Taylor Brewer

Tammy Maahs

Clinical Dental Hygiene DH 220

December 1, 2016

Dental Office Specialty Observation Report

The office that I chose to observe was an orthodontics office owned and operated by Dr.

Pickard located in Moscow, Idaho. Dr. Pickard owns two separate offices on the Palouse, one in

Moscow and one in Pullman, Washington. The Moscow office is open on Tuesdays and

Thursdays while the Pullman office operates on Mondays and Wednesdays. The Moscow office

was in a pleasant location on the Palouse and gave off an excellent first impression. When I

approached the front office, I was warmly greeted with nothing but smiles; as expected when

entering an orthodontic office.

Orthodontic offices treat patients anywhere ranging from seven years old to adulthood;

depending on the individual and their specific needs. The American Orthodontic Association

recommends that children starting at the age of seven should make an appointment for an

orthodontic consultation so that the orthodontist can make any changes or corrections in their

dentition or jaw before the childs skull becomes fully developed and makes treatment difficult.

These specific dental offices specialize in treating patients who present crowding or spacing in

their dentition and provide treatment for bite correction. Treatment by the orthodontist involves

using appliances ranging from clear aligners, closing springs, temporary anchorage systems,

orthodontic elastics, lower lingual holding arches, space maintainers, palatine expanders, reverse

pull headgear, face masks, brackets and orthodontic bands; depending on the individual needs of
the patient and the condition they present. These appliances aid the patient by correcting their

dentition into proper occlusion that will allow for long term function of the teeth and keep them

aesthetically pleasing. Orthodontists perform a variety of different procedures to aid in correction

of malocclusion that includes bonding brackets to teeth, prescribing and changing arch wires to

apply force for bite correction, prescribing orthodontic elastics, removing braces, repositioning

brackets that may be out of place and many other procedures that may aid in the progress of

orthodontic treatment.

The office team members are very important components that provide specific tasks and

each take on individual responsibilities depending on the job title. In Doctor Pickards office, he

had a variety of team members all focusing and providing different responsibilities that are all

important to the function of the clinic. The financial coordinator, Emily, aids in any financial

work that the office may run into that includes both clinical and patient funds. The treatment

coordinator, Sharee, ensures completion of the cycle from the clinical diagnosis to a patient on

the schedule who has, in the past, made clear agreement to pay for the treatment. The scheduling

coordinator works at the front desk, primarily, and schedules the appointments and places them

in the correct time frames that aids in smooth running of the clinic day by day. The lab

technician, Eli, aids the clinic in the lab work and fabricates everything for the clinic. The lab

work consists of making three different types of retainers, creating space maintainers, forming

palatal expanders, constructing IBO trays, pouring and trimming models and then making digital

scans from these models that is kept for future reference. The clinical technicians, Shannon, Sepi,

Courtney, Tanya, Lacy, Dawn, Brenda and Maris, all do the assistant work around the clinic.

They perform all the work that the dentist instructs them to do including seating and dismissing

the patient, sterilizing, disinfecting, applying brackets, removing braces, changing wires, taking
impressions, doing regular checkups on orthodontic progress and charting the procedure in the

patients notes and chart at the completion of the procedure. At this specific office, there are two

dentists, Dr. Pickard and Dr. Alatsis that both confirm, refer, instruct and evaluate treatment and

the needs of each patient. There was no dental hygienist employed within this office.

The sterilization room has separate and distinguished areas for both clean and dirty items.

