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11th edition 11th edition T L ee xv Levison’s t bis Levison’s Textbook for o o Dental Nurses o n k ’ fs o Textbook for In this brand-new 11th edition of the original, best-selling book, Levison’s gives you the same great r comprehensive coverage of everything students preparing for their dental nurse qualification need to D know, and also offers for the first time: e Dental Nurses • A new look and feel, packed with illustrations and diagrams to make visual learning easy n • Key Learning Points in every chapter to help you master essential information t a • An interactive companion website with self-assessment exercises to help you test your knowledge l N Fully in line with the most recent developments in dental nursing practice and education, Levison’s u Textbook for Dental Nurses is the only dental nursing book written specifically to cater to the new r NEBDN Diploma in Dental Nursing. Written by Carole Hollins, the former Chair of the National Examining s CAroLe hoLLins Board for Dental Nurses, the new edition of Levison’s classic textbook is the only companion you need e to get you through to qualification as a successful and accomplished dental nurse. s Visit the companion website at: www.levisonstextbookfordentalnurses.com • Interactive MCQs 1 • Interactive EMQs 1 t • Glossary h • Lecturer image bank e d i t About the Author i o Carole hollins is a dental practitioner and member of the British Dental Association. She is a member n of the Faculty of General Dental Practitioners and a former presiding examiner for the NEBDN. She was a previous Chairman of both the National Certificate Committee and the Qualifications Council. Carole Hollins is the author of NVQs for Dental Nurses, Questions and Answers for Dental Nurses and Basic Guide to Dental Procedures. h reLAted titLes o Questions and Answers for dental nurses, basic Guide to Anatomy and Physiology for L 3rd edition dental Care Professionals L Carole Hollins Carole Hollins i n ISBN: 978-0-470-67090-3 ISBN: 978-0-470-65611-2 nvQs for dental nurses, 2nd edition Advanced dental nursing, 2nd edition s Carole Hollins Robert Ireland ISBN: 978-1-4051-9256-9 ISBN: 978-1-4051-9267-5 ISBN 978-1-118-50044-6 C Q s an M d h E M t 9 781118 500446 i Q w s Hollins_Levinsons_9781118500446_pb.indd 1 14/05/2013 11:01 Levison’s Textbook for Dental Nurses This book is dedicated to the memory of Henry Levison – a visionary dentist and author who set the standard for dental nurse training and education. Levison’s Textbook for Dental Nurses Eleventh Edition Carole Hollins General Dental Practitioner Member of the British Dental Association Former presiding examiner for the National Examining Board for Dental Nurses This edition first published 2013. © 2013 John Wiley & Sons, Ltd © 2004, 2008 Blackwell Munksgaard © 1960, 1963, 1969, 1971, 1978, 1985, 1991, 1997 Blackwell Science Ltd First edition published 1960; Second edition published 1963; Third edition published 1969; Fourth edition published 1971; Fifth edition published 1978; Sixth edition published 1985; Seventh edition published 1991; Eighth edition published 1997; Ninth edition published 2004; Tenth edition published 2008; Eleventh edition published 2013. Registered Office John Wiley & Sons, Ltd, The Atrium, Southern Gate, Chichester, West Sussex, PO19 8SQ, UK Editorial Offices 9600 Garsington Road, Oxford, OX4 2DQ, UK The Atrium, Southern Gate, Chichester, West Sussex, PO19 8SQ, UK 2121 State Avenue, Ames, Iowa 50014-8300, USA For details of our global editorial offices, for customer services and for information about how to apply for permission to reuse the copyright material in this book please see our website at www.wiley.com/wiley-blackwell. The right of the author to be identified as the author of this work has been asserted in accordance with the UK Copyright, Designs and Patents Act 1988. All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, except as permitted by the UK Copyright, Designs and Patents Act 1988, without the prior permission of the publisher. Designations used by companies to distinguish their products are often claimed as trademarks. All brand names and product names used in this book are trade names, service marks, trademarks or registered trademarks of their respective owners. The publisher is not associated with any product or vendor mentioned in this book. It is sold on the understanding that the publisher is not engaged in rendering professional services. If professional advice or other expert assistance is required, the services of a competent professional should be sought. The contents of this work are intended to further general scientific research, understanding and discussion only and are not intended and should not be relied upon as recommending or promoting a specific method, diagnosis or treatment by health science practitioners for any particular patient. The publisher and the author make no representations or warranties with respect to the accuracy or completeness of the contents of this work and specifically disclaim all warranties, including without limitation any implied warranties of fitness for a particular purpose. In view of ongoing research, equipment modifications, changes in governmental regulations and the constant flow of information relating to the use of medicines, equipment and devices, the reader is urged to review and evaluate the information provided in the package insert or instructions for each medicine, equipment or device for, among other things, any changes in the instructions or indication of usage and for added warnings and precautions. Readers should consult with a specialist where appropriate. The fact that an organisation or website is referred to in this work as a citation and/or a potential source of further information does not mean that the author or the publisher endorses the information the organisation or website may provide or recommendations it may make. Further, readers should be aware that internet websites listed in this work may have changed or disappeared between when this work was written and when it is read. No warranty may be created or extended by any promotional statements for this work. Neither the publisher nor the author shall be liable for any damages arising herefrom. Library of Congress Cataloging-in-Publication Data Hollins, Carole. Levison’s textbook for dental nurses / Carole Hollins. – 11th ed. p. ; cm. Textbook for dental nurses Includes bibliographical references and index. ISBN 978-1-118-50044-6 (pbk. : alk. paper) – ISBN 978-1-118-50043-9 (ePub) – ISBN 978-1-118-50042-2 (Mobi) – ISBN 978-1-118-50041-5 – ISBN 978-1-118-68990-5 I. Levison, H. (Henry). Textbook for dental nurses. II. Title. III. Title: Textbook for dental nurses. [DNLM: 1. Dental Assistants. 