Do we have to impress any dental practitioner about the
importance of dental assisting? In our opinion, much of the success
or failure of typical dental practices is directly related to the
effectiveness of dental assistants. The public relations, the productivity
and the revenue of a practice can be significantly
increased when dental assistants are motivated, educated and
trained in the essentials of dental assisting, and have become
genuine "team" members (Fig. 1).
Figure 1: Developing a genuine team requires proactive planning, organization and
implantation of correct concepts by the dentist.
Several decades ago, many dental schools had a significant
amount of integrated dental assisting-dentist education in their
curricula. Usually, these programs were funded by federal grant
programs, which subsequently have disappeared. Highly valuable
studies to determine the desirable ergonomic characteristics
for dental practices were also funded by the government at that
time. The result was development of operating chairs of the
most desirable size and function; recognition of the necessity for
correct positioning of dentist and dental assistant; the most
adequate sterilizing and storage systems; efficient instrument
passing to dentists; simple infection control and myriad other
important subjects directly related to effective dental assisting.
Dr. Christensen was involved in structuring and teaching in
these programs many years ago. Unfortunately, as these programs
lost funding, most of the teaching of dentist-dental assistant
interaction ceased. There are now many dental students
graduating from dental school who have never worked with a
dental assistant, and who have no idea about any of the necessary
characteristics for optimum use of dental assistants. Poor
habits and practices learned in other practices are often brought
into the new dentist's office because of this inexperience.
In the following information, we will list and discuss the
optimum characteristics of dental assistants, emphasize some
of the most important clinical tasks that can be legally delegated
to properly prepared dental assistants and make suggestions
on how to best implement these important characteristics
into your practice.
Maximizing the Professionalism of
Most dental assisting schools provide many of the aspects of
becoming a true professional dental assistant. However, just as
with new dentists, professionalism usually requires time for development.
Over many years, we have heard and observed the dental
assistant characteristics that are sought by dentists. See if you can
develop these and other characteristics you might consider important
in your dental assistants. Among the most important and
desirable dental assistant characteristics to us are the following:
Training/Education: Although many dental assistants learn
primarily by preceptor experience, we suggest for a person
entering dental assisting, to enroll in and complete an accredited
dental assisting program. There are many such programs
available in local community colleges or private schools. The
following Web site is an excellent source of information:
Constant Continuing Education: Dentistry changes rapidly,
and dental assistants must keep up with those advancements.
We suggest you encourage your dental assistants to take
CE on a scheduled basis. Taking CE courses periodically is
mandatory to keep up with the ongoing changes in the profession.
Dental assistants can gain significant useful information by
attending courses that are primarily oriented toward dentists.
Certified Dental Assistant (CDA) Designation: Encourage
your dental assistants to obtain the CDA designation. This distinction
adds to their professional identification and enhances
Leadership: Many people, including some dental assistants,
are satisfied to let others lead them, while others are always
thinking ahead and making suggestions for improvements in
whatever they are doing. This characteristic can be stimulated by
congratulating and thanking dental assistants for their creativity
and innovativeness as they exhibit such characteristics. Some
practices have incentive programs for dental assistants who provide
methods for improvements in the practice, increasing revenue
or cost savings.
Outgoing and People-oriented: An introverted dental assistant
is a liability. These persons must have excellent interpersonal
skills. They must be constantly looking for ways to make
people feel welcome and comfortable in your office. Encourage
the development of such characteristics.
Cheerful and Optimistic: This is an attribute that is
extremely necessary in almost every vocation. A happy employee
makes happy patients. Encourage and praise these characteristics
and be an example yourself. Your dental assistant can make people
feel as though you have the best office and staff in the country,
and that you, the dentist, are highly competent and
qualified. Encourage such behavior by recognizing the optimism
and thanking staff for their support.
Empathetic Behavior: Dental assistants are the staff persons
who make your patients feel comfortable, informed and confident
in your office environment. They should be thinking of the
patients at all times, and recognizing the feelings of the patient.
Give your dental assistants instruction on how to best develop
and maintain this characteristic.
Clean, Neat, Well-groomed: This one goes without saying.
However, it is a delicate subject to tactfully present your feelings
to a dental assistant who might have dirty shoes, bad
breath, smoke odor, body odor, greasy hair, too much makeup,
potent perfume, dandruff, unkempt appearance or other
unpleasant physical characteristics. We suggest personal interviews
with individual staff persons on a routine basis, asking
them to evaluate themselves. You should also critique your
own behavior and demeanor, because you are the example for
your staff. In a personal interview, the staff person's physical
negatives will naturally emerge without significant embarrassment
for either party.
Clinically Competent: Having dental assistants master the
essentials of four-handed and six-handed dental assisting is a
major asset to any practice. Such concepts greatly improve productivity,
patient comfort, speed of operation, quality of the
procedures and ultimately office revenue. If your assistants do
not have these abilities, it is time to develop them as soon as possible.
Within reason, adding an additional dental assistant
almost always increases revenue beyond the expense of the additional
salary. Expanded clinical functions can easily double the
productivity of a typical general practice. However, it requires
that the dentist and staff are willing to learn how to integrate the
expanded clinical functions into office activity, create a true
team and make practicing dentistry easy and enjoyable for all
involved. The following section of this article lists and discusses
many of such responsibilities.
