TOWNVIEW DENTAL
CLINIC REFERENCE
MANUAL
Xochilt Garcia
Table of Contents
Table of Contents.......................................................................................................................................... iii
Introduction ................................................................................................................................................... v
Chapter One Performing Receptionist Duties................................................................................................. 3
Opening the Reception Area ..................................................................................................................... 3
Handling the Reception Area..................................................................................................................... 3
Infection Control ................................................................................................................................... 3
Safety..................................................................................................................................................... 3
Children ................................................................................................................................................. 4
Creating a New Patient Chart .................................................................................................................... 4
Translating Forms .................................................................................................................................. 4
Handling Appointments............................................................................................................................. 4
Making Appointments ........................................................................................................................... 5
Suggested Procedure Times .................................................................................................................. 5
Handling No-Shows ............................................................................................................................... 5
Billing Patients ........................................................................................................................................... 6
Closing the Reception Area ....................................................................................................................... 6
Chapter Two Performing X-Ray Technologist Duties ...................................................................................... 9
Opening the X-Ray Room .......................................................................................................................... 9
Taking Radiographs ................................................................................................................................... 9
New Patients ......................................................................................................................................... 9
Recurrent Patients................................................................................................................................. 9
Developing Radiographs .......................................................................................................................... 10
Closing the X-ray Room ........................................................................................................................... 10
Chapter Three Performing Sterilizer Duties ................................................................................................. 13
Opening the Sterilizing Room .................................................................................................................. 13
Receiving Contaminated Instruments ..................................................................................................... 13
Working the Autoclave ............................................................................................................................ 13
Instruments that can be Autoclaved ................................................................................................... 13
Bagging Instruments............................................................................................................................ 14
Autoclaving instruments...................................................................................................................... 14
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Twonview Dental Clinic Reference Manual
Storing Instruments ................................................................................................................................. 15
Preparing Trays........................................................................................................................................ 15
Chapter Four Operatory Duties .................................................................................................................... 19
Preparing the Operatory ......................................................................................................................... 19
Preparing the Patient for Procedures ...................................................................................................... 19
Taking Patient Vital Signs ..................................................................................................................... 19
Preparing Patients’ Mouth .................................................................................................................. 19
Working with the Dentist ........................................................................................................................ 20
Maintaining the Work Area ................................................................................................................. 20
Cleaning the Operatory ........................................................................................................................... 20
iv
Introduction
Introduction
The Townview Dental Clinic is a dental office run by student interns who are supervised by a
dentist and a teacher. The Townview Dental Clinic (TVDC) is designed to give the students
experience necessary to pass the Registered Dental Assistant exam and be able to work
immediately in a dental clinic outside of school.
TVDC student interns rotate through various positions throughout the school year to experience
the many different aspects of working in a dental clinic. To maximize the potential intern times
the students begin intern in October after only one month of classroom time. During the one
month, students are primarily taught about infection control and as much as possible regarding
dental clinic procedures and policies. Because the learning time is so short, it is expected that
students may not retain all the information taught. The internship then becomes a “learn as you
go” experience. Since the internship is hands on learning, asking questions is encouraged.
At the TVDC, children of the Dallas Independent School District who cannot afford dental care
are attended. Many children are seen throughout the school year. TVDC stays busy by booking
as many appointments as possible. With many appointments, everyone in the clinic is busy
during the whole working day especially the teacher and dentist. While asking questions is
encouraged, sometimes it is difficult to contact the teacher or dentist because of the busy
schedule. In most cases, it’s a question that has been asked before whose answer is easily
forgotten. In such instances, a quick reference is convenient.
This reference manual is made to provide information quickly and to the point for frequently
asked questions. This manual provides quick references in case one should forget a minor detail
in setting up a procedure and to provide a quick guide as to what a position’s duties are.
It is stressed that this manual is not thorough and does not go into detail about procedures. It is
written for dental assistant students who have studied the course foundations (such as infection
control and safety) and are able to perform safely in the clinic. This reference manual contains
technical terms student interns should be familiar with by the time they begin working in the
TVDC.
If there is a question that is not answered in this manual, it is vital that a supervisor is contacted.
