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THE UNIVERSITY OF OKLAHOMA COLLEGE OF DENTISTRY DEPARTMENT OF DENTAL HYGIENE DENTAL HYGIENE MANUAL 2007-2008 TABLE of CONTENTS SECTION A - ADMINISTRATION Page and other important information Dental Hygiene Faculty and Staff 1 Distance Sites Faculty 2 College of Dentistry Phone List FERPA-Family Educational Rights and Privacy Act 6 Background Checks Blackboard 8 SECTION B - GOALS, PHILOSOPHY Goals 9 Mission Statement/Goals 11 Philosophy 14 Patient Care Clinical Dental Hygiene Objectives 15 Clinical Course Evaluation 17 SECTION C – PROFESSIONALISM, ATTENDANCE Attitude/Professionalism 19 Deficiency in Professional Conduct Form 22 Dress Code 25 Attendance 26 Reporting Absences 27 SECTION D – SCHEDULES Academic Calendar 29 Orientation Schedule 31 Junior DH Classroom Schedule-fall 33 Senior DH Classroom Schedule-fall 34 Faculty Clinic Schedule 35 OKC Clinic Schedule 36 DS IV Rotation Schedule 37 Senior DH Classroom Schedule-spring TBA Junior DH Classroom Schedule-spring TBA SECTION E – CURRICULUM and COMPETENCIES Dental Hygiene Curriculum 39 Competencies for Entry Level Dental Hygienist 40 Clinical Competencies by Student Level 46 SECTION F – HEALTH ISSUES Antibiotic Premed Guidelines 48 Antibiotic Regimens 49 PreMed Protocol at OUCOD 50 Blood Pressure Policy 51 Coumadin Protocol 52 Emergency Procedures 53 Emergency Numbers 54 Protocol for Life Threatening Emergencies 54 Safety Protocol for Clinics and Labs 56 SECTION G – SENIOR COMPETENCIES and other Clinical Evaluations/Forms Air Polishing Evaluation 58 Bleaching Protocol 59 Bleaching/whitening 60 Bleaching Consent Form 65 Bleaching Follow-up Instructions 66 Calculus Charting Exercise 67 Competency Evaluation Summary 68 CDI C Scaling Competency Information 69 CDI D Scaling Competency Information TBA Self-Assessment for Scaling Competency 70 Local Anesthesia Competency 72 Local Anesthesia Placement Table 75 Nitrous Oxide Competency 77 Periodontal Charting Competency 79 Transitional Dentition Charting Exercise 80 Treatment Planning Competency Form 81 Ultrasonic Scaling Competency 82 Senior Clinical Course Requirements 84 Senior Clinical Competencies 85 Senior Clinical Exercises 86 SECTION H – JUNIOR COMPETENCIES and CLINICAL EXERCISES Abbreviations 88 Barnhart Competency 90 EIE Competency 91 Fluoride Tray Competency 92 Gracey 1/ 2 Competency 93 Gracey 11/12 Competency 94 Gracey 13/14 Competency 95 H6 H7 Competency 96 Mouth Mirror Competency 97 ODU 11/12 Explorer Competency 98 Periodontal Probe Competency 99 Polishing-Rubber Cup Competency 100 Patient/Operator Positioning Left Handed 101 Patient/Operator Positioning Right Handed 103 Unit Disinfection Competency 105 SECTION I – SENIOR CLINICAL REQUIREMENTS Fall Requirements 106 SECTION J– CLINICAL EVALUATION, CLINICAL PROTOCOL AND PROCEDURES DH I Evaluation Criteria 108 DH II Evaluation Criteria 110 Patient/Operator Positioning 112 Patient Reception/Positioning 113 Permission to Proceed (PTP) 116 PTP Monologue 119 Subsequent PTP Monologue 122 Case Complete Monologue 120 PTP Laminate 121 Case Complete Sequence 123 Vital Signs 124 Blood Pressure Procedure 125 EIE (Extra-Oral, Intra-Oral Exam) 127 Definitions of Terms for EIE 129 EIE Palpation 131 EIE Sequence 132 Lesion Description Flow Chart 137 Periodontal Charting 139 Bleeding Index 140 Oral Diagnosis Charting Key for Existing Conditions 141 Occlusion/Malpositions 144 Plaque Index 145 Stress Reduction Protocol 146 Sterilization Table 148 Infection Control Terminology 149 TPNs & Recall Card 151 Radiography Guidelines 153 SECTION K – CLINIC FORMS One Year Release Form 158 Patient Satisfaction Survey 159 CDI Screening Form 160 CDI Form 159 Clinical Evaluation Form 160 Competency Self- Assessment Worsheet 161 Scaling/Polishing Competency Evaluation Summary 163 Rotation Report Form 164 Dental Hygiene Care Only 165 Blue DH Recall Examination Form 166 Sign-Up Sheet for Clinic 167 Treatment Plan-Dental Hygiene 168 Adjustment to Account Form 170 Patient Absence Form 171 OD Exam Sign Up Form 172 Local Anesthesia Worksheet 173 Post-Op Scaling/Root Planing Instructions 174 Post-Op Instructions for Arestin 175 Post-Op Instructions for Fluoride Varnish 176 Non-working Ultrasonic Form SECTION L – BOARD EXAMS INFORMATION NBDHE 178 State Jurisprudence Exam WREB SECTION M – STUDENT ORGANIZATIONS 180 Class Officers 180 SADHA 181 SECTION N – OKC SITE CLINIC MISCELLANEOUS See E-Version of COD Clinic Policies Manual, Section B -Appointment Scheduling - Patient Contact Card Protocol - Cancellation Policy - Fee Schedule Fax in Green Clinic 183 Medical Consult Form for Fax 184 Fax Cover Sheet 185 Recall Exam Interval info 186 Patient Treatment Protocol 187 DH Documentation Check List 190 DH Patient Information-Clinic Ops 193 SECTION O – COMMUNITY DENTAL CLINICS 194 SECTION P – ROTATIONS- OKC SITE 198 Clinical Rotation Protocol 199 Clinical Assistant 200 Assist Senior DH Rotation 201 Crossings Community Center 202 Good Shepherd Mission 203 Map Good Shepherd Mission 204 Graduate Periodontics 205 Health for Friends Clinic 211 Implantology 212 Oral Diagnosis 213 Pediatric Dentistry and Sealant Clinic 214 Sealant Clinic 215 Radiography 216 Screener 219 Teaching Assistant 221 Tinker Air Force Base 222 Tinker Map 224 VA Dental Clinic 226 SECTION A2 Administration & other important information FACULTY and STAFF DENTAL HYGIENE FACULTY-OUCOD SITE Vicki Coury, R.D.H., M.Ed, M.P.H. Department Co-Chair, Clinical Faculty DCSB 572 271-4435 Jane Gray, R.D.H., CDA, M.Ed Senior Clinical Coordinator/Clinical Faculty DCSB 570 271-4445 (M) 405-830-4880 Tammie Vargo, R.D.H., M.Ed Junior Clinical Coordinator/Clinical Faculty DCSB 582 271-4562 Laurie Cunningham, R.D.H., CDA, M.Ed Clinical Faculty DCSB 565 271- 4423 Carolyn Ray, R.D.H., M.Ed Full Time Faculty DCSB 574 271-4435 Kathy Miller, R.D.H., B.S. Asst. Director of Clinics/ Clinical Faculty DCSB 521C Implantology 271-8001 x34143 Carol Zerby, R.D.H.,B.S. Clinical Faculty / SADHA Advisor DCSB 583 271-6532 Donna Brogan, R.D.H., B.S. Part Time Clinical Faculty DCSB 583 271-4435 Sheri French, R.D.H., B.S. Part Time Faculty DCSB 583 271-6532 Kim Graziano, R.D.H., B.S. Part Time Clinical Faculty DCSB 583 271-4435 Kathy Rogers, R.D.H., A.A.S. Part Time Clinical Faculty DCSB 583 271-4435 Stephanie Schmidt, R.D.H.. B.S. Part Time Clinical Faculty DCSB 583 271-4435 Kristy Jurko Administrative Secretary DCSB 567 271-4435 DENTAL HYGIENE FACULTY DISTANT SITES ARDMORE Southern Oklahoma Technology Center Christy Brannock, Site Coordinator Dept Of Dental Hygiene Mobile: (580)-504-9421 2610 Sam Noble Parkway Office: (580) 223-2070 x 268 Ardmore, Ok 73401 Keila Pierson- Admin Secretary (580) 223-2070 ext 268 (clinic x285) Lindsey Hays- Clinical Instructor Judy West- Clinical Instructor x278 Room Numbers: #C1 (Senior Room) (580) 224-9861 #C2 (Junior Room) (580) 224-9863 Fax: (580) 223-4261 BARTLESVILLE Tri County Technology Center Lydia Snyder, Site Coordinator: Dept Of Dental Hygiene Mobile: (918) 277-6222 6101 S.E. Nowata Rd Office: (918) 331-3282 Bartlesville, Ok 74006 Nina Hill Admin Secretary (918) 331-3218 Tammie Golden- Clinical Instructor Abbie Gustafson- Clinical Instructor Room Phone Numbers: #326 (918) 331-3378 #107 (918) 331-3201 Fax: (918) 331-3499 WEATHERFORD Western Technology Center Julie McClung, Site Coordinator Dept Of Dental Hygiene Mobile (405) 831-1406 2605 E. Main Office: (580) 772-0294 Ext 243 Weatherford, Ok 73096 Evelyn Tilson, Admin Secretary (580) 774-0224 Ext 241 Tina Tuck- Clinical Instructor x244 Room Phone Number: #1: (580) 772-0294 Ext 248 #2: (580) 772-0294 Ext 228 (Jr rm) Fax: (580) 772-2967 University of Oklahoma Patient Care Coordinators 15422 Chart Room 34147 College of Dentistry ACCOUNTING Ellen Ware, Business DENTAL SERVICES ADMINISTRATION Manager 5363 (COMMUNITY DENTISTRY) Janet Powell 4919 ADMINISTRATION Roxanne Vidal (34158) 5444 Dunn Cumby * 46229 Rosita Long 46236 Stephen K. Young, Dean 15444 Hugh McDougall 14919 Kenneth Coy, Associate Dean Academic Affairs 34159 DENTAL HYGIENE Kristy Jurko 4435 Diana Stone, Administrative Manager Jane Bowers * 14436 34163 Jane Gray 14445 Carla Lawson, Student Affairs Specialist Vicki Coury 13869 34162 Carol Zerby 46532 Sally J. Davenport, Administrative Laurie Cunningham 14423 Secretary Tammie Vargo 14562 34160 Dean's Office Fax #' 271-3423 or 271-7775 DENTAL INFORMATICS______ 3694 ADMISSIONS Scott Newhouse 34152 Judy 34156 / Erica 34128 3530 Hal Horton 3412 Jason Jones 34154 Randy Jones, Director, Admissions / Stu. Affairs Computer Lab - (Across from Dean's 34155 Office) x34151 13651 Student Affairs OUHSC DENTAL MATERIALS 6545 Kate Stanton 12416 AEGD Jan Fortelney Delores Sharukh Khajotia * Simpson 5222 Stephen Reagan, Director 14121 Jan's DEVELOPMENT 4380 Office #323 6486 Jodana Johnson, Director 34153 Amanda Bleakley, Assistant 14050 Barry Greenley 46451 or 52, 53 ENDODONTICS Irene Quintero Clinic Room #318 46454 Fax # 3851 5550 David Clement * 48556 Harry S. Heget 48553 Clinic Operations 5422 Andrew Goldbeck 48550 Jeanne Panza, Asst. Dean for Clinics FIXED PROSTHODONTICS Julie Hall 34134 5346 Kathy Miller, Asst. Director of Clinics Luis Blanco * 48547 34143 Frank Lipsinic 48567 Barry Greenley 48544 Tammy Vogt, Billing & Technology David Sather 48546 Administrator 34137 Siler, J. 46884 Linda Hale, Staff Assistant/Patient Booseh Jafari 48566 Advocate 34135 Glenda Jenkins, Supervisor of Clinics MAXILLOFACIAL Teri Forster5744 34136 OCCLUSION Julie Hall 5052 Kathan Kent, Infection Control Officer Edwin Wilson * 48549 13083 Central Business Office 14711 Deans * Departmental Chairs/Directors Alan Miyake 46976 or 50057 New Patient Screening Lisa Nichols 46964 Van Henson 46940 OPERATIVE Suzan Stone 5735 Terry J. Fruits * 46878 Oral Facial Surgery Center 4955 Randy White 46877 Robert Miller 46883 ORTHODONTIC Terrie Birdsong 6087 Frank Miranda 46880 Frans Currier * 46836 Lynn Montgomery 46879 T. Dandajena 33277 Colin Foster 46884 John Clayton 46837 Seminar Room 46838 ORAL DIAGNOSIS Andie Yellow/Orange Clinic 14148 or 33263 Stringfellow 5988 Appt. Desk "New" Patients GRAD. ORTHODONTICS Screenings 6056 Angel Miller 4271 Grad. Clinic Heather 4148 or 33261 Susan Settle * 46824 Donna Mead 33260 Dr. Jennings 46826 Emile Farha 46829 PEDIATRIC DENTISTRY Dr. Beavers 46825 Roberta Rains 5579 Farah Masood 46827 Kevin Haney * 46523 Dr. Lyda Radfor 46828 Nancy Romano 46525 Radiology Staff 15687 Theresa White * 46522 Clinic Dispensary 14946 Charlene Shaw 14945 PERIODONTICS Robin Barnes 4544 Robert Carson * 46534 ORAL IMPLANTOLOGY Jana Doug Hall 46533 Williams 3956 Jane Amme 46538 Nancy Jacobsen *48640 Sharon Severson 46537 Joy Hasebe 46521 David Weiner 46536 ORAL PATHOLOGY GRAD. PERIODONTICS Ann Karen Lassiter 4333 Sullivan 6531 Robert Carson - Director Glen Houston * Joy Beckerley 17020 David Lewis REMOVABLE PROST. Ruth Alferos 4160 ORAL PATHOLOGY LAB Frank Wiebelt * 48561 Geri Stevens 5880 Joseph Cain 48564 Paul Mullasseril 48542 ORAL SURGERY (Sheri Foster-4955) Nancy Jacobsen 48563 46963 4441 Removable Lab 48565 Dan Tylka 48548 Steven M. Sullivan *50055 Appointment Desk 4079 RESEARCH Development Luellen Kevin Smith *50056 Chenoweth 2929 Debbie Wedemeyer 46981 John Dmytryk, Assoc. Dean Research * RESTORATIVE Suzan Stone 6400 James Kessler * 18751 CHILDRENS HOSPITAL SUPPORT LAB David Dembinski 4565 940 NE 13TH Room Info. STOREROOM 5620 X5437 Allen Williams Darla Hall (Store Rm 46663) 5560 CHO Dental Clinic Dr. King - #44138 or Billy Harley Rose X-4750 44137 Cyndi Hughes (Store Rm 46664) Jack Dever CLINICS Blue 3rd fl Fixed Fax #1x5192 X5222 or 5056 Rocky Polk 15053 Brown 2nd fl Restorative UDFG RECEPT. 6333 Felita Sapp 5714 Burgundy 3rd fl Removable Tim Rudd, Executive Director * 48562 4008 Appt. Desk 2209 Gold 3rd fl Operative Jody Maddox 46583 6532 Jade 46575 Green 4 th fl Endo/Maxillofacial 6953/5744 ADMISSIONS & RECORDS OUHSC 2359 Yellow/Orange 4th fl Registration 1539 Pedo/Ortho 2360 Records 1537 Maxillofacial 2nd fl Oral Surgery 5744 BOARD OF GOVERNORS OK PRACTICES 524-9037 New Screening and Emergency Clinic OD 2nd fl 6056 Linda Campbell, Executive Director Fax 524-2223 COMMONS AREA 1ST FLOOR 4690 BURSAR Sherry Glover 2433 COMPUTER LAB CAB SERVICES: YELLOW CAB 232-6161 3691 CAMPUS POLICE Emergency FACULTY HOUSE Reservations 4911 235-8212 Non-Emergency 4300 FINANCIAL SERVICES Fire 4112 2345 Coronary Care – St. Anthony's 236-0191 Financial Aid OMH = Emergency 4363 Pam Jordon 12118 A/P 2410 Fax 2367 CENTRAL STERILIZATION Budget Office 2404 5350 Ext. 46504 Labs: Dental Support 4565 Bursar 2441 Pre-Clinic Lab 6462 Fax 2057 Controller 2376 Grants & Contracts 2177 Payroll 2055 Fax 2057 SUR Accounting 2246 Special Account 2410 Terry, Lanny, Terri, Trish 2173 POISON CONTROL 15454 GOOD SHEPHERD MISSION 232-8631 POST OFFICE 2225 216 NW 12TH PROVOST HOUSEKEEPING Cheryl – 521-7931 Ann Whittmann X2332 X 48400 5726 Becky Wood 12332 LEGAL 2033 Vice President - Provost Jill Raines Dr. Ferretti 12399 Fax 1076 Cheryl Ottman 48416 Dr. Marcia Bennett 48408 OKLAHOMA DENTAL ASSOCIATIO Peggy Brown 48409 848-8873 Legal –Jill Raines 12033 Dana Davis Fax 848-8875 Fax 3151 Karen Ambrose, Dr. Raskob's Office 48401 PURCHASING 5313 Director 4903 RATCLIFFE'S BOOKSTORE Assoc. Director 6587 Sammi 2448 Secretary 5313 Fax 2148 SITE SUPPORT 1121 rd LAB 3 Floor 4565 LECTURE HALL STAPLES KITCHEN - In Room 108 2567 Located in The Commons 6323 STATE FUNDS APPROPRIATIONS 2355 LOCK SHOP Charlie or Tom 2158 ST. ANTHONY'S HOSPITAL 272-7373 1000 N. LEE MARY MAHONEY CLINIC 769-3301 STUDENT AFFAIRS Kate Stanton 271-2416 NORMAN CAMPUS INFORMATION 325-0311 SWITCHBOARD Front Desk Jo Rumley 6326 PARKING OFFICE Larry 2020 TICKETS Football/Basketball PRE-CLINIC 433 LAB 6462 (Norman) 325-2424 Senior Lab 301 2635 TRAVEL Reimbursements PRINT SHOP Tony 2322 SCB - 218 2038 PERSONNEL OFFICE Fax 3925 2180 UNIVERSITY OMH (OMS) 271-4131 Administration 2191 Employee 2190 Benefits 2188 V.A. HOSPITAL 270-1505 Dr. Nasser2 270-5139 Wage / Salary 2187 WEATHER LIN 6499 1) Worker's Comp. Unemployment2189 WREB Records 2186 602 – 944-3315 A Fax 602 – 371-8131 PHOTOGRAPHY FERPA Family Educational Rights and Privacy Act http://www.ed.gov/policy/gen/guid/fpco/ferpa/index.html The Family Educational Rights and Privacy Act (FERPA) (20 U.S.C. § 1232g; 34 CFR Part 99) is a Federal law that protects the privacy of student education records. The law applies to all schools that receive funds under an applicable program of the U.S. Department of Education. FERPA gives parents certain rights with respect to their children's education records. These rights transfer to the student when he or she reaches the age of 18 or attends a school beyond the high school level. Students to whom the rights have transferred are "eligible students." D. Parents or eligible students have the right to inspect and review the student's education records maintained by the school. Schools are not required to provide copies of records unless, for reasons such as great distance, it is impossible for parents or eligible students to review the records. Schools may charge a fee for copies. E. Parents or eligible students have the right to request that a school correct records which they believe to be inaccurate or misleading. If the school decides not to amend the record, the parent or eligible student then has the right to a formal hearing. After the hearing, if the school still decides not to amend the record, the parent or eligible student has the right to place a statement with the record setting forth his or her view about the contested information. F. Generally, schools must have written permission from the parent or eligible student in order to release any information from a student's education record. However, FERPA allows schools to disclose those records, without consent, to the following parties or under the following conditions (34 CFR § 99.31): G. School officials with legitimate educational interest; H. Other schools to which a student is transferring; I. Specified officials for audit or evaluation purposes; J. Appropriate parties in connection with financial aid to a student; K. Organizations conducting certain studies for or on behalf of the school; L. Accrediting organizations; M. To comply with a judicial order or lawfully issued subpoena; N. Appropriate officials in cases of health and safety emergencies; and O. State and local authorities, within a juvenile justice system, pursuant to specific State law. Schools may disclose, without consent, "directory" information such as a student's name, address, telephone number, date and place of birth, honors and awards, and dates of attendance. However, schools must tell parents and eligible students about directory information and allow parents and eligible students a reasonable amount of time to request that the school not disclose directory information about them. Schools must notify parents and eligible students annually of their rights under FERPA. The actual means of notification (special letter, inclusion in a PTA bulletin, student handbook, or newspaper article) is left to the discretion of each school. For additional information or technical assistance, you may call (202) 260-3887 (voice). Individuals who use TDD may call the Federal Information Relay Service at 1-800-877- 8339. Or you may contact us at the following address: Family Policy Compliance Office U.S. Department of Education 400 Maryland Avenue, SW Washington, D.C. 20202-5920 University of Oklahoma Health Sciences Center (OKC/OU-Tulsa) On-Site Provision of Services at K – 12 Schools Policy Background Checks Application of Policy This policy applies to all employees, residents and students of the University of Oklahoma Health Sciences Center and OU-Tulsa who provide University sponsored services on K – 12 school premises. Faculty, staff, or students who volunteer to perform services unrelated to the business of the University to support humanitarian, charitable, or public service activities are not subject to this policy; but are subject to any policies and procedures regarding background checks established by the organization where they volunteer to provide services. A. Purpose 1. Oklahoma state law prohibits entities that contract with or provide services to school districts from allowing any person to provide services on school premises if the person has been convicted of any sex offense, subject to the Oklahoma Sex Offenders Registration Act (or similar state or federal law), or any felony offense, within the past ten years. The entity providing services is legally responsible for compliance with this law. 2. This policy is intended to ensure the state law requirements for persons providing services on K-12 school premises are met, and the University provided on-site services meet their commitments. B. Statement of General Policy 1. It is the policy of the University of Oklahoma Health Sciences Center and OU- Tulsa that all employees, residents and students who provide on-site services on K – 12 school premises complete the University of Oklahoma Declaration Regarding Prohibition of Sex Offenders and Convicted Felons on School Premises form and have this background information verified prior to and as a condition of providing on- site services to schools. Faculty, staff, or students who volunteer to perform services unrelated to the business of the University to support humanitarian, charitable, or public service activities are not subject to this policy, but are subject to any policies and procedures regarding background checks established by the organization where they volunteer to provide services. 2. This policy applies to all employees, residents and students who provide any University sponsored on-site services to K – 12 schools. Individuals subject to this policy must notify Human Resources and their department if there is any change in their status regarding criminal or violent offender registry. 3. Declining to submit the declaration is grounds for not selecting or allowing an individual to participate in the services. Discovery of violations of University policies shall be handled in accordance with paragraph C, Sanctions for Violation. Appropriate action will be taken by the department in consultation with the applicable campus Human Resources office. University of Oklahoma Health Sciences Center Human Resources September 1, 2006 University of Oklahoma Health Sciences Center (OKC/OU-Tulsa) On-Site Provision of Services at K – 12 Schools Policy 4. Providing on-site services may not begin until the University has received the Declaration and verified the information. C. Sanctions for Violation Violations of University policies, discovered after approval to provide services to include providing false or misleading information, will be handled in accordance with applicable University policies and procedures; providing for disciplinary actions up to and including termination of employment from the University. Violations by students or residents will be handled in accordance with University policies regarding standards of conduct. D. Appeals Individuals who are notified they are listed on the registries and will not be permitted to provide services on K – 12 premises may contact the appropriate Human Resources office to initiate an appeal. Office Responsible for this Policy Office of Human Resources Effective Date September 1, 2006 University of Oklahoma Health Sciences Center Human Resources September 1, 2006 Blackboard Instructions for Students How to Access Blackboard 1. Enter the Blackboard site at ouhsc.blackboard.com (Do not precede with www.) 2. Sign-on using campus username and password 3. Click on the course that you wish to enter How to Access On-line Course Evaluation 1. Enter the Blackboard site at ouhsc.blackboard.com (Do not precede with www.) 2. Sign-on using campus username and password 3. Click on the course that you wish to complete the course evaluation on the right side of the Welcome screen 4. On the left side of the Announcement screen, click Course Evaluation. 5. On the next screen, click Course Evaluation and follow instructions given. SECTION B Goals & Philosophy DEPARTMENT OF DENTAL HYGIENE GOALS and PHILOSOPHY The philosophy of the Dental Hygiene Program at the University of Oklahoma is one of commitment to the education of oral health professionals who are capable of integrating educational, clinical, and individual services that support and promote the total health of the patient as well as optimal oral health. In addition to the broader goals of the University and the College, the following goals have been adopted. Graduates of the Department of Dental Hygiene are expected to: 1. Be competent in recognition, evaluation, and appropriate treatment of oral diseases. 2. In all settings in which responsibility has been delegated, apply scientific principles and an analytic approach to the practice of dental hygiene, educational endeavors, public health and research. 3. Act as an integral member of the dental health team by performing quality preventive and therapeutic dental hygiene services, in a variety of settings, in order to improve the oral health status of the consumer. 4. Function as a valuable member of interdisciplinary teams of health personnel recognizing the unique contributions of each discipline. 5. Communicate effectively with patients and colleagues, develop intellectual curiosity and demonstrate the skills necessary to enhance learning and continue professional development throughout their career. The curriculum is designed and implemented with the goals as a foundation. The facilities offer a good environment for basic science and pre-clinical instruction, laboratory and clinical experiences. Faculty are dedicated to excellence; sensitive to the depth of the curriculum offered; offer a wide range of professional experiences; and attempt to establish an atmosphere of respect and understanding with students. The program goals require that students provide appropriate treatment of oral diseases, apply the scientific principles and an analytic approach to all aspects of dental hygiene practice, act as an integral member of the health team, communicate effectively with patients and colleagues and demonstrate skills necessary to enhance continued professional development. In order to meet the goals of the program, one of the educator's primary challenges is to provide opportunities to foster and improve the students' critical thinking skills. This task falls not just to didactic course directors, but even more importantly to clinical instructors who are most likely to have more occasions to reinforce theoretical concepts and apply what has been learned in the classroom to actuality. 9 The attainment of the program's goals necessitate background knowledge and skills in a variety of curriculum areas but just as importantly, the addition of knowledge of the latest scientific advancements and innovations in dental hygiene practice and health care systems. This essential information on the latest scientific advancements is provided by faculty in the classroom, laboratory, clinic and community projects, but training for student involvement both while in the educational process and later as a professional is provided by requiring active participation by the students in the attainment of information (i.e., library assignments, reading updated texts, individual research assignments, sharing of information by peer presentations, etc). The goals are a living document sensitive to the changing needs of the profession. Each year usually in late summer the goals are reviewed, evaluated and revised as necessary by the faculty during a faculty retreat established for that purpose. The retreat is mandatory for faculty holding 50% or greater commitments to the school and other part-time faculty may attend. 10 DEPARTMENT OF DENTAL HYGIENE MISSION STATEMENT The mission of the Department of Dental Hygiene (DDH) is to improve the health of Oklahomans and shape the future of dentistry by developing highly qualified dental hygienists through excellence in education, patient care, research, community service, faculty, and facilities. GOAL #1: EDUCATION Prepare students, through appropriate academic and clinical education, to be qualified dental hygienists. 1.1 Recruit students of the highest quality who can reasonably be predicted to successfully complete the educational programs of the College within specified time frames. 1.2 Provide appropriate didactic and clinical instruction through an inter- active, competency-based curriculum that is reviewed regularly and modified as necessary to address the dynamics of a constantly changing profession. 1.3 Provide didactic and clinical instruction in a positive learning environment that leads to social and ethical development along with technical competency and practice management skills. 1.4 Create opportunities for life-long learning. 1.5 Develop a curriculum that incorporates critical thinking skills and is evidence-based where possible. 1.6 Integrate biomedical and clinical sciences throughout the curriculum. GOAL #2: PATIENT CARE Provide appropriately supervised dental hygiene treatment of the highest quality. 2.1 Provide comprehensive patient-centered care throughout the clinical education programs as an integral component of the College's teaching and service missions. 2.2 Develop and implement a quality of care program based on measurable criteria that facilitate reliable and valid assessment. 2.3 Teach the necessity of professional ethics and responsibility in the delivery of patient care. GOAL #3: RESEARCH and SCHOLARLY ACTIVITY Create a positive and rewarding academic environment that facilitates research and scholarly activity by both students and faculty. 3.1 Provide opportunities for the discovery and dissemination of new knowledge in oral health science and dental hygiene education through research programs involving faculty and students. 3.2 Provide faculty with sufficient time and resources to engage in productive research and other scholarly activities. 11 3.3 Create a culture in which achievements in research and scholarly activity by both faculty and students are recognized and rewarded. GOAL #4: COMMUNITY SERVICE Foster opportunities for involvement in service activities that are consistent with the dental hygienist's responsibility to promote oral health care as an integral component of the overall health and welfare of the community. 4.1 Identify new and strengthen existing relationships between the College's academic programs and the public. 4.2 Encourage student and faculty participation in and support of professional service organizations that promote the service mission of the College and the dental profession. GOAL #5: FACULTY Provide students with highly qualified faculty and provide faculty with an environment that facilitates personal and professional growth. 5.1 Recruit and retain highly qualified faculty with the requisite education, knowledge, clinical skills, and motivation to facilitate student advancement of the College's didactic and clinical goals. 5.2 Provide a total compensation package and an environment that are competitive with peer institutions. 5.3 Provide opportunities for faculty development. GOAL #6: FACILITIES Provide a state-of-the-art educational environment. 6.1 Incorporate relevant innovations in information technology and management as an integral facet of the College's goals in the areas of teaching, patient care, research, and service. 6.2 Expose students to advanced dental technology and equipment to best prepare them for practice. 6.3 Initiate an ongoing program for facility maintenance and improvement. Adopted by Faculty June 14, 2007 12 DEPARTMENT OF DENTAL HYGIENE PHILOSOPHY The philosophy of the Dental Hygiene Department is one of commitment to the education of oral health professionals who are capable of integrating a full range of knowledge and skills that support and promote the total health of the patient as well as optimal oral health. The curriculum is designed and implemented with competencies as the foundation. The program goals require that students provide appropriate prevention and treatment of oral diseases, apply scientific principles and an analytic approach to practice, act as an integral member of the health team, communicate effectively with patients and colleagues, and demonstrate continued professional development. In order to meet the goals of the program, one of the educator's primary challenges is to provide opportunities to foster and improve the students' critical thinking skills. This task falls not just to didactic course directors, but even more importantly to clinical instructors who are most likely to have more occasions to reinforce theoretical concepts and apply what has been learned in the classroom to actuality. The attainment of the program's goals necessitate background knowledge and skills in a variety of curriculum areas but just as importantly, the addition of knowledge of the latest scientific advancements and innovations in dental hygiene practice and health care systems. Students are required to take active roles and responsibility for their education, including attainment of information and skills and self-assessments. Areas of emphasis within the curriculum will include, but not be limited to the following: I. PROFESSIONALISM The competent dental hygiene practitioner provides skilled care using the highest professional knowledge, judgment and ability (ADHA Code of Ethics). This skilled care should be based on contemporary knowledge, and the practitioner should be capable of discerning and managing ethical issues and problems in the practice of dental hygiene. However, the practice of dental hygiene occurs in a rapidly changing environment where therapy and ethical issues are influenced by regulatory action, economics, social policy, cultural diversity and health care reform. Additionally, dental hygiene is trying to create a unique identity for the profession and increase the knowledge base. Thus, the competent dental hygienist must have regular involvement with large and diverse amounts of information in order to be prepared to practice in this dynamic environment. II. HEALTH PROMOTION AND PREVENTION The dental hygienist serves the community in both practice and public health settings. Public health is concerned with promoting health and preventing disease through organized community efforts, which is an important component of any interdisciplinary approach. In the practice setting, the dental hygienist plays an active role in the promotion of optimal oral health and its relationship to general health. The dental hygienist therefore should be competent in the performance and delivery of oral health promotion and disease prevention services in the public health, private practice and alternative settings. 13 III. PATIENT CARE The dental hygienist is a licensed preventive oral health professional that provides educational and clinical services in the support of optimal oral health. The dental hygiene process of care applies principles from biomedical, clinical and social sciences to diverse populations that may include the medically compromised, mentally or physically challenged, or socially or culturally disadvantaged. 14 CLINICAL DENTAL HYGIENE OBJECTIVES As the student progresses through the clinical program, he/ she will be expected to assume greater responsibility for total patient care. The student will utilize problem solving and critical thinking skills to apply knowledge from didactic courses to the clinical setting. OBJECTIVES: The student will: ACTIVITY USED TO ACHIEVE OR MEASURE OBJECTIVE: l. Exhibit professional demeanor a. Faculty serves as a role model. (i.e. attitudes, conduct, and personal appearance). b. Students exhibit professional demeanor. 2. Utilize correct dental terminology a. Student utilizes professional professional communications. terminology with professionals. b. Student utilizes layman terminology with patients c. Student utilizes correct terminology in presentation of oral exam findings. d. Student utilizes correct terminology in written communications (i.e. clinic records and treatment plans). 3. Demonstrate proper maintenance, a. Student satisfactorily sterilization, and storage of clinical completes clinical assistant armamentarium. duty assignments. b. Faculty monitors student preparation and maintenance of equipment and armamentarium by commenting on student/faculty comment sheets. 4. Demonstrate principles of asepsis a. Faculty monitors demon stration in treatment of all patients. of asepsis Comments on student/faculty sheets. b. Student demonstrates competency by performing all criteria stated in asepsis performance 15 5. Demonstrate use of fundamental a. Student identifies principles of, and perform patient necessary treatment evaluation, data collection, treatment for each patient, planning, and delivery of documents these indicated indicated therapeutic and services on the treatment plan. preventive services with emphasis on b. Student prepares written individualized treatment and/or patient treatment plan according to need. criteria. c. Student satisfactorily completes clinical requirements specified in clinical contract, meeting competency level. 6. Apply basic principles of a. Student completes instrumentation for patient competencies for basic examination and removal of deposits. instrumentation for removal of deposits as well as root planning with Gracey curets. b. Tissue trauma and calculus removal is within acceptable limits. 7. Assume responsibility for a. Student plans in order his/her educational experience. to complete clinical requirements. b. Student matches patient profile with requirements. c. Student completes proper preparation and evaluation. 8. Demonstrate effective time a. Faculty monitors skills management skills in completing completed with specified clinical services. time expected. b. Student performance demonstrates efficient time utilization. 9. Identify or describe anatomic a. Student interprets and utilizes structures and conditions in a radiographs for patient given radiograph. education and treatment planning. 16 CLINICAL COURSE EVALUATION Evaluation Policy Goals: The dental hygiene program faculty at the University of Oklahoma believes that learning should be based on a firm foundation of didactic education, and then built layer by layer with practical experience and additional learning. Evaluation is basically another methodology by which learning can be facilitated. The intent of evaluation is not to penalize, to discipline or to measure a person's potential worth, but rather it is an effective mechanism to provide constructive feedback to aid in student learning. In addition, evaluation provides a medium for ingraining those skills and attributes indicative of the professional health care provider. In addition, the faculty desires that evaluation be a two-way interaction between student and faculty. Evaluation allows improvement in both directions. The faculty hopes to foster a climate of teamwork with mentor and scholar having the same ultimate goal...the education of a learned ethical professional dental hygienist. The following further explain the clinical evaluation process: 1. Evaluations are based upon specific instructional objectives that are made known to the student as early as possible and appropriate for each phase of the clinical educational process. 2. Skills are defined in didactic, laboratory and clinical instruction. Competencies have been established for each critical skill and step-by-step evaluations are provided. Grading is based on the degree of skill demonstrated by the student in carrying out the established steps within each competency. 3. Competencies are based on progression and in the final semester will be at the appropriate level for the entry-level dental hygienist. 4. Product will be evaluated as well as process and all domains are appraised. 5. The student has ultimate responsibility for the degree of clinical aptitude that will be acquired in the professional program of dental hygiene. It is expected that the student will have a positive attitude and a driving thirst for knowledge making use of faculty expertise at -every opportunity. Students are encouraged and expected to seek maximum help from faculty members particularly in the early development of clinical knowledge and skills. 6. As the student progresses through the program, critical clinical thinking skills become more finely honed. The faculty will encourage the student to progressively assume more responsibility for clinical planning, therapies, and outcomes, but will remain available for consultation and assistance as necessary. 7. Performance objectives and evaluation criteria are established in the Dental Hygiene Manual. For a student to be successful in the dental hygiene clinical program, it is mandatory that the student be thoroughly familiar with these clinical expectations. It is further requisite that the student evaluate his or her personal performance according to the specified criteria for each clinical skill 17 8. Clinical course requirements and grading are established based on student need and are written in contract form at the beginning of each clinical semester. Amendments to the grade contract may be made upon agreement of both faculty and students. 9. Fellow students may not be used as patients to fulfill requirements except in special circumstances that have been approved by the course director. Please refer to course syllabus. 