Jesse Grossman

DH 222A
General Dental Office Visit
General dentists are dentists who do not have a specific dental specialty. General dentists can treat
patients for a broad variety of dental needs. This is different than dental specialists who focus on a
specific type of dentistry such as orthodontics or endodontics.
General dentistry is often called family dentistry because they see a wide range of patients for a wide
range of needs. I spent a morning at the Lewis & Clark Dental Clinic for my general dentistry office visit. I
spent the morning shadowing Lonnie Druffel, RDH. This was a great opportunity because I have spent
time at Lewis & Clark Dental Clinic as a patient and as a volunteer. My office visit was an opportunity to
learn a lot about this clinic as a whole, and answer very specific questions that I do not get the
opportunity to ask when I am volunteering.
The Lewis & Clark Dental Clinic is located in Clarkston, Washington. It is part of CHAS (Community Health
Association of Spokane) and is a non-profit organization. Lewis & Clark Dental Clinic accepts patients
that have Medicaid, Medicare, and even patients with no insurance. Lewis & Clark Dental Clinic has a
sliding pay scale that gives patients without insurance the opportunity to get discounted dental care
depending on their income and family size. I first learned about Lewis & Clark Dental Clinic several years
ago when I needed dental care but did not have insurance. They were great to work with and provided
high quality care for me.
At the Lewis & Clark Dental Clinic the office personnel and clinicians are very good with patients. They
treat patients with respect and compassion. It is a very professional atmosphere and all of the staff are
very good at interpersonal communication. This is especially important at a place like this because
patients often have not had regular dental care and may be uncomfortable with the situation. The staff
at Lewis & Clark Dental Clinic do not judge patients or treat them poorly for any reason.
The staff have a morning huddle at the beginning of each day. The patients and treatments will be
discussed, and if the hygienist needs an assistant for something they will discuss it at this time.
Throughout the day the office, assistants, hygienists, and doctors will communicate verbally over a twoway radio system (like walkie talkies). This makes it so it is not necessary to have an intercom system.
At Lewis & Clark Dental Clinic they run like a well-oiled machine. It is a government funded program, and
they have a very specific system for scheduling appointments. They have a very high demand, and it can
be hard to get an appointment. It is good for patients to understand this so that they are aware of the
fact that are not going to be able to get restorations before they have an evaluation appointment and a
cleaning appointment. The software that they use is called Nextgen. According to Lonnie this software is
specific to CHAS Health. This software is used for scheduling, patient records, and charting. At Lewis &
Clark Dental Clinic cleaning appointments are allotted one hour and fifteen minutes. This gives them
about an hour for the actual cleaning and then fifteen minutes of overlap, in case the appointment runs
over. As I mentioned, it is very obvious that they have a great system for scheduling, record keeping, and
patient care. It seems to work well for them to assure they stay on schedule and stay organized.

Because the Lewis & Clark Dental Clinic is so busy, it is not easy to become a new patient. Their
appointments fill up very quickly, and often times you have to call at 7:30 am Monday mornings to get
on the schedule. If you do not get ahold of them early, their schedule will fill up again and they will not
be able to book anything until the following Monday. Currently, they are booked until the end of August.
They are also unique in the sense that you cannot just be seen any time for whatever you want. For a
new patient, they will first have to come in for an evaluation appointment, in which they will take
radiographs and the doctor will write up a treatment plan for the patient. The doctor and dental
assistant are the only ones with the patient at this appointment. At the end of this initial appointment,
the patient will get their treatment plan printed off by the office staff with prices listed for each
treatment. If the patient brings in proof of income, their sliding pay scale may be set at this appointment
and the prices will reflect that. Next, the patient must come in for a cleaning appointment. The hygienist
is the only one working with the patient at this appointment. This should take only one appointment
unless the patient needs NSPT, in which case they will have four cleaning appointments. After the
cleaning appointments, then the patient can start scheduling work from the treatment plan. The doctor
usually has this planned out for treatments to be done in a specific order. It is important to keep these
appointments. Because they are booked so far out, it can be hard to re-schedule a missed appointment.
Another thing that is important for patients to understand is that no matter what, the patient will have
to have a doctors examination every year. This can be frustrating for patients who have not even
finished their original treatment plan, but it is just the way it works for this non-profit, government
funded clinic.
At the Lewis & Clark Dental Clinic, NSPT patients can schedule their maintenance appointment after
quadrant scaling is finished. The hygienist will perform these maintenance appointments, and they may
have an assistant if necessary. The hygienist does the perio charting at the beginning of these
appointments (perio charts only done once per year). Unfortunately, because they only schedule out
three months in advance, these maintenance appointments may already be full. If the patient is
recommended to schedule for a six-month maintenance appointment, they will have to wait and
schedule within three months. Another thing to consider is that a lot of the patients have Medicare or
Medicaid, which will only pay for NSPT once every two years. NSPT or maintenance patients are also
only allowed to have two appointments on the books at a time. As far as the quality of care goes, these
interesting scheduling quirks do not affect the patient care. Patients are treated well and the Lewis &
Clark Dental Clinic has a high standard of care and provides quality care to all patients.
At the Lewis & Clark Dental Clinic the dental hygienists have an interesting schedule. There are usually
two hygienists working at a time. For half of the day one of the hygienists will do prophys, NSPT, or
periodontal maintenance while the other hygienist follows the doctor around administering local
anesthesia and working on restorations. Then halfway through the day, the two hygienists switch roles.
Hygienists perform the following client services: NSPT, prohys, restorative, and local anesthesia on
restorative patients. Lonnie explained that another important task is patient education. She said they
see a lot of tough, high risk patients. Lonnie said she never gives them a hard time, and that she just
really wants to educate them about their oral health. She also mentioned that the more the hygienists
help out, the quicker and smoother things run. Things run best when everyone is being a team player.
The hygienists are responsible for the sharpening of their instruments, which is done when they are dull.
There is not whitening, and not a lot of other cosmetic procedures.

