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1 Family Dentistry Clinical Protocols 2016-2017 General START CHECKS

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1 Family Dentistry Clinical Protocols 2016-2017 General START CHECKS 1 Family Dentistry Clinical Protocols 2016-2017 General 1. The instructor who verifies comprehensive examination findings must “sign” (approve in AxiUm) the treatment plan before you can begin any restorative care. All proposed treatment (including from recall exams) must be entered in the treatment plan module. With complex cases, if the treatment plan is not finalized, limited treatment can be performed only if the instructor makes a specific notation on the Treatment Plan/findings sheet. 2. Except for excused absences, you are expected to be on the clinic floor and/or available to handle emergencies. If you are not in your clinic operatory, you must let your instructor know where you are and leave a note on your clinic chair indicating where you can be reached. If you have no scheduled patient or a patient fails, immediately contact the clinic clerks to be placed on the emergency call list. If you have no patient or when appointments are finished early, you can also practice on manikins for boards examinations while you wait to be assigned emergencies. 3. You are responsible to review your patient’s medical, clinical and radiographic history prior to the appointment and be familiar with previous treatment as well as the patient’s current status. You are expected to present this information in a professional way to the faculty and provide a summary or overview of the patient’s status and chief complaint during the initial check. We recommend you use the following outline for start checks: START CHECKS -Introduce patient -Medical hx (summary) -Medications / allergies -Blood pressure -Chief complaint -Radiographs (needed?) -Caries risk assessment (if time allows while waiting) - Modifiers (ie: DWP, XIX, travel time) -Your plan for the appt. -If recall, ask faculty if they want to check the exam before the prophy 4. Rubber dams must be used for restorative treatment. This includes post preparations. Your instructor must give you permission if an exception is to be made. 5. AxiUm notes, codes, and any FAMD required paperwork must be completed before your faculty gives you the final check for each patient. Keep in mind that adjunct faculty may not be back for a week (or more) to swipe or sign incomplete items. 6. DO NOT forge instructor signatures on any paperwork. Those who do will be referred to the Collegiate Academic Professional Performance Committee for disciplinary action. 2 7. Out of courtesy, if you intend to call in a consult or work with another instructor on a specific procedure, please advise the instructor on the floor of your intention at the start of each clinic session. 8. A diode laser is available in the dispensary. Before using, read the College of Dentistry Laser Safety Manual and take the Laser Safety Course on Intradent / Faculty / Laser Safety Training. Submit your quiz to Cheryl in the FAMD office. The laser screen is stored in S306. Supervising faculty must be laser certified. The list is posted on the main bulletin board. Use the laser template for charting. Return the laser storage tub exactly as you found it. If using the laser as an adjunct to a procedure, when electrosurgery or retraction cord are also options, use code D4999 (unspecificed periodontal procedure) and charge $5.00 to cover the cost of the disposable tip. There will be 0 RVUs awarded. If, on the other hand, tissue MUST be removed to enable the restorative procedure, use code D4212 (gingivectomy or gingivoplasty to allow access for restoration). Be sure to treatment plan the procedure and advise the patient of the fee ($90). This procedure is worth 3 RVUs. Contouring of hyperplastic gingiva with the laser would be coded D4211 (gingivectomy/plasty 1-3 teeth) with a fee of $110 and 6 RVUs. This would not be in conjunction with a restorative procedure. 9. All patients requiring antibiotic premedication are to be pre-rinsed with chlorhexidine gluconate .12% (10 ml 30 second swish and expectorate). This must be charted as a prescription. This protocol will be one of the dosage selections under chlorhexidine. There is no wait time. The procedure can begin immediately. The chlorhexidine is located at the ends of both teaching stations. If alcohol use is contraindicated (for example: religious belief, Antabuse, recovered alcoholics), go to the pharmacy to receive 10ml of alcohol free chlorhexidine. U. of Iowa COD SDF Protocol 1. Obtain verbal consent for the application of SDF that covers the following items: Expected change in color (decay will turn black), likelihood of reapplication, need for future treatment, and possible temporary discoloration to the gums and cheeks in case of accidental exposure. 2. Make sure you use a metal pan to contain all supplies used during silver application. 3. Standard Personal Protective Equipment (PPE) for provider and patient, extra plastic lined cover (patient bib) for counter tops. 4. You will receive one drop of SDF in a dappen dish from the dispensary. 