Familiarize yourself with each patient and their scheduled treatment.
Chart all appropriate data during the exam and treatment.
Take, develop, x-rays.
Take every opportunity to educate the patient on dentistry and their treatment.
Help maintain schedule flow by monitoring the doctor/treatment progress. If running ahead or behind schedule, notify the schedule coordinator.
Maintain maximum operatory function by keeping it adequately stocked.
See to clinical equipment and instrument maintenance through proper preventive maintenance, cleaning, and sterilization.
PRIOR TO SEATING A PATIENT:
Review patient record. Verify that consent for treatment has been completed. Review medical history for necessary precautions. Highlight medical alerts using red alert stickers. Record all medical history information provided by the patient on the patient information sheet. If there are no medical precautions, write ‘WNL’ (within normal limits).
Record patient information onto computer – CDR. Verify that the spelling of the patient name is correct.
Make sure the operatory is completely set up for treatment. All equipment should be turned on and ready to go.
Enter the first letter of the patient’s last name.
Using the arrow keys, scroll up or down alphabetically to find the patients name.
Once you have located the patient’s name, press ENTER.
Note: not all returning patients will be registered in the current computer memory. Our files are historically compressed (filed by date) and may have been transferred to CD or
disk. If search does not produce the patients name, enter the patient as a new patient exam.
SEATING A PATIENT
Call the patient by their first name and escort the patient to the operatory.
Indicate to the patient where coats and purses, etc. may be placed during treatment. “Sally, there is a hook in the far left corner if you would like to hang your coat.”
Introduce yourself to the patient. “My name is Molly. I will be assisting Dr. Goerig with your treatment today.”
Gather diagnostic information from patient. Listen intently to the patient, they will give you the diagnosis. Record diagnostic information onto patient information sheet.
Take initial x-ray on computer.
Notify the doctor that the patient is ready for exam.
Return to patient and see to their comfort. Offer the patient a magazine. All conversation should be directed toward the patient needs. If the patient has any concerns about treatment or is apprehensive, note this on the patient information sheet. Address patient fears; be careful not to negate the patient’s feelings.
DOCTOR INTRODUCTION AND ANESTHETIC:
Doctor will enter the operatory, glance at the patient information sheet and make the appropriate introduction. (If the ‘N” is circled, this indicates to the doctor that this is a new patient. If the “N” is crossed out, it indicates that this patient has previously been into the office.) The doctor will then address any patient fears, if indicated. It is very important that any patient apprehension has been communicated to the doctor. After fears have been addressed and introductions have been made…
Put the patient chair back.
Adjust examination light and doctor tray for doctor use.
Record all diagnostic tests onto patient information sheet.
When patient has given verbal consent to recommended treatment, pass topical anesthetic and 2x2 gauze to doctor.
Receive topical, pass anesthetic syringe. For all mandibular (lower) teeth, Citanest Plain (black) carpule and yellow needle should be used. For all maxillary (upper) teeth, 2% Xylocaine (red) or 2% Polocaine (brown) carpule and blue needle.
Prop the needle cover onto cotton pliers for recapping.
Receive the anesthetic syringe and recap immediately.
Pour a cup of water for the patient and offer tissue for the patient to rinse.
Turn engine drill on.
Place the appropriate bur in the handpiece:
Porcelin crown – round diamond
Temporary – 1158
Decay – round bur* in slowspeed
Calcified – round, L-N bur, and have sonic ready
* Round bur size should correlate with tooth size. For example, if molar, a large bur (8) would be appropriate. If bicuspid or anterior, a smaller size (4 or 6) is more suitable.
Explain to the patient that doctor allows the anesthetic to soak for ten minutes.
Offer the headphones and explain how they work.
Ask if the patient has any questions regarding insurance. In most cases, financial arrangements have already been discussed with the insurance specialist/front staff. Occasionally, however, the patient may have additional financial concerns. If so, explain to the patient that you will submit their treatment plan to the front desk and our insurance specialist will be in to answer their question(s).
Submit completed route slip to the front desk. Request that someone “go over fees” with the patient if necessary.
