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teamTALK By Vicki Pralgausky D 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 8 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 www.comda.org ❖❖❖ 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