DA Course Handouts

Sealant Certification Process1. Complete an application and pay fee toTSBDE.2. Provide proof of CPR training.3. Provide proof of 16 hours of didactic andclinical education to place sealants at anaccredited dental hygiene school approved bythe TSBDE.Sec. 265.004Sealant Certification Renewal1. Pay the renewal fee to TSBDE.2. Provide proof of CPR training.3. Provide proof of 6 hours of CE intechnical and scientific areas. Nomore than 3 hours can be in selfstudy.4. Before January 1st each year.Rule 114.3www.tsbde.state.tx.us/Dental Privilege¾ Privilege is the confidentiality ofinformation created by the dentist, therecord and the patient.¾ Patient is the holder of the Privilege.¾ Privilege applies regardless of when thepatient received the professional servicefrom the dentist.Sec. 258.102Information That Is Privileged Information between the dentist and patient asit relates to dental treatment. Any information in the dental record. Privileged information may NOT be disclosedunless patient consents in writing.Exception: (1) Parent or legal guardian of patient(2) Dentist acting on patient’s behalf(3) Attorney appointed by patient.(4) Executor of deceased person’s estate.Sec. 258.10410

Dental Assistant May Be RegisteredWith The State Board In 3 AreasDental PrivilegeSigned Consent Must Include1. Specific information being released.2. Person to whom the information is beingreleased.3. The purpose of the release of information.1. Radiology2. Sealant Placement3. Nitrous Oxide Monitoring¾ There is no “cross-over” registration. Ifyou are registered in one area, you arenot registered in the other areas.Sec. 258.104Authorization Under HIPAAmust contain all the above plus:4. Expiration Date5. Statement that the Authorization can be revoked at any time.Dental Assistant Requirements ForMonitoring N20Nitrous Oxide Monitoring Dentist must have a permit and must induce andmaintain the N20. Dentist must maintain direct supervision overpersonnel who are monitoring the procedure. Assistant can reduce the levels of Nitrous Oxideor turn it off. Passed the N20 Test from the TSBDE.Maintain CPR certification.Under direct supervision of the dentist.Document the name of the assistant,concentration of N20 administered and time ofadministration.Rule 108.34Downloadable File(s)(The files below are the same files you would receive in paper form from the SBDE)Rule 108.34Microsoft Word FileFILE NAMEAdobe Acrobat File (PDF)APPLICATION FOR NITROUS OXIDE MONITORING CERTIFICATERecords Of The DentistDental record Includes The Following RadiographsMedical and dental historyPeriodontal chartingDiagnoses madeTreatment plansInformed consent statementsStudy models, casts, and impressionsBilling and payment recordsAppointment recordsRule 108.8Dental Records Must be kept not less than 5 years. Are the sole property of the dentist. This ownership shall not prohibit thetransfer of a copy of the records to thepatient nor transfer of the original recordsto another Texas dentist who will providetreatment to the patient.Rule 108.811

Consumer InformationPatient Request For Records Dental record must be provided to patientwithin 30 days. Can charge reasonable fee or copying:* 25 for first 20 pages* 0.15 for each additional page* 15 for FMX, Pano, Ceph* 5 for single filmRule 108.3 Patients shall be notified that complaintsconcerning dental treatment can be directedto State Board. Must provide the patient with the name,mailing address, and phone numbers of theState Board.Rule 108.8Consumer InformationX-Ray LaboratoriesRule 108.3 Three ways to provide consumer info:1. Sign prominently displayed2. Info on each registration form,application, brochure or contract.3. On a bill of service. Must be located in the dental office ofa Texas licensed dentist. Must have appropriate degree ofsupervision.Patients protected with lead apron andthyroid collar.X-ray equipment must be properlymonitored by the authorized agencyRule 113.2An Investigator From The State BoardWith Sanitation Complaint Must Be:Continuing Education Requirements RDA – 6 hours of CE each year. Granted immediate access to the entireoffice. Failure to grant access may result intemporary license suspension.Rule 108.223 hours can be self study. Dentist, Hygienist, Certified Dental Tech12 hours each year. State Board will do random audits toensure CE is being done. Keep registration certificate andcompletion codes.Rule 104.112

www.crest.comCE Accepted By State Board¾ American Dental AssociationLocal societies of the ADA¾ Academy Of General DentistryLocal societies of the AGD¾Free Continuing Education From Proctor & Gamble28 Courses In ThisSection13

