PERS 4.

2a Endodontic procedure Pulpectomy (firs stage)

1. Endodontic Procedure Carried Out:

Guidance Notes:
Students should state the procedure to be carried out.
Students should explain how the clinincal area was made ready for this particular procedure, how
they assisted both the clinician and the patient during the procedure.
Students should describe the patient on which the treatment was carried out
PROCEDURE TO BE CARRIED OUT: Endodontic Procedure- first stage of pulpectomy on lower
right 6
TYPE OF PRACTICE: Mixed NHS and Private dental practice.
AGE AND GENDER: Patient was 34 -year-old female
MEDICAL HISTORY: fit and well, with no medical conditions apart from hay fever and no
medications are taken.
SOCIAL HISTORY: Smoker- 10 cigarettes a day; 2 -3 unites alcohol a week
CONSENT: Written signature
MEDICAL RECORDS: Patient medical history was checked and made sure it was up to date.
Also, patient’s radiographs and dental chart were available on the computer for the dentist.
EQUIPMENT SWITCHED ON: Turned lights on, dental chair, compressor unit, computer, X-
ray machine, suction pump, light cure, amalgamator, water distillation unit, ventilation,
autoclave- which was filled with distillate water. A TST strip was placed in the autoclave for the
first morning cycle to check sterilisation process and recorded in the dated log book. The
ultrasonic bath was filled with enzymatic cleaning solution and water and de-gas process
started.
Patient was provided with safety glasses and protective bib.
PPE for the Dentist included- uniform, visor, disposable gloves, apron and mask.
PPE for the nurse (myself) – full uniform, including closed toe shoes, visor, apron, disposable
gloves and mask.
INSTRUMENTS: disposable tray liner, exam kit includes-mouth mirror, right-angle probe and
BPE probe, also tweezers, flat plastic, ball burnisher, plugger, spatula, fast and slow
handpieces with relevant burs, aspirating syringe, endodontic probe, endodontic block,
endodontic ruler, gates Glidden drills, barbed broaches, root canal hand files, endodontic apex
locator handpiece, reamers, rubber dam punch, rubber dam clamp forceps, rubber dam frame,
molar clamp, spoon excavator and scissors.
MATERIALS: Cotton rolls, LA cartridge was 2% lidocaine hydrochloride and adrenalin
(epinephrine) 1:800000 with batch number-B228446AB and expiry date- 06/2020, LA needle
long-32 mm with 30-gauge thickness, paper pad for mixing, disposable irrigating syringe whit
needle, sodium hypochlorite, paper points, zinc-oxide based endodontic dressing, periapical
x- ray radiograph film, rubber dam, EDTA-endodontic lubricant, temporary filling material,
disposable aspiration tip, disposable 3 in1 tip and disposable saliva ejector.
PREPARATION OF THE SURGERY: Prior to starting for the 1st stage root canal treatment I confirmed the
procedure with the dentist. I prepared anaesthetic appropriate to the patient’s medical history which was
checked with the dentist. Afterwards I applied hand detergent to wet hands, washed and dried them with
paper towel. Also, I placed new PPE- mask, visor and gloves. After that I disinfected all working surfaces-
chair, control buttons, bracket table, light handles, light, spittoon, computer, cupboards, x-ray machine,
amalgamator with viricidal disinfectant and paper towels. Then I flashed the lines through with distilled water
for 30 seconds to make sure the suctions were working, and the tubes were clean. Afterwards I removed PPE-
gloves, mask, visor and disposed in the orange clinical waste and applied alcohol-based hand gel.

I discussed with the dentist prior to treatment if needs any materials and then I put on new PPE- mask, visor,
gloves and set up for the clinical procedure.

