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The Position of Records Technician by Carolyn Friedman

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The position of the Records Tech has many different definitions. I have been in offices where the person in this position strictly takes orthodontic records and he or she is the only one who takes the records. Other practices have its records tech multi-tasking with assisting, as well as being the treatment coordinator. Whichever the case, the mission should always be the same:
  • To deliver value and make a difference in everything he or she does
  • To offer comfort, one patient at a time
  • To provide excellent service and a great experience to every patient
  • To be consistent with high quality records

So I ask: When a patient is passed-off from the treatment coordinator to the records tech for records, does the commitment and excitement continue? Commitment, caring and consistency equals great clinical records and a stronger connection with the patient.

If a parent has had orthodontic treatment, seize the opportunity. This is the perfect time to build up your practice and explain how orthodontics has changed over the years. Explaining that there is less discomfort and fewer appointments will sometimes have an impact on his or her decision to start treatment.

Make sure the records tech introduces himself or herself and explains what is going to happen. This is when you build credibility for your practice. If the treatment coordinator and records tech are different people, communication is essential. For instance, if it was difficult for the treatment coordinator to take photos, the person who will be taking the impressions should be given a heads up. Example: the patient was very active, didn’t sit still, was bothered by retractors, etc.

Please remember, if you have a new employee in the office taking your records, there are some real issues. Two new people, a new patient who is forming an opinion of your practice and a new employee trying to figure out if he or she is doing things correctly, can be a setting for a disaster. If you have a new employee as a records tech, he or she should not share that fact with the new patients. Talking to the patients during the records process will also help them be more comfortable and put them at ease. It helps the time go faster and relaxes the patients.

Patients will go elsewhere if we make them feel uncomfortable, they will not remember everything we say, but they will remember the way they are treated. Therefore, a pleasant experience for the patient is essential to building confidence in your practice.

Now, let’s get to specific things that should happen with new patients’ records. New patients should never have to wait for their appointment and should have a very positive experience. This comes from the records tech understanding the value of the records and spending the time to do things right the first time.

First, be prepared:
  • The room should be clean and ready for the next patient
  • Make sure your camera has fresh batteries
  • Make sure your retractors are ready
  • Make sure your X-ray machine is ready
  • Have all the impressions trays and alginate ready

Training and education for every position is essential to the success of the practice. For the record tech, knowing the simple mechanics of his or her job is not enough. He or she must be trained as to the value and technical aspects of taking records.

X-rays: Panex, Panorex: This Xray has great value to the orthodontist. It will show the development of the teeth, if there are congenitally absent teeth, supernumerary teeth, transposed teeth and the root relationship. The records tech must understand the patient positioning to achieve the best possible X-ray.

Improper positioning will result in the X-ray being distorted and teeth appearing elongated or shortened. When the head is positioned forward or down as in the photos, the teeth will appear shortened. Note the curve of the X-ray (Figs. 1 & 2).

If the head is positioned upward the teeth appear elongated (Figs. 3 & 4).

Cephalometric X-ray: This X-ray is traced to assist the orthodontist in determining the skeletal growth pattern and the jaw relationship. The level of the patient’s head is critical so that you don’t get a double image of the teeth or the mandible. In the event that the X-ray shows two mandible images and you are tracing the X-ray, split the difference and draw in the middle of the two images. It is also important to make sure the head is level to be able to clearly see the soft tissue. A patient’s profile can look different if his or her head is positioned up or down (Figs. 5 & 6).

Photos: The value of photos is huge and should not be taken lightly. Photos can be a tremendous tool to protect and to market your practice. Great photos can assist when braces are removed and mom or dad doesn’t remember that their child had decalcification prior to starting orthodontic treatment. Also, photos are a great marketing tool. Make sure your patients leave with a printed composite which includes you’re office logo and information. This will be valuable information for the parent who did not attend the appointment. I like to go through the photos and explain why each view was taken and what it shows. I look at this as an educational time. This builds the value of the treatment and helps the patient understand his or her individual need for orthodontic treatment. This is also a great time to make a connection with the patient. I love to kid around during the photos and make sure the patient has a great experience.

Impressions: Does your records tech appear to dislike doing impressions? We tend to avoid what we don’t do well. I recommend that the records tech work on becoming very comfortable taking impressions. This is the area that most patients dread and if the person doing them is also dreading them, there is a potential problem. It is especially important that the records tech ensure that the patient feels comfortable and confident before taking impressions. Many times the parents have had orthodontic treatment and have made that dreaded statement about how they almost died when they had impressions or that it was the worst thing that they had to do. I typically tell parents things really have gotten so much better over the years!

Correct fitting of the trays is one of the ways to make sure you get great impressions, and more importantly, that the patient is comfortable. If the tray is too large or too small, it will be difficult to place in the patients mouth and therefore uncomfortable for the patient. Things that can improve the comfort for the patient are:
  • placing wax on the distal molar area to avoid having to go to a larger size tray that is more difficult to seat.
  • placing wax along the top ridge of the impression tray if you are using metal trays.
  • seating the tray from the distal so that the flow of the alginate will not flow toward the throat.
  • talking with patients while taking an impression which helps them to concentrate on what you are saying and not what you are doing.
  • removing archwires when taking impressions on a transfer patient or a patient in treatment with braces to make the process of removing the impression tray so much easier.

Training in every position of the practice is essential to make sure everyone is comfortable with the job. Many times the records tech will go ask if the impression is OK when he or she already knows it’s not. Remember, the rule is the model can only be as good as the impression. The lab is not able to improve on a bad impression. If the teeth are through the impression, you will lose detail. If a tooth is not completely clear in the impression, it will not be clear on the model. The records tech must take a few minutes to make sure to get it right the first time. Your patients will really appreciate it.

A records tech must have strong technical abilities to produce quality records for the orthodontist, but this is only one aspect of the job. This person also markets the orthodontic practice. From the interactions with the records tech, the patient will be forming an opinion of your office and deciding whether to go forward with treatment. It is also important for this person to have a good personality, to bond with each patient, and offer them a pleasant experience. Think about all the issues covered: quality, communication and consistency. Each one of these both market and protect your practice. The task at hand and the delivery of the task go hand-inhand to providing an excellent experience.

*This article was made possible through the support of an education grant from G CARE, an educational alliance supported by Dentsply GAC.
Author's Bio
Carolyn Friedman continues to work in the same progressive orthodontic practice that she has worked for 39 years. Beginning as an orthodontic assistant, and having worked in every area of the orthodontic office, she currently is the office manager and treatment coordinator. She is the founder of OrthoAssist, a business focused on orthodontic consulting and training of orthodontic staff members. She is also the author of the OrthoAssist Library, interactive programs consisting of training programs for all areas of the practice. Carolyn is a continuing education provider for the Florida Board of Dentistry, conducting educational programs for hygienists on orthodontic appliances, their application and care. Learn more at www.orthoassist.com.
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September 2025
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