OINTMENT TOPICAL ANESTHETICS.\ You may be asked by the dental officer to place an ointment topical anesthetic at an injection site before injection of dental anesthesia. Always follow the manufacturer's instructions before use. To start this procedure, take a sterile 2-inch 2-inch gauze and gently wipe and dry the area of the mucosa where the topical anesthetic is to be placed. Next take a sterile cotton tipped applicator and open the container and place a small amount of the ointment on it. Always use a sterile applicator each time you use the ointment to prevent contamination and replace the cover when not in use. Place the cotton portion of the applicator with the ointment on the area to be anesthetized. Patients must be told NOT to swallow any of the anesthetic. Have the saliva ejector or high-speed evacuator (HVE) standing by to remove any fluids the patient may have accumulated while the topical anesthetic is taking effect. After the dental officer has completely anesthetized the patient, use the 3-way syringe and HVE to rinse the patient's mouth completely, paying attention to the area where the topical anesthetic and anesthesia have been placed and injected.

TOPICAL DENTAL SPRAY.\The use of topical dental sprays is an effective means to assist patients, who may have an exagerated gag reflex to complete dental procedures. Always consult with a dental officer, when treating a patient who has a gag reflex. It may even be documented on his/her health history form. Use of lidocaine spray in some cardiac patients or children could cause problems. Certain patients are very sensitive to any objects placed in the oral cavity, especially posterior X-rays, and prosthetic impressions. Special care and time must be given to these patients to ensure the patient does not have a bad experience, such as gagging or vomiting, during the procedure. The time you spend to make your patient comfortable will benefit your patient and the quality of the procedure you are doing. When using a topical spray, follow the directions the dental officer will give you, along with the manufacturer's instructions.

LIQUID TOPICAL ANESTHETICS.\Liquid topical anesthetic come in the form of a viscous (thick) liquid. They produce the same effect as spray topical anesthetics by numbing the oral mucosa and the mouth, but in addition can be used to gargle to anesthetize the pharynx. Under the direction of a dental officer, the patient takes the liquid and swishes it around in the mouth, which is removed by a saliva ejector HVE or by spitting. It is useful for patients who need to be anesthetized for gag reflexes when taking prosthetic impressions or dental radiographs. In addition the dental officer may prescribe liquid topical anesthetics to patients for the temporary relief of pain from ulcers, wounds, and periodontal treatment in the mouth.

Miscellaneous Drugs

Numerous other drugs are used in dentistry. Some drugs, for example, are used as antisialagogues. Such drugs as atropine sulfate, scopolamine hydrobromide, and methantheline bromide reduce a patient's salivary flow, thereby providing a drier field of operation. Other drugs are used in specialized areas of dentistry and will be discussed, where appropriate, in later chapters.

PROCURING DRUGS

For a patient to receive drugs, both controlled and noncontrolled, the dental officer will use the DOD Prescription (DD 1289) or Polyprescription (NAVMED 6710/6). Many dental treatment facilities, are able to prescribe drugs and medications through an automated pharmacy system (computerized). This saves the patient valuable time by not having to stand in line and wait for prescriptions. All drugs prescribed are to be documented by the dentist in the patient's Dental Health Record on the SF 603/603A. Instructions for preparation of outpatient prescriptions and automated pharmacy procedures can be found in the MANMED, chapter 21.

LABELING DRUGS

Most drugs for direct patient use have cautions or warnings preprinted on the label warning the user of hazards of handling involved. When no label is on a drug, you must clearly place a label indicating its name, proper warnings, and its strength. Powerful and dangerous drugs require special labeling. The information on these special labels should be typed or printed in RED with the caution warning above the name. Listed below are examples of cautions you might encounter.

POISON

CAUSTIC

FLAMMABLE/VOLATILE

It is your responsibility to know every precaution of use, handling, and storage for each drug or chemical you come in contact with for the safety of yourself and your patient.

CHAPTER 8 NUTRITION AND DIET

The important role of nutrition and diet in overall health is widely recognized. As a member of the Navy, and as a Dental Technician, you must be healthy so you can perform your professional duties. Part of maintaining a healthy lifestyle starts with eating a well- balanced diet and exercising. Many people in the Navy and Marine Corps do not have a proper daily diet and you may be responsible for providing counseling on nutrition to your dental patients. Some patients may need a little motivation. If you are healthy and enthusiastic, the knowledge you share with them on nutrition and diet may be more credible and may help them to adopt a healthier lifestyle.

ESSENTIAL NUTRIENTS

An essential nutrient is defined as one that must be provided by food because the body cannot synthesize it at a rate sufficient to meet our needs. Nutrients can be divided into six main classes: carbohydrates, fat, protein, minerals, vitamins, and water. Good food sources contain substantial amounts of nutrients in relation to caloric contents and contribute at least 10 percent of U.S. Recommended Dietary Allowance for the nutrient in the selected serving size. Most of us can get enough of these nutrients each day by eating a variety of foods from the five major food groups. The six classes of nutrients are described as follows:

Carbohydrates include starches, sugars and dietary fiber. Starch and sugar supply the body with energy. Dietary fiber provides bulk to the diet, which promotes regularity.

Proteins are the building blocks of the body. Proteins are needed for growth, maintenance, and replacement of body cells. They also form hormones and enzymes used to regulate body processes. Extra protein is used to supply energy or is changed into body fat.

Fats provide energy and help carry fat soluble vitamins. Fats also add flavor to foods. Some fats help form cell membranes and hormones.

Vitamins are organic substances needed by the body in very small amounts. They do not supply energy, but help release energy from carbohydrates, fats, and proteins. They also help in other chemical reactions in the body.

Minerals are inorganic compounds found in foods, body structures, and compounds in the body that regulate body processes. Minerals are also needed in relatively small amounts and do not supply energy. Minerals are used to build strong bones and teeth, and to make hemoglobin in red blood cells. They help maintain body fluids and help other chemical reactions in the body.

Water is often called the "forgotten nutrient." It is needed to replace body fluids lost in urine and sweat. Water helps to transport nutrients, remove waste, and regulate body temperature.

COMPLEX CARBOHYDRATES

One gram of carbohydrates provides four calories. A calorie is not a nutrient. It is a measure of the energy supplied by food when it is used by the body. Complex carbohydrates, such as starches, are in breads, cereals, pasta, rice, dry beans and peas, and other vegetables, such as potatoes and corn.

SIMPLE CARBOHYDRATES

Simple carbohydrates are found in sugars, honey, syrup, jam, and many desserts. Sugar can contribute to tooth decay and should be used in moderation.

PROTEINS

One gram of protein provides 4 calories. Protein is found in both animals and plants. All protein is made up of small building blocks called amino acids. There are approximately 20 amino acids. Our body can make all but 9 of these. The 9 that we can't make are called "essential amino acids." We must get them from food, and we need all 9 at one time so our body can function properly. The only foods that contain all 9 are animal foods (meat, milk, eggs, etc.). For this reason, animal foods are called "complete" proteins. Plants (grains such as rice, corn, beans, and wheat) each contain several but not all 9 essential amino acids.