A student intern should never assume or attempt anything without the correct knowledge as this
can be a hazard to both the intern’s health and the health of the patients.
v
Chapter One
Chapter One
Performing Receptionist Duties
A receptionist is important in a dental clinic. As a receptionist you are in charge of maintaining
the patient schedules and preparing the necessary patient paper work.
Opening the Reception Area
At the beginning of the day, there are several tasks you must perform to ensure the clinic runs
smoothly for the day.
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Turn on all lights in the clinic.
Pull patient charts.
Make all the patients charts that are being attended that day readily available.
Make sure all appointments are confirmed.
If not, call to confirm.
Clean countertops.
Handling the Reception Area
The reception area of the TVDC can get a little out of control due to the young children that are
attended. It is necessary to maintain this area under control in order for patients to remain safe.
The receptionist is in charge of maintaining a clean, safe, and calm environment.
Infection Control
Maintaining the reception area clean and disinfected reduces disease from spreading. This is
especially important when working with young children. Keeping the reception area clean is
easy. Simple actions that keep the area clean are:




Disinfectant Wipes. Wipe down the counter and high contact areas (chair arm rests, door
knobs, and pens) with disinfectant wipes.
Do this at the beginning of the day and when the clinic closes.
Hand Sanitizer. Make hand sanitizer easily available.
Offer incoming patients hand sanitizer as they come in. It is more effective if it is done
before they come into contact with clinic supplies such as pens.
Food. Do not allow food or drinks into the clinic.
Food and drinks can potentially carry bacteria and can create messes in which bacteria
can grow.
Contaminated Items. Check the reception area frequently for contaminated items.
This can include gloves, instruments from the operatories, and radiographs. These items
can carry bacteria.
Safety
Maintaining safety in the reception area is important. There are several safety measures that must
be checked for frequently.
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Twonview Dental Clinic Reference Manual
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Check for obstructions. Make sure nothing is obstructing the fire exit.
In case of emergency, the fire exit must be easily accessible.
Check for a clear floor. Reduce tripping hazards by making sure there is nothing on the
floor.
Check chairs for stability. Make sure chairs in the clinic are stable and can support
patients.
Unstable or broken chairs can result in serious injuries.
Check for sharp objects. Make sure all sharp object are cleared from the area and are
not accessible to young children.
Check electrical appliances. Reduce electrical hazards by making sure all appliances are
not damaged and do not have frayed cords.
Children
Young children can be unruly at times. Do as much possible to maintain the children calm.
Unruly children can cause problems in the clinic that can harm them and others. Keeping
children busy is an easy way to maintaining the reception area calm. There are a few options to
do this.
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Movies. Put a movie on.
You can ask the children what they want to watch to make sure they are interested in the
movie and will pay attention.
Coloring Pages. Offer the children a coloring page and colors.
Music. Play music at a low volume to entertain the reception area.
Creating a New Patient Chart
When a patient comes in for the first time, they have to fill out paper work. Without this paper
work, we are unable to attend them. There are several forms a patient must fill out. Present these
forms to the patient before they are seen by a dentist.
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Health History.
The health history allows the dentist to make decisions on medications and anesthetics
that will be administers.
HIPPA Disclosure.
This form allows student interns to discuss patients and treatments within the office for
educational purposes only.
Treatment Consent Form.
This consent forms allows student interns to perform simple non-hazardous tasks on
patients.
Translating Forms
All these forms are available in both English and Spanish. All forms must be translated into
English by the receptionist.
Handling Appointments
As the receptionist, it is your duty to maintain a steady flow of patients. Do not over or under
book the clinic.
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Chapter One
Making Appointments
To make appointments either by phone or face to face:
1. Suggest the next available space in the appointment book.
2. Ask the patient what day it is convenient to book an appointment.
Do not schedule more than two weeks in advance.
3. Suggest a time for the appointment or ask when it is convenient for them to come in.
4. Block off 30 minutes to an hour for the appointment.
This depends on the procedure being performed. (Suggested times are listed below.)
Do not book multiple patients in a time slot unless otherwise directed by the teacher.
5. Once a time and date are settled, ask the patient for the following information.
a. Patient’s full name
b. Working phone number
c. Address
d. School which the patient attends
6. In addition, write in what procedure will be performed.
It is a new patient, write “NP”
If it is not a new patient, check the back of their patient chart. Here, the dentist writes
what will need to be done in the next appointment.
