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ASDAUCLAChapter
Clinic&LabEducationCommittee
TTThhheeeLLLeeeaaadddPPPiiipppeee
AAACCCllliiinnniiicccGGGuuuiiidddeeeaaannndddSSSuuurrrvvviiivvvaaalllMMMaaannnuuuaaalll
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~2~
Feelingabitlostwhiletryingtotreatyourpatients?ForgetthedifferencebetweenFujiIandFujiIX?
Cantfindsomeonearoundyoutoansweryourquestions?ThisdocumenthasbeencreatedtohelpoutintimeslikethesebyservingasastudentgeneratedguidetohelpyouweaveinandoutoftheUCLADental
Clinic.Therearetonsofinstructionmanuals,handbooksanddocumentsfloatingaroundattemptingto
answerquestionsyoumayhave,butwearehopingtocondensethosethatstudentshavefoundmost
usefulintoONEClinicGuide.Astherearealwayschangesandnewprotocolsarisingintheclinic,this
documentisinherentlyanongoingproject.Ifyouhaveanysuggestionsorcorrectionspleasesubmit
them!Allcontributionsarewelcomeandstudentswillappreciateandbenefitfromthemforyearsto
come.
NinaMendoza,c/o2012ASDAClinicandLabEducationCoordinator
neenah789@gmail.com
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TableofContents
Anesthesia .............................................................................................................................................. 5
AntibioticProtocol............................................................................................................................... 6
ATP:AdvancedTreatmentPlanning ............................................................................................. 7
BasicCubicleSetup............................................................................................................................13
BillingOffice.........................................................................................................................................14
BlockSchedulesWhere?When? ................................................................................................15
CashierWindow..................................................................................................................................18
ChartRequests....................................................................................................................................19
ChartReviewRecallvsActivePatient......................................................................................20
Consultations.......................................................................................................................................22
ClinicvsBlock......................................................................................................................................26
Competencies ......................................................................................................................................27
DirectProcedures ..............................................................................................................................28
Endodontics .........................................................................................................................................31FixedProcedures ...............................................................................................................................33
FujiWhat?.............................................................................................................................................36
Hygiene..................................................................................................................................................38
Implants ................................................................................................................................................39
Inactivatingvs.DischargingPatients ..........................................................................................40
InitialPerioTherapy.........................................................................................................................41
Insurance ..............................................................................................................................................43NewPatient:Screening&Radiographs......................................................................................44
NitrousOxide(N2O)..........................................................................................................................45
OralDiagnosis .....................................................................................................................................46
OralFacialPain...................................................................................................................................48
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PatientAssignment............................................................................................................................49
PaymentPlans.....................................................................................................................................51
PatientRequests.................................................................................................................................52
PediatricDentistry ............................................................................................................................53
PerioClinic ...........................................................................................................................................56
Periodicexam......................................................................................................................................58
Preventive ............................................................................................................................................59
ProphySurvivingYourFirstOne!..............................................................................................60
Radiology ..............................................................................................................................................62
RecallDentureExam.........................................................................................................................63
RestorativePrimers:HurrisealandCavityConditioner.......................................................64Requirements......................................................................................................................................65
RubberDam.........................................................................................................................................68
RyanWhitePolicy ..............................................................................................................................69
SchedulingAppointments ...............................................................................................................70
SubmittingaTreatmentPlan.........................................................................................................72
UrgentCare ..........................................................................................................................................74
QuickLinks...........................................................................................................................................76
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~5~
Anesthesia
Ifthisisthefirsttimeyouareinjectingapatient,justrelax&workupyourconfidencedontbesurprisedifyoureshaking!
- Topicalanesthetic:o Iswearbytopicalanestheticforeverythingbutpalatalinjectionso Placeitwhereyouaregoingtoinject&dontletitgetalloverinthepatientsmouth
Takeoneofthosetopicalswabs&stickitalloverinyourmouth&seehowmuchyoulikeit Eitherusethesalivaejectororplacea2x2justbehindtheswabtoabsorbexcess
o Leavethetopicalthereforawhilemaybeaslongas2minutes Youcanfillthetimegettingthingsreadywhileitdoesitsjob
- Deliverslowly:o Movetheneedleslowly&injectslowlyo Onceyoustart,watcharoundtheptseyesforwincingiftheptflinches,slowdowno Youcantake2minutestoinject,whichfeelslikeaneternity,butwillbelessirritatingtothepatient
- Tellthepttobreathethroughtheirnose&useotherformsofdistraction- Providing(near)painless,profoundanesthesiaisworthitsweightingold
- ForIAblocks,ifyouaregoingtobeworkingintheareaforawhile,give1.5-2carpuleso Thisislotsbetterthanhavingtoinjectthroughtherubberdamlaterintheappointment
- Forthemaxilla:o Youcanalmostalwaysgivelocalinfiltrationinthemaxilla,asopposedtogivingaPSA,MSA,orASAblocko Forinfiltrations,remembertoanesthetizethetooththatyouplantoclamp,notjusttheoneyouwillbe
workingono Forthepalate:
Youcanalwaysgiveagreaterpalatineinjection,OR YoucanuseDr.Hargismethod:onceyouvecompletedthebuccalinfiltration&thebuccalgingivais
numb,youcaninjectthroughthepapillafromthebuccal,whichwillprovideanesthetictothelingual
lookforblanching
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AntibioticProtocol
ProphylaxisforPatientswithJointReplacement
Amoxicillin,Clindamycin,Cephalexin
ProphylaxisforInfectiveendocarditis
Amoxicillin,Clindamycin,Cephalexin,Azithromycin
Prescriptions(for3visits):
Rx:
Amoxicillin500mg Disp:12tablets
Sig:4tablets(2g)30-60minutespriortodentalvisitandrepeatateach
appointment
Rx:
Clindamycin150mg
Disp:12capsules
Sig:4capsules(600mg)30-60minutespriortodentalvisitandrepeatateach
appointment
Rx:
Cephalexin500mg Disp:12tablets
Sig:4tablets(2g)30-60minutespriortodentalvisitandrepeatateach
appointment
Rx:
Azithromycin500mg
Disp:3tablets
Sig:1tablet30-60minutespriortodentalvisitandrepeatateachappointment
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ATP:AdvancedTreatmentPlanningFromstarttofinish
WhoneedstogotoATP?
AnythingthatsnotFastTrack.WhatsFastTrack?SeethehandoutfromDr.Woodss2nd
yearspringcourse.I
cantfindit,andyoumightnotbeabletoeither,sohereistherelevantportion:
Basically,ATPisanythingwherethetreatmentisnotsoobvious.Occasionallyyoumaytrytodoaperiodicexam
(regularconsults)andhaveitblowupintoATPbecauseatthatappointmentyoufindthattoomanythingsneed
tobereplaced.
Sobasically,itsATPifyouneedextractions(otherthan3rdmolars),morethan8fixedrestorations,replacingmore
thanonetooth,anyRPDs.ReplacingonlyonetoothcanqualifyasFastTrack.Anobviousdenturecasewhereits
clearallteethneedtobeextracted(i.e.theresonlyonecleartreatmentpathway!),canalsoqualifyforFastTrack.
ATPiswhereyougotodecidehowtoreplacemissingteeth(debatingbetweenRPDs,implants,andbridges),or
doinglarge-scalerestorations(morethan8crowns,unreasonableocclusion,severeattrition).
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WhatdoIneedtodobeforeATP?
YouneedtodoaPre-ATPappointment.BookitonGSDassuchandyouwillgeteitherperioorrestorativefaculty
coverage.Itslikeregularperio/restorativeconsults,exceptyoureprettymuchonyourown(becausethe
instructorexaminationswilltakeplaceatATP).Doyourperioprobingsandhavethecoveringperiodontistlock
yourperiochart(thisisanewadditiontotherequirementsbeforeATP;theywanttheprobingsandothermeasurementstobeaccuratesotheydonthavetoquestionthemattheATPappt).Therestorativeexamis
completedasnormal(butwithoutafacultyconsult).Ifyouaretryingtodothisinthe1.5hoursafterOD,youmay
ormaynothaveenoughtime.
YouwillalsoneedmountedcastsfortheATPappointment.Sotakeupperandloweralginateimpressions,pourin
yellowstone.(Theywilllikeitifyourmountingandcasttrimmingisnothorrid).Youcantrytocapturethe
vestibulesifyouareplanninganRPD,buttheyllprobablybefineifitsnotperfect(sinceitsjustapreliminary
studycast).Youwillprobablyneedafacebowtomountthecasts.Generally,youwillwanttohand-articulatethe
casts(becausethisismostaccurate),unlesstherearenotenoughteethtodoso.Inwhichcase,youwillneed
recordbasesandwaxrims.(Notblue-mousseorcompoundorwaxwafersoranythingelse).Moreonthat
below
IfanRPDisapossibletreatmentoption,youllwanttogetapre-ATPdesign.Thewhiteformsfordrawingthe
designareon2nd
floorinfrontoftheremovablelab.Drawyourproposeddesign,andgotoaremovableconsult
(thescheduleforthisison2nd
floornearNancysdesk).Bringthemountedcasts,aswellasthepatients
radiographs.
Thepresentation:Afteryougetyourdiagnosticinfo,prepareyourtreatmentplan(ifyourewrong,thatsfine.
ATPisnotevaluatingyouforcorrectnessbutjustforthoughtfulness).Followtheorderonthisotherhandoutfrom
Dr.Woodsspringcourse.(nextpage)Afewthingstonote:Makesuretoknowthepatientssnackinganddietary
habits,oralhygienehabits.Besuretostateplaque/marginalbleedingindicesbeforeperioprobings.Knowtheir
typeI/typeII/etcpreventive.Andtelltheoverallbigpictureoftreatmentbeforegoingintoittooth-by-tooth.
Thereareprobablymanyexamplepresentationsfloatingaround.Belowisoneexample.Ifyouneedothersjustask
aclassmatefortheirpresentation.Followingtheexamplecasepresentationonthenextpageshouldcovermost
questionsyoumaybeaskedinATP.
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PATIENTINTRODUCTION
Demographics: Age: Occupation: FinancialStatus/Insurance: Initialexamdate: WhyatUCLA:
ChiefComplaint: Originallycameinbecauseofpaininlowerleftquadrant,whichisnolongeroccurring.Ptis
concernedabouttheestheticsandlossoffunctionofhermissingposteriorteeth,andof#21in
particularasitisvisibletoptwhenshesmiles.
HPI: Ptlostrestorationon#21approximately1yearagoandhadpaininthatareaapproximately2
weekspriortoinitialexam.Ptisunawareofthehistoryoftheotherinvolvedteeth,butreports
nothavingreceiveddentalcareforabout10years.
SYSTEMIC
MHx,medications: Ptreportsnoactiveorsignificantpastmedicalproblemsandisnotcurrentlytakingany
medications.
LastBPtaken11/22/2009andwas128/82/80bpm/regularrhythm Allergies:Seasonalallergies,NKDA
DHx: Lastdentalvisitwasapproximately10yearsago. Patientreportsdissatisfactionwithpreviousdentalcareataprivatedentistassociatedwith
havingthewrongtoothpreparedandcrownedandalsoduetodifficultyachievinglocal
anesthesia.