10. In addition to specified requirements, students must complete the following • For the clinical program to be considered complete: treatment for all assigned patients has been concluded or arrangements have been made for continuation of long term therapy • documentation is complete and has been reviewed with assigned case instructor • any equipment loaned to the student by the Dental Hygiene Department has been returned or paid for in full 11. Final clinical course grades will be assigned in the following way- A - 90-100 B - 80-89 C - 70-79 D - 60-69 F - <60 18 SECTION C PROFESSIONALISM ATTENDANCE ATTITUDE/PROFESSIONALISM Members of the health professions need to exemplify the traits which they hold as objectives for others if response and cooperation is to be expected. As future members of a health profession, dental hygiene students must be willing to accept the responsibilities placed on them in order to prove themselves capable of assuming future responsibilities. The transition from layperson to professional which must be made during professional training is not easy, but can be facilitated by the individual's striving to learn and transferring this learning to clinical experiences. Professional behavior is a combination of technical skills, mature observation and judgment, and ethics. Technical skills are achieved through the preclinical dental hygiene course and gradually refined through clinical experiences until the students achieve the level of proficiency required for graduation. Clinical observation of normal and abnormal must be mastered, based on the knowledge acquired in the didactic clinical courses and in clinical experiences. Judgment is based on obtaining and utilizing pertinent information gained through observation and patient need, patient-student interaction, technical skills and continuing clinical experiences. Professional ethics is concerned with the conscientious use of technical skills, observation and judgment affecting the patient's health and well-being, interpersonal relationships, community involvement and a commitment to service. The following are specific expectations of dental hygiene students at The University of Oklahoma. A willing attitude on the part of the student to accept these responsibilities in a positive manner is partial evidence of {our ability and sincere desire to become an effective member of the dental health team. I. General Clinical Guidelines A. The Clinic Manual must remain at the clinic station at all times, and students must refer to the manual to ensure that procedures are properly done. B. Certain procedures (i.e.: asepsis, appearance, patient management, professionalism, patient education, etc.) apply to each patient and are considered part of the total competency evaluation . C. The student will utilize feedback given by instructors on all procedures. D. Once a student has achieved competency in a certain procedure, that procedure may be subject to spot checks. An unsatisfactory spot check will require an additional demonstration of competency for that procedure. E. Faculty must be in clinic for any procedure to be started on a patient. F. PTP is to be obtained from a clinical instructor before procedures are begun. 19 II. General Clinic Conduct A. During clinic sessions, students entering the clinic must be in uniform. B. According to the departmental policy, food, drinks, or smoking are not allowed in the clinic area. III. Professional Conduct A. Class, Laboratory and Clinic Attendance You are expected to attend all classes, laboratories, and clinic sessions and to have patients for all clinic appointments. B. Absenteeism from pre-clinic to laboratory and clinic sessions must be reported to the dental hygiene secretary at 271-4435 and the course director in advance of the session to be missed. C. Gum chewing is not permitted in any area where patient contact is likely. IV. Professional Attitude A. Shows initiative while seeking to utilize free time. B. Uses time efficiently. C. Demonstrates responsibility for the total preventive treatment of all patients assigned. D. Demonstrates discretion when conversing in the clinic. E. Protects patient's rights to privacy. F. Upholds honest and ethical behavior in all situations G. Demonstrates maturity in judgment, actions and reactions during clinical situations. H. Willingness to accept suggestions for improvement and evaluation of procedures gracefully. I. Continued eagerness to learn. J. Placing the patient's welfare first when planning and implementing patient care. 20 K. Attitudes of respect, concern, and cooperation toward fellow classmates, support personnel, and faculty. L. Honesty. 21 DEFICIENCY IN PROFESSIONAL CONDUCT OR PERFORMANCE Purpose: To document serious deviations from acceptable norms of professional conduct or performance. (1) * Name of Student Date Faculty/Staff Time Chart # (if applicable) Location Check applicable category(ies) of deficiency: Conduct Performance Attitude Interpersonal relations Judgment Skill/competence Behavior Integrity Preparation Other Dress Code Other Patient neglect Description of occurrence and immediate action taken: (continue on reverse side if necessary) Faculty/Staff recommendation(s) for further action: (continue on reverse if necessary) _____________________________________________ _____________________ Faculty/Staff Signature Date _____________________________________________ _____________________ 22 Student Signature (2) * Date Submit completed form to the Associate Dean for Student Affairs or the Associate Dean for Clinics (3) * (1) This form is intended to document serious occurrences that should be considered when evaluating a student's fitness for promotion and advancement. Examples of such occurrences include, but are not limited to: a. Actions endangering a patient's well-being b. Cheating, plagiarism, or falsification of records c. Harassment or discrimination d. Theft e. Serious and/or repeated lapses of professional behavior, preparation, judgment, or competence in clinical, pre-clinical or classroom areas (2) The student signature acknowledges awareness of this documentation, but does not imply agreement or disagreement with its contents. The student may provide a written response to the Associate Dean for Student Affairs or the Associate Dean for Clinics. (3) This form is to be submitted promptly to the Associate Dean for Student Affairs or the Associate Dean for Clinics who will coordinate distribution of copies to the student, Course Director, and the Chair of the appropriate Periodic Review Committee. _____________________________________________________________________________ _ Description of occurrence and immediate action taken (continued): 23 Faculty/Staff recommendation(s) for further action (continued): 24 COLLEGE OF DENTISTRY DRESS CODE (Revised July 24, 2006) Because patient care is delivered in the College of Dentistry throughout the year, it is important that all students, whether in the clinic, pre-clinic or classroom maintain a professional appearance at all times. Therefore this policy is in effect from 7:30 a.m. to 5:30 p.m. Monday through Friday. General Attire Students are expected to dress and act professionally while enrolled in the College of Dentistry, when present anywhere on the Health Sciences Campus and when representing the College of Dentistry at any external site. Neatness, cleanliness and modesty are expected. Guidelines Hair must be kept clean, neat, and out of the patient's face and operator's eyes. Moustaches and beards must be kept neatly trimmed. The remainder of the face must be clean-shaven. No jewelry worn in facial body piercing (other than ear lobes) is allowed. Acceptable: Dresses, skirts of professionally appropriate length, dress slacks, casual or dress shirts with collars or blouses (long or short sleeve), polo type shirts with collars, and sweaters. Most varieties of footwear are acceptable as long as they are clean and presentable. Jeans are discouraged; however, if worn, they must be neat and clean, with no holes, tears or frayed fabric. Unacceptable: Rubber flip-flops, T-shirts, baseball caps or other hats. Bare midriffs, exposed undergarments, and improperly fitting clothing are expressly prohibited. Pre-clinic Attire Scrubs must be worn in the preclinical laboratory, room 433. Clinic Attire Professional appearance should be maintained at all times by all students. Going to and from a clinic laboratory will require the appropriate clinic attire. Hands must be clean and well manicured with fingernails short and free of nail polish to ensure efficient work and cleanliness. Artificial nails are not permitted. Certain jewelry, rings (with the exception of smooth surface wedding rings), watches, long necklaces or large earrings must be removed during patient treatment to avoid unnecessary collection of microorganisms and possible cross-contamination. 25 Clothing such as jeans, shorts, and open-toed sandals and bare ankles are not allowed in clinics. Although there is no restriction on hair length of students, long hair must be pinned up while in clinic and the pre-clinic laboratory. Scrub tops and pants are required as general clinic attire. Scrubs are issued as part of your student kit. You are responsible for laundering them. A white short sleeve T-shirt or a tee shirt matching the color of the scrub top may be worn under the scrub top provided no writing or design is visible and the shirt tail of the T-shirt is worn inside the scrub pants. Shoes must be white, clean and in the judgment of the attending clinical faculty, appropriate for clinic. High-tops, hard-soled clogs, sandals and heels are expressly prohibited. Socks covering the ankles are required. "Crocs" are acceptable as long as they are white and not perforated. (Amended August 17, 2005) If replacement scrubs are required, they must be purchased from The Uniform Shoppe and be identical to the original issued scrubs in both company of manufacture and color. They must also be monogrammed with the students name above the pocket. You must wear a long-sleeve gown (provided in each clinic) for procedures in which splatter with blood or saliva is likely. Contaminated gowns must be turned in at the end of the clinic session in the container designated in each clinic. Gowns may not be worn going to and from clinics and the support laboratory during patient care, and may not be worn to the Student Commons or outside the building. The College will provide and launder these gowns. Violations of this policy will be handled in the following manner: First offense: writing warning (copy to Associate Dean of Student Affairs) Second offense: written reprimand (copy to Associate Dean of Student Affairs) Third offense: appearance before the appropriate Periodic Review Committee, which could result in further disciplinary action. 26 ATTENDANCE Classroom and Laboratories Attendance at classroom, seminar, and laboratory sessions is of value and is, therefore, MANDATORY. Exceptions can be made for legitimate excuses acceptable to the course directors. The methods of enforcing the attendance policy will be carried out at the departmental level. Students will be informed of departmental procedures for checking attendance at the beginning of each course. Unexcused absences may result in grade reduction or failure, at the discretion of the department chairperson and/or course director. Clinics Attendance in clinic is required unless the student is excused by the course director. If not treating a patient, the student will be expected to be assisting in clinic. PROPER PROCEDURE FOR REPORTING ABSENCES Unanticipated absences, (i.e., personal illness, family emergency, transportation problems, etc.) are to be reported to individual course directors and the departmental Administrative secretary at 271-4435 on the date the absence occurs and before the class/clinic missed ends on that date. In the case of unanticipated absences necessitating cancellation of patient(s), it is your responsibility to notify the patient and the Clinical Coordinator. Anticipated absences, (i.e., family events, advanced program interviews, personal business, doctor appointments, etc.) should be discussed with appropriate faculty prior to the time of the absence so arrangements can be made for make-up work. All absences are to be reported to the Course Director/ Dept Administrative Secretary and the Clinical Coordinator for documentation; however, this DOES NOT EXCUSE the absence. Arrangements must be made with individual course directors 27 SECTION D SCHEDULES SUMMER II SEMESTER 2007 June 22 ...............................................................................................................DH1 Orientation June 25 ............................................................................DS1 Orientation/White Coat Ceremony June 26 ....................................................................................................... DS1 Anatomy Begins July 4 ..................................................................................................Independence Day Holiday July 13 ..................................................................................................... DS3 Last Day of Clinic July 16 .................................................................................................................. Faculty Retreat July 17-19 ................................................................... DS4 Professional Development Workshop July 17 ................................................................................................................DH Board Exam July 18 ................................................................................................................DS3 Grades Due July 23-Aug 3 .........................................................................................DS4 Group 1 Externship August 6-17 ............................................................................................DS4 Group 2 Externship August 9 .................................................................................. DS 1 Anatomy Final Examination ORIENTATION August 14 & 15................................................................................................... DS2 Orientation August 15 & 16................................................................................................... DS3 Orientation August 15-16 ......................................................................................................DH2 Orientation August 15-17 ......................................................................................................DH1 Orientation August 17 ........................................................................................................... DS1 Orientation August 20 ........................................................................................................... DS4 Orientation FALL SEMESTER 2007 August 14 .....................................................................DS2 EPD (BSEB-ELH) begins at 8:00am August 15 ..................................................... DS1 Embryology (BSEB-WLH) begins at 10:00am August 17 ...............................................................DS1 Physiology (CPB-103) begins at 8:00am August 20 ........................................................................................................ All Classes Begin August 21 ........................................................................................................ ODA Fall Festival September 3....................................................................................................Labor Day Holiday TBD......................................................................................................................OUCOD Picnic October 5 ................................................................................... Fall Break (no classes or clinics) November 2-4.........................................................................Hinman Student Research Meeting November 16 .......................................................................Statehood Day (no classes or clinics) November 19-21....................... ..................................DS2 & DS4 Board Review (NO CLASSES) November 21-25 ........................................................................................ Thanksgiving Holiday December 7 (week 16) ................................................................................... Last Day of Classes December 10-14 (week 17) ................................................................... Final Examination Week December 17-18.................................................................................................... Faculty Retreat December 19 ..............................................................................................................Grades Due December 15.................................................................................Student's Winter Break Begins 29 SPRING SEMESTER 2008 January 2-4 .......................................................................................DS1 Dental Material Course January 7 ........................................................................................ Dental Student Classes Begin January 14...................................................................................... Dental Hygiene Classes Begin January 21......................................................................................... Martin Luther King Holiday February 23.................................................................................................... OUCOD Kids' Day March15-23 ............................................................................................................. Spring Break March 25 ................................................................ National Board Dental Hygiene Examination April 2-5 .............................................................................................................. AADR Meeting TBD........................................................................................................................Scientific Day TBD..................................................................................................... WREB Dental Orientation TBD............................................................................................................. WREB Dental Exam May 5-9 (week 17)................................................................................. Final Examination Week May 10................................................................................... OU Norman/Dental Hygiene Commencement May 11.................................................................................................................Dental Hygiene Convocation May 13 ........................................................................................................... DS1-3 Grades Due May 26 .....................................................................................................Memorial Day Holiday June 6 (week 20).................................................................................... DS4 Last Day of Classes June 7 .......................................................................................................Dental Commencement June 10 ...............................................................................................................DS4 Grades Due TBD...................................................................................... WREB Dental Hygiene Orientation TBD............................................................................................... WREB Dental Hygiene Exam DS1 POST SESSION: May 12-May 30 (weeks 18-20) May 30 .......................................................................................................... Last Day of Classes June 3 .........................................................................................................................Grades Due DS2 POST SESSION: May 12-June (weeks 18-21)* June 6 ............................................................................................................ Last Day of Classes June 10 Grades Due DS3 LATE SPRING CLINIC: May 5-July 11 (weeks 17-26) July 4 .......................................................................................................................Independence Day Holiday July 11 ............................................................................................................Last Day of Clinics July 15 ........................................................................................................................Grades Due DS4 SUMMER II SESSION: July 15-August 15 July 15-17…...…………………...……………………………………Prof Develop Workshop July 21-August 1…...………………………………………………………Group 1 Externship August 4-15………………………………………………………………...Group 2 Externship 2007-08AcadCal (SKY & KC approved; 6/13/07 30 DH II ORIENTATION SCHEDULE – HSC STUDENTS CLASS OF 2008 WEDNESDAY, AUGUST 15, 2007 HSC Students only 10:00 am Room 108 TB Shots Judy Davis ALL DH II STUDENTS AT COD 10:30 a.m. Room 108 Welcome Back Dr. Bowers/ Ms. Coury Background Checks Complaint Log Student tutoring/policy 11:00 a.m. Room 133 Instrument Kit Issue Darla Hall StudentStore 12:00 p.m. Commons Lunch and Welcome to Class of 2009 Senior DH Students 1:00 p.m. Room 108 Welcome Dr. Bowers/ Ms. Coury (with DH I Review of Student Handbook Students) Must read, sign that you have read the document, and return to Kristy Jurko or your site coordinator before Friday of the first week of classes that you agree to comply with handbook regulations Explanation of Program Competencies Enrollment/Details 2:00 p.m. BSEB 320 Oral Pathology Dr. Glen Houston Dr. David Lewis 3:00 pm – BSEB 320 Clinical Dental Hygiene Orientation Professor Jane Gray, 5:00 pm TA orientation Senior Clinical Coordinator THURSDAY, AUGUST 16, 2007 8:30 a.m. Room 364 Rotation Information Professor Jane Gray, Senior Clinical Coordinator 10:00 a.m. Room 364 Clinical Operations Update Ms. Kathy Miller Asst. Director of Clinics 11:30 a.m. Room 364 Implantology and Pedo Ms. Nancy Romano Pedo Coordinator 12:00 p.m. Lunch (on your own) 1:30 p.m. Room 364 Oral Diagnosis & Radiology Orientation Dr. Susan Settle, Chair Oral Diagnosis 2:00 p.m. Room 364 Tinker Dr. McLeod Diana Mills 2:45 p.m. Break 3:00 p.m. Room 364 Good Shepherd Mission Dr. Lipsinic 3:30 p.m. Brown Graduate Periodontics Orientation & Tour Jean Lapham Clinic 31 The University of Oklahoma Department of Dental Hygiene Fall 2007 DHI MONDAY TUESDAY WEDNESDAY THURSDAY FRIDAY 8AM Dental Morphology Lecture 9AM CDH I Theory CDH I Theory CDH I Theory Lecture/ Dr. Ed Wilson Computer Orientation Lecture/ Clinic Lecture/ Clinic Clinic Jason Prof Tammie Vargo Prof Tammie Vargo Prof Tammie Vargo 10AM Oral Radiology Head & Neck Dr. Farah Masood Anatomy Lecture Lydia Snyder Lydia Snyder Lydia Snyder Lecture Prof. Julie Mc Christy Brannock Christy Brannock Christy Brannock Clung Julie McClung Julie McClung Julie McClung 11AM 12 NOON 1PM Oral Diagnosis CDH I Theory Lecture Preventive Dentistry Perio I Lecture Lecture Lecture (10 weeks) / Dr. Robert Carson Oral Radiology Lab Prof Tammie Vargo Health Education OUCOD* (5 weeks) 2PM Dr. Kay S. Oral Radiology Lab Staff Beavers Prof. Laurie Staff Cunningham Prof. Sheri French 3PM Gen/Oral Histology Prof. Julie Mc Clung 4PM The University of Oklahoma Department of Dental Hygiene Fall 2007 DHII MONDAY TUESDAY WEDNESDAY THURSDAY FRIDAY 8 AM Perio III* Pain Control DH 4601 DH 4472 Dr. John Dmytryk Dr. Van Henson 9 AM DH Process of Care Rotation I DH Process of Care CDH III DH 4332 DH 4331 DH 4332 DH 4336 Prof. Jane Gray Prof. Jane Gray Prof. Jane Gray Prof. Jane Gray Tammie Golden Tammie Golden Christy Brannock Christy Brannock 10 AM Oral Pathology Community DH 4144 Health Issues DH 4552 Prof. Laurie Dr. Glen Houston Cunningham 11 AM 12 NOON 1 PM CDH III CDH III CDH III Oral Pathology DH 4336 DH 4336 DH 4336 DH 4144 Prof. Jane Gray Prof. Jane Gray Prof. Jane Gray Dr. Glen Houston Tammie Golden Tammie Golden Tammie Golden Christy Brannock Christy Brannock Christy Brannock 2 PM 3 PM 4 PM Dental Hygiene Faculty Clinic Schedule Travel days Coury Thursday Cunningham Wednesday Gray Wednesday Vargo Wednesday Zerby Wednesday Monday a.m. Tuesday a.m. Wednesday a.m. Thursday a.m. Blue Yellow/Orange Green Yellow/Orange (4 faculty) (5 faculty) (4 faculty) (5 faculty) DH I Lecture/Clinic/Lab DH I Lecture/Clinic/Lab DH I Lecture/Clinic/Lab ONLY 12 Junior Partners 12 Junior Partners 12 Junior Partners 12 Seniors Tammie Vargo Tammie Vargo Tammie Vargo Carol Zerby Carol Zerby Carol Zerby Carol Zerby Sheri French Kim Graziano Laurie Cunningham Kathy Rogers Laurie Cunningham Donna Brogan Stephanie Schmidt Sheri French Sheri French Vicki to VA Carolyn Ray prn Vargo prn Monday p.m. Tuesday p.m. Wednesday p.m. Green Green Green (5 faculty) (4 faculty) (3 faculty) 18 Seniors 16 Seniors 12 Seniors Jane Gray Jane Gray Jane Gray Carol Zerby Kathy Rogers Donna Brogan Sheri French Stephanie Schmidt Carol Zerby Carol Zerby Carolyn Ray Kim Graziano Sheri French prn Laurie Cunningham prn Carolyn Ray prn 2008 SPRING Dental Hygiene Faculty Clinic Schedule Travel days Ray Tuesday Coury Thursday Cunningham Wednesday Gray Wednesday Vargo Wednesday Zerby Wednesday Monday a.m. Tuesday a.m. Wednesday a.m. Thursday a.m. Yellow/Orange Blue Yellow/Orange Green (5 faculty) (4 faculty) (5 faculty) (4 faculty) DH I Lecture/Clinic/Lab DH I Lecture/Clinic/Lab DH I Lecture/Clinic/Lab ONLY 18 Juniors Spring ONLY 12 Juniors 18 Juniors Spring ONLY Spring ONLY 12 Seniors Tammie Vargo Tammie Vargo Tammie Vargo Carol Zerby Carol Zerby Laurie Cunningham Carol Zerby Sheri French Kim Graziano Stephanie Schmidt Kathy Rogers Laurie Cunningham Donna Brogan Sheri French Sheri French Jane Bowers Carol Zerby to IHS Vicki to VA Monday p.m. Tuesday p.m. Wednesday p.m. Green Green Green (5 faculty) (4 faculty) (3 faculty) 18 Seniors 16 Seniors 12 Seniors 3 to TAFB Jane Gray Jane Gray Jane Gray Carol Zerby Kathy Rogers Donna Brogan Carol Zerby Stephanie Schmidt Carol Zerby Sheri French Laurie Cunningham Kim Graziano Tammie Vargo prn Labor Day - September 3 CLINIC SCHEDULE Fall Break - October 5 FALL 2007 Eminent Scholar TBD Statehood Day - November 16 No Classes Thanksgiving - November 21 - 25 AUGUST 20 DECEMBER 07 Final Exam Week - December 10 - 14 WEEKS 1 - 16 AM Monday Tuesday Wednesday Thursday Friday DS-4 DS-4 - PEDO DS-4 DS-3 DS-4 Perio (GRN) 6 PERIO 20 PERIO 20 OPER 24 P. SURG 2 DS-3 P. SURG 2 P. SURG 2 FPD 7 OPER 24 PERIO 16 FPD 23 OPER 24 *RPD 12 FPD 22 P. SURG 2 RPD 12 FPD 6 ENDO 11 ENDO 11 OPER 24 ENDO 6 RPD 12 OD - BURG 6 RPD 12 FPD 6 OD - BURG 6 ENDO 6 RPD 12 OD - BROWN 4 DS-2 PAIRED ENDO 6 PERIO/OD 24 OD - BURG 6 Grad Perio 3 **Reserve 3 TPC 10 OCCL 1 DH-1 DH-1 DH-1 DH-2 Yellow/OR 24 BLUE CLINIC 12 YELLOW/OR 24 GRN CLINIC 12 PM Monday Tuesday Wednesday Thursday Friday DS-3 PEDO/ORTHO DS-3 & DS-4 DS-4 PEDO/ORTHO DS-4 DS-3 PEDO/ORTHO PERIO 16 OPER 24 DS-2 PAIRED P. SURG 2 DS-3 FPD 22 DS-4 PERIO/OD 24 OPER 24 OPER 24 ENDO 11 FPD 21 OCCL (DS-2) FPD 21 RPD 12 ENDO 6 OPER (TX PLANS) RPD 12 ENDO 11 DS-1 PAIRED OD - GRN 6 ORAL 3 6 Grad Perio OD - BURG PROPHYLAXIS **Reserve 3 TECHNIQUE TPC 10 BRN CLINIC 24 OCCL 1 OD 5 DH-2 DH-2 DH-2 GRN CLINIC 24 GRN CLINIC 16 GRN CLINIC 12 2 DS-IV Dental Hygiene Rotation Fall 2007 P.M. P.M. Week 1 Week 9 Tues, Aug Tues, Oct 16 McConnell, Mindy 21 Wed, Aug 22 Wed, Oct 17 McNair, Daniel Week 2 Week 10 Tues, Aug Fortenberry, Alan Tues, Oct 23 Dunnington, Cody 28 Wed, Aug 29 Hobbs, Randi Wed, Oct 24 Mohanna, Parnam Week 3 Week 11 Tues, Sep 4 Bockus, Marie Tues, Oct 30 Pfeifer, Somer Wed, Sep 5 Coever, Ashley Wed, Oct 31 Schafer, Nicki Week 4 Week 12 Tues, Sep 11 Deming, Steven Tues, Nov 6 Vinson, Christopher Wed, Sep 12 Saumur, Michael Wed, Nov 7 Vu, John Week 5 Week 13 Tues, Sep 18 Spencer, Lauren Tues, Nov Lawson, Mark 13 Wed, Sep 19 Sulaver, Blake Wed, Nov Ludwig, Brian 14 Week 6 Week 14 Tues, Sep 25 Adams, John Nov 19 -23 Happy Thanksgiving Wed, Sep 26 Allen, Ross Week 7 Week 15 Tues, Oct 2 Abou-Nasser, Elie Tues, Nov Holder, Wendy 27 Wed, Oct 3 Adams, Blake Wed, Nov Torabi, Ali 28 Week 8 Week 16 Tues, Oct 9 Hammond, Kendra Tues, Dec 4 Christensen, André Wed, Oct 10 Kierl, Philip Wed, Dec 5 Jenkins, Jennifer Week 17 Dec 10 – 14 Finals Week 3 Spring Rotation, if you have not been assigned a Hygiene Recall date for the fall Bullard, Blake Pettigrew, Janna Tetik, Whitney Cole, Matthew Dauphin, Jeromy Weaver, Zane Hager, Mary Wright, Asher Sigmon, Clay Hammond, Lindsay Spurlock, Sara Winters, Tyler Jensen, Jamon Albiston, Robert Shutts, Terrance Swisher, Brendon Chang, Jason Tims, Kara Lanman, Ryan Sixkiller, Cheryl Whitman, Ryan Noah, Ryan Odejimi, Shina Streight, Ryan Peterson, Lindsay Roberts, Ryan Youngblood, Chase Whenry, Lauren 4 SECTION E Curriculum & Competencies University of Oklahoma College of Dentistry 2007-2008 DENTAL HYGIENE CURRICULM 3RD Course Title Clock Faculty/Student Course YEAR Crd Hours/ Ratio Director Hrs Week Fall Lec Lab Cln Lec Lab Cln DH 3342 Head & Neck Anatomy 2 2 0 0 1:46 McClung DH 3242 Gen/Oral Histology 2 2 0 0 1:46 McClung DH 3271 Dental Morphology 1 1 0 0 1:46 Wilson DH 3313 Clinical DH Theory I 3 3 0 0 1:46 Vargo DH 3312 Clinical Dental Hygiene I 2 0 8 0 NA 1:4 Vargo DH 3322 Oral Diagnosis 2 2 0 0 1:46 Beavers DH 3423 Oral Radiography I 3 2 2 0 1:46 1:5 Masood DH 3513 Preventive Dentistry 3 3 0 0 1:46 Cunningham/ French DH 4401 Periodontics I 1 1 0 0 1:106 Carson TOTAL for Semester 19 16 10 0 Spring DH 3111 1 1 0 0 1:46 White Pediatric Dentistry DH 3113 Pharmacology 3 3 0 0 1:46 Settle DH 3121 Geriatric Dentistry 1 1 0 0 1:46 Beavers/ Vargo DH 3422 Clinical DH Theory II 2 2 0 0 1:46 Vargo DH 3323 Clinical Dental Hygiene II 3 0 0 9 NA 1:4 Vargo DH 3421 Oral Radiography II 1 1 0 0 1:46 Masood DH 3441 Dental Mat. Science 1 1 0 0 1:46 1:12 Khajotia DH 3523 DH Research Methods 3 3 0 0 1:46 Coury DH 4421 Ethics and Jurisprudence 1 1 0 0 1:46 Cunningham DH 4501 Periodontics II 1 1 0 0 1:106 Weiner TOTAL for Semester 17 14 0 9 4th YEAR Fall Applied Dental Materials 1 0 1 0 1:46 1:10 Coury/Bowers DH 3411 DH 4144 Oral Pathology 4 4 0 0 1:46 Houston DH 4331 Clinical Rotation I 1 0 0 3 NA 1:5 Gray DH 4332 Dental Hygiene Process of 2 2 0 0 1:46 Gray Care DH 4336 Clinical Dental Hygiene III 6 0 0 12 NA 1:5 Gray DH 4472 Pain Control 2 2 0 0 1:106 1:5 Henson DH 4552 Comm. Health Issues 2 2 0 0 1:46 Cunningham DH 4601 Periodontics III 1 1 0 0 1:106 Dmytryk TOTAL for Semester 19 11 1 15 40 Spring DH 4341 Clin. Rotation II 1 0 0 3 NA 1:5 Gray DH 4442 Advanced Clinical DH 2 0 0 0 1:46 Gray Practice DH 4446 Clinical Dent. Hyg. IV 6 0 0 12 1:46 1:5 Gray DH 4411 Practice Management 1 1 0 0 1:46 French DH 4413 Senior Capstone Seminar 3 2 2 0 1:46 Bowers DH 4541 Comm. Health Practicum 1 0 3P 0 NA Cunningham P = Practicum TOTAL for Semester 14 3 5 15 PROGRAM TOTAL 69 44 16 39 41 Competencies for the Entry-Level Dental Hygienist UNIVERSITY OF OKLAHOMA COLLEGE OF DENTISTRY COMPETENCIES FOR THE ENTRY-LEVEL DENTAL HYGIENIST Introduction/Definitions Dreyfus, et al.* describe five stages from beginner to being an expert. Stage One (Beginner) is characterized by learning facts and features relevant to a skill and acquiring the rules for determining actions. "They are rule driven, externally motivated, lack understanding of any but the surface features of what they are doing, fail unless a knowledgeable person structures nearly ideal situations and offers frequent guidance."** Stage Two (Novice) is characterized by obtaining practical experience in concrete situations with meaningful elements. "They understand a great deal about the theory underlying what they are doing and are sometimes able to use it in combination with rules to guide behavior. Stage Three (Competence) is characterized by a hierarchical procedure of decision making. "They are capable of independent performance. They are skilled enough to handle situations that arise under normal circumstances, understand what actions are necessary, recognize when the challenge is beyond their talents, manage tasks that are not going well, take pride in doing well, and find intrinsic reward in their own good performance."** Stage Four (Proficiency) involves the development of intuition to use patterns without decomposing them. "Proficiency involves greater breadth and depth of understanding, and ability to handle a wider range of presenting problems."** Stage Five (Expert) is characterized by knowing what to do based on mature and practiced understanding. This level "includes fluid and natural responses to a great range of problems. It also includes the highest level of professionalism in terms of internalized standards."* ______________ * Dreyfus, H.L. and Dreyfus, S. E.: Mind Over Machine. New York: The Free Press, 1986. ** Chambers, D.W.: Competencies: A New View of Becoming A Dentist. Personal communication. The entry-level dental hygienist is generally considered to be at stage three -- competency. With additional experience and perhaps additional training, he/she may progress to become a master or expert in dental hygiene. The development of competency statements is an attempt to define 42 what knowledge, skills and attitudes the entry-level dental hygienist should possess that are a typical part of the practice of dental hygiene and able to be performed at or above an acceptable level of defined standards by entry-level dental hygienists. These then provide a standard for defining the core content of the curriculum and allowing the assessment of outcomes of our curriculum. ORGANIZATION Domains The general organization of this document (And ultimately the curriculum) is structured from the general to the more specific. Three "Domains" have been identified. These represent broad categories of professional activity and concerns which occur in the general practice of dental hygiene. By design, these categories have not been related to specific sections within the University of Oklahoma College of Dentistry Department of Dental Hygiene because that administrative structure does not reflect the delivery of oral health care. The concept of Domains is intended to encourage an eventual structure and process in the curriculum that is more interdisciplinary and less sectional. In this document, the Domains are indicated by Roman numerals (I-VI). Major Competencies Within each Domain, one or more "Major Competencies" are identified as relating to that Domain's activity or concern. A Major Competency is the ability to perform or provide a particular, but complex, service or task. For example, "The entry-level dental hygienist must be able to perform an examination that collects biological, psychological and social information needed to evaluate the medical and oral condition for patients of all ages." The complexity of this service suggests that multiple and more specific abilities are required to support the performance of any Major Competency. In this document, Major Competencies are indicated by Arabic numbers (1-20). Supporting Competencies The more specific abilities could be considered subdivisions of the "Major Competencies" and are termed "Supporting Competencies." Examples of Supporting Competencies would include "The ability to identify the chief complaint and reason for the patient's visit." or "The ability to perform a radiographic examination appropriate for the patient." Achievement of a major competency requires the acquisition and demonstration of all Supporting Competencies related to that particular service or task. While less complex than a Major Competency, a Supporting Competency also requires more specific abilities which are termed "Foundational Competencies." The Supporting Competencies are listed by decimal numbering under their respective Major Competencies. Foundational Competencies Foundational competency is the product of didactic and laboratory instruction which imparts the information and experiences that are prerequisite for satisfactory attainment of Supporting Competencies. Foundational ability encompass knowledge, skill and attitudes. Foundational knowledge is the ability to use information and correctly answer specific questions when asked, for example, on an examination. Foundational attitudes are positive intellectual and behavioral actions, i.e., scheduling appointments in the patient's best interest and not at the student's convenience. The basic medical and dental sciences, behavioral sciences and clinical sciences all provide instruction at the foundational level. Didactic, small group, seminar and laboratory instruction 43 provides information and psychomotor experiences that enable students to acquire and demonstrate competence in the clinical setting or context. The inclusion of any specific foundational competency in the curriculum should be based on the direct support of one or more of the "Supporting" and "Major" Competencies. Once a competency has been stated, it is not repeated even though it may relate to later "Major" or "Secondary" competencies as well. In time, a complete definition of the curriculum will identify all "Foundational Competencies." These "Foundational Competencies" are associated with particular "Supporting Competencies" and are listed without regard to ranking or priority. The "Foundational Competencies" are listed by decimal numbering under their respective Supporting Competencies. SUMMARY The worth and practicality of Competencies for the Entry-Level Dental Hygienist will depend on its acceptance and application by the faculty responsible for the dental hygiene educational mission of the University of Oklahoma College of Dentistry. In the process of defining the curriculum content, competencies also emphasize the educational philosophy that ensures new dental hygiene graduates are competent to provide whole patient care. Competencies should never be chiseled in stone, but responsive to and reflective of the educational needs of our students. Ultimately, the true measure of the value of competencies will be the quality of our graduates in the care they render to the patients they treat. 44 THE UNIVERSITY OF OKLAHOMA COLLEGE OF DENTISTRY COMPETENCIES FOR THE ENTRY-LEVEL DENTAL HYGIENIST I. PROFESSIONALISM The competent dental hygiene practitioner provides skilled care using the highest professional knowledge, judgment and ability (ADHA Code of Ethics). This skilled care should be based on contemporary knowledge, and the practitioner should be capable of discerning and managing ethical issues and problems in the practice of dental hygiene. However, the practice of dental hygiene occurs in a rapidly changing environment where therapy and ethical issues are influenced by regulatory action, economics, social policy, cultural diversity and health care reform. Additionally, dental hygiene is trying to create a unique identity for the profession and increase the knowledge base. Thus, the competent dental hygienist must have regular involvement with large and diverse amounts of information in order to be prepared to practice in this dynamic environment. 1. Ethics: the entry-level dental hygienist must be able to discern and manage ethical issues of dental hygiene practice in a rapidly changing environment. Specifically, the dental hygienist must: 1.1. Apply the provisions of the Oklahoma State Dental Practice Act in dental hygiene practice. 1.2 Apply the provisions of the American Dental Hygienists' Association Code of Ethics in dental hygiene practice. 1.3. Apply the principles of ethical behavior in decision-making, in interactions with patients and staff, and in personal conduct. 2. Information Management and Critical Thinking: the entry-level dental hygienist must be able to acquire and synthesize information in a critical, scientific and effective manner. Specifically, the dental hygienist must: 2.1 Recognize and use written and electronic sources of information. 