#14 – Assists the Pediatric Dentist | Dental Practice Coaching

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#14 – Assists the Pediatric Dentist

When a patient comes in and has multiple areas of decay we give the parents a handout itemizing treatment to be done. These handouts explain treatment to be done and how we handle the appointment, itemizes treatment and also it includes how we recommend parents prepare kids for their appointment, parents will need to sign-make a copy-one for parent one for chart.

There is a separate hand out that is given when oral sedation, laughing gas, IV sedation or hospital visit is recommended.

When a child needs to be put to sleep in the office or hospital, we will do a family consultation. The family will be given all necessary information regarding treatment and finances. We will answer their questions, work out a financial plan, and discuss how the anesthesiologist and scheduling works. At this time, we will also go over Tx and consult forms and have parents sign them.

Vocabulary:

Mouth prop – “tooth pillow”
High and low speed handpieces – “mechanical toothbrushes”
Explorer – “tooth counter”
Extraction instruments – “tooth spoon”, “tooth wiggler”, “tooth holder”
Syringe – “Sleepy juice”
Topical anesthetic – “Tooth jelly”
Nitrous oxide – “Happy air”
Suction – “Vacuum” “Mr. Thirsty”
Wet Q-tip to clean off amalgam on filling – “Hi-shine”
Burnisher – “Giving tooth a smiley face, or writing his initials”
Crown, space maintainers – “Tooth jewelry”
Etch-it gel – “soap”

Crown crimper
Hal pliers
Bite stick
Rubber dam
Clamp
Clamp holder
Frame
Molt mouth prop
Band pusher
Band remover
3-prong
Bite stick

TERMINOLOGY

TREATMENT abbreviations:
Occlusal – O
Lingual – L
Buccal – B
Mesial – M
Distal – D
Facial – F
Incisal – I
*** tooth #A may be a mesial occlusal lingual filling so you would write A-MOL

Amalgam – amal
Alloy – alloy
*** both terms indicate silver fillings – for example above, if #A were to be a silver filling, then it would be written A-MOL-amal or A-MOL-A for the second “A” indicates it is amalgam or alloy which are the same things

Composite – comp
*** indicates tooth-colored filling – usually composites are on front teeth but occasionally there will be composites on back permanent teeth (example of treatment for front tooth #8 is 8-MFL comp) Successful placement requires isolation ( no salvia contamination) , child cooperation, and speed. Composites are more technique sensitive and take more time.

Pulpotomy – pulp
*** treatment of a nerve-similar to a root canal
Indirect pulp cap- ind pulp cap
*** treatment of tooth before decay reaches the nerve

Stainless steel crown – SSC
*** placed on teeth that have decayed too much for it to be saved by a filling – will often be placed on teeth that have had an indirect pulp cap, but will always be placed on teeth that need a pulpotomy (example of how it would be written: # J-pulp/SSC or # J-ind pulp cap/SSC)

Extraction – ext
Patient – pt
Bitewings – BWX or BW’s
Occlusal X-rays – occ x-ray
Preventive care appt. – PC
Happy visit – HV
Fluoride treatment – FL tx
Fluoride gel – FL gel
Fluoride supplements – FL supps
Unilateral space maintainer – uni SM
Bilateral space maintainer – bil SM
Mouthguard – MG

1) Replace seat cover for every treatment
*** Saran Wrap on air/water dispensers or light handle that was not in use can remain there until they are used

X-Rays
• 2 – 4 (depending on how big child’s mouth is)
• BWX’s every 12 months
• Occlusal x-rays age 3-6
• No x-rays under age of 3
• Panoramic film starting at age 6, but insurance does not cover BWX’s and pano same day. If patient has had BWX’s in last 12 months take pano, if not take BWX’s and do pano at next visit

Fluoride
• Dr. always talks to parents and children about fluoride (toothpaste)
• At prophy, and any treatment done, he places topical fluorde varnish every appointment for every age
• Recommends if patient under age of 3, they still use non-fluoridated toothpaste
• If patient has high risk of decay he will put child on Prevident 5000, or MI Paste Plus if the child is old enough to not swallow toothpaste (He will decide on MI Paste or Prevident)
• If patient is/has been decay-free (low risk) their six month checkup he just recommends topical varnish at prophy. If this ever changes, he will decide when and if to put child on MI Paste/Prevident.

