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 * The Lead Pipe ||
 * A Clinic Guide and Survival Manual ||
 * A Clinic Guide and Survival Manual ||

This document is meant to act as a guide to help you weave in and out of the UCLA clinic. There are many instructional documents out there for all the different types of appointments you may encounter during your time in the clinic but hopefully this can become the meeting place for all of them. This is an ongoing project as many people are constantly working on new sections and thinking of new additions. If you have any suggestions or corrections please submit!

Table of Contents Antibiotic Protocol ........... 5  ATP: Advanced Treatment Planning ........... 6  Basic Cubicle setup ........... 9  Billing ........... 10  Block Schedules – Where? When? ........... 11  Consultations ........... 13  Clinic Vs Block ........... 17  Competencies ........... 18  Endodontics ........... 19  Fuji What? ........... 20  Hygiene ........... 22  Initial perio therapy ........... 24  Insurance ........... 26  Nitrous Oxide (N2O) ........... 29  Oral Diagnosis ........... 30  Oral Facial Pain ........... 32  Patient Assignment ........... 33  Patient Requests ........... 35  Pediatric Dentistry ........... 36  Periodic exam ........... 37  Periodontics ........... 38  Preventive ........... 39  Radiology ........... 41  Recall Denture Exam ........... 42  Requirements ........... 43  Ryan White Policy ........... 44  Scheduling Appointments ........... 45  Submitting a Treatment Plan ........... 47  Treatment Guidelines ........... 49  Urgent Care ........... 57  Quick Links ........... 58

Prophylaxis for Patients with Joint Replacement Amoxicillin, Clindamycin, Cephalexin Prophylaxis for Infective endocarditis Amoxicillin, Clindamycin, Cephalexin , Azithromycin Prescriptions (for 3 visits): Rx: 500 mg Disp: 12 tablets Sig: 4 tablets (2 g) 30-60 min utesprior to dental visit and repeat at each appointment Rx: 150 mg Disp: 12 capsules Sig: 4 capsules (600 mg) 30-60 minutes prior to dental visit and repeat at each appointment Rx: 500 mg Disp: 12 tablets Sig: 4 tablets (2 g) 30-60 minutes prior to dental visit and repeat at each appointment Rx: 500 mg Disp: 3 tablets Sig: 1 tablet 30-60 minutes prior to dental visit and repeat at each appointment

= : Advanced Treatment Planning = // From start to finish //

**Who needs to go to ATP?** Anything that’s not FastTrack. What’s FastTrack? See the handout from Dr. Woods’s 2nd year spring course. I can’t find it, and you might not be able to either, so here is the relevant portion: 

Basically, ATP is anything where the treatment is not so obvious. Occasionally you may try to do a periodic exam (regular consults) and have it “blow up” into ATP because at that appointment you find that too many things need to be replaced. So basically, it’s ATP if you need extractions (other than 3rd molars), more than 8 fixed restorations, replacing more than one tooth, any RPDs. Replacing only one tooth can qualify as FastTrack. An “obvious” denture case where it’s clear all teeth need to be extracted (i.e. there’s only one clear treatment pathway!), can also qualify for FastTrack. ATP is where you go to decide how to replace missing teeth (debating between RPDs, implants, and bridges), or doing large-scale restorations (more than 8 crowns, unreasonable occlusion, severe attrition).

**What do I need to do before ATP?** You need to do a Pre-ATP appointment. Book it on GSD as such and you will get either perio or restorative faculty coverage. It’s like regular perio/restorative consults, except you’re pretty much on your own (because the instructor examinations will take place at ATP). Do your perio probings and have the covering periodontist lock your perio chart (this is a new addition to the requirements before ATP; they want the probings and other measurements to be accurate so they don’t have to question them at the ATP appt). The restorative exam is completed as normal (but without a faculty consult). If you are trying to do this in the 1.5 hours after OD, you may or may not have enough time. You will also need mounted casts for the ATP appointment. So take upper and lower alginate impressions, pour in yellow stone. (They will like it if your mounting and cast trimming is not horrid). You can try to capture the vestibules if you are planning an RPD, but they’ll probably be fine if it’s not perfect (since it’s just a preliminary study cast). You will probably need a facebow to mount the casts. Generally, you will want to hand-articulate the casts (because this is most accurate), unless there are not enough teeth to do so. In which case, you will need record bases and wax rims. (Not blue-mousse or compound or wax wafers or anything else). More on that below… If an RPD is a possible treatment option, you’ll want to get a pre-ATP design. The white forms for drawing the design are on 2nd floor in front of the removable lab. Draw your proposed design, and go to a removable consult (the schedule for this is on 2nd floor near Nancy’s desk). Bring the mounted casts, as well as the patient’s radiographs. The presentation: After you get your diagnostic info, prepare your treatment plan (if you’re wrong, that’s fine. ATP is not evaluating you for correctness but just for thoughtfulness). Follow the order on this other handout from Dr. Woods’ spring course. (next page) A few things to note: Make sure to know the patient’s snacking and dietary habits, oral hygiene habits. Be sure to state plaque/marginal bleeding indices before perio probings. Know their “type I/typeII/etc” preventive. And tell the “overall big picture” of treatment before going into it tooth-by-tooth. There are probably many example presentations floating around. Below is one example. If you need others just ask a classmate for their presentation. Following the example case presentation on the next page should cover most questions you may be asked in ATP.

**__ SYSTEMIC __** **__ URGENT __** · None
 * __ PATIENT INTRODUCTION __**
 * // