Colored at The End 2012 Das Lwit Dental Clinic 66 Page Packet Seema J Dent 113 Digital

DENT -113 (BRING THIS PACKET TO EVERY CLINIC SESSION) Seema Jain 11/1/2012
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INDEX Page #s 1. Few Abbreviations, Request Sheet & Cassette #s 2. Top Prescribed Med Pronunciation 3. 25-Steps to Follow at the Beginning of the Day 4. 20 Dos and Donts in the Clinic 5. Setting-Up and Cleaning the Op Protocol 6. Health History Review Questionnaire 7. Contd. RHH Ques. & Blood Pressure Guidelines 8. Example of HH Write-up (1st and Subsequent Visit) 9. Notice of Privacy & Medical Emergency Protocol 10. ASA Codes & White Card Sample w/ ASA Code 11. Chart Write-Up Criteria (Contd. Next Page) 12. Chart Entry Legend, No Show, Draft & Signing Criteria 13. Protocol to Follow for (New Patient) Initial Exam 14. Protocol to Follow for CC/Coronal Polish (Prophy) 15. 10-Steps Protocol for coronal polish & Emx 16. CWU: NP Pedo Exam 17. CWU: 6 Month Continuing Care/CC (Pedo) 18. Superbill Sample for Coronal Polish/ CC 19. Digital superbill 20. CWU: Sealants & Steps for Placing Sealants 21. CWU: Consultation & Toothache Questionnaire 22. CWU: Emergency Exam w/ No TX & EMX w/ TX 23. CWU: NP Initial Exam (Adult)& protocol steps 24. Set-Up: Standard Op & Removable Appliances (Cleaning) 25. CWU: Alginate Impressions & CD/RPD/NG Seat 26. CWU& Set-Up: Composite 27. CWU& Set-Up: Amalgam, Rubber Dam Punching
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Page #s 28. CWU& Set-Up: Crown Prep 29. CWU& Set-Up: Build-up & Crown Seat 30. Samples: Seabrook Lab Slip & N2O calculation 31. Set-Up Endo: Rotary & Lateral Condensation 32. CWU: RCT (Endo) Procedure Start 33. CWU: RCT (Endo) Procedure Finish 34. CWU: Simple Extraction 35. CWU& Set-Up: Surgical Ext. & Post Op Instructions 36. Tips for BWX Radiographs & Priority (DAS/DHS) 37. Radiology Assistants (RA) Duties & Opening the Plates 38. Instructions for Duplicating a Film (w or w/o Machine) 39. Instructions for taking panoramic radiograph 40. 20 Steps to Follow at the End of the Day 41. Treatment Classification (DHS or DDS) Pages 41 A-C Limited Exam and Addendum Pages 41 D-G Dr.s Exam: Restorative TXP 42. COLORED PAGES 43. Tooth Surf. & Blacks Cavities Classifications 44. Pre-clinic (Morning) Huddle Sheet Sample 45. Topical & Injection Sites, Anesthetic Types 46. Charting Mixed Dentition & Plaque Index Calculation 47. Universal Numbering System: Primary, Perm., Mixed 48. Recognizing Mixed Dentition (Clinically & X-Rays) 49. Radiographs Placement Reference Sheet for FMX (pg. 50-59) (pg. 60-66) Tooth Charting (TC) Perio-Charting (PC)
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A Few Abbreviations Used in This Packet

ASA: American Society of Anesthesiologists Amal: Amalgam B/U: Build Up BWX: Bitewing X-Ray CC: Chief Concern (Progress note) CC: Continuing Care (TxP sheet) Comp: Composite Cr.: Crown CHF: Chronic Heart Failure COPD: Chronic obstructive pulmonary FM: Full Mouth Fl: Fluoride FMX: Full Mouth X-rays H.S.: High Speed LL: Lower Left LMX: Limited Exam PI: Plaque Index R: Radiograph (PA, Pano, FMX, BWX) RCT: Root Canal Treatment RDI: Rubber Dam Isolation RPD: Removable Partial Denture Rx: Prescription RXNs: Reactions SRP: Scaling & Root Planning SSC: Stainless Steel Crown S.S.: Slow Speed TA: Toothache Tx: Treatment TXN: Treatment Next TXP: Treatment Plan TXT: Treatment Today UL: Upper Left UR: Upper Right *X-rays: radiographs
lpm: Litres per minute

LR: Lower Right Mand: Mandibular Max: Maxillary N2O: Nitrous oxide N/G: Night guard NSF: No significant findings O&B: Open & Broach OHI: Oral Hyg. Instructions PA: Periapical PC: Patient Communication PE: Patient Education PFM/PFC: Porcelain Fused to Metal
disease CVA: Cerebrovascular accident

CWU: Chart write up CXL: Cancelled DAS: Dental Assisting student DHS: Dental Hygiene student EMX: Emergency Exam Epi: Epinephrine Ext.: Extraction FGC: Full Gold Crown
REQUEST SHEET Student Name: Patient Name:
A3 Date: ______________ AM / PM Op # ______________________
PLEASE HIGHLIGHT THE ITEMS YOU NEED Contra-angle (all ops) CROWNS Straight Nose (all ops) Porcelain Polish Kit Motor (all ops) Polycarbonate Temps Adapters (high speed) (if B1/ B2/ B3) (return at the end) Aluminum Temp. Crowns Adapters (slow speed) (if B1/ B2/ B3) (return at the end) Trim Acrylic Torque Reducer (Prophy) Acrylic Bur Surgical Handpiece (extraction) Miscellaneous Lavender Rotary Handpiece (Endo) Large Adult BP Cuff Fiber-Optic High Speed Handpiece (Restorative- Yellow band) Electro surge Fiber-Optic High Speed Handpiece (Rest. Hygiene- Green band) Post or Pins Non-Fiber Optic High Speed Handpiece (B1/ B2/B3- White band) Torch and Matches DENTURES Vitality Tester Denture Reline Material Large Amalgam Well Denture Polishing Kit Surgical Burs (extraction) PIP Paste Extra: CASSETTE #S (In Restorative ops) 100: Restorative (Amalgam & Composite) 200: Rubber Dam 300: Endo (Root Canal Therapy) 700: Crown & Bridge Prep & Seat 600: Prophy (Carts top sliding shelf near x-ray
room/B1) ########################################################################
(In Restorative hygiene ops near F1) 800: Screening for Hygiene 900: Hygiene Restorative Amalgam & comp. 900 A: Hygiene Restorative Rubber Dam Request sheet filled: 400: Oral surgery (Ext.)(request) 500: Exam (request)
Websites for audio:
http://pharmacy.umich.edu/medchemlibrary/files/genericnames.html http://sitemaker.umich.edu/medchemlibrary/files/tradenames.html http://merck.com/mmhe/resources/pronunciations/index/a.html
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By: Seema Jain Switch the master button OFF (O= off) and remove the bottle from the unit and put little bit of bleach in the bottle. Leave it aside for 10 minutes. Wash your hands and start setting-up your op with barriers. Open cassette and remove the integrated strip from inside. Keep green taped forceps on clean side. Put on the lab coat (Put on the name tag unbarriered red & blue pen in the pocket.) (*pierce name tag in your lab coat & scrub as well so that you dont throw it in the laundry basket along with your labcoat at the end of the day.) Bring the request tray, high speed, slow speed. Bur blocks are in the R & RH carts drawers. Bring pt's chair down, headlight away, rheostat on the operator/ dentists side. Turn on the computer and pull patients latest digital radiograph (if any) on the screen. Or put the traditional radiographs on the view box. Have latest FMX (if any Digi. or Trad.) for viewing. Empty the bleach from the bottle & rinse and fill with tap water and place it on the unit. Check Master button 'On', water bottle 'On' too. (pressure In=I) Check that suctions & Hand pcs are working. (hs-556 or 34, ss 4 round) Keep appropriate A-# grade sheet (e.g. A-8 ) on the counter/cart. (Even if you are a patient yourself, you need A-6 sheet). Each day you need one A-# sheet (otherwise zero for the day). Bring the patients chart and be ready for morning huddle with golden yellow sheet (should be filled and left inside the chart one day prior). After that take the superbill and bring the pt in. Remember to call pt by first and last name. (There can be two patients with the same first name) Review hhx, and take vitals. Write down on rough sheet for the 1st time only and get it approved by your block instructor and transfer it to the HH sheet. Fill in the medical alert box (red if alerts or blue/black if none). Patient and DAS sign and then block instructor signs. Put bib on Pt, give glasses, give Listerine for rinse, apply Vaseline on pts lips. Put on your PPEs (mask, glasses, gloves go on last). Choose the shade (if composite), bring shade capsules after ungloving. Light & chair in place (semi/supine) for Dr. Place topical (2-3 minutes before injection)(instructor check), DHS/ Dr. Give anesthetic, DAS rinse. Confirm shade with block instructor/ Dr. and ask what type of isolation Dr. prefers (RD, Matrix, Mylar, G-ring, Cotton rolls). RD Isolation (Write start time on A-8 sheet, you need to finish in 20 minutes to get check-off for RD) instructor check, Offer bite block to pt. Procedure start.DAS assist.Procedure completed (1-2 hrs), Give tissue paper to the pt to wipe lips, hand mirror to see the final dental work result. TXT pink highlight.... TXN yellow highlight. Fill the superbillTXT & TXN, where it is going to be done(Hyg. or Rest. Hyg or Rest.) DAS sign, write down Dr. name (Dr does not sign), instructor sign. Escort pt out to the front office. Hand the superbill to office assistant. Rough write-up...show it to instructor...transfer to chart...instructor sign...Dr. Sign, put back in checkin folder. (or instructor/Dr. folder) Clean up the operatory...purge the units.chair up & light touching. (refer to cheat-sheet for cleaning the operatory.)
25 STEPS TO FOLLOW BEFORE & AFTER THE PROCEDURE
Suggestions & comments:
20 Dos & Donts in the Clinic.By Seema Jain

1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. Throw the indicator strip out of the cassette when you open the cassette. Write down patient's name and procedure on A-8 sheet last page before the morning huddle. Write down patient's name and procedure on the cart paper (tooth# and surfaces: composite or amalgam or any other procedure). And about latex allergy and injections to be given. Patient should NOT LEAVE OP with bib on. (For restroom or radiographs.) Students /operator should NOT WALK OUT OF THE OP with gloves on. Must write down HEALTH HISTORY in the HH sheet (yellow) before proceeding with TX. Patient signs this one & DAS and CDA. Get your instructor's sign on HH sheet BEFORE calling the DDS. Must get DDS signature on Radiograph sheet BEFORE exposing any x-rays. Write patient name and op # on the cup BEFORE you start exposing the radiographs. Dont (never) touch the cup from outside w/ gloves on after exposing x-rays. REMOVE patients glasses before you start exposing radiographs, it can come in the way of x-ray After you are done exposing radiographs place the blue/clear tape on the butcher paper to hint RA that that cart paper/room is contaminated. Remove BWX tabs and leave them on the cart. Students should not write down on the bright pink sheet for ordering the forms. Tell Ms. Stauch or your block instructor and Ms. Sharon (front office) takes care of that. Leave the filled in morning huddle sheet in the chart so that even if you are absent, next day other DAS can use that. Also at the end of the day if you dont see your instructor (busy) the leave rough chart write up in the chart with your, dentist and patients name and procedure before leaving it in instructors folder to approve. DAS who takes over the procedure for the ABSENT DAS must fill the absent sheet for him/her for that day. And also for the next day: Must fill request sheet for that student and also the morning huddle sheet. (Absent student cant do it. Correct?) Don't use saliva ejector, but use HVE when RD is on. RD Punching needs to be confirmed before the application. Get instructor's signature for start-time and finish-time for RD. Don't birex the paper-pad as they become warped (wrinkly) and it becomes difficult to use them later. Just peel off the top sheet which you used. Dont birex your eyewear (use soap and rinse right away). Give goodies to the traditional hygiene (pedo patients) like brush, toothpaste and toy to choose. (Ask for treasure box in the front office.) Don't break down operatory if patient is no show as that op can be used for next procedure. Write down clean op for next day on butcher paper. Mostly you cant set up the op for next day because ops are used for lab for DA and DH classes. Dont fill forms for NP until patient comes. Grade yourself with A/I or S, but not as 5/3 or 1. You MUST have grade sheet for each clinic session (AM and PM clinic each, absent or becoming patient). You will need to have them all on your conference day. IF its new patients HH then write down all the answers to 'yes' on a rough piece of paper and transfer to the chart once instructor approves it. If it is not the first time visit then you can write down RHH< No changes in HH, no new meds, BP, P directly in the chart but remember to leave the left margin properly. Write down patient(s) name(s) on your check-off sheet and take instructor's signature at the end of the day or next day. You have to submit this check-off packet before you go for externship in the last quarter. You will be deducted 15 for each missing check-off, so be proactive and finish your check off when you get the opportunity.
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Suggestions & comments:
SETTING UP AND CLEANING THE OP PROTOCOL
By: Seema Jain
Bleaching the Bottle Turn-off the unit before taking-off the empty bottle. O is for off. I is for pressure In. You will find 1:10 ratio of bleach solution in each ops cupboard. Put 3-4 oz of bleach solution in water bottle. Swish and let it set for 10 minutes. (During this time you can start setting up your op). Continue later** Setting up the barriers Wash your hands. You shouldnt wear gloves before you start setting up your ops. One chair-side white paper bag Five sleeves: For air/ water tip; saliva ejector; high volume evacuation (HVE) & hs & ss handpieces. One light-cure sleeve: For light-cure machine One light-cure tip cover: For light-cure machine tip Two light handle covers: For overhead light Two blue rubbers: For light toggle button and pen (for delivery table) Five blue barrier films: For chair up/down handles, mouse and x-ray viewing on button One 40 bag: For Patients (Pts) chair Five 30 bags: 2 for DDS and DAS chairs ; 2 for each side of delivery table and 1 for keyboard Cut almost exact size butcher paper (white paper). Take four pieces of masking tape. Open cassette and throw sterile strip away before arranging instruments. Cover it with bib afterwards. **Now Cont.: Empty the bottle. Rinse & fill bottle w/ tap water. Reattach it to the unit and turn the unit ON. If your patient is allergic to iodine then change the iodine straw before placing water bottle. ######################################################################### Cleaning the Op after Finishing the Procedure All the PPEs (lab coat, mask, eye wear, utility gloves/exam gloves) need to be worn for this part. Utility gloves are mandatory for discarding sharps. They can be found in each op or in sterilization room. Discard the needle and carpule (scalpel blade, sharp things etc. but not endo files) in sharps container 1st. Put the syringe and clean forceps in the cassette along with all the instruments. Close cassettes properly, Remove hand pieces (but not the adapters) and take them with bur blocks to the contaminated window. Bring amalgam jar from sterilization room and discard unused amalgam from the amalgam well. *Wash utility gloves, like washing your hands, before putting them away. (Exam gloves or utility gloves are ok for this portion) Remove all barriers starting w/ patients chair bag turned inside out. Place all other barriers in patient chair bag. Misc. items disposed-off in general trash are: articulating paper, floss, and 2x2s. Birex all the reusable items and wipe them w/ 4X4s before putting them back in the drawers. Purging the Unit Turn-off the unit: Find the plastic container in your units cupboard. Empty the water bottle in the container and fill the container w/ 2 liters of tap water. Vac solution is the solution you can find in each units cupboard or get it from sterilization room before cleaning the op at the end of the day. (DO NOT use VAC solution at the end of PM clinic). Put 1 oz. of this solution in the container containing water. (Water goes in 1st) Turn-on unit: Place-back empty water bottle in the unit and turn the water toggle switch on rheostat. Purge the high-speed and air-water syringe UNTIL water stops coming. (Rationale: because biofilm can be formed due to water running through them) Dip the saliva ejector and HVE in the container to suck all of the solution. (Rationale: to clean and disinfect the lines where saliva has passed through) Wipe the counters w/ 4x4 soaked in Birex. Turn-off the unit at the end of cleaning procedure. Patient chair goes all the way up and light touching the chair. Rheostat back in its slot.
HEALTH HISTORY REVIEW QUESTIONAIRE

(Draft written for instructors approval. Write down answers in complete sentences so that there is no need to refer to questions. Bring the chart with you with forms hole punched and assembled in the chart. Notice of privacy goes to patient or front office. After approval you transfer to the light yellow sheet BEFORE starting the procedure.)
If your patient circles any "Yes" answers: (retrace in red pen or pencil) 1. Why? If patient seeing a doctor for this? 2. What changes? Elaborate in detail, and when. 3. Write down date of last physical exam. 4. For what? For routine care, or for a specific medical problem? 5. Write down name, address & phone # of physician 6. Describe illness/operation. What was it? When? Is it resolved? Taking any meds? Any complications? 7. Describe as in #6. 8a. When? Does patient have heart murmur as a result? 8b. What type? 8c. Is it functional or organic? Does patient need pre-med? 8d. Is patient on blood pressure medications? What is their usual reading? 8e. Describe in detail. When? Any complications? Does patient need premed? If patient has a pacemaker, they can't be near a Cavitron or near the ultrasonic cleaners. 8f. Does patient need premed (almost always yes)? 8g. When? What was done? Any complications? Taking any medications (including aspirin)?-if so, dosage and frequency 8h. Describe in detail. 1. Due to what? 2. Due to what? Overweight? Smoking? A medical condition? 3. How often? Due to what? Taking medications for this? 4. Due to what? 8i. In what area? When was it placed? Does patient need premed? 8j. Allergy to what? Does patient take medications for it? 8k. What causes it? 81. How often does the patient have an attack? Does the patient use an inhaler? Any medications? 8m. What is the condition? How long has patient had it? Any complications? Any medications? 8n. When? Did patient get treated? If so, what did they take (Isoniazid?), and for how long? Was a chest x-ray done? 8o. How often? When was the last episode? What caused it? Is patient epileptic? Does patient take medications for it? Does patient get an "aura"? If so, what? 8p. What type (juvenile, or adult onset)? Does patient take medication? If so, what and how often? 8q. Which type? Any complications? Is patient a carrier? 8r. How severe? Any medications? 8s. How severe? How often does it flare up? Any medications? 8t. What kind? Is it resolved? Any medications? 8u. Describe in detail. When? Any complications? Any medications? Does pt. Premed? 8v. What substance? (We need to know specifically-for example, if its cocaine, we have a concern about giving patient anesthetic with epinephrine; also, if patient has a relapse, we need to know). How long has patient been "clean"? 8w. What disease? When? Is it resolved? 8x. When was it diagnosed? Is patient taking medications? Any present Symptoms? 8y. Same as 8x . 9. Describe in detail. 10. What happened? When? Any complications? 11. Explain circumstances. When? Is condition resolved? 12. Describe in detail. 13. What was the condition? When? What treatment was done? Is condition resolved.
14. For what? When? How long? 15. For what? When? How long? 16. a. What antibiotic/sulfa drug? For what condition? Last taken when? b. Name of medication. How often? For what? c. Name of medication. d. How often? For what? e. Same as above f. How often? For what? g. Name of medication. How often? Is diabetes well controlled? h. Name of medication. How often? For what? i. How often? j. Name of medication? How often? For what? 17. Name of medications, and dosage 18. Please indicate which, or both 19. What type of reaction did you have (rash, itching, couldn't breathe?) 20. What type of situation? What kind of exposure? 21. How long have you been wearing the contact lenses? 22. When? If no, encourage patient to get a tetanus booster. 23. Are you trying to become pregnant? 24. When is baby due? 25. Please describe 26. Which teeth? Any problems? When were they placed? 27. Explain in detail 28. Where? What kind (cold sore? Other sore?)? Any medications? How long to heal? 29. What sort of injury? When? Resolved? 30. When? How bad? 31. When? Only when flossing? 32. Which teeth? Sensitive to what (hot, cold, sweet, pressure)? 33. Why? 34. Why? 35. Does patient have night guard? If yes. Does patient wears it? 36. Please describe 37. Please describe 38. Please describe what was done and when, and on which teeth 39. Please elaborate 43. Date and type of x-rays (Bitewings, or FMX, or 1 PA) #########################################################################
Adult Blood Pressure Guidelines

Systolic BP <140 140-159 Diastolic BP <90 90-94
ASA Classification I II
Dental Therapy Considerations Routine dental treatment Routine dental treatment If BP is elevated for 3 consecutive appointments, a medical consult is recommended Recheck BP in 5 minutes for accuracy, if still elevated seek medical consult before dental TX Recheck BP in 5 minutes for accuracy, seek immediate medical consultation
160-199 >200
95-114 >115
III IV
Pre-Hypertensive: 120-139/80-89 Stage 1 Hypertension: 140-159/90-99 Stage 2 Hypertension: >160/>100
Example of HH write-up 1st & Subsequent Visits (light yellow Form O4) Health History Comment Sheet Patient Name ___Jerry Sinatra____________Date 7/28/11
Aspirin Daily Sulfa Drug Allergy Medical Alert
7/28/11 RHH, vitals, hhx details are as follows: 1. Has angina and Parkinsons and is 87 years old. 2. In the past year has had more deterioration with Parkinsons. L 4. No under the care of Connie Smith 899-6800 every 3 months. E 5. Serious illness Parkinsons disease in around early 70s. A 7. Hospitalized for bowel problems sometime in the last year (2002-2003). V Also has had high blood pressure since 2003. Also had stitches in June from falling. E 8h2. Short of breath after walks, not very long walks. 8j. Allergic to sulfa drugs. L 8k. Used to have hay fever in younger days, but no longer gets signs & symptoms. E 8l. Used to have asthma, light case, no longer. Never had inhaler. F 8o. Had fainting spell last month (June 04). T 8r. Arthritis in hands for about 10 years. 16f..Takes aspirin daily for heart. M 16h. Takes Toprol every day, tablet. A 16l. Multivitamin, Vitamin E, and vitamin for bones calcium. R 17. Taking celexa, cardopa, topral, laxatives, stool softeners, levotroid (thyroid), G I Metamucil, and genuge sulfat. Taking all for years except celexa in past year. N 22. Had last tetanus shot in the past year (2004) 27. Has chewing problems and infections (may be gone now) trouble chewing due to B missing teeth. L 28. When he chews he bites inside of gums, heals quickly if stops biting it. A 29. When 10 yrs. Old broke nose with a baseball bat. N 30. Has had sinus problems in the past with allergies, gets stuffed up. K 33. Has difficulty opening mouth wide due to Parkinsons disease. 34. Difficulty chewing food due to missing teeth. 38l. In 1951 they chipped bone off of right side of nose because it was sealing shut. Had two teeth taken out in 2002-2003. BP: 128/80, or L arm, manual or auto, cuff Pulse: 64 bpm, reg or irregular (*by signing here patient is consenting that info. is correct) Signature patient Print Full Name DAS (Print last name outside margin) Signature Instructor Doctor Signature required ONLY 1st time on hhx sheet 8/5/11 RHH, No changes in HH, no new meds. BP: 125/82, or L arm, manual or auto, cuff Pulse: 66 bpm, reg or irregular Signature patient Print Full Name DAS (Print last name outside margin) Signature Instructor
Goes to patient or back to front office
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Dental Programs Medical Emergency Protocol 1. Operator: Activates the clinic emergency system, and alerts another person (Team Member A) who will inform the block instructor and doctor of the emergency. The operator will initiate BLS (*P-A-B-C-D) and remain with the patient throughout the emergency. * position (P), airway (A), breathing (B), circulation (C) and definitive treatment, differential diagnosis, drugs, defibrillation (D) 2. Team Member A: Brings the portable oxygen system, emergency first aid kit and a medical emergency timekeeping sheet to the site of the emergency, and assists the operator with BLS, monitoring vital signs, and maintaining records. 3. Instructor and Doctor: Activates the EMS, decides if AED is needed, and designates two other people, (Team Member B) to call 911 and (Team Member C) to get AED and alert the front office. 4. Team Member B: Dials 9 then 911 (9-911), tells the operator the nature of the emergency, gives directions to the dental clinic, and stays on the phone with the operator until EMS arrives. Address at LWIT is: Directions for the EMS: 11605 132nd Ave NE Turn left off of 132nd into the LWIT east entrance, go through the stop Kirkland, WA sign, park in front of the dental clinic/east entrance sign, and walk Room E107 down to the dental clinic on level 1. (425) 739-8130 5. Team Member C: Gets the AED if needed, informs the front office of the emergency, meets the EMS by the dental clinic/east building sign in the parking lot, and escorts them to the clinic. 6. Front Office: Calls campus services (8218), the dean of allied health (8255), and Dennis Long/student services (8313) and alerts them to the emergency. 7. Operator, Instructor and Doctor: Assist each other in the care of the patient. 8. All Participants: Write incident report, making sure Campus Services, Instructional Office and Student Services has a copy.
ASA PHYSICAL STATUS CLASSIFICATION SYSTEM ASA I-normal and healthy ; no abnormalities found; can tolerate stress; treatment modifications usually not needed, -green flag for treatment ASA II (dental treatment with caution)-mild systemic disease or show extreme anxiety and fear toward dentistry. -less stress tolerant, but still minimal risk toward dental treatment; treatment modifications may be needed; yellow flag for treatment -examples of mild systemic disease: 1. well-controlled, non-insulin-dependent diabetes mellitus 2. well-controlled epilepsy 3. well-controlled asthma 4. well-controlled hyperthyroid or hypothyroid disorders who are under care and presently have normal thyroid function. 5. ASA I patients with upper respiratory infection. 6. healthy, pregnant women. 7. otherwise healthy patients with allergies (especially drug allergies) 8. otherwise healthy patients with extreme dental fears. 9. healthy patient over 60 years old. 10. adult blood pressure between 140-159 and/or 90-94. ASA III (dental treatment with caution) -severe systemic disease. -at rest do not exhibit signs of distress, but will do so when stressed in any way. -yellow flag for treatment. -represents a greater risk during treatment, but elective dental care is not contraindicated; treatment modifications needed. -examples of severe systemic disease: 1. stable angina pectoris 2. >6 months postmyocardial infarction with no residual signs and symptoms. 3. >6 months postcerebrovascular accident with no residual signs and symptoms. 4. well-controlled insulin dependent diabetes 5. congestive heart failure with orthopnea and ankle edema. 6. chronic obstructive pulmonary disease-emphysema or chronic bronchitis. 7. exercise induced asthma. 8. less well-controlled epilepsy. 9. hyperthyroid or hypothyroid disorders that are symptomatic 10. adult blood pressure between 160-199 and/or 95-114. ASA IV (no dental treatment) -incapacitating disease that is a constant threat to life. -severe medical problem of greater importance to the patient than planned dental treatment. -elective dental care should be postponed until medical condition has improved to ASA III. -distress present even at rest. -red flag for treatment. -management of dental emergencies /pain should be treated as conservatively as possible until condition improves. -examples of ASA IV patients: 1. unstable angina pectoris 2. myocardial infarction within the last 6 months 3. CVA within the last 6 months 4. adult with blood pressure greater than 200/115 5. severe CHF or COPD requiring oxygen and/or confined to a wheelchair 6. uncontrolled epilepsy 7. uncontrolled insulin-dependent diabetes.
ASA V (no dental treatment) -moribund and not expected to survive more than 24 hours -almost always hospitalized, terminally ill patients -elective dental treatment contraindicated -red flag for dental treatment -emergency dental treatment may be necessary (pain relief only) -examples of ASA V patients: 1. end-stage renal disease 2. end-stage hepatic disease 3. terminal cancer 4. end-stage infectious disease
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CRITERIA FOR CHART WRITE-UP

Health History, Treatment Plan, Progress Notes & Superbill *********CHART NEVER LEAVES THE CLINIC********* 1. Health History: For the 1st time or filling in the new HH sheet: All the questions answered yes should be circled in red, and answers written on rough sheet 1st time only (2nd time onwards you can write in HH directly). Get them approved by the instructor and transfer them in the HH sheet. Followed by the vitals. Signatures of patient, student (DAS/DHS), and instructor are required before the dentist comes and renders the treatment. DDS signs only the 1st time on HH sheet or when new HH sheet is filled after 2 years. 2. HH is reinitialized by pt if it is older than 1 year and new one filled if it is older than 2 years. 3. A patients medical history is reviewed at all the visits and changes are noted on the (yellow) HH sheet followed by patients vitals. THREE signatures are required: 1. patient, 2. Student (Print Full Name), 3.instructor before the dentist comes and renders the treatment. 4. The white quick reference card located inside chart on the left side should be filled out to completion and updated at every visit. Do not leave any section blank, if no information is applicable then write in none. 5. Write down ASA Code on the white card attached inside the front cover of the chart. Medications that are taken daily or currently should be researched and written up prior to any dental treatment on the (golden yellow) medication sheet. Patients name should be written in on all pages of the chart. Make sure you know the pronunciation of meds. 6. Patients name should be written on all the pages of the chart. 7. Medical alerts must be written in Red on all pages of the chart. If there are no medical alerts, then it should be written in blue or black ink stating the term none. 8. Treatment Plan: Dr. Exam is written down completely filling all columns. Patinet and doctor signs it and then it is scanned into the Eaglesoft as a smart document. 9. If any doctors opinion differs from the TXP, Addedum form is filled and signed and scanned. Addendum must be done with changed / new TXP in addendum section. e.g. MOD was TX planned by one doctor and second doctor says its MO only then addendum will have MO and MOD will be crossed out with written as per Dr. Xyz. 10. Dental Hygiene Care: Is entered directly into the Eaglesoft. 11. FOUR signatures are required on TXP: 1. Student (Print Full Name ), 2. Instructor 3. DDS, 4. patient Progress notes : A rough draft for progress notes must ALWAYS be written on a separate piece of paper first, and then reviewed by your assigned block instructor for correct format and completeness before writing it in the chart as part of the permanent legal record. 12. Writing in blue or black ink is acceptable for progress notes documentation. Green ink is used by hygiene students only for differentiating between restorative and hygiene care. 13. Correct spelling is essential. Dictionaries are provided in the clinic for your reference. 14. If you wrote down something wrong then cross out w/ single line so that it is still legible and initial the entry with your name. 15. THREE signatures are required on progress notes: 1. Student (Print Full Name), 2. Instructor, 3. Doctor on final written progress notes in the patients chart. The instructor and dentists name should be printed outside the right margin. The chart can then always find its way back to the instructor and dentist for his/her signature. 16. If DDS sign is/are missing on TXP / HH sheet then leave sticky note hanging out of chart. 17. Superbill: Digital superbill is needs to be filled in its entirety. Make sure that Treatment Accepted is the same as what you completed that day. If there is any change (e.g. #18 MO was accepted but
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you did #18 MOD) then make sure that reflects in the TXP. Also the addendum has to be signed and given to the front office personnel. 18. Before walking the patient out you have to right click and edit the TX by checking the condition no longer exists box. Then changing the completed TX to Walk-out. 19. Also change the next treatment to accepted from proposed. You can see which treatment is next from smart docs. 20. Notes about new changes:
*CC EO IO GD TC Chief Concern-reason for seeking treatment. Extra-Oral Examination-note any changes at each appointment. Intra-Oral Examination-note any changes at each appointment. Gingival Description-note all changes at each appointment. Tooth Chart-note any existing conditions and needs at initial exam, update as needed. If more than one year since last appointment, complete a new tooth chart. R Radiographs include kind (FMX/BWX/PA/Pano), Style (D digital or t traditional) and number of films (20/4/1 etc) exposed by DAS/DHS (1st name last name initial DAS). PI Plaque Index- includes form and figure percentage. PE Patient Education-include any aids that were given. PC Patient Communication *TxT Treatment Today-be complete *TxN Treatment Next Signatures: Student-Print Name Supervising Instructor Supervising Dentist *These codes are always written for every progress note. Rest of the codes are written whenever applicable
Legend for Chart Entry Abbreviations for Progress Notes O6 in Column 2
If patient has cancelled or is a no show then write down single line in the chart and only you sign.
If you write down rough chart write up draft on a scrap paper then leave it in the front of the chart with entries: procedure, date and your/DHS/DDS/instructor & patients name. Leave the chart in your instructors folder so that she can check/approve it next day. It is your responsibility to check the chart & draft so that you can transfer it to the progress notes sheet ASAP after approval. If for some reason you could not transfer it, let the chart be still in the instructor /charts to write folder so that if the patient is coming back, then the OA/front office person can find the chart easily. Never leave it in your op or classroom E-109, your locker or car. *1st line *Students written signature, Print only your first name in the outer right margin for name legibility. **2nd line *Instructors written signature (leave space open). Print instructors last name in the outer margin for legibility and for chart to be signed by designated block instructor. ***3rd line *Doctors written signature (leave space open). Print doctors last name in the outer margin for legibility and for chart to be signed by designated doctor. ****If your designated instructor and doctor are unavailable to sign after you write up your approved final draft, place chart into instructors file for signing and your instructor will forward it to the doctor folder.
Chart signing criteria (See example below)
Harry D., DAS Amy R Cram, CDA James D. Haberman, DDS
Harry Cram Haberman
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Protocol for Initial Exam

Student reviews health history with patient and takes vital signs (BP & Pulse) Patient, DAS, CDA (Instructor) and DDS sign Health History form & Comment sheet DDS May Performs Preliminary Exam and Signs Radiographic Request Form Assisting student takes necessary radiographs Retakes of unacceptable radiographs with help from instructor Student perform simplified EO & IO (mention any unusual findings) Student performs dental charting Let patient brush then disclose Student performs plaque index Student performs oral hygiene instruction Student performs coronal polish Instructor (CDA) Checks Coronal Polish & Charting Pull up Pt. BWX on the computer DDS Performs Exam and Formulates Treatment Plan Student performs fluoride treatment Student Complete Treatment Plan of Restorative Assessments and Codes Student Signs and Presents Treatment plan to Parent and Parent Signs Student fills out necessary referral forms Student fills out fee slip correctly (including Next Appointment & Insurance information) CDA Signs fee Slip & DDS Signs any Referral Forms Dismiss Patient Treatment plan signed by CDA, DDS, and Guardian/Patient Student, CDA & DDS sign Progress Notes
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Protocol for Continuing Care

Student reviews Health History with patient and takes vital signs (BP & Pulse) Patient updates health history with new signature & date once a year Patient completes new Health History form every 2 years Patient, DAS, and CDA Sign Medical History comment sheet (If new Health History DDS must sign) DDS May Performs Preliminary Exam DDS Signs Radiographic Request Form Assisting Student takes necessary Radiographs Retakes of unacceptable radiographs with help from instructor Redo dental chart if there are multiple changes or in three year intervals-3yrs, 6yrs, 9 yrs & 12yrs Student performs simplified EO & IO exam Let patient brush, then disclose and show missed areas Student performs plaque index Student performs oral hygiene instruction Student performs coronal polish Instructor (CDA) Checks Coronal Polish & Charting DDS Performs Final Exam and formulates Treatment Plan Always fill a new TXP sheet for 6 month CC Student performs fluoride treatment Student Completes treatment Plan of Restorative Assessments and Codes Student signs and presents treatment plan to Parent and Parent Signs Student fills out fee Slip Correctly (including Next Appointment Student fills out necessary referral forms CDA Signs Fee Slip and DDS signs any referral Forms Treatment plan signed by CDA, DDS, and Guardian BEFORE Dismissing Patient Write Rough Draft for instructor to approve Student, CDA, and DDS sign Progress Notes
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10 Steps Protocol for Coronal polish (Pedo) 1. 2. 3. 4. 5. 6. 7. 8.
By : Seema Jain
Review Health History & Vitals Take 2 or 4 BWX (size 0 or 2) Let patient brush teeth Disclose Tooth Charting & Plaque Index Coronal Polish Dr.s Exam TXP filled & signed by parent *Sealants? (Depending on **situation) 9. Fluoride 10. Superbill*** * Sealants must be done BEFORE Fluoride treatment if needed. **situation: Parents financial concerns/Insurance coverage (molars vs. premolars)/ patients willingness, comfort/enough time for DAS [10:30am] & patient. *** Give toothbrush, paste & something from Treasure box (kept in front office). There is fluoride instructions (color) paper kept with fluoride which you should send with these goodies. Fluoride Instructions for the Patient 5% Sodium fluoride White Varnish Today your teeth have been treated with 5% sodium fluoride varnish. This treatment delivers fluoride, calcium phosphate and protective coating to your tooth surfaces. To obtain the maximum benefit, we ask that you follow these recommendations after you leave the office: Do not brush or floss for at least 4-6 hours If possible, wait until following morning to resume normal hygiene. Eat a soft food diet and product the treatment period. Avoid hot drinks and products containing alcohol (i.e., beverages, oral rinses, etc.) during the tx period. You will be able to feel the varnish on your teeth. At the completion of the treatment period you may brush and floss to remove any remaining varnish. 10 Steps Protocol for EMX Patient Care Steps Review Health History Take Vitals/get it approved and transfer on HH sheet/get signatures. Use toothache questionnaire to gather info. for DDS Present info. to DDS; Get DDSs permission for PAs Take 1 (or 2) PAs (tooth of concern) Write your Op # for exams on the board (near the clinic entrance door). Dr. performs exam. DDS decides txp for that tooth. Write that on TXP sheet in the top emx box If Rx has to be given: get Rx notebook from Mrs. Stauchs office. Give RX to pt & Return Rx notebook. 9. Fill out TxP sheet. Get Pt. signature. (Instructor and DDS signatures) 10. Fill out superbill. Walk Pt. out. 1. 2. 3. 4. 5. 6. 7. 8.
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Example of Charting New Patient Pedo (Initial Exam) Progress Notes Patient Name ____________________Date_______________ Date 7/28/11 Treatment Quad Code or Tooth CC EO IO Explanation
Alerts in red ink. If none, write NONE in blue/black ink. Medical Alert
GD TC R PI
Mom wants teeth examined and cleaned. Vermillion zone: dry and cracked. Commissures: L tissue split due to excessive dryness. No other significant findings. Buccal mucosa: bilateral linea alba present. Hard palate: round. Tongue: dorsal surface coated white. Palatine tonsils: present, normal appearance. Parotid glands: bilateral (+) saliva flow, pink, firm, stippled. Pink, firm, stippled See tooth chart. 2 BWX (#0) (D) exposed by Jenny T. (DAS) (Paste in CLEAN plaque index card at this point)
Demonstrated proper brushing (Bass method) and flossing techniques. Stressed the importance of brushing after eating sugary snacks. PC Told mom that Johnny is missing posterior gumline areas of both max and mand molars. TXT RHH, Vitals, no anesthestic EO, IO, GD, TC, R (2 BWX), PI, coronal polish w/ bubble gum fine grit, Fl TX w/ 5% sodium fluoride, initial exam (see TxP), TXP presented to the patient and signed by the patient. TXN #A : MO Amalgam (Rest.) #J : MO Amalgam (Rest.) 6 month CC (Hyg.) Print Full Name DAS (Print last name outside margin) Signature Instructor (Print last name outside margin) Signature Doctor Cassette # 600 (Kept in the top sliding drawer near the x-ray room 104e) ** After Drs exam: If SEALANTS have been suggested then try to do as many as possible in the same appointment (depending on time left and insurance factors), but BEFORE the fluoride treatment.
PE
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Example of Charting 6 Month Continuing Care (Pedo) Progress Notes Patient Name ____________________Date_______________ Date 7/28/11 TX Code CC *EO *IO *GD TC R PI Quad or Tooth Explanation
No concerns. No significant findings (changes) Buccal mucosa: apthous ulcer R side, no other finding/changes. Pink, healthy, firm, stippled. No changes 4 BWX (D) by DAS Sara G. (Insert CLEAN plaque index card with transcribed findings here.)
Demonstrated to pt proper tooth brushing technique and stressed the importance of regular flossing w/ proper technique. TXT RHH, Vitals, no anesthestic *EO, *IO, *GD, TC update, R (BWX), PI, PE, coronal polish w/ fine grit, periodic exam (see TxP-treatment plan),TXP presented to the patient and signed by the patient, fluoride varnish tmt w/ 5% sodium fluoride TXN #3 : Sealant (Rest.) #14 : Sealant #19 : OB Sealant #30 : OB Sealant 6 month CC (Hyg.) Print Full Name DAS (Print last name outside margin) Signature Instructor (Print last name outside margin) Signature Doctor Cassette # 600 (Kept in the top sliding drawer near the x-ray room 104e) * Mostly there are no significant findings so we dont write EO, IO, GD. But if there are some findings which are to be mentioned then we will write them. *Always add a new treatment plan sheet for 6 month continuing care. Do not add to the old one. On Eaglesoft TXT AcceptedWalk-out Txt will be coronal polish, 2 or 4 BWX, Dr. Exam and fluoride. Walk-out Status will be changed to existing once front office personnel charges the patient/insurance. Treatment proposed should be entered after Dr. Exam. Change status to accepted for TXN.
PE
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Example of PAPER Superbill for 6 month CC (pasted on clinic wall at various places for tentative pricing)
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DIGITAL SUPERBILL TXT = Walk-out (change accepted TX to WALK-OUT at the end of the day before walking the patient out) TXN= Change from proposed to Accepted You must walk the patient to the front desk and let the office assistant know what was the treatment completed for that day (today) and what should be scheduled next.
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Example of Charting -SealantsProgress Notes Patient Name ____________________Date_______________ Date Treatment Quad or Explanation Code Tooth 7/28/11 CC Sealants TXT RHH, vitals, no anesthetic #3 O, etch, 3M single bond, 3M clinpro sealant, checked & adj occl #14 OB, etch, 3M single bond, 3M clinpro sealant, checked & adj occl #15 OL, etch, 3M single bond, 3M clinpro sealant, checked & adj occl. Pt. became difficult to manage during sealant application. TXN No Restorative needs (Rest.) 6 mo CC. (Hyg.) Print Full Name DAS (Print last name outside margin) Signature Instructor (Print last name outside margin) Signature Doctor Cassette # 600 (Kept in the top sliding drawer near the x-ray room 104e) **Insurance coverage for sealants: Up to age 14 on premolars and molars on most insurance, up to age 21 on molars only for DSHS patients. (check with front office)
STEPS FOR APPLYING SEALANTS By: Seema Jain 1. Make sure you get the sealant tip (thinner) and syringe (Not flowable ones) when setting up for sealant. 2. Clean all the surfaces: O, B & L w/ prophy brush & water only. No prophy paste. 3. Hang/ place saliva ejector on the opposite side and leave it there till the end. 4. Isolate with dry angle on Buccal side to cover the parotid gland. 5. Isolate with cotton rolls on Lingual side. (Lingual cotton roll is necessary for any arch.) 6. Place and leave the floss in interproximal area (if youll be sealing two adjacent teeth). You will pull this floss just before light curing the sealant. 7. Place bite block on the opposite side OR place bubble on the same side. 8. Dry the tooth and etch for 15-30 seconds. 9. Rinse for 30 seconds. (Air & Water together). 10. Suck most the water from the cotton rolls w/ HVE before drying. Re-isolate with new cotton rolls/dry angle if needed. 11. Dry for 20 seconds and look for frosty white enamel. (Have instructor check). 12. Apply single bond and thin with air. (No need to light cure at this point.) 13. Apply sealant material from mesial to distal and cover B & L grooves also. 14. Dab & Drag microbrush gently on pits and grooves to remove excess sealant material. 15. Pull the earlier placed floss up/down from interproximal area before light curing. (if adjacent teeth are being sealed) 16. Light cure for 20 seconds. 17. Check for glossy feel with explorer while tooth is still isolated, add only sealant material if you feel clicks. (If isolation was compromised start all over from etching step.) 18. Remove the isolation and ask the patient if the bite is normal. If not, only then use the articulating paper to check for high spots and adjust accordingly BEFORE proceeding to the opposite side or before sending the patient home. 19. Adjust high spots BEFORE proceeding to the opposite side. 20. Floss and rinse before sending the patient home.
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Progress Notes
Date Treatment Code Quad or Tooth Explanation
Example of Consultation
Patient Name _______________________ Date ___________
7/28/11 CC PC
U/
TXT U/ TXN
Pt wants maxillary partial (RPD/) Discussed with patient the need to complete various restorative needs prior to beginning the process of fabricating an RPD/. Pt understood info given and will schedule to have restorative work done. RHH, vitals, No anesthetic, consult Consultation for RPD/. See PC and treatment plan. #2 BU/Crown prep: (Restorative) 6 mo CC: (Hyg.) Print Full Name (DAS) Signature/Instructor Signature/DDS
U/ = upper arch /L = lower arch U/L = both arches
Cassette # 500
"Toothache" Questionnaire By Seema Jain Ask your patient the following questions to help determine the cause of their discomfort. Discuss patient's answers with the DDS during the exam. Patient Name: Date: 1. Can you show me which tooth/teeth is/are bothering you?: 2. How long has this /these tooth/teeth been bothering you?: 3. Did something happen to the tooth to cause this pain, such as getting hit in the teeth or falling on the teeth, or did you recently have any dental work on this/these tooth/teeth?: 4. How would you classify the pain? A dull ache, a sharp pain, or a throbbing sensation (like a headache)?: 5. On a scale of 1-10, 1 being the least and 10 being the most, how bad is the pain?: 6. Does the pain wake you up at night? How often? How many times a night?: 7. Is/Are the tooth/teeth sensitive to hot or cold fluids and foods? Is it sensitive to both? Is sensitive to sweets such as chocolate or sugary candies?: 8. Are you currently or have you tried taking any medications for the pain (such as Tylenol, ibuprofen, etc.)? Did it temporarily relieve the pain?: 9. Do you have any other questions or concerns you would like me to discuss with the Doctor?: DAS/DDS/CDA Notes: *not for patient but for DAS info so you can get ready. If patient is feeling Reason can be possible will need hot and cold RCT endo endo ice sensitivity tooth
Abscessed tooth hot and cold sensitivity pain when chewing
Class V filling
Gum Recession
Crown prep or Extraction

