OBJECTIVES
After completing this chapter, you should be able to do the following:
•
Spell and define key terms
•
Identify the different types of computers found in the dental office
•
List various types of peripherals used with computers
•
Describe common administrative applications used in the dental office
•
Describe the clinical applications of a computerized practice management program
•
Explain how to use the Internet effectively in the dental office
•
Discuss the ethical considerations involved in computer use
•
Demonstrate the use of proper ergonomics when working at a computer
•
Identify other pieces of equipment commonly found in the dental office and demonstrate
how to use them
KEY TERMS
•
laptop
•
tablet PC
•
desktop
•
central processing unit
•
computer system
•
peripheral
•
monitor
•
Internet security system
•
cookies
•
viruses
•
search engine
T
he role of computers in the workforce today has become central to daily operations.
The dental office is no exception. In both administrative and clinical areas of the den-
tal office, the computer plays a central role. For dental office administrators, the com-
puter acts as the daily schedule, accounts receivable and payable center, and the patient
financial file. The computer aids the dentists in taking and interpreting radiographs, taking
295
Technology
OUTLINE
The Computer
Hardware
Core Components: Processor
and Internal Drives
Essential Peripherals
Monitor
Keyboard
Mouse
Optional Peripherals
Network Card and Modem
Printer
Scanner
Speakers
External Hard Drive and
Backup Devices
Digital and X-Ray Cameras
Applications
Administrative Applications
Word Processing
Spreadsheets
E-mail
Backup Management
Performing Basic
Computer Tasks
Clinical Applications
Charting
Digital Imaging
Peripheral Integration
Patient Education
Internet Basics
Security
Internet Searches
Computer Ethics
Ergonomics
Other Office Equipment
Fax Machine
Copier
Postage Machine
Shredder
Calculators
Point of Sale Terminals
Chapter Summary
OUTLINE
The Computer
Hardware
Core Components: Processor
and Internal Drives
Essential Peripherals
Monitor
Keyboard
Mouse
Optional Peripherals
Network Card and Modem
Printer
Scanner
Speakers
External Hard Drive and
Backup Devices
Digital and X-Ray Cameras
Applications
Administrative Applications
Word Processing
Spreadsheets
E-mail
Backup Management
Performing Basic
Computer Tasks
Clinical Applications
Charting
Digital Imaging
Peripheral Integration
Patient Education
Internet Basics
Security
Internet Searches
Computer Ethics
Ergonomics
Other Office Equipment
Fax Machine
Copier
Postage Machine
Shredder
Calculators
Point of Sale Terminals
Chapter Summary
chapter FOURTEEN
chapter FOURTEEN
in the
Dental Office
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296 PART III Dental Office Management
intraoral photographs, and providing patient education. As a dental office administrator,
you must be confident in using dental practice management software as well as other
computer software.
The purpose of this chapter is to develop your skills and knowledge of computers and
both administrative and clinical applications in the dental office. Note that the coverage
of administrative applications here is merely an overview, with more detailed coverage of
individual applications—such as communication, patient record management, recall and
recare systems, appointment management, electronic filing, inventory, insurance claims fil-
ing, and financial transactions—being integrated throughout the book in the chapters cor-
responding to these topics. Moreover, this chapter presents Internet basics, ergonomics,
and guidelines on performing basic computer tasks. Finally, you will learn about the use of
other common equipment in the dental office.
THE COMPUTER
Computers come in many shapes and sizes (Figs. 14-1 and 14-2) to accommodate
the many preferences and uses for computers in the dental office. For example, a
laptop or Tablet PC may be preferred by the dentist for use in the operatory,
whereas the front desk may be best suited for a desktop computer. Regardless of the
style of computer, there are certain elements that they all have in common.
Hardware
Computer hardware includes all of the physical core and peripheral components
that make up the computer or that may be linked to and used with the computer.
These include core components, such as the processor and internal drives, essential
peripherals, and optional peripherals.
Core Components: Processor and Internal Drives
Probably the most important part of the computer is the central processing unit
(CPU). A CPU, housed within the computer’s case, is the minute circuitry imprinted
on silicon chips that processes computer language data and instructs the operation
FIGURE 14-1 Lap-
top computer.
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CHAPTER 14 Technology in the Dental Office 297
of the computer. The speed at which these silicon chips can analyze data and run the
computer varies. Computer CPUs are rated with a number that refers to their clock
speed, or the basic number of commands or “cycles” that they can perform per sec-
ond (hertz). With modern processors, these speeds are so fast that they must be
measured in billions of cycles per second or gigahertz (GHz). Furthermore, a single
CPU can have multiple cores or processors within their architecture that all run at
gigahertz speed. These CPUs are termed dual core or quad core chips, depending on
the number of cores included. The computer can use each one of these cores either
together for one program or separately when running more than one program at a
time. Effectively this is like having many computers running within one case to help
speed up the multitasking that is so necessary when using a computer in today’s den-
tal environment.
A
B
FIGURE 14-2
Desktop computer.