63 Courses InThis SectionInfection Control Test Will HaveQuestions OnHow To Follow OSHA’s BloodbornePathogens Standard Infection ControlAnd OSHA Requirements Read the Bloodborne PathogensStandard, identify the major elements andimplement in your office. Main Thing – have a written plan in youroffice entitled “The Exposure Control Plan”that explains the major elements of theStandard and how you implement them inyour office. Provide yearly training onBloodborne Pathogens.Key Requirements Of BloodbornePathogens Standard Infection Control CourseImplementing Universal PrecautionsUse of Personal Protective Equipment (PPE)Sharps & Recapping NeedlesHepatitis B VaccineEngineering ControlsUse of Safety Needles and Safety ScalpelsMedical records on each exposed employeeWhat to do after a needlestick. OSHA refers to thisas the Post Exposure EvaluationUniversal Precautions¾ Universal Precautions means using thesame infection control procedures for ALLpatients for a given procedure.¾ Standard Precautions is coming into useand it means taking precautions against allbody fluids to include secretions andexcretions.14

Personal Protective Equipment (PPE)Sharps And Recapping Needles Gloves should be worn any time the hands comeinto contact with blood, saliva or mucousmembranes. Protective eyewear, face mask, and a protectivegown should be worn when performing aprocedure that generates splash or splatter.The protective gown must: Sharps must be immediately placed into aSharps Container at end patient procedures. Sharps include needles, scalpels, sutureneedles and orthodontic wire. Needles can be recapped with:99999Protect street clothes & exposed skin (arms)Have long sleevesDisposable or reusable (cotton or cotton-polyester)Be waist length or knee lengthDoes not have to fluid proof for dentistryHepatitis B VaccineOffered To All Employees With Exposure To Blood Offered within 10 days of starting work Free of charge to employee 1 to 2 months after the HBV, the HBantibody test should be offered to theemployee. If the employee has antibodiesto Hepatitis B, this is indication ofseroconversion and the employee is nowimmune to Hepatitis B.Use Of Safety Needles & Scalpels Bloodborne Pathogens Standard requireseach dental office to consider the use ofsafety needles and devices once a year. The Standard does NOT require their use,but their use must be considered. The Standard also requires that the dentaloffice gets the Employees Input intowhether these devices are to be used.9 One handed scoop technique9 Mechanical recapping deviceEngineering Controls OSHA mandates the use of EngineeringControls to prevent transmission of bloodborne diseases. Example is the sharps container or highvolume evacuator.Examples Of Safety NeedlesHypoSafety Syringe (Top)Safe Mate Safety Needle15

Safety ScalpelsMedical Records Sandel Safety ScalpelFutura Safety ScalpelNeedlestick or Spash ProceduresNeedlestick or Splash of Blood or SalivaMain Thing - Who Do You Report This ToFirst Aid ProceduresEmployee Should Be Offered A MedicalEvaluation (but are not required to go)Explain Accident To Patient and Get TheirPermission To Go For Blood TestingBlood Tests For Patient & Employee Bloodborne Pathogens Standard requires3 blood test to be run on the employeeand the patient (if patient willing to go).HIVHepatitis BHepatitis CBloodborne Pathogens Standardrequires a medical record on eachemployee exposed to blood and saliva.Initially, the medical record needs only 3items of information:1. Employees Name2. Employees Social Security Number3. Dates of Hepatitis B VaccineFirst Aid Procedures After An AccidentNeedlestick or Puncture WoundWash the wound & go for medical evalSplash (onto mucous membranes of eye, nose, mouth)Go to the eyewash station and flush theeyes for How To Follow OSHA’s HazardCommunication Standard Read the Hazard CommunicationStandard, identify the major elements andimplement in your office. Main Thing – have a written plan in youroffice entitled “The Hazard CommunicationPlan” that explains the major elements ofthe Standard and how you implementthem in your office. Provide initial trainingon Hazard Communication.16

Hazard Communication StandardRequirements For Labels There are two types of labels under thisStandard:1. Primary Labels which are place on a productby the manufacturer and must have 3 items ofinformation: (1) Product Name (2) ManufacturerName and Address (3) Hazardous Warning2. Secondary Labels are required when aproduct is removed from its original container andplaced into another container. The secondarylabel must have the (1) Product Name(2) Hazardous Warning.Material Safety Data Sheets(MSDS) Hazard Communication Standard requiresa MSDS on each dental material andchemical (disinfectants & x-ray solutions) in theoffice. Collect these from the manufacturer andplace them in a notebook or file. There is no standard format for MSDS soeach one may be different.Material Safety Data SheetsMaterial Safety Data SheetPurpose Of Infection Control ProgramInfectious Diseases In The Dental OfficeBreak The Chain Of Infection FromPatient To PatientPatient To Dental StaffDental Staff To Patient Dental Assistant may come into contactwith a number of infectious diseases in thedental office. These diseases fall into 4 categoriesdepending on their mode of transmission.17

