#13 – Assists Periodontist

A. Charts
B. Seat Patients
C. Consultation and NP Exams
D. Charting and Exam Sheets
E. Diagnosis/ Charts
F. Surgeries
G. After Surgery Rechecks

Introduction
Dr. ____________  is a periodontist. Periodontists treat gum diseases.

A. Dr.’s  assistant should arrive at least a half an hour before the first patient to prepare. She uses rooms ___________. This is a list of items that should be checked:
1. Every chart should include:
-Treatment Sheet
-Control Program Sheet/Charting
-Periodontal Diagnostic Sheet
-Referral Sheet, already filled out
2. The assistant’s carts should be cleared of everything.
3. Watch the schedule carefully. Clients who have 15-minute appointments should always be seen before specialty exams that are 45 minutes long, even though the clients are scheduled to arrive at the same time. Dr.  does NOT break from an exam once she has started.

B. When you seat a patient for Dr., don’t be shy about telling her while she is already with a patient that she has another patient. It is Dr.’s preference that if she is behind on her scheduled time that you say so, even in front of a current patient. She chooses not to get sidetracked and have a patient wait.

It is very important to keep Dr.  on schedule – she expects that of you.

C. On the initial visit, the patient will either be there for a periodontal consult or a new patient exam. Dr.  will let you know, but for either one you will need.
1. A Mirror
2. A Currette
3. Nabors Probe
4. Explorer
5. A Probe
6. A Couple of 2x2s
7. A Slow Speed Suction Tip
8. Two Air/ Water Tips

On a tray in a clean operatory. After Dr.  looks at the patient, she will decide whether or not she wants to do a full exam and charting or tell the patient what is wrong with them. If Dr. is telling the patient what is wrong with them, the assistant won’t be needed. If Dr. decides to do the exam, then the assistant will need to chart. For the exam sheet, the assistant will read off from the list and if Dr. repeats or says yes then the assistant will underline that specific selection from the list. For the charting, the assistant will be charting the depths of the gum surrounding the teeth. The depths are recorded in three sections on the facial, and three sections on the lingual of each tooth. There are lines on the sheets surrounding the tooth. For any depths over 5mm the assistant will count up however many millimeters and graph them as needed.

-Dr.  will spend about 35 minutes examining the patient.
-During this time Dr.  might ask you to chart for her. Don’t worry, this is easy.
-Start on the sheet with all the teeth on it, she will start at tooth number one and then
tell all the teeth that are missing.
-Then you will go back to tooth number one and she will give you three numbers for each tooth that is still there, theses are the probing depths. Make sure you are on the correct tooth and in line one.
-At the end of the exam Dr.  will tell the patient what is wrong with them and if she can help them or not. This can be the tough part, when a patient finds out that they need four thousand dollars of traumatic surgery to their mouth they usually don’t take it very well.
-Dr.  will then need to fill out the blue treatment sheet first, so you can take this up to the secretaries. Find out what the charge for today.
-Many surgeries need to be submitted to insurance first. It generally takes 2-3 weeks to get a pre-treatment estimate back from insurance, so you can schedule the appointment.

D. Surgeries
-The set up for all surgeries, except a graft, is the same.
-In Dr.’s bin she will have:
a package of instruments with a stone in it,
a plastic monoject syringe,
two large white sterile bibs,
a metal bowl wrapped in a cloth (if he forgets to bring this just use one of our
white plastic cups),
two bib clips (that look like funny hemostats)
– We provide:
Sodium Chloride,
Syringe, with septocaine and a long yellow needle with a metal hub,
Topical, two or three cotton tipped applicators loaded,
Air/ Water syringe tips,
Suction tips, use the green surgical and slow tips and have extra,
Plenty of 2×2 gauzes,
Two gray bibs
-Place a bob on the assistant cart, unwrap one of the large white sterile bibs and place it over the gray bib, unwrap the instruments and place them neatly on the sterile bib.
-Pour the Sodium Chloride in the metal bowl or plastic cup and fill the monoject syringe.
-Load the anestecic syringe, have 3 or 4 extra carpels of septocaine handy.
-Prepare topical.
-Cover all the instruments and syringe with the second white bib.
-Bring the patient back, and place the gray bib on them and then the white one and clip the white one to the gray one using Dr.’s bib clips.
-Let Dr.  know that the client is ready.
-She will give anesthetic, wait, and then begin.
-Have lots of 2×2 gauzes ready.

