A dental nurse's role in… direct restorations

… You can also find out how to deal with a mercury spillage and yet, despite using amalgam extensively in community dentistry, I haven't seen a mercury spillage since the days of the Dentomat.

The dental nurses role as far as restorations are concerned has changed beyond recognition since I was a dental nurse – way back in the dark ages! I remember making an amalgam filling with a pestle and mortar, squeezing out the excess mercury with a gauze square! And no gloves! Instruments were sterilised in a water boiler and it was anyone's guess how long they'd been in there for, as new instruments were constantly being added. A big dollop of Sedanol was mixed at the beginning of the day and stored so as not to dry out. Every time the dentist needed a lining, I just took a small amount from the daily ration. We worked standing up and there was certainly no four-handed dentistry! Eventually – and thankfully – things changed and chairside assisting was ‘the thing’ and amalgam was mixed in the above-mentioned Dentomat. We had to fill the reservoirs regularly with mercury and alloy and mercury spillages were common. Yet, still there was no mercury spillage kit. Along came Kalzinol, which had to be hand mixed for each patient, on a glass slab, which got a quick wipe over with a gauze square between patients. Dycal was used as a liner under silicate restorations (the only available white filling material) and as a subliner under Kalzinol occasionally for deep fillings. Soon amalgam could be purchased in capsule form as concerns regarding mercury vapour were emerging. The first composite materials, Composite and Adaptic came along – both self-curing and taking about four minutes to set. Hot air ovens replaced the water boilers and then my first autoclave (when nursing in the Navy) – but were they tested? Not to my knowledge. TST strips? Not invented. With the advent of AIDS, cross infection suddenly became paramount and we had to start wearing gloves. By then, I was a dental therapist and, because of the additional cost implications, we were told to wash them in between patients and only change them at the end of the session! They were latex and became stickier with each wash. Thankfully, things have moved on and I now see the role of a dental nurse from the safe ignorance of a clinician. HTM01-05? CQC? Just tell me what to do, Doris [insert the dental nurse's name here].