Mon - Fri: 6:30am-8:30pm
Sat: 7:00am - 1:30pm
509-228-3834
OFFICE DIRECTIONS

NEW PATIENT FORMS

ADULT CHILD
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Back Office Processes

Back Office 3.2.2

SET UP
DateInitialTrainerDescription
Sign Employment Offer
Orientation
Set up Open Dental log in
Set up Email
Website photo
Website bio
Copy of Documents to Office Manager
Add to contact list
Add schedule to calendars
Laundry Protocol
Deliver How-to's
Open Dental Tutorial on YouTube
Practice on pt Minnie Mouse or Little Mouse
Break Room Etiquette
Introduce Sterilization Protcol
Introduce Daily Check off sheet
How to clock in and out
Including google doc time correction sheet
Understand HIPAA/OSHA standards.
MSDS Location
3 DAYS
DateInitialTrainerDescription
Restorative Set Ups
Fillings
Crown Preps
Endo
Extraction- simple
Including PO instructions
Extraction- surgical
Including PO Instructions
Crown Seat
Limited exams
Botox
Juvederme
PO Extraction appointment
Including Verbiage
PO Implant appointment
Including Verbiage
PO Bone Graft appointment
PO Fillings
Invisilign
6 Month Smiles
Sterilization Protocol
Daily Check off Sheet
Chart Hand-Off's
2 WEEKS
DateInitialTrainerDescription
Restorative Set Ups
Implant placement
Implant Impression
Comprehensive Exam
Schedule an Appointment
Attach Lab Case
Proper Completion of ALL Chart Auto Notes
Sopro Software
Pro-Suni Software
EZ Dent Training-
CT Scan
Pano
MSDS Location
Lab Case Slip/location
Podium
How to collect payments, know available financial options
How to use diagnodent
2 MONTHS
DateInitialTrainerDescription
Schedule PDI with your team leader
Review all items above

 

Anesthetic

Topical Anesthetic

  • Dry area with cotton 2×2 if wet
  • Rub a cotton tip applicator with topical anesthetic over area until red spots appear, do so gently as it can hurt if not gently done
  • Cover with cotton 2×2, otherwise the topical will dissolve in the saliva, and can make patients throats tickle

Anesthetic

  • Syringe is out with needle on
  • Shorts for Dr. Josh and Dr. Ball
  • Dr. Amy
    ⦁ Short upper
    ⦁ Long lower
  • 2 Reds with 1 red loaded, 1 septo out and 1 plain out
  • Drs select anesthetic they’d like

Nitrous Protocol

  • Turn on tanks using the key counterclockwise.
  • Only turn on oxygen and turn it up to the # 3 mark and put nose hose around pt nose and let pt take deep breaths in for about 2 mins.
  • Slowly introduce the nitrous (do not exceed the oxygen to nitrous ratio 70% nitrous and 30 % oxygen)
  • After the procedure is done turn off the nitrous and flush the PT system with oxygen for 5 mins, this will ensure that the Pt will be fine to get up and drive and function normally.
  • When turning off nitrous use the key and turn off all tanks clockwise.

General Anesthesia

  • All our general anesthesia goes through Apex Anesthesia
    ⦁ When a patient wants GA doctor will tell you how much time to add to the TX plan usually it is in 30 or 15 min increments  once those are added you will quote the patient the treated with the added on GA time doctor suggested.
    ⦁ Advise the patient even though we are quoting for general anesthesia we do not actually bill them for it they get billed separately from Apex for that and we bill them for the treatment.
  • The patient will leave without scheduling you will call apex and get a couple dates that they are available to do treatment.
  • You will then call the patient and let them know what dates you have to make an appointment once they pick you will call apex back and schedule with them.
  • Also inform the patient if they have not had a recent physical they will need to get one two weeks prior to the appointment date.
  • You will then have from office send apex by email or fax the patient’s health history, insurances info, treatment being performed and any demographics we have.
  • Patient will need pay for their dental work with us (Not Apex) 2 weeks before their appointment to reserve the time for Apex and our doctors

Day of Treatment

  • Usually these appointments happen first thing in the morning so an assistant will have to be here at 6am for apex to set up what they need and the patient comes at 7 for treatment.
  • Apex will bring the patient back as they have consents and paperwork for the patient to do before hand and they set the patient up on general anesthesia as well.

Apex Brochure Instructions

Day Before Surgery

Our office will contact you to confirm your procedure and go over the pre operative instructions. If we are unable to reach you, please call the office and confirm your appointment.

Food & Drink

  • We recommend that you not consume food after midnight, however the surgery is late in the day, you may eat as indicated in the NPO (nothing by mouth) guidelines table, additionally, we recommend that you do not smoke, chew tobacco or consume alcohol for at least 24 hours prior to your surgery.
FOODEXAMPLEHRS
Clear liquidsWater, Apple Juice, Soda,Pedialyte, Popsicles, Kool-aid2
Human milkHuman Breast Milk4
MilkCow, Formula6
Foodtoast , Cereal, Orange juice6
MealMeats, Eggs, French Fries, Fatty Foods, Proteins8

Medications

  • Prescription medications should be taken as scheduled with clear liquids (water or apple juice) up to 2 hours before the procedure, unless previously directed by your doctor. You may take your usual blood pressure, heart, acid reflux, and or seizure medicine on the morning of surgery with a sip of water.
  • If you are currently taking prescription blood thinner (coumadin, plavix, ect.) on a regular basis, please contact your prescribing doctor for further instructions.
  • Do not take any diabetic medicine the day of surgery. However, please make sure to bring your diabetic medications and your blood sugar measuring device with you. Please provide us with an accurate list of your daily medications. If you have any questions on which medications you may or may not take the day of your procedure, please contact our office 509-764-5399
  • If you experience any health changes, such as an elevated temperature, cough or other health related problems, please notify our office immediately.

Transportation

  • Patients are not permitted to drive or leave office unattended after the procedure. It is necessary to make arrangements for a responsible adult or caregiver to drive you home and stay with you for 24 hours following surgery. Without these arrangements, your surgery will be cancelled. A parent or guardian must remain on premises while their child is having treatment.

Day of Surgery

  • You may brush your teeth prior to surgery, but remember not to swallow liquids after midnight. Contact lenses and eye makeup must be removed. Jewelry and body piercings should not be worn on the day of surgery.please leave all valuables at home.
  • Please wear comfortable, loose clothes. For children, please bring extra undergarment and or diapers. You may bring their favorite toy or blanket as well.
  • You will be asked to arrive early to confirm availability of all necessary information. The anesthesia provider will do the preoperative assessment and will go over the anesthesia consent. Females of childbearing age will be required to provide a urine sample for the pregnancy test.
  • Your surgeon will confirm with you the treatment and will request your permission to perform the scheduled procedure.
  • A parent or legal guardian must accompany any minor or impaired adult the day of surgery and must remain at the office throughout the patient’s stay.

Recovery

After your Surgery

  • After your procedure is completed, you will be cared for in the recovery area, where you will be closely monitored by our experienced staff until you are deemed ready to go home. At the time of discharge, we will give your escort specific instructions regarding you homecare. All instructions related to your surgical treatment will be given by your surgeon or his /her staff.

Returning Home After Surgery

  • Due to the use of anesthesia and/or narcotics, you may experience sleepiness, dizziness, or nausea. These are normal side effects, which may continue for 12-24 hour. Remember to drink plenty of liquids upon your return home. If teeth were extracted, do not use a straw. Please follow soft food diet.
  • Muscle aches, a sore throat or a low grade fever may occur following the anesthesia. These symptoms are very common and usually disappear within 24 hours.
  • A common post-operative complication is a nosebleed, which is the side effect from the intubation- a breathing tube placement. The nosebleed usually stops easily by pinching the tip of the nose for at least 10-15 mins.
  • Due to the symptoms you may experience after the anesthesia, please do not do any of the following activities for at least 24 hours after the discharge, or longer if you are taking pain medications:
    ⦁ Drive and operate equipment or machinery
    ⦁ Sign important papers
    ⦁ Make significant decisions
    ⦁ Drink alcoholic beverages

Oral Meds

When patient goes to schedule TX we usually offer some version of sedation whether it be NO2 or oral sedation or even general anesthesia.

  • Once patient choose the type of sedation for example: oral meds
    ⦁ Your job as the assistant is to schedule the patient 2 days prior to the treatment appointment for an oral med consult, when you treatment plan this will automatically pop up as part of treatment.
  • On the day of the oral meds consult front office goes over financials so please make sure those are correct before patient leaves your appointment, they also have the patient sign consents and they give them prescriptions for the day of the patient’s appointment
    ⦁ Triazolam .25mg  qty. 1
    ⦁ Hydroxyzine HCL 50mg qty. 1
    ⦁ Diphenhydramine 25mg qty. 1
  • Treatment is to be pre-paid by office guidelines. No later than the oral med consult appointment.
  • Above is the list of RX they give to the patients and they take those 90 mins prior to their appointment time EX: appointment at 7 am they would take the medication at 5:30 am
  • Once patient is back in the chair you as the assistants will notice physical traits on how they are responding to the medication, you want them to be relaxed kinda sleepy
    ⦁ Some patients it does not affect as easily and they are acting normal, talking and making conversation, alert. In those cases, we consult with the doctor and give the patient another Triazolam .25mg
    ⦁ DOCTORS ARE THE ONLY ONES WITH ACCESS TO THESE PILLS
    ALSO PATIENT IS REQUIRED TO HAVE A RIDE HOME WHEN THEY SHOW UP FOR APPOINTMENT AS YOU CANNOT DRIVE ON ORAL MEDS.