To do surgeries with Dr. the assistant will mostly suction. Dr.  sets up her own instruments and instructs the assistant to retract and where to retract from. When suctioning during a surgery with Dr., you won’t have that great of vision, so when Dr.  leaves the mouth with instruments hurry in and suction. The most important thing about suctioning during surgery is to keep the blood from going down the throat. Dr. will irrigate as needed in the mouth.

-When Dr.  is done you are in charge of cleanup, wet some gauze with the sodium chloride and wipe off the patient’s teeth, tongue, mouth and lips.
-Sit the patient up and give them a couple Hot Towels and a mirror so they can make sure that they have all the blood off of their face.
-Let the client sit up and relax for a while before you walk them out, ask Dr. if they will need a recheck in one or two weeks.

E. Graft surgeries are set up and done almost the same as other surgeries. Here are the differences:
-Dr.  might use marcaine, have some ready.
-She will also bring materials for sutures,
-Two or three fifteen blades and a handle,
-White surgical suction tips, 7 or 8 of them,
-LOTS of gauze

How a graft surgery is performed:
-Dr.  will anesthetize the client.
-She will then cut the gums away from the clients teeth using a fifteen blade, then she will cut farther down the gums and make a flap, you will suction a lot of blood at this time, she will place gauze in the flap, during this time she might ask you to retract the lips with your fingers- wait until she asks.
-Be sure to change your suction tip as needed when it clogs.
-Dr.  will anesthetize the client again in the roof of their mouth.
-She will cut the roof of the client’s mouth in a rectangle pattern. She will stress A LOT not to get your suction too close or it will suck up the loose tissue. DO NOT SUCTION THE LOOSE TISSUE!!!
-She then will remove the tissue. Now is the time to suction all the blood, while she cuts the tissue to his desired shape.
-Now Dr.  will place the tissue in the first flap she made and begin to suture it closed. DO NOT SUCTION THE LOOSE TISSUE!!!
-When she is done she will go to the counter and make a sterile dressing to cover the wounds. Keep suctioning the blood and begin cleaning up the patient’s mouth of blood with saline.
-After she returns and places the dressing, the patient is done. They will need a recheck in one or two weeks to remove the stitches.

Dr.  always wants her charts back immediately after each appointment. She prefers to fill them out herself.

Surgery Re-Checks – A patient will come in for check-ups two weeks after surgery for rechecks until Dr. thinks that everything is okay.

Surgery Re-Check Set Up
– mirror
– cotton pliers
– surgical scissors
– explorer
– mouth rinse

Perio Charting for Dr.  –
1. Click on patient
2. Go to tooth chart
3. Click on perio chart
4. Click on set-up
5. Click on entry settings set-up
6. Select import from file, hit ok
7. Go into computer
8. Select F drive; open
9. Select Dr’s perio exam, open
10. Dr’s  perio exam will be highlighted; hit ok
11. Go to Script; select Dr. perio exam
12. Then will perio chart how Dr. charts

Periodontist’s Clinical Assistant

General Description
The assistant is our periodontist’s personal assistant in the operatory and is also responsible for maintenance of dental equipment, sharpening, sterilizing instruments, and clinical inventory.

Setting up instruments and operatories Instruments and operatories will be set up differently according to the procedure being performed by the doctor.
To set up the rooms, refer to the schedule to see what procedure is being performed in each room. Then refer to the index cards* which explain instrument and material set up for each procedure. Place the prepackaged materials. Once instruments are opened make sure they are covered to preserve sterility.

*Following is the information contained on each index card.

