Dental Assistant Instruction Pack 2 PDF

Dental Assistant Instruction Pack 2 Lessons 9-16 0204551LB02A-14 Dental Assistant Instruction Pack 2 Lesson 9—Front Office Procedures Lesson 10—Disease Transmission Lesson 11—Safety in the Dental Office Lesson 12—Introduction to Oral Anatomy Lesson 13—Dental Anatomy and Terminology Lesson 14—Charting and Classification Lesson 15—Chairside Assisting Lesson 16—Dental Pain Management No part of this document may be reproduced or transmitted in any form or by any means, electronic or mechanical, for any purpose, without the express written permission of U.S. Career Institute. Copyright © 2009-2024, U.S. Career Institute. All Rights Reserved. 0204551LB02A-14 Acknowledgments Margaret Graham, M.Ed., Author Sheila D. McCray, M.S., CCS, CCS-P, Author Martha Roden, B.S., Author Celeste Yeik, AAS, Subject Matter Expert Editorial Staff Janet Perry, B.A., Vice President of Academics and Compliance Brenda Blomberg, B.A., CPC, Curriculum Department Manager Christopher Pimental, B.A., Project Manager Julia Bauernfeind, B.S., Editorial Assistant Jane Bullinger, Editorial Assistant Jessica Babb-Raymundo, B.A., Graphic Designer U.S. Career Institute Fort Collins, CO 80525 www.uscareerinstitute.edu Biographies Margaret Graham, M.Ed. Margaret Graham is an experienced educational writer and editor with more than 30 years of experience. Sheila D. McCray, M.S., CCS, CCS-P Sheila McCray is an experienced instructional designer, writer and medical coder. Sheila earned her master’s degree Instructional and Performance Technology from Boise State and a bachelor’s in Journalism from Temple University. Martha Roden, B.S. With a bachelor’s degree in Nutrition and Natural Resources, Martha Roden started her career as a nutritionist, explaining vitamins, nutrition and diet to her clients. A chance conversation with a client led her to a job as an engineering assistant and a technical writer. Next, she moved into technical training to get firsthand feedback from people regarding her explanation skills. However, teaching people to use software made her realize how difficult it was to use, so Martha moved into the usability profession—helping design software that was intuitive and easy-to-use. She’s definitely had a dynamic career, but everything she’s done has focused on helping people “find what they need and understand what they read.” Celeste Yeik, AAS Celeste graduated from Laramie County Community College in 2006 with her AAS degree in Dental Hygiene. She serves as the SME of dental assisting with U.S. Career Institute. Celeste also works as a full time clinical hygienist for Peak Dental Services where she acts as a Lead Hygiene Mentor. Celeste resides in Colorado and enjoys spending time outdoors with her husband Dustin and their three daughters. Table of Contents Lesson 9: Front Office Procedures Step 1: Learning Objectives............................................................................................................................................. 1 Step 2: Lesson Preview..................................................................................................................................................... 1 Step 3: Step into an Administrative Dental Assistant’s Shoes..................................................................................... 2 Copiers................................................................................................................................................................ 4 Scanners.............................................................................................................................................................. 4 Telephone Systems............................................................................................................................................. 4 Computers.......................................................................................................................................................... 5 Proper Equipment Care.................................................................................................................................... 5 Step 4: Appointment Scheduling.................................................................................................................................... 5 Scheduling Methods—Yesterday and Today.................................................................................................. 6 The Art of Scheduling....................................................................................................................................... 7 Planning Ahead................................................................................................................................................. 8 Special Situations............................................................................................................................................... 9 Confirming Appointments............................................................................................................................. 10 When Something Clogs the System.............................................................................................................. 10 Time-saving Techniques................................................................................................................................. 11 Step 5: Practice Exercise 9-1.......................................................................................................................................... 12 Step 6: Review Practice Exercise 9-1............................................................................................................................ 15 Step 7: Preventive Recall Systems................................................................................................................................. 16 Recall System Duties....................................................................................................................................... 17 Types of Recall Systems.................................................................................................................................. 18 Tips for All Recall Systems............................................................................................................................. 19 Step 8: Patient Records in the Dentist’s Office............................................................................................................ 20 What Are the Records?................................................................................................................................... 20 Keeping Track of Patient Records................................................................................................................. 22 Select Your Favorite Filing Method............................................................................................................... 22 Taking Care of Files......................................................................................................................................... 24 Step 9: Inventory Management in the Dentist’s Office............................................................................................. 25 Which System Works Best? Automated or Manual?.................................................................................. 25 How Do You Know When to Reorder?........................................................................................................ 26 Stocking Inventory.......................................................................................................................................... 27 Keeping Records.............................................................................................................................................. 27 Dental Assistant Step 10: Practice Exercise 9-2....................................................................................................................................... 28 Step 11: Review Practice Exercise 9-2.......................................................................................................................... 31 Step 12: Why This Matters............................................................................................................................................ 32 Step 13: Summary........................................................................................................................................................... 32 Step 14: Journal Entry.................................................................................................................................................... 33 Step 15: Quiz 9................................................................................................................................................................ 33 Lesson 10: Disease Transmission Step 1: Learning Objectives............................................................................................................................................. 1 Step 2: Lesson Preview..................................................................................................................................................... 1 Step 3: Introduction to Pathogens.................................................................................................................................. 2 Bacteria............................................................................................................................................................... 2 Viruses................................................................................................................................................................. 4 Fungi.................................................................................................................................................................... 8 Step 4: Disease Transmission.......................................................................................................................................... 9 The Agent........................................................................................................................................................... 9 The Host and Susceptibility........................................................................................................................... 10 The Environment............................................................................................................................................. 11 Step 5: Pathways of Disease Transmission.................................................................................................................. 12 Direct Transmission........................................................................................................................................ 12 Indirect Transmission..................................................................................................................................... 12 Splash or Spatter Transmission...................................................................................................................... 