Modes Of Disease TransmissionIn Dental Offices1. Direct contact with infectious lesionModes Of Disease TransmissionExamples Of Each Mode Airborne - TB, Measles, Chickenpox2. Indirect transmission via contaminatedobject3. Bloodborne by splatter of blood, saliva ornasal secretions onto broken skin ormucosa4. Airborne by aerosolization of microbesPrecautions: Do not treat until disease is resolved. Bloodborne - Hepatitis & HIVPrecautions: (1) Standard Precautions (2) PPE(3) Work Practice Controls Direct Contact - HerpesPrecautions: Do not treat until disease resolves.Herpes Of The FingerHerpetic WhitlowHerpes Of The EyeOcular HerpesHepatitis VirusesVaccinations Recommended byCDC For Dental StaffSpread By Fecal-OralSpread By BloodNot Occupational DiseaseOccupational Disease Hepatitis A Hepatitis E Hepatitis BHepatitis CHepatitis DHepatitis FHepatitis G Hepatitis BFluMeaslesMumpsRubella or German MeaslesVaricella-Zoster or Chickenpox18

Work Restrictions For Health CarePersonnel Recommended By CDCNo Vaccination For Following Diseases HIV or AIDS Hepatitis C TB or TuberculosisPreventing Cross-Contamination & DiseaseTransmission In The Dental Office Perform Proper Hand WashingUse Disposable Items Wherever PossibleUnit Dose ConceptUtilize Barrier Techniques and PPEHand Sanitizers ConjunctivitisDiarrheaHepatitis AHerpes (on hands)MeaslesMumpsPertussisRubellaStaphylococcus aureusTBProper Hand WashingCDC RecommendationsAlcohol based hand rubs (hand sanitizers)if the hands are NOT visibly soiled.If the hands are visibly soiled, use regularsoap OR antimicrobial soap and water.Recommended wash time is 15 seconds.Surgery Procedures – wash hands withantimicrobial soap and water for 2 to 6min.Hand WashingSoap Containers: CDC Recommendations(1) Use disposable containers OR(2) Wash and dry containers before refilling.(3) Do not “top off” containers.19

When To Wash HandsCDC RecommendationsFingernailsFingernails are the dirtiest parts of the hand¾Keep fingernails short with smooth edges for(1) thorough cleaning and (2) prevent glovetears.¾ Use of artificial fingernails is usually notrecommended¾ Do not wear hand or nail jewelry IF it makesdonning gloves difficult or compromises fit orintegrity of glove.Use Of Disposable Items Use disposable items whenever possibleto prevent cross-contamination. Disposable items include:Saliva EjectorHigh Volume Suction TipsProphy Angles & Prophy CupsAir-Water Syringe TipsImpression TraysUnit Dose Concept Dispensing the amount of material needed for a givenprocedure. Done before the patient procedure. Excess is discarded. Examples: cotton balls, cotton rolls, 2x2s, waxes,compound, Vaseline, cements. Unit dosing prevents cross contamination of cabinetsand drawers. To get supplies out of cabinet: (1) Remove gloves or(2) Use over-gloves over the latex gloves.1. When hands are visibly soiled with blood orinfectious matter.After touching items contaminated by blood,saliva or respiratory secretions.3. Before and after treating patients.4. Before and after glove use.2. Hand washing is the MOST importantstep in preventing cross contamination.Disposable ItemsCannot be reliably cleaned State Board Rules state that disposableitems shall not be used in the treatment ofmore than one patient. CDC recommends that disposable itemsnot be used in the treatment of more thanone patient.Utilize Barrier Techniques and PPETo Prevent Cross-Contamination Barrier techniques include plastic wrap,impervious paper and aluminum foil. These can be placed over work surfaces anddifficult to clean items such as electricalswitches. Work surfaces that can be barrier wrappedinclude light switches, light handle, air watersyringe, bracket table, -x ray equipment and anysurface that is touched or comes in contact withcontaminated items.20

