Introduction

Within a maxillofacial and oral surgery department different clincs can run parallel with one another. They are catergorised as being either an assessment or treatment clinic. Assessment clinics involve the patient being assessed by a maxillofacial surgeon. Once assessed the patient is either listed for a procedure for further investigations, kept under consultant review, given advice or a prescription, or discharged back to the referring dentist or doctor’s care. Treatment clinics, as the name suggests, involve the patient undergoing a type of treatment or procedure. These patients have already been assessed by a maxillofacial consultant or a clinician within the maxillofacial team. They have previously been listed for the planned procedure to either treat or ameliorate a diagnosed condition. If a biopsy was listed, this will aid the maxillofacial consultant or clinician in gaining a definitive diagnosis. In either case, the basic role of the dental nurse involves the same responsibilities and skills required whenever a patient receives dental treatment.

Assessment Clinics

Prior to the clinic commencing, the dental nurse assigned to the clinic should undertake a pre-clinic check. The dental nurse should ensure that any previously ordered images or reports for patients attending a review appointment are available for the consultant. The consultation room is made ready by undertaking cross-infection control procedures and preparing any items that may be required during the consultation. The session list should be checked for any new referrals, along with establishing if any relevant radiographs are attached to the referral and, if so, these are available for the clinician. If none are provided by the referring clinican and there is a possibility that an image may be required, this should be highlighted to the clinician so that a request for one can be made.

An assessment appointment comprises several different elements. These may include:

• • Greeting the patient.
• • Recording the patient’s height, weight and body mass index (BMI).
• • Clinician recording the patient’s medical, social and dental history.
• • Discussion regarding the reason for referral.
• • Clinical examination.
• • Radiographic examination.
• • Patient’s pathway discussed in respect of further investigations and, dependent upon outcome, possible treatment plans.
• • Consent may be taken.
• • Advice provided.
• • Patient discharged and return to referrer’s care.

Equipment and Medicaments Used During Complex Procedures

Drills, burs and irrigation

During surgical procedures bone removal may be necessary to expose underlying teeth and structures. To undertake this, a surgical hand-piece (Figure 4.1) with long flexible irrigation tubing attached is used. The solution used for irrigation is 0.9% sodium chloride. This comes in large bags which are single-use. A surgical hand-piece will have an intergral thin metal tube that one end of the irrigation tubing is connected to. The other end is attached to a surgical hand-piece motorised unit that passes the sodium chloride through the tubing when the hand-piece is in use. If this system is not available, the dental nurse will be requested to irrigate using a sterile disposable syringe (Figure 4.2) 0.9% containing sodium chloride (Figure 4.3) to avoid the bur overheating and aid the clinican’s vision. The commonly used surgical burs are a No. 6 rosehead (Figure 4.4) and No. 4 tapered or flat fissured bur (Figure 4.5). The rosehead bur is used to remove bone and the flat fissured bur to bisect a tooth for easier removal.