Fillings

Set up

  • Patient Bib, clip, glasses
  • Gloves and mask for doctor and yourself
  • Topical
  • High speed and slow speed handpiece–Rheostat check–confirm bur spins/water sprays
  • Bur Block
  • Restorative tray (locking pliers on back of counter for CLEAN)
  • Anesthetic syringe with short needle.
  • 1 black, 2 red, 2 gold anesthetic not loaded
  • Pink dye on tuff brush, Etch, 1 drop Prime, 1 drop Bond, Dappen Dish with 2 tuff brushes
  • Composite gun with 3 extra composite
  • Curing light with cover
  • Floss
  • 5 2X2s
  • 2 Cotton rolls (If lower or anterior)
  • Purple and yellow Bite block
  • Cheek guard
  • Articulating paper
  • HVE, Saliva ejector
  • Items that vary base on case
    ⦁ Class V fillings (cord with hemostat)-do not dispense until needed
    ⦁ Anterior fillings (Mylar strip with wedge)
    ⦁ Posterior fillings (M+D=bands, silver bands with wedge and compositite matrix with forceps)
    ⦁ Pulp Cap ( Mixing pad, spatula, Vitrebond liquid/powder)
    ⦁ Isolite for any posterior filling

During Procedure

  • Seat patient
  • Review HH
  • review procedure, ask if there are any questions
  • Offer Netflix
  • Place napkin/glasses/topical
  • Let QB know we are ready for doctor
  • After each injection give patient a rinse
  • Place bite block (if Dr. likes), cheek guard/cotton roll if Dr. wants
  • rinse/dry pink dye after prepping
  • Mylar or ring as needed
  • Etch enamel only for 15 seconds
  • Desensitize for 20 seconds-air dry
  • Bond for 20 seconds, air dry thin for 5 seconds
  • Fill
  • Check bite

End of Procedure

  • “Front office, 2 minute warning for ______, no changes, anything needed?”
  • Post-Op instructions
  • Schedule for next appointment
  • Walk patient to front, hand off sheet, clean room.
  • Set up for next patient
  • Finish patient notes
  • Sterilize instruments

Post Operative Instructions

  • Cold sensitivity for a few weeks on the new fillings. If it gets worse instead of better, call us and we will see what could be causing the sensitivity.
  • Sharp spot? Call for polish
  • Bite-should feel good after 1 week, if not call for quick no anesthetic needed polish

Crown Prep

Set up

  • Patient Bib, clip, glasses
  • Gloves and mask for doctor and yourself
  • Topical
  • High speed and slow speed handpiece–Rheostat check–confirm bur spins/water sprays
  • Bur Block
  • Restorative tray (locking pliers on back of counter for CLEAN)
  • Anesthetic syringe with short needle.
  • 1 black, 2 red, 2 gold anesthetic not loaded
  • Pink dye on tuff brush, Etch, 1 drop Prime, 1 drop Bond, Dappen Dish with 2 tuff brushes
  • Impression guns with the following: Blue bite, Temp crown material, light body, heavy body
  • Curing light with cover
  • Floss
  • 5 2X2s
  • 2 Cotton rolls
  • Purple and yellow Bite block
  • Cheek guard
  • Articulating paper
  • HVE, Saliva ejector

During Procedure

  • Seat patient
  • Update Medical History
  • Set up Netflix show for patient
  • Take Pre-op Impression ( only 1 tooth mesial and 1 tooth distal)
  • Take shade
  • Place Topical and rub til tissue is slightly red
  • Get Dr. for Anesthetic
  • Wait Appropriate Time for Anesthesia for Upper or Lower
  • Dr. Confirms shade only if needed
  • Dr. preps tooth/teeth
  • Pack Cord (if needed), use cord packers only, If first cord disappears pack a second cord, do not push to hard and cause bleeding
  • Pull top Cord only if 2 cords present, Dr will decide when and if to pull
  • Final Impression Posterior: H&H impression taken with Blue bite and green light body, No water, just air dry the prep
  • Final Impression Anterior: Taken with Monophase and pink light body, Rinse and dry the Prep. Dr/EFDA places light body around prepped tooth while assistant fills triple tray with monophase.
  • Prelim Impression used to fabricate temp,
  • Trim and Smooth Temporary, If temp is not up to standard, retake temp crown impression with prelim impression.
  • Check Bite only after it is fully seated
  • Adjust as needed (out of the mouth)
  • Seat with Tempbond almost always and rarely Dentitemp, or Flowable depending on patient.
  • Clean excess cement after it is tacky, Clean dentitemp immediately
  • 2 Minute Warning
  • PO instructions
  • Schedule Patient Back for Crown Seat (3 weeks Laxmi, 2 weeks Glidewell)
  • Attach lab case tracking to Crown seat appointment
  • Walk Patient Out

Crown Seats

Set up

  • Patient Bib, clip, glasses
  • Gloves and mask for doctor and yourself
  • Topical
  • High speed and slow speed handpiece–Rheostat check–confirm bur spins/water sprays
  • Bur Block
  • Crown Seat tray (locking pliers on back of counter for CLEAN)
  • Anesthetic syringe with short needle.
  • 1 black, 2 red, 2 gold anesthetic not loaded
  • Floss
  • 2 2X2s
  • 2 Cotton rolls
  • 3 micro-brushes
  • Articulating paper
  • HVE, Saliva ejector
  • BWX Rinn
  • Xray barrier
  • Nomad and sensor

During Procedure

  • Seat patient
  • Update Medical History
  • Ask patient how tooth has been feeling
  • Explain to patient that we will remove temp, clean tooth, rinse and dry tooth and place final crown without anesthetic. But if anything bothers them to let us know.
  • Remove Crown with forceps, Gently wiggle side to side, making sure that you mobilize the crown without squeezing the handle of the hemostat to hard. Too much hemostat pressure will flex the temporary crown more firmly on the tooth. There is a threshold of pressure that you do not want to cross. Take 20 seconds if necessary to apply the back and forth pressure without crossing the threshold of moving the tooth too far to the extant that it is painful.
  • Remove Crown
  • Clean excess cement from the prep with use of mirror. Avoid making the gingiva bleed.
  • Try on Permanent Crown, Do not press too hard or it will not come off.
  • Quality Checks in this order:
    ⦁ Adjust contacts until it will fully seat visually. Use red round tip bur. A sharpie can be used to show where the pressure spot is. Contacts usually are tighter after cementation than prior.
    ⦁ Check margins with explorer to confirm crown is fully seated and sealed
    ⦁ Check floss to confirm contacts are ideal and not keeping crown from fully seating
    a. Adjust as needed
    ⦁ Take X-ray to confirm crown is fully seated and sealed
    ⦁ Check Check Bite ( do not have patient bite unless you are certain that the crown is fully seated. Biting on a crown that is not fully seated can break it.)
    a. Adjust as Needed with red football with water, go slow to avoid head build up.
    b. If adjusting and feel like you’ll have to adjust “too much” call doctor in to finish
  • Dr. checks margins, bite, and flosses interproximally
  • Rinse and dry crown
  • Rinse and dry tooth if possible, most of the time cotton will be used to dry
  • Express the first bit of cement on the tray to ensure proper mixing
  • Place small amount of Rely-X luting cement. Focus on spreading it up the margins not necessarily filling the entire crown full.
  • Dr. places crown
  • Patient bites on cotton roll
  • Excess cement cleaned interproximally, buccal and lingual
  • 2 minute warning and final x-ray
  • Remove residual cement
  • Apply Fluoride around crown just seated
  • Patient Rescheduled
  • Dismiss

Dentures

What is a Denture

Dentures are artificial teeth and gums that are formed to your mouth and created by your dentists to replace lost or removed natural teeth. Dentures can either be full or partial, meaning they can either replace all teeth on either the top or bottom gum line, or just a few that are missing. Regardless of what kind of dentures you may need, they will be custom designed to fit your mouth, and visually matched to your existing teeth unless the patient and doctor decide otherwise

Immediate Denture

Consultation & Treatment Planning

  • You will take a panoramic x-ray and the doctor will perform a comprehensive oral evaluation and develop a treatment plan for the patient’s individual needs .
  • Once you have determined the type of denture you are making you will chart and treatment plan it,for instance an Immediate Lower Denture all lower teeth for Extraction, you will treatment plan one molar Surgical Extraction and the rest Simple Extractions which is shown on page 2/3, then you will go under the tab denture and choose Immediate Lower Denture that will automatically add a hard reline and soft reline to the treatment plan.
  • Next go into Treatment plan and break it into phases which I have shown on page 4/5, with that being said even though it is broken into phases they will pay for the whole treatment plan if they choose to start impressions today or down the road. ( This is done because we do not want to the patient surprised 6 months later if they now have to pay for a hard reline when at the beginning they think they have paid for everything.)