12 Airborne Transmission................................................................................................................................... 12 Parenteral Transmission................................................................................................................................. 13 Step 6: Practice Exercise 10-1....................................................................................................................................... 14 Step 7: Review Practice Exercise 10-1.......................................................................................................................... 17 Step 8: The Immune System.......................................................................................................................................... 19 What is Immunity?.......................................................................................................................................... 19 What Diseases Require Immunizations?...................................................................................................... 19 HIV and the Immune System........................................................................................................................ 20 Step 9: Roles of the CDC and OSHA........................................................................................................................... 20 The Occupational Safety and Health Administration................................................................................ 22 Step 10: Organization for Safety and Asepsis Procedures......................................................................................... 26 Step 11: Practice Exercise 10-2..................................................................................................................................... 26 Step 12: Review Practice Exercise 10-2........................................................................................................................ 30 Step 13: Why This Matters............................................................................................................................................ 31 VI 0204551LB02A-14 Table of Contents Step 14: Summary........................................................................................................................................................... 31 Step 15: Journal Entry.................................................................................................................................................... 32 Step 16: Quiz 10.............................................................................................................................................................. 32 Endnotes........................................................................................................................................................... 32 Lesson 11: Safety in the Dental Office Step 1: Learning Objectives............................................................................................................................................. 1 Step 2: Lesson Preview..................................................................................................................................................... 1 Step 3: Safety Equals Infection Control......................................................................................................................... 2 The Infection Control Coordinator................................................................................................................ 3 Infection Control Information......................................................................................................................... 3 Schedule Staff Training..................................................................................................................................... 6 Present New Information to the Dental Team............................................................................................... 7 Monitor, Evaluate and Upgrade Procedures.................................................................................................. 7 Step 4: Immunizations..................................................................................................................................................... 8 Hepatitis B.......................................................................................................................................................... 9 Influenza............................................................................................................................................................. 9 Other Vaccine-preventable Diseases............................................................................................................... 9 Step 5: The Latest on Hand Hygiene.............................................................................................................................. 9 Here’s How it Works: Effective Hand Hygiene............................................................................................ 11 Step 6: Practice Exercise 11-1....................................................................................................................................... 12 Step 7: Review Practice Exercise 11-1.......................................................................................................................... 15 Step 8: Putting on Your Gear: Personal Protective Equipment................................................................................ 16 Protective Clothing.......................................................................................................................................... 17 Protective Eyewear.......................................................................................................................................... 19 Protective Masks.............................................................................................................................................. 19 Gloves................................................................................................................................................................ 20 Step 9: Practice Exercise 11-2....................................................................................................................................... 23 Step 10: Review Practice Exercise 11-2........................................................................................................................ 24 Step 11: Environmental Surface Disinfection............................................................................................................. 26 Cleaning and Disinfecting—What’s the Difference?.................................................................................. 26 CDC Recommendations for Environmental Surfaces................................................................................ 26 Disinfectants..................................................................................................................................................... 27 Step 12: Surface Barriers................................................................................................................................................ 30 Guidelines for Using Surface Barriers........................................................................................................... 31 Step 13: Engineering Devices........................................................................................................................................ 32 0204551LB02A-14 VII Dental Assistant Step 14: Waste Management in the Dental Setting.................................................................................................... 32 Waste Classifications....................................................................................................................................... 33 Extracted Teeth................................................................................................................................................ 34 Proper Disposal Procedures........................................................................................................................... 34 More on Secondary Containers and Labels................................................................................................. 35 Step 15: Practice Exercise 11-3..................................................................................................................................... 35 Step 16: Review Practice Exercise 11-3........................................................................................................................ 38 Step 17: Preparing for Patients: Disinfecting and Sterilizing Patient Care Items.................................................. 40 Instrument Processing Protocol.................................................................................................................... 41 Instrument Processing.................................................................................................................................... 41 Instrument Processing from Start to Finish................................................................................................. 50 Step 18: Evacuation and Safety..................................................................................................................................... 52 Biohazardous Situations................................................................................................................................. 52 Evacuating Basics............................................................................................................................................. 53 Evacuating Essentials...................................................................................................................................... 54 Step 19: Key Asepsis Safety Elements.......................................................................................................................... 55 Step 20: Practice Exercise 11-4..................................................................................................................................... 56 Step 21: Review Practice Exercise 11-4........................................................................................................................ 59 Step 22: Why This Matters............................................................................................................................................ 60 Step 23: Summary........................................................................................................................................................... 60 Step 24: Journal Entry.................................................................................................................................................... 61 Step 25: Quiz 11.............................................................................................................................................................. 