Figure 2: Properly implanted four-handed dentistry can significantly improve patient care, office efficiency and income. Figure 3: Developing the ability to use six-handed
dentistry is a major advantage in a busy practice. Figure 4: Two dental assistants are average in the U.S. However, incorporation of expanded functions requires using additional
assistants for optimum efficiency.
Expanded Clinical Activities for
Dental practitioners are finitely limited in our productivity
by our own two hands. Whatever we can do in a specific
time period is readily identifiable. In spite of attempting to
speed up clinical procedures, the outcome is limited to only
minimal increases, unless you add additional staff. Adding
more skilled hands to the clinical team can increase productivity
significantly. The American Dental Association reports
that the mean number of dental assistants used in most U.S.
dental offices is slightly less than two (Figs. 2 & 3). However, the dentist and this team of two dental assistants might still
have limited productivity.
Dentists have only two methods to increase productivity and
still maintain the production of quality services. They can
increase fees, which is the mantra of some continuing education
courses in practice management, or they can elect to educate
staff members on how to accomplish some of the clinical tasks
usually done by dentists.
Significantly increasing fees is not a viable alternative in
most communities. Patients are educated to find those practitioners
who have moderate fees, and third-party payers are critical
of dentists who are charging fees significantly above the
The most logical alternative for increasing productivity
while still maintaining clinical quality is to delegate clinical tasks
to qualified staff, increase practice organization and efficiency
and obtain the fastest, easiest and best products for use in practice.
Some states, provinces and countries limit the tasks that can
be delegated to staff, while others are relatively liberal on this
subject. We suggest dentists limit themselves to doing only those
tasks that no one else can legally accomplish. You need to obtain
a copy of the practice regulations for your geographic area to
determine the laws related to your practice activity.
The following tasks are some we have found to be very
appropriate for delegation. Please look over the list and determine
which of the tasks can be delegated in your practice. Do
you have staff persons who are capable of learning to accomplish
the specific tasks? Do you need to hire additional staff (Fig. 4)?
Which tasks do you want to delegate? Are these tasks legal for
staff in your area? Some might not be allowed in your area
because of specific local regulations. We suggest that you compare
the potential delegated staff tasks with your practice regulations
to avoid delegating illegal tasks. The following tasks are
listed alphabetically, and are not prioritized. You might already
be delegating some of them. Some of them are what we call
"escape tasks," in other words, they are dental assistant optional
tasks that you, the dentist, might commonly accomplish, but a
phone call, a hygiene check, a denture adjustment or whatever interruption, takes you away from the patient being treated, and
you delegate the escape task to a qualified staff person. We have
noted the primary tasks by the word "recommended," which a
staff person usually accomplishes (Fig. 5), and those that are
occasionally accomplished by staff as "optional" (Fig. 6).
Figure 5: Some tasks, such as patient education can be delegated almost entirely to
dental assistants and others, thereby freeing the dentist for clinical treatment. Figure
6: Some tasks can legally be accomplished by the dentist or qualified staff. Educating
staff in such responsibilities allows dentists to leave the treatment room when other
responsibilities or emergencies arise. Figure 7: Consulting with dental assistants on a
routine basis allows the dentist to know the needs and the challenges faced in the
office and potential methods to improve them.
Please note that the majority of the previously described recommended
tasks are accomplished primarily by staff with dentist
supervision required, and that the optional tasks allow the
dentist to leave the treatment room when a need arises or can be
accomplished by the dentist if desired.
In a typical general dental practice, delegation of the described
and other tasks significantly increases productivity, allows treatment
of more patients, increases gross revenue with only a moderate
increase in overhead and provides a much more diverse and
interesting vocational role for staff. After years of delegating all
of the described tasks and many more, we can factually state that
after an expected period of learning and repeating the tasks, the
staff person to whom the tasks were delegated becomes more
proficient in completing the task than the dentist who taught
the person to accomplish the task. Additionally, the diversity of
dental assistant activity provides much more job satisfaction for
the staff person.
In-service Education for Dental Assistants
In-service education sessions should be a part of every practice.
These sessions are easy to organize and conduct. We suggest
the following sequence of events:
- Decide as a team the areas in which you need education
- Decide which team member will provide the education.
- Set a time. Early morning before practice is a great time.
One hour before practice starts usually offers adequate
time for the session, as well as a 10-minute "huddle"
before the practice day begins. If more time is required,
either use two separate one-hour sessions or a longer single
one with lunch.
- Start the session on time, provide the education, end on time
and expect implementation of the concept immediately.
- Continue the sessions as needed. Once per month is usually
a good schedule.
Dental school and dental assisting education could be integrated
better to assist in producing more efficient practice characteristics,
faster and better patient service, higher quality
treatment and increased office revenue. Because of the need for
more integration of dentists and dental assistants, dentists can
overcome the challenge by proactive training/education of dental
assistants and expanding clinical functions for dental assistants.
This concept can improve patient care and make it easier,
speed up procedures, create happy patients and also improve