> ## Documentation Index
> Fetch the complete documentation index at: https://docs.bizaxl.com/llms.txt
> Use this file to discover all available pages before exploring further.
# Laboratory and Dental Lab Orders
> How to manage dental laboratory work (crowns, bridges, dentures, orthodontic models) and blood tests ordered before surgical or sedation procedures.
The laboratory module at a dental clinic covers two distinct functions: tracking dental laboratory work sent to external labs for fabrication (crowns, bridges, dentures, retainers), and ordering blood tests for patients scheduled for oral surgery under sedation or general anaesthesia.
***
## Part 1: Dental Laboratory Work
Dental laboratory work is physical work sent to an external dental laboratory for fabrication and returned to the clinic for fitting. The system allows you to track each item of lab work from the impression date through to the fit appointment.
***
### What Gets Sent to the Dental Lab
| Lab Item | Procedure It Relates To |
| ---------------------------------------------- | -------------------------------------------------------- |
| Metal-ceramic crown | Crown preparation - tooth prepared, impression taken |
| Full porcelain crown (Zirconia / EMAX) | Crown preparation - often requires digital scan |
| Bridge unit (per pontic and abutment) | Bridge preparation - multiple teeth involved |
| Acrylic partial denture | Denture impression - patient's remaining teeth |
| Cobalt-chromium partial denture | Denture impression with metal framework |
| Complete denture (upper or lower) | Multiple impression stages |
| Orthodontic study models | Orthodontic assessment - poured from alginate impression |
| Orthodontic retainer (Hawley or vacuum-formed) | Post-treatment or retainer stage |
| Custom bleaching trays | Teeth whitening case |
| Special trays | Custom impression trays for complex restorations |
| Surgical stent | Implant planning (where applicable) |
***
### Tracking Dental Lab Work in the System
The system does not have a dedicated dental lab work module out of the box, but you can track lab work effectively using the **Clinical Procedure record** and the Notes / Attachment features:
**Recommended method:**
1. When taking the impression for a crown or bridge, create or open the Clinical Procedure record for the procedure (e.g., "Crown Preparation - Tooth 26")
2. In the Notes field, record:
* Date impression taken
* Laboratory name and contact
* Shade recorded (e.g., A2 using Vita Classical)
* Material specified (Zirconia, EMAX, Metal-ceramic)
* Special instructions (e.g., "match adjacent crown", "staining required", "long contact point required")
* Expected laboratory return date
* Lab job reference number (assigned by the lab)
3. Attach the lab prescription (delivery docket / work instruction form) as a file attachment to the Clinical Procedure record
4. When the lab work is returned:
* Update the Clinical Procedure notes with the received date
* Check the quality before booking the fit appointment
* Book the fit appointment (Crown Fit, Bridge Fit, Denture Delivery, etc.)
5. Create a new Clinical Procedure record for the fit appointment (e.g., "Crown Fit - Tooth 26") and complete it when the crown is cemented
**Using the appointment notes:**
Add the expected lab return date to the patient's appointment notes so the front desk knows when to schedule the follow-up.
***
### Lab Quality Check Before Fitting
Before cementing a crown or fitting a denture, always check:
| Check | Crown / Bridge | Denture |
| ------------------------------ | ------------------------------------------ | ---------------------------------- |
| Shade match | Compare to adjacent teeth and shade guide | Tooth shade and mould as specified |
| Fit on model | Confirmed by lab | N/A |
| Margin fit on tooth | Check fit in mouth before cementing | N/A |
| Occlusion | No premature contacts | Even contacts across all teeth |
| Contact points (for bridges) | Tight mesial and distal contacts on pontic | N/A |
| Patient appearance and comfort | Patient approval of aesthetics | Patient comfort in all dimensions |
Record the quality check outcome in the Clinical Procedure notes for the fit appointment.
***
## Part 2: Pre-Surgical Blood Tests
Before dental procedures under intravenous sedation or general anaesthesia, blood tests are required to assess the patient's fitness for sedation. Some patients also require blood tests before tooth extraction if they have medical conditions that increase procedural risk.
***
### When Blood Tests Are Required
| Scenario | Tests Required |
| ------------------------------------------------------- | ----------------------------------------------------------------------- |
| IV sedation or general anaesthesia | Full blood count (CBC), blood glucose, renal function, clotting profile |
| Patient on Warfarin (before extraction) | INR / PT - ideally within 24 hours of procedure |
| Patient on newer anticoagulants (Apixaban, Rivaroxaban) | Discuss with prescriber; check recent renal function |
| Known or suspected diabetic (before oral surgery) | Fasting blood glucose, HbA1c |
| Procedure requiring bone surgery (implants, sinus lift) | Full blood count to confirm adequate haemoglobin |
***
### Ordering a Lab Test
1. Go to Healthcare workspace → Laboratory card → **Lab Test** → New
Or order from within the Patient Encounter using the Service Request section.
