Th Digital

Imaging and the assistant's role

May 1, 2001
Remember that old saying, "A picture is worth a thousand words"?

by Mary Govoni, CDA, RDA, RDH, BS

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Remember that old saying, "A picture is worth a thousand words"? It has never been so true than in our current age of digital imaging in dentistry. Helping patients to understand their oral-health conditions can be especially difficult in an emergency situation. If a patient is experiencing pain, swelling, or has a fractured tooth, his or her ability to comprehend an explanation is most likely decreased due to their anxiety. But, through the use of imaging devices, the dental assistant can perform a valuable service for patients by producing pictures or images of their teeth and oral conditions, which can greatly enhance their understanding and acceptance of necessary treatment.

Many, if not all, of the imaging tasks can be performed by the chairside assistant during an emergency patient visit, maximizing the use of the doctor's time and minimizing the schedule interruptions that typically result from emergency patients.

With an emergency patient in the treatment room, the assistant's initial task should be to perform a preliminary review of the patient's medical history (if the patient is new) or update the history if he or she is an established patient. After this review, the doctor should come to the treatment room to evaluate the patient. If the patient is new to the practice, this establishes him or her as a "patient of record."

Once the patient has related his or her chief complaint, the doctor can delegate necessary procedures to the assistant, which may include radiographs, intraoral imaging, and patient education.

The use of imaging technology to accomplish these tasks is an effective method of case presentation, since communications experts believe that at least 75 percent of learning is visual. If a practice uses digital radiography, once the assistant has captured the image, it can be enlarged on the computer screen for the patient — and subsequently the doctor — to get a much better view of a tooth or area of concern. The assistant can point out certain features to the patient (being careful not to present a diagnosis) and simply state that the doctor will want to look at a particular area. For example, the assistant can tell the patient, "That tooth appears to have a fracture," thus establishing a foundation for the doctor's diagnosis.

In addition to radiographs, images captured with an intraoral camera are extremely helpful for the assistant to show to a patient their existing conditions in a real-time mode. In this case, the assistant can literally take patients on a tour of their mouths and point out any areas that the doctor may want to take a closer look at for caries or fracture, areas where there appears to be gingival irritation, or perhaps where oral hygiene needs improvement. Seeing these problems or conditions enlarged on a computer screen or television monitor makes them much more real for patients. Patients will own the problems that they can see. In addition, copies of the images can be printed and sent home, along with treatment recommendations or home-care instructions.

This all sounds rather simplistic, doesn't it? All you have to do is utilize the communication skills of the assistant, along with the technology tools, and the emergency patients will be well taken care of. So why don't more practices utilize the technology? There are a number of reasons.

First, some practitioners are reluctant to make the financial investment in the technology. In the past, many of the imaging systems, such as intraoral cameras, were stand-alone, costly products. Today, cameras are much more portable, and imaging software such as Vipersoft and DiCom can often integrate the imaging into practice-management software. On the other hand, wireless intraoral cameras, such as Digital Doc (right), have their own memory for storing images, and can be used independently of computer technology in the operatories. There are appropriate devices for every practice need. Although the investment in the equipment can be substantial, the return on the investment can be realized in a relatively short time, due to increased case acceptance.

The second reason many practices don't regularly use intraoral cameras or imaging devices is in adequate training and/or practice time. With any technology or task, there is a learning curve to be conquered. Sufficient time must be allowed for all members of the team to become proficient in the use of the technology. Because the time needed to utilize the intraoral camera is greater in the beginning, resulting in increased time needed for procedures, many team members dismiss the technology as an efficiency tool and it is never fully utilized or integrated into diagnostic procedures. Remember, it typically takes 21 to 30 days to establish new habits. Planning for additional time in appointment schedules for the first three to four weeks after the introduction of new procedures and/or technologies will allow team members to get through this learning curve, and the "lost" time will be quickly regained in new efficiencies and greater case acceptance.

A third factor in the under-utilization of technology is its accessibility. If imaging technology is to be fully utilized, it must be available in all treatment rooms. If a practice invests in one intraoral camera that comes on a rather large cart, it is more difficult and time-consuming to move the cart from room to room, and the tendency to utilize the camera in all treatment applications decreases. Portability should be a major consideration for a practice considering the purchase of an intraoral camera.

The last question to be answered is: Why don't practices more fully utilize the capabilities of the assistants? The short answer: Not enough assistants are viewed as direct contributors to the productivity of a practice. Many are viewed simply as an adjunct to the doctor's productivity. While it is true that the definition of a dental assistant is one who assists the doctor, that "assist" can be measured in terms of the monetary value of the services that each assistant performs and in the dentistry that the assistant sells in the practice.

In closing, it is my hope that you all take a second or third look at the use of imaging technology to enhance patient treatment and increase case acceptance. And of course, put that technology to use in the very capable hands of the dental assistant!