 Hello everybody, Andrea Majeski here with Dental Tutoring. I had just uploaded a video of What every new dental assistant is thinking you're not alone. So if you haven't seen that yet I do talk about how you know You kind of feel like a fish out of water as soon as you leave your you know college And then you have to start in the real world in a dental office. You're probably thinking oh my goodness Please don't ask me any questions all of these instruments. I still haven't memorized How am I going to be 10 steps ahead? Because in school they probably tell you over and over and over again for any procedure The dental assistant is expected to be 10 steps ahead and always know what the dentist is thinking to pass them that Instrument or those materials next, but they will not expect that from you So I do kind of talk about that a little bit in the in the video that I had just uploaded So if you haven't seen that check it out But I am also here to help you guys be 10 steps ahead and to kind of give you an idea of what the dentist will be asking for Especially if you have to set up your own trace Hopefully you will have a dental assistant at least for the first couple weeks set up the trace for you and train you that way because I Remember I remember when I was a dental assistant I had taken over for the past assistant who went on maternity leave early So they didn't expect her to leave that soon I don't even think she had her baby yet, but she had to be in the hospital or something So they were looking for a dental assistant ASAP and I was new like fresh out of school I felt like I knew nothing to be honest and there was nobody there to train me because That dentist only had the one assistant So I kind of had to learn things on the fly, but that will not be you You will hopefully have somebody to show you so I want to talk to you guys about the composite trace set up Okay, keep in mind, please that depending on the office things might be a little bit different But if you have all of this on your tray, you're in good shape And I know it's it's blurry hard to see so that's why I'm going to go through everything with you Okay So let me first say for a for a composite tray set up This is when basically you see on the on the chart that the patient has a cavity that that needs to be fixed If your dental office does amalgam then you might be doing an amalgam instead of a composite So hopefully it will be specific on the tray what you'll be doing if it's composite or amalgam So this is for a composite tray set up Um in the offices where I work at now. We don't even use amalgam It's just something that nobody seems to want so it would always be composite anyway so What's not shown here Would be the local Anesthetic so if the patient needs the the the area numb which they normally would unless it's such a tiny cavity That the dentist tells you that local anesthetic is not needed So what's not seen here is you will need the topical anesthetic You will need a q-tip for the topical you will need the anesthetic syringe You will need the needle that is being used So if if the dentist is freezing the teeth on the top You will have out a short needle if the dentist is freezing the teeth on the bottom You will have out a long needle And I would always put out at least two carps Of the anesthetic that they want sometimes offices have like literally 10 different ones So just ask the um ask the dentist what carp they want to use Um because it could be lidocaine. It could be anything So I find that dentists have their own preference for certain carps So make sure to add that um on your tray set up to usually I leave it off to the side And on the dentist's side so that they can set it up how they want it, but everybody's different Sometimes they would have it on the assistant's side And you would prepare the syringe ahead of time So you would put the needle in the syringe You would put in the carp after that and then you would pass The syringe to the dentist under the patient's chin not you know over here not behind the head But under the patient's chin Some dentists prefer the syringe to be passed behind the patient's head Um, they're not going to be that picky like I don't see you passing it. Let's say under the chin And the dentist says, uh, what are you doing? That's supposed to be passed behind the head. No They just might say something to you afterwards like oh, if you could please pass that behind the patient's head from now on Or please make sure to pass it under the patient's chin from from now on. They're not going to be that picky Um, typically the dentist will apply the topical for a minute or two And then so always pass them the topical first So I would put the topical on the q-tip and then pass that to them You know, they will apply the topical and then pass them Take the topical from them and then pass them the syringe after that um, I always suggest having the air water ready and the uh, the slow speed suction to give the pace To give the patient a rinse in that area afterwards because it doesn't taste very good Um after they give them the needle sometimes they have the patient set up Sometimes they prefer to have the patient laid down Every dentist is different, but typically they will give the patient a couple minutes to allow Um the freezing to take effect That is when the dentist will probably leave the room to do a check for a hygiene patient To maybe take some notes and then they will come back after that You should always stay in the room with the patient. This is not the time to be Leaving the room talking to your co-workers You know setting up