Charli Young

LCSC Distance Site

11/05/2016
Dental Office Specialty Observation Report

I observed at Dentistry4Children in Dr. Jeremy Wiggins pedodontist office here in

Lewiston, Idaho. They were extremely welcoming and thoroughly explained all of their
daily procedures to me.
This office had an excellent team of individuals who all appear to work great
together. There is first the front desk staff, including the office manager and insurance
specialist, there are five dental assistants, and Dr. Wiggins. This pedodontist office
doesnt employ any hygienists. Being a specialty office for children, there are not many
patients who present with calculus. Those patients that do have calculus are lightly
scaled supragingivally by the assistants. If any subgingival calculus removal is
necessary, the doctor will scale it. There is not enough work to warrant employing a
hygienist, so Dr. Wiggins doesnt.
As Im sure you can guess, this pedodontist office completely caters to children.
From the time you walk into the office until you leave, it is a fun environment filled with
games, bright colors and overall brain stimulation. The waiting room has a TV playing a
Disney or Pixar movies and video games to keep the children occupied until they can be
seen. The kids are then greeted by one of the five friendly, smiling assistants and taken
back to the openly laid out operatory room.
The general process for patients in this office is to take any necessary x-rays
including a panoramic and bitewings at the initial appointment, followed by a thorough
polish with the prophy cup by an assistant, completed with a comprehensive exam by the
dentist and a fluoride varnish application. The entire time the patient is in the dental
chair, there is a movie playing on a small TV screen mounted to the ceiling above their
head with the sound coming through a pair of headphones the kids are encouraged to
wear. The only instruments set out on the counter for this appointment were a mirror and
explorer. The parent or guardian of the patient is asked to come back to the
clinic/treatment area to be with the patient during the exam so that they are aware of any
treatment or observations made by Dr. Wiggins. If there is any restorative work to be
completed, the patient will be rescheduled, either for treatment at the clinic or at the
hospital, depending on the procedure and patient. If orthodontic treatment is
recommended, Dr. Wiggins decides whether it can be completed at his clinic or whether
it should be referred to a general orthodontic office. I asked what determines whether the
patient is referred to an orthodontic specialist or not, and no one had an answer for me.
The best they could come up with was that if Dr. Wiggins saw a case that he would be
comfortable with, he would do the treatment but that determination was made on a case-
by-case basis. The instruments used for restorative and orthodontic treatments are the
same as what would be used in a general practice dental office or orthodontic office.
While I was observing in this clinic, they performed many different procedures
including personal oral homecare instructions, child prophys, orthodontic treatment,
stainless steel crowns, fillings, and simple extractions. These are all procedures that can
be done in the comfort of the clinic, although in some circumstances, Dr. Wiggins and
one of his assistants will go down to the hospital to do dental work on children under
general anesthesia. Some instances of this include children who have multiple large
fillings or crowns to do, extremely young children, children with extreme anxiety, and
children who misbehave or are at risk of putting themselves in danger during a dental
procedure.
After a patient was seen, all disposable items such as suction tips, prophy cups,
and air water syringes were removed and thrown into the garbage along with the plastic
headrest cover. This office didnt cover near as many surfaces as we do in our clinic.
For instance, the counter space, patient chair, and hand-piece units were not
covered/bagged with plastic. I believe they made up for this in their disinfectant process
though. After cleaning the chair of any instruments and disposable pieces, everything
remaining was thoroughly sprayed with a Birex disinfectant and left to soak for 10
minutes before being wiped with a CaviWipe and set up for the next patient. In our
clinics, we dont double disinfect by spraying everything we use first, we just wipe it
with Birex before re-bagging everything. The assistants and doctor wore proper PPEs
including long sleeves, proper eye wear, gloves, closed toed shoes, and a face mask, and
were careful not to cross-contaminate anything between patients, even siblings.
All instruments used were placed in an open ultrasonic bath (without placing a lid
on the container). After being shaken for 15 minutes, instruments were bagged in
appropriate sterilization bags and placed mainly in the small Statim sterilizer. The
assistants informed me that they only went through enough instruments to run the large
MidMark sterilizer twice a day; once during lunch and once at the end of the day.
Instruments were allowed to dry completely in the sterilizers before being returned to
their appropriate storage areas. Although I believe their disinfection techniques achieve
what they are supposed to, I think LCC/LCSC should stick with our infection control
procedures.
Dentrix is the computer-charting program of choice in this office. The assistants
briefly chart the procedures completed for that day, including oral hygiene, x-rays taken,
polishing, the exam, and any comments or recommendations Dr. Wiggins makes for the
patient. For the ortho and restorative treatment appointments, the assistants chart exactly
what was done that day, along with plans for future appointments. There arent any chart
notes made specific to a pedodontist office, because all the notes they make would be
made just the same in a general practice office.
A common rationale for referring a patient to Dentistry4Children is the patients
age. Some dentists arent comfortable working on children that are young, or on children
that are scared or misbehaved in a dental office. Pedodontists are designed to manage
children displaying both these characteristics, and everything in between.
Overall, I had a very pleasant experience in this office. Everyone worked well
together for the best of the patient, and had a great attitude throughout. They all seemed
to have good relationships with their patients and the patients parents. I learned that the
biggest thing to remember with children is to remain calm, firm and friendly all at the
same time. This information will be useful in the future with any children I may see.