Initial Exam-Used for new patient exams
Instruments
• Mouth mirror
• Nabers probe
• Perio probe
• 11/12 explorer
Accessories
• 1-cotton tip applicators
• suction funnel with liner
• 2-“2×2” gauze
• plastic cup
• horse shoe articulating paper
Special Information
• make sure the doctor reviews the chart before the patient is seated
• take patient’s blood pressure and pulse and write it down in the chart

Oral Hygiene instruction
Instruments
• mouth mirror
• #23 explorer
Accessories
• 6cc bottle of disclosing solution
• suction funnel with liner sample Listerine bottle
• small floss container
• end-tufted brush
• proxa-brush tips
• Plastic cup
• 1-cotton tip applicator
• toothpaste
• soft toothbrush
• interdental brush handle
• traveler proxa-brush

Suture Removal (PO#1)-seven to ten days after surgery
Instruments
• Mouth mirror
• Scissors
• Younger-Good 7/8 scaler
• College pliers
Accessories
• 2-“2×2” gauze
• ultra soft brush
• Lactona stimulator

Postop#2-two weeks after surgery
Instruments
• mouth mirror
• perio probe
Accessories
• 1-“2×2” gauze
• travelor proxa-brushes-both types
Postop #3-three weeks after surgery, only if patient is healing slowly
Instruments
• mouth mirror
• perio probe
Accessories
• 1-“2×2” gauze
• traveler proxa-brushes—both types
Special Information
• additional instruments may be necessary depending upon case.

Post-Initial Exam-used for patients after root planning has been completed
Same for Re-Evals
Instruments
• mouth mirror
• Nabers probe
• Perio probe
• 11/12 explorer
Accessories
• disclosing solution in dappen dish
• 1-cotton tip applicators
• suction funnel with liner
• 2-“2×2” gauze
• plastic cup
• horse shoe articulating paper

Scaling/Root Planing
Instruments
• mouth mirror
• anterior Gracey scaler
• 13/14 Gracey scaler
• supragingival scaler
• Nabers probe
• Perio probe
• 11/12 Gracey scaler
• 7/8 younger good scaler
• 11/12 explorer
Accessories
• 2-cotton tip applicators
• 2-30 gauge short needles
• 2-high speed suction tips
• universal cavitron tip, in cavitron, pink
• air/water syringe tip
• 1-irrigation syringe filled with Peridex, per quadrant
• 1-anesthetic carpule, 1:100 epi, per quadrant
• 1-anesthetic carpule, 1:50 epi, per quadrant
• 2-anesthetic syringes, preferably with wings
• topical anesthetic
• 1-27 gauge long needle
• 2-sterile gauze packs
• beaver tail cavitron tip, unopened
• sharpening stones
Special Information
• flush cavitron tip holder
• fill cavitron tip holder with water before placing tip
• take patient’s blood pressure and pulse and write it down in the chart

Supportive Periodontal Therapy-also for Prophies
Instruments
• mouth mirror
• anterior Gracey scaler
• 13/14 Gracey scaler
• supragingival scaler
• Nabers probe
• Perio probe
• 11/12 Gracey scaler
• 7/8 younger good scaler
• 11/12 explorer
Accessories
• 2-cotton tip applicators
• 1-30 gauge short needle
• 2-high speed suction tips
• universal cavitron tip, in cavitron
• air/water syringe tip
• slow speed motor
• long cone
• prophy paste
• suction funnel with liner
• 1-anesthetic carpule, 1:100 epi
• 1-anesthetic syringe, preferable with wings
• 2-irrigation syringes, with Peridex
• 1-27 gauge long needle
• 1-sterile gauze pack
• beaver tail cavitron tip, unopened
• sharpening stones
• torque multiplier
• disposable prophy head
• plastic cup with water
• disclosing solution in dappen dish
• 1-anesthetic carpule, 1:50epi
Special Information
• flush cavitron tip holder
• fill cavitron tip holder with water before placing tip
• take patient’s blood pressure and pulse and write it down in the chart

Surgery- for all surgical procedures except soft tissue grafts

Instruments
• 1-mouth mirror, double sided
• perio probe
• Younger-good 7/8
• 11/12 Gracey scaler
• tissue foreceps
• college pliers
• needle holder