Cracked/Fractured tooth
Composite Setup (w/ Cord packing) Tooth sleuth (sterilization room)
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Example of Chart Write Up Emergency Exam With No Treatment Alerts in red ink. If none, write NONE in blue/black ink. (Top section of TxP filled out) Medical Alert Progress Notes Patient Name ____________________Date_______________ Date Treatment Quad or Explanation Code Tooth 7/28/11 CC UL TA (upper left toothache) R #14 1 PA (Digital, exposed by Rina S. DAS) PC #14 Patient presents w/pain for two weeks especially when she tries to sleep, it keeps her awake. Radiograph showed an abscess. Dr. recommended an antibiotic and root canal tmt. Pt. understood. TX to be done. TXT RHH, Vitals, no anesthetic, R (1PA), Emx #14 Emx, reviewed radiograph and gave Rx for PEN VK for abscess. See TxP for tmt. TXN #14 RCT: (Rest.) 6 mo CC: (Hyg.) Print Full Name DAS (Print last name outside margin) Signature Instructor (Print last name outside margin) Signature Doctor Cassette # 500 (request from sterilization) ***Make sure that you get patient signature on treatment plan sheet before patient leaves. Example of Chart Write Up Emergency Exam With Invasive Treatment (Top section of TxP filled out) Progress Notes Patient Name ____________________Date_______________ Date 7/28/11 Treatment Quad or Code Tooth CC R #30 PC Explanation
LR TA (Lower right toothache) 1 PA, 1 BWX (Digital, exposed by Gina P. DAS) Avoid hard and sticky foods on R side for next 24 hrs post procedure. Dr. informed pt that #30 may need RCT in the future, decay is close to pulp. TXT 20% benzo topical, 1.5 carps of lido 2% w/ epi, no RXNs. RHH, vitals, Emx, R (PA, BWX) #30 MODL, dycal, amalgam, occlusion adj. Deep decay, no pulp exposure. TXN #2 MOD Amalgam: (Rest.) 6 mo cc & periodic exam: (Hyg.) Print Name DAS (Print last name outside margin) Signature Instructor (Print last name outside margin) Signature Doctor Cassette # 500 (request from sterilization)
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Example of Charting NP Initial Exam (Adult).Progress Notes Patient Name ____________________Date_______________ Date 7/28/11 Treatment Quad or Code Tooth CC EO Explanation
UR gum irritation & needs exam & cleaning Vermilion border: Herpes I lesion L maxillary border, healing stage no active pustule, crusted over lesion. Vermillion zone: dry and cracked. Commissures: L tissue split due to excessive dryness. TMJ: R sided popping, slight tenderness bilaterally. IO Buccal mucosa: bilateral linea alba present. Hard palate: vaulted w/ tori present. Tongue: dorsal surface coated white. Lateral border of tongue: apthous ulcer, early stages, very tender. Palatine tonsils: present, enlarged. Maxillary vestibule: L side anterior early stage apthous ulcer present, painful. Mandibular alveolar ridges: tori present. Lingual frenum: absent attachment. L Parotid gland: (-) saliva flow. GD Generalized stippling, firm. Color: pink. Localized area of bleeding and inflammation area of #12 PFM. TC See tooth chart. R FMX (D) 20 films (3 Retakes) exposed by DAS Sara P. PC Discussed w/ pt the immidiat (LJ.) immediate need to replace the PFM on #12 as there is an open margin on the facial aspect w/ decay. Pt. understood info given and stated she will schedule a crown prep appt next week. TXT RHH, vitals, EO, IO, GD, TC, R (FMX) PC, initial exam (see TxP.) TXN #12 Crown prep: (rest.) PC & scale/polish: (Hyg.) Leena J. DAS (Print last name outside margin) Signature Instructor (Print last name outside margin) Signature Doctor Cassette # 500 (Fillin request sheet) FMX (D for digital or T for traditional), 20 films (3 Retakes) exposed by DAS Sara P. FMX/BWX/PA/Pano/Perio (Type of radiograph exposed), (D for digital or T for traditional style), # of films (# of Retakes) exposed by DAS or DHS (Full 1st name Last intial) 5 step Protocol steps for NP exam 1. Punch forms and put them in chart. 2. RHH, get it approved by your instructor and write down in HH sheet. 3. NP can be in the clinic for various reasons. Toothach (treat like EMX), FMX, consultation , coronal polish , broken filling done somewhere else etc. 4. Take care of the concern for which the pt came and fill TXP properly. 5. Get signatures and fill superbill and dismiss pt.
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STANDARD OPERATOR SET-UP 1. Barriers in place--WATER BOTTLE FULL WITH TAP WATER 2. Hand-pieces and burs in place and working (556 for HS #4 round for SS) (34 for anterior restorations) 3. Foot control in proper position (OPERATOR SIDE) 4. High and low volume suction tips in place 5. Air water tip in place and working 6. Chair in position for patient to comfortably sit down 7. Safety glasses ready for assistant and patient-pt bib and clip 8. Gloves and mask, ready and in reach for assistant, for DOCTOR & instructor 9. Tray set up COMPLETE (no instruments underneath other instruments) 10. Position of instruments KEEP IN ORDER 1-5 6. 2x2s, cotton rolls and pellets and dry angles Clean tray for extra 1. Mirror 7. Bur block on operator side supplies 2 Explorer 8. Floss ready (out of container) one on each side 3. Cotton pliers TWO 9. Anesthetic syringe ready, needle, anes., needle guard Rubber dam ready (one clean for retrieving supplies) 10. Topical ready on Q-tip (Punch, retainer, 4. Articulating paper in forceps 11. Kleenex box in reach forceps, frame, 5. Arrange remaining instruments 12. Hand mirror napkin, scissors, 13. Small amount of Vaseline in dappen dish with Q-tip lubricant) DENTURES, PARTIALS and NIGHTGUARDS SEATING DENTURES, PARTIALS and (bleach trays) NIGHTGUARDS CASSETTE # 500 (request from sterilization) CASSETTE # 500 (request from sterilization) Alginate or Affinis Three pronged pliers needed if prosthetic contains wire Mixing bowl and spatula clasps Measuring cup/ Paper towel Denture polishing kit includes acrylic bur Metal Impression trays Straight nose cone Wax rope to extend trays if needed Prophy cup and pumice Bioform Shade Guide / Vita Shade Guide PIP (Pressure Indicating Paste) with brush May need jet bite or flat wax for occlusal registration Green Can of Occlude Seabrook Dental Lab: Phone # 1-800-693-7487 or Special articulating paper (horseshoe shape) 425-776-7718 Miller forceps with articulating paper ACCUFILM Lab slip bag and box Warm bowl of water to place prosthetic If you are sending a WET PICK-UP be sure to let lab For a WAX try in: Flame and WAX spatula: Flat soft boxing know when you call for pick-up red wax MAKE sure impression is wrapped in MOIST paper Make sure APPLIANCE is in clinic the night before patients towels before placing in bag appointment And then request case by putting pts name on request sheet
PROCLEAN INSTRUCTIONS (FOR CLEANING ALL APPLIANCES W/ULTRASONIC) or ask Ms. Stauch for help. Removable Appliances are dentures, night guards, partials, and Flippers. You, as the student with the patient, are responsible for the cleaning process of the removable appliance. Bring the appliance to the sterilization area in the cup. DO NOT drop-off the appliance at the contaminated window. DO NOT hand-off the appliance to the sterilization crew. Place the cup in the Yellow ZONE With clean gloves or hands remove denture brush, proclean solution (above the sink) and 2 zip-lock bags. Write down the patients name and the op# on the cup and baggie. DOUBLE THE ZIP LOCK BAGS AND ADD CONTENTS OF THE PROCLEAN PACKET WITH 1 CUP OF WARM WATER. PLACE THIS IN THE ULTRASONIC BATH NEAR THE CORNER WINDOW, NOT IN THE ULTRASONIC NEAR THE SINK. RUN for 10-15 minutes. AFTER THAT RINSE THOROUGHLY WITH THE TAP WATER TO REMOVE PROCLEAN SOLUTION FROM APPLIANCE (You may rinse-off appliance with mouthwash) Please do not place it in the sink. Return the cleaned appliance back to the patient in the cup with the brush for the patient to keep (the one you used to clean)
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Example of Charting Alginate Impressions for RPD or N/G Progress Notes Patient Name ____________________Date_______________ Date Treatment Quad or Explanation Code Tooth 7/28/11 CC No concerns PC Pt told he would need to return for RPD/ framework try-in in one week. We will select the shade at that time. Or Pt told he would need to return for N/G delivery TXT RHH, vitals, no anesthetic U/L Alginate (fast set) impressions for fabrications of framework for RPD/ (or N/G). Bite registration taken w/ jet bite impression material, Wet Impressions poured at LWIT dental lab and then sent to Seabrook dental lab. TXN U/ Try-in metal framework for RPD/, select tooth shade. Or N/G delivery (Rest.) 6 mos CC (Hyg.) Print Full Name DAS (Print last name outside margin) Signature Instructor (Print last name outside margin) Signature Doctor Cassette # 500 (request fill-in) N/G is night guard ****Wet Impressions are mostly poured at LWIC dental lab right after the impressions are taken and then picked/sent to Seabrook dental lab. ########################################## Write in red ink for med alert Example of Chart Write Up CD/RPD/NG Seat/Delivery Blue or black ink if none Progress Notes Medical Alert Patient Name ____________________Date_______________ Date Treatment Quad or Explanation Code Tooth 7/28/11 CC No concerns PC Pt given verbal instructions for the care of RPD/ (removable partial denture). Informed pt to store RPD/ in water when not wearing, to keep it hydrated for optimal fit and longevity. Use non abrasive toothpaste w/toothbrush to cleanse daily and after meals. Call for further adjustments. TXT RHH, Vitals, no anesthestic. U Seated RPD/, adjusted to pts comfort and polished. Pt pleased with fit. TXN U/L Alginate impressions for mandibular /RPD (Rest.) 6 mo CC: (Hyg.) Print name DAS (Print last name outside margin) Signature Instructor (Print last name outside margin) Signature Doctor *******NOTE: CD is a Complete Denture. RPD is Removable Partial Denture. N/G is a Night Guard {Cassette # 500 (request sheet filled-in)}
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Example of Chart Write Up - COMPOSITE Progress Notes Patient Name ____________________Date_______________ Date 7/28/11 Treatment Quad Code or Tooth CC #4, #5 PC #4, #5 Explanation
fillings, no other concerns Pt informed she can eat on restoration immediately, but be careful until anesthetic wears off as not to traumatize oral tissue TXT 20% benzocaine topical, 2 carpules of Lidocaine 2% w/ epi. 1:100,000, no reactions (RXNs). RHH, Vitals, anesthestic #4 MOD, RDI (rubber dam isolation), Vitrebond, etchant, Singlebond, Filtek flowable composite, *3M Filtek Supreme Ultra composite #A1E (enamel) shade, adjusted occlusion #5 F (Cl V), #00,#1 Cord packed, etchant, Singlebond, Premium Ultra composite #A2 shade TXN #12 : F (Cl V) comp :(Rest.) 6 mo CC due on 12/11/09 (Hyg.) Print full name DAS (Print last name outside margin) Signature Instructor (Print last name outside margin) Signature Doctor Cassette # 100 & 200 (RD) or 900 & 900 A (no request kept near/in ops) Flowable mostly used for Class II filling involving M and/or D surfaces of post. teeth. *3M Filtek Supreme Ultra composite #A1E enamel shade / A1B body shade or C4D dentin shade ***** Remember the order in which following FOR COMPOSITE 15. Polishing goes: VEGS ****** Cassette# 100 paste, V itrebond (May be depending upon depth of 1. Etch 16. Enhance prep) 2. Single bond / dappen point & cup Light E tchant (Always used) dish cure machine G luma (May be depending upon depth of prep) 3. Benda or micro brush 17. Toffelmier S inglebond (Always used) 4. Wedges ################################# 5. Gluma /dappen dish *Etchant is acid and should not touch the mucosa 6. Caries detector (SNOOP) because it will give burning sensation to the patient. 7. Mylar strip: G-rings and Suck the etchant 1st with the HVE and then rinse bands with air & water. Do not desiccate the prep tooth. 8. Dycal tubes/ vitrebond (For sealants you must see the frostiness of the 9. Shade guide tooth, but not for comp.) 10. Composite capsules ** Do not touch the comp. with gloves when 11. Composite applicator dispensing it on the paper pad. Dispense with 12. Flowable any instrument end. *** You must check that there are no water droplets 13. Discs/ Mandrel coming out of the air-water tip BEFORE drying the 14. Finishing strips
single bond. Check it on patients bib.
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Example of Chart Write Up AMALGAMProgress Notes Patient Name ____________________Date_______________