For the appointment I added disposable aspirating tip, disposable saliva ejector and fitted
disposable 3 in 1 tip. I also applied disposable plastic covers for the armrest, light handle, head
cover, all couplets and over the aspirator tubes. Placed disposable cup with mildly antiseptic
mouthwash tablet and water provided on the side of the chair with a box of tissues for the patient.
Then placed the lined tray with instruments on the bracket table with unassembled syringe, needle,
and cartridge and connected fast and slow handpieces. I disposed PPE- mask, gloves and
visor in the clinical waste.
In the clinical area I placed earlier a container with a lid, filled with enzymatic solution and water,
available to collect the contaminated instruments. On the clean side I placed some extra hand files,
gates Glidden drills and endodontic apex locator handpiece ready for the procedure on the
dentist request.
I greeted the patient in a friendly manner and sat her comfortably, and applied a protective bib and safety
glasses. I reassured the patient that there is nothing to be worried about the procedure.
For myself I placed PPE- mask, visor and gloves before the treatment started.
Once the dentist given the local anaesthetic and anaesthesia was achieved, the dentist then proceeded to place
the rubber dam. I assisted with the placement of the rubber dam on the rubber dam frame.
Afterwards I placed the saliva ejector under the rubber dam to make the patient more
comfortable all along the procedure.
Throughout the treatment on the dentist request I provided endodontic apex locator
handpiece, paper points which were placed on the tray and the zinc-oxide based endodontic
dressing on the mixing pad.
I was supporting the dentist with clear and dry operative field throughout treatment, using
retraction and aspiration techniques.
Before the procedure was completed the dentist took a radiograph which I processed and
saved on the computer.
All along the treatment I was monitoring the patient for any signs of distress or discomfort to
informed the dentist if necessary.
At the end of the procedure, I assisted the patient by removed the protective bib and safety
glasses and ensured she was cleaned before leaving the surgery.
The patient made an appointment for the second stage of the root canal treatment in one
week time.
I followed the practice guidelines, safety procedures and HTM-01-05 compliances.

2. Aim of the Procedure:

Guidance Notes:
Students should state the overall aim of the process.
This endodontic procedure is to try and safe the permanent tooth from extraction, once has suffer irreversible
pulpitis. The aim of the treatment is to remove all of the pulpal tissue from the pulp chamber and root canal, and
replace it with a sterile root filling material. This must be placed to fully seal the whole root canal system and
prevent any contamination from causing a
repeated infection at the root apex, so the material used must be isolated from saliva and tissue.

3. Reflective Account:

Guidance Notes:
Students should identify their strengths and weaknesses during the procedure and describe any action they
would take to address weaknesses in the future, if required.
My strength was that I assisted the dentist well when he was placing the rubber dam.
My weakness was that I

Preparation:
Student turned on all equipment required for the procedure:
Student donned appropriate PPE (gloves, mask, eye protection, appropriate clinical dress):
Student cleaned work surface using viricidal disinfectant or detergent solution:
Student flushed through all water lines:
Student applied disposable covers to required areas of the dental surgery e.g. light handles, control panel etc:
Student made all required patient records and radiographs available:
Student prepared all relevant equipment and materials:
Student established zoning of clean and dirty areas within the working field:

During Procedure:
Student greeted patient appropriately:
Student provided the patient with a bib and safety glasses:
Student aspirated and retracted soft tissues when appropriate:
Student provided eye shields when required during use of curing light:
Student followed safe practice procedures throughout:
Student monitored the patient throughout:
Student reassured the patient during the treatment:
Student prepared anaesthetic appropriate to the patients medical history:
Student assisted with the placement of the rubber dam (if used):
Student prepared any materials required as requested by the clinician:
Student prepared x-ray equipment when required:
Student processed and mounted the radiograph:
Student maintained contemporaneous notes as directed by the clinician:
Student ensured the patient was cleaned prior to leaving:

Professionalism:
Student demonstrated professionalism in his/her duties and effective team working towards the delivery of sa
Student demonstrated effective clinical decision making throughout the task:
Student managed themselves and the clinical environment in line with current standards and guidelines:
Student demonstrated knowledge and clinical skills appropriate to the patient's condition:
Student communicated appropriately, effectively and sensitively with the patient, their relatives or carers and