DAA cheat sheet

Four-handed dentistry assigns the dentist and assistant fixed zones: dentist typically 7-12 o'clock, assistant 2-4 o'clock, patient oral cavity as clock center.

Transfer zone is the patient's chin area below and in front of the mouth; instruments are exchanged there, never over the patient's face.

Instrument transfer rule: assistant passes with the working end oriented toward the dentist's fingers, handle leading, so the dentist grips without looking.

A seated operator uses the operating stool with thighs parallel to floor, feet flat, and patient positioned so the operator's forearms are near horizontal.

Maxillary arch: patient chair reclined so maxillary occlusal plane is roughly 25-30 degrees from vertical for direct vision.

Mandibular arch: chair back more upright, occlusal plane near parallel to floor, allowing indirect vision via mirror only when necessary.

High-volume evacuation tip is held near the tooth being cut (within a few millimeters) to capture aerosol and coolant before it escapes.

Suction and retraction are the assistant's primary duties during cutting; the assistant also keeps the field dry and the light positioned on the operative site.

Suture removal, rubber dam placement, and matrix band assembly are typical expanded-function assistant tasks where permitted by state law.

Spore test (biological monitor) for steam autoclave: Geobacillus stearothermophilus; for dry heat and chemical vapor: Bacillus atrophaeus.

Sterilization monitoring hierarchy: physical (gauge/printout), chemical (indicator strips), biological (spore test); biological is the definitive check.

Critical items (surgical instruments, scalers) penetrate tissue and must be sterile; semicritical items (mirrors, impression trays) contact mucosa and require high-level disinfection or sterilization.

Hand hygiene: soap and water when hands are visibly soiled or after contact with spores (e.g., C. difficile); alcohol-based rub otherwise, with 15-30 second contact.

PPE sequence donning: mask, eyewear/face shield, gown, then gloves; remove gloves first, then gown, eyewear, mask, then perform hand hygiene.

Sharps rule: never recap by hand; use scoop technique or a recapping device, and place needles in rigid sharps containers filled no more than 3/4 full.

Surface disinfection: use an EPA-registered hospital disinfectant with tuberculocidal claim for blood-contaminated surfaces; barriers are preferred for difficult-to-clean items.

Dental unit waterlines must meet ≤500 CFU/mL heterotrophic bacteria; flush lines at start of day and between patients.

Nitrous oxide scavenging and proper ventilation reduce occupational exposure; mercury spills are cleaned with sulfur powder and a mercury spill kit, never a vacuum.

Universal numbering: 1-16 maxillary right to left, 17-32 mandibular left to right; Palmer uses quadrant brackets and FDI uses two-digit quadrant-tooth codes.

Anterior teeth: incisors (8) and canines (4), 32 permanent teeth total; premolars (8) and molars (12) make up the posterior.

Maxillary first molar (tooth 3) has the largest crown and typically four cusps plus the cusp of Carabelli on the mesiolingual surface.

Mandibular first molar (tooth 19) typically has five cusps and two roots (mesial and distal); mandibular molars have two roots, maxillary molars three.

Primary dentition has 20 teeth; eruption generally begins around 6 months with mandibular central incisors and completes by about 2-3 years.

Permanent first molars erupt around age 6 (often before any primary tooth is lost), followed by central incisors and canines.

Enamel is the hardest tissue (96% mineral) and is non-vital; dentin is softer, contains tubules, and is innervated by odontoblastic processes.

Pulp chamber and root canal house the neurovascular supply; apical foramen is the exit point of the pulp into periapical tissues.

Periodontal ligament fibers (principal fibers) suspend the tooth in the alveolus and transmit occlusal force; the gingival sulcus depth is normally 1-3 mm.

Amalgam: silver-tin-copper-mercury alloy; sets by amalgamation, expands slightly, and is not used where esthetics matter or in direct contact with opposing gold.

Composite resin: dimethacrylate matrix with silane-treated filler; cured by visible blue light (450-490 nm), with incremental layers ≤2 mm to ensure adequate depth of cure.

