Dental Systems Manual

The following is the manual that I give to every new employee that I hire. I personally wrote this as an aid to new team members so that they can more easily and quickly catch up to the rest of the team. This manual was designed to be read by every employee at every skill level: I certainly aim to hire knowledgeable employees, but I also don’t make the assumption that they know everything and as such, it is good practice to establish a baseline.

While this was written and personalized for my office, it certainly is a great baseline for all offices. I encourage all users to tailor and personalize this to their own office depending on your style and services provided. My office is a comprehensive general dentistry FFS office so we offer a wide range of services. This document is written in non-technical terms so that all employees more readily understand the procedures and how they work. The vast majority of people and patients do not like technical explanations so these explanations will also help you relay these procedures to your patients.

Some of the forms (e.g. New Patient, restorative/SCRP) are forms designed to:

1 Help the office stay on track and not forget important steps.
2 Aid in a core concept called co-diagnosis where information during appointments (e.g. hygienist is seeing patient) is quickly and readily transferred to the doctor so he/she knows what the clinical staff have been discussing. Remember, the main job of all staff members is actually education and our hands skills and physical dentistry that we do are secondary to our information and education. All these concepts and many more are taught in the Dental Maverick course at www.dentalmaverick.com

There is an important term called calibration: simply, this means that everyone in our office from doctor to hygienist to assistant to front desk should understand why, how and the benefits of treatment recommended. Our goal is to have consistency with all treatment plan presentations regardless of who does the presenting. If a patient hears the same reasons from multiple people, they are much more likely to understand why they need treatment and accept treatment. When someone is here in the office, it is the best time to have treatment plans accepted; if they leave without scheduling or we have to follow-up, the likelihood decreases. They are here today and motivated!

We will now discuss the major and most important procedures done in our office in easy to understand terms. This is for you to get acquainted and also to help you explain to patients why certain procedures are needed and why it helps the patients. The goal is to have you and everyone in the office “calibrated” meaning that each and everyone understands the same thing so that everything can be sufficiently explained by anyone.

• Periodontitis:
•
◦ See attached Soft Tissue Management Program Page for understanding periodontitis (perio)
◦
▪ There are 2 forms of gum disease: gingivitis and periodontitis. Gingivitis is a form of gum disease WITHOUT bone loss.  Clarification is below, but it is a reversible form of gum disease where some of the criteria that we use to evaluate this form is based on the measurements that we obtain when we measure (probe) the gum tissue. Measurements are between 1-3 mm and can include bleeding when probed.
▪
▪ Basically perio is irreversible gum disease. It is a disease that cannot be cured, only maintained. Once the bone levels are lost, they do not regrow*. All we can do is help the patient keep it clean to prevent further bone loss. We do this by having regular cleaning intervals called perio maintenance (D4910).
▪
◦ What is the sequence? What are procedure steps
◦
▪ See attached Perio Sequence Page for exact steps.
▪
▪ Probing is done on each and every patient above 18 years old (and as needed under 18 if early disease is suspected) and done on 6 points around the tooth. Typically in our office, the hygienist will complete a full periodontal charting (measuring each tooth in the mouth).
▪
▪ The probings (measured in mm) tell us basically the health of their gums. We consider healthy with measurements of 1-3 mm w/o bleeding.
▪
▪ We consider gingivitis (reversible gum disease w/o bone loss) when there are probings of 1-3 mm with bleeding.
▪
We consider periodontitis (irreversible gum disease with bone loss) when probings are >4mm with bleeding. The higher the number, the

▪ It is a clear acrylic custom mouthpiece that is worn at night. A night guard is made by taking custom upper and lower alginates (models) and sending them to a lab.
▪
◦ What is the code: D9940
◦
◦ Why is it needed? Night guard is used for many reasons. Someone who grinds and clenches their teeth will need one. Some main reasons include:
◦
▪ Soreness and pain in jaw joint. Jaw joint pain is something we want to control early in the game. If jaw pain is allowed to continue, it becomes chronic and much more difficult to address (worst case is surgery). If we get a night guard in early, often times it reduces pain and stops it.
▪
▪ Recession. Recession is an issue with the gums receding down. When gums recede down, the roots will become exposed. Exposed roots lead to sensitive teeth. Recession is a result of hard, incorrect brushing, gum disease (as bone is lost, the gums come down with it) and grinding and clenching. A night guard would reduce the forces of grinding and clenching.
▪
▪ Broken teeth. This is the biggest issue with grinding. People that grind will eventually wear down their teeth and eventually cause cracks in them which eventually break apart. We do not want teeth breaking b/c if they do, the worst case scenario is that it breaks below the gums and we cannot fix it. If we can, a broken teeth typically requires a crown and perhaps a root canal. A good line to use is for less than a crown, you will have very good insurance against other teeth breaking.
▪
▪ Crack tooth Syndrome. Teeth can break apart, but often times they will progress to a stage called crack tooth syndrome (CTS) where the tooth will hurt very bad when you bite or chew on it. The pain is typically very sharp/shocking/electrical/nerve pain. The reason this occurs is because cracks have formed deep inside the tooth and when someone puts pressure on the tooth, the pressure flexes the crack deep inside the tooth and causes the nerve to feel the pain.
▪
▪ Popping out of facial (cheek side) fillings. There are many types of fillings (below). A facial filling is one on the side of a tooth. When someone grinds, the teeth flexes slightly. Fillings on the side do not flex the same and eventually will pop off b/c of the difference in flexing.
▪
▪ Why is a custom one better than non-custom?
▪
;4mm with bleeding. The higher the number, the

If you work in the front desk, the following pages are checklists that you will use and start for each patient that has an appointment. These forms are used from the moment a patient makes an appointment and passed along until the patient is done and finished with the appointment that day.