All instruments, that are acceptable, go into an ultrasonic for 10 minutes and then the instruments

are sterilized. For sterilization, appropriate PPE is worn and the instruments are placed onto the

tray and into the statim without being individually bagged; the statim is what they usually use in

their office but they also have an ultraclave sterilizer for other use if needed. Once sterilization is

finished, they separate their instruments on the clean side onto separate labeled trays depending

on their specific use and type. The instruments are then prepped onto trays for patient treatment

and taken to the clinicians chair. Disinfection after patient treatment is done with CaviWipes on

specific treatment areas with the appropriate barriers; such as head rest covers. Their sterilization

and disinfectant process differs from LCCs policies in that they dont use Birex as a disinfectant,

not as many barriers are used for the client care area, they only use the statim for sterilization,

they dont bag their instruments prior to sterilization and they use trays for sorting clean

instruments. I do not think that LCC should use any of these procedures or change them because

we deal with more biohazard material and our instruments, primarily, contact areas where blood

and bone is contacted so we need a stronger disinfectant and a heavy-duty sterilizer that holds

more instruments. Also, bagging our instruments helps sort them out and ensures they are sterile

and ready to be stored for clinic use.

The procedure that I observed and thought was particularly interesting was the appliance

of braces/brackets. The first step in this process after seating the patient was to polish the tooth
surface where the brackets will be placed, not the full tooth, with the slow speed hand piece and

a medium grit polish. Next, the Nola was applied for extra check, lip and tongue retraction to

help keep the surfaces optimally dry throughout the procedure and aid the clinician in suction

when needed. Once placed, the patient was then rinsed and thoroughly dried before the etchant

was applied. The etchant used for this procedure was a gel 6.5g with phosphoric acid. Applying

the etchant to the tooth surface helps condition the teeth for glue application. Once applied to the

whole maxillary for 20-30 seconds, the dentition was rinsed and then air dried. Next, the bonding

agent was applied with a cotton tip applicator; this aids the procedure by working as a sealant.

The bonding agent used was SurePlus which is an adhesive paste 3M Unitek Transbond XT-

light cured paste. Once applied across the entire maxillary, the teeth were air dried and then the

brackets were applied directly onto the tooth surface. The brackets were connected on the inside

of a tray that was specifically made for the patient from their impressions and the tray was firmly

placed over the dentition. Once the brackets were in place, pressure with the clinicians hand was

applied to help keep the bracket in the correct spot while the curing light goes around the

dentition. The curing light is then done again after bracket and tray removal to ensure security of

the bond. The same process is then done to the mandibular dentition. At the end of the bracket

appliance, since this specific patient had a significant overbite, TransBond was applied in

increments on the cusps of the first molars to make them taller and to prevent the patient from

biting directly down onto her lower brackets when occluding. Other procedures that I saw were

basic treatments that involved replacing wires, adding brackets to newly formed teeth, taking

impressions, pouring up models, occlusion checks and applying new colors or bands to braces

after a new wire was placed for further progression of treatment.

 The software that the office uses is called Dolphin Management and Imaging. This

program includes auto notes that populate in columns for each appointment and each patient.

Within the chart, the clinician notes the date, the clinician that did the procedure, the doctor,

OHI- which is rated from poor, fair, good and excellent-, the arch wire involved, the elastics the

patient is wearing, a tooth chart for a visual, treatment or doctor notes, what appointment will be

completed next time, how long the appointment will last and the number of weeks until the next

appointment. All the appointments consist of codes that were made up by the office.

For referral, as stated before, the American Orthodontic Association recommends all

children at the age of 7 go to an orthodontist for a consultation. Dr. Pickard accepts patients

without a referral but he also gets patients referred to him at all ages from surrounding dentists

for malocclusion, crowding, overbite, overjet and a variety of other bite corrections that may be

needed.

Overall, I had a great experience observing Dr. Pickards office. I think that orthodontics

is an interesting dental specialty and I learned a lot about the procedures provided and how

treatment is done within their clinic. The office was very fast paced and all the workers were

involved in their jobs, helping the day run smoothly, and provided great care to their patients

even with the short amount of time they had. Everyone that worked within the office was very

nice and made me feel very welcome to ask questions and observe over their shoulder. For future

application of this knowledge, I think that I can really identify what I am looking for in my

patients as far as referring them for orthodontic treatment. I can also explain to them the basic

treatment that would be provided to them and overall why bite correction is so important.
Contact Information:
Pickard Orthodontics- Dr. Pickard
208-882-6360
info@pickardortho.com