II. Clinic Information

Malpractice Insurance

Malpractice Insurance is provided by the program and is only for patient care provided in the school.

Communication Policy

1. Residents are required to provide a contact number (cell phone number is preferred). There is no overhead pager system.
2. Residents should respond to pages promptly (ideally within 5 minutes, more than 15 minutes is considered not answered).
3. Residents will be provided with a University of Maryland e-mail address which will become the official e-mail address for Program communication.
4. Residents should review their University of Maryland e-mail account at least once a day and Friday afternoon before leaving work. E-mail will be the primary source of non-urgent communication.

After Hours Emergencies - Responsibilities

1. All residents must be accessible (24 hours/7days a week) in order to manage treatment of your emergency patients during non-clinic hours (cell phone number is preferred).
2. Handle all “emergency” telephone inquiries from your assigned patients (provide a referral if necessary or a prescription).
3. Contact either Dr. Barnes (443.271.2194) or Ms. Chenowith (443.504.8292) for assistance as required.
4. The next work day, after the emergency care, the AEGD Office Manager will pull the chart to ensure that the resident makes an entry and have it co-signed by a faculty member.

Operating Hours for AEGD Clinic

1. Patient appointments are 8 am to 4 pm,. Residents are required to arrive by 7:30 am and not to depart until 4:30 pm.
2. CLINIC Schedule

   First Patient – 8 am to 9:30 am

   Second Patient – 9:30 am to 11 am

   Third Patient – 11 am to 12 noon

   LUNCH – 12 pm to 1 pm

   Fourth Patient – 1 pm to 2:30 pm

   Fifth Patient – 2:30 pm to 4 pm

Scheduling of Emergency Patients

1. If emergency patient is assigned to a resident, anyone in the TEAM will see the patient if there is an opening.
2. Emergency patients will be given any empty slot in the appointment schedule with any available resident.
3. If there is no empty slot, the TEAM captain will decide who will see the patient.

Treatment Plans

1. All treatment plans must be reviewed by an attending and signed by the patient, resident and attending before any restorative treatment can begin.
2. In treatment planning cases, especially if they are complex, residents must first collect all necessary data, including mounted diagnostic casts. Sometimes, diagnostic wax-ups may be required and patient can be charged for it. There is no charge to the patient if the wax-up is done for the resident’s benefit, unless wax-up is done by outside laboratory (only if approved by the faculty).
3. Format for treatment planning is discussed in Introduction to Treatment Planning Technical Criteria.
4. Residents are expected to have a treatment plan written out before approaching an attending for evaluation. By presenting the case in such a manner, a more meaningful discussion will emerge. Always bring mounted casts, x-rays and the chart for treatment planning.
5. A sequenced treatment plan should be written after final attending approval and discussion.
6. All treatment plans must be entered into Axium and swiped by attending faculty.
7. When a comprehensive treatment is completed and prior to entering the patient into the stem, a chart audit (record review) and case complete audit must be performed (see Case Complete Form Instructions).

Medical Consults

For medically compromised patients where dental treatment plans will need to be altered due to patient condition, a medical consult form must be filled out. Residents will send the information request via the patient to the medical doctor. The patient will then return the form to the resident and it will be added to the patient’s dental chart. See example of a medical consult form. Any ASA III and IV patient requires a medical consult and medical clearance prior to dental treatment.

When residents are phoning medical doctors for patient consults, it is advised that the resident prepare in advance what to say. In general, the resident should include the following:

1. Identify yourself (DDS, Dental Resident at UMAB) and your patient.
2. State the known health condition of the patient.
3. Describe the dental procedures planned. Medical doctors tend not to have a detailed understanding of these procedures; thus, account the details of the surgery, the extent of bleeding predicted, the intended local anesthetic or medication to be used, and/or the possible effects of the dental treatment on the patient.
4. Specifically ask the information required from the medical doctor. Examples: “Should antibiotic prophylaxis be administered prior to dental therapy?” “Is the use of epinephrine in the local anesthetic contraindicated?” Avoid asking too general a question like, “Is there anything that should concern me about the patient?”
5. Document discussion in the Progress Notes of the patient’s record and ask for written documentation from attending physician.

