Melody Ferzacca

DH 222-A
General Office Visit Report
I did my office visit at Aspen Dental in McMinnville with Grace Schroeder, RDH on
Wednesday, May 25, 2016. She is the only dental hygienist at this office. I chose to shadow
Grace for two reasons; I absolutely adore her and know she wouldnt make me feel out of place
like I have at past office visits, and I was really interested in a behind-the-scenes look at a
managed care practice. I have heard so many bad things about these types of offices and I have
formed a pretty strong opinion of them as well based on what I have heard. I figured the best
way to form a true opinion is to see how some of these offices work.
At the beginning of each day, the entire office has a morning huddle discussing what is
on the schedule for the day. They discuss things like patients who are there for hygiene services
as well as restorative services and who will be seeing the patient first. They also discuss any
difficult patients that may be scheduled for the day and how certain situations may be
handled. They do not have an intercom or light system. There are 4-5 operatories at this office,
somewhat in-line with each other. At the end of the walkway going to the operatories, there
are 4 file bins with different labels. The bins are labeled and when a patient has arrived and
ready to be seen, their file is placed in the appropriate bin. The bins are visible from each
operatory letting the clinicians know when their next patient has arrived.
This office is somewhat still on paper charts. Their periodontal chart and radiographs
are all computerized, but their treatment plans and chart notes after treatment are still on
paper. The computer systems they use for periodontal charting, scheduling, etc. are all specific

to Aspen Dental. This program is called Aspen Dental Charting, or ADC. Grace says she usually
tries to get her notes done twice each day; once before lunch and once before she leaves for
the day. She said this doesnt always happen though, and she is sometimes catching up the next
morning. Patients requiring more than one quad of scaling and root planing have appointments
scheduled for an hour and a half. Patients needing periodontal maintenance and/or prophylaxis
appointments are scheduled for one hour.
New patient exams are provided at this office free of charge. These appointments
consist of one of three dental assistants taking a panoramic radiograph, followed by a full
mouth series of radiographs, a dental exam and a dental hygiene exam. This is a standard for
every patient, with or without third molars. After radiographs are taken, the dental assistant
who took them lets Grace and one of the dentists know that there is a new patient exam. While
the patient is waiting, they have the option to take a test drive with an Oral-B, like the ones
we received last year. They have disposable brush heads that the patient can brush with. This
results in two things, the patient experiencing how clean their mouth can get, as well as cleans
up any biofilm that may interfere when Grace does her periodontal assessments. Whoever is
finished with their current patient and available first performs independent assessments. Grace
is usually first to complete the exam so the dentist can have a periodontal chart completed
prior to the dental exam. Grace evaluates the radiographs and checks pocket depths while the
dental assistant records the probing depths. Grade does not chart each tooth with recession,
but rather indicates on the computer chart notes her generalized findings and localized
findings. After completing the periodontal chart and evaluating radiographs, she documents her
dental hygiene diagnosis in the computer, as well as tissue statements. She then creates a

dental hygiene treatment plan based upon her findings. She informs the patient of her findings
and of what she recommends for treatment, but the treatment plan is not signed by the patient
until they check out with the receptionist. The dentist then performs a comprehensive oral
exam and documents his findings, creates a dental treatment plan, and informs the patient of
his suggestions for treatment as well.
As Grace has Mondays off, if a new patient exam happens on a Monday, the dentist
evaluates the patient and provides a Periodontal Screening and Recording rather than a full
periodontal exam. In these instances, Grace completes the periodontal chart and assessment at
the patients initial therapy appointment.
After both the dentist and Grace have done their exams, the patient is walked to a
reception desk by the dental assistant. Here, one of two people discuss fees and options with
the patient. Aspen accepts basically all insurances except for Oregon Health Plan. For patients
who do not have insurance, Aspen Dental also offers financing. Financing options are discussed
with the patient and their monthly payments are discussed. If the patient liked the Oral-B
toothbrush and shows interest in purchasing one, this is added to the treatment plan as it can
be financed for patients. Once fees, insurance, and financing are discussed, the patient can
then decline any services proposed on the treatment plan. Anything they do agree to is then
signed by the patient and the treatments they agreed to are then scheduled to be performed.
Grace informed me that when she started at Aspen Dental, she was able to order
supplies, including instruments. Hu-Friedy was not an option, so she had to learn new brands.
Her typical set up has sickles and universal scalers for periodontal maintenance and prophylaxis

patients. She always has a sterile setup with a Gracey , 11/12, and 11/13 at the ready, along
side her 25K ultrasonic scaler in the event a patient has heavy deposit and/or needs scaling and
root planing. She has her sharpening instruments, along with new stones, from when she was in
the dental hygiene program. Her operatory also came with a Hu-Friedy Sidekick sharpener that
she rarely uses.
Grace is able to perform ZOOM whitening in her office as well as place sealants as part
of the services she provides. Another thing she does when a patient comes in for initial
treatment after a new patient exam is an oral cancer screening with ViziLite. This is done after a
standard clinical oral cancer screening. The ViziLite system has a 1% acetic acid solution that the
patient rinses with for 30-60 seconds. While the patient is rinsing, Grace breaks a light stick,
similar to a glow stick, and shakes it. She assembles it in to the light holder and wears
specialized eyewear to perform a second oral cancer screening. Any lesions that may be of
concern will be a whitish color and are then documented. These lesions are then marked with a
blue substance, 0.5% tolonium chloride solution, staining the lesions dark blue. Intraoral photos
are taken of these lesions, and if needed, a referral is made for a biopsy. The patient then rinses
again with 1% acetic acid solution after the oral cancer screening is completed.
Dentures are made at Aspen Dental so patients do not need to be referred out if they
are seeking or need dentures. Dental assistants are allowed to take impressions on patients for
temporary dentures that the patient can use while waiting on their permanent dentures to be
fabricated. The dentist, however, must take impressions for permanent dentures.

Asepsis still seemed thorough to me, without being overdone, for lack of a better
term. Grace has a metal tray, like what we set our plastic trays on at the clinic, for her
instruments. The sterilization room is directly across from her operatory and she does not use a
cassette to transport her instruments to sterilization. She places her instruments into a cassette
before running them through the ultrasonic. They are then bagged and sterilized. Before taking
her instruments into the sterilization room, she takes all of her barriers down and sprays
everything with Bi-Rex to let it sit while she is doing what she needs to in sterilization. When
she returns to her operatory, she washes her hands and changes gloves before wiping
everything down with Cavi-Wipes. Barriers are placed on the head rest of the dental chair, the
mouse and keyboard of the computer, and the handle of the light on the side that she sits.
Rather than changing hand pieces between every patient, it is wiped down with a Cavi-Wipe
between patients.
Overall, I have a different perspective of managed care offices, at least for Aspen Dental.
Before my office visit, I told myself I would not work for a managed care office. Now, I would
actually consider it. Grace is still able to individualize home care to each patient, as well as show
them specific tools and how she wants them to utilize them. She has a very large typodont and
toothbrush in her operatory, as well as her restorative typodont to help show home care. She is
also allotted $2,000 each month for supplies as long as they are on the ordering system that
Aspen provides. This allows her to order supplies she needs for treatment, as well as home care
aids she wants for her patients. She said there is a pretty decent selection, rather than just one
brand or type of tool. One thing I did not care for was the feel of working retail again. Grace has
a daily goal of billing to bring in of $1,350. There are contests throughout the region and

incentives for making your goals, but I feel like its retail. There is also grades posted in the
breakroom for all parts of the office for everyone to see how they are doing with production.
This was really the only thing I did not care for at this office. However, I would still consider it
for employment to at least get my foot in the door.