At the Lewis & Clark Dental Clinic they do not use a lot of abbreviations. They do use the term SRP
instead of NSPT. Because the Nextgen system is so well set up and easy to understand, they do not need
to use a lot of abbreviations. The entire system is auto-notes, and then they add handwritten notes at
the very end. The system just leads them through a series of prompts, which avoids the manual entries.
Everyone does a really good job of working together at the Lewis & Clark Dental Clinic. The front office is
separate than the clinic, and they are responsible for working with patients, checking them in, taking
payments, preparing charts, letting the doctor or hygienist know the patient is ready, answering phones,
and scheduling. The dentists, hygienists, and dental assistants all work hand in hand which makes things
run smoothly. The clinic also has a separate billing department and an office manager. The office
manager runs the show, taking care of the entire office as a whole.
At the Lewis & Clark Dental Clinic, all of their equipment is state of the art and top of the line. They use a
Cavitron, but do not have a Piezo. For the Cavitron inserts they use triple bend and slim line, plus a
heavy insert like the beavertail. For instruments they use the following: Barnhart 4/5, Gracey 11/12 and
13/14, and posterior sickles. They do not use files. They do not used re-tipped instruments. They are
limited in the variety of homecare aids. They only have a couple types of floss, floss threaders, and perio
aids. Patients are given both woven and waxed floss. They do not have soft picks, but Lonnie actually
brings her own to show to the patients. They do have reach flossers, but Lonnie does not like to give
these to adults because they are just not as effective as regular floss. Kids that live in the juvenile
detention center come into the clinic and are given reach flossers because they are not allowed to have
regular floss (due to safety issues). Although they are a state of the art clinic, they are limited in the
products they can order (this is because it is a government funded non-profit). All ordering is done off of
a formulary sheet and CHAS Health can order from Patterson.
The Lewis & Clark Dental Clinic uses the spray, wipe, let dry method for asepsis and infection control.
The exam areas are all covered with plastic and then stripped down and sprayed after each patient. The
sprayed areas are then wiped with 4X4s soaked in Birex. They also give every patient Chlorhexidine
Rinse before treatment to kill bacteria and cut down on microbial aerosols.
As I have previously mentioned, the clinic runs like a well-oiled machine. The style of the clinic and
waiting room is very clean and organized. The waiting room has a little section with a couple things for
kids to play with and the office staff also has several electronic tablets that kids can check out and use
while in the waiting room. It is a very kid and family friendly clinic, especially because they have flat
screen televisions above every exam chair. They are usually playing a Disney movie, which is pretty cool
for kids (and adults). The overall vibe of the staff is very knowledgeable and caring. They seem to truly
care about patients and it shows.
I have really enjoyed spending time at the Lewis & Clark Dental Clinic. I like the staff and the patients. I
am interested in a community health type setting, so this would be a great fit for me. I like that the
hygienists get a change of scenery, essentially switching it up halfway through each day. The clinic itself
is nice, clean and organized and it is great for hygienists. It is very fast-paced and busy, which is actually
a positive for me. I also love the idea of doing restorative, which they get to do with it being in
Washington. This general office visit gave me a new perspective on a clinic that I already enjoyed. I plan
to put an application in at the Lewis & Clark Dental Clinic and cross my fingers.