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298 PART III Dental Office Management
The speed of the CPU is an important factor governing the speed of a computer,
but the amount of memory that is included is equally important in determining the
applicability of the usefulness of the machine. Memory is used in a computer for
storage of data that needs to be constantly changed, such as pictures on the screen,
Web pages, or mathematical calculation results. The smallest memory part is called
a bit. You can think of a bit as a light switch. It can be either on or off, so, if for in-
stance, a particular bit in memory is set to on, that may mean one small dot on the
computer screen is white, when it is off, that dot may be black. The place that bit is
located, or its address, determines what it does. The CPU keeps track of all of these
addresses. Eight bits equals one byte, 1024 bytes equals one kilobyte (kB) and a mil-
lion kilobytes is a gigabyte (GB). Computers can run quite well with one gigabyte
of memory, but many modern computers have up to 16 GB of memory. As memory
has become much less expensive in recent years, the amount seen in modern com-
puters has been increasing dramatically. Less important than size, memory also has
a speed just like a CPU, but it is usually rated much slower and is rated in mega-
hertz (MHz) or millions of instructions per second. This number determines how
fast the memory can change what is being held in its addresses.
The information that is contained in the computer’s memory is not permanent,
and therefore a method to permanently record and recall the information is re-
quired. If the information is to be read-only, and not changed, it can be stored as a
permanent record on a compact disk (CD) or digital video disk (DVD) using a
CD/DVD recorder. DVDs make excellent archival storage media. Most manufac-
turers give at least a 50-year predicted life for the data on a DVD, they are inex-
pensive, they are easily stored, and they can carry a lot of data. One DVD can eas-
ily carry all the financial and appointment data for 10 years of the daily activities of
an average dental office. But data can be written only once to most DVDs and then
not changed. To store data permanently, but still have the ability to change it, com-
puters use devices referred to as hard drives. Hard drives can be internal, or within
a desktop or laptop computer, or they can be external, which adds to their porta-
bility. The data that are typed into a computer first are stored in memory, and then
if the user decides to keep the data, it is written to metallic plates within the hard
drive. Hard drives are rated on their size. Common sizes for hard drives range from
250 to 1000 MB or one terabyte (TB). Internal hard drives are usually used for the
day-to-day data storage operations of the dental office, whereas portable hard drives
are used for backup at the end of the day. Monthly backups can be burnt to a DVD
and stored off-site for security and fire protection. Some older computers may use
either floppy drives or zip drives. These storage devices are good for archival stor-
age of records but tend to be slower and more cumbersome to use, and so they are
being phased out quite rapidly.
The combination of the essential peripherals and optional peripherals along
with the CPU is what makes up the entire computer system.
Essential Peripherals
A peripheral is a type of computer hardware that is added to a computer in order
for the intended use of the computer to be fulfilled. Peripheral devices are normally
viewed as optional items that are connected to a computer. Peripheral devices are
connected to a computer through a port, or bus, such as a Universal Serial Bus (USB)
port. Items such as monitors or keyboards are not usually considered peripheral
items since they are not truly optional; that is, it is impossible to use the computer
without them. They are referred to here as essential peripherals. Box 14-1 lists some
guidelines for properly caring for peripherals.
Essential peripherals consist of the following:
• monitor
• keyboard
• mouse
POINT
check
POINT
1. What are the
components that make
up a computer system?
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CHAPTER 14 Technology in the Dental Office 299
MONITOR A monitor is the visual display screen used with the computer. The var-
ious sizes and shapes available in monitors are designed to address the different
needs for monitors. A CRT monitor (cathode-ray tube) is a bulkier style monitor,
which uses the same technology as used in most televisions to display the infor-
mation on the computer screen. An LCD monitor, or liquid crystal display, also
known as a flat-panel monitor, is a thin, modern-looking computer monitor that
takes up much less space at the computer area. Graphic professionals still use CRT
monitors as they are said to have truer colors and less glare and cause less distor-
tion of images. These graphic series monitors can be very expensive, are found
only in sizes up to 27 inches, and are not often seen in a dental office. The bene-
fits of size and price have all but caused the replacement of the CRT monitor in
most office situations with LCDs. LCD monitors can be found in sizes from 14
inches to more than 60 inches (measured diagonally) although practical sizes
range from 20 to 24 inches. They are much less expensive than comparably sized
CRT monitors. These monitors create a small “footprint” or amount of spaced
used on the desk, and so allow for more room for other items. It should be noted
that smaller, older CRT monitors may be found in some dental offices, and when
due for replacement, they should be disposed of at the proper facilities, as they
contain recyclable materials.
KEYBOARD To enter information into the computer such as patient information, a
keyboard is required. There are several different keyboards that may be consid-
ered for the dental office. The standard keyboard has a cord that attaches it to the
keyboard input on the outside of the computer’s case. This keyboard usually has
alphabetic and numeric keys, function keys, editing and navigation keys, and a nu-
meric keypad. Manufacturers may also add multimedia keys to control playback
of music or movies. The keys on the keyboard may be in straight rows or may be
in a more ergonomic, curved pattern that may help some people with problems
like repetitive stress injuries. Some keyboards are wireless and do not require a
physical connection to the computer. This can be very handy if the keyboard is
some distance from the computer case. Washable and sterilizable keyboards
should be strongly considered for the dental office where the possibility of cross-
contamination of surfaces is possible. These keyboards can be wiped down or
cleaned with antibacterial sprays without worry of ruining the mechanical aspects
of the keyboard.
BOX 14-1
Care of Peripherals
Use the following guidelines regarding the care of
peripherals in the dental office to maintain their use:
• Place a dust cover over the peripheral at the end of
the day or when it is not to be used again for some
time. Dust can be damaging to the insides of the pe-
ripheral if allowed to accumulate.