Date 7/28/11 Treatment Code CC PC TXT Quad or Tooth #2 Explanation
#2 TXN
Fillings, no other concerns. Avoid sticky and hard foods on right side for next 24 hrs. 20% benzocaine topical, 1 carpule. Lido 2% w/epi 1:100,000. No RXNs. RHH, Vitals, anesthestic MOD, RDI (rubber dam isolation), dycal, amalgam, adj. occlusion #12 DO amalgam : (Rest.) #13 MO amalgam : (Rest.) 4 mo CC: (Hyg.) Print Full Name DAS (Print last name outside margin) Signature Instructor (Print last name outside margin) Signature Doctor
1. 2. 3. 4. 5. 6. 7. Amalgam ready in triturator Dycal Tubes Band in Toffelmier Wedeges Gluma Caries Detector (SNOOP) Vitrebond (basal/liner) 8. 9. Light Cure Machine Amalgam Well
Cassette # 100 & 200 (RD) or 900 & 900 A (no request kept in ops cupboard)
***** VEGS ****** V itrebond (May be used depending upon depth of prep) E tchant (Not used) G luma (May be used depending upon depth of prep) S inglebond (Not used)
RUBBER DAM PUNCHING INSTRUCTIONS CHECK FOR THE TEETH PRESENT: FROM THE RADIOGRAPHS / CLINICALLY IN THE MOUTH. PUNCH TWO BIGGER HOLES ON THE CORNERS FOR RECOGNIZING THE MAXILLARY ARCH. FOR MAX. Punching: CREASE RUBBER DAM IN HALF Vertically and leave 1 margin from top (*nose). *(V:X) For MAND. Punching CREASE RUBBER DAM IN HALF Horizontally. *(H:D) When placing RD: make sure that pts nose is not covered with RD. Fold it if thats the case. Do not cut it. FOR MAXILLARY ARCH: (REFER TO PIC 1 & 2) Always start punching from centrals (Pic 1) and punch to canines (anteriors). (MAXILLARY post. RD) start at same side central (of the tooth to be worked on) and add premolars & molars. FOR MANDIBULAR ARCH: (REFER TO PIC 3-4) For Anteriors: Fold in half (1/2nd ) vertically on this crease punch from canine to canine. For Posteriors: Fold in thirds (1/3rd ) vertically & punch last (present) molar (Pic 4) and punch towards Anteriors. (For lab: punch from last molar to opposite canine, For clinic: punch to the same side central).
Maxillary ant.
Maxillary post.
Mandibular Ant.
Mandibular Post.
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Example of Chart Write Up CROWN PREP Progress Notes Patient Name ____________________Date_______________ Date Treatment Quad or Explanation Code Tooth 7/28/11 CC #15 Crown prep no other concerns. PC Pt. instructed to avoid sticky foods and chewing gum and to use pull through floss method. Instructed if temporary falls off or breaks to call for an appt to re-cement or re-fabricate temporary. Pt informed that permanent crown will be ready in two weeks. TXT 20% benzocaine topical, 1.5 carpules of Septocaine with Articain 4% 1:100,000. No RXNs. RHH, vitals, anesthetic. #15 Crown prep (FGC), preliminary impression w/ jetbite, #00, #1 cord packed (removed), final impression w/ exalence, temporary fabrication w/ Protemp (or Luxatemp), cemented w/ tempbond. Impression sent to Seabrook Dental Lab, shade #A1. TXN #15 Seat FGC (Restorative) 6 mo CC due in 8/11/11 (Hyg.) Print Full Name DAS (Print last name outside margin) Signature Instructor (Print last name outside margin) Signature Doctor ***Note: A PFM crown is porcelain to fused metal crown. A FGC is full gold crown. CROWN PREP: Cassette 700; Hand pieces: high speed, straight nose and contra angle Note: Drs Frere and Haberman require rubber dam for crown prep appointments Black Bur Block in CART (PREP BURS) White stone for cleaning burs Preliminary impression - Jet Bite (yellow) One clear Baggy Final Impression tray, metal triple tray or full arch plastic; Shade Guide (VITA); Exalence extra light/heavy body, Yellow tip for Dr. use; Blue tip (tube is longer) for filling tray; Acrylic (Luxatemp/protemp) in gun for temporary fabrication with proper tip; Acrylic bur and or pop on discs or Moore discs; Temp bond cement; Packing cord, hemodent and dappen dish, Gingi-Pak 2 PLY cord for Hansen and Frere Prelim. Imp. (place in baggy with pts name, tooth # and date/ place in Plastic cart in LAB **If Build-up is needed, use comp core or composite Seabrook Lab Slip, Box and clear lab bag. You have to CALL the LAB for pick-up from clinic phone. Dial #91- 425-776-7718- listen to beep-then dial code. 3542741 Take lab box to front office
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Example of Chart Write Up BUILD UP (BU) Blue or black ink if none Progress Notes Medical Alert Patient Name ____________________Date_______________ Date Treatment Quad Explanation Code or Tooth 7/28/11 CC #14 My tooth broke when I was eating a piece of bread. PC #14 Pt informed she will need a crown within the next few months or there could be a possibility that the tooth could break again. She can eat on restoration immediately, be careful until anesthetic wears off, as not to traumatize oral tissue. TXT 20% benzocaine topical, 1.5 carpules of Carbocaine 3% no epi, no reactions (RXNs). RHH, Vitals, anesthestic #14 BU, RDI, vitrebond, etchant, singlebond, Compcore, adjust occlusion. TXN #14 Crown prep (PFM): (Restorative) 6 mo CC due in 8/11/11: (Hyg.) Print Full Name DAS (Print last name outside margin) Signature Instructor (Print last name outside margin) Signature Doctor Cassette # 100 & 200 (RD) or 900 & 900 A (no request kept near/in ops) or 700 if done w/ prep
Example of Chart Write Up CROWN SEAT (CASSETTE #700) Medical Alert Progress Notes Patient Name ____________________Date_______________ Date Treatment Quad or Explanation Code Tooth 7/28/11 CC #4 Crown Seat PC #4 Pt informed that she can eat on crown side immediately. Instructed to floss daily to ensure crown longevity. TXT RHH, vitals, no anesthetic #4 Crown seat (PFM) w/ Rely X Vitremer. Adjusted occlusion. Pt pleased w/ results. TXN #12 : F (Cl V) comp : (Rest.) 6 mo cc due in December : (Hyg.) Print Full Name DAS (Print last name outside margin) Signature Instructor (Print last name outside margin) Signature Doctor ** A (PFM) crown is Porcelain Fused to Metal/ A (FGC) is a Full Gold Crown Set-Up for Crown Seat Purple Bur Block in CART (smaller of the two) SEAT BURS Rely X vitremer cement Gluma / dappen dish/ micro brush Check the night before to Make sure CASE is in clinic Porcelain polishing kit from sterilization if crown is porcelain Gold kit if crown is gold Dr. Frere: Moore Discs and snap on mandrel/ Dr. Hansen: Joe Dandy with screw on mandrel (straight nose) If seating a bridge, packet of FLOSS THREADERS needed to remove cement under pontic. Send extras home with patient and inform them how it is to be used.
red ink for med alert
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SeaBrook Lab Slip
Call for pick-up Dial: 91425-776-7718 beep.then dial code 3542741 Total volume of nitrous + Total volume of Oxygen = Total lpm N2O Sticker in drawer near R-5 op N2O divided by total lpm = # multiply w/ 100 = # % N2O_2_lpm/O2_4_lpm = Total _6_lpm e.g. 2 + 4 =6 30 % N2O for 30 minutes 2/6 = 3 X 100 =30% O2 flush for 5 minutes *litres per minute (LPM) Complications: ______________________
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ENDO ROTARY SYSTEM (Endo /plastic cart near op 7) Cassette #300 & A-8 Form: For Both Endo Systems Signed Consent Form Hand piece (lavender color) MAKE SURE YOU HAVE TWO RULERS IN YOUR CASSETTE Contra angle (to be wrapped separately at end of procedure) Expeditor rotary file (orange or gold colored band-no stopper) used 1st Sybron Obturation System 2 aluminum Sybron Covers for plugger and gutta percha handpieces Cidex wipes in ops 7& 8 Sybron Gutta Percha Set: When empty disposable Sybron Plugger Set: Sterilize after procedure Set of K-files Stiff #6 #8 #10 #15 Apex Locator with fish hook (fish hook sterilized/wrapped separately) K-Files (complete SETS) Starting with #s 6.8.10.15.20.25.30 Three regular K-files #6: pink in color Broaches found in Endo Cart Flecks cement Two black sponges Calcium hydroxide powder put small amount in a dappen dish Eucalyptol liquid Green Endo RINN and lavender film wrapped in plastic Sealer A & H in small purple and white tubes Gates Glidden Burs size 1-6 in Endo Cart 3cc syringe with a cup of NaOCl (sodium hypochlorite) and sterile water Green Endo Bur Block in Endo Cart Endo sticker to record measurements (green drawer Op 5) Endo CHX 2 min IRM or Cavit & RC PREP 6 capsules with syringe You will also need your regular high and low speed hand pieces X-ray unit on with proper barriers/ blue tape on activation buttons Write on butcher paper last measurement and landmark TCM handpiece to be requested from sterilization ROTARY FILES Use only twice and discard in sharps, remove yellow stopper after first use. Dispose in sharps after using it, if it only has a red or a blue
stopper on it.
RETURN EMPTY BUR BLOCK TO STERILIZATION Rotary files in blue bur blocks Sizes .04 15-40 2 bur blocks Sizes .06 15-50 3 bur blocks Round container displaying .04 paper points .04 gutta percha Round container displaying .06 paper points .06 gutta percha
Endodontic Supplies Lateral Condensation Endodontic Explorer Spoon Excavator Plugger and Spreader Glick No.1 (Paddle / rod shaped end) Millimeter Ruler Gates-Glidden Burs Cotton Pellets RC Prep (Softens calcified canals) Calcium Hydroxide- Dappen Dish Cavit or IRM (Temporary filling) Irrigation Solution and Syringe (Sodium Hypochlorite) BLEACH Formocresol-medication for permanent teeth during root canal Broaches- Fish like hooks, removes bulk of tissue (Dispose after each use) K-Files- Stiff twisted design, initial debridement, shaping, contouring canals K-Files( For Narrow Canals are Flexible Hedstrom File (Greater cutting efficiency for final enlargement of canal) Paper Points (Dry Canals) Gutta Percha Points (Fills canals, natural rubber material) Root Canal Sealer- Base and catalyst name brands must match (Cement that seals unfilled voids) Laboratory Burner and Matches (request from Sterilization) Film and appropriate film holding device/ cup with pt name Make sure x-ray unit is on and barriers in place including activation buttons High speed and contra angle handpieces (Request from Sterilization) Flex Cement Endo/CHX for irrigation RX may be needed Op #1., #2., #7 & #8 are designated ops for endo (YOU are responsible for making arrangements the night before to be in those ops)
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Example of Chart Write Up Root Canal Treatment: RCT (RCT STARTED) Progress Notes Patient Name ____________________Date_______________ Date 7/28/11 Treatmet Quad Code or Tooth CC R #19 PC TXT #19 Found in drawer near op R-5 Explanation
Latex Allergy HBP meds Medical Alert
Medical Alert
RCT, no other concerns 3 working length PAs Pt informed that tooth might be sensitive for few days but if pain increases then pt must call. 20% benzocaine topical, 2 carpules lido w/epi 1:100,000, no Rxns RHH, Vitals, anesthetic RCT, RDI, Accessed, instrumented w/ RC Prep, irrigated w/NaOCl, Measurements are:
Tooth Number CANAL MB DB DATE 19 WORKING LANDMARK FINAL INSTR W/ LENGTH FILL 20.5 mm MB CUSP GUTTA PERCHA 19.5mm DB CUSP NOT FILLED 7/25/11 7/25/11
THIS STICKER IS AVAILABLE IN RESTORATIVE CLINIC FOR PASTING IN THE CHART
TXN
#19
Closed w/ calcium hydroxide pellet and IRM Continue RCT : (R ) 6 mo. CC (Hyg.) Print name DAS (Print last name outside margin) Signature Instructor (Print last name outside margin) Signature Doctor
Cassette # 300
*When you are taking radiographs during RCT, then please let the RA know that it is a working length radiograph.
**From Restorative clinic, if patient has not gone for dental hygiene care and FMX and comprehensive Dr.s exam, then patient should be routed to DH clinic, when immediate concerned tooth is treated in restorative clinic.
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Example of Chart Write Up Root Canal Treatment: RCT (RCT FINISH)
Progress Notes
Patient Name ____________________Date_______________ Date Treatment Quad or Explanation Code Tooth 7/28/11 CC My tooth has been sensitive. R 2 working length PA, 1 final PA PC Pt informed that tooth will require a buildup and a crown to ensure that the tooth doesnt break. If pt remains asymptomatic, then he can schedule after two weeks. Pt understood information given TXT 20% benzo topical, 1.5 carpules of lido 2% w/ epi 1:100,000. No RXNs. RHH, Vitals, Anesthetic #31 Complete RCT (root canal treatment), RDI(rubber dam isolation), accessed, instrumented w/RC Prep, irrigated w/ NaOCl (bleach). See measurements on prior endo sticker. Gutta percha w/ A&H sealer, closer w. Cavit then Flecks to ensure a good seal. *Add restorative if you did on the same day. TXN #31 BU (buildup) after two weeks: (Rest.) 6 mo CC: (Hyg.) Print Full Name DAS (Print last name outside margin) Signature Instructor (Print last name outside margin) Signature Doctor ****If restoration is placed immediately then add to superbill to be charged and this write up will be ADDED to TXT: #31 MO Comp, etchant, singlebond, Premium Ultra comp #A2, adj occlusion Or #31 MO amal, adj occlusion TXN No restorative need: (Rest.) 6 mo CC: (Hyg.) Print Name DAS (Print last name outside margin) Signature Instructor (Print last name outside margin) Signature Doctor Cassette # 300 **From Restorative clinic, if patient has not gone for dental hygiene care and FMX and comprehensive Dr.s exam, then patient should be routed to DH clinic, when immediate concerned tooth is treated.
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Example of Chart Write Up SIMPLE EXTRACTION
Progress Notes
Patient Name ____________________Date_______________ Date 7/28/11 Treatment Code CC PC Quad or Tooth Explanation
Extraction no other concerns. Pt given verbal and written post op instruction, surgical consent form signed, additional gauze sent home w/ pt. Pt. given RX for Vicodin (*write # of tablets here) pain meds (see RX in back of chart.) TXT 20% benzo topical, 2.5 carpules of lido 2% w/ epi 1:100,000. No RXNs. RHH, Vitals, anesthetic #18 Simple extraction, 301 elevators, 151 forceps, root tip pick, ronguers, irrigated with sterile water, no sutures, gauze placed TXN #20 MOD Composite : (Rest.) 6 mo CC: (Hyg.) Print Full Name DAS (Print last name outside margin) Signature Instructor (Print last name outside margin) Signature Doctor ****If sutures are placed then write up will be like this: TXT 20% benzo topical, 2.5 carpules of lido 2% w/ epi 1:100,000. No RXNs. RHH, Vitals, anesthetic #18 Simple extraction, 301 elevators, 151 forceps, root tip pick, ronguers, 2 sutures w/ 4.0 silk suture, no complications TXN R: #18 P.O check in 7-10 days w/ suture removal. H: 6 mo CC: (Hyg.) Print Full Name DAS (Print last name outside margin) Signature Instructor (Print last name outside margin) Signature Doctor Cassette #400 (request sheet filled-in) From Restorative clinic, if patient has not gone for dental hygiene care and FMX and comprehensive Dr.s exam, then patient should be routed to DH clinic, when immediate concerned tooth is treated in restorative clinic. Get consent form signed before you start the extraction. Also explain the post-op instructions. Give patient take home bag with sterile gauze and after care instructions.
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Example of Chart Write Up SURGICAL EXTRACTION
Progress Notes Patient Name ____________________Date_______________