First Appointment

  • The day of appointment call the lab to schedule pick up if local lab. If not then simply get the shipment ready.
  • Take upper and lower impressions in Alternative alginate and you want to make sure when taking impressions  that you get all the ridges and contour of the patients vestibule and bone structure without the tray showing thru, also take a Bite registration with the  Super Fast  Set Blue bite. It may be necessary to place alternative alginate in the vestibule prior to inserting the impression tray loaded with alginate.
  • You will then make up a lab slip explaining what step you would like to do next also the shade in which the doctor has chosen  or upload photos for lab if they have been taken for custom shade and have the doctor review and sign before a lab pickup.
IMMEDIATE DENTURE1.) impress and take a bite ( depending on the case there may be a bite rim appointment, depending on how bad the teeth are. If the teeth are so bad that they do not create a good bite then a bite rim appointment is necessary. If they do provide a good " stop" then no bite rim appointment needed.
2.) Ext and deliver
PARTIAL DENTURE1.) Prepare rest seats and impress, also take a bite reg,
2.) Framework try in appointment ( shorter appointment), select shade
3.) Bite rims if needed
4.) Delivery of Partial
CONVENTIONAL DENTURE1.) Impress edentulous arch and opposing arch, Send to lab for bite rim
2.) Bite rim appointment ( 2nd visit.) send to lab for fabrication, shade and mould taken
3.) Delivery of denture

Second Appointment

  • Once the lab  slip gets sent depending on the doctor’s request  you will be scheduling for a wax rim try in appointment which would just be a post op and put in the note when making the appointment that it is for wax rim try in and usually it is 2-3 business days  from lab pick up, or if no wax rim is required you will be making an appointment for process to deliver the denture which is usually about 7 business days and 8 business days for scheduling appointment for the patient.

NOTE: depending on the steps taken to make a denture  you may have more than two appointments. Below is a chart on  what the steps could be and days it takes the lab to make it. When making the patient’s appointment you will always schedule 2 days from what the lab recommends, It allows extra time so the patient does not need to  be rescheduled and if the case shows up before the patient’s appointment  you can call and ask the patient if they would like to come in sooner.

DENTURES
1.) Custom Tray4 Business days ( on lab slip put meet due date)
2.) Wax Rim Try In4 Business days ( on lab slip put meet due date)
3.) Wax Try in With Teeth ( look See)4 Business days ( on lab slip put meet due date)
4.) Process for Delivery (final)10 Business days
PARTIALS
1.) Any parital work sent lab10 Business days
2.) Crown and Partial combo15 Business days

Room Setup For Immediate Upper or Lower Denture

  • Extraction cassette
  • Two bibs laid out on desk if possible ( try to do treatment in op 6 if available)
  • Anesthetic: lidocaine(3) septocaine(3)
  • One syringe
  • 2 Short needle’s
  • 2X2 gauze
  • Cotton swab with topical anesthetic
  • HVE
  • Saliva Ejector
  • Surgical Suction
  • Bard parker but don’t open
  • 1 15 blade but don’t open,
  • SOCKET!
  • Baggie with take post op  instructions  for immediate denture extra gauze and plastic syringe
  • Plastic syringe with saline water for irrigation
  • Surgical Handpiece and surgical bur 702

Immediate Denture Post-op Instructions

  • For the first 24 hours your immediate denture is not to be removed from your mouth. If the denture is removed, swelling may occur that will make it difficult or impossible to replace the denture. Oozing of blood around the denture is normal and is not cause for concern. Your immediate denture not only replaces your missing teeth, but it is acting to protect the surgical site, control swelling, and control bleeding. The denture needs to be in place to be effective.
  • In addition to your routine brushing, gently rinse your mouth with a lukewarm salt-water solution (made by dissolving 1/2 teaspoon of table salt in an 8 oz. glass of warm water.) Rinse 3 to 4 times a day for four or five days. Take care not to strain or empty your mouth with undue force.
  • After extractions do not spit, smoke or suck on a straw. Do not rinse your mouth vigorously. Do not drink any hot beverages or carbonated beverages. All of these things can dislodge blood clots that are necessary for healing.
  • Take all medications as prescribed. If a prescription for pain is written, you should not operate a motor vehicle while taking this medication. Some discomfort may be expected following oral surgery procedures.
  • Swelling is common after oral surgery for up to one week with the maximum amount of swelling usually present on the second day after surgery. The swelling will slowly resolve over 4-7 days. Apply an ice bag to the outside of the face for 20 minutes, and then leave off for 20 minutes. Repeat this procedure for 24 hours. This will reduce discomfort, bleeding and swelling.
  • You may eat and drink. Soft foods are advisable for at least 24 hours. Avoid hard or crunchy foods. Drink as much liquid as possible, but do not go on a liquid diet. Do not consume liquids through a straw. You may resume normal physical activity as tolerated 2-3 days after your surgery.

Re-aligns

Soft Reline

For patients with recent extractions up to 6-8 weeks, dentists may opt to reline the denture surface with a softer, more flexible material. Although easier on the gums, this type of relining may have to be replaced more often to maintain a proper fit.

Materials needed for Soft Reline:

  • Limited Cassette
  • Spatula
  • Torch and  buffalo knife
  • Box with soft tissue conditioner
  • 2×2 gauze
  • Timer
  • Plastic Cup
  • vaseline

 

Process for Soft Reline:

  1. Take acrylic bur to very minimally roughen the area of the denture up or reline any old soft reline material till its only the acrylic, then make sure the denture is cleaned out with water and soap and a little elbow grease. Cavicide spray or wipes also work well, rinse thoroughly afterward. Take a cotton roll and dip into the Primer jar that looks identical to reline liquid material. ( don’t mix up.) and rub the cotton roll with primer soaked into it onto the bearing surface of the denture to the border extending 2-3mm past the border.
  2. You will pour the proper amount of powder vs. liquid that the tissue conditioner box recommends into the plastic cup and mix it with the spatula, you want the soft reline material to be like a sticky liquid in the beginning. It may be necessary to add more powder
  3. Pour the Mixture into the denture throughout the whole arch. Spread liquid up the walls in every direction but not beyond the top of the flange. It may slump. When slumping slows and partially stays up on the walls it is then time to insert the denture.
  4. Place the denture back in the patient’s mouth with the midline correct and have them slowly bite down firmly to make sure occlusion is correct. You may need to wiggle the denture for about 5 seconds while applying pressure to make sure it is fully seated and in the correct orientation as prior to the reline. Once fully seated and midline confirmed and bite visually correct you can have the patient stay biting down while doing border molding movement:  Mandibular – lip pucker and tongue thrust. Maxillary: lip pucker and say “AHHHH” (NOTE; you do not want to overfill the denture to the point the patient is gagging but you want to put enough in there so it covers the vestibule and contours the patient’s mouth.) Then have the patient hold that bite for 8-10 minutes.
  5. Once the time is up you can remove the denture you will have excess soft reline material that will needs removed and smoothed, you can use a buffalo knife or heat up a spatula and it makes it easier to remove excess and melt the rough area’s down.
  6. Finally have the patient try in the denture as you are in progress of fixing it and removing excess until it feels good to the patient.

 

Hard Reline

Materials needed for Hard Reline

  • Vaseline,
  • Cotton swab,
  • Hard reline acrylic ( powder and liquid),
  • A second liquid called primer,
  • Acrylic burs
  • Acrylic handpiece

Process for Hard Reline

  1. Take acrylic bur to very minimally roughen the area of the denture up or reline any old soft reline material till its only the acrylic, then make sure the denture is cleaned out with water and soap and a little elbow grease. Cavicide spray or wipes also work well, rinse thoroughly afterward.
  2. Apply primer on inside surface of denture, extending to 2 mm onto facial, and air thin.
  3. Apply vaseline copiously where you don’t want acrylic to adhere, ( up to the border of where the vaseline was applied.)
  4. Measure and mix the powder and liquid, adding more powder than is called for ( slightly)
  5. after mixing for 60 sec. pour into denure and brush up onto every surface, preventing the pooling of it. After it is no longer slumping quickly insert into the mouth. Let set for 8 minutes.
  6. During first 1 minute border mold by having patient do mouth movements: Mandibular – lip pucker and tongue thrust.  Maxillary: lip pucker and say “AHHHH”
  7. make sure denture is fully seated posteriorly and anteriorly.  You can rock the denture back and forth to make sure it is seated all the way and no air bubbles are trapped.
  8. have patient bite down and make sure they affirm verbally that it feels fully seated and that they can bite down all the way.
  9. instruct patient to wait 8 minutes
  10. remove denture after 8 minutes and trim with acrylic burs and polish up with finer burs and then the rag wheel and pumice. FInish to being very smooth.

Night Guard Impressions

  • Seat patient
  • Review Medical History, make  necessary changes.
  • Show the patient the model of the night guard we have in the office. Inform the patient that for 1-2 weeks they may spit out the NG during sleep but if persistent they will get used to it.
  • Ask the patient if they would like clear or teal.
  • Explain to the patient we are taking 2 impressions today and a bite registration.
  • Try trays for proper fit in pt’s mouth for correct size.
  • Take lower impression first with alginate alternative.
  • Take Upper impressions next with alginate alternative.
  • Take Bite Registration with Super-fast set blu bite.
  • Schedule the patient back in 1 week + 1 day.
  • Walk the patient out.
  • Fill out lab slip for a COMFORT HARD night guard. Have Dr sign the lab slip.
  • Send the patient’s case out with impressions and bite reg to glidewell laboratories.
  • FedEx automatically picks up 1 time per day.

