Mindy Duran

DH221A
Due 3/9/2015

Periodontal Dental Office Observation Report

Andrew N. Dow, DDS, MSD
Eugene Periodontics & Implant Dentistry
I observed Dr. Andrew Dow and his staff at his periodontal office in Eugene on January 26,
2015. I observed several periodontal surgeries and appointments during my time in his office,
each one being schedule 30 to 45 minutes long. The procedures performed were: an implant
patient, a biopsy with a connective tissue graft, placement of a healing abutment, and an
allograft. This office was very fast paced, compared to the office oral and maxillofacial surgery
office I observed last term, I was really unable to ask many questions during the first two
procedures or after they were completed. By the time the third procedure came around,
realized I needed to start asking questions since there was no time to review once the
procedure was completed. A general dentist typically refers a patient to Dr. Dows office, as
well as other periodontist offices, for various reasons, such as: severe chronic periodontitis,
aggressive periodontitis, furcation involvement, bone grafting, extractions, excessive bone loss
and/or defects, progressive gingival recession and/or significant root exposure, peri-implant
disease, and other acute periodontal conditions.
This office had seven full time staff that were working at the office, when I observed, they
consisted of an office manager, an administrative assistant/receptionist, two dental hygienists,
Dr. Dow, and two assistants that worked directly with him. However, the dental hygienists
provided treatment in another area of the clinic and I was unable to observe the work they
provided in the office. The two office staff are in charge of scheduling appointments, processing
billing and payments, as well as, various other duties required of the office. The two hygienists
provided mainly non-surgical periodontal therapy, and perio maintenance, they also provided
communication between the periodontist and the patient. The two assistants alternated
providing assistance to Dr. Dow during the procedure being completed while the other
assistant completed patient dismissal, room turnover (taking instruments to the sterilization
area and setting up the room for the next appointment schedule, and also acted as a floater).
I did not get to see the charts used in this office thoroughly. However, I did have a chance to
briefly look at their paperless charts. They utilized the Panda Software which consists of tabs
named: patient history, intra/extraoral exam, basic vital signs administered sedation, soft
tissue, dental-bone, suture, treatment, comments/notes, linked, and deleted questions. All of
these tabs are utilized for every patient, and every patient has a picture of themselves in their
patient profile, as well as, pictures are taken to document every procedure performed.

The first procedure I observed was an implant placement of tooth number 19. The procedure
began before I arrived at the clinic, by the time I had arrived they already had used the scalpel
to access the bone. Dr. Dow was using the drill which was operated with a foot pedal while his
assistant used the Minnesota retractor and suctioned. He used a drill stop ensuring he did not
go too far into the bone. Dr. Dow used the probe to measure the depth of the hole he drilled
into the bone, after confirming that he had not gone deep enough, he used the drill tap and
drilled once more. The assistant then took a radiograph of the area to ensure everything looked
the way it needed to. After verifying the radiograph, he drilled the #13 implant into place and
placed the healing abutment (HC536) into place before using gut sutures to reattach the tissue.
This patient was under moderate conscious sedation and Dr. Dow spoke with the patient
reminding him of some of the homecare procedures he had already discussed before treatment
began.
Once this procedure was completed, Dr. Dow reminded the patient to be careful around that
area, answered any questions the patient had, and left the room, the assistant then
documented vitals and dismissed the patient. She then took all the instruments used for that
procedure to the sterilization area, disinfected the room and set the room up for the following
appointment. While the assistant completed room turnover, Dr. Dow went to the next
operatory and began his next procedure. He first introduced me and asked if they minded if I
observed the procedure, once the patient replied that it was okay, he began anesthesia. This
patient was having a biopsy of the buccal alveolar mucosa between #s 14 and 15 with a
connective tissue graft. Dr. Dow used two carpules of Lidocaine and gave a GP and AMSA, while
the assistant mixed a small amount of tetracycline. He began the procedure by separating the
gingiva from the alveolar bone using a small periosteal. He then used a scalpel to harvest a
section of the tissue used for a biopsy and asked me to open a small container with a screwing
lid which had saline solution. He placed the tissue in the bottle, I sealed the lid and placed it on
the counter. Dr. Dow then placed tetracycline on the exposed root and tissue, let it sit then
rinsed it off. He then used the scalpel to make an incision on the palate adjacent to teeth #13
and 14. The grafted tissue was then placed it where the biopsy was obtained from. He placed
5.0 polypropylene suture material (stating to me that he usually uses 6.0 but since it was in the
posterior, he decided to go with 5.0) and sutured the graft into place using two separate sling
sutures.
He instructed the patient that they will need to leave the area alone and will need to schedule
an appointment to have the sutures removed; mentioning that if the sutures start rubbing the
cheek to put Vaseline on their finger and rub it on the cheek. He then left the room and the
assistant escorted the patient to the front office to schedule their appointment.
I followed Dr. Dow into the next treatment room, where he again asked the patient if they
minded if I observed the procedure. The patient stated that they did not mind and told the
patient we are going to uncover the sewer drain and place the fire hydrant. He then placed
topical on the alveolar mucosa next to tooth #8, removed the cotton tipped applicator and