Ptreportsahxofdentalphobia.URGENT
None
PREPARATORY
Preventive MBI:35.58% PI:38.46% TypeII Highcariesriskduetovisiblecavitations,exposedroots,andinterproximalradiolucencies. Atinitialexam,ptreportedhxofbrushing1x/dayandoccasionalflossing. Txplan:
Dietanalysis Recommenduseofsugar-freexylitolgumaftereating RecommenduseofOTC0.05%NaFrinsesuchasACT1x/dayafterbrushingteethin
morning
Prescribe1.1%NaFtoothpastesuchasPrevident5000tobeusedwhilebrushingteethbeforesleeping
OHIincludingBassmethodandflossinginstruction Recommenduseofelectrictoothbrush
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Periodontal:
2-4mmgeneralizedpocketdepthsonmaxillaryandmandibularteethwith5-7mmlocalizedpocketdepthsonmaxillaryposteriorteeth.
Nofurcationinvolvementormobility. 3mmrecessionon#3lingual. Moderategeneralizedhorizontalboneloss. ModerategeneralizedBOPandinflammation. Moderategeneralizedchronicadultgingivitiswithlocalizedmoderateperiodontitisinthe
maxillaryposterior.
Txplan:2apptSc/RP.4weekperiore-eval. Endo/OralSurgery/Ortho/OrofacialPain/Esthetic:
Endoconsult: Teeth:19,28(re-treat)
Oralsurgeryconsult: Extract:
Teeth:13,15,21 Roots:30
Implantconsult:
Dependingonfinaltxplan,teeth:13,20,21,and/or30RESTORATIVE
Overalltreatmentapproach: Maxilla:Extractions,operativeandfixedtoaddressactivedentaldisease,andeither:
12-13-14FPDor singletoothimplanttoreplace13
Mandible:Extractions,operativeandfixedtoaddressactivedentaldisease,andeither: singletoothimplantstoreplace20,21and30or singletoothimplantstoreplace20and21and29-30-31FPDtoreplace30or mandibulartooth-borneRPDtoreplace20,21,and30
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~11~
Toothbytoothplan:Tooth Description Problem Plan Fee
1 Missing
2 Oamalgam FracturedMamalgam Ocomposite $99
3 PFM 3mmlingualrecession,gingival
hyperplasiaonM
4 PFM GingivalhyperplasiaonD
5 DOamalgam Mcaries MODcomposite $148
6
7 Mcaries MLcomposite $105
8 PFM OpenFmargin PFM $495
9 PFM/post/RCT OpenFmargin PFM $495
10 MLcomposite RecurrentMdecay,Ddecay ML,DLcomposite $115
11
12 DOamalgam Mcaries MODcomposite $148
13 Crownfracture/grosscaries Ext
Replacewithsingleimplant
($2,000-$2,500)or3-unit
bridge($1,485)
$125
(+?)
14 OLamalgam Mcaries MOLcomposite $148
15 Crownfracture/grosscaries Ext $125
16 etccontinueto#32
ELECTIVE
NoneMAINTENANCE
Preventive Fluoride:topicalfluoriderecommendedafterSc/Rporprophy OHIateachrecallprophy
Periodontal PhaseIinterval:3moperiorecall
Restorative(Monitor/Watch) 1yearrecallforperiodicexamandBWX
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AtATP
Ifyoudoneedtotakeawax-rimbiteregistrationduetoinsufficientteeth,youcantrytobookthepatientforan
11amor4pmATP(forexample),andbringthemintothegeneralclinicat9amor2pm.Dothewax-rims,then
finishmountingthemandibularcast.
BookanappointmentunderWWATPAM(orPM)andspecifywhetheryouwant9am,10am,or11am.(Each
appointmentisanhour).Atthetimeofthiswriting,ATPtakesplaceM/TafternoonsandThursdaymornings(but
ifyouforget,youcanalwaysjustchecktheGSDscheduleforNewRoomandseewhenATPis;theothertimes
areusuallyEstheticsclinic).RemembertoconfirmyourATPapptthedaybefore!Otherwiseitwillbedeletedand
youllbeoutofluck.
RemembertobringtheATPgradesheet(pink).Atthetimeofthiswriting,itcanbefoundon2nd
floornotwithall
therestofthepapers,butaroundtheback(closetoorthoandthebacksideofsterilization).
Sityourpatientdownanywhere,haveyourcomputerout,mountedcasts.Itcanbehandytohaveyour
presentationnotesonpaperratherthancomputer,sotheother2facultycanlookatradiographsonXDRwhile
oneisexaminingthepatient.
AttheendyouwillfilloutPREVTX1-4,andwritetheATPconsultnotes.Basicallyitshouldcontainallthefindings
&treatmentyoudiscussed.
WhatdoIdoafterATP?
IfyoutrytoaskDr.Woodsthis,hewillhandyoutheconvenienthandout(availableatyourATPappointment)with
mosteverythingspelledout.IfRPDispartofyourfinaltreatmentplan,youwillneedapost-ATPRPDdesign(by
attendingremovableconsults).DragstuffoveronGSD(justlikeanytreatmentplan),fillouttheyellowinitialplans
formandproblemlist,putthepinkgradesheetin,andsimplysubmitthecharttothechartroom(askthemto
putitinDr.Woodsbox).Toknowwhenitsdone,simplycheckGSDtoseeifthetreatmentplanhasbeenapproved(redstarsbecominggreen).Thenthechartwillbeavailableinthechartroomagain.
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BasicCubicleSetup
- Fromthecentralsterilizationarea,pickupapieceofwaxpaper- Fromthecentralislandsbackwindowarea(orfromyourhomecube),obtainthefollowing:
o ***Youcankeepallthisstuffonhandatyourhomecubeo 1bigbagfortraytable(nolongerrequiredforoperatorchair)o 1plasticlaptopbago Bluegown&facemasko High&lowspeedsuctiontips,air/watersyringetipo Patientbibo Anycottonrolls&2x2syouplantouse
Findingsupplies
- Cartsatthebackwindowincludesuchthingsas:o Impressionmaterial(alginate,polyvinyl
siloxane)&trays
o Bluecompositeo Packingcordofvarioussizes(althoughyou
shouldhaveyourowncordinthat
hemostasiskitfromUltraDent)
o Ropewax
o Greenstickcompoundo Vaselineo Matrixbandso Clearmylarstripso Bitestickso Tempbondo Matrixbuttons
- Cartintheremovableclinicincludessuchthingsas:o Pinkcompoundo Greencompoundo Disposablemirrorso Tonguebladeso PIP
o Disclosingwaxo Denturecupso Impressionmaterialo Impressiontrayso Indelibleinksticks
- Centralsterilizationwillhave:o *Basicallyforeverythingthattheclinic
doesntwantyoutosteal*
o Studentbags=bagsyoudropoffwithyournumberwrittenontop
o Restorative,perio,rubberdam,exam,ODexamcassettes
o Anyinstrumentsmissingfromanycassettes(includingrubberdamclamps)
o Fujigunso Integritymaterialo GCFujiLiningLCpasteo Endotestingsupplies(Endoice,EPT)o Endocubiclesetupstuffendofiles,gutta
percha,etc.
o Scalpels&scalpelbladeso Orthowiresfortreatmentpartialso T-barforremovingoldcrowns
o Cavitrono Electrosurgthingforelectrocauteryo *Anythingelsethatyoucantfindinthe
cabinetsatthebackwindowsORanything
youhaventheardofwhentheinstructor
asksyouDoyouhave?
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BillingOfficeBillingholds(lockedoutofchart): yourpatienthasanoutstandingbalanceandneedstopaytheirbalancebefore
youcanaccesstheirchart.Thisincludesschedulingappointments.Oncetheyhavepaidtheirbalance,gotothe
billingofficeandaskthemtounlocktheirchart.
Insurance:UCLAacceptsdirectpaymentfromonlyDeltaDental.Allotherinsurancecompaniesreimbursethe
patientafterwards.
Mail:Youcanalsofindtheboxtoputanypatientmailthatneedstogetsentoutonthecounternearthedoor.
MakesuretheenvelopeisaddressedcorrectlyandthatithasbeenstampedbyyourGPD.Nopostagerequired.
RyanWhiteForms :OncetheblueformsforyourRyanWhitepatientshavebeenfilledoutandsignedbyDr
Younai,droptheformsoffinthebillingoffice.Oncetheyareprocessedanotewillappearinthetopwindow
undertheNotestabinGSD.
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BlockSchedulesWhere?When?Throughoutyourtimeinclinic,youwillalsoneedtopayattentiontoyourassignedblockschedules.Theseareall
notedinthecalendarthatisupdatedandemailedtoyoueachquarter.Thesecalendarsarealsopostedintheclinic.ThedatesshouldalsobeblockedoutonGSDsothatyoucannotaccidentallyscheduleapatient.Itisagood
ideatochecktheseoveratthebeginningofthequartertoensureyourcalendarmatcheswithGSD.
Differentblocksmeetondifferentdaysanddifferenttimes.Somemaylasttheentireweekandothersonly20
minutesintheafternoon.ThekeyforreadingtheBlockschedulecalendarisavailableonline.
InglewoodChildrensDentalCenter (1day/weekfor1quarter):o InglewoodBlockRotationisoneofyourtwoPediatricdentalrotationsatUCLA.Theother
rotationoccursoverthecourseofaweekattheWestwooddentalclinic.Moreoftenthannot,
theInglewoodrotationwillbeyouronlyopportunitytoperformactualproceduresonchildren
patient(asopposedtoexamsandprophysattheWestwoodclinic).Theblockrotationoccursoverthecourseof1quarteronthesamedayeveryweekduringeithertheD3orD4year.Expect
tobetherefrom8:30amuntilapproximately4:30pm.
YoumaynotbecompletelysurewhattodowhenyoushowuponthefirstdayofWeek1.Ifso,readthis
shortlisttobeprepared:
o Printyour3competencyandsignaturesheets.TheseareavailableonAngel.Asmuchaswehateit,youwillbechasingthealmightysignatureforyourcompetetenciesandexperiencesat
Inglewoodaswell.
o Bringallsupplies.InglewoodClinicisverylowonsuppliesduetoalimitedbudget.Anythingyoucanbringisgoingtovastlyimproveyourexperience.Handpiecesandburblocksataminimum;
buteverythingnecessaryforacompositerestorationisabetterrecommendation.
o Showupat8:30am.Theaddressis300BuckthornSt.Inglewood,CA90301.TherewillbeanorientationduringthemorningofDay1intheToothFairyCottage(directlyacrossthestreet
fromtheactualclinic)wheretherestoftheblockwillbeexplainedtoyou.
o BrieflyreviewPedotopics.JustquicklyreviewhowtodoaClassI,ClassII,SSC,andpulpotomy.Dontspendtoomuchtimewiththesetopicsasyoumaynotbetoobusyduringyourfirstweek.
However,youmayendupdoingastainlesssteelcrownasyourfirstpediatricexperience(likeI
did);andyoullappreciatehavingbrieflyreviewedthetopics.
OralDiagnosisBlocko Thisblockiscompletedthreetimes;thefirstduringsummerof3rdyearforoneday,thesecond
timeforaweek,andthelasttimeyouarescheduledfortwodaysinoneweek.Forthisblockyou
mustshowupat9AMand2PMintheODcliniconthefirstfloor.Bringeverythingwithyouthat
youneedtocompletetheexam(thisincludes:examkit,gloves,gown,eyeprotection,masks,BP
cuff,Rxbook,computerandthenecessarycords).