Whitening Trays

  • Try in impression trays for correct size, upper and lower
  • Use alginate
  • Take impressions, Mandibular first followed by Maxillary
  • Wrap in damp paper towel
  • Disinfect with Cavicide spray
  • Dismiss patient
  • Mix stone
  • Pour models
  • When set trim models
  • Use .040 tray material
  • Make suck down
  • Wait for it to cool before removing
  • Cut upper and lower trays with scissors straight across
  • Disinfect with cavicide spray for 1 minute. Rinse with water.
  • Place in plastic holding case
  • Put together trays with whitening syringes and instructions in bag
  • Let patient know the tray will be ready in 2 office days.
  • Give patient at home instructions with bag

In Office Whitening

  • Place whitening syringes in warm water 30 min before
  • Take before photos and shade using B1, A2, etc shade guide
  • Prophy using the gray plain paste
  • Rinse
  • Mix whitening gel
  • Place cotton rolls and cheek retractors
  • Place gum protection barrier
  • Cure
  • Apply from 1st bicuspid to 1st bicuspid
  • Set 30 min timer
  • Use surg suction to get gel off
  • If patient is up for it apply again
  • 30 min – can leave on longer if patient would like
  • Suction
  • Remove barrier
  • Take photos
  • Remove retractors and cotton rolls
  • Dismiss patient with sensitive toothpaste.

Invisalign

Consult Appointment

Step 1: Take pano when pt comes in for diagnostic purposes.
Step 2: Check to see if pt has any treatment that needs to be done before we begin Invisalign (trays will not fit if you have to do a filling, crown or any other type of treatment)
Step 3: Take impressions using both putties and green light body, impressions must be perfect and okayed by the Dr.
Step 4: Take intra orals, 2 side shots, 1 facial shot, 2 occlusal shots. Let pt know that  we will call them when their trays come in, it could take up to 3 weeks.

Delivery Appointment

Step 1: Prophy teeth with pumice, put cheek retractors in.
Step 2: Etch all teeth that will have an attachment on them, rinse dry, place bond on all teeth with attachments (do not cure)
Step 3: Fill template trays with flowable composite (do not overfill too much) have pt bite down to ensure the tray is fully seated and light cure each attachment 2 times.
Step 4: Have pt take trays in and out a couple times to unsure their attachments stay on.
Step 5: Take round slow speed bur around attachments to remove any flash glue

Check Up Appointment

Have Clincheck opened and review to see if any new attachments, have pt put in the retainer they were wearing for the past 2 weeks to evaluate if all teeth are tracking well (fully seated in the tray) before moving onto the next tray. Deliver 3 sets of trays and reinforce full time 22 hours wear everyday. Do IPR when needed.

Cleaning Trays

Step 1: Do not use toothpaste, this will make the retainer cloudy and gross.
Step 2: Soak your toothbrush in mouth wash and brush retainers, if that doesn’t get rid of the smell you can soak retainers in hydrogen peroxide and rinse really well before putting them back in.
Step 3: Always tell pt to keep the last set of trays (if they come in wearing tray #3 and are switching to tray #4 have them keep tray #3 in case they lose #4)

Last Appointment

Step 1: Review with pt if they are happy with treatment and if there is anything they would like to further correct.
Step 2: If pt is happy then take attachments and smooth teeth, do enamelplasty if needed. Take intra orals pictures.
Step 3: Take alginate impressions for clear retainers. Clear retainers must be worn for the first 3 months all the time after 3 months pt only wears them at night.

Root Canal Treatment

Set Up

  • Patient Bib, clip, glasses
  • Gloves and mask for doctor and yourself
  • Topical
  • Endo Cart
  • Endo Handpiece
  • Apex finder
  • Torch and Alcohol
  • High speed and slow speed handpiece–Rheostat check–confirm bur spins/water sprays
  • Bur Block
  • Endo Bur block
  • Restorative tray (locking pliers on back of counter for CLEAN)
  • Anesthetic syringe with short needle.
  • IsoDry
  • IsoDry mouthpiece and connector
  • 1 black, 2 red, 2 gold anesthetic not loaded
  • 5 2X2s
  • HVE, Saliva ejector, White surgical suction
  • RC Prep
  • 2 Syringes with diluted bleach with purple needle
  • K-files in endo sponge/holder
  • Root canal sealer
  • Mixing pad
  • Endodontic measurers
  • Paper points
  • Gutta percha cones and guttacore
  • Rotary File
  • Vaseline on tray with cotton tip applicator
  • Nomad
  • X-ray sensor

During Procedure

  • Seat patient
  • Review HH
  • Review procedure, ask if there are any questions
  • Offer Netflix
  • Place napkin/glasses/topical
  • Have X-ray pulled up and measure from the crown of the tooth to the apex of each root for proper length of files
  • Let QB know we are ready for doctor
  • Explain IsoDry to the patient
    ⦁ Let them know it feels big and bulky until you have it in properly.
    ⦁ Explain its a mouthpiece that suctions, allows them to rest without thinking, and is a new alternative to a rubber dam that offers better patient comfort.
  • After each injection give patient a rinse
  • Place IsoDry when Dr is ready to begin procedure
  • Place vaseline on pt’s lips

 

After Dr has accessed canals, and found proper length with the apex finder:

  • Dr may verify length with an x-ray.
  • Dr will irrigate using diluted bleach water to his/her standards to ensure canals are bacteria free.
  • Dr will dry canals using paper points until canal is completely dry.
  • Dental Assistant will mix root canal sealer on paper pad.
  • Once mixed Dr will place root canal sealer in each canal.
  • Dr will then use either the guttacore or the gutta percha cones.
    Guttacore: Place guttacore in warmer and press down all the way. The warming setting should be on #1. Light around button will flash when its fully heated. Remove guttacore with cotton pliers and hand to the doctor.
    Gutta percha cones: Light torch, take endo condenser and place in flame until the entire end of the condenser is orange and glowing (approx 20 seconds). Hand HOT condenser carefully to the Dr where they will condense the gutta percha cones.
  • Have a 2×2 ready to remove any excess gutta percha off the condenser.
  • Dr then takes the slow speed handpiece and removes any excess gutta percha on the occlusal portion on the prep.
  • Place a small cotton ball saturated in alcohol to ensure cleanliness of the prepped portion of the tooth. Dry tooth.
  • Next step is BU for a crown or a filling.
  • Take final PA
  • Go over post-op instructions and give any prescriptions that the DR tells you to print.
  • Dismiss Patient

End of Procedure

  • “Front office, 2 minute warning for ______, no changes, anything needed?”
  • Post-Op instructions
  • Schedule for next appointment
  • Walk patient to front, hand off sheet, clean room.
  • Set up for next patient
  • Finish patient notes
  • Sterilize instruments

Simple Extractions

Set Up

  • Patient Bib, clip, glasses
  • Gloves and mask for doctor and yourself
  • Topical
  • Surgical High speed–Rheostat check–confirm bur spins/water sprays
  • Surgical Burs
  • Surgical Cassette (locking pliers on back of counter for CLEAN)
  • Anesthetic syringe with 2 short needles.
  • 1 black, 2 red, 2 gold anesthetic not loaded
  • 10 2X2s
  • Purple and yellow Bite block
  • HVE, Saliva ejector, Surgical HVE
  • Saline and syringe
  • Sock-it
  • Sutures (unopened with cup of warm water)
  • Proper Forceps
  • Green Luxator
  • Bone graft material if applicable

During Procedure

  • Ask about any changes to patient’s health
    ⦁ Confirm patient is not on any blood thinners
    ⦁ If patient is diabetic, what’s A1C and last blood sugar reading\
  • Take blood pressure
  • Place topical
  • Anesthetic
  • Periosteal elevator or Woodson
  • 301 elevator or Luxator
  • extract tooth
  • curette away debris and granulation tissue,
  • Irrigation with saline
  • Place Sock-It if no bone graft
  • If Bone Graft Placed:
    ⦁ Small amount of Peridex placed in syringe.
    ⦁ Dr rinses extraction site. Place gauze for 5 minutes.
  • Dr places Bone graft material followed by (purple package) resorbable suture
  • Save bone graft information for chart note
  • moist gauze placed
  • Wait 5 min
  • Make sure bleeding has slowed
  • Go over post op instructions
  • 2 min warning to front desk
  • Walk patient up front

Surgical Extractions

Set Up

⦁ Patient Bib, clip, glasses
⦁ Gloves and mask for doctor and yourself
⦁ Topical
⦁ Surgical High speed–Rheostat check–confirm bur spins/water sprays
⦁ Surgical Bur
⦁ Surgical Cassette (locking pliers on back of counter for CLEAN)
⦁ Anesthetic syringe with 2 short needles.
⦁ 1 black, 2 red, 2 gold anesthetic not loaded
⦁ 10 2X2s
⦁ Purple and yellow Bite block
⦁ HVE, Saliva ejector, Surgical HVE
⦁ Saline and syringe
⦁ Sock-it
⦁ Sutures (unopened with cup of warm water)
⦁ Proper Forceps
⦁ Green Luxator
⦁ Bone graft material if applicable

