c linic o rientation aka everything we learned the hard way

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CLINIC ORIENTATION Aka “Everything we learned the hard way”

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Page 1: C LINIC O RIENTATION Aka Everything we learned the hard way

CLINIC ORIENTATIONAka “Everything we learned the hard way”

Page 2: C LINIC O RIENTATION Aka Everything we learned the hard way

CLINIC PROTOCOL

Huddle Rules:Starts at 8am

Variances for tardinessYou must be in huddle unless you

are on rotationIf you are on rotation in the morning

but have a patient in the afternoon you must put a check next to your name that you have verified that what you are doing on the schedule is correct

Page 3: C LINIC O RIENTATION Aka Everything we learned the hard way

CENTER LAB

NO STONE ZONE

Page 4: C LINIC O RIENTATION Aka Everything we learned the hard way

CLINIC PROTOCOL

Infection Control Protocol After seeing patient clean operatory and spray

wipe spray Put chair to upward position with rheostat on

chair on paper towel Do NOT leave the operatory with gloves on Do NOT enter supply room with gown on Have red bag taped to assistant table and for

items soiled with blood (red bag goes in red biohazard boxes)

All sharps go in sharps container Wash hands properly when you enter the

operatory before you put gloves on

Page 5: C LINIC O RIENTATION Aka Everything we learned the hard way

CLEAN OPERATORY

Page 6: C LINIC O RIENTATION Aka Everything we learned the hard way

OPERATORY SET-UP

Page 7: C LINIC O RIENTATION Aka Everything we learned the hard way

CLINIC PROTOCOL

Have your name plate at your station for the duration of the appointment

Always have a napkin on your patient even if you’re just looking real quick

Always have goggles on your patientDo not bring a patient into the clinic without faculty present

Page 8: C LINIC O RIENTATION Aka Everything we learned the hard way

CLINIC PROTOCOL

If you are in your station with a patient you are required to be wearing a gown even if you are only at the computer taking a medical history

Be done with procedure by 11am and 4pm to have time for chart notes, making follow-up appointments and end checks

Know the procedures to follow should there be an emergency with your patient

Know where the aid kits, the AED, and the oxygen are in our clinic

Page 9: C LINIC O RIENTATION Aka Everything we learned the hard way

SOME TIPS:

Use the plastic boxes at your stations to gather supplies before the appointment and only take out what you need to avoid wasting supplies

Become familiar with the different products we use in the clinic (for example types of composites and when to use each)(Don’t be afraid to ask for the instructions the product comes with)

When you put the patient in the chair make sure the headrest is adjusted properly

Assist each other whenever possible Do NOT schedule a patient if they have not paid

their bill

Page 10: C LINIC O RIENTATION Aka Everything we learned the hard way

STERILIZATION TIPS: If something in your kit is missing or

broken, tell sterilizationExtra 330 burs can be found in our supply

room (the ones in the kits are often dull)Ask for an “operative setup” as opposed to

tray Don’t check out more than one handpieceLeaving scalpel, needle, glass or other

sharps on trays given to sterilization can result in a variance

Page 11: C LINIC O RIENTATION Aka Everything we learned the hard way

COE: COMPREHENSIVE ORAL EVALUATION

1. Medical Dental History Form2. Physical Exam (old blue form)3. Hard Tissue Charting4. Perio Charting5. Diagnostic Impressions/FB/Bite record6. Phase I Treatment Plan

Page 12: C LINIC O RIENTATION Aka Everything we learned the hard way

BEFORE THE APPOINTMENT

Have reviewed the radiographs and completed an interp (the FINDINGS HANDOUT is good)

Have your station set up (obviously)

Have what you will need for the appointment ready (exam kit, bite fork, goggles, gown, mask, facebow)

Check under TRANSACTIONS to make sure the patient does not have a balance before you sit them!