OralFacialPainBlock OralMedBlock(atthistime,thisblockhasbeeneliminated) OralSurgeryBlock(1week)
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o Thisblockisonlycompletedonce.Itcoverseveryclinicsessionforoneweek.BeforethefirstsessionitmaybeagoodideatopickupthepacketofinformationfromtheOSofficeonthe5
th
floor.Thispacketcontainsthepagethatrequiressignaturesthroughouttheweekandmustbe
turnedinaftertheweekisover.Forthefirstmorning,meetintheOSclinicontheAlevelat9
am.Youcanbringyourbackpackandleaveitintheconferenceroom.FindDr.Hargisinthemain
clinicarea.Heprefersifyoubringapenwithyouasthefirstsessionsincludesomenotetaking.o ThebeginningoftheweekismostlyspentwithDrHargislearninginstrumentsandtyingknots.
Refertothescheduleforspecifics.
OralSurgeryBlock(3weeks):o Thisblockconsistsofa3-weekrotation,whichyouhavetheoptionofchoosingbothtimeand
place(sortof).Yourclasswilldecidehowtocreatealotterysystemtoenableadraftforpicking
yourtopchoice.Youcanchoosefrom4differentclinicsandblocksoftimethroughoutyour4th
year.Someblocksalsoextendintothebreakstolimittheamountoftimeyouareoutofthe
generalclinic.Theclinicstochoosefromare:UCLA/Harbor,VASepulveda,WestLAandMLKCare
Center.
OrthoBlocko Thisblockiscompleted3differenttimesduringthe3
rd
/4
th
year.Ontheafternoonyouarescheduled,meetintheorthocliniconthe2
ndfloorat2pm.Youwillcompleteanorthoexamwith
apartnerduringthefirsttwosessions.Atyour3rd
timeintheclinic,youwillspendthetime
observingtheresidents.Thisblockcanbecompletedveryquicklyandrarelyarestudentsstill
workingafter3PM.
PedoBlock(3days)o ThisblockoccursduringWinterorSpringquarterofyourthirdyear.Itoccupies6clinicsessions
duringoneweek.YoumustmeetinthePedoclinicstarting9AMonMondaymorning.Theblock
continuesthruTuesdayafternoon,Wednesdayisoptional,andfinishesonThursday.Thereare
severaldocumentsyoushouldbringtogetsignedduringthisweektoproveattendanceand
competency.TheseareexplainedinmoredetailinthePediatricsection.
PerioBlock(4sessionsinoneweek)o Thisblockisonlycompletedonce.Theblockcovers4clinicsessions:MondayAMandPM,
TuesdayPMandThursdayPM.Thefirstmorningmeetsat9AMinaconferenceroomacrossthe
PerioclinicontheBlevel.Thereisaninteractivelectureduringthisfirstsessionandtherest
consistofshadowingandassistingintheperioclinic.Youmustbepresentduringtheentire
sessionsintheclinic.YouwillneedtocheckinwithGwenatthefrontdesk.DoNOTbringyour
backpackwithyou;cometotheclinicwithagown,masksandeyeprotectionandthatisit.
RadiologyBlocko Thisblockisdoneonceaquarter.Itlaststheentireday,howeveryouwilllikelyfinishearlyin
eachsession.Themorningsessionbeginsat9AMandtheafternoonsessionat2PM.Youdonot
needtobringanythingwithyou.MeetintheradiologyconsultroomacrossfromtheODchairs.
SpecialPatientCareBlock(1session+1earlymorning)o Thisblockisonlycompletedonce.ItcoversWednesdayAMandPMsessionsthefirstweekandis
from8-9AMontheWednesdayofthefollowingweek.Forthefirstsession,meetinthe
WeintraubcenterontheBlevelacrossfromtheProsthoffice.Youwillspendthefirsthour
listeningtothepresentationgivenbythepreviousweeksgroup.Youcanleaveyourbackpackin
thisroomanddonotneedtobringanythingelsewithyou.Duringthesecondsession,youwill
presentapreparedPPTaboutaspecialcarepatientthatyouencounteredduringyourfirst
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session.DrSunmaybepresenttoquizyouonsomeofthemoreimportanttopicssodosome
research.
UrgentCareBlock VeniceBlock(1day/weekfor1quarter)
o ThisblocklastsanentirequarterandiseitherWinterorSpringof3rdyear,orSummerorFallof4
th
year.YourspecificdaywillbesometimeTuesThurs.Youmustreportfororientationat7:50AMonyourfirstdayofblock.Theoreticallyyouonlyneedtobringtheequipmentfromyour
cubiclethatyouneedfortheappointmentsyouhavescheduled,howeveryoumayalwaysbe
givenanurgentcareatthelastminuteandsoyouwanttomakesureyourprepared.Theclinicis
nearthecornerofRoseandLincoln.TheentrancetotheclinicandtheparkinglotisonRose.
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CashierWindowThecashierwindowiswhereyoushouldideallybegineveryappointment.Itcanbefoundtotherightofthechart
roomwindowonthemainfloorinthepatientwaitingarea.Itsalwaysimportanttotryandgetyourpatienttopay
beforetreatmentisstarted!Thiswillsaveyoualotofheadachedowntheroad!
Cashierhoursare:Mon,Wed,Thurs,Frifrom8am-5pmandTuesfrm8am-8pm Cashierphone#is(310)825-5253 Thewalk-Inaddressis714TivertonDrive
Whensendingyourpatienttothewindow(orwhenaccompanyingthemthere)itisimportanttotellthecashier
thepatientschartnumber(justhandthemthechart)aswellasthechargefortheday.Thepatientscanalsodo
thisontheirownontheirwayoutattheendoftheappointmentaslongastheyhavethisinformation.
Acceptableformsofpaymentincludecash,personalcheckswithpreprintednameandaddress(thisincludes
moneyordersandcashierchecks),andcreditcardsandATMcardswiththeVisa,Mastercard,AmericanExpressor
Discoverlogos.
Patientscanalsocalloverthephonetocompleteapayment.Theyneedtoknow:
Chartnumber Amttobepaid Creditcardnumber Expirationdate Card-holdersname Zipcode Contactphonenumber
Ifyouareunsurewhatyourpatientowes,checktheirrecordsonGSDbyclickingonthemoneysymbolatthetop
ofthescreen.Ifyouhaveayfurtherquestions,theBillingOfficewillansweranyquestionsyouhave.
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ChartRequestsChartscanberequestedfromtheChartRoom,whichisfound,totheleftoftheCashierWindowonthemainfloor
oftheclinicinthepatientwaitingarea.
Chartroomhours:M-F7:30am-12pmand1pm-5pmaswellasTuesuntil8pm Havechartnumberreadytoenterontherequestsheetalongwithpatientinitialsanddentalstudent#
andinitialsTheywillcheckthisoffastheysignthechartouttoyou
Rushhoursare8am-10amand1pm-3pm Max2chartsduringrushhourandmax4duringnormalhours
WhatifIneedmorethan4charts?
Ifyouhaveachartreviewandneedmorethan4charts:o PrintyourpatientlistfromAcademicSystemo Highlightthechartsyouneed
Thosewithcode07forrecallchartreview Allotheractivepatientsfortheregularchartreview Writeyourname,student#andchartreviewdateandtimeatthetopofthepaper
Turnthisintothechartroom24hrsbeforeyourchartreviewandtheywillcreateastackwhichyoucanpickupthenextday
EXCEPTION!IfyourchartreviewisonaMonday,turninthechartrequestlistonThursdayWheredoIreturnthecharts?
Chartscanbereturnedanytimeduringregularbusinesshoursthroughthewindow,butitismucheasiertosimplydropthemintheslotsfounddirectlytotheleftofthewindow
Afterclosinghours,chartsshouldbereturnedonlytothedropbox IfyouhavealargechartthatdoesNOTfitintooneoftheslots,ithasbeensaidthatyouareallowedto
keepthechartovernight,HOWEVERyoucanusuallysidethewindowsopentothechartroomwindow
andsetthechartonthecounterinsidethewindowbeforeclosingthem
Whatifmypatientrequestsacopyoftheirrecords?
YoucanreferyourpatienttoAjaStanleywhoiscustodianofrecords:
1stFloorLabby,Room10-138,Window#5
ph#(310)825-3195
fax#(310)825-7620
ObtaintheAuthorizationformandprovidepatientwiththisinpersonorbyemail,faxorsnailmail.Informyour
patientthatthereisa$15chargeeachforwritten/computerizedandbillingrecordsorsinglesheet/pageofxrays.
Requestswilltakeupto7daysfromthetimepaymentiscollected.
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ChartReviewRecallvsActivePatientEveryquarter(fromsummertospringofyour3rdyear)youmustcompleteoneRecallChartReviewandone
regularChartReview.TherecallchartreviewisconductedwithyourGPAandmayberelativelyshort.Theother
chartreviewisdonewithyourGPDandisscheduledusuallywithinthefirstfewdaysofthequarter.
RECALLCHARTREVIEW
Thisisconductedtoensurethatrecallpatientsarebeingtakencareof.SeeyourGPAsometimeatthebeginning
ofthequartertoschedulethisappointment.PrintyourlistofpatientsfromAcademicReportandhighlightthose
thatarerecall(shouldhavea07code).
Beforeshowinguptoyourchartreview,youshouldlookoverthepatientschartonGSDandentersome
informationintotheNotessectionoftheirchart.Basicallythisshouldrecordwhentheirnextpreventiveand
consultationappointmentsshouldbedone.Anexamplenoteentrymaybe:
RecallChartReviewDueDates:
PE:7/19/11
Prophy:8/8/11
BWX:7/19/11
FMX:7/19/13
OD:1/24/14
Ifthisisadenturerecallpatient(code09),youonlyneedtodocumentthenextexamandODdates.Ifthenew
entrynoteswillnotreflectachangefromthelastrecallchartreview,youmayenter:
RecallChartReview:
Statusunchangedseenoteson(includedate)
Youcanfindthisinformationinanumberofplaces:
ThelastsetofconsultscanbefoundbyfirstgoingtotheCharttabandclickingonProblemLists/Consultstab;thenclickthepencilorplussigntoseealistofcompletedconsultswithassociated
dateandnotes(thisisalsowhereyoushouldfindtheperiorecallinterval)
ThelastcleaningmaybefoundbyfirstgoingtotheCharttabandclickingontheH;sortthelistbydateandscrolluntilyoufindthelastentryfor:1110BProphylaxisAdult.Determinethedateforthenext
prophybyaddingtheappropriaterecallinterval(3/4/6mos)tothedateofthelastprophy. TofindthelastODyoucanlookeitherontheDetailstabintheboxlabeledNextODWorkUporby
lookingundertheCharttabandlookingforthelatestgreenODtabtofindthedateofthelast
appointment
Tofindthelastradiographs,lookundertheCharttabandfindtheredRadiographtabtofindthexraytabCompletethisforeveryrecallpatientunderyourname,gatherthechartsfromthechartroomandtakethesewith
youtomeetwithyourGPA.
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ACTIVEPATIENTCHARTREVIEW
Whilethisappointmentcanbemorerigorousandstressfulthantherecallchartreviewthepreparationissimilar.
Beforeyourscheduledtime,makesureyouhavereviewedallyouractivepatients.Youshouldbelookingforthings
like:
Medicalissuesandlabslipsupdatedrecently(andmakesureyouhaveathoroughunderstandingoftheissuesinvolvedwhentreatmentthispatient,ifany)
OD/PEcurrent Radiographscurrent Treatmentplanscreatedwithin10-11mos Allsignatureontreatmentplanpresent Allconsultssignedforandcompleted Allappointmentschargedout(youshouldnotbegettinganyDailyUnchargedSummariesemails) Nosignificantamountofmoneydueonthepatientsaccount
ItsalwaysagoodthingtomeetupwithyourCPCteamtogooverpatientstomakesureeveryoneontheteamisfamiliarwithcurrenttreatmentplans.Aslongasyoupreparethingsshouldgosmoothly.
