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Samenvatting Praktische vaardigheden voor tandartsassistenten
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Samenvattingen van de hoofdstukken 1-6 en 8 voor het boek Praktische vaardigheden voor tandartsassistenten.
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Praktische vaardigheden voor tandartsassistentenDe wettelijke basis.................................................................................................................................................................................................................................................................................................................................................3
1.1 Het tandheelkundig team........................................................................................................................................................................................................................................................................................................................................... 3
1.2 Wet BIG......................................................................................................................................................................................................................................................................................................................................................................................3
1.2.1 Titelbescherming...........................................................................................................................................................................................................................................................................................................................................3
1.2.2 Voorbehouden handelingen............................................................................................................................................................................................................................................................................................................... 4
1.2.3 Tuchtrecht......................................................................................................................................................................................................................................................................................................................................................... 4
1.3 WGBO........................................................................................................................................................................................................................................................................................................................................................................................ 4
1.3.1 Recht op informatie.....................................................................................................................................................................................................................................................................................................................................4
1.3.2 Dossierplicht................................................................................................................................................................................................................................................................................................................................................... 4
1.3.3 Toestemmingsvereiste.............................................................................................................................................................................................................................................................................................................................. 4
1.3.4 Geheimhoudingsplicht............................................................................................................................................................................................................................................................................................................................ 4
1.3.5 Plichten van de patiënt........................................................................................................................................................................................................................................................................................................................... 4
1.3.6 Hulpverlenersplicht....................................................................................................................................................................................................................................................................................................................................4
1.4 Richtlijn Tandheelkundige Radiologie...............................................................................................................................................................................................................................................................................................................4
1.4.1 Rechtvaardiging............................................................................................................................................................................................................................................................................................................................................ 4
1.4.2 ALARA................................................................................................................................................................................................................................................................................................................................................................... 5
1.4.3 Dosislimieten...................................................................................................................................................................................................................................................................................................................................................5
1.4.4 Zwangerschap en röntgenstraling.................................................................................................................................................................................................................................................................................................5
Grootinstrumentarium....................................................................................................................................................................................................................................................................................................................................... 5
2.1 Praktijkuitrusting.............................................................................................................................................................................................................................................................................................................................................................. 5
2.2 De behandelunit...............................................................................................................................................................................................................................................................................................................................................................5
2.2.1 De behandelstoel.........................................................................................................................................................................................................................................................................................................................................5
2.2.2 Het spittoon.................................................................................................................................................................................................................................................................................................................................................... 6
2.2.3 De unit................................................................................................................................................................................................................................................................................................................................................................. 6
2.2.4 De operatielamp.......................................................................................................................................................................................................................................................................................................................................... 6
2.2.5 Het werkblad...................................................................................................................................................................................................................................................................................................................................................6
2.2.6 De tandartsstoel en de assistentenstoel...................................................................................................................................................................................................................................................................................6
2.2.7 Overige apparatuur in de behandelkamer..............................................................................................................................................................................................................................................................................6
2.3 Roterend instrumentarium....................................................................................................................................................................................................................................................................................................................................... 6
2.4 Aan- en afvoer van elektriciteit, water en lucht........................................................................................................................................................................................................................................................................................ 7
2.5 Kleininstrumentarium en verbruiksmaterialen..........................................................................................................................................................................................................................................................................................7
Ergonomie................................................................................................................................................................................................................................................................................................................................................................. 7
3.2 Ergonomisch werken in de tandheelkunde.................................................................................................................................................................................................................................................................................................. 7
3.2.1 Gezond zijn en werken.............................................................................................................................................................................................................................................................................................................................. 7
3.2.2 Belasting en belastbaarheid...............................................................................................................................................................................................................................................................................................................7
3.2.3 Houding en beweging..............................................................................................................................................................................................................................................................................................................................8
Infectiepreventie.................................................................................................................................................................................................................................................................................................................................................... 8
4.1 Infectiepreventie aan de behandelstoel......................................................................................................................................................................................................................................................................................................... 8
4.2 Ziekteverwekkers..............................................................................................................................................................................................................................................................................................................................................................8
4.2.1 Aerosol................................................................................................................................................................................................................................................................................................................................................................. 8
4.2.2 Legionella-infectie......................................................................................................................................................................................................................................................................................................................................9
4.2.3 Via direct contact overdraagbare ziekten............................................................................................................................................................................................................................................................................... 9
4.2.4 Via de lucht overdraagbare ziekten............................................................................................................................................................................................................................................................................................. 9
4.3 Richtlijn Infectiepreventie in Mondzorgpraktijken.................................................................................................................................................................................................................................................................................. 9
4.4 Persoonlijke hygiëne..................................................................................................................................................................................................................................................................................................................................................... 9