Glass ionomer bonds chemically to tooth structure and releases fluoride; avoid desiccation during setting and protect with varnish.

Zinc oxide-eugenol is a sedative temporary material; eugenol inhibits polymerization of composite resin, so do not use them together.

Impression materials: alginate is hydrocolloid and dimensionally unstable (pour within minutes); elastomers (polyvinyl siloxane, polyether) are more stable and accurate.

Gypsum products: Type I (impression plaster), II (model plaster), III (dental stone), IV (die stone, high strength, low expansion), V (high-expansion die stone).

Water-to-powder ratio controls setting time and strength: more water slows setting and lowers strength; more powder speeds setting and increases strength.

Hand instrument parts: handle, shank, working end; cutting edges of scalers and curettes are assessed for sharpness and resterilized between patients.

Burs: carbide (tungsten carbide) cuts faster and lasts longer; diamond burs are used for enamel and ceramic, with grit size controlling surface roughness.

Bisecting-angle technique: central ray perpendicular to the bisector of the long axis of the tooth and the film/sensor plane; used for periapical views.

Paralleling technique: film/sensor parallel to the long axis of the tooth, central ray perpendicular to both; gives less distortion but requires a holder.

Bitewing images show crowns of both arches and crestal bone; periapicals show the entire tooth and periapical region; occlusal images show a larger arch segment.

ALARA principle: use the lowest exposure reasonably achievable; collimate, use rectangular collimation, and select fast film (E/F speed) or digital sensors.

Radiographic density is overall darkness (controlled by mAs); contrast is the difference between light and dark areas (controlled by kVp).

Cone-cut error results from the PID not covering the entire receptor; elongation/foreshortening results from incorrect vertical angulation.

Elongation occurs when the central ray is angled too shallow relative to the receptor; foreshortening when angled too steeply.

Digital sensors are more sensitive than film, so exposure times are reduced; sensor placement requires a holder to avoid bending or damage.

Radiation protection: lead apron with thyroid collar, film badge dosimetry where required, and no retakes without justification.

Syncope (vasovagal) is the most common dental emergency: place patient supine, elevate legs, loosen clothing, monitor airway and vital signs.

Angina: stop treatment, give oxygen, administer sublingual nitroglycerin per protocol; if pain persists >5 minutes or worsens, activate EMS.

Myocardial infarction: chest pain radiating to arm/jaw, diaphoresis, dyspnea; call EMS immediately, oxygen, aspirin if not contraindicated.

Anaphylaxis: epinephrine IM (adult 0.3-0.5 mg of 1:1000) into the anterolateral thigh, oxygen, call EMS; antihistamines are adjuncts only.

Hypoglycemia in a diabetic: give 15 g fast-acting oral carbohydrate if conscious; if unconscious, do not give oral fluids, call EMS and consider glucagon.

Asthma attack: position upright, give the patient's own bronchodilator inhaler, oxygen; call EMS if no improvement.

Choking/airway obstruction: encourage coughing if effective; for complete obstruction use abdominal thrusts (Heimlich) and activate EMS.

Local anesthetic overdose: signs include CNS excitation (tremor, seizures) then depression; stop injection, support airway, monitor and call EMS.

Seizure: protect the patient from injury, do not restrain or place objects in the mouth, time the event, and call EMS if it lasts >5 minutes.

Lidocaine 2% with 1:100,000 epinephrine: maximum recommended dose ~4.4 mg/kg (or ~300 mg adult), and 7 mg/kg for plain lidocaine.

Epinephrine concentration 1:100,000 means 0.01 mg/mL; 1:50,000 means 0.02 mg/mL; 1.8 mL cartridge of 2% lidocaine contains 36 mg lidocaine.

Articaine 4% with 1:100,000 epinephrine: maximum ~7 mg/kg; available in dental cartridges, has both amide and ester characteristics.