• Wipe the peripheral on a weekly basis using an anti-
static cloth and solution designed for computers and
peripherals. Always spray the cloth with the solution
and then wipe; never spray the peripheral directly.
• Never touch a computer monitor with your fingers,
especially if the monitor is a liquid crystal display
(LCD) monitor. The oils secreted from human skin
can be damaging to the screen and may shorten the
life of the monitor.
• Keep backup drives or disks stored in a protective
case. Maintaining the proper care of these items will
prolong their use and ensure that they are effective
when needed. Backup drives and external hard
drives should be stored in a safe place, where they
will not be exposed to harsh temperatures.
• Do not eat or drink around computer peripherals.
Food and beverages accidentally spilled on them
can cause permanent damage.
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MOUSE The mouse started to become a standard input device for computers in the
1980s. Early mouse devices had a mechanical mechanism based on a rolling ball
that allowed the user to move an arrow or other pointing device on the screen and
select and move different items. Very soon after the introduction of the mouse, the
mechanical parts, which tended to be prone to failure, were replaced with optical
parts that could detect the movement of the mouse over a surface with great accu-
racy. The optical mouse and its components, either a light-emitting diode or a laser,
proved to be much more accurate and much more reliable and required less clean-
ing than the mechanical mouse and so has largely replaced it. The mouse may be
attached to a USB port or a mouse port on the computer case or more conveniently
may be wireless. Wireless mice will require battery replacement or battery recharg-
ing from time to time. Typically a mouse has a left and right button and a scroll
wheel. After moving the pointer, or focus of attention on the screen, by moving the
mouse, the new area under the pointer can be selected by pressing the left mouse
button. This is termed “point and click.” The right mouse button generally is used
to perform an action on this area of focus. The scroll wheel quite commonly allows
movement through lists or through pages in a rapid fashion by rolling the wheel
with the finger. Clicking twice in quick succession on the left mouse button can ac-
cess different functions. This action, termed “double clicking,” usually will select
an item and allows the user to perform an action on the selected item. As you can
see, the term usually is used quite often here as every program that is used may
have different mouse responses and requirements. Programmers have made an at-
tempt at standardization of responses to mouse gestures, but the software manual
should be consulted with regard to what mouse actions will provide the proper re-
quired response for the user.
Optional Peripherals
Optional peripherals are those that, while not necessary, extend the capabilities of
the computer. Peripherals make day-to-day necessary procedures easier to accom-
plish, such as printing statements for patients, sending dental claims electronically,
and obtaining information for patient charts. Optional peripherals include network
cards and modems, printers, scanners, speakers, external hard drives and backup
devices, and digital cameras.
NETWORK CARD AND MODEM Most dental offices have access to the Internet and the
ability to communicate with other computers in the office, which is made possible
through the use of a modem. A modem is a device that encodes and decodes the dig-
ital signal of a computer to send it as electrical information. Modems are available
in various speeds, which means that the faster the speed the modem can provide, the
faster the transmission of information. The type of connection to the Internet, which
the modem provides, can vary between telephone (dial-up) or a cable system (high-
speed Internet). Because some dental programs and dental insurance providers insist
on communicating with dental offices by way of older dial-up modems that use reg-
ular telephone lines, it is sometimes necessary to have a computer that has this ca-
pacity. Newer computers have forsaken this type of modem, and so a telephone mo-
dem quite often has to be purchased as an add-on to the system. This modem can
be purchased in an external or internal configuration. The external modem will plug
into a modem port on the back of the computer, while an internal modem will fit
into a card slot inside the computer. A telephone line is then plugged into the mo-
dem. Because the speed of dial-up modems is limited to not much more than 56
thousand pieces of data per second, or 56 Kbps, newer broadband modems have
taken their place. These newer modems can be as fast as 1 billion bits per second.
DSL modems, cable modems, and satellite modems allow the user to send larger files
such as radiographs or pictures to other computers in a reasonable amount of time.
This is not possible or is at least not practical with dial-up modems. The concept is
the same, however, in that the computer must encode and decode data to send it to
POINT
check
POINT
2. What are essential
peripherals? List three
examples.
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CHAPTER 14 Technology in the Dental Office 301
other computers. Even computers that are networked within the same office must
have a network card that operates as a modem to “talk” to other computers. These
network cards can be wired to each other with a cable that looks like a thick tele-
phone line (RS232) or they can be wireless. A wireless modem can be attached ex-
ternally or internally to a computer to provide wireless access for several computers
in one office. Wireless cards and access must be configured with security measures
to prevent unwanted access to computers or to data on those computers.
PRINTER The printer is a commonly used peripheral and is used in the dental office
for such tasks as printing out patient statements, claim forms and submission re-
sults, daily and monthly reports, and daily schedules. The printer is especially im-
portant for offices that maintain hard copy files of important documents that are
created or received electronically.
The two primary types of printer used in the dental office are the ink-jet and
laser printers. The ink jet printer uses liquid ink that is sprayed on the paper in the
form of very small dots to form an image. The laser printer uses a powder called
toner that is heated on to the paper to form its image.
The ink jet printer is very versatile. It can print very good text documents and
can also print photographs that will rival the output of professional photography
labs. Printing radiographs or images of teeth is easily accomplished. The pages can
be printed fairly quickly, and ink jets print color very well. The initial cost of an
inkjet printer tends to be quite low, but the cost of replacement inks can be very ex-
pensive and the cost per page of most ink jets is quite high.