61 Endnotes........................................................................................................................................................... 61 Lesson 12: Introduction to Oral Anatomy Step 1: Learning Objectives............................................................................................................................................. 1 Step 2: Lesson Preview..................................................................................................................................................... 1 Step 3: Overview: Oral Anatomy................................................................................................................................... 1 Landmarks of the Face...................................................................................................................................... 2 Landmarks of the Oral Cavity.......................................................................................................................... 3 Step 4: Virtual Flashcards................................................................................................................................................ 7 Step 5: Practice Exercise 12-1......................................................................................................................................... 7 Step 6: Review Practice Exercise 12-1............................................................................................................................ 9 Step 7: Anatomic Landmarks of Bones.......................................................................................................................... 9 Foramen and Meatus....................................................................................................................................... 10 Fossa.................................................................................................................................................................. 10 VIII 0204551LB02A-14 Table of Contents Spinous Process................................................................................................................................................ 10 Suture................................................................................................................................................................ 10 Symphysis......................................................................................................................................................... 10 Tubercle............................................................................................................................................................. 10 Step 8: Bones of the Head.............................................................................................................................................. 10 Single Bones of the Skull................................................................................................................................. 11 Paired Bones of the Skull................................................................................................................................ 13 Step 9: Bones of the Face............................................................................................................................................... 15 Single Bones of the Face................................................................................................................................. 15 Paired Bones of the Face................................................................................................................................. 17 Step 10: Bones of the Neck............................................................................................................................................ 20 Step 11: Virtual Flashcards............................................................................................................................................ 20 Step 12: Practice Exercise 12-2..................................................................................................................................... 21 Step 13: Review Practice Exercise 12-2........................................................................................................................ 23 Step 14: Major Muscles of the Head and Neck........................................................................................................... 24 Muscles of the Face.......................................................................................................................................... 25 Muscles of Mastication................................................................................................................................... 27 Tongue Muscles............................................................................................................................................... 28 Muscles of the Soft Palate............................................................................................................................... 28 Muscles of the Floor of the Mouth................................................................................................................ 29 Muscles of the Pharynx................................................................................................................................... 29 Muscles of the Neck........................................................................................................................................ 29 Step 15: Virtual Flashcards............................................................................................................................................ 31 Step 16: Practice Exercise 12-3..................................................................................................................................... 32 Step 17: Review Practice Exercise 12-3........................................................................................................................ 35 Step 18: Blood Supply of the Head and Neck............................................................................................................. 36 Major Arteries of the Face and Mouth......................................................................................................... 36 Major Veins of the Face and Mouth.............................................................................................................. 37 Step 19: The Lymphatic System.................................................................................................................................... 38 Step 20: Nerve Supply of the Head and Neck............................................................................................................. 39 Maxillary Nerves.............................................................................................................................................. 40 Mandibular Nerves.......................................................................................................................................... 41 Step 21: Virtual Flashcards............................................................................................................................................ 42 Step 22: Practice Exercise 12-4..................................................................................................................................... 42 Step 23: Review Practice Exercise 12-4........................................................................................................................ 44 0204551LB02A-14 IX Dental Assistant Step 24: Why This Matters............................................................................................................................................ 45 Step 25: Summary........................................................................................................................................................... 46 Step 26: Journal Entry.................................................................................................................................................... 46 Step 27: Quiz 12.............................................................................................................................................................. 46 Lesson 13: Dental Anatomy and Terminology Step 1: Learning Objectives............................................................................................................................................. 1 Step 2: Lesson Preview..................................................................................................................................................... 1 Step 3: Introduction to Dental Anatomy....................................................................................................................... 2 The Upper Arch................................................................................................................................................. 2 The Lower Arch................................................................................................................................................. 3 The Midsagittal Plane....................................................................................................................................... 3 Step 4: Classifications of Dentitions............................................................................................................................... 4 Deciduous Dentition......................................................................................................................................... 5 Permanent Dentition........................................................................................................................................ 5 Step 5: Classifications of Teeth....................................................................................................................................... 6 Step 6: Virtual Flashcards................................................................................................................................................ 9 Step 7: Practice Exercise 13-1......................................................................................................................................... 9 Step 8: Review Practice Exercise 13-1.......................................................................................................................... 11 Step 9: Dentition Periods............................................................................................................................................... 12 Primary Dentition Period............................................................................................................................... 12 Mixed Dentition Period.................................................................................................................................. 12 Permanent Dentition Period.......................................................................................................................... 