7. Repeat the information for the next appointment to patient.
Suggested Procedure Times
New Patient (Prophylaxis)
Extractions
Fillings (Amalgam and Composite)
Root Canal
30 minutes
30 minutes for one tooth + 10 mins per additional tooth
1 hour
1 hour 30 minutes
Confirming Appointments
Confirm appointments to make sure the clinic stays busy and there is no gaps between
appointments. To confirm appointments:
1.
2.
3.
4.
5.
Call the patient one work day before their scheduled appointment.
Remind the patient of the time and date of their appointment.
Ask the patient if they will be able to make the appointment.
If they say yes, write confirmed on their patient chart and the schedule book.
If they say no, reschedule the patient for a later date.
Handling No-Shows
On occasion, a patient does not attend their appointment and does not call the clinic to
reschedule in advance. This creates a gap between patients that is not productive. If a patient has
more three no shows in their records, TVDC can no longer book them. In the case of a no-show:
1. Cross out their schedule slot in the appointment book in red.
2. Write “NS” next to their appointment.
3. Write their name and the date in the “No Show” section in the back of the appointment
book.
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Twonview Dental Clinic Reference Manual
4. If they had a previous no-show, write the current no-show under the previous one.
5. Notify the dentist and teacher of a no-show.
Billing Patients
The Townview Dental Clinic is a non-profit clinic. We do not take any money from our patients.
There is no need to bill patients.
Closing the Reception Area
At the end of the day organizing the area is important. This is because the next day will run
smoother.
To close the reception area:
1. Clean and disinfect the area.
2. Return all charts and patient files to the cabinets.
3. Turn off all clinic lights.
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Chapter Two
Chapter Two
Performing X-Ray Technologist Duties
As the x-ray technologist, it is your duty to processing radiographs. Because you are not a
registered dental assistant it is not possible for you to take radiographs on patients. This is a duty
which you must have certification in order to perform. The teacher will take all radiographs.
Opening the X-Ray Room
Perform these tasks at the beginning of the day before any patients arrive.
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Turn on the processing machine by flipping the red switch.
Turn on the hot water faucet that is connected to the processing machine.
Run the empty panoramic radiograph in the processing machine.
Turn on the viewing box.
Taking Radiographs
Although you cannot personally take the radiographs, you can make sure the patient’s records
have the correct radiographs. Before appointments begin, check the patient’s files for current
radiographs.
Patients need one set of radiographs throughout their yearly dental experience. A new set of
radiographs are taken every year or when noticeable differences are found. Making only one set
of radiographs a year reduces the amount of radiation exposure a patient receives.
New Patients
A new patient needs four bitewings taken. A new patient is someone who has not received dental
care in six months. A bitewing allows the dentist to see both mandibular and maxillary arches in
one radiograph. The bitewings that must be taken are:
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Left Posterior.
This bitewing should include the left molars and bicuspids.
Left Anterior.
This bitewing should include the left first bicuspid, cuspid, lateral incisor, and central
incisor.
Right Anterior.
This bitewing should include the right first bicuspid, cuspid, lateral incisor, and central
incisor.
Right Posterior.
This bitewing should include the right molars and bicuspids.
Recurrent Patients
A recurrent patient is one who has received dental care in the last six months. A full set of
radiographs is not needed unless instructed specifically by the dentist. In addition to the basic set
of bitewings, a dentist may also request periapical radiographs of individual teeth.
In most cases this is done prior to performing a root canal and the radiograph must represent the
tooth with precision.
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Twonview Dental Clinic Reference Manual
Developing Radiographs
Developing radiographs is your primary duty. Developing radiographs properly is necessary for
the radiograph to be clear and easy to examine. The developing process is easy.
1.
2.
3.
4.
5.
6.
7.
Carry the unprocessed radiograph films from the operatories to the processing room.
Disinfect the films by wiping them with an alcohol disinfectant wipe.
Remove your gloves.
Process one film at a time.
Take a film in your hand.
Insert your hands into the gloves of the processing machine.
Lift the black cover to expose the orange light shield.
This enables you to see what you’re doing without exposing the films to light.