The purpose of these forms is to aid in each one of us to not forget certain steps and for the doctor to confirm if you have completed your responsibility.

The tooth chart is to be filled out by the clinical staff that sees the patient and will aid the doctor in knowing what was discussed and likely occurring with the patient. This is a concept called “co-diagnosis” covered in the Dental Maverick course. If you’d like to learn more, then please visit www.dentalmaverick.com and sign up.
[then there are pages with a flow sheet that i use in the office that allows quick transfer of info to anyone in the office]

[this deals with insurance gathering]

• Patient’s DOB: DOB of person whom the appointment is for.

Box 4
• Date Verified: the date YOU verified this insurance and spoke to the insurance company
• Your name: put your name here
• Name of person at insurance company: the insurance rep you spoke to
• Insurance claim address – this is the address to send claims to.

Box 5
• Annual Max: This refers to maximum insurance coverage for the year. Typically 1000, 1500 or 2000.
• Pt Ded: this is patient deductible. Deductibles apply to basic and major services typically and can range from 25-150 that have to met annually.
• Family Ded: this is family deductible. Does not apply to our services.
• Ded applies to type:
◦ Type 1 refers to procedures that are considered DIAGNOSTIC and PREVENTATIVE (typically prophy, exams  and x-rays)
◦ Type 2 refers to BASIC proc. (fillings, root canals, perio and oral sx)
◦ Type 3 refers to MAJOR procedures (typically crowns, bridges, dentures)
• Coverage: Single – if  plan only applies to policy holder or Family plan if there are dependents on the account (spouse or children)
• Is Year: Fiscal  - running from dates other than Jan to Dec. – Calendar – runs from Jan 1st to dec 31st.
• Policy Effective Date: This is when the insurance coverage is first effective.
• Are we IN NETWORK: ALWAYS NO
• Do they pay off  FEE SCHEDULE: if yes, acquire the name of the fee sched
• Claim Required: Always yes
• Is this Plan PPO: yes or no
• Indemnity: in addition to their ppo plan and would require us to be in network to receive their max benefits
• Dependent Age: age that a parent can carry a child under their insurance plan – usually up to age 19
• Student Age: age the child can be in college until and still under insurance plan – usually up to age 25
• REMAINING BENEFITS: the amount of benefits remaining from the annual max for the year.

Recall/Unscheduled Treatment/Follow Up System
Recently, I decided to overhaul my follow up on patients without appointments and missed hygiene appts. We were doing it inefficiently with papers here and there. Reports from this and that report scattered throughout the office were not as efficient and systematic as I would like.

As such, I overhauled the system. I am placing a system in place that makes it as easy and quick as possible to follow up on patients. Certainly at the beginning, this will require more work as more patients have to be “caught up.” As time goes on, this will be systematic and each pt that comes in through the office will have appointment notes for follow up (as you will see) be done in the computer before the appointment is complete by the front desk staff.

This is to provide for you an outline and idea of how to implement such a system or a similar system. I do not know how to explain to you the technicalities of how to do this or that with your PMS. I hope this aids you in closing your “back door” or outflow of patients.

First chart refers to New Patients (NP) and Limited (LOE) emergency exam patients. Second chart refers to Recall patients. 

PC = Post Card. We have a generic post card that reminds patients that has 2 boxes: one that says their recall appointment is coming up within a month OR they are overdue for an appointment.
Email refers to the emails listed below which we input into Open Dental for easy access. Note, these are generic instructions that do not address HIPAA email requirements. There are varying services that will integrate with Outlook and some PMS that offer HIPAA-compliance which you should look into. 
HYG email refers to the email below which is an HTML format email that was created hiring someone on Fiverr. It can be inserted into email and acts as a generic reminder for overdue HYG appointment.

SCRP-need follow up:

Hi!

Thank you for your recent visit to XYZ! Dr. Pham and our hygienists were recently reviewing your chart and saw that we recommended for you a deeper cleaning (gum therapy). The reason that we recommend a deeper cleaning is that we see that your body is resorbing bone away due to gum disease called periodontitis. It’s tricky and most people don’t know they have it because it does not hurt unless it is very severe.

The last time that you had your teeth cleaned, you may have noticed pieces of build up called tarter coming off your teeth. You may also have noticed how much smoother and clean your teeth felt afterwards J Well the reason a deeper cleaning is recommended (and why there is bone loss occurring) is that there is a lot more of the tarter build up underneath your gums. A deeper cleaning is a much more thorough cleaning that will clean and remove that build up underneath your gums and get your gums as healthy as possible. As you know, a healthy mouth contributes to a healthy body!

Please reply to this email or give us a call at 123-456-7890 if you are ready to schedule or have any questions regarding the severity of  your gum disease!