12 How Does it Work?......................................................................................................................................... 13 Step 10: General Eruption Sequences.......................................................................................................................... 13 Deciduous Teeth Eruption............................................................................................................................. 13 Permanent Teeth Eruption............................................................................................................................. 14 Step 11: Numbering Systems for Teeth........................................................................................................................ 15 Universal Numbering System........................................................................................................................ 16 Palmer Notation Method................................................................................................................................ 16 Fédération Dentaire Internationale System................................................................................................. 18 Putting it All Together.................................................................................................................................... 19 Step 12: Virtual Flashcards............................................................................................................................................ 21 Step 13: Practice Exercise 13-2..................................................................................................................................... 21 Step 14: Review Practice Exercise 13-2........................................................................................................................ 24 X 0204551LB02A-14 Table of Contents Step 15: General Oral and Dental Anatomy: Definitions......................................................................................... 25 Periodontium................................................................................................................................................... 25 Anatomical Features of the Tooth................................................................................................................. 26 Step 16: Virtual Flashcards............................................................................................................................................ 29 Step 17: Practice Exercise 13-3..................................................................................................................................... 29 Step 18: Review Practice Exercise 13-3........................................................................................................................ 31 Step 19: Dental Nomenclature...................................................................................................................................... 33 Anterior Teeth.................................................................................................................................................. 33 Posterior Teeth................................................................................................................................................. 33 Step 20: Tooth Surfaces.................................................................................................................................................. 34 Line Angle........................................................................................................................................................ 36 Point Angle....................................................................................................................................................... 37 Thirds of Crowns and Roots.......................................................................................................................... 39 Step 21: Virtual Flashcards............................................................................................................................................ 40 Step 22: Parts of the Tooth............................................................................................................................................ 40 Tooth Landmarks............................................................................................................................................ 40 Step 23: Virtual Flashcards............................................................................................................................................ 45 Step 24: Practice Exercise 13-4..................................................................................................................................... 45 Step 25: Review Practice Exercise 13-4........................................................................................................................ 49 Step 26: Why This Matters............................................................................................................................................ 52 Step 27: Summary........................................................................................................................................................... 53 Step 28: Journal Entry.................................................................................................................................................... 53 Step 29: Quiz 13.............................................................................................................................................................. 53 Lesson 14: Charting and Classification Step 1: Learning Objectives............................................................................................................................................. 1 Step 2: Lesson Preview..................................................................................................................................................... 1 Step 3: G.V. Black’s Classification System of Dental Caries........................................................................................ 2 Step 4: Color Codes for Charting................................................................................................................................... 3 Step 5: Symbols for Charting.......................................................................................................................................... 4 Step 6: Practice Exercise 14-1......................................................................................................................................... 6 Step 7: Review Practice Exercise 14-1............................................................................................................................ 7 Step 8: Dental Abbreviations........................................................................................................................................... 7 Single-surface Restoration Abbreviations...................................................................................................... 7 Multiple-surface Restoration Abbreviations.................................................................................................. 8 0204551LB02A-14 XI Dental Assistant Step 9: Soft Tissue Examination..................................................................................................................................... 8 Step 10: Periodontal Examination.................................................................................................................................. 9 Step 11: Radiographic Examination............................................................................................................................. 10 Step 12: The Treatment Plan......................................................................................................................................... 11 Step 13: Treatment Plan Presentations........................................................................................................................ 11 Consultation Room......................................................................................................................................... 11 Presentation...................................................................................................................................................... 12 Financial Arrangements................................................................................................................................. 12 Step 14: Recording the Dental Treatment................................................................................................................... 12 Step 15: Correcting Charting Errors............................................................................................................................ 13 Step 16: Practice Exercise 14-2..................................................................................................................................... 13 Step 17: Review Practice Exercise 14-2........................................................................................................................ 15 Step 18: Why This Matters............................................................................................................................................ 16 Step 19: Summary........................................................................................................................................................... 16 Step 20: Journal Entry.................................................................................................................................................... 17 Step 21: Quiz 14.............................................................................................................................................................. 17 Lesson 15: Chairside Assisting Step 1: Learning Objectives............................................................................................................................................. 1 Step 2: Lesson Preview..................................................................................................................................................... 1 Step 3: Your Role in Chairside Assisting....................................................................................................................... 2 Step 4: Preparing the Operatory Area........................................................................................................................... 3 Barriers................................................................................................................................................................ 3 Step 5: Seating the Patient............................................................................................................................................... 5 Step 6: Practice Exercise 15-1......................................................................................................................................... 