5. Isolate affected teeth with cotton rolls / dry angle and saliva ejector. 6. THOROUGHLY dry affected tooth surfaces with triple syringe. 7. Bend microbrush, immerse into SDF, remove excess on side of dappen dish. One drop can treat 5-8 lesions. 3 8. Apply directly onto the affected tooth surface(s) with microbrush . Application time: 1-3 minutes. 9. For interproximal lesions, apply to buccal or lingual with microbrush. The SDF will wick. 10. Apply Fluoride varnish on the treated area with BendaBrush. If you apply varnish to the rest of the teeth, use ANOTHER BendaBrush. 11. Invert any supplies that have encountered SDF into your gloves during removal. Then deposit directly into garbage container. 12. In case of possible touching or contamination of the lips or face with silver, use a saturated solution of salt on a 2”X2” gauze to wipe the area. 13. Please watch the videos available at this link for application of the agents prior to your application: https://www.youtube.com/watch?v=Hpv43jvNn9s 14. Use code D1354 Interim Caries Arresting Medication ($35) whether you treat one or more teeth. This code gets billed out only once per visit, irregardless of the number of lesions treated. 15. Remember, SDF will permanently stain almost all surfaces BLACK. Prosthodontics (4/2015) A. Diagnostic Casts 1. Diagnostically articulated casts are considered part of the diagnosis and treatment plan. They MUST be completed on all patients requiring removable partial dentures, two or more fixed units, or combination cases where both fixed and removable partial dentures are planned. Mounted diagnostic casts must include an occlusal analysis (yellow form) before any restorative work is started. Occlusal vertical dimension, space for restorative material, and occlusal plane acceptability will all be evaluated during occlusal analysis. 2. If there is a change in the oral condition as a result of the treatment completed during the disease control phase (such as the loss of one or more key teeth), the diagnostic casts will likely need to be remade. B. Removable Prosthodontics 1. The prosthodontics gold sheet with a removable RPD design is part of the patient’s diagnosis and treatment plan. This must be completed for all RPD patients PRIOR to any restorative treatment (not while the patient is in the chair). When changes occur with key teeth during the disease control process, any fixed or removable treatment plan must be re-evaluated (again, not while the patient is in the chair). 2. RPD master casts being sent to a laboratory for framework fabrication MUST be articulated when opposed by natural teeth or another RPD. 4 3. All RPD work authorizations must be accompanied by two casts. One is the tripoded and articulated master cast, the second on which the design has been drawn. This will require two separate impressions (of which one may be a good alginate). 4. All complete denture cases will be articulated with a facebow transfer on a Hanau, semi-adjustable articulator. 5. Continuity of faculty supervision is important in all complex prosthodontic cases, and especially for complete denture cases. It is highly recommended that students schedule all appointments for a complete denture patient under the supervision of the same faculty member. Department of Family Dentistry policy states that MEE credit will NOT be awarded if there are more than two faculty signatures from preliminary impressions through final denture insertion. “Dentures by committee” ARE NOT ALLOWED. 6. Deviations from protocol MUST stay with the same instructor to completion and follow- up. 7. MEE Complete Denture credit will not be awarded if the complete dentures, upon delivery, are not clinically acceptable or QA form not filled out and turned in. C. Fixed Prosthodontics 1. Determine restoration type before starting prep. 2. Indications/ Contraindications for All-Ceramic Crowns: 1) Conventional single units only (no FPD or RPD abutments) unless cleared through Group Leader 2) Adequate occlusal-gingival height of unprepared tooth (at least 6 mm). 3) Stable occlusion: a. Posterior restorations: One should be able to achieve minimal excursive contacts on the all-ceramic restoration; especially against natural teeth. There should be anterior/canine guidance or progressive group function present. b. Anterior restorations: Finished all-ceramic restoration should be in harmony with existing anterior guidance. Avoid exclusive guidance on all-ceramic restoration (harmonize the guidance with natural teeth) c. Patient should not have parafunctional habits (presence of multiple wear facets) 4) All-ceramic restorations are not indicated where a feather edge margin may have to be used. (Examples; deep foundations, pins present in foundation, fractured teeth etc.). 5) Anteriors with deep vertical overlap and centric contacts near the gingiva usually do not provide adequate clearance and are contraindicated. 6) Patients who have multiple teeth with a questionable prognosis or have an existing RPD may not be appropriate candidates for all ceramic crowns.
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