8. Remove the packaging of the film.
9. Discard the packaging.
10. Insert the film into the processor.
11. Wait 6 minutes.
12. The developed film will exit the processing machine through the top of the machine.
Closing the X-ray Room
Perform these tasks at the end of the day.
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10
Turn off the viewing box.
Close the hot water faucet that is connected to the processor.
Turn off the processor.
Chapter Three
Chapter Three
Performing Sterilizer Duties
Sterilizing is an important part of the dental clinic. By sterilizing instruments, many diseases are
avoided. As the sterilizer you must adhere to all rules to avoid any sort of contamination.
Opening the Sterilizing Room
Perform these duties at the beginning of a work day.
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Turn on the autoclave by flipping the black switch at the bottom of the machine.
Fill the ultrasonic instrument cleaner with the enzyme solution.
The enzyme solution is blue, located underneath the sink, and labeled “Ultrasonic
Enzyme Solution.”
Fill the glass Bard- Parker tray with sterilizer.
The sterilizer is also located under the sink. The solution is green and labeled “BardParker.”
Receiving Contaminated Instruments
Once instruments are used in the operatories, they are brought to the sterilizing room to be
cleaned. Follow the following procedure to clean instruments before sterilization.
1. When receiving a dirty tray, place only on the “dirty” side of the sterilizing room.
This is the side which contains the ultrasonic cleaner and the autoclave.
2. Discard of all paper and plastic materials into regular trashcan.
3. Discard of all blood soaked or saliva soaked cotton supplies into the biohazard trashcan.
4. Rinse all instruments with warm water.
5. Run the ultrasonic cleaner.
a. Place all instruments in the ultrasonic cleaner.
b. Turn the knob to 3.
c. Cover the ultrasonic cleaner with the lid.
d. Wait three minutes.
6. Remove the instruments from the ultrasonic.
7. Rinse all instruments with warm water.
8. Dry all instruments completely.
Working the Autoclave
After all the instruments have been thoroughly cleaned they must be sterilized. Sterilization can
be achieved by running instruments in an autoclave.
Instruments that can be Autoclaved
Things that can be autoclaved include:
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Metal instruments
Metal containers
Cotton supplies
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Twonview Dental Clinic Reference Manual
 Plastic biteblocks
All other plastic and glass instruments must be placed into the Bard-Parker cold sterilization
solution.
Bagging Instruments
Instruments must remain sterile after leaving the autoclave. To ensure this, they are placed into
paper bags before being introduced into the autoclave. Bag all the instruments observing the
following guidelines.
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Bag syringes individually in bags labeled “Syringes.”
Bag all instruments individually in the long, thin bags.
Label all bags
Include:
o Bag contents
o Date sterilized
o Your name
Autoclaving instruments
Once all the instruments are dry and bagged, they must be sterilized.
Loading the Autoclave:
1. Place the instruments bags inside the autoclave.
2. Disperse the instruments.
3. Do not overload the autoclave.
4. Close the autoclave door.
5. Pour autoclaving alcohol into the spout.
The autoclaving alcohol is located underneath the sink. This chemical is clear and labeled
“Autoclave.”
6. Turn the top knob to point to “pressurize.”
7. Wait until the pressure needle is in the green area.
8. Turn the bottom timer knob to 20 minutes.
9. Wait 20 minutes.
Unloading the Autloclave
1. Turn the top knob to “depressurize.”
2. Wait until the pressure needle is in the black area.
3. Open the autoclave door.
4. Put on the heat resistant gloves
5. Remove all instruments with gloved hands.
6. Place all sterilized instruments on “clean” side of sterilizing room.
The clean side is the side of the room which does not have contain the ultrasonic cleaner
or autoclave.
7. Let instruments cool.
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Chapter Three
Storing Instruments
To maintain sterilization all instruments must be properly stored. All instruments have
designated drawers. All drawers are clearly and specifically labeled. Place the instruments in the
correct, labeled drawer.
Preparing Trays
In order for the clinic to run quickly, it is important to have trays prepared before the patient
arrives. The tray must include all instruments necessary for the procedure that will be performed.
There are lists with all the necessary instruments for procedures compiled in the sterilizing room.
The lists are located on the “clean” countertop.