6 Step 7: Review Practice Exercise 15-1............................................................................................................................ 6 Step 8: Controlling the Operating Field........................................................................................................................ 7 Moisture Control............................................................................................................................................... 7 Oral Tissue Retraction.................................................................................................................................... 19 Step 9: Practice Exercise 15-2....................................................................................................................................... 20 Step 10: Review Practice Exercise 15-2........................................................................................................................ 22 Step 11: Instrument Transfer........................................................................................................................................ 24 Four-handed Dentistry—A Review.............................................................................................................. 24 Grasping an Instrument.................................................................................................................................. 25 Operator and Assistant’s Transfer Technique.............................................................................................. 26 XII 0204551LB02A-14 Table of Contents Step 12: Practice Exercise 15-3..................................................................................................................................... 28 Step 13: Review Practice Exercise 15-3........................................................................................................................ 30 Step 14: Pre- and Post-op Instructions........................................................................................................................ 31 Step 15: Operatory Tear-down...................................................................................................................................... 32 Surface Cleaning and Disinfection................................................................................................................ 32 Handpiece Cleaning and Sterilization.......................................................................................................... 34 Keeping Dental Unit Waterlines Sanitary.................................................................................................... 36 Step 16: Practice Exercise 15-4..................................................................................................................................... 37 Step 17: Review Practice Exercise 15-4........................................................................................................................ 37 Step 18: Why This Matters............................................................................................................................................ 38 Step 19: Summary........................................................................................................................................................... 39 Step 20: Journal Entry.................................................................................................................................................... 39 Step 21: Quiz 15.............................................................................................................................................................. 39 Lesson 16: Dental Pain Management Step 1: Learning Objectives............................................................................................................................................. 1 Step 2: Lesson Preview..................................................................................................................................................... 1 Step 3: Dealing with Anxiety.......................................................................................................................................... 2 Step 4: The Role of Anesthetics in the Dental Office.................................................................................................. 3 Step 5: Topical Anesthetics.............................................................................................................................................. 4 How Topical Anesthetics Work....................................................................................................................... 4 Administering Topical Anesthetics................................................................................................................. 5 Step 6: Practice Exercise 16-1......................................................................................................................................... 5 Step 7: Review Practice Exercise 16-1............................................................................................................................ 6 Step 8: Local Anesthetics................................................................................................................................................. 7 How Local Anesthetics Work.......................................................................................................................... 7 Characteristics of Local Anesthetics.............................................................................................................. 8 Components of Local Anesthetics................................................................................................................... 9 Local Anesthetic Complications.................................................................................................................... 10 The Local Anesthetic Syringe Setup............................................................................................................. 11 Using the Anesthetic Syringe......................................................................................................................... 14 Step 9: Practice Exercise 16-2....................................................................................................................................... 17 Step 10: Review Practice Exercise 16-2........................................................................................................................ 18 Step 11: Sedation and General Anesthesia in Dentistry............................................................................................ 21 Different Methods for Administering Sedation.......................................................................................... 21 Different Levels of Sedation........................................................................................................................... 22 0204551LB02A-14 XIII Dental Assistant Nitrous Oxide—Characteristics.................................................................................................................... 22 The Dental Assistant’s Role in Administering Nitrous Oxide................................................................... 23 Step 12: Practice Exercise 16-3..................................................................................................................................... 25 Step 13: Review Practice Exercise 16-3........................................................................................................................ 27 Step 14: Why This Matters............................................................................................................................................ 29 Step 15: Summary........................................................................................................................................................... 29 Step 16: Journal Entry.................................................................................................................................................... 30 Step 17: Quiz 16.............................................................................................................................................................. 30 XIV 0204551LB02A-14 Lesson 9 Front Office Procedures Step 1: Learning Objectives When you have completed the instruction in this lesson, you will be trained to: Describe the duties of the administrative dental assistant. Identify the administrative office equipment used in the dental office. Illustrate how to schedule appointments. Describe the process for handling special scheduling situations. Outline the procedure to maintain a patient recall system. Apply common techniques used to properly file dental records. Explain how patient files are kept confidential. Illustrate how to maintain an effective inventory control system. Step 2: Lesson Preview The administrative dental assistant’s duties that this section covers will help build your knowledge base. It will also give insight toward empathizing with what others must do in your office. This offers an understanding of how the whole office runs and how different people fit in. This leads to a more cohesive, understanding team. The administrative assistant is a pro at patient interaction, appointment scheduling and supplies, records and files management—to name a few. You’ll discover more in this lesson. Additionally, you’ll learn about the typical offices that seek administrative dental assistants’ services. You’ll also review all of the office equipment you’ll use, including copiers, faxes, phones and computers. You’ll also explore recall systems. This is a protocol set that reminds patients to return to the dental office for routine care, generally within six months. Some systems are automatic, with lots of features. Some are old- fashioned phone and postcard systems. You’ll learn about all of them, so you’re prepared for anything. Finally, you’ll build on what you learned regarding form-filling and patient confidentiality. Dental Assistant Administrative dental assistants are often the first person clients see. This lesson concludes with a section on inventory management and ordering supplies. Throughout the lesson, you’ll learn why this function is so vital to a smoothly running dental practice. Let’s begin by exploring further the role of the administrative DA. Step 3: Step into an Administrative Dental Assistant’s Shoes Consider Gina. On a typical day, you might find her keyboarding insurance codes on the computer. Why? She’s filing a claim with an insurance company regarding a patient who just left. The phone rings. Seamlessly, Gina answers, routes the call and answers another. Gina remains unfazed while she switches screens on her computer to look up the caller’s information. Within moments, she changes the caller’s appointment. That done, she looks up to greet a salesman that entered. She politely listens and then directs the salesman regarding setting up an email appointment to schedule a sales pitch. It goes on like that throughout the day. Gina jumps from one task to the next. Patience and knowledge are key traits. She’s also organized, enthusiastic and efficient. Her duties demand it. Some are more difficult than others. Insurance forms can be complicated, but she keeps up with the codes and regulations. She can let her mind rest when she needs to print forms or send emails. Whatever the case, Gina’s contributions as an administrative dental assistant contribute to the office. She knows where all the files are. She recognizes the patients. She controls the flow of visitors—and income— through the office. She’s the point person, where every visit begins and ends. 9-2 0204551LB02A-09-14 Front Office Procedures Every office has at least one Gina. They go by different names and titles. Here is a list of a few: Title General Duties Other Office Manager Oversees office, organizes it to In a large office, works Business Manager run smoothly, including schedules, with all of the clerical billing and payments, writing staff including hiring and letters and using all of the office terminating employees, equipment. training staff. Liaison between staff and the dentist. Receptionist Greets patients, checks them in Opens and sorts mail and out, handles some patient and performs basic word scheduling issues, answers the processing tasks. phone and routes and screens calls, provides information to the public. Insurance Clerk Communicates with insurance Negotiate terms of contracts companies, verifying eligibility for with insurance companies patients and determining their and collecting copayments benefits, filing insurance forms on from patients. behalf of patients. Records Manager Organizes patient files, test results, Keeps files up to date, clinical notes, payment and accurate and accessible. insurance information. Classifies, Locates files for daily stores, retrieves and updates appointments and refiles information. them later. Marketing Updates website content, Establishes referral networks Coordinator responds to questions from and prepares or orders potential new clients, interacts marketing brochures. with community organizations to recruit new patients. Data Processor She enters billing and diagnostic Generates letters of referral notes into the computer. to specialists and maintains patient databases. Bookkeeper Might handle accounting Could prepare financial information, including patient statements for supervisors, invoices and receipts and make deposits and file tax payments to suppliers, manage reports. office payroll, record transactions. Appointment Makes and changes NA Clerk appointments for patients and manages a recall system. Administrative dental assistants help with the smooth operation of the office. They free other DAs, hygienists and dentists to focus on patients. Note, however, that small-office administrative dental assistants often split their time between clinical and the front office. The in-depth training that you’ll receive here expands your value to a potential employer. You’re already familiar with most of the equipment that you’ll find in your office, but let’s take a closer look at some of the key tools that make your job easy and efficient. 0204551LB02A-09-14 9-3 Dental Assistant Copiers Copy machines will likely never go out of style. You’ll need to copy receipts and information for patients, supply orders, patients’ insurance cards and insurance claim forms. Some copiers are more complicated than others. You’ll learn as you go depending on your office. Scanners While some dental offices continue to emit paper records, most use computers—to record diagnostic notes or scan records into digital files. Scanners continue to grow more sophisticated. Depending on what type of equipment you use in your office, you’ll learn how best to create and organize digital files. Telephone Systems Most offices will have multi-line systems, with some lines possibly dedicated to different areas. If you’re in charge of answering the phones for your office, you’ll learn about their advanced features. Beyond putting people on hold, you might patch people into conference calls. You could route phone calls to various extensions, or pick up voice messages or forward them to coworkers. Your office will have its own protocols and duties—and phone system. Headsets prove useful to help with multitasking. An after-hours answering service can handle dental emergencies. Generally, an answering service pages or calls the dentist on his cellphone. Some dentists record their cell phone numbers on the after-hours outgoing message, so that patients calling with an emergency can call them directly. As the administrative DA, you will probably be the person who records the outgoing voicemail message for your office. 9-4 0204551LB02A-09-14 Front Office Procedures Computers Of course, you’ll use a computer as an administrative dental assistant. Here are the key tasks you’ll conduct: Updating patient records Entering exam notes and treatment plans Word processing Sending and receiving email Surfing the internet to determine insurance eligibility and benefits, researching new products and updating the office website Handling bookkeeping and patient ledgers Billing and collecting on accounts Processing insurance claims Scheduling appointments Processing payroll Organizing recall reminders Ordering supplies Each of these tasks will likely have its own software package, either store-bought or custom made. You’ll get on-the-job training in either case. Proper Equipment Care As an administrative dental assistant, you’ll likely be responsible for administrative equipment upkeep. You’ll order paper, ink and other supplies, schedule a service technician as needed. Clean and well-maintained equipment makes your job easier and more efficient. Step 4: Appointment Scheduling In contrast to medical doctors’ offices, most dental offices run on time. Why? Because an efficient DA will schedule appointments with care, accuracy and a depth of knowledge. When an assistant overbooks patients, this grinds the office system’s gears. Patients can grow irritable or worse, offended that you don’t value their time. Continued mis-scheduling might cause them to look for a better-run office. Overbooking also puts the whole staff on edge. All of its consequences affect everyone. Staff might grow impatient, overstressed. Quality of care could erode as the dental team rushes to catch up. 0204551LB02A-09-14 9-5 Dental Assistant As you learn more in these lessons and you spend some time in your new job, you’ll learn how much time a routine dental cleaning takes. You’ll work with the other DAs, the hygienists and the dentists to know when they need breaks. Perhaps you’ll come to learn some of your patients’ preferred appointment times. If your duties include office administration, you’ll grow to become a master scheduler. Even if not, as a clinical assistant, you’ll know which procedures require extra time—and you’ll communicate this to the ADA. Teamwork and knowledge helps the entire office stay on point and on time. As you can see, scheduling includes both the simple mechanics of entering accurate information into the system and the intuition that experience and training bring. The mechanics are discussed later, but your intuition is the true beauty of scheduling. When a translator calls to make an appointment for a hearing- impaired patient, you’ll know that an extra 10 minutes will help everyone adjust to the patient’s needs when she arrives for her appointment. And if you know that two of the hygienists like to have lunch together every day, you can arrange their appointments so they can break for lunch at the same time. When a scheduler does his job well, the whole office breathes easier because there’s no stress from hurrying to catch up with the schedule. Scheduling Methods—Yesterday and Today While mostly obsolete, you might find yourself in an office that uses—partially at least—an old paper and pen form filling and filing system. This concept uses an appointment book matrix in reference to these manual appointment systems. This lesson won’t cover that, but you are aware of it—and you’ll learn it on- the-job if it comes to that. However, in most modern dental offices, you’ll encounter electronic scheduling software (ESS). ESS is computer software that keeps track of staff hours and patient appointments, among other odds and ends. Some of these systems operate in manual mode. Here, the scheduler scrolls through dates and selects an open time slot. Conversely, in automatic mode the computer does the legwork of searching for the best fit for each patient. Computerized scheduling software has many beneficial features. ESS packages often have high-tech features like tracking missed appointments, generating patient lists for reminder calls and pop-up boxes with reminders of all sorts. 9-6 0204551LB02A-09-14 Front Office Procedures Regardless of the type of scheduling system that you use, you’ll need to enter the same information for each patient. This includes: Patient’s first and last names Patient contact information, including home, work and cellphone numbers A code identifying the procedure to be performed Amount of time the procedure will take Indication of any lab work needed for the procedure (as well as whether the lab work has returned from the lab) Any special notes such as premedication required or if it’s a first-time patient or a patient with special needs Finally, if you run the schedule for your office, you’ll need to know a little bit about your team members’ personal lives so you can block out their vacation, professional travel and sick time. The Art of Scheduling An important concept to keep in mind when scheduling appointments is this: When more patients come through your office, the office collects more money. And more money means more pay for everyone. So scheduling lots of short appointments may seem ideal, right? But speeding everyone up only works as long as patients receive quality care. That’s why you should remember a second important concept: When patients enjoy their experience, they return for additional treatment. They also refer their friends to your office. Providing a quality experience can slow certain things. The office scheduler sets the pace. That said, everyone has input. This includes clear directives from bosses and teammates. Still, the scheduler must often make judgment calls throughout the day. An effective scheduler considers these important guidelines: Know the personal habits of staff members, including when they perform at their peak. Are they “morning people” or do they have more energy after lunch? Be alert for procedures that require additional personnel such as an Expanded Function Dental Assistant and book appointments when everyone involved is available. Keep a list of questions to ask patients regarding their schedule preferences and time limitations. Be savvy about directing flexible patients away from times that are in peak demand so you can save those times for people who really need them. Flag patients who require extra time for appointments so you can schedule accordingly. Notice patterns in your patients—for example, is it better to schedule young children early in the day so they’re not tired and cranky during their appointment? 