for the next patient. I mean, I'm not saying that's bad But the patient's probably nervous I I I always say that you should stay in the room with the patient And what if they have a medical emergency and you leave the room you won't be there to help them, right? So stay in the room and then you will likely have to tell the dentist when the patient says Yeah, I'm starting to feel pretty numb So you might have to ask the patient after a couple minutes like oh If they froze on the top say oh is your lip starting to feel numb there and they might go no Well, then wait a couple minutes or they might go yet starting to feel numb They won't feel it as much on the top They will be numb But they won't feel it as much as on the bottom On the bottom if the patient's being frozen they will likely say oh, yeah I'm I'm starting to feel pretty numb And they might talk a little bit funny. They look exactly the same, but it does feel a lot more numb on the bottom Okay, so let's walk through the procedure here I'm sorry. I wish I had some water, but I think I left it downstairs So the dentist may apply the rubber dam. So this isn't shown either Because sometimes they use the rubber dam sometimes they don't The dentist will let you know I have a separate video on how to apply the rubber dam and how to punch it So if you need help let me know, but let's just say they're not using the rubber dam So what they will need to do first is take out the cavity They might even check to make sure that the tooth is numb first But typically what they want to do next is take out the cavity So you would be giving them the high speed handpiece and they will choose a burr of their choice Now these are really hard to see and every dentist is different So I don't like to tell you guys what burr that they're going to use because I find every dentist is different But they will use the high speed to take out the cavity first So you will have to have ready the high speed suction Sometimes they want you to hold the mirror to help hold the cheek back They they might prefer to hold the mirror themselves Um, and then you would just have to have the high speed suction in your hands So every dentist is different things like this you will learn But the next thing to pass them will be the spoon excavator, which isn't on here I just realized that you guys let me go find a picture really quick of that one moment There everybody's sorry. So I just realized that the spoon excavator isn't on here So this is what the spoon excavator looks like this right here So this is obviously a much larger image But this is what it looks like and that is used after the high speed Sometimes after the slow speed to to help to take out the rest of the cavity Sometimes they can take it it all out with the high speed and the slow speed But sometimes they can't so they might be asking you to pass them the spoon excavator and have the Have a gauze in the other hand to help to catch or to help to wipe off the instrument if they need it So after they remove the cavity, let me think here let's say They let's say the cavity is an is an mo a deal You know something where the cavity is interproximal. So you would have to set up The toffel meyer and a matrix band as well Sometimes the dentist likes to set that up. Sometimes they want you to So you would set up the toffel meyer, which here is called the retainer and a matrix band For whichever side you need it on the left side or the right side. I do have another video showing that So if you need help, let me know So you would set that up for them and then pass it to them and they would put it on the tooth The wedge is afterwards Some dentists like to put the wedge in first to open up that space And then they take the wedge out and then they want you to pass them Um the um the matrix band with the toffel meyer But just to keep it simple the wedge would go afterwards. Okay So pass them the toffel meyer and the matrix band. They would put it on, you know tighten it up Um, and then they would put the wedge. Let's say it's for the mo They would put the wedge on the mesial say it's for the do then they would put the um the wedge on the distal If it's a if it's an mod then they will need to So the wedges um The wedges Are for the interproximal area. So does that make sense Sometimes they might want you to pass them the burnisher after that to kind of burnish the band around the tooth So keep that in mind as well. They might want to do that They will look to make sure that it is seated properly If they're, you know, happy with it, then it's time to get started before I forget The shade guide Some dentists do check the shade before they take the cavity out. So before they cut into the tooth Not a lot of dental offices do that because all of the shades are pretty average like for our office We pretty much use the shade a two for everybody if the teeth are quite light Then we might pick a one if the teeth are darker, then we might pick a three but we don't really worry about it too much because You can't really tell anyway, but that's just why the shade guide is there in case they do have different colors Different color composite and that they want to pick the perfect shade, which why not? But these days they just don't worry about that too much So once everything's placed the toffle mire with the matrix band The dentist will want to rinse and dry the tooth well to make sure it's as clean as possible Then you will want to patch the um pass them the edge So that is used so you would pass that to of course the dentist They would um um edge all inside the tooth They would leave the edge