Jenoa Ashcraft

GENERAL PRACTICE OFFICE OBSERVATION

I went and observed Becca, the lead hygienist at Dr. Gemmells office on River Road during
Spring break.
Communication
Every morning, the staff has a meeting to go over the days schedule. They discuss the needs of
the patients on both the doctors and the hygienists schedules, how long since last treatment, and
what radiographs are needed. During treatment, when the hygienists are ready for an exam with
the doctor or need the sterilization assistant to help chart or turn over their room for the next
patient, they use a system on their computers in which they push the button to signify which
person they need and what room they are in.
When a patient arrives for their appointment, there is a bar next to their appointment that changes
to purple to signify that they are done with their paperwork and are ready to be taken back. Once
the doctor does the exam, if there is any needed restorative work, the hygienist enters it into the
chart and answers any questions the patient might have. The treatment plan coordinator then
meets with the patient after the hygiene appointment to discuss and schedule needed restorative
work. If the patient needs non-surgical periodontal therapy, the hygienist actually schedules the
appointments themselves. The hygienists are in charge of their schedule, for the most part. After
a maintenance cleaning, the hygienist asks the patient if she can schedule their recall cleaning
right there in the room. Every patient the hygienist saw that day scheduled their next
appointment, as opposed to needing to send out cards or calling the patient when closer to their
recall month.
Records Management
This office uses Dentrix for all of their record keeping. For an initial appointment, the system has
a template that includes health history, chief complaint, date of last exam, if they have their third
molars, if they have had orthodontic treatment, if they have TMJ issues, if they smoke, amount of
sugar intake, and current homecare status. The template also has a place to document findings
from an oral cancer screening, location and severity of plaque, staining, supra and sub deposit,
bleeding, loss of attachment, radiographic findings, caries risk and the hygiene diagnosis. They
also document any complicating factors for hygiene, any handouts the patient was given, any
treatment they discussed, other comments, next appointment, and who the provider was.
For a maintenance appointment, the chart note includes a health history update, vitals, chief
complaint, an oral cancer screening, diagnosis, loss of attachment, caries risk, descriptions of
plaque, calculus and staining, the doctors findings from the exam, oral hygiene instruction,
treatment completed, patient management specifications, comments, PARQ, next visit, and who
the provider was.
Scheduling
As I stated earlier, the hygienist is in charge of their schedule for the most part. The schedule
does have built in blocks of time for certain types of appointments. For example, the morning
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portion of the schedule is usually reserved for non-surgical periodontal therapy appointments and
the afternoons for maintenance appointments. The hygienist has the option to alter the schedule a
bit to accommodate patients. The first appointment of the day usually starts at 8, but if the
hygienist determines that she needs a bit more time due to patient management issues, she may
decide to start the patient at 7:45 instead. The same goes for before and after lunch. Lunch is
usually taken between one and two and they are done for the day at 5.
The hygienist that I shadowed was on time for most of the day. If she was a minute or two late,
she always made up for it during the next appointment. She stated that it is very important to her
that she stays on schedule. She explained that it is relatively easy to stay on schedule because
their office allows more time for hygiene treatment compared to other offices. She gave me a
copy of their scheduling guidelines for hygiene treatment.
For a maintenance appointment, they allow 60 minutes. If the patient is due for an exam and
bitewings, they allow 70 minutes. If they need to also complete a new perio chart, they add
another 10 minutes. If they need a new full mouth, exam and a new perio chart, the patient is
scheduled for a 90 minute appointment.
Adult prophys are scheduled for a 40 minute appointment. If an exam, radiographs or a perio
chart is needed, more time is allowed up to 80 minutes.
If a patient requires non-surgical periodontal therapy, they allow 60 to 90 minutes per quadrant.
They try to schedule most or all of the quadrants on the same day. They explained that a lot of the
time, the patients like this better so they can just get it done all at once. If the patient isnt
comfortable with staying that long, they try to complete treatment within a week. The hygienist is
in charge of treatment planning and scheduling the appropriate amount of they would need to
complete treatment. During the appointment, the hygienist and the patient take a 10 minute
break after each hour to prevent fatigue and discomfort.

Client Services
When a patient is new to the practice, they schedule a two hour appointment in which they
primarily do assessments and an exam with the doctor. The hygienist explained that they usually
dont complete hygiene treatment during that appointment, but will if there is enough time left
over. When the patient is brought back, the hygienist goes over their health history and takes
vitals. They then take radiographs. After exposing radiographs, the hygienist calls in the
sterilization assistant to assist with taking intraoral and extraoral photos. After that, the hygienist
performs an oral cancer screening and then completes a perio chart while the assistant documents
everything. The hygienist then documents tissue statements, deposit, existing restorations, and
obvious caries. The hygienist then goes into the dentists office and discusses her findings before
he comes in to do the exam. For a new patient, they allow 30 minutes for a comprehensive exam
with the doctor, where he confirms any caries the hygienist found, along with any other
restorative needs. The hygienist then treatment plans any hygiene needs with the patient and
schedules that. The patient speaks with the front desk regarding any financial questions.

During adult prophys and maintenance appointments, they use a base set up that consists of a
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mirror, probe, explorer, universal scaler and an ultrasonic insert. They have different instruments
that have been sterilized available in each hygiene room to grab when needed, such as sickle
scalers, graceys, files and alternate ultrasonic inserts. For NSPT, the base set up consists of the
instruments found in the maintenance set ups, along with Graceys. If the patient is sensitive, she
pre-polishes with Clinpro polish. She also has each patient rinse with Peridex at the beginning of
each appointment.
She stated that they sharpen their instruments prior to every NSPT client. When tips need to be
replaced, she said that they usually send them out to be re-tipped. She explained that it is cheaper
to do it that way, and as the doctor pays for the instrument upkeep, they want to save him money.
The hygienist explained to me that she goes over homecare at the end of the appointment because
she has a better idea on what methods would benefit them best after she has cleaned and knows
what areas they have the most trouble with. She likes to show her patients the sulcabrush to use
in areas of deep pocketing. She dispenses a small bottle of Peridex and instructs them to dip the
toothbrush in the Peridex and use it interproximally in problem areas.

Client Referral
I asked her when they would refer to a periodontal office and she stated that they only refer one
to two patients a year to a periodontist. She said that since they provide Non-surgical periodontal
therapy regularly, they dont have a need to refer out. Dr. Gemmell does his own implants and
Dr. Holland performs connective tissue grafts. They only refer in cases that dont respond to
treatment they are able to provide.
Quality of Care
I feel that this office has exceptional quality of care. I really like that the dentist realizes the
importance of periodontal health and allows more than enough time to provide treatment. From
the assessments to the exam and actual treatment, they take the time to do everything right and
thorough. You can tell that their patients really appreciate that, as every patient seemed so happy
to be there and scheduled their recall immediately, instead of waiting.
Office Team Members
The office has three hygienists, two part time sterilization assistants, four assistants, and two
dentists. The sterilization assistant is in charge of room turnover and instrument circulation. The
hygienist that I shadowed said that if the sterilization assistant is backed up, she will help out. If
there is a no show, she said that she takes that time to catch up on charting and sharpening
instruments.
The team members all wear the same jacket, depending on what day of the week it is. Other than
that, they are allowed to wear whatever scrub pants and clinic shoes they desire. One thing that I
noticed is that they wore ear plugs when using the ultrasonic or handpiece. I asked about that, and
the hygienist said that she had noticed that her hearing had started to decline from using the
equipment for so many years, so she decided to start wearing them to prevent further damage.

Asepsis and Infection Control

I would describe their infection control methods as very similar to ours. They dont use nearly as
many plastic barriers as we do, but when turning rooms over, they thoroughly soaked all of the
surfaces with Cavicide. They use cassettes to sterilize and store instruments and sterilize their
handpieces after every patient. They dont wrap their cassettes, unless they dont plan on using
them for a while. They do package any extra scalers they end up using so that they can be stored
until they need them again.
Impressions
I would describe this office as professional and updated with a sophisticated atmosphere. Their
clientele consists primarily of adults. I was really impressed with this office, and could definitely
see myself fitting in here. I really liked how much importance was put on quality treatment and
you could tell that their main focus is the health and well-being of the patient. Both of the doctors
are very friendly and the rest of the staff seems to mesh well together.