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Consultations
Consultsrefertooneoffourthingsgenerally:
1)Initial/periodicconsultationforcreating/updatingtreatmentplans2)Consultationwithoneofthespecialties(endo,oralsurgery,ortho,removable)duringongoingTx
3)Removableconsults,whereinyoudiscussRPDdesigns,denturesetups,etc.,witharemovableprofessor
NOTE:youcanhavearemovableconsultwithyoupatientintheremovableclinic,oraremovable
consultwithjustthefacultyinanofficesetting
4)Implantconsult
PREATPCONSULT
ThisistheappointmentpriortotheATPapptthatyouwillhaveonthesecondfloor.Thisappointmentdoesnot
requirefacultycoverageexplicitly,howeveryoudoneedtohavetheperiochartlockedbyfloorcoverage.Consult
tabsshouldNOTbecreatedastheconsultisdoneofficiallyintheATPappt.SOAPnotesshouldbewrittenand
signedoff.ThisisexplainedinfurtherdetailintheATPsection.
Duringtheappointmentyouneedtogatherallthesameinformationasisobtainedintraditionalrestorativeand
perioconsults.However,inadditionyoumustalsoobtainaccurateimpressionsofyourpatienttocreatestone
modelstomountandbringtoATP.Thesecastsshouldbemountedaccuratelywithafacebowrecord.Theycanbe
handarticulatedifthepatienthasenoughremainingdentitiontocreatesolidocclusion.Ifthisisnotthecase,wax
rimsshouldbecreatedandalsobroughttoATP.
Ifyouneedmoreguidanceinregardstowhatinformationtoobtain,followtheATPpresentaiontguidelineorfind
thegreensheetbehindcentraloutliningthesameinformation.Ifanobvioustreatmentplanisntpresentingitself
toyouduringtheappointment,youcanalwaysaskfacultyiftheywillgivesomeadviceastohowtoproceed.
FASTTRACKCONSULT
ForFastTrackcases,yougenerallyonlyneedperio&restorativeconsults;additionalspecialtyconsultsaresometimesneededaswell.
o Iftheptneeds1+extractions,youwillneedanoralsurgeryconsultintheOSclinicfollowingTxplanapprovalbyyourGPD
WHERETOENTERCONSULTNOTES:
o InyourptschartinGSD-ACADEMIC,gotothecharttab&clickontheconsultstaboninthelowerright-handcorner.Click+orpencil,whichopensanewwindow.ClickontheConsultationstab&thenclick
+orpencil.Besureyouchecktheboxtoaddconsultwithoutassociatedcondition.Thereisadrop-
downboxtoselectthesubspecialtyyouarecompletingtheconsultfor(e.g.,perio).
o Whenyouvedonethat,youllseeanewlineintheconsultationtabwindow.o Double-clicktheconsultyouwanttodothisopensupablankwindow.o Inthebox,youneedtoenterthedetailsoftheconsultation.o Whenyouvetypeditallintherecorrectly,closethewindow&clickcompleteconsult.o Oncethefacultyhassigneditoff,verifythatthewordcompletedappearsontheconsultline.
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PERIOCONSULT
o Completeperiocharting:noteanymissingteeth,measureperiodontalprobingdepths,BOP,recession,attachmentloss,presence&extentofplaque/calculus,health&appearanceoftissues
o Lookatbonelevelsradiographicallynoteanygeneral&localboneloss&possibleperiolesions Usebitewings,notPAs,tolookatbonelevels(BWXprovideamorelevelviewofboneheight)
o Exampleconsultnotes(tobetypedupbeforefacultycomesoverandapprovedbythemaftertheirassessment):
PtInformation:
Typeofexam(initialvs.periodic) CC SignificantMedicalcomplications Lastdentalvisit/cleaning HxPerio/OS Restorativeexperience
RadiographicFindings
DescriptionofCalculusfindings DescriptionofBoneLoss(GenvsLoc;mild(
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RESTORATIVECONSULT
o Thewisestudentwillhavealreadycompletedaradiographicanalysis,soyoushouldalreadybehalfwaythere(doradioconsultbeforetheappointment)
o Performatooth-by-toothexam¬eanythingabnormalcaries,demineralization,discoloration,chippedteeth,deeppits/fissures,currentrestorations,failingrestorations,developmentalstuffanything
worthnoting
o Useyourbestjudgmenttodevelopaplanforeachtooth TheinstructorwillhelpyoudecideonthebestTx Ifyoudisagreewiththeinstructor,youcanaskwhytheywouldntdowhatyouthoughtyoushould
do
Theymayactuallysay,ThatwouldbeanotheracceptableapproachORtheywillexplainwhyyourideaisnotasgreatastheirideaeitherwayyoulearnsomething
IntermsofrestorativeTx,itisbesttogiveyoupatientoptions(e.g.,goldinlayvs.amalgam)withpros&consofeach(cost,longevity,esthetics,etc)
o Exampleconsultnotes(tobetypedupbeforefacultycomesoverandapprovedbythemaftertheirassessment):
PtInfo:
TypeofExam(initialvs.periodic) CC SignificantMedicalcomplications Restorativeexperience
ToothbytoothFindings(indecorder)
1-32radiographicandclinicalfindings(specify) i.e.#14crownhasradiographicopenmarginandclinicaldecayatmargin #21incipientocclusaldecay
ToothbytoothTxplan(indec.Order)
1-32:mentionallteethinfindings(includingwatch) i.e.#14PFMCrowninformptofcrownlengtheningorendopossibility #21watch
Re-Eval:
BWXevery12mo,FMXevery3years
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SPECIALTYCONSULT
o Theseinclude,butmaynotbelimitedto:oralsurgery,endo,removable,perio,restorative,orofacialpaino Duringanygivenappointment,youmaywishtohaveaconsultwithaprofessorfromoneofthese
specialties
Restorative,perio,&endodonotrequireaseparateappointment Orofacialpainconsultsmustbescheduledintheredbookfoundattheendofthe1strowofcubicles
intheOralDiagnosis/Radiologyclinic OralsurgeryconsultsarescheduledattheOralsurgerywindowontheA-level
Youmaybeabletobeseenonawalk-inbasis,dependingonhowbusytheclinicis&whatyourptsneedsare
Removableconsults(clinical)aremadebyappointmentinGSD-ACADEMIC
ENDOCONSULT
o Ifyouareconcernedwiththevitalityofatooth,gathersomeinformationbeforepresentingtoendofaculty:
Testforpalpation/percussion,coldtestandEPTo Bringthisinformationalongwiththeradiographtotheendoclinicandpresnto Exampleconsultnotes(tobetypedupbeforefacultycomesoverandapprovedbythemaftertheir
assessment):o Exampleconsultnotes(tobetypedupbeforefacultycomesoverandapprovedbythemaftertheir
assessment):
PtInfo:
TypeofExam(initialvs.periodic) Chiefcomplaint SignificantMedicalcomplications
TestResults:
Palpation/percussion(+/-),coldtest,EPTresults
Radiographstaken:
Assessmentofprognosisofthetooth
Proposedtxplan Needforpermanentrestoration Needforfurtherconsultsingeneralorgradendoclinic
REMOVABLECONSULT
o Whenyouareintheprocessofmakingaremovabledenture(completeorpartial),youmusthaveeachstepsignedoffalongthewayforbothclinicalworkandlabwork
o So,aconsultconsistsofyou,theremovableinstructor,yourcasts,theptschart,articulators,blue/redpencil,&surveyor
o Theinstructorinspectsyourlabwork&providestheall-importantsignature
IMPLANTCONSULT
o ThisisaspecialconsultationwitheitherDr.Shah(removable)orDr.Hewlett(restorative)o Hereyoupresentthecaseofanyptwhowouldlikeimplantso Yourptispresent&yougettodiscussallthedetailsofTxplanninganimplantcase
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ClinicvsBlockClinic:
Generalclinictimesareasfollowsunlessotherwisestated:
Monday Tuesday Wednesday Thursday Friday
9-12 9-12 9-12 9-12 9-12
2-5 2-5 2-5 2-5
6-9
ThereisnocliniconFridayafternoons;thisiswhythereisTuesdaynightclinic.
Block:
Youareexpectedtoattendallblockrotations.YourappointmentbookonGSD-Academicwillbeblacked
outandyoucannotscheduleappointmentstoseeyourpatients.Blockrotationstakeprecedenceoverclassand
clinic.Intheeventyoumustswitchablock,youwillneedtofilloutablockswitchform.Youcangetthesefrom
yourGPA.Tofillitoutyoumustindicatewhoyouareswitchingwith,whatdatesyoutwohaveblock,youwillalso
needasignaturefrombothstudentsandtheblockdirector.Onceallthisisfilledout,youwillneedtobringthe
formbacktoyourGPAandtheywillmaketheswitchinGSD-Academic.
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DirectProcedures
Operative:
oGenerallyspeaking,alwaysbedoingsomething: Whilethetopicalistakingeffect,loadthesyringe Whilethelocalanestheticissettingin,getyourrubberdamreadytogo Whilewaitingfortheinstructor,typeyourSOAPnotes
o Startcheck: Youshouldbefamiliarwiththefollowing:
CurrentmedicalHxlookinthechart Treatmentplan&yourplanfortheappointment Radiographs NOTE:themoreprepared&confidentyouare,thebetterthefacultyinteraction.Youwillbe
abletoworkmoreindependently,yetgetthehelpyouneedwhenyouneedit.