Date 7/28/11 Treatment Code CC PC TXT #18 TXN #18 Quad or Tooth Explanation
Alerts in red ink. If none, write NONE in blue ink. Medical Alert
Extraction no other concerns. Pt given verbal and written post op instruction, surgical consent form signed, additional gauze sent home w/ pt. Pt. given RX for Vicodin pain meds (see RX in back of chart.) 20% benzo topical, 2.5 carpules of lido 2% w/ epi 1:100,000. No RXNs. RHH, Vitals, anesthetic Surgical extraction, sectioned, 301 elevators, 151 forceps, root tip pick, ronguers, 2 sutures w/ 4.0 silk suture, no complications #18 P.O check in 7-10 days w/ suture removal. : (Rest.) 6 mo CC: (Hyg.) Print Full Name DAS (Print last name outside margin) Signature Instructor (Print last name outside margin) Signature Doctor
SURGICAL SET-UP: Cassette #400 ************* Consent Form SIGNED*********** Post op instructions/Sterile 150 upper molar forceps Bird beak forceps for Potts (2) gauze / White bag anterior extractions Suture 4-0 silk : 151 lower molar forceps Maxillary forceps 88-R or Root tip 4-0 absorbable 88-L picks (2) East /West ---Cryers Elevators 23 lower molar forceps Bardparker Rongeurs 2 Surgical suctions /High Monojet syringe/Cup of Surgical burs 557, 4-6 round 12 and 15 volume suction/Cup of water Chlorhexidine & sterile H2O and high speed hand pc blades Surgical hand piece may be needed (Request from sterilization) *******May need Prescription pad from Richelles office****** Return it back after filling the prescription. Dr. Frost always wants an elevator with pink tape around it. Only one in the clinic. Following instruments are in the cassette Minnesota/ Cheek Retractor 301/34 elevators Curette Bone file Needle holders Periosteal Elevator Hemostat surgical scissors
POST OP INSTRUCTIONS FOR THE PATIENT 1. After surgery, you may be given a prescription for pain. Have it filled and follow the directions. 2. We will give you gauze to bite down on to help form a blood clot. Keep pressure on the site for at least one-half hour. 3. Avoid rinsing, spitting, sucking through a straw or smoking for 48 hours after surgery, since this can break up and dislodge the clot causing a dry socket which is very painful. 4. Should you experience any unusual bleeding, pain, or foul odor in your mouth, call our office immediately. 5. 24 hours after surgery you can rinse with warm salt water to help promote healing. 6. Continue to maintain good oral hygiene, brushing the surrounding teeth gently yet thoroughly. 7. Keep activity level to a minimum the day of your surgery. (No exercise, heavy housework, or lifting) 8. Maintain a nutritious diet. Avoid hard/rigid foods like nuts, popcorn, and chips, etc. 9. Drink plenty of fluids to stay hydrated, but NOT through a straw. 10.Dont be alarmed if after the surgery you begin to swell. Apply an ice bag or cold towel to the area
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Tips for taking diagnostic BWX radiographs (Seema Jains) Triple PPP Rule
Placing the Phosphor Plate in the mouth (back for molars/ forward for premolars.) Positioning the Patients occlusal plane (head) Parallel to the floor (Chin down command) Positioning the PID so that the primary ray Pass through the contacts. PID 10* down. MOLAR BWX PREMOLAR BWX nd Which teeth you should Molars and distal of 2 PreMolars and distal of canine seen in the radiograph: premolar (not 1st PM) Most common Operator Most commonly: we miss Most commonly: we miss mesial of 1st errors: Distal of 3rd / 2nd molar. PM/ D of canine. How to fix the error: Ignore the 1st molar and try Think about canine too although you rd st to get 3 molar/area. 1 are taking premolar x-ray. Because molar can always be seen in only then you will be able to get M of rd the premolar x-ray but 3 1st premolar. molar you cant see anywhere else if you miss it. Placement of BWX The tab should be placed on The tab should be placed on the both plates in the mouth: the second molar. the premolars. (hide the premolars under the tab.) Mesial of the tab should be touching the distal canine. Positioning patients Occlusal plane parallel to the Occlusal plane parallel to the floor. head: floor. (chin down) (chin down) Alignment of PID: Outer canthus of R/L eye Inner canthus of R/L eye Dont talk about gagging; pt. thinks about it and gags. Distract the patient w/ small talk. Solution for taking x-rays on gaggers: Gag: Try to take all radiographs on the arch opposite from where the patient is experiencing the urge to gag. (Mostly soft palate gag reflex area) but keep track of the x-rays you are taking because you are taking out of sequence. Moderate Gagger: 1st try with salt: Give salt to pt. in a dappen dish; have pt. lick it. (Salt is in the cart in the bottom drawer outside pano room.) Extreme gagger: Spray topical on the roof of the mouth. (It is kept in the cart in the bottom drawer outside pano room.) For Pts. With Partial/s: Put Cotton Roll/s where there are missing teeth to create the height of the missing tooth/teeth. Keep the partial in the mouth when taking PAs on the side opposite to the partial. Remove RPD when taking PAs on the same side. (Metal can interfere with the diagnostic quality) ALWAYS Remove the partials for BWX. PRIORITY FOR DAS/DHS FOR TAKING RADIOGRAPHS
1ST HALF OF THE WINTER & SUMMMER (SENIOR DAS LAST QUARTER ): DAS GETS PRIORITY IRRESPECTIVE OF DHS QTRLY REQUIREMENTS. DHS GETS PRIORITY IF BOARD PT. IRRESPECTIVE OF ANY QUARTER. FALL & SPRING QUARTERS: DHS GETS PRIORITY. DHS MUST FINISH THEIR QTRLY REQ. 1ST BEFORE GIVINGTO DAS IN FALL & SPRING QTRS. DHS ALSO SHOULD PRACTICE MORE THAN QTRLY REQM. DHS SHOULD GIVE BWX AND PAs TO DAS BECAUSE DHS DONT GET CHECK OFF FOR THOSE.
1. 2. 3.
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RA duties: Beginning of the Day:

1. 2. 3. 4. 5. 6. 7. 8.
Seema Jain
Run the cleaning film through the ScanX machine on the 1st clinic day back each month. Turn on the ScanX machine. You can see the power (ready) button on the display panel. Turn on the computer (CPU). Logon in to Eaglesoft. Turn on the lights of all the X-ray rooms. Keep the trash can near to you where you will be opening the plates in dim (pano) room. Keep one piece of butcher paper in the dim (pano) room for opening the plates from the cup. Turn- on the x-ray machines and make sure they are set to 25. (except for E-104B) Prep the rooms by putting plastic barriers on tube heads and chairs in each room. There should be three butcher papers on each cart for each room. Dont keep on adding the butcher paper to carts, just use from the other carts so that you dont waste paper towards the end of day. 9. Put blue/transparent plastic sticky tape on the exposure buttons. 10. Dispense plates and film holders (RINNs) according to patient needs. 11. Check that all the plates are barriered: #0, #1, #2 (put BW tabs on a few plates for H & V BWX ). 12. Turn on 1 traditional x-ray processor (if needed). Instructions are in the developing room. 13. In your down time: Make barriers as needed. Spray your hands with alcohol and let them dry before putting the plates in the barriers as they are being erased. Keep in mind the infection control protocol. RA duties: End of the Day 1. Log-off from the Eaglesoft software by clicking on log-off icon or from dropdown list from file. 2. Shut-down the computer by clicking start menu and choosing shut down. 3. Turn off the ScanX machine. You can see the power press button on the left of the display panel. 4. There should not be any barriers left on the carts. 5. Turn off the lights of all the X-ray rooms. Turn- off all the x-ray machines. 6. Place the tube heads against the wall with the tube head facing down towards the floor. 7. Throw the butcher paper away from the dim (pano) room which was used for opening the plates. 8. Keep the trash can outside the dim (pano) room. 9. Keep the transfer boxes and plate packet boxes inside the cart. 10. At the end of clinic make sure all of the x-ray and dark rooms are stocked with gloves and masks. 11. Turn off the traditional x-ray processor. Instructions are in the developing room. 12. Once a WEEK (end of week): Wipe with Birex 4X4: all of the transfer boxes, tube heads, arms, lead apron, carts, and the counters in the dim room. Arrange the radiology lab cart (Dexter RINNS) too. 13. Self-evaluate yourself by filling the daily evaluation / grade sheet. OPENING THE PHOSPHOR PLATE HANDLE THE PLATES GENTLY Open the box 1st for dropping the plates in & turn off the lights. Dump the plates on the paper towel to wipe the saliva. Put on the gloves and open the plates. Hold the plate vertically w/ the writing side up. Hold the plate so that the opening notch is away from you (hold the dot w/ your L-hand). Gently rip the notch & Pull ONLY the right hand side notch towards you with your R-hand. Without touching w/ your gloves wiggle the plate out in the box.
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DUPLICATING THE RADIOGRAPHS Basic concept: Original film towards the light source, Pimples of both (original & dup) films towards light source . Rationale: The light has to pass THROUGH the ORIGINAL to cast shadow of image (teeth) onto the dup. film. For duplicating traditional radiographs in the duplicating machine: 1. Open and set the ORIGINAL FILM (size 1 or 2) on top of the machine with pimple down (light for duplicating coming from bottom). Room light can be on for this step. 2. Set dup time 15 sec. Turn off the room light and place dup. film on top of original film with pimple facing down. (*pimple in dimple like spoon in spoon) Or For FMX: Take (pano size) dup. film from sterilization room. Go to dark room. Set the FMX on the dup machine, pimples facing down and turn-off the light and feel zig zag teeth of the dup. film in dark. & place it on top of original FMX with teeth like notches on top right side of machine. * 3. Close the lid and press the duplicating button on the machine and then press timer button * if dup. comes out lighter then to get darker dup. reduce the time by 10 seconds or vice versa. 4. While room light is still off, open lid of machine and feed film in processor. 5. Write down patients first and last name on the coin/manila envelope with the date when the original radiograph was/were taken. IF DUPLICATING MACHINE IS NOT WORKING Use the normal room (ceiling) light for duplicating. Just reverse the process. 1st Turn-off the light in the dark-room. Open and set the dup film on the counter with pimple up and place original on top pimple facing up. (*dimple in pimple like spoon in spoon). For FMX set: Turn-off the light and place pano size dup film on the counter with teeth on top left and then place the FMX facing up (pimples up) on top of dup film. Turn-on the room light for 30 seconds. (Need wrist watch or stop clock or count yourself.) and turn-off the room light again. Feed the film in the processor in dark. Write down patients first and last name on the coin envelop and the date when the original radiograph was taken. Films w/ raised dots down
Pimple (raised dot) ALWAYS goes towards the light source (which is coming from bottom in this case.)
LIGHT SOURCE
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Operation of the Panoramic X-Ray Machine