Page 13: C LINIC O RIENTATION Aka Everything we learned the hard way

COE: COMPREHENSIVE ORAL EVALUATION

Once faculty is in clinicCheck your messages to see if your

patient has checked in (it may just pop up on your screen)

Bring patient upTake BPChart add COE and Diagnostic

casts as planned treatmentUnder COE add HEADER tx note

and fill it out

Page 14: C LINIC O RIENTATION Aka Everything we learned the hard way

BLOOD PRESSURE

BP > 160/94 we cannot treat (let patient relax and take again in 5 min)

diastolic > 110 refer to doctorDiastolic > 120 refer to EREven if you are using an

electronic BP cuff you must check pulse for RRR

Page 15: C LINIC O RIENTATION Aka Everything we learned the hard way

Get START CHECK from team leader

Have team leader approve planned treatment:COEDIAGNOSTIC CASTS HEADER

Page 16: C LINIC O RIENTATION Aka Everything we learned the hard way

1. MEDICAL DENTAL HISTORY

Under FORMS add the MEDICAL DENTAL HISTORY FORM

Complete forms and summarize Make sure to look up medicationsKnow why the patient is taking each

medicationKnow when to get a MEDICAL

CONSULT(paper form)

Page 17: C LINIC O RIENTATION Aka Everything we learned the hard way

MEDICAL CONSULTS Handout

When to get medical consult Pre-medication for total joint replacement:

Much controversy < 2 years premedicate > 2 years discuss with team leader if you should

get a medical consult with patients physician Medical consult should request that patients physician

provide patient with script if they deem premedication necessary

*If patient needs premedication or premed consult you cannot probe that day

Page 18: C LINIC O RIENTATION Aka Everything we learned the hard way

2. PHYSICAL EXAM (OLD BLUE FORM)

Under FORMS add PHYSICAL EXAM (old blue form)

Complete extraoral and intraoral analysis Learn how to do a good oral cancer screening

handout

Summarize findings (unless there really is nothing at all significant)

Page 19: C LINIC O RIENTATION Aka Everything we learned the hard way

CHECK

Summarize patient medical history and significant findings

Have TEAM LEADER check and approve medical history and physical exam form

Get the OK to continue COE!

Page 20: C LINIC O RIENTATION Aka Everything we learned the hard way

3. HARD TISSUE CHARTING

Chart: (can use FINDINGS HANDOUT)1. Missing teeth2. Existing restorations (use xrays for RCT)3. Findings (primary decay, recurrent decay,

fractures…) In Axium:

Chart missing teeth (click on teeth, right click and scroll to missing)

Under CHART ADD add as FINDINGS: Existing restorations Findings

Page 21: C LINIC O RIENTATION Aka Everything we learned the hard way

3. HARD TISSUE CHARTING CHECK

Have team leader or operative faculty check and approve existing restorations and findings

Discuss possible restorative treatment options… add to third column of FINDINGS HANDOUT

Page 22: C LINIC O RIENTATION Aka Everything we learned the hard way

4. PERIO CHARTING (SOFT TISSUE)

Under PERIO CHARTING chart pocket depths, furcations, bleeding, GM, and gingival defects

If you don’t have an assistant to input directly into axium we have dry erase boards to chart and them copy the info into axium

Make sure to press SAVE or your data will be lost!

Page 23: C LINIC O RIENTATION Aka Everything we learned the hard way

4. PERIO CHARTING CHECK

Get information checked and COMPLETED/APPROVED by PERIO FACULTY

Discuss treatment options with faculty Diagnosis MUST be in general note for

that day Review your periodontal disease

diagnosis criteria!