0204551LB02A-09-14 9-7 Dental Assistant Put procedures that require intensive concentration (such as complex bridge or crown preparation, implants or surgery) at times when staff are at their highest energy level. Make efficient use of windows of time that are created when staff members need to sit idle. For example, for procedures that require a local anesthetic, the dentist is waiting for three to five minutes for the anesthetic to take effect, and he could be checking a hygiene patient during that time. Guidelines for Creating and Using a Schedule Most offices use 10, 15 or 30 minute increments. Some offices mark time as units. For instance, a dentist might say, “Schedule four units of time for Mrs. Porter’s crown.” So, if each unit is 30 minutes, you know the dentist is asking for 120 minutes or two hours. The administrative assistant will schedule accordingly—based on treatment areas. Some dentists like to use several treatment areas simultaneously. In this case, if the office were using the pen and paper appointment book, the assistant divides the book into treatments areas and time. Most appointments start as pencil-based to facilitate any changes—in a manual entry system. (If you ever have to double up on administrative duties, be sure to provide details in the appointment book—or software program.) When an assistant schedules, it’s effective to provide clients with an appointment card. It notes the days and times of the next appointment. Savvy DAs double check to ensure the schedule book or software matches the card. They also know to consider how long area set-up, pre-clean and post-clean will take. They adjust schedules accordingly. Also imperative is to protect the appointment book. It contains private information. As such, it’s regulated by HIPAA rules! Planning Ahead It’s standard procedure to outline the office schedule several months ahead. Standards in most offices run up four to six months in advance. Also, key dates get noted, including: Holidays and other special dates—Dates that the office is closed due to major holidays, school breaks, too. Personal days and other scheduled vacations can affect the scheduling too. Savvy DAs plan in advance to cover shifts. Staff meetings and other meetings—When the whole staff gathers for whatever reason, the schedule will denote it ahead of time—and appear as blocked units and times. Dentists will also block out time they intend to be absent for meetings, trips or training. Buffers—Key slots for emergencies. Most office policy dictates these remain available within a 24 hour window. They try to protect that time until you’re within a 24 hour window. You can also use buffers for short, last minute requests such as denture adjustments or suture removal. However, many office try to accommodate emergency patients into these slots. Office hours—Lunch hour and staff cushions for opening and closing routines will appear blocked, too. If your office uses an electronic scheduling system, it will allow for input parameters, automatic blocking and more. 9-8 0204551LB02A-09-14 Front Office Procedures Special Situations Here are some examples of what can happen when special (scheduling) situations arise. Emergency Patients At times, patients are in pain and need immediate relief. In such cases, an office must determine if the patient is new or established. Often, office policy tries to accommodate new patients when in crisis. Others, however, hold their emergency slots open for only established patients. In either case, administrators try to fit the emergency patient into a buffer slot. If no free time appears, some offices will attempt to juggle other patients. Here, diplomacy is key—and some established patients might be available to change. Let them know of the expected delay and offer to reschedule. It’s important too for administrative assistants to determine whether the patient calls with a true emergency. Questions to Use in Assessing an Emergency Patient On a scale of one to 10, how severe is your pain? Is the pain constant or “on and off ”? Where is the pain? How long have you had the pain? What do you think is the source of the pain (any recent injury or dental treatment)? Do you have a fever or swelling? Have you tried anything (heat, cold, pain reliever) to treat the pain? New Patients Dental offices like to make a good first impression. So, when a prospective patient decides to make an appointment, she’ll be impressed if the office can find a slot for her right away. For this reason, many dental practices hold time slots open—specifically for new patients. Probably the most annoying part of being a new patient is all the paperwork. There are two ways assistants can help the new patient save time and keep the office’s schedule. Most assistants ask the patient to arrive 15 minutes early. That way he can fill the forms and stay on time. Otherwise, some offices prefer to email (or snail mail) forms to the patient. He can bring them pre-filled. Either way, most form send-outs will likely include a welcome package, too. Typical contents of the packet include: Welcome letter Information about office policy and staff background and credentials Map with directions to the office and parking information Medical and dental history and patient information forms 0204551LB02A-09-14 9-9 Dental Assistant Children A child’s age has a big influence on when to schedule her appointment. Preschoolers tend to do better in the mornings when their energy level is high. Naptimes, not so much. They might be cranky for a dental visit. Parents of school-aged children, however, tend to prefer after-school appointments or days when school is out of session. A Series of Appointments Some procedures require more than one appointment. If a patient is getting a prosthetic device or having multiple teeth restored, these procedures could require two or more appointments. Here is some key information an assistant should consider: How many appointments are needed for this procedure? How long should each appointment be? How many days between appointments will be necessary for any lab work to be completed? A good trick for administrators is to schedule the appointment at the same time and the same days of the week. This helps the client get into a routine. Confirming Appointments It’s standard for dental offices to place reminder calls to patients the day before an appointment. It’s important that office assistants always ask for and record patients’ most current numbers. Some offices are taking advantage of their patients’ email or text messaging habits. If patients indicate that they check their email regularly, this method can be a great reminder method. Most offices tend to send these reminders weekly—since not everyone checks email daily. When Something Clogs the System The purpose of all those reminder calls and emails is to try to prevent missed appointments, cancellations and late arrivals. That said, patients are human and problems arise. This causes a myriad of scheduling issues. Late Arrivals People run late. Traffic, kids, weather—it happens to everyone. Understanding and patience will soothe patients as they transition from their own schedules to a high- tension rush to an appointment. Sometimes, administrators have wiggle room in the schedule. Other times a late patient can muck up the whole day. An assistant’s mood and approach to a late patient has a ripple effect on the whole office. Calm nerves and emotions will help everyone who needs to pick up the slack. However, some patients are chronically late. In most cases, the whole office can input ideas on how to deal with this type of person. Assistants with wiggle room might schedule the patient 15 minutes earlier than his real time. As long as the entire staff is aware, they can be prepared—in case he arrives early! 9-10 0204551LB02A-09-14 Front Office Procedures Late Cancellations Some patients give notice prior to cancelling. Any notice at least is positive, as it gives an assistant time to juggle schedules or fit in emergency patients. Again, the whole office should become aware of any changes. In such cases, good assistants document anything that goes wrong—particularly if a patient fails to keep an appointment. Often, they use the code “BA” for broken appointment. They track these BAs in patients’ records. In the rare event of a malpractice suit, a string of BAs in a patient’s record can establish a pattern of contributory negligence on the patient’s part. Short Notice Appointments Some patients will want an appointment sooner when one is available. These people will usually agree to wait on a call list for short notice appointments. A call list is like a waiting list at a restaurant. Due to a last- minute cancellation, or if a buffer slot doesn’t fill, assistants can call people from the call list. They’re happy to get in sooner, and your office runs more efficiently. The trick is to keep the call list current. Assistants should remove patients’ names when they no longer need appointments. Time-saving Techniques Keeping a call list is one time-saving technique. Another is to keep track of patients who need multiple treatments. If a slot opens, many of these patients would be willing to come in early to finish their treatment. Assistants will often call and offer to complete treatments ahead of time. A Scheduler’s Daily Routine Another great time-saving technique is to establish a daily routine at the end of each day. A DA might: 1. Pull patient records for the next day’s schedule. 2. Note any special instructions to highlight for the next day, including patient premedication. 3. Confirm the arrival of tomorrow’s laboratory work. 4. Ensure that all of tomorrow’s patients have received reminders of their appointments. 5. Use the call list to fill in any gaps in tomorrow’s schedule. 6. Print (or copy) tomorrow’s schedule. 7. Give out the schedule and patient files at the same time and review the day with your team. 8. The next morning, check voicemail and email in the morning to note any changes to the schedule and fill in any holes or rearrange appointments to accommodate emergencies. 9. Keep the dental team updated as changes come up. By having a daily routine, assistants know they’ve done everything possible to keep the schedule full and the office running on time. 0204551LB02A-09-14 9-11 Dental Assistant Let’s pause here to review the material you’ve learned so far with a Practice Exercise. Step 5: Practice Exercise 9-1 Select the best answer from the choices provided. 