Laser printers print excellent text documents, in most cases exceeding the qual-
ity of ink jets. In general, laser printers print single and especially multiple pages
faster than ink jet printers. Color laser printers are available, but they do not print
color or black and white photographs very well. It is not practical to use a laser
printer to print patient photographs or radiographs. The cost per page of laser
printed output is less than with an ink jet, and toner cartridges tend to last longer
than ink cartridges.
The solution for many offices is to have at least one ink jet printer and at least
one laser printer. In this way, the laser printer can be used to print day-to-day and
important documents at a fast speed. When color or graphic output is required,
the ink jet can be used. Printers can be attached to the office network so that they
are accessible from any computer on the network. Some printers will even attach to
the network wirelessly, so they require no physical connection to the system.
Some practice management programs may require a specific type of printer to
be used for printing.
SCANNER The scanner is a peripheral device that is used to make digital copies of
documents for storage on and output from the computer. Paper forms can be
scanned with the scanner, and the resultant scanned document can be sent by e-mail,
reprinted as many times as necessary, or stored for future reference. If a document
is scanned, a program called an OCR or optical character recognition program can
be used to make the document editable in a word processing program. Many scan-
ners can perform the functions of a copier, and this is one of their more common
uses. Many ink jet printers have scanners built into them, making the copying
process very easy. These so-called “three in one” ink jet printers can also fax docu-
ments, making it an easy job to scan a document, save a copy, print a duplicate, and
fax it to someone, all with one peripheral.
SPEAKERS Speakers allow a user to interact with a computer by playing audible
sounds. At first it may seem like speakers have no practical application in a dental
office, but they can be quite useful. Speakers for most computers can be very inex-
pensive and require very little desk space and so they should not be ruled out as su-
perfluous. For many applications used on the computer, there is an audio cue when
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the user has made an error, or when a message arrives. This audio cue can be very
helpful to the operator. If a computer is used for patient education or entertainment,
speakers are a necessity, especially if the educational materials are in the form of a
video presentation. Speakers can enhance the usefulness of a computer and make it
more pleasant to use.
EXTERNAL HARD DRIVE AND BACKUP DEVICES Using a backup device to save com-
puter system information is a necessary procedure in the dental office. Computers
are machines, and they can break down, sometimes losing all of their data. The
loss of data that can occur will be a very serious problem. It is also important to
have a copy of all vital data in case of fire, flood, or theft. It can be easily imag-
ined what will happen if all medical, financial, and appointment data are lost. It
will bring most modern dental offices to a standstill. Several types of backup de-
vices are available. An external hard drive is a stand-alone drive that may be eas-
ily connected, disconnected, and moved from computer to computer. External
drives come with varying storage capacities from a few gigabytes to many ter-
abytes. Larger drives can easily contain all the information that is stored on the
hard drive of a computer. Typically, the external hard drive is connected to the
computer with either a USB cable or a firewire cable. The most common method
is USB as it is found on most computers. Firewire is not as commonly found, al-
though it transfers data more quickly. Patient and financial files kept on the com-
puter are typically saved to a backup hard drive at the end of each day and should
be taken home with a staff member.
Other methods of backing up the information include recordable compact
disks (CD-ROMs), zip drives, or recordable DVDs. Smaller amounts of data can
be stored on flash drives. A USB flash drive is a small device, sometimes called a
thumb drive because of its small size. It is plugged directly into a USB port, and
the computer recognizes it as a disk drive. They are handy for moving photos or
documents from one location to another. They have no moving parts and so are
very durable, and the capacity of these drives is getting bigger every year. Some
flash drives have capacities over 64 GB. Keeping saved information off-site is nec-
essary, should there be a fire or flood and the information is required for insurance
purposes.
DIGITAL AND X-RAY CAMERAS Technologically progressive dental offices may use pe-
ripheral equipment such as digital cameras and digital x-ray or intraoral cameras.
These peripherals are usually found in the clinical areas. However, a camera used to
take patient pictures is usually the responsibility of the dental office administrator.
The digital x-ray is used by the dentist and clinical staff to diagnose disease, estab-
lish the health of the oral and perioral structures, and provide patient education.
They must be available to the office administrator in order that they can be for-
warded to insurance companies or a specialist’s office. For this reason, the office ad-
ministrator should be aware of what x-rays are available, and what their limitations
are, how to access them, how to e-mail them, and how they are stored and recov-
ered. Likewise, the intraoral camera is used for many of the same purposes, taking
pictures of oral and perioral structures for diagnosis and education. Again, the of-
fice administrator should be aware of the benefits and limitations of intraoral pho-
tographs and how the camera works.
Applications
In addition to understanding the computer hardware used in most dental offices, it
is also important that you understand the most common programs or software ap-
plications that are used in the dental office. The applications used in the dental office
may be divided into two categories: administrative applications and clinical appli-
cations.
POINT
check
POINT
3. What are optional
peripherals? List three
examples.
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CHAPTER 14 Technology in the Dental Office 303
Administrative Applications
As noted earlier, detailed discussion of the various components of dental practice
management software is integrated throughout this book, where appropriate. Pro-
vided below is a brief overview of these programs. Also provided is an overview of
other, more general administrative applications, such as word processing applica-
tions, spreadsheet applications, e-mail, and backup management.
WORD
PROCESSING
Several different word processing programs are available for use
in the dental office. Some practice management programs have simple text process-
ing programs integrated into their structure, but for more advanced uses, it is im-
portant to be familiar with a more full featured program. To write formal letters to
other doctors, lawyers, or patients, it is often necessary to have the features of these
products. The manuals that come with these programs should be consulted to pro-
vide familiarity with the program.