Medical Updates

Medical updates form should be completed for every patient who has not been in the AEGD Clinic in the last one year and shall be co-signed by a faculty member. It should be resident’s customary question to ask about any changes in patient’s medical condition at every visit.

Dental Hygiene

An integral part of the AGD family are the hygienists; they provide oral care instructions, prophylaxis treatment, debridements, and fluoride treatments and placement of Arestin. These services are available via (1) completed prescribed treatment plans and/or (2) appointed recall visits with the hygienist. Treatment plans are to be comprised of full mouth probings and chartings and radiographs annually. During the recall, the hygienists uses the PSR system for record bleeding points (see Periodontal Screening & Recording System (PSR)).

Hygiene visits can commence prior to or in conjunction with restorative appointments. At completion of the hygiene visit a recall card is completed to be mailed at the appropriate interval as a reminder for the patient. There are also hygiene products available for application or by prescription or for purchase via the clinic.

AEGD Dental Assistants

We, the assistants welcome you to AEGD. We are looking forward to working with you during this next year. Listed below are items that you can expect from us as a group each and every day:

Clinic Coordinator

The Clinic Coordinator provides patient support services that are both efficient and caring.

1. Acts as a patient advocate, acquainting patients with policies and procedures relevant to their care and helping them navigate the system as necessary. Provides excellent customer service to internal and external calls regarding information, treatment and special needs. Responds to patient concerns and forwards concerns to the program director as necessary.
2. Provides individualized coordination of care; when necessary, reviews chart to monitor patient clinical progress.
3. Assesses outcomes of care; analyze complaints to determine trends. Surveys patient via questionnaires; resolve complaints.
4. Assists students with patient management.

Communication and Teamwork

These are the items you can expect from the assistant on a day-to-day basis. The key to a great relationship between residents and assistants is communication. Talk to your assistant. Let them know if there is a change in your schedule. Communicate to them what time you will really need their assistance. The more we talk to one another, the easier the day will flow.

Production Report

This report is given monthly to the resident to monitor procedures completed by ADA codes.  The resident is responsible for maintaining the record in their portfolio.  (See Production Report.)

Exposure Reporting and Management Procedure, Baltimore Campus

If an exposure has or may have occurred:

1. STOP and IMMEDIATELY remove item responsible for exposure to prevent a DOUBLE exposure
   • Note if item is visibly bloody.
2. Remove PPE and set aside gloves for checking later if a glove breach is not obvious (SOD nurse can help with this).
3. Wash all wounds with soap and water, and flush exposed mucous membranes with cool water
   • Do not force wounds to bleed
4. DO NOT dismiss source patient/stop patient from leaving (if possible)
5. Prepare to report the incident, make note of patient medical history/risk factors and have patient ID #
6. Report incident to your attending faculty (student/resident), or department supervisor (staff)
7. Report exposure to an SOD nurse; the most efficient way to do so is to use the emergency pager system
   • To place an emergency page:
   • Locate the button marked Emergency on a clinic wall phone and press (emergency pager number will be auto dialed) or dial 410-389-1324 (dial 9 first if using an SOD phone)
   • After 3 beeping tones are heard, enter your room or quad number, followed by the # sign (lower level dial 777)
   • Nurse(s) will respond to your area within a few minutes (page again, if no response in 3-5 minutes)*

     * If unable to contact SOD nurse, phone the University of Maryland Immediate Care, Bloodborne Pathogen Exposure Hotline (BBPE Hotline) at 667-214-1886; if using an SOD phone, dial 9 first. DO NOT go to the ER without a referral from Dr. Baronas or a member of his staff.

8. Complete the required forms (all incident details must be provided to an SOD nurse as soon as possible)

Required Injury Reporting Forms:

1. Student/Resident, Staff, Employee and Volunteer forms will be provided by a SOD nurse, or can located in bins on SOD nurses’ office doors
   • Employees can also find injury report documents online (always report details to SOD nurse as well
   • State forms: http://www.umaryland.edu/ehs/programs/workers-compensation/
   • Corporate forms: FDSP Associate injury report forms are not available online

Adverse Incident Forms (old format) in bin on nurses’ doors and can be used to record the facts, or write the details on paper until a nurse can enter them online. Never refer to an incident report in the EPR; record incident facts only.