2. Dental Care. WU 90] RK60.5 617.6′0233–dc23 2013012752 A catalogue record for this book is available from the British Library. Wiley also publishes its books in a variety of electronic formats. Some content that appears in print may not be available in electronic books. Cover image: © Irfan Ahmad, BDS Cover design by Meaden Creative Set in 10/12pt Calibri by SPi Publisher Services, Pondicherry, India 1 2013 Contents Introduction to the Eleventh Edition vi Introduction to the First Edition viii Acknowledgements ix Abbreviations x How to use your Textbook and Companion Website xiii Copyright Information xv Chapter 1: Structure of the Dental Profession 1 Chapter 2: The Dental Nurse 9 Chapter 3: Legal and Ethical Issues 30 Chapter 4: Health and Safety in the Dental Workplace 74 Chapter 5: General Anatomy and Physiology 123 Chapter 6: Medical Emergencies 155 Chapter 7: Microbiology and Pathology 181 Chapter 8: Infection Control and Cleanliness 197 Chapter 9: Head and Neck Anatomy and Physiology 229 Chapter 10: Oral Anatomy and Physiology 248 Chapter 11: Oral Disease 274 Chapter 12: Oral Health Assessment and Diagnosis 307 Chapter 13: Oral Health Promotion and Disease Prevention 352 Chapter 14: Pain and Anxiety Control 386 Chapter 15: Restorative Dentistry 417 Chapter 16: Prosthodontics 473 Chapter 17: Extractions and Minor Oral Surgery 529 Index 556 Introduction to the Eleventh Edition Since the last edition was written, dental nurses have joined other members of the dental team to become registered professionals with the General Dental Council (GDC), and have at last been elevated to their well-deserved status as invaluable dental care professionals. With this professional recognition comes the necessity for set standards of attitude and behaviour outside the workplace, as well as suitable qualification, ethical work practices and the requirement for lifelong learning and continuous professional development during their careers. This edition provides the underpinning knowledge required to cover the extensive curriculum contents of the National Examining Board for Dental Nurses’ (NEBDN) new National Diploma qualification, which supersedes the old National Certificate. You can view the full curriculum for the NEBDN National Diploma in Dental Nursing at http://www.nebdn.org/diploma_in_dental_ nursing.html. A similar textbook will be available to cover the City & Guilds’ curriculum for its new Diploma in Dental Nursing qualification. Although the same register-able qualification is awarded to successful candidates following either route to registration, the training and assessment methods involved for each are quite different. The revised and updated text of this latest edition embraces all the numerous legislative and regulatory changes that have occurred in the last 5 years, including issues around Health and Safety, infection control, information governance, quality assurance requirements and the expansion of the concept of continuous professional development into that of team members becoming ‘reflective practitioners’. In particular, the text in relevant chapters puts particular emphasis on the standards to be attained in becoming dental professionals, and has been continuously cross-referenced to the GDC’s own Standards Guidance booklets, as well as some of its other publications such as Fitness to Practise, in the hope that their content is easily absorbed into the understanding and knowledge base of the readers. In addition and where appropriate, website addresses are included to allow readers to access further information on many topics covered throughout the text – especially links to the NEBDN’s curriculum and charting booklet download facilities, and links to more information on subject topics with national variations, such as infection control. Introduction to the Eleventh Edition It is hoped that the increased use of photographs and illustrations, as well as that of bullet vii points to highlight key facts throughout the text, makes this edition particularly user-friendly and easy to understand for all readers, without detracting from the high standards now expected of dental nurse students as they evolve into fully fledged dental professionals. Finally, and as always, I sincerely hope that this text stimulates at least some readers into becoming sufficiently inspired during their studies to continue their careers beyond their initial qualification, and consider extended duties, postregistration qualifications and further dental professional careers. NEBDN National Diploma in Dental Nursing You can view the full curriculum for the NEBDN National Diploma in Dental Nursing at http://www.nebdn.org/diploma_in_dental_nursing.html. Carole Hollins Introduction to the First Edition This book is designed to cover the syllabus for the British Dental Nurses and Assistants Examination. Although written primarily for nurses preparing for this examination, it also provides an outline of dental surgery for those embarking on a career of dental nursing, thus helping them gain a greater understanding of the nature and aims of their duties. For examination purposes, the subject matter is deliberately presented in a dogmatic fashion and, to aid final revision, there is a summary after each chapter. The text was prepared during a winter spent in the North Isles of Shetland with the School Health Service mobile dental unit; and for helpful advice and encouragement throughout, I am indebted to my former dental nurse, Miss M.E. Isbister. I wish to thank my wife for typing the man- uscript; my sister, Miss B. Levison, for the drawings; the Amalgamated Dental Trade Distributors Ltd for providing some new blocks; and Mr P. Saugman of Blackwell Science for his guidance. H. Levison