SPREADSHEETS Spreadsheets are useful programs for the office administrator to
learn to use. Modern spreadsheets allow the user to display and perform calcula-
tions on numerical data in several different ways. They can be used to make a list
of accounts receivable, petty cash purchases, inventories, or any other purpose
where a chart or form is required. The spreadsheet has become a very versatile pro-
gram as it can also display data graphically in the form of charts and graphs. A
smart office administrator will become familiar with spreadsheets, as they are a use-
ful addition to their armamentarium.
E-MAIL For the modern dental office, it is essential that an e-mail program be
adapted and learned by the office administrator. E-mail can be used to communicate
with patients, other dentists, and insurance companies. Many patients prefer to get
appointment reminders, make appointments, or get notified of the result of prede-
terminations all by e-mail. It is easy to send digital x-rays to other dentists for
referral, and insurance company correspondence is quite often accomplished by e-
mail. Composing a good letter and learning how to retrieve and send e-mail have
become essential skills. All operating systems on computers today have an e-mail
program that comes with the system.
BACKUP MANAGEMENT The practice management program usually includes in its
software a method of keeping an up-to-date copy of the software program and its
contents. The backup system can be done through the use of an external hard drive
as discussed earlier in the chapter. In some cases, a dental management program will
have automatic backup that can be directed to an external drive. In other cases, the
backup must be performed manually. Usually this can be set in the program prefer-
ences, but it is best to refer to your software manual or software professional for ad-
vice on this topic. It is also sometimes possible to back up only certain data com-
ponents in order to save space. Decisions should also be made as to how many
backups are kept. For the most part, the most recent backup is the most important,
but keeping a few other copies, but certainly no more than five, may be prudent in
case of errors, or data corruption. The backups should be done on a schedule, ei-
ther automatically by the program itself or manually by the operator. In busy offices,
daily backups should be the rule, but weekly backups may be enough for a smaller
office. The general rule of thumb is that you should back up frequently enough so
that if the data are lost before the next backup, retrieval and reentry will not be a
problem
PERFORMING BASIC COMPUTER TASKS There are several basic computer tasks that
should become second nature to the effective office administrator. It will be as-
sumed that the reader has a basic understanding of turning a computer on and off,
using a mouse, opening a program or document, and typing on a keyboard. If this
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is not the case, then a beginning book on the operating system you are using would
be an intelligent purchase. It is important to learn as well how to create a folder,
how to create a text document, how to cut and paste between documents, and how
files can be deleted or retrieved. These skills should be part of the basic armamen-
tarium. There are, however, some tasks that should be performed on a daily or
monthly basis to keep the computer running smoothly and cleanly, and having a
neat appearance.
Every day, after the computer is turned on, the following tasks should be per-
formed. If it does not happen automatically, any antivirus programs should have
their definitions updated. An e-mail program should be opened to check for incom-
ing e-mails. Any urgent e-mails should be answered and any documents that require
typing should be finished. Any seldom used or frivolous icons on the desktop should
be removed. At the end of the day, a backup should be performed if one does not
occur automatically. There may be other tasks that you like to perform daily, and it
may be prudent to keep a written list so that they are not forgotten.
On a monthly basis, the disk drive should be defragmented. This is a process by
which the hard drive optimizes itself for the best performance. This process may
take as long as a few hours but can be left at the end of the day to happen over night.
Unused or unneeded files should be removed, but care should be taken to avoid re-
moving critical files. It may also be necessary to check on a monthly basis for pro-
gram updates. Many programmers will issue updates to their programs that may
contain important improvements to the program. It is a good idea to check for these
updates for the programs you use most often by visiting the Web site of the program
manufacturer on a monthly basis.
Clinical Applications
The clinical application of the dental software program is designed to assist the
dentist, hygienist, and dental assistant in providing the patient with detailed, ef-
fective dental health care. The components most commonly used by the clinical
staff in a dental software program are charting, digital imaging, and the use of
other peripherals.
CHARTING The main use of the computerized system in the clinical areas is for
charting purposes for the dentist and the hygienist. Figure 14-3 is an example of a
computerized dental chart for a patient. Each tooth in the dentition of the patient
can be clearly seen and any of the surfaces requiring restoration easily viewed. An
anatomical view of each tooth is used in order that an accurate charting of the den-
tition is displayed. Electronic charting varies depending on the software used, but
generally, work that is required is indicated in red, work that exists is indicated in
blue. Extracted teeth have an X through them, and teeth with root canal therapy
have a line in each root. Beyond this, there are specific differences from program
to program, and these differences should be learned by consulting the user’s man-
ual or learning from other staff members. It is important that an office administra-
tor learn to read a dental chart, as there is little time in the day for the dental as-
sistant or dentist to explain the meaning of each item on the chart. Charts of the
patient dentition are important medical records, are private, and will be stored
within the patient’s file on the computer. These charts can be viewed by any mem-
ber of the dental team on his or her computer but should be considered a private
part of patient records.