administered an infiltration injection using septocaine. The scalpel was used to cut an incision
around the implant and used the Orban to separate the tissue; he removed the epithelial tissue
leaving the connective tissue in place. He then used the HC453, used the screwdriver (1.5 mm)
Hex to remove the sewer drain (screw) and replaced it with the fire hydrant (Abutment) by
screwing this onto the implant. The patient was instructed to come back in two weeks, and to
brush the teeth around it but not that area. The assistant was left to dismiss the patient and
turn the room over.
Dr. Dow and I proceeded to the next room, where he was placing an allograft on teeth #s 2931. He again asked the patient for their permission to allow an observer in the room, she stated
that she did not mind. He then placed an IV into the arm and secured it into place with a piece
of tape to prevent it from moving around. He then used a needle attachment to obtain a
sample of blood into a vacu-tube with anticoagulant citrate dextrose already in it. The assistant
then placed the sample of blood into the Salvin-Centrifuge 1310, which is a machine used to
speed up and enhance grafted bone healing, and spun for 10 minutes.
Once the blood began to agitate, Dr. Dow began IV sedation. He ended up using
Dexamethasone, Fentanyl, and midazolam. After administering the sedative medications
through the IV, he used one carpule of lidocaine to administer an IA nerve block, and half a
carpule of septocaine to administer infiltration injections. The procedure began with the use of
the Piezo ultrasonic scaler on #s 28-31, he then placed a ratchet in the patients mouth in order
to keep the patients mouth open during the procedure. The Orban and small periosteal were
used to separate the gingiva from the alveolar process. Once enough gingiva was separated, he
placed tetracycline (which the assistant mixed into a mixing dish) to the area, after Dr. Dow
obtained enough tetracycline, he advised the assistant to rinse the dish out. Once the
tetracycline sat on the tissue and was rinsed off, the sample of blood was removed from the
centrifuge machine. Dr. Dow, removed the platelet poor plasma using the surgical suction and
placed a small amount of the platelet rich blood into the mixing dish, he then placed the cut
piece of allograft material into the same mixing dish allowing it to soak with a piece of wet
gauze over the top. The soaked allograft was then retrieved and placed in to the area needing
the graft. He used the younger good 7/8 and the large straight to pack the material into the
tissue. Once the area was packed with the grafting material, he used 3.0 silk suture material to
reattach the gingiva.
This office was absolutely great, the staff all seemed to get along very well. I really liked that Dr. Dow
was very down to earth and had a great relationship with all the staff (that I observed). From what I
observed, he also built a great relationship with each of his patients. I also liked the fact that he took
pictures with every procedures so he was able to visibly see/show the improvements being made, this is
something I would like to carry forward into a practice I work/manage someday. I look forward to being
able to work in an office where I am able to build a relationship with each patient I have, especially
being able to follow the progress of every procedure performed.