Pediatric Dental Associates

I chose to visit Pediatric Dental Associates in Albany for my specialty office visit. This is a
very busy, and fast paced office! There are two specialty dentists at this office, Dr. Drew and Dr.
Jay (his last name is Vaikuntam). On the day of my visit, Wednesday, November 25, 2015, Dr.
Jay was the working dentist. Although Dr. Jay and Dr. Drew are both the primary dentists at this
office, they do not work together on the same days.
The dentists at this office provide specialty care to infants, children, and adolescents.
Some of their patients are in their early twenties, as they have yet to find a general primary
dentist. Specialty care is also provided to patients who may have physical and/or mental
disorders, such as Down syndrome, or other handicaps. The services provided at this office are
pulpotomy of deciduous teeth, extractions of deciduous dentition due to infection or overretention, amalgam and composite restorations, sealants, applying space maintainers, and of
course, prophylaxis. Nitrous-oxide oxygen sedation is used for all procedures in this office,
along with local anesthetic, with the exception of radiographs and prophylaxis, or if the parents
elect for their child to have treatment without nitrous-oxide administered. In all other
instances, nitrous-oxide never exceeds 40%. The units at this office are automated, and after
placing the nasal inhaler on the patient, the setting is set and the unit turned on. Once
treatment is completed, the assistant or the dentist will press another button that turns the
nitrous-oxide portion off, and the child inhales oxygen only for a minimum of five minutes. The
button for oxygen only administration is usually pressed directly after the treatment is
completed, and the child will inhale oxygen while the dentist speaks with the parent(s) about

post-treatment suggestions. This may include having the child eat on the opposite side of the
mouth from where treatment was performed for a couple of hours to prevent biting of the
cheek or tongue, leaving gauze in the mouth for a couple hours to help stop bleeding, as well as
complications to watch for or to call if they have any concerns.
Aside from the dentists, this office employs several others; three receptionists, a
sterilization person, six dental assistants, and two dental hygienists. Between assistants and
hygienists, each clinician sees eleven to thirteen patients daily for routine dental care. This does
not include treatments in which the dentist performs. This office runs as a team, and everyone
helps each other out. If multiple patients from the same family are being seen, they are usually
brought back together. If there is more than one chair open, then the patients will be seen by
different clinicians. Sometimes there are not always multiple chairs available, though. When
this happens, the sibling patients will be seen individually by the same clinician, at the same
chair, but never with the same tray. If a chair adjacent to the clinician seeing the siblings comes
available, another clinician may come and treat one of the sibling patients.
They have seven treatment areas, labeled chairs one through seven, six of which are
open spaces, similar to our clinic setup. No hygienist or assistant has their own treatment
chair, except Christina (she is their only left-handed clinician). Chair seven is an enclosed room
with two doors on one wall, giving both the dentist and hygienist or assistant easy access in and
out of the room. This room may be utilized if there are not anymore chairs available and there
is a patient waiting to be seen. However, chair seven is mainly used for patients who may not
take well to treatment or who may be loud during treatment due to fear, anxiety, or a

behavioral or mental disorder. It is not meant to isolate the patient, but to prevent negativity,
or something that may be perceived negatively, to be distributed to the other patients being
seen at the time. Another use for this room, though rare, is privacy that may be needed for one
reason or another. Such reasons may be if the patient has an existing condition that needs
follow up on their medical history (HIV for example), or if the clinician or dentist feels a private
consult with the parent or caregiver is necessary. They may want to consult with the parent
regarding home care, or lack thereof, or something they may possibly find intraorally that could
illicit concern for the child. I was not told specifics further than this, but I can guess a couple
things she might be referring to.
They want patients to enjoy going to see the dentist, not be fearful. Aside from using
words that will not scare the child, and also using words the child will understand, the comfort
they seek for their patients is especially evident with their recent remodel. Each chair has a
(fairly large) television screen. With parental permission, the clinician will let the child choose a
movie to watch during their appointment. They have found that it helps the child stay
entertained, and not get antsy and ready to be done before their appointment is completed. It
also aids in keeping the patient looking toward the ceiling, rather than everywhere else. The
child wears headphones so as not to distract other patients, and the volume is controlled by the
clinician, ensuring it is not too loud for the patient. For the sibling patients who may be waiting
their turn, or for patients who may be brought back when there may not be a chair readily
available, there are two iPad stations for those patients to play on while they wait. There are
also a few Nintento DS handheld units and several games to choose from. For the children who
have limited, if any, technology restrictions, it keeps them occupied. For the patients who may

not be allowed to use a lot of these devices, as long as their parents allow it at their visit, it
gives them incentive to see the dental team. At the end of any appointment, when dismissed,
each patient is given two tokens to put into a vintage style gumball type machine. It has eight
different prizes to choose from, and with the two tokens, each patient gets two prizes.
Madison, Karen, and Teresa are the receptionists for the office. They each play equal
roles in scheduling and confirming appointments, pulling and replacing patient charts, as well as
creating new patient charts for new patients.
Malerie is the offices sterilization technician. She is in charge of making sure
instruments and trays are cleaned, sterilized, and maintained appropriately and efficiently so
the hygienists and assistants readily have whats needed. Hand pieces for rubber cups are a hot
commodity in this office, and when busy, can be on short supply, which keeps Malerie on her
toes. Each morning, Malerie looks at the schedule and sets up trays for ops appointment
patients, and labels these trays with the patients names. These are patients who will be
receiving treatment, such as restorations, extractions, or a pulpotomy. She also sets up several
trays each day for prophylaxis patients. These trays are small in size, and do not contain a lot of
equipment. There are trays for patients size small, medium, and large. All trays are supplied
with maxillary and mandibular fluoride trays, a mouth mirror, suction, air/water syringe, an
explorer, two or three cotton 2x2s, floss, a screw-on rubber cup for the hand pieces, and a
polish holder. The main difference between the three patient tray sizes is the size of the
fluoride trays, small and medium patient (younger to mid-aged pediatric patients) trays are
supplied with a sickle scaler, and large patient (mid- to older aged pediatric patients) trays are

supplied with a universal scaler. Malerie does not have a given number of trays she puts
together. There are three stacking tray holders; one for each tray size. Each morning Malerie
makes sure the stacks are filled, placing newly made trays at the bottom. Malerie is also in
charge of making sure items throughout the clinic are stocked, such as toothbrushes, floss,
cotton rolls (tooth pillows), etc., as well as post-treatment items. Ghosties are one of those
post-treatment items and are used to pack in the area of an extraction to help stop bleeding.
When ghosties are low, Malerie makes more to restock. They are made by unfolding a 2x2
into a long rectangle, opening a small hole in the center of the top layer, creating a nest. A
second 2x2 is then folded or wadded up and placed in the nest. The long ends of the unfolded
2x2 are then tied together into a knot to secure the wad. Malerie also assists the clinicians to
turn over their chairs to get ready for their next patient.
Stephanie is one of the six dental assistants at this office, but she also essentially runs
their office and plays a second role of office manager without the title. She has a similar office
role to our Melanie. Stephanie makes sure that billing in done properly, daily appointment
schedules are put out and scheduled properly, and in general makes sure the office runs
smoothly, while also attending to her regular duties as a dental assistant.
The other dental assistants are Kayla, Emilia, Danielle, Vanessa, and Keyanie, and they
have several duties. They take and mount radiographs, review and update medical histories,
apply topical for local anesthesia, as well as assist Malerie in the sterilization room when
needed and help stock supplies. The dental assistants at this office also perform rubber cup
prophylaxis. The dentists at this office feel that most children, especially the younger ages, do

not acquire heavy calculus buildup, most often resulting in the need plaque removal. The
assistants also get ops patients ready for treatment to be performed by the dentist. This
entails acquiring the correct tray for the patient and the treatment to be completed. The dental
assistants at this office are also allowed to monitor patients under nitrous-oxide oxygen
sedation.
Christina and Katya are the dental hygienists at this office. They have a lot of similar
duties as the dental assistants, such as helping in sterilization, restocking, rubber cup
prophylaxis, and standard prophylaxis requiring scaling, etc. However, Christina and Katya are
frequently called on throughout the day by dental assistants. A dental assistant may ask a
hygienist to administer nitrous-oxide oxygen sedation, to administer local anesthesia, or to
scale for a patient who has calculus buildup, requiring removal by means other than a rubber
cup and hand piece. When administering local anesthesia on a patient, they hygienists are
called upon twice, as they do their injections via a two-step process. The majority of injections
administered are supraperiosteal injections, and inferior alveolar nerve blocks, depending on
the tooth or area to be treated. After topical is placed and has had time to take effect, Christina
or Katya will administer the first injection in which the needle is inserted about 2-3mm (making
sure not to deposit solution into any blood vessels) and a small amount of solution is deposited
(maybe a stopper length). The reason for this is because topical penetrates the first 2-3mm of
tissue, allowing a small amount of anesthetic solution to be deposited and allowed to take
effect. Once the first injection has been effective, a hygienist will administer the second part of
the injection, depositing the rest of the correct amount of solution with minimal to zero
discomfort for the patient.

Both hygienists and assistants report their findings (home care, hyperplastic teeth, etc.)
to the dentist when he/she comes to perform the exam. I did not observe specific home care
being demonstrated to the parent or child, but I did observe the clinicians asking the patients
about home care and their current routine, as well as asking the parent(s) to confirm home care
routines. Any suggestions or modifications were told to the parent and the child by the
clinician. The clinician would also relay this information to the dentist in front of the patient and
the child. It was repetitive, but this way both parent and child heard the information three
times. Hygienists and Assistants also use intraoral cameras to take pictures of different
anomalies or things to monitor as the patient grows and matures, such as occlusion, crowding,
hypoplasia, etc.
The sterilization and infection control procedures at this office are quite different from
those at LCC. They do have a clean and dirty side in the sterilization room. The only barriers
they use on and around the dental units are a plastic headrest cover. Each tray is covered by a
plastic barrier bag, which fits perfectly over the headrest of the dental chair. Christina told me
that their main reason for the barrier on the chair is so theres another use for the plastic and is
not just discarded. The chair, light, all suctions, air/water lines, countertops, computer
equipment (mouse and keyboard), bib clips, and patient glasses are wiped down with
CaviWipes (similar to our Birex wipes) after each patient. The chair is the only thing not wiped
down if siblings are using the same dental chair. Dentists, hygienists, and assistants wear masks
and gloves, but do not wear lab coats or safety glasses during patient care. In the sterilization
room, gloves are the only PPE worn. Trays are either washed in a dishwasher, or wiped with
CaviWipes or sprayed with Cavi spray. Trays are then placed on a drying rack. When trays are

made, there is no barrier between the tray liner and the tray itself. Hand pieces are placed in a
machine that lubricates and runs them before they are put into the autoclave or statim. Items
that can be ran in the ultrasonic bath are done so prior to being sterilized. When items are ran
in the statim or autoclave, multiple items are placed in large sterilization bags, but the bags are
not sealed. Once the instruments and equipment have been sterilized, they are removed from
the sterilizer, removed from the bag, and placed on clean counter spaces lined with clean
towels to dry. Once instruments, hand pieces, and other equipment have dried long enough to
cool down, they are then placed in organized drawers on the clean side of the sterilization
room. Even their air/water tips are autoclavable. Prophylaxis paste, patient glasses, extra
fluoride trays (in the instance the one provided does not fit), cotton rolls, bibs, and bib clips are
kept in drawers at each dental unit.
The day of my visit was the day before Thanksgiving, and most kids were out of school
for the day. Christina and Katya both said that day was the busiest they have been in a long
time. They even got backed up with patients a couple of times in the three hours I was there.
Because they were so busy, I shadowed Christina for the most part, and was only able to
observe two treatment procedures, aside from prophylaxis procedures.
The first procedure I observed was on an eight year old patient who needed an
extraction due to over-retention of a primary tooth. Dr. Jay said this is a somewhat common
occurrence for pediatric patients. The patients #26 was partially erupted superior to its normal
position, but #Q was not very loose and it did not appear that it would be shed on its own.
Christina administered nitrous-oxide oxygen sedation to the patient, and Keyanie came in to

monitor the patient while it took effect. About ten minutes later, after Keyanie placed topical,
Christina came back and administered a two-part supraperiosteal injection of Articaine 4%,
delivering about of a cartridge of anesthetic solution on #Q. Once the area had profound
anesthesia, Dr. Jay came in to perform the extraction, with the assistance of Keyanie. Keyanie
performed suction, while Dr. Jay used extraction forceps (I did not get the exact name of them)
to remove the deciduous tooth. It seemed to be a very fast procedure, and the extraction fairly
simple. Most of the root had been resorbed, but it never gave signs of natural shedding. Dr. Jay
turned off the nitrous-oxide, leaving the patient with only oxygen while he explained to the
parent that bleeding may continue for a couple of hours. If the child experienced any pain,
giving Childrens Tylenol would be fine, but as it was such a simple procedure, the child
shouldnt experience very much pain, if any. Dr. Jay also told the parent to call if bleeding did
not stop within three hours. While Dr. Jay was speaking with the parent, Keyanie went and got
the patient a tooth box to take his tooth home in. Once the patient had received five minutes of
oxygen, Dr. Jay told him how brave he was and how great of a job he did. He also told him that
the extraction was kind of like losing a tooth, so he might bleed for a little bit just like when he
lost his other teeth. Dr. Jay told them to have a good weekend, and that they would see them
next time. Keyanie asked the parent if the tooth fairy visited their house, and the father said
Yes. Keyanie placed the patients tooth in the tooth box and told him that even though Dr. Jay
had to help him get that tooth out, he could still give it to the tooth fairy. The patient and his
dad were both dismissed.
The second procedure I observed was on a seven year old child. He was scheduled to
receive an amalgam restoration on the occlusal surface of #14. Katya administered nitrous-

oxide oxygen sedation, and Emilia stayed to monitor the patient as she was also going to be
assisting Dr. Jay with the restoration. After about five minutes, Emilia placed topical for #14,
and about one minute later, Christina administered the first part of the supraperiosteal
injection for this tooth using Articaine 4%. Once the first part of the anesthesia had taken
effect, Katya came and administered the second portion of the injection using the same syringe,
cartridge and needle. Once profound anesthesia had been reached, Dr. Jay came to look at the
area he would be working on. Dr. Drew had diagnosed the tooth to be restored, but Dr. Jay had
not yet seen the patient. After looking at the treatment area, he opted to not place a rubber
dam. The patients molars were hypoplastic, with minimal amounts of enamel covering the
tooth surface. Dr. Jay felt it would be better to perform the restoration without the use of a
clamp and rubber dam as there was no tooth distal to #14 to anchor to, let alone a tooth with
more enamel. Dr. Jay explained the patients condition to the patients mother, as well as his
reasoning for not using the rubber dam to isolate the tooth. The mother understood and told
Dr. Jay that she also has hypoplasia, especially in the molar region. Intraoral images of the
hypoplastic tooth at his last appointment. Dr. Jay used a friction grip fissured bur to remove the
small amount of enamel, caries and dentin to create the preparation while Emilia suctioned to
keep debris from going into the patients mouth. Once the cavity preparation was complete,
Emilia placed the amalgam capsule in the amalgamator while Dr. Jay removed the smear layer
created by preparing the cavity. Dr. Jay placed the restoration, condensing between additions
of amalgam, while Emilia maintained suction to prevent amalgam debris from falling into the
patients mouth. Once Dr. Jay was satisfied with the amount of amalgam places, he began
carving the anatomy so as to keep the patients appropriate bite and tooth function. After

carving was complete, and no residual amalgam was left in the patients mouth, Dr. Jay checked
the patients occlusion by having him bite down on articulating paper. There was no color left
from the articulating paper indicating high areas, so he asked the patient how he thought it felt.
The patient said his bite was fine and did not feel funny. Dr. Jay turned the nitrous-oxide
portion off, while Emilia removed her gloves and sanitized her hands. She retrieved a cotton roll
from the drawer, and told the patient she was going to put a tooth pillow in his mouth so while
his tooth was still asleep, it would have a nice pillow to rest on until it was awake again in a
couple of hours. Dr. Jay told the patients mother that her son may experience some mild
sensitivity, but should subside within a couple days. He asked if she had any questions, and she
said she did not have any at the time. Dr. Jay told her that if she thought of any, to feel free to
call the office any time. He wished them both a good long weekend, and told the patient what
an awesome helper he was, and that he did a great job. Emilia informed the mother too that
her sons tooth was sleeping on a pillow, and that the tooth may be asleep for a couple of more
hours. She told the mother the reason for the tooth pillow was that it prevented the patient
from biting his cheek or tongue until the local anesthetic wore off. After a full five minutes of
oxygen, the patient and his mother were dismissed.
Prophylaxis appointments are fairly standard at this office. Radiographs are taken prior
to being brought to the treatment area. The clinician places the patients bib and glasses on
them. A clinical exam of the patients dentition is performed and then the child chooses a
toothpaste (prophylaxis paste) flavor. Their entire dentition is polished and biofilm removed,
and if needed, the hygienist scales any areas that may have calculus formation. Homecare is
discussed with the patient and the parent. Once polishing is completed, the clinician flosses

between every tooth, and then fluoride treatment is delivered. After the prophylaxis, flossing,
and fluoride treatment have all been completed, the dentist comes to do the exam. The
clinician tells the dentist of her findings, home care, and has radiographs ready for the dentist
to interpret. The dentist then discusses with the parent his/her findings, and any further
treatment that may need to be completed, such as restorations, extractions, etc.
This office has not yet updated to computer patient charts. They are still using paper
charts. Due to HIPAA regulations, and invasion of privacy, I was unable to view an actual
patients chart. Christina was able to tell me what types of things they put into a patients chart,
though. A patients chart at this office is very thorough (like ours). Procedures and/or treatment
performed, as well as any anesthesia are always recorded, along with type, amount of
anesthetic delivered, and any complications that may have been experienced. Any homecare
suggestions and/or modifications are documented, along with current homecare strategies and
their effectiveness. The amount and extent of biofilm and/or calculus is documented. Special
requests from the patient, such as not wanting the rubber cup to be used, are also
documented. The patients behavior, as well as the parents behavior is also adequately
documented. This is to help the clinician who next sees the patient accommodate the patient as
needed to improve their behavior if possible. It also helps the next clinician know if the parents
actions, words, etc. were a factor in the childs behavior, or if the parent is helpful when
treating the patient. It also lets the clinician document whether the parent is aiding with
adequate home care or not. What the parent gives permission for or denies for the child are
also documented, such as nitrous-oxide oxygen sedation, fluoride treatments, movies and/or
games, etc.

There are several reasons a general practicing dentist may refer a patient to a pediatric
dental office. If a child at a general practice office has behavioral issues that would be better
handled by the staff at a pediatric dental office, they may receive a referral. Other examples of
reasons for referral may be that a child has anxiety when at the dental office, and pediatric
dental offices help ease that anxiety because they see other children as being patients, as well
as the administration of nitrous-oxide oxygen sedation to help ease a patients anxiety. Children
are found to be less anxious if they see their peers going through the same things they are
going through. Extractions, pulpotomies on deciduous dentition, and the need for space
maintainers may be another reason for referral to a pediatric dental office.
I really liked this office! I liked the staff, the way they worked with their patients and
how comfortable the patients were made to feel, and I loved the fast paced environment. I
wish I would have been able to see some more procedures, so Im hoping to go back one day
when they arent so busy so I can actually follow the dentist around to observe him. I was not
looking forward to going to a pediatric office, to be completely honest, but I am so glad I had
the experience. I dreaded pedo days last year, and I have told myself since then that I would
never work in a pediatric specialty office to work with kids day in and day out. After leaving this
office, I told Michelle that after my office visit, I would actually consider working in a pediatric
office. I would suggest that anyone who has children, and does not currently take them to a
pediatric dental office, to start, unless theyre established and comfortable with their current
dentist. My dad took me to a general dental office when I was a child and I remember my very
first experience. I was taken back, my dad stayed in the lobby, and as soon as I saw the sharp
instruments on the tray, I ran out screaming. He took me to a different office two more times

before I would finally open my mouth for anyone. I think if I would have gone to a pediatric
office, it would have been a much different situation.
Since I shadowed Christina for the majority of my visit, I am leaving her as the contact.
The telephone number for Pediatric Dental Associates is 541-928-1509.