Introduction to Dental Assisting

© Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION partNOT FOR SALE OR DISTRIBUTIONi © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION

1 The Dental Assisting Profession 2

4 Ethics and Law 33 © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION

9781284268133_CH01_001_014.indd 1 19/03/20 8:18 AM © Jones & Bartlett Learning, LLC chapter© Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR1 DISTRIBUTION © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION The Dental Assisting © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC ProfessionNOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION

CHAPTER OUTLINE © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FORIntroduction SALE OR DISTRIBUTION History of DentalNOT Assisting FOR SALE OR ProfessionalDISTRIBUTION Organizations History of Dentistry History of Dental Hygiene Certification Early History Women and Minorities in Dentistry Middle Ages Education in Dental Professions Renaissance Dentists Dentistry in America © Jones & BartlettDental Learning, Assistants LLC © Jones & Bartlett Learning, LLC Dental Hygienists Dentistry Around the WorldNOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION Contemporary Trends in Dentistry Dental Laboratory Technicians

© Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC CHAPTER CHECKLIST KEY TERMS NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION On completion of this chapter, students will be able to: Albucasis (al-byuh-KA-sis) – noted Islamic physician (936–1013). In addition to his accomplishments as a surgeon, he identified 3 Discuss the contributions various ancient civilizations tartar on the teeth as a major cause of gingival disease and wrote made to the field of dentistry. detailed instructions on how dentists could effectively scrape it 3 © Jones & BartlettIdentify the Learning,major figures inLLC the history of dentistry © Jonesaway using & specialBartlett dental Learning, instruments LLC he had designed and describe their key achievements. American Dental Assistants Association (ADAA) – profes- NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION 3 Identify the educational requirements for the various sional organization representing dental assistants on a national level members of the dental team. American Dental Association (ADA) – the world’s largest and 3 Identify major professional organizations in the field oldest professional organization dedicated to dentistry and den- and describe their functions. tal health issues 3 Identify the requirements© Jones for becoming & Bartlett a certified Learning, The LLC American Dental Hygienists© Jones Association & Bartlett (ADHA) Learning, – LLC dental assistant (CDA).NOT FOR SALE OR DISTRIBUTIONlargest professional organizationNOT representing FOR SALE the interest OR DISTRIBUTIONof dental hygienists cosmetic dentistry – branch of dentistry that deals with improving the appearance of otherwise healthy teeth dental assistant – dental professional trained to provide support © Jones & Bartlett Learning, LLC to a dentist by© performingJones & aBartlett multitude Learning,of tasks ranging LLC from NOT FOR SALE OR DISTRIBUTION clerical work NOTand assistance FOR SALE at chairside OR DISTRIBUTION to laboratory work, infection control, and possibly additional enhanced functions Dental Assisting National Board (DANB) – agency that administers the national examination to certify dental and orthodontic assistants © Jones & Bartlett Learning, LLC ©dental Jones hygienist & Bartlett (hi-JEN-ist) Learning, – licensed, LLC professional auxiliary in dentistry who is both an oral health educator and clinician, NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION 2

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© Jones &and Bartlett who uses Learning, preventive, LLC therapeutic, and educational© JonesIsaac Greenwood& Bartlett – Learning, first American-bor LLCn dentist NOT FOR methodsSALE ORfor the DISTRIBUTION control of oral diseases NOTHippocrates FOR SALE – ancient OR DISTRIBUTION Greek physician (500 bce) who is con- dental implant – a metal fixture typically made of titanium sidered the father of modern medicine. Many fundamental which is surgically embedded into the jaw. The implant acts concepts of modern medicine, including patient confidenti- as the root and allows for an abutment or prosthesis to be ality and the ethical obligation to do no harm, can be traced attached to it, such as a crown, bridge, or denture attachment to his early writings and teachings dental laboratory technician© Jones – dental& Bartlett professional Learning, who LLCAmbroise Paré (AME-brohz© Jones pah-RA) & Bartlett– 16th-century Learning, LLC provides support to dentalNOT practices FOR SALE by filling OR prescriptions DISTRIBUTION French surgeon who is consideredNOT FORthe Father SALE of Surgery. OR DISTRIBUTIONHe from dentists for crowns, bridges, dentures, and other den- wrote extensively on dental procedures, particularly extrac- tal prosthetics tion and reimplantation, in his Complete Works dentistry – the science and art concerned with the preven- restorative dentistry – branch of dentistry that deals with tion, diagnosis, and treatment of deformities, diseases, and restoring or replacing damaged or missing teeth injuries© Jones to the teeth, & Bartlett gingiva, oral Learning, cavity, and jawsLLC veneer (vuh-NERE)© Jones – a& thin Bartlett layer of Learning,acrylic, composite, LLC or Pierre Fauchard (pee-AIR foe-SHARD) – 18th-century porcelain used to cover the facial (front) surface of badly FrenchNOT physician FOR whoSALE is known OR DISTRIBUTION as “the Father of Modern stained teethNOT or toFOR improve SALE the shape OR ofDISTRIBUTION highly visible front Dentistry.” He described advanced techniques for cleaning teeth the teeth and filling caries in his comprehensive textbook whitening – lightening of teeth to a whiter color by the use on dentistry, Treatise on the Teeth (1723) of dental bleaching materials © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION

early civilizations frowned on pulling, or extracting, teeth, Introduction especially the cuspid, or “eye” teeth, and reserved the practice for a last resort. Each region of the world had its favor- © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC Dentistry is one of the world’s oldest medical arts. For ite materials for constructing the dentures used to replace thousands of years, peopleNOT haveFOR tried SALE to careOR forDISTRIBUTION their lost teeth. Dentistry developedNOT steadily FOR asSALE early ORpeoples DISTRIBUTION teeth well enough to keep their mouths healthy and used whatever resources and knowledge were available to pain-free for a lifetime. The concerns of people through them. (See Table 1-1.) the ages have remained surprisingly similar, whereas the technology© Jones available & Bartlett for modern Learning, dental care LLC continues Egypt © Jones & Bartlett Learning, LLC to advance and better address those needs. As the profes- NOT FOR SALE OR DISTRIBUTION As early asNOT 5,000 FOR years SALEago, physicians OR DISTRIBUTION in Egypt began sion has grown over the years, the roles and responsibili- to move from treating the entire human body into spe- ties for the various members of the dental team, including cializing in healing and treating specific parts of it. Some dental assistants, have become better defined. Formal edu- doctors specialized in the eyes, others in the stomach or cation and a structured certification process ensure that head. Records remain of a physician named Hesi-Re, who patients receive quality care. A number of professional © Jones & Bartlett Learning, LLC © Joneswas known & Bartlett to his colleagues Learning, as “chief LLC of the toothers” and organizations exist to promote professional standards, is recognized as the first known dentist. Evidence from NOT FORadvocate SALE soundOR DISTRIBUTION oral health care practices, and supportNOT Egyptian FOR SALE graves ofOR that DISTRIBUTION era shows that his patients suffered members of the dental profession. tooth and bone loss from gingival disease and had surgery to drain dental abscesses.

