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Savanna Beddoes

DH220A
December 1, 2015
Dental Office Specialty Observation
For my specialty office visit, I chose to visit Dr. David Wilkinsons Orthodontics office
here in Lewiston, Idaho. My contact person there was Jenn Sharp at phone number 208-7460479. Dr. Wilkinsons office team members included the following individuals:
Jenn: receptionist and schedule coordinator
Nichole: financial coordinator
Jesse: records coordinator and photographer
Nicole: ortho assistant, helps with HIPPA and OSHA as well
Brittany: ortho assistant; helps with school talks
Kayla: ortho assistant; helps with special projects
Jaimie: ortho assistant; helps with special projects
Megan: ortho assistant
Tanya: sterilization technician
Diane: lab technician
Debbie: insurance coordinator
The assistants in the office help with adjustments, bondings, D-bands and are also able to use
high speed handpieces.
The first assistant I observed was Brittany. She has been employed at Dr. Wilkinsons for
the past two years. That morning she was seeing a patient by the name of Matthew in order to
redo an adjustment. One of the first things I noticed is that no barriers were used on the chairs

and equipment in the office. Matthew has had his braces on for the past 20 months and comes in
every six weeks for an adjustment. Brittany first used an instrument called a wine guard to
remove the wire. The doctor then comes over and she explains to him that the patient is open
12 to 12 with a closed spring on the upper left. The doctor removes the side swipe and looks in
the patients mouth at the dentition. He then has the patient occlude. Doctor puts a closed spring
on the wire, checks the length of the wire and determines that it needs to be slightly shorter. The
assistant explains to me that the goal is to consolidate all upper teeth in order to close the space
on the distal of tooth #13. The doctor removes the mandibular wire. He shows me where two
mini screws have been placed into the mandible just below the canines. He explains that the
screws act as an anchor to intrude all mandibular teeth so the patient doesnt occlude so much.
Satisfied, the doctor leaves the assistant to complete the adjustment. The assistant (who is
allowed to where nails) hand sanitizes, uses a bully gauge to measure the contact spaces. She
then uses an air water syringe to rinse the area and uses a set of pliers to place the elastic thread
through the tad to wire an anchor in order to pull the tooth forward. She explains that intrusion is
used to pull bone in and extrusion is used to pull bone out in order to decrease overbite. Brittany
then clips the excess thread away.. She explains to me that she is putting in an open coil spring
and closed spring to open more space and maintain space on the other side. She puts in the
springs and reapplies the bands starting with the maxillary and finishing with the mandibular. As
she puts the band back on she applies color ties. The assistant tells the patient that they would
like to see him back in 3 weeks to change the elastic thread.
The next patient is in for just a very quick check up. The assistant advises me that there
are springs attached to his molars to bring them forward and down and that the patient can get
them off in the next three months once his bite is corrected. She adds a little piece of metal to

compress the springs and then calls the doctor over to check her work. I ask her about the
computer system they use and she advises me that it is called CS Ortho Track. In each patients
chart there is a picture of the patient and they make note of what was done during that
appointment, writes in the doctors comments and when the next appointment will be. She tells
me that adjustments will be every six weeks unless otherwise specified. One of the biggest
differences is the way that the teeth are numbered. Instead of going from 1-16 and 17-32, they
number the teeth 1-8 and then assign the quadrant.
Next, I move to the sterilization room to observe Tanya who is cross-training to become
an assistant. In the sterilization room there is a dirty side and a clean side. Instruments are
placed in the ultrasonic for ten minutes after any visible debris is scrubbed off. Tanya wears
gloves but no mask or eyewear. There is no autoclave but there are 2 statims, one for bagged
instruments and one for unbagged. A basic instrument pack consists of a hand mirror, explorer,
scaler, 2 cotton pliers, ligature directure, bird beak, wine guard, ligature cutter, distal end cutter
and mattow. Tanya uses lots of gloves going through the sterilization process. There is a tub for
cold sterile, which is interesting to see since we do not have one of these on campus. Items that
cannot be put into the statim stay in the tub for 12 hours, Etch is used frequently in the office.
Each etch tube is sprayed with birex for reuse and the tip is thrown away. There is a separate
cage for burs. Trays are Caviwiped, sprayed with Birex and left to air dry. There is a separate
room off to the left that is used for lab. Retainers, molds and other appliances are created and
stored in this room.
Next, I am able to observe a bonding appointment. This is a 1 hour appointment. The
assistant is Jaime and the patient is thirteen year old, Sydney, who is accompanied by her mother.
Sydney is there to correct her crossbite. Jaimie explains that they have previously taken an