Preparation:
o Beforeyoudrill,verifyyouareonthecorrecttooth,doingthecorrectrestoration,fortherightreason Checkthechart,theradiograph,thentheptsmouthjusttobesure
o Controlthewater Youonlyhavetwohandsdecidehowyouaregoingtoseewhatyouredoing,dowhatyouredoing,
andkeepthewateroutoftheway
Sometimesitsbesttousedirectvision&holdthehi-volumesuction Sometimesitsbesttojustplacethesalivaejectorneartheclampsoyoucanholdthemirrorwith
yourfreehand
Sometimestheptiswilling&abletoholdthesuctionwhereyouwantit Sometimesyoucouldreallyuseanassistant
o Beaggressive(butdontdrillforoil) Goahead&stepdownonthepedal
Youwillfindthatitbeatspreparingthetoothoneenamelrodatatime
Justbecarefulaboutyourpulpaldepth(inbothpulpal&axialdirections),especiallywithdeepcaries Remembertheanatomyofthepulpchamber&checkyourradiographs
o Preptoideal,thenhavetheinstructortakealook Tellthemthatyouwantedthemtotakealookbeforeyouextendyourprep Theinstructorwillappreciateyourabilitytodoanice,idealprep,evenifthecariesifgoingtochange
allthat
o Cariescontrol Makeanymajordesignchangeswiththehighspeed Removecarieswithaspoonorroundburonslowspeed
Useaslargearoundburaswillfitcomfortableintheareao Ifyouthinkaboutit,itmakesthebroadestcuttingarealesschanceofpunchingintothe
pulp
Youcanalwaysusecariesindicator(e.g.,Snoop)toseeifcariesisstillpresento Justapplyw/amicrobrush,rinse/dry&inspectthetooth
Lookforcariesontheaxialwall,anywherealongtheDEJ,andunderthecuspsinyourproximalextensions
Restoration:
o Bases&liners Iftheinstructorsays:Usealittleglassionomertolinetheprep,s/heprobablymeansusingalittle
VitrebondorFujiIILCtolineadeeppreparation
Vitrebondisapowder&liquidmixturethatyoulightcure Vitrebondmaynolongerbeavailable,butmanyprofessorswillrefertoit
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o ThereplacementisGCFujiliningLCpaste,whichcomesinabluetube Youeachhaveyourownmetaldispenser
o Dispensethetwoliquids,mixwithaspatulaonamixingpad,andapplywithasmallhandinstrumenttojustbarelylinetheareaofinterest
o Lightcure Forabase,youwoulduseamoresubstantialamountofFujiIILC
YoualsolightcuretheFujiIILC Afterapplyingabaseorliner,removeanyexcess(dontletittouchthemarginofyourprep)
Amalgam:
o Completethepreparation&haveitcheckedoffo Placeanyliners,asinstructedbythecoveringfacultyo PlaceamatrixbandforclassIIrestorationswedgeinterproximallytoclosethegingivalmargin
Usetheballburnishertoburnishintheareaoftheplannedcontacto Clean&drythetoothbesurethereisnobloodenteringtheprepfromthegumso Note:Someprofessorswillhaveyouetch,prime&bondpriortoplacingtheamalgamo Getallyouramalgaminstrumentslinedupo Mixtheamalgam(11-14sec)
Fromhereonout,youneedtoworkfairlyquicklytopreventtheamalgamfromsettingtooquicklyo ForclassIIrestorations,placetheamalgaminthebox&condenseintothecornerswello Continue,justasyoulearnedfromDr.Wongo Itsokay(andoftennecessary)tomixmoreamalgamo Condensequickly&firmlyo Condensethemarginalridgeswell,thenfinishcondensingintotheocclusalportion
Removeocclusalflash&carveinsomeroughanatomy Ifthemarginalridgeshavesetwell,youwillbelesslikelytofracturingthemarginalridgewhenyou
removethematrixband(trustme,itsnofuntoremoveanotherwisegreatrestoration&startover)
o Carefullyremovethewedge(s)&matrixbando Carvethemarginalridgestothecorrectheight(usuallytotheheightoftheadjacentmarginalridge)o Finishinterproximallyw/aninterproximalcarverorexplorero Finishocclusalanatomyo Checktheproximalcontactwithflosspriortoremovingtherubberdam
Nocontact=startovero Getitlookedatbytheprofessorbeforeremovingtherubberdamo Removetherubberdam&checktheocclusionhavethepatienttaplightlyifyoususpecttheocclusionis
high
o Adjustwithhandinstruments,ifpossible(Itoldyoutoworkquickly)o Whenyouseethepatientnexttime,polishyourbeautifulrestorations!!!
Composite:
o Besuretoselecttheappropriateshadebeforeplacingtherubberdamwritedownthechosenshadeo Placeasectionalmatrix(kidneybeanshapedmatrix)withaplasticwedge&BiTinering
TheBiTineringwillprovidesomeseparationofadjacentteeth,whichaidsinestablishingproximalcontact
Besuretoburnishthecontactareawelltoensureyoudevelopagoodcontacto Verifyyouhavetotalmoisturecontrolpriortorestoring
Ensurethegingivalmarginissealedo Etch/rinse/dry,prime/airthin,bond/airthin,lightcureo Placeasmallamountofcompositeworkinincrementso ForclassIIrestorations
Forcecompositeintoonecorner,thenlightcure Repeatfortheothercorner Finally,filltherestofthebox&lightcurethisimprovesyourchancesofmakingagoodcontact
o Incrementallycompletetherestorationo Generaltips:
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Becarefulnottooverfillitsbettertolightcureitwhereyouwantit,notoverfill&drillawayexcess Remembertheshapeofyourprepitseasytolosesightofwhereyouaregoing Youcandipyourapplicator(IPC,footballburnisher,etc)inbondingagenttomakethecompositeless
sticky
o Finishing Onetipistouseadisposable#12blade(thebladecurvesinward)toremoveflash(generallyfrom
thegingival&proximalextensions) Inspectthetoothforareasofflashdistinguishbetweentooth&compositeremoveany&allflash
Trya7404or7901onyourhighspeeddrill Checktheocclusion&makeappropriateadjustments
GlassIonomer(FujiIX,FujiIILC)
o ThisisusuallyusedeitherasapermanentrestorationforclassVlesionsorasatemporaryfixo GIworksprettywellinareaswheremoisturecontrolisanissueo SometimesinclassVlesions,ifyoucannotplacea212clamp,theprofessorwillhaveyouretractthe
gingivabypackingcord&usingcottonrollsandanassistant,wherepossible
o TheGIbondsdirectlytotoothstructure,soyoudontetch/prime/bondo Finishasyouwouldacompositerestoration
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Endodontics
1. Endoconsultsareobtainedfromthefacultyintheendocliniconthe3rdfloor.Theydonotneedtobescheduledinadvanced;justwalkuptothefacultyandaskforaconsult.MakesuretocreateaconsultnoteonGSDandgetitsignedoff.
2. AppointmentsintheendoclinicaremadeonGSDandneedtobeconfirmedby8:00AMonthedayoftheappointment.Toconfirm:right-clickonthescheduledappointmenttoeditappointmentnoteandwrite
Confirmed.AppointmentsarescheduledbyLindaandLorraineatthe1stfloorinformationdesk,talkto
themconcerninganyissuesyouhave.
ENDODONTICREQUIREMENTS:
YouwillberequiredtopurchasetheEndoClinicmanualduringyourfirstclinicalendocourse.Thismanualgoes
overtheendorequirementsingreaterdepth,buttheoverallendograduationrequirementsareasfollows.
Minimumof3PATIENTCases(1anteriortooth,1premolartooth,and1molartooth) Minimumof3ANY-TYPECases(maybepatientcasesorsubstitutionslistedbelow)
o 2molarTYPODONTcases=1ANY-TYPEcaseo 3EMERGENCYcases=1ANY-TYPEcase
Minimumof1EMERGENCYcase(pulpectomy/pulpotomy/otheremergencyprocedure) Minimumof2RECALLevaluationsofpreviouslytreatedendocases PortfolioReflectiveEssay(500-1000words)tobewrittenaftercompletionofallotherrequirements.The
essayshouldbeacritiqueandreflectionofallcompletedcases.
PAPERWORKANDDOCUMENTATION:
Documentationforpatientcases,typodontcases,emergencycases,andgradendoreferralformscanbefoundin
theendocliniconthe3rd
floor.Aftereachcaseiscompleted,makephotocopiesofyourdocumentationformsand
thenturninthemanilaenvelopepackettoSusanLeeinroomA3-078.
ENDOAPPOINTMENTCHECKLIST:
Showupearly!Cubiclepreparationforendoproceduresismoreinvolvedandtimeconsumingthanotherprocedures.Dontforgettoplacebarriersonthex-raymachineheadandendomicroscope.
Bringyourhandpieces,endoburblock,rubberdampunch,apexlocator,glassslab,sealer,hanautorch,andlighter.Fingerspreadersandrotaryinstrumentationequipmentmayalsobeusefultobring.
Obtainanendopatienttray(orendotypodonttray)fromCentralServices;itwillcontaintherestoftheequipmentneededforyourRCTprocedure.Cavit,IRM,additionalx-rayfilms,etc.arefoundinCentral
Services,butnotparttheendotray.
Photosarelocatedonthefarwalloftheclinicbythewindowstoassistyouwithcubicleset-up.
REFERRALTOGRADENDO:
FordifficultcasesthatneedtobereferredtoGradEndoforcompletion,filloutaGradEndoReferralForm(found
intheendoclinic)andobtainthenecessarysignatures.GradEndoappointmentsarescheduledwithWalteronthe
3rd
floorinfrontoftheendoclinic.
ENDOPILOTPROGRAM:
Thisprogramwasdesignedforustoabletotakemorepatientsthruendotreatmentintheclinicandalsotoallow
patientsthatmaynotnormallybeabletoaffordtreatmentatUCLAtobetakencareofbyavoidingextractionof
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thetoothinquestion.Basicallythepatientmustpayforthecrownandpost(orbuildup)BEFOREyoubeginthe
rootcanal.Ifthisisdoneandtheyareacceptedintothepilotprogramthentheywillreceive50%offendo
treatment.
Tobegintheprocessyouhavetofirstfindthepinkfeereductionformandhaveitfilledoutbyanendofaculty
memberaswellasbyDr.Goldstein(bringhimreceiptofpaymentforthecrownandbuild-upaswell).
Youareallowedtotakeamaxof2patientsthroughthisprogram.
**Makesuretheptunderstandsthatifthecasebecomestoocomplicatedandhastobetransferredtogradendo
thanthepilotprogramfeereductioncannolongerbehonored.
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FixedProcedures
Startcheck&anesthesia:o Followthesameprotocolasforoperative
Prep:
o Therearemanydifferentprepsyouwilldo,eachwithitsownspecialconsiderationsduringthepreparation,impression,&cementation.Dr.Morganspowerpointsprovidedveryusefulreviewsofthese
considerations&Ijustdontgetpaidwellenoughtoreviewallthatinthisdocument.Iwillgiveone
exampleofasingleunitPFMprep.
Hereisalsoabriefnoteaboutbridges(fixedpartialdentures): Forbridges,youmayneed2-3apptsforpreparation&impressiontaking.Theyousendthecase
tothelabtogetametalframework.Youwillneedtogothroughcastingcontrolthenmakean
apptfortheframeworktry-in.Ifeverythingisgood,yousenditback&thelabwillbake
porcelainontotheframework.Youthengothroughcastingcontrolagain&scheduleanapptfor
cementation.
o Suppliesyoullneed: Basiccubiclesetup Highspeed&Fixedburblock Slowspeedw/straightattachment&Acrylicburblock Rubberdamcassette Restorativecassette Packingcord Hemostaticagent(HemoginorViscostat) Impressionguns,light&heavybodyPVS Stentofappropriatequadrant Suppliesformakingatemporarycrown Floss,articulatingpaper Emorytray TempBond,spatula&mixingpad
o Drilling Discussthedesignbeforebeginning.Doesthepatientpreferaporcelainmarginonthebuccal,isthe
patientokaywithalingualmetalmargin?
Selecttheshade:havethepthelpdecidebetweentwoshadesitgivesthemsomeownershipinthefinaloutcome
Usearubberdam,untilyouarereadytofinishthemargins&verifyocclusalreduction Preparethetoothwiththefinaldesigninmind
Mostofushaveatendencytounderreduce,especiallyontheaxialwallonthebuccal&theocclusalreductionofthelingualcusps
Dontlosetrackofwhereyouaregoingfollowtheshapeoftheadjacentteeth&getyourcusptipsinline
ReducewithconfidenceusethehighspeedatfullspeedjustdontreducetoomuchImpression
o Packingcord Cordispacked~5-10minutespriortoimpressiontaking,and/ortogiveyouabetterviewofthe
marginforfinalrefinementofyourprep
Tips HereisthebesttipIcangive:useeven,firmpressure,ratherthanshort,abruptjabbing
movements
Bepatient&deliberateburythecordwithauthorityhelpthecorddoitsjob!