J. Naglik, RN 4/12/2016

Medical Emergency Response Protocol

For Immediate Life-threatening Emergencies or Behavioral Incidents:

1. During Normal Business Hours (Mon-Fri 8:00AM – 5:00 PM; Tue, Wed and Thurs (C-3 Clinic) 5:00PM – 7:00 PM:

   (1) Use a clinic phone to call Campus Police by dialing 711 (DO NOT dial 9 first). Campus Police will call for an ambulance if needed, and/or send officers to assist.

   (2) Always follow a call to campus police with a page of the School of Dentistry Emergency response page (see Protocol for Dental School Emergency Response Team Paging /Response described below)

2. When there is no nurse coverage in the evening or no nurse available during the daytime, attending faculty will manage the incident:
   1. Use clinic phones to call 711 (campus police will call for an ambulance or come to assist as needed).
   2. Report the incident to a Dental School nurse verbally or by email at the earliest opportunity.

Protocol for Dental School Emergency Response Team (ERT) Paging / Response:

1. Press the button labeled “Emergency” on a clinic wall phone pre-programmed to page the ERT
   1. From a non-clinic phone within the building, page using the number 9-410-389-1324
2. After triple beep tone, enter the nearest room/quad # where the emergency is occurring (ground or lower level, and large areas without a clear room number like reception rooms, follow pink emergency response signs near area phones).
3. Emergency responders will report to the area received on the pager and provide treatment if available. If no response within 5 minutes page again to rule out pager malfunction, and always refer to attending faculty for guidance. It may be that all emergency responders are otherwise engaged.

Before Responders Arrive:

1. If bodily fluids present and/or victim is coughing, don the appropriate PPE where available
2. first responder will act as “captain” and direct interventions until a more qualified or experienced individual arrives to take over that role.
   1. Position victim so as to protect from further injury on the floor or in a dental chair.
   2. If campus police have been called to send an ambulance, designate a person to alert the guard in the atrium lobby, and to assist the EMTs to the location of the emergency.
   3. Bring, or have someone bring the Emergency Cart/Oxygen tank into the room/quad (located outside clinic prep area or in some side hallways off main corridors).
      1. Start oxygen with a nasal cannula for oxygen support at 2-4 L/min, or with a non-rebreather mask, or if the patient is distressed due to shortness of breath, at 10- 15L/min (make sure bag attached to the non-rebreather mask inflates).
      2. Provide treatment if trained; Do not wait for emergency responders, if basic life support is needed (See basic CPR instructions from the AHA in the front of white emergency binders on top of red Emergency Cart if necessary).

Using the Emergency Response Team for Non-Life-Threatening Emergencies:

• Page the Dental School Emergency Response Team only, not campus police

For A Glucometer Test or Blood Pressure Verification on an Asymptomatic Patient:

• Members of the Emergency response team can be paged individually at pager numbers listed below. Nurses are to be paged before the Doctor.

Members of the Emergency Response Team include, but are not limited to the following individuals who will be alerted when the emergency pager number 9-410-389-1324 is activated:

Preliminary Patient Dental Care Needs Assessment

Preliminary Patient Dental Care Needs Assessment Form

Laboratories

Restorative Materials and Equipment Used in the AEGD Clinic

Amalgam

Sybraloy

FastSet

Composite

TPH 3

Esthet X-Flowable

Esthet HD

Esthet XHD

Surefil SDR Flow

Glass Ionomers

1. Fuji 9

   Class V

   Ketac

2. Build Ups

   FluoroCore II

   KetacFil

3. Liner

   Vitrebond

Bonding Agents

Prime + Bond NT

Clearfil Repair

Photo Bond

Elect

Sealants

DeltonLC

Bleaching Solutions

1. In Office

   *Zoom

2. Home Treatment

   Night White Excel 16%

Temporary Crown Material

1. Acrylic/Jet Alike
2. Resin

   Integrity

3. Inlays

   Fermit

Cementing Systems

1. Without Bonding

   Zinc Phosphate

   Duralon

   Fuji Cem

2. With Bonding

   Panavia F

   Calibra

   Variolink

Porcelain or Composite Veneers, Inlays and Onlays

Variolink

Calibra

Calibra Universal

Desensitizing Agents

Gel Kam

Protect

Duraphat

SE Bond

Post and Core Material

FluoroCore II

Amalgam

TPH Composite

ParaPost

Flexi-Post

Impression Posts/Cast Post

PINS: TMS (Regular and Minum)

Stabilok

Hemostatic Solutions

Hemodent

Visco Stat Plus

Impression Material

Alginate

Aquasil

Bite Registrations

Duralay

Regisil

Reline Materials

GC Reline (soft)

Coe-Soft (soft)

Coe-Comfort (soft)

UfiGel (hard C)

Temporary Cements

Duralon

Temp Grip

Endo Supplies

Ept, EndoIce

Apexlocator (RootZX)

Brassler Sequence

CaOH2

Cavit

Implants

3i Implant

ITI (Straumann)

Nobel Biocare

Miscellaneous

Perio: freeze dried bone

Graft material, endogain,

Cerec

Laser – Soft Tissue

Interra Chairside Occlusal Guard

Air Abrasion

1. An air abrasion unit is available and it can be moved into the clinic as required. Unless familiar with the apparatus, a resident’s first use should be under close supervision of an attending who is comfortable with the equipment.
2. Some of the many applications for air abrasion are:
   1. Removal of stains
   2. Preparation of pit and fissures prior to sealants
   3. Preparation of cavity preps that are small, including cervical abrasion sites
   4. Micro-etching porcelain for composite repairs
   5. But, NOT for amalgam removal

Clinical Intra-Oral Camera

There is one conventional clinical camera and an intraoral video camera available for documenting cases.

Residents must purchase a digital media compact flash (256 mb) for their own use.

Itero and Cerec 3D Systems

The AEGD clinic has an Itero system and Cerec 3D system. Training will be provided before the resident can use the system.

Documentation and Charts

Patient Chart Entries: All Patient Record entries require the use of the Assessment/Treatment/Evaluation Next Appointment (ATEN) system.

Guidelines for Completing a Medical Consultation Form

A. Reasons For Requesting a Medical Consultation

1. Clarification of a specific condition or a specific drug therapy
2. Clarification of a condition that may require pre-operative antibiotic coverage
3. Requesting specific
   1. Laboratory test results, or
   2. Complete findings from a recent complete physical examination

B. Providing Information to the Consulting Healthcare Practitioner

1. Oral diagnoses
2. Use language suitable to the knowledge of the other healthcare provider
3. Include all oral diagnoses
4. Include some indication of the severity of each diagnosis
   1. i.e. “moderate to severe” periodontitis
   2. “1.5 cm.” squamous cell carcinoma with “associated lymphadenopathy”

C. Advising HCWs About Recommended Dental Treatment

1. Include all foreseeable forms of treatment that may be employed
   1. All procedures that will cause significant bacteremia (e.g. deep scaling, C&B cord, etc.)
   2. All procedures that involve mucogingival surgery
      1. Biopsies, exodontia, implant placement
   3. All modes of anesthesia
      1. Local anesthetic; regional block anesthesia
      2. N2O, IVSD, general anesthesia
   4. Drug therapies: antibiotic pre-meds, antibiotic management of perio dx, alteration of Coumadin, Amicar
2. This is the most important part of any medical consultation request
   1. It establishes, for the physician or other HCW, that you have been careful in:
      1. Taking a thorough patient history