1.
2.
3.
4.
5.
6.
7.
Cover a tray with a plastic cover.
Retrieve all necessary instruments
Remove all instrument bags.
Place all instruments on tray.
Cover the tray with an additional plastic cover.
Write patient’s name on a sticky note.
Place sticky note on top of tray.
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Chapter Four
Chapter Four
Performing Operatory Duties
Preparing the Operatory
To prepare the operatory for a patient it is necessary to create a clean and safe environment.
Perform the following duties before each patient.
1.
2.
3.
4.
Cover chair with plastic chair cover.
Cover all handles with plastic covers.
Retrieve patient’s chart from receptionist.
Retrieve patient’s tray from sterilizers.
Preparing the Patient for Procedures
Once the room is prepared, the patient can be seated. Perform the following procedures on the
patient before the dentist attends them.
Taking Patient Vital Signs
Take the patient’s vital signs before each appointment. Tell the patient you will be taking their
vital signs before beginning.
Pulse and Blood Pressure
To take the patient’s pulse and blood pressure, use the automated blood pressure cuff.
1. Place the cuff around the patient’s writs.
2. Place their wrists above on their chest.
3. Push the green start button.
4. The cuff will inflate and disinflate.
5. Remove the cuff.
6. Notice the pulse and blood pressure measurements on the cuff’s screen.
7. Write these measurements on the back of the patient’s chart in the vital signs section.
Respiration
Measure the patient’s respiration manually while their pulse and blood pressure is being taken.
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Watch for the rise and fall of the patient’s chest. Placing their hand over their chests helps
indicate when their chest rises and falls.
Track this for 20 or 30 seconds
Multiply the number of breaths
If you counted for 20 seconds, multiply by 3.
If you counted for 30 seconds, multiply by 2
Record respiration on the patient’s chart
Preparing Patients’ Mouth
Before the dentist arrives, make sure the patient’s mouth is in a workable condition.
1. Ask the patient to open their mouth.
2. Look for a clean mouth.
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Twonview Dental Clinic Reference Manual
3. If their mouth is not clean
a. Hand the patient a new disposable toothbrush, toothpaste, and a box of floss.
b. Ask the patient to brush and floss their teeth.
c. This can be done in the operatory room or they can go into the restroom if they
choose.
Applying Vaseline
To avoid damaging the patient’s lips, applying Vaseline is recommended.
1. Ask the patient if they would like to apply Vaseline.
2. If they say yes, apply generously with a cotton swab.
You can also ask them if they’d like to apply it themselves.
Working with the Dentist
Your main duty is to create a working area for the dentist. This includes maneuvering the light
and keeping the area of the mouth dry.
Maintaining the Work Area
Light
Adjust the overhead light so that it lights the area of the mouth the dentist will be working on.
Frequently, the dentist will ask you to move this light into a certain position.
Maintaining the Area Dry
Keeping the area dry is necessary so that saliva does not interfere with the procedure. There are
various methods that can be employed to maintain the area.
Suction
Suction can be used frequently or throughout the entire procedure.
1. Take the suction tip into your right hand.
2. Turn the suction on by turning the knob.
3. When there is an excess of saliva or blood, place the suction tip in the area.
4. Do not tell the patient to close their mouth around the suction tip.
Air/Water Syringe
The air/water syringe can be used to rinse the mouth. Use this when instructed to do so by the
dentist.
1. Take the air/water syringe into your right hand.
2. Spray water into the mouth by pressing the button on the left of the air/water syringe.
3. Spray air into the mouth to dry off the mouth by pressing the button on the right of the
air/water syringe.
Cotton Equipment
Cotton equipment is used when the area of the mouth has to remain dry for long periods of time.
Place cotton pellets, triangles, or rolls in the mouth as directed by the dentist.
Cleaning the Operatory
Cleaning the operatory is necessary after each patient.
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Chapter Four
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Collect all contaminated instruments on instrument tray.
Take tray to the sterilizing room and place on “dirty” side.
Remove all plastic covers.
Spray all surfaces with Cavicide.
Let Cavicide sit for 3-5 minutes.
Wipe down all surfaces.
Re-spray all surfaces with Cavicide.
Allow Cavicide to dry on surface
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