*Kodak Film for traditional style panoramic (kept in sterilization room in the plastic drawer). Color & size of Pano box is almost same as duplicating box, so make sure to check that before taking it to dark room. ** Digital Plate for digital style panoramic (kept inside the cassette or in pano room) (@ LWIT dental clinic we take digital pano). Can be emailed to another dentist after release form signed and kept in patients chart. *** Have x-ray release form signed (front office) if pano needs to be sent/ email to another DDS **** You do not need to put on gloves for taking pano. (not dealing with saliva). 1. Load film in cassette in the dark room/ or plate in the dim room. 2. Turn on machine. (follow instruction of the message display). 3. Load cassette into carriage. 4. Make patient size selection (mostly medium size is set by default). 5. Press reset key (in front of the patient is recommended so that patient sees how machine rotates). 6. Place barrier (light handle barrier) over the bite guide. 7. Have patient remove all jewelry, dentures, partials, and glasses. (offer cup to put jewelry etc.) 8. Put lead apron on the patient. (Do not pull it up too much towards the chin: error lead shadow). 9. Move forehead support (labeled 1) completely towards the mirror and fully open the forehead support ( labeled 2). 10. Move the overhead carriage to the proper height for the patient. (press up or down button) 11. Have the patient grasp the handles on either side for stability. Have the patient step forward slightly. Toes must be on blue tape on floor. Have the patient stand as straight as possible (neck fully extended). 12. Have the patient bite on this guide so that the incisors are resting in the notch. (show beforehand) 13. Turn on the positioning lights. (bulb icon) (if light turns off during positioning press it again). 14. Check that the vertical light is centered on the patients mid-sagittal plane. Gently turn the patients head to align or patient can do this him/herself by looking into the mirror. 15. Position the patient head until Frankfort plane (ala-tragus line) is parallel to the floor. (Ask patient to bring forehead forward or you bring the overhead carriage little bit down. Neck must be extended). 16. Center the lateral light (canine eminence) on the cuspid (Ask the patient to smile to see cuspid). 17. Adjust the forehead support (1 & 2) to secure the patients established head position. 18. Instruct patient to swallow and keep tip of the tongue to the roof of the mouth (palate) and lips closed until machine stops. 19. Activate exposure switch which is outside the room (press & hold it down the entire time machine rotates around the patients head). 20. After exposure, have patient move back. 21. Remove lead apron and return denture / partial / jewelry etc. 22. Remove cassette. 23. If digital pano: 1st select patient name in Eaglesoft and panoramic template acquire start and feed plate into ScanX machine without taking the #1 or #2 guides out, white side away from you by gently pushing down. After the plate falls down, put it back in the cassette and load the cassette in pano machine ready for the next patient. If traditional film: In the dark room and feed the film through the developing machine (in dark).
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1. 2. 3. 4. 5. 6.
7. 8. 9. 10. 11. 12. 13. 14. 15. 16.
17. 18. 19. 20.
20 STEPS TO FOLLOW AT THE END OF THE DAY/PROCEDURE By Seema Jain Give a thorough rinse to the patient and remove the patient bib. Apply Vaseline on patients lips and show him/her the result of the visit (filling, crown etc.) Remove the exam gloves and fill the superbill with the TXT and TXN, DAS Sign and write Dr.s name and get instructors signature. Also highlight TXT pink and TXN yellow in the patients chart BEFORE discharging the patient. Walk the patient to the front office and have the front office assistant schedule for the next appointment. Put on the overgloves (thin transparent) and utility gloves (thick colored) on top of overgloves. These will remain on your hands UNTIL it is time to keep the birexed things back into the drawers. (Refer to Cleaning the op protocol ) Collect all the stuff which needs to be kept back into the drawers e.g. cements, single bond, gluma, snoop etc. from the contaminated delivery tray and birex them onto a clean cart/tray and let them air-dry. (DONT birex the paper pad, because it will soak up the Birex and become wrinkled. Just remove the top paper carefully without touching the lower paper.) Complete the cassettes by counting the instruments (procedure cassette and rubber dam cassette). Dont forget to put back the clean forceps in the cassette. Remove the articulating paper from the forceps, and floss from the clamps and the bite block before putting them back into the cassettes. Remove the high-speed & slow speed hand pieces and the motor from the unit. Take the cassettes, high-speed & slow speed hand pieces and bur blocks back to the contaminated windows. (Refer to clinic protocol sheet for cleaning the op after finishing the procedure) Come back to your op and switch the master button and bottle button OFF. Take out the empty bottle, yellow/pink solution vacusol and the plastic container out from the side cupboard. Empty the water from the units bottle into the container and replace the second bottle to the unit and switch the master and bottle button ON. Fill the container with tap water to level # 3 and pour one cap (top portion) full of yellow/pink solution into this filled container. Suck all the solution from the container by dipping the saliva ejector and the HVE into the solution. (These two suck the saliva from the patients mouth during the procedure thats why these need to be cleaned after each procedure.) Now bring the button towards the red/blue dot on the rheostat. (i.e. water button on rheostat is on On position) Purge the HIGH SPEED HAND PIECE & AIR WATER TIP by pressing onto the rheostat), into the sink or trash can UNTIL water stops coming from the air-water tip & high-speed hand piece. It might take 1-2 minutes. Rationale: Purging is done to avoid the building of the biofilm or to keep the biofilm to its minimum. Come back the remove all the barriers by inverting the patient chair bag and putting all the contaminated barriers in this bag. Put this plastic bag into the trash compactor and rotate the start button. Remove the gloves and wash your hands and put the birexed things back into the drawers. (Wipe them with 4x4 if not air-dried by now.) Grade yourself for the day.
Suggestions and comments:
40
TREATMENT PLAN CLASSIFICATION (on TXP sheet) 1. The student gathers all pertinent information and radiographs and presents it to the dentist. 2. The dentist formulates the treatment plan, determines the sequence of treatment, as well as the restoration class (i.e., if the procedure is to be done in the Restorative Clinic I, Restorative Hygiene or Teddy Bear Chairs, and the difficulty level AA, A, B, or C). 3. The student fills out a new treatment plan form. A new treatment plan form is completed at each continuing care interval. Do not add treatment from the previous treatment plan continuing care intervals. 4. The treatment plan should also list referrals and watches. 5. Digital: TXT on Eaglesoft is Proposed before you start the TX and status changes to completed after front office charges the patient at walk-out time. 6. The student presents the treatment plan to the patient/parent. The patient/parent signs the Dental Hygiene Care and Restorative Care sections of the treatment plan form first followed by the student signatures 7. The dentist and block instructor then review and sign the treatment plan. In case of emergency patients, the dentist may opt to list only emergency care (and possibly dental hygiene care). In this case signatures are required in the appropriate section(s). Classification System for Restorations for DHS to finish Hygiene Restorative Clinic All Quarters AA - sealants, PRR, small pit & fissures [Class I ] some [V & VI] A - small, conservative preps not deep [Class I IV] nd 2 Quarter of 2nd Year B - moderate is size [Class I IV] C - larger in size; may be deep enough to require base; no pulp proximity Restorative Clinic (DDS does these) R - to be done in restorative clinic by dentist only.DDS; large, deep preps that may involve pulp; undermined cusps, anything requiring pins or post (New DAS class: Spr & Fall) Junior DAS gets Doctors exam done after senior DAS take their (Jr. DAS) FMX (by end of qtr). Summary for all the dental work to be done on Jr. DAS will be typed on a sheet in the pano room. DHS can refer to this sheet for DAS to be a patient for their quarterly requirement. Write with pencil your name next to the TX so that other DHS knows. Also write down the DAS name on the sign-up calendar for the schedule treatment day. ONLY one DAS can be patient/day. DHS: You can take few molars for sealants but leave premolars for DAS. ONLY one DAS can become your patient only if his/her rotation is covered. Dont ask ST/CA/OA/RA to become a patient. Rotations will be placed in pano room. Cross out the tooth after TXT completed from the summary sheet. DAS: BEFORE you commit to the DHS to become his/her patient, get approval from your block instructor. You cant become a patient until your rotation is covered by anyone from your class. And Fill A-7 sheet for the day even if you are a patient.
41
Colored pages start from next page
42
Each tooth has 5 Surfaces
BLACKS CLASSIFICATION OF CAVITIES
43
Pre-Clinic Patient Chart Review (Morning Huddle Sheet) (Greet DDS & instructors 1st. Then introduce yourself [and dental hygiene student (if in RH.)] DAS Name : DHS Name : In Rest. Hygiene ops
Patients Name : _gotta look in the chart__ Patients Age : __In the chart__ Tooth / Teeth # :___On the schedule______ Surface(s) : _Schedule_ Procedure : Amal / Comp / CC / EMX / Crown Prep / Cr Seat / Endo / Ext / other Reason : Decay, preventive etc. *Is Anesthetic needed? Yes / No **Anesthetic type: Lido / Carbo / Septo / Other
*No anesthetic for Sealants/PRR/prophy/seat crown/NG etc. **Septo for Maxillary arch block injections Only (Not for IA) ; Lido for Lower
(Sky : Up :: Septo & Short: upper arch); Land: Low:: Lido & Long : Lower arch) Needle Type: Long / Short Needle Color (Gauge): red / yellow / blue
Short: shirt (Top--maxi) Long: pants (Lower--mandi)
*DHS: uses red needle

LONG NEEDLE, LIDO ON LOWER ARCH (IA)
Medical conditions/concerns: Mention only yeses in huddle ASA Code: ____ High Blood Pressure: Yes / No Asthma: Yes / No On Birth Control: Yes / No Inhaler dependent: Yes / No Latex allergic: Yes / No Diabetes: Yes / No (if yes, use non-latex dental dam) Insulin dependent: Yes / No Medications: *Practice pronunciation one day prior.____________ for: ______________ Date of most recent x-rays: FMX/ BWX / PA / Pano : Traditional or Digital Date of most recent FMX: ______________ : Traditional or Digital
*FMX: full mouth x-rays (mostly 20)/ BWX: Bite wings (4)/ PA: Periapical (1) Date of last Dr. exam:_Find last green ink handwriting written by DHS and /or TXP_
Date of last *prophy /**cleaning: _
* Prophy coronal polish on children Done by Dental Assisting Student **SRP/ Quad scaling/ cleaning on adults Done by DHS (green ink) Date of last probing:______*On pink periodontal examination sheet
TX plan classified and sequenced: ___________ Yes / No (If not done earlier, Let DDS complete it today) TX plan signed by all: _DAS/DHS/CDA/DDS/Patient______Yes / No (If any signs missing get them today) Health History current (*12 months or less)? ____ Yes / No
*If older than 1 yr but less than two yrs then have patient re-date and intial after RHH.
Consent signed (i.e. Patient release, oral surgery, minor patient)? Yes / No
*On bright green sheet only one time signature needed. **For minors white sheet signed & carbon copy goes to parent.
DAS / DHS / DDS / Instructor: is / are left handed
*Dr. Petkov is left handed. If assisting left handed DHS then bring DAS chair and an extra operator (computer) chair on the right side. (Switch the hand piece holder and HVE holder towards DAS side, but not the table.) At the end of the day switch everything back to right handed operator position.
Questions for the Doctor/Hygienist: _____________________________________ ---------------By: Seema Jain
44
Most often used Anesthetics