| Field | What to Enter |
| --------------- | -------------------------------------------------------------------------------------------------------- |
| Patient | The patient needing the test |
| Template | Select the appropriate test template (e.g., "Full Blood Count", "INR", "Fasting Blood Glucose", "HbA1c") |
| Practitioner | Ordering dentist |
| Date | Date the test is ordered |
| Request Date | Date sample should be collected |
| Request Details | Any specific instructions (e.g., "fasting required", "collected before sedation date of \[date]") |
***
### Lab Test Templates for Dental Pre-Surgical Screening
Set up the following Lab Test Templates:
1. Go to Healthcare workspace → Laboratory Setup card → **Lab Test Template** → New
| Template Name | Test Type | Normal Range |
| -------------------------------------- | --------------------------------- | ----------------------------------------------------------------------------------- |
| Full Blood Count (CBC) | Descriptive (multiple parameters) | Hgb >12 g/dL (female), >13 g/dL (male); Platelets 150-400 x10³/μL; WBC 4-11 x10³/μL |
| INR (International Normalised Ratio) | Single | INR 0.8-1.2 (normal); therapeutic target 2.0-3.0 for AF; >3.5 = extraction risk |
| Fasting Blood Glucose | Single | \<6.1 mmol/L (normal); 6.1-6.9 (impaired fasting); >7.0 (diabetes threshold) |
| HbA1c | Single | \<6.5% (normal); 6.5-8% (controlled diabetes); >8% (increased surgical risk) |
| Urea and Electrolytes (Renal Function) | Descriptive | Relevant for sedation drug dosing |
| Prothrombin Time (PT) | Single | 11-13 seconds (normal) |
| Platelet Count | Single | 150-400 x10³/μL |
| Blood Group and Cross-Match | Descriptive | For major surgical cases |
***
### Reviewing and Approving Lab Results
1. After the test is completed by the external laboratory, the results are entered into the Lab Test record
2. A user with the **LabTest Approver** role reviews the results
3. If results are within acceptable range for the planned procedure, the result is approved
4. Approved results trigger an SMS notification to the patient
5. Results must be approved before the surgical appointment proceeds
**Surgical Go / No-Go Thresholds for Dental Surgery:**
| Test | Result | Action |
| --------------------- | ------------------- | ------------------------------------------------------------------------ |
| INR | Less than 3.5 | Proceed with extraction (local measures for haemostasis) |
| INR | 3.5 or above | Discuss with patient's anticoagulation clinic before proceeding |
| Fasting blood glucose | Less than 11 mmol/L | Proceed with caution, morning appointment preferred |
| Fasting blood glucose | 11 mmol/L or above | Defer elective extraction, optimise glycaemic control first |
| HbA1c | Less than 9% | Proceed with planned surgery |
| HbA1c | 9% or above | Defer elective implant or bone surgery; discuss with patient's physician |
| Haemoglobin | Above 10 g/dL | Proceed |
| Haemoglobin | 10 g/dL or below | Investigate cause before major bone surgery |
| Platelet count | Above 80 x10³/μL | Proceed |
| Platelet count | 80 x10³/μL or below | Specialist review before oral surgery |
***
## Field Guide: Lab Test
| Field | Description |
| ----------------------- | ---------------------------------------------------------- |
| Patient | The patient requiring the test |
| Lab Test Template | The type of test ordered |
| Healthcare Practitioner | Ordering dentist |
| Request Date | When the sample is needed |
| Date | Date the test was ordered |
| Submitted Date | Date the test was submitted for processing |
| Status | Draft → Submitted → Approved |
| Result | Result values entered against each test parameter |
| Approved By | User who approved the result |
| Approval Date | When the result was approved |
| Invoiced | Ticked when a sales invoice has been created for this test |
***
## Best Practices
* Order blood tests at least 1 week before the scheduled surgery date - this gives time to receive results, review them, and reschedule if needed
* For Warfarin patients, the INR result should ideally be from within 24-72 hours of the planned procedure - an INR taken 2 weeks earlier may not reflect the current level
* Record the lab job reference number for every dental lab item in the Clinical Procedure notes - this is essential for querying the laboratory if items are delayed or need to be remade
* Never proceed with a sedation procedure without an approved blood result on file - record the approval in the patient's notes
* For implant patients, check HbA1c before implant placement: poorly controlled diabetes significantly increases implant failure rates and infection risk after bone surgery
***
## Troubleshooting
**Blood test results are not appearing in the patient's timeline**
Check that the Lab Test record has been submitted. Draft lab tests are not included in the patient history timeline.
**Lab test results have not been approved but surgery is tomorrow**
Contact the LabTest Approver urgently. Do not proceed with sedation without approved results. If the approver is unavailable, escalate to the clinical lead.
**The lab has returned a crown but it does not fit correctly**
Document the issue in the Clinical Procedure notes (why it does not fit: margin open, occlusion high, shade wrong) and return the crown to the laboratory with a new work instruction. Book the patient for a new fit appointment when the crown is remade.
***
## Related Features
* [Dental Treatments](/health-wellness/dental-clinic/dental-treatments): Crown and bridge procedures generate lab orders
* [Oral Surgery](/health-wellness/dental-clinic/oral-surgery): Blood tests are required before sedation surgical procedures
* [Orthodontics](/health-wellness/dental-clinic/orthodontics): Study models and retainers are tracked as lab work
* [Billing and Finance](/health-wellness/dental-clinic/billing-finance): Lab tests are billable items