DIGITAL IMAGING Most digital imaging software that is part of the practice man-
agement program is compatible with most or all digital cameras. This is an impor-
tant aspect to consider before purchasing the software program, since the incom-
patibility of software digital imaging devices will limit the software or digital devices
that can be used. Digital imaging devices used in the dental office consist of digital
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CHAPTER 14 Technology in the Dental Office 305
cameras, digital x-ray sensors, intraoral cameras scanners, and Web cams. A good
dental imaging software component of the program will allow the following:
• Link images to the patient’s chart and manage them by allowing categoriza-
tion of images
• Make notes directly on the image as well as adding or subtracting colors to
the image for educational purposes
• Use patient images to explain and describe treatment and provide a rendition
of the image of what it would look after treatment
• Protect images automatically, which prevents irreversible altering of the im-
age
PERIPHERAL INTEGRATION Some dental practice management programs support the
integration of peripherals commonly used in dental offices. A popular peripheral
used by dentists is the Tablet PC, which is a handheld notebook computer that rec-
ognizes handwriting and speech or voice commands and is optimized for wireless
network connections. The Tablet PC is particularly useful in the dental office be-
cause of its great portability, wireless connection to the network, and ease of use
while examining a patient. Using a stylus directly on the screen to enter charting in-
formation is a simple, fast, and effective method of getting data into the computer
without using paper forms or a keyboard. The surfaces of most tablets can be dis-
infected, making them ideal for use in the operatory. Some offices use Tablet PCs for
FIGURE 14-3 Tooth charting. DENTRIX image courtesy of Henry Schein Practice Solutions, American Fork,
UT.
POINT
check
POINT
4. What are two features
of a digital imaging
system that are
advantageous to the
dentist?
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306 PART III Dental Office Management
patients to enter their identification data. The Tablet PC can help create a truly pa-
perless office.
PATIENT EDUCATION Patient education can be a very effective aspect of treatment ac-
ceptance. Dental software programs can provide patients with a 3D animation of their
own teeth to explain and have them understand the treatment they require. Dental
software programs also include a stock of images and educational shorts on proce-
dures and recommendations for treatment. Educational leaflets, or pamphlets that
provide patients with information regarding procedures they may be curious about or
require, are helpful in preparing patients for the procedure and answering questions
that they may have. Patient images can also be included with treatment plan letters to
patients or as a marketing device in encouraging patients to accept treatment.
Internet Basics
The Internet, or the World Wide Web, is a household term in today’s society. In the
dental office, the Internet is used by both administrative staff and clinical staff. The
administrative staff may need to access the Internet for various reasons, such as lo-
cating addresses of insurance companies and patients, ordering supplies online from
office and dental supply companies, and contacting the help desk of the dental soft-
ware provider currently used in the dental office.
The Web browser used by the office you are in will be identified as an icon on
the computer screen that you can click on with the mouse to connect to the Inter-
net. Web browsers can vary, but the most the common ones are Internet Explorer
and Netscape Navigator.
Security
A firewall or Internet security system should be available on the computer you use
and enabled at all times. The Internet security system provides the computer with
protection from harmful viruses and intruders who may be able to sabotage the files
on the computer. Companies like Symantec and Trend Micro provide some of the
more commonly used security systems. AVG and Zone Labs provide very good free
programs for security, but they may not be as fully featured as the pay programs. It
should be remembered that these programs should have their software and virus
definitions updated on a daily basis, in order that they may keep up with the con-
stantly changing world of computer security.
Additional security measures include using sites that are approved by the den-
tal regulating bodies and following Health Insurance Portability and Accountability
Act (HIPAA) guidelines on transferring patient information. These sites often have
what is called a secure sockets layer. This means that as the information is trans-
ferred from the dental office computer, it becomes scrambled so that it is incompre-
hensible for anyone who intercepts it. When it arrives at the correct site, the infor-
mation is unscrambled and easily legible.
Keeping the Internet security system on at all times may deny the acceptance of
cookies on your computer. A cookie is a small file that is placed on the hard drive
of your computer by a remote site and that contains information that can identify
or control your computer in certain ways. Not accepting cookies may make certain
Web pages fail to appear or prevent them from operating correctly.
HIPAA requires that passwords be used to access computerized patient infor-
mation. From time to time, the passwords should be changed to ensure that infor-
mation is protected. Viruses can be very destructive to a computer system. A virus
is a small file that may be transferred to your computer system with the intent to
sabotage or annoy. The effects of a virus can be as annoying as shutting your com-
puter down periodically or as destructive as erasing your entire hard drive. Viruses
can enter your computer system in different ways, such as when downloading
information from the Internet or opening an attachment in an e-mail. A worm is a
POINT
check
POINT
5. How can dental
practice management
programs be used to
provide patient
education?
legal TIP
Patient information stored
electronically on the
computer system must be
protected from exposure
to persons who are not
intended to see the
information. Maintaining an
Internet security system on
the office computer will
ensure that patient
information will not be
exposed. It is important
that the security system is
not disabled for any reason.
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CHAPTER 14 Technology in the Dental Office 307
specific type of virus that enters through an e-mail. Opening e-mail attachments at
work should be avoided, particularly if they are sent via personal e-mails! Use the
following guidelines when using the Internet at work:
• Do not open e-mails from unknown addresses or suspicious Web site
addresses.
• Keep the Internet security system enabled at all times while the computer is
on and ensure that the virus protection software is updated as notified.
• When downloading information from the Internet, download only informa-
tion that pertains to work. Do not download information for personal use.
• Change all passwords on a regular basis.
Internet Searches
Finding the information you need on the Internet is done through the use of a search
engine. A search engine allows you to enter a search term and then collects all the
sites that match your search terms. Examples of common search engines are Google,
Yahoo, and Excite.