Page 24: C LINIC O RIENTATION Aka Everything we learned the hard way

5. DIAGNOSTIC CASTS/FACEBOW/BITE RECORD

THIS SHOULD BE DONE AT THE FIRST APPOINTMENT REGARDLESS OF WHERE YOU STOP IN YOUR DATA COLLECTION

Take alginate impressions Take facebow with bite fork and blue mousse Take bite record with blue mousse or aluwax If your patient doesn’t have posterior support

or vertical dimension is in question: take impressions and fabricate wax rims to take an accurate bite and facebow upon next visit

Page 25: C LINIC O RIENTATION Aka Everything we learned the hard way

END CHECK

Write GENERAL NOTE with that days findings and procedures and FOOTER TEMPLATE NOTE

Have TEAM LEADER: Check impressions Approve chart notes Approve COE as IN PROGESS and DIAGNOSTIC

IMPRESSIONS(1st step) as COMPLETED (the status is changed by right clicking and choosing)

Page 26: C LINIC O RIENTATION Aka Everything we learned the hard way

YOUR PATIENT

Schedule an appointment for next visit with team coordinator

Give patient yellow payment slip of $105 for COE and DIAGNOSTIC IMPRESSIONS

Bring patient to cashier to pay (if your patient does not pay make sure not to see him or her again until they have paid)

Page 27: C LINIC O RIENTATION Aka Everything we learned the hard way

PHASE I TREATMENT PLAN

Based on the mounted diagnostic models, radiographs, and information from the COE create a phase I treatment plan (keeping in mind your possible phase II treatment plan)

Page 28: C LINIC O RIENTATION Aka Everything we learned the hard way

PHASE I TREATMENT PLAN

Under treatment plan:Add PROBLEMSAdd DIAGNOSISAdd DETAILED PLAN (each

item must have a dx)

Page 29: C LINIC O RIENTATION Aka Everything we learned the hard way

PERIO FLOW CHART

Perio exam

SRP

Prophylaxis

SPT (Periodontal Maintenance)

Phase 1 (simple or complex)

SRP4-6 wks No

improvement

Improvem

ent/maintenance

3 or 6 month prophy recalls

periodontitis

Health/

Gingivitis

Page 30: C LINIC O RIENTATION Aka Everything we learned the hard way

AHA PREMEDICATION GUIDELINES artificial heart valves a history of having had IE certain specific, serious congenital (present from

birth) heart conditions, including: unrepaired or incompletely repaired cyanotic

congenital heart disease, including those with palliative shunts and conduits

a completely repaired congenital heart defect with prosthetic material or device, whether placed by surgery or by catheter interventions, during the first six months after the procedure

any repaired congenital heart defect with residual defect at the site or adjacent to the site of a prosthetic patch or prosthetic device

a cardiac transplant which develops a problem in a heart valve

Page 31: C LINIC O RIENTATION Aka Everything we learned the hard way

MEDICAL CONSULT EXAMPLE 1Dear Dr. Valdez:

Jane Smith, an 84 yo female who is a patient of your practice, came to my dental office in need of dental extractions of teeth #19, 20 due to severe bone loss due to periodontal disease.

 She has a medical history significant for atrial fibrillation for which she takes

coumadin, diabetes for which she takes glucophage and metformin, and congestive heart failure.

 I anticipate the dental extractions to be simple with minimal blood loss and plan

to place one suture to help with closure and hemostasis. I plan to check her INR the day before the scheduled extractions and will proceed with extractions if the INR is less than 3.

 Please advise within the next week if you have other recommendations in the

management of her medical conditions in light of the planned dental extractions, most specifically her cardiovascular status.

 Sincerely,Tom Johnson, D.M.D.

Page 32: C LINIC O RIENTATION Aka Everything we learned the hard way

MEDICAL CONSULT EXAMPLE 2

Patient presented with:         Hypertension, back pain,  bipolar disorder, schizophrenia and    COPD.  Reports being on Methylprednisolone 80 mg and a   lidoderm patch. The patient requires the following dental treatment:         Full mouth extractions, aveolplasty, and Denture placement.      This will involve the use of lidocaine and all extractions and aveoloplasty will be preformed simultaneously.

Please evaluate the patient for:         Does the patient need to be put on an increased steroid dosage   due to current methylprednisolone use?  Is there any     complications due to methylprenisolone or lidoderm patch use     that prohibit this dental treatment.?  Is the patient’s  hypertension, biploar disorder, schizophrenia, and COPD well     controlled with medication?  Is there any other information      that we should be aware of before treating this patient?  Please         respond below with comments, sign, and return.