GENERAL

PRACTICE OFFICE
OBSERVATION
AND INTERVIEW

Reyna Gutierrez

DH234
 On the third floor of the University Health Services Building at the University of Oregon

is a full-service dental clinic that is open year-round. This dental clinic operates Monday through

Friday and offers services exclusively to the faculty, staff, and students at the University of

Oregon. Currently, this office does not see children; however, this is something they hope to

offer soon. This office operates with one dentist, Dr. Jason Ellis, two assistants, and two

hygienists. I interviewed Bethany, a previous graduate of Lane Community College. The

University of Oregon dental clinic has operated with one hygienist since it opened over twenty

years ago. However, due to the increased number of patients, Bethany was hired as an additional

hygienist last year.

Communication within the office is simple because of the smaller office size and

workforce. There is one monthly meeting and no morning huddles between hygienists and the

doctor. The schedule is color-coded based on the treatment being provided, which alerts the

dentist, hygienists, and assistants to the nature of the appointment. The hygienists work

independently, receiving no assistance during each appointment. If an exam is indicated, the

hygienist leaves their operatory to ask the dentist for an exam verbally.

Once any appointment is scheduled, reminders are communicated via phone call and text

to the patient. Additionally, hygienists can communicate with their patients via text through a

portal specific to the University of Oregon. For example, Bethany forgot to write down one of

her mouthwash recommendations for her patient but was able to send a text through their portal

system after they left. Once a hygiene appointment is completed, the next appointment is set at

the front desk unless the patient is about to graduate or move. All fees are first billed to the

patient's insurance, and if no insurance is provided or there are additional fees, they are billed to

their University of Oregon student account.

 As previously discussed, appointments are colored-coded based on the type of procedure

being performed. The system for scheduling these appointments and record management is

called "Fuse Dental." According to Bethany, Fuse Dental is a lot like Eaglesoft, which are both

products of Patterson Dental. When scheduling regular prophy or maintenance appointments,

each patient is scheduled for an hour. Bethany said she likes to set aside one hour per quadrant

when performing SRP procedures. She said there is a lot of flexibility, and hygienists get to make

the call about how much time they want to be allotted to each appointment based on each

patient's needs.

Chart notes for each patient include patient vitals (blood pressure and pulse), cancer

screening, dental history, history of ortho, medication list, allergies (medicaments,

environmental, food), description of hard and soft deposits, periodontal stage and grade, patient

plaque control, tissue statements, bleeding on probing, degree of staining, treatment provided,

current home care and oral hygiene instruction provided, if there is a prescription given, PARQ,

the next RDH appointment, next appointment with Dentist which including referrals, and a social

section where the clinician fills in their anticipated graduation date, major(s), and interests. In

addition to these chart notations, the type and amount of anesthetic is included in the note when

completing non-surgical periodontal therapy appointments. Upon the conclusion of every NSPT

appointment, a complimentary bottle of chlorhexidine is given to each patient. Unlike Lane

Community College, where the clinician must write out each finding, the autonote at the

University of Oregon is set up like a questionnaire, where clinicians must select the correct box

pertaining to their findings in each section of the note. Once all boxes are checked, and all

sections are completed, the note is automatically generated in an easy-to-read format. At this

time, the hygienist can add additional information when necessary.

 Initial patient exams are scheduled with the dental assistant and the doctor. Indirect

bitewing images, panoramic images, and select indirect periapical images are the only

radiographs taken at the University of Oregon dental clinic; the assistant takes them. During the

initial exam, bitewing images are taken, the dentist conducts an exam to identify restorative or

additional needs, and then a hygienist enters to complete a periodontal assessment. After this

assessment, the dental hygiene treatment plan is created in collaboration with Dr. Ellis. The

assistant is in charge of discussing fees while the patient is still in the operatory.

A common need uncovered during these initial appointments is a mouthguard. The

University of Oregon dental clinic is responsible for taking the dental impressions of their

student-athletes. The assistants take these impressions, which are then sent to a business that

fabricates the mouthguard. There are several designs for student-athletes to choose from, all

centering around their school colors and mascot. During the initial appointment and throughout a

student's time at the University of Oregon, referrals are common due to a younger population.

Common referrals are for third molar extractions, orthodontics, and to an endodontist for root

canal therapy. Sometimes patients must be referred to a periodontist if they are non-responsive to

NSPT treatment or if the extent of bone loss and calculus buildup is too great.

For maintenance appointments, bitewing radiographs are taken once a year, and

periodontal charting is completed once yearly as long as the patient is stable. If patients present

with 5mm or higher pocket readings, Bethany will often chart or spot-probe the areas again.

Otherwise, bitewing and periodontal probing are alternated every six months. For example,

periodontal charting is due when bitewings and an exam are due at the next appointment. All

three procedures I observed were maintenance appointments. The patients had received their
bitewing images and exam at their previous appointments, and they were due for a prophy and

periodontal probing.

Each appointment began with a medical history check followed by vitals. Periodontal

probing was next and completed electronically using the Florida Probe system, which utilizes a

voiceworks headset for periodontal charting. Periodontal probing was completed in less than 5

minutes using this system. Next, Bethany spent a few minutes discussing oral hygiene instruction

and discovering how the patient cares for their teeth. A Bobcat Pro 25K was used on each

patient, and then hand scaling was completed using a combination of scalers. The power scaling

and hand scaling took about 15-20 minutes. Next, polishing was conducted using the lightweight

Nupro freedom cordless polisher and completed within 3 minutes. This office does not have an

air polisher unit. Bethany always spent time during each appointment discussing the patient's

current classes, future educational plans, and plans for summer.

