GENERAL

OFFICE VISIT REPORT

OBSERVATION OF THE DENTAL HYGIENIST

MACKENZIE HARRIS

Kenzie Tingle
June 6th, 2016
DH 222
Leslie Clark
Office Visit Report
I chose to do my general office visitation at Dr. Mike Lees office in Roseburg,
Oregon. Its a small private practice with two hygienists and two dental assistants. I was
able to observe three patient treatment sessions with the hygienist.
Communication
The office primarily communicates between office personnel through EagleSoft, a
program used for electronic records and scheduling. There is a messaging component that
allows the hygienist to inform the dentist when shes ready for an exam. It also allows
them to let the other hygienist and assistants know when the doctor is currently with their
patient. Although its a small office, the layout does not allow for the hygiene and
restorative sides to physically see each other.
When a patient arrives the front desk changes the status of the patient to
checked-in to inform the hygienist that they are ready for treatment. Upon walking to
the front the hygienist grabs a printout from the front desk that lists the proposed
treatment for the day. For hygiene this is typically determined by the hygienist or doctor
at their last recall appointment. It also lists any unmet treatment needs that were
previously treatment planned or in progress. Once hygiene treatment has been completed,
the hygienist completes services provided in the electronic record and then notes on the
patient information sheet the next appointment.

Typically the front desk will schedule the patient upon leaving for hygiene
services up to 6 months in advance. Some patients prefer to wait and request a post card
or phone call be made when they are due for their next appointment. The hygienist does
not discuss fees with the patient; this is solely the responsibility of the front desk.
Records Management and Scheduling
As mentioned before, the office utilizes EagleSoft for their dental electronic
records. Each hygienist has their own AutoNote that they have personalized to their
liking. There are five descriptors used for types of patient cleanings: CP for a child
prophy, AP1 for an easy prophy, AP2 for a more difficult prophy, RPC for root planing
and curettage, and lastly SPT for supportive periodontal therapy. AP1 is typically
designated for adults 21 and under, while AP2 just means that there might be more buildup or complicating factors such as recession and furcations. AP1 prophys are given 50
minutes per appointment, AP2 prophys and SPT are given 60 minutes, and RPC is
determined on a case-by-case basis by the hygienist treating that particular patient.
The hygienist uses the same chart note for maintenance and nonsurgical
periodontal therapy patients. The note consists of completed treatment, notes (scale,
polish, probe), RC schedule (recall), x-ray schedule, exam schedule, class type
(periodontal case type), patient informed of perio condition (yes or no), bleeding and
inflammation, calculus and plaque, recommendations and instructions, PARQ, and chief
complaint. If any anesthesia is used she will add a separate AutoNote specifically for that.
I found it interesting that she didnt make any notations about the gingival appearance.

Client Services
When a new client comes in the hygienist obtains a full mouth series of
radiographs. Then she proceeds to complete a periodontal assessment and the necessary
dental hygiene treatment. The hygienist determines the need for non-surgical periodontal
therapy, perio maintenance, or prophylaxis. There is no discussion of fees associated with
services provided between the hygienist and the patient. These are matters to be discussed
with the front office and their insurance provider. The doctor will come in after treatment
has been completed to perform a dental exam. The hygienist records all treatment
recommendations in the electronic record. During the initial and all periodic exams the
doctor performs a soft tissue check.
Most maintenance patients are on a 6-month recall. Radiographs are only
completed once a year unless the patient is at a high risk for decay in which they will
obtain them every 6 months. Periodontal charts are also completed on a 6-month basis.
The hygienist does not receive any assistance during charting procedures or cleaning of
the dental operatory. The assistance do however take care of the sterilization of
instruments.
The office does have Cavitron units, however the hygienist states she rarely uses
it. Only in cases with moderate build-up and scaling and root planing will she use the
ultrasonic. They do not have a Piezo or an air polisher. They do provide NSPT patients
with oral irrigation devices to fill with warm salt water or chlorhexidine mouth rinse if
needed. The hygiene side does not have light cure units because for sealants because they
are completed on the restorative side.

The hygienist uses American Eagle instruments, which are designed so that they
do not need to be sharpened. The hygienist still sharpens them but feels that she doesnt
have to do so as often as with other brands. She said she usually will sharpen when she
has a cancellation or before or after she begins patient treatment for the day. All hygiene
cassettes contain the same instruments; a universal 5/6, anterior and posterior sickle
scaler, Gracey 11/12, Gracey 13/14, mirror, probe, and explorer. In a side drawer she has
files available to her if needed. She always keeps a couple of sharp cassettes in a drawer
to pull out in case she has a patient in the chair who unexpectedly needs NSPT.
Homecare aids utilized include toothbrush, floss, Plackers flossers, soft picks, and
the perio-aid. They do dispense prescription fluoride toothpaste and chlorhexidine rinse.
The hygienist does not do any sealants or whitening procedures. Only one hygienist in
the office provides nitrous oxide for patients, and they do this because her operatory is
bigger and they can always leave the unit set up and ready to go. None of the hygienists
at this office have their restorative endorsement and intraoral cameras are not utilized.
Client Referral
Clients are sometimes referred to a periodontist, however they have a high rate of
patient resistance due to the high costs of seeing a specialist. Most patients prefer to just
have treatment performed at the general dental office because their insurance covers the
cost. However they do note in the electronic record that the recommendation was made
and that the patient declined.
Quality of Care
I feel that these patients are being provided the standard of care. Patients are seen
regularly and all of their dental needs are addressed and taken care of in a timely manner.

I dont feel that this office goes above and beyond the standard of care. They dont offer
any special services like laser or gingival curettage, but I also dont feel that this takes
away from the services that they do provide.
Office Team Members
There are two hygienists and two assistants that comprise this dental team. The
assistants role in hygiene treatment is just to sterilize the cassettes and return them to the
hygiene operatories. The two sides of the office are very secluded and they really dont
work together. If a patient happens to no-show the hygienist will sharpen instruments or
stock her operatory with home care supplies, air-water syringes, suctions, and gauze. The
hygienist doesnt have any other duties in the office besides taking care of her own
operatories. Assistants are in charge of changing the traps once weekly and ensuring that
all sterilization has been completed. The team members wear whatever scrubs they are
comfortable in. Both hygienists wore lab coats but the assistants did not.
Asepsis and Infection Control
This office does not wrap their cassettes, which I find a little disturbing because
they are not being used right away. Any loose instruments are bagged and placed in a
drawer. Handpieces are sterilized between each patient, however they do not wrap them
and in-between uses they are stored in a drawer. They also do not use barriers on their
air-water syringes or suctions; they just simply wipe them down after use. She states that
they try to use minimal barriers. I also noticed that they hygienist did not wear a mask
when wiping down the room, but Ive also seen this at other offices Ive observed in and
Im not sure of the exact protocol on that.

Impressions
I really enjoyed this office. It was very laid back and had a traditional feel to it.
They dont try to get to fancy with new technology yet they are up to date. Each
operatory is its own room with a door, which patients seem to really like for privacy. Its
a very quiet and calming atmosphere throughout. Each operatory has a TV where the
patient can select a show to watch during their appointment, which gives the office a
more casual relaxing, feel. I love how laid back this office is and how comfortable you
feel walking into the operatories. The one thing Im not as impressed by is their
sterilizing of the cassettes without wrapping. I just feel like when they are sitting in the
drawers the instruments collect dust and then they are going to be used subgingivally on a
patient.




















Contact Information:
Dr. Mike Lee, DDS
Front Desk: Jan
541-672-2461