dental tech asist on all on 4 and such???

[dentcre]

hey guys, how many here are actually asisting the
clinician on implant and all on 4 procedures.
I mean the transfer impression beeing the most critical part of importance for us the Lab side , I will asume ither do the same as I do, thats beeing there for the transfer impression and verification if needed,
otherwise a remake will be very costly to the Lab.
I do verifyvthe impression all the time and make sure even with xrays that impresion coping are properly seated at times.

however , I am very curious to hear from other on how do they aproach this , since there might be a liability issue once you assist a dentist .

I dont see a better way for success in implant work than having a technician by your side , and since this is a growing demand , I think we need to be prepare and make sure of liability issues.
like such as having a lab prescription requesting you to assist the Doc etc.

how many here also have seen xrays of poor implants beeing restored and have no right to comment that you know it will fail .

when assisting when do you shut up and when do you speak out .

If I see an implant that has terrible bone integration and beeing used to make an all on 4, I speak out rightaway even if dentist dont like it or patient, because I am assisting and we need to remember that we as techs ,we do not have the insurance dentist have so be cautious on what you
do .
I have never had any problems but sometime I think
since the demand is growing ,we need to keep an open eye.

will like to hear discusion and coments on this subject..

 

[user name]

Interesting. When I was younger than all the Drs I worked for, I was very quiet and just did what I was told. I knew my place. Now, most of the Drs are younger than me, and in spite of sounding dumb on most of my comments on DLN, Ive actually broadened my vocabulary and have improved my knowledge of techniques, so Im more confident on offering opinions and suggestions.

I don't think you need an Rx to cover liability of assisting. I did receive a verbal reprimand for some comments I made to a patient recently. I was reminded that Im not the Dr, so with that guy I just keep my mouth shut. Im in the middle of a big case right now though; full arch, and I had to ask for new impressions and prep modifications multiple time. I was nearing the point of just asking the Dr if theyd mind if I took the impression.

Its a balancing act. Most of my troubles have begun when I choose to say something and it doesn't come out like I intended.

 

[Contraluz]

how many here are actually asisting the
clinician

Most of my clients are at least 100 miles away, I rarely see patients, let alone go to the Dentist's offices. Just recently I had a case where I would have loved to be there to give my client a hand. Would have saved him from getting the pt. back in. But he is a 4 hours drive away.

there might be a liability issue

And there is, at least here in Virginia. Just recently there was a communication circulating, that only licensed persons can put their hands into a pt mouth (Eg: we, the techs, not). It seems there have been incidents, recently, where so called Drs (Techs with a big ego) put hands on patients.

and have no right to comment that you know it will fail

Sometimes it is tricky to speak up, especially with the pt present. However, once the pt is gone, I always make a point and let the Dr. know about the implications of certain, not so ideal, situations. That way he carries the responsibility if he decides to carry on.

that has terrible bone integration and beeing used

That is not your fault and does not fall into your responsibility, if the treatment fails. Also see comment above.

since the demand is growing ,we need to keep an open eye

Yes, demand is growing and many Drs with no or little knowledge venture into the 'all on 4' territory. It is definitely important to stay current and give sound advise to our clients.

 

[Contraluz]

Now, most of the Drs are younger than me, and in spite of sounding dumb on most of my comments on DLN, Ive actually broadened my vocabulary and have improved my knowledge of techniques, so Im more confident on offering opinions and suggestions.

That is very important! Especially if you are doing these type of cases (full arch, all on 4 etc). The clinician has to see you at the same level. I do know not all of the Docs will accept that. Prepare yourself with visiting Dr's courses and conferences and let the facts speak for yourself. Have a good portion of self confidence and don't fold at the first moment, you are challenged.

ts a balancing act. Most of my troubles have begun when I choose to say something and it doesn't come out like I intended.

If I have a to comment something a bit more complicated or give bad news (re impression etc),I like to write an email or Message. This way, I can write out what I want to say without being interrupted or so.

 

[user name]

That is very important! Especially if you are doing these type of cases (full arch, all on 4 etc). The clinician has to see you at the same level. I do know not all of the Docs will accept that. Prepare yourself with visiting Dr's courses and conferences and let the facts speak for yourself. Have a good portion of self confidence and don't fold at the first moment, you are challenged.


If I have a to comment something a bit more complicated or give bad news (re impression etc),I like to write an email or Message. This way, I can write out what I want to say without being interrupted or so.

On this current full arch that I was having so many problems...not good impressions, poor preps, etc, after the 3rd time of rejecting the impressions and feeling like im not being heard or understood, I said I need an email address. Our visits are not getting results and text mssg isn't enough. I want to be able to write down and print off a copy of our communications for my protection.

 

[Marcusthegladiator CDT]

I spend a lot of time chair side with the doctors, one of which is my employer. We've worked together to come up with the best plans that work for both of us for restoring edentulous patients with fixed bridges.

 

[JMN]

First, Dental Assistant is a protected term only allowed to be used by those that are licensed by the state to do exactly that.

Second, no Rx will protect you in any way from a state law (and the possiblity of charges or formal reprimands) or patients lawyer if you touch the pt. A dentist signing a script does not make you a licensed individual.

However, I have known some who did make physical contact with the patient, and their defense was they were doing nothing permanant(no handpice on tooth/bone/etc) and the dentist was there to 'oversee' like happenes in dental residency.

Being in the room and not wanting to take the matter into your own hands is super frustrating at times, but unless I get an assistant cert I'm not willing to do that.