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Dryaroundthetoothbeforepackingcorditseemstohandlebetterifthefieldisdry YoumightwanttosoakthecordinHemoginpriortopacking(checkitoutfromcentral)this
preventsbleeding
o Hemecontrol=controllingblood Bloodwillruinyourimpression Besurebloodisundercontrolbeforemixingtheimpressionmaterials
o Takingtheimpression Getyouimpressionsuppliesready TryintheEmorytraytoensuretheptcanbitdowncomfortably
Takenoteofwherethehabitualbiteisyoullwantthepttorepeatthispositionduringtheimpression
Besuretorinse&dryeverything Placecottonrolls,whereappropriate Dependingontheretractiontechniqueyouused,removethecord(s),ifnecessary Rinse/dry&checkforblood Ifnobleeding,haveyourassistantfillthesmallsyringewithlightbodywhileyoukeepthefield
clean/dry
Oncetheassistanthandsyouthelightbody,s/hefillstheemorytrayasyouinject Injectintothesulcusallthewayaroundthetooth Leavethetipinthematerialtoavoidairentrapment Coverthewholetooth&theocclusalofadjacentteeth
Takethetrayfromtheassistant,positionthetray&havetheptbitedownslowlyintothehabitualposition
Holdthejawfor7-8minuteswhiletheimpressionsetsup Havetheptopenabruptlytoreleasetheimpression Takecareofthepatient(rinse,suction,napkin,etc)priortoinspectingtheimpression Inspecttheimpressionandlookforthefollowing:
Canyouseetheprepsmarginallthewayaroundthetooth? Youhavematerialextendingbeyondthemarginallthewayaroundthetooth? Doyouhaveblebs,bubbles,orareaswherethelight&heavybodydidnotflowtogether? Didbloodgetincorporatedintotheimpression?
Temporizationo Youshouldbepreparedtomakeatemporaryaccordingtothediscretionoftheinstructor.Although
usingIntegrityisfairlycommonduetoitsfavorablesetuptime,dontforgethowtotemporizelikeyou
didinlab
o Indirectmethod(Jetacrylic) Youshouldallknowhowtodothis
o Directmethod(Integrity) Thekeyhereistoremovethestentbeforethetempsetsup InjectIntegrityintothestent&squishthewholethingontothetooth After~45sec,removethestent&placeitonthetoothagain(akapumpthetemporary) Afteranother~30-45seconds,removeitagain&seeifitissettingup Waitforthematerialtosetupmorecompletelybeforetrimming Trimasusual
o Directmethod(Jetacrylic) Askyourprofessorthistakesalittlemoreskill
o Note:besureyouadjusttheptsocclusiontopreventlossofthetempbetweennow&cementation Also,ensureyouhavegoodproximalcontactsthatwillholdthespaceforagoodfitofyourfinal
crown
o Labslipo Thelabslipshouldincludeclearinstructionswithregardsto:
Buccal&lingualmargindesign Shade
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o Includeyourcontactinfo(phonenumber)incasethelabhasanyquestionso Fillouttheupperleftboxo Ontheupperright,checktheboxesindicatingwhatyouaresubmitting(inthiscase,justthedouble-bite
impression)
o Havetheinstructorsigntheslipo Dontforgettohavetheinstructorsignyourrestorativecardaswello Turninthelabslip&doublebiteimpressiontoMarissainDr.Goldsteinsoffice
BesuretogetabillingsignaturepriortoturningthecaseinCastingControl
o AfteryoupickupthecasefromMarissa,signupforacastingcontrolappointmentinthe3rdfloorlabo Takealookatthecrownonadieundermagnificationpriortocastingcontrol,soyouareawareofany
potentialissues
o Youwilllookatthecasesimultaneouslywiththeprofessorunderamicroscopeo Aftergettingasignature,yourereadytocementthecrown!!!
Cementationappt
o Whatyoullneed: Fujigun FujiIorFuji+
Fuji+setsupfaster,whichcanbegoodorbad Highspeed&Porcelainburblock Floss,articulatingpaper,shimstock
o Afterstartcheck,removethetemp&cleanoffthecement Iftheptcanhandleit,donotgiveanesthesia,becausetheirabilitytosensetheocclusioncanbevery
valuable
o Placeanopen2x2atthebackofthemouththispreventsobviouscomplicationso Try-in:
Tryonthecrownwithoutapplyingpressure Lookforareasthatbind,preventingcompleteseating Proximalcontactsarethemostlikelyproblemarea
Placeonefingeronthepartiallyseatedcrown&flossthrougheachcontact,lookingforshreddingofthefloss
Iftheflosssnapsthrough,itisagoodcontact Theintagliosurfaceisthenextareaofconcern
YoucancheckoutFit-checker,whichisapowder/liquidsiliconemixturethatshowsareasthatneedtobereducedfromthemetalundersideofthePFM
Oncethecrownseatsperfectly&themarginsareallclosed,checktheocclusion Makeadjustmentsextraorally,asnecessary
Aftereverythingisready&theinstructortakesapeek,youcancementthePFMo Rinse/drytheareao Placecottonrolls,asneededo MixFuji&applytotheundersideofthePFM,justcoatingallsurfaces(dontsimplyfillthewholecrown
withFuji)
o Placethecrown&seatitdownallthewayhaveacottonrollreadyforthepttobitedownono Havetheptbitedownforseveralsecondso Havetheptopen&removeanygrossexcessbynowthematerialshouldberubberyo Holdthetoothdown&flossthrougheachcontactwithapieceofflossthatyouhavetiedasingleknotin
Theknothelpsforceexcessmaterialoutoftheproximalarea Pulltheflossthroughtheembrasure,notbackthroughthecontactocclusally Useanexplorertoremoveanyremainingcement
o Re-checkocclusion,polishasnecessaryo Getyourcardsigned
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FujiWhat?FujiType Function Cure Mixing
time
Setting
time/
Finishing
time
MftrInstructions
FujiI RadiopaqueGIlutingcement Self 10s 2'15"/
4'30"
1) loosenpowderbytapping2) activatecapsulebypushing
plungerflushwithmainbody,
placeinapplierandclickonce
3) mixfor10sinamalgamator(4000rpm)
4) loadinGCCapsuleapplier5) 2clickstoprime6) extrudedirectlyinto
restoration
Fujiplus Radiopaquereinforcedglassionomerlutingcement
self 10s Mftr:2'0"/
4'15"
(clinically
maybe
less?)
1) Placecavityconditioner(polyacrylicacid)10sec,rinse
anddrybutdonotdessicate.
2) loosenpowderbytapping3) activatecapsulebypushing
plungerflushwithmainbody,
placeinapplierandclickonce
4) mixfor10sinamalgamator(4000rpm)
5) loadinGCCapsuleapplier6) 2clickstoprime7) extrudedirectlyinto
restorationFujiII:
baseor
liner
Radiopaquelightcured
reinforcedglassionomer
restorativeas
1.RestorationofClassIII,V
andlimitedClassIcavities
withlimitedisolation
2.Restorationofprimary
teeth.
3.Corebuildup.[weare
taughtthatthisisano-noas
itlacksthemechanical
characteristicsneededto
servethispurpose]4.Caseswherearadiopaque
restorationisrequired.
5.Geriatricapplications.
6.Asabaseorliner(F-
release)
LC 10s 3'15"
working
time
20"curing
time
1.8mm
curing
depth
1) Prep:excessivemechanicalretentionnotnecessary(ionic
bonding)
2) Placecavityconditioner(polyacrylicacid)10sec,rinse
anddrybutdonotdessicate.
3) activatecapsulebypushingplungerflushwithmainbody,
placeinapplierandclickonce
4) mixfor10sinamalgamator(4000rpm)
5) extrudecementdirectlyintopreparation
6) contourandshape7) lightcure20swith470nm
wavelength.Layerifdeeper
than1.8mm
8) Finishunderwaterspraywithsuperfinediamond,silicone
point,polishingstrips.
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FujiIX Radiopaquelightcured
reinforcedglassionomer
restorative
1.ClassIandIIrestorationsin
deciduousteeth.
2.Non-loadbearingClassI
andClassIIrestorationsin
permanentteeth.
3.Intermediaterestorative
andbasematerialforheavy
stresssituationin
ClassIandClassIIcavities
usingsandwichlaminate
technique.
4.ClassVandrootsurface
restorations.
5.Corebuild-up.
self 10s 2'00"
working
time
2'20"
setting
time
6'00"
finishing
time
1) Prep:excessivemechanicalretentionnotnecessary(ionic
bonding)
2) Placecavityconditioner(polyacrylicacid)10sec,rinse
anddrybutdonotdessicate.
3) activatecapsulebypushingplungerflushwithmainbody,
placeinapplierandclickonce
4) mixfor10sinamalgamator(4000rpm)
5) extrudecementdirectlyintopreparation
6) contourandshape7) finish6minutesafterstartof
mixing
FujiLiner
LC
Radiopaque,light
curedresin-modifiedglassionomerliningcementused
asabaseorlinerinprepared
cavities.Donotuseaspulp
cap(CaOHinstead).
Light 10s
(hand)
2'15"
workingtime
20"curing
time
1.3mm
depthof
cure
1) Prep:standard.DeepprepsindicatedforFujiliner.Removesurfacemoisture,do
notdessicate.
2) makesurepistonisretractedintodispenser
3) Load"PastePak"cartridgeintodispenser
4) slidereleaseleverforwarduntilitstops
5) bleedpastes6) depresslevertodispense
pastesontomixingpad;level
andcutoffextrudedmaterial
fromtipsbymovingcartridge
touprightpositiononpad.
7) Mixthoroughlywithlappingstrokesfor10secondsusing
plasticspatula
8) workingtimeis2'15"(highertemperatures=lessworking
time)
9) transfercementtopreparationusingsyringeor
otherplacementinstrument
coveringdentineuptoDEJ
10) Lightcurewithlightascloseaspossibletosurface(20s)11) Preptoideal,andproceed
withstandardrestorative
techniques.
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Hygiene1 HygieneStudentswillemailtheDentalStudentsintheirCPCTeam
2 HygieneStudentswillgetnamesofpatientsfromtheirDentalStudentswhoaredueforhygieneservices.
HygieneStudentmustobtainthefollowinginformationoneachpatientfromthatDentalStudent:
Patientname ChartNumber PatientsTelephoneNumber Servicesdue(quads,prophy,periomaintenace,etc.)
IfHygieneStudentwillnotbeatUCLApriortotheappointment,DentalStudentmustalsofurnishthe
HygieneStudentwiththefollowinginformation:
DateoflastODappt. DateoflastPeriodicExam DateoflastHygieneServices,andtypeofservicethatwasperformed SpecialInformation(pre-med,medicalaccommodations,etc.)
Note:HygieneStudentswillberequiredtodismissanypatientthatpresentsforhygieneservicesthatisnotup-to-
dateonODorPeriodicExam.GPAswillbenotifiedifpatientsarereferredtoHygieneStudentswhoarenot
up-to-date.
3 HygieneStudentwillcallPatientandofferavailabledatesandtimes,andchooseadate/timetoappointthe
patient.HygieneStudentmustletpatientknowthatallhygieneappointmentsmustbeself-paid(cash,
check,creditcard,etc.)priortothestartoftheappointment,billingwilloccurlater,andinsurancewillbe
reimbursedaccordingtoUCLAsbillingpolicies.TheonlyexceptionisapatientwithDeltaDentalwhoslast
prophywasover6monthsago.