2.2 Evaluate the credibility and potential hazards of dental products and techniques. 2.3 Evaluate published clinical and basic science research and integrate this information to improve the oral health of the patient. 2.4 Recognize the responsibility and demonstrate the ability to communicate professional knowledge verbally and in writing. 2.5 Accept responsibility for solving problems and making decisions based on accepted scientific principles, as well as the accepted standard of care. 3. Professional Identity: the entry-level dental hygienist must be concerned with improving the knowledge, skill, and values of the profession. Specifically, the dental hygienist must: 3.1 Advance the profession through leadership, service activities and affiliation with professional organizations. 3.2 Expand and contribute to the knowledge base of dental hygiene. 3.3 Promote the values of the profession to the public and other organizations outside of the dental profession. II. HEALTH PROMOTION AND PREVENTION 45 The dental hygienist serves the community in both practice and public health settings. Public health is concerned with promoting health and preventing disease through organized community efforts, which is an important component of any interdisciplinary approach. In the practice setting, the dental hygienist plays an active role in the promotion of optimal oral health and its relationship to general health. The dental hygienist therefore should be competent in the performance and delivery of oral health promotion and disease prevention services in the public health, private practice and alternative settings. 4. Self-Care Instruction: the dental hygienist must be able to provide planned educational services using appropriate interpersonal communication skills and educational strategies to promote optimal health. Specifically, the entry-level dental hygienist must: 4.1 Promote preventive health behaviors by maintaining optimal personal oral and general health. 4.2 Identify the health needs of individuals and assist them in the development of appropriate and individualized self-care regimens. 4.3 Respect the goals, values, beliefs and preferences of the patient while promoting optimal oral and general health. 4.4 Evaluate factors that can be used to promote patient adherence to disease prevention and encourage patients to assume responsibility for health and wellness. 5. Community involvement: the entry-level dental hygienist must be able to initiate and assume responsibility for health promotion and disease prevention activities for diverse populations. Specifically, the entry-level dental hygienist must: D. Promote the values of oral and general health and wellness to the public and organizations within and outside the profession. 5.2 Identify services that promote oral health and prevent oral disease and related conditions. 5.3 Assess, plan, implement and evaluate community-based oral health programs. 5.4 Be able to influence consumer groups, businesses and government agencies to support health care issues. 5.5 Use screening, referral and education to bring consumers into the health care delivery system. 5.6 Provide dental hygiene services in a variety of settings including offices, hospitals, clinics, extended care facilities, community programs, and schools. 5.7 Discuss selected reimbursement mechanisms and their impact on the patient's access to oral health care. III. PATIENT CARE The dental hygienist is a licensed preventive oral health professional who provides educational and clinical services in the support of optimal oral health. The dental hygiene process of care applies principles from biomedical, clinical and social sciences to diverse populations that may include the medically compromised, mentally or physically challenged, or socially or culturally disadvantaged. 46 6. Assessment: the dental hygienist must be able to systematically collect, analyze and accurately record baseline data on the general, oral and psychosocial health status using methods consistent with medicolegal principles. Specifically, the entry-level dental hygienist must be able to: 6.1 Obtain, review and update a complete medical, family, psychological, and dental history, including assessment of vital signs, and be able to record the findings. 6.2 Recognize the patient record as a legal document and maintain its accuracy and consistency. 6.3 Recognize medical conditions and medications that require special precautions or consideration prior to or during dental hygiene treatment. 6.4 Identify the patient at risk for a medical emergency and be prepared to handle the emergency should it occur during an appointment. 6.5 Perform an extraoral & intraoral examination and record the findings. 6.6 Perform an examination of the teeth and accurately record the results. 6.7 Recognize need for & obtain radiographs of diagnostic quality. 6.8 Radiographically distinguish normal from abnormal anatomical findings. 6.9 Evaluate the periodontium and identify conditions that compromise periodontal health and function. 6.10 Identify conditions and diseases that affect dietary intake and food selection, and recognize risks and benefits of alternative food patterns. 6.11 Analyze and interpret the data related to and congruent with the diagnosis of the dentist and other health professionals. 6.12 Utilize, interpret and analyze appropriate indices for patient assessment. 6.13 Assess and analyze patient risk factors that may impact dental hygiene care. 7. Planning: the dental hygienist must be able to discuss the condition of the oral cavity, actual and potential problems identified, etiological and contributing factors, as well as recommended and alternative treatments available. Specifically, the entry-level dental hygienist must be able to: 7.1 Use critical decision-making skills to reach conclusions about the patient's dental hygiene needs based on all available assessment data including: 7.1.1 Use of assessment findings, etiologic factors, clinical and other diagnostic data in determining a dental hygiene diagnosis. 7.1.2 Identification of patient needs and significant findings that impact the delivery of dental hygiene care. 7.2 Determine priorities and establish oral health goals with the patient/family and/or guardian as an active participant. 7.3 Using a problem-based approach establish a planned sequence of educational and clinical services based on the diagnosis. 7.4 Communicate the plan for dental hygiene services to the dentist or other interdisciplinary health team members to determine its congruence with the overall plan for oral health care. 7.5 Communicate the plan for dental hygiene services to the patient, including its congruence with the overall plan for oral health care. 8. Implementation: the dental hygienist must be able to provide treatment in compliance with the overall treatment plan that includes preventive and therapeutic procedures to 47 promote and maintain oral health and assist the patient in achieving oral health goals. Specifically, the entry-level dental hygienist must be able to: 8.1 Evaluate and utilize methods to ensure the health and safety of the patient and the dental hygienist in the delivery of dental hygiene care. 8.2 Apply basic and advanced principles of both hand and powered dental hygiene instrumentation to locate and remove deposits without undue trauma to hard and/or soft tissue: 8.2.1 Compare/contrast use of hand & powered instruments; 8.2.2 Identify indications and contraindications for sonic and ultrasonic use; 8.2.3 Identify appropriate instrument and/or insert for task; 8.2.4 Demonstrate finger rests & fulcrums for use of hand instruments; 8.2.5 Demonstrate placement, adaptation, angulation and working strokes with hand instruments; 8.2.6 Appropriately utilize explorers, curettes, scalers, and other suitable hand instruments; 8.2.7 Demonstrate finger rest modifications for powered instruments; 8.2.8 Utilize standard ultrasonic or sonic insert for removal of heavy calculus; 8.2.9 Utilize modified ultrasonic inserts for subgingival debridement and root planing. 8.3 Control pain and anxiety during treatment through the use of accepted clinical techniques and appropriate behavioral management strategies, including, but not limited to: 8.3.1 administration of local anesthesia 8.3.2 application of topical anesthesia 8.4 Select and administer appropriate chemotherapeutic agent and provide pre- and post-treatment instructions. 8.4.1 subgingival irrigation technique 8.4.2 use of site specific delivery vehicle systems 8.4.3 professional and home fluoride therapy 8.5 Provide adjunct dental hygiene services that can be legally performed including, but not limited to: 8.5.1 application of pit and fissure sealants 8.5.2 cleaning of removable prostheses and insertion 8.5.3 placement of temporary restoration 8.5.4 care and maintenance of restorations 8.5.5 selective coronal polishing 8.5.6 taking impressions 8.5.7 providing health education and preventive counseling 8.5.8 providing nutritional counseling related to oral conditions and/or disease 8.6 Describe experiential adjunct procedures 8.7 Implement and evaluate measures to minimize occupational hazards in the work place, including postural and engineering factors, such as equipment and instrument design. 9. Evaluation: the dental hygienist must be able to evaluate the effectiveness of planned clinical and educational services and modify as necessary. Specifically, the entry-level dental hygienist must be able to: 9.1 Determine the outcomes of dental hygiene interventions (re-evaluation) using indices, instruments, examination techniques and patient self-report. 9.2 Evaluate the patient's satisfaction with the oral health care received and the oral health status achieved. 48 9.3 Provide subsequent treatment based on evaluation findings. 9.4 Develop and maintain a continuing care program. ACKNOWLEDGMENTS This document is based on work previously completed at the University of Oklahoma College of Dentistry, as well as that carried out by several other schools of dentistry, including the University of California, Los Angeles; Baylor College of Dentistry; SUNY at Buffalo; University of Puerto Rico; The University of Texas Health Science Center at San Antonio; and the University of the Pacific, as well as the AADS document, Competencies for Entry into the Profession of Dental Hygiene. The Commission on Dental Accreditation will review complaints that relate to a program's compliance with the accreditation standards. The Commission is interested in the sustained quality and continued improvement of dental and dental-related education programs but does not intervene on behalf of individuals or act as a court of Appeal for individuals in matters of admission, appointment, promotion or dismissal of faculty, staff or students. A copy of the appropriate accreditation standards and/or the Commission's policy and procedure for submission of complaints may be obtained by contacting the Commission at 211 East Chicago Avenue, Chicago IL 60611 or by calling 1-800-621-8099 extension 2719. 49 Clinical Competencies by Student Level Pre-Clinic I *Dental Charting *Medical History Infection Control Multiple Instrument Competencies Rubber Cup Polishing Fluoride Tray Oral Inspection and Recording (EIE) Instrument Sharpening Clinic II Calculus Removal on CDI B Plaque Removal Patient Education for basically healthy periodontal and dental patients (OHI) *Treatment Planning – CDI B patient *Care of Removable Prosthesis *Medical Emergencies Clinic III *Treatment Planning - CDI C patient Periodontal Charting on CDI C patient Calculus Removal and Root Planing on CDI C patient Ultrasonic Scaling Nitrous Oxide/Oxygen Analgesia Administration Clinic IV Periodontal Charting on CDI D patient Calculus Removal and Root Planing on CDI D patient Local Anesthesia *Competency determined by written exam All other competencies examined by clinical exam 50 SECTION F HEALTH ISSUES ANTIBIOTIC PREMEDICATION GUIDELINES (2007) Current AHA Recommendations for Antibiotic Premedication for Prevention of Subacute Bacterial Endocarditis (SBE) Table 2: Primary Reasons for Revision of the IE Prophylaxis Guidelines • IE is much more likely to result from frequent exposure to random bacteremias associated with daily activities than from bacteremia caused by a dental, GI tract or GU tract procedure. • Prophylaxis may prevent an exceedingly small number of cases of IE, if any, in individuals who undergo a dental, GI tract, or GU tract procedure. • The risk of antibiotic-associated adverse events exceeds the benefit, if any, from prophylactic antibiotic therapy. • Maintenance of optimal oral health and hygiene may reduce the incidence of bacteremia from daily activities and is more important than prophylactic antibiotics for a dental procedure to reduce the risk of IE. Table 3: Cardiac Conditions Associated with the Highest Risk of Adverse Outcome from Endocarditis for Which Prophylaxis with Dental Procedures Is Recommended • Prosthetic cardiac valve • Previous infective endocarditis • Congenital heart disease (CHD)* o Unrepaired cyanotic CHD, including palliative shunts and conduits o Completely repaired congenital heart defect with prosthetic material or device, whether placed by surgery or by catheter intervention, during the first six months after the procedure** o Repaired CHD with residual defects at the site or adjacent to the site of a prosthetic patch or prosthetic device (which inhibit endothelialization) 48 • Cardiac transplantation recipients who develop cardiac valvulopathy * Except for the conditions listed above, antibiotic prophylaxis is no longer recommended for any other form of CHD **Prophylaxis is recommended because endothelialization of prosthetic material occurs within 6 months after the procedure Table 4: Dental Procedures for which Endocarditis Prophylaxis is Recommended for Patients in Table 3 All dental procedures that involve manipulation of gingival tissue or the periapical region of teeth or perforation of the oral mucosa * *The following procedures and events do not need prophylaxis: routine anesthetic injections through noninfected tissue, taking dental radiographs, placement of removable prosthodontic or orthodontic appliances, adjustment of orthodontic appliances, placement of orthodontic brackets, shedding of deciduous teeth and bleeding from trauma to the lips or oral mucosa. 49 Table 5: Regimens for a Dental Procedure Regimen- Single Dose Situation Agent 30-60 minutes before procedure Adults Children Oral Amoxicillin 2gm 50mg/kg Unable to take Ampicillin 2g IM or IV* 50 mg/kg IM or IV oral medication Or Cefazolin or ceftriaxone 1 g IM or IV 50 mg/kg IM or IV Allerigic to Cephalexin**† 2g 50 m/kg penicillins or OR ampicillin Clindamycin 600mg 20 mg/kg Oral OR Azithromycin or Clarithromycin 500mg 15 mg/kg Allergic to Cefazolin or ceftriaxone† 1 g IM or IV 50 mg/kg IM or IV penicillins or OR ampicillin and Clindamycin 600 mg IM or IV 20 mg/kg IM or IV unable to take oral medication *IM – intramuscular; IV – intravenous. **or other first or second generation oral cephalosporin in equivalent adult or pediatric dosage. †Cephalosporins should not be used in an individual with a history of anaphylaxis, angioedema, or urticaria with penicillins or ampicillin 50 PROTOCOL FOR PRE-MED PATIENTS at OUCOD Rev 7/06 REMEMBER: **If a patient has taken antibiotic pre-medication, they may not be rescheduled for appointment #2 for 9-14 days. ASK ALL PATIENTS IF THEY NEED PREMED, just to verify, when you are scheduling an appointment AND confirming. IF A PATIENT NEEDS A PRESCRIPTION CALLED IN Request chart, give to Linda Hale with note attached requesting premed and Director of Clinic Operations will call it in. Then, call the patient & inform them that the prescription awaits them. IF PATIENT ARRIVES WITHOUT TAKING PRE-MED Go to OD with chart, ask for antibiotic, get chart signed by OD faculty. Dispense medication to your patient. Proceed with NON-INVASIVE treatment, waiting a minimum of 1 HOUR before probing. IF THERE ARE NO FACULTY IN OD, go to GOLD CLINIC. Request antibiotic from dispensary personnel, have faculty in Gold Clinic sign the log book AND sign patient chart. 51 OUCOD Hypertension Guidelines November 12, 2003 The Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure has issued n guidelines for classification of hypertension for purposes of prevention and management, as of May 2003. BP Scheme for Adults • Normal systolic BP < 120 and diastolic BP < 80 • Pre-hypertension SBP 120-139 or DBP 80-89 • Stage 1 hypertension SBP 140-159 or DBP 90-99 • Stage 2 hypertension SBP > 160 or DBP> 100 For patients with hypertension, the basic BP control target is <140/<90, but the target is <130/<80 for patients with diabete renal disease. PRESSURE RANGE OUCOD DENTAL THERAPY CONSIDERATIONS <120 Routine dental management. Recheck every recall. <80 120-139 Routine dental management. Recheck on subsequent visits. 80-89 Stress reduction protocol if indicated. Refer to physician if in this range for 3 consecutive appointments. 140-159 Recheck in 5 minutes. If still elevated, other factors (age, apparent 90-99 health, apprehension, history or hypertension, etc) will determine if dental treatment is possible at this time or medical referral is necessary. 160-180 Recheck in 5 minutes. If still elevated, medical consult prior 100-110 to dental treatment is indicated. After medical clearance, routine dental care with indicated stress reduction. >180 Recheck in 5 minutes. Immediate medical consultation if still 110 elevated. No dental therapy until elevated blood pressure under control OUCOD COUMADIN THERAPY PROTOCOL Spring 2007 Each patient should be considered on a case-by-case basis. Consult regarding INR: If INR 3.5 or less, most surgical procedures can be performed (like perio surgery and extractions) with no modifications. Local measures may be instituted to control blood loss, including gauze pressure, Gelfoam, CollaPlug, Surgicel, Bone wax, tranexamic acid and some others. However, this should only be necessary when major invasive events have occurred. Generally there is no need to stop or alter anticoagulant therapy for most dental procedures. For those (again, major) in which it is necessary, low molecular weight heparins are available to bridge the gap between cessation of Coumadin and starting it again post-op. This is a physician's call, not the dentist's. The AAP's official position is no treatment modification is indicated in patients with an INR of 3.5 or below, and implementation of local hemostatic agents is encouraged. So, ideally, you should know the patient's most recent INR (like within the last month or so). However, that is sometimes difficult to find out easily. If a patient is on 2.5 mg of Coumadin per day, they are more than likely going to be within the recommended INR range. If they are taking 5 mg, they are probably still okay, although bleeding may need to be controlled with local measures. At a dose of 10 mg, you should definitely have a physician recommendation, as the INR will probably be above 3.5. Recommendations for restorative procedures, simple exodontia and scaling/root planing would call for the patient to continue their anticoagulant medication. 53 EMERGENCY PROCEDURES Medical Emergencies in the Dental Office: The student is expected to: 1. Perform prophylactic procedures for preventing emergencies prior to treatment at each appointment (or ascertain that this has been accomplished) including: A. Always review the medical/dental history. B. Always perform a general assessment of patient. C. Always check vital signs when indicated by COD blood pressure protocol. 2. Evaluate and identify symptoms of medical emergencies which may occur in the dental office including: A. Circulatory emergencies 1. syncope 2. shock 3. toxic reaction 4. cardiac arrest 5. angina pectoris 6. acute myocardial infarction 7. postural hypotension B. Neurologic disturbances 1. seizures 2. cerebrovascular accident (stroke, CVA) C. Allergic reactions 1. anaphylaxis 2. allergic reaction to penicillin 3. acute asthmatic attack D. Metabolic disease 1. diabetic hypoglycemia 2. diabetic hyperglycemia 3. acute adrenal insufficiency 4. thyroid storm 5. myxedema coma E. Respiratory disturbances 1. hyperventilation 2. airway obstruction 3. acute pulmonary edema 54 PROTOCOL for LIFE THREATENING EMERGENCIES at OUCOD 1. Summon aid immediately without alarming the patient or other patients. Notify clinic faculty. They will remain with your patient and institute basic life support if needed. 2. The clinic faculty will: a. send someone to retrieve AED. b. send someone to the 1st floor main entrance to meet the EMS. c. direct someone to call Oral Surgery x 1-4079 d. direct patient's student to call 14911 (DO NOT call -16326) e. campus police will connect you to the EMS 1. identify yourself 2. identify the college 3. give floor number 4. give name of clinic 5. remain on telephone until EMS arrives NOTE: Students are required to achieve certification in CPR in the fall of the junior and senior year. EMERGENCY NUMBERS are posted in clinic next to telephone. Campus police 1-4911 Oral Surgery 1-4079 or 1-4441 Ambulance 1-4911 Fire 1-4911 Poison Control 1-5454 Exposure, needlestick/injury Kathan Kent 1-3083; (M) 206-3978 Infection Control Office 1-3083 Patient aspiration foreign object 1-3083 Kathan Kent pager 9-660-7656 55 Equipment Emergency drugs and equipment shall be readily available in assigned location in the clinic area. This emergency kit shall be currently equipped and organized to provide treatment for unconsciousness, respiratory difficulty, seizures, drug-related emergencies, chest pain and cardiac arrest Personnel All clinic faculty and students will be certified to perform basic life support and cardiopulmonary resuscitation. This certification will be renewed annually. Emergency drugs and equipment must be available in the dental clinic. Most emergency situations will not require drug administration; however, emergency drugs may prove to be life- saving on some occasions. Eye Station In the event a foreign body gets into the eyes, an eye station is available for emergency care. The station is centrally located and attached to a sink. The eye station is marked for easy detection. Students are taught the use of this station. All incidents of injury should be reported to the Clinic Coordinator. Chemical Burns The accidental contact of strong acids or alkalines to skin produces changes that are very similar to those resulting from heat. It is important, however, to ascertain in all cases of chemical burns the nature of the offending material so that intelligent treatment may be given. Acid burns may be neutralized with a mild alkaline (e.g., 5% sodium bicarbonate solution), while alkaline burns may be rinsed with weak acids (vinegar - 3% acetic acid). Washing the burned area with a generous amount of water is preferable followed by the placement of a sterile dressing. 56 SAFETY PROTOCOL FOR CLINICS & LABORATORIES l. Students and faculty will observe all precautions noted in the section on Asepsis and according to the COD Hazard Communication document. 2. Gloves (clinic or utility), masks and protective eyewear (barrier technique) will be worn when handling potentially hazardous materials or equipment. Materials/equipment will be appropriately labeled as to type of hazard. (i.e. caustic, abrasive, corrosive). 3. Students and faculty, staff and patients will observe radiation safety guidelines. Adequate shielding (walls and lead aprons) and distance will be maintained when exposing radiographs in order to protect clinician, faculty, staff and patients as specified in section on Radiation Guidelines. 4. An eyewash station is located in a central clinic location. All students must demonstrate ability to operate eyewash during orientation to clinic (Spring, Junior Year). 5. Avoid injury with sharp instruments and needles. A. Handle sharp items carefully. B. Do not bend or break disposable needles. C. All sharp items are to be placed in an appropriate puncture-resistant container. D. If needles are not recapped, place in a separate area. If recapping is necessary, use a method that protects hands from injury. 6. In the event of an injury with a sharp item, the incident must be reported to Kathy Kent, infection control office (ICO), at x13083 57 SECTION G SENIOR COMPETENCIES & CLINICAL EVALUATION FORM Contraindications -Restricted sodium diet (use sodium free powder) - Respiratory risk - Difficulty swallowing UNIVERSITY of OKLAHOMA COLLEGE of DENTISTRY - Communicable diseases Department of Dental Hygiene - Restorative materials - Exposed root surface AIR POLISHING EVALUATION - Soft spongy gingival - Immunosuppressed STUDENT: CI: DATE: SCORE: /10 Objective: Using an air polisher (Prophy Jet ®, Prophy Mate® etc), and an appropriate patient with light to moderate stain, the student will air polish a minimum of one quadrant using disclosant and following the guidelines with 75% accuracy. Procedure: Student requests permission from CI to verify qualifying patient. CI may provide guidance & direction in patient selection. CI observes procedure and marks "S" if step is satisfactory or "U" if unsatisfactory. (1 point each) Evaluation: 75% accuracy (7.5/10 points) GUIDELINES S U 1. Recognizes indications and contraindications. 2. Properly assembles equipment according to manufacturer's instructions. 3. Properly adjusts controls; applies water based lubricant to patient's lips; applies disclosant 4. Demonstrates proper grasp and fulcrum. 5. Demonstrates proper patient/operator positioning. 6. Demonstrates proper angulation of tip. 7. Controls aerosols, uses correct evacuation. 8. Uses water to rinse periodically. 9. Manages patient to minimize anxiety, discomfort. 10. Properly disassembles unit, disinfects, bags tip, COMMENTS University of Oklahoma College of Dentistry 58 Department of Dental Hygiene Protocol for Bleaching/Whitening Patients PATIENT SELECTION Patient does not have to be a regular clinic patient. (family members, friends are acceptable) RECORDS Patient should have a chart with health history completed The Procedure and Consent form signed Dental Hygiene Only form signed (OKC only) Post-op instructions to patient PROTOCOL Patient should have had a recent prophylaxis (within a year) Patient is scheduled during a regular clinic session Exam for patient acceptability determined by supervising dentist prior to procedure (OKC students email Dr. Panza several days prior to appointment; call her to examine patient at first appointment) PTP from Clinical Instructor PROCEDURE APPOINTMENT #1 Obtain impressions Wrap in a moist towel & place in a ziplock baggy Have CI sign encounter form & TPNs Pour up impressions After 24 hours, trim the casts down to make the trays (stone should be dry prior to placing block-out resin; do not plan on making the trays immediately after you have trimmed them. The block-out resin won't adhere to a moist or wet stone surface) Fabricate trays to be delivered at BOOST appointment Have CI evaluate trays for acceptability APPOINTMENT #2 Perform the Boost whitening treatment Dispense trays with TAKE-HOME whitening syringes AND desensitizing agent Provide verbal and written post-op instructions 59 IN-OFFICE BLEACHING PROCEDURE (BOOST) Armamentarium Mirror explorer surgical suction Saliva ejector Vaseline cheek retractors Cotton swabs air/water 2x2's Isoblock vita shade guide curing light Opal Boost Opal Dam Polaroid camera for pre/post photos 1. Take maxillary and mandibular alginate impressions (pour during first 15 minute session) Trays will be given to patient at completion of visit for at-home-bleaching 2. Establish initial Vita shade with dental shade guide and record findings. a. Lateral and canine shades in both maxillary and mandibular arches 3. Place retractors a. Petroleum jelly on inside of retractors and lips b. Pinch handles, scoop one side of commissure, then the other c. Gently release handles and free lips from retractor borders d. Place bilateral bite block (Isoblock) in premolar area Isoblock keeps patient in comfortable position and able to swallow 4. Place liquid dam a. Dry gingiva with A/W syringe b. Scallop gingiva with gingival barrier (Opaldam) so NO gingiva shows i. Go 1/2 mm onto tooth c. Place dam 1 tooth distal to bleaching area (General rule: first premolar to first premolar, but may be larger due to patient's smile area) i. Build dam slightly larger on most distal tooth to prevent backflow of Hydrogen Peroxide whitening gel d. Move to 12:00 and look toward the apex of the mandibular teeth or lean to 6:00 and look toward the apex of the maxillary teeth; observe for any areas of visible pink gingiva. e. If any visible gingival is seen, recover with Opaldam f. Light cure Opaldam in continuous sweeping motion 3 mm from gingival surface 20 seconds per quadrant (40-60 seconds per arch) 5. Attach activator and Boost end to end a. Mix back and forth 25 times 6. Apply tip to syringe (FX – black with fuzzy white end) 7. Dry teeth,; place whitening agent approximately 1mm thick on facials 8. Allow whitening agent to sit 15 minutes 9. Remove with surgical suction located on INCISAL HALF of tooth – DO NOT TOUCH DAM WITH SUCTION AS THIS MIGHT DISLODGE DAM ALLOWING LEAKAGE a. Gingival burn could result 10. Replace whitening gel for a second 15 minute application. Repeat for 3rd and 4th application if desired In determining how many applications use the vita shade guide (make certain shade tabs are in order of lightest to darkest) 60 B1, A1, B2, D2, A2, C1, C2, D3, A3, D4, B3, A3.5, B4, C3, A4, C4 Under C1 2-15 minute application C1-B3 3-15 minute applications Over B3 4-15 minute applications You can adapt depending on age and shade, choose more or less if desired. Young or yellow teeth whiten faster than old or grey teeth. 11. After final application, suction with surgical suction free of whitening solution, rinse well, and remove dam in one piece 12. Remove cheek retractors and rinse mouth well 13. Check shade with shade guide and record (full shade change will not occur for 24 -48 hours) 14. Place desensitizing tray in patient mouth (if determined useful) Follow up instructions for patient No red wine, grape juice, blackberries, blueberries for 3 days. Drink colas through a straw. If you must drink coffee brush your teeth immediately. If happy with shade change whiten one time at home with trays If patient needs to they can continue whitening with trays. DURING THE PROCEDURE, INSTRUCT PATIENT TO RAISE HAND OF RELATED QUAD IF STINGING SENSATION OCCURS a. Look for bubble in bleaching agent which would relate to probable leak in dam b. Use surgical suction to remove bleach from that point to distal in that quad c. Clean surgical tip d. Go back with surgical suction and rinse area e. Dry area and patch and cure dam f. Replace bleaching solution Fabricate at-home bleaching trays TIPS • Look up the teeth for tissue coverage with the dam • Do not apply the Boost over the incisal edges • Use surgical suction to remove Boost, stay on INCISAL HALF OF TOOTH to avoid dislodging dam • Do not rinse between applications • Place stack of 2x2's on pt napkin to wipe Boost off saliva ejector • If you run out of dam you can use LC block out but be careful of heat • Always have Opalustre handy 61 University of Oklahoma College of Dentistry Department of Dental Hygiene Whitening Options White strips • fund raiser • non-patients of the COD • teenagers • patients with subtle staining • patient who is not ready to commit to tray or in-office whitening Advantages 1. Inexpensive 2. Does not require supervision. 3. Does not require instruction. 4. Does not require tray fabrication. 5. Stepping block to other whitening options 6. Builds patient awareness of dental health Disadvantages 1. Not as effective on crooked teeth because it will not reach into contact area. 2. Not as effective on patient with large smile because it is only canine to canine. 3. Not as effective on patient with tall anatomical crowns because it may not cover entire facial surface. 4. Recommended touch up period of 6 months. 5. Not able to remove more difficult stain TresWhite • Same indications and advantages as strips • Does not have disadvantages 1, 2, 3 or 4 • May require second box for more difficult stain At-home Tray Whitening • 95% of teeth will whiten • removes stains caused by aging • removes stains caused by diet • most effective choice for removing stain caused by medication • 99% of offices offer tray whitening Advantages 1. Inexpensive 2. Custom tray that fits patients teeth perfectly and comfortably 3. Semi-permanent, touch ups only need to be done every 2-4 years and are inexpensive because patient already has the custom tray 4. Can be worn day or night 5. Fast, average patient is done in 6-8 nights or 14 days. 6. Less sensitivity than light activated in-office whitening ***** 7. Very little clinician time required 62 8. Builds cosmetic awareness in patient, usually improves home care 9. Practice builder Disadvantages 1. Sensitivity 2. Patient compliance, they must wear tray consecutive days or nights 3. Tray fabrication takes time to learn 4. Some patients do not like to wear the trays 5. Some patient can not wear the trays In-office or Power Whitening • 95% of teeth will whiten • removes stains caused by aging • removes stains caused by diet • partially effective at removing stain caused by medication • many more offices offer in-office whitening now than ever before • hygienists can perform treatment Advantages 1. Immediate gratification 2. Fast, appointment time from 1-2 hours 3. Patient has trays to do inexpensive touch up in 2-4 years 4. Very little compliance required from patient 5. Increased production on hygiene schedule 6. Depending on the type of in-office whitening done there may be less sensitivity than with trays. This is not true if a light is used to activate gel*** 7. Increases cosmetic awareness and sometimes improves home care 8. Practice builder Disadvantages 1. Most expensive option for patient 2. Most chair time required 3. Requires at least one follow up session with trays 4. Learning curve on placing gingival protection, patient can be burned 5. Cheek retractors can be uncomfortable for patient General statements about whitening 1. Whitening is the least invasive procedure we can offer our patients. 2. It is the least expensive 'makeover' they can give themselves. Compare it to Botox injections, $200+ per area and repeated every 4-6 months, micro pigmentation (tattooed lipstick) $500 and repeated every 3-6 years, chemical peels, $100-800 repeated forever, fake nails $30-40 every 2 weeks. Compare it to dental procedures; one veneer is $800- 900. You can whiten all of your teeth for a fraction of one veneer. Many times whitening will satisfy a patient so much that they cancel appointments for full veneers. This is the least invasive cosmetic procedure available. 3. Whitening is extremely safe. Carbamide peroxide is even used to treat babies with oral candidiasis (thrush). 63 4. Carbamide peroxide is anti-bacterial and anti-microbial. Many times patients with gingivitis will see a reduction in bleeding points and swelling. This is only temporary and will resume if home care does not improve. However, the whitening also tends to increase patient awareness of their home care and many improve it on their own. 5. Whitening occurs when hydrogen peroxide moves through the enamel and into the dentin. The peroxide then breaks up the stain inside the tooth. 6. Yellow or young teeth whiten fast and grey or more mature teeth whiten slower. 7. Tetracycline stained teeth can take up to 6 months to whiten. A patient with these stains should be aware of the time commitment and the extra expense of buying more gel. 8. Whitening will not change the color of crowns, veneers, or composites. Patients should be made aware of this and be prepared to replace those restorations if needed. The COD will not replace restorations due to shade only. Whitening will not harm any restorations. 9. To alleviate sensitivity have patient fill tray with toothpaste containing Potassium Nitrate and wear it for an hour or so. 10. If patient has pain we can supply them with a Potassium Nitrate desensitizing gel to wear in their tray for 1 to 8 hours. 11. Inform patient that acidic drinks such as colas and juices will make the sensitivity worse. 12. Inform patient that sensitivity should not worsen and will go away within a day of the last application. 13. Speed of whitening occurs in direct relation to % of product and time of contact. 14. At-home tray whitening and in-office power whitening followed by at home application will give you the same end result. Everyone has a shade that they can reach irregardless of the percentage used. The difference between the two is just how fast they will get to that shade. 64 University of Oklahoma College of Dentistry Department of Dental Hygiene WHITENING PROCEDURE INFORMATION AND CONSENT • Tooth whitening can, in many cases, restore the youthful color of your teeth. • As in all cosmetic enhancement procedures, there are variables and no results are guaranteed. This procedure does not add color to your smile, but rather returns your teeth to their natural youthful appearance. The type of discoloration affecting your teeth, your dietary habits and maintenance, and the overall condition of your teeth may affect the outcome of the treatment and the length of your results. Additional charges may be incurred for special cases. • Tooth sensitivity may occur during tooth whitening and persist for several days. You may experience "zingers" (shooting sensations that last for a few seconds). The sensitivity is temporary and will resolve with time. The sensitivity may be relieved by a mild analgesic such as Advil or Tylenol. A desensitizing agent may also be used in the bleaching tray overnight until sensitivity subsides. • Exposed root surfaces are grooves, notches or depressions where the teeth meet the gums. These will be isolated from the whitening gel, yet may be sensitive during and/or shortly following the treatment. Exposed root surfaces will not whiten. • Dental restorations such as bridges, crowns (caps), veneers and fillings WILL NOT lighten evenly with other teeth and may need partial or complete replacement. The College of Dentistry DOES NOT replace functional restorations based on color. I understand the nature and purpose of the tooth whitening procedure and I understand the risks, benefits, possibility of complications as well as the expected results of the tooth whitening procedure. I have been given an opportunity to ask and have my questions answered. I further acknowledge that no guarantees have been given to me regarding the results of this procedure and that I may refuse this procedure without jeopardizing any current or future dental treatment with the College of Dentistry. _____________________________ _______________ Patient Signature Date 65 University of Oklahoma College of Dentistry Department of Dental Hygiene INSTRUCTIONS FOR PATIENT No red wine, grape juice, blackberries, blueberries for 3 days. Drink colas through a straw. If you must drink coffee, brush your teeth immediately. If you are happy with the shade change, whiten once at home with custom bleaching trays. If you desire a lighter shade, you may continue whitening with custom bleaching trays. If at any time you experience sensitivity, apply desensitizing gel in trays and wear them for several hours or at night. This may need to be done a several days in a row prior to applying bleach again. If discomfort persists for more than a few days, contact your dental hygiene student at _______________ and s/he will schedule a consultation appointment. 