CLINIC ORIENTATIONAka “Everything we learned the hard way”
CLINIC PROTOCOL
Huddle Rules:Starts at 8am
Variances for tardinessYou must be in huddle unless you
are on rotationIf you are on rotation in the morning
but have a patient in the afternoon you must put a check next to your name that you have verified that what you are doing on the schedule is correct
CENTER LAB
NO STONE ZONE
CLINIC PROTOCOL
Infection Control Protocol After seeing patient clean operatory and spray
wipe spray Put chair to upward position with rheostat on
chair on paper towel Do NOT leave the operatory with gloves on Do NOT enter supply room with gown on Have red bag taped to assistant table and for
items soiled with blood (red bag goes in red biohazard boxes)
All sharps go in sharps container Wash hands properly when you enter the
operatory before you put gloves on
CLEAN OPERATORY
OPERATORY SET-UP
CLINIC PROTOCOL
Have your name plate at your station for the duration of the appointment
Always have a napkin on your patient even if you’re just looking real quick
Always have goggles on your patientDo not bring a patient into the clinic without faculty present
CLINIC PROTOCOL
If you are in your station with a patient you are required to be wearing a gown even if you are only at the computer taking a medical history
Be done with procedure by 11am and 4pm to have time for chart notes, making follow-up appointments and end checks
Know the procedures to follow should there be an emergency with your patient
Know where the aid kits, the AED, and the oxygen are in our clinic
SOME TIPS:
Use the plastic boxes at your stations to gather supplies before the appointment and only take out what you need to avoid wasting supplies
Become familiar with the different products we use in the clinic (for example types of composites and when to use each)(Don’t be afraid to ask for the instructions the product comes with)
When you put the patient in the chair make sure the headrest is adjusted properly
Assist each other whenever possible Do NOT schedule a patient if they have not paid
their bill
STERILIZATION TIPS: If something in your kit is missing or
broken, tell sterilizationExtra 330 burs can be found in our supply
room (the ones in the kits are often dull)Ask for an “operative setup” as opposed to
tray Don’t check out more than one handpieceLeaving scalpel, needle, glass or other
sharps on trays given to sterilization can result in a variance
COE: COMPREHENSIVE ORAL EVALUATION
1. Medical Dental History Form2. Physical Exam (old blue form)3. Hard Tissue Charting4. Perio Charting5. Diagnostic Impressions/FB/Bite record6. Phase I Treatment Plan
BEFORE THE APPOINTMENT
Have reviewed the radiographs and completed an interp (the FINDINGS HANDOUT is good)
Have your station set up (obviously)
Have what you will need for the appointment ready (exam kit, bite fork, goggles, gown, mask, facebow)
Check under TRANSACTIONS to make sure the patient does not have a balance before you sit them!
COE: COMPREHENSIVE ORAL EVALUATION
Once faculty is in clinicCheck your messages to see if your
patient has checked in (it may just pop up on your screen)
Bring patient upTake BPChart add COE and Diagnostic
casts as planned treatmentUnder COE add HEADER tx note
and fill it out
BLOOD PRESSURE
BP > 160/94 we cannot treat (let patient relax and take again in 5 min)
diastolic > 110 refer to doctorDiastolic > 120 refer to EREven if you are using an
electronic BP cuff you must check pulse for RRR
Get START CHECK from team leader
Have team leader approve planned treatment:COEDIAGNOSTIC CASTS HEADER
1. MEDICAL DENTAL HISTORY
Under FORMS add the MEDICAL DENTAL HISTORY FORM
Complete forms and summarize Make sure to look up medicationsKnow why the patient is taking each
medicationKnow when to get a MEDICAL
CONSULT(paper form)
MEDICAL CONSULTS Handout
When to get medical consult Pre-medication for total joint replacement:
Much controversy < 2 years premedicate > 2 years discuss with team leader if you should
get a medical consult with patients physician Medical consult should request that patients physician
provide patient with script if they deem premedication necessary
*If patient needs premedication or premed consult you cannot probe that day
2. PHYSICAL EXAM (OLD BLUE FORM)
Under FORMS add PHYSICAL EXAM (old blue form)
Complete extraoral and intraoral analysis Learn how to do a good oral cancer screening
handout
Summarize findings (unless there really is nothing at all significant)
CHECK
Summarize patient medical history and significant findings
Have TEAM LEADER check and approve medical history and physical exam form
Get the OK to continue COE!
3. HARD TISSUE CHARTING
Chart: (can use FINDINGS HANDOUT)1. Missing teeth2. Existing restorations (use xrays for RCT)3. Findings (primary decay, recurrent decay,
fractures…) In Axium:
Chart missing teeth (click on teeth, right click and scroll to missing)
Under CHART ADD add as FINDINGS: Existing restorations Findings
3. HARD TISSUE CHARTING CHECK
Have team leader or operative faculty check and approve existing restorations and findings
Discuss possible restorative treatment options… add to third column of FINDINGS HANDOUT
4. PERIO CHARTING (SOFT TISSUE)
Under PERIO CHARTING chart pocket depths, furcations, bleeding, GM, and gingival defects
If you don’t have an assistant to input directly into axium we have dry erase boards to chart and them copy the info into axium
Make sure to press SAVE or your data will be lost!
4. PERIO CHARTING CHECK
Get information checked and COMPLETED/APPROVED by PERIO FACULTY
Discuss treatment options with faculty Diagnosis MUST be in general note for
that day Review your periodontal disease
diagnosis criteria!
5. DIAGNOSTIC CASTS/FACEBOW/BITE RECORD
THIS SHOULD BE DONE AT THE FIRST APPOINTMENT REGARDLESS OF WHERE YOU STOP IN YOUR DATA COLLECTION
Take alginate impressions Take facebow with bite fork and blue mousse Take bite record with blue mousse or aluwax If your patient doesn’t have posterior support
or vertical dimension is in question: take impressions and fabricate wax rims to take an accurate bite and facebow upon next visit
END CHECK
Write GENERAL NOTE with that days findings and procedures and FOOTER TEMPLATE NOTE
Have TEAM LEADER: Check impressions Approve chart notes Approve COE as IN PROGESS and DIAGNOSTIC
IMPRESSIONS(1st step) as COMPLETED (the status is changed by right clicking and choosing)
YOUR PATIENT
Schedule an appointment for next visit with team coordinator
Give patient yellow payment slip of $105 for COE and DIAGNOSTIC IMPRESSIONS
Bring patient to cashier to pay (if your patient does not pay make sure not to see him or her again until they have paid)
PHASE I TREATMENT PLAN
Based on the mounted diagnostic models, radiographs, and information from the COE create a phase I treatment plan (keeping in mind your possible phase II treatment plan)
PHASE I TREATMENT PLAN
Under treatment plan:Add PROBLEMSAdd DIAGNOSISAdd DETAILED PLAN (each
item must have a dx)
PERIO FLOW CHART
Perio exam
SRP
Prophylaxis
SPT (Periodontal Maintenance)
Phase 1 (simple or complex)
SRP4-6 wks No
improvement
Improvem
ent/maintenance
3 or 6 month prophy recalls
periodontitis
Health/
Gingivitis
AHA PREMEDICATION GUIDELINES artificial heart valves a history of having had IE certain specific, serious congenital (present from
birth) heart conditions, including: unrepaired or incompletely repaired cyanotic
congenital heart disease, including those with palliative shunts and conduits
a completely repaired congenital heart defect with prosthetic material or device, whether placed by surgery or by catheter interventions, during the first six months after the procedure
any repaired congenital heart defect with residual defect at the site or adjacent to the site of a prosthetic patch or prosthetic device
a cardiac transplant which develops a problem in a heart valve
MEDICAL CONSULT EXAMPLE 1Dear Dr. Valdez:
Jane Smith, an 84 yo female who is a patient of your practice, came to my dental office in need of dental extractions of teeth #19, 20 due to severe bone loss due to periodontal disease.
She has a medical history significant for atrial fibrillation for which she takes
coumadin, diabetes for which she takes glucophage and metformin, and congestive heart failure.
I anticipate the dental extractions to be simple with minimal blood loss and plan
to place one suture to help with closure and hemostasis. I plan to check her INR the day before the scheduled extractions and will proceed with extractions if the INR is less than 3.
Please advise within the next week if you have other recommendations in the
management of her medical conditions in light of the planned dental extractions, most specifically her cardiovascular status.
Sincerely,Tom Johnson, D.M.D.
MEDICAL CONSULT EXAMPLE 2
Patient presented with: Hypertension, back pain, bipolar disorder, schizophrenia and COPD. Reports being on Methylprednisolone 80 mg and a lidoderm patch. The patient requires the following dental treatment: Full mouth extractions, aveolplasty, and Denture placement. This will involve the use of lidocaine and all extractions and aveoloplasty will be preformed simultaneously.
Please evaluate the patient for: Does the patient need to be put on an increased steroid dosage due to current methylprednisolone use? Is there any complications due to methylprenisolone or lidoderm patch use that prohibit this dental treatment.? Is the patient’s hypertension, biploar disorder, schizophrenia, and COPD well controlled with medication? Is there any other information that we should be aware of before treating this patient? Please respond below with comments, sign, and return.