HygieneStudentwilladvisepatientofthefollowing:
Clearlycommunicatedateandtimeofappointmentwiththepatient Advisethattheappointmentwillbeforthefullmorning/afternoon Remindofpre-med(ifapplicable) Remindthatappointmentmustbeself-paidpriortostart Askpatienttoarrive15minutespriortostart(8:00amor1:00pm) AdvisepatienttocalltheUCLASchoolofDentistry,310-206-3904orthehygienestudentdirectlyifthey
needtocancel.
4 TheHygieneStudentwillberesponsibleforschedulingtheHygieneappointment.
5 OncetheGPAhasconfirmedthattheappointmenthasbeenscheduled,HygieneStudentwillcontactthe
DentalStudenttoletthemknow.
6 IfaDentalStudentencountersdifficultycommunicatingwiththeirassignedHygieneStudent,theyshould
contactWLACInstructorNatashaKerllenevichatkerllen@wlac.eduor310-210-3294(textingisokay).Ifa
HygieneStudentencountersdifficultycommunicatingwiththeirassignedDentalStudent,theyshould
contacttheirCPCTeamsGroupPracticeAdministrator.
WestLosAngelesCollege,February2011
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ImplantsAllappointmentsinvolvingimplantsaredoneWednesdaymorningsintheremovableclinicwithDr.Shah.When
youscheduletheappointment,youmustindicateinthenotessectionthatyouhaveanimplantcaseandneedto
workwithDr.Shah.
NeedtohavepanoandImplantInfoSheet.
Implantconsults:
WednesdayafternoonwithDr.Hewlett
ThursdayafternoonwithDr.Shah
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Inactivatingvs.DischargingPatients Therearetwowaysyoucanremoveapatientfromactivestatus(otherthanplacingthemonrecall)dependingon
whetherthepatientplansonreturningtotheclinicinthenearfuture.
Inactivation:Thisisforpatientsthatforsomereasoncannotcomeintoclinicforashortamountoftime.Thiscan
beforvariousreasonssuchasbeingoutoftownforamonthormoreorperhapsthepatientcannotpayfortheir
treatmentuntiltheysaveup.WriteanoteundertheNotestabinthepatientsfileonGSDadtakethechartto
yourGPA.YourGPAshouldhavethelettersappropriatetosendtothepatienttoinformthemoftheirstatusatthe
clinic.Fillouttheletters,addresstheenvelopesandgivethechart(withonecopyofthelettertoyourGPA).The
originalletteristhenmailedtothepatient.Thereareinstructionsforthepatienttofollowwhentheyareableto
returntotheclinicandcontinuewiththeirtreatment.
Discharge:Thisoptionisforpatientsthatdonotwishtoreturntotheclinic.Thismaybeapatientthatwas
recentlyassignedbutneverreturnedastudentsphonecallorsomeonethatdecidesthattheclinicisnotappropriateforthem.Studentsmayalsodischargepatientsthatarebeingdifficultbutthisrequiresmoreworkon
thestudentsendtodocumentthingsthataresaidandtheactionsthataretaken.Aletterisdraftedandmailedout
withthehelpofyourGPD.IfthesepatientswishtoreturntotheUCLAclinictheyhavetobegintheprocessfrom
step#1(screening).Youmustinformthepatientthatifdischarged,theymaynotbeacceptedasapatientifthey
wishtoreturnlater.
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InitialPerioTherapy1-apptperiotherapy
o Aka:cleaning=prophy=phaseI,1-appointmentprophyo
Amulti-appointmentcleaningiscalledscaling&rootplaning,andusuallyshouldinvolveanesthetizingoneormorequadrantstoallowyoutoplanetheroots.Seebelowformoreinfo.
o Thingsyoushouldhave: Basiccubiclesetup(seebelow) Periokit(yoursorcheckoneoutfromcentral) Slowspeedhandpiecew/straightattachmentorprophyattachment Prophycup&paste
o Tips: Usesharpinstruments
Sharpenbeforethepatientarrives Dontoversharpenjustafewstrokesshoulddothetrick Checkforsharpnessonthewhitesuctiontipasharpinstrumentwillpeeloffplasticlikepeeling
apotato
Onlyremovethecalculussavetherootplaningforpatientswhoneedrootplaning Movearoundaslittleaspossible&tradeinstrumentsoutasfewtimesaspossible:
Followaplannedroutine,suchas:MaxanteriorsBthenL,URB&ULL,URL&ULB,LRB,LLL,LRL,LRB,MandanteriorsLthenB
o ByworkingonURbuccal&ULlingual,youcanstayinthesameposition&usethesameinstrumentsinthesameorientation
Also,followaroutineforeachposteriorquadrant,suchas:allthemidfacialormidlingual,thenallthemesialproximalsurfaces,thenallthedistals
Movethepatient:Looktowardme&Lookawayfrommeworkgreatfromthe8-9oclockposition
Also,usethefewestnumberofinstrumentsaspossibleconsidereliminatingtheuseofthe11-12,orslowlybecomecomfortablewiththeUniversal
Onebigpieceofadvice:checkoutaCavitronanduseit!Asksomeonehowtosetitup,andjustletitworkitsmagic.ItworkskindoflikeaUniversalthatmakeslikeamilliontinystrokesasecond.Things
gomuchmorequicklywiththeCavitron.Youshouldalwaysfollowupwithanexplorerand/orhand
instrumentstocheckforspotsyoumissed.
o Administrativestuff: Startchecks:
Beforegettingastartcheck,reviewthepreviousperiocharting,medHx,dateoflastprophyorScRP,etc.
Periosignature: Periosignaturescanonlybeobtainedfromperiodontistsorhygienists.Aperiosignaturemay
comein2possibleforms:electronicorhand-written.Thehand-writtensignatureisgivenonthe
patientsprintedtreatmentplanform.Electronicperiosignaturesaredraggedoverandsigned
offlikeanyotherprocedure(findthecodeinthePeriodontalsectionofproceduresinGSD).
YoumusthaveaperiosignaturepriortobeginninganyIndirectrestorativeworkwithyourpatient.
2-or4-apptperiotherapy
o Aka:ScRP,S/RP,quadscaling,scalingandrootplaning,deepcleaning(dontcallitthat)o Differencesbetween1-appt&multi-apptcleanings
ScRPrequiresafollow-upapptusually3-6weeksfollowingTxtoreassessthetissuehealth Youusuallyuseanesthetic.Ifthepatientcantfeelit,thenyouprobablyarentworkinghardenough
Youneedtoreallygetinthere&removeallthatsubgingivalcalculus Theresalotofblood,andthatsokay.Keepabunchof2x2shandyforScRP.
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Yougenerallywontbeabletofinishall4quadrantsinonesession,especiallywhenyouareanesthetizing
o Besureyoucleaneachquadrantthoroughlyifyoudont,thegumswillnotbehealthyattheF/Uappto Ifyouhavetime,youcandotheopposingquadrantonthesameside.Itsusuallynoproblemsendinga
patienthomewiththewholeleftORrightsidenumb,butitsgenerallyNOTokaytosendthepatient
homewithawholearchnumb.
o Usetheperioprobingandradiographstoyouradvantage.Oftenthesepatientshavemany4s,5s,ordeeper.Scaleaccordingly.- Follow-upappointment
o AftertheappropriatehealingtimeafterScRP,seethepatientagaintofollowupontheirperiohealth.o Thisapptinvolvescompleteprobings&re-evalofallperiotissues
ItisessentiallylikedoinganewperioconsultandyouwillcompleteanewconsultsintheConsultssection
o Iftheptisintheclear,youcangetasignature&moveono Ifnot,youmaystillgetasignatureafterscalinginselectareasoryoumayneedyoudomoreextensive
treatment(e.g.periosurgery)&haveanotherfollowupapptlateron
Referringtohygiene:
o YoucanreferyourpatientstohygienestudentsbyusingfollowingthedirectionsoutlinedintheHygeinesectionofthismanual.
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Insurance Allinsurancecompanies(exceptDeltaDental),patientsmustpaythefullfeeandtheinsurancecompanywill
reimbursethepatient.AllfeeschedulescanberequestedfromtheChartRoom.
DELTADENTAL:UCLAonlydealswithDeltaDentaldirectly.ForpatientsthathaveDeltaDental,youcanaskthem
topayonlytheportionoftheprocedurethatDeltadoesnotcover.ForALLotherinsuranceplans,thepatientmust
payupfrontandinformthemthattheywillreceivetheirrefunddirectlyfromtheirinsurancecompanyinthemail
andnotthroughUCLA.
MEDICAL/DENTICAL: CheckMediCal/DentiCaleligibilityatthebillingofficeatthebeginningofeach
month.PatientswithMediCalreceivecourtesyfeesthatexistedwithDentiCal.Onlyextractionsarecoveredby
DentiCalduetoafederalmandate.However,radiologyisnolongercoveredforadults,nordotheyreceiveafee
reductionforradiographs.Furthermore,DentiCalcoverageisonlyappliedtochildrenundertheageof
21.DentiCalwillcoverradiographsforeligiblechildrenundertheageof21.
RYANWHITEPATIENTS: RyanWhiteptsareallowedupto$1,500.00tospendondentaltreatmentperyear.FeereductionformsmaybefoundinMarissasoffice(Dr.Goldsteinsassistant)andmustbeapprovedandsignedby
Dr.Younaipriortotheprocedure.Oncesigned,takefeereductiontothebillingoffice.
UCLADENTALSTUDENTS:Mostproceduresareapproximately50%off.
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NewPatient:Screening&Radiographs
- Sixpatientsarescreenedbyagrouppracticedirector(GPD)MondaythruThursdayfrom~7:45-9:00amor~12:30-2:00pm- TheGPDlooksateachptfor~10minutestodecidegenerallywhattheptneeds&explaintheclinicprocess
briefly
o ThepurposeoftheexamistodetermineifthepatientscaseissuitableforadentalstudentaswellastomaketheptawareofthepolicieswehaveatUCLAandourexpectationsofthepatientstoadhereto
them
- TheoverallpossibleTxneedsarenotedonawhiteformthatgetsablueformstapledontopofit- Ifaccepted,thepatientwillgotothecashierswindowtopay$110
o $70foranFMXo $40forInitialODandPeriodicExam
- ThiswillthenbedeliveredtoastudentintherotatingfileonyourGPAsdesk.Anemailwillalsobesenttoyou.
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OralDiagnosis
1. Thisisthe1st
appointmentyouscheduleforyourpatientafterassignmenta. BesureyourptunderstandswhattheODexamis,becausesometimestheyconfuseODwiththe
briefscreeningexamdonebythegroupdirectorsattheirveryfirstvisit
b. YoucanscheduletheODapptonGSD-ACADEMIC.c. Appointmenttimeoptionsare:9AM,10:30AM,2PMor3:30PMd. Theseappointmentsareexpectedtolast~1-1.5hourse. Ifyouscheduleat9:00or2:00,youcanusuallymakeitupstairsintimetoconductoneormore
consults
i. WhenschedulingconsultsafterOD,makesuretherewillbeenoughfacultycoverageforwhatyouwanttodo.Fordetailsregardingconsults,seetheConsultssectionofthis
manual.
ii. Ifthepthasacomplicatedmedicalhx,youmustschedulefor9AMor2PMsotherewillbeenoughtimetocompletetheOD(thiswillbenotedontheblueintroductoryform).