History of Dentistry© Jones & Bartlett Learning, LLCGreece © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTIONThe ancient Greek physicianNOT Hippocrates FOR SALE, who OR lived DISTRIBUTION Early History around 500 bce, raised the art of medicine to a high level. The ideals of modern medicine, including patient confi- Some early dental practices were strikingly similar to our dentiality and the ethical obligation to do no harm, can be own and continue into the present day. For example, to traced to his early writings and teachings. Hippocrates is help ©prevent Jones tooth & Bartlettdecay, or caries,Learning, the people LLC in many perhaps best-known© Jones for & the Bartlett Hippocratic Learning, Oath, which LLC out- early NOTcivilizations FOR wereSALE urged OR to DISTRIBUTION rinse their mouths after lines the standardsNOT FOR and ethical SALE responsibilities OR DISTRIBUTION of health care every meal. Some cultures even included the practice providers. A version of the Hippocratic Oath is still taken in religious rituals. Toothbrushes took many forms and by many medical practitioners today (see Chapter 4, Ethics were made of a wide assortment of materials, including and Law). Like his predecessor, the famous Greek physi- animal hair and twigs. A surprising number of early den- cian Aesculapius, Hippocrates appreciated the importance © Jones tists& Bartlett and doctors Learning, around the LLC world explained caries and© Jonesof teeth & andBartlett devoted Learning, many pages LLC of his writings to them. NOT FORpain SALE as products OR DISTRIBUTION of a mysterious “toothworm.” Nearly allNOT He FOR rejected SALE the useOR of DISTRIBUTION magic to treat toothache and dental

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© Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FORTABLE SALE 1-1OR DISTRIBUTIONTimeline: Dental History NOT FOR SALE OR DISTRIBUTION DATE LOCATION EVENT 2600s bce Egypt First known dentist (Hesi-Re) practices 500–300 bce Greece Aristotle and Hippocrates advance practice of medicine and © Jones & Bartlett Learning,dentistry LLC © Jones & Bartlett Learning, LLC 250 bce ChinaNOT FOR SALE OR DISTRIBUTIONFirst cleft palate repair NOT FOR SALE OR DISTRIBUTION 25 bce–50 ce Rome Celsus writes on oral health and dental treatments 166–201 ce Etruria (Italy) Etruscan artisans fashion notable bridgework and dentures 410 Rome Fall of the Roman Empire; Middle Ages begin in Europe 500–1000© Jones & Europe Bartlett Learning, LLCMonks practice medicine,© Jonessurgery, and& Bartlett dentistry Learning, LLC 700 NOT FORChina SALE OR DISTRIBUTIONFirst mention of silver amalgamNOT FOR for treating SALE caries OR DISTRIBUTION 1000s Islamic Spain Albucasis describes how to remove tartar 1130–1163 Europe Pope forbids monks from practicing surgery or tooth extraction 1130–1163 Europe Barber surgeons take over practice of surgery and tooth extraction © Jones &1210 Bartlett and Learning,France LLC Barbers© continue Jones tooth& Bartlett extractions; Learning, other surgeons LLC train for general NOT FOR SALEonward OR DISTRIBUTION surgeryNOT FOR SALE OR DISTRIBUTION 1530 Germany First book devoted to dentistry, The Little Medicinal Book for All Kinds of Diseases and Infirmities of the Teeth, published 1575 France Ambroise Paré, Father of Surgery, includes writings on dentistry in © Jones & Bartlett Learning,his Complete LLC Works © Jones & Bartlett Learning, LLC 1723 FranceNOT FOR SALE OR DISTRIBUTIONPierre Fauchard, Father of Modern Dentistry,NOT completes FOR SALE his textbook, OR DISTRIBUTION Treatise on the Teeth 1760 United States Irish dentist John Baker immigrates from England to set up practice in America 1760–1780© Jones & United Bartlett States Learning, LLCCareer of Isaac Greenwood,© Jones first American-born & Bartlett Learning,dentist LLC 1768–1770NOT FOR United SALE States OR DISTRIBUTIONBoston silversmith PaulNOT Revere FOR enters SALE dental ORpractice DISTRIBUTION 1789 France First patent issued for porcelain teeth 1790 United States First dental foot engine invented 1790 United States First dental chair, with headrest and arm extension © Jones &1801 Bartlett Learning, United States LLC Richard© C. Jones Skinner & writes Bartlett Treatise Learning, on the Human LLC Teeth, the first dental book published in America NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION 1825 United States Commercial manufacture of porcelain teeth begins 1832 United States First reclining dental chair 1833–1850 United States First American use of amalgam restorations for dental caries 1840 Baltimore,© Jones Maryland & Bartlett Learning,First dental LLCcollege in the world founded© Jones & Bartlett Learning, LLC 1841 AlabamaNOT FOR SALE OR DISTRIBUTIONFirst laws regulating dental practice in theNOT United FOR States SALE OR DISTRIBUTION 1844 Connecticut First use of nitrous oxide as an inhaled anesthetic 1864 United States Rubber dental dam invented 1866 Ohio (College of Dental Lucy Beaman Hobbs becomes first woman to earn a dental degree © Jones & BartlettSurgery) Learning, LLC © Jones & Bartlett Learning, LLC 1869NOT FOR MassachusettsSALE OR DISTRIBUTION(Harvard Robert Tanner FreemanNOT becomes FOR first SALE African OR American DISTRIBUTION to earn a University Dental School) dental degree 1871 United States First commercially manufactured foot-treadle dental engine 1877 United States First pump-type hydraulic dental chair © Jones &1880 Bartlett Learning, United States LLC First manufacture© Jones &of tubeBartlett toothpaste Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION

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© Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FORTABLE SALE 1-1OR DISTRIBUTIONTimeline: Dental History (Continued )NOT FOR SALE OR DISTRIBUTION DATE LOCATION EVENT 1885 New Orleans, Louisiana C. Edmund Kells employs first female dental assistant, or “lady assistant” 1890 University© Jones of Michigan & Bartlett Learning,Ida Gray becomes LLC first African American© womanJones to &earn Bartlett a dental Learning, LLC SchoolNOT of FOR Dentistry SALE OR DISTRIBUTIONdegree NOT FOR SALE OR DISTRIBUTION 1895 Germany Physicist Wilhelm Roentgen discovers the x-ray 1905 Germany Invention of Novocaine 1908 United States Reformer and educator G.V. Black publishes Operative Dentistry 1913© Jones & Bridgeport, Bartlett Connecticut Learning, LLC Fones Clinic for Dental ©Hygienists Jones opens& Bartlett Learning, LLC 1917NOT FOR Connecticut SALE OR DISTRIBUTIONIrene Newman receivesNOT first dentalFOR SALEhygienist OR license DISTRIBUTION 1924 United States American Dental Assistants Association (ADAA) founded 1928 United States National Board of Dental Examiners established 1938 United States First toothbrush with synthetic bristles marketed © Jones &1945 Bartlett Learning, United States LLC Fluoride© firstJones added & toBartlett community Learning, water supplies LLC NOT FOR1947 SALE OR DISTRIBUTION United States DentalNOT Assisting FOR National SALE Board OR (DANB) DISTRIBUTION established 1958 United States First fully reclining dental chair 1989 United States First commercial tooth bleaching products for home use 1990s United States Popularity of cosmetic aesthetic dentistry increases © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION

pain, and stressed a rational approach to medicine. His eventually conquered by the Romans and absorbed into successor, Aristotle, continued to write on dentistry and their empire. connected the eating of figs and other soft sweets popular with Greeks© Jones to the & development Bartlett Learning, of caries. LLC Rome © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION Early RomanNOT dentistry FOR combined SALE the OR medicine DISTRIBUTION of the Greeks Etruscans with the restorative dentistry of the Etruscans. Among the The best examples of early restorative dentistry, or most famous Roman physicians, Celsus lived from 25 bce to using dentures to replace missing teeth, can be found 50 ce. Like his Greek predecessor, Hippocrates, he rejected among the crowns and bridges made by Etruscan crafts- magic and believed that poor physical health in general © Jones men& Bartlett in the hills Learning, of Central LLC Italy about 2,500 years ago© Jonescaused & dental Bartlett caries Learning, and disease. LLC For dental pain he pre- NOT FOR(Figure SALE 1-1). OR Gold DISTRIBUTION bands fastened natural teeth to artificialNOT scribed FOR SALEnarcotics OR and DISTRIBUTION advocated use of the cautery, or hot ones and calves’ teeth were grooved in the center to appear iron, to sear and destroy diseased gingival tissue. He urged as two central incisors, or front teeth. The Etruscans were the extraction of badly broken down teeth and was among the first to recommend filling the tooth’s cavity with lead prior to extraction to reduce the chance of fracturing the © Jones & Bartlett Learning, LLCcrown as it was pulled. He also© describedJones & the Bartlett earliest techLearning,- LLC NOT FOR SALE OR DISTRIBUTIONniques for straightening and NOTrepositioning FOR SALEteeth. OR DISTRIBUTION Archigenus, who practiced medicine and dentistry in Rome after Celsus, recognized pulpitis, or the inflammation of the pulp of the tooth, as a source of pain, and invented the first dental drill that would allow access into © Jones & Bartlett Learning, LLC the pulp chamber© Jones to treat & Bartlett it. Learning, LLC NOT FOR SALE OR DISTRIBUTION Galen, consideredNOT FOR the SALE greatest OR physician DISTRIBUTION since Hippo- crates, classified teeth into centrals, cuspids, and molars. He was the first to write about nerves in the teeth, believ- ing them to be related, among other things, to the sense of taste. Along with pulpitis, he recognized pericementitis, © Jones Figure& Bartlett 1–1 An Learning, ancient Etruscan LLC gold-banded bridge with© Jones & Bartlett Learning, LLC two teeth. (Courtesy of National Museum of Science & Industry, or inflammation of the radicular portion of the tooth, as a NOT FORLondon, SALE UK.) OR DISTRIBUTION NOTsource FOR ofSALE toothache. OR DISTRIBUTION

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© JonesHebrews & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FORThe SALE Jewish OR scripture, DISTRIBUTION the Talmud, written between 300 and 400 ce, describes false teeth made of gold, silver, and wood, and blames the mysterious “toothworm” for dental caries. Surviving Hebrew writings describe little more about dentistry. © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION China The toothbrush as we know it today, with bristles sideways to the handle, was invented by the Chinese in the 1490s, but advanced treatments and practices began much earlier in China.© JonesAncient manuscripts& Bartlett describe Learning, the repair LLC of a cleft © Jones & Bartlett Learning, LLC palateNOT around FOR 250 SALEbce. Dentists OR DISTRIBUTIONlater combined mercury Figure 1–2 NOTThe siwak FOR, aSALE toothbrush OR stick DISTRIBUTION still used in parts with silver to fill dental caries more than a thousand years of the world today. (Courtesy of National Museum of Dentistry, before dentists in the West, and developed full dentures Baltimore, MD.) as early as the 12th century ce. In the 13th century, the explorer Marco Polo describes Chinese who, whether for © Jones & Bartlett Learning, LLC © JonesIslamic & religious Bartlett authorities. Learning, Siwaks LLC continue to be used in cosmetic or treatment purposes, adorned their teeth with parts of the world today. NOT FORcarefully SALE fitted OR DISTRIBUTIONthin pieces of gold. NOT FOR SALE OR DISTRIBUTION

Japan CHECKPOINT The earliest Japanese dentures were carved from a single 41-1 Which ancient Greek physician is credited with establishing piece of wood, usually a© sweet-smelling Jones & Bartlett variety, such Learning, as box, LLCfundamental ideals that are still used© Jones in medical & professions Bartlett Learning, LLC cherry, or apricot. TreatmentsNOT FORfor toothache SALE includedOR DISTRIBUTION cau- today? NOT FOR SALE OR DISTRIBUTION tery and acupuncture as well as occasional use of charms and magic incantations. Extraction remained a last resort. Middle Ages Islamic World © Jones & Bartlett Learning, LLC After the Roman© Jones Empire & Bartlettfell in 410 Learning, ce, most Europeans LLC Physicians of the Islamic world, which, after the 8th cen- adopted the practice of using magic and superstition to tury ceNOT, included FOR the SALE Middle OR East, DISTRIBUTION North Africa, and Spain, NOT FOR SALE OR DISTRIBUTION treat dental disease and pain and rejected the medically wrote widely on medicine, including dentistry. During based approaches of the Greeks, Romans, and others. Sound Europe’s Middle Ages, they rejected magic and superstition European medical knowledge became the property of the as cures, and helped keep alive the rational approaches monasteries, where monks became practicing doctors and of the Greek physicians who had come before them. The dentists. Barbers acted as their assistants. When medieval © Jones noted& Bartlett Islamic Learning,physician Albucasis LLC (936–1013) of the© Jones & Bartlett Learning, LLC Christian religious authorities in the 10th century declared NOT FORSpanish SALE city OR of DISTRIBUTIONCórdoba understood that the accumulaNOT- FOR SALE OR DISTRIBUTION that priests and monks must not participate in the cutting tion of tartar on the teeth was a major cause of gingival of the body and the shedding of blood during surgery, bar- disease and wrote detailed instructions on how dentists bers took over the practice of surgery. Known as barber could effectively scrape it away using special dental instru- surgeons, these practitioners included tooth extraction ments he had designed. Illustrations of these and other among their surgical duties; outside the monastery walls, instruments, including ©forceps Jones for & surgery, Bartlett cautery Learning, irons, LLC © Jones & Bartlett Learning, LLC they were joined by “tooth drawers,” who traveled from one and dental saws and files,NOT were FOR featured SALE in his OR famous DISTRIBUTION book NOT FOR SALE OR DISTRIBUTION medieval town to another providing their services. Among on medicine and surgery, The Method. the most famous of barber surgeons was Ambroise Paré, The most famous Islamic physician, known in the West the 16th-century French surgeon considered the Father of as Avicenna, stressed the importance of keeping the teeth Surgery, who wrote extensively on dental procedures, par- clean and recommended various tooth powders for this ticularly extraction and reimplantation, in his Complete purpose,© Jones including & salt Bartlett and powdered Learning, snail shells.LLC © Jones & Bartlett Learning, LLC Works. PopularNOT toothbrushesFOR SALE called OR DISTRIBUTIONsiwaks were made from NOT FOR SALE OR DISTRIBUTION twigs of the evergreen tree Salvadora persica (Figure 1-2). They retained the sodium bicarbonate, tannic acid, and Renaissance other astringents found in the tree’s wood and proved beneficial to the gingiva. Using the toothbrush, as well With the arrival of the Renaissance period in 16th-century © Jones as& rinsingBartlett the Learning,mouth after LLCmeals and before prayer, was© JonesEurope, & maBartlettgic and Learning,superstition beganLLC to fall out of favor NOT FORan SALE important OR part DISTRIBUTION of the cleanliness ritual advocated byNOT as FOR approaches SALE toOR medicine DISTRIBUTION and dentistry. Physicians and

