Taylor Brewer

General Observation Report

6/4/2017

General Observation

The office that I chose to observe dental hygiene at was Dr. Meyers and Folsom located in
Clarkston, Washington. My initial impression of the office was that the staff was very friendly and
helpful upon my arrival and throughout the morning I spent there. The office was very professional and
clean which gave off a very good first impression. I enjoyed the giant windows that were in each
treatment room and the overall setup of the office seemed very effective and efficient. In this office,
there are three hygienists a day and one extra hygienist/assistant on Thursdays. There are also two
doctors, Dr. Folsom who works Tuesday, Wednesday, Thursday, Friday and Dr. Meyer who is present in
the office on Monday, Tuesday and Wednesday. Darla, one of the hygienists in the office, typically starts
her day earlier than the rest by seating patients in her chair at 7 a.m. while the other hygienists start
seeing patients at 8.

Communication within this office started off by having a morning huddle promptly at 7:40 a.m.
that consisted of everyone in the office. During the huddle, Dr. Folsom, the only doctor present for that
day, went over the patient and treatment game plan. The front desk communicates to the clinicians with
an electronic wall pager that is in each treatment room. When a patient has arrived, an alert is sent to
the appropriate clinician through the pager on the wall and the alert is to be cleared by the clinician.
Communication to the patient about their treatment plan is done verbally at the beginning of the
appointment and all communication is documented in the computer. When a hygienist is ready for a
doctor exam, the office uses a note system where they write/fill in the important information on a
pre-made information pad about the patient and it is then either set on the table in the treatment room
where the doctor is currently working or it is set on the table in the lab; depending on which doctor you
are requesting.

Records management was all done electronically through Dentrix. Prior to treatment, the
clinician goes over medical and dental history with the patient and asks about any changes to their
medications verbally. Charting is done through a template system that was personally set up by the
office that utilizes a system where you click the appropriate box that appears on the screen and the note
is then formulated for you at the end; no auto notes are used. The charting is typically done when the
doctor is doing the patient exam. When scheduling for a re-care or a periodontal maintenance patient,
the appointment length is typically forty-five minutes. For NSPT patients, the appointment length is an
hour and a half. Some abbreviations that are used for services on the schedule include NSF (no
significant findings), OHI (oral hygiene instruction), OC (oral cancer screening), WNL (within normal
limits), CD (complete denture), ABx (antibiotics), Tx (treatment), PD (partial denture), Brux (bruxism),
Ans (anesthesia), HH (health history), Px (prescription), NV (next visit), etc. The typical treatment
procedure the hygienist would provide for an NSPT client would include an hour and a half appointment
doing half of the mouth at a time. The chart entry would include an exam, NSPT procedures and
quadrants, NSPT consent, OHI, radiographs, PARQ and treatment/referral information. For an NSPT
patient, it is typically charted that a 3-month re-evaluation is recommended and is also noted in the
chart. A typical chart entry for a maintenance patient would include an exam, periodontal maintenance
procedures, OHI, radiographs, PARQ and treatment/referral information. These patients are typically
recommended 6-month follow-up appointments that is also noted within the chart.

