth, periapical tissues and oral mucosa such as dental caries, pulpites and others.
-Oral surgery is a branch of dentistry that practices such methods of treatment as: tooth
extraction, bone grafting, preparation for implantation of teeth, dental imlantology as well as a
variety of aesthetic surgery in Periodontology.
-Maxillofacial surgery is a surgical specialty aimed at the treatment of inflammatory
diseases of soft and hard tissues of the face and neck, injuries of soft tissues and bones of the
maxillofacial region and their complications, benign and malignant neoplasms of the
maxillofacial region, congenital and acquired defects of the facial Department of the head, neck,
jaws, hard and soft tissues of the oral cavity and maxillofacial region.
-Orthodontics is a branch of dentistry that specializes in treating patients with improper
positioning of teeth when the mouth is closed (malocclusion), which results in an improper bite.
Orthodontics also includes treating and controlling various aspects of facial growth (dentofacial
orthopedics) and the shape and development of the jaw. An orthodontics specialist is called an
orthodontist.
-Prosthodontics is one of the branches of dentistry that deals with the replacement of
missing teeth and the associated soft and hard tissues by prostheses (crowns, bridges, dentures).
-Pediatric dentistry is a specialty that adapts techniques and procedures from general
dentistry and specialties to provide primary and comprehensive preventive and therapeutic oral
health care for children. Pediatric dentists treat a broad range of diseases in infants, children and
adolescents, including those with special health care needs, and are experts in providing care to
make their patients feel comfortable. Pediatric dentists also educate their patients and the
patient’s parents about the importance of oral health and preventative oral health care.
Pre-clinical course is an introduction to any science, preliminary introductory course,
systematically outlined in a concise and elementary form.
Dental clinic consists of reception room (area should be not less than 10 square meters),
waiting room (area should be not less than 6 square meters. It should include a wardrobe), dental
officies for different branches of dentistry, lavatory room or comfort room (area should be not
less than 3 square meters), infirmary aids for emergency cases, business and secretary’s office,
rest or recovery room, dark room – for developing radiographs, store room (area should be not
less than 3 square meters), sterilization room.
The reception room or waiting room.
Desirable but optional features:
Receptionist
Reading materials of general interest
Basic items in a homey living room
Correct interior decoration like educational work of art
Dental office requirements
• At least 14 square meters are required for a dental unit area.
• For oral and maxillofacial surgery office - at least 23 square meters are required for a
dental unit.
 • Every other dental unit requires additional 10 sq. meters.
• No more than 3 dental units are allowed to be set in one office.
• The height of the office is 3 meters at least.
• The length of the office is 6 meters.
• The walls are painted in light colors.
• The floor should be covered with linoleum or ceramic tile.
Types of lighting in a dental office.
1. Natural lighting refers to the day-time light.
There is special measurement of natural lighting – light ratio.
Light ratio means the ratio of the window surface to the floor surface.
It should be equal to 20 – 25%.
2. Artificial lighting.
The most acceptable for general lighting of dental offices are fluorescent lamps.
Local lighting is carried out by dental unit reflectors.
Stationary dental chair
Characterized by a wide base and is too heavy
Designed to conform with the approximate contour of the patient’s anatomy
Usually upholstered
For utmost comfort of patients
Dental unit.
Cuspidor or spittoon – a bowl-like receptacle for the reception of saliva, fluids and
debris coming from the mouth of the patient, usually provided with water pipes to cleanse the
bowl to push them toward the drain.
Saliva egector – a metal or plastic holed mouthpiece wich helps in kipping the mouth
and the field of operation free from the interference of saliva
Air syringes – gives off air blasts directly aimed to the tooth being treated.
Water syringes – dives off a fine thin stream of water for flushing or cleaning the tooth
being treated
Dental operating light (reflector) – a shade-free electric bulb (lamp) that can be swung
in all directions to light up the oral cavity.
Opaque glass plate (X-ray viewer) – holds radiograph in place for reading and
interpretation
Bracket table holds the hand instruments and other materials and the like used by a
dentist.
High and low speed adaptors – devices used to hold the handpieces used by a dentist.
Foot control allows the handpiece to function as needed.
Push bottoms allow adjustments of the chair to permit the dentist to place the patient in
convenient position.
They may be placed on the foot control or next to speed adaptors.
Dental chair and patient position
Modern dental chairs are designed to provide total body support in any chair position.
The patient head is supported by a head rest cushion which elevates the chin and thus
reducing strain on neck
A patient who is in a comfortable position is more relaxed, has less muscular tension
and is more capable of cooperating with the dentist.
The choice of patient position varies with the operator, the type of procedure, and the
area of the mouth involved in the operation.
For operative dental procedures , the patient may be seated in one of the following
positions:
1. Upright position
2. Almost supine
3. Reclined 45 degrees

