Bruce Goldstein D.D.S, M.S

BRUCE GOLDSTEIN D.D.S, M.S.

MICHAEL FEINBERG D.D.S, M.S.

AFFILIATED PEDIATRIC

ORTHODONTICS

ORTHODONTIC ASSISTANT

MANUAL

DUTIES OF CLINICAL ASSISTANTS:

1. The duties of a clinical assistant are not just assisting and cleaning instruments. When there are no patients, this is the time to catch up on cleaning the treatment area, trays, etc., (refer to the daily checklist). The treatment area should look immaculate at all times. This cannot be emphasized enough.
2. When the doctor asks you to do anything or directs any statements to you, always acknowledge him with an audible “okay” if you understand the doctor. If you don’t understand, ask the doctor to clarify the statement.
3. When speaking with the patient, always promote the office and the doctor. Keep your comments positive and lead conversations to permit the patient to talk about him or herself. Do not talk about personal troubles or situations.
4. When assisting the doctor, try to comfort the patient. Some patients want you to hold their hands, or just need some comforting words. Talk with the patient to relax them while assisting or doing the procedure. When alone, explain to the patient what you are doing to minimize fearof the unknown.
5. When assisting, follow the doctor with the overhead light. When the doctor asks the patient to move, it is your cue to move the overhead light.
6. When assisting, both hands should be used at all times.
7. Be prepared, the clinical assistant must anticipate the doctor’s needs. If the doctor has to be asking for instruments repeatedly, then you are not anticipating.
8. When assisting, the assistant must keep the tray plus countertop free of debris and keep it neat. All instruments must be in an orderly fashion.
9. If asked by patient when appropriate, advise the patient that we use the best lab, the best materials, braces and equipment possible.
10. Again, the assistant must promote the doctor and the orthodontic office so as to relax the patient and encourage referrals. This is all part of the assistant’s job performance.
11. When the patient is dismissed, he must feel we did everything possible to make the comfortable, ask patient if anything is poking and make sure patient feels all around. We cannot be just average in this category. The assistant is an integral part of this function in that they spend a lot of time with the patient.
12. When the doctor enters the room, you must start in this order:

Have all X-raysavailable in imaging pulled up

Appropriate instrumentation is ready for procedure

Review health history noting any changes

Pre-med if any

Place orthodontic napkins when needed around

patients neck.

Position chair

Comfort patient, and reassure them about appt

Divert attention of patient away from procedure

with interesting conversation

Ask if patient is “okay”

If banding clean patients mouth, pt can rinse

13.The doctor should not have to request the assistant to do

these functions. It is the responsibility of the

assistant to be ahead of the doctor

14.When preparing for the procedure do it in the

sequence by which the doctor would use the

items. Therefore, if the doctor or anything

else interrupts you, this ensures you will be

several steps ahead of the doctor(anticipation)

15.When not assisting directly with the doctor, be

prepared for the next appointed patient. Set up

the units for the next procedure.

16.The patient is the number one priority! We must

complete his /her treatment ASAP to minimize

the patient’s time in the chair

17.It is the responsibility of the assistant to oversee

the schedule and check the monitor when the patient

arrives and seat him/her immediately. There are

very few duties that take priority over this. Being

on time is the key to success and happy patients

18.Befriend the patient. Ask him/her about their

parents, children, where they are originally from,

vacations, etc. Most people like to talk about

themselves.

19. The assistant must promote the orthodontic

practice and review patient charts routinely

You will do this either prior to or after seating the

patient, depending on whether the doctor is

running on time or behind schedule. The assistant

should know the patient’s total treatment and any

questions should be reviewed with the doctor, if

necessary.

1. Always go over home care instructions and any

questions they might have.

1. When the doctor calls you, you must stop what

You are doing and check with him, unless you are seating a patient or taking an x-ray.

1. When dismissing the patient, make sure he/she has

nothing poking, discuss any potential problems that may arise prior to their next visit, be specific

1. Always discuss with patient/parent what the next

Procedure is for them, if any. Remember

a completed treatment plan and a well satisfied patient is what we want.

ACCORDING TO OSHA GUIDELINES

Lab jackets are to be worn at all times by all assistants working with patients.

Gloves must be worn at all times when caring for a patient. They should also be changed after ever patient and if a rip or tear develops.

Gloves are kept in stock to fit each employee.

Gloves, protective eyewear and masks must be worn at all times during patient care where contact with blood may occur and during cleaning of operatory after patient has been dismissed. If for some reason you leave the operatory during a procedure, remove gloves and replace them with a new pair when you reenter the operatory. Never wear gloves from one chair to another.

Gloves should be worn when a clinical staff member is decontaminating a work area or service. They should be worn while cleaning instruments, operatories, and anything else that has become contaminated during treatment.

Hands should be washed thoroughly after caring for each patient and after removing gloves. Hands and other skin surfaces should be washed thoroughly and immediately after possible contact with blood and/or body fluid.

Always wear gloves when attending patients or cleaning the operatory.