66 UNIVERSITY of OKLAHOMA COLLEGE of DENTISTRY Department of Dental Hygiene CALCULUS CHARTING EXERCISE STUDENT: 0=SMOOTH SURFACE CI: KEY: 1=GRANULAR, LIGHT CALCULUS , OR SMOOTH BURNISHED SCORE: 2=SPICULE(S), MODERATE CALCULUS DATE: 3=LEDGE, RING, HEAVY CALCULUS Objective: Using the ODU 11/12 explorer and mirror, direct vision, transillumination, radiographs and compressed air, the student will chart one quadrant of a CDI "C" or "D" patient on the chart below using the criteria in the key with 75% accuracy. Procedure: • Student requests permission from CI to verify qualifying patient. CI may provide guidance & direction in patient selection. • CI assigns one quadrant with a minimum of 10 clicks of calculus. • Student records amount of calculus present on each of 4 surfaces (M, D, F, L) using key. • CI evaluates while student reads values and marks out incorrect values in RED. • CI calculates score. Divide total correct by total possible. Evaluation: 75% accuracy FACIAL 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 2 R LINGUAL L LINGUALL INGUAL 32 31 30 29 28 27 26 25 FACIAL 24 23 22 21 20 19 18 17 67 SECTION H Junior Clinical Competencies ABBREVIATIONS anes - anesthetic approx. - approximate appt - appointment ASA - aspirin ASAP - as soon as possible b.i.d. - twice a day bilat. - bilateral BP - blood pressure BWX - bitewing radiographs BX - biopsy CC - chief complaint C/C - complete dentures C/P - complete maxillary denture/mandibular partial Ca - cancer Cau. - Caucasian CBC - Complete blood count CHD - Congestive heart disease CHF - Congestive heart failure CNS - Central nervous system cont. - continued COPD - Chronic obstructive pulmonary disease CP - Cerebral palsy CVA - Cerebral vascular attack DC - discontinue DH - dental hygiene DOB - date of birth DX - diagnosis EBV - Epstein Barr Virus EKG or ECG - Electrocardiogram EEG - Electroencephalogram Endo - Endodontics ENT - Ear, nose and throat Eval - evaluation Ext. - extract FMX - Full Mouth survey FPD - Fixed Prosthodontics HBV - Hepatitis B Virus HHx - health history IDDM - Insulin Dependent Diabetes Mellitus IM - Intramuscular mand. - mandibular max. - maxillary meds. - medications MI - myocardial infarction MVP - Mitral Valve Prolapse OP - Operative OS - Oral Surgery prn - as needed PCN - Penicillin 1-A 88 Pt. - patient q. - every q.i.d. - four times a day RCT - root canal treatment Rec. - recommend RHD - Rheumatic Heart Disease RPD - Removable Partial Denture or Removable Prosthodontics Department RXN - reaction SBE - Subacute Bacterial Endocarditis t.i.d. - three times a day TMJ - temporal mandibular joint w/ - with w/o or s - without WNL - within normal limits 1-A 89 BARNHART 5/6 Process Competency Examination TASK COMPONENTS AREA 1 AREA 2 PTS. EVAL OPERATOR POSITIONING Correct height of operator's stool 3 Back in neutral position 3 Wrist in neutral position 3 Correct seating area for instrumentation (Clock positions) 3 PATIENT POSITIONING Back of patient chair adjusted for appropriate arch 3 Height of patient chair adjusted to level of operator's elbow 3 Patient's head adjusted for treatment area 3 Light positioned appropriately for treatment area 3 MOUTH MIRROR Appropriate for area (retracts when appropriate, indirect when 3 appropriate) GRASP Thumb and index finger pads positioned opposite one another on 3 handle; fingers not touching or overlapping Index finger and thumb near handle/shank junction with thumb 3 flexed outward Upper inside corner of middle finger rests lightly on shank 3 Handle rests between second and third knuckle of index finger 3 All fingers contact as a unit (NO SPLITTING) using a stacked 3 fulcrum FULCRUM Tip of ring finger standing as tall as possible 3 Fulcrum on incisal/occlusal edge or embrasure 3 As close as possible to instrumentation area 3 Appropriate palm direction 3 ADAPTATION/INSERTION Correct working end chosen 3 Adapts terminal 1-2 mm of working end 3 Point of insertion appropriate 3 Inserts as close to 0-degrees angulation as possible (terminal shank 3 tipped toward the midline of tooth) Demonstrates insertion into col (half-way facial to lingual) 3 Establishes working angulation of 70-80 degrees 3 ACTIVATION/STROKE (DEMONSTRATED SUPRAGINGIVALLY) Activates with appropriate wrist/forearm motion 3 Pivots stroke from fulcrum 3 Rolls instrument in fingers around line angles 3 Appropriate stroke direction 3 Covers circumference of tooth by channel scaling 3 Toe directed obliquely toward junctional epithelium 3 Short, controlled strokes 3 Appropriate speed 3 OTHER Recognizes tooth number 2 Maintains asepsis 2 INSTRUCTOR: 100 Comments: 1-A 90 _________________Student EXTRA/INTRA ORAL EXAM Process Competency Examination TASK COMPONENTS EVAL PREPARATION Assembles correct armamentarium 2 Patient seated upright in dental chair 2 Removes glasses of patient 2 Operator standing 2 SEQUENCE OF EXTRA ORAL EXAM Uses appropriate technique, pressure, stroke while palpating the following: Visual assessment of patient looking for anomalies of head and neck area 3 Frontal and supraorbital region 3 Infraorbital and zygomatic process region 3 Maxillary sinus region 3 Mandible and parotid gland region 3 Temporal region (pre-auricular) 3 TMJ and masseter 3 Submental, submandibular and sublingual regions 3 Trachea and thyroid 3 Sternocleidomastoid muscle (Anterior cervical lymph chain) 3 Supraclavicular region 3 Trapezius muscle and occipital region (Posterior cervical node chain) 3 Back and lateral portions of neck posterior to Sternocleidomastoid muscle 3 SEQUENCE OF INTRA ORAL EXAM Uses appropriate technique, pressure, stroke while palpating and/or evaluating the following: Visual assessment of lips and commissures 3 Labial mucosa 3 Buccal mucosa 3 Vestibule and frenulas 3 Floor of mouth 3 Tongue 3 Hard and soft palate 3 Uvula, tonsillar pillars, oropharynx 3 Alveolar mucosa 3 Edentulous gingiva if indicated 2 Assess salivary flow by stimulating Stenson's Duct 3 GINGIVAL ASSESSMENT (VERBALIZE TO FACULTY) Color 3 Form 3 Density 3 OTHER Utilizes 'SCSCMLDS' to describe intra/extra oral findings 2 Utilizes mirror where appropriate 2 Correct pt/op positioning for area 2 Light placement appropriate for area 2 Describes self-exam techniques to patient 2 Maintains asepsis 2 INSTRUCTOR: 100 COMMENTS: 1-A 91 ________________Student TOPICAL FLUORIDE (TRAY) Process Competency Examination TASK COMPONENTS PTS. EVAL PREPARATION Assembles complete armamentarium 5 Correct patient positioning (upright) 5 Selects correct tray size 5 Selects appropriate type of fluoride and states rationale 5 PROCEDURE Thin band of fluoride dispensed in tray 8 Thoroughly dries maxillary, then mandibular teeth 8 Instructs patient not to swallow fluoride 8 Correctly places mandibular, then maxillary tray 8 Instructs patient to chew/tap into tray to disperse fluoride to gingival margin thoroughly 8 Places saliva ejector between trays for continuous suction 8 Times procedure correctly 8 Removes trays and excess fluoride 8 Gives appropriate post-treatment instruction 8 OTHER Maintains asepsis 8 INSTRUCTOR: 100 COMMENTS: 92 __________________Student GRACEY 1/2 Process Competency Examination TASK COMPONENTS AREA 1 AREA 2 PTS EVAL OPERATOR POSITIONING Correct height of operator's stool 3 Back in neutral position 3 Wrist in neutral position 3 Correct seating area for instrumentation (Clock positions) 3 PATIENT POSITIONING Back of patient chair adjusted for appropriate arch 3 Height of patient chair adjusted to level of operator's elbow 3 Patient's head adjusted for treatment area 3 Light positioned appropriately for treatment area 3 MOUTH MIRROR Appropriate for area (retracts when appropriate, indirect when 3 appropriate) GRASP Thumb and index finger pads positioned opposite one another on handle; 3 fingers not touching or overlapping Index finger and thumb near handle/shank junction with thumb 3 flexed outward Upper inside corner of middle finger rests lightly on shank 3 Handle rests between second and third knuckle of index finger 3 All fingers contact as a unit (NO "SPLITTING") using a stacked fulcrum 3 FULCRUM Tip of ring finger standing as tall as possible (Handle parallel to long axis) 3 Fulcrum on incisal/occlusal edge or embrasure 3 As close as possible to instrumentation area 3 Appropriate palm direction 3 ADAPTATION/VERBALIZATION OF INSERTION Correct working end chosen 3 Point of insertion appropriate (overlaps midline) 3 Adapts terminal 1-2 mm of working end 3 Verbalizes insertion (slight closure of instrument face to tooth) 3 Establishes working angulation of 60-70 degrees (demonstrate supra) 3 ACTIVATION/STROKE Activates with appropriate wrist/forearm motion 3 Pivots stroke from fulcrum 3 Rolls instrument in fingers around line angles 3 Appropriate stroke direction 3 Covers circumference of tooth by channel scaling 3 Tip directed obliquely toward junctional epithelium 3 Short, controlled stroke 3 Appropriate speed 3 OTHER Recognizes tooth number 3 Maintains asepsis 4 INSTRUCTOR: 100 COMMENTS: OOOO __________________Student GRACEY 11/12 Process Competency Examination TASK COMPONENTS AREA 1 AREA 2 EVAL OPERATOR POSITIONING Correct height of operator's stool 3 Back in neutral position 3 Wrist in neutral position 3 Correct seating area for instrumentation (Clock positions) 3 PATIENT POSITIONING Back of patient chair adjusted for appropriate arch 3 Height of patient chair adjusted to level of operator's elbow 3 Patient's head adjusted for treatment area 3 Light positioned appropriately for treatment area 3 MOUTH MIRROR Appropriate for area (retracts when appropriate, indirect when 3 appropriate) GRASP Thumb and index finger pads positioned opposite one another on handle; 3 fingers not touching or overlapped Index finger and thumb near handle/shank junction with thumb 3 flexed outward Upper inside corner of middle finger rests lightly on shank 3 Handle rests between second and third knuckle of index finger 3 All fingers contact as a unit (NO "SPLITTING) using a stacked fulcrum 3 FULCRUM Tip of ring finger standing as tall as possible 3 Fulcrum on incisal/occlusal edge or embrasure 3 As close as possible to instrumentation area 3 Appropriate palm direction 3 ADAPTATION/VERBALIZATION OF INSERTION Correct working end chosen 3 Point of insertion appropriate (distal line angle) 3 Adapts terminal 2 mm of working end 3 Verbalizes insertion (slight closure of instrument face to tooth) 3 Establishes working angulation of 60-70 degrees (demonstrate supra) 3 ACTIVATION/STROKE (DEMONSTRATED SUPRAGINGIVALLY) Activates with appropriate wrist/forearm motion 3 Pivots stroke from fulcrum 3 Rolls instrument in fingers around line angles 3 Appropriate stroke direction 3 Covers facial to mesial tooth surface by channel scaling 3 Toe directed obliquely toward junctional epithelium 3 Short, controlled stroke 3 Appropriate speed 3 OTHER Recognizes tooth number 3 Maintains asepsis 4 INSTRUCTOR: 100 COMMENTS: 94 __________________Student GRACEY 13/14 Process Competency Examination TASK COMPONENTS AREA 1 AREA 2 EVAL OPERATOR POSITIONING Correct height of operator's stool 3 Back in neutral position 3 Wrist in neutral position 3 Correct seating area for instrumentation (Clock positions) 3 PATIENT POSITIONING Back of patient chair adjusted for appropriate arch 3 Height of patient chair adjusted to level of operator's elbow 3 Patient's head adjusted for treatment area 3 Light positioned appropriately for treatment area 3 MOUTH MIRROR Appropriate for area (retracts when appropriate, indirect when 3 appropriate) GRASP Thumb and index finger pads positioned opposite one another on handle; 3 fingers not touching or overlapped Index finger and thumb near handle/shank junction with thumb 3 flexed outward Upper inside corner of middle finger rests lightly on shank 3 Handle rests between second and third knuckle of index finger 3 All fingers contact as a unit (NO "SPLITTING") using a stacked fulcrum 3 FULCRUM Tip of ring finger standing as tall as possible 3 Fulcrum on incisal/occlusal edge or embrasure 3 As close as possible to instrumentation area 3 Appropriate palm direction 3 ADAPTATION/DEMONSTRATION OF INSERTION Correct working end chosen 3 Point of insertion appropriate (distal line angle) 3 Adapts terminal 1-2 mm of working end 3 Demonstrates insertion (slight closure of instrument face to tooth) 3 Establishes working angulation of 60-70 degrees (demonstrate supra) 3 ACTIVATION/STROKE (DEMONSTRATED SUPRAGINGIVALLY) Activates with appropriate wrist/forearm motion 3 Pivots stroke from fulcrum 3 Rolls instrument in fingers around line angles 3 Appropriate stroke direction 3 Covers distal tooth surface by channel scaling 3 Toe directed obliquely toward junctional epithelium 3 Short, controlled stroke 3 Appropriate speed 3 OTHER Recognizes tooth number 3 Maintains asepsis 4 INSTRUCTOR: 100 COMMENTS: 95 __________________Student H6/H7 SCALER Process Competency Examination TASK COMPONENTS AREA 1 AREA 2 EVAL OPERATOR POSITIONING Correct height of operator's stool 3 Back in neutral position 3 Wrist in neutral position 3 Correct seating area for instrumentation (Clock positions) 3 PATIENT POSITIONING Back of patient chair adjusted for appropriate arch 3 Height of patient chair adjusted to level of operator's elbow 3 Patient's head adjusted for treatment area 3 Light positioned appropriately for treatment area 3 MOUTH MIRROR Appropriate for area (retracts when appropriate, indirect when 3 appropriate) GRASP Thumb and index finger pads positioned opposite one another on 3 handle; fingers not touching or overlapped Index finger and thumb near handle/shank junction with thumb 3 flexed outward Upper inside corner of middle finger rests lightly on shank 3 Handle rests between second and third knuckle of index finger 3 All fingers contact as a unit (NO "SPLITTING") 3 FULCRUM Tip of ring finger standing as tall as possible 3 Fulcrum on incisal/occlusal edge or embrasure 3 As close as possible to instrumentation area 3 Appropriate palm direction 3 ADAPTATION Correct working end chosen (lower cutting edge) 3 Adapts terminal 2 mm of working end 3 Establishes working angulation of 70-80 degrees 3 Tip directed obliquely toward junctional epithelium 3 Overlaps midline at initial placement of instrument 3 ACTIVATION/STROKE Activates with left to right wrist/forearm motion 3 Pivots stroke from fulcrum 3 Rolls instrument in fingers around line angles 3 Appropriate stroke direction 3 Covers circumference of tooth by channel scaling 3 Tip directed obliquely toward junctional epithelium 3 Short, controlled stroke (2-3mm in length) 3 Appropriate speed 3 OTHER Recognizes tooth number 3 Maintains asepsis 4 INSTRUCTOR: 100 COMMENTS: 96 __________________Student MOUTH MIRROR Process Competency Examination STUDENT MUST UTILIZE NON-DOMINANT HAND TO HOLD MIRROR TASK COMPONENTS AREA EVAL MIRROR TECHNIQUE Demonstrates (using NON-DOMINANT hand) and explains uses of mouth mirror: a. Illumination 8 b. Transillumination 8 c. Retraction 8 d. Indirect Vision 8 Thumb and index finger pads positioned opposite one another 7 on handle; fingers not touching or overlapping Index finger and thumb near handle/shank junction 7 Upper inside corner of middle finger rests lightly on shank; 7 touches the ring finger Fulcrum appropriate for area 7 Light position appropriate for area 7 Provides for patient comfort with insertion and placement of 7 mirror Pt/Op position appropriate for area 8 Recognizes tooth number 8 Maintains asepsis 10 INSTRUCTOR: 100 COMMENTS: 97 __________________Student _________________ Student Name ODU 11/12 & SHEPHERD HOOK EXPLORERS Process Competency Examination TASK COMPONENTS EVAL OPERATOR POSITIONING Correct height of operator's stool 3 Back in neutral position 3 Wrist in neutral position 3 Correct seating area for instrumentation (Clock positions) 3 PATIENT POSITIONING Back of patient chair adjusted for appropriate arch 3 Height of patient chair adjusted to level of operator's elbow 3 Patient's head adjusted for treatment area (ex. toward/away, chin-up / down) 3 Light positioned appropriately for treatment area 3 MOUTH MIRROR Appropriate for area (retracts when appropriate, indirect vision when appropriate) 3 GRASP Thumb and index finger pads positioned opposite one another on handle; fingers not 3 touching or overlapped Index finger and thumb near handle/shank junction with thumb flexed outward 3 Upper inside corner of middle finger rests lightly on shank 3 Handle rests between second and third knuckle of index finger 3 All fingers contact instrument as unit (NO "SPLITTING") using a stacked fulcrum 3 Grasp is relaxed but secure (no blanching of fingers) 3 FULCRUM Tip of ring finger standing as tall as possible 3 Fulcrum on incisal/occlusal surface or embrasure 3 As close as possible to instrumentation area (1-2 teeth away) 3 Appropriate palm direction 3 ADAPTATION, INSERTION Correct working end chosen 3 Point of insertion appropriate 3 Adapts 1-2 mm of tip to tooth 3 ACTIVATION/STROKE Activates with appropriate wrist-forearm motion 3 Pivots stroke from fulcrum 3 Rolls instrument in fingers around line angles 3 Appropriate stroke direction (oblique on facial and lingual; vertical into proximal) 3 Light, exploratory stroke pressure 3 Slow, feeling stroke speed 3 OTHER Recognizes tooth number 3 Maintains asepsis 3 SHEPHERD HOOK EXPLORER Demonstrates vertical stroke with appropriate pressure into occlusal surface 10 COMMENTS/INSTRUCTOR INITIALS 100 98 __________________Student PERIODONTAL PROBE Process Competency Examination TASK COMPONENTS AREA 1 AREA 2 EVAL OPERATOR POSITIONING Correct height of operator's stool 4 Back in neutral position 4 Wrist in neutral position 4 PATIENT POSITIONING Back of patient chair adjusted for appropriate arch 3 Height of patient chair adjusted to level of operator's elbow 3 Patient's head adjusted for treatment area 3 Light positioned appropriately for treatment area 3 MOUTH MIRROR Appropriate for area (retracts when appropriate, indirect vision 3 when appropriate) GRASP Thumb and index finger pads positioned opposite one another on 3 handle; fingers not touching or overlapping Index finger and thumb near handle/shank junction with thumb 3 flexed outward Upper inside corner of middle finger rests lightly on shank 3 Handle rests between second and third knuckle of index finger 3 All fingers contact as a unit (NO "SPLITTING) using a stacked 3 fulcrum Grasp is secure and relaxed (no blanching of fingers) 3 FULCRUM Tip of ring finger standing as tall as possible 3 Fulcrum on incisal/occlusal edge or embrasure 3 As close as possible to instrumentation area 3 Appropriate palm direction 3 ADAPTATION/INSERTION Initial insertion at line angle 3 Tip remains in contact with tooth surface 3 Maintains parallelism to long axis of tooth/root morphology 3 Insertion to junctional epithelium 3 ACTIVATION/STROKE Activates with left to right wrist/forearm motion 3 Pivots stroke from fulcrum to maintain parallelism 3 Controlled stroke remaining in sulcus 3 Vertical stroke direction 3 Walking, short stroke covers circumference of tooth 3 Walks to proximal contact 3 Maintains contact with tooth while readjusting angulation to 3 enter col Light pressure against junctional epithelium 3 OTHER Maintains asepsis 4 Recognizes tooth number 3 INSTRUCTOR: 100 COMMENTS: 99 ________________Student RUBBER CUP POLISHING Process Competency Examination TASK COMPONENTS AREA 1 AREA 2 PTS EVAL OPERATOR POSITIONING Correct height of operator's stool 4 Back in neutral position 4 Wrist in neutral position 4 Correct seating area for instrumentation 4 PATIENT POSITIONING Back of patient chair adjusted for appropriate arch 4 Height of patient chair adjusted to level of operator's elbow 4 Patient's head adjusted for treatment area 4 Light positioned appropriately for treatment area 4 MOUTH MIRROR Appropriate for area (retracts when appropriate, indirect when 4 appropriate) GRASP Uses modified pen grasp 4 Holds as near working end as possible 4 FULCRUM Appropriate for working area (intraoral when appropriate and 4 extraoral when appropriate) ADAPTATION/INSERTION Angles rubber cup to flare apical half 4 Appropriate cup direction (Cup pointed toward incisal/occlusal) 4 Turns handpiece to adapt to proximal surface- wraps around line 4 angles Places cup near or slightly below gingival margin 4 ACTIVATION/STROKE Begins stroke at distal/mesial cervical margin 4 Uses intermittent, overlapping strokes 4 Strokes across facial and lingual covering entire surface into 4 proximal Pivots stroke from fulcrum 4 Uses light but secure/controlled stroke 4 Covers occlusal surface with brush 3 Slow, even speed with handpiece 4 OTHER Flosses, rinses and evacuates patient's mouth 3 Recognizes tooth number 3 Maintains asepsis 3 INSTRUCTOR: COMMENTS: 100 ________________Student PATIENT/ OPERATOR POSITIONING (LEFT-HANDED OPERATOR) FRONT of chair denotes operator at 3:00-4:00 BACK of chair denotes operator at 12:00- 1:00 MIDDLE of chair denotes operator at 2:00 MANDIBULAR ARCH POSITIONING Area Chair Back Op Pt Mirror MF=Mirror Face Fulcrum Mandibular Anterior Sextant (22-27) 15 ° up Front Chin Down/ Toward Op Facial: Palm Lingual: Left Commissure #28-24 Near Surfaces (Facial and Lingual) Back Chin Down/ Away from Op Facial: Palm Lingual: Right Commissure #21-25 Far Surfaces (Facial and Lingual) Mandibular Right Posterior Facial Right Facial: Retract from Lt. Commissure Anterior to 15 ° up Front Chin Down/ Toward Op working Mandibular Left Posterior Lingual Left Lingual: Retract tongue, MF toward area tooth, directed from left Commissure Mandibular Right Posterior Lingual Right Lingual: Retract, MF toward tooth Anterior to 15 ° Middle Chin Down/ Away from Op from left commissure working area Mandibular Left Posterior Facial Pos. Facial: Retract , MF toward tooth from left commissure 101 ________________Student MAXILLARY ARCH POSITIONING (Left - handed) Area Chair Back Op Pt Mirror MF = Mirror Face Fulcrum Maxillary Anterior Sextant (6-11) Near Surfaces (Facial and Lingual) 5° up Back Chin Up/ Straight Facial: Palm Lingual: Right Commissure #9-12 Far Surfaces (Facial and Lingual) Maxillary Right Posterior Facial Right Facial: Retract from Lt. Commissure Posterior or 5 ° up Middle to Chin up/ Toward Op on lingual Front cusp of Maxillary Left Posterior Lingual Left Lingual: Retract tongue, MF toward working tooth, directed from Lt. area commissure Maxillary Right Posterior Lingual Right Lingual: Retract, MF toward tooth Anterior to 5 ° up from left commissure working Middle area Maxillary Left Posterior Facial Chin Up/ Away from Op Pos. Facial: Retract , MF toward tooth from left commissure 102 ________________Student PATIENT/ OPERATOR POSITIONING (RIGHT-HANDED OPERATOR) FRONT of chair denotes operator at 8:00 - 9:00 BACK of chair denotes operator at 11:00 - 12:00 MIDDLE of chair denotes operator at 10:00 MANDIBULAR ARCH POSITIONING Area Chair Back Op Pt Mirror MF=Mirror Face Fulcrum Mandibular Anterior Sextant (22-27) 15 ° up Front Chin Down/ Toward Op Facial: Palm Lingual: Rt. Commissure #21-25 Near Surfaces (Facial and Lingual) Back Chin Down/ Away from Facial: Palm Lingual: Left Commissure #28-24 Op Far Surfaces (Facial and Lingual) Mandibular Right Posterior Right Facial: Retract from Rt. Commissure Anterior Facial 15 ° up Front Chin Down/ Away from Op to Left Lingual: Retract tongue, MF toward working Mandibular Left Posterior tooth, directed from rt. Commissure area Lingual Mandibular Right Posterior Right Lingual: Retract, MF toward tooth Anterior Lingual 15 ° Middle Chin Down/ Toward Op from rt. commissure to working Mandibular Left Posterior Pos. Facial: Retract , MF toward tooth area Facial from left commissure 103 ________________Student MAXILLARY ARCH POSITIONING (Right-handed) Area Chair Back Op Pt Mirror MF=Mirror Face Fulcrum Maxillary Anterior Sextant 6-11) 5° up Back Chin Up/ Straight Facial: Palm Lingual: Left Commissure #5-8 Near Surfaces (Facial and Lingual) Far Surfaces (Facial and Lingual) Maxillary Right Posterior Right Facial: Retract from Rt. Facial Commissure Posterior or 5 ° up Middle to Chin up/ Away from Op on lingual Front cusp of working area Maxillary Left Posterior Left Lingual: Retract tongue, MF toward Lingual tooth, directed from rt. commissure Maxillary Right Posterior Right Lingual: Retract, MF toward tooth Anterior to Lingual 5 ° up from left commissure working area Middle Chin Up/ Toward Pos. Facial: Retract , MF toward tooth Maxillary Left Posterior Facial from left commissure 104 _________________Student DISINFECTION AND SET-UP OF THE DENTAL UNIT AREA Process Competency Examination TASK COMPONENTS/PROCEDURES EVALUATION Obtain supplies (goggles & alligator clip) from carry box. Place on paper towel. 2 Perform short scrub (15 seconds)- gather PPE & cup to flush evacuation system 2 Put on mask and glasses. Perform thorough scrub (3 latherings and rinses in 30 seconds) 2 Put on gloves and overgloves; position op and asst. chairs, light (position light pole to opposite side of 2 operator), carts, & rheostat Flush evacuation system for 2 minutes (cup in sink with running water) -Does not include HVE* 2 (*unless you plan to utilize the HVE) Flush water lines for 30 seconds 2 Remove overgloves and discard into round opening next to sink 2 PRECLEAN ("Modified spray-wipe-spray" technique using disinfectant unless otherwise noted) Dental light switch and handles 3 Operators and assistant's levers 3 Discard paper towel 2 Dental chair, operator's and assistant's stools (soap & water) 3 Discard paper towel 2 Bracket table and accessories (A/W syringe, connectors, holders and hoses) 3 Discard paper towel 2 Assistant's cart, swivel arm and accessories ( A/W syringe, connectors, holders and hoses) 3 Discard paper towel 2 Viewbox, paper towel holder, soap dispenser, faucet handle, countertops & sink rim 3 Discard paper towel; Remove gloves, discard into round opening next to sink 2 Wash hands - gather supplies 3 Cover chair w/plastic, plastic tape on switches, controls, and arm rests—includes the hydraulic lever 3 Cover bracket table and cart with patient napkins; Place instrument cassette on bracket table 3 (Retain bag for instrument return to central sterilization area) Fill water bottle with properly treated water 3 Insert saliva ejector and A/W syringe tip; cover with plastic sleeves 3 Hang biohazard bag from unit; Tape overgloves to unit below bracket table/tray 3 BREAKDOWN PROCEDURE (FOLLOWING PATIENT TX AND PATIENT DISMISSAL) Reglove, remask, and put on protective eyewear 3 Close instrument cassette securely; place in retained autoclave bag or inverted headrest cover for 3 transport to central sterilization area Place contaminated disposables in red biohazard bag; remove and place bag into 3 biohazard container. Remove contaminated gloves into container, wash hands and dry thoroughly. Reglove 3 Disinfect unit using modified spray-wipe-spray technique. 3 Flush water and evacuation lines for 30 seconds 3 Return equipment to its original position; rheostat on dental chair (on paper towel) 2 Remove protective eye wear and disinfect (operator and patient); remove mask 3 Remove gloves into round opening next to sink 3 Wash hands and dry thoroughly 3 OTHER Maintains asepsis 3 Thoroughness of disinfection process 2 Leaves surface area wet after disinfection process 2 Performed in appropriate time frame 2 Professional appearance 2 Instructor: 100 105 SECTION I SENIOR CLINICAL REQUIREMENTS 106 MINIMUM COURSE REQUIREMENTS CLINICAL DENTAL HYGIENE III PROCEDURE MINIMUM NUMBER & CRITERIA DATE 1. Air Polishing - 1 patient- light to mod. Stain (fall and spring) 2. Bleaching (Boost) - 1 patient, includes bleaching tray (fall or spring) 3. Calculus Charting - 1 CDI C or D pt (fall and spring) - minimum of 10 clicks in one quad - chart entire quad - 75% accuracy; remediation required 4. CDI Class A-B -12 patients; must be signed off by faculty (12 in fall & 12 in spring) 5. CDI Class C - 7 patients; must be signed off by faculty (7 in fall and 7 in spring) 6. CDI Class D - 4 patients or 8 quads; must include tx plan & re-evaluation 7. CDI Class E - as assigned (1 quad = 2 quads of 'D') 8. Chemotherapeutics - 1 appropriate patient (fall & spring) (Arestin or Perio Chip) 9. Desensitization (Super Seal etc) - 1 appropriate patient (fall & spring) 10. Impressions/Study Models - 1 patient for bleaching tray (fall or spring) 11. Sealants - 12 teeth; may be completed over fall & spring semesters 1st & 2nd yr 12. Temporary Restoration -PRN (experiential only) 13. Transitional/Mixed Dentition - 1 each (fall and spring) during open clinic time charting 14. Local anesthesia -10 mandibular blocks (total for fall and spring) - 14 Infiltrations (total for fall and spring) -5 PSA -5 Infraorbital -2 Nasopalatine -2 Greater Palatine 15. Pediatric patients - 6 minimum (fall and spring) (does not include sealant patients) TOTAL MINIMUM NUMBER OF ADULT PATIENTS FOR THE ENTIRE SENIOR YEAR: 60 (credit will be given for patients treated at all rotation sites) Other additional procedures PRN: Temporary restoration 107 Vitality testing Re-margination Amalgam polishing Additional patients-all patients appointed, regardless of rating shall be seen as assigned. If a patient is not seen as scheduled without CI approval, the student will be assessed a penalty of one letter grade. ALL ROTATIONS MUST BE COMPLETED AS ASSIGNED CLINICAL COMPETENCIES PROCEDURES CRITERIA 1. CDI C - 8 quads of CDI C prior to comp - minimum of 9 points from Group 4 - minimum 18 clicks in 1 or 2 quads - maximum 25 clicks in 1 or 2 quads - 75% accuracy 2. PERIODONTAL CHARTING - to be accomplished on CDI C or D patient - approved by CI (1 quadrant) - 75% accuracy 3. ULTRASONIC SCALER - appropriate clinic patient - 1 quadrant - 75% accuracy 4. NITROUS OXIDE/OXYGEN - clinic partner ANALGESIA ADMINISTRATION - 75% accuracy OTHER CLINICAL EXERCISES 1. CALCULUS CHARTING - 1 CDI C or D pt - minimum of 10 clicks in one quad - chart entire quad - 75% accuracy; remediation required 2. TRANSITIONAL/MIXED - 1 using cast DENTITION CHARTING - use pediatric dentition chart - 75% accuracy; remediation required 108 SECTION J Clinical Evaluation Protocol & Procedures DH I CLINICAL EVALUATION CRITERIA STEP CLINICALLY ACCEPTABLE NEEDS DEVELOPMENT ASSESSMENT PTP HHX / Vital Signs • Comprehensively collects and synthesizes • Lack of documentation or differentiation all appropriate data between significant and insignificant findings • Use of incorrect terms Extra/Intra oral exam Dental Evaluation Periodontal Evaluation/occlusion • Recognizes need for consult • Failure to seek faculty assistance and adaptations in care • Failure to recognize necessary adaptations in • Seeks consultation prn care CDI • CDI accurate • CDI inaccurate Radiographic interpretation • Utilizes radiographs for assessment and in • Failure to utilize radiographs developing treatment plan Risk Assessment Patient Education • Identifies all relevant assessment data • Unable to identify or omits essential • Involves patient in planning process • assessment data Treatment Plan • Follows logical sequence of prioritized care • Does not involve patient in planning process • Provides sound rationale • Plan content is inappropriate; lacks essential • Treatment proposed includes comprehensive elements DH intervention • Sequence choice compromises care • Integrates and logically sequences patient self- • Answers to questions indicate inadequate care knowledge • Sets acceptable goals with patient input • Omits patient self-care • Assesses patient progress at each • Goals not established appointment; modifies prn • Does not reassess patient progress or modify • at each appointment • Establishes and maintains rapport with patients, peers, and faculty • Demonstrates concern for patient's well-being • Lack of rapport with patient, peers, faculty Patient management • Lack of concern for patient's well-being • Documentation accurate and complete • Records are illegible, unorganized, inadequate Documentation • Assesses caries index, tissue healing • Omits or fails to identify correlation to overall Nutritional Assessment/Counseling • Assesses need for intervention health • Omits or fails to address need for behavior • Sets acceptable goals with patient modification Tobacco Cessation DH I EVALUATION CRITERIA STEP CLINICALLY ACCEPTABLE NEEDS DEVELOPMENT CLINICAL Instrumentation • Demonstrates safe instrument control • Hazardous instrument control • Activates with appropriate adaptation and • Unacceptable adaptation and stroke stroke pressure Ultrasonic use • Effectively utilizes US scaler and appropriate • Ineffective use of US scaler inserts Calculus removal • Self-evaluates with light, air, and explorer • Self-evaluation is ineffective or omitted • Identifies remaining areas to faculty in advance • Excessive hard deposits remain • Able to remove remaining deposits identified o Class A 2 or more by faculty o Class B 4 or more o Class C 6 or more • Removes areas of disclosable plaque/stain Plaque removal • Evaluates adequacy of patient's self-care • Excessive plaque/stain remains • Involves patient in evaluation of results o Class A,B,C 4 or more • Appropriate recall interval set • Fails to follow up on patient self care and/or • Recognizes need for consultation adapt to patient need • Does not involve patient in evaluation process • Recognizes tissue as inflamed, not traumatized • Tissue traumatized by hand or ultrasonics Tissue Trauma • Excessive trauma 2 or more • Selects correct instruments and maintains • Faculty assists in instrument selection; sharpness sharpness not maintained Instrument care • Follows infection control protocols throughout • Does not follow infection control guidelines clinical period or breaks aseptic chain Infection control • Correct patient/operator positioning • Improper patient/operator positioning • Prepared prior to clinical session so treatment • Demonstrates lack of clinic preparation Posture moves smoothly resulting in major clinic interruptions • Uses time efficiently and effectively • Does not complete procedures in a timely Time management • On time for clinical session fashion • Late for clinic session Professionalism • Exhibits professional appearance • Unprofessional appearance • Demonstrates concern for confidentiality • Violates patient's confidentiality • Demonstrates ethical behavior • Demonstrates unethical behavior 109 DH II EVALUATION CRITERIA STEP CLINICALLY ACCEPTABLE NEEDS DEVELOPMENT ASSESSMENT • Comprehensively collects and synthesizes • Lack of documentation or differentiation between Comprehensive health history/vital signs all appropriate data significant and insignificant findings Extra/Intra oral exam • Recognizes need for consult/adaptations in care • Use of incorrect terms Dental charting • Seeks consultation prn • Failure to seek faculty assistance Perio charting/occlusion • Failure to recognize necessary adaptations in care • CDI accurate • CDI inaccurate CDI • Utilizes radiographs for assessment and in • Failure to utilize radiographs Radiographic interpretation developing treatment plan • Unable to identify or omits essential assessment data Comprehensive treatment plan developed/pt. • Identifies all relevant assessment data • Does not involve patient in planning process education • Involves patient in planning process • Plan content is inappropriate; lacks essential elements • Follows logical sequence of care • Sequence choice compromises care • Provides sound rationale • Answers to questions indicate inadequate knowledge • Treatment proposed includes comprehensive • Omits patient self-care DH intervention • Goals not established • Integrates and logically sequences patient self- • Does not reassess patient progress or modify at each care appointment • Sets acceptable goals with patient input • Assesses patient progress at each appointment; modifies prn Documentation • Records are illegible, unorganized, inadequate • Documentation accurate and complete • Establishes and maintains rapport with patients, peers, and faculty • Lack of rapport with patient, peers, faculty Patient management • Lack of concern for patient's well-being • Demonstrates concern for patient's well-being Nutritional Assessment/Counseling • Assesses caries index, tissue healing • Omits or fails to identify correlation to overall health • Assesses need for intervention • Omits or fails to address need for behavior modification • Sets acceptable goals with patient Tobacco Cessation 110 CLINICAL Instrumentation • Demonstrates safe instrument control • Hazardous instrument control • Activates with appropriate • Unacceptable adaptation and stroke adaptation and stroke pressure Ultrasonic use • Effectively utilizes US scaler and appropriate • Ineffective use of US scaler inserts Calculus removal • Self-evaluates with light, air, and • Self-evaluation is ineffective or omitted explorer • Excessive supra deposits remain 2 or more • Identifies remaining areas to faculty • Excessive sub deposits remain in advance • B more than 2 per patient • Able to remove remaining deposits • C more than 3 per patient identified by faculty • D more than 2 per quad • E more than 2 per quad Plaque removal • Removes areas of disclosable plaque/stain • Unable to remove remaining deposits • Excessive plaque/stain remains more than 4 • Tissue traumatized by hand or ultrasonics Tissue Trauma • Recognizes tissue as inflamed, not traumatized • Excessive trauma 2 or more • Does not plan for soft tissue evaluation when appropriate Re-evaluation • Soft tissues evaluated after appropriate • Fails to follow up on patient self care and/or adapt to healing patient need • Evaluates adequacy of patient's self-care • Does not involve patient in the evaluation • Involves patient in evaluation of results process • Appropriate recall interval set • Inappropriate recall interval • Recognizes need for consultation • Faculty assists in instrument selection; sharpness not maintained Instrument care • Selects correct instruments and • Does not follow infection control guidelines or breaks • maintains sharpness aseptic chain Infection control • Follows infection control protocols throughout • Improper patient/operator positioning clinical period • Demonstrates lack of clinic preparation resulting Posture • Correct patient/operator positioning in major clinic interruptions • Prepared prior to clinical session so treatment • Does not complete procedures in a timely fashion moves smoothly • Late for clinic session • Uses time efficiently and effectively Time management • On time for clinical session • Unprofessional appearance • Exhibits professional appearance • Violates patient's confidentiality • Demonstrates concern for confidentiality • Demonstrates unethical behavior Professionalism • Demonstrates ethical behavior 111 STEP CLINICALLY ACCEPTABLE NEEDS DEVELOPMENT SUPPORTIVE TREATMENT • Recognizes need for procedure • Faculty identifies need Diet counseling • Explains rationale to patient • Needs moderate faculty assistance Tobacco cessation • Follows prescribed technique to complete Impressions, bleaching trays • Procedure completed according to • Finished product is not clinically Amalgam polishing guidelines acceptable Care of removable prosthesis • Quality of product is acceptable Desensitization • Administers pain control when necessary • Omission of pain control compromises patient care Sealants • Proper protocol/technique is followed when • Protocol not followed when administering pain control Remargination administering pain control Pain control (IA, PSA, Infiltrations) Nitrous Oxide & oxygen sedation 112 PATIENT RECEPTION AND OPERATOR/PATIENT POSITIONING l. Prepares for appointment: A. positions patient chair in comfortably upright position, with the chair seat at its lowest position B. adjusts operator stool so that the operator's knees are parallel or slightly below, the thighs are parallel to the floor and the backrest is positioned to provide support to the lumbar spine (a pillow, rolled up towel, back support, or cushion may be used for additional support) C. Removes all obstacles from the patient's pathway to the chair, including cart, light, and operator stool, taking care not to obstruct the pathway of adjacent clinicians 2. Greets the patient: A. secures patient records B. greets patient by name, makes eye contact C. introduces self to patient, maintaining friendly attitude and eye contact 3. Escorts patient to operatory using the center aisle and asks patient to place personal belongings in the closet, or place on floor beside light post 4. Assists the patient in being seated in the patient chair on the side opposite the light post. 5. Secures patient napkin and provides the patient with tissue(s) for removing lipstick, and/or for later use 6. Completes all forms, including medical history interview, completes vital signs and obtains PTP extraoral examination, with patient in comfortable seated position 7. Asks for patient's removable appliances and secures appropriately 8. For procedures beginning with the intraoral examination and if not contraindicated by medical history, lowers backrest of chair to place the patient in a comfortable supine position being careful that the neck rest is in a slightly upright position providing support to the neck. 113 9. Lowers or raises the total chair until the field of operation (mouth) is parallel to the operator's elbows l0. Warns the patient of need for eye protection from airborne debris and provides patient with appropriate safety glasses or goggles 11. Asks small patient or child to place head at upper edge of chair for optimum visualization and operator position 12. Positions patient chair for mandibular instrumentation: A. lowers the chair back to 20° B. lowers or raises the chair base until patient's mandibular occlusal plane is parallel to operator's elbows, does not attempt to raise chair to allow placement of legs under chair back if they do not fit with the patient at the appropriate height for operator C. asks patient to lower chin and/or to turn to the appropriate side for optimum visualization D. directs light directly down over area of instrumentation, adjusting light to optimally illuminate instrumentation area (may be to patient's left, right, or in the center) 13. Positions patient for maxillary instrumentation: A. lowers the patient into the true supine position at 5° B. lowers or raises the chair base until the patient's maxillary occlusal plane is parallel to operator's elbows, does not attempt to raise chair to allow placement of legs under chair back if they do not fit with the patient at the appropriate height for operator C. asks patient to raise chin and/or to turn to the appropriate side for optimum visualization D. directs light down over patient's chest, then up toward area of instrumentation adjusting light to optimally illumination instrumentation area (may be to patients left, right, or in the center) 14. Maintains optimum operator positioning throughout procedure(s): A. determines operator's individual neutral spine position and maintains throughout, and when necessary, moves forward by rotating from the hip. Absolutely does NOT bend or arch spine, does NOT twist torso, does NOT 114 lean laterally. Asks patient to adjust his/her head position to allow visualization of instrumentation area B. maintains eye level at 14-16 inches from the field of operation C. correctly assumes the following clock positions for the area of instrumentation: 8 - 12 o'clock for right-handed operators; 12 - 4 o'clock for left-handed operators. D. feet may be flat on floor to provide a stable tripod, legs should be separated as necessary to assume optimum position. E. places cart and light for easy access from the operator's position with a minimum of turning or reaching F. maintains shoulders in neutral, relaxed position G. remains conscious of optimum operator/patient positioning throughout procedure H. takes a break every thirty to sixty minutes by standing up and doing gentle back bends, stretching and walking around a little, does not work in the same position for longer than one hour I. allows patient five minute break following each sixty minutes of active treatment 115 Permission to Proceed (PTP) Presentation 1. Age, race, sex of patient e.g.: 25 year old white female 2. Medications a. if taking medications either prescribed or over the counter, student will state: i. names of all drugs ii. reason for taking 5 student should be prepared to answer questions from faculty about relevant drugs; student may use Dental Drug Reference or PDR c. all PRESCRIBED drugs must be listed on Medical Alert form in patient's chart d. if taking no drugs, student will state "no medications" 3. Past Relevant Illness a. previous illnesses/hospitalizations impacting dental hygiene care (faculty will check medical history to determine correctness of student statement) b. student will state factors of illness that necessitate modifications to treatment c. student will state necessary modifications d. e.g.: History of rheumatic fever at age 12 years; will require prophylactic antibiotic therapy prior to treatment. e. if no relevant illness; will state "no previous illness of concern." 