         Assessing the patient’s simple or complex medical status, AND MOST IMPORTANTLY

3. That you have appropriately analyzed the significant medical factors in the patient’s history and FORMULATED A SPECFIC SET OF RELEVANT QUESTIONS.
4. All medical consultations should be narrowly tailored to ask specific medical management questions that call for specific objective answers.
5. Only if the objective data is particularly open to a fairly wide range of clinical judgment, should an opinion on that objective data be expressly requested by the dentist and given by the consulting physician or other HCW.
6. Better medical consultations identify the dental management problem for the physician to consider, in the first line of this section, and then suggest a specific management approach to be used to ameliorate the problem.
7. Example: 72 y.o. AA female è h/o MI x 3, CABG, and A-fib, on Coumadin.
   1. Must have patient’s INR 2.0-2.5 to proceed. If pt.’s INR is higher, we would normally D/C Coumadin 2 days prior to tx, do stat PT/INR the AM of tx, and resume Coumadin at the next scheduled dose. OK?

      Please report the pt.’s most recent INR and advise.

8. It is extremely important that a medical consultation reflects the patient’s comprehensive needs so that repeated consults are not required because the dental practitioner failed to think through potential medical complications which may arise with different modalities of treatment.
9. Telephone consults are strongly discouraged!
   1. They should be limited to clarification of the physician’s recommendation, if it is illegible or contrary to regular regimens employed throughout Dentistry or Medicine.
   2. For example, chronic renal failure patients on hemodialysis may require a different antibiotic for SBE prophylaxis, and/or a different dosing regimen than other patients.
   3. A contemporaneous note in the chart should summarize this clarification of the initial consult.

D. The following patients may be unable to reliably relate their medical histories:

1. Elderly
2. Those suffering dementia or Parkinson’s disease
3. Developmentally Challenged; Special Needs Patients
4. Mentally Disable (psychosis patients)
5. In these cases, the only reliable method for determining relative safety to treat is the Complete Physical Examination findings.
6. The Complete Physical Examination
7. Interpreting the Findings for Relative Safety to Treat the Dental Patient
8. Who Cannot Reliably Relate a Medical History.

Outline of Physical Examination (HandPE)

1. Vital signs: Temperature, pulse, blood pressure (both arms), respiratory rate. These observations need not be repeated under their respective subheadings.
2. General appearance: state of orientation; development, state of nutrition, degree of discomfort, cooperativeness, other conspicuous general characteristics of appearance (including dress, neatness, behavior, gait and posture).
3. Skin: color, temperature, texture, moisture, eruptions, ecchymoses or petechiae, hair distribution, nails. Significant scars.
4. Head and face: Conformation, symmetry, abnormal movements, signs of injury, tenderness.
5. Eyes: extraocular movements, sclerae, conjunctivae, pupils, (size, equality, regularity, reaction to light and accommodation), gross vision and visual fields.
6. Ears: pinna, external canal, tympanic membrane, gross hearing, mastoids.
7. Nose: obstruction, discharge, septal perforation or deviation. Sinus tenderness.
8. Mouth: breath, mucous membranes, teeth, tongue, tonsils, faucial pillars, postnasal drip.
9. Neck; stiffness, masses, venous distention, abnormal pulsations, thyroid, position of trachea; carotid bruits.
10. Lymph nodes: size, consistency, tenderness, and mobility of cervical, supraclavicular, axillary, inguinal. (All nodes may be described here, or the regional nodes may be described with appropriate areas as examined.)
11. Thorax: configuration, AP diameter, symmetry, and amplitude of motion.

    Breasts: masses, tenderness, discharge from nipples, areolae.

12. Lungs:

    Inspection: respiratory excursion, rhythm, symmetry.

    Palpation: fremitus (tactile).

    Percussion: resonance, lung borders and descent.

    Auscultation: breath sounds, spoken and whispered voice sounds (vocal fremitus), rales, friction rubs.

13. Heart:

    Inspection: Precordial movements, precordial bulging.

    Palpation: apex impulse and PMI, thrills, shocks.

    Percussion: Heart borders, sternum.

    Auscultation: rhythm, heart sounds, murmurs (include left lateral position and sitting in full expiration), friction rubs, extracardiac.

14. Abdomen:

    Inspection: contour, engorged veins, protrusions, umbilicus, visible peristalsis.