Bupivacaine 0.5% with 1:200,000 epinephrine provides long-lasting anesthesia (up to several hours) and is useful for post-operative pain control.

Prilocaine is associated with methemoglobinemia at high doses; benzocaine (ester) is a common cause in topical anesthetics.

Ester anesthetics (procaine, benzocaine) are metabolized by plasma pseudocholinesterase and more often cause allergy; amides are metabolized in the liver.

Inferior alveolar nerve block targets the mandibular nerve before it enters the mandibular foramen; landmarks include the coronoid notch and pterygomandibular raphe.

Greater palatine nerve block anesthetizes the posterior palate; nasopalatine block anesthetizes the anterior palate; both require aspiration to avoid intravascular injection.

Epinephrine-containing anesthetics are used cautiously in patients with uncontrolled hypertension, severe cardiovascular disease, or hyperthyroidism.

Recall intervals are based on caries risk and periodontal status; low-risk adults often 6-12 months, high-risk patients shorter intervals.

Accounts receivable aging: 0-30 days current, 31-60, 61-90, and 90+ days; 90+ days indicates collection risk and should trigger follow-up.

Appointment scheduling: block longer procedures earlier in the day, confirm 24-48 hours ahead, and use a recall system to reduce no-shows.

OSHA requires a written exposure control plan, training records, and hepatitis B vaccination offered to at-risk employees.

HIPAA privacy rule limits disclosure of protected health information; minimum necessary standard applies to uses and disclosures.

Informed consent requires disclosure of risks, benefits, alternatives, and the right to refuse; documentation in the chart is essential.

Dental insurance: coinsurance is the patient's share; deductible is the amount paid before benefits begin; annual maximum caps yearly payment.

Fee schedules and treatment estimates should be provided in writing before treatment; pre-authorization is often required for major procedures.

Record retention and documentation: chart entries should be contemporaneous, legible, dated, and signed, with no alterations after the fact.

Motivational interviewing uses open-ended questions, reflective listening, and affirmations to build patient commitment to behavior change.

Teach-back method: ask the patient to restate instructions in their own words to confirm understanding.

Plain-language communication targets a reading level around 6th-8th grade; avoid jargon such as 'caries' in favor of 'cavities'.

Brushing recommendation: twice daily with a fluoride toothpaste; flossing or interdental cleaning once daily.

Fluoride varnish application is recommended for caries prevention in children and high-risk adults; it sets on contact with saliva.

Caries risk assessment considers diet (sugar frequency), fluoride exposure, saliva flow, past caries, and oral hygiene.

Smoking cessation counseling follows the 5 A's: Ask, Advise, Assess, Assist, Arrange.

Informed decision-making for children involves the parent/guardian as the legal decision-maker while engaging the child at an age-appropriate level.

Cultural competence: use trained interpreters rather than family members for consent discussions, and confirm understanding with teach-back.

Tooth surfaces: mesial toward midline, distal away, buccal/facial toward cheek, lingual toward tongue, occlusal for posterior, incisal for anterior.

Line angles are the junction of two surfaces; point angles are the junction of three surfaces, used in cavity preparation descriptions.

Maxillary central incisor is the widest anterior tooth and has a nearly straight mesial incisal edge; maxillary lateral incisor is narrower with a more rounded distal incisal angle.

Canines have a single cusp and a prominent cingulum; they are the longest teeth and serve as the cornerstones of the arch.

Premolars: maxillary first premolar typically has two roots and two cusps; mandibular first premolar has a small lingual cusp and a prominent buccal cusp.

Root canal systems: maxillary first molar typically has three roots (MB, DB, palatal) and often four canals (two in the MB root).

Gingival attachment: junctional epithelium attaches to the tooth at the base of the sulcus; loss of attachment defines periodontal disease.

Occlusal scheme: canine guidance and group function distribute lateral forces; balanced occlusion is important for removable prostheses.

Eruption sequence for permanent teeth: first molars, central incisors, lateral incisors, first premolars, canines, second premolars, second molars, third molars.