4. Present Relevant Illness a. present illnesses impacting dental hygiene care (faculty will check medical history to determine correctness of student statement) b. student will state factors of illness that necessitate modifications to treatment c. student will state necessary modifications d. e.g.: Hypertension currently under control with diet and exercise; will take blood pressure pre and post treatment. e. if no relevant illness; will state "no present illness of concern." 5. Relevant Allergies a. allergy impacting dental hygiene care (faculty will check medical history to determine correctness of student statement) b. student will state previous patient reaction to allergen c. student will state necessary modifications to treatment protocol d. allergy of concern must be listed on Medical Alert form in patient's chart e. e.g.: allergy to latex; patient experienced hives and respiratory distress; will utilize nitrile gloves for all treatment. e. if no relevant illness; will state "no allergy of concern." 116 6. Vital Signs a. student will state blood pressure, pulse and respiration values b. if not within normal limits, student will state protocol for deviation c e.g.: after two readings two minutes apart, current blood pressure appears to be in the Stage 2, moderate hypertension category; however, patient has not been diagnosed and will be referred to her physician for further evaluation within one month. Pre & post- treatment blood pressure will be taken. 7. Dental History a. student will summarize dental visits history (i.e., periodic or emergency only) b. previous periodontal charting summary (recall only) and/or history of periodontal care c. approximate time since patient's most recent prophylaxis d. patient's last dental treatment e. if any negative dental experiences, the student will describe f. e.g.: patient has previously been seen on an emergency basis only "whenever he recognizes that he has a problem"; patient had periodontal surgery and graft on facial of lower anteriors in 1995; previous charting depths of record dated May 13, 1994 indicated generalized pockets of 4-5 mm; last prophylaxis was May 13, 1994; last dental treatment was root canal done last month on #6. 8. Contributory Factors a. student will state possibly detrimental oral habits b. student will state lifestyle factors possibly impacting oral health 6 e.g., "patient smokes two packs of cigarettes daily" 7 if there are no apparent detrimental habits noted at this time, student will state, "no apparent contributory factors" 9. Current Oral Health Concern(s)/Complaint(s) 8 student will state concerns in the patient's words 9 if there are no concerns or complaints; student will state "no current oral health concerns or problems" 10. Family Health History a. summarize contributory family health history factors b. state relevance of history to patient care c. e.g.: both parents had history of hypertension; father died at age 47 years from CVA; mother currently has CHF at age 67. Patient may be genetically predisposed to hypertension. d. if family health history is not an apparent factor, student will state, "family health history is non-contributory" 11. Family Dental History a. summarize contributory family dental history factors 117 b. state relevance of history to patient care c. e.g.: older sister had an extra third molar; will take panograph to check for supernumerary third molar. d. if family health history is not an apparent factor, student will state, "family health history is non-contributory" 12. Patient Suitability Opinion Statement a. end with a general statement of patient's apparent suitability as a patient in the dental hygiene clinic b. provide rational for any other than suitable patient c. e.g.: patient should not be seen in the dental hygiene clinic at this time because of an active herpes simplex lesion; patient will be instructed to reappoint after the lesion heals. d. if patient is suitable as a dental hygiene patient, student will state, "patient appears to be a good candidate for dental hygiene treatment. MEDICAL ALERT SHEET: The medical alert sheet at the front of the patient's chart should be completed in any of the following circumstances: 1. Allergies to medications or materials likely to be encountered as a dental patient. 2. Prescribed medications that are being taken. 3. There is a history of either contributory present or past illness(es). 4. There are conditions for which antibiotic prophylaxis or other premedication is indicated. 5. Include current physician's name and phone number for EVERY patient. NOTE: Information for PTP as stated above should be presented in the order given. The information should be presented only at the initial appointment. The only requirement for subsequent appointments is an oral review of the critical elements of the health history and a statement of any changes since the last appointment. 118 INITIAL VISIT PTP MONOLOGUE Student States: Patient presents as a (age, race, sex) in apparent (poor, fair, good health) with (no chief complaint/chief complaint) of "___________________". This patient is (new, recall) at the COD. Patient is currently taking: (meds) for (reason for meds). Student must state dental considerations related to medication. Patient states (drug allergies/sensitivity) to the following: _________ with a reaction of ________. Patient reports a history of : (pertinent personal health history information) Patient reports a family history of: (pertinent immediate family health history information). (Ex. Mother is hypertensive) Patient reports a dental history of: If a new patient to COD: This information will be provided by the patient. i.e. Regular dental care, emergency care only, etc. If a recall patient at the COD: This information should include past probing depths (localized/generalized perio information statement , date of last prophy/exam, date of last radiographs, last CDI classification) Patients vitals are: BP: ______, Pulse _____bpm, Respirations_____rpm. Patient appears to be a _________candidate for dental treatment at the COD. 119 SUBSEQUENT VISIT PTP MONOLOGUE Student states : 1. Appt number with patient. (Ex. This is appt. #2 with this patient) 1. Changes in health history from the last appointment and/or significant health information (Ex. Asthma, diabetes, high BP, cardiac problems or any other medical issues that might effect Tx. 2. Current medication information. 3. CDI of patient and significant dental and perio findings of last appointment ( ex. severe bruxism, gross caries, ANUG, probe depths, BOP, etc). 4. Procedures that are to be accomplished at today's appointment. 5. Any other information that the faculty may request to acquaint or reacquaint themselves with the patient. CASE COMPLETE MONOLOGUE 1. Probing depths (pre-treatment and post-treatment) 2. BI (pre-treatment and post-treatment) 3. Amount/areas of residual calculus 4. Assessment of patient compliance 5. Reasons for non-resolution 6. Recommended recall 7. Further DH treatment/recommendations (including patient ed) 120 INITIAL VISIT PTP MONOLOGUE (1st visit of series) Student States: Patient presents as a ________________________________(age, race, sex) in apparent _____________________(poor, fair, good health) with a (no chief complaint/chief complaint) of "________________________________". This patient is _____________________(new, recall) at the COD. Patient is currently taking: _______________________________________(meds) for _____________________________________________________(reason for meds). Dental considerations related to medication_____________________________________ Patient states _____________________________________(drug allergies/sensitivity) to the following meds: _________________________________________with a reaction of ___________________________________________________. Patient reports a history of : (pertinent personal health history information)______________________________________________________________ ______________________________________________________________________________________ __________________________________________________________ Patient reports a family history of: (pertinent immediate family health history information). ______________________________________________________________________ __ Patient reports a personal dental history of: ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ Patients vitals are: BP: ____________, Pulse _________BPM, Resp__________RPM. 121 SUBSEQUENT VISIT PTP MONOLOGUE (2nd….etc visit of series) Student states : This is appointment no. _________________ with patient (state name) There have been ____________________________________changes in health history from the last appointment and/or there have been no changes since the last appointment. The patient's significant health information includes: ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ The patient currently takes _________________________________________(state meds) for _____________________________________________________________________ with dental considerations of:_________________________________________________ At work-up I documented: (Chief Complaint, EIE, CDI , and any significant dental and perio findings of last appointment) ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________ Today I plan to accomplish: ______________________________________________________________________________________ __________________________________________________________ 122 THE COMPLETE SEQUENCE 1. Arrive at 8:30 am: pick up cassette, handpiece, and sharpening stones at Central Sterilization (allow 10 minutes for set-up and 15-20 minutes for sharpening) 2. Seat patient at 9:00am. a. Faculty must be present before seating patient. 3. Obtain (if new patient) or review (if recall patient) health history, vitals, medical alert sheet a. Follow COD Blood Pressure Protocol Guidelines 4. Obtain Permission to Proceed (PTP) from assigned instructor. a. Written documentation in TPN and verbal presentation to faculty 5. Complete Work-up Includes: EIE, D/P charting, BI, PASS PI, Case Difficulty Index (CDI), Occlusion, Overbite, Overjet 6. Sign up for instructor check of work-up STOP! NO FURTHER PATIENT TREATMENT MAY OCCUR UNTIL INSTRUCTOR HAS CHECKED WORK UP! a. You may begin working on DH Tx Plan while waiting for instructor check. If not complete by time instructor arrives, you may complete at home and bring to appt. 2 b. Oral diagnosis exam may be done after work-up check 7. Disclose and perform OHI 8. Scale 2 quads – you may choose either 1 &4 or 2 & 3 9. Sign up for instructor check of scaling after 2 quads a. Hold paperwork up on opposite side of dental chair b. You may being scaling other 2 quads while waiting for instructor check 10. Sign up for instructor check after scaling the remaining 2 quads a. You may begin RC polishing while waiting for instructor check of scaling 11. Sign up for final instructor check after 4 quads of polishing complete a. RC or TB Polish entire mouth. b. Check your work with disclosing solution. c. Have disclosing solution and cotton tip applicator ready for faculty 14, Administer fluoride after final instructor check of patient The LATEST time to sign up for completed work TO BE CHECKED by faculty is 11:15 am. A time extension may be granted on a CASE BY CASE basis by assigned faculty, but must be requested prior to 11:15am. If no instructor check is needed, 11:45 am is patient dismissal time 123 VITAL SIGNS 1To be obtained at the primary appointment; 2on subsequent appointments for the patient with a history of heart disease or abnormal blood pressure, or any other systemic condition that dictates blood pressure monitoring; 3if the patient takes a medication that alters blood pressure; 4during pregnancy; 5prior to the administration of local anesthetic or nitrous oxide analgesia. PULSE 1. Positions patients arm on a flat surface at level of the heart 2. Holds patient's forearm palm downward in palm of hand with index, second, and third fingertips securely over the radial artery 3. Places thumb on opposite side of wrist 4. Exerts firm pressure over radial artery and observes pulse for 30 seconds 5. Records pulse rate on patient's record by multiplying 30 seconds rate by 2 6. Records rhythm, volume, condition of arterial wall if abnormalities are observed 7. Pulse reading is accurate within 5 beats RESPIRATION 1. Counts patient respiration while pulse is held as if being taken 2. Observes respirations before or after measuring the pulse 3. Counts for 30 seconds and multiplies by 2 if respirations observed are regular or counts respirations for one full minute if abnormalities of respiration are observed 4. Observes respiratory movements so patient is not aware of this observation 5. Records respiratory rate promptly 6. Records and reports observations if rhythm, depth or character of respirations are abnormal 7. Respirations are accurate within 2 breaths 124 BLOOD PRESSURE 1. Secures manometer, pressure cuff, and stethoscope 2. Determines whether patient has just engaged in physical activity, smoking , eating 3. Discusses activity to be carried out with the patient 4 . Removes all clothing from the extremity 5. Places manometer at proper viewing angle and distance 6. Wraps the cuff snugly and smoothly on the extremity 7. Places the center of the inflatable bag directly over the artery with the lower edge one inch above the antecubital space 8. Locates radial pulse and holds as if taking pulse 9. Inflates cuff until radial pulse is no longer palpated and notes reading obtained 10. Deflates cuff 11. Locates brachial pulse and apply bell to pulse area 12. Places earpieces in ears 13. Inflates cuff to 10 - 20 mm Hg higher than pressure necessary to stop radial pulse (step 10) 14. Allows pressure to fall evenly and notes systolic and diastolic readings 15. When diastolic is reached, releases cuff pressure 16. Inflates cuff and retakes after 30 seconds 17. Removes the cuff and stethoscope 18. Averages the two readings and records the measurement 19. Reading for systolic and diastolic are accurate to within + 5 mm Hg 20. Returns equipment to its storage place 125 EVALUATION 1. Identify abnormal levels/rates for each vital sign. 2. Recognize need to obtain an OD consult or terminate appointment. 3. Notify patient of need for medical consult if vital signs are above normal ranges. (See Blood Pressure Protocol). 126 EXTRAORAL/INTRAORAL EXAMINATION EXTRAORAL 1. Assembles armamentarium: mouth mirror, adequate light, two 2X2" gauze sponges, tongue depressor, personal protective equipment 2. Looks at the skin of the neck and face. 3. Asks the patient to open and close the mouth while observing T.M.J. and mandibular movements. 4. Places the hands flat against the patient's face with the index fingers firmly resting over the TMJ. 5. Asks the patient to open and close the mouth while the operator's hands remain in place to feel deviation in TMJ glide and to note possible vibrations from crepitation 6. Palpates the muscles A. temporalis - bilateral temple (fan) to coronoid process B. masseter - bilateral cheek to angle of mandible C. buccinator - bilateral lips back toward ramus D. sternocleidomastoid - bilateral & bidigital 7. Palpates the lymph nodes: A. submandibular - by placing the fingers of each hand against the skin of the neck approximately 1 or 2 inches below the interior border of the mandible. The fingers should be perpendicular to, and pressing firmly into the neck. The fingers are then drawn up slowly until the inferior border of the mandible is reached. Fingers are "walked" from most posterior position until they meet in the anterior portion of the mandible B. preauricular bilateral technique C. postauricular bilateral technique D. submental - bilateral digital technique E. anterior and posterior cervical chain (while palpating cervical tissues surrounding the sterno-cleidomastoid) F. parotid (while examining TMJ) G. supraclavicular - bidigital technique H. thyroid - bimanual, digital - pressing alternately on opposite sides of the larnyx, trachea, and above notch of sternum. Ask patient to swallow while plating thumb and fingers over the area INTRAORAL 1. Observes the lips and labial mucosae. The labial mucosae are examined with the lips reflected up for the upper lip and down for the lower lip. 2. With the lips reflected, examines the labial and buccal gingivae and mucobuccal folds. 3. Palpates the lips and labial mucosa bidigitally. 4. Observes the buccal mucosae by holding cheek taut with the index and middle fingers. Has the patient turn his head in the direction of the side being observed. 5. Palpates buccal. mucosae bidigitaly. Observe Stenson's Duct of parotid gland and note presence of Fordyce Granules. 127 6. Observes the dorsum of the tongue, asks the patient to touch the palate with the tip of the tongue and examines the ventral surface of the tongue and the floor of the mouth. Note presence of papillae coatings 7. Palpates the floor of the mouth bimanually by placing a flat hand firmly inferior to the mandible as far as the neck and using one or two fingers of the opposite hand to presses firmly. May be done after step 9 is completed. 8. Examines the posterolateral border of the tongue by protruding the tongue and moving it to) one side, grasping the tongue with gauze sponge and gently pulling it forward and laterally. Note color of papillae. 9. Palpates the lateral borders of the tongue and the body of the tongue bidigitally. 10. The mandibular lingual gingivae and retromolar gingiva are observed using the mouth mirror. While the gingiva is seen on the reflecting (glass) side of the mirror the back of the mirror retracts the tongue. 11. Observes the palatal gingivae and mucosa of the hard palate either, by direct vision (changing head position appropriately), or indirectly with a mirror. 12. Observes the maxillary alveolar ridge and maxillary tuberosities using mouth mirror. 13. Depresses the patient's tongue with tongue blade or mirror, and observes the soft palate and uvula. 14. Observes the tonsillar pillars and oropharynx by depressing the tongue blade or mirror and having the patient say "aaah". 15. Note and record presence of mouth odor, such as fetor oris or sweet fruity smell. 16. Note and observe quantity and consistency of saliva. CHARTING 1. Fills out all blanks on the extraoral and intraoral examination section on the patient chart. 2. Notes deviations from normal on the chart and records answers to the following questions:. A. location B. description: size C. description: color D. description: surface texture E. description: consistency F. history: whether or not lesion is known to patient G. history: duration H. history: symptoms 128 DEFINITIONS OF TERMS bidigital palpation - Use of one or more fingers and the thumb to examine tissues by grasping the tissue between thumb and fingers bilateral palpation - examination of structures on both sides of the face or neck simultaneously to detect differences between the two sides bimanual palpation - examination of structures on both sides of the face or neck simultaneously to detect differences between the two sides bullae - large (5 mm to several centimeters) vesicles that are relatively deep seated and less prone to rupture; often seen with pemphigus circular compression - moving the fingertips in a circular pattern over a structure while simultaneously applying pressure to the tissue confluent - blending or occurring together, originally separate, but subsequently combined diffuse - spread out, blended together; used to describe borders of lesions digital palpation - use of a finger to examine tissues discrete - separate, well-defined, not blending; used to describe borders of lesions erosion - shallow surface defect that does not extend through the epithelium into underlying tissues erythema - red area of variable size or shape induration - hardened area of tissue keratosis - abnormal thickening of the outer layers of skin or mucosa that may appear as white, grayish white, or brown lesions; examples are linea alba, cheek-biting, nicotine stomatitis, lesions of lichen planus, and leukoplakia macules flat areas that are differentiated from surrounding tissues by color; may vary in size, shape and color; examples are petechiae, ecchymoses, freckles, and maleness manual palpation - use of all the fingers of one hand to examine tissues nodules - enlarged papules that are seated in the submucosa or lower dermis; examples are traumatic fibromas, lesions associated rheumatoid arthritis, Kaposi's sarcoma 129 papules - small (pinhead to 5 mm) superficial elevated areas of tissue, which may appear flattened, rounded, or pointed; color may vary; examples are found in lichen planus, and some condylomas pedunculated - elevated papillary type of lesion attached to underlying tissue by a stem or narrow connector petechia(e) - minute round red spot(s) pustules - vesicles that contain pus sessile - attachment of lesion by a broad base tumor - solid growth of hard or soft tissue; swelling or overgrowth of cells independent of normal tissue; examples are papillomas, polyps, and tori ulcer - defect in the skin or mucosa that extends beyond the surface epithelium and into the underlying issues; may be ragged or punched out; may be smooth, granular, glazed, pus-covered, or hemorrhagic, painless or extremely sensitive verrucous, or verrucose - resembling a wart; denoting wartlike elevations vesicles - small elevations containing fluid with a thin surface covering of epithelium or mucosa (e.g., blisters); they may occur singly or in clusters; examples are herpetic lesions well-circumscribed - differentiated; having discrete borders and a definite shape 130 131 EXTRAORAL/INTRAORAL EXAMINATION SEQUENCE General Instructions: 1. Operator uses the ends (fleshy parts) of finger pads for palpating tissues, and when possible, maintains contact between the fingers (index through fifth) in order to broaden palpation surface of hand and reduce chance of missing deviations 2. Operator detects and questions patient regarding any tenderness as evidenced by verbal or nonverbal behavior. 3. Overgloves should be worn when documenting findings. 4. Findings should be documented when: a. baseline information is needed b. the area needs to be re-evaluated at subsequent appointments c. the finding may affect future treatment options Note: Scars, freckles, tori, linea alba, indentions from glasses, and other findings that have been present for an extended period of time and/or that will not change and are currently within normal limits should not be documented. 5. Findings should be described using the following categories and terminology: a. Size – measure in mm. b. Color – pink, red, magenta, blue, white, yellow c. Shape – linear, circular, irregular d. Consistency – fluid-filled, firm, ulcerated e. Mass – flat-macule, raised-papule f. Location – specific – on left buccal mucosa adj. to #19 generalized – max. left alveolar ridge g. Duration – how long has it been present h. Symptoms – tender, asymptomatic Example: 3 mm. pink round firm sessile papule on left buccal mucosa adjacent to #19, dur.-unknown, asymptomatic. 6 General assessment of patient should include: 7 body build, gait, ease of movement 8 intellectual ability, degree of alertness 132 9 speech 10 habits with physical manifestations 11 general hygiene 7. Assemble armamentarium: mouth mirror, probe, 2X2 gauze squares, ppe. Extraoral Examination 1. Don gloves. 2. While positioned standing in front of the patient (with the patient in a seated, upright position), look at the skin and structure of the face and neck observing symmetry as well as skin abnormalities. 3. Utilize bilateral palpation beginning with the forehead and progressing with the temple*, cheeks, nose, upper lip area, chin, and submandibular area. * After palpating the temple area, place two to three fingers over the TMJ position and ask the patient to open their mouth as wide as they can slowly and note any deviations and/or abnormalities (i.e. clicking, popping, crepitus, subluxation, or deviation). Be sure you are positioned in front of the patient to observe the TMJ. D. Bidigitally palpate the tracheal area, including the thyroid. Observe the thyroid area and have the patient swallow. 5. Palpate the right sternocleidomastoid muscle simultaneously anteriorly and posteriorly beginning at the base and moving superiorly. Move around to the other side of the patient and repeat with the left sternocleidomastoid muscle. 6. While standing behind the patient, ask them to lean their head forward and down. Utilize bilateral palpation to examine the back of the neck, suboccipital area, and behind the ears. Utilize bidigital palpation to examine the trapezius muscle and supraclavicular area. Intraoral Examination Recline patient into supine position. Wash and reglove. Follow similar palpating and examination procedures as for extraoral exam. The operator should be seated. 1. Lips 10 Observe with the mouth closed and observe the location of the philtrum and the vermilion borders. 11 Observe with the mouth open and observe the labial commissures for a restricted opening. 133 12 Grasp the patient's lower lip with the thumb and index fingers of each hand and gently palpate using both a bidigital and bilateral technique. 13 Repeat (c) on upper lip. 2. Labial and buccal mucosa 8. Gently grasp the patient's lower lip with the thumb and index finger of each hand and deflect lower lip. 9. Visually examine the labial mucosa, the vestibule and the labial frenae. 10. Gently palpate this area. 11. Repeat a.,b.,c., on upper lip. 12. Instruct patient to open wide and examine the buccal mucosa and buccal vestibule. 13. Observe and palpate the tissue from the inner commissure of the lip anteriorly to the retromolar pad posteriorly. 14. Check the appearance of the Parotid (Stensen's duct). 15. Test the duct by gently stroking it with a dry gauze and checking if the gentle stimulation has caused secretion of saliva. Examine both right and left ducts. 3. Floor of mouth (operator should be seated at 8/9 o'clock) 8 Have patient open their mouth and tilt chin upward slightly. 9 Utilize bimanual palpation technique, with one finger in the floor of the mouth and two fingers directly opposite, underneath the chin. 10 Cover the entire area, one side at a time (unilaterally). 11 First, move from deep under the tongue and proceed towards the anterior aspect of the sublingual area. 12 Next, cross the mid-line area and palpate the opposite side in the same manner. 13 Have patient touch tip of tongue to the roof of his mouth so that the ventral surface of the tongue and the floor of the mouth can be observed. 14 Observe the attachment of the lingual frenulum. 4. Tongue 8 Examine the tongue as it normally rests in the mouth by instructing the patient to partially open. 9 Have the patient extend his tongue and visually observe any deviation or asymmetry. 134 10 After advising the patient of your intent, ask him to extend or "stick out" his tongue. Gently, but firmly, grasp the tip of the tongue in a 2X2 gauze square and pull it forward and laterally. Observe both left and right borders in this manner. 11 Use bidigital palpation along the lateral borders with your free hand. 5. Hard palate and soft palate a. Instruct the patient to tilt his chin up and to open the mouth wide. Use direct and indirect vision to observe the hard and soft palates. b. The hard palate should be palpated with the index finger to feel if there is any deviation or swelling not readily observed visually. c. If easy observation of the soft palate is not possible with the patient in this position, the base of the tongue may be gently depressed with a mouth mirror or tongue blade while the patient is instructed to say "Ahh". 6. Uvula, Tonsillar Pillars, Oropharynx To observe the oropharynx area, it may be necessary to maintain gentle forward and slight downward pressure of a tongue blade or mouth mirror on the base of the tongue to depress it out of the line of vision (may also need the patient to say "Ahh"). Be aware you may trigger the gag reflex if you depress too far posteriorly. Compare landmarks on both sides of the oropharynx. 6 Alveolar mucosa Check visually at the apices of all teeth, both facially and lingually. 7 Edentulous gingiva Visually examine for deviations. Palpate with thumb and forefinger. 8 Gingival Screening Will follow periodontal charting and should include a brief description of the clinical observations of the periodontium. The following should be included in the description: Quality – mild, moderate, severe Quantity – localized, generalized Location – scattered, area-specific (i.e. mand. ant., max. post., etc.) Consistency/Texture – firm, spongy, fibrotic, etc. 135 Contour/Form – uniform, recession, clefting, bulbous, rolled margins, etc. Color – coral pink, pink, red, magenta, etc. Sulci – include a summary of depths and bleeding observations (i.e. gen. 2-3 mm. with no BOP with loc. 4 mm. in max. post. with mild BOP) Utilizing this descriptive terminology will enhance observation skills and therefore improve the ability to better define the needs of the patient. 9 Other May note any unusual findings that do not fit in the above categories. 10 Saliva 1. Note consistency 2. Note extreme dryness (xerostomia) or extreme salivation. 136 Elevated Lesions (above the normal plane of mucosa) Localized Generalized (limited to a small focal area) (involves most or all of an area) Single Multiple Multiple lesions are either separate (widely spaced with distinct margins) or coalescing(close to each other with margins that merge) Blisterform Nonblisterform (containing fluid with translucent (solid lesion containing no appearance and a soft consistency) fluid and of a firm consistency) Vesicle Bulla Papule Tumor (less than 1 cm (greater than (less than 1 cm in (1 cm or greater in in diameter, contains 1 cm in diameter diameter, consists of diameter, consists of serum or mucin) contains serum tissue) tissue) or mucin, may contain extravasated blood) Pustule Nodule Plaque (contains pus, yellowish color (smaller than 1 cm in (slightly raised any size diameter, consists of with a broad flat tissue) top and a "pasted on" appearance) 137 Depressed Lesions (below the normal plane of mucosa, usually an ulcer where there is loss of continuity of epithelium Single Multiple Multiple lesions are either Separate or coalescing Regular Outline Irregular Outline (continuous linear outline that resembles a circle or oval) (numerous deviations from a circular or oval pattern) Smooth Margin Raised Margin (margin of lesion is on the same plane as normal mucosa) (margin of lesion is above the plane of normal mucos) Superficial Deep (distance from base of depression to plane of margin (distance from base of depression to plane of is less than 3 mm.) margin is greater than 3 Flat Lesions (surface is on the same plane as the normal mucosa) Single Macule Multiple Macules (flat lesion of abnormal color) multiple lesions are either separate or coalescing Regular Outline Irregular Full mouth periodontal charting to be completed on new patients. 138 PERIODON TAL CHARTING 1.Probes entire pocket topography of each tooth in the sextant(s) 2. Notes and records the deepest clinical probing depths found in six areas of the tooth: DB, B, MB, ML, L, DL 3. Notes and records gingival recession measuring from CEJ to junctional epithelium (clinical attachment level) marginal gingiva 4. Notes and records furcation involvement A. Class I - tactile exposure of the groove or concavity on the root trunk only, detectable by the Naber's probe B. Class II - bone loss that extends between the roots with a roof created by the root trunk; probe cannot be passed from the entrance of the furcation to another furcation area C. Class III - bone loss allowing communication from one tooth surface to another, such as facial to lingual on mandibular teeth and facial to proximal on maxillary teeth D. Class IV- through & through (gingival recession, furcation visible, probe easily penetrates through furcation, visible from other side 5. Notes and records mobility using two instrument handle ends placed on the facial and lingual aspects of each tooth and pushing in the facial-lingual direction, tooth movement can be compared to adjacent teeth A. Class I - tooth deflection measuring 0.5 mm to 1.0 mm facial-lingual (any perceptible movement) B. Class II - deflection measuring greater than 1 mm, but less than 2 mm facial- lingual (movement that is more than perceptible) C. Class III - deflection measuring 2 mm or more facial-lingual, or a tooth that is depressible in the socket 6. Given charting information above, can compute total attachment loss 7. Given charting information above, can compute probable bone loss 8. Notes and records bleeding index 9. Periodontal charting documentation is legible 10. Sign and date the form. Obtain faculty signature 139 BLEEDING INDEX 1. Utilize aseptic technique. 2. Communicate with patient re: procedure rationale and method. 3. Position patient appropriately. 4. Assemble armamentarium. A. adequate illumination B. mirror, periodontal probe C. appropriate chart 5. Accurately probe to depth of pocket. 6. Identify and record presence of bleeding in indicated area of chart. 7. Calculate and record the summary BI for the patient [total of teeth exhibiting bleeding point(s,) over total number of teeth, i.e. 15/28]. 140 ORAL DIAGNOSIS CHARTING /KEY FOR "RECORD OF EXISTING ORAL CONDITIONS" 1. Chart all conditions which are detectable by clinical examination and/or radiographic examination in red or blue pencil. Existing normal (healthy) conditions in blue; existing abnormal (unhealthy) conditions in red. 2. Mark all missing teeth not replaced by fixed prosthesis with a blue "X" through the entire tooth including occlusal and lingual views as well as the buccal and root view. 3. Outline every restoration in blue showing exactly what you see clinically from occlusal, buccal and lingual views. 4. Outline every crown in blue according to its outline or margins as you view it from occlusal, buccal, or lingual. 5. Fill in the interior outline of any amalgam restoration solidly in blue. 6. Fill in the interior of any gold restoration with slanting blue parallel lines. 