During Procedure

  • Ask about any changes to patient’s health
    ⦁ Confirm patient is not on any blood thinners
    ⦁ If patient is diabetic, what’s A1C and last blood sugar reading
  • Take blood pressure
  • Place topical
  • Anesthetic
  • Periosteal elevator or woodson
  • Surgical handpiece used to cut crown in half
  • 301 elevator or luxator
  • extract tooth
  • curette away debris and granulation tissue,
  • Irrigation with saline,
  • Place Sock-It if no bone graft
  • If Bone Graft Placed:
    ⦁ Small amount of Peridex placed in syringe.
    ⦁ Dr rinses extraction site. Place gauze for 5 minutes.
  • Dr places Bone graft material followed by purple package of resorbable sutures
  • Save bone graft information for chart note
  • moist gauze placed
  • Wait 5 min
  • Make sure bleeding has slowed
  • Go over post op instructions
  • 2 min warning to front desk
  • Walk patient up front

Extraction Post-op Instructions

What to Expect After Wisdom Tooth Extractions

First Hour: There will be moist gauze placed over surgical areas, and a pack of gauze sent home with you before you leave the office. Make sure that you are biting gently but firmly to keep them in place. The gauze may be removed after one hour unless bleeding persists, then new moist gauze can be placed to obtain pressure for another 20 mins. If necessary, change as needed, every 20 mins until bleeding stops.
Discomfort: Our office will be sending you home with a total of 5 prescriptions
**Amoxicillin 500mg: Antibiotic used for infections
(Some antibiotics can reduce the effectiveness of female oral contraceptives. Use alternate birth control methods for two months following)

**Medrol Pack: Anti-inflammatory steroid used for controlling swelling

**Etodolac 40mg: (NSAID) used for pain management and inflammation

**Hydrocodone 5mg: Opioid (Narcotic) used for severe pain management

**Ondansetron: Anti-Nausea used to help prevent nausea/vomiting

Bleeding/Persistent Bleeding: Bleeding after surgery, is not uncommon. It is normal to ooze blood for 24-48 hours after surgery. Replace moist gauze as needed every 20 minutes. Bleeding should never be severe, if it seems to be more than oozing try biting on a moistened and cooled tea bag. The tannic acid in tea leaves helps promote blood clotting. If after an hour the bleeding persists, please call our office.

Swelling: Swelling is anticipated following extractions. To minimize swelling, apply an ice pack to your face for 15 minutes on and 15 minutes off for the first 24 hours following extractions. You may continue ice compresses for the next 48 hours as needed.

Diet: For the first 24 hours, your diet should consist of fluids and soft foods. Avoid hot, crunchy foods. Food suggestions are eggs, ice-cream, yogurts, cool soups, mashed potatoes and pasta. Drink at least eight large glasses of water or fruit juice per day for the first few days. Avoid foods like: nuts, rice, seeds, popcorn, etc., which may get lodged in the extraction sites.

Oral Hygiene: It is important to keep the mouth clean, brush your teeth gently around the surgical sites. Do not vigorously rinse or probe the extraction sites. Smoking, sucking through straws or drinking carbonated beverages will slow the healing process, causing increased discomfort and chance of dry sockets.

We Strongly Suggest:

**Avoid spitting, blowing your nose forcefully or using a straw
**Avoid smoking and drinking alcoholic beverages for 24 hours
**Do not swish or vigorously rinse your mouth for the first 24 hours

Healing/Bruising: The first few days after surgery are usually the most uncomfortable with some swelling and pain. By the 3rd to 4th day you should be more comfortable, although there could still be some swelling and the development of black, blue, green or yellow bruising. Lower wisdom tooth extraction sites may ache for 1-2 weeks.

Sharp Edges: If you feel something hard or sharp in your surgical site areas, it is likely you are feeling the bony wall which once supported the extracted teeth. Occasionally small slivers of bone may work themselves out after surgery. If they are causing discomfort, please tweeze them out or call the office for removal.

Sore Throat/Stiff Jaw: Because your mouth is open for so long during a surgical procedure, it is not uncommon to develop a sore throat or stiff jaw muscles. Muscles get swollen while being stretched and may cause limitations in opening the mouth or even make it hard to swallow for a few days after surgery. This is a normal post-operative event and usually resolves during the week after surgery.

Activities: Bending, lifting, or strenuous activities like exercise, may cause an increase in bleeding, swelling, and discomfort. Exercise should be avoided immediately following surgery.

Warm Salt Water Rinses: If there is minimal bleeding, saltwater rinses may begin 24 hours after surgery. (1 tablespoon of salt to 8 ounces of warm water). Swish gently allowing the water to drip from your mouth into the sink. Rinses can be done 2-3 times a day.

It is our desire at Dr. C Family Dentistry, that your recovery be as smooth and pleasant as possible. Following all these instructions will assist you, but if you have questions about your progress, please call the office at 509-228-3834

What to Do After Tooth Extraction

First Hour: There will be moist gauze placed over surgical areas, and a pack of gauze sent home with you before you leave the office. Make sure that you are biting gently but firmly to keep them in place. The gauze may be removed after 30 minutes unless bleeding persists, then new moist gauze can be placed to obtain pressure for another 20 mins. If necessary, change as needed, every 20 mins until bleeding stops.

Bleeding/Persistent Bleeding: Bleeding after surgery, is not uncommon. It is normal to ooze blood for 24-48 hours after surgery. Replace moist gauze as needed every 20 minutes. Bleeding should never be severe, if it seems to be more than oozing try biting on a moistened and cooled tea bag. The tannic acid in tea leaves helps promote blood clotting. If after an hour the bleeding persists, please call our office.

Swelling: Swelling is anticipated following extractions. To minimize swelling, apply a wrapped ice pack to your face for 15 minutes on and 15 minutes off for the first 24 hours following extractions. You may continue ice compresses for the next 48 hours as needed.

Diet: For the first 24 hours, your diet should consist of fluids and soft foods. Avoid hot, crunchy foods. Food suggestions are eggs, ice-cream, yogurts, cool soups, mashed potatoes and pasta. Drink at least eight large glasses of water or fruit juice per day for the first few days. Avoid foods like: nuts, rice, seeds, popcorn, etc., which may get lodged in the extraction sites.

Oral Hygiene: It is important to keep the mouth clean, brush your teeth gently around the surgical sites. Do not vigorously rinse or probe the extraction sites. Smoking, sucking through straws or drinking carbonated beverages will slow the healing process, causing increased discomfort and chance of dry sockets.

We Strongly Suggest:

**Avoid spitting and blowing your nose forcefully for 24 hours
**Avoid smoking for 4-6 hours and drinking alcoholic beverages for 24 hours
**Do not swish or vigorously rinse your mouth for the first 24 hours
**Do not use a straw for 3 days

Healing/Bruising: The first few days after surgery are usually the most uncomfortable with some swelling and pain. By the 3rd to 4th day you should be more comfortable, although there could still be some swelling and the development of black, blue, green or

Appointment For Post Op Extraction

Do not use the term Dry socket, (they will assume the worst)

  • Plastic cup half filled with warm water
    ⦁ Test temperature on wrist
    ⦁ No cold water
  • Fill Monoject Syringe
  • Cut Out any loose sutures if silk
  • Irrigate upper sites while saliva ejector is in mouth, keeping tip out of socket but close
  • Irrigate lower sites with saliva ejector
  • Repeat on lower until all debri is out
  • Dry Sockets:
    ⦁ Place heliplug coated with clove paste with cotton forceps
    ⦁ Allow patient to sit until they feel relief
    ⦁ Oxygen if needed
    ⦁ Or, use Sock-IT

Implants

What is an Implant?

An implant is a titanium post that placed in your bone with a crown attached to replace a missing tooth.

Parts:

  • Implant body
  • Abutment ( attaches the crown to implant)
  • Crown (looks like a natural tooth)

Process:

Tooth Existing: Half the time we can place implant the same day with a bone graft. The other half of time the hole is too big where the tooth is and the we don’t have enough bone to screw into, so we just place bone graft.

No tooth: Place implant (no bone graft needed) Let the bone integrate into implant for about 3-6 months. Take impression for crown.  GET A NEW TOOTH BACK!

Frequent Questions from Patients:

  • Do I have to clean my implant? A: Yes gently with tooth brush (no electric), Especially around gum line to preserve bone.
  • Does it hurt? A: less than an extraction.
  • Will it look like  natural tooth? A: yes, looks like a normal tooth.
  • Is an implant better than a Bridge? A: Yes, implants just involve one tooth.A bridge involves the 2 adjacent teeth that are having tooth structure removed ( hair cuts around the tooth). The lifespan of implants can out last a bridge in most cases. Cleaning around a bridge is more difficult that cleaning around an implant.

Implant Procedure

Implant Day of Placement: What happens today? Extract the tooth if needed, place implant into bone. Tighten down to ideal Newtons of force (35-45). Last thing, placed healing cap and let implant integrate into bone.

  • Implant Cassette
  • Implant unit with saline tube connected to handpiece, step on reostat to see water emerge
  • Type of implant with corresponding healing cap
  • Helie-plug ( unopened) and sutures ( unopened)
  • 1 syringe – 2 cups: one with chlorhexidine 15 mls and fill remaining up to ⅓ of the way up the blue cup with water and one cup with saline  1 inch high
  • Container with chlorhexidine
  • Implant pilot guide burs
  • Osteotomy kit (drill bits)
  • Direct or noble kit with correct wrenches ( unopened)
  • Implant post op directions
  • Cup of chlorhexidine for patient to swish with prior to anesthetic
  • Make sure prior to appt the Patient has been on their prescription of the antibiotic and the day of if needed a pain prescription printed off.