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© Jonesdentists & Bartlett returned Learning, to the respect LLC for science and learning© Jones & Bartlett Learning, LLC NOT FORthat SALE had character OR DISTRIBUTIONized earlier periods and civilizations.NOT 4 FORCHECKPOINT SALE OR DISTRIBUTION Their careful observations of medical and dental techniques 1-2 When monks in 10th-century Europe were no longer able brought many new ideas to preventive care and innova- to practice surgery, which group became responsible for tions to dental surgery. The study of human anatomy took performing surgery and basic dental procedures? on more importance at universities and medical schools. Renaissance artists, such© asJones Italy’s Leonardo& Bartlett da Vinci, Learning, drew LLC © Jones & Bartlett Learning, LLC the skeletal and muscularNOT details FOR of theSALE human OR body DISTRIBUTION with Dentistry in America NOT FOR SALE OR DISTRIBUTION great accuracy. He studied the skull and all external and internal structures of the body very carefully. Though not Early American Dentistry trained as a doctor or dentist, he was the first anatomist to Robert Wooffendale, a British-trained dentist, arrived distinguish between premolars and molars. © Jones & Bartlett Learning, LLC in North America© Jones in 1766 & Bartlett and traveled Learning, throughout LLC the Pierre Fauchard (Figure 1-3), an 18th-century French American colonies. He offered surgical procedures and physician,NOT became FOR knownSALE asOR “the DISTRIBUTION Father of Modern Den- reconstructionNOT of missingFOR SALE teeth. Wooffendale OR DISTRIBUTION was followed tistry.” He disputed the long-held belief that caries was caused by John Baker, an Irish physician who chose to practice by a “toothworm” and described advanced techniques for dentistry. Baker set up practices in numerous colonial cleaning the teeth and filling caries in his comprehensive cities, including Philadelphia, New York, and Boston. He textbook on dentistry, Treatise on the Teeth, published in © Jones & Bartlett Learning, LLC © Jonesincluded & BartlettGeorge Washington Learning, among LLC his patients. 1723. Led by his example, other dentists in Europe began Though he practiced a relatively short time, the most NOT FORdescribing SALE ORand sharingDISTRIBUTION their discoveries on dental surgeryNOT famous FOR SALEdentist ORof early DISTRIBUTION America was undoubtedly the and care in articles and books published for their colleagues. patriot and silversmith Paul Revere of Boston. Revere stud- Despite other advances in his thinking, Fauchard continued ied dentistry as an apprentice under John Baker in Boston. to advocate for the practice of people rinsing their mouths In 1768, when Baker moved to New York, Paul Revere took each morning with several tablespoons of their own fresh © Jones & Bartlett Learning, LLCover his dental practice. His© primary Jones interest & Bartlett in dentistry, Learning, LLC urine. Once widely practiced, this hygienic ritual continues however, was the use of his skills as a silversmith to pro- today in some isolated NOTregions FOR of the SALE world. OR DISTRIBUTIONduce pontics and dental instruments.NOT FOR Despite SALE eventually OR DISTRIBUTION tiring of his practice, Revere left his mark on dental history by making the first forensic identification of a corpse using dental records. He identified the anonymous remains of a © Jones & Bartlett Learning, LLC man killed ©at theJones Battle & of Bartlett Bunker Hill Learning, as a former LLC patient for whom he had constructed a dental bridge some years NOT FOR SALE OR DISTRIBUTION earlier. NOT FOR SALE OR DISTRIBUTION Isaac Greenwood, born in 1730, is considered the first American-born dentist. Like Paul Revere, he studied under John Baker in Boston. His son, John Greenwood, entered dental practice in New York following the Revolu- © Jones & Bartlett Learning, LLC © Jonestionary & War Bartlett and served Learning, as another LLC of George Washington’s NOT FOR SALE OR DISTRIBUTION NOTdentists. FOR SALE OR DISTRIBUTION

Evolution of Modern Dentistry Dentistry as we know it today in the United States began to © Jones & Bartlett Learning, LLCtake shape in the early part of© the Jones 19th century. & Bartlett A patient Learning, of LLC NOT FOR SALE OR DISTRIBUTIONthe New York dentist John Greenwood,NOT FOR Horace SALE H. ORHayden DISTRIBUTION was inspired to become a dentist himself. He lectured to medical school students on dentistry and wrote dental textbooks and articles for professional journals. He and his student, Chapin A. Harris, established the first professional © Jones & Bartlett Learning, LLC organization© for Jones dentists & in Bartlett the United Learning, States. In 1840, LLC they NOT FOR SALE OR DISTRIBUTION founded theNOT world’s FOR first SALE dental ORcollege, DISTRIBUTION the Baltimore Col- lege of Dental Surgery, now the School of Dentistry at the University of Maryland.

G. V. Black © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC Figure 1–3 Pierre Fauchard, French physician and the “Father Born in 1836, Dr. Green Vardiman Black (Figure 1-4) NOT FORof SALEModern DentistryOR DISTRIBUTION.” NOTbecame FOR SALE known OR worldwide DISTRIBUTION as a dental reformer and

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© Jones & Bartlett Learning, LLC © Jonesrevolutionized & Bartlett medicine Learning, and forever LLC changed how dental NOT FOR SALE OR DISTRIBUTION NOTdisease FOR SALEwas detected OR DISTRIBUTION and diagnosed. For a detailed look at Roentgen and his discovery, see Chapter 29, Basics of Dental Radiography.

© Jones & Bartlett Learning, LLCCHECKPOINT © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION41-3 Which American dentist isNOT credited FOR with first SALE using ORnitrous DISTRIBUTION oxide as an inhaled anesthetic during surgeries?

© Jones & Bartlett Learning, LLC Dentistry© Around Jones &the Bartlett World Learning, LLC NOT FOR SALE OR DISTRIBUTION Dental careNOT and oral FOR hygiene SALE practices OR DISTRIBUTIONvary widely around the world. They may even vary between people who live in cities and towns and those in the countryside and among people from different economic backgrounds in the same country. © Jones & Bartlett Learning, LLC © JonesMany & Bartlettpeople around Learning, the world LLC continue to practice NOT FOR SALE OR DISTRIBUTION NOThabits FOR firstSALE introduced OR DISTRIBUTION by traditional healers or medical and religious authorities in the distant past. Basic preventive care, such as cleaning and regular examination, is not available everywhere. When dental caries and pain appear, professional dentists may not be locally available or treat- © Jones & Bartlett Learning, LLCment may be beyond the financial© Jones reach &of Bartlettsome.American Learning, LLC NOT FOR SALE OR DISTRIBUTIONand British dentists workingNOT in AfricaFOR SALEhave described OR DISTRIBUTION patients who had to travel more than 1,000 miles to reach Figure 1–4 G.V. Black, the “Grand Old Man of Dentistry.” (Cour- adequate care when an oral infection had progressed into tesy of University of Maryland Health Sciences & Human Services the bones of the jaw. Despite care, one patient lost all her Library, Baltimore, MD.) lower teeth. © Jones & Bartlett Learning, LLC Getting access© Jones to dental & Bartlettcare is harder Learning, in countries LLC where educator.NOT He FOR championed SALE OR dentistr DISTRIBUTIONy as a profession the number NOTof dentists FOR is very SALE low compared OR DISTRIBUTION to the number of separate from medicine. He invented numerous den- residents. In industrialized countries, such as the United States, tal instruments and machines. Along with serving as a Britain, Japan, and Australia, there may be 1 dentist for every professor and dean, he wrote more than 500 articles 1,600 people. In countries with scarcer economic resources, and several books on dentistry, including such as many in Africa and Southeast Asia, there may be 1 den- © Jones & Bartlett Learning, LLC Operative© Jones & Bartlett Learning, LLC Dentistry in 1908. Black stressed the importance of tist for every 119,000 people. To make matters worse, most NOT FORpreserving SALE OR healthy DISTRIBUTION teeth with preventive care, ratherNOT professionally FOR SALE trained OR DISTRIBUTIONdentists in developing countries have than simply waiting to restore them following disease settled in large urban population centers, although many resi- or damage. dents continue to live in distant rural areas.