We know about prosthesis, they know about anatomy. Working together there can be great outcomes. The other side is that if you do anything outside what you are supposed to do and something, anything, goes wrong which you were tangentially involved with physcially touching you WILL get blamed. It WILL be told around town.

I do chairside with any local doc that asks. We've worked out an eye contact and look to the door when something needs to be adddressed so the patient keeps their confidence in the doc, office, and the process. Confidence management is one of the largest things that never gets discussed. It is vital. The pt must see the tech as a member of the team, not as someone who's there to keep the dentist from screwing things up.

In the all-on-4 class I attended this was brought up. The speaker said that it gets asked every time because the process is so dependant upon the tech and operatory staff working closely for hours. The resulting coversation was quite similar to what you see in mine and others comments. What you take on, you will take blame for, or you will take praise for. And you need to be as willing to take both, not just one.

The luting of the impresion posts was agreed at that meeting to be the most likely place a tech would want to jump in, and the hair splitting about touching them was not touching the patient will not fly. At least not in Virginia.

if you choose to assist, see about the local technical/vocational schools class hours and if you can get licensed in evenings and weekends. It would be a huge plus to having you as part of the team, and would give you credible, credentialed, advantages with the docs thst no other lab would have.
Leaders must accept the negative results in order to be due the resultant honor of positive results.

 

[Contraluz]

I want to be able to write down and print off a copy of our communications for my protection.

Super important! Although, sometimes they don't want to be reminded of not listening in the first place...

PS. By no means I am saying, I don't make errors (quite the opposite is the case...)

 

[Contraluz]

We've worked together to come up with the best plans that work for both of us for restoring edentulous patients with fixed bridges.

That is great! But it requires that both of you are listening to each other. I am sure you have earned the respect of your employer and so has he earned yours.

 

[Contraluz]

If I have a to comment something a bit more complicated or give bad news (re impression etc)

I want to add that this type of message always goes accompanied with pictures, pointing out what can be improved. Modern cell phones are perfect for that. You can zoom/crop in on a single tooth level and add arrows or circles to point things out.

This would look like that:



Or this:



And this:

 

[droberts]

Have assisted approx. 30 between 5 offices in the last year. All treatment planned with the OS and the clinician,
occasionally I get called in to discuss. We all work as a team, and have respect for each others protocol.

 

[Flipperlady]

I think there's a way to get things across and i have never been shy about asking the important questions. That said, I would never say what I was thinking in front of the patient, I discreetly point or use code words that point to the issue. In the lab I always bring up any concerns (note them on lab slip for future reference and they give the answer on lab slip) I have, and let the dentist decide what they want to do. It's out of my hands after that, if they want a lime green denture, they will get one, and with that they also carry all of the liability.

 

[kcdt]

First, Dental Assistant is a protected term only allowed to be used by those that are licensed by the state to do exactly that.

Second, no Rx will protect you in any way from a state law (and the possiblity of charges or formal reprimands) or patients lawyer if you touch the pt. A dentist signing a script does not make you a licensed individual.

However, I have known some who did make physical contact with the patient, and their defense was they were doing nothing permanant(no handpice on tooth/bone/etc) and the dentist was there to 'oversee' like happenes in dental residency.

Being in the room and not wanting to take the matter into your own hands is super frustrating at times, but unless I get an assistant cert I'm not willing to do that.

We know about prosthesis, they know about anatomy. Working together there can be great outcomes. The other side is that if you do anything outside what you are supposed to do and something, anything, goes wrong which you were tangentially involved with physcially touching you WILL get blamed. It WILL be told around town.

I do chairside with any local doc that asks. We've worked out an eye contact and look to the door when something needs to be adddressed so the patient keeps their confidence in the doc, office, and the process. Confidence management is one of the largest things that never gets discussed. It is vital. The pt must see the tech as a member of the team, not as someone who's there to keep the dentist from screwing things up.

In the all-on-4 class I attended this was brought up. The speaker said that it gets asked every time because the process is so dependant upon the tech and operatory staff working closely for hours. The resulting coversation was quite similar to what you see in mine and others comments. What you take on, you will take blame for, or you will take praise for. And you need to be as willing to take both, not just one.

The luting of the impresion posts was agreed at that meeting to be the most likely place a tech would want to jump in, and the hair splitting about touching them was not touching the patient will not fly. At least not in Virginia.

if you choose to assist, see about the local technical/vocational schools class hours and if you can get licensed in evenings and weekends. It would be a huge plus to having you as part of the team, and would give you credible, credentialed, advantages with the docs thst no other lab would have.
Leaders must accept the negative results in order to be due the resultant honor of positive results.

If there's no bonafide framework legally in your locale, then you should keep your mitts off the patient.

Dr's in a hurry and seeking convenience, they aren't lawyers, so I don't care what won't fly if with them if it' my ass on the line.
They took boards to get the licence to do this job, they should effing do it.

I'm fed up with yahoo Dr's jumping into sh*t they aren't trained in and then expect someone else to stretch the legal limits to make it work.

 

[kcdt]

If there's no bonafide framework legally in your locale, then you should keep your mitts off the patient.

Dr's in a hurry and seeking convenience, they aren't lawyers, so I don't care what won't fly if with them if it' my ass on the line.
They took boards to get the licence to do this job, they should effing do it.

I'm fed up with yahoo Dr's jumping into sh*t they aren't trained in and then expect someone else to stretch the legal limits to make it work.

Previous rant isn't a critique of JMN quote. In fact I agree wholeheartedly; the topic just unspools an emotional response.

I just wasn't sure if that came across right