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By Vicki
Delegation of orthodontic procedures
uring active treatment, every orthodontic
appointment has a typical sequence of events,
and most orthodontists have developed specific
sequences they follow. The sequence can vary
from the assistant performing most of the clinical
procedures to the orthodontist performing most
of the procedures with little assistance.
So the question is: who should do what? By the way,
in California, we have two levels of clinical assistants
in orthodontic offices: the Dental Assistant (DA) and
the Registered Dental Assistant (RDA). The RDA
has training and license to perform more complicated
procedures in the mouth.
The Routine Adjustment Visit
At the PCSO Annual Session in Honolulu, my
colleagues and I had the opportunity to speak
with people from other offices and learned how
they handle the sequence of events for the routine
adjustment visit. For the most part, larger practices
had more assistants and the doctor spent less chair
time with the patient and assistant during bonding
procedures. Smaller practices had more doctor
time with each patient and had more four-handed
procedures. The flow of the office is definitely
a factor in how it affects the level of delegation.
Some of the larger practices allow only 15 minutes
for routine adjustment visits, whereas some of the
smaller practices schedule up to 30 minutes.
To find the right time for any kind of appointment,
try timing your procedures to figure out how
much time the assistant and doctor really need.
The second issue is choreography. If there are
three patient chairs for bonding upper and lower
brackets, two of the chairs can be prepped while
the third one is ready for the doctor to start.
Obviously the doctor cannot be in all three chairs
at the same time, so the assistants will begin the
procedure without the doctor. By the time the doctor is finished with the third chair, he or she can
move to the second, and then the third chair.
The appointments can be scheduled to make
this work by tracking the doctor time throughout the day. Many offices can accomplish this;
it just takes trial and error.
Sequence of Events
In many orthodontic practices, the assistant
seats the patient, makes some small talk and
then checks for broken parts and evaluates hygiene.
She or he will remove the ties and have the patient
brush and give oral hygiene instruction as needed.
When the orthodontist sees the patient, the assistant can update the orthodontist on current
status. Then the doctor can make any adjustments
and instruct the assistant regarding completing the
appointment and future scheduling. Doctor chair
time should be about 10 minutes. After the orthodontist has done the examination, the doctor will
then move on to the next patient and the assistant
can finish up the patient with the orthodontist’s
instructions. Ideally, the orthodontist will not have
to take extra time to re-examine the patient after
the assistant is finished. During the new assistant
training period, this might happen when the orthodontist wants to make sure the instructions were
followed clearly.
With good training and experience, an assistant
can anticipate the doctor’s typical moves at the
appointment before he or she sits down and examines the patient. Then the supplies and instruments
will be ready. This, of course, takes time and experience, but it does make the flow of patients move
more efficiently for the assistant and orthodontist.
In Conclusion
Two key points to remember are:
Allow adequate doctor time for each patient.
Stagger the scheduled appointments according
to the time the doctor needs at each chair
(doctor time scheduling).
Furthermore, the assistant is not alone performing
all the orthodontic duties at the appointment, nor
is he or she waiting for the doctor unnecessarily.
For more information, recent updates on California
RDA functions, and a list of permitted duties,
go to
Victoria Pralgausky graduated from the DVC
dental assisting program in 2000 and took the
state board exam for her RDA license in 2001.
She earned her BS degree in Human Development from UC Davis in June 2003, and has
been working as an ortho assistant for nearly
seven years. Vicki says she enjoys working with
Vicki Pralgausky patients to achieve the smile of their dreams!
P C S O B U L L ET I N • S P R I N G 2 0 0 7