Procedure to be carried out: Cavity restoration procedure on UR6 (Upper Right 6) -

Amalgam restorative material used.

Patient details: age 57, Female,
Social Habits: no smoking, drinks 2 units a week
Medical history: No Medical Concerns
Last visit and last treatment: 26 February 2024, Routine Examination
Clinical area: NHS Dental Practice
Preparation of the clinical area for cavity restoration procedure on UR6 to be done,
using Amalgam restorative material:
I am wearing my scrubs, I have short nails, I am not wearing any jewellery, I washed
my hands in line with HTM 01-05 regulations, as stated in the handwashing poster
found above each handwashing sink and after that I used rinse-free hand
disinfection gel on my hands and wrists. I am wearing Personal Protective
Equipment (PPE) that I put in the following order: first I put on the plastic apron and
tied at the waist, second, I put on the disposable face mask and made sure it covers
my nose, mouth and chin, then I got the visor and lastly the disposable nitrile
powder-free examination gloves.
I made sure that surgery is kept dry and adequately ventilated at all times to
eliminate exposure of airborne materials, toxic hazards and improve the comfort of
dental staff and patients. Temperature, humidity, and ventilations systems are
regularly maintained/checked following HTM 03-01 specialised ventilation for
healthcare premises guidance. Natural light combination with ambient lighting is
used to establish a comfortable environment in a way that helps the patients feel
confident and calm.
I switched on and visually checked all the equipment required for the procedure
according to the manufacturer’s guidelines:
 Air compressor, which is located downstairs, I switched on the power by
pressing the switch button on the wall, and then pulled on the safety valve to
test it which released a hiss of escaping air. After I had done that, I watched
the pressure gauge, waiting for the needle to stop moving. This signifies that
the air inside has reached optimum pressure.
 X-ray Machine, I switched on the power by pressing the red switch button on
the wall, and visually checked if the equipment works within diagnostic
reference levels (DRL), checked if warning lights and alarms functioning
correctly, checked if isolation switch is working, and I checked if the arm is not
loose and moving, and if the head is in good working condition with the
collimator on, recording the findings in the Log in record sheet.
 Dental chair- I switched on the power by pressing the green switch button
from the bottom of the dental chair unit, and I filled a reservoir bottle with
 freshly made distilled water and water lines decontamination solution
( tosylchloramide sodium solution), in a concentration of 10ml solution to
990ml distilled water, according to manufacturer guidelines, for preventing the
biofilm in dental unit waterlines I attached it to the chair securely and flushed
all dental unit water lines (DUWL) like 3 in1 syringe, slow and fast speed hand
pieces and scale and polish, for 2 minutes and flushed again for 30 seconds
between each patient (HTM01-05). This is done to remove stagnant water
and to also reduce the microbiological count within the water lines and to
prevent cross contamination. I am aware that Legionella and Pseudomonas
bacteria can be spread through the handpieces to the patient or staff and can
cause mild to severe illness.
 The Suction line was switched on together with the dental chair, and now
used my finger to completely cover the Regulator Port to check the suction
strength.
 Amalgamator- I switched on the power by pressing the switch button on the
wall, hearing the beep sound confirming that the amalgamator is on.
 Light cure- I switched the power on and checked it was working by removing
the light cure and placing it back on the charging unit watching the charging
light come on.
 switched on the computer from the plug and pressed the on/off button at the
bottom of the screen which then brought power to the computer and logged
into the system.
All the equipment was in good working condition for the day.
All staff in our practice are responsible for checking and setting up the
Decontamination room every morning, by turning all the equipment on - the lights
pressing the swich on, the fun extractor, that is very important because ensures a
good ventilation taking out the air from the room and bringing in fresh air, the
illuminated magnifier by pressing the switcher on, and the Autoclave type N that I
filled with freshly distilled water and I run an autoclave test cycle using TST strip to
test the sterilising conditions. Before the cycle starts, I do the safety checks looking if
the door seal is intact and checking for the door pressure interlock and door closed
interlock. During this cycle the air is sucked out of the vacuum chamber which
creates a steam which allows it to contact all surfaces, including any hollow
instruments. The autoclave heats to 134 degrees Celsius and holds a bar pressure
of 2.25 for 3 minutes. A full cycle length is 15 minutes, and I knew the test was
successful when the yellow circle present on the TST strip had turned to purple once
the cycle had complete. I write down all the findings in the Log sheet, and signed
with my initials, together with the cycle number, the Autoclave model and serial
number. There are no other automatic cleaners in my practice. I scrubbed the dirty
instruments washing sink and the instruments rinsing sink with cream cleaner paste,
the taps as well, making sure there is no limescale deposits, and then I cleaned them
with warm water. I sprayed all the flat work surfaces with disinfectant spray 2 in 1 anti
-microbial non- alcoholic surface cleaner and wiped them with paper towels.
Back in surgery room, I sprayed all the flat work surfaces with disinfectant spray 2 in
1 anti -microbial non- alcoholic surface cleaner and wiped them with paper towels.
For the dental chair, dental light, control panels and for the bracket table that holds 3
in 1, slow and faster speed hand pieces and scale and polishing handle, I used anti-
microbial surface cleaning pre-saturated and alcohol-free wipes following
manufactures guidelines (we don’t apply disposable covers to the dental chair
handles and headrest in the surgery room I worked this day, but we do it in other
surgery rooms were the dental chair have any sign of wear or tear, and I am aware
that the best practice according to HTM 01-05 guidelines Best Practice there should
be disposable covers applied to the aspirator tubes, control panels and handles
dental light). Computer keyboard is covered with protective silicone cover. I clean
these areas in between each patient with anti-microbial cleaning wipes following
manufactures instructions. I prepared the dirty instruments box, which is lockable,
rigid and puncture proof by spraying it with disinfectant spray 2 in 1 anti -microbial
non- alcoholic surface cleaner and wiped it with paper towels.