UPRIGHT POSITION
This is the initial position of chair from which further adjustments are made

ALMOST SUPINE POSITION:

In this position the chair is tilted so that the patient is almost in a lying down posture
The patient’s head ,knees and feet are approximately at the same level
Patient’s head should not be lower than feet except in case of syncopal attack

RECLINED 45 DEGREE POSITION:

In this position the chair is reclined at 45 degrees so that when the patient is seated, the mandibular
occlusal surfaces are almost at 45 degrees to the floor
Once the treatment is over the chair is brought back to upright position so that the patient can leave
the chair easily

Operator position:
Once the patient has been comfortably positioned, the dentist and the assistant should sit themselves
in the proper positions for treatment.
Correct positioning of the operator is very important to have good visibility and accessibility to oral
cavity.
 Usually sitting position is preferred in modern dentistry to relieve stress on operator's leg and
support the operator's back.
 The level of teeth being treated should be placed at same level as the level of operator's elbow.
 Forearm parallel to the floor
 Thighs parallel to the floor
 Hip angle of 90 degrees
 Seat height positioned low enough so that the heels of your feet touch the floor
 When working from clock positions 9-12:00, feet spread apart so that your legs and the chair
base form a tripod which creates a stable position
 Back of the operator should be always straight
 Head erect and should not be bent of drooping
FOR A RIGHT HANDED OPERATOR:
1. Right front or 7’o clock position
2. Right or 9’o clock position
3. Right rear or 11’o clock position
4. Direct rear or 12’oclock position
LEFT HANDED OPERATOR'S POSITIONS ,
5 o'clock, 3 o'clock and 1 o'clock .

RIGHT FRONT OR 7’O CLOCK POSITION

This is convenient for examination and working on the
1. Mandibular anterior teeth
2. Mandibular right posterior teeth
3. Maxillary anterior teeth
RIGHT OR 9’O CLOCK POSITION
The operator is directly to the right of the patients.
The position is convenient for operating on the
1. Facial surface of the maxillary & mandibular right posterior teeth
2. Occlusal surface on mandibular right posterior teeth .
RIGHT REAR OR 11’O CLOCK POSITION
Position of choice for most operations.
Most areas of mouth are accessible and can be viewed directly or indirectly using a mouth mirror.
The dentist sits to the right and slightly behind the patient and the left arm is positioned around the
patient’s head
WORKING AREAS INCLUDE:
a) Palatal and incisal surfaces of maxillary teeth (indirect vision)
b) Mandibular teeth, particularly on the left side (direct vision).
DIRECT REAR OR 12’OCLOCK POSITION
Here the dentist sits directly behind the patient and looks down over the patient’s head
 This position is mainly used only for working on lingual surfaces of mandibular and maxillary
anterior teeth.
The patient’s head should be rotated according to need of operator without hesitation
During working maxillary occlusal surfaces should be perpendicular to the floor and for mandibular
occlusal surface should be 45 degrees
The operator should maintain space between the patient as while reading a book
There should be reduced contact with patient
a) The operator should never rest his hand on patient’s face
b) The chest of patient should never be used as trays to keep instruments
The left hand should be kept free to retract using the mouth mirror
INSTRUMENT EXCHANGE
 All instrument exchanges between the operator and assistant should occur in the exchange zone
below the patient’s chin and several inches above the patient’s chest.
 Instruments should not be exchanged over the patient’s face.
 Any sharp instrument should be exchanged very carefully
 Each person should be sure that the other has a firm grasp on the instrument before it is released.

Dental ergonomics

Ergonomics (from the Greek ergon for work, and nomos for law). Ergonomics, ergonomic
design, ergonomic equipment. And why, in fact, is it necessary?
Ergonomics is a science that studies various objects that are in direct contact with a person
in the process of his life activity.
Its goal is to develop the design of objects and provide a system of interaction with them that
would be most convenient for a person when using them.
Ergonomics is a science that comprehensively studies the functional capabilities of a person
(a group of people) under the specific conditions of his (their) activity, which is connected with the
use of technical means in production and at home.
Ergonomics is a scientific discipline that comprehensively studies a person in the specific
conditions of his activity, and the influence of various factors on his work.
The basis of ergonomics comprises many disciplines from anatomy to psychology, and its
main task is to create such working conditions for a person that would contribute to maintaining
health, improving work efficiency, reducing fatigue, and simply promoting good spirits throughout
the whole working day.
The term «ergonomics» was adopted in England in 1949, when a group of English scientists
initiated the organization of the Ergonomic Research Society.