Inhalation Anesthesia © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC Horace Wells, a ConnecticutNOT FOR dentist, SALE first OR used DISTRIBUTION nitrous NOT FOR SALE OR DISTRIBUTION oxide as an inhaled anesthetic, or painkiller, in 1844. His Dental Facts India discovery revolutionized all surgeries, including dental surgery, which had previously relied on alcohol or opium In many areas of India, toothbrushes made from or other equally troubling and ineffective methods to dull fresh twigs, with the ends frayed into fibers, are pain during© Jones surgery. & Bartlett Learning, LLC favored for ©daily Jones brushing. & Twigs Bartlett are selected Learning, from specific LLC trees according to the season of the year and the individual user’s NOT FOR SALE OR DISTRIBUTION temperament.NOT Most FOR brushes SALE have a bitterOR tasteDISTRIBUTION and an astringent Wilhelm Conrad Roentgen (1845–1923) quality believed to be beneficial to the gingiva. After brushing their Another of the most important discoveries in modern den- teeth, Indians traditionally use a curved silver instrument to scrape tistry occurred just at the end of the 19th century when the the tongue free of accumulated coatings and then rinse the mouth German physicist Willhelm Conrad Roentgen discovered with water combined with specially selected herbs and spices. © Jones the& Bartlettmysterious Learning, x-ray, or radiograph, LLC in 1895. His discovery© Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION

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© Jones & Bartlett Learning, LLC © Jonestooth’s & enamel Bartlett into Learning, the dentin. ALLC light source or heat is NOT FOR SALE OR DentalDISTRIBUTION Facts China NOTused FOR to SALE speed ORup the DISTRIBUTION lightening process. Patients not A longstanding shortage of professionally trained interested in undergoing whitening treatments in the den- dentists persists in China, particularly in rural tal office may instead ask you about commercially avail- areas. As the Chinese government works to increase the number able home whitening treatments. For more information on of university-trained professional dentists, the gap in care in rural tooth whitening, see Chapter 46, Cosmetic Dentistry. areas is filled by young,© specially Jones trained & Bartlett technicians, Learning, known as LLC © Jones & Bartlett Learning, LLC “barefoot dentists.” They NOToffer various FOR kinds SALE of basic OR dental DISTRIBUTION care, Veneers NOT FOR SALE OR DISTRIBUTION including simple restorations, extractions, and treatment of some gingival ailments. They have some medical resources available to Veneers are thin layers of acrylic, composite, or porcelain them, such as anesthetics to kill pain during procedures, but they placed on the outer surface of the teeth to improve their commonly lack x-ray machines and other specialized equipment. appearance or shape. Their placement requires little if any For dental© Jones emergencies, & Bartlett they must referLearning, their patients LLC to large den- removal of ©existing Jones tooth & structure,Bartlett butLearning, may require LLC some tal facilities in major Chinese cities and provincial capitals. NOT FOR SALE OR DISTRIBUTION surface preparationNOT FOR before SALE they are OR bonded DISTRIBUTION in place. Some veneers require routine polishing and regular mainte- nance after they are placed; others are more durable. Resin and porcelain are two of the materials frequently used for To help provide as much access to dental care as pos- veneers. For more information on veneers, see Chapter 38, © Jones sible,& Bartlett some countries Learning, have begun LLC using community health© JonesFixed &Prosthodontics. Bartlett Learning, LLC NOT FORnurses SALE and OR other DISTRIBUTION appropriately trained health care providNOT- FOR SALE OR DISTRIBUTION ers to provide a basic package of oral health care to people Implants regardless of where they live. Ingredients of basic care may Dental implants are a popular method of replacing one include pain relief, fluoride treatments, dental health edu- or more missing teeth. Implants are metal devices surgically cation, and basic restorative treatments to fix caries and placed into the jaw bone and allowed to bond with the broken or damaged teeth.© Jones & Bartlett Learning, LLCsurrounding bone tissue over© aJones period of& 6Bartlett months. AfterLearning, LLC NOT FOR SALE OR DISTRIBUTIONsuccessful bonding, the implantNOT may FOR be SALEused to ORanchor DISTRIBUTION Contemporary Trends in Dentistry in place a single crown, a bridge, or a partial or full denture. For a detailed look at dental implants, see Chapter 38, Patients today are more active participants in their own Fixed Prosthodontics. medical and dental treatment. Many make it a point to keep ©current Jones on &new Bartlett developments Learning, in dental LLC treatment, History of© JonesDental & Assisting Bartlett Learning, LLC especiallyNOT opportunities FOR SALE to ORmaintain DISTRIBUTION oral health and pre- NOT FOR SALE OR DISTRIBUTION vent dental disease from developing in the first place. Before the late 19th century, dentists sometimes hired men Some patients have a particular interest in improving the and boys to assist them in their practices. In 1885, a New appearance of otherwise healthy teeth, or they want to put Orleans dentist, C. Edmund Kells (1856–1928) (Figure 1-5), the finishing touches on restorative dental work by seek- © Jones ing& Bartlettout the latest Learning, techniques LLC in cosmetic dentistry. Cos©- Jones & Bartlett Learning, LLC NOT FORmetic SALE dentistry OR DISTRIBUTIONincludes many techniques and proceduresNOT FOR SALE OR DISTRIBUTION already practiced in dental offices, but begins by examin- ing the patient’s entire oral cavity—including the shape, color, and structure of teeth—and working to improve overall appearance, or aesthetics. Television, advertising, and other visual media ©have Jones a powerful & Bartlett influence Learning, over the LLC © Jones & Bartlett Learning, LLC expectations of many patients.NOT FOR Along SALE with questions OR DISTRIBUTION about NOT FOR SALE OR DISTRIBUTION brushing, flossing, rinsing, and other preventive measures for better dental health, you can expect to answer numerous patient questions about treatment options that have a purely cosmetic or aesthetic purpose. © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC WhiteningNOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION As we age, our teeth may appear increasingly stained or worn. Habits such as drinking tea or coffee and chewing or smoking tobacco can increase this appearance. Whiten- Figure 1–5 C. Edmund Kells, the first dentist to hire female ing, or bleaching, has become one of the most requested © Jones & Bartlett Learning, LLC © Jonesdental &assistants, Bartlett shown Learning, with his assistants. LLC (Courtesy of Bird DL, services provided in dental offices and is often performed Robinson DS. Torres and Ehrlich Modern Dental Assisting, 9 th ed. NOT FORby SALE dental ORassistants. DISTRIBUTION Whitening materials penetrate theNOT Philadelphia, FOR SALE Saunders: OR 2009.)DISTRIBUTION

