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names so privacy is a very important aspect of HIPAA abuse and neglect in dentistry so in California if you hold a dental license so the DDS the RDA the RDAEF the RDH RDHAP you are a mandated reporter of abuse and neglect of a patient so a patient comes in and they have signs of being abused and neglectedaway from the dental office not something that happens in the dental office certainly you should be reporting that as wellbut we are a mandated reporter now I have heard interpretation that even if you hold a dental radiography certificate it’s considered a license even though these days we call it a certificate and so then that kind of makes all the clinicians the DA RDA RDAEF DDS RDH RDHAP everyone a mandated reporter for not only children but also elders and it specifically refers to children and elders now this is an example sad and serious example of an ethical situation if you are the chairside assistant and

you see signs of abuse and neglect you’re a mandated reporter but you alsoshould go tell the dentist now if the dentist says oh I don’t want to be involved then this is an ethical choice that you have to make this is an ethical situation you have to decide to comply with being a mandated reporter and then what the dentist is saying and so it’s a it’s a personal choice it’s an ethical choice that that you would have to makeother areas that we’re gonna look at that deal with law and ethics is unprofessional conduct unprofessional conduct there are a number of behaviors by the dentist by the dental auxiliaries that can result in penalties and fines possible suspension or revocation of a license or there may be requirements to attend diversion programs diversion programs meaning to assist people in maybe alcohol and drug rehab or community service anger management those types of programs penalties and fines







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comes to practice from another state it is unethical unprofessional and illegal for them to practice dentistry with a suspended or revoked license in another state and remember California doesn’t have reciprocity anyway so they can’t you know use their license from that other state but according to this specific unprofessional conductregulation they cannot practice here even with a suspended or revoked license from another state alteration of a patient’s record with intent to deceive so in this unprofessional conduct this means that whether you have a paper record or a digital record you’re not going to change a patient’s record to to deceive either if records are asked to be for some type of investigation you never want to use whiteout because that kind of looks like you’re trying to hide something right and so you don’t want to use wideout on a patient record if you are computerized records using computerized records in

your office then you want to make sure that only certain people have access to those records and let’s see what else here I think that’s it there okayunsanitary or unsafe office conditions and I believe that is also kind of obvious as what would be customary practice and standards of the dental profession you want to follow infection control standards the office should be dirty be infested with critters have boxes all around or equipment in that needs repair food stored where there are dental products those types of situations abandonment of a patient without written notice so this type of unprofessional conduct means that you can’t just tell a patient you can’t come here anymore maybe the patient’s a difficult patient maybe they’re not paying their bill now a dentist can dismiss a patient from a practice but they have to be very careful how that’s done so if a patient is in treatment maybe they have a provisional and they’re







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Dentistry we’recoming to the end now some other unprofessional conduct is that the DDS must perform or allow excuse me let me start overfor the DDS to perform or allow any treatment by any auxilary the patient must be a patient of recordand so a patient of record is where the doctor has examined the patient reviewed their medical dental history and developed a treatment plan and then the auxiliary is allowed to perform treatment nowthere’s some exceptions where a doctor can perform a preliminary exam let’s say it’s a dental emergency so maybe they want to get the image going and so the doctor can say to the auxiliary go ahead and take a radiographic image and they look at the patient’s they say what tooth is bothering you and they say ok number 12 take a PA of number 12 so that’s anexception to having a full exam by the doctor reviewing the health history although that should always be looked at

you know to make sure of the patient’s health before you know seating the patient excuse me my opinion or no exam if for specified situations that would be if let’s say in a clinical or clinic situation telehealth via the internet a a patient is excuse me a dentist is not required to review patient records if they’re going to use telehealth next some ethical practices for dental radiography now this is just in general it is not specific to the California Dental Practice Act but I believe that auxiliaries should be aware of patient selection criteria and of course since we’re following the RDA exam plan this is part of that exam plan remember that patient selection criteria is evidence-based it is no longer based on the calendar it was old practice to say everyfive years a patient must have a full mouth x-ray or every year a patient has to have bite wings that is not the case anymoreit is evidence-based do they actually need this these dental