there for about 30 seconds So you just kind of have to look at each other for 30 seconds And then take out the high speed suction take out the water and then you will probably be in charge of Rinsing the edge off. I put the high speed suction over the the tooth completely And then try to rinse. I'm sorry. I thought I heard something and then try to rinse like under this suction So you're covering the tooth as much as possible because you don't want the edge To hit their lips cheeks tongue anything. So hopefully that makes sense So just put that high speed suction over the entire tooth lift it up a little bit So you're able to get the air water syringe in there to Blast the water and then dry the tooth really really well The dentist might prefer to dry the tooth the dentist might prefer to rinse also And then you would just be in charge of the high speed suction but just to give you guys an idea After the edge is the prime and the bond So let's say you have a separate prime and bond The well that you see here you would put about let's just say one drop of primer And one drop of bond in each of the separate wells Sometimes one drop sometimes two drops. I don't know but I just always think less is is more Why put in two if you don't need to if they need more just put another drop it right So I would put a drop of primer in a drop of of the bond Sometimes prime and prime and bond are mixed in so you only have the one Well, but let's just say they're separate because that's more common So you would have the well in your hand and then you know Move that over to the dentist and give them a micro brush So then they're able to dip it in And then they put it on the tooth primer is first Sometimes they will put the primer in and then you will have to air dry just a little bit Sometimes they want you to air dry sometimes not when they feel like there's enough primer They will want to take another micro brush for the bond So they will put the micro brush in the bond Put it of course on the tooth or in the tooth the same area And then light cure, which is not seen here. You guys sorry the um the curing light is not shown here But light cure for usually about 20 seconds So you want to hold that curing light over that tooth, okay? Not all the way over here not all all the way over there But on top of that tooth so it is actually being light cured You don't have to touch the tooth, but be very very close to it Um, and that's it sometimes they might want to put more primer bind sometimes not it really does depend But I should mention to always keep an eye on the patient saliva If they have a lot of saliva you might even have to hold that High-speed suction or the saliva ejector in there the whole time to keep the saliva off If you're not using the rubber dam because No saliva can get anywhere near the tooth or the compass it will not work So after the primer the bond it's been light cured You would hand them the composite gun with a material So the material goes in here Um, it just sort of snaps in or sometimes you have to push it in depending on the type of gun that's being used And the shade depends on what shade they want to use So you would pass them the gun with the composite in there and move that composite tip Towards the two fats being worked on if that makes sense. So, you know, think about it Let's say you're working on the upper left hand side You want to pass them the gun and the composite tip is pointed up because it's the upper left hand side You don't want to pointing down because then when you pass the gun to the dentist They they take it and then they'll probably have to move it and then which is not the end of the world But it just shows what an amazing assistant you are if you have the composite I guess tip in the right position if that makes sense So composite they will put in the composite the the layers of composite go in a little bit at a time It is called in increments, which you probably learned for the board exam, right? One millimeter to two millimeter increments. So very very little some dentist out there just put in the whole thing No, hopefully you do not work for somebody like that because the composite Will not turn out well at all. So hopefully they are putting it in increments So what I mean by that is that you will have to pass them that several times So you will pass them the composite they will put a little bit in Then you would likely pass them the condenser. So this is what the condenser looks like I'll make it a little bit larger for one second This is what the condenser looks like right here, you guys So I have some other pictures kind of in the way But this is what the condenser looks like you would pass them that because they have to condense the composite Into the cavity prep depending on how large that cavity prep is it might take time Because the composite does have to go in increments. You would pass them the gun They would put the composite in they would probably pass you back the gun and then you would give them the condenser They would condense it in then you would either cure that for them or pass them the curing light and then they would cure it themselves For about 10 to 20 seconds depending on what the dentist wants to do and then just keep that up pass them the composite Um, they would put the the sorry pass some of the composite guns They will put the composite in pass them the condenser, you know And then you would like here. So you have to go through that until the tooth looks like a tooth again Sometimes when it's almost at that point of the tooth being Full of composite they might want to use the ball