7. Leave the interior of the outline of any "white" restoration clear. 8. Fill in the interior of any part of a crown which is gold with slanting blue parallel lines; leave any "white" part of the crown with only the blue outline already crown. 9. If a tooth is missing and replaced by a fixed bridge, "X" the root only in blue and mark the pontic in the same manner as a crown. Connect the abutments and the pontic with parallel lines at the occlusal view (Posterior) and lingual view (anterior). Mark the connecting parallel lines according to the material used in the bridge. 10. Mark any root canal fillings in blue as they appear radiographically. Also mark access restoration according to material used. 11. Circle impacted or unerupted teeth in blue including all views in your. circle and Place a large blue arrow within the circle indicating the long axis of the tooth and where the crown is pointing. 12. Mark open contacts with parallel blue lines between the two teeth and extending through all three views of the crown. Note the extent of the opening to the closest millimeter. 141 13. Mark drifted or repositioned teeth with an arrow indicating the new position of the tooth. For extruded teeth or unusual drifting, make a statement about it in "Other findings". 14. Mark rotated teeth with an arrow around the occlusal view. 15. Mark an overhang as an extension in blue of your drawing of the restoration exactly as it appears, either clinically or radiographically, and circle the overhang area in red. 16. Mark carious lesions in red exactly as they appear clinically. If seen interproximally by radiograph only, mark them as a chevron (>) on the buccal view just as you view the radiographs from the buccal. 17. Mark open or carious margins of restorations in red exactly where you see them. 18. Mark any periapical radiolucency in red as it appears on the radiograph. 19. Outline any other pathology seen radiographically in red, identify it with a number within or near your outline and describe the lesion in "Other findings" prefixed by your identifying number. 20. Mark fractured, missing parts of teeth with a red line along the fracture site. 21. Missing parts due to carious activity would be colored in red; fractured, missing parts which have become carious on the fracture site would be marked solid red. 22. Do not mark any treatment suggestions on this chart, e.g. do not mark teeth to be extracted with two vertical parallel blue lines. 23. Indicate excessive wear, abrasion, or any condition localized to individual teeth in "Other findings" space. 24. For generalized conditions use space marked "Comments" at the bottom of the page. 25. Draw abnormal gingival architecture as accurately as possible with detail to clefts, recession and interproximal contour, using the red pencil. Do not mark normal gingival contour. Draw a line indicating the mucogingival junction in blue on the root surface the proper distance from the C-E junction and the free gingival margin in these areas of abnormal gingival architecture only. Remember, the lines on the root drawings indicated 2 mm increments. 26. Mark clinical furcation findings with an open triangle (^) in the furcal area and note the extent of involvement with the number 1, 2, 3 (1, 2, 3). 142 27. Mark high muscular or frenum attachment in the approximate location with a "V" shaped line in red. 28. Write in areas of food impaction on the slanted lines indicating "Other Findings". 29. Mark mobility in Roman Numerals on the buccal view of the crown in red using an I through M scale. 30. Record all sulcular depths of 1-3 mm in the appropriate space in blue. Record sulcular readings 4 mm or greater in red. Circle the corresponding probing depths of any bleeding points. 31. Indicate any exudate in "other findings". 32. Classify occlusion according to Angle's system and record in "Comments" section. 143 OCCLUSION - MALPOSITIONS 1. Labioversion - a tooth that has assumed a position labial to normal. 2. Linguoversion - position lingual to normal. 3. Buccoversion - position buccal to normal. 4. Supraversion - elongated above the line of occlusion. 5. Torsoversion - turned or rotated. 6. Infraversion - depressed below the line of occlusion. OCCLUSION - MALRELATIONSHIPS OF GROUPS OF TEETH 1. Crossbites - Anterior maxillary incisors ate lingual to mandibular incisors. 2. Edge to edge - (Anterior teeth) incisal surfaces of maxillary teeth occlude with incisal surfaces of mandibular teeth instead of overlapping as an ideal occlusion. 3. End to end - (Posterior teeth) Molars and premolars occlude cusp to cusp viewed mesiodistally. 4. Openbite - Lack of occlusal or incisal contact between maxillary and mandibular teeth because have failed to reach the line of occlusion. 5. Overjet - The horizontal distance between the labibincisal surfaces of mandibular incisors and the linguoincisal surfaces of maxillary incisors. 6. Underjet - Maxillary teeth are lingual to mandibular teeth. 7. Overbite - Vertical distance by which the maxillary incisors overlap the mandibular incisors. OCCLUSION - TYPES OF FACIAL PROFILES 1. Mesognathic - having slightly protruded jaws. 2. Retrognathic - (CONVEX) Having a prominent maxilla and a protruded mandible. 3. Prognathic - (CONCAVE) Having a prominent, protruded mandible and a normal maxilla. 144 PLAQUE INDEX 1. Utilize aseptic technique 2. Assemble armamentarium A. adequate illumination B. mirror C. disclosing solution in cup D. cotton applicator 3. Communicates with patient re: rationale and method for procedure 4. Positions patient properly (reclining) 5. Apply disclosing solution to all surfaces of all teeth 6. Rinse with water 7. Identify and record all designated surfaces that exhibit staining due to plaque 8. Tabulate the plaque score according to chart instructions; record in appropriate place on chart 9. Perform and record plaque index on patient at each subsequent visit 10. Subsequent plaque scores should be generated only if patient's initial score is above 20%. Generally, this will be done at the re-evaluation appointment. Plaque scores can be calculated at any appointment and will be left to the discretion of the clinician and case instructor. 145 STRESS REDUCTION PROTOCOL 1. Determines ASA status A. ASA I i. normal and healthy ii. little or no anxiety iii. little or no risk B. ASA II i. mild systemic disease or healthy ASA I with extreme anxiety 16. examples: well-controlled diabetes, epilepsy, asthma, and/or hypothyroid or hyperthyroid conditions; ASA I with upper respiratory condition, pregnancy and/or allergies 17. minimal risk during treatment C. ASA III i. severe systemic disease that limits activity, but is not incapacitating ii. examples: angina pectoris or MI history, CVA history insulin dependent diabetes, CHF(congestive heart failure) with orthopnea and ankle edema, COPD (chronic obstructive pulmonary disease (emphysema, chronic bronchitis, exercise asthma) iii. dental treatment indicated, but stress reduction protocol and other treatment modifications are indicated D. ASA IV i. incapacitating disease that is a constant threat to life, problem that is of greater importance than the planned dental treatment. If possible, treatment should be postponed until medical condition has improved to at least ASA III 2. Utilizes Stress Reduction Protocol for normal, healthy anxious patient (ASA I) A. recognize anxiety B. clinic dentist may premedicate with an antianxiety or sedative-hypnotic agent on the night before or immediately before appointment, prn C. morning appointment D. minimize waiting time E. non-drug psychosedation during therapy, such as telling the patient what to expect and using TLC, Using a low, monotonous tone of voice or any technique which helps get the patient's thoughts centered oft something other than the procedure being accomplished F. Uses adequate pain control during therapy, anesthesia may be administered by the clinic dentist G. vary length of appointment depending on desire of patient (patient may prefer longer appointments to "get it over with", or may prefer shorter appointments) H. telephones the patient later in the day of treatment to see how patient is doing and to reassure 146 3. Utilizes Stress Reduction Protocol for Medical Risk Patient (ASA II, III, IV) A. recognize risk B. medical consult prn C. morning appointment D. minimize waiting time E. preoperative and postoperative vital signs monitored F. psychosedation as described above G. adequate pain control determined by clinical dentist H. length of appointment variable, dependent on the tolerance of the patient I. postoperative pain/anxiety control as determined by clinical dentist J. telephones the patient later in the day of treatment to see how patient is doing and to reassure K. arrange for the appointment to be early in the week so that the patient will not be left over the weekend L. other precautions may be taken dependent on the patient's condition, such as: oxygen administration during the procedure, modifications of patient position, contraindication of rubber dam use 4. Positions patient properly (reclining) 5. Apply disclosing solution to all surfaces of all teeth 6. Rinse with water 7. Identify and record all designated surfaces that exhibit staining due to plaque 8. Tabulate the plaque score according to chart instructions; record in appropriate place on chart 9. Perform and record plaque index on patient at each subsequent visit 10. Subsequent plaque scores should be generated only if patient's initial score is above 20%. Generally, this will be done at the re-evaluation appointment. Plaque scores can be calculated at any appointment and will be left to the discretion of the clinician and case instructor. 147 STERILIZATION Temp Method Time Requirement Pressure Autoclave 20–30 minutes 250 degrees F 15 psi 121 degrees C Dry Heat 60-120 minutes 320 degrees F 1 hour to reach temp 160 degrees C & 1 hour at 320 degrees Chemical Vapor 20 minutes 270 degrees F 20-40 psi 132 degrees C Ethylene Oxide Gas 10-16 hours 75 degrees F 25 degrees C DISINFECTANTS GLUTERALDEHYDES High level disinfectant for instruments – Fumes toxic 2% neutral 2% alkaline 2% with phenolic buffer 2% acidic CHLORINES Intermediate level disinfectant – Not recommended for aluminum or metal Chlorine Dioxide Sodium hypochlorite (Household Bleach) IODOPHORS High level disinfectant for chairs, unit, etc. Stains many surfaces 1% available iodine PHENOLICS Intermediate level – irritating to skin. Used at OUCOD *Water based Alcohol- based PROPERTIES OF AN IDEAL DISINFECTANT 1. Broad spectrum 2. Fact acting 3. Unaffected by physical factors: Active in the presence of organic matter 4. Non toxic 5. Surface compatibility – non corrosive to metal, rubber and cloth surfaces 6. Residual effect on treated surfaces 7. Easy to use 8. Odorless 9. Economical 148 INFECTION CONTROL TERMINOLOGY ANTISEPTIC Chemical agent that is used to inhibit or kill microorganisms on tissue surfaces. (Ex: handwash agent) ASEPSIS Removal or destruction of disease or infected material. Includes sterile condition obtained by removing or killing organisms. ASEPTIC TECHNIQUE (ASEPSIS) The use of procedures that break the cycle of infection and ideally eliminate cross contamination AUTOGENOUS INFECTION Self-Produced infection Ex: Candidiasis (Yeast) BACTEREMIA Presence of bacteria in the blood. Demonstrated by blood culture. Antibiotic treatment is specific to the organism found and appropriate to the location of infection BACTERIOCIDAL A chemical agent which is capable of directly killing target microorganisms BACTERIOSTATIC A chemical that is capable of inhibiting the growth and metabolism of a target microorganism but does NOT directly kill the microbe CLEANING Physical removal of debris and reduction of microorganisms present. First step in decontamination CROSS-CONTAMINATION Passage of microorganisms from one person or inanimate object to another CROSS INFECTION Passage of microorganisms from one person to another DISINFECTION The use of chemical agents to accomplish the destruction of disease-causing microorganisms, but not necessarily all pathogens or resistant spores on inanimate objects or surfaces IATROGENIC INFECTION Infection caused by treatment or diagnostic procedures NOSOCOMIAL INFECTION Infection acquired during hospitalization OPPORTUNISITIC INFECTION Infection caused by normally non-pathogenic microorganism in a host whose resistance has been decreased or compromised 149 PATHOGEN Any microorganism capable of producing disease SEPTICEMIA Systemic infection in which pathogens are present in the circulating bloodstream having spread from an infection in any part of the body. Diagnosed by blood culture and vigorously treated with antibiotics. Also called "blood poisoning". STERILIZATION Destruction or removal of all forms of life, with particular reference to microbial organisms. The limiting requirement is destruction of heat resistant bacterial spores SEPSIS Infection, contamination 150 TREATMENT PROGRESS NOTES: New Patient Documentation PTP DOCUMENTATION COMPONENT (Fill out this section PRIOR TO PTP and bring completed chart & Superbill with you to conference room at PTP with faculty) Obtain HHX: Meds/ Med Allergies: Name current meds and what prescribed for CC: Write only if patient has specific concerns. Vitals: BP, Pulse, RPM Student Sig./ PTP Faculty Sig. POST-TREATMENT DOCUMENTATION COMPONENT (Fill out this section AFTER TX HAS BEEN COMPLETED FOR THE DAY and bring to conference room for faculty signature) EIE: WNL or state specific finding PERIO: Statement of probe depths, BOP, calculus and plaque findings, recession, furcation involvement, mobility (Ex: Gen. 2-3mm w/loc BOP, gen lt sub cal w/mod supra cal mand ant, gen. lt cervical plaque, Class II mobility #5, Class I furcation #3) HTC: This may be omitted if no suspicious areas of caries are present. If isolated area is present: note specific tooth no. If multiple areas are present: note "see chart". DHTP: Enclosed PI____%, BI______%, CDI_____, OHI: State SPECIFIC recommendations given to patient TX: State TX that has been completed. State TX that is in progress *On final appt write DH Tx Comp, CDI RECALL (Rec): On final appointment, state recommended recall interval (Ex. 6 MRC) Student Sig./Faculty Signature *Write Patient Name and Chart Number in upper right of TPN sheet *Write date, procedure number and fee form (Superbill) number in columns to left of notes on TPN sheet 151 RECALL PATIENT DOCUMENTATION (Blue Recall Form) PTP DOCUMENTATION COMPONENT (Fill out this section PRIOR TO PTP and bring completed chart & Superbill with you to conference room at PTP with faculty) Patient Name ____________ Chart No. ________ Date, Procedure Nos., Fee Form Number (Superbill) Last FMX______ BWX _____ Last Prophylaxis______ Last Caries________ Med Hx: __________________ Alert/ Meds_______ Chief Complaint: _______ Vitals________________(BP, Pulse, RPM) PTP for Recall Exam: Student Signature/Faculty Signature POST-TREATMENT DOCUMENTATION COMPONENT (Fill out this section AFTER TX HAS BEEN COMPLETED FOR THAT DAY and bring to conference room for faculty signature) EIE: Note any significant findings Multiple significant findings: Enclosed Risk Assessment: State specific risks that present for this patient (Ex. Xerostomia from meds, high sugar intake on caries, recession/ dentinal hypersensitivity Nutritional Assessment/Counseling: State specific behavior modifications that you wish to accomplish to address specific risk factors (Ex. Daily sugar exposures, adequacy of food intake, oral implications of vitamin and mineral deficiencies) Tobacco Cessation Assessment/Counseling: State specific recommendations for behavior modification that you wish to accomplish to address specific risk factors. (Ex. Advised patient of side effects--provided motivational materials, assisted with an intervention program, and/or follow-up plan) OHI: State specific behavior modifications that you wish to accomplish to address all presenting risk factors CDI ____ Plaque Score ______ Bleeding Index_____ Occlusion: R & L Overbite: _______ Overjet: ________ Radiographs Taken: Check appropriate or site-specific PA area Dental Chart: All chartable items until further notification Perio Chart: Only 4 mm and above Bleeding points circled Recession and MGJ TX Received: Document exact TX performed that day (Ex. Work-up – do NOT re-document individual findings from first appointment day, SC Quads 1& 4. Began Quad 3) On final appointment with patient, write DH TX Compete. Please remove from my list Recommended Recall Date: ________ Student Signature/Faculty Signature **next CDI and recall: top, right of form 152 Guidelines For Prescribing Dental Radiographs The recommendations in this chart are subject to clinical judgment and may not apply to every patient. They are to be used by dentists only after reviewing the patient's health history and completing a clinical examination. The recommendations do not need to be altered because of pregnancy. The recommendations contained in this material were developed by an expert dental panel comprised of representatives from the Academy of General Dentistry, American Academy of Dental Radiology, American Academy of Oral Medicine, American Academy of Pediatric Dentistry, American Academy of Periodontology, and the American Dental Association under the sponsorship of the Food and Drug Administration (FDA). The chart is being reproduced and distributed to the dental community by Eastman Kodak Company in cooperation with the FDA. *Clinical situations for which radiographs may be indicated include: A. Positive Historical Findings 1. Previous periodontal or endodontic therapy 2. History of pain or trauma 3. Familial history of dental anomalies 4. Postoperative evaluation of healing 5. Presence of implants B. Positive Clinical Signs/Symptoms 1. Clinical evidence of periodontal disease 2. Large or deep restorations 3. Deep carious lesions 4. Malposed or clinically impacted teeth 5. Swelling 6. Evidence of facial trauma 7. Mobility of teeth 8. Fistula or sinus tract infection 9. Clinically suspected sinus pathology 10. Growth abnormalities 11. Oral involvement in known or suspects systemic disease 12. Positive neurologic findings in the head and neck 13. Evidence of foreign objects 14. Pain and/or dysfunction of the temporomandibular joint 15. Facial asymmetry 16. Abutment teeth for fixed or removable partial prosthesis 17. Unexplained bleeding 18. Unexplained sensitivity of teeth 19. Unusual eruption, spacing or migration of teeth 20. Unusual tooth morphology, calcification or color 21. Missing teeth with unknown reason 153 **Patients at high risk for caries may demonstrate any of the following: 1. High level of caries experience 2. History of recurrent caries 3. Existing restoration of poor quality 4. Poor oral hygiene 5. Inadequate fluoride exposure 6. Prolonged nursing (bottle or breast) 7. Diet with high sucrose frequency 8. Poor family dental health 9. Developmental enamel defects 10. Developmental disability 11. Xerostomia 12. Genetic abnormalities of teeth 13. Many multisurface restorations 14. Chemo/radiation therapy 154 Guidelines For Prescribing Dental Radiographs Patient Category Child Adolescent Adult Primary Dentition Transitional Permanent Dentition Dentulous Edentulous (prior to eruption of Dentition (following (prior to eruption of first permanent eruption of first third molars) tooth) permanent tooth) New Patient* Posterior bitewing Individualized Individualized radiographic examination consisting Full mouth intraoral All new patients to examination if proximal radiographic of posterior bitewings and selected periapicals. A radiographic surfaces of primary examination consisting full mouth intraoral radiographic examination is examination or assess dental teeth cannot be of periapical/ appropriate when the patient presents with clinical panoramic examination diseases and growth visualized or probed occlusal views and evidence of generalized dental disease or a history and development posterior bitewings or of extensive dental treatment panoramic examination and posterior bitewings Recall Patient* Posterior bitewing examinations at 6-month Posterior bitewing Posterior bitewing Not applicable Clinical caries or intervals or until no carious lesions are evident examination at 6- to 12- examination at 12- to month intervals or until 18-month intervals high-risk factors for no carious lesions are caries** evident No clinical caries Posterior bitewing Posterior bitewing Posterior bitewing Posterior bitewing Not applicable and no high-risk examination at 12- to examination at 12- to examination at 18- to 36- examination at 24- to factors for caries** 24-month intervals if 24-month intervals month intervals 36-month intervals proximal surfaces of primary teeth cannot be visualized or probed Periodontal disease Individualized radiographic examination Individualized radiographic examination consisting Not applicable or a history of consisting of selected periapical and/or bitewing of selected periapical and/or bitewing radiographs periodontal radiographs for areas where periodontal disease for areas where periodontal disease (other than (other than nonspecific gingivitis) can be nonspecific gingivitis) can be demonstrated treatment demonstrated clinically clinically Growth and Usually not indicated Individualized Periapical or panoramic Usually not indicated Usually not indicated development radiographic examination to assess assessment examination consisting developing third molars of a periapical/occlusal or panoramic examination 155 SECTION K CLINIC FORMS Date__________________ Patient Name__________________ Chart number______________ In order to fulfill our mission to provide optimum educational experiences for students, the College of Dentistry must release patients from the program that no longer meet the educational requirements we must provide. The College of Dentistry is a teaching institution and patients remain in the care of the College as long as their dental treatment needs have educational value. According to the College of Dentistry Clinic Operations policy, patients will receive recall care for one year after their dental care has been completed and then they will be released from the program to pursue care in private practice. Our records indicate that you have received recall care for one year after it was determined that your dental care had been completed. Patients whose treatment is considered complete cannot be re- screened to return to the program. At this time, you are being released from the College of Dentistry dental program and it is strongly recommended that you seek continuing oral health care in a private practice. We have appreciated your willingness to participate in the education of dental and dental hygiene students at the College of Dentistry. Your confidence in our abilities to provide for your oral health care needs and your commitment to the program have also been greatly appreciated. Respectfully, Jeanne Panza, D.M.D. Kathryn F. Miller, R.D.H., B.S. Assistant Dean for Clinics Clinical Associate Professor Director of Clinics Assistant Director of Clinics 159 DENTAL HYGIENE PATIENT SURVEY The University of Oklahoma College of Dentistry Department of Dental Hygiene Clinical Site: HOW ARE WE DOING? The Oklahoma University College of Dentistry (OUCOD) Dental Hygiene Department is dedicated to providing highest quality oral health care to our patients. What you think of our services is very important to us in meeting our goal of quality care. Individual answers are confidential. Please take a few minutes to complete this survey and drop it in the box as you exit the clinic. Thank you for helping us make the OUCOD a better place to receive dental hygiene care. Please check the box that best describes your opinion using the following key: 4 = Strongly agree 3 = Agree 2 = No opinion 1 = Disagree 0 = Strongly Disagree 4 3 2 1 0 1. I received professional and competent care by the dental hygiene student. Student name ______________________________________________________ 2. School policies were made clear to me. 3. The student seemed organized and efficient. 4. The student thoroughly informed me of the status of my oral health. 5. I was able to contact my dental hygiene student if needed 6. The student explained what was going to happen before each procedure. 7. The student made me feel protected from catching a disease or infection. 8. The student discussed treatment costs with me. 9. The student kept discomfort to a minimum. 10. At the completion of treatment, the student informed me of when I needed to return for continuing care. 11. The instructor treated me with courtesy and respect. Instructor name_______________________________________________________ 12. I will refer my friends and/or family to this clinic. The following questions are optional and individual answers will be kept confidential. Age:_________ Gender: Male Female Race/Ethnic Background: a. White/Caucasian d. Hispanic b. Black e. Oriental c. Native American f. Other Please circle the letter that includes your family income level: a. less than $16, 000 per year b. between $16, 001 and $49, 999 per year c. $50,000 or more per year E. Please circle the letter that indicates the highest level of education you have completed? 1. less than high school 4. Associate degree 2. high school 5. Baccalaureate degree 3. some college or trade school coursework 6. Graduate degree Thank you very much for your time and assistance! DENTAL HYGIENE CASE DIFFICULTY INDEX (CDI) PATIENT ___________________________________ DIRECTIONS: 1. Circle value for finding(s) in each category DATE ______________________________________ 2. Add point values to determine index rating STUDENT ___________________________________ 3. Use Classification Index below Group 1: Periodontal Classification Group 2: Localized or Generalized Active CASE DIFFICULTY INDEX Health 0 0 0 KEY Gingivitis 1 1 1 Periodontitis - Slight 1 2 1 0-4 Points =Class A Periodontitis - Moderate 2 3 5-10 Points =Class B 1 Periodontitis - Severe 3 4 11-15 Points =Class C 1 16-20 Points =Class D NUG or NUP 1 2 1 >20 Points =Class E Group 3: Supra Calc Group 4: Sub Calc None 0 None 0 1 Lower anteriors only-light 1 Isolated spicules 3 2 CDI Anteriors & molars 2 Generalized spicules 6 3 Heavy or bridged 3 Generalized spicules 9 4 & isolated ledge(s) Generalized ledges 12 HSC 7384 rev 6/06 DENTAL HYGIENE CASE DIFFICULTY INDEX (CDI) PATIENT ___________________________________ DIRECTIONS: 1. Circle value for finding(s) in each category DATE ______________________________________ 2. Add point values to determine index rating STUDENT ___________________________________ 3. Use Classification Index below Group 1: Periodontal Classification Group 2: Localized or Generalized Active CASE DIFFICULTY INDEX Health 0 0 0 KEY Gingivitis 1 1 1 Periodontitis - Slight 1 2 1 0-4 Points =Class A Periodontitis - Moderate 2 3 5-10 Points =Class B 1 Periodontitis - Severe 3 4 11-15 Points =Class C 1 16-20 Points =Class D NUG or NUP 1 2 1 >20 Points =Class E Group 3: Supra Calc Group 4: Sub Calc 1 None 0 None 0 2 CDI Lower anteriors only-light 1 Isolated spicules 3 3 Anteriors & molars 2 Generalized spicules 6 Heavy or bridged 3 Generalized spicules 9 4 & isolated ledge(s) Generalized ledges 12 158 DENTAL HYGIENE CASE DIFFICULTY INDEX (CDI) PATIENT ___________________________________ DIRECTIONS: 1. Circle value for finding(s) in each category DATE ______________________________________ (only 1 in Groups 1-4, up to 3 in group 5) 2. Add point values to determine index rating STUDENT ___________________________________ 3. Use Classification Index below NOTE: Localized: <30% of sites Generalized: >30% of sites Group 1: Periodontal Health/ Disease Classification Group 2: Disease Status Localized or Generalized Active Stable (Inactive) Health 0 0 Gingivitis 1 1 0 0 Chronic Periodontitis - Slight 1 2 1 0 Chronic Periodontitis - Moderate 2 3 1 0 Chronic Periodontitis - Severe 3 4 1 0 NUG or NUP 1 2 1 0 1 0 Group 3: Supragingival Calculus Group 4: Subgingival Calculus None 0 None 0 Veneer only, lower anteriors only 1 Isolated spicules – anterior OR posterior 1 2 3 Veneer is visible, but thin (< 1mm) (definite click when explored) & RP prn Veneer only, anterior & posterior 2 Generalized spicules & RP prn 6 Generalized spicules with isolated random Anterior crustaceous – has thickness ( > 1mm) 2 ledge(s) & RP prn 9 Anterior & posterior crustaceous 3 Generalized ledges in each quadrant & 12 RP prn Group 5: Other Difficulty Factors Examples of "Other" Difficulties (√ max of 3) Intrinsic, or in deposit, or light isolated stain 0 Overhanging margins Crown & Bridge Generalized medium-heavy stain 1 Tongue issues Loquacious Gingival enlargement Anxiety Tooth hypersensitivity 1 Behavior Dilemma Patient positioning Less than 5 teeth/quad=minus 1 point/quad -1 -2 -3 -4 Excessive hemorrhage Caries Hyperactive gag reflex Other "Other" (requires faculty initials) maximum of 3 1 2 3 1 Group 2 Totals CASE DIFFICULTY CI CDI INDEX KEY Verification 3 4 5 0- 4 Points =Class A Other (CI initial) 5-10 Points =Class B 11-15 Points =Class C 16-20 Points =Class D CDI Total >20 Points =Class E 159 CLINIC SITE: Survey completed UNIVERSITY of OKLAHOMA COLLEGE OF DENTISTRY Department of Dental Hygiene CLINICAL EVALUATION FORM STUDENT PTP (1) PTP (2) PTP (3) PTP (4) PTP (5) PTP (6) PATIENT Age MC CDI # Teeth Tx. Complete Date CI: ASSESSMENT CLINICAL ADJUNCT SERVICES REQUIREMENTS PTP/HHx A A- ND Instrumentation A A- ND Desensitization A A- ND Air Polish EIE A A- ND Ultrasonic Use A A- ND Restoration Care A A- ND Bleaching Dental Evaluation A A- ND Plaq/Stn Removal A A- ND Care of Prosthesis A A- ND B Scaling Comp C Scaling Comp Periodontal Evaluation A A- ND Re-eval/CCM A A- ND Chemotherapeutics A A- ND Cor Polish Comp DH Dx/CDI A A- ND Instrument Care A A- ND Sealants A A- ND Calc charting Risk Assess/Pt Education A A- ND Infection Control A A- ND Implant Care A A- ND D Scaling Comp Treatment Plan A A- ND Ergonomics A A- ND Pain Management A A- ND Desens/Chemo Patient Management A A- ND Time Mgmt A A- ND Experiential A A- ND Impressions Documentation A A- ND Professionalism A A- ND Local Anesthesia Nutritional Assess/counsel A A- ND Radiographs A A- ND Nitrous Tobacco Cessation A A- ND Perio Charting Comp Sealants Transitional Dentition S=Supra D=Definite Sub R=Roughness sub T=Tissue Trauma P=Plaque St= Stain Ultrasonic 2 Pts in 1 clinic Quad 1- UR Quad 2- UL 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 CI CI Date Date Errors Errors A/ND A/ND 32 31 30 29 28 27 26 25 24 23 22 21 20 19 18 17 CI CI Date Date Errors Errors A/ND A/ND Quad 4- LR Quad 3- LL Supra Calculus Sub Calculus 2 or more per pt A > 2 per pt FACULTY COMMENTS: TOTAL HARD DEPOSITS REMOVAL RESULTS EVALUATION of all 4 quads (A, B or C pts) : A or ND B > 4, 2 per pt HSC-7397 rev 06/07 Plaque/St C > 6, 3 per pt >4 per pt D > 2 per quad Trauma 2 or more E > 2 per quad 160 COMPETENCY SELF-ASSESSMENT WORKSHEET Student Name________________ Date/ Faculty Signature________________ S/RP: B C D Polishing Error Total Error Self-assessment of Error (.25) Correction Method (.25) Removed (0.5) 161 Error Value Error Self-assessment of Error (.25) Correction Method (.25) Removed (0.5) 162 Student Date CI CLASS 'B' 'C' 'D' SCALING or POLISHING COMPETENCY EVALUATION SUMMARY SCALING EVALUATION / + = Formula: Number of removed deposits + Self-Assessment Points/Total # Deposits POLISHING EVALUATION / + = Formula: Number of removed deposits + Self-Assessment Points/Total # Deposits HSC 7428 Rev 06.06 163 UNIVERSITY OF OKLAHOMA COLLEGE OF DENTISTRY DEPARTMENT OF DENTAL HYGIENE ROTATION REPORT FORM Student _________________________________ Date ______________ Patient __________________________________ Chart # ROTATION SITE VAMC Implantology Graduate Periodontics Good Shepherd Mission Tinker Air Force Base Junior Dental Hygiene Clinic Pediatric Dentistry Geriatric Rotation Oral Diagnosis Senior Dental Hygiene Clinic Other: (List)___________ CLINICAL SERVICES PROVIDED Alginate Impressions Amalgam Polishing, Removal of Overhang: Tooth #(s) _____________ Assist Dental Hygiene Student: Procedure: ______________________ Assist Dental Student or Dentist: Procedure: _____________________ Desensitization: Tooth #(s) _____________ Diet Counseling Local Anesthesia: Type and site ______________________________ Nitrous Oxide Sedation Removable Prosthesis Care: Type ___________________________ Rubber Dam Placement Sealant Placement: Tooth #(s) _____________ Temporary Restoration Other: List_____________ COMMENTS: Faculty/Staff Signature 164 DENTAL HYGIENE CARE ONLY In the event that I am not accepted for complete dental treatment by the College of Dentistry, I would still like to have my TEETH CLEANED (dental hygiene treatment) by dental hygiene students of the University of Oklahoma College of Dentistry. I, __________________________________________________________, consent Print First MI Last Name to have my teeth cleaned at the University of Oklahoma College of Dentistry and: A. understand that after this care I must seek to have other dental work completed by a private dentist. B. shall in no way hold the College of Dentistry or any of its faculty, staff, or students responsible for my failure to obtain dental treatment. C. authorize the administration of local anesthetics or medications deemed necessary for completion of dental hygiene treatment. D. authorize the taking of x-rays or photographs as deemed necessary for dental hygiene treatment. ____________________________ Signature of Patient ____________________________ Date HSC 7444 rev 6/06 165 DH RECALL EXAMINATION Patient Name: Expected CDI Recall Interval Date: Chart No. Fee Form Number: 3mrc 4mrc A B C D E 6mrc 12mrc Procedure Numbers: Last FMX: Last BWX: Last Prophylaxis: Last Caries: Med Hx: ALERT / MEDS: Chief Complaint: Vitals: BP 5 Min retake Pulse RPM PTP EIE: Risk Assessment: Nutritional Assessment/Counseling: Tobacco Cessation: Periodontal Assessment: OHI: CDI: Plaque Index: Bleeding Index: Occlusion: R L Overbite: Overjet: Radiographs Taken: None 2 BWX 4 BWX PAX # Other Tx: Dental Tx Recommendations: DH Faculty: Examining Dental Student: Dental Faculty: Reviewed by Associate Dean for Clinics Date: HSC-7520 rev 06/07 166 Faculty UNIVERSITY of OKLAHOMA COLLEGE OF DENTISTRY DEPARTMENT of DENTAL HYGIENE CLINIC SIGN UP SHEET Student Chair Number Time Service Needed Faculty UNIVERSITY of OKLAHOMA COLLEGE OF DENTISTRY DEPARTMENT of DENTAL HYGIENE CLINIC SIGN UP SHEET Student Chair Number Time Service Needed Rev 06/06 CDI: ABCDE DENTAL HYGIENE PLAN FOR CLINICAL SERVICES PATIENT NAME DATE STUDENT NAME CI ASSESSMENT HHx/Meds Chief Complaint EIE Perio Evaluation Dental Chart Oral Hygiene Technique Risk Assessment Nutritional Assessment/Counseling Tobacco Cessation Date of Last Prophy APPT. PATIENT EDUCATION CLINICAL SERVICES APPT PATIENT EDUCATION CLINICAL SERVICES Patient Signature.____________ _________ Student Signature._______________________ OU COLLEGE OF DENTISTRY ADJUSTMENT TO ACCOUNT Patient Number:____________________________________________ Name:_____________________________________________________ Doctor Number:_____________________________________________ Location:___________________________________________________ Account Code:______________________________________________ Date:______________________________________________________ Debit Amount:______________________________________________ Credit Amount:_____________________________________________ Reference:__________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ UNIVERSITY of OKLAHOMA COLLEGE of DENTISTRY DEPARTMENT of DENTAL HYGIENE NAME: DATE: TIME of APPOINTMENT: This patient was treated in our clinic as noted. Please excuse this absence. Sincerely, Clinical Faculty Department of Dental Hygiene HSC 7442 rev 6/06 OU College of Dentistry Dental Hygiene Program Daily Periodic Exam Schedule Exam Chair Date of Last Patient Requires Complete Student Name Patient Name Chart Number Number Exam 1YR 2 YR Signature Examining Faculty: ______________________________ Signature Hygiene Faculty:_______________________________ DEPARTMENT OF DENTAL HYGIENE LOCAL ANESTHESIA WORKSHEET Student Name __________________ Date ___________ Patient Name __________________ Chart #__________ Procedure Area _______________________________ Type of Injection _______________________________ Nerve(s) Anesthetized _______________________________ Type of Anesthetic _______________________________ Volume of Anesthetic _______________________________ Medical History Considerations _______________________________ Evaluation of Technique: A/ND Comments: ________________________________________________________________________ ________________________________________________________________________ Number of Injections Tooth Number(s) or Quadrant(s) _____ PSA ________ _____ MSA ________ _____ ASA ________ _____ Nasopalatine ________ _____ Greater Palatine ________ _____ Infraorbital ________ _____ Inferior Alveolar & LB ________ _____ Infiltration ________ _____ Incisive/Mental ________ Faculty Signature ___________________ Date ___________ INSTRUCTIONS FOLLOWING ROOT PLANING PROCEDURE: Root planing is a procedure whereby the roots of the teeth are cleaned and smoothed, even below the gumline, to remove deposits of plaque, calculus (tartar) and other irritants which contribute to your periodontal disease. Root planing combined with your daily effective plaque control should improve your periodontal condition. MOUTHRINSES: Following the appointment, you may rinse with warm water, or warm salt water (1 tsp. to 8 oz of warm water). You may rinse as often as you feel is necessary. Rinsing will help keep your mouth clean and promote healing. Use any prescribed mouthrinse as directed. ORAL HYGIENE: Brush very thoroughly, but gently, as you have been directed. Follow any additional plaque control measures that you have been shown. A clean mouth heals faster. BLEEDING: You may notice some blood clots or minor oozing of blood immediately following the appointment. Do not attempt to wipe the clots away. Continue to clean your mouth as instructed. The gums may even bleed slightly for a few days but this is normal and should gradually decrease over time. If heavy bleeding occurs, please call. DISCOMFORT: There may be some discomfort following root planing for a day or two. If necessary, you make take a mild pain medication that you normally take for a headache (such as Tylenol). If pain is persistent, please call. Occasionally, an abscess will occur. You may also notice sensitivity to cold, heat and certain foods (such as sweets) but this should gradually diminish. Good plaque control will help, but please advise us if the sensitivity persists. ANESTHETIC: If a local anesthetic was used during your appointment, be careful that you do not bite your lips or tongue if they are numb. The numbness will last approximately 1-4 hours. ADDITIONAL INSTRUCTIONS: PHONE NUMBER: NEXT APPOINTMENT: HSC 7430 Directions For Care After Treatment With Fluoride Varnish After the application you will feel a coating and may notice a difference in color while the varnish remains on your teeth. To obtain the maximum benefit during the 4-6 hour treatment period, we ask that you take the following care after you leave our clinic: Do not remove the varnish by brushing or flossing for at least 4-6 hours. If possible, wait until tomorrow morning to resume normal oral hygiene. Eat a soft food diet during the treatment period. Avoid hot drinks and products containing alcohol (i.e.: beverages, oral rinses, etc.) during the treatment period. A thorough brushing and flossing will easily remove any remaining varnish. Your teeth will return to the same shine and brightness as before the treatment. ARESTIN POST OP INSTRUCTIONS: Avoid eating hard, crunchy, or sticky foods for 1 week Postpone brushing for a 12-hour period Avoid touching treated areas Postpone the use of interproximal cleaning devices (ex. Floss) for 10 days after administration of Arestin Some mild to moderate sensitivity is expected during the first week after administration of Arestin Notify the dentist promptly if pain, swelling, or other problems occur SECTION L Board Exams 178 DENTAL HYGIENE BOARD EXAMS NATIONAL BOARD DENTAL HYGIENE EXAM (NBDHE) 211 East Chicago Ave Chicago, IL 60611-2678 www.ADA.org 800-232-1694 Date: Last Tuesday in March Application deadline: February 4, 2008 Fee: $165.00 Application process online, after January 1. Requires 2 passport photos Results usually available 6 weeks WESTERN REGIONAL BOARD EXAM (WREB) 9201 N. 25th Ave. Suite 185 Phoenix, AZ 85201 (602) 944-3315 Fax (602) 371-8131 Email: firstname.lastname@example.com www.wreb.org Date: end of May 2008 Fee: $825.00 Application process online after January 1 Must submit verification from COD Requires 2 passport photos Results available usually 2-3 weeks OKLAHOMA BOARD OF DENTISTRY JURISPRUDENCE EXAM FOR STATE LICENSURE 201 NE 38th Terr, #2 Oklahoma City, Ok 73105 (405) 524-9037 Linda Campbell, executive director www.state.ok.us/dentist/ Date: 3rd – 4th week of April; each site scheduled at different times; Fee: $100 Application process: form available 1st of March Requires physical exam Requires passport photo Must be notarized Results available immediately 179 SECTION M Student Organizations 180 DH II Officers 2007-2008 Ardmore B-Ville OKC Weatherford Class Advisor Ms. Brannock Ms. Snyder Dr. Bowers Ms. McClung Julie Charnock Amanda Beal Sheena Chance Falisha Bowers President Te Idleman Linda Tran Lindsey Shores LaNae Meacham VP Bonny Farmer Melissa Smith Teresa De Luna Rachel Harper Sec/Treasurer Kristen Caruthers STUCO Rep (2) ??? Staples ?????? ????? Yearbook (2) Tiffany Newberry Andrea Mouser Julie Swift Melanie Carr Cassie Puckett Kara Knop Brooke Zorger SADHA Advisor Ms. Gustafson Ms. Zerby Ms. Tuck ??? SADHA Pres Sherri Jolly Alisha Soule Amanda Pickering Heather Coleman SADHA VP Tiffany Newberry Linzi Sabeh Ayoun Sheena Chance LaNae Meacham SADHA Sec/Treas Cassie Puckett Melissa Smith Lindsey Shores Falisha Bowers 180 Dental Hygiene Class Officers Election and Duties ELECTION PROCESS 1. The faculty advisor will be call and preside over a class meeting for the purpose of electing officers 2. Nominations will be accepted from the floor and voted by office. 