Implantology and the role of the dental nurse
I have been a dental nurse for the past 18 years or so and in that time I have witnessed how the profession has changed. Gone are the days where the nurse would be in the surgery just to smile sweetly and use the suction once in a while. I have worked with dentists who did not even like you to talk to the patient or let you put a sympathetic hand on a shoulder. Thank goodness for change!
Our role in implantology is one with many caps to wear. We are no longer just a nurse but a co-ordinator; someone who can deal with all aspects of the treatment, whether it be ordering stock, cross infection control or patient management, the latter being probably the nicest part of the role. There is nothing better than talking to a very nervous patient before treatment and having them leave the surgery saying how easy the treatment was and how confident they felt in our hands.
Of course we expect the patients to be apprehensive, especially when two weeks prior to their surgery I have sent out pre- and postoperative instructions for them to read. Who would not be nervous when it says that they could be swollen, bruised and sore for a few days after surgery!
The nurse’s duties
The day-to-day duties are many and some are listed below:
• Check all equipment is in working order
• Make sure that surgical templates are back from the laboratory and that all necessary radiographs and models are available
• Check that patient documentation is signed. This includes a signed treatment plan and schedule of costs, as well as a signed consent form for implant/graft placement
• Check that you have the necessary implants and healing abutments, as well as any bone augmentation materials, tacks, bone screws, etc
• All work surfaces need to be cleared and sprayed and wiped, floor to ceiling, with surface disinfectant such as Mikrozid. This then should be sprayed again and left to dry for 15 to 20 minutes
• Careful zoning of your surgery is important. You and your assistant nurse should know which are the sterile and non-sterile areas
• Sterile instruments should be unwrapped and placed on sterile drapes. These then can only be touched by the members of the team that are scrubbed and gowned
• A strict aspiration protocol should be observed. Remember that if you are using a bone trap this should only be used at the osteotomy site and not used to collect the saliva from the back of the mouth. Make sure when aspirating that you do not get too close to the drills. The drills and the bone need to be kept cool by the chilled saline. Keep a gallipot of saline close by, so that used drills can be placed in it. This helps make the drills easier to clean afterwards
• Once the surgery is completed, make sure that you look after the patient well. Clean the face with a nice wipe if possible, not just a wet tissue. Apply some Vaseline to the lips and give the patient an ice pack to hold on the area to help reduce swelling
• Always ring the patient the next day to see how they are; they always appreciate it
• Note taking is an important role we have to play. Our notes must be accurate and concise. Any conversation with a patient, whether it is on the telephone or in reception, should be logged in their notes
• Cross infection control is one of our most important roles. This protects us, the other members of our team and the patients themselves.
Everything should be cleaned thoroughly, put through the ultrasonic, washer disinfector and then autoclaved. We have a vacuum autoclave and therefore all of our instrumentation cassettes are wrapped prior to autoclaving. One tip is to take photographs of all of your instrument cassettes so that if ever you are away and someone else is using them, it is an easy reference for putting everything back in the right place!
I heartily welcome the concept of registration, but I know that this not a view shared by all. I feel that this is a positive step for dental nursing and that it recognises the important role that we have in the practice.
Combining registration with continuing professional development can only be a positive thing.
Courses are varied, interesting and abundant. Techniques and materials are changing all of the time and it is important for the whole team to be as up to date as possible in order to be able to offer the best treatment options to the patient. There are many courses that cover implantology, whether you are just starting out or are a seasoned dental nurse. They are a great place to meet other people and share experiences.
Dental nursing should be a career, not just a job. At the end of the day, we are the surgeon’s left and right hand and often we actually seem to grow another pair as well!
I fell into the implant field by accident. I was moving back into the area and had asked for a reference from my present practice as I had worked there many years earlier, prior to getting married. As it happens there was a vacancy, which I applied for and luckily got.
This, for me, has been the best seven years of my working life. I work with an amazing surgeon who acknowledges the hard work that dental nurses do. I think that the nicest thing is that he listens to my opinions and he never makes me feel inferior. I love being able to spend time with my patients, listening to them and being a hand to hold during the difficult parts of treatment. The best feeling is seeing them when everything is completed. A smile is worth a thousand words.
Implantology is a great field to work in and I hope that you feel the same way about it that I do. So go out and find some good courses to attend and further your experience.
Remember this is a career, not just a job!