2. DENTAL SURGERY
■ DEFINITION : Any operation performed on your teeth, gums, jaw or
surrounding oral and facial structures. It includes a wide range of procedures,
including teeth extractions, dental bone grafts, periodontal (gum) grafts and
corrective jaw surgery.
■ Why is dental surgery important?
■ It will help one to make correct problems related to bite or jaw
displacements. One should surely understand the importance of oral hygiene
and ensure to plan regular checkups with the dentist.
3.
4. DEPARTMENT OF DENTAL SURGERY
■ INTRODUCTION : Dental surgery department is a department that provides its
services mostly on outpatient basis. The admissions are rather rare-in cases
requiring major procedures or patients with sepsis. This is one of the busiest
departments in a hospital particularly so if the staff has professional competence,
a tender touch and inspires confidence among patients through high quality
services.
■ SERVICES PROVIDED BY DENTAL SURGERY DEPARTMENT
■ The department provides following services:
■ 1. Consultation, diagnosis and treatment of dental ailments.
■ 2. Oral/maxillofacial surgery procedures in collaboration with plastic surgeons/ENT
surgeons.
■ 3. Improvement of dental/oral hygiene by scaling and other procedures.
5. ■ 4. Cosmetic procedures such as smile design and braces for straightening of
teeth.
■ 5. Provision of dentures/bridgework as replacement of missing teeth.
■ 6. Implantation of permanent artificial teeth.
■ 7. Maxillofacial prosthetic procedures for cancer rehabilitation.
■ 8. Dental check up to detect any asymptomatic diseases for timely treatment.
■ 9. Education and advice for improvement of dental hygiene and prevention of
diseases.
6. QUALITY OF DENTAL SERVICE
■ Quality of all the above services can be evaluated from the quality of
outcome, i.e. patient care provided by the department and the extent of
satisfaction of patients.
■ Quality of Outcome : A high quality outcome in dental department would
mean:
1. Minimum waiting period for the patients and consultation preferably by prior
appointment.
2. Quality of consultation where the doctor listens to the patient, discusses the
problem and involves the patient in decision making.
3. Procedures justifiable and painless.
4. Safety of patients against radiation hazards.
5. Outcome as predicted/expected, without any complications.
6. Cost of treatment in conformity with the initial estimate and within
affordable limits.
7.
8. QUALITY OF STRUCTURE
■ 1. Space, Layout, Fittings, Fixtures
■ Since most of the dental procedures are carried out on outpatient basis, dental
surgery department must have the requisite facilities depending upon the type
and volume of workload. McGibony” has recommended minimum two chairs for
enhancing the work efficiency by conserving the dentist’s time otherwise wasted
in waiting between the patients. The barest minimum requirements would be:
■ a. A dental surgery room: 15 Sq M (Not less than 4.2 M wide and 3.6 M deep).
■ b. A dental laboratory (for prosthetic work) and storage closet: 7 Sq M.
■ c. An enclosure for the X-ray equipment as per radiation safety norms.
■ d. A recovery room, for observation, if possible: 7 Sq M.
■ e. A comfortable patient waiting cum reception room (18 Sq M and 6 Sq M for each
additional treatment room) with attached toilet facility.
■ f. In busy clinics with more than 2-3 dental surgeons, a separate office may be
required. There should also be an attached toilet and a staff room.
9. ■ 2. Staffing : Staffing may be as per the norms and depending upon the workload.
Minimum requirement would be: A qualified/registered dental surgeon with at
least one qualified (2 years diploma) dental operation room assistant per chair,
one dental technician and one qualified (2 years diploma) dental hygienist.
■ 3. Equipment : Availability of high quality equipment such as:
■ a. Dental chair (preferably two), X-ray equipment, Light cure equipment, Radio
Visiography (RVG) (uses 1/10 of the usual radiation dose and the image can be
stored in the computer), Intraoral camera, arrangement for sterilization of
instruments, a syringe and needle destroyer, the equipment required in the dental
lab and the instruments for surgical procedures.
■ b. Personal protection equipment (lead apron, gloves, etc.) for the technician
doing the X-rays.
■ c. Eye protection for the patient and the doctor while using Light Cure equipment
as it emits ultraviolet rays.
■ d. TLD badges (Thermoluminescent dosimeters) for the technicians doing X-rays,
for monitoring the dosage received.
■ e. Computer terminal with printer and software for explaining to the patient the
problem/procedure.
10.
11. 4. Quality of Materials :Materials supplied such as the drugs, surgical gloves,
sutures, disinfectants, lab chemicals, should be of acceptable quality.
5. Engineering Support Services :Running water supply, stable/uninterrupted
power supply, a wash hand basin with foot operated taps, adequate lighting
(general lighting 150 Lux, working area 400 Lux), ventilation and cupboards for
safe storage of instruments, drugs and other chemicals used in the dental
laboratory.
Arrangement for disinfection of pipelines from the terminal to the chair.All
cables/pipelines should be underground.
12. QUALITY OF PROCESS
■ Quality of process should be such as would ensure the following:
■ 1. A departmental quality manual documenting the quality aspects of all the
activities carried out (as outpatient/inpatient) in the dental surgery
department.
■ 2. A system of consultation by appointments including priority attention to the
emergency cases.
■ 3. A documented checklist for conducting any invasive procedures.
■ 4. A procedure for confirming fitness of the patient for surgical/invasive
procedure such as by eliciting- .
■ a.The details of patient’s problems
■ b. Ruling out any important concurrent illnesses such as diabetes,
hypertension, bleeding disorders, cardiac ailments, any infectious diseases
(HIV/AIDS/hepatitis), any sepsis in the oral cavity that may flare up with the
invasive procedures
■ c.Any drugs that the patient may be taking such as aspirin, steroids, cytotoxic
drugs and history of any drug allergies.
■ In case of major procedures/cases with history of other illnesses, fitness
should be certified by a physician.
13. ■ 5. Procedure for asepsis during surgery such as-
■ a. Use of disposable water glasses for rinsing the mouth.
■ b. Disinfection of nozzle of the suction apparatus in between the cases/ or use
of disposable nozzles.
■ c. Wearing a cap and surgical mask
■ d. Change of gloves before attending to the next patient.
■ 6. A protocol for pain management.
■ 7. A protocol for quick and effective management of anaphylactic reactions.
■ 8. A protocol for control of unusually heavy bleeding.
■ 9. A procedure for complete oral examination.
■ 10. A procedure for observation of the patient after surgery, where indicated.
■ 11. Procedure for maintenance of case record of patients (OPD/IPD) as in other
patients.
■ 12. A protocol for attending to dental emergencies.
14. ■ 13. Compliance of legal provisions as applicable and the Dentists’ Act 1948
including professional ethics, etiquettes and conduct rules.
■ 14. Requirement of an attendant with the female patients.
■ 15. A documented antibiotic/other drugs policy especially in children pregnant
women, elderly.
■ 16. Procedure for disinfection/segregation/collection and disposal of bio- medical
waste as per the rules.
■ INDICATORS FOR EVALUATION OF QUALITY OF SERVICES
■ 1. Level of patient satisfaction as ascertained from the surveys/complaints
received.
■ 2. Incidence of postoperative sepsis.
■ 3. Incidence of unsafe invasive procedures leading to transmission of
HIV/Hepatitis.
■ 4.Incidence of unexpected but avoidable complications such as improper
extraction, impacted tooth, or a failed root canal treatment leading to tooth