Return to patient.
Transfer diagnostic findings into patient chart.
ROOT CANAL PROCEDURE:
Hand Dr. anesthetic with new carpule. Use2% xylocaine (red) or 2% polocaine (brown) for second injection.
Receive anesthetic; pass rubber dam and forceps.
Place safety glasses on the patient.
Use the air/water and suction to maintain clear visibility for the doctor as he opens the tooth.
When Dr. uses RC Prep, hold the file holder in your left hand angled toward the tooth. Replace files in order onto sponge as they are used. Always inspect files for unwinding or bending; discard and replace as this occurs.
Maintain a wet working environment as Dr. uses gates glidden drills. Wash tooth between sizes. When Dr. has finished using the gates, wash and dry tooth.
Place lip clip (apex locator) on the corner of the patients mouth opposite side of working area. Pass probe (straight end) and finger ruler to Dr.
As Dr. reports measurements, record them onto pt information sheet.
Pass engine drill to Dr. Hold engine drill files with left hand angled toward tooth. Support engine drill cord away from patient.
Measure hand files to lowest reported length.
Turn on Obtura and touch-n-heat. Always place lever switch on touch-n-heat on "touch”
Suction and stay close when Dr. uses sodium hypochlorite.
As Dr. begins to place engine files into tooth, place lead drape over patient.
Measurement X-ray will be taken. For Dr. Goerig, position x-ray head within reach of Dr.
When Dr. has positioned x-ray head and is beginning to exit operatory, press red floor pedal.
Press x-ray button located in hall. All hall buttons are marked with room number.
After Dr. OK’s x-ray, remove x-ray head and lower lead drape. (Fold lead drape over patients lap.)
Continue with engine drill files.
When Dr. has finished using engine drills, suction as he rinses the canals with sodium hypochlorite.
Hold file block as Dr. instruments canals. Record master cone sizes as they are reported by Dr. and place appropriate sized cone to measurement onto grey file block. As each cone size is determined, reset files to next greater length.
Suction as Dr. uses sodium hypochlorite. Pass cotton pliers as Dr. pulls back on syringe.
After Dr. has placed paper points into each canal, position air/water syringe over points and dry into canal.
Hold measuring file block with gutta percha points and sealer towards doctor.
When gutta percha is in place, another check x-ray will be taken. Put compactor into slow speed. Position Obtura on endo cart arm, tip facing away from Dr.
Receive touch-n-heat, wipe with 2x2. (Dr will take Obtura from arm of endo cart.)
Wipe obtura tip as indicated by Dr.
Pass slow speed handpiece (with compactor).
Wipe excess from compactor tip, pass 5-7 plugger.
Receive 5-7, pass touch-n-heat.
Receive touch-n-heat, pass 5-7 plugger.
Have ready to pass 5-7 plugger and glick; Dr. will choose the one he wants. If Dr. chooses 5-7, pass Obtura. If Dr. chooses glick, pass alcohol soaked cotton pellet. Restoration of tooth is determined and placed.
Pass rubber dam forceps.
Wash (rinse) patients mouth.
Final X-rays are taken. Initial x-ray will be taken on computer. After Dr. approval of computer x-ray, change settings on x-ray wall mount for final x-ray. Pass snap-a-ray with double film to doctor.
Remove lead apron from patient and raise patients chair.
Review post op instructions and give patient written post op sheet (Completion of endodontic treatment).
Prepare a prescription for the patient if the doctor has indicated the need for one.
Verify and/or amend route slip to reflect actual treatment.
After Dr. has approved final x-ray, escort patient to the check out counter.
Inform front staff personnel that patient is ready for a walkout statement.
Signal to Dr. that patient is in the process of checking out.
Complete patient record.
Return to operatory to assist with preparation for the next patient.
CHARTING As with many aspects of dental assisting, writing patient records is a meticulous duty. All patient records should be admissible as evidence in a court of law. Therefore, details are very important. Ultimately, Dr. Goerig is responsible for what is written into patient records. With these details in mind, an example chart write up is provided on the following page.