For a new client within the clinic, the initial appointment consists of them being seen by the
doctor first. The assistant does the dental charting, x-rays and periodontal charting so that the
treatment can then be assumed or guessed based on the results for their next appointment. Hygienists
within this office dont typically seen the new patients until the second appointment. Fees and methods
of payment are usually talked over with the patient at the first appointment by the assistant. For a
maintenance client, a full periodontal chart is done by the hygienist yearly and exams are done every 6
months along with maintenance procedures and treatment. For radiographs, bitewings are taken once
per year and a pano is taken every 3-5 years depending on the patients needs. Client services that can
be provided by a hygienist includes taking x-rays, charting, administering anesthetic, scaling and root
planing, some restorative, nitrous administration, whitening, intraoral cameras, air polish and sealants.
The soft tissue management program for NSPT clients always consists of Peridex irrigation within the
ultrasonic during each treatment. The client is also recommended to take pain relief medication and to
rinse with warm salt water after treatment is completed. Soft tissue management that the hygienists
performs during patient treatment includes the use of Oroquix, Nitrous and anesthetic as necessary. The
basic everyday equipment available for hygiene services conclude an ultrasonic with several different tip
types and thicknesses, mirror, probe, explorer, Gracey 1/2, Sickle Scaler, Universal 5/6, Gracey 13/14
and irrigation with CHX used specifically for scaling and root planing patients. A typical instrument set-
up for NSPT and maintenance clients would be a Gracey 1/2, 5/6, 11/12, 13/14 and the use of a triple
bend ultrasonic tip. In this specific dental office, they re-tip their instruments because it is cheaper than
buying all new instruments. Instruments are sharpened usually in the morning prior to patient care or
whenever the hygienist has time. As far as how often they sharpen, everyone had a different schedule
but at least once a week was the average. Some home-care aids that are available for patients to take
include Oral-B toothbrush heads, toothpaste, manual toothbrushes, soft piks, threaders, proxy brushes,
rubber tips, perio-aids, Clinpro, CHX, Listerine, Sensodyne, Colgate, MI paste, denture brushes,
stimudents, bleach for whitening and tooth and gum tonic.

Client referrals are provided to patients by the front office as a referral slip. The information is
filled out and it is also noted in the patients treatment records. The receptionist either makes the
patient an appointment and calls the office, or the Doctor from the referred office will call the patient
and set up treatment; depending on what office they are referring the patient to for treatment.

Instrument sterilization is done by packaging all the instruments used together and placing them
into a basket for ultrasonic sterilization. After sterilization, instruments are stored until further use. The
Cavitron tips get placed through the Statim unpackaged and then they are placed into a sterile drawer in
each treatment room. This is different than the LCSC process because we have cassettes that our
instruments are placed in and sterilized as opposed to just packages. We also place our Cavitron tips into
a package prior to sterilization and store them appropriately. The quality of care that the hygiene clients
received at this practice was like the care that our patients receive in our clinic. Each patient was treated
and accommodated to by the hygienist with great care. While I was observing, a patient came in that
was unable to leave his wheelchair and go into the dental chair for treatment so, one of the hygienists,
Kari, accommodated to this barrier and provided him with treatment while standing so he could stay in
his chair. Proper care of our patients is a hygienists number one job and it is important to treat each
patient as an individual with specific needs; which is exactly what each hygienist in this office did.

The office team members that I observed for the day were Darlyn, Darla, Kim, Keri, Kari and Dr.
Folsom. All team members wore matching scrubs with plain long sleeves underneath. Darla is a part of
the front desk reception crew and is responsible for calling patients, billing patients and working on the
schedule. Kari is the only one in the office that provides both hygiene and assistant knowledge and skills.
On Thursdays, Kari is there all day performing hygiene services while the rest of the week she is the
assistant. All the team members are important to the office because they all provide valuable skills and
knowledge to properly administer quality of care that benefits each patient. Most of the hygienists
sharpen their instruments once a week prior to patient care; usually in the morning. When there is a
last-minute change in the schedule or a no show, it isnt too big of a deal for the hygienist. When this
happens, it is important that the front desk is aware of the no-show so that they can contact the patient
for further information. In the down time when a patient doesnt show up, the hygienist usually stocks
the office, sharpens, helps sterilize or helps in other ways around the office until their next patient
arrives. At the start of the day, the hygienist is responsible for looking at the schedule, reading their
patients last chart note, starting the ultrasonic and storing away the instruments from the day before. At
the end of the day, the hygienists roles are to set up their room for the next morning, take the garbage
out, make sure that everything is stocked for the next day in the treatment room, check the schedule
and log off the computer.

Overall, I had a great experience observing this private practice and learned a lot in that short
time observing. It made me excited to go out into the world and find a practice that fits me best!