    Percussion: Hepatic, splenic, bladder dullness, gaseous distention, shifting dullness.

    Auscultation: peristaltic sounds, vascular bruits.

    Palpation: tenderness, rebound tenderness, rigidity, fluid wave, liver, spleen, kidney masses, hernias. If liver or spleen are palpable, note character or edge. Costovertebral tenderness.

15. Spine: Vertebral curvatures, mobility, tenderness.
16. Extremities:

    Joints: swelling, effusion, deformities, tenderness, increased warmth, mobility. Clubbing, cyanosis, edema. Calf tenderness, Homan's sign. Character and equality of radial, femoral, posterior tibial and dorsalis pedis pulses; sclerosis of arterial walls; abnormal venous structures (varicosities, telangiectases).

17. Neurological: A limited or screening neurological examination is part of every routine physical examination. When positive findings make a more complete study necessary, the complete examination is done. Mental status; gait and station, abnormal movement; cerebellar signs; cranial nerves; muscle strength, atrophy, fasciculations; sensation: touch, pain, vibration, position sense; reflexes: (biceps, triceps, Hoffman, abdominals, cremasterics, knee jerks, ankle jerks, plantar); meningeal irritation (nuchal rigidity, Kernig's sign).
18. Genitalia:
    1. Male: penis, scrotum, testes, epididymis, spermatic cord. Discharge, inguinal canals.
    2. Female: speculum examination of vagina and cervix, palpation of uterus and adnexa. Pap smears, culture when indicated.
19. Rectal: External hemorrhoids, fissures.

    Digital: Sphincter, hemorrhoids, prostate, seminal vesicles (or uterus and cervix), Feces (description of gross appearance) and test for occult blood.

    * Summary

    Concise summary of relevant points in history and physical examination.

    * Formulation

    This is intended to alert the reader to the basis on which the diagnoses were made and the direction in which the work-up will process.

    It is a statement of what the leading diagnoses are, which diagnoses you favor and why, how you will differentiate between the likely diagnoses and a general approach to therapy, if there is a presumptive diagnosis.

Diagnosis: _______________________________________________________

Plans for further investigation and management: __________________________________________________________________________________________________________________

Introduction to Treatment Planning Technical Criteria

Format for Comprehensive Treatment Plan Work Up

I. History (S)

1. Chief Complaint (CC)
   1. It should be a symptom - record the patient’s impression of disease/problem in his/her own words.
2. History of Present Illness (HPI)
   1. Record details of chief complaint and related complaints - history of chief complaint.
3. Past Medical History (PMH)
   1. Record health history of systemic conditions, injuries, and hospitalizations in detail - medical consultation is present, if indicated.
      1. Childhood diseases
      2. Serious illnesses/transfusions
      3. Family health history which may bear on patient’s present or future health status
   2. Allergies and sensitivities
   3. Current medications
   4. Review of systems (ROS)
4. Environmental/social history
   1. Describe in detail any environmental factors that could impact on diagnosis and treatment planning, i.e., alcohol intake, tobacco usage, vocation, finances, etc.
5. Dental History
   1. Describe in detail the patient’s awareness of and involvement in previous dental treatment.
   2. Family dental health history (parents, siblings, spouse, children)
   3. Oral hygiene habits

II. Examination - Findings; list problems requiring attention, all of these must be addressed in TX sequence; charting must be complete - (O)

1. List general observations and systemic findings - age, vital signs, skin, limbs, development nutrition.
2. Record oral and extraoral findings: perform a thorough examination of the head, neck, face, and oral tissues.
   1. Head, neck, eyes, ears, nose, skin and secretions
   2. Lips, oral mucus, palate, pharynx, tongue and floor of mouth
   3. Gingival - color, texture, consistency, contour, amount of keratinized tissue, bleeding; details of periodontal condition on appropriate form
   4. Occlusion/musculature - a general statement of condition; details on appropriate form
   5. Dentition - a general statement of condition; details on appropriate form
   6. Oral hygiene - a general statement of condition; details on appropriate form
3. Radiographic Findings
   1. Obtain indicated radiographs which my include the following:
      1. periapical films (full mouth survey)
      2. posterior bitewing films
      3. panoramic film
      4. any necessary supplemental films
4. Microscopic - if indicated, obtain a phase contrast evaluation of microflora

   NOTE: The case is mounted on an articulator, all required radiographs, laboratory and clinical tests are obtained.