9781284268133_CH01_001_014.indd 9 19/03/20 8:18 AM 10 PART I INTRODUCTION TO DENTAL ASSISTING

© Jonesbecame & Bartlett the first Learning, dentist to employLLC a female dental assistant.© JonesMedicine & Bartlettin 1869, becoming Learning, the LLCfirst African American to NOT FORThe SALE public ORresponded DISTRIBUTION positively to his decision and otherNOT graduate FOR SALE from ORdental DISTRIBUTION school. From the 1870s until dentists followed his example. The first “lady assistants,” as educational desegregation in the 1950s, most African they were originally known, made it more comfortable and American dentists were educated at traditionally black respectable for women patients to visit a dental practice Howard University in Washington, D.C., or at Meharry Medi- alone. The assistants began by helping with office duties cal College, a private medical school for black physicians in and gradually moved into© Jones helping &dentists Bartlett chairside. Learning, This LLCNashville, Tennessee. © Jones & Bartlett Learning, LLC made it possible for dentistsNOT FOR to increase SALE the OR number DISTRIBUTION of In 1890, Ida Gray becameNOT the FORfirst SALEAfrican AmericanOR DISTRIBUTION patients they saw and the amount of dentistry that their woman to graduate from a U.S. dental college. After her practice could perform. More and more dentists saw the graduation from the University of Michigan’s School of value in employing assistants and began to train their own. Dentistry, she went on to practice dentistry in Chicago In the 1930s, an accepted curriculum to train dental assis- until her retirement in 1928. tants began© Jones to emerge. & Bartlett In 1948, Learning, what is now LLC the Dental © Jones & Bartlett Learning, LLC AssistingNOT NationalFOR SALE Board OR (DANB)DISTRIBUTION was formed to NOT FOR SALE OR DISTRIBUTION recognize the professional competence and qualifications Education in Dental Professions of trained dental assistants. In the 1950s, colleges and other institutions increased the number of programs available to train professional dental assistants. Dentists © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOTTo FOR practice SALE dentistry OR DISTRIBUTION in the United States, a dentist must History of Dental Hygiene graduate from an accredited dental school approved by the American Dental Association’s (ADA) Commission on Den- A dental assistant in Connecticut was the first person tal Accreditation (CODA). Dental education accreditation to be trained as a dental hygienist. In the early 1900s in began in the early part of the 20th century and is intended Bridgeport, Irene Newman© Jones began &to Bartlett provide preventiveLearning, LLCto ensure the quality and ©continuous Jones &improvement Bartlett Learning, of LLC care services under theNOT supervision FOR SALEof Dr. Alfred OR C.DISTRIBUTION Fones, dental and dental-related educationNOT FOR in the SALE United OR States. DISTRIBUTION who wanted to allow time in his practice for other pro- Typically, a dentist completes an undergraduate education cedures. Dr. Fones went on to found the School of Dental and goes on to study at a dental school, which includes Hygiene that bears his name at the University of Bridgeport both coursework and clinical practice on patients. When in 1913. Irene Newman became the first licensed dental the dentist graduates, he or she receives either a doctor hygienist© Jones in 1917. & Bartlett Learning, LLC of dental surgery© Jones (DDS) & orBartlett a doctor Learning, of medical dentistry LLC NOT FOR SALE OR DISTRIBUTION (DMD) degree.NOT Many FOR dentists SALE go onOR to DISTRIBUTIONadditional specialist training. In addition to these requirements, dentists need Women and Minorities in Dentistry to take and pass a national written exam and written and Though women in the 18th century and early 19th cen- clinical exams in the states in which they plan to practice. tury were not allowed to formally study for a career in den- After obtaining a license to practice, most dentists go © Jones tistry,& Bartlett they nonetheless Learning, found LLC ways to enter the profession© Jonesinto general & Bartlett dentistry Learning, where they LLC handle a wide variety NOT FORand SALE paved ORthe wayDISTRIBUTION for the nearly 50% of dental studentsNOT of FOR situations SALE and OR patients. DISTRIBUTION Other dentists choose to spe- today who are women. cialize in one of nine specialties. For more information Emeline Roberts of Danielson, Connecticut, was the about dental specialists, see Chapter 3, The Dental Office Additional coursework and written and practical first woman to practice dentistry in the United States. Team. After observing her husband practice dentistry, she stud- © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC ied basic science on her own and, in 1859, became her From the Dentist’s Perspective husband’s partner in hisNOT dental FOR office. SALE Upon OR his DISTRIBUTIONdeath in NOT FOR SALE OR DISTRIBUTION 1864, she took over his practice, supporting herself and I’ve been practicing for 10 years, and every year my her small children, and continued practicing dentistry for practice gets busier. New families move into town. My colleagues the next 60 years. retire and refer their patients to me. I’m glad, but it does keep me Lucy B. Hobbs-Taylor originally apprenticed with a male busier than I expected. I know one thing: I could not do everything dentist© in Jones Cincinnati, & Bartlett Ohio. She Learning,later established LLC two dental I do without© my Jones terrific staff. & JustBartlett last year ILearning, hired a new dental LLC assis- practicesNOT of FORher own. SALE She remained OR DISTRIBUTION determined, however, tant, Daniel.NOT He graduated FOR SALEfrom the ORprogram DISTRIBUTION at our community to enroll as a student at the Ohio College of Dental Surgery. college, got an associate degree, and passed his Certification Exam to become a certified dental assistant. He is wonderful with the Despite many obstacles, she persisted in her efforts and patients and really great with all of us here in the office. I can really finally graduated in 1866, the first woman in the world to see the difference from other assistants I hired over the years. graduate from a dental school. © Jones & Bartlett Learning, LLC © JonesWhen & I started Bartlett out, I wanted Learning, to train my LLC own assistants. I felt I could Robert Tanner Freeman earned a doctor of medical den- do a better job of letting them know what I needed. It did not turn NOT FORtistry SALE degree OR from DISTRIBUTION Harvard University’s School of DentalNOT FOR SALE OR DISTRIBUTION

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© Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FORout SALE that way. OR I just DISTRIBUTION did not have enough time to do a good job. NOT FOR SALEVoice OR of DISTRIBUTION Experience Sometimes I skipped over the most important details, just because I thought I had already gone over them. Daniel came prepared. The best part of my job is meeting people. Sometimes He completed the practical experience he needed for his degree that is the most challenging part, too, but it is always at a big clinic downtown. He saw everything there and worked interesting. My patients come from all over the country with children, older adults, people from other countries, people and all over the world. No matter where they are from, with less money, people with© Jones more money. & BartlettHe is comfortable Learning, with LLCI try to see them all as individuals.© I tellJones myself I& am Bartlett helping to treatLearning, LLC everyone and really knowsNOT how to FOR get people SALE to open OR up DISTRIBUTIONand talk somebody’s grandmother or somebodyNOT FOR else’s dad.SALE When OR I work DISTRIBUTION with him. He knows what to expect and how to prepare for each with people from another country, who are new to my town, I try to type of procedure I do. I always know he will have everything ready make them as comfortable as possible. I do not ask endless ques- before we start. He also keeps up on things. Last time he brushed tions about where they are from and what the government is like up on his Continuing Education credits, he got to use what he had there, for example. I do not ask them about their accents. But I do learned© rightJones away when& Bartlett I worked onLearning, a patient who LLC had recently try to find out© Joneshow they feel& Bartlettabout their teeth, Learning, how they takeLLC care of them, and whether they have pain and where. I try to find out gone NOTthrough FOR a whole SALE series ofOR cosmetic DISTRIBUTION procedures at another NOT FOR SALE OR DISTRIBUTION office. Daniel got the best training he could and set out to succeed how they brush their teeth, whether they floss, and if they are com- at his job; he helps all the rest of us at the office succeed, too. fortable with mouthwash and what they use. I have gotten some strange answers from people, believe me. One person told me he preferred to keep brushing his teeth with the twigs and sticks he had grown up using. He did not like plastic and synthetic bristle © Jones examinations& Bartlett areLearning, required for LLC dentists to specialize in any© Jonestooth &brushes. Bartlett They feltLearning, too big and clumsyLLC in his mouth and he NOT FORof SALEthese areas. OR DISTRIBUTION NOT FORmissed SALEthe bittersweet OR tasteDISTRIBUTION of the wood twigs. I selected a smaller Dentists today are more involved than ever with their toothbrush for him that fit his mouth better and suggested he might patients’ overall general health. While treating the gingiva like to try an herbal-flavored toothpaste. Whatever people tell me, I and teeth, many detect early signs of other health con- try to make them comfortable enough so that they’ll tell me more. When I suggest ways they could improve their care, I do it quietly ditions that require referral to a physician. Dentists may and calmly. Working together, we can both feel more at home. employ dental assistants,© dentalJones hygienists, & Bartlett and dental Learning, labo- LLC © Jones & Bartlett Learning, LLC ratory technicians in theirNOT offices. FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION

Dental Assistants Dental Hygienists Most dental assistants acquire their training in community© college, Jones trade & Bartlett school, or Learning, technical institute LLC training Dental hygienists© Jones provide& Bartlett preventive Learning, dental LLCcare by programs.NOT Some FOR dental SALE assistants OR areDISTRIBUTION trained in schools asso- removing calculus,NOT FOR stains, SALE and plaque OR DISTRIBUTIONfrom teeth, and by ciated with the armed forces. ADA’s CODA accredits more teaching patients about good oral hygiene. Additional than 260 formal training programs across the country. An responsibilities can include developing dental radiographs, accredited training program for dental assistants includes applying fluoride treatments, and performing other patient both classroom and laboratory instruction in dental assist- care tasks. © Jones ing& Bartlettskills. Students Learning, also gain LLCpractical experience in dental© JonesIn nearly& Bartlett all states, Learning, dental hygienists LLC become licensed NOT FORoffices, SALE clinics, OR DISTRIBUTIONand schools before they graduate. CompleNOT- by FOR graduating SALE from OR aDISTRIBUTION dental hygiene program accredited tion of a 2-year program at a community or junior college by the ADA’s CODA, and passing written and clinical exam- may lead to an associate’s degree; most schools, including inations. Most accredited programs, such as many at junior trade schools and technical institutes, offer a certificate or or community colleges, lead to an associate degree. Others the ability to obtain licensure. Regulations regarding pro- lead to a certificate or a bachelor’s degree. Some lead to a grams and degrees differ© byJones state, so& beBartlett sure to checkLearning, the LLCmaster’s degree. Graduates of© 2- Jones and 4-year & Bartlettprograms whoLearning, LLC regulations in your area.NOT Students FOR may SALE search OR for DISTRIBUTION dental successfully complete theirNOT licensing FOR examinations SALE OR useDISTRIBUTION assisting programs accredited by CODA at www.ada.org/ the title registered dental hygienist (RDH) after their name prof/ed/programs/search_index.asp. (some states use the title LDH, which stands for licensed dental hygienist).

© Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC American Dental Association Dental Laboratory Technicians CommissionNOT FORon Dental SALE Accreditation OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION 211 East Chicago Avenue Dental laboratory technicians, also known as den- Suite 1900 tal technicians, provide support to dental practices by Chicago, Illinois 60611 filling prescriptions from dentists for crowns, bridges, telephone: 800-621-8099 or 312-440-4653 dentures, and other dental prosthetics. They customize © Jones &e-mail: Bartlett [email protected] Learning, LLC © Joneseach prescription& Bartlett accordingLearning, to modelsLLC of the individual NOT FOR SALE OR DISTRIBUTION NOTpatient’s FOR SALE oral cavity, OR DISTRIBUTION bite, and adjoining teeth. Dental

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© Jonestechnicians & Bartlett are Learning, skilled artisans LLC whose work is detailed© Jones & Bartlett Learning, LLC NOT FORand SALE demanding. OR DISTRIBUTION They may work for individual dentists orNOT FORCertification SALE OR DISTRIBUTION for dental laboratories. Some technicians train in business and management and go on to establish their own dental Dental assistants who have graduated from an ADA- laboratories. accredited educational program, or those who have com- Formal training to become a dental technician varies pleted 2 years of full-time or 4 years of part-time work greatly in length and in© theJones level &of Bartlettskill acquired. Learning, Train- LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTIONexperience as a dental assistant,NOT may FOR apply SALEto take the OR certi DISTRIBUTION- ing programs are available through community and junior fication examination to become a certified dental assistant colleges, vocational-technical institutes, and through the (CDA) or certified orthodontic assistant (COA). Successful armed forces. Some programs are accredited by CODA. completion of the certification examination, given by the These programs combine classroom and laboratory instruc- DANB, recognizes the dental assistant’s qualifications and tion with supervised practical work experience. Becom- professional competence. More than 30 states recognize or ing a fully© Jones trained &dental Bartlett technician Learning, may take LLC 3 to 4 years, © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION require DANBNOT certification. FOR SALE Some OR states DISTRIBUTION allow dental assis- but more on-the-job experience is required to become an tants to perform special expanded functions in the dental accomplished technician. Dental laboratory technicians office, such as taking radiographs and performing other spe- seeking credentials to reflect their qualifications and pro- cial procedures. These special tasks can only be performed fessional competence take and pass an examination to by dental assistants who have completed additional train- become certified dental technicians (CDTs). © Jones & Bartlett Learning, LLC © Jonesing and & passedBartlett a certificationLearning, examination.LLC Some states NOT FOR SALE OR DISTRIBUTION NOTalso FOR require SALE the ORdental DISTRIBUTION assistant to obtain a license from the state radiological board or equivalent to perform additional procedures. Requirements and expanded functions Professional Organizations vary from state to state. DANB administers examinations that qualify dental assistants to perform these expanded functions according to the regulations in their home state. Founded in 1859, the American© Jones &Dental Bartlett Association Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTIONFor a list of requirements andNOT allowed FOR functions SALE forOR your DISTRIBUTION (ADA) is the world’s largest and oldest professional state, visit www.danb.org/main/statespecificinfo.asp. organization dedicated to dentistry and dental health All applicants for DANB certification must hold and issues. Made up of dentists from all over the United States, maintain up-to-date certification in cardiopulmonary the group works to advance professional standards and resuscitation (CPR). After successful completion of the to promote good oral health practices for the public. examination, they must also complete Continuing Educa- Involved© Jones in the testing & Bartlett and rating Learning, of dental products,LLC the © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION tion creditsNOT each yearFOR to SALEqualify forOR annual DISTRIBUTION recertification. ADA awards a seal of approval to items that it considers Certification examination schedules and other information safe and effective. The ADA is also involved in establish- are available at www.danb.org. ing educational standards for dentists and other dental professionals. In addition, the group produces a monthly publication called the Journal of the American Dental Check Your Ethics © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC Association. For more information, go to the ADA’s web- You are assisting the dentist while he performs a radiographic pro- NOT FORsite SALE at www.ada.org. OR DISTRIBUTION NOT FORcedure onSALE a patient. OR The DISTRIBUTIONpatient is correctly positioned, and the den- The American Dental Assistants Association tist is getting ready to take the radiograph when he is interrupted by (ADAA) is the oldest and largest organization in the the news that a patient has arrived who needs emergency dental United States representing professional dental assistants. It care. The dentist asks you to finish taking the radiograph. You’ve promotes the advancement of the profession in matters of been taking a class in radiography, and you know exactly what to education, legislation, credentialing,© Jones & and Bartlett professional Learning, activ- LLCdo, but you also know that state ©law Jonesprevents you & fromBartlett performing Learning, LLC ities and seeks to enhanceNOT the FOR delivery SALE of qualityOR DISTRIBUTION health this procedure without certification.NOT FOR SALE OR DISTRIBUTION 1. What would you do? care to the public. Statewide chapters exist in many states. 2. How do you explain your actions to the dentist? See Chapter 2, Professionalism, for more information about 3. What are the possible consequences if you perform the the ADAA and its role in the education and professional procedure? development of dental assistants. The© AmericanJones & BartlettDental HygienistsLearning, AssociationLLC © Jones & Bartlett Learning, LLC (ADHA)NOT is FORthe largest SALE professional OR DISTRIBUTION organization repre- NOT FOR SALE OR DISTRIBUTION senting the interests of dental hygienists. It offers profes- CHECKPOINTS sional support and educational programs to advance the 41-4 Name the division of the American Dental Association art and science of dental hygiene and to promote the responsible for accrediting dental education programs. highest standards of education and practice in the profes- © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC sion. Publications and other information are available at 1-5 What does “DANB” stand for? NOT FORwww.adha.org. SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION

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✦ Dentistry is one of the world’s oldest medical arts. Some veneers, and implants are among the techniques used in early dental practices were strikingly similar to our own, this branch of dentistry. including rinsing the© mouth Jones and & using Bartlett a toothbrush. Learning, LLC ✦ In the 19th century, dentists© Jones began hiring & Bartlett assistants Learning, to LLC ✦ The Egyptian physician Hesi-Re is believed to be the help them in their practices. By the 1930s an accepted first dentist. NOT FOR SALE OR DISTRIBUTIONcurriculum to train dentalNOT assistants FOR began SALE to ORemerge. DISTRIBUTION ✦ The ancient Greek physician Hippocrates developed In 1948 what is now the Dental Assisting National many concepts that are fundamental to medical prac- Board (DANB) was formed to recognize the profes- tice today, including patient confidentiality and the ethi- sional competence and qualifications of trained dental cal ©obligation Jones to& do Bartlett no harm. Learning, LLC assistants.© Jones & Bartlett Learning, LLC ✦ Early Roman dentistry combined the medicine of the ✦ Dentists must pass written and practical licensing GreeksNOT with FOR the SALErestorative OR dentistry DISTRIBUTION of the Etruscans. examinationsNOT and FOR have SALE a degree OR from DISTRIBUTION a dental school Among the many advances during this time were the accredited by the American Dental Association’s (ADA) classification of teeth, the invention of the dental drill, Commission on Dental Accreditation (CODA). and the use of narcotics to ease dental pain. ✦ Most dental assistants acquire their training in commu- © Jones & ✦ InBartlett Europe inLearning, the 10th century, LLC barbers took over the© Jonesnity & college, Bartlett trade Learning, school, or technical LLC institute training practice of surgery. Known as barber surgeons, these programs. Dental assistants who have graduated from NOT FOR SALEpractitioners OR DISTRIBUTIONincluded tooth extraction among theirNOT FORa program SALE accredited OR DISTRIBUTION by the American Dental Associa- medical duties. tion, or those who have completed 2 years of full-time ✦ In the Renaissance period, beginning in the 16th century, or 4 years of part-time work experience as a dental assis- European physicians and dentists returned to the respect tant, may apply to take the certification examination to for science and learning© Jones that had & Bartlettcharacterized Learning, earlier LLCbecome a certified dental© Jonesassistant &(CDA) Bartlett or certified Learning, LLC periods and civilizations. Their careful observations of orthodontic assistant (COA). medical and dental techniquesNOT FOR brought SALE many OR new DISTRIBUTION ideas ✦ In nearly all states, dentalNOT hygienists FOR become SALE licensedOR DISTRIBUTION to preventive care and innovations to dental surgery. by graduating from a dental hygiene program accred- ✦ In the United States, dentistry as we know it today began ited by the American Dental Association’s (ADA) Com- to take shape in the early part of the 19th century. The mission on Dental Accreditation (CODA) and passing first© Jonesprofessional & Bartlettorganization Learning, for dentists LLC was founded, written and© Jones clinical examinations.& Bartlett Learning, LLC and the first dental college was established. The use of ✦ Formal training to become a dental technician var- nitrousNOT oxide FOR as SALEa painkiller OR andDISTRIBUTION discovery of the x-ray ies greatlyNOT in length FOR andSALE in the OR level DISTRIBUTION of skill acquired. further advanced the practice of dentistry. Training programs are available through community ✦ Dental care and oral hygiene practices vary widely and junior colleges, vocational-technical institutes, and around the world. Basic preventive care, such as clean- through the armed forces. Dental laboratory techni- ing and regular examination, is not available everywhere. cians can take an examination to become certified den- © Jones & GettingBartlett access Learning, to dental LLC care is harder in countries© Jonestal technicians& Bartlett (CDTs). Learning, LLC NOT FOR SALEwhere theOR number DISTRIBUTION of dentists is very low compared toNOT FOR ✦ Professional SALE ORorganizations DISTRIBUTION in the field of dentistry the number of residents. include the American Dental Association (ADA), ✦ Cosmetic (or aesthetic) dentistry emphasizes improving American Dental Assistants Association (ADAA), and the the appearance of otherwise healthy teeth. Whitening, American Dental Hygienists Association (ADHA). © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION

Review Questions © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC 1. TheNOT first FOR known SALE dentist, OR Hesi-Re, DISTRIBUTION lived in 2. Which NOTof the followingFOR SALE tasks ORis the DISTRIBUTION responsibility of a a. Ancient Rome. dental lab technician? b. Ancient Greece. a. Making crowns c. Ancient Egypt. b. Polishing teeth © Jones & Bartlettd. Medieval Learning, Paris. LLC © Jones c. &Removing Bartlett calculus Learning, from teeth LLC NOT FOR SALE OR DISTRIBUTION NOT FORd. Processing SALE OR test DISTRIBUTION results

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© Jones &3. BartlettThin layers Learning, of acrylic, composite, LLC or porcelain used to© Jones c. &Inhalation Bartlett anesthesia Learning, and the LLC radiograph. NOT FOR SALEcover the OR fr ontDISTRIBUTION surface of stained teeth are called NOT FORd. Amalgam SALE ORrestorations DISTRIBUTION for dental caries and tooth- a. Sawiks. brushes with synthetic bristles. b. Veneers. c. Lacquers. 8. Which of the following has the least effect on access d. Bleachings. © Jones & Bartlett Learning, LLCto dental care in developing© Jones countries? & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION a. The number of residentsNOT ver susFOR dentists SALE available OR DISTRIBUTION 4. The first toothbrush as we know it today, with bristles b. Whether dentists tend to reside in the cities or the sideways to the handle, was invented in the 1490s by countryside a. The Italian explorer Marco Polo. c. Whether trained individuals other than dentists can b. ©The Jones Japanese. & Bartlett Learning, LLC provide© Jonesbasic car &e Bartlett Learning, LLC c. NOTThe Chinese. FOR SALE OR DISTRIBUTION d. The attitudesNOT FOR of traditional SALE ORhealers DISTRIBUTION toward profes- d. Renaissance artists. sionally trained dentists

5. Albucasis, one of the best known physicians of Spain 9. Which of the following is not used to speed up the © Jones & Bartlettand the Islamic Learning, world, believed LLC that the accumulation© Jonesprocess & Bartlett of tooth Learning, whitening? LLC of tartar on the teeth was a major cause of NOT FOR SALE OR DISTRIBUTION NOT FORa. Lasers SALE OR DISTRIBUTION a. Discoloration of the teeth. b. Low-intensity heat b. Gingival disease. c. Sealants on the surface of the teeth c. “Toothworm” infestation. d. High-intensity light d. Mouth sores. © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION 6. A primary role of a dental hygienist is 10. In addition to graduation from an accredited program in dental assisting, a certified dental assistant (CDA) a. Removing calculus from teeth. must have completed b. Designing dentures. a. 50 hours of community service in a neighborhood c. Updating patient records. © Jones & Bartlett Learning, LLC dental© c Joneslinic. & Bartlett Learning, LLC d. NOTAssessing FOR a patient’s SALE bite.OR DISTRIBUTION b. The certificationNOT FOR SALEexamination OR administeredDISTRIBUTION by the Dental Assisting National Board (DANB). eries of the 19th cen- 7. The two most important discov c. The certification examination administered by the tury to impact the practice of modern dentistry were assistant’s home state. a. Fluoridation of water and fluoride toothpastes. d. Additional training in one of the nine dental © Jones & Bartlettb. The invention Learning, of Nov LLCocaine and the rubber dental© Jones &specialties. Bartlett Learning, LLC NOT FOR SALEdam. OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION

Active Learning Exercises Application Activities © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC 1. Make a list of the professionalNOT FOR dental SALE organizations. OR DISTRIBUTION 1. Visit the website for the DentalNOT AssistingFOR SALE National OR Board DISTRIBUTION Identify each organization’s founder and which pro- (DANB) to gather what information you can about fession’s members belong to each organization. Are your state’s requirements for dental assistants. List the these organizations still operating today? dental assisting job titles that are available in your state and write a short summary listing the requirements for 2. Go© onlineJones and & research Bartlett the Learning, necessary credentials LLC for obtaining© Jonesa license &in eachBartlett of the Learning,positions. LLC atNOT least fiveFOR surrounding SALE OR states. DISTRIBUTION Identify and list the NOT FOR SALE OR DISTRIBUTION requirements for Registration, Certification, Licensure 2. Select one of the professional organizations discussed or other credentialing. in the chapter and locate several journals or other items published by the organization. Read the material and 3. What role does the dental laboratory technician write a paragraph or two summarizing what you’ve play with regard to the dental office? Locate several learned. Be sure to consider how the organization could © Jones & Bartletttechnicians Learning, in your area LLC and find out if they work © Jonesbe & used Bartlett to expand Learning, your career opportunities.LLC Be prepared NOT FOR SALEindependently OR DISTRIBUTION or within a dental office. NOT FORto discuss SALE your OR findings DISTRIBUTION during the next class period.

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