Never touch a chart, phone, pen, etc., with a glove or hand that has been in contact with the patient’s saliva, blood etc.

Chart is to be kept by monitor or chart holder not on working surface with instruments.

After removing your latex gloves, alwaysmake sure that your hands have been thoroughly scrubbed and cleaned before touching anything.

TRAY SET UPS

We use the following kinds of tray set ups

1. Fixed retainer
2. Banding
3. Retainer checks
4. De-Band
5. Herbst
6. Cement RPE/Holding arch/Pentex
7. Bonding
8. Adjustments
9. Repositioning
10. Bond second molars

It is very important to make sure all appropriate instruments are on the correct trays and everything is set up before the orthodontist is ready to start.

1. Fixed retainer tray-ortho flex wire, etch tip, cotton plier, straight cutter, hemostat, transbond LR, transbond LR adhesive gun, curing light, floss, solo stick, transbond primer, brush applicator, scaler, 3 prong/loop plier.
2. Banding tray-Band pusher, scaler, bite stick, cotton rolls, blue etchant, 2 brush applicators, band lok ultra, cheek retractors, mix pad and spatula, wax or chapstick for bands, toothpicks, large/small suctions, 2x2 gauze, curing light, bracket holder, cotton plier, band remover, concise past A/B concise liquid A/B, enhance A/B, archwires.
3. Retainer check tray-bird beak plier, three prong, scaler, mirror
4. Deband tray-band removing plier, bracket removing plier, diamond bur, articulating paper, 2x2 gauze, high speed, slow speed, prophy angle and paste
5. Herbst tray-fuji, band pusher/scaler, bite stick, 2 long cotton rolls, herbst wrench, hemostat, mixing pad and spatula,band remover, mouth mirror, metal air/water syringe, Vaseline with q-tip, mixing stick, small and large sution, lab handpiece
6. Cement RPE/lower lingual arch/pendex/nance tray-mirror, scaler,cotton rolls, 2x2 gauze, band lok, band remover, bite stick, curing light, small and large suction. If occlusal rests placed will need etch syringe, transbond, paste, liquid, brush applicator.
7. Bonding tray-adjustment set up tray plus cotton plier, cheek retrators, etch syringe, small and large suction tips, bracket holder, concise paste A/B, concise liquid A/B, enhance, brush applicator, toothpick, mixing stick, archwires.
8. Adjustment tray-weingard, birdbeak, straight cutter, end cutter, mirror, scaler, exployer, Mathieu.
9. Repositioning tray- adjustment set up, cotton plier, cotton rolls, band remover, deband plier, high speed with acrylic bur, bite stick, mixing pad and stick, etch syringe, large and small suction, band lok, concise paste A/B, concise liquid A/B, enhance A/B, cheek retract, brush applicator, chapstick or wax, bracket holder,archwires
10. Bonding of 2nd molars tray-adjustment tray, cotton plier, 2nd molar bracket holder, cotton rolls, driangles, small and large suction tips, brush applicator, archwires.
11. New patient exam tray- Mouth mirror, millimeter ruler.

ORTHONDONTIC BANDING BAG

The following items will be given to the patient after their banding appointment and you will need to visually and verbally go over everything with them and a parent if here. Bag includes-travel and regular toothbrush, floss, floss threaders, proxy brush, tooth brushing guide, food list, fluoride, wax.

Progress notes are written documentation of what occurred during a patient’s orthodontics procedure in a standardized form. Once the procedure has been performed, the assistant is responsible for filling out all progress note entries, dating, initialing, and obtaining the doctor’s approval or head tech’s approval once completed.

Some patients experience anxiety and/or nervousness at the orthodontic office. It is our job to alleviate as much of this as possible, both before and during the patient’s orthodontic treatment. The nervous patient can be difficult to treat. The best environment in which to do so is one that is quiet and free from external noises and movement.

Reassurance is also important. This patient must be assured that the treatment delivered will be done with the minimal amount of discomfort possible. It is important to keep this patient relaxed and comfortable. We can all take part in making the nervous patient’s visit to the orthodontist a successful one.

STAYING ON TIME

It is extremely important that we, as an office, stay on time for our patients. Our being on time ensures us and the patients that all procedures for which he/she is scheduled that day will be completed.

STOCKING OPERATORY

All orthodontic drawers should be correctly stocked with orthodontic supplies-

Gloves, cotton rolls long and short, bibs, cavicide, 2x2 gauze, curing light bags, light handle covers, large/small suctions, masks, air water syringe tips, mouth mirror, articulating paper, floss, lighters, Chapstick,white marking pencils, ligature ties, silver/clear power chain, open coil springs, color ties and wax.

OPERATORY CLEAN UP AFTER

PATIENTS HAVE BEEN TREATED

The following are the steps that need to be taken immediately after the patient is dismissed to the front desk to check out:

1. Remove all non-disposable items from the tray
2. Wipe everything with cavicide, let air dry. Wipe orthodontic chair, including arms and near headrests, tray, air and water syringe, counter tops, doors and operatory light.
3. Reset chair in the upright position ready for the next patient to be seated.