Limiting the number of responses you receive on your search is important
(Box 14-2). Being specific in the terms that you enter to begin your search is im-
portant to avoid wasting time. The Internet can provide hundreds of thousands of
Web sites containing information you need if the terms you enter are too general.
For example, if you are looking for information on tooth-whitening toothpastes and
you enter the search term “toothpaste,” you would find innumerable Web sites con-
taining information about toothpaste, from definitions of toothpaste to discussion
of ingredients. Entering the terms “whitening toothpaste” will provide a compre-
hensive list of sources to gather information on whitening toothpastes. When
searching for information regarding dental products or procedures, it is a good time
saver to begin with searching dental association Web sites for information on the
product or topic or going to manufacturer Web sites.
If you are surfing for information that will be used in the dental office for pa-
tient information, make sure to print out a copy of the information that will have
the name of the Web site on it. Also, make every effort to find information provided
by credible Web sites, or Web sites that represent reliable sources of information on
the dental industry. Credible Web sites include your local dental association Web site
or a well-known dental product supplier, such as Oral-B or Colgate.
Computer Ethics
As a dental administrator, you should use the computer professionally as a tool for
proficient and efficient work at all times. HIPAA provides comprehensive guidelines
for the uses of computers for storing, viewing, and transferring patient information;
POINT
check
POINT
6. What is a cookie and
how can one be
avoided?
BOX 14-2
Tips for Searching on the Internet
1. Select a search engine.
2. Choose one or two words in your query to narrow
your search down.
3. If a long list of sites is displayed, refine the search
further by entering another key word.
4. If no sites are listed after your initial search, check
the spelling of your search terms and try again.
5. Always view more than one site before making a final
decision about the information you have found.
6. Download the information or print the information
necessary.
POINT
check
POINT
7. How does one gather
information quickly
and accurately on the
Internet?
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308 PART III Dental Office Management
adherence to these guidelines ensures the privacy of the patients in the practice. Use
the following guidelines in the dental office regarding the use of computers:
• Never leave patient information displayed on the computer when you are not
present in the area.
• Always close the screen when you are not in front of the computer.
• Assign separate passwords and log in names for each employee.
• Not all employees should have access to all administrative functions allowed
on the computer, such as writing off charges or changing billing or payment
information.
• Never use a computer when another employee is logged in under his or her
own name on that same computer. Ask the employee to log off or sign off and
then use the computer.
• Never access your personal e-mail or download personal information while
you are at work.
• Always enter information into the computer with extreme care, making sure
that you are entering the information into the correct patient account and
using the correct codes. Never stop entering information half way through a
transaction.
• Keep the information you read and send by e-mail in the dental office confi-
dential by respecting patient confidentiality and not discussing the informa-
tion outside of the dental office.
Ergonomics
Because you will be spending a lot of time sitting in front of a computer, it is im-
portant that you practice proper body positioning and proper typing style and that
a rest period is obtained at regular intervals.
While sitting in front of the computer, you should adjust your chair so that your
back is straight, and your neck and back muscles are relaxed. Arm supports should
be adjusted so that your arms form no less than a 90 degree angle at the elbow. If
the back of your chair is adjustable, it should be adjusted to create gentle support
for your pelvis and neck. Feet should be flat on the floor, and the height of the chair
should be adjusted so that your thighs are approximately level with the floor.
While typing, your elbows should be above the level of the keyboard. This will
prevent fatigue and numbing of arms that can occur from prolonged posturing of
your arms at an angle to the work surface. You should sit close to the desk in order
that your elbows can be close to your body. Wrists should not rest on the table or
keyboard when typing, as this will cause stress on your wrists. Use your whole arm
to support your hands and fingers.
Make sure, during the day that you take time away from your desk, and take
time away from the computer. While entering data or typing for a long period of
time, make sure you look away from the screen every so often and let your eyes fo-
cus on a more distant object. During breaks or lunch periods, make sure you get up
from your desk and walk around. Gently stretch and rotate your neck if you have
been sitting in the same position for a long time.
If you start to exhibit any symptoms of back pain, neck pain, or repetitive stress
injury, check your posture and your rest periods, and make sure you are doing the
right thing. It may be prudent to request an ergonomically correct chair for your
workstation if you cannot work with the chair you have now.
OTHER OFFICE EQUIPMENT
Many offices that you may work in may have several other office machines that you
will have to gain familiarity with in order that you can efficiently use them when the
need arises. The manuals for these machines should be made available and should
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CHAPTER 14 Technology in the Dental Office 309
be consulted to gain expertise with each type of equipment. If the manuals are not
available, most companies have online manuals in the form of pdf documents that
can be downloaded and printed.
Fax Machine
Although many computers can provide the services of a fax machine, the ease of
sending a paper document over telephone lines that a fax machine provides cannot
be denied (Fig. 14-4). When sending a fax, always take care that fax numbers are
entered carefully. Sending medical or dental records to the wrong phone number can
have embarrassing or serious consequences. A cover letter should always be in-
cluded before each fax in order that the receiver of the fax knows its source, the
length of the fax in pages, who else received the fax, the phone number of the sender,
and the date that the fax was sent.
Copier
It is quite often easier to use a dedicated copier rather than a scanner or a fax ma-
chine when making a large number of copies of a document, although in recent
years, office supply stores and copying companies provide very cost efficient copy-
ing services for larger numbers of copies. For single copies, most fax machines or
computers with scanners can copy documents quickly and easily.