burnisher at the end This so I have two different images of a ball of burnisher. Actually This is called an acorn burn. Oh, sorry guys. This is called an acorn burnisher right here See that so some offices will have this It's a acorn burnisher. So it just means a different way of Of finishing off the composite to make it look nice. This is a ball burnisher This is what I find most offices have so it's just there's a little ball at the end and it just helps to kind of carve or Smooth out the amalgam a little bit nicer I'm a restorative hygienist and what I like to do when I'm doing the composite filling Is I will use the burnisher at the end, but then I will also Place some of the bond On my burnisher to smooth it out a little bit more and then and then I will ask the assistant to let cure that I don't know if everybody does that though That's just what my dentist had taught me to do and it just always makes it look so much nicer But if the dentist doesn't ask you to put the burnisher in the bond Don't because then they'll be like, what are you doing? So don't do it unless they ask you to I don't know But just a little tip for you guys. Um, and then of course light care and then that's it So when they feel that it looks the way they want it to Then they have to check with the articulating paper. So they will Have the patient um grind from side to side. That's what I say So I so you would pass that to the the dentist. They will put the articulating paper and the holder in um They will have them tap tap tap And then grind from side to side And then they will look at that too to see if there's any high spots if they're If there are which there usually is um, they would take the high speed and usually a football shaped bur Actually, let me find you that burr because that's probably one that you will use. So one moment Okay, guys, sorry about that. So this is actually a football diamond burr So you might not want to give them a diamond burr unless they ask for it Sometimes it's just like a normal football shaped burr. So this is the shape of it Um, but it won't be as coarse. So depending on what type of office But this is what they will use to polish it up and to carve down any of the high spots So I'm just going to make this smaller just what looks just so I can continue on for you guys So they will do this several times So they will take a high speed with the football burr Polish it up and then check with the articulating paper because you don't want to over polish or take away too many spots on the teeth So they will take away a little bit check with the articulating paper again And then polish it down more check with the articulating paper again polish down more until they are Absolutely happy with how it looks And the patient says yep things feel pretty good And that's where it can get tricky if the patient's been numb They might not be able to feel if it's good or not So it's it's pretty much up to the dentist to be able to tell if it's high or not Always tell the patient, you know, wait until tomorrow If anything feels high let us know because you're not able to tell us if it feels okay to you now Because you're still pretty numb, but if it feels high Come back let us know he just he or she just has to polish it up for 10 minutes and then you're all set So that is your composite procedure you guys. Um, that was probably a longer video. Sorry, but I wanted to go through everything If you have questions, let me know If you're still a student and this is probably seeming very overwhelming to you Have it have a look at the dental assisting board exam prep academy I go through all of this with you So you don't have to be so overwhelmed Starting in the office because I go through everything with you step by step and I am always here to help So this was the composite tray setup procedure Now you will all be experts. Okay experts. Um, oh, you know what? I kind of forgot something you guys Well, I didn't really forget but what I shouldn't mention was Sorry guys what I should have mentioned so go back to when the dentist is filling up the tooth with composite Once it's it's full They will want to take off the tall The tuffle mire and the matrix band the wedge actually usually comes off first So they will take off the wedges with Either called the cotton pliers or the forceps same thing, but just different names Um, they will take out the wedge and then they will loosen up the tuffle mire and then take off the tuffle mire with the matrix band Because if the fillings inter proximal, they will need to polish the the Inter proximal areas too. We've all seen those x-rays where the filling material doesn't look smooth Against the inter proximal surfaces, right? They are called overhangs overhangs happen when the dentist Doesn't remember to polish inter proximally. So that's a bad dentist or they just for some reason forget and don't look I don't know because it's pretty obvious So sorry, so I should have mentioned if the dentist wants to polish inter proximal That's a different shaped burr. Let me see if I can find that for you guys. Let's see um I'm a hygienist now. So I'm trying to think what that burr is called I teach it to my students, but I'm running a blank. Yes. Sorry guys. I can't find it But it's just kind of like a pointy shaped burr. Okay, that will be used to polish inter proximal That's all I wanted to say. Sorry guys. Sorry. Okay. Now I will leave you alone Thank you guys so much for watching if you need more help Let me know comment below and make sure to hit subscribe if you haven't yet Thank you guys for watching and I'll see you very very soon