2. TheactualODexamisperformedbyastudentonblocka. Thepatientsassignedstudentshouldbetherefortheexam,sotheywillknowwhatsgoingon
3. TipsforspeedinguptheODappt(regardlessofwhetheryouaredoingtheODorifyouareassistingtheblockstudent):
a. Besureyouvereviewedthepatientschart(i.e.,thehealthquestionnaire&radiographs)b. Findablockstudent&letSusanknowthatyourpatientispresentandthatitappearsthata
blockstudentisavailable
c. Whenyouseatthepatient,havehim/hersigntheDMFformi. PlacetheDMFforminthechartonepageaheadofthesalmon-coloredProgressnotes
d. ThestudentNOTdoingtheexamshouldlookupanymedswhiletheblockstudentisaskingquestions
e. Whentheblockstudentputsthegloveson,offertotypetheirfindingsintothecomputerf. Spendtimewiththeimportantstuffi. Inquirewellaboutpastillnesses¤tconditionsgetalltheinfoyouneed
ii. Usethemedicationstheptistakingasyourguide1. E.g.,iftheyaretakingAtenolol,youshouldbesureyouaskabout
Hypertension,eveniftheydidntmentionit
iii. Askappropriatefollow-upquestionsg. Dontspendextratimeontheeasystuff
i. Iamyettohaveapatientfailthesensorynerveexamyouremember:Isthissoftorsharp?
1. So,dontspend5minutestestingV1,V2,andV3ii. Bebriefwithyourexaminationoftheteeththemselves(attrition,erosion,abfraction)
1. Therewillbeplentyoftimeforatooth-by-toothexamupstairs2. E.g.,dontworryifthereis2or2.5mmrecessionontheMBaspectof#14
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h. Beawareofthefaculty&theotherpatientsbeingexamined
i. Case-in-point:iftwoothergroupsarewaitingfortheinstructor&youarealmostfinished,putyournameonthelist
1. Bythetimetheyareavailable,itsyourturn2. Atthesametime,dontstartalistuntilyouarereadybereasonable&
considerateofyourclassmates
ii. Fillouteverythingbeforetheinstructorseesyourpatient1. CompletetheSpecialtytabsectioninGSD-ACADEMIC2. DoyourSOAPnotesforthesession3. Filloutthebeigepageofthepatientchart(ontheleftundertheHIPAAform)
4. AttheendoftheODexam,youmustgetthechartclearedbyIrenebeforeleavingtheODclinica. Otherwise,youwillnothaveaccesstothechartwhenyougoupstairsforconsultsb. MakesuretheDMFformisintherightplaceonepageaheadofthesalmon-coloredProgress
notes
5. Ifaperiodicexamisdoneinadditiontothe3yrOD,thetotalcostisonly$25andcoversboththeODexamandtheperiodicexam.TheyareNOTtwoseparatecharges.
WhenyouareinOD,theyhaveaspecificformatthatmostfacultymembersliketoseeinyourSOAPNotes.Itis
postedonthewallinmostofthecubicles,sononeedtomemorizenow.
S --yearoldm/fpresentsforinitialexamandODworkup(or3yrODrecall)
CC:whatevertheycomplainof
Lastdentalvisit:
O ReviewedmedicalhistorywhichwasnotableforotherwiseNSFandNKDA.
Allergies:
Meds:
BP=--/--,HR(reg/irreg),RR
EOE:
IOE:
Hardtissue:
SoftTissue:Noteanyfindingslikelesionsorsoresonthemucosa,orbandsofdiscolorationalongteeth.
(-)EOEcancerscreening
Oralhygiene:poor,moderate,good.
Mild,moderate,severeplaque.
A Healthyptwithminordentalprecautionssuitableforcomprehensivedentalcare.
Ptcanproceedtoconsults.
P Completedinitialassessment/3yearODrecallexamincludingprocuringthehealthhx,areviewofsystems,
obtainingthevitalsignsandanextraandintraoralexam.Oralcancerscreeningcompletd.
DiscussedwithpatientswhattoexpectwhenbeingtreatedhereatUCLA.Ptleftsatisfied.
NV Perioandrestconsults/PreATP
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OralFacialPain
Weneedsomehelpfillingoutthissection!IfyouhaveanythingtoaddpleasefindyournearestASDAcabinetmembertosubmit!
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PatientAssignment
- Youwillreceivepatientassignmentsinoneofthreeways:o 1)Newpatientassignmentfromyougroupdirectoro 2)Greenslipsomeoneyouknowo 3)Pttransferforwhateverreason
- Fornewptassignments,youwillgetanemailfromyourGPDorGPA(G.P.Administrator)o Youwillalsogettheaforementionedblueformwithwhitepagestapledbehindit
PickuptheformatyourGPAsdesk Thebluepagehastheptname,chart#,andphone# ThewhitepagedescribesthelikelyoverallTxneeds(operative,fixed,endo,perio,etc)
ThispagemayindicatethatyourptneedsATPo YoucanalsodeterminethepatientsneedsinGSD-ACADEMICunderthePatientstab
Clickonthecharttab,thenfindthegrayMisc.tabnexttotheredRadiologytab TheMisc.tabhasaseriesofnotesfromtheinitialptscreening,indicatingtheoverallprobableneeds
ofyourpt
o UsethetwoabovesourcesofinfotodetermineifyourpatientneedsATPo YourGPDmayalsoaddnotestothisbluepageindicatingwhetherthepatientistobesharedwith
anothermemberofyourCPCteamaswellaswhetherthepatientmayrequireATP.
o Onceyouaregivennoticeyoumustattempttocallyourpatientwithin48hours.o Radiologyconsultationshouldbedonepriortoperio/restorativeconsults.
- ATPvs.Fasttracko ATP=AdvancedTreatmentPlanning
Thisisasessionwhereinyoumeetwitharestorativeinstructor,aperioinstructor,andaremovableinstructor
Byhavinginputfromallthreeareas,youcan,intheory,createabettertreatmentplan PriortotheATPappt,youneedproperlymountedcasts,andhavecompletedyourownpre-ATP
workup Pre-ATPreferstothegatheringofinfoyouwoulduseforconsults(tooth-by-toothexam,perio
charting,proposedRPDdesigns,ifapplicable)+impressions&records(facebow,interocclusal
record)
ATPcasesdonotrequireanyconsultsotherthantheATPconsultitself MoredetailisfoundbelowinthesectionforConsultations
o Fasttrack: Theseptshavemorestraightforwardcases,sotheydonotrequireATP FollowingOD,youobtainanynecessaryconsultations(restorative,perio,endo,etc.)priorto
submittingthetreatmentplantobeapprovedbyyourGPD.
o FollowDr.WoodsguidelinesforwhatconstitutesanATPvs.Fasttrackpatient ThisinfoisfoundonapinkTxplanningformatthebackwindowsintheclinicbehindcentral
sterilizationorintheStudentLounge
TheFasttrackcriteriaareasfollows: Simpletointermediateperioneeds(noanticipatedextractions,otherthan3rdmolars) Eightorfewerfixedunits(simple3-unitbridgeO.K.) Nopartialdentures Reasonableocclusion NoTMdisorderorsignificantattrition
- Youareexpectedtocalltheptwithin48hoursofreceivingnotificationofptassignment
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o Assoonasyoucan,checkouttheptschart&lookattheradiographs,soyouknowwhatyouredealingwith
o Speakwithyourgroupdirectoraboutdoingaradiographicconsultassoonasyougetthechart- Contactthept&introduceyourself,indicatingthatyoudliketoscheduletheir1stapptassoonaspossible
o PlanaheadsoyoucanofferthepttwoorthreeavailabletimesfortheODappt(dontcallitOD) Seenextsection:SchedulingAppointmentsformoreinfo
o Patientsareusuallynotfullyawareofhowtheclinicworks ItmayhelptoexplainthatthereisaTxplanningphaseofupto3apptsbeforebeginningactualTx,
andthatthisphaseisimportanttodeterminealloftheptsneedssowecangivethemthebestTx
possible(helpthemseethatitisintheirownbestinterest)
Tellthemthatthefirstexamisareviewoftheiroverallhealth&medications,andincludesanoralcancerscreening
Explainthattheexamlastsabout1-1.5hours Ifyoucanschedulea9:00or2:00ODappt(seebelow),thentellthemthatfollowingthefirstexam,
youplantogointotheclinictoexaminetheirteeth&gumsandtakeimpressionsoftheirteeth,if
necessary.
CautionwhenattemptingthisasitdependsalotonhowbusyODisasmanyappointscanextendfurtherthan1.5hrs.
IftheptneedsATP,considerinformingthemthattherewillbeanotherexam,whereinyouwillmeetwiththreeinstructorsfromdifferentspecialtiestodeterminetheirneeds&plantheircase
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PaymentPlansPatientseligibilityforMonthlyPaymentPlan
Thepatientsaccountmustbecurrentandingoodstanding Thetotalcostoftreatmentmustbeatleast$500.00 ThepatientorguarantormustbeabletoprovideavalidUSDriversLicenseorpictureIDandCreditCard
Requirements
Thepatientstreatmentplanmustbesignedbythestudent,patientandthegroupdirector PaymentplanisfortheGeneralClinicOnly.Forotherclinicssuchas: Implantcenter OralSurgery Pedo Endo OFP AEGD
**Pleasecontacttheirrespectivecoordinators
Procedurescantbeginuntilapaymentplanhasbeenarranged Subsidiesanddiscountscannotbeusedforpaymentplans Thestudentwillchoosethetreatmentforwhichthepaymentplanwillbeneededanddiscusswiththe
patient
ThestudentmustbringthepatientscompletetreatmentplantoPaymentcoordinatorfewdaysinadvance
Breakdownofthepaymentplanwillbegiventothestudent.Studentisresponsibletocontactthepatient:
Discussthebreakdownandthe25%downpayment Discusstherequirements Setanappointmentwithpatient Notifyandsetanappointmentwithcoordinator
Patient/Guarantorisrequiredtofilloutandsignthepaymentplanform.
Appointmentday
Patient/GuarantorneedstobringvalidUSDriversLicenseorpictureID,andcreditcard. 25%initialdownpaymentofthetotalcostofthetreatmentuponsigningthepaymentplanform.Down
paymentcanbepaidwith:cash,check,creditcardorATMCard
Theremainingbalancewillbedividedinto: 3monthsMinimumtotalcostis$1,500orless 6monthsMaximumtotalcostismorethan$1,500 Monthlyinstallmentswillbeautomaticallyprocessedevery15thoftheeachmonth.Ifthe15thfallsona
weekendorholiday,paymentwillbeprocessed2dayspriororaftertheduedate.
AnydeclinedCreditCardswillautomaticallybesuspendedandremovefromthemonthlyinstallmentplan.Guarantormustnotifytheclinicassoonaspossibleiftherearechangesontheaccount(i.e.credit
cardhasbeenreportedlost/stolen).
Forotherquestionsand/orconcernspleasesee: AnetHaratunianFirstfloorlobbyroom10-139
Contact#(310)825-7363
Emailaharatunian@dentistry.ucla.edu
Hours:Mon-Frifrom7:30am-4pm
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PatientRequestsRequestsfornewpatientsmustbemadethroughyourGPD.GroupAistheonlygroupthatshouldstillbeusing
patientrequestforms,whichcanbeobtainedfromtheGPAingroupA.Ifyoufeelyouhavethetimeforanadditionalpatient,mentionthistoyourGPDandtheappropriateactionwillbetaken.
IfyouareingroupC,theGPDisawareoftheproceduresthatyoustillneedtograduateandsowillhelptofinda
patientthatwillspecificallyfillthoseneeds.
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