III. Diagnosis - (A)

1. List disease processes and abnormalities that address all pertinent findings.
   1. Systemic diagnosis
   2. Dental diagnosis

IV. Treatment Objectives - (A)

1. Make a general statement of the desired goals of treatment taking into account the findings, the patient’s situation and the resources of the practitioner. List considerations:
   1. Patient health
   2. Patient desires
   3. Patient age
   4. Patient financial restraints
   5. Prognosis (long and short term)
   6. Provider skills
2. Devise ideal (long-term) treatment objectives and immediate objectives (if applicable) that will support the ideal; formulate a segmented (progressive) treatment plan. Discuss all treatment options with the patient.
3. All fees for all treatment must be listed when the treatment plan is presented to the patient.

V. Planned Treatment Sequence - (P)

(The Written Treatment Plan)

1. A planned, well organized sequence of treatment is listed according to treatment phases that addresses all diagnosis and pertinent findings; materials to be used and alternate treatment plans are listed; best treatment plan for that individual patient is presented.
2. Order of treatment (Enter Each Phase - e.g., If N/A Enter “Phase 1 - N/A”)
   1. Systemic phase

      Systemic health considerations. Consult with physician when in doubt. Determine need for premedication, diet, precautions to protect patient and dental team, etc.

   2. Acute Urgent phase

      Treat problems of acute pain, bleeding, lost restorations, etc.

   3. Disease Control Hygienic phase (most import phase - steps necessary to control disease) for this specific patient generally in the order listed:
      1. Patient education and instruction in plaque control; fluoride program
      2. Biopsies if necessary
      3. Preliminary gross scaling - if necessary
      4. Caries control, and endodontic therapy
      5. Extraction of hopeless teeth. Temporary CPD’s and RPD’s if needed.
      6. Root planning
      7. Maintain plaque control
      8. Preliminary occlusal adjustment if indicated
      9. Minor tooth movement/orthodontic treatment
      10. Occlusal splints if indicated
      11. Definitive occlusal adjustment when necessary
      12. Continuous evaluation of oral hygiene and tissue response, and reassessment of the entire treatment plan
   4. Definitive/Corrective phase: correct environment to allow patient to maintain good oral hygiene
      1. Hemisections with temporary splinting
      2. Periodontal surgery, bone and soft tissue grafting
      3. Treatment of hypersensitive teeth
      4. Implants
      5. Restorative dentistry (should wait at least two months following extensive surgery)
      6. Recheck and refine occlusion
   5. Maintenance phase:
      1. Re-examine for effectiveness of plaque control, recurrence of periodontal disease, caries, and occlusal problems: reinforce oral hygiene instruction, perform prophylaxis including topical fluoride application. Recall based on the specific patient’s needs.
      2. Complete periodic radiographic survey of the dentition if indicated. Compare with prior radiographs
      3. Recheck prosthetic treatment
      4. Treatment of any active periodontal disease
      5. Treatment of recurrent carious lesions
      6. Endodontic therapy if pulpal and/or periapical lesions have developed or not resolved
      7. Replacement of restorations which no longer satisfy health, function or esthetic requirements
      8. Make new occlusal splints when old ones are broken down, worn out or lost

VI. Prognosis

1. State a prediction, based on an educated calculation, of the response of hard and soft tissue to the treatment planned, both long and short term.

VII. Signing the Treatment Plan

1. The patient must sign the treatment plan prior to any treatment being rendered. This is to establish that the patient accepts the treatment plan. The resident and faculty member should also sign the treatment plan.

Periodontal Screening & Recording System (PSR)

Example of Monthly Production Report

Production Report

Treatment Details by Provider from 02-Nov-2003 to 30-Nov-2003

AGD-R- AGD Resident Activity

Treatment Requirements

Treatment Requirements