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I will be using notes throughout coz it’s a topic which I think that most people find confusing so I don’t know all of this off the top of my head I will still be referring to my own notes throughout just to make sure I can explain it as clearly as possible so I’ll pop up some little pictures and diagrams throughout and subheadings to try and break it down make it a bit clearer but if you do have any further questions after then please drop me a message and get in touch so what is occlusion basically occlusion is a relationship between the teeth and the top and the bottom jaw when chewing or at rest there are two things that determine occlusion said the position of the teeth and the position of the jaw so the maxilla which is the top jaw and the mandible which is the lower jaw so we’ll just start with a couple of definitions which I’m going to put on the screen now most of these are from the workbook which I got from my occlusion course

of one I’ve already discussed the advanced center of excellence so these are going to come up on the screen as I’m talking you through them so firstly is the ICP or the intercostal position and this is the relationship of the mandible to the maxilla when the teeth are maximally inter digitated so this is basically as the teeth meeting together and it’s the contact between the greatest number of opposing teeth so is tooth determined so the centric relation position or CR is the relationship of the mandible to the maxilla when the condyles are in their most superior positions in the glenoid fossa with their anterior surfaces acting against the posterior facing surfaces of the mennenga and i always struggle with that word so hopefully that makes sensenow CR can be maintained over a range of vertical dimensions so it’s not an explicit clinical description of a draw relationship unless the vertical dimension is specified so alternative terms for







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guidance and when you get to the point of protrusion all of the posterior teeth should be discluded so as you slide the jaw forward the back teeth should come apart to protect them so this is anterior guidance protecting the posterior teeth when it comes to lateral movements there are three types of guidance which we can consider so first of all this canine guidance secondly is group function or third is a combination of both now something that you’ll need to understand to make the rest of this clearer is what the working side is and the non-working side so the working side is the side which the jaw is moving towards so the mandible is moving towards so if I move my jaw to the left like this the working side is my left so I’m not sure which way round you’ll be seeing this looking at me but I’m moving my jaw to the left and so the left is the working side in canine guidance only the canine on the working side is meeting when

you’re in a lateral movement so if I slide my jaw to the left only my canines meet on that side and all of my other teeth are open so they’re propped opened by my canines so on my left hand side I have a canine guidance because it’s just canines on the working side which is the side my jaw is moving towards or in occlusion the rest are all discluded the canine guidance is also known as a canine protected occlusion is also known as canine lift and canine rise so they’re different ways which it may be referred to what that is referring to canine guidanceso group function is when two or more pairs of teeth come together in a lateral excursion and the rest of the teeth are propped opens or discluded so when I personally slide to the right like this my premolars meets on that side so I have two pairs of teeth meeting so that’s group function now the third type of guidance is a combination of both so it’s possible that you will have k9







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features of an ideal occlusion and we won’t always achieve these but like I said it’s in an ideal thing an ideal world firstly in an ideal occlusion we want anterior guidance so when you do a lateral movement or a lateral excursion we want the teeth on the working side to contact and immediately discs lose teeth on the non-working side so that’s your canine guidance or your group function we also then want Impa true Civmovements anterior guidance to disclude the posterior teeth to protect them secondly we want posterior stability so that’s really important that we have a balanced posterior occlusion third we want there to be an absence of posterior interferences so ideally we don’t want anyinterferences with different movements of the mouth we want everything to be working in harmony we also want centric occlusion to be achieved at a centric relation position and finally we want occlusal loads to be transmitted

axially or axially through the teeth sodownwards through the teeth and we can check ACLU’s or contacts using either shim stock articulating paper now the eye tarot scanners that sort of thing are amazing at scanning the teeth and they can track tooth wear over time so we can actually look at the occlusion using a 3d digital scannerit have been helpful nearly everything which I’ve discussed today if not everything is what I learnt on the occlusion course I went on at the advanced center of excellence that was a really good day I learn well three days and I learned so much there were only 12 of us – three supervisors plus a lab technician so we got really great hands-on experience we had real patience we made a Lucia jig a Michigan splint and we worked in small groups with a supervisor showing us what to do getting that hands-on experience so it was extremely valuable I’d really recommend it I haven’t been asked to say this I think







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