General Office Visit Report: Dr.

Fedak
By: Kaylin McConville

The hygienist that I shadowed was named Chelsie Stringfield, and she works at Thurston

Family Dental. Dr. Fedak is the Dentist at this location, with two assistants and two dental

hygienists joining him. One of the first things I noticed about this office was the very welcoming

environment. As soon as I walked in, I was greeted with a friendly “hello”, and immediately met

by Chelsie. As I continued throughout my day, I quickly realized that this friendly warmth I was

greeted with was not an anomaly, but a standard in this office. Every patient was treated with the

same standard when I was there, and I noticed that their way of explaining was very similar

amongst all clinicians. I also noticed that all of the clinicians spoke to each other very

respectfully, and kept it very professional at the same time.

The software that Dr. Fedak’s office uses is Dentrix. From the little time I was able to

observe this software being utilized, I noted that it seemed fairly similar to Eaglesoft. Chelsie

told me that, “In my opinion, it’s much more straight-forward than Eaglesoft”. The information

that is added to the electronic chart as a part of the auto note is: blood pressure, color contour and

consistency, dental chart, Treatment, and OHI. It was much more minimal than the notes I am

used to taking at LCC. The schedule is a different part of this software that has its own

organizational structure. Each hygienist has their own column with a different color. The

appointments are based off of the type of treatment, and there are specific abbreviations that are

used on the main schedule. Those abbreviations are:

 FMPC=full mouth periodontal chart

 4BWX= 4 bitewing radiographs

 RPC 1-3 or 1-4= NSPT

 Periodic x = periodic exam

  Comp x = Comprehensive Exam

 FMX = Full Mouth Survey Radiographs

 Scale/pres= scaling in the presence of mod-severe inflammation

 Permaint= Periodontal maintenance

 Fulldebrd= full mouth debridement

If a new patient is coming into the office, they will come for an initial exam with the

hygienist and the dentist. At this appointment, they will get radiographs taken, periodontal

assessments will be done, and a comprehensive exam will occur. Dependent upon the amount of

treatment suggested, the treatment plan will be ready at the end of this appointment or by their

following appointment. There was a patient that I was watching get a comprehensive exam who

had nearly 20 different treatment needs. The dentist told the patient that he was going to sit down

and create a treatment plan in order of importance, as well as monetary estimates for the patient

with alternate treatment options. This patient did not receive his treatment plan at the same

appointment, because his needs were too great. This is the end of the initial appointment for a

new patient, and they will begin treatment at the next appointment.

If a patient has any needs that need to be addressed by a specialist, there are two ways that

this patient can proceed with a referral. One option is that the patient firsts call the office where

they are being referred to, then that specialty office will call the primary dentist for “approval”.

The second option is for the patient to request a “paper referral to physically take into the

specialty office if they prefer.

In this office, by the time the patient has gotten to their treatment appointment for periodontal

maintenance, the dentist will not need to see them during this appointment. If there are any
emergency dental needs to address, the dentist would do a limited oral evaluation. The hygienist

is the one providing treatment for periodontal maintenance patients. They will do the OHI,

periodontal assessments, and periodontal maintenance. This office does not apply fluoride to

their patients unless they have high levels of active decay, so fluoride would only be provided to

some patients. If the patient is receiving nonsurgical periodontal therapy, there is likely to be

more appointments as well as additional services to the patient. After medical history and vitals

are recorded, anesthesia is usually administered immediately. I was able to watch Chelsie do two

quadrants of NSPT on one of her patients, and these were the same steps that she followed. After

anesthetizing the first quadrant, she began using her ultrasonic scaler, and then moving onto her

hand instrumentation. After continually checking she was done with one quadrant, and

anesthetized the second one. She repeated the same steps as the first quadrant, until all calculus

was removed. She did OHI after debridement, which I found interesting. The patient was eager

to get out of there, but I can understand how sometimes OHI needs to be saved for the end, in

case time runs tight. After OHI, the hygienist has the responsibility of scheduling the next

appointment for the patient before they leave. Most offices have the front desk doing that, but the

hygienists are required to do this at Dr. Fedak’s office.

During these types of appointments, the hygienist has access to many different

instruments and equipment. One of the first things I noticed was that Chelsie was using her

syringes that she got from being in the dental hygiene program at lane. Each hygienist has their

own cassettes and instruments, so she has been able to keep them in good condition since

graduating. The instruments that Chelsie uses most often, and normally fills her cassette with are:

Gracey 11/12, 13/14, and 17/18, Nevi, and Barnhardt 1/2. When the hygienist is not hand

scaling, an ultrasonic scaler with a 25K handpiece is available in every unit. A piezoelectric
scaler is also available for any patient with a contraindication to the ultrasonic. Each unit has a

pid to be shared with one other hygienist, and that provides the ability to take radiographs in the

same unit as the treatment. There is also one panoramic machine available for imaging. Some of

the home care aids that are available in this office are: toothbrushes, floss, proxi brushes,

perioaid and MI paste. I found it interesting that Arestin was not offered at this office.

Thurston Family Dental offers many different services, but the ones provided by the dental

hygienists specifically are: OHI, periodontal maintenance, NSPT (SRP), adult and child

prophies, radiographs, nitrous oxide sedation and sealants. The other services/roles that are

offered at this office because they are roles of Dr. Fedak are: crowns and bridges, dentures,

fillings, implants, whitening, sealants, root canal therapy, extractions and veneers. Although I

have not spoken much about them, there are other personnel in the office besides the hygienists

and the dentist; the front desk staff, and dental assistants. I mentioned previously that there are

two different assistants that work in this office, and they are both mainly assistants for Dr. Fedak

during his treatment. I noticed that they will jump in to help a hygienist chart if they are

available, but I was told that most of their time is spent chairside with the dentist. The front desk

are the last staff members in the office. Their primary job is to handle insurance, billing,

reminder phone calls, answer phone calls, and answer emails. The front office staff seem to have

a good relationship with the clinicians, providing a smoother work day all around.

The infection control protocols were very similar to the ones we have been taking during

COVID at LCC. The hygienist is responsible for flipping their own room, getting their

instruments into circulation in the sterilization room, and for using proper asepsis the entire time.

Plastic is used as barriers on every surface that will be touched during treatment, and shields are

used over their N-95 masks and protective eyewear. The one thing I did notice that seemed a
little different than LCC clinic was the abundant use of hand sanitizer. It is used all the time at

our clinic, but it seemed like every time a clinician did anything, they washed and then used hand

sanitizer no matter what. Chelsie said this was not protocol, they are all just used to doing

everything extra-cautiously since COVID has begun.

Based on the little time that I spent shadowing Chelsie, I can say that I believe she is

providing her patients with quality care. I can also say this about Dr. Fedak, based off of one

exam I watched with a patient. This patient had extensive needs, and the doctor took his time to

explain every single one thoroughly. I really enjoyed my time shadowing this office, and have

taken away a better understanding of the kind of office I would enjoy working in when I

graduate!

References

https://www.thurstonfamilydental.com/

Chelsie Stringfield, RDH: 541-844-6752