Suppose a patient is indicated for non-surgical periodontal therapy. In that case, the first

appointment may be a debridement dependent upon the amount of calculus present, followed by

the beginning of NSPT treatment at their next appointment. If the patient requires treatment

localized to 1-3 teeth in a quadrant, Bethany said she could complete two quadrants in an hour.

Otherwise, a full NSPT quadrant is scheduled for one hour. The topical anesthetic is called

"Ultracare Walterberry," a 20% benzocaine topical anesthetic. This office uses lidocaine,

articaine, and Oraqix, as indicated. Other services provided by the dental hygienist at this office

include dental sealants, local anesthesia for NSPT patients, and intraoral photos. After NSPT

treatment, Bethany likes to see the patients back every three months to provide periodontal

maintenance procedures and check pocket depths. Once stable, which she defined as improving

or stabilizing pocket depths and biofilm accumulation, the frequency changes to 4-6 months.
 According to Bethany, the clinic sees about 20% SRP patients, 20% debridement patients,

20% Scaling in the Presence of Inflammation, and 40% Prophylaxis patients. She said it's been

interesting working with patients from all over the world, and she's noticed that many patients

have never had scaling procedures completed subgingivally. Because of the wide array of

patients Bethany sees, she prepares her trays according to which procedure she is scheduled to

complete that day but keeps packaged, sterile instruments in drawers in her operatories in case

she ever needs them.

Bethany's periodontal maintenance tray includes the following: mirror, Shepheard hook

explorer for the Dentist, periodontal probe, anterior sickle (SH5), anterior universal (SBH5/6),

posterior universal (SBH1/2), and Montana Jack (R138). For SRP patients, her tray set-up

includes the R/L cavitron inserts, files, and Gracey's (1/2, 11/12, 13/14). She said she will grab

her SRP instruments if her patients have severe recession. Re-tipped instruments are never used

at this location. When instruments are worn out, reordering what she needs is never an issue.

Bethany mentioned it's hard to find the time to sharpen and does it when she can. She uses the

same sharpening wheel we were issued at Lane Community College and the Sharpen-Rite guide,

which are kept in her operatory.

The only homecare supplies they have to give out are toothpaste, toothbrushes, and floss,

which are all of limited quantity. Frequently they run out of homecare supplies. The good news?

Just two floors down from the dental clinic is the University's pharmacy. At the pharmacy,

students can purchase their prescribed fluoridated toothpaste as indicated, Sonicare toothbrushes

for $60, manual toothbrushes, dental floss, and toothpaste for a very reasonable price. Although

they do not sell these products at their office or the pharmacy, Bethany loves to recommend
Smart Floss by Dr. Tungs, Expanding Cocofloss, and a Waterpik. She noted that the Waterpik is

about $40-50, making them very affordable for students.

This office consists of one dentist, two assistants, and two hygienists. The dentist

oversees everyone in the office; however, because they are all employees of the University of

Oregon, they are all union members. The assistants are in charge of new patient radiographs,

medical history, discussing the treatment plan, including the fees, and maintenance of the

autoclaves and weekly spore testing. The hygienists are responsible for assisting with the dental

hygiene diagnosis and treatment plan and caring for their assigned patients. Each member of the

office helps with sterilization procedures, and each member is responsible for disinfecting and

setting up their room and suctioning at the end of the day. The University has a cleaning crew

that vacuums and takes the garbage out at night. Since the Covid-19 pandemic, gowns and N95s

have been used. Gowns are not changed between patients on the hygiene side, however, there is a

washer and dryer unit in-house to wash them at the end of the day. Laundry is a team effort and

is completed by whoever has time.

Asepsis and infection control are similar to how we operate at the LCC dental clinic. At

the end of each appointment, instruments are gathered and taken to the sterile room, where they

are promptly added to the ultrasonic before going into the autoclave. Once going through the

autoclave, instruments are rinsed and then packaged. Since Bethany does not use cassettes, all

her instruments are kept together in one sterilizable pouch and sealed until their use. The room is

then wiped down using 4X4s and Cavicide before placing plastic barriers. The only difference I

saw was the ultrasonic handpiece was wiped down instead of going through the ultrasonic each

time. Everyone is responsible for sterilizing their own instruments, however if someone has extra

time, they assist others and load the sterilizer, increasing efficiency.
 My general impressions of this practice are professional, warm, and relaxing. The facility

was small but beautiful, having large windows that overlooked campus. The women at the front

desk and the employees in the office were warm and welcoming. Nobody seemed rushed in-

between patients, which helped with the calming atmosphere. Bethany has said she has enjoyed

her time at the University so far, and the environment is much more relaxed than in some offices

she has worked. What impressed me the most about this clinic was that everyone seemed

genuinely happy to be there. I wish I had known about this clinic when I attended the University

of Oregon. I used the student health clinic each year which is located on the first floor however, I

had no idea the same building housed a dental clinic. What an excellent option for students who

have moved away from home.

University of Oregon Dental Clinic

Faye Young, EFDA

541-346-2752
Dental Services Manager

https://health.uoregon.edu/dental