The dental assistant (1954)

my name is and Ilham and the bedroom nurse assistant in London England my age is 17 and I have had five months experience in dental work since leaving school I live in a small village called Bors green in Hertfordshire this is our house it is over 400 years old it takes me an hour and 20 minutes to reach the surgery I like to allow about 20 minutes to have everything ready for first patient usually do it 9 o'clock first of all as in housekeeping it will be understood that nurse doc routine would be satisfactory for different houses our practice is by no means typical and as you will see some of our equipment is not new but I shall try to show and describe the general pattern of the sort of work I do for example the many odd jobs which are done at the start of each day some people think one can just walk in at 9 o'clock and greet the first patient but this is not serve any sort of high standard is to be achieved and if not well the job lose interest at least it would for me as a slipshod to practice will attract slipshod assistants and ultimately slip short work which is bad for everyone concerned since I left last evening the daily cleaning has done the general cleaning but not of course the working parts of any of the equipment in most surgeries there are perhaps a dozen electrical checkpoints apart from the many fuses which one should be able to locate and repair quickly when needed such pairs as fuses and lamps should always be right to hand one item which cannot be planned ahead is their sudden failure there should never be any atmosphere of rush or bustle every patient even the most exacting and unappreciative one must feel that she is receiving the best possible care and attend the only simple way to achieve this is to take the same individual interest in each patient and interest is the keyword right through without it the job is twice as hard and is not done half as well spray bottles and the water reservoirs of turbine attachments meet watching during busy sessions as they may need additional replacement one duty is to see that there are clean towels and that the surgeon always appears in a clean ungreased cooked also anytime a sludge is noticed he is requested to change in a busy practice there is little time to look in the mirror if any of the staff get any smudge or mark horse hair is untidy to slip sharing etc one of the others immediately but quietly draws attention to it the mixing of anaesthetic solutions and the maintenance of adequate supplies of drugs and oxygen are two most responsible tasks carefully double-checked by the surgeon or a senior nurse until safe proficiency is achieved I have not done this very often one of the faults at first is not holding the needle firmly on the syringe when mixing spilling but few drops of water when mixing will alter the strength of the solution if dosage is gauged from previous records this may well alter the depth and length of an anesthesia if not conscientiously and accurately recorded the preparation of any local injection is also subject to strict control if the oxygen supply ran out during an ounce easier the results may be even more serious so the machine must be checked each morning while it is well to realize the vital importance of such personal responsibility this does not weigh too heavily after the first few cases as the routine and it's checking become automatic all the record sheets for the day are ready in the fryer these are checked in sequence with the appointment book so that each is ready as required together with any relevant x-rays or laboratory works everything is prepared in advance so that when the patient comes into surgery there is no delay while any necessary data is being obtained when the patient comes in no instruments or models are in sight headrest pad or mirror last minute check and orders now ready for the first patient and the surgeon the headrest is adjusted either short or long bed placed as you cried the tissue for removing lipstick while the mouthwash is placed the clean tissue for patients use water is ready in the basin while the surgeon washes he should be able to see the name and any special or personal notes about the patient so that he is not only able to greet her by name but also maybe to inquire about little Johnny's measles or a special tooth which may have been treated recently the treatment to be done this visit is clearly marked on the small slip attached to the record tear already a just right and always see that the light is not allowed to shine in the patient's eyes [Music] if treatment is to be given along with rather than a short bit due to assistance would normally be present the next sequence shows the many tasks of the assistant who may be suddenly single-handed during any part of an anaesthetic case and should be able to carry on without the surgeon being delayed at all this ability to take over at any moment is one of the most important parts of an assistance training and the success of any operation under any type of general anaesthetic whether given by a medical or dental anesthetist depends in no small measure on the assistants efficiency as a vital member of the team only two people are shown here for clarity you're labeling more crowded but the general principles of assisting are the same whatever the technique a dense flange mass spec properly positioned will prevent the finest particle of foreign matter being inhaled on the airstream this is even more important since high speed methods came into use in anaesthetic assisting the first duty of every member of the team just keep an eye on the airway and respiration during concentrated attention to some part of operating the surgeon may inadvertently move the palatal part of the pack flange if he does the assistant stops him operating for the moment while it is repositioned the mass spec is changed as frequently as is necessary everything is aimed at saving time and motion for the surgeon an anesthetic time for the patient throughout you will notice that the hands of the surgeon seldom have to move more than a few inches away from the job and his eyes are seldom diverted from the work for example the zinc oxide dressing which has been mixed at the beginning of the day and is kept at the right consistency in a silica gel bottle is presented with the instruments within a few inches of the site of application the action is simply to show than to explain in practice the