Postage Machine
A postage machine is a very convenient method for providing postage for the large
quantities of mail that goes out of a dental office. A postage machine prints a me-
tered amount of postage directly on an envelope after postage is purchased for the
machine over the phone line or Internet. Generally they are very easy to operate, and
the manufacturers are normally more than happy to provide online or phone sup-
port for their use.
Shredder
A shredder is an important part of keeping patient records private (Fig. 14-5). Quite
often, confidential information will appear on items that need to be recycled or
thrown away. A heavy-duty shredder is of paramount importance in protecting the
confidentiality of these records by rendering them unreadable. Remember, even
phone notes that you have taken while conferring with a patient should be shred-
ded. The shredded material can be recycled when necessary.
FIGURE 14-4 Fax
machine.
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310 PART III Dental Office Management
Calculators
A printing calculator is a useful part of the office equipment on the front desk.
Quick additions on patient estimates, verification of deposits, or quick confirmation
of order totals can be done without resorting to paper and pencil.
Point of Sale Terminals
Many dental offices have adopted terminals that allow the patient to easily and
quickly use credit cards or debit cards to make payments on their accounts. These
machines are quite specific to the financial institution that supplies them, and so the
instruction manuals should be consulted for their use. Training courses and advice
are usually provided free of charge from the company that supplies the terminals.
Great care should be taken to provide accuracy when using the terminals, and pri-
vacy should be available while patients are entering private codes or pin numbers
into the terminals.
Chapter Summary
There are many different types of computers used in the dental office. Desktop com-
puters are more commonly used in the administrative areas, whereas laptops and
Tablet PCs may be found in the clinical areas. Although the type and use of a com-
puter may vary, the core components and peripherals needed for the computer are
FIGURE 14-5
Shredder.
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CHAPTER 14 Technology in the Dental Office 311
common among them. Peripherals include essential items such as monitors, key-
boards, and mice and optional items such as network cards and modems, printers,
scanners, speakers, external hard drives and backup devices, and digital x-ray and
camera equipment.
The use of a computerized practice management program, along with other
common administrative programs, will assist in the maintenance of patient flow in
the dental office. Becoming proficient in both the clinical and administrative com-
ponents of the computer program will assist the dental office administrator in en-
suring complete and accurate patient records and maintenance of patient dental
care. Competency using computers and confidence with computer programs is
essential.
Moreover, dental office administrators should be familiar with using the Inter-
net effectively, understand the ethical considerations of computer use in an employ-
ment setting as well as the HIPAA applications regarding computerized patient
records, and practice proper ergonomics. Finally, dental administrators should be
familiar with the use of other common office equipment, such as copiers and fax
machines.
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Review Questions
Multiple Choice
1. A spreadsheet is primarily used to
a. arrange text in a format suitable for printing and
to create letters.
b. format numbers in a layout suitable for calcula-
tions and analysis.
c. create presentations to show to the patients for
their education.
2. A USB flash drive
a. can hold any kind of data and plugs in to a port
called a USB port.
b. can hold digital images only and plugs in to a
port called a firewire port
c. can hold only numerical or text data and plugs in
to a port called a flash port.
3. Which of the following is true about computer
modems?
a. An external modem is always slower in speed
than an internal modem.
b. A modem always requires an attachment to a
phone line.
c. A computer must have a modem to get e-mail
from the Internet.
4. A good dental imaging software component of the
program will allow the clinician to
a. link images to the patients’ chart and manage
them by allowing categorization of images.
b. allow for notes to be made directly on the image.
c. use patient images to explain and describe treat-
ment.
d. all of the above.
5. The Internet security system provides the computer
with
a. cookies that appear when you want.
b. a history of Web sites visited in the past.
c. protection from harmful viruses and intruders.
d. none of the above.
6. Which of the following is not a guideline for proper
computer use?
a. Assign separate passwords.
b. Never use the computer when another employee
is logged in.
c. Always treat all patient information entered into
the computer with extreme care.
d. Using screen savers is at the discretion of the
dentist.
7. Which of the following is considered a clinical ap-
plication of dental software
a. word processing
b. spreadsheets
c. charting
d. internet searches
8. Administrative applications in dental software in-
clude all but which one of the following
a. back up management
b. digital imaging
c. email
d. spreadsheet applications
9. The Tablet PC in the dental office is an example of
a. computer peripheral
b. patient education
c. administrative application
d. back up management
10. Ergonomics in the dental office refers to
a. proper hand and back positioning
b. correct posture
c. proper posture while typing
d. all of the above
Critical Thinking
1. Is there a difference between the handling of a dig-
ital x-ray and a physical x-ray as far as patient pri-
vacy is concerned. What special considerations
might have to be thought of with regard to the pri-
vacy of digital x-rays?
2. If a fax has been sent to a specialist’s office, what
should be done with the original cover sheet that was
sent with it? Is it important to keep it or to shred it?
3. If an e-mail is sent to a patient, should a hard copy al-
ways be printed out for the patient chart? Compare
and contrast how the answer may be different in
offices with different philosophies on the use of paper.
2. Search for three different Web sites for dental offices
in your state. What components of the Web sites do
you find useful? What components would you like to
change?
HANDS-ON ACTIVITY
1. Locate the Web site of the state
dental association in your area. Navigate throughout
the Web site as if you were a patient wanting to
locate a dentist close to your home.
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