20% benzocaine topical, # of carpule/s of Lido 2% w/epi 1:100,000. No RxNs. (Red band) 20% benzocaine topical, 1 carpule of Carbocaine 3%, No epi. No RxNs. (Tan band) 20% benzo., 2 carp. of Septocaine w/ articaine 4% w/epi 1:100,000. No RxNs. (Golden band) ################################################################### **When inserting the carpule inside the syringe make sure that the bar code is seen from the smaller BARREL window of the syringe (NOT towards the bigger window because operator has to see the amount of anesthetic being administered). **(Engage the harpoon BEFORE placing the needle, so that the anesthetic do not leak while engaging). After putting the carpule in syringe, engage the syringe by tapping FIRMLY with your palm 2-3 times. ALWAYS CHECK engagement BY PULLING PLUNGER (Thumb) OUT. **When passing the syringe to DHS have the bigger window towards the thumb direction (up or down). Injections are administered with bigger barrel window always facing up (max. or mandibular arch). **Have needle protector writing side towards DHS so that operator can cap needle easily. **ALWAYS engage the syringe. Esp. placing 2nd carpule. If you dont engage the syringe and DHS has penetrated the site, negative aspiration will not happen and DHS will have to come out and reinsert the needle. Ouch!!
45
UNIVERSAL NUMBERING SYSTEM: FOR ALL TYPES OF DENTITIONS Get your PI card ready before the patient arrives.
For Patients less than 12 years old: Insert Mixed dentition TC (pink) form in the chart on top of the adult TC form
46
47
Recognizing mixed dentition If you start counting from UR molars then it can be confusing. Counting MIXED
dentition from the mid line would be less confusing. You count the teeth from midline in one quadrant. Mostly R and L quadrant have same # of teeth (mirror image) If 5 teeth/ qdrt then all primary teeth. If 6 teeth/qdrt then permanent 1st molars are erupted. #3,14,19,30 If 7 teeth/qdrt then permanent 1st & 2nd molars are erupted. #2, 15, 18, 31 Start recognizing each tooth from midline. (It is very important to count permanent molars properly because those are sealed quite often. ) Mixed Dentition age is usually from 6-12 yearsit can vary. So if patient is younger than 6 yr then probably all primary teeth # A-T. 1st: Central Incisal: Mamelons & yellower. If you see mamelons then those teeth are newly erupted permanent central incisors, yellower than adjacent baby teeth. Circle 8, 9 & 24, 25 on PI card. Parents get worried about yellowness but let them know to wait until all permanent teeth erupt. 2nd: Lat. Incisor: mamelons on the lateral incisors too then circle 7, 10 & 23, 26. 3rd: Canines: whiter, are usually the last ones to erupt so canine would be primary C, H, M, R (*CHaRM) 4th & 5th : Molar or Premolar 1st & 2nd Primary molar: B, A: Will be wider occlusally and will look worn down. (Probably have amalgam fillings or SS crowns). : Looking at BWX help to see if Premolars are erupting or erupted Also checking clinically. 1st & 2nd Permanent premolar: 5, 4: Will look newer, w/ two sharper cusps. Radiographs will clearly show premolars erupting between primary molar roots. 6th & 7th : have to be permanent teeth. >5 teeth/qdrt Permanent 1st & 2nd Molar: 2, 3
Mamelons on newly erupted permanent teeth
Baby lateral incisors #N Permanent 1st premolar #5
Primary molar #A
(2) 3,
A(4), B(5), I(12), J(13), 14, 15
(31) 30, T(29), S(28).L(21), K(20), 19, 18
48
49
GUIDE TO TOOTH CHARTING TC

LWIT Dental Clinic
50
DENTAL CHARTING Refer to Key # 1 & 2

RECORD IN BLUE PENCIL (PEN)
1. Missing teeth Draw an X through all views of the missing tooth (Ex: tooth #1 & #21 on key ).
2.
Unerupted/ impacted teeth
Circle all views of the tooth (Ex: tooth #6 on key).
3.
Amalgam Restorations
Draw and color in as they appear. (Ex:#18 MO O, & #3 B, #5 MOD)
4.
Tooth colored restorations
A. * such as composite, silicate, unfilled resin, and B. **Full Porcelain Crowns (write FPC at apex) Porcelain Veneer (write PV at apex) Porcelain Fused to Metal ( write PFM at apex). Outline in blue as they appear in the mouth (Ex: #2 PFM, #3 O, #7 ML, #8 F, #9F, #10 ML, #25 PFM, #29 PFM)
5.
Gold Restorations
Outline crown or restoration with diagonal lines inside. Write the type of restoration or crown at the apex of the tooth. (Ex: #15 FGC, #20 FGC, #22 GC)
51
6.
Stainless Steel Crowns
Outline all views of crown and fill in with blue. Write SS at apex of tooth (Ex: #16)
7. 8.
Sealant Implants
Write and S on the occlusal surface.(Ex: tooth #14) Draw horizontal lines on the root of the tooth to show the implant. Chart the restoration and write IMP at the apex of the tooth. (Ex: #29)
9.
Temporary Restorations/ Crowns
Outline the area as it presents itself and record temp at the apex of the tooth. (Ex: tooth #12 has a temporary occlusal filling)
10.
Completed Root Canal
Draw in the completed canal(s) on all views. (Ex: tooth #15)
11.
Apicoectomy
Record completed root canal as above and place a blue filling at the root tip. (Ex: tooth #20)
12. 13.
Drifting Fixed Prosthetics (Bridge)
Note if any drifting has occurred on the buccal of the incisal /occlusal view with an arrow indicating the direction of the drift (Ex: #20) Record gold and/or porcelain restorations as recorded previously. X out the root of the missing tooth/teeth (pontic) and draw in the restoration for that tooth. Draw in a line along the crowns on all views indicating the extent of the appliance. (Ex: three unit bridge #30 through #32 Tooth #31 is the pontic (missing tooth) and all of the teeth have PFM crowns)
52
14.
15.
Retained deciduous teeth (if unerupted) Retained deciduous teeth (if extracted) Supernumer ary
For retained deciduous teeth circle the permanent tooth, if it is impacted/unerupted (Ex: #4), and write in the letter of the retained deciduous tooth (Ex: #4 becomes A)
For retained deciduous teeth X out the permanent tooth, if it is absent or has been removed (Ex: #1 and #13). X out the number for the permanent tooth and write in the letter of the retained deciduous tooth (eg. #13 becomes J). Draw a representation of the supernumerary tooth (Ex: Between #8 & #9).
16.
17.
Appliances (partial or complete dentures)
CD = Complete Denture Place an X through the entire arch and write CD above the complete denture. (Ex: Key #2)
RPD = Removable Partial Denture X out the missing teeth and draw a line on the buccal view connecting the two sides to show a removable partial denture. Write RPD on the buccal view. (Ex: Key #2)
53
RECORD IN RED PENCIL (PEN)

1. Tooth/Teeth to be extracted Mark a large X through all views. (Ex: tooth #17)
2.
Caries
Outline carious areas in red on the surfaces where the caries appear. Mark incipient caries with a W for watch. When restorations are completed, fill in the red outlined area with blue.(Ex: Caries on #18 B ,#28 MO & #27 D watch) Place an OH with an arrow pointing to the affected area on the occlusal/ incisal view. (Ex: #18 mesial overhang) Outline the restoration with a solid red line.(Ex: #19 failing MOD)
3.
Overhanging Restorations Failing Restorations
4.
5.
Fractured Tooth
Draw in the fracture with a zigzag red line. (Ex: #26 has a horizontal fracture)
6.
Abscess
Place a red circle at the location of the abscess (root tip) (Ex: #10 shows a periapical abscess)
54
55
56
57
58
59
GUIDE TO PERIODONTAL CHARTING PC
60
PERIODONTAL CHARTING
Refer to Key # 3
RECORD IN BLUE PENCIL (PEN)
1. 2. Probings Rotations Record sulcus depths in millimeters in the box provided. 3mm or less in blue Note any rotated teeth on the buccal aspect of the occlusal surface. Draw a curved arrow in the direction of the rotation. (Ex: #24 and #25 rotated mesially, #12 rotated distally) Use the symbol N on the occlusal view of posterior teeth to show marginal ridge discrepancies. (Ex: #30/31) Use the symbol on the occlusal/incisal view to indicate open contacts. (Ex: #10/11) Use the symbol )( on the occlusal/incisal view to indicate poor contacts. (Ex: #6/7) Record plunger cusps with a V over the interproximal embrasure involved. (Ex: #28/29 ) Note on the occlusal view: Buccoversion (Ex: #8) Linguoversion (Ex: #9) Note on the lingual view: Extrusion/supraversion (Ex: #28) Intrusion/infraversion
3. 4.
Marginal Ridge Discrepancies Open Contacts and Poor/Loose Contacts Plunger Cusps Malpositions
5. 6.
61
RECORD IN RED PENCIL (PEN)

1. 2. Probings Gingival Recession Furcation Involvement Class I Record sulcus depths in millimeters in the box provided. 4mm or more in red Record a line on the root (buccal or lingual) of the affected tooth. Place the number of recession, in millimeters, distal to the root. Note any furcation involvement with the following symbols In the furcations involved. Beginning involvement. Concavity of furcation can be detected with an explorer or probe, but it cannot be entered. Cannot be detected radiographically. (Ex: #3) Probe enters furcation but does not penetrate through to the opposite side. (Ex: #30) Through-and-through involvement, but the furcation is still covered by soft tissue. A definite radiolucency in the furcation area is visible on a radiograph. (Ex: #14 and #31) Through-and-through furcation involvement that is not covered by soft tissue. Clinically, it is open and exposed. (Ex: #19)
3.
Class II
Class III
Class IV
4.
5. 6. 7.
Record mobility classification of any teeth that are mobile on the facial view of the tooth. Use roman numerals to chart severity. I = Slight mobility in a facial & lingual direction (Ex: #23) II = Moderate mobility faciolingually and slight mesially and distally (Ex: #19). III = Tooth may be depressed in socket Bleeding Points Place a red dot above the probe reading and in the box. Mobility Suppuration / Clinical /Total Attachment Loss :CAL / TAL Attrition Exudate: Place a circle around a dot. (Ex: #19MB and ML) Measure CAL (from the CEJ to base of sulcus) and record the number in the box provided. (Add the straight buccal perio number & buccal recession #s) (Ex: #19: CAL = 3+6=9) Mark three short lines on incisal/occlusal in the affected area (buccal & lingual). (Ex: #26 and #27) Record a V shape on the tooth root. (Ex:#27) Measure WAG (from the base of the sulcus to the mucogingival junction) and record in the box provided if it is 2mm or less.
8.
9. 10.
Abfraction Width of Attached Gingiva:WAG
62
Patient Name _______________________ Date ___________

WAG TAL Probe Probe Probe Probe Date 1 2 3 4 5 6 7 8 9 10 11 12
Medical Alert
13
14
15
16
Buccal
Lingual
Date Probe Probe Probe Probe 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
TONGUE
Probe Probe Probe Probe Date 32 31 30 29 28 27 26 25 24 23 22 21 20 19 18 17
Lingual
Buccal
Date Probe Probe Probe Probe TAL WAG 32 31 30 29 28 27 26 25 24 23 22 21 20 19 18 17
63
64
65
On PERIO view : the following can be charted: PD=Perio Depth GM=Gingival Margin Recession FG=Furcation MOB=Mobility BLEEDING=Heme/blood SUPPARATION=Exudate/pus After Saving the PC view: The following will be completed on Tooth Charting View although written on laminated perio sheet: Rotations Marginal Ridge Discrepancies Open Contacts and Poor/Loose Contacts Plunger Cusps Malpositions (LinguA/ bucco/ supra and infraversion) Attrition Abfraction Width of Attached Gingiva:WAG
66

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Colored at The End 2012 Das Lwit Dental Clinic 66 Page Packet Seema J Dent 113 Digital

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DENT -113 (BRING THIS PACKET TO EVERY CLINIC SESSION) Seema Jain 11/1/2012

A Few Abbreviations Used in This Packet

lpm: Litres per minute

disease CVA: Cerebrovascular accident

REQUEST SHEET Student Name: Patient Name:

A3 Date: ______________ AM / PM Op # ______________________

Websites for audio:

http://pharmacy.umich.edu/medchemlibrary/files/genericnames.html http://sitemaker.umich.edu/medchemlibrary/files/tradenames.html http://merck.com/mmhe/resources/pronunciations/index/a.html

25 STEPS TO FOLLOW BEFORE & AFTER THE PROCEDURE

Suggestions & comments:

20 Dos & Donts in the Clinic.By Seema Jain

15. 16. 17. 18. 19.

Suggestions & comments:

SETTING UP AND CLEANING THE OP PROTOCOL

By: Seema Jain

HEALTH HISTORY REVIEW QUESTIONAIRE

Adult Blood Pressure Guidelines

Pre-Hypertensive: 120-139/80-89 Stage 1 Hypertension: 140-159/90-99 Stage 2 Hypertension: >160/>100

Aspirin Daily Sulfa Drug Allergy Medical Alert

Goes to patient or back to front office

CRITERIA FOR CHART WRITE-UP

Legend for Chart Entry Abbreviations for Progress Notes O6 in Column 2

Chart signing criteria (See example below)

Harry D., DAS Amy R Cram, CDA James D. Haberman, DDS

Harry Cram Haberman

Protocol for Initial Exam

Protocol for Continuing Care

10 Steps Protocol for Coronal polish (Pedo) 1. 2. 3. 4. 5. 6. 7. 8.

Patient Name _______________________ Date ___________

Crown prep or Extraction

Composite Setup (w/ Cord packing) Tooth sleuth (sterilization room)

Example of Chart Write Up AMALGAMProgress Notes Patient Name ____________________Date_______________

red ink for med alert

SeaBrook Lab Slip

Latex Allergy HBP meds Medical Alert

THIS STICKER IS AVAILABLE IN RESTORATIVE CLINIC FOR PASTING IN THE CHART

Example of Chart Write Up Root Canal Treatment: RCT (RCT FINISH)

Example of Chart Write Up SIMPLE EXTRACTION

Example of Chart Write Up SURGICAL EXTRACTION

Progress Notes Patient Name ____________________Date_______________

RA duties: Beginning of the Day:

Operation of the Panoramic X-Ray Machine

7. 8. 9. 10. 11. 12. 13. 14. 15. 16.

17. 18. 19. 20.

Suggestions and comments:

Colored pages start from next page

Each tooth has 5 Surfaces

BLACKS CLASSIFICATION OF CAVITIES

Short: shirt (Top--maxi) Long: pants (Lower--mandi)

*DHS: uses red needle

Most often used Anesthetics

Baby lateral incisors #N Permanent 1st premolar #5

A(4), B(5), I(12), J(13), 14, 15

(31) 30, T(29), S(28).L(21), K(20), 19, 18

GUIDE TO TOOTH CHARTING TC

DENTAL CHARTING Refer to Key # 1 & 2

Unerupted/ impacted teeth

Circle all views of the tooth (Ex: tooth #6 on key).

Draw and color in as they appear. (Ex:#18 MO O, & #3 B, #5 MOD)

Tooth colored restorations

Stainless Steel Crowns

Temporary Restorations/ Crowns

Completed Root Canal

A3 Date: AM / PM Op # ________

Patient Name _____________ Date _

Example of Chart Write Up AMALGAMProgress Notes Patient Name ______Date_

Progress Notes Patient Name ______Date_

Patient Name _____________ Date _