General Dental Office Visit Report

Sophia Gomes
May 30, 2024
DH 234
 On March 22nd, I had the privilege of interviewing a hygienist at Oakmont Family

Dental in Eugene. This bustling office involves a team comprising four schedule coordinators,

eight sterile technicians, ten administrative staff, twelve dental assistants, fourteen dental

hygienists, and eight doctors, two of which are practice owners. Each department is led by

dedicated individuals called "leads" who organize meetings and ensure protocols are followed

seamlessly.

Communication within the office primarily occurs through Messenger, facilitating quick

patient care and support exchanges. For more formal matters, such as meeting notifications, the

team relies on written communication via the office email accounts provided to each employee.

Beyond the office walls, they stay connected through the Slack app, which fosters collaboration

and coordination for activities like team bonding and shift coverage. Throughout my observation,

the interaction between patients and staff exuded professionalism and efficiency, reflecting the

cohesive teamwork at Oakmont Family Dental. The office staff manages all patient

communication regarding appointment confirmations, fees, scheduling, and inquiries. While

hygienists handle scheduling recall appointments, Kaylin emphasized that patients are welcome

to contact the front office to reschedule if they prefer to wait to schedule instead of immediately

after their appointment.

At the onset of the day, Kaylin engages in a morning huddle, a vital forum where the

team joins to strategize for the day ahead. They review the hygiene daily audit and production

tracking sheet, which they filled out the day prior. This comprehensive audit includes essential

details such as appointment types (continuing care or new patient), patient names, last

periodontal chart dates, recent radiographs, preferred doctors, pending treatments, and alerts,

along with any relevant risk factors, premedication requirements, and allergies. At the bottom of
this audit sheet lies the production tracking section, encompassing the number of patients seen,

fluoride and sealant treatments administered, reappointments scheduled and kept, new patients

received, total production figures, hours worked, and the average production per hour. Following

this review, Kaylin sets up the operatory and dons a scrub coat the practice provides. It's noted

that this coat is worn until lunchtime, after which it is changed as part of the practice's hygiene

protocol. She then ensured all equipment is primed and ready for use. This involves running

water lines for the ultrasonic scaler and preparing the workspace for the incoming patient. This

office benefits from sterile technicians who organize and provide instruments to the designated

areas outside the operatory, ensuring a seamless workflow and adherence to sterilization

protocols.

The office relies on Eagle Soft as its practice management software, handling everything

from record-keeping to scheduling and chart entry. Within this comprehensive system, a variety

of note templates streamline processes for procedures such as adult prophy, periodontal

maintenance, scaling and root planning, child prophy, and happy visits. Happy visits are

scheduled for one hour and involve patients under three years old. This appointment includes a

child prophy or a polish consisting of a comprehensive exam, fluoride varnish, and oral hygiene

instruction with the parents. It was also recommended that the parents use a rice-sized amount of

fluoride toothpaste daily. A child prophy consists of an exam, radiographs, polish, and fluoride

treatment (varnish or tablets). The bleeding, gingival status, deposit evaluation, stain, oral

hygiene instruction, and next recall interval are noted in the chart. An adult prophy appointment

note encompasses a detailed array of information: services rendered, including a prophy and

fluoride treatments, insurance providers, comprehensive medical history review with updates on

providers and medications, premedication details, patient comfort preferences, concerns, fluoride
type, and rationale, periodontal diagnosis, probing depth range, calculus presence, treatment

methods, and recommended recall intervals.

Similarly, the periodontal maintenance note expands upon these details, integrating stage

and grade assessments, bone loss (vertical and horizontal) percentages, and discussions on

periodontal etiology and implications. In scaling and root planing (SRP) cases, specific details

such as anesthetic administration and quadrant notation are recorded to ensure patient comfort

and procedure effectiveness. Additionally, a periodontal treatment narrative highlights critical

factors contributing to periodontal disease and outlines the rationale behind the recommended

treatment plan. The hygiene note, supplemented by the doctor's comprehensive exam assessment,

covers a broad spectrum of patient health indicators, including medical history, premedication,

blood pressure and pulse readings, radiograph review, patient concerns, referrals, and various

dental history elements. For effective scheduling and communication, the daily schedule

employs concise abbreviations such as 'Prophy,' 'PM,' 'SRP,' 'Comp Exam,' 'Lim Exam,' 'Fl,'

"BWX," and "NP Exam" ensuring efficient coordination among the team members.

All prophy and periodontal maintenance recall appointments are scheduled for one hour,

including cleaning, exams, radiographs, probing, and home care. Kaylin described that at each

appointment interval, you as a clinician either update the patient's periodontal chart or take

radiographs, but never both within one appointment. This helps keep patients up to date and the

hygiene schedule on track. She also explained that a doctor is always scheduled for daily hygiene

exams. The dentist typically pops in periodically or when they present the use of a "flag system"

outside the operatory. This system lets the doctor know when they are ready for an exam or if

they need assistance with periodontal charting. When hygienists have SRP/NSPT (scaling and

root planning/non-surgical periodontal therapy) patients, they are scheduled for two hours,
typically treating two quadrants. As for new patients, these appointments are two hours long and

involve one hour with the dentist and assistant, where a CMS (complete mouth series) and

comprehensive exam are completed. Then, they are moved to the hygiene chair, where one hour

is dedicated to periodontal probing and applicable cleaning—for example, a prophy or

potentially one quadrant of SRP. The doctor will then provide the treatment plan and explain the

rationale. If the restorative treatment needed is extensive, the patient will sit down with the

treatment manager to discuss fees; if this treatment plan is not extensive, the assistant will take

over this role; as for the hygiene treatment plan, the hygienist explains this, and if they have

further questions, they can meet with the treatment plan coordinator.