3. Candidates each office will be provided two minutes to speak to 4. their colleagues if desired. 5. Votes will be counted by the site faculty advisor and an appointed official. JUNIOR CLASS OFFICER JOB DESCRIPTIONS/DUTIES PRESIDENT will: 1 AT EACH SITE • call and preside over meetings of the Site Class • assume responsibility for representing the Site Class and act as spokesperson for the Site Class when indicated • act as liaison between Dental Hygiene Department Co-Chairs, Site Coordinators, and the Class • be responsible for informing DH Department Co-Chairs of Class activities, event, and functions • coordinate functions, schedule locations of events for the Class with the Dental Hygiene Department, Dean's office and various COD departments as necessary • call a meeting in April of the first year to elect Senior Class Officers • serve as member of the Class Executive Council VICE-PRESIDENT will: 1 AT EACH SITE • assume duties of the President in case of absence • assist the president in organization of class functions • carry out other duties assigned by the president • serve as member of the Class Executive Council SECRETARY/ TREASURER will: 1 AT EACH SITE • collect and deposit individual site class funds • maintain an accounting system for individual class funds • work with COD accounting Department to monitor class funds derived from the Student Activity Fee record minutes from class meetings • disburse funds on behalf of the class • serve as member of the Class Executive Council Class Executive Council will consist of: Site Presidents Site Vice Presidents Site Secretary/Treasurer 180 Duties: 1. Plan and coordinate class activities, events, and social functions (in collaboration with DH I and DH II Executive Councils from individual sites or jointly with all sites if indicated 2. Delegate class members to arrange facility, time, invitations, food, beverages and clean up DH I STUDENT COUNCIL REPRESENTATIVES (2) will: *MUST BE OKC SITE STUDENTS AS MEETINGS OCCUR ON WEDNESDAY AFTERNOONS AT 5:00PM AT COD OKC Site President, VP will represent all sites as a voting members of Student Council • represent the DH I Class from all sites on the Student Council (STUCO). • attend monthly STUCO meetings • volunteer as appropriate in activities organized by STUCO • keep classmates informed about the activities of STUCO and promote participation in its activities STAPLES SOCIETY REPRESENTATIVE will: MUST BE OKC SITE STUDENT • attend and participate in Staples Society meetings • participate as appropriate in the various activities and fund raisers of the Society • keep classmates informed about activities of the Society and promote participation in Society activities YEAR BOOK COMMITTEE will: 2 AT EACH SITE • responsible for collecting pictures and other information about the class for publication in the yearbook • coordinate items, photos, etc from class to be included in the COD yearbook SADHA OFFICERS will: 3 AT EACH SITE SADHA officers will be elected as DHI and will continue these elected positions through the second year President - elect will: • plan assigned SADHA meeting date and speaker in collaboration with the Site SADHA Faculty Advisor • inform class of ADHA and ODHA meeting dates, activities, and national and state issues Vice President-elect will: • represent the president in her/his absence • Assist the president with planning meetings and functions Sec-Treasurer-elect will: • record proceedings from SADHA Meetings • collect and deposit SADHA funds DH I CLASS SITE FACULTY ADVISOR will: • provide guidance and counsel to class officers • approve individual site fund-raising activities 181 • Junior Year Responsibilities o Fundraising o Senior Sendoff • Assist Seniors with WREB backup patient pool Senior Year Responsibilities • New Class Welcome during orientation • Fundraising • Christmas Party (Optional) • WREB Backup patient pool 182 SECTION N OKC COD Clinic Miscellaneous 1 FAX TRANSMITTAL INFORMATION Green Clinic In the event that the patient needs a Medical Consult from a physician, please do the following: 1. Fill out medical consult form 2. Cross out the phone number (271-3158) & change it to 271-4181. 3. Fill out the Fax Transmission form 4. Contact Terri Forster in the Maxillofacial Clinic to request permission to send fax 5. Lay forms face down on fax machine. Dial 9 + number & press green button to send. 6. If long distance, contact Terri for further information. 7. PLACE FAX TRANSMITTAL FORM IN PATIENT'S CHART 183 184 University of Oklahoma College of Dentistry Department of Dental Hygiene 1201 N. Stonewall, Suite #567 Oklahoma City, OK 73117 (405) 271-4435 Telephone (405) 271-4181 Fax TO: F COMPANY/DEPARTMENT: A ADDRESS: C FROM: S REFERENCE: TOTAL NUMBER OF FAX PAGES I MESSAGE: M I CONFIDENTIAL – PATIENT INFORMATION If this fax is accidentally received by a party other than the above intended, please call (405) 271-4435 to report the error L and destroy the fax copy sent to you. Thank you. E 185 Macintosh HD:Us ers:jane:Desktop:DH M anual 07-08:Sec N COD Clinic Info.doc DENTAL HYGIENE RECALL EXAMINATION Interval/Examiner Protocol Effective 1-25-07 6-Month Recall Exam DS 4 Code 1120-10 (oral eval-no supervision) There is no charge to the patient for this procedure Bitewings & PAs to be charged for when taken at this appointment 1-Year Recall Exam Dental Faculty Code 120 Examination includes 4 bitewings if needed (do not mark on form, they are included) 2-Year Recall Exam Dental Faculty Code 120 Examination includes bitewings & periapicals if needed Additional radiographs should be charged for when taken Dr. Panza 46828 186 Macintosh HD:Us ers:jane:Desktop:DH M anual 07-08:Sec N COD Clinic Info.doc DENTAL HYGIENE PATIENT PROTOCOL Fall 2007 Only RECALL patients receive an OD exam. Only RECALL patients may receive a Graduate Periodontics consultation DH ONLY can be taken to Grad Perio to set up an appointment upon advice of CI. PATIENT TYPE DH TREATMENT PROTOCOL • Scheduled by patient scheduler to check in at Cashier's Desk on 2nd floor at 12:30. 1:15, 2:00 & 2:45 to register (seen 30 minutes later in clinic) 271-7327 SCREENING PATIENTS • Fill out all forms for Dental Hygiene Only (use OLD OD screening forms stamped DH Only) (Friends, family members, VA, • On Screening form-write down where patient heard about program and note the CDI OUHSC, Project Challenge, or • Go over HHx, take BP, get PTP from CI. anyone) • Request radiographs to be exposed (limited to 2 BWX or reasonable alternative) • CI to sign for films on radiographic log • Expose & develop prescribed radiographs & collect data to complete CDI (recession, spot probing, supra & subgingival calculus) • CI to confirm CDI • CI will be responsible for ensuring that acceptance as "Hygiene Only" forms are completed, and a payment policy is signed and distributed for each patient accepted • Stamp front of chart and TPNs with Dental Hygiene Only stamp. • Student must fill out rotation form. • DH student completes new patient work-up & provides DH treatment. • Patient does not receive an OD exam. DH ONLY PATIENTS • Take 2 BWX Patients screened in DH Clinic or OD • These patients may be placed in recall system if deemed an ongoing teaching case at the discretion & accepted for hygiene only – no of the Clinical Instructor. other dental care provided. • Patient is told to seek care in private practice for other dental care, including exams. • Stamp front of chart and TPNs with Dental Hygiene Only stamp. "PROJECT CHALLENGE" • Must have $50 voucher (covers ALL DH tx) • Make note on encounter form to prevent additional charges (Project Challenge) ALL TECHNOLOGY • Stamp front of chart and TPNs with Dental Hygiene Only stamp CENTER PATIENTS • DH Only consent form must be signed. • Tx documented on white TPNs (including 4-6 wk re-eval) • If follow-up is in 3-4 months, use Blue Recall Form & stamp DH only in exam section • Can continue DH care if deemed ongoing teaching case and enrolled in Project Challenge • Workup and treatment is the same as all new DH patients PATIENT TYPE DH TREATMENT PROTOCOL • Patients are scheduled by Graduate Periodontics & charts are available day prior to appt to review; go over meds etc. Charts will be in the tub in Green Clinic with schedule • Patients are seen in DH Clinic, with DH faculty supervision. • Use Graduate Periodontics fee schedule; add any additional procedures to encounter form & inform GP sec'y. Use lines below to add any additional procedures GRADUATE • Rev HHx. (Recent meds already reviewed by ROD. List any new meds, & dental considerations only; at PTP: mention only changes in meds b/c ROD has already reviewed. Quick but thorough PERIODONTICS EIE; Probe but note marked recession, major changes in PD or BOP; get CDI check from CI. PATIENTS • DH tx as deemed necessary (radiographs, OHI, S/RP, CMT, polish, fluoride etc) Updated 3-07 • Have CI check scaling at end of appt. either before or after ROD. • Exam by ROD at end of appt to check for remaining deposits, and PD. (at their discretion) • Discuss case and your tx with ROD. Have ROD sign encounter form • Check boxes for current appt info (Green Clinic, Grad Perio, DH, AM or PM) on enounter form • Take patient to Brown Clinic to check out & make mext appt. • DH student can reappoint on any subsequent open appt in GC. (complete all DH tx asap to facilitate Phase II therapy) • 4910 perio maintenance includes fluoride treatment • DH student completes new patient work-up including 2 BWX, unless done recently elsewhere, & PERSONAL PATIENTS provides DH treatment. Patient is friend/relative of DH • Patient does not receive an OD exam. student • Acquire forms from Pt Care Coordinator ( Payment policy, HIPPA form, HHX form, Case history form and DH Only letter. Return to Health Record (chart) to Pt. Care Coordinator. • These patients are not placed in recall system unless deemed an ongoing teaching case. Otherwise, patient is told to seek care in private practice. Patient will be released upon graduation of student. • Stamp front of chart and TPNs with Dental Hygiene Only stamp. • Immediate family receives 25% discount. WREB SCREENING • Using WREB screening packet, patient completes WREB HHx/Consent & OU Consent Form. PATIENTS • Student explores for calculus • If patient appears to be acceptable, student completes calculus charting form (on a scale of 1-3) & documents probing depths • If acceptable, patient will need PAX & BWX of area to be submitted • Patient is responsible for payment of radiographs • A radiographic log should be placed on outside of WREB packet & signed by faculty PATIENT TYPE DH TREATMENT PROTOCOL • DH student completes new patient work-up & provides DH treatment. • Patient does not receive an OD exam or referral to any other clinic – patient will be assigned to dental student for treatment. RECALL PATIENTS • Dental student's Case Complete appt should be documented in TPNs & on white post-op All Restorative Treatment has been dental/perio charting form • DH student completes recall work-up & provides DH treatment. completed by dental student • Patient receives an OD exam every 6 months. • Treatment needs are noted on the Blue Recall Form (take BWX/PAX of involved area). If patient needs endo, removable, or fixed appropriate departmental faculty must be consulted. If departmental faculty are unavailable, OD student must note there was no consultation. Patient is told if not contacted by recall date to call 271-7327 for follow up. • If pt has completed 2 years of recalls, he/she may be given the option of being re-classified DH Only; must sign new DH Only Consent Form • If not interested in being re-classified as DH Only, must sign DH Release Letter. Original is secured in chart on top of white TPNs & a notation made in TPNs that patient is not interested in DH Only & is being released due to completion of recall • Consent form and DH only form to be signed • Patients do not have to be previous patients of record. BLEACHING PATIENTS • There is no screening fee, however Dr. Panza or Dr. Radfur must approve the pt. for bleaching. • Includes impressions, bleaching trays, Boost procedure (9972) • Dispense patient bleach and desensitizer with trays • 2 appts CITY RESCUE MISSION • Scheduled on Wednesday afternoons only by Pt. Care Coordinator • Pt completes blue adult health history form (as they are able) with Pt. Care Coordinator. It will be noted 'CRM' and the assigned students' names at the top of the form. • Forms are copied and charts are made • Pt. Care Coordinator will escort the patients to Green Clinic and deliver the forms to assigned students. • Rev HHx. (List meds, & dental considerations only; at PTP. Quick but thorough EIE; Probe enough to classify disease and determine CDI. Check in by CI. • DH tx as deemed necessary (radiographs, OHI, S/RP, CMT, polish, fluoride etc) • Patients should have a bus ticket for their transportation when the appointment is over. • If patient needs to be reappointed, they may be seen on other Green Clinic days other than Wednesday if they have transportation. Dental Hygiene Documentation Check List PTP has student and faculty signatures and stamps Dates and signatures/stamps are on: o EIE form o Dental/Perio Charting o CDI form o Radiographic Log Patient name and date are on radiographs Recall exam notes are present, signed and stamped, and clearly understood Recall interval and expected CDI are noted at the top of the recall form Completed treatment notes have been verified for accuracy and signed/stamped by student and faculty member All Dental Hygiene Only patients must have a new (8/06) Dental Hygiene Only Consent Form in the chart (the new form allows us to follow up on their dental hygiene care without providing a dental exam) With the exception of white TPN's, all Dental Hygiene documents are placed behind the purple Dental Hygiene divider which should be behind the Oral Diagnosis section If a release letter has been completed, the original is secured in the chart on top of the white TPN page 190 Macintosh HD:Us ers:jane:Desktop:DH M anual 07-08:Sec N COD Clinic Info.doc Dental Hygiene Patient Information August 2006 At PTP: Determine the type of patient Recall Dental Hygiene Only Complete Treatment 1. Should be stamped "Recall" on the chart. 1. Patients from technology centers have a 1. This is noted on the back of the $50 voucher agreement with the COD. screening form Be sure to make a note on the encounter form to prevent additional charges. 2. The dental student's case complete appointment for the patient should be documented in the TPN's and on the white post-op dental/perio charting form. 2. All treatment is documented on 2. Chart and TPN form should be stamped white TPN pages. 3. Follow recall exam protocol. "Dental Hygiene Only". 4. Treatment is documented on the blue recall form. 3. Treatment is documented on white TPN page (including the 4-6 week re-eval). 4. If it is a follow up appointment in 3-4 months, use the blue recall form and stamp "Dental Hygiene Only" in the exam section. At the completion of treatment: Recall Dental Hygiene Only Complete Treatment 1. If patient has completed two (2) years of recalls, 1. Patients can continue dental hygiene care 1. Note in TPN's that he/she may be given the option of being re- if deemed a good teaching case; must have dental hygiene classified as Dental Hygiene Only; must sign the new (8/06) Dental Hygiene Only Consent care is complete the new (8/06) Dental Hygiene Only Consent Form. Form. and the patient needs to be trans ferred 2. If not interested in being re-classified as DH Only, to a dental he/she must sign and be given a copy of the DH student for Release Letter. The original is secured in the chart restorative treatment. on top of the white TPN's and a notation is made in TPN's that the patient is not interested in being DH Only and is being released due to completion of recal 191 Macintosh HD:Us ers:jane:Desktop:DH M anual 07-08:Sec N COD Clinic Info.doc SECTION 0 COMMUNITY DENTAL CLINICS RESOURCES 194 Oklahoma City Area Reduced-Rate Dental Care Resource Listing (last updated February 16, 2007; Dr. Frank Lipsinic, O.U. College of Dentistry, Ph: 271-5346) denotes "free" clinic ** - denotes there are special qualifications for free care EXTRACTIONS or ORAL SURGERY: Baptist Community Clinic (at Mt. Olivet Baptist Church) 1201 NW 10th St.. Ph: 951-2645 - call 951-2645 for service availability - 3:00 P.M. on 2nd, 3rd, ad 4th Mondays - first come, first served - tooth extractions only - Oklahoma County residents only Baptist Mission Center 2125 Exchange Ave. Ph: 235-6162 - call for service availability - tooth extractions only Cross and Crown Mission 1008 N. McKinley, Ph: 232-7696 - NO DENTIST AT THIS TIME Good Shepherd Mission 1201 North Robinson Ave., Oklahoma City Ph: 232-8631 for general information and client qualification Oklahoma City residents only Extractions and pain (adults) -free simple extractions, or adults in pain - care by undergraduate dental students, with faculty supervisors - Monday evenings, September through May - call Mondays after 9:00 A.M. for limited appointments Children's Dental Clinic - extractions and restorative services - licensed local area dentist volunteers, some dental & dental hygiene students - every other Tuesday evening, September through June - referrals from local school nurses; call 232-8631 for information and qualification ** Lighthouse Medical Ministries, Inc. at Capital Hill Church of Christ, 2801South Robinson, Oklahoma City Ph: 622-6371 - Serving the Hispanic community of the south side of OKCity - tooth extractions; cleanings Oklahoma University College of Dentistry, Undergraduate Student Oral Surgery Clinic 1201 N. Stonewall, Oklahoma City Ph: 271-4079 - $25 exam fee for first visit of year - care by undergraduate dental students with faculty supervision, Mon-Friday - $36 per tooth extraction (up to 6 teeth) - simple extractions only; not impacted wisdom teeth Oklahoma University College of Dentistry, Oral and Maxillofacial Surgery Resident Clinic 1201 N. Stonewall, OKCity Ph: 271-4079 - Care by Oral Surgery residents; may be scheduled or asked to come through University Hospital E.R. - $35 consultation fee applies; includes x-ray - Medicaid accepted - cost ranges from $54 per extraction to $225 for impacted tooth 195 - sedation and general anesthesia available - don't do full mouth extractions at one setting (unless denture is "ready") **Oklahoma City Indian Clinic (free care to CDIB card holders) (see information below) **El Reno Indian Health Center (free care to CDIB card holders) (see Oklahoma City Indian Clinic information below) **Saint Anthony's Hospital (Medicaid & fee for service) (see information below) GENERAL DENTISTRY: D-DENT Program (Oklahoma City and Tulsa areas) (A cooperative program utilizing local dentists, the Oklahoma Dental Association, and other community partners) (424-8092, Shirley Harris, Executive Director) Call 1-800-522-9510 for information and applications - Free dental care to non-insured patients over age 60, and adults with developmental disabilities - covers the full range of general dentistry; except, does not cover implants -"D-Dent" pays lab fees; Oklahoma dentists volunteer their services for limited number of patients a year - care provided by private dentists - call above 1-800 number for applications and info Good Shepherd Mission 1201 North Robinson, Oklahoma City Ph: 232-8631 for general information and qualification Children's Dental Clinic Oklahoma City residents (children) only - extractions, restorative services, and prevention - licensed local area dentists and volunteers - every other Tuesday evening, September through June - referrals from local schools; call 232-8631 for information ** Oklahoma City Indian Clinic (I.H.S) 4913 W. Reno, Oklahoma City Ph: 948-4900 - FREE CARE TO CDIB Card Holders only; limited dental staff - cleanings, fillings, extractions, and anterior root canals - emergencies, "triage" at 7:45 A.M., Mon., Tue., Thur., & Fri. mornings - taking first 5 patients - care by contract dentists - call 1st working day of each month for scheduling and appointment availability **Indian Health Service - El Reno (I.H.S.) Ph: 262-7631, call for information - No dental care available at this time **Mary Mahoney Memorial Health Center 12716 NE 36th Street, Spencer, OK Ph: 769-3301; call for registration and qualification - adults & children; all types of restorative dentistry, cleanings - Medicaid & sliding scale fees - call after 8 A.M. on 1st business day of the month - call for specifics about eligibility and fees - refers their dentures to local area and Tecumseh, OK private dentists Neighborhood Services Organization (NSO) Health Center 431 S.W. 11th Street, Oklahoma City (at South 11th St. & Walker) Call 236-0413, ext 111 for appointment availability and qualification - sliding scale fees - Mon-Friday, 8:30-5:00 P.M. - extractions, cleanings, fillings - exams $10-35; dentures $230-460 **The City Rescue Mission 800 W. California, Oklahoma City Ph: 232-2709 at 10:00 A.M. for information - free care for residents of Rescue Mission Shelter only, and dependant children - simple extractions, fillings, and dentures 196 - Mon, Wed, and and Friday evenings; 6-8:30 P.M. **Saint Anthony's Hospital 1000 N. Lee Street, OKCity Ph: 272-7373 - Medicaid children and adults under age 21 are the only free care - dentures $1,200-1,400 Oklahoma Community Health Services, Inc. (formerly Southeast Area Health Ctr) 1025 Estrake Terrace, Oklahoma City 73139 (near I-240 & Western) Call 632-6688 for availability of services and qualification - sliding scale fees - women and children age 8 and up - extractions, fillings, root canals, crowns, and cleanings - Mon-Fri; care by contract/staff dentist - $30 minimum fee plus x-rays; call for appointment University of Oklahoma College of Dentistry (comprehensive student care) 1201 N. Stonewall, Oklahoma City Ph: 271-6056, Oral Diagnosis - Preventive and Restorative care available at reduced rates (60% of downtown fees) - once screened, typically a waiting list for student assignment - call for emergencies; clinic schedules vary during school year PREVENTIVE CARE or CLEANINGS: Oklahoma University College of Dentistry, Dental Hygiene Department 1201 N. Stonewall, Oklahoma City 73117 Ph: 271-7327 -$10 screening required to establish suitability for hygiene student care -Following a screening appointment and determination of acceptability for Dental Hygiene care, an assignment is made and appointment scheduled -$34-165 fee for cleaning only, depending on difficulty level Rose State College I-40 and Hudiburg Drive, Midwest City Ph: 733-7336 -Adult and Child Cleanings -adults only Mondays, 8:30-11:30, and 1:30-4:30 -children, call for schedule -Screening and cleaning $5 -Call for screenings starting 1 August (until "full") -Sealants and x-rays upon doctor's prescription -Full-mouth X-Rays, $10 postage fee to send to private dentist **NORMAN Health for Friends 317 East Hines, 73070 Ph: 329-4161 -serving Norman area -general dentistry -sliding scale fees; dentures $440 upper & lower **TULSA Eastern Oklahoma Donated Dental Services, Inc. (formerly D-Dent East) Ph: (918) 595-4151/4152 -free care or dentures, for elderly or disabled low-income patients -call for information -Web Page info at (EODDS.org) FINDING OKLAHOMA STATE RESOURCES - Oklahoma D-Dent community clinic listing - go to <www.d-dentok.org>, and navigate to "Dental Referral List" on left side of page, and then "Dental Referral Listing" as an Adobe Acrobat file. 197 SECTION P OKC Rotations 198 GRADUATE PERIODONTICS ROTATION for DENTAL HYGIENE STUDENTS 2nd floor, west side of Brown Clinic Dr. Robert Carson, D.M.D., M.S., Chair Dr. John Dmytryk, D.M.D. M.S. Dr. Joy Beckerley, D.D.S., M.S. Ms. Diane Yamamoto- Patient Account Representative; ext 1-7020 Anne Sullivan-Office Manager 271-6531 Jean Lapham-Clinic Supervisor 271-7064 Heather- Dental Assistant GOAL: To provide the dental hygiene student with the opportunity to observe and carry out periodontal evaluation, treatment planning, therapeutic debridement; to assist in surgical phases of periodontal therapy and to observe case presentations of graduate periodontal residents in order to better understand the rationale for various types of periodontal therapy. PROTOCOL: Plan to arrive and set up operatory 30 minutes prior to the assigned clinic time. The dental hygiene student will be assigned to attend clinic sessions each semester. Dental hygiene students will report to the graduate periodontics clinic on the west side of Brown Clinic and will be assigned to work with the Graduate Periodontics Resident of the Day (ROD). Proper clinic attire is mandatory. Students will assist the residents in whatever phase of therapy to be performed that clinic session, or will provide maintenance therapy for assigned patients. GENERAL PROTOCOL FOR NEW PATIENT ASSIGNMENT I. Patient Assignment: The Patient Account Representative for Graduate Periodontics will assign the new patient to the dental hygiene student. Concurrently, the patient will also be assigned to a periodontal resident. • If the assigned resident is not available, a graduate periodontics faculty member or another resident will cover. • Radiographs will be taken, as indicated, as early as possible in the appointment sequence as possible. II. Setting up the unit • Spray paper towel with disinfectant, wipe down unit, repeat towel/spray/wipe method. (Includes chrome areas as well as operators cart & chrome) • Place large chair cover for entire back of chair • Sticky tape barriers on chair control panels, light handles & operator table handles • Place clear, long sheaths over all suction tips & air/water tips. Only push tips through sheaths when using them. 206 • Place headrest covers as barriers for ultrasonics • Place red biohazard bag to handle of bracket tray III. Seating the patient • Provide appropriate DH treatment IV. Periodontal Evaluation and Data Collection: The dental hygiene student will: • Take a complete medical and dental history • Take and record vital signs • Record medication history • Obtain PTP from the ROD. • If a medical concern is present - consult with the assigned resident or Graduate Periodontics faculty. • Perform a head and neck examination. • Comprehensive periodontal evaluation/charting with all appropriate entries entered in the dental record. It is not necessary to record sulci depths 3mm and less. • Chart restorations/ caries. • Assist resident in photographs, occlusal analysis, TMJ, muscle evaluation and/or any other diagnostic evaluation. • Take alginate impressions, prn, obtain approval of impressions prior to pouring-up study casts. • Document subjective and objective findings. V. Treatment planning by Graduate Periodontics Resident: • Upon completion of all data collection by the dental hygiene student, the assigned resident will confirm, and obtain all necessary consultations. • The resident will formulate a comprehensive treatment plan (in writing) which must be discussed and approved by a Graduate Periodontics Faculty. • The dental hygiene student should plan to attend treatment planning discussions, if possible. VI. Non-surgical phase: • The dental hygiene student will consult with the resident and dental hygiene faculty to coordinate parameters of involvement in therapy. • The dental hygiene student will complete the oral hygiene evaluation: o Ascertain patient's oral hygiene status (by Plaque Index and evaluation of routine) o Correlate level of plaque control to Bleeding Index score. o Discuss etiology of patient's disease & appropriate preventive POH, include discussion of limitations of POH in restoring health. 207 • The dental hygiene student will perform Supportive Periodontal Therapy (SPT) which may include scaling, root planing, polishing and fluoride treatment. Generally 2 to 5 appointments will be necessary. o The dental hygiene student will perform therapy under the joint supervision of Graduate Periodontics faculty & assigned resident. o All procedures performed by the dental hygiene student will be evaluated by ROD for technique and results. o The Resident will be available for appropriate support, such as anesthesia, occlusal adjustment, emergency care, questions, etc. • After Phase I therapy, the patient will be re-evaluated to determine: • progress obtained as a result of Phase I therapy based on comparisons of objective baseline and post-treatment assessments; • resident will determine need for surgery. VII. Surgical Phase • The dental hygiene student will assist the resident in surgery & suture removal, as possible. VII. Recall Upon completion of treatment, the recall interval for the next appointment will be determined and patient's name placed in the computer. This is done in Brown clinic. VIII. Dismissing the patient • Make certain the fee slip is filled out with the code/fee/comments and next appointment information before the patient leaves the clinic and notify the Clinic Coordinator who then will schedule the patient and give them a token for dismissal. If patient is seen in Green Clinic, fill out the encounter form and escort the patient back down to Brown Clinic to collect fees & reschedule patients as needed. IX. Procedure for instrument sterilization • Disinfect dental unit after patient is dismissed • Rinse & place all instruments in metal container and ultrasonic for 16 minutes • Drain, day and place them in proper sterilization • Label front of bag with "G Perio" using black felt pen • Handpiece maintenance: o Place prophy angle head in ultrasonic, making sure end cap is tight o Wipe off adapter and motor with alcohol sponge o When dry, oil slow speed handpiece adapter gears and head port holes 208 GENERAL PROTOCOL FOR RECALL MAINTENANCE PROCEDURE in Brown Clinic Patients are placed on the periodontal recall following completion of their definitive periodontal therapy. These patients are recalled for maintenance (Supportive Periodontal Therapy SPT) according to need. I. The Clinic Supervisor will assign the recall patient to the dental hygiene student. The student will greet and seat the patient promptly at 9:00 or 1:00. If the patient is not present 15 minutes after the hour, it is the student's responsibility to notify the Clinic Supervisor, who will then call the patient and determine the patient's status. The Patient Accounts Representative will confirm all appointments. • Review dental record and past dental history • Review and update medical history o If medical concern, consult ROD or Graduate Periondontics faculty • Obtain and record vitals • Update medication summary • PTP • Perform Head & Neck exam • Periodontal charting and dental evaluation • Use safety glasses on all patients • render DH treatment as necessary • After treatment is rendered, record the encounter slip number and procedure code in chart with date and progress notes. A fee notation is NOT required 209 GRADUATE PERIODONTICS PATIENTS IN GREEN CLINIC GOALS: To provide the dental hygiene student the opportunity to provide dental hygiene care for patients from the Graduate Periodontics. Routine maintenance, Phase I therapy (S/RP) and re-evaluation appointments will be scheduled in Green Clinic. REQUIREMENTS: o Attend scheduled rotation (denoted "GPG" on the rotation schedule) in Green Clinic. PROTOCOL: o Refer to Graduate Periodontics fee schedule and document on the encounter form if different from present information. Use lines below to add any additional procedures. o Fill out encounter form with faculty signature & stamp. ROD should also sign in appropriate box above or below dental hygiene faculty signature. o At bottom of encounter form, put the next appointment information (reappt for S/RP, 3mrc, 4mrc etc) o In the event of a cancellation or no show, turn form into Josie with documentation on the encounter form. ASSIST GRADUATE PERIODONTICS GOALS To provide the student with the opportunity to: Apply the didactic principles and clinical skills learned in Clinical Dental Hygiene I and II in assisting senior dental hygiene students or Graduate Periodontics Residents REQUIREMENTS Attend scheduled Graduate Periodotnics clinic rotations as listed on the Clinic Rotation Schedule. Dress in appropriate clinic attire and bring safety glasses. 210 Assist a senior dental hygiene student or grad perio resident during the assessment and treatment of a patient. (Principles of four-handed dentistry are to be followed during assisting.) Assist in care, sterilization and disinfection of instruments and equipment. PROTOCOL Students are to report to the Resident of the Day (ROD) and present a rotation report form to him/her. He/she will instruct the student as to his/her specific duties for that clinic session. The dental hygiene student is expected to be present during the entire clinic session. RESPONSIBILITIES FOR DENTAL HYGIENE STUDENTS IN PERIODONTAL SURGERY PLEASE REMEMBER TO USE STERILE TECHNIQUE AT ALL TIMES! NEVER TOUCH ANYTHING STERILE UNLESS YOU ARE WEARING STERILE GLOVES. You must wear proper PPE when assisting or observing in surgery. (gown, mask, goggles, and head cover).When assisting, please see the dental assistants for assistance with proper sterile technique. Students will assist Residents in perio surgery, including: 1) taking blood pressure on the patient before and after surgery 2) mixing the periodontal dressing 3) please keep tray free of dirty 2 x 2's. There will be a red biohazard bag on the side of the assisting cart for this purpose. Students will also be responsible for cleaning up after the surgery, including: 1) cleaning the surgical instruments in ultrasonic cleaner and replacing them on the tray. 2) replacing the suction bag 3) replacing the headcover on the chair 4) placing a new patient napkin on the tray behind the chair 5) wiping the entire surgery room with the disinfecting solution When assisting the perio surgery, the following will be worn: 1) surgical cap 2) hat 3) mask 4) sterile gloves When observing in perio surgery, the following will be worn: 1) surgical cap 2) mask 211 HEALTH FOR FRIENDS 317 E. Himes Norman, OK 73069 (405) 329-4161 Jaime Hajjari- Dental Coordinator Mrs. Ashley Langford, R.D.H., B.S., Adjunct Faculty Mrs. Kala Phillips, R.D.H., B.S., Adjunct Faculty GOAL To provide the dental hygiene student with the opportunity to: Apply the didactic principles from Clinical Dental Hygiene to providing dental hygiene services to persons from economically disadvantaged circumstances. REQUIREMENTS PROTOCOL Students should report to dental hygiene adjunct faculty no later than 12:30 p.m. for clinic on dates assigned. Patients will be scheduled at 1:00 p.m. Take the following items: • Check out ultrasonic scaler from Green Clinic • instrument cassette and RDH handpiece • lab coat (or take blue gown & return it in a red biohazard bag to OUCOD) • BP cuff, stethescope • Clinic evaluation form, CDI, local anesthesia worksheet and any other forms possibly needed • Biohazard bag • Get PTP from faculty • Provide necessary services • Clinical evaluation, CDI and other forms to be turned in for credit DIRECTIONS: I-35, exit on US 77. Turn LEFT on Robinson going east. Turn LEFT on Porter. Go 3 blocks south & turn RIGHT on Himes. 