The patient is an existing patient, so I opened her file records, I checked the last X-
ray taken and I opened her medical history to check for any allergies or red flag
warnings, to inform the dentist accordingly. Any change in patient's Medical history
was documented and electronically signed and dated at the Reception, as for each
patient. I can see that for today the patient have planned an amalgam restorative
procedure on UR6. The planned procedure is confirmed with the dentist. I made sure
I have got the consent from the patient as a trainee dental nurse to use the
information about the treatment for my RoE records. Patients consent was gained for
a trainee dental nurse to assist the clinician prior to treatment.
On the dentist side I placed the tray with: mirror, straight probe, college tweezers,
ball ended burnisher, condenser double ended, spoon excavator, ward carver, cotton
rolls and cotton pellets for moisture control, 3 in 1 disposable tip, disposable band
retainer (6mm Wide Band), anaesthetic safety holder, short (blue) needle
hypodermic syringe and Scandonest 3% Anaesthetic ( Mepivacaine Hydrochloride
3%) B31115AA - 2025/01 (following the dentist guidance, after checking patient's
medical history), slow speed contra angle handpiece with small size and medium
size disposable steel burs, and fast speed handpiece (the dentist picked himself the
necessary diamond burs). On the nurse side I placed: the topical anaesthetic gel
(5% lidocaine) and cotton roll, amalgam carrier, disposable dish, amalgam capsule
(restorative material containing a silver metallic alloy and mercury), a disposable
aspirator tube, a cup of fresh mint mouthwash and a box with soft tissues. I changed
my gloves and prepared PPE for the dentist and for the patient, as follow: for the
dentist prepared disposable nitrile powder-free examination gloves, plastic apron,
disposable face mask and visor, and for patient prepared the safety googles and bib.
Procedure:
I politely invited the patient into the surgery room and asked them to have a seat on
the dental chair. I provided the safety googles and covered her with the bib, always
making sure and asked if the patient is comfortable to start the procedure. After got
the consent from the patient to start the procedure, I put a small amount of topical
anaesthetic gel (5% lidocaine) on a cotton roll and handed to the dentist to numb the
oral tissue prior to infiltration anaesthesia injection, to reduce the sensation of pain,
and after manufacturer’s recommended waiting time, when the patient felt confident
to carry on, the dentist delivered the infiltration injection. After manufacturer's
recommended waiting time, when the patient said she feels no pain sensation while
dentist is checking the gingiva using straight probe, the dentist starts accessing the
tooth cavity with the fast speed handpiece, while I am aspirating with fast suction
tube, catching caries and tooth tissue and the water sprayed from the fast
handpiece, keeping the mouth area clean and dry. After the cavity been accessed
more in depth, the dentist used the spoon excavator to remove soft decay from
inside the tooth cavity, while I was keeping a clean paper tissue for him to dispose of
the debris gathered on the spoon excavator. The dentist, then, sprayed some water
using 3 in 1 syringe, and I was ready with the suction, to aspirate any decay, and
tissue keeping the patient’s mouth clean. Next, the dentist uses the slow speed
handpiece to remove more of the decay from the tooth, and after he finished drilling,
he sprayed water using 3 in 1 syringe, to clean the tooth inside, and I was ready with
the suction, to aspirate any decay, and tissue keeping the patient’s mouth clean.
When the cavity was prepared, the dentist placed the matrix band retainer around
the tooth, to restore anatomic proximal contours and contact areas for the material,
cotton rolls using the college tweezer, in the buccal vestibule, to absorb saliva and
provide retraction of soft tissue, and I started to mix the amalgam, by placing the
amalgam capsule into the Amalgamator machine(a computerized mixing system that
works under the control of a microprocessor to ensures a precise, controlled, and
consistent mix) for 20 seconds and pressing the start button, and when the machine
made a long beep, I took a out the amalgam capsule because that meant the
amalgam was mixed and ready to use. I, then, opened the capsule and poured the
content into the disposable dish, and using the amalgam carrier, I pushed the tip of
the carrier into the amalgam compound in order to fill the hollow cylinder of the
carrier tip, and when the cylinder was full, I handed the carrier to the dentist who
pressed the carrier plunger to deposit the amalgam compound on to the cavity, using
the condenser to properly pack the material. When the cavity been filled with
amalgam material, the dentist used the ward carver to remove excess material from
the tooth surface, and to give a proper and tidy shape to the tooth. I was assisting by
keeping the suction tip close to the tooth working area and be very careful that no
piece of amalgam material fell on the patient’s soft tissue, anywhere in the mouth,
but goes straight into the aspiration tube. He then asked the patient to close her
mouth and to tell if fills that all teeth meet together to ensure a good occlusion, and if
the tooth surface feels smooth. The patient answer that everything feels ok.The
patient was constantly monitored and reassured through the entire procedure. Now
the amalgam restorative procedure was done. After I checked that the patient was
clean and tidy, without water traces on her face, I asked her to rinse their mouth, and
after that I asked her if I can remove the bib and if I can have the googles back.
When the patient left, I escorted her to the Reception.