According to Kaylin, the services provided by dental hygienists include sealants, local

anesthesia (only for their patients, not doctors), prophylaxis (prophy), scaling and root planing

(SRP), and laser treatment on rare occasions. Periodontal maintenance appointments typically

occur every 3-4 months for 99% of patients. Radiographs, periodontal charting, and

examinations are conducted as needed based on individual patient factors such as decay rate,

recession, or bone loss. Bitewing radiographs are typically updated every six months to a year

for prophylaxis patients, with a pre-polish using mild grit. As for SRP/NSPT appointments, local

anesthesia, topical benzocaine, lidocaine, or Articaine is used to treat two quadrants per

appointment. After hygiene treatment, patients are scheduled for a 3–4-month recall; during the

subsequent recall, their tissue is evaluated, teeth are cleaned, and fluoride varnish is applied.

Laser treatment may be incorporated based on the patient's home care and inflammation levels.

Additionally, patients with implants receive yearly flushing with Closys and a radiograph

of each implant. At the end of each appointment, Kaylin provides home-care instructions,

emphasizing areas for improvement and demonstrating techniques such as "C" shaped flossing
and sulcular brushing. Patients are provided with interproximal aids like gum picks for patients

exhibiting moderate bone loss. Every patient receives a home care kit, including a toothbrush and

toothpaste.

The level of quality care delivered to periodontal patients at Oakmont Family Dental

aligns closely with the standards taught in our dental hygiene program. Comprehensive

periodontal assessments, including thorough periodontal charting and radiographic evaluation,

are conducted to diagnose and plan treatment accurately. Non-surgical periodontal therapy is

then implemented with informed consent and a detailed treatment plan tailored to each patient's

needs. Subsequent reevaluation appointments are scheduled 3-4 months later to assess tissue

healing and provide further oral hygiene instruction. If necessary, patients may be referred to a

periodontist for specialized care. This commitment to excellence ensures that periodontal

patients receive the highest standard of care and support for optimal oral health outcomes.

In terms of instruments and equipment, the 3D/Panoramic machines are centrally located.

Each hygiene and doctor's room is equipped with radiograph units and sensors. Kaylin utilizes

instruments from her school collection and cassettes, incorporating new additions such as gold

minis and sickles. She employs specific cassettes containing posterior sickles, a Barnhart ½ and

5/6, Gracey ½, 11/12, and 13/14 instruments, along with a cavitron green triple bend insert for

periodontal maintenance and prophy appointments. When performing SRP treatment, Kaylin

uses separate cassettes featuring the same Gracey instruments with extended shanks, along with

langer and file instruments, in addition to the blue cavitron insert known as the beaver tail.

Instruments are sharpened during downtime, such as patient cancellation. Kaylin often takes the

opportunity to sharpen instruments before or after staff meetings, ensuring they are always in
optimal condition for patient care. The sharpening process involves using a diamond card to

maintain the sharpness and effectiveness of the instruments.

Hygienists receive assistance during periodontal probing from sterile technicians

whenever they are available. These technicians also play a pivotal role in room turnover and the

transportation of instruments to and from the sterilization area. After each patient visit, the

hygienist or sterile technician wipes the room with a CaviWipe. The sterile technicians manage

the entire sterilization process, similar to the LCC dental clinic protocols regarding instrument

processing. The method includes running instruments through an ultrasonic bath and autoclaving

using a Midmark. Hygiene cassettes are wrapped and sealed with the same material and tape

provided at LCC.

Additionally, slow-speed handpieces are oiled in the room, bagged, and sent to autoclave

sterilization after each use, guaranteeing optimal cleanliness and patient safety. Laundry duties

and lab coat maintenance are efficiently managed either by the sterile technicians or by the

hygiene team when cancellations occur. In conversations with the sterile technicians, they stated

there is one OSHA coordinator for each office (Eugene/Springfield). This individual organizes

quarterly in-person meetings and circulates monthly newsletters that all staff members must read,

sign, and date, ensuring comprehensive compliance with safety regulations and protocols.

Regarding referrals, specific procedures are directed to specialized offices based on

patients' individual needs. For instance, they typically refer to two oral surgeons—one catering to

younger patients and another preferred by older individuals. Orthodontic referrals are similarly

tailored to address specific patient needs, such as occlusion issues or tooth movement

requirements. Root canals may also be referred out, particularly for complex cases or based on

the doctor's assessment. Generally, the doctor provides the treatment in-house if a tooth has a
single root. Similarly, implant procedures are evaluated for complexity; if a patient requires a

sinus lift or is deemed intricate, the doctor may refer the patient to a specialist.

Upon entering and leaving Oakmont Family Dental, one is greeted with genuine warmth

and kindness. Despite its large staff, the office maintains a close-knit atmosphere. While my

observation on a Friday revealed a calm and relaxed environment, Kaylin shared that the

weekdays are bustling with activity, filled with patients and staff. The office exudes a strong

sense of family orientation, with everyone genuinely caring for each other. This experience has

left a lasting mark on me, solidifying my desire to work here after hygiene school. I am thrilled

to announce that I have secured a position as a registered hygienist at Oakmont Family Dental. I

look forward to embarking on this new chapter of my career and learning from my esteemed

colleagues to help patients achieve improved oral health.

Kaylin McConville (Registered Dental Hygienist)

541-484-2046
oakmontfamilydental.com