1. A business manager _____. a. greets and checks in patients, answers the phone, can make last minute changes to appointments and processes the mail b. verifies insurance eligibility, submits claims and collects copayments c. classifies, stores, retrieves and updates patient files d. organizes and oversees the office, hires and trains staff and acts as a liaison between the staff and dentist 2. A receptionist _____. a. greets and checks in patients, answers the phone, can make last minute changes to appointments and processes the mail b. verifies insurance eligibility, submits claims and collects copayments c. classifies, stores, retrieves and updates patient files d. organizes and oversees the office, hires and trains staff and acts as a liaison between the staff and dentist 3. An insurance clerk _____. a. greets and checks in patients, answers the phone, can make last minute changes to appointments and processes the mail b. verifies insurance eligibility, submits claims and collects copayments c. classifies, stores, retrieves and updates patient files d. organizes and oversees the office, hires and trains staff and acts as a liaison between the staff and dentist 4. A records manager _____. a. greets and checks in patients, answers the phone, can make last minute changes to appointments and processes the mail b. verifies insurance eligibility, submits claims and collects copayments c. classifies, stores, retrieves and updates patient files d. organizes and oversees the office, hires and trains staff and acts as a liaison between the staff and dentist 9-12 0204551LB02A-09-14 Front Office Procedures 5. A marketing coordinator _____. a. maintains patient database, enters diagnostic and procedure codes on the computer and generates letters of referral b. handles accounting information, invoices, receipts, payroll and makes deposits c. edits the website, interacts with community groups and prepares marketing materials to attract new patients d. manages patient appointments and the recall system 6. A data processor _____. a. maintains patient database, enters diagnostic and procedure codes on the computer and generates letters of referral b. handles accounting information, invoices, receipts, payroll and makes deposits c. edits the website, interacts with community groups and prepares marketing materials to attract new patients d. manages patient appointments and the recall system 7. A bookkeeper _____. a. maintains patient database, enters diagnostic and procedure codes on the computer and generates letters of referral b. handles accounting information, invoices, receipts, payroll and makes deposits c. edits the website, interacts with community groups and prepares marketing materials to attract new patients d. manages patient appointments and the recall system 8. An appointment clerk _____. a. maintains patient database, enters diagnostic and procedure codes on the computer and generates letters of referral b. handles accounting information, invoices, receipts, payroll and makes deposits c. edits the website, interacts with community groups and prepares marketing materials to attract new patients d. manages patient appointments and the recall system 9. To keep equipment in good order, you need to keep it clean and well-maintained. a. True b. False 10. In most modern offices, you’ll use _____ to keep track of staff hours and patient appointments. a. paper scheduling software b. electronic scheduling software c. custom scheduling software 0204551LB02A-09-14 9-13 Dental Assistant 11. You have to balance quantity vs. speed when scheduling appointments. a. True b. False 12. Most dental offices divide their appointment books into this standard time increment. a. 10 b. 15 c. 30 d. All the above 13. Buffers are time slots that schedulers set aside for emergencies, filling them only when it’s 24 hours or less before that time slot. a. True b. False 14. If a patient is a new patient in your office, you are legally required to make time for him to be seen for an emergency under the abandonment clause of dental regulations. a. True b. False 15. BA stands for broken appointment. a. True b. False 16. A call list helps you fill in last-minute cancellations. a. True b. False Answer as directed. 17. Are you more likely to find an administrative dental assistant in a small or a large dental practice? Why? 18. Many dental practices have become paperless. With all of the patient’s information on the computer, why might you still need a copier? 19. What is a scanner used for in the dental office? 20. What are three tools that dental offices employ to help patients reach dentists for after-hour emergencies? 21. Computers have become indispensable tools in the dental office. You learned of ten functions that used to be performed using pencil and paper that a computer can now do. What two functions do computers perform that weren’t available in the paper era? 9-14 0204551LB02A-09-14 Front Office Procedures 22. Mary, the administrative DA in Dr. Jorgenson’s office, scheduled an appointment for Sandy Peters. She entered this information in the computer while making the appointment: Name: Sandy Peters Home phone: 555-9985 Work phone: 555-9003 Cell phone: 222-7443 Procedure time: 30 minutes Lab work: none Special notes: none Oops! What information did Mary forget to enter? Step 6: Review Practice Exercise 9-1 Review the answers to the Practice Exercise and use this as a study tool when preparing for your Quiz. 1. A business manager d. organizes and oversees the office, hires and trains staff and acts as a liaison between the staff and dentist. 2. A receptionist a. greets and checks in patients, answers the phone, can make last minute changes to appointments and processes the mail. 3. An insurance clerk b. verifies insurance eligibility, submits claims and collects copayments. 4. A records manager c. classifies, stores, retrieves and updates patient files. 5. A marketing coordinator c. edits the website, interacts with community groups and prepares marketing materials to attract new patients. 6. A data processor a. maintains patient database, enters diagnostic and procedure codes on the computer and generates letters of referral. 7. A bookkeeper b. handles accounting information, invoices, receipts, payroll and makes deposits. 8. An appointment clerk d. manages patient appointments and the recall system. 9. To keep equipment in good order, you need to keep it clean and well-maintained. a. True 10. In most modern offices, you’ll use b. electronic scheduling software to keep track of staff hours and patient appointments. 11. You have to balance quantity vs. speed when scheduling appointments. b. False 12. Most dental offices divide their appointment books into this standard time increment. d. All the above 13. Buffers are time slots that schedulers set aside for emergencies, filling them only when it’s 24 hours or less before that time slot. a. True 14. If a patient is a new patient in your office, you are legally required to make time for him to be seen for an emergency under the abandonment clause of dental regulations. b. False 0204551LB02A-09-14 9-15 Dental Assistant 15. BA stands for broken appointment. a. True 16. A call list helps you fill in last-minute cancellations. a. True 17. Are you more likely to find an administrative dental assistant in a small or a large dental practice? Why? A small dental practice because an administrative DA can fulfill the administrative and the clinical role. 18. Many dental practices have become paperless. With all of the patient’s information on the computer, why might you still need a copier? To copy receipts and information for patients, supply orders, patients’ insurance cards and insurance claim forms. 19. What is a scanner used for in a dental office? You can scan records into digital files. 20. What are three tools that dental offices employ to help patients reach dentists for after-hour emergencies? An answering service, a cell phone and a pager 21. Computers have become indispensable tools in the dental office. You learned of ten functions that used to be performed using pencil and paper that a computer can now do. What two functions do computers perform that weren’t available in the paper era? Sending and receiving email, and surfing the internet to determine insurance eligibility and benefits, research new products and update the office website 22. Mary, the administrative DA in Dr. Jorgenson’s office, scheduled an appointment for Sandy Peters. What information did Mary forget to enter? The procedure code identifying the procedure to be performed Step 7: Preventive Recall Systems A preventive recall system reflects a series of reminders to keep patients updated and solidly scheduled. Particularly for regular treatment. The recall system structure, which focuses on preventive care, differs from office to office. Many patients want to care for their teeth. So, they readily respond to the postcard, phone call or email that nudges them to schedule their regular appointment. However, some patients need coaxing to follow dentists’ recommendations for regular care. Dental assistants play an important role in shaping patients’ responses with a recall system. You can list several reasons that patients need routine and regular care, including: Regular dental care minimizes dental disease, pain and discomfort. Catching problems early keeps patients’ costs down. Receiving regular, routine dental care allows some patients to cash in on their dental insurance plans’ incentive programs. For example, an insurance company may pay 70 percent of a routine cleaning in the first year, 90 percent in the second year and 100 percent in the third year. Overall, patients spend less time at their dentists’ office with early detection and treatment for problems. 9-16 0204551LB02A-09-14 Front Office Procedures Your office benefits from an effective recall system, too. The more often patients visit, feel welcomed and leave with positive experiences, the more loyal they become. Those good feelings extend into referrals to friends and family. And a steady stream of patients helps toward profitability. Relaxed, comfortable patients tend to follow tooth care advice. Most preventive appointments are scheduled at six-month intervals. Some patients must be seen every three months or even every month, however, depending on conditions and ailments. Check with the dentist if you’re unsure of a patient’s recall scheduling. Components of a Recall Appointment Typically, recall appointments include: Prophylaxis Exam from dentist X-rays (also called radiographs) at prescribed intervals Education about home care (flossing and brushing) Discussion of any needed follow-up care Fluoride treatment (generally for children) Recall System Duties It’s possible that you’ll be in charge of a recall system one day. A system might be in place or you may be able to help design one. Either way, once you’ve got a system set up, keeping it going is simple. Here are a few tips to guide you: Be consistent and include every patient in the system. Use your relationship building skills—a patient who feels connected to you and your office will be responsive to your recall system. 0204551LB02A-09-14 9-17 Dental Assistant Keep it simple so it’s easy on you, the other team members in your office and your patients. Track the patients’ responses to the system. Be flexible and adapt the system to meet your patients’ needs. Coordinate the system with your patients’ insurance companies so you’re in compliance with their requirements for reimbursement. Types of Recall Systems You’ll find a range of recall systems in dental offices and clinics. They vary depending on the number of patients served, availability of resources and pre

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