Implant 101 Guide

Implants are the new future of dentistry,  making someone feel confident and excited to smile and take on the world again. After losing a tooth there wasn’t much to do about it, but now we can! This implant 101 guide will take any new member of your AWESOME team and make them implant experts. The means for this is to make you feel comfortable about the process and also having someone to go to if you have any questions. That person will be Ivy (ask away!)

Process: Extract the tooth (if immediate placement.) Place the Implant body into bone. Let the implant integrate into bone for about 4 months. Take impression for crown.  GET A NEW TOOTH BACK!

Day of Placement Set Up:

  • With Cup of Chlorhexidine rinse and syringe
  • Post op instructions
  • Anaesthetic needed

 

New Implant Kit (located in room 6) – Has all drill bits that dr will need

Implant Driver Wrench (located under the implant kit)

Implant Screw Drivers

Implant Impression Coping

 

  • As you can see they come in small, medium and large and depending on tooth and location you will choose what size to use.
  • They are universal for any size of implant that was placed.

 

Also in picture:

  • Heli-plug, sutures, and bone graft
  • Healing cap beside implant ( unopened)

STEP BY STEP

1. Pre-surgery meds

  • Antibiotics:
    1. Healed site – straight forward
      • 1000mg Amoxicillin or 600mg Clindamycin
      • Give them 1 dose for that night
    2. Socket Grafting – Full course starting 2 days before surgery
    3. Chronic Infection – Full course starting 2 days before surgery

2. Take BP and place topical, have anesthetic admin

3. Dr will use scalpel to reflect a flap

4. Dr will then start using drills to make a guide for implant. He will be ibtermediately changing them out from smaller to bigger sizes. During this process he may use the pilot drill to take x rays to verify location. Must view the apex

5. Once the hole is at adequate size, then he will take the implant and hand torque it down using a wrench already in the implant surgery kit.

  • 35Ncm = OK for immediate provisional restore
  • 25Ncm = He’s happy
  • 15-20Ncm = Healing abutment OK
  • Spin my finger is difficult but doable = bury implant and healing abutment

6. After everything ideal then we will place the healing cap and possibly a suture if needed. Take final x ray and when we will see Pt back 3 week for a post op to make sure everything is normal

Implant Supported Options

Hybrid: (normally up to 4 to 8 implants in either arch that have a denture that is screwed in permanently)  Denture made out of Zirconia ( crown material) The denture does not rest on any tissue.

COST: 25,000 each arch

Snap in denture: that is held in by 4 or 2 implant upper or lower that are removable and have a snap locator that locks into the denture.

COST: 10,000 – 4 implants both arch – 7,000- 2 implants lower

IMPLANT SUPPORTED DENTURE STEPS

Steps- Remove all teeth and try and place same day implants if possible. ( if not place bone grafts and let pt heal for 3 months).

Hybrid- Pt will be in a temporary hybrid that will be a healing device for the 6 month interim period.

Snap in- PT will use a regular denture until that 2-6 month mark and once the implants are ready then we will take impressions of the lower denture and send it off to the lab to put in the snaps that will attach to the locators on the implants.

Implant Post-Op Instructions

** the reason for a implant track sheet is so we can easily track where the patient lies within a treatment time period. Some cases will take over 6 months to finalize and we need a tracking sheet so the patient does not fall through the cracks.

1. there is an implant binder that will have a blank sheets for every patient that has implant treatment.

2. 1st appt will be stated with what procedure was completed and there will be a box where it will prompt you to write down what the next step will be for the patient and what date that will happen on. You do this until all Tx is complete with implant.

  • As you can see, please make sure you attached the sticker ( that comes off the implant to the tooth number) this gives us the ref # and the lot # of the implant for record purposes.
  • Once the all the Tx is completed with the implant after the last APP you can draw a line and write completed.
  • Please put PT sheet in a clear sheet and place it in the correct month it was started.  
  • Ref# and Lot# of Implants and Bone graft only. These are not required for analogs, or abutments or copings or healing caps.

Post Ops For Implants

3 week/3 month post op

  • Ask pt how it has been
  • Explain to patient we’re going to look at the area ( avoid saying anything that could concern them.) Look for redness swelling, pus, bone loss on x-ray. Remove any sutures if sild was used.
  • Take x-ray and present to doctor
  • Look for redness, swelling, pus in mouth.
  • Inform patient of any needed info, use discretion

HYBRID – 1 week post op, 3 week post op, 3 month post op.

SNAP IN- 3 week, 3 month

1 SINGLE IMPLANT – 3 week , 3 month

Implant Crown Impressions

What happens here:  After the 2-5 month mark and the implant is ready for the crown we will take a series of final impressions, shade desired and in about 2-3 weeks the patient will get a new tooth!

Check Off Sheet

⦁ Implant kit ( Core dent, Implant direct, Nobel)
⦁ Correct implant impression coping  fully seated and x -ray verified. Closed tray technique preferred
⦁ Full tray
⦁ Impressions material ( heavy body one with large blue tip and light body)
⦁ Bite registration ( material)
⦁ Wax ( that will be used to clog the impression coping hole so we can remove it after the impression is taken )
⦁ Take shade,
⦁ Going to glidewell ( get sheet ready)
After impression is perfect then we place the healing cap back on PT hand tight,( you are not strong enough to over tighten if done by hand with just fingers.) implant and wait 3 weeks until crown comes back.

Impressions

⦁ Check for overgrown tissue ( if so get PT numb)
⦁ Removed healing cap
⦁ Place the correct impression coping with wax in screw hole. ( take xray to make sure it is fully seated)
⦁ Use tray that correlates with impression coping.
⦁ Fill tray with  heavy body impression material
⦁ Dr will use light body around the impression coping
⦁ Take shade, putting healing cap back onto full finger tightness
⦁ Take bite reg, and send the impression coping in impression to lab!

Implant Crown Seat

  • Remove healing cap
  • If screw retained:
    ⦁ Tighten down tooth and take x ray to confirm abutment is fully seated
    ⦁ Adjust interproximal contacts
    ⦁ Adjust bite
  • If cement retained:
    ⦁ screw down abutment and take x ray  to confirm abutment is fully seated
    ⦁ Try on crown
    ⦁ Adjust interproximal contacts
    ⦁ Check margins with 2nd x-ray
    ⦁ Adjust bite

Limited Exam

  • Blood pressure for NP
  • Health history
  • Xrays: BWX and 2PA
    ⦁ Only bill for the 2 PAs
  • Listen for dr to call out what to fill in on exam sheet
    ⦁ Caries
    ⦁ Gum measurements
    ⦁ Cold
    ⦁ Percussion
    ⦁ Tooth sleuth
    ⦁ Palpation
    ⦁ Mobility
  • Present patient with treatment options and treatment plan
  • Same day dentistry or reschedule
  • If built positive rapport request review if its NP

Sterilization

DO NOT CROSS CONTAMINATE

  • Dirty Side to the Right of the Yellow Tape Line:
  • ultrasonic
  • Sharps container
  • Cavi wipes
  • Cavi spray
  • Scalpel blade remover
  • Recycling Container for teeth with metals in them
  • Cold Sterile
  • Quattro Handpiece Lubricator

-wipe down Nomads, Sensors, Chairs, Pano Machine, Statim, Midmark, and cupboards with CLOROX wipe. The Cavi is too strong and will disintegrate the plastic and chair material

-With gloves on: Take dirty instruments from room

-Rinse impressions, spray with cavicide let sit for one minute, rinse off, place in lab bags.

-Dispose of any sharps, organize tray. Teeth go in the sharps container, teeth with metal in them go into the recycle container by the sink.

-Place all instruments in ultrasonic for 10 minutes except for handpieces/connectors.

-Take instruments out of ultrasonic and rinse

-Place any cold sterile instruments in Cold sterile

-Wrap restorative trays with sterilization paper and label the color

-Wipe down handpieces with alcohol wipe and place high speed in Quattro

-Take handpiece out of Quattro, wipe down any excess lube and place both handpieces in bag

-The outside of the sterilizers is DIRTY, we do not wipe these down with Cavi wipes as they eat away at the plastic. Use gloves to open the sterilizers. Place Statim on dirty side. Once it is open take off gloves and place clean instruments on the CLEAN side.

-Put on gloves and place dirty instruments in sterilizers.

-Flip the Sterile/Unsterile sign as needed

-Clean room and check walls and cupboards for spattered products.

Clean Side is the Wall Opposite of the Sink:

-All sterilized instruments from midmark and statim are placed on clean towels.

-If instruments/packs aren’t fully dry, allow them to sit on clean counter to air dry

-check sterilized bur blocks for accuracy of bur placement and replace as needed.

-Put instruments in respective spots

How to Take a CT Scan / Pano

Panoramic x rays

Get into Open dental software on the computer next to the front office ( can only use this computer.)

  1. Find the patient on the schedule you would like to take the pano of
  2. Click once on it and then hit chart on the left side of the screen.