4.5 Persoonlijke beschermingsmiddelen................................................................................................................................................................................................................................................................................................................ 9
4.6 Handhygiëne...................................................................................................................................................................................................................................................................................................................................................................... 9
4.7 Accidenteel bloedcontact....................................................................................................................................................................................................................................................................................................................................... 10
4.8 Reiniging, desinfectie van oppervlakken, ruimten, apparatuur en materialen................................................................................................................................................................................................................10
Instrumenteren..................................................................................................................................................................................................................................................................................................................................................... 10
5.1 De basisset.......................................................................................................................................................................................................................................................................................................................................................................... 10
5.2 Four-handed dentistry............................................................................................................................................................................................................................................................................................................................................... 11
5.2.1 Uitvoering four-handed dentistry...................................................................................................................................................................................................................................................................................................11
5.2.2 Instrumenteren spiegel en sonde.................................................................................................................................................................................................................................................................................................. 11
5.3 De afzuigbuis hanteren............................................................................................................................................................................................................................................................................................................................................. 11
5.3.1 Instrumenteren afzuigbuis...................................................................................................................................................................................................................................................................................................................11
5.3.2 Instrumenteren meerfunctiespuit................................................................................................................................................................................................................................................................................................. 12
Assisteren bij diagnostiek...............................................................................................................................................................................................................................................................................................................................12
6.1 Diagnostiek......................................................................................................................................................................................................................................................................................................................................................................... 12
6.2 Periodiek mondonderzoek...................................................................................................................................................................................................................................................................................................................................... 12
6.2.1 Inhoud PMO....................................................................................................................................................................................................................................................................................................................................................12
6.2.2 Anamnese........................................................................................................................................................................................................................................................................................................................................................12
6.2.3 DPSI...................................................................................................................................................................................................................................................................................................................................................................... 12
6.3 Het onderzoek..................................................................................................................................................................................................................................................................................................................................................................13
6.3.1 De tray bij een pmo...................................................................................................................................................................................................................................................................................................................................13
6.3.2 Assisteren bij het periodiek mondonderzoek.......................................................................................................................................................................................................................................................................13
6.3.3 Instrumenteren bij het PMO.............................................................................................................................................................................................................................................................................................................. 13
6.4 Bitewing-opnames........................................................................................................................................................................................................................................................................................................................................................ 13
6.4.1 Zelfstandige handeling: Bitewing-opnames maken..........................................................................................................................................................................................................................................................13
6.5 Pijnklachten........................................................................................................................................................................................................................................................................................................................................................................13
6.5.1 Diagnostische hulpmiddelen.............................................................................................................................................................................................................................................................................................................13
6.5.2 Instrumenteren bij een sensibiliteitstest met koudeprikkel....................................................................................................................................................................................................................................... 13
6.6 Solo-opnames.................................................................................................................................................................................................................................................................................................................................................................. 14
6.6.1 Opnametechnieken voor solo-opnames...................................................................................................................................................................................................................................................................................14
6.6.2 Zelfstandige handeling: Solo-opnames maken...................................................................................................................................................................................................................................................................14
Assisteren bij restauratieve tandheelkunde.........................................................................................................................................................................................................................................................................................14
8.1 Restauratieve tandheelkunde............................................................................................................................................................................................................................................................................................................................... 14
8.2 Instrumenten en materialen bij restauratieve behandelingen....................................................................................................................................................................................................................................................14
8.2.1 Airrotor, hand- en hoekstukken....................................................................................................................................................................................................................................................................................................... 14
8.2.2 Boren.................................................................................................................................................................................................................................................................................................................................................................. 15
,8.3 Restaureren met plastische materialen........................................................................................................................................................................................................................................................................................................ 15
8.3.1 Plastische vulmaterialen....................................................................................................................................................................................................................................................................................................................... 15
8.3.2 Assisteren bij het vervaardigen van een composietrestauratie.............................................................................................................................................................................................................................15
8.3.3 Classificatie van caviteiten en restauraties........................................................................................................................................................................................................................................................................... 16
8.3.4 Assisteren bij het vervaardigen van een restauratie met glasionomeercement........................................................................................................................................................................................16
8.3.5 Zelfstandige handeling: Matrixband aanbrengen........................................................................................................................................................................................................................................................... 16
8.4 Kroon- en brugwerk..................................................................................................................................................................................................................................................................................................................................................... 16
8.4.1 Assisteren bij een kroonpreparatie.............................................................................................................................................................................................................................................................................................. 17
8.4.2 Zelfstandige handeling: Een noodkroon vervaardigen................................................................................................................................................................................................................................................ 17
8.4.3 Assisteren bij een kroonafdruk....................................................................................................................................................................................................................................................................................................... 17
8.4.4 Zelfstandige handeling: Afdrukken maken met alginaat.............................................................................................................................................................................................................................................17
8.4.5 Assisteren bij het plaatsen van een kroon............................................................................................................................................................................................................................................................................. 18
, De wettelijke basis
1.1 Het tandheelkundig team
Tandartspraktijk: preventie- en de paropreventieassistent, de mondhygiënist & tandprothetici.