PPE Can Be Use To Prevent CrossContamination and Disease Transmission Gloves – Should Be Changed After Each Patient Masks – When To Change1. Between Patients2. When Wet3. Splashed With BloodSurgical Masks1. Change between patients.2. Change when wet.3. Change when contaminated with blood. Eyewear – Face Shield or Glasses1. Wash Between Patients Protective Gowns1. Change if splattered with blood.2. Long sleeves3. Disposable or reusable cotton or cotton polyesterSARS Or Flu EpidemicN-95 Masks N – means normal air with no oil in the air. 95 – means that it will filter 95% of theparticles down to .3 microns.Protective Eyewear4 Types1. Safety Glasses2. Goggles3. Face Shields4. Prescription glasses with side shieldsUtility Gloves Should Be UsedIn 3 SituationsCDC Recommendations1. Decontaminating the operatory2. Cleaning instruments3. Handling chemicals such as disinfectants21

Performing Disinfection Procedures1. Select appropriate PPE.2. Select, prepare and use chemical agentsfollowing manufacturers instructions.3. Prepare surfaces for disinfection.4. After treating the patient, disinfect:Treatment roomDarkroomInstrument Processing AreaAll associated equipmentSelecting PPE For Disinfection ProceduresCDC Recommendations¾ Wear the complete ensemble to includegloves, mask, eyewear, and gown.¾ Use puncture resistant utility gloves.CDC recommends utility gloves when:Disinfection vs. SterilizationDefinitions From State Board Rules Disinfection - the partial elimination of active growthstage bacteria and the inactivation of some viruses. Thepotential for infections remains after disinfection,including infection with M. tuberculosis, hepatitis A virus(HAV) and hepatitis B virus (HBV). The humanimmunodeficiency virus (HIV) may also remain activefollowing disinfection. Sterilization - a process by which all forms of life withina defined environment are completely destroyed.Select And Prepare ChemicalDisinfectants Follow the manufacturer’s instructions forcorrect use of disinfecting products. If using bleach, must be mixed daily. Do not use Chemical Sterilants (such asglutaraldehydes) on surfaces.1. Cleaning instruments2. Cleaning and disinfecting surfaces3. When handling chemicalsClinical Contact SurfacesLight Switch, Light Handle, Bracket Table, Mobile CabinetCDC Recommendations Use an EPA registered hospital disinfectant* Low level activity (HBV and HIV claims)* Intermediate level activity (TB claim) Use Intermediate Level disinfectant if visiblycontaminated with blood.Chemicals That Can Be Used ForDisinfectants For Surfaces Chlorine, phenols and iodophors Alcohol should not be used. Glutaraldehydes should not be use. EPA or Environmental Protection Agencyis the agency that registers disinfectants inthe USA. Your disinfectant should have anEPA Number on the label.22

Housekeeping SurfacesFloors, Walls & SinksCDC RecommendationsPrepare Surfaces ForDisinfection Surfaces must be clean before Soap and WaterOR EPA Registered Hospital Disinfectant Clean walls, blinds and window curtainsin patient care areas when visibly dustyor soiled.Performing Sterilization Procedures1. Select appropriate PPEWear the complete ensemble of PPEWear utility gloves when cleaning instrumentsdisinfecting. Any debris may protectmicroorganisms from the disinfectant. Surfaces may be cleaned and disinfectedwith a “Spray-Wipe- Spray” procedure.The disinfectant is sprayed on thesurface and then wiped off as a cleaningprocedure. Then the disinfectant is againsprayed and left for the contact timelisted on the label.Properly Prepare Instruments ForSterilization Clean all blood or debris from instrumentsState Board Rules require all visible debris removedbefore sterilizing2. Prepare dental instruments forsterilization3. Apply appropriate method for sterilizationof dental instruments and equipment.4. Label and store all instruments properly5. Monitor effectiveness of sterilizationprocess Use Ultrasonic Cleaner OR InstrumentWasher If hand scrubbing, use long handle brush Wear utility gloves – puncture resistance If hand scrubbing wear (1) Utility Gloves(2) Eyewear (3) Mask (4) ProtectiveGownMiele Instrument WasherLong Handle Scrub Brush23

Ultrasonic CleanerBubble Cleaning ActionElectricity is converted to bubbles in the solution. Thebubbles “implode” which sends out shock waves thatremove the debris.DebrisApply Appropriate Sterilization MethodCDC Recommendations Heat sterilize all Critical and Semi-criticalinstruments.¾ Aut

Registration Renewal Renewal forms must be submitted to the TSBDE in Austin. Renewal forms will be reviewed within 3 working days. If forms are complete, renewal certificates will be mailed out to the DA. If not complete, will be returned