Once the chart is open, on the top of the chart is a menu bar

  1. Click on ProfSuni
  2. When the program pops up you will see a BLUE radiation symbol
  3. Click it and a screen will pop up  that says select the teeth for which you will be cartupring a digital x ray.
  4. You will click right in the center of all the teeth

– The system will then start setting up the pano and a new screen will pop up.

– You will get your patient lined up in the pano machine by making sure patient has removed any earrings and removables in the mouth ( and placing protective radiation cover if they want it)

  • They will place their chin on the white rest and place their anterior teeth on the bite tab.
  • The machine will place a line vertical and horizontal on the patients face
  • The vertical line needs to be place down the center of the patients face
  • The horizontal line needs to be level with bottom of the eye socket.
  • Both hands will hold the handle bars under the chin rest
  •  Patient will place both feet together

– Once the patient is set up you can hit READY on the computer at the bottom right

– The system will get ready on its on and tell you when you can take the scan.

– The button is on the way next to our guest bathroom that way you are blocked from any radiation.

– Once the pano lets you know it is done scanning you will save the pano and then you are able to close out ( make sure to save before closing the system or the pano will not save to the patient’s chart.

CT Scan

⦁ Get into Open dental software on the computer next to the front office ( can only use this computer or Dr. Josh’s computer to access CT scans.)
a. Find the patient on the schedule you would like to take the pano of
b. Click once on it and then hit chart on the left side of the screen.
⦁ Once the chart is open, on the top of the chart is a menu bar
a. Click on EZdent
⦁ The program will open up and show the patients personal information, make sure this is correct before taking CT scan
⦁ You will then click Acquisition
⦁ Click CT scan on the right hand side
⦁ You will get your patient lined up in the pano machine by making sure patient has removed any earrings and removables in the mouth ( and placing protective radiation cover if they want it)
a. They will place their chin on the white rest and place their anterior teeth on the bite tab.
b. The machine will place a line vertical and horizontal on the patients face
i. The vertical line needs to be place down the center of the patients face
ii. The horizontal line needs to be level with bottom of the eye socket.
a. Both hands will hold the handle bars under the chin rest
b. Patient will place both feet together
⦁ Click confirm on the lower right side and the computer will let you know when the system is ready for you to take the scan.

Downloading CT/Pano images to DVD/CD

⦁ To download Ct/Pano onto a CD/DVD it will have to be done on the computer’s that have EZdent which include Dr. Josh’s office computer or the computer in front of our CT machine.
⦁ The DVD’s can be found in the Drawer below the CT machine.
⦁ You will place it in the disk drive, on the computer you will click  EZdent  and find the patient you are looking for.
⦁ You will bring up the patient’s CT Scan and up on the top task bar there is a picture of a CD you will click on that.
⦁ A screen will pop up asking what kind of image you would like 2D Viewer, 3D viewer and 3D simple Viewer.
⦁ Click 3D Viewer and hit ok
⦁ Another screen will pop up giving you the option to burn the CD which you will hit.
⦁ The computer will let you know when the CD is finished, remove and write patient’s initial of their first name and full last name on CD.
⦁ This will either be given to the patient to take with them or be mailed to the referring doctor.

Back Office Check List

  • The back office checklist is located above the sink in sterilization
  • Every day there is a QB- (quarterback)  which you also will find on the list per each day
  • This QB is in charge of making sure the list gets done, NOTE: this does not mean you are required to do everything yourself you just needs to make sure everything is finished before the end of the day.
  • You are required to get the first 6 jobs on the checklist which include
    ⦁ Turn on lights, music, suction
    ⦁ Fill ultrasonic with HOT water
    ⦁ Load washer
    ⦁ Fill water bottles
    ⦁ Remind Dr to look at follow up sheet
    ⦁ Post op calls from previous afternoon if needed ( anyone who had anesthetic )
  • When doing check list make sure what ever job you are doing it get’s done before  marking it off on the checklist. ( We tend to get busy and sometimes it doesn’t get done like we would like.)
  • At the end of the week which would be our Saturday, whomever works that day once you finish the checklist it is your job to scan the check list in up in front office.
    ⦁ Go into Start and click on devices and printers
    ⦁ Click on ADS 1500W
    ⦁ Click on Scan a Document or Picture
    ⦁ Open the scanner and and face the checklist towards you as you slide it in ( may need to pull it thru as it’s going or it can get stuck.)
    ⦁ Down in the right hand corner of the screen it will pop up with the scan you just took will have a box to put the date you scanned it, then hit import, it will pop up on the screen again; keep it up and go down and hit start and click on documents.
    ⦁ The folders file will pop up and you will click on drop box, then click on Dr. C family dentistry
    ⦁ Up in the right hand corner you will search task list and click on the link below.
    C:\Users\employee.DENTAL\Dropbox\Dr. C Family Dentistry\Audits\Back Office
    ⦁ Click and grab your scan and put it in the task list folder.

Chart Note Audit / “Red Dot”
Checklist

Lead DA will change “dot color” to RED if chart note is incomplete.
What to look for if you have a “red dot” chart
⦁ MedHx in chart notes and updated?
⦁ BP charted if necessary?
⦁ Is the treatment performed actually in the chart note correctly?
⦁ Is all LA noted?
⦁ Is Crown Prep narrative correct?
⦁ Is the composite shade correctly noted?
⦁ Do you have a lab case attached?
⦁ Is RCT chance noted?
⦁ Pulpal/apical DX noted?
⦁ Do you have a crown shade?
⦁ Did you use any sedation methods? If so, is it charted correctly?
⦁ Did you type your initials and the DRs initials at the end of your chart note?
⦁ Is next visit charted?
⦁ Is AOC notated?

Calling Lab Cases

  • Fill out Form by Front
    ⦁ Patient
    ⦁ Lab Case Shipped Back – Date
    ⦁ Lab Received at Facility?
    ⦁ Date Expected Back
    ⦁ Patient Contacted and Informed?
    ⦁ Patient Rescheduled
  • Call Laxmi or Glidewell
    ⦁ Commlog communication

Repair OP Units

Water for Handpieces

When the handpieces no longer are spraying water out even when you are turning the water valve up or down.

Underneath the unit there is a black knob and the word brake next to it.

On the bottom of this unit you will see a little hole that fits an allen wrench size “⅛”  

Place the allen Wrench  in and tighten the knob, it has a little screw inside that grips the valve which controls the amount of water that is coming out.

Air/Water Units in OPS

When having trouble getting the buttons to work whether they stick or are leaking water out most likely one of two things is happening, 1.  The buttons need replaced or the 0-ring inside the Air/ Water needs replaced. PLEASE MAKE SURE UNIT IS TURNED OFF AS WELL AS WATER UNIT IN THE OP YOU ARE WORKING ON.

Replacing Air/Water Buttons

On the left  side of the air/water you will see what looks like a hole with a pin in it.

You will take something small enough like the tip of a pen and push that pin till it starts to come out the other side. 

Then while holding down both buttons you will take the pin out using hemostats or pliers.

Once you remove the pins the buttons will slowly start to pop themselves out or you can pull them out, springs will come out with buttons

Before replacing these buttons trying cleaning them water and a paper towel

DO NOT USE ALCOHOL  you will rinse the buttons and springs and lightly wipe them down.

After that you will take a damp paper towel and clean inside the Air/water handpiece. ( next to Arrow)

So once you have replaced ( once a year at the latest) or cleaned you will place both buttons back in with the springs and push down with your thumb

Then you will take the one metal pin and place it back in the hole on the right side.

Once the pin is in you will use something with a flat tip like a spatula and push it back in till you can see it on the other side

Replacing Air/Water O-Rings

You will take an allen wrench  “5/32”and place it in the air/water insert and remove   both the center ring and the outer ring.

Once removed at the very bottom is a little black ring you will take out with an explorer and place a new one in without tearing the O-ring.    

When placing the metal air/water ring back over the entry you must line up the open grooves on the metal to the insert in the air/water handle and hold down the outer ring before using the allen wrench to screw it back in.   ( Steps shown below)

Replacing Air/Water Unit

Replacing the air/water unit is the final step if nothing else you have tried worked, at this point the unit air/water unit is broken and needs replaced.

We have a spare in back/ sterilization with our extra instruments above handpiece lubricator for this occasion and once you replace and use the spare you will let team leader know another is to be order for backup.

First you will unscrew the head from the body of the air/water.

Once you remove the two pieces you will see two cords one is for Air (A)  the other is for water (W)

AGAIN PLEASE MAKE SURE UNIT IS OFF WHILE DOING THIS. Then you will pull both cords out of the Head.      

You will take the New head and before placing the lines back on you can turn on the unit to see which one is flowing air and then turn it off again once you found it.

Place the cords according to air and water back in the Head and in the right slots as directed on the picture below.

NOTE: you can choose to remove the handle and replace it as well  when you replace the head but it is not necessary, if your choose to all you need to do is slide the handle off once you remove the head from the air and water cord.

Here is a list op Henry Schein part number and how the air/ water breaks down:

How to Create, Send and Receive Lab Cases

  • The shelf located at the front of the office (above the first check out desk). This is where all lab cases will go when they are needing to be picked up.
  • If a lab case is needing to be created in Open Dental these are the steps in doing so:
    1. Make sure you scheduled the seat/deliver appointment. Once this appointment is scheduled you will
    2. create the lab case in this appointment (not the appointment they were just in for)
    3. Once the appointment is on the schedule you will double click on it.
    4. On the right hand side of the appointment there is a “lab” button. Click on it
    5. Once you have clicked on “lab you will be then need to hit the new button.
    6. Once you have clicked on the new tab you can select the lab you are wanting the case to go to
    7. In the instructions box write what the lab case is for. Example #20 crown, Occlusal guard, etc
    8. One the upper right corner you will see that the case has been created with the day and time. You will want to select sent. This is will show when the lab case was sent out.