APPEARANCE GUIDELINES
– keep hair back
– keep nails short
– avoid wearing dangling jewelry or excessive jewelry
– always wear mask and glasses while assisting and always wear gloves when handling items that have been in a patient’s mouth
– be professional

SEATING PATIENTS
– use first name only when calling for them (check in chart for nicknames – i.e. Nicholas goes by Nick)
– always introduce yourself to new patients
– ask how they are doing or how their day has been
– show kids where they are to sit and ask mom or dad if they would like to have a seat in the chair right outside the operatory
*** for apprehensive patients, explain to parents that they can pull their chair into operatory and sit next to their child to help them feel safer and more secure, or do a lap exam
– ask patient if s/he would like to watch a movie and name a few of the ones we have available
– chat a little with the patient so they are more comfortable (i.e. compliment outfit, ask about their weekend, how school is going, etc.)
– when Dr.  enters the room for treating patient, secure the bib on the patient
– for treatment Dr. always sets up laughing gas (nitrous)
– have sunglasses ready for when we turn on our big flashlight (overhead light)
– have varnish ready for every operative and prophy patient
***ALWAYS keep tray covered with a bib so patient does not feel intimidated when s/he enters operatory and hide anes. Syringe

Staffer understands basic assisting with me

____________________________________
Dr. ____________ Date

Ambulatory Anesthesia Cases

Treatment
Usually patients come in as another doctor’s referral, or a parent notices decay and brings them as an emergency, after associated with pain or a first cleaning appointment. During this appointment it is important to discuss home care, diet, fluoride, prevention, and health history with parents. Try to help identify contributing factors to dental decay and discuss with parent in a non-judgmental way. Take x-rays if needed. Take photos of patient (if cooperative get photos of their teeth).print 2 sets, if dentist recommends IV Sedation he/she will discuss with parents, when dentist is gone answer any other questions parent may have, give them the “Fear of Dentistry” handout, and discuss consult appointment with them. Enter treatment next into computers, walk them to desk to set up consult appointment. Be sure to give patient new patient “goodie bag”, and prescription for antibiotic, Dr.  occasionally prescribes fluoride.

Consult Appointment
At this appointment, the assistant will meet with the parents and go over treatment, answer all their questions and have them sign necessary forms. The secretary will then discuss scheduling and financial arrangements and set up appointment at children’s.

Treatment Days
Arrive a little earlier for setting up on Ambulatory Anesthesia days. Charts would have been reviewed the previous day to make sure all forms and health histories are signed, and schedule will have treatment listed. Set up for all possible treatment in room 15 (have crowns, surgery, bands etc. ready). Turn on Nitrous/Oxygen checking fullness of tanks. Help the anesthesiologist set up as needed, she will need a trash can, a sharps container, gloves, extra chair, room dividers, gauze or cotton rolls and toys out. There should be a Nitrous / Oxygen unit in recovery room with emergency O2 tank between the two rooms, 14 and 15. Check the fullness of the O2 and N2O tanks.

When our anesthesiologist is ready to start she will bring parents and child back, listen to the child’s heart and lungs and start the child on N2O if cooperative she will place IV, if not she will have to give a shot before IV. Someone will need to help hold N2O nose, and someone will have to help hold child’s arm still when child is sedated parents will be escorted to waiting room and child will be put on O2 with plastic nose tubing, monitors are placed and eyes are taped. When she says child is ready placed topical and take x-rays if indicated, then get dentist. He/She will use mouth prop and place throat pack, or use rubber dam. Put x-rays on t.v. as soon as ready (before already taken), and begin treatment. One assistant will assist dentist, one will assist assistant, and chart and be the runner. They will rotate for each case. About half way through procedure the runner will go out and let parents know how child is doing and discuss treatment changes with parents, fill out a change of tx sheet and give to the coordinator after discussing any changes with parents.

After treatment is done be sure to clean off the child’s face, let the coordinator know the anesthesiologist total cost, let parents check out and then put them on deck for the dentist he/she will give parents post-op info. Child will be moved to recovery room with her recovery assistant. The parents can come back when our anesthesiologist okays, and they will leave when she okays, there is a wheel chair if it is needed, as quickly as possible, turnover the room, and get ready to repeat the process.

Post Op Visit
Two weeks after the treatment date the patient will be appointed for a post op check. Bring the child back, ask parents how he did after treatment. Take post op photos if patient and family are good candidates for referrals have them sign a release and write up a brief statement. Sometimes at this appointment we will need to seat space maintainers and place varnish.

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Dr. ________ Date