The high-tech assistant

May 6, 2008
The assistant becomes the driver of the bus who is responsible for incorporating the new technology into the practice and getting the rest of the staff on board.

By Rand T. Mattson, DDS

The latest and greatest in new technology was described, praised, and purchased at the most recent convention--now the convention's over and the shipment is on its way. The assistant opens the box to see the new acquisition. The dentist, still motivated and excited about the item, tells the assistant to "figure out how to use it." The assistant becomes the driver of the bus, so to speak, responsible for incorporating the new technology into the practice and getting the rest of the staff on board. This is the equivalent of a field promotion to the high-tech assistant, and the opportunity may determine the fate of a new piece of equipment and the high-tech direction of the practice.

Technology is and will continue to be a vital part of today's practices. High-tech assistants should view incoming technology as an opportunity to diversify their skills and exercise leadership qualities. By arming themselves with training and an opportunistic attitude, assistants can develop stronger technological skills, motivate and guide fellow staff members, and deliver better patient care.

Are You Prepared for the Ride?
A few truths need to be discussed regarding the purchase of high-tech items for the office.

1. Assistants rarely make the ultimate decisions about high-tech purchases. Because high-tech usually means high money, the dentist makes decisions about the purchase of this equipment.

2. The dentist's high-tech purchases force change on the clinical staff, and most often that staff has not been consulted or allowed input. The new equipment generally changes how work flows in the operatories. Some changes are as simple as reducing the curing time for composites, while others are more revolutionary, such as changing from film to digital radiographs. Resistant or less enthusiastic staff may drag their feet regarding implementation of any new high-tech acquisition.

The high-tech assistant moves toward new technology, techniques, and systems by embracing change. The high-tech assistant is motivated and unshaken when the bus takes a new turn. The high-tech assistant asks for training for himself or herself and the rest of the staff.

Training ensures everyone plays a part in implementing a new technology. Training should include the dentist and all relevant team members such as front office personnel, who are not only patients' first contact with the office, but also their last contact after treatment. Training might take 15 minutes or several days. Training time is not time off, and should be used to become proficient, knowledgeable, and confident with new technologies.

3. Delays in implementation can decrease the dentist and staff's motivation. The longer the time from purchase until use, the higher the likelihood that the new item will be relegated to the storage closet, where it will likely remain unused.

The high-tech assistant works to implement technology as quickly and smoothly as possible, and holds daily discussions regarding implementing the equipment and techniques for new situations, implementations that went well, and how to improve use of the new technology. This daily communication should continue until the new technology is up and running. Morning huddles are the ideal place to update staff on technology. Huddles keep all staff up to date and avoid many team members making the same mistakes during the learning period.

4. Change is difficult because it forces people out of their comfort zones and makes them learn new concepts. Sometimes staff feels like dentists are forcing high-tech devices into the daily routine, and thus have a difficult time accepting change. High-tech dentists realize change is inevitable and are not looking to change staff attitudes, but are looking for the right staff to be on board. They want staff that embraces change and high-tech dentistry. Dentists do not necessarily want to change the people on the bus as technology changes; they want to hire and keep the right people who will change and grow with technology and the practice.

The high-tech assistant meets the challenge of change head-on. Technology implementations can make assisting more interesting and enjoyable. Assisting duties will increase in complexity and skill, which will garner more respect from the dentist, patients, and fellow staff members. Work flow will become easier, more efficient, and more valuable. Knowledge of current systems will secure the assistant's position as an educator. The high-tech assistant can become the staff member who educates and encourages patients, trains new staff, and helps staff stay current on all systems used in the office.

Your Bus Ride: Predicting the Unpredictable
Work life on the high-tech bus is ever changing. Treatment procedures are constantly being revisited, expedited, and improved. New equipment means new training and better experiences for both the patient and assistant. Many changes involve computerized operatories, digital radiography, and curing lights--all of which modify the workflow. Following are a few shots of the ways technology can transform and revolutionize a practice; however, it's important to remember that the face of dentistry is always changing. This requires staff flexibility and enthusiasm.

Computerized Operatories
In-operatory computers are a recent addition to the modern dental practice. Adoption has been rapid, as use has soared from 33 percent of general practitioners who report a computer in one or more operatories in 2003, to 73 percent in 2007. These so called computerized operatories are not robotic deliverers of dental care, but simply incorporate computers to increase efficiency and allow the use of other technologies chairside. More often than not it is the chairside assistant who manages these high-tech resources.

