use them in practice, there are suitable qualifications already available in both techniques. A brief outline of each discipline is given.
Hypnosis
This is a technique of anxiety control that relies purely on the skill of the hypnotist to produce an altered state of mind in the patient, so that they are neither fully awake or asleep. It is achieved by verbally achieving hypnotic suggestion, to produce the altered state.
No clear definition of hypnosis is available but it can be described as ‘an altered state of awareness in the patient, so that they are more amenable to suggestion’. When it is successfully suggested to them by the hypnotist that dental procedures are painless or pleasant or even happy experiences, this is a powerful tool in overcoming a dental phobia.
Full dental hypnosis is not currently practised by many dentists but with patients who are already consciously sedated using one of the conventional techniques involving drug administration, it is relatively easy for the depth of their sedation to be accentuated by using hypnotic suggestion as well. The easiest method is for the dentist to merely alter the tone and depth of their voice while talking to the sedated patient, so that a low and slow, monotone style of speech is used. The desired suggestions are then repeated to the patient in a calm, deep voice, often with key words dragged out in length, so for example the word ‘slow’ becomes ‘sloooow’.
The technique requires lots of practice to be used successfully, and every dentist will develop their own favourite phrases and patter with time. Some examples are as follows.
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‘… and any pain you feel will be just a tiny insect bite …’•
‘… and all the pain has been sucked away, and everything feels good now …’•
‘… and as you breathe in you can feel yourself becoming more and more relaxed …’•
‘… and you’re lying on a nice sunny beach, and you can hear the waves gently lapping onto the shore …’Acupuncture
This is a branch of traditional Chinese medicine in which special needles are inserted into the patient’s skin for the following reasons.
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As therapy for various disorders.•
To produce anaesthesia.•
To reduce anxiety.Again, no qualifications are currently required, but the GDC would expect any dentist to have at least attended a validated training course before using the technique on patients.
The manner in which acupuncture works is not fully understood, but it is believed to be a combination of the following.
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The needle prick causes the patient’s body to release its own painkillers (called endorphins) which act as local analgesics.Chapter 14 Levison’s Textbook for Dental Nurses
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The technique helps to induce a form of hypnosis in the patient.•
The needle prick acts as a distraction from the original source of pain.However it works, acupuncture has been successfully used to carry out painless dental treatment, as well as to remove the ‘gag’ reflex in susceptible patients so that impressions can be taken. It is also used as a technique for long-term management of chronic dental pain in temporomandibular disorders. Although acupuncture can be used to reduce the anxiety associated with dental treatment, it is currently seldom used to do so.
Further resources are available for this book, including interactive multiple choice questions and extended matching questions. Visit the companion website at:
www.levisonstextbookfordentalnurses.com
Levison’s Textbook for Dental Nurses, Eleventh Edition. By Carole Hollins.
© 2013 John Wiley & Sons, Ltd. Published 2013 by John Wiley & Sons, Ltd. Companion website: www.levisonstextbookfordentalnurses.com
Following a dental examination during an oral health assessment, the dentist may often diagnose the presence of a cavity in a tooth. Cavities are caused by dental caries attacking the hard structure of the tooth, and if left untreated they will cause pain for the patient, and will develop into a more serious dental problem that may result in the loss of the tooth. A cavity will therefore require treatment and once its presence has been determined, a treatment plan will be decided upon based on the following information.
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Cavity size – is restoration of the tooth feasible with a restorative filling alone, or should a fixed restoration (such as a crown) be considered?•
Cavity position – which tooth surface or surfaces are involved, and do aesthetics need to be considered?Restorative Dentistry
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Key learning points
A factual knowledge of
• cavity classification
• temporary and permanent filling materials A working knowledge of
• cavity preparation and restoration using filling materials
• the instruments and equipment used in tooth restoration A factual awareness of
• the causes of pulp death
• the various non-surgical endodontic techniques available to preserve a tooth
• the instruments and medicaments used in non-surgical endodontic techniques
• the technique of apicectomy
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Tooth involved – is a posterior chewing tooth involved, that will require a strong and long-lasting restoration, or is an anterior tooth involved where chewing forces are less but aesthetics have to be considered?•
Extent of caries – is it possible that full caries removal will cause pulp exposure, so that endodontic treatment will also be required?•
Patient’s wishes – is the patient amenable to restorative treatment, or are they likely to be unco-operative, as may occur especially with younger children and some patients with special needs?Taking into consideration all these points, restoration by filling may be on a temporary or a permanent basis.
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Temporary restoration – in less co-operative patients, and if a fixed restoration is being consid- ered as the final restoration in the short term. The usual materials used are:○ zinc oxide and eugenol cement
○ zinc phosphate cement
○ zinc polycarboxylate cement.
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Amalgam restoration – in posterior teeth, where restoration strength and longevity are more of an issue than aesthetics.•
Composite restoration – in anterior teeth for aesthetics, although more modern composite materials are suitable for use in restorations in posterior teeth too.•
Glass ionomer restoration – in deciduous teeth (because of its fluoride release) and in certain cavity sites where retention of the restoration is difficult.The aims of good cavity preparation are the same, wherever the lesion has occurred and whatever restorative material is to be used.