Checking lab cases in:

  1. When a lab case has come back to our office you will find that it has been placed in the bin that is was placed in to be sent out.
  2. You will need to take it to the back.
  3. Check the quality
  • Check shade
  • Check crown margins on pour up model
  • Place crown varnish and brush in lab case bag
  1. Place it in the lab bin
  2. Check it in through Open Dental
  3. Go to the patient
  4. Select which appointment it is for
  5. Open up the lab case that was created when it was sent out ( see above if you forgot how to get to this point)
  6. On the upper right you will see that you can select received and quality checked. Please push the “now” button and you have successfully checked in a lab case!

Ordering Supplies

  • All back office supplies has a yellow order tag.
  • This tag is pulled when you removed the supplies bundled from that tag.
  • The tag then goes into the yellow “to be ordered” folder.
  • Once the order is processed, all tags then get put into the green “ordered” folder.
  • Once the order is received then the yellow tags get placed back on the ordered supplies.
  • Place yellow tags on items, so we have one weeks worth of inventory left. Guideline below:
    • Cements: 1
    • Impression material- 1 box
    • Tip out bin disposables- fill line
    • Lab shelf disposables- ¼ of the last package
    • Lab shelf boxed items- 1 box
  • Any items that fall into similar categories
  • When putting away new supplies we need to follow the FIFO method to avoid expired product.

Care to Share Program

  • When giving the patient their next appointment card show them the referral card
  • “The biggest compliment we can get from our patients is a referral to their friends and family!” “With this card, if they bring it in with your name on it, the first gift you will receive is 2 movie tickets! “Then every card a patient brings in with your name after that you receive $50 off your treatment!”
  • Make sure you fill out the card for them with their first and last name on it with your initials in the upper corner so you will receive your bonus

Quarterback

Job description- This is all about time management. You are in charge of making sure the BO runs smoothly. Making sure the pt’s time is a priority and to keep drs on tempo.

Expectations

  1. Know the schedule in advance before you send Dr to an op.
  2. Don’t get stressed over a busy schedule.
  3. Have a plan of action for when things get busy.
  4. Quickly communicate to dr what exam or procedure he is walking into. If it’s a comp exam or periodic exam. Tell the dr to keep the periodic exams at a maximum of 3 minutes and where they need to go next.
  5. Be waiting for the Dr to remind them on where they are going, so Dr doesn’t get side tracked.
  6. When Hygiene radios “we are ready for exam in OP __,” Dr has 5 minutes to get into that OP.
  7. Control the radio chatter so everyone knows exactly where Dr is going and when the Dr will be in their op.
  8. You are responsible for keeping all assistant aware that you make the decisions for when and where dr needs to go.
  9. Making sure the task list is getting completed before anyone leaves.
  10. You are responsible for completing all AM tasks.

Photo Uploading to a Lab

  • For now you will need to use Dr. Ball’s computer for uploading photo’s until software can be properly installed in other computers.
  • Remove memory card from camera and place in USB card and plug into computer
    • Auto play  will pop up on the screen
    • Choose  view/download images from imagebrowser EX for Canon
      • Download images
  • Photo’s will  pop up at bottom of the screen  find your photo’s you want and one by one let click and hit “ move to folder”
    • Browse for folder will come up
      • Click the folder PIX and hit OK
  • Exit out of images browser once you have finished moving photo’s
    • For each individual lab they have different emails and you will have to send the emails with the attached photo’s thru our contact@drcfamilydentistry.com email address. Which will include patient’s name, case number if you have it, and our office name and number and any lab info that doctor would like them to be aware of. EXAMPLE: please custom shade made we were thinking 3M3 here are some photo’s I have attached.
    • Once photo’s get sent to lab you will then go into the patient’s chart and go to SOPRO
    • Click image on top menu bar
      • Then hit import, and pick the file that has the patients photo’s in and place in sopro for future reference.
  • Below is the lab’s and contact info for uploading
Miller LabRonmillerCDT@millerdentallab.net
GlidewellAt this time you will call to get email for certain material ( example: implant crown, bridge)
LaxmiWill need to call for email based on material used
Golden Dental (NICK)nickgrishin@hotmail.com
Golden Dentalgoldenspokane@gmail.com

Patient Post Op Calls

  • Daily quarterbacks will be responsible to make post op calls from the evening before and the am patients who had anesthetic.
  • In certain circumstances Dr. Ball will let us know which patients he would like to call. If he hasn’t stated which ones we are to call all of them.
  • Make sure to document conversation in commlog. Even if you only left a VM.
  • Make sure to read chart before calling so you are prepared if patient does indeed have any questions.
  • Here is an example of how a post op call should go.
  • Depending on what their procedure was remind them of their post op instructions
  • Thanks ladies for your help with taking some of the load off of the docs!

Hi, this is ——————- from Dr. C Family Dentistry. Dr. ——————- wanted me to call and check on you and see how you are feeling today? If you have any further questions or concerns, feel free to give us a call! Our number is 509-228-3834.

Podium

  • Check for review eligibility in SSB
  • “ The biggest compliment we can get is if you wouldn’t mind taking 30 seconds out of your day and write us a review with a few words” “Would it be ok if I sent it to you in an email or a text?”
  • Log in to podium
  • Click send review
  • Put in patient name and patient number or email
  • Press send
  • Record in ssb with review sent date and initials

How to Schedule a Patient Back

  • Go into open dental
  • Upper right side of the screen there is a calendar, click on the next working day
  • Then Click on the print button right above the calendar
  • Once printed use the back to write down pt information pertaining to the next day
  • You will go through each pt on restorative side by clicking on the patient’s appointment then hitting the chart button
  • Make note of TX that still needs done also make note of needing HYG or Recall scheduled
  • Check SSB if needs updated
  • Does pt require Nitrous or Oral Meds?
  • Is pt a Cross over from Hyg?
  • Also make note of any health issues or conerns pt may have (Example: Pre-med or pt request we turn off smells in office due to allergy’s)
  • At bottom of the sheet you will also make note of when each doctor has next availability for high production (Example: Dr.Josh next availability is two weeks out on whatever date that is)

Emergency Calls Protocol

For patient’s that call in on the weekend with pain, primarily Sunday, we can call in an antibiotic, mouthwash, anti-nausea, etc, to help alleviate pain.

Wisdom Teeth Extractions:

PO discomfort is best treated with Ibuprofen and ice (for the first 24 hours after the extraction) or heat compress (after the first 24 hours). If the patient has Hydrocodone they can also supplement the Ibuprofen with that. We can not call in narcotics.

  • Food Impaction:
    • Have the patient irrigate with the monoject syringe with warm saline or warm water until all food particles come out.
  • Dry Socket:
    • Have the patient use the Sockit! As much as possible. Patient can also pick up clove oil (most grocery stores carry this) and use the dropper to apply a number of drops into the affected site. This will help soothe the nerve.

Infection:

For infection, Dr. will likely call in an antibiotic.

  • Signs of an Infection:
    • Radiating pain down the neck and in lymph nodes.
    • Putrid smell
    • Puss
    • Swelling, Redness

DEA Numbers

Dr. Joshua CochranDr. Amy CochranDr. Morgan Ball
DEA #: FC 239 8899DEA #: FC 333 5848DEA #: FB 3357060

Common Antibiotics

ANTIBIOTICDispense:Sig:Refills:
Penicillin VK 500mg40Take 1 tablet 4 times per day0
Amoxicillin 500mg21Take 1 tablet every 8 hours until gone0
Clindamycin 150mg56Take 2 tablets every 6 hours until gone0
Erythromycin 250mg (enteric coated)40Take 1 tablet 4 times per day0
Z-pack (for patients who are allergic to pen and clyn)1Take as directed on package0
MOUTHWASH
Chlorhexidine16ozSwish 15 mL (1 capful) for 30 seconds, 2 times a day for 10 days, then expectorate. Do not swallow, no eating for 2-3 hours.0
MUSCLE RELAXER
Flexeril 10mg40Take 1 tablet before sleep (depending on need and if no side effects, add 1 tablet in the morning, after 3 days)0
ANTI NAUSEA
Ondansetron 8mg15Dissolve 1 tab orally up to three times a day0
ANTI FUNGAL
Diflucan 150mg2 tabsTake first tab right away then 2nd tab 2 days later0

Dentists Open On Sundays

LocationDentistDrs.HoursAddressPhone #
Post Falls7 Day Dental SmilesDr. Rheanna Burnham
Dr. Matt Fletcher
Dr. Scott Lake
Dr. Jim Landers
7:00 AM to 5:00 PM105 E. 10th Avenue, Post Falls, ID. 83854208-773-8388
Spokane ValleyHarken Dental ExcellenceDr. Brad Harken7:00 AM to 7:00 PM13314 E. Nora Avenue, Spokane Valley509.924.7600
Dr. Josh Chocran

EMERGENCY? | 509.590.2522 | Reserved Openings every day for dental emergencies