Treatment charted at chairside--existing, proposed, and completed--is instantly available throughout the office and not dependent on a paper chart. It is faster, more uniform, legible, and aids in rendering consistent care. Practice management software makes it simple to plan treatment of proposed work, preauthorize with insurance, and inform patients of cost. Clinical staff can post treatment as it is completed in the operatory, thus reducing the risk of not billing for a procedure, or incorrectly billing because of communication errors between clinical and business staff.

Operatory computers running practice management software allow clinical staff to make the patient's next appointment in the operatory. Making appointments chairside can help reduce the number of patients that do not make return or follow-up appointments. It also allows the office to customize appointment times to accommodate patients with unique issues, such as allowing extra time for someone with a small mouth or for someone difficult to anesthetize. Operatory computers can also be used to present educational materials and images chairside. Many offices use patient education software (such as CAESY Education Systems from Patterson, Vancouver, Wash., CAESY), which necessitates software training of all staff members who tend to patients.

Chairside education programs explain most dental procedures in non-technical English or Spanish. Printed versions or patient customized CDs can be given to patients. The information presented to the patient can be automatically documented in the patient's treatment record. Used properly, chairside education systems help answer patients' questions and resolve reservations so treatment can be scheduled. A significant advantage of using these systems in the operatory or the consultation room is clarification of treatment in the patient's mind. When the patient clearly understands the recommended treatment, it can be scheduled on the spot. This prevents the buyer's remorse that may occur between the operatory and the scheduling coordinator. Far less treatment goes unscheduled.

Digital Radiography
If the office is already using computers in the operatories, digital radiography is the next logical step. Motivated high-tech assistants who are truly interested in patient care embrace digital radiography, which keeps them in the operatory with patients rather than down the hall developing film. Digital radiography reduces the time when patients are alone, time that can stress some patients. Patients appreciate the speed and lower exposure to radiation. They also like the large image that helps them better understand as the assistant educates and explains the situation. When compared to film, the speed of digital radiography drastically changes clinical workflow. Appointments can be shortened and time reallocated to patient education, production, scheduled breaks, or any other tasks the office deems useful.

Curing Lights
Curing lights are high-tech devices that have been used in dentistry since the advent of light-cure composite. In1970 LD Caulk introduced ultra violet light cure Prisma Fil, and two years later ICI introduced visible light cure Foto Fil. Today only visible light is used to cure composite. Allowing essentially unlimited working time, light curing was a nirvana moment for dentistry.

The first curing lights were unwieldy boxes with a curing hose that were generally in the dentist's control. Today curing power has increased, reducing cure times, and held units are the norm, which places curing lights in the assistant's hands. Shorter curing time means less time isolating the site and retracting the cheek or tongue. This makes life easy compared to older methods (for example, five-second cures versus 30 seconds or more with a challenging case).

High-speed curing lights are another quantum leap forward in operatory work flow. Light-emitting diode curing lights are portable and can be placed in the assistant's care during a procedure. The increased power allows dramatically reduced curing times, which requires both the dentist and assistant to play their "A-game." Any slack time in a composite restoration is gone.

A high-tech assistant who manages the curing light becomes a more integrated part of a restorative team. Anticipation and strict attention on the part of the assistant helps save minutes per composite, and improve restoration quality. Speed reduces the chance of restoration contamination in even the best isolated sites. The time saved can be used for developing the assistant/patient relationship, or adding value to the restoration through digital image documentation. The time saved is also a public relations bonanza; patients appreciate the reduction in open-mouth chair time.

Many offices have taken the high-tech road and use high-speed curing lights and electronic caries detection. These are relatively low cost and can be implemented and adapted into the practice with only minor changes to the established office routine. Further down the road is CAD/CAM technology for restorations. If your practice does not include these high-tech items, your role as the high-tech assistant is to encourage the dentist to adopt new technology.
The truly high-tech assistant should always be on the lookout for new techniques and products that can increase office efficiency and enhance patient experience. High-tech assisting requires knowledge of the products and the ability to clearly explain them to the public. Patients are amazed and better services are performed when these devices are properly integrated into the overall dental experience.

The high-tech assistant is an indispensable team member. Technology will continue to course through the daily practice of dentistry, and the high-tech assistant will embrace that technology because it makes the bus ride more exciting and fulfilling. There are no assigned seats and the route is less predictable, but the right person on the bus is self-motivated and in for a thrill. To be part of that staff, become proficient and view change as a challenge instead of a disruption in the routine. By being the right person on the bus, the high-tech assistant can help polish the reputation of the practice, deliver quality care, and strengthen relationships with patients while making the office a great place to work.

The author is a stockholder in Patterson Dental.