Ergonomics is divided into mini-, midiand macro ergonomics.

► Macroergonomics refers to research and design of systems like man / society,
organization / system of organizations.
► Microergonomics refers to research and design of human / machine systems.
At work the dentist is exposed to loads associated with strong concentration and muscle
tension. Inconvenient posture and isometric musculature strain have an adverse effect on the health
of the dentist and his assistant (fig. 7.1).
 Fig. 7.1

Starting in the 1960s, ergonomics began to be implemented in the work of dentists. Correct,
ergonomic organization of your workplace and working process allows you to significantly save
time, energy and, most importantly, health!
The concept of ergonomics of work in dental practice can be divided into three main
components:
► position of the dentist and assistant, placement of instruments;
► position of the patient in the dental chair;
► technique of the assistant doctor/dentist. Position of the dentist and his assistant
All the working surfaces of the dentist and his assistant must be on the same level at an
equal distance from the doctor's or assistant's hand. The dentist's area is shown in red and the
assistant's area is blue (fig. 7.2).
The concept of a divided space assumes existence of separate working areas for the dentist
and his assistant.
The zone is located behind the patient's head. There are instruments that the dentist touches
with his left hand without moving the body.
► The zone is located behind and to the right of the dentist and he can reach it with his right
hand.

Fig. 7.2
 ► The zone is to the right of the patient's head and the assistant reaches out to it with his
right hand without turning the body.
► The dentist's chair should be located at such a height that the angle between the thigh and
the shank is 105° (fig. 7.3).

The assistant's chair is slightly higher than the doctor's to ensure a good view of the oral
cavity during work. The pedal is located under the patient's head. The doctor should reach it without
changing his comfortable posture.
Position of the patient in the dental chair. The patient is always in the reclining position, the
inclination of the back is less than 45°! In this situation, the tongue tightly closes the pharynx,
protecting the patient from aspiration of foreign bodies. When performing long treatment sessions
(more than 45 minutes), grease the corners of the patient's mouth with petroleum jelly or bipatten
ointment.
The position of the patient in the dental chair while upper teeth are treated is shown in Fig.
7.4. A pillow is placed under the neck for maximum comfort and tipping the patient's head.

Fig. 7.4
Technique of the assistant's work
The technique of four-handed dentistry is clearly illustrated in the following diagrams (fig.
7.5-7.10). Green color is for the holding fingers, and red is for the supporting fingers.
Segments of the lower jaw
The position of the dentist and assistant at work in the lower frontal segment is shown in fig.
7.5.

The working position of the dentist and assistant during treatment of the left distal segment
of the lower jaw is shown in fig. 7.6.
 The working position of the dentist and assistant during treatment of the right distal part of
the lower jaw is shown in fig. 7.7.

Fig. 7.7

Segments of the upper jaw

The position of the dentist and assistant at work in the upper frontal segment is shown in fig.
7.8.

Fig. 7.8

The working position of the dentist and assistant during treatment of the upper left distal
segment is shown in fig. 7.9.

Fig. 7.9 Fig. 7.10

The working position of the dentist and assistant during treatment of the right distal part of
the upper jaw is shown in fig. 7.10.
 Task:

1. Study the educational material Practical class №1 presented in electronic form in EIEE
(ЭИОС).
2. Start a separate notebook on discipline "Dentistry (Pre-clinical course)". In this notebook,
summary should be written on the topic of each practical class performed using Distance Learning
Technologies (DLT). Summary is written by hand with the topic and date of the practical class. To
write a summary of the educational material (2-5 pages), you have to answer the questions and
complete the following tasks on the topic of the practical class in writing form.

Questions and Tasks.

1. Draw schematic illustration (plan) of dental clinic (department) that includes all the
entrances, rooms, and offices necessary for the operation of dental clinic, and all the treatment
offices for various branches of dentistry.
2. Give definition of different branches of Dentistry.
3. Give requirements for each room (office) of Dental clinic.
4. Draw schematic illustration (plan) of dental unit.
5. Write names of parts of dental unit.
6. Write functions of each part of dental unit.
7. Choose and write down position of dental chair (upright position / almost supine /
reclined 45 degrees), position of dentist and assistant (by hours / by clocks) for treatment of
different groups of teeth:
a) maxillary anterior teeth
b) maxillary left posterior teeth
c) maxillary right posterior teeth
d) mandible anterior teeth
e) mandible left posterior teeth
f) maxillary right posterior teeth
3. Solve the Test 1 of Practical class №1 presented in electronic form in EIEE (ЭИОС).