The ideal dental assistant
by Priya D. Kothari, DMD
originally published in Dental Economics, November 2004
Reprinted by permission

The dental assistant plays a critical role as a link between the patient and the dentist before, during, and after treatment. The person in this position is a principal in the successful delivery of treatment. What makes an ideal dental assistant? How are strengths and weaknesses assessed? How do you identify gaps in his or her performance? Finally, what actions can be taken to close those gaps?

Anticipation is a key factor for a dental assistant. The ability of the dental assistant to anticipate the needs of the dentist in any procedure—and to act promptly on them—will determine whether an office will be able to increase its speed in treating patients without compromising the quality of care. After all, efficiency is very important in the practice of dentistry. Since dentistry is obviously a customer-oriented business, it behooves all practice members to work as a team. This will result in patients receiving high quality services with an efficiency that allows an increase in overall productivity. The quality of service the dental assistant provides—no matter what the patient load per day—makes the difference between a mediocre practice and an outstanding one.

Since dental assistants' various responsibilities are paramount in the success of the office, it is vital to have employees who consider themselves to be career professionals. They must be willing to increase their knowledge through continuing education, challenging opportunities, and involvement in professional dental assisting organizations. Although responsibilities will differ from practice to practice—and even within the practice—the functions of a dental assistant can be grouped into five sections. These sections are based on the flow of activities in the typical dental office.

1) Prior to patient arrival
2) When the patient arrives
3) When the doctor arrives and treatment begins
4) When the patient is ready to leave
5) Always—a part of professionalism, ethics, and teamwork

A checklist has been designed and is presented below that will help you assess the skills needed to for the average dental assistant to transform himself or herself into an outstanding contributor in any practice. This checklist can be adapted and modified to suit the policies and practices of any office.

Mark "yes" (Y) in the box to the left of each statement under each of the five categories if they are followed diligently and performed regularly by the assistant. Mark "no" (N) if they are not. Check the "yes" score after completing the checklist and recommend actions for improvement at the end.

1. Prior to patient arrival

• Patient's chart is readily available and in treatment room with X-rays mounted for review.

• Treatment room should be set up for procedure to be performed with appropriate armamentarium. (Check what treatment is planned for each visit by reviewing the patient's chart ahead of time.)
Standard requirement: Personal protective equipment (PPE), high volume evacuator (HVE), air/water syringe, basic instruments, high/slow-speed handpieces, and burs.
Procedures: Amalgam/composite restorations, fixed and removable prosthetics, root canal therapy, extractions, child prophies, scaling and root-planing, and impressions.

• Ensure that personal appearance and treatment room appearance are presentable and clean! Follow OSHA guidelines. Keep in mind that a health service is being provided, and in order for the informed consumer to "buy" the service, it is imperative to have cleanliness, neatness, and office organization, and for the patient to perceive this.

2. When the patient arrives

• Inform patient and front desk if doctor is running behind schedule. Invite patient into the operatory and make him or her comfortable. Confirm that patient chart/X-rays correspond to the patient in the chair. Verify the date of the patient's last visit, and note any changes in insurance status.
• Update patient's medical history, take blood pressure if needed, and review whether any premedication is required.
• If this is a new patient, take appropriate radiographs (e.g., FMX, Panorex, four BWs, two PAs), as allowed by state law.
• If this is an emergency, ask patient for location of discomfort. Then, take necessary X-rays as allowed by state law.
• If the procedure requires simple alginate impressions, have them ready before the doctor arrives.

3. When the doctor arrives

• Use discretion! Discuss in private if there is anything you wish to bring to the doctor's attention regarding the patient or treatment, prior to beginning treatment.
• Use nonverbal communication with doctor in presence of patient (e.g., use eye or hand communication, jot down notes to each other).
• Anticipate next move in each procedure, and try to prepare for it.
• Pay attention to priority tasks — check with doctor (e.g., ask when to pour impressions).
• Keep doctor informed to ensure that work in the operatory runs smoothly and efficiently.
• Clean up and set up treatment rooms as required to maximize usage and accommodate patients.

4. When the patient is ready to leave

• Help patient to look presentable—wipe face, offer a rinse, hand him or her a mirror.
• Ensure that patient has after-hours office number and post-operative instructions if there are questions or concerns regarding treatment.
• Mark down codes for services provided on the "router" and verify with doctor.
• Check what work is planned for the next visit and make note of it in chart and on the router.
• Verify doctor has documented treatment in patient chart.
• Break down room per standard procedure. (Follow OSHA Infection Control Guidelines.)

5. Always — Professionalism, ethics, and teamwork

• Out of courtesy and ethics, respect patient confidentiality. Disrespecting it is a violation of a patient's privacy rights under HIPAA. Do not leave patient chart open on counter, easily available for other patients to read. Avoid gossiping with other personnel regarding the patient's health.

• Respect provider confidentiality. Do not criticize another service provider in the presence of a patient, even if the patient is a friend, colleague or a fellow employee.

• Obtain doctor's permission before changing his or her schedule or phoning patients directly regarding medical or treatment issues.

• Show up on time during scheduled office hours. Contact office immediately in case of delays. Cultivate network and teamwork to provide backup support.

• Discuss concerns openly with your doctor. Recognize where you need help ... and ask for it!

When you have completed the checklist, check the total points by counting the "Yes" responses and refer to the chart above to determine what steps should be taken to improve an assistant's performance. If the score is a perfect 25, then the office has an ideal dental assistant who can probably perform his or her duties blindfolded!

Above all, take initiative, anticipate, and follow up. Keep your doctor informed. Be frank about what you can and cannot do. Spring no surprises. Ask if you have questions or need clarification. Follow professional ethics. You are now on your way to becoming an outstanding dental assistant. Remember, this is a team effort and you are a major player in providing superior quality service. The doctor cannot do it without you!

This article would not be complete without a word to the dentist. The dentist as the head of the dental team must take an active role in cultivating the ideal dental assistant. Without the involvement and encouragement of the dentist, the practice will never have an ideal dental assistant. Continuing education and membership in the American Dental Assistants Association should always be part of an assistant's benefit package. Remember to treat your dental assistants as you would want to be treated.

Dr. Priya Kothari graduated from the Boston University School of Dental Medicine in 1997 and then completed an AEGD residency at the University of Pennsylvania. Since then, she has been practicing general dentistry and has developed a keen interest in improving office productivity and efficiency. She currently practices in King of Prussia, Penn. She can be reached by e-mail at priyadmd@yahoo.com.