UNTRASONIC LOADING

Ultrasonic removes debris from instruments prior to the sterilization process. All loose instruments are loaded into the basket of the ultrasonic for 10 minutes. Once the ultrasonics are loaded, turn the dial clockwise to activate the unit. Set the timer, the units agitate and remove debris from the instruments prior to autoclaving. After the cycle is complete, remove the basket with the loose instruments and rinse thoroughly with water and place in the stainless steel colander to dry. When the loose instruments and cassettes are dry, they are then ready to be wrapped and sterilized in the autoclave. All plier hinge instruments must be dipped in milk bath solution prior to sterilizati9on do not rinse

CARE OF ULTRASONIC

The solution in each must be changed every week 2 x’s a week.

Drain each unit. The valve for the ultrasonic drain is located on the side where the hose is attached. Remove the stainless basket, wipe the inside, outside and lids with a damp cloth.

Clean out traps located in the bottom of the unit.

Clean stainless steel tray and basket, and then replace it in its proper unit.

Close units’ drain valve.

Fill the ultrasonic with enzol( 2 pumps). Fill up the rest of the unit with distilled water.

HOW TO USE THE AUTOCLAVE

First, wrap all instruments in either bags or cassettes, whichever is appropriate

Place the instruments to be sterilized in statim. Do not overload

Open the door of the autoclave and place trays on the rack in the autoclave.

Close the lid, place in statim press pouch button and start

After autoclave has cycled(when the bell rings) Be careful! Steam will be released! When beeps after venting press stop button pull cassette out open remove bags place on towel to cool.

All instruments are sterilized in the statim especially instruments that normally penetrate soft tissue (band removers, scalers and burs) must be sterilized after each use. All instruments should be cleaned to remove blood and saliva. Cleaning may be accomplished by placing instruments in the ultrasonic, rinse prior to heat sterile. Metal and heat stable orthodontics instruments should be routinely sterilized between each use by steam under pressure (autoclaving). Pliers need to be dipped in milk barrier bath after rinsing.

CLEANING INSTRUMENTS

Remove debris(elastic ties etc.,) instruments from trays get wiped off any cement or adhesive first then gointo the ultrasonic solution, including pliers, scalers, exployers, bracket holders, burs etc., These are to be in the ultrasonic for about 20 minutes. Rinse thoroughly then dip pliers into milk bath. Plastic are placed into autoclave bags and ran thru plastic cycle or statim clear side down. Bagged instruments get placed clear side down on metal tray and get autoclaved.

COLD STERILE ONLY’’’’

Clear cheek retractors and plastic alginate trays. Cold

disinfectant is located in sterile lab

Cleaning the cold disinfectant the solutions must be changed every 28 days. Empty each cold sterile container, wipe clean using Clorox cleanup and refill with new cold sterile

solution.

KEEP INSTRUMENTS STERILIZED

Every day we work together as a team so our schedule can flow smoothly at all times. It is very important for the sterilization process to flow smoothly, also. For example, we should never run out of adjustment trays. When we don’t stay on our job with instruments, they tend to pile up on top of the ultrasonic and in the sink. This looks very unprofessional and unorganized.

In order to maintain a smooth flowing and professional atmosphere with the instruments, please follow these steps.

1. Do not just set the instruments on top of the ultrasonic or counter top.
2. If there are instruments in the ultrasonic, take them out.
3. Place instruments in ultra sonic basket.
4. When ½ full run thru ultrasonic
5. Place instruments in sterilization bags and run the statim

Before taking a lunch break, check to make sure all instruments are running in the ultrasonic, drying or bagged and ready to be sterilized. Keep it flowing! Remember to run the autoclave if it is full. This will greatly help the other staff members.

DAILY ROUTINE

1. Turn on room lights and open blinds
2. Check for cleanliness and neatness
3. All clinical assistants should arrive 15 minutes prior to the morning patients
4. Check all supplies
5. Put away all clean instruments
6. Set up operatories for the procedure indicated, set up bonding adhesive
7. Turn on computers and chairs
8. Be ready for our patients at 7:30 when they arrive
9. Assist doctor at chair whenever needed
10. Clean chair after each patient
11. Prepare for next patient
12. Keep sterile lab and instruments clean
13. Write down anytime you use the last item or feel we need more of the supplies
14. Keeping the brushing area cleaned all through the day

END OF DAY

1. Be sure all instruments are clean and turn on the statim
2. Clean all operatories-clean suction 1x a month
3. Clean sinks, counters, chairs, brushing area
4. Ensure all lights are off, air is off.
5. If you are the last to leave the office, ensure all the lights are off and doors are locked
6. Make sure the power is off at each chair.
7. Turn off the statim and unplug ultrasonic.
8. Log off all computers at end of each day, on the last patient day of the week shut down the computers all the way

QUALITIES OF A CLINICAL