Crown Lengthening (C.L.P.) and Biopsies
• 1-mouth mirror, single sided
• 2-surgical blade handles
• medium elevator, #9
• crane Kaplan scaler
• anterior Gracey scaler
• 13/14 Gracey scaler
• tissue scissors
• cotton pliers
• suture scissors

Accessories
• 2-cotton tip applicators
• 2-30 gauge short needles
• 2-high speed suction tips
• universal cavitron tip, in cavitron
• air/water syringe tip
• 1-plastic cup with water
• 1-silk suture FS-2, per quadrant +1
• 1-scalpel blade, #15, per quadrant +1
• post-op instruction booklet
• 1-anesthetic carpule, 1:100 epi, per quadrant
• 1-anesthetic carpule, 1:50 epi, per quadrant
• 2-anesthetic syringes, preferably with wings
• 1-irrigation syringe filled with Peridex, per quadrant
• 2-sharp lockers
• 1-27 gauge long needle
• 2-sterile gauze packs
• beaver tail cavitron tip, unopened
• sharpening stones
• 1-plastic cup for bloody gauze
• 1-silk suture J-1
• 1-scalpel blade, #12B

Special Information
• flush cavitron tip holder
• fill cavitron tip holder with water before placing tip
• keep bottle of Gel-Foam on assistant’s counter
• take patients’s blood pressure and pulse and write it down in the chart

Note for osseous grafts (Hapsetordecalcified freeze-dried bone allograft
• take out appropriate graft material

Soft Tissue Graft- for pedicle and detached palatal grafts

Instruments
• 1-mouth mirror, double sided
• 2-surgical blade handles
• small elevator, #7
• younger-good 7/8
• tissue scissors
• cotton pliers
• needle holder
• perio probe
• Small tissue forceps
• College pliers
• Suture scissors

Accessories
• 2-cotton tip applicators
• 1-30 gauge short needle
• 2-high speed suction tips
• air/water syringe tip
• 1-plastic cup with water
• 1-scapel blade, #15, per graft
• post-op instruction booklet
• 1-anesthetic syringe, preferably with wings
• 2-sharp lockers
• 1-27 gauge long needle
• 2-sterile gauze packs
• 1-silk suture J-1
• 1-plastic cup for bloody gauze
• 1-scalpel blade, #12B

Special Information
• take patient’s blood pressure and pulse and write it down in the chart
• keep bottle of Gel Foam on assistant’s counter
• for detached palatal grafts the following is needed:
-1-piece of Ortho foil
-1-cup with sterile saline water
-surgical stent
-one piece of Gel Foam cut in half

X-Rays-for full mouth series (FMX)
Instruments
• anterior bite block
• vertical bitewing bite block
• anterior positioning arm
• anterior/bitewing ring
• posterior bite block
• bitewing positioning arm
• posterior positioning arm
• posterior ring

Accessories
• 18-large film packs, #2
• 2-“2×2” gauze
• lead apron for patient
• empty plastic cup for film

Special Information
• place plastic sleeve on X-ray head
• cover remote x-ray button with saran wrap

Nightguards-adjusting or delivering
Tray Colorant applicable

Instruments
• mouth mirror

Accessories
• 1-piece of horse shoe articulating paper
• low speed motor
• oil for hand piece
• 2-“2×2” gauze
• long cone, unopened
• acrylic bur, unopened

Occlusal Adjustment

Instruments
• mouth mirror
• articulating forceps
Accessories
• 1-piece of horse shoe articulating paper
• high speed hand piece
• spray oil for hand piece
• bur block with one green midget and one white midget
• 2-“2×2” gauze
• 1-piece accu-film
• 2-pieces occlusal indicating wax

Impressions

Instruments
• mouth mirror

Accessories
• 1-container of alginate, per impression
• 3-paper towels, per impression
• 1-rubber mixing bowl, per impression
• impression trays
• 1-water measuring cylinder
• wide alginate spatula

Special Information
• assess patient’s mouth size before getting impression trays
• if Dr. wants bite registration the following is needed:
-hot water bath
-wax bite wafer

See master manual for pictures
Staffer understands basic assisting for me
________________________________
Dr ____________ Date