alloy would be mixed by a second assistant or be done right at the chair side much faster than shown here it is loaded into a number of carriers and the assistant can either place the amalgam into the cavity as directed or place a loaded carrier in the hand of the surgeon in such a way that he can use it in a single movement it is not lavish equipment which saves time but careful pre-planning and being taught what is being done and why one can then anticipate the next action the engine mallet is being used here to condense the amalgam [Music] you see now how the head of our volunteer patient is being supported during extractions in the upper molar region the surgical pressure is up foots and outwards the assistant presses the head rather like a rugby ball countering the sideways Trust in the lower molar region the rotational force must sometimes be applied and to save this stress being fully transmitted to the articulation this is protected as well as possible by firm support on both sides countering the applied thrust as soon as the surgeon has completed his work the assistant must be responsible for the patient fighting on a suitable PEC will temporarily prevent the blood being swallowed while the patient walks to the recovery room clinical photography is often another small but interesting part of one's work when selecting trays or holding impressions in place one must bear in mind where the standing teeth are and of course see that impressions go to the laboratory at once and would the necessary data if forgotten shared cannot be matched over the telephone no patient should carry away with her the slightest visible sign of her session in the surgery when giving appointments the attention of the patient should be drawn to any necessary preoperative instructions in cleaning surgery between patients an automatic routine is followed us is headrest pad mouthwash mirror handpiece records and instruments instruments will of course be clean before sterilizing [Music] then comes a general surgery check the surgery must always look spotless no matter what the previous operation may have been floor cleaning is not on a normal agenda but if needed during the day the only indignity attached to it is not doing it properly as in general nursing there's always cleaning to do one thing we do the floor is a messy basin if everyone remembers to use the soap with dry or almost dry hands keeping it out of the water many hours of cleaning are saved in a year the practical routine haves the work compared with the laborious approach which would also be more tiring though one sees surgery sterilizing here and instruments being placed back in their correct places between patients it may well be that as in our everyday custom the sterilizing is done in a separate sterilizing room and instruments refiled at any time during the work when it is convenient such a plan requires the use of more instruments than will be the simple method shown but each is suitable for its particular purpose one learns to cast metals in emergency here I am learning a hard way as you may guess this is the first time I have ever cast one it is the best way to learn how care for one must be in handling models and other laboratory work trimming is much easier if the plaster is not lift to get as hard as this I thought I'd hate looking at teeth but it becomes quite fascinating history pointment is for prosthetic orthodontic or other work when necessary models must be ready to hand chalking is quite a game of skill sometimes when teeth have moved our surgeon were trapped for six is missing then find a cavity in it the one is not quite sure which is training and which an error the x-ray machine is handled not with fear but with respect one should never stand in front of the x-ray tube while it is working the developing of x-rays is a simple task once one realizes the necessity of careful time and temperature control with a plan for changing solutions and no matter how quickly required never skipped the initial rinsing fixer marks cannot be removed from uniforms we don't usually mount our x-rays but merely lift and fry them unless they're to be sent away the phone numbers of x-rays taken also reminds one to change the developer solution in good time such foiling and other equipment maintenance jobs were often accumulate during busy periods and be done in order of urgency as soon as time allows broken appointments cancellations or special time being allotted for maintenance here you see some of the essential maintenance jobs taking scratches our two statues and plastic filling instruments sharpening cutting edges always remove oil from SAP afterwards amalgam carriers can often be freed by passing over flame in cleaning burrs never scrub hard with a brass wire brush if one strokes the burr over the tips without bending them the job takes half the time and the brush lasts many times as long mercury or solvent is used to remove alloy from diamonds which are always stood in small holders and never laid down on glass for medium high speeds thirty thousand to sixty thousand revolutions per minute mechanical hand pieces need constant lubrication with special high speed oil or they will overheat slack bearings must be changed at once occasional dismantling for checking just takes a minute [Music] those items which should be autoclaved are packed in a drum and sent away for sterilization never try to keep up with the Joneses during Duty hours let them try to keep up with you see required standard which will pass in any company tidy hair well-groomed hens natural and clean nails no slip shearing simple shoes no obvious decoration or makeup you may wear a full fight rig and cap this is merely our way at the end of each day the sterilizer is emptied and cleaned notes are made of any items to be replenished from stock bikal cheats are completed and the last Altman is done so that one arrives at a fresh tidy surgery in the morning when first starting this type of work unless one has been used to hospital ward work one feels quite exhausted with feet which seem to ache more each day for a week or two even afterwards the work is sometimes tiring always exacting but never stale it has endless variety and interest and gives that special personal satisfaction of being a really worthwhile sort of job I don't do all these jobs every day of course but I hope this has given you an idea of the type of work I have to do I wouldn't change it for anything