RDA (AMT) common mistakes
RDA · Understand the traps and how to avoid them.
During a restorative procedure the assistant hands the handpiece and mirror with the working end oriented toward the dentist and releases the instrument before the dentist has closed a grip on the handle, then scrambles to reposition a bur mid-cut.
Transfer technique was learned as a list of instruments to hand over rather than as a physical sequence with fixed grip points, and it is almost always practised on a live patient under time pressure instead of dry before the appointment.
What to do instead
Drill transfer mechanics on a manikin or with a partner: palm-to-palm for mirror and explorer, thumb-to-thumb for handpiece, hold until you feel the dentist's grip close, then release and retract. Rehearse the full instrument order for each procedure type from a laminated sequence card before the patient is seated.
The high-volume evacuator tip is parked in one spot on the floor of the mouth or on the same side as the handpiece, and it is lifted out during cutting so the field floods and the dentist has to stop and ask for suction.
The assistant treats suction as 'holding the hose' rather than as active field control, and cannot see the working tip well enough from a seated position without repositioning the mirror and light.
What to do instead
Practise keeping the HVE tip at the occlusal-lingual margin of the tooth being cut, trailing just behind the bur, and keep it in place through the cut while adjusting only the angle. Rehearse on a typodont with water running and time how long you can keep a dry field without prompting.
The assistant answers the phone, opens drawers, takes a chart from the counter, or types on the keyboard while still wearing the same gloves used on the patient.
Gloves are mentally filed as 'hand protection' rather than as a patient-contact barrier, and the front desk is only a few steps away, so the contamination chain is invisible until an inspector or examiner asks about it.
What to do instead
Adopt a strict touch rule: gloved hands touch only the patient and items that will be discarded or sterilised. Establish a clean runner or use a barrier-covered pen, and build doffing plus hand hygiene into a written room-turnover checklist that you actually run in order.
Handpieces and prophy angles are wiped with a disinfectant wipe and put back in the drawer, and dental unit waterlines are not purged at the start of the day or between patients.
Surface disinfection and sterilisation get collapsed into one idea because both 'clean' an item, and waterline flushing has no visible result, so it is the first step dropped when the schedule runs late.
What to do instead
Memorise and apply the split: items that penetrate soft tissue or touch broken mucosa are sterilised (autoclave, with spore testing and indicator monitoring), items that only touch intact mucosa are disinfected at the correct level. Attach waterline purge and handpiece bagging to a physical checklist taped inside the operatory so it survives a busy day.
For a patient who cannot tolerate the sensor, the assistant or a parent holds the receptor in the mouth with a finger inside the primary beam, or the sensor is propped with cotton roll and a finger at the edge of the field.
It solves an immediate behaviour problem, and the assistant may believe that holding 'just the edge' is acceptable because it was done that way in a previous office.
What to do instead
Treat any body part in the beam path as a hard stop. Use receptor holders and bite blocks, stabilise the child's head rather than the film, and if the patient truly cannot cooperate, stop and reschedule rather than expose a hand. State the rule to yourself as 'no hand in the beam, ever' when answering scenario questions.
The exposure is made with only the lead apron draped over the chest (or no apron at all for a 'quick' bitewing), the thyroid collar is left off for maxillary films, and the operator stands in the room or in line with the primary beam instead of behind the barrier.
Aprons feel like a courtesy for pregnant patients rather than a required barrier for every patient, and the operator's own positioning is invisible in the rush of a single exposure.
What to do instead
Build a pre-exposure pause: apron and thyroid collar on every patient regardless of pregnancy status, and the operator at least 6 feet away or behind a properly shielded barrier at 90 degrees to the beam. Rehearse the sequence until it is automatic, and know that the question to ask is not 'are you pregnant?' as a gate for shielding but as a modifier of the prescription.
The assistant applies fluoride varnish, places sealants, or performs coronal polishing and scaling on a patient because 'the dentist is busy' and the task is routine in the office, without a specific delegable order or the required state credential.
Scope rules are memorised as a vague list, and in a busy practice the boundary blurs because the dentist is in the next operatory and will 'sign off later'.
What to do instead
Know your state's delegable-function list in two columns: tasks requiring direct supervision, and tasks requiring a specific certificate in addition to your RDA licence. Do not perform a function until the supervising dentist has authorised it for that patient, and be able to state the supervision level for each expanded function you perform.
When a caller identifying as a family member asks whether the patient was in today and what was done, or an outside office asks for copies of radiographs, the assistant answers or sends them without checking authorisation, or faxes the chart to a number taken over the phone.
The request sounds routine and helpful, and the phone-call format feels less formal than a written records request, so the authorisation step never comes to mind.
What to do instead
Use a fixed script: verify identity, confirm a signed release is on file, verify the receiving party's contact details against the chart rather than the caller's word, and log the disclosure. When in doubt, take a message and route it to the dentist or privacy officer - refusing to disclose is never the wrong answer on a jurisprudence item.
Post-operative instructions after an extraction or restorative visit are delivered as a rapid verbal stream of clinical terms ('avoid positive pressure, don't dislodge the clot, take the analgesic prn'), with no written handout and no check that the patient understood.
The assistant is anxious to get the patient out and the next one in, and familiarity with the terms makes them feel plain. The patient, who is numb and anxious, retains very little of an uninterrupted monologue.
What to do instead
Use teach-back: give two or three instructions at a time in plain language, hand over a written sheet at the patient's reading level, then ask the patient to state back what they will do in the next 24 hours. Rehearse the core post-extraction and post-restorative scripts until they are fluent, and document that instruction was given and understood.
The medical history is treated as a one-time form: it is not reviewed or updated at recall visits, allergies and current medications are not confirmed aloud, and vital signs are not recorded before local anaesthetic is administered.
The chart is accepted as complete because it was completed once, and blood pressure and pulse feel like dentist territory rather than a shared responsibility with a defined trigger point.
What to do instead
Make an oral review of allergies, current medications, and any hospitalisation or new diagnosis a standing first step of every appointment, with the patient's answers documented and dated. Record baseline vital signs before anaesthetic and know the thresholds at which you stop and get the dentist, so the decision does not rest on improvisation.