FMX, side x-ray set and pano, and that this is her initial appointment with doctor to have braces
applied. Jaimie inserts a cheek retractor to keep mouth open and to keep the dentition dry and
isolated. A suction goes in over the tongue to dry the teeth. She then paints etch on all buccal
surfaces, leaves it on for 30-40 seconds, rinses the etch off, suctions, blows air until a frosty
white color appears (much like with sealants) and the area is completely dry, primes with proseal
light cured primer and a tiny brush, and then light cures adhesive on the base of each bracket and
pushes onto the center of each tooth, removing extra adhesive as she goes. She moves left to
right in the mouth, posterior to anterior in each quadrant. She explains that she is bonding
different teeth at different levels so that everything blends well. It is after this that she calls the
doctor over.
After placing the wire, doctor changes the rotation on the brackets to get roots parallel.
The doctor explains that this will bring Sydneys smile into focus. A bracket bonding gauge is
used to position the brackets correctly. Doctor explains that he wants to move tooth #7 down to
look longer as it has had a delayed eruption. A soft tissue laser can also be used to help assist in
this. Doctor uses an explorer to position and center the brackets and then light cures each
bracket for 6 seconds. After trhis the suction is removed, the wire is placed, excess length is
clipped off, and the mattow is used to place rubber bands. Doctor begins with mandibular and
then moves to maxillary. He informs me that radiographs will be taken every six months, and
that wires will progress and be adjusted accordingly. Bands (the colored part of the appliance) is
changed every three to six weeks. At this time, the doctor exits the room and Jaimie takes over
again. She has the patient watch an informational video and gives her a home care kit consisting
of a proxy brush, wax, timer, mirror, orabase, disclosing tablets, flossers, a toothbrush and
laminated pamphlet of dos and donts. OHI is not demosnstrated, but the patient is instructed to

continue to see her regular dentist every six months for cleanings. She also explains Ortho
Bucks to Sydney. Multiple Ortho Bucks can be earned at each visit. Good oral hygiene must be
exhibited at each visit in order to be eligible. One Orhto Buck can be earned for:

Exhibiting clean teeth and healthy gums


Arriving to your appointment on time
Having nothing broken or loose
Achieving academic excellence (As or Es)
Wearing Wilkinson Orthodontics T-shirts to scheduled appointments
Winning office contests
Liking Wilkinson Orthodontics Facebook page

Ten Ortho Bucks can be earned for referring a friend. Ortho Bucks are saved by the patient
throughout their treatment and can then be cashed in for a gift card when they have their braces
removed. The patient also has the option of submitting their Ortho Bucks for a donation to the
charity of their choice. I ask Jaimie some more questions about the procedure and she informs
me that molar bands will be placed at the next appointment, that doctor uses the traditional
method more than Invisalign and that lingual bars and retainers are placed after the braces come
off.
Returning her attention to the patient, Jaimie advises her that she should work the angles
of her brush in four different ways. She also warns about decalcification due to not brushing
adequately. She tells Sydney that she may use sugar free gum, that she should brush four times a
day, floss once daily using the floss threaders, and use a mouth rinse with fluoride before bed
each night. She instructs the patient to avoid hard, crunchy and sticky foods, and to use a knife
to cut all food rather than trying to tear food with her teeth. She explains to Sydney that it is a
heat activated wire so it is flexible and will not break, but to stick to soft foods for the next few
days. Sydneys next appointment will be in five weeks. At that time bands will be applied, and
then adjusted every six weeks accordingly. Jaimie places build up on the patients most posterior

molars. This is an adhesive so when she bites down she will not knock brackets off. The doctor
comes back to inspect the dentition and Jaimies work. The patient signs an agreement with the
doctor and is dismissed. Chairs are birexed and wiped down and instruments brought to Tanya in
the sterilization room.
After observation, I sit down with the doctor for a bit to ask him some more questions.
He advises me that they have 4 chairs, 5 assistants working at a time, and see anywhere between
60 and 80 patients a day. Four spots are reserved for new patients each day. They do not where
gowns in the clinic but everyone wears matching scrubs. Nails and any shoes are permissible.
Braces may be applied for a number of reasons including: traumatic occlusion, deep bite,
missing teeth, habit of tongue thrusting, poor occlusion, overjet, underbite, crossbite, or loss of
space. The services offered at his clinic include ortho, laser, invisalign, molds, retainers, night
guards and mouth guards. In addition, the doctor states that when charting, the assistants are
asked to record the archwire set, when the next appointment is, what was done that day, the
treatment plan, and a 10 point check list to make sure that the doctor is thorough.
Personally, I found this assignment to be one of the most interesting observations thus far.
It made me want to work in an orthodontics office (even though I know they do not staff
hygienists). I was surprised that gowns and other PPE were not worn such as face masks and
protective eye wear, and that nails were permitted. I was also surprised that barriers were not
used on chairs. It was new and interesting to see the cold sterilization set up and in use. I think
it would be neat to have separate rooms for the lab and for sterilization like they had at Dr.
Wilkinsons office. This doctor was incredibly personable with both his staff and his patients. I
thought the idea of Ortho Bucks was absolutely genius, and really enjoyed that he gave the
option of donating to charity. I would really like to observe at this office again and must say that

I am disappointed that orthodontists do not employ hygienists, as I found this to be such an


exciting field. The doctor took me around the office to show me before and after pictures of his
most successful patients and I was absolutely blown away at the difference. One of the reasons I
chose this profession was to make a difference and help people with their smiles as I know how
much it can affect a persons self-esteem. Seeing the pictures of what a difference dentistry can
make really impacted me. Dr. Wilkinson and his team really took the time wo explain things to
me and to the patient, and I would recommend observation with him to anyone looking to
observe at a specialists office.