212 IMPLANTOLOGY 3rd floor, Burgundy Clinic Mrs. Kathy Miller, R.D.H., B.S. Assistant Director of Clinics Clinical Faculty Department of Implantology (405) 271-8001 x 34143 GOAL To provide the dental hygiene student with the opportunity to: Apply the didactic principles from Clinical Dental Hygiene to providing dental hygiene services to patients with dental implants. REQUIREMENTS Attend scheduled implantology rotations as listed on the Clinic and Rotation Schedule. Dress in appropriate clinic attire and bring your safety glasses. Specific implant instruments will be available in the clinic PROTOCOL Students should report to dental hygiene faculty no later than 8:30 a.m. and 12:30 p.m. for clinic. • Use chairs 32 and 35 in the east side of Burgundy Clinic • Oral hygiene products are in the red/black cabinet against the wall at unit 32 and fluoride and sonic scaler lubricant are in the cabinet at unit 35. • Sonic scalers are available • Bring instrument cassettes and RDH handpiece • Get PTP from Mrs. Miller (follow laminated guide sheet) • No clinical evaluation sheets or blue recall forms are used • No HTC; chart recall perio prn on perio chart; EIE updates are noted in the TPNs • Recall appointments are scheduled by Mrs. Miller at the end of the appointment 213 ORAL DIAGNOSIS 2nd floor, OD clinic Dr. Susan Settle, Chair Dr. Jeanne Panza Ms. Charlene Shaw, Clinic Coordinator 271-4945 Judy Hinkle-Radiology Technician 271-5687 Donna Harrison, CDA - Radiology Technician Pam Lujan– Radiology Technician Dr. Robert Jennings-Clinic Faculty Dr. Susie Beavers-Clinic Faculty Dr. Farah Masood- Clinic Faculty Dr. Emil Farha-Clinical Faculty Dr. Lida Radfar-Clinical Faculty GOALS To provide the dental hygiene student with the opportunity to: Perform oral examinations on patients applying for dental treatment at the College of Dentistry. Assist dental students in providing emergency dental care to patients. Purpose of screenings: • Provide suitable patients for dental hygiene and dental students • Provide students with a diagnostic experience • Increase awareness of oral conditions beyond patients assigned to you REQUIREMENTS Attend oral diagnosis rotations as listed in the Clinic and Rotation Schedule. Dress in scrubs and bring your safety glasses. Comply with College of Dentistry Infection Control Policies. PROTOCOL Students are to report to staff in the dispensing area of the Oral Diagnosis clinic promptly at 9:00 a.m. for morning clinics and 1:00 p.m. for afternoon sessions. You will screen 2-3 patients each clinic session. Dental hygiene students assigned to clinics designated for screening patients applying for dental treatment at the College will perform the following: 214 • Seat patient & review health history • If questions regarding pre med etc., contact OD faculty • Take vital signs (blood pressure, pulse and respirations). • Ask faculty if they would like to briefly examine patient at that time • HHx reviewed by faculty • Complete a head and neck examination: record under "Comments" • Record carious lesions; restorations that are fractured, have defective margins, recurrent decay, or are missing; and missing teeth. • Record periodontal probe readings: only deepest in each sextant is recorded • Record an abbreviated CDI. (Case Difficulty Index) • Request appropriate radiographs. Faculty will sign for radiographs. • Patient returns to reception area & is then called to Radiology • Place the Patient Folder in the chart holder in Radiology • Expose and process radiographs as directed by dental faculty. • Radiology tech will return the folder to the clinic when films are developed. • Review films and findings with faculty • Return patient to chair and review findings with faculty • Accept or Reject the patient o Provisionally accepted may NOT ever be assigned If patient is accepted: • Give patient the "Patient Bill of Rights" • Tell patient they will be contacted by a student but there is no set time they will be called If patient is rejected: • If they inquire, we can make copies of the screening films to either be sent to another dentist or taken with them • There is a $5.00 charge for duplicating Types of patients to reject: • Patients with unrealistic expectations • Patients who do not have time to commit to OUCOD • Patients with rampant caries • Patients with severe periodontal disease • Many other complex dental conditions Give Original Superbill to Charlene and the copy to the patient. MISCELLANEOUS Dental students may be seeing emergency or screening patients during your rotation. Dental hygiene students assigned to clinics designated for emergency dental care will: • Assist dental students in the provision of dental care. 215 • Provide clinical services such as: o Placing temporary restorations. o Exposing and processing radiographs. o Pulp vitality testing. o Administering local anesthesia (after successful completion of DH 4472 Pain Control) ALWAYS GET FACULTY PERMISSION TO LEAVE CLINIC PRIOR TO 12:00 OR 4:00 ASSIST ORAL DIAGNOSIS GOALS: To provide the dental hygiene student with the opportunity to: Assist and observe in oral diagnosis, screening clinic and radiology. REQUIREMENTS: Attend scheduled rotations as listed on the Rotation Schedule. Oral Diagnosis is conducted in Orange Clinic on the 2ndd floor of the COD. Clinic begins at (9:00 am or 1:00 pm. Assist and observe a dental or dental hygiene student during the Oral Diagnosis screening clinic. Appropriate clinic attire and safety glasses are mandatory. PROTOCOL: Students are to report to the dentist in charge to present a rotation report form. They will then direct the dental hygiene student to assist a dental student utilizing four-handed dental methods. The dental hygiene student is expected to be present during the entire procedure/clinic session or until released by the faculty of the assigned clinic. 216 PEDIATRIC DENTISTRY and SEALANT CLINIC 4th floor, Yellow/Orange Clinic Mrs. Nancy Romano, R.D.H., B.S. Clinical Faculty Department of Pediatric Dentistry (405) 271-8801 X 46526 GOAL To provide the dental hygiene student with the opportunity to: Apply the didactic principles from Developmental Dentistry and Clinical Dental Hygiene to providing dental hygiene services to children and young adults. REQUIREMENTS Attend scheduled pediatric dentistry rotations as listed on the Clinic and Rotation Schedule. Dress in appropriate clinic attire and bring your safety glasses. Each student should bring their handpiece and prophy angle. PROTOCOL Students should report to dental hygiene faculty no later than 12:30 p.m. for Wednesday afternoon clinic. I. RECALLS • One patient will be seen every 90 minutes with no assistant • Use chairs 1, A, B, C Protocol review for BWX: • One year or longer since last BWX • Caries history • Interproximal watch areas from last visit • Diagnostic integrity for previous BWX • Remember to look for actual BWX and not just rely on radiographic log • No BWX if bands and brackets are in place Students will be required to provide the following services for 2-3 pediatric dentistry patients during the scheduled clinic session: 1. Update the medical history. 2. Chart deciduous and mixed dentition teeth. 3. Periodontal probe as directed by pediatric dentistry faculty. 4. Do a plaque score. 5. Provide patient education. 6. Provide a prophylaxis. 7. Expose and process radiographs as indicated by dental faculty. 2. SEALANTS • Use designated "quiet room" 198 • 2 students will work as partners seeing one patient every hour (1:00, 2:00 and 3:00) • complete a Rotation Report Form, obtain Pediatric faculty signature and turn in to Senior Clinical Coordinator for credit. ASSIST PEDIATRIC DENTISTRY GOAL: To provide the dental hygiene student with the opportunity to: Assist DH II students in unit set-up, four-handed dentistry, and unit break-down during treatment of children, adolescents and young adults. REQUIREMENTS: Attend scheduled pediatric dentistry rotations as listed on the Clinical Rotation Schedule. Dress in appropriate clinic attire. PROTOCOL: Students should report to Ms. Nancy Romano. R.D.H. for student assignment. 199 RADIOGRAPHY 2nd Floor, OD Clinic Ms. Judy Hinkle, Dental Radiology Supervising Staff Ms. Donna Harrison-CDA, Radiology Tech Ms. Pam Lujan- Radiology Tech (405) 271-5687 GOALS To provide the dental hygiene student with experiences that will develop proficiency in intraoral radiographic technique, patient management, radiation protection, infection control, quality evaluation, and diagnostic analysis. Students will be familiarized with panoramic and extraoral technique, darkroom care, film processor maintenance, and radiographic duplication. REQUIREMENTS 1. Attend scheduled Oral Radiology Clinic sessions as assigned on the Clinic and Rotation Schedule. 2. Complete a minimum of ten complete intraoral radiographic surveys with a 70% score or better. 3. Complete other radiographic procedures as directed during rotations. PROTOCOL 1. Report to the Radiographic Technicians in the Oral Radiology Clinic for room and patient assignment. 2. Prepare the cubical and x-ray unit for the patient. 3. Comply with "Radiation Use Policy" upheld by the University of Oklahoma College of Dentistry. 4. Expose and process films in compliance with The University of Oklahoma College of Dentistry Infection Control Policy. 5. Evaluate radiographic quality, document this evaluation and determine the number and type of retake radiographs necessary with the agreement of the teaching faculty. 6. Complete the rotation report form, recording the names of patients and the number and type of radiographs. Turn this form in to the Senior Clinical Coordinator for credit. 200 SCREENER in GREEN CLINIC GOALS To provide the dental hygiene student with the skills to screen prospective patients for senior clinic. REQUIREMENTS 1. Attend scheduled Screener sessions as assigned on the Rotation Schedule. 2. Properly fill out required forms for DENTAL HYGIENE ONLY patients. Patient will arrive in Green Clinic with the following forms: • White OD Screening form (Health History) • Encounter form indicating payment made • Copy of insurance card if applicable • Notice of Privacy Practices • Hand written receipt for payment made Screener will have these forms: • DH ONLY form (white & yellow copy) • CDI screening form • Radiograph log (ask CI to dispense) • Radiographs properly labeled 3. Fill our Rotation Report Form & have CI sign. PROTOCOL • Patients will be scheduled by DH patient scheduler every 45 minutes beginning at 12:30. Screener will see patients at 45 minute intervals with the first patient at 1:00 pm, and the last patient at 3:15. • Fee for DH only screening is $10 and includes radiographs. This is paid for prior to the appointment. Patient will have the encounter form and will already have a token. There is no need to take patient down to the Cashier at the end of the appointment. • Patients will check in at the Cashier's Desk on 2nd floor to complete paperwork & pay the $10 screening fee. (The "Old" Oral Diagnosis screening forms will be used and stamped with "Dental Hygiene Only" on the top of the form). • Set up assigned unit & request exam sets from the dispensary personnel Green Clinic. These are in the locked cabinets. (Includes 11/12 explorer, mirror, probe). You may set up an extra chair if one is available. For Tues, Wed & 201 Thurs clinics, please check with dispensary personnel to verify a chair is available. • The DH patient scheduler will send a list of screening patients to Green Clinic. It will be located in the tub with the charts. • Seat patient and go over the white screening form (Health History), fill out information on first page regarding surgeries, hospitalizations etc, take BP & get PTP from CI. Request radiographs to be exposed. (limited to 2 Bitewings only or a reasonable alternative when a significant number of posterior teeth are missing). Have CI sign and stamp for films on the back of the white OD screening form. • Expose & develop prescribed radiographs • Collect enough data to complete the CDI. Use the boxes on the dentition chart to record probing depths. • Spot probe and chart only 4mm & above. On those teeth, draw recession & circle bleeding points. • Detect supragingival & subgingival calculus. • Have CI confirm CDI. Additional points may be added at the discretion of the CI. The CI must initial the CDI Screening form. • CI will be responsible for ensuring that acceptance as "Hygiene Only" forms are completed, and a financial policy is signed and distributed for each patient accepted. Have CI sign & stamp white Screening form at the bottom of the form. • On the back of the screening form, check the box "DENTAL HYGIENE" and put the CDI on the form. • Paper-clip all forms together & turn in to Rick Steucken in the Chart Room at the end of the clinic session. • Place instruments in autoclave bag & write your "Name", "Green Clinic" and "Screener Exam Kit". Place these in the basket on the cart at the dispensary. • Screener will assist other students in clinic when patients are not scheduled. 202 TEACHING ASSISTANT in JUNIOR CLINIC Mrs. Jane Gray, R.D.H., CDA, M.Ed, Senior Clinical Coordinator (405) 271-4445 (M) (405) 830-4880 Mrs. Tammie Vargo, R.D.H., M.Ed, Junior Clinical Coordinator (405) 271-4562 GOALS: To provide the student with the opportunity to apply the didactic principles and clinical skills learned in Clinical Dental Hygiene I, II, III, and IV in assisting and mentoring junior dental hygiene students. REQUIREMENTS: Review all class/lab/clinic material(s) prior to attending the rotation. Attend DH-I & DH-II lectures, as instructed to do so by Mrs. Vargo. Attend scheduled junior clinic rotations (see 'Clinic Rotation Schedule'). Dress in appropriate clinic attire and bring your safety glasses. Write a summary of the clinic experience and upload to Blackboard at the end of the day. DUTIES: Fall 1. Assist and mentor junior students in lab and clinical exercises 2. Assist clinical faculty as requested Spring 1. Check instrument sharpening at the beginning of each clinic session. 2. Assist and mentor radiographic technique 3. Assist and mentor junior student in organization and treatment sequencing (Senior student is not allowed to record probing depths or hard tissue until notification by Mrs. Vargo) 4. Assist clinical faculty upon request by: a. evaluating work-ups and documenting results on evaluation form. b. evaluating polishing and documenting results on evaluation form. 203 c. providing instrumentation technique feedback and documenting prn d. providing individualized mentoring at chairside for students providing care for Class 'C' patients 6. Dental hygiene faculty must co-sign all record documentation entries • This rotation is for the duration of the academic year (fall and spring semesters) Selection process for TA is by application only. Those expressing interest should contact the senior clinic coordinator in the spring of the junior year. A one page essay on "Why I would like to be a Teaching Assistant" should be submitted. 204 TINKER AIR FORCE BASE 72 Dental Squadron 5700 Arnold Street TAFB, OK 73145 (405) 736-2000 (dental clinic) (405) 736 -3159 FAX (405) 736-2072 Diana Mills, R.D.H. Staff Dental Hygienist firstname.lastname@example.com GOALS To provide the dental hygiene student with experiences that will develop competency in the areas of patient assessment, treatment planning, patient care and adjunct services in an environment similar to a private practice setting. REQUIREMENTS Attend scheduled Tinker rotations as assigned in the Clinic Rotation Schedule. Need to provide: • TB test results • OUCOD HIPAA security training • Proof of liability (malpractice insurance) Records may be requested by DH Department Administrative Secretary from: OU Family Medicine Student Health Clinic 900 N.E. 10th St Oklahoma City, Ok 73104 (405) 271-2577 Fax#: (405) 271-4059 Dress in street clothes or wear your scrubs and change into provided clinic attire (provided by Tinker) at the rotation site. Wear your clinic shoes. Take your own instruments and ultrasonic tips. Be prepared to finish by 3:40…clinic closes at 4:00 Provide patient treatment according to the guidelines established in the TAFB manual. PROTOCOL Students should report at 12:30 for the PM. clinic. First patient will be seen at 1:00. Locker assignments and name tags provided. Enter at Sooner Road Gate Tell guard you are with OU Dental Hygiene Program Need: • Current DL • Proof Ins • Current tag NO cell phone use while driving on base Watch speed!!! Do not park in reserved spots (cars will be towed) Bldg 5801 170 TINKER RADIOGRAPHY GOALS: To provide the dental hygiene student with experiences that will develop competency in intraoral radiographic technique, patient management, radiation protection, infection control. quality evaluation, and diagnostic analysis. Students will be familiarized with panoramic and extraoral technique, darkroom care, film processor maintenance, and radiographic duplication. REQUIREMENTS: 1. Attend scheduled Oral Radiography Rotation as assigned on the Rotation Schedule. 2. Complete radiographic procedures as directed during rotations. PROTOCOL: 1. Report to the Radiographic Technicians in the Oral Radiology Clinic for room and patient assignment at Tinker AFB. 2. Prepare the cubical and x-ray unit for the patient. 3. Comply with the OUCOD Radiation Use Policy. 4. Expose and process films in compliance with the Infection Control Policy. 5. Evaluate radiographic quality, document this evaluation and determine the number and type of retake radiographs necessary with the agreement of the teaching faculty. 6. Complete the rotation report form, record the names of patients and the number and type of radiographs. 171 172 VETERANS ADMINISTRATION HOSPITAL ROTATION Department of Veterans Affairs VAMC 921 N.E. 13th St. Oklahoma City, OK 73104 Ms. Colleen Whorton Administrative Officer- Dental Service (405) 270-5139 (dental clinic) Fax (405) 290-1650 email@example.com Mrs. Vicki Coury, Clinical Faculty (405) 271-3869 (405) 826-3411 Connie Martin, Staff Dental Hygienist Michelle Williams, Staff Dental Hygienist GOALS To provide the student with an opportunity to learn hospital procedures as they relate to: (l) dental care, and (2) the team concept of total comprehensive patient care. REQUIREMENTS 1. Observing a hospital-based dental hygienist perform patient care. 2. Providing direct patient care in the hospital dental clinic. 3. Adapting dental hygiene procedures to accommodate the special needs of the hospitalized patient. 4. Establish patient rapport. 5. Adapting home care procedures to meet the needs of each individual patient. 6. Assisting the dental staff in the clinic as necessary. 173 VAMC Statement of Commitment and Understanding As an employee of the Department of Veterans Affairs (VA), I am committed to safeguarding the personal information that veterans and their families have entrusted to the Department. I am also committed to safeguarding the personal information which VA employees and applicants have provided. To ensure that I understand my obligations and responsibilities in handling the personal information of veterans and their families, I have completed both the annual General Privacy Awareness Training (or VHA Privacy Training, as applicable) and the annual VA Cyber Security Training. I know that I should contact my local Privacy Officer, Freedom of Information Act Officer, Information Security Officer, or Regional or General Counsel representative when I am unsure whether or how I may gather or create, maintain, use, disclose or dispose of information about veterans and their families, and VA employees and applicants. I further understand that if I fail to comply with applicable confidentiality statutes and regulations, I may be subject to civil and criminal penalties, including fines and imprisonment. I recognize that VA may also impose administrative sanctions, up to and including removal, for violation of applicable confidentiality and security statutes, regulations and policies. I certify that I have completed the training outlined above and am committed to safeguarding personal information about veterans and their families, and VA employees and applicants. _____________________________ ___________________________ [Print or type employee name] Employee Signature ______________________________ ___________________________ Position Title Date 174 VA DENTAL CLINIC INSTRUCTIONS BEFORE COMING TO THE VA ***You must annually complete the VA privacy training, print a copy of the training and turn in to the Course Director. You can access the website at vhaprivacytraining.net *** Print out the certificate & turn in to Course Director. You must also read and sign the Statement of Commitment form & turn it in. Annual TB testing is required and verfication must be on file. Fingerprinting is also required. *** STUDENTS NEED TO CHECK OUT AN ULTRASONIC RESERVOIR TYPE SCALER FROM GREEN CLINIC PRIOR TO COMING TO VA *** ***ALL ASSISTANTS SHOULD BRING THEIR INSTRUMENT KITS IN THE EVENT THAT A PATIENT IS AVAILABLE TO BE SEEN BY A STUDENT*** • Read this handout care thoroughly and bring it with you for reference. • Review procedures you might use such as care of partials and dentures, placement and patient instructions for fluoride varnish. • Bring your Mosby's Drug Reference because the patients you will see are generally on multiple medications. • If you do not see a patient you will need to fill out a Rotation Report form; otherwise your Clinic Evaluation form will suffice. TIMES • For your first VA session, we will meet in the Commons at 7:30 and go as a group. • For subsequent sessions, be at the VA no later than 8:00. The clinic opens at 7:30 and you may go over and begin setting up your unit any time after 7:30. • The operatories you will be working in will be marked with a sticky note. RESTROOM • Located in the hall outside the clinic, across from the patient waiting area. PROCEDURES Review patient's chart • New HHx yearly (front desk should give to patient) • Review active medicines on printout 175 • Determine need for radiographs (pano every 5 years, BWX yearly) Set up operatory • Gowns are in operatory drawers or in Linen Closet (first closet) on right side of hallway (Door will be locked) • Motors, adapters and cavitron tips are in Instrument Prep room on right side of hallway (also locked) • You will bring your own instrument kit (and sterilization bag to transport it back to the dental school) • Wash hands after every time you touch anything • Fill water bottles on unit and cavitron with deionized water from sterilization area if necessary Get patient from reception area • Verify full name and social security number in private (remember HIPAA laws) Expose and process necessary radiographs • Some rooms have an x-ray unit in them. If yours does not have a unit, take them prior to seating your patient in your operatory. • Mark off number of x-rays taken on log in x-ray room Seat patient in your operatory and • Verify medication information with patient • Review Health History on left side of chart with patient -positive answers must have a comment written in Dentist Remarks section -all sections must have a notation, so write N/A if not applicable • On right side of chart fill out clinical findings and remarks; make sure personal information is correct • Fill out patient post card for next visit (you write patient's name and address) • Take vital signs. Write a listed summary in the boxes at the lower right of the HHx form to include: PMH (past medical hx), diabetes, hypertension, heart attack (what year), stroke (what year), heart murmur, allergies, blood sugar number, medications, etc. In the note box under question #36, the appropriate med(s) should be circled and med alert sticker placed if needed. • Diabetic patients should be asked what their blood sugar range is and what the number was when the patient tested it that morning. Perform a finger stick and document blood sugar number as "FBS - #" (Finger Blood Stick). Always ask the patient if a good breakfast was eaten. Ensure is available if the patient's blood sugar is too low. If blood sugar is over 200, the patient is not treated. • An INR time should be known for patients on Coumadin and results should be below 3 for treatment. Patients are scheduled for bloodwork in the lab at 7:30 so their results should be ready by 8:30. We will consult with a dentist if unsure whether treatment can be done. 176 Obtain PTP from OU CLINICAL FACULTY. Monologue should include significant HHx information; names, indications, and dental considerations of medications; and vital signs. Begin treatment: EIE, dental and perio charting, CDI (check in with OU CLINICAL FACULTY for CDI C or greater). If possible we will enter dental and perio charting on the VA computer program. If someone is not available to enter data on the computer, it can be done on hard copies and entered later. Fill out Oral Examination Findings and Treatment Recommendation on right side of chart. Disclose, provide OHI. This must be done PRIOR to scaling procedures. If patient has a partial or denture, place it in a baggie (available in each operatory) and go to sterilization area. Put Tartar and Stain Remover in the baggie (located underneath the sink) and place the baggie in the PRO Sonic ultrasonic cleaner. Scrub with a denture brush in operatory. Scale and root plane prn, polish. Request check out with OU CLINICAL FACULTY. Checkout should be no later than 11:15. At this time, it will be determined if an exam is needed and a DDS will be asked to perform the exam after check out of scaling and polishing. Prior to the dental exam, the right side of the exam sheet should be completed by the student. During the exam, the student writes in the proposed treatment on the left side of the exam sheet. • DENTIST MUST SIGN BOTH HEALTH HISTORY AND CLINICAL FINDINGS AND REMARKS • PATIENT MUST SIGN UNDER CLINICAL FINDINGS AND REMARKS Treatment progress notes should be entered on the back of the exam sheet and write in PTPW if the "patient tolerated treatment well". If not, note why not. A copy of the format for TPN is available from OU CLINICAL FACULTY or in the main hygiene room. Administer tray or varnish fluoride treatment. Escort patient to the reception area to schedule any additional appointments. Complete paperwork. Break down operatory , • Wear all PPE to disinfect. Disinfectant bottles are located under the sink. • Open glove drawer before washing hands, wash hands, take out and put on gloves and close drawer with hip 177 • Remove headrest cover, turn inside out and put all disposable contaminated items inside and throw in trash. • Bag instruments in sterilization bag brought with you from OUCOD • Close operatory door when leaving a contaminated room when no one is in it. • Carry handpiec and motor to Soiled Instrument closet. It is locked, so someone will have to open it for you. Place contaminated handpiece and motor in DRY contamination bucket. PPE must be worn in the contamination room. • XCPs and air/water syringe tips go in blue ultrasonic in sterilization area • Ultrasonic tips are disinfected, put in a sterilizing bag and placed in the sterilizer tray. • Return to operatory, disinfect all contaminated surfaces with Cavicide, including chairs and let set 10 minutes • Empty water bottle if operatory will not be used in the afternoon. D. RESET UNIT with • Headrest cover • Sticky tape on light switch and light handles • Place large bag over hoses and switches VAMC TREATMENT PROGRESS NOTES The following items are to be written in the TPNs: • BP • Radiographs obtained (BWX, pano) • Px • Rev HHx: NSF or state what findings • H&N exam: NSF or state what findings • Assessment • Perio charting • Tx rendered: o Examples: E. Scaled, hand and ultrasonic scaled polished, flossed, fluoride varnish, OHI : TB, floss aid etc. • Patient understands OHI • PTPW • RTC: any treatment remaining: restorative, S/RP etc) or TC F. S/RP UR quad, hand and ultrasonic scaled, POI, OHI (state what kind) • PTPW 178 • RTC: any treatment remaining (restorative, S/RP etc) or TC G. S/RP UR & UL quad, hand and ultrasonic scaled; type of local administered etc. POI, OHI (state what kind) • PTPW • RTC: any treatment remaining or TC Student signature/OU Faculty signature Abbreviations: BP Blood Pressure PX Peridex Pan Panorex 4 BWX 4 bitewings NSF No significant findings OHI Oral hygiene instruction TB Tooth brushing PTPW Patient tolerated procedure well RTC Return to clinic TC Treatment complete 179 OUCOD SITE CLINICAL ROTATIONS Pediatric Dentistry Tinker AFB Graduate Periodontics Radiology Oral Diagnosis Implantology VA Medical Center Good Shepherd Mission Health For Friends Indian Health Clinic Crossings Community Center CLINICAL REQUIREMENTS 1. Students will provide dental hygiene services to patients during the fall semester in Pediatric Dentistry, Implantology, Graduate Periodontics, Oral Diagnosis and Radiology, VA Medical Center, Crossings Community Center, Indian Health Clinic and Good Shepherd Mission. In each of these rotations, students will be under the direct supervision of dental, dental hygiene faculty and/or staff. 2. The Dental Hygiene Clinic Manual contains the goals, requirements and protocol for each rotation site. Students are advised to consult this manual prior to attending each rotation. Orientation to the rotations will be scheduled at the beginning of the semester prior to students' attendance in the rotation. 3. Student use of local anesthesia and nitrous oxide analgesia is prohibited until notification by Ms. Gray that the student has attained a passing grade in the didactic and clinical exams for the use of local anesthesia and nitrous oxide analgesia •Note: Administration of local anesthesia must be documented on the Local Anesthesia Report Form to receive credit 4. All students must have a current TB skin test on file and must also complete HIPAA training prior to VA rotations. You may log on to www.vhaprivacytraining.net to complete the training. Failure to do so prior to the beginning of the rotation schedule will prevent the student from participating in the VA rotation and will result in a failing grade in the clinical rotation course. 180 Oklahoma City Indian Clinic (I.H.S) 4913 W. Reno, Oklahoma City Ph: 948-4900 x 263 -front desk in dental clinic; John Fish - dental assistant 948-4918 x 271- Dr. Anna Farrell 948-4927 Fax 948-4918 x 277 (Personnel) –Yolanda Items needed by students: All clinic forms Ultrasonics with reservoirs Local anesthetic syringes (Petite syringes if desired) Sign in and out in the black log book that is located in the office on the left as you enter the building on the east side. (morning, after lunch & when you leave at the end of the day) Wear scrubs Report any incidents to supervisor Black ink ONLY (not gel- use ball point pen) Fire drill once a month so be prepared. Call pts back to tx area by their chart number, not their name Radiographs are in brown envelope in back of chart Need criminal background check Need shot record (MMR, Varicella, HBV, TB) Items on hand: Arestin & syringe Oraqix & cartridges Desensitizer – Seal and Protect Local anesthetic & 27 gauge long & short needles Fine prophy paste Crest Pro Health Rinse Faculty: Orientation Sign in & out in log book Use last 3 operatories All pts have had exams, bwx & pano Only perio chart pts who have commercial dental insurance Current pts are diabetic pts. Check BP, blood sugar; Check for premed Dental info on Left Side of chart…purple tab Meds on Left side of chart… All charts are combination Medical & Dental Green sheet on outside of chart: put check by 4341 & put # of quads completed; then under NV: put what is needed at the next visit. 181 BARTLESVILLE SITE CLINICAL ROTATIONS CLINICAL REQUIREMENTS 1. Students will provide dental hygiene services to patients during the fall semester in clinical rotation sites as assigned. In each of these rotations, students will be under the direct supervision of dental, dental hygiene faculty and/or staff. 2. The Dental Hygiene Clinic Manual contains the goals, requirements and protocol for each rotation site. Students are advised to consult this manual prior to attending each rotation. Orientation to the rotations will be scheduled at the beginning of the semester prior to students' attendance in the rotation. 3. Student use of local anesthesia and nitrous oxide analgesia is prohibited until notification by Ms. Gray that the student has attained a passing grade in the didactic and clinical exams for the use of local anesthesia and nitrous oxide analgesia. •Note: Administration of local anesthesia must be documented on the Local Anesthesia Report Form to receive credit. 182 ARDMORE SITE CLINICAL ROTATIONS CLINICAL REQUIREMENTS 1. Students will provide dental hygiene services to patients during the fall semester in clinical rotation sites as assigned. In each of these rotations, students will be under the direct supervision of dental, dental hygiene faculty and/or staff. 2. The Dental Hygiene Clinic Manual contains the goals, requirements and protocol for each rotation site. Students are advised to consult this manual prior to attending each rotation. Orientation to the rotations will be scheduled at the beginning of the semester prior to students' attendance in the rotation. 3. Student use of local anesthesia and nitrous oxide analgesia is prohibited until notification by Ms. Gray that the student has attained a passing grade in the didactic and clinical exams for the use of local anesthesia and nitrous oxide analgesia •Note: Administration of local anesthesia must be documented on the Local Anesthesia Report Form to receive credit. 183 WEATHERFORD SITE CLINICAL ROTATIONS CLINICAL REQUIREMENTS 1. Students will provide dental hygiene services to patients during the fall semester in clinical rotation sites as assigned. In each of these rotations, students will be under the direct supervision of dental, dental hygiene faculty and/or staff. 2. The Dental Hygiene Clinic Manual contains the goals, requirements and protocol for each rotation site. Students are advised to consult this manual prior to attending each rotation. Orientation to the rotations will be scheduled at the beginning of the semester prior to students' attendance in the rotation. 3. Student use of local anesthesia and nitrous oxide analgesia is prohibited until notification by Ms. Gray that the student has attained a passing grade on the didactic and clinical exams for the use of local anesthesia and nitrous oxide analgesia •Note: Administration of local anesthesia must be documented on the Local Anesthesia Report Form to receive credit 184 185 Crossings Community Center Dental Clinic 2208 W. Hefner Road, Suite B Oklahoma City, OK 73120 Mrs. Jane Gray, R.D.H., CDA, M.Ed, Senior Clinical Coordinator (405) 271-4445 (M) (405) 830-4880 Dr. Teresa Davis, Supervising Dentist 473-4032 (M) GOAL To provide the dental hygiene student with the opportunity to: Apply the didactic principles from Clinical Dental Hygiene to providing dental hygiene services to adults from the community. REQUIREMENTS Dress in appropriate clinic attire and bring your safety glasses. PROTOCOL Students should report to The Crossings Community Center no later than 5:30 for Tuesday evening clinic. The rotation will be from 6:00 to 8:30 p.m. Students will be required to provide the following services (but not exclusively) for 2-3 pediatric dental patients during the scheduled clinic session: 1. Help take and/or update the medical history. 2. Charting as needed. 3. Provide patient education. 4. Provide a prophylaxis, scaling & root planing, fluoride treatment, sealants as needed. 5. Expose and process radiographs as indicated by dental faculty. 6. Administer local anesthesia as needed, following successful completion of DH 4472 Pain Control. A Rotation Report Form must be signed by supervising dentist and turned in by noon on Friday of the week of the rotation for credit. 202 204 205 CLINICAL ROTATION PROTOCOL Each student assigned to any rotation or completing any unassigned rotations are required to complete a Rotation Report Form. These forms are available in Clinic. Any adjunct service or rotation requirement completed on a rotation site should be marked by the dental hygiene student including the patient's name and chart number and signed by attending dental faculty/dental hygiene faculty/staff. Rotation Report Forms must be completely filled out, signed by faculty, resident or dental student as appropriate and turned in to the Department of Dental Hygiene by 5:00 p.m. on Friday of the week of the rotation. Credit will not be given for any forms that are not received in the department by the aforementioned time. Compliance with the College of Dentistry Infection Control Policy is mandatory at all rotations. Students are reminded that all guidelines for clinical appearance and behavior apply to all clinical rotations. Students are expected to assume responsibility for learning: ask appropriate questions, be on time, be courteous, be helpful, Do NOT leave early unless specifically directed by the faculty responsible for the rotation experience. Please remember that we are guests at the rotation sites. Few dental hygiene students are afforded similar opportunities for enhancement of their dental hygiene educational experience. In case of an emergency that prevents attendance, the student must contact BOTH the rotation site coordinator and the Course Director. It is strongly recommended that every effort be made to attend the assigned rotation. Grade penalty may be imposed for repeated absences. 198 CLINICAL ASSISTANT ROTATION GOALS To allow each student the opportunity to experience dental assistant duties. The duties involve skills necessary for: l) efficient maintenance of the clinic and 2) chairside assistance in dental hygiene procedures. Students will serve as clinical assistants in the event that there is no patient available during clinic. REQUIREMENTS: 1. Dispensing instruments and supplies to dental hygiene students prn. 2. Assist clinicians/instructors, as requested, with procedures such as periodontal charting and ultrasonic scaling. Duties: Students assigned to clinic assistant position will perform the following infection control procedures: l. Observe asepsis protocol in clinic. 2. Procure and distribute equipment and supplies in accordance with asepsis protocol. 3. Abide by clinical asepsis protocol when assisting clinician chairside oral stations. 4. Wear appropriate barrier equipment when handling contaminated, caustic or otherwise dangerous materials. These materials will be labeled. See section on Safety Protocol. 5. Properly sterilize, disinfect, sanitize equipment, instruments, and counters. Students assigned to be clinic assistant should report to the clinic 15 minutes before the clinic begins and should remain on duty until the close of the clinic period when all students and patients have left the clinic area. Reporting: The clinic assistant should report to the Clinical Coordinator to receive specific duties. However, any faculty member may request the student's help. 199 ASSIST SENIOR DENTAL HYGIENE ROTATION GOALS To provide the student with the opportunity to: Apply the didactic principles and clinical skills learned in Clinical Dental Hygiene I and II in assisting senior dental hygiene students. REQUIREMENTS Attend scheduled senior clinic rotations as listed on the Clinic Rotation Schedule. Dress in appropriate clinic attire and bring safety glasses. Assist a senior dental hygiene student during the assessment and treatment of a patient. (Principles of four-handed dentistry are to be followed during assisting.) Assist in care, sterilization and disinfection of instruments and equipment. PROTOCOL Students are to report to the Clinical Coordinator and present a rotation report form to her. She will instruct the student as to his/her specific duties for that clinic session. The dental hygiene student is expected to be present during the entire clinic session. 200 GOOD SHEPHERD MISSION The Mission Clinics-Good Shepherd Ministries, OKC, Inc. 222 N.W. 12th Street (12th & Robinson) Oklahoma City, Ok 73110 (405) 232-8631 Dr. Frank Lipsinic OUCOD Faculty Coordinator (405) 271-5346, ext 48567 (405) 821-7343 (M) www.goodshepherdokc.org GOAL To provide the dental hygiene student with the opportunity to: Apply the didactic principles from Developmental Dentistry and Clinical Dental Hygiene to providing dental hygiene services to children from the community. REQUIREMENTS Dress in appropriate clinic attire and bring your safety glasses. Students will wear overgown provided at the Mission. PROTOCOL Students should report to The Good Shepherd Mission no later than 5:30 for Tuesday evening clinic. Students will be required to provide the following services (but not exclusively) for 2-3 pediatric dental patients during the scheduled clinic session: 1. Help take and/or update the medical history. 2. Chart deciduous and mixed dentition teeth as needed. 3. Provide patient education. 4. Provide a prophylaxis, fluoride treatment, sealants as needed. 5. Expose and process radiographs as indicated by dental faculty. 6. Administer local anesthesia as needed, following successful completion of DH 4472 Pain Control) A Rotation Report Form must be signed by supervising dentist and turned in by noon on Friday of the week of the rotation for credit. 201
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