1.2 Wet BIG
Absolute verbod op onbevoegd uitoefening van de geneeskunde is komen te vervallen. Doel:
om de kwaliteit van de gezondheidszorg te bewaken, te bevorderen & patiënten te beschermen
tegen onzorgvuldig handelen door zorgverleners. Door: titelbescherming en beroepsregistratie,
bepaalde risicovolle handelingen apart te regelen & het tuchtrecht.
1.2.1 Titelbescherming
Je mag een titel alleen gebruiken als je de opleiding voor dit beroep hebt afgerond en staat
ingeschreven in het BIG-register. Hier staat ook of een beroepsbeoefenaar onder voorwaarden
zijn beroep mag uitoefenen, of helemaal niet meer. Iedere 5 jaar moet een tandarts zich laten
herregistreren, waarbij werkervaring en nascholing aangetoond moeten worden. Er staat of bij
specialisme de tandarts bekwaam maakt bevoegd. Bij- en nascholing van tandartsen wordt
geregistreerd in het Kwaliteitsregister Tandartsen (KRT). Hier staat een overzicht van tandartsen
die hun kennis doorlopend actualiseren en die werken volgens algemene praktijkrichtlijnen.
1.2.2 Voorbehouden handelingen
Voorbehouden handelingen: mogen alleen zelfstandig door bevoegde zorgverleners worden
uitgevoerd. Voorbeelden: röntgenfoto’s maken, lokale anesthesie geven, heelkundige
handelingen (prepareren, extraheren, snijden, hechten) & geneesmiddelen voorschrijven.
Niet-voorbehouden handelingen: alle medische handelingen die niet tot de voorbehouden
handelingen gerekend worden. Voorbeelden: afdrukken maken, gebitselementen sealen zonder
ze te beslijpen & de fluoride applicatie. Risicovolle handelingen: leveren bij ondeskundige
uitvoering risico op voor de patiënt. Voorbeeld: tandsteen verwijderen. Regels bij voorbehouden
handelingen voor tandartsassistenten: tandarts geeft de opdracht, tandartsassistent vertelt de
patiënt dat hij een voorbehouden handeling uitvoert in opdracht en vraagt toestemming
hiervoor, tandarts moet overtuigd zijn van de bekwaamheid van de tandartsassistent,
tandartsassistent moet zichzelf bekwaam achten, opleiding tot het uitvoeren moet worden
gevolgd onder toezicht van professionals in het opleidingscircuit & tandarts moet fysiek
aanwezig zijn in de praktijk. Delegeren: overdragen van verrichtingen aan praktijkmedewerkers.
Administratie en beheer: verrichtingen invoeren, nota’s opstellen, praktijkboekhouding &
verbruiksmaterialen inkopen. Indirecte patiëntenzorg: intake bij aanmelding van nieuwe
patiënten en bij klachten, communicatie en logistiek in de samenwerking met het tandtechnisch
laboratorium & tandtechnische werkzaamheden als het uitgieten van afdrukken, modellen
ingipsen in een articulator, prothesereparaties en individuele afdruklepels vervaardigen. Directe
patiëntenzorg: afdrukken nemen, röntgenfoto’s maken, fluoride-applicaties toedienen, sealants
vervaardigen & cofferdam, matrices en wiggen aanbrengen.
1.2.3 Tuchtrecht
Van toepassing bij beroepsgroepen die vallen onder de Wet BIG. Strafmaatregelen: berisping,
geldboete, voorwaardelijke schorsing, schorsing van max. 1 jaar, gedeeltelijke ontzegging van de
bevoegdheid & doorhaling van de inschrijving in het BIG-register. Strafmaatregelen voor
tandartsassistenten via een civielrechtelijke procedure of via het strafrecht: geldboete, taakstraf,
gevangenisstraf (hechtenis)& ontzetting uit het beroep.
1.3 WGBO
Regelt de relatie tussen de patiënt en de hulpverlener. Regels: recht op informatie, dossierplicht,
toestemmingsvereiste, geheimhouding, plichten van de patiënt & hulpverlenersplicht.
1.3.1 Recht op informatie
De patiënt heeft recht op voorlichting in begrijpelijke taal over aandoeningen, de behandeling,
de gevolgen en risico’s van die behandeling & over eventuele alternatieve behandelingen. De
patiënt heeft ook het recht om geen informatie te willen.
1.3.2 Dossierplicht
Een hulpverlener heeft de plicht om een apart dossier van elke patiënt bij te houden.
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