Mon - Fri: 7am-7pm
Sat: 7am-1:30pm
(509) 591-9317


Monitor Icon

Hygiene Processes

Hygiene Training Week 1

Philosophy for Dr. C Family Dentistry
5 Core Values
Tribal Language
How to clock in
How to view time card
How to view your pay period
How to create an appointment/schedule
How to use the "edit appointment" screen. Add, delete, how phased tx shows up here.
How to use the "edit appointment" screen to add on any preventive treatment to current appointment
How to view and "go-to" appointments from schedule screen
How to read and change status of patients (in room, checked out, etc.)
How to tell difference between color print on ledger (provider color)
How to change providers (important for exams)
How to enter medical history in main chart and auto note
Pre-med protocol, diabetes protocol
How to create an auto note
How to use Secret Service Box- ?ssb
Make notes for you & dr's
How to take an xray in Sopro
How to take a PANO in prof- suni
How to take an intra-oral photo
How to take a CT Scan in EZ Dent
How to chart existing in the computer
How to chart on the exam sheet and understand each section of exam sheet.
How to make a pop up note- ex: pt needs pre-med
How to successfully fill out autonotes for paperless office
How to view "images" such as exam sheet (after it has been scanned in) while charting notes
Exam flow for new patients
Exam flow for existing patients
Pre-assessing the patient & Dr. (documented in computer)
How to create treatment plans/restorative and hygiene appointments
How to save treatment plans
How to delete treatment plans successfully
Red dot items- what is missing in your chart
How to make a commlog when communicating with patients
How to offer NP coupons with insurance and without
Dental Savers Voucher NP special- What does it cover and what is it for?
Lifetime Whitening- retention program- How much and what are the rules
How to read treatment plan to determine out of pocket estimate
Verbiage for discussion out of pocket estimates & collecting
How to read insurance verbiage and when to ask questions
Hygiene instrument locations
Restorative handpieces and burs locations
How to set up hygiene rooms for prophy, laser, gum infection therapy (we need how to's made)
How to set up iso-dry for sealants
How to set up for in- office whitening
Sterilization Room etiquette and expectations
How to use a diagnodent
Make email address (office admin will do for you)
This is how we communicate with whole office: Email & google docs for calendar
Radio etiquette
Verbiage for discussing "mandatory, preventive, and cosmetic" treatment in terms of priorities for tx
Learn tasks for week and month for hygiene team
How to scan in task list on Saturdays & email to Lead
How to empty water bottles in op's + turn off heaters
How to stock sterilization instruments
How to stock operatory essentials
Lab and Break Room Clean up
Scrub allowance & rules (we wash all scrubs in house- OSHA/WISHA)
Birthday Buddy
90 Day Review Expectations
Snap Jar- How we celebrate each other
Monthly Potlucks
Weekly meetings every Wednesday- All staff is mandatory
Start Hygiene 2.0 on Team Training Institute
Find a locker/space for belongings
Refrigerator etiquitte 🙂
Care to Share Bonus- referring friends and family to practice
CPR current
Imunizations current
OSHA current
Write bio and website photo

Hygiene Training Week 2

Review how to add on any preventive treatment to an appointment
Review how to schedule appointments for hygiene and restorative
Review how to create treatment plans/restorative and hygiene appointments
Review how to save treatment plans
Review how to delete treatment successfully
Review verbiage for adding in preventive treatment: sealants, fluoride, seal & protect
Review exam Flow for New patients
Review exam Flow for existing patients
How to treatment plan gum infection therapy (GIT)/FMD/ Laser
Verbiage for gum infection therapy program/ FMD/ Laser
Verbiage for adding in preventive treatment: sealants, fluoride, seal & protect
How to set a patient as "perio"
How to change a perio patients recall date to 3, 4mrc
How to edit, move, add, delete images in Sopro
Review pre-assessing for Dr's- how to document on scanned in chart and computer chart
How to treatment plan fillings
How to treatment plan crowns
How to treatment plan implants/hybrids
How to treatment plan bridges
How to treatment plan partials
How to access referrals
Documenting Life time whitening in UL hand corner of chart
Documenting completed treatment plans
How to make an rx and print
What does the red dot mean on a chart?
Review how to read insurance breakdowns
How to read account ledger
How to collect payment in back office
How to print out receipts
How to figure out pre-payment for 20-50%
How to read treatment plan to determine out of pocket estimate
Verbiage for discussion out of pocket estimates & collecting
Financing Options: More Mastercard, Care Credit, 90 days same as cash, pay in full discount
How to make notes in account box for pre-payment
Review where hygiene instruments are located
Review where xray tools are located
Review how to set up hygiene rooms for prophy, laser, gum infection therapy
Review how to set up iso-dry for sealants
Review how to set up for in- office whitening
What handpieces and burs Dr needs to adjust fillings/crowns/occlusal guards
How to change controls on unit
How to hand off to Dr during an exam
How to hand off to assistants for tx
How to hand off to front dest to assist in financials/scheduleing
How to set up air powder polisher
How to make time clock corrections in google docs
How to make a google doc
Radio etiquette
Review task list for hygiene rooms & phone calls
How to clean suctions
How to change traps
Where to take trash to
Scrub etiquitte- zip up jacket, place in bathroom, where to put away in break room
How to make re-care hygiene bags
N20 set up/put away/how to use & change tanks
Supplies in back, what to do if you see the yellow tag
Post op calls for perio, etc
What to do with open time in schedule- etiquette for helping others
Philosophy for Dr. C Family Dentistry
5 Core Values
Tribal Language

Hygiene Training Month 2

Review creating appointment/schedule
Review how to change providers: ie: which Dr. did the exam
Review how to create & delete treatment plans/restorative and hygiene appointments
Implants, Bridges, Extractions, Bone grafts, Ortho,
Review how to treatment plan gum infection therapy/FMD/ Laser + Verbiage
Review how to add on any preventive treatment to an appointment + Verbiage
Review how to save multiple treatment plans to show correct out of pocket and benifits
Make sure the priority of treatment plans is documented in heading note
How to track correspondence with comm-log
How to schedule from the recall list
How to see unscheduled GIT in dental intel
How to send unscheduled treatment to "unscheduled list"
How to send reviews with Podium
Review Hygiene Diamonds 2.0
What does the red dot mean on a chart?
How to collect payment in back office
How to figure out pre-payment for 20-50%
How to read treatment plan to determine out of pocket estimate
Verbiage for discussion out of pocket estimates & collecting
Dental Savers Voucher - review
Review 90 days same as cash (for hygiene patients ONLY)
Review all other financing options
In house financing
New patient coupons + care to share cards
How to take impressions for whitening trays/fluoride trays/night guards
How to pour up impression models and make whitening trays
How to fill out paperwork for occlusal guards and send request to fex ex
How to preform in- office whitening
Recare phone call tracking google sheet- ask kim
Unscheduled list google sheet- ask hygiene coordinator
Hygiene tracking numbers with dental intel google sheet- Weekly
Done and recorded weekly- keep in room 2 top shelf- Scanned and emailed every Saturday
How to make re-care phone calls- 5 attempt method
How to make New Patient phone calls, introducing yourself as hygienist
How to write New Patient thank you cards
Completed Hygiene 2.0 training- TTI
How to check your pay stub online- Gusto
Verbiage review & scenario's (misc categories)
How to approach your concerns/ conflict resolution
How to find google doc master file for meeting history, protocols
Philosophy for Dr. C Family Dentistry
5 Core Values
Tribal Language

Hygiene Training Month 3

3 Months - 90 Day PDI
How to clock in
How to view time card
How to create an appointment/schedule
How to change providers
How to tell difference between color print on ledger
How to create treatment plans/restorative and hygiene appointments
Chart Notes/ Auto Notes/ SSB correctly filled out
How to save treatment plans
How to make financial notes after taking payments
How to delete treatment successfully
Charting "Completed" on tx plans that have been treated
How to treatment plan gum infection therapy/FMD/ Laser
Verbiage for gum infection therapy program/ FMD/ Laser
How to treatment plan fillings
How to treatment plan crowns
How to treatment plan implants/hybrids
How to treatment plan bridges
How to treatment plan partials
How to add on any preventive treatment to an appointment
Verbiage for adding in preventive treatment: sealants, fluoride, seal & protect
How to create and print a rx (prescription)
How to find a dental code
How to take impressions for night guard/ lifetime whitening/ how to pour up and set follow up appointments
Xrays in all softwares & intra oral camera photos at every appointment
Pre-assessing for dentist
Review handoffs
Pre-assessing for dentist
Review handoffs
Pre-assessing for dentist
Review handoffs
Coupons and financing options
Where hygiene instruments
How to set up hygiene rooms for prophy, laser, gum infection therapy
How to set up iso-dry for sealants
How to set up for in- office whitening
What does the red dot mean on a chart?
Checking email daily
Radio etiquette
How to address concerns, questions, who to go to for email. . . all problems or concerns must have a soultion given
Review podium reviews
Confident in making re-care, post op, and new patient phone calls
Confident in where all products and instruments are located
Confident in charting task list & turning in on Mondays
How to use compensation spread sheet to track your daily production
Review of benifits at 90 day review
Monthly one on one's
Fishbowl 2.0
How to request time off
Weekly KPI's documented
Asking for time off/switching shifts/getting a temp hygienist/sick time accrued in Deputy
Leave early form
Philosophy for Dr. C Family Dentistry
5 Core Values
Tribal Language

Perio Protocol Handbook

Periodontal Classifications

Class I Gingivitis

  • Bleeding easily on probing and/or exploring on 4+ sites
  • Periodontal probing measurements up to 3-4mm
  • no bone loss evident on radiographs from bacteria

Treatment: Therapeutic Scaling (4355) followed by prophy (01110)

Class II Beginning Perio Disease

  • Bleeding on probing and exploring
  • Periodontal probing measurements up to and including 4-5 mm
  • less than 1/3 bone loss evident on radiographs
  • No furcation involvement

Treatment: Localized Gum Infection Therapy (scaling and root planing) could use laser therapy

Class III Moderate Perio Disease

  • Bleeding easily on probing and exploring
  • Periodontal probing measurements up to and including 4-6 mm
  • more than 1/3 bone loss evident on radiographs
  • Possible Class I furcation involvement

Treatment: Gum Infection Therapy (Scaling and root planing) with Laser Therapy

Class IV Advanced Perio Disease

  • Bleeding easily on probing and exploring
  • Periodontal probing measurements greater than 7+ mm
  • more than 1/2 bone loss evident on radiographs
  • Possible Class I, II, III furcation involvement
  • Possible mobility
  • Possible suppuration

Treatment: Gum Infection Therapy (Scaling and root planing), possible referral to periodontist

Standard of Care:

– Gingivitis therapy (4355) is recommended when a patient presents with 4+ sites of bleeding in each quad.  The patient returns in 6 weeks for a follow up prophy (0110).  The following medicaments are recommended:  CTx4 rinse.

Recommended continuing care interval will depend on evaluation/findings at 6 week check healing appointment.  3 mo, 4 mo, 6 mo recare appointment

CODE: 4355 followed by 1110

– Localized periodontal therapy (root planing and scaling) is recommended when the patient presents with 1-3 pocket(s) with a depth of 4mm or greater, when bone loss is present.  Quads with 1-3 teeth with periodontal involvement would require using CODE: 4342

Healthy dentition can be cleaned using CODE: 1110 at the first/initial visit.

– Generalized periodontal therapy is recommended when the patient presents with the above conditions but it is more widespread.  Quadrants with 4+ teeth involved would require more extensive treatment and time requirements.

CODE: 4341 is used under these circumstances.

(the two codes can be combined at one appointment depending on the involvement in specific quadrants.)

– A follow up evaluation (check healing) appointment is scheduled 6 weeks after the final session of periodontal therapy.

CODE: 4910/check healing


Continuing Care Interval:

  • Healthy Periodontium 6 month
  • Gingivitis/Ortho 3-6 month
  • Localized Perio 3-6 month
  • Generalized Perio 3-4 month
  • Aggressive Perio 3 month or referral to periodontist

Periodontal Retreatment:

Patients are transitioned back into active periodontal therapy from perio maintenance when the patient presents with active disease and involving more than 2 teeth (after 1 or more years after gum infection therapy completed).


We recommend site-specific chemotherapeutic (CTx4 Rinse) therapy when the patient presents with pocket readings of 4mm or greater that are advancing and/or bleeding.


We refer patients for surgical intervention due to bone defects or for a second opinion when pockets measure 8 mm and/or when sites are specific to non-surgical therapies (grafting).  



  • <6 years old-30 minute appointment
  • Check for fluoride and sealants to be done same day/appointment






  • 3-4 month re-care for duration of orthodontic treatment

Radiographs: What to take?  How often?  

  • BWX – High risk every 6 months, Low-Mod risk 1x/year
  • Vertical BWX – Moderate perio every 6 months
  • PA– High risk 6 months (Crowns, implants, RCT), Low-Mod risk 1x/year
  • PAN- New Patients/ High Risk 3 yrs/ Low-Mod 5 yrs
  • FMX- New Patients (see below)/ High Risk 3 yrs/ Low-Mod 5 yrs
  • CBCT Scan- New and Existing patients- New patients if they have written that they are missing a tooth or are in pain, take CBCT instead of the PANO at first visit

What to look for on Xrays:

  • New Patients: Take Pano, 4BWX + 2 PA and any additional PA for existing Crown, RCT, Large existing fillings, Abscess/fistula present intraoral, if full FMX or CBCT Scan is needed, please take
  • Bone level needs to be shown on BWX (if not, take VBWX)

Homecare & Risk Factor Recommendations

Healthy Teeth and Gums– Electric toothbrush, daily floss, mouth-wash (Listerine Zero or ACT), fluoride varnish, sealants, regular 6 month hygiene therapy

Gingivitis– Essential Smile, 4355 then 01110, electric toothbrush, daily floss, RX fluoride toothpaste, fluoride varnish, regular recommended hygiene therapy

Periodontal Disease– Electric toothbrush, daily floss, rubber tip stimulator, mouth-wash (Listerine Zero, Essential Smile, or Act), fluoride rx toothpaste, fluoride varnish, regular 3-4 month hygiene therapy

Furcations– Rubber tip stimulator, proxabrush, soft picks

Recession/Abfraction– Seal & protect, RX fluoride toothpaste, fluoride varnish, rubber tip stimulator

Dry Mouth– CTx4 gel, xylo-melts OTC, Act Dry Mouth mouthwash or Biotene mouthwash OTC, fluoride trays, fluoride varnish

Moderate to High Caries Risk– BWX every 6 months, fluoride varnish, RX fluoride toothpaste, fluoride trays, spry mints or gum

Other- CTx4 rinse with every 4341, 4342, 4355 (gingivitis), use disclosing solution on every patient for oral hygiene instructions.

Laser Therapy- For full mouth debridement (LBR) and gum infection therapy (LBR, LSD)

Class I - Tissue
Gingival Disease
Inflamed, red, swollen tissue that bleeds upon probing
and exploring. Exudate may be present
1-3mm, no bone loss. More than 14 types of gingivitis.
Class II - Chronic Periodontitis
Bleeding, swelling, redness, suppuration
May be localized or generalized
Slight-Moderate Loss of Periodontal Support
Loss of up to 1/3 of supporting periodontal tissues.
If furcation involvement, no more than Class I.
Probing depth up to and including 4-5mm with CAL up to 4mm.
Radiographic evidence of bone loss and mobility may be present.
Class III - Moderate-Advanced
May be localized or generalized
Moderate- Advanced Loss of Periodontal Support
Loss of greater than 1/3 of supporting periodontal tissues.
If furcation involvement, may exceed Class I.
Probing depth will exceed 6mm with CAL greater than 4mm.
Radiographic bone loss is evident. Mobility may be present.
Class IV Periodontitis as a Manifestation of Systemic Disease/ Aggressive Periodontal DiseasePeriodontal disease caused by or worsened by various systemic diseases. There is evidence of several systemic conditions that may cause destruction of supporting periodontal structures.
Rapid rate of progression. Often appears in individuals who otherwise appear healthy. Amounts of microbial deposits may be inconsistent with severity of disease. Disease may be self-arresting.
Class V Necrotizing Periodontal DiseaseAcute infection of gingiva that has progressed to include attachment loss. May include ulceration and necrosis of papilla, bright red, painful gingival that bleeds.
Class VI Abscesses of the PeriodontiumGingival, periodontal, periocoronal abscess
Class VII Periodontitis Associated with Endodontic LesionPeriodontitis associated with an active endodontic lesion.
Class VIII Developmental or Acquired Deformities and Conditions

Periodontal Charting Protocol

You must document annually a comprehensive periodontal exam.  Here is what should be included:

  • Pocket depths
  • Bleeding
  • Recession
  • Furcations
  • Mobility
  • Mucogingival Defects
  • Suppuration
  • Calculus
  • Plaque

This will give you, your patient and third parties the information that is necessary to make informed decisions as to what treatment will be required.


All hygienists working in the practice must routinely review their method of taking periodontal measurements.  All hygienists should use the same periodontal probing instrument and technique to ensure that record taking is consistent and accurate.

Technique:  The periodontal probe is placed parallel to the long axis of the tooth with exception of the col area.  In this case, the probe is angled slightly at the interproximal to measure the sulcus below the contact point of the teeth.

Sample Periodontal Probing Script:

“Mrs. Jones, next I will be evaluating the health of your gum and bone.  I will be using a small round ruler that I place between the tooth and gum to measure the space.  Ones, twos and threes are all good numbers.  Anything above a three shows disease.  The higher the number, the more involved the disease.  If I call out any bleeding, it is a sign of active infection.  I will be calling the numbers so you will be able to follow along.  If you hear me say a number followed by the word recession, that means that there is bone and gum loss on that tooth, in other words the tooth appears longer, because root structure is exposed. Normally this is not an uncomfortable procedure unless the tissue is unhealthy. Please listen carefully so that we can discuss the findings when I am done.  Let’s get started.”

Re-Care Appointment:

Duration: 60 Minutes

  • Medical History and Concerns
    • Blood Pressure-wrist cuff
    • Medication Considerations, Pre-medications
  • Patient Values and Dental Concerns
  • Necessary Radiographs
    • Cysts and Abscesses
    • Caries
    • Periodontal Lesions
  • Head and Neck and Oral Cancer Exam
  • Intra-Oral Camera Tour (have patient watch along)
  • Decay Exam
    • DIAGNOdent
  • Occlusal Exam
    • Attrition / Wear Facets/evidence of grinding-clenching
    • Abfractions
    • Ortho Classification
    • Balancing Interferences
  • Complete Periodontal Exam
    • 6 point probing with recession, bleeding points, furcations and mobility
  • Radio 1st time for exam: “Ready for exam in op ___, just starting hygiene”
  • Ultrasonic Debridement and Hand Scaling and Polish/Floss (20 min. max)
  • Education (This takes place throughout the appointment as the clinician comes across   specific things to point out).
    • Add-ins: Sealants, Bleach/Fluoride trays, Occlusal guard, RX mouthrinses, electric toothbrush
    • Radio 2nd time for exam: “Ready for exam in op ___, hygiene is complete”
  • Homecare Techniques/tools
    • o “Tell me about your homecare routine”
  • Dr. Exam (keep it quick)
  • Patient Re-appoint/Schedule treatment/Recall
    • Radio to front: “Front desk, 2-minute warning with (patient first name), (state changes in treatment), do you need anything from them?”
  • Room Turnover

Fluoride Tray Protocol

  • For moderate-high caries risk patients (i.e. dry mouth/cancer/radiation/etc.)
  • Includes 1 tube cari-free gel, additional tubes cost $20
  • Patients will wear every day for 15 minutes only
  • Place a tiny amount of cari-free in block outs around gumline and do not rinse mouth after use
  • 30-minute appointment (For scheduling purposes, you can add in to any appointment if you have the time)
    • Take maxillary and mandibular impressions
    • Educate patient
    • Schedule back in 48 hours for delivery- give appointment card
    • Create lab case in computer
    • Write patient name on lab tracker and due date
  • Turn Room Over
    • Pour up models (if help is needed please ask an available assistant)
    • Once models have hardened: trim and smooth impressions
    • Place block out material along gumline, somewhat thick
    • Make trays
    • Trim trays
    • Place cari-free and models together
    • Check name off lab list
    • Check lab received in computer
  • How to use (for patient):
    • Place a small amount of Cari-Free gel along the gumline of clear trays
    • Place in mouth
    • Wear every day for 15 min max at least 3x/week
    • Do not rinse mouth out afterwards
    • Clean trays with toothbrush

New Patient Appointment

  • Mark patient in room (purple dot)
  • Take PANO
  • Record Medical History and Chief Concerns
    • Take blood pressure
    • Ask if all medications, allergies, and health concerns are correct in computer
    • If diabetic- record last A1C # and blood sugar
    • If stroke or heart attack- record date event occurred (If less than 6 months we cannot treat; must be rescheduled for all treatment/perio)
    • Artificial Joint? Where and when & did they take Pre-med?
    • Pacemaker? Gather physicians phone number, pacemaker card information & call for clearance to use cavitron
  • Take necessary radiographs
    • FMX (Unless radiographs are being mailed to office, check quality and if necessary take complimentary 4 BWX + 2 PA and any additional PA’s to address CC
  • Ask if they would like to watch Netflix while laying back, if so give 1-2 options
    • Provide smudge-free sunglasses
  • Fill out “secret service box”- Help Dr. get to know your patient
    • 1-2 items about the patient, family, work, etc.
  • Record Existing / Pre-assess TX on laminated and computer chart
    • Occlusal Exam:
    • Attrition/Wear Faucets
    • Abfractions
    • Ortho Classification
      • Ask patient “if happy with alignment of teeth?”
  • Take Intra Oral photos
    • Chief Concern
    • Fractures on existing amalgam fillings/teeth/crowns
    • Stain/Decay
    • Chipped teeth/fillings
  • Diagnodent
    • Virgin teeth
    • Any dark grooves
    • Record all numbers on laminated chart and in computer
  • All teeth with pits fissures or grooves should either be sealed or filled or if suspicious have fluoride recommended to help remineralize and check in 6 months.
  • Diagnodent all unsealed/ unfilled pits and fissures of teeth.
  • Diagnodent numbers:
    • <19 –  Ok to seal before exam is done as long as hygienist feels tooth looks and feels ok to seal, make sure stain is cleaned out of groove and use clinical judgment, if unsure have Dr. inspect before placing sealants or tx planing sealants
    • 20+ – pre-assess as filling and have Dr. come confirm, tooth most likely has decay.
    • Make sure IO photos are taken of a tooth needing a sealant/ or filling and show patient and explain.
  • Oral Cancer Screen
    • Record any findings on laminated and computer chart
    • Take intra-oral photo of any lesion
    • Record specific location/measurement (mm) of lesion
    • Show patient lesion with hand held mirror, ask duration, pain on palpation, changes, etc.
    • Have Dr. address at exam; possible referral for biopsy/excision
  • Complete Periodontal Exam
    • 6-point probing, recession, furcations, mobility, bleeding points, suppuration, calculus, and plaque
  • Review of all risk factors, show intra-oral pictures
    • Caries
    • Perio
    • Occlusion/TMJ
    • Esthetic
  • Same Day Add In’s:
    • Fluoride Trays: $64
    • Whitening
      • Lifetime: comes with custom fit trays and FREE bleach refills as long as patient stays on recommended hygiene re-care $99
      • In- Office: Lifetime whitening + 1 ½ hour in office whitening treatment $249
    • Sealants:
      • $35 per Sealant ON SMILE SAVERS PLAN ONLY
      • Cannot give discount with contracted insurance carriers
    • Fluoride
      • Varnish or RX toothpaste
      • Varnish on Smile Savers Plan $35
    • Seal and Protect
      • Sensitivity/cold
      • $29 per tooth
    • “Quarterback, Ready for comp exam in op ____, just starting hygiene”
    • Or, 1-2 important items discussed, and gum infection therapy is rec, ready for exam now
  • Polish, Floss, Ultrasonic Debridement, and Hand Scale
    • 20 minutes max
    • If you think this will take longer the patient either needs to be scheduled back or educated on gum infection therapy or debridement for their dental hygiene therapy
  • OHI
    • Should take place throughout the appointment as you the clinician come across specific things to point out
    • Go over specific homecare techniques necessary per patient
  • Radio to Assistants:
    • “Quarterback, ready for comp exam in op _____, hygiene is complete”
  • Dr. Exam
    • Have mirror clean (use alcohol wipes), explorer, gloves and mask out and ready
    • Keep it quick
    • Give Dr. a review of all risk factors discussed (only mod-high risk factors)
      • Caries
      • Perio
      • Occlusion
      • Esthetic
    • Input all TX in computer, categorize in phases, save and label TX plan correctly, and print to give to patient
  • Wrap up the appointment:
    • Place fluoride (if appropriate; covered or paid for)
    • Take payment for any homecare rec: Toothpaste, Sonicare, Cari Free, etc
    • Schedule Re-call appointment
      • Fill out “value sheet” for appointment
      • Give appointment cards and go over referral gifts/ask for review
      • Have patient fill out post card
    • Go over restorative diagnosis, give TX plan, discuss financials, and schedule
      • We offer care credit and discounts when patient schedules and pre-pays for appointment (4% for credit card and 7% when paying cash or check)
  • Patient Hand Off
    • Radio to front desk you’re on your way up and if you need any help going over financials or ask the front desk if they need to collect payment from patient
      • Introduction
      • What we did today
      • What we need to do next: Urgency Statement
  • Turn Room Over/Chart Notes
  • Help Sterilization (if time)

Anesthetic Protocol for Dr. Josh, Dr. Ball, & Dr. Amy

Fillings, Crowns, Bridges


  • Infiltration buccal Septocaine – 1.5 carp (if multiple teeth ½ carp each)
  • Palatal Septocaine-.5 carp (needed for crown & bridge only)


  • IABL block Septocaine – 1 carp
  • Buccal nerve Septocaine – 1/3 carp
  • IAL block Plain- 1 carp
  • Dr. Amy – IABL block Lidocaine 1 carp, followed with 1 carp Plain

Crown Seat


  • Infiltration buccal Septocaine – 1 carp


  • IABL block Septocaine – 1 carp
  • Buccal nerve Septocaine – 1/3 carp
  • IAL block Plain- 1 carp
  • Dr. Amy – IABL block Lidocaine 1 carp, followed with 1 carp Plain

Extraction, Root Canals, Implants


  • Infiltration buccal Septocaine – 1.5 carp
  • Palatal Septocaine – .5 carp


  • IABL block Septocaine – 1 carp
  • Buccal nerve Septocaine – 1/3 carp
  • IAL block Plain- 1 carp
  • If premolar or anterior – buccal infiltration Septocaine – 1/3 carp
  • Dr. Amy- IABL block Lidocaine 1 carp, followed with 1 carp Plain


Wisdom Teeth Extraction


  • Lidocaine 1:100,000 epi – 1 carp
    • GP
    • PSA
  • Marcaine – 1 carp
    • PSA


  • Lidocaine 1:100,000 epi – 1 carp
  • Marcaine – 1 carp

*Palatal anesthetic needed for following procedures only; RCT, extraction, Crown & Bridge, Implant placement, surgical procedure, alveoplasty.


GIT (Gum Infection Therapy)
Appointment Guide

Using AAP from Perio chart determine Gum Infection Therapy (GIT) program

    • Full GIT/ Localized GIT
      • Phase I – Full mouth debridement or skip to Phase II (if time allows)
      • Oral Home care tools ( FL trays, FL TP, Essential smile rinse, Sonicare- we do not sell them)
      • Phase II
        • SRP all quads ( 2 quads per patient /insurance preference)
        • Laser Sulcular Debridement
        • FL varn
        • Pre Perio rinse
      • Phase III
        • 4-6 week check healing
        • Laser Bact reduction no charge
        • FL varn
      • Phase IV
        • Perio main appt (Probe, Perio rinse)
        • Determine recare ( 3, 4, 5, 6 mrc)
        • FL varn
        • Laser bacterial reduction retreat ($35)
    • Gingivitis GIT (Full Mouth Debridement)
      • Phase I
        • Full mouth debridement
        • FL varn
        • Pre Perio rinse
        • Laser bact reduction
        • Oral Home care tools ( FL trays, FL TP, Essential smile rinse)
      • Phase II
        • 6-12 week check healing Prophy
        • Determine recare ( 3, 4, 5, 6 mrc)
        • FL varn

Denture Hybrid Hygiene Protocol


Full denture:

1 appointment per year:

  • $41-9932 (upper cleaning denture) $41-9932 (lower cleaning denture), $0- 0330 (pano), $37-(0120), $0 – (1330) oral hygiene instruction
    • Cleaning and inspection of denture. Remove deposits.
      • Patient cost: $119 / year
      • Hygiene time: 30 min
      • Doc time: 10 min
      • Total time = 40 min appointment

Hybrid upper and lower:

2 appointments per year
Appointment 1:

  • $41-9932 (upper cleaning denture) $41-9932 (lower cleaning denture), $0- 0330 (pano), $37-(0120) P Ex, $12/each/$48- (0230) Add PA’s 4, $0 – (1330) oral hygiene instruction
    • Cleaning and inspection of denture. Remove deposits.
      • Patient cost: $167
      • Hygiene time: 30 min
      • Doc time: 10 min
      • Total time = 40 min appointment

Appointment 2:

  • $41-9932 (upper cleaning denture) $41-9932 (lower cleaning denture), $0 – (1330) oral hygiene instruction
    • Cleaning and inspection of denture/ implants. Remove deposits.
      • Patient cost: $82
      • Hygiene time: 30 min
      • Total time = 30 min appointment

If any teeth present code D1110

Laser Guide

  • Laser Sulcular Debridement (LSD)
    • Used with gum infection therapy
      • LSD + LBR in treatment areas
      • GIT
      • Laser debridement
        • Continuous mode
        • Power at 0.8 to 1.0
        • Tip initiated w/ cork or blue paper
        • May need anesthesia
        • 20-30 seconds per pocket (do not exceed 1 min per tooth)
        • decrease/increase setting as needed based on comfort/result.
      • Do not irrigate sub gingival – could remove clot
      • Re-hydrate lased areas with VitE
      • 4 week check healing appt scheduled- no subgingival probing or scaling for 3 months
  • Laser Bacterial Reduction (LBR)
    • Used with Prophy, Perio main, GIT, debridement
      • Full mouth LBR
        • Pulsed mode
        • Power at 1.8
        • Tip uninitiated
        • 10-15 seconds in free space
        • 3-5 minutes total treatment
      • Perio charting
      • HS / US
      • Re-hydrate lased areas with VitE
      • Recall scheduled
  • Root Desensitization
    • Pulsed mode
    • Power 1.0
    • Tip uninitiated – NON TOUCH PROCEDURE
    • 2-3mm from root surface, moving fiber in consistent overlapping pattern, covering entire area, 30 seconds
    • Repeat for another 30 seconds – repeat again if necessary
  • Herpes Labialis / Apthous Ulcer
    • Continuous mode
    • Power 0.7
    • Tip uninitiated – non touch procedure
    • 6-8mm over the lesion, move the fiber in a circular pattern, spreading 2mm past the visible blisters/lesion – 20-30 seconds
    • Check pt comfort at each setting
    • Power 0.7, 4-6mm, 20-30 seconds, WATCH FOR CHANGES
    • Power 0.7, 2-4mm, 20-30 seconds
    • Do not exceed 2minutes total treatment time
        • Caution around pigmented vermillion border
        • Aphthous ulcer may appear milky/cloudy when treatment complete

Sealant Technique With APP

Step 1: Set Up:

  • Sealant
  • Etch
  • Air powder
  • Isodry (hose, adaptor, mouthpiece)
  • Micro brushes
  • Cotton tip applicator
  • HVE
  • Saliva ejector
  • Mirror
  • Explorer
  • Floss
  • Practitioner preference of gauze, cotton roll and dry angles.


Step 2: Seal the Teeth

  • Clean grooves. Air powder with HVE
  • Rinse thoroughly and lightly dry
  • Etch 3 seconds.
  • Rinse
  • Etch at least 15 sec and no longer than 60sec.
  • Rinse thoroughly and dry so there is no standing water drops in grooves.
    • If tooth gets saliva contamination Re-etch 5 seconds
  • Apply sealant. Point sealant tip towards ceiling and load the tip with sealant. Then brush onto the tooth.
  • Light Cure 20 seconds per surface (ex. Buccal or Lingual needs it’s own 20 sec. cure) as  close to tooth as possible.

Step 3 Evaluation and Post Op

  • Evaluate for bubbles, voids or missed grooves
  • If tooth has not been contaminated with saliva: ensure no standing water and add sealant
  • If contaminated: re-etch 5 seconds, rinse, dry lightly, seal.
  • Use a cotton tip applicator or gauze to remove bitter film from sealant (your patient will be much happier if you do)  
  • Give POI
  • Complete chart notes.

Diagnodent Tip Retention & How To

  • Immediately After Use
  • Place tip in small sterilization bag in operatory
  • Bring to sterilization room

How to use Diagnodent

  • Turn on
  • Press Enter
  • Hold tip to yellow calibration circle until both numbers are 75
  • Squeeze neck of diagnodent to clear
  • Calibrate to virgin anterior tooth:
    • Dry tooth, hold tip of crystal to tooth, and squeeze neck of diagnodent until you hear 2 beeps
  • Dry desired area off and hold calibrated diagnodent over deep pit or groove, move laser light around to ensure you’re getting every reading.
  • Record reading on exam sheet
  • 0-19 safe to seal
  • 20-above = needs treatment

Medical Clearance


  • Blood Thinners – INR < 3.5, consult to see if med doctor wants to alter blood thinners
  • Diabetes- ask what type: A1C# – 6.5-7% controlled, over 8% uncontrolled
  • History of IV bisphosphonates
  • Cancer therapy –   If heavy doses of head and neck radiation, refer to oral surgeon for management of healing
  • Recent heart attack or stroke


Asthma- patient should bring inhaler to appointment

  • Kidney disease- prescriptions will be limited to not metabolized by kidney
  • Epilepsy- patient must have taken normal daily meds
  • Hypertension- must be controlled
  • Hyperthyroidism- cautious with the epi
  • Radiation- ONJ
  • Antidepressants- low saliva flow, slow healing after ext
  • Smokers- slow healing


Premedication Protocol:

  • Prosthetic cardiac valve or any prosthetic material for cardiac valve repair
  • History of endocarditis
  • Cardiac Transplant that develops cardiac valvulopathy
  • Congenital heart defect with prosthetic valves
  • Joint Replacements
  • Port-a-cath “port”- used for cancer chemotherapy/medication treatment
    • Do not need premed for PEG tube-used for feeding/nutrition/medication used during cancer treatment
  • If No allergies: Amoxicillin 2000mg or 2 G (= 4 pills)
  • If allergies to Amox or any “cillin”; or if patient is already taking amoxicillin for another infection use: Clindamycin 600 mg

Example Letter For Joint Replacement Clearance

13514 East 32nd Ave, Ste. B

Spokane, WA 99216-2231


Patients Name

Patients Address


Day and Full Date (EX: Wednesday, 5/10/17)


To whom this may concern:


Patient presented with active periodontal disease on (date), we performed scaling and root planing in all four quadrents on (date). We re-evaluated (patients) periodontal health on (date). Patient is still presenting with localized areas of active periodontal disease, pockets measuring 4-5mm, no redness, pus, or swelling is present in gum tissue. We recommended seeing patient more frequently for hygiene maintenance for (his/her) oral systemic health.


Dr. Cochran reviewed (patients) xrays taken today: bitewings + 3D CT scan of all roots. There were no radiolucencies present. (Patient) has a broken tooth present in the upper right with no infection.





Joshua Cochran, DMD

Charting Basics

  • Health History w/ updates, notes and blood pressure (copy to auto note and to the top of medical history box)
  • Chief Complaint
  • Extra Radiographs/ CT scan
  • EO/IO findings w/ documentation of picture and description.
  • Perio chart findings.
  • Perio diagnosis. “Informed of….. Slight, mod or severe…etc…”
  • AAP type, I, II, III, or IV
  • Perio Status: Active, Stable
  • Plaque level and location
  • Calc level and location
  • Tissue description and location
  • Bleeding level and location
  • Stain level and location
  • Exam findings & concerns
    • Examples: #2 (existing), (diagnodent # + surface for molars), Dx, Options for tx.
    •    #3 MO-A, Diag L-14, Decay MODL option fill.
    •    #4 Diag – 2 option seal for prevention
    •    #12 Monitor M incipient lesion
    •    #14 Diag 54. Decay OBL option fill
    •    #15 MOBL, fx occlusal, Less than 30% remaining tooth structure, option BU/CRN
  • Fill in priorities for Exam:
    • Mandatory tx (written out by priority)
    • Preventive tx
    • Cosmetic tx
  • OHI recommendations and current habits
  • Flavor of fluoride or why patient declined (+ edu on warranty, if relevant)
  • Next Restorative work scheduled or what is needed to schedule
  • Why restorative wasn’t scheduled and if they would like us to follow up
  • Next Hygiene appointment procedures
  • Area of concern: (ex: keep warranty valid, gum health, monitoring for cavities)
  • Change Dr. initials to the examining Dr.
  • Hygienist initials.
  • Secret Service Box: place of work, kids, pets, where they’re from. Netflix show they like. If Review invite was sent, Warranty info (#3 filling valid (date completed), Sealant info.
  • Treatment plans (labeled mandatory 1st priority: #3, 4, 5 etc. or Preventive: Sealants or Cosmetic: invisalign, Lifetime whitening etc.)  
  • Next hygiene visit labeled on treatment plan
  • Providers selected properly
  • Notes for Next appointment Box (date, postcard?, text and email, area of concern)

Creating / Organizing Treatment Plan


Adding Treatment to chart


  • Click on tooth
  • Make sure “tx plan” is selected
  • Click on surfaces (for fills)
  • Click type of tx
  • Tx will appear in red on tooth chart and will appear in tx plan


Organizing treatment in tx plan for patient


  • Identify/ per dr recommendation or pts pref, tx priorities
  • Highlight 1st priority/phase of tx
  • set at phase 1
  • highlight phase
  • click save tx plan
  • Name tx plan  ex: Mandatory Priority 1: Upper right fillings #2,3,4
    • Ex: Mandatory Priority 2: UL Crown #14
    • Ex: Preventive: sealants
    • Ex: Cosmetic: invisalign
  • Do this with all phases of treatment in order of priority
  • Why?  So front office / other staff  can easily schedule next priority if patient calls wanting to schedule what’s needed next


Saving Next hyg treatment


  • Schedule next hyg or add next hyg visit to tx plan if not scheduling
  • Go to tx plan , select all procedures for hyg visit, select no priority
  • Save and name tx plan : Next hyg Mar 2018
    • Ex: Next hyg visit: check healing
    • Ex: Next hyg visit: GIT L side need 90 minutes
  • Why? – Front office or other staff can schedule hyg procedures as rec by hyg and when due


Saving Perio programs


  • Click on 1st phase of tx and add
  • Go to tx plan, set priority 1
  • Go back to chart and add 2nd phase of perio program and then go back to tx plan set as priority 2
  • Repeat for all phases
  • Delete any procedures that have been declined (i.e laser if pt does not want) or if not starting that day delete debridement.  
  • Highlight entire tx plan , all phases from SCRP , heal check , 1st perio maint and save entire tx plan together
  • Let pt know entire out of pocket for entire plan ( the entire amount should be collected at time of starting tx by front)
  • Name tx plan  example:  Gum infection therapy program ( collect for all visits: $318.00)
  • Put note in 1st appt if made for front office to see as a reminder to collect for whole program not just that visit with amount
  • Put note in account notes amount to collect for whole program
  • Why? – when we collect for entire program pt only has one charge for the program rather than multiple for each visit, pt is already paid for the whole tx and less likely to cancel future appointments and helps ensure they complete the program entirely, creates less confusion for patient having one charge rather than diff charges for each appt.

Chart Audits

Chart Audit
Patient Name
Date of Appt
Stored DocumentsCompleteNot CompleteItemDetails to ResolveInitial When Complete
0 Remaining Red Dot Charts
Providers selected
Med HX w/ BP and details for diabetes, surg. dates etc.
Med Hx pasted to all three locations properly.
SSB noted every 6 months
Reviews/Sealants documented
Sealants charted and saved as "Preventive"
Existing Fills on tooth chart and in notes.
Tx plan phased, saved and labeled.
Next Hygiene Visit Saved on tx plan
Time needed for GIT in chart notes and tx plan
Label Tx plans "COMPLETED"
Patient set Prophy or Perio correctly
Risk Assessment done at NP visit
Pop-up's current
Lifetime whitening warranty documents in UL chart
Sealant warranty
Weekly numbers in google docs
Clinical Area
Correct Title on Group note
Chief Concern addressed and documented.
Current Radiographs
Current Diagnodent numbers in chart notes
Exam notes completed
Current Perio Chart- recession and case type
Hygiene findings for plaque,calc. tissue completed
Next Hygiene Visit details in chart note
If collected $ down- written in account
SchedulingNV Restorative: documented and if/when for follow up call
Recall visit scheduled properly: 3,4,6mrc
AOC noted: in chart and next appointment
PC noted
Shared Tasks
# of initials for 4 weeksEmpty and Fill water bottles
Instruments sharpened
End of Day restock operatory
End of Day restock sterilization instruments
Hygiene computers logged out
Misc TasksRecall/GIT phone calls made and comm logged
# of initials for 4 weeksPost op calls made and comm logged
NP calls made and comm logged
Traps changed out on Saturdays
Flush lines on Saturdays
Break room cleaned up
Lab cleaned up

Red Dots On Chart Audits

Here is why a red dot may still be on your chart

  • Chart note is not completed
  • PC (post card) made or not needed (documented on NV appointment note)
  • AOC (area of concern) not documented in chart note and in NV note (cavities/gum infection/warranty/crowns or rct’s needed/ sealants, fillings/ lifetime whitening)
  • Secret Service box not updated (needs to be updated every 6 months, review, sealants, and warranty all need a narrative also) ctrl +d = date then info. Newest entry goes right above review with date line so it’s always current when Dr enters the room.
  • For new patients in secret service box type: ?ssb and this will appear:

Patient hobbies, job, family (two things):

Review: Didn’t Ask, Sent, Denied

Sealants: Asked? Denied? Other:

Warranty Reviewed:

  • Next Hygiene Visit not charted, if not scheduled needs to be noted why, what they will need in 3, 4, or 6 months (ex: pt will call due to not knowing schedule, needs 6mrc prophy, exam, 4bwx + 2 pa, varn) (and if moved put on Kimberly’s google document so she can inactivate)
  • Secondary Provider not selected (remember to uncheck the box- same for entire family)
  • Gum infection therapy time needed not documented + if anesthetic or laser is needed or not
  • Finances noted at end of chart note (what was or wasn’t talked about)
    • EX: *gave pt treatment plan for all sealants, quoted, and collected 20% today, your initial
    • EX: *asked if pt was ready to schedule any treatment, they wanted to take treatment plan home and discuss with family, asked pt if we could follow up in a few weeks. (then send to unscheduled list)


Treatment presentation:

  • Fee for service here, what insurance covers here, what we cover/discount here, what your cost out of pocket here

Down payment

  • Due to our busy schedule doctor asks for a downpayment of (20% 1,000 under /50% 1,000++) to reserve your appointment. How would you like to pay for that today?

Payment options

  • Care credit — The best way to pay for treatment is through care credit. We try to make it as easy as possibly for treatment to be paid so we offer interest free options with care credit. Depending on your treatment costs we will cover your interest for 6, 12, or 24 months.
    • Terms:
      • 200-1,000 (6 mo)
      • 1,000-2,400 (12 mo)
      • 2,400 + (24 months)
  • Hygiene only — 90 days same as cash – first payment made day of treatment
    • Can be used on Gum Infection Therapy and Sealant Bundles
  • NP only with insurance — $100 off coupon:
    • If you would like to pay for your GIT all together I can offer you 100 off coupon
    • If you would like to get started on treatment today (same day) I can offer you a 100 off coupon. (this would be good for adding in sealants/ fluoride)


  • The best compliment we can receive is through a review so that other people are able to see it as well. Would it be ok if I sent you one through text or email?
  • We would love you to share your experience with us today through a review if that would be ok? I can send it through text or email, it’s very quick and easy.
  • _pt name__ we are always trying to improve which is why we love feedback. Other people also like to look up and see feedback before they come to our office which is why we ask for reviews. Would it be ok if I sent you one? They take less than 5min and are sent directly to you. We really appreciate it.


What is it? – a laser light that shines in the grooves or pits in teeth and gives a number reading as an extra diagnostic tool to help us see if there is a cavity in the grooves or just stain.  Also, if the number is 19 or lower and there is no cavity in between the teeth, we can seal over the groove to help prevent cavities in the future.

It is a light, so patient does not feel it, makes a beeping noise.  Takes a few seconds/tooth to check.

Less than or equal to 19-  can be sealed

19-24-  have dr look at tooth and let you know if decay or watch (rec flu tp to help remineralize) check again at next visit.

25+:  likely a cavity and needs a filling, pre assess as a cavity and have dr confirm


What are they?  –  a white coating/barrier placed in the deep pits a groove of the biting surfaces of the teeth where the toothbrush cannot adequately clean.  The barrier prevents plaque/bacteria from getting into those areas and eventually causing a cavity.

Statistic: studies show that unsealed grooves have a 90% chance of getting a cavity in them at some point in a person’s lifetime, sealants brings that risk down to 10% chance

*Why would you recommend sealants? Spokane is one of the largest cities in the US without fluoride in the water and that makes our teeth more at risk to the cavity causing bacteria.

*Eventually bacterial will win if we do nothing

Warranty:  Sealants are warrantied for replacement if they wear down or fall out for 3 years and replaced free of charge as long as patient is coming in for the recommended recall (hygiene) visits.

Process: no numbing or drilling required!  Tooth surface is dried, an etch liquid material placed on and then rinsed off to help sealants stick, tooth is dried, liquid white sealant placed in grooves and light cured.  

Time: plan for approx 1 min/tooth (kids or those with more saliva or harder to work on may take a little longer)

Verbiage for Sealants

Have the picture of their tooth up in front of them.

Say this:

We basically have two choices at this point:

You can do nothing and given your risk status this tooth will probably turn into a cavity and then we have to number you up, drill on your tooth, and destroy enamel to fix it.


You can have a preventive sealant placed on this tooth which is like fingernail polish for the groove, which is the best option for preventing a cavity in that groove.

Seal and Protect:

What is it?:  – a protective barrier (like a clear sealant) placed on the root surfaces of sensitive teeth to help dull or eliminate sensitivity.  It is infused with fluoride and not only will help your sensitivity from root exposure it will prevent future toothbrush abrasions while adhered to your tooth. They last for about 2 years.

45 MILLION adults who suffer from hypersensitivity (nearly 25% of whom are chronically affected) – Wendy Briggs

Warranty- 2 years as long as recall recommendations are being followed, the seal and protect can be replaced for that time on any teeth starting to feel sensitivity again.

$29/ tooth or if patient has generalized root surface sensitivity there is a code for a quad (¼ of the mouth)

Process: tooth doesn’t have to be numbed. Surface is dried with air if tolerable or with gauze if not, seal and protect liquid applied, small amount of air blown to spread and then light cured.  1-5 applications.  

Time: plan for 1-2 min/tooth   10 min/quad if generalized sensitivity

Perio program:

Periodontal disease- what is it?  –  Infection where plaque/bacteria in the mouth has caused you to start losing the structures that hold the teeth in (attachments from gums to the teeth and jaw bone that surrounds the teeth) 


How do we tx?-  numb if needed affected areas, clean to the bottom of the pockets and down root surfaces of the teeth to remove heavy buildup and bacteria,  laser to kill bacteria, flush pockets with prescription strength rinse to help kill bacteria   ( infection will continue unless bacteria and /or plaque buildup is removed and then kept clean)

Pt will then come back in about 4-6 weeks to check healing and laser complimentary to help things continue to heal. And then will come for their perio maint cleaning appointments after about every 3-6 months depending on what patient needs to help keep things stable and healthy.

Will it hurt: any sensitive areas will be numbed with either anesthetic or a numbing rinse as needed to help keep patient comfortable

What about after? –   sometimes there is some soreness from keeping mouth open for longer than a typical dental visit.  Gums can be slightly tender after if so use warm salt water rinse, but more patients don’t report much more post- sensitivity than they do if they were to floss.  Patients should be able to eat and do the same activities after they normally do once the anesthetic wears off.

What is the laser??-  the laser is a light laser that kills bacteria below the gumline, it can also remove dead gum tissue in the pockets that will not heal so that new tissue can be generated and attach back to the teeth.   Laser tx helps to sterilize below the gums and get rid of dead tissue so that inflammation goes down much more quickly, and gum will want to re attach to the teeth.   Does not cause any more sensitivity for the gums (pt is numb if any tissue needs to be removed)

Exam handoffs:

New patient:

Hi Dr _____, this is patient’s name, state personal fact about patient to break ice.   

Go over risk factors with Dr after Dr says hello and prompts you to discuss what you have already talked about

Gums:  let dr know how long ago their last cleaning (type) and exam was, let dr know perio charting numbers (general) perio diagnosis, and recommendation you’ve given to patient (do they need a prophy or gum infection therapy) let dr know if you’ve shown patients pictures of buildup or bone-loss or inflammation.

Teeth: compliment patient on home care or nice teeth, Let dr know that patient has some suspicious areas between teeth (if any)  or that patient is really great with home care and that you took xrays for him to check for decay.   – let dr know if you showed any specific xrays or intra oral photos to the patient of decayed teeth and also what you discussed with the patient as possible treatment options ( i.e : i showed  kellie an area on the lower left where there is some darkness in between the last two teeth and that it is quite large, i showed her the photo of the large filling that is already there and , i explained that there isn’t much tooth structure left so it may need a crown to help hold the tooth together so it doesn’t break on her later, but that you will check and see .  She is cold sensitive, but it goes away right away.  

Bite:   Kelly is not aware that she is doing any grinding at night and doesn’t have a lot of wear on her teeth, I let her know you will check for any crack areas to make sure there is no risk of teeth fx.  I showed her a picture of #3 where i noticed she has a crack, she is not having any sensitivity with chewing.

I did notice that tom has some wear on his back teeth, he does think he may grind a little and sometimes wakes up with a sore jaw or sensitive teeth.  i showed him cracks on some teeth and told him you will check them to see if they are at risk for breaking and if any are we may rec crowns to help protect them long term.


Kelly has had braces and has beautiful straight teeth, she is interested in whitening and i went over our whitening options with her.

Tom: does have some areas in the lower front teeth with some crowding making it harder for him to keep clean, i let him know we do offer some options to help straighten his teeth to help with keep those areas cleaner, he has been thinking about straightening them out.

Chief concern:  

Kelly did mention she is having some cold sensitivity on the UR that sometimes wakes her up at night, but tylenol helps, it has been happening for about 2 weeks but the last few days it has been worse.  

(After main concern is mentioned then dr talks and starts exam)


Can be done at any reasonable time during the appointment if there is something that the practitioner is waiting for. If there are multiple members of the family being seen same day, then it may be best to find out who is in charge of the family’s schedule.

Scheduling hygiene 1st may be easier because there are less follow-up questions from the patient than when scheduling a restorative appointment.

Example: Mary, for your next appointment in ___ months, is there a day or time that works best for you?

Ask if a postcard or reminder card is needed or the email and text reminder is working well for them.

Barrier: Doesn’t want to reschedule because she doesn’t know what her schedule will be in 6 months.

Answer: Let’s just pick a date and time to reserve your space and if you need to reschedule as the date approaches, then that is perfectly okay. This is good because you will get a reminder and won’t fall behind schedule for your check ups.

Barrier: Doesn’t want to follow recommended hygiene interval.

Answer: Mary, it is recommended that you come in every 3 months because research shows that the bacteria responsible for causing bone loss around your teeth will have multiplied enough to begin causing damage again.

If the patient is high risk decay: Mary we also apply the professional strength fluoride at this visit to protect the work you’ve had done.

The reason we base the warranty on following the recommended visit frequency is because we can catch small problems and fix them before the problem becomes bigger (ie small incipient lesions, excessive biting forces). Also, we can catch flare ups caused by perio bacteria before leading to further bone and supporting tissue loss.

Barrier: Moving out of the area

Answer: See Kimberly’s tracking sheet for people who are moving.

Pano and Pas:

We are going to take a Pano today to check for anything out of the ordinary in your jaw that can’t be seen with regular radiographs.

How often do I need a Pano? The picture will give us an image from ear to ear and only needs to be done once every 5 to 10 years unless there is something to monitor more frequently.

How much radiation am I getting?  Short answer: With digital sensors you are getting less than you would on a cross country flight, living in a brick house for a year, or using gas appliances for a year. Dental images only account for 2-3% of the radiation from natural background sources and 1% of our total radiation exposure. We take the least amount of radiographs that we need to monitor the health of your teeth and surrounding bone.

PAs: I’m going to take a close-up picture of your (crown, implant, rct’d tooth) today to make sure it is still in good shape. (see below for more PA verbiage)

Radiation from Dental X-rays are equivalent to less than one day of background radiation.

More info for our own knowledge base: Advances in digital technology allow us to get a good x-ray image using much less radiation than was previously required. The National Council on Radiation Protection (NCRP) says that the average resident of the U.S. receives about 360 mrem every year from background sources, and 360 from medical sources. Background sources comes from outer space, radioactive materials in the earth, and small amounts of radioactive material in most foods we consume.

Some typical sources that may expose you to radiation also include smoke detectors (less than 1 mrem per year), living in a brick house instead of a wood one (about 10 mrem per year due to radioactive materials in the masonry), cooking with natural gas (about 10 mrem per year from radon gas in the natural gas supply), and even from flying in an airplane (about 5 mrem for one cross-country flight because of the increased altitude.)

Sourced from ADA and Idaho State University Physics Department

Verbiage for PA’s

Dr and I were discussing your chart in our morning meeting, and he/she asked me to take some x-rays of your front teeth because we haven’t looked at them in quite a while


Joe, we have two types of professional whitening in our office:

  1. First, we have custom trays with professional strength gel (14% Hydrogen peroxide) that you can take home and use for 20 minutes a day for 2-3 weeks until you achieve your desired shade.
  2. Second, we have in office whitening which can take up to an hour (40% Hydrogen peroxide). We do in office whitening in 20-minute intervals up to 3 times during the visit.
  3. With the custom trays we have an awesome program where you receive a complimentary tube of whitening at each dental hygiene appointment. This program is 99.00 and includes the trays and an initial 3 tubes of whitening. It is valid as long as you follow the hygiene schedule recommended by your hygienist.
  • If you would like the in-office whitening it is 198.00, It’s a faster overall result.
  • If you would like extra savings we can package both whitening options for 249.00 so you save $50.00.


Q: Is whitening going to damage my teeth

A: There is no harm to the enamel or fillings with whitening.  There are a couple documented cases of misusing whitening gel for prolonged periods where the enamel lost its luster.

 The whitening product we use also has potassium nitrate and Fluoride which helps reduce sensitivity and strengthen the teeth.

Q: What is the difference between Carbamide Peroxide and Hydrogen Peroxide?

A: Carbamide Peroxide only has 3% of the active Hydrogen Peroxide so even though the percentage appears higher it isn’t necessarily more effective.

Q: How does whitening work?

A: The oxygen in the Hydrogen peroxide is released into the teeth and is able to break apart the stain molecules in the enamel, Also, peroxide has some cleansing effects. ***Oxygen is released as a free radical and breaks the double bond of pigment molecules. Breaking the pigment molecules down can change their optical properties.

Q: Are my teeth going to be sensitive.

A: Not always. 30-60% of people experience sensitivity in most studies. Usually lasting 1-3 days. With the in office whitening it is important to stop tx when you start feeling sensitive. Even though the product is no longer on the teeth, the free oxygen molecules continue to make their way through the enamel, dentin and pulp (whitening along the way) for a couple days after the treatment. This means that the sensitivity can increase over the next 24 hrs.

Q: How long will the whitening results last?

A: Results vary upon diet, age, medications and such, you can use your custom trays to touch up when needed.

Q: Can my child whiten safely.

A: Teeth continue to harden for at least 2 yrs after eruption and children are more likely to NOT follow instructions for duration. So not good to recommend under 15 yrs old or if a tooth erupted less than 2 yrs ago.

Q:  Is whitening toxic

A: There have been no scientific evidence showing a systemic effect.

Q: Is it safe to whitening while pregnant

A: No evidence showing that it isn’t safe but if mom can wait it would be ideal

Dental Hygienist Job Description

  • A dental professional whose main goal is identifying risk preventive care.
  • Dental hygienists treat gum infections by removing calcified plaque and bacteria from the teeth above and below the gumline. They also use a laser treatment to remove infected
  • Dental hygienists educate patients on ways to improve and maintain good oral health.


    • Arrive early to work and ready for morning meetings- clock in 6:45-6:55 am
    • Keeps up with culture of the office
    • Set up room’s
    • Stock room’s and follow task list
    • Treat patients with respect and remember that patient care comes first
    • Follow radio protocol with communicating to office about patient changes
    • Schedule patients back appropriately
    • Go over treatment plans and discuss finances
    • Take payment when possible
    • Clean up room
    • Finish all chart notes before end of day
    • Assist in sterilization daily
    • Close room down properly

Radio etiquette

  • Press and hold for 3 seconds before talking
    • Radio: “Front office”, “Back office”, “Hygiene”, “name”.
    • When responding for your department: “go ahead”
    • After hearing the “go ahead” then start radio conversation
  • Try not to radio between other people already talking
  • Tone of Voice IS IMPERATIVE– stress in anyone’s voice can come across as being passive aggressive & disassemble the vibe of the office
  • Our Core Values are to put the patient first, have team work, and the radio is one of our best qualities for team work. The radio also most fragile element of teamwork due to how we communicate with each other via tone.
  • If there is a stressful situation going on, seek help from quarterback first if regarding patients waiting.
    • Second: We are all a team, if one person is stressed it could be a trickledown effect
    • Ask for help (and when someone asks for help, we should not ever hear silence.
    • When team members are asking for help and you see your team mates are busy (who could actually answer the question, please be kind and radio that they are on the phone or with a patient & will answer as soon as possible. OR ask what they need and see if you can solve the problem for the person with the question. Silence is the worst when you actually need help 🙂
  • Side conversations are not to be on the radio- keep those for lunch or after work (not that we always have to be serious, but keeping focus on patients and keeping this office running
  • If your patient wants you to confirm something with their account and you feel it would be easiest to have another set of eyes for confirmation say, “I have read the account note, or I have read over their insurance coverage, just wanted to clarify this is correct.” This will help the front know that you are aware of how to find info, but they will also understand that we may only be radioing for “the patient’s” sake in confirmation!
  • Stepping out of the room to radio about the patient is 100% ok, especially if you don’t want the patient to know. This is preferred over walking up to front desk and asking question. Please step in to Dr’s office or into the lab to radio your message.

Fluoride Verbiage in Back Office

Based on what I’m seeing in your Med HX, your Risk Assessment and in your mouth, I’m going to make a recommendation for a professional strength fluoride treatment.

Good news/Bad news-this is not an area insurance traditionally HELPS with for adults, however its only $30. Isn’t it worth $30 to protect this investment you’ve made in your mouth.

Fluoride Verbiage for Front Office

Patient states, “Do I really need the fluoride, or I don’t want it because of out of pocket expense”

Front: “we recommend a fluoride varnish treatment to every patient in this office 2x/year, especially because we do not have any fluoride in our water and it’s been proven to reduce your cavity risk by 70%. I get it every time I have my teeth cleaned because it is one of the best ways for me to prevent cavities.”

Area of Concern/AOC

  • Area of concern is a retention strategy that we use in our chart notes to communicate with the front desk when a patient calls to cancel or reschedule their appointment potentially out of their warranty deadline.
  • EX: AOC: Sealant warranty/ gum health
    • Crown warranty
    • Filling warranty
    • Lifetime whitening
  • When the front desk see’s this information they are armed and ready to help that patient keep their appointment.


  • Our dental warranty is another retention strategy to help the patient maintain optimal oral health. It states that as long as the patient has their dental cleaning done 2x/yr (unless hygienist recommends otherwise) and fluoride treatment 2x/year we will guarantee our work for the following amounts of time:
    • Sealants: 3 years
    • Crowns: 5 years
    • Fillings: 5 years
    • Lifetime Whitening: Meaning, as long as they stay a patient here and current with hygiene recare, they will receive 1 tube of whitening gel

The 5 R’s

  • Recall
  • Retention
  • Recovery
  • Reactivation
  • Referrals


Every patient leaves with appt

  • Best way to ensure future health
  • Schedule fills up quickly, make sure they have a appt at preferred time/hyg
  • Postcard filled out by patient in red
    • Gives patient ownership of appt
    • Remind patient postcard comes 3 wks before appointment need to confirm appt or will assume they’re not coming
    • state to pt when making appt that they need to confirm so they hear it mult. Times.
    • At checkout FO make sure recall appts made for restorative and hyg pts

Dialogue examples:   

Do not ASK if patient would like to schedule.  

“I recommend getting you back for your next hygiene appt in. (FO: Chelsea wants to see you back in..), would another wednesday morning most likely work best for you? “

“We’ll send you a postcard asking you to call to confirm your appointment, please call us back to confirm or well think you aren’t coming!  If your appointments already been confirmed don’t worry, you’ll still get the reminder text the day before!”

Recall -Confirmation of appts:

1st attempt:  Recall cards mailed 3 wks before asking pt to call to confirm

  • Recall cards must ask pt to call back to confirm (state appts need to be confirmed)

2nd attempt:  1 weeks call for unconfirmed

  • Courtesy call for any patients scheduled 6 months previously and have not back after PC sent to confirm their appointment
  • Leave voicemail: “Hi Sarah, this is Becky calling from Dr C Family Dentistry regarding your hygiene appointment next Tuesday at 5 pm, if you could please call us regarding this appointment we would appreciate it! Leave number.”

3rd attempt: text/email gets sent to patient 5 days before appointment if unconfirmed

4th attempt:  call 2 days before appointment if patient does not confirm call to confirm

  • VM: “Hi this is Becky calling AGAIN from Dr C family dentistry calling regarding your appointment with Chelsea on tuesday.  Please give us a call back to confirm your appointment, if we do not hear from you by tomorrow morning at 9am, we cannot guarantee that appointment for you, so please give us a call to let us know if you are coming!”

-Any appts unconfirmed by 9am the next day are ghosted so we can use recovery methods to fill empty spaces in schedule.

Text/Email Reminder: reminder night before/morning of for CONFIRMED appts ONLY

IN THE EVENT – an unconfirmed/ghost patient shows up and another patient has been scheduled, we get the confirmed/ newly scheduled patient back on time and let the unconfirmed patient know “We are so happy you are okay, we have been trying to reach you.   We didn’t think you were coming since we didn’t hear back from you. Unfortunately, this appointment was filled but if you don’t mind waiting, we can do our best to try to fit you in or if you’d rather we can get you rescheduled.”

Recall- Overdue (Less than 18 months overdue)

  1. after cancellation- send PC to schedule “sorry we missed you”, “feel better” if not R/S within 1 week, can be made when pt calls to cancel or have list made to work off of.
  2. 1 week later Call pt to schedule, letting them know: “Hi, Sally!  Dr asked me to give you a call to get you scheduled back for your overdue hygiene appointment so that we can keep your gums healthy/ keep your dental work under warranty/ he can check that area he was concerned about.”   If no answer LEAVE MESSAGE: “Hi Sally this is Patricia calling from Dr C family dentistry regarding your hygiene appointment, if you could call us back at your earliest convenience, we would appreciate it, leave number”  

 Patient will likely call back saying they weren’t aware of that appt you can say: “oh it looks like that’s why Patricia was calling, Dr asked her to call to get that appointment scheduled for you, Patricia is on the phone, but i can go ahead and get that scheduled for you, is there a certain day that works best for you?”  

  1. 3 overdue months -send overdue hyg PC
  2. 6 months overdue -call again leave message
  3. 12 months overdue -Send letter stating patient is overdue asking to call back to schedule.

(any patients already overdue, make sure at least one phone call has been made with message left and then go off of where they are in overdue schedule)


Reactivation -( Deactivated patients/ over 18 months overdue)

  1. De Activate patients who have had 4-5 attempts to schedule or are over 18 months since last dental appointment (check if had rest appts too)
  2. Pts who are 18 months overdue and have not had at least 4 contact attempts: Phone call – leave message – deactivate and then follow below steps.

Reactivation plan:

  1. Reactivation Email (sent right away)
  2. Letter- special offer (sent 1 month after email if pt has not activated)
  3. Free whitening / exam x rays or promotion for something for their specific tx plan needs



Method of helping patients to keep their appointments

Lifetime Whitening

    1. Offer to everyone
      • FO hand out LW sheet to patients checking in.  “Have you heard about our Lifetime whitening program?  Heres info on it you can look over until you’re brought back, if you have any questions let your hygienist/assistant know!”
    1. Make note in appointment / flag patient’s account
    2. Give pts in program their refills/ track those who don’t follow recall.
    3. Cancellations must give 48 hr notice, pt needs to be seen within 2 weeks of missed appointment to stay in program – if they are kicked off re enrollment is $99
    4. Use as leverage when pts cancel or to get pts to keep/schedule appts.

 Dental Warranty

  1. Have every patient sign and scan in images
  2. Every patient who has done any treatment in our office should have read and signed this, check when checking in, back office check during appts.

AOC (Area of concern) found in appt or in last appt chart notes

  • Area that Dr wants us to check next appt
  • Use when patients cancel/ mention when confirm hyg appts
  • Pt cancelling verbiage: when pt cancelling appt “oh- no!  I’m sorry… Dr Josh was really worried about…. Is there anything we can do to help you keep this appointment?”
  • “oh no-  Let me get you rescheduled before…. So, we can keep your fillings under warranty / keep your whitening program active!”

Patients cancelling appts

      • Send get well/ thinking of you card

Patients with hx of breaking appts (more than 2x)

      • Schedule same day only
      • Send letter informing patient they will be scheduled same day only
      • Put pt on PA list (call them when open time in schedule, filling open spots same/next day)


      • Filling empty holes in today’s schedule for the afternoon and tomorrow’s schedule starting with the morning.
      1. Check patients already on hyg/restorative schedule around that time and see if they can do hyg /treatment same day, call and ask (ideally done before when doing confirmation calls)
      • “Hi Harry, i saw you are coming in this afternoon for your fillings and noticed you are due for a cleaning too, would you like us to do that for you at your appointment too so that you don’t have to come in twice?”
      1. Start with ASAP lists
      • Asking every patient who is scheduling “If we have an opening come available sooner on the same day /time would you like us to call you?”
      1.  Next week’s schedule
      • Start with same day and time of day (perio maint appts and SRPs more likely to move)
      • When scheduling hyg book out 6 months plus 2 weeks to allow to come in sooner if called
      • When calling still check ins freq first
      1. Fill schedule with NPs
      • If not enough time for a 1.5 hr appt then offer to do comp fmx pano to start and if we have time we can try and squeeze in a cleaning.  Or schedule comp fmx pano on Dr side and if time in hyg schedule do hyg after
      1.  Call Broken Appt lists, Recall Lists and Unscheduled tx lists (SRPs and sealants) (maybe offer incentive for coming in today?)

Patient calling to cancel (Verbiage)

Make sure when trying to remind patients about warranties or staying with hyg to get them to keep appt/or schedule to not say it in a tone that is condescending or punishing but more as if youre trying to help or look out for them.

“if you cancel and don’t r/s within 2 weeks your warranty is void”  VS.  “oh no! Well let me HELP you to get r/s to keep your work warrantied.”  

Get them r/s

I’m sorry you aren’t able to make it to your appointment, let me go ahead and get you rescheduled so that…. (you can get back in with kalie again before she’s booked up / you’re scheduled within the 2 week grace period to keep your dental work under warranty!)

Try and keep the appt

“Ok i can go ahead and take you off the schedule, i do want to let you know that Kalie’s schedule is very full right now esp at that particular time and i know you’ll probably want to get in soon to keep your warranty on your dental work, is there anything i can do to help you keep your appointment?”

I’ll call back when ready

Ok Sally we can wait to hear from you to schedule if you need to check your schedule, I know you’re probably really busy, your dental work we did is under warranty when you cancel a hygiene appointment as long as we get you back within the 2 weeks, would you like a courtesy reminder if we don’t hear from you in the next few days?”

What warranty Signed-  Oh glad you asked I’d be happy to remind you, you might remember them going over it with you when you did your fillings on “date”, many offices dont have a warranty on dental work but Dr C is all about prevention and wants to offer patients an incentive to stay cavity free, so we warranty fillings if patients are coming for their rec cleanings and getting fluoride!  If patients have to cancel their hygiene appts for being sick or an emergency, we just ask that you try and give 24hrs notice and r/s within 2 weeks!”  “When you signed it we sent you home with a copy but we have a copy of your signed one here if you lost your copy we’d be happy to get you another”

Haven’t signed- Dr C recently decided to start offering a warranty on all new fillings and crowns as long as patients are coming to their hygiene appts and getting fluoride we, since this is a new program if you get any new work done here and are doing those things we can definitely warranty them for you!

(if patient has had a recent exam and coming regularly/flu already and has had fills done here and no tx planned decay on those teeth  let pt know you can check into extending the warranty to their older fillings/crowns placed before we started offering the program)

Do I need xrays?  

ADA recommends getting them on all patients at least once a year because there are things we can find in them that can’t be seen with our regular eyes and we don’t want to miss something while it’s small or starting and could be prevented and wait till its large and more expensive to take care of”

  • Still dont want-  other reasons- “ ok ill definately let your hygienist know for you and that way she can address any questions if you have any!” 🙂


        1. When scheduling appts let pt know about Care to Share Program
          • Patient refers family/friend and gets incentive for their referral
            • -1st: movie tickets
            • – 2nd or more referrals: $50 credit (each referral) to account for tx only (no product)
            • -Referring patient name must be on the card
          • Referred patient bringing in Referral card gets $50 credit to account for tx
            • cannot be combined with $100 np gift- one or other
            • Patient needs to bring card in with referring patients name on it
          •  Team member with initials/name on card will get $25 / card brought in.
        2. Referral cards can be sent out in NP thank you cards for NP to give to friends

Daily Hygiene Checklist

Sharpen instrumentsWFMM
Recall phone calls madeWFMM
Post OP calls made by end of weekWFMM
NP calls made (week prior)WFWM
NP Cards made by end of weekWFWMFridaySaturday
Take home Hygiene bags madeTTHMW
Take out hygiene op trashMTWTH
Make sure all hygiene computers are logged offTTMW
Empty/ Fill all water bottles - check with last offTTMW
Break room clean upMTWTH
Lab clean upMTWTH
Make sure scrubs are put awayMTWTH
Flush Lines SATURDAY
Change Traps
Week 1Week 3Week 1Week 3


Dr. Josh Chocran

EMERGENCY? | 509.590.2522 | Reserved Openings every day for dental emergencies