Chelsea Litton

Dental Office Specialty Observation

DH220A
I observed at Chvatal Orthodontics in Eugene. The services provided at this office
include treatment for some common dental problems such as crowded teeth, open bite, deep
overbite, congenitally missing teeth (missing lateral incisors), underbite, overjet, and spacing of
teeth. This office Invisalign treatment and does a variety of styles of braces including: traditional
metal braces, self-ligating braces, clear (ceramic) braces, clear removable aligners, and lingual
braces.
I observed a full banding procedure for self-ligating braces on a young female patient.
Before the banding procedure began, the dental assistant took the patient to another room to take
a lateral cephalometric radiographic image with the Orthoceph. All patients also have a
panoramic image taken (this patient already had one on file) and then taken every 6 months to
monitor progress. Cephalometric and panoramic images help with diagnosis and treatment
planning.
The banding procedure began with the dental assistant drying the mouth with some
cotton 2x2s and placing a cheek stretcher in the patients mouth. The assistant proceeded to place
an etching conditioner on all the facials of the maxillary teeth. This was set for 30 seconds and
then was rinsed off with air/water and high-speed suction. The assistant then placed a sealant
called ProSeal on the facials of all of the maxillary teeth except for the maxillary molars which
she placed Transbond Plus because it is water/saliva resistant.

The braces were then placed on each tooth, the brand of braces they use are called
Innovation braces. The braces were tooth specific and were numbered based on Palmers
notation (this is where the centrals are 1s and laterals are 2s etc.). Once the assistant placed all
the maxillary braces, Dr. Chvatal came over and placed them exactly where they needed to be
using a bracket height gauging device. The assistant cured them with the curing light. The
assistant then clipped an arch wire so it could fit into the patients mouth. To clip the arch wire,
the assistant used a distal end cutter, she then placed the wire in each bracket with a directing
tool. Because each brace is self-ligating, the wire is closed in by each individual brace without
the need for bands. Once the wire was placed, the assistant then placed crimp stops so the arch
wire will stop from sliding past a certain point. This whole procedure was then done on the
mandible. Once the mandible was completed, the assistant placed an orthodontic wax to help
prevent the wire from poking the patient.
The office doesnt employ a dental hygienist, but they do provide oral hygiene
instructions. The oral hygiene instruction was given by the dental assistant and this included
tooth-brushing, use of a floss-threader, and interproximal brush. The assistant also gave the
patients mother a detailed list of food regulations to help keep the braces intact. The patient was
instructed to come back in 8 weeks to see progress and change out the arch-wire.
The office team members included:

Kara- the scheduling coordinator, she is the front desk employee who schedules
all appointments for the office.

Tashara- the treatment coordinator. She is the first person a new patient would
meet with once the patient is referred to the office. She can answer many
questions the patient may have about their treatment.

Courtney- the financial coordinator and office manager. As the financial

coordinator, she works with the patients and their insurance companies to make a
payment plan that the patient can afford. As the office manager she supervises the
rest of the administrative staff and ensures that they have all supplies that they
need in the office.

Brandon- is an aid for the clinical staff in the office. He has many duties including
pouring up dental impressions, sterilizing instruments, sending impressions to the
lab, making sure everything is stocked (in clinical area), disinfecting units, and
taking out the trash.

Chelsea, Makenzie, Amanda, and Marissa are all orthodontic assistants. The
assistants aid the orthodontist with treatment (preparation and finishing work),
taking radiographic images, educating the patients on oral hygiene and appliance
care, and are with the patient for the majority of the appointment.

Brad Chvatal, DMD, MS is the orthodontist at this office. He is a specialized

dentist in treatment of improving patients smiles through correcting teeth
alignment and development of facial structure. Dr. Chvatal will also develop the
treatment plan and diagnosis and supervise the assistants in the orthodontic
procedures that need to be done.

The software used at this office is Dolphin Imaging and Management which is designed
specifically for orthodontic practice. This program includes a customized tooth chart where arch
wire sizes, elastics, power-chains, brackets, brands, archives, c-chain, ligating, primary dentition,
unerupted, and impacted can all be charted. The orthodontic information can all be charted as
proposed (prescription charting) or existing. The program also includes a torque chart, bracket

height chart, and a patient GPS so all the assistants and the dentist can follow what everyone is
doing (i.e. which chair the dentist is at and where the dentist needs to go next, how many patients
are scheduled, who has checked in at the front desk, and who has completed their appointment).
The GPS system is good to have in this type of office when there is only one dentist but possibly
up to 6 patients being seen at the same time.
Sterilization, disinfection and infection control procedures are similar to our procedures at
LCC. This office has the same Midmark Ultraclave and Statim that our office has and they also
have a small Biosonic ultrasonic cleaner. The sterilization room has a dirty area that all the
instruments and cassettes are placed after patient treatment. After instruments are sterilized they
are placed in a clean cupboard. For disinfection procedures they use Birex spray and DisCide
disinfectant wipes for all the dental units.
The main difference I noticed in our clinic and this office is the amount of plastic that they
use. There was only a small amount plastic used at this office but the procedures that they
perform at this office are in less need of the precautions that we take. While I think that they
have a good system for sterilization and infection control, I dont think that we should adopt their
techniques. For a smaller office that doesnt perform scaling and other procedures that often
produce blood their techniques are adequate. At the LCC clinic we have many patients,
clinicians, and students all working together. Because of the amount of people working at our
office, the procedures that are performed at our office, and since it is a school where students are
still learning proper sterilization and infection control techniques I think that our infection
control and sterilization procedures should stay the same.
A general dentist could refer to an orthodontist if the patient has any form of malocclusion
that is affecting them currently or could in the future. There are many reasons for a referral to an

orthodontist: crowded teeth, open bite, deep overbite, congenitally missing teeth (missing lateral
incisors), underbite, overjet, and spacing teeth. The corrective procedures performed by an
orthodontist can not only improve appearance but can also improve function (i.e. someone who
has difficulty chewing). Some orthodontic procedures can also help with sleep apnea, jaw pain,
and even speech impediments.
I was very impressed at my visit to Dr. Chvatals office. I was surprised with the amount of
productivity at this office. When I first went there, I was expecting to see one or two patients
because there is only one orthodontist, but there was often 6 patients there simultaneously. The
members of the staff worked as a team, and the dental assistants were very competent with
patient treatment, so the orthodontist wasnt needed that often. I was also impressed with how
current they were with products. For example, they have and iTero intraoral camera that does
digital scans of the teeth and bite to make a 3D impression.
Patient satisfaction and motivation was very important at this office. I think this is a great
focus because majority of their patients are young people. This office had tools to keep these
patients more excited about coming to their appointment and taking good care of their
orthodontic appliances. This office would often give out free shirts, gift cards, and other prizes
for the young patients who would come in to the office. They hold different types of contests like
bringing in Halloween candy (so the patient isnt eating it) in exchange for tokens to win
something like an iPad or movie tickets. Overall I think it would be enjoyable to work in an
office like this