Megan Baitey

Spring Term 2021

6/3/2021

General Office Visit Report

I had the opportunity to observe a hygienist named Tyree at Dr. Rezaee dental office. I was only able to
be there for a couple hours and was able to observe two patients while there. These two patients were
both adult prophylaxis appointments where the hygienist took radiographs and updated their
periodontal chart. Between my time at the office and the interview with the hygienist I was able to learn
more about the office and how it works which gives me a better idea of how my career might look
outside of the Lane Dental Clinic.

The staff at this office communicate with each other in person, but they also do monthly staff meetings
to make sure everyone is up to date and on the same page. They do not do any messaging systems
between each other, but rather go find the person they need to talk to. An example of this is that the
hygienist will find the dentist and verbalize the need for him or her. Another example is that in this office
the assistant will go to the hygienist and explain procedures that were done and what was found during
the comprehensive exam before the hygienist starts her treatment. As far as communication between
patients and the staff, the front desk handles most of it, with the exception of the obvious
communication that must take place during treatment and exams. The front office personnel will call
patients to remind them of their upcoming appointments, to take pre-medication if needed, or to bring
any necessary documentation. The front desk is also in charge of scheduling recall appointments and
taking care of referrals whether it be through email or phone calls.

The software they use at this clinic is a little different than we use at the Lane Dental Clinic. They use
Dentrix for their charts and Dexis for their radiographs. Everything is electronic in this office so no paper
copies of charts are needed. However, they do provide paper route slips at the end of the appointment
that the patient brings to the front desk so the front staff knows what they need to bill and when to
schedule the patients next appointment. As far as charts go, hygienists have their own templates they
follow to put in details of the appointment. If the patient had an exam with the doctor, then the doctor
would also sign the chart at the end of the day, but if the patient was seen only by the hygienist they are
responsible for the chart by themselves. An example of a template used at this office for nonsurgical
periodontal therapy would include: medical history, vital signs, which quadrant was treated, what
anesthesia was used, whether topical anesthesia was used, how much anesthesia was used and where it
was used, after treatment instructions, if irrigation was used or not, tissues statements, bleeding,
hard/soft deposits, techniques used, and whether or not an implant scaler was used. Some
abbreviations that are used in the dental chart include: Periodx (periodic exam), Compx (comprehensive
exam), ProA (Adult prophy), ProC (Child Prophy), SRP/UL (Scaling and root planning upper left quadrant),
ScaFull (Scaling in the presence of moderate to severe inflammation), 4BWX (4 Bitewings), etc.

When a new patient arrives at the office, they first meet with the doctor for a comprehensive exam for
about 30 minutes. The doctor or assistant will typically take intraoral photos and radiographs during the
comprehensive exam. After the comprehensive exam, the patient will see the hygienist for about an
hour. While with the hygienist they will get their treatment plan done, periodontal chart done, dental
chart done, oral hygiene instruction, and the cleaning done depending on how advance they are. The
doctor will come back in the room after the hygienist is done to talk with the hygienist and patient about
the treatment plan. If the patient ends up needing NSPT then the hygienist will typically do a gross
debridement at the initial appointment. When the patient’s appointment is completed the fees and
payments will be discussed at the front desk. This office takes most payment methods and insurance
plans. If the patient ends up needing a referral, the dentist will let the hygienist know who to refer the
patient to and the hygienist will let the front desk know so they can take care of it. The referred provider
should contact the patient, but if they don’t within a week, they tell the patient to call them back and let
them know.

Most appointments are an hour long for cleanings, but if the patient needs NSPT they might only get
two quadrants done within the hour and have to come back for another appointment to finish. Most
patients will get a periodic exam done by the dentist every six months unless the patient refuses. If
that’s the case, in the chart the hygienist would write a notation of “informed refusal”. This is the same
procedure if the patient rejects getting radiographs taken as well. They do not require the patient to sign
a refusal form. However, if the patient refuses radiographs for two years, the doctor has the option to
terminate any further treatment. Adult prophylaxis appointments happen about every six months, and
periodontal maintenance appointments are every 3-4 months. The periodontal chart is updated every
year. Bitewings are taken yearly as well, and pano’s and/or full mouth series are done every five to six
years. Fluoride is not pushed too much at this office. They will typically only ask patients under the age
of 18. The assistants will typically do the prophy’s for children under the age of ten, and will sometimes
help the hygienist with radiographs, cleaning rooms, and periodontal charting whenever they are
available. Nonsurgical periodontal therapy is in the same sequence as a maintenance appointment for
the most part, with the exception of needing more than one appointment to finish, and the use of
anesthetic. The periodontal chart for NSPT patients is updated again at the 4-6 week recall appointment,
or if they aren’t going to be seen again for three months it would be updated at the three-month
appointment. After its updated at either or those appointments, it is then only updated once a year.
Radiographs are taken yearly as well on NSPT patients, but they mainly will do vertical bitewings on
periodontal patients rather than horizontal bitewings.

The hygienist might see a variety of patients at this office, but adult prophy patients are about 40% of
the patients they see. Periodontal maintenance patients are about 30% of the patients there, following
NSPT patients as 20%, and children about 10%. Other than the actual cleaning the hygienist provides,
they also take intraoral photos and radiographs. They also will do anesthesia, nitrous oxide, oraqix when
needed, use the ultrasonic, hand scalers, files, minis, or they even use irrigation syringes containing
peridex to irrigate deeper pockets (6mm or more). This office does not have an air polisher, nor do they
use cassettes. As far as ultrasonic tips they have the regular slim tips and the gross debridement tips, but
they do not have the left and right-angle tips. A typical instrument set-up for an adult prophy patient
includes: a mirror, probe, explorer, universal 5/6, Gracey 13/14, posterior sickle, and a nevi sickle. The
instrument set-up for an NSPT patient includes everything the prophy set contained with the addition of
the Gracey 11/12, Gracey 15/16, and the minis. The whole office shares 2 digital sensors for radiographs
and 2 intraoral cameras as well which are both kept in the sterilization room. The office also provides
the following as homecare aids the patient can take home: toothbrushes, toothpaste, floss, soft picks,
rubber tips, proxy brushes, and fluoride mouth rinse. Patients can also purchase the following products
for home use: prevident, peridex, and cloys.
Each clinician has their own set of responsibilities in the office. The dentists are obviously in charge of
overseeing things, restorative work, etc. The assistants provide assistance to the dentist and even
sometimes the hygienist. They also take radiographs, help keep up with the sterilization room, and they
do the laundry for everyone at the office. The hygienist is in charge of their normal radiographs,
charting, cleaning procedures, etc., but they also help with trashes, the sterilization room, cleaning up
rooms, and asking if anyone else needs help when they aren’t with a patient. If there is a cancellation or
a no show then the hygienist will get caught up on chart notes, catch up the sterilization room, or do
instrument sharpening. The front office staff is in charge of communicating with patients and other
providers, communicating with the other staff, billing, appointments, etc.

I believe the quality of care for periodontal patients at this office would be up to the standards of most
dental offices. I think they following the correct guidelines regarding whether or not to refer, taking
accurate notes, taking accurate radiographs, and keeping up with periodontal chart, and reevaluation
appointments. The dentist is also very hands on in regards to the patient’s periodontal condition and
explaining the importance of the disease alongside the hygienist which I believe might help emphasize
the importance of treatment to the patient.

The office follows standard guidelines for asepsis and infection control. Each room contains an air
purifier and an extraoral suction that is used for polishing and ultrasonic use. They use plastic on the
tray, chair, and x-ray button, and wipe down everything twice after each patient. The slow speed
handpiece is wiped down between each patient and sterilized at the end of the day. All proper PPES are
worn by the dentists, assistants, and hygienists including: gowns, proper shoes, masks, shields, glasses,
gloves, etc. The sterilization room is kept clean by all staff and each item is properly stored to stay
sterile. For the most part this office shared the same asepsis procedure that we follow at the Lane
Dental Clinic. The few differences would be they did not have to wear hair coverings while seeing
patients, they only had to wear N95 masks while seeing patients, and sterilizing the handpiece at the
end of the day rather than between every patient.

It was a great experience being able to observe and speak with a hygienist at a general dentist’s office,
especially since that is the type of office I believe I would want to work at. This office was very clean and
gave a very warm/formal impression. The staff seemed to communicate well with each other and the
office as a whole seemed to run smoothly. Seeing how an office runs outside of the Lane Dental Clinic
was a good experience for me. I believe for the most part our schools dental clinic runs similar to how
this office ran, aside from having no instructor check offs, and seeing a lot more patients throughout the
day. Being on time and efficient is going to be very important working in a dental office, so that
everything keeps running smoothly and patients are in and out in a timely manner.

Eugene Oregon Dentist: Personalized Dental Care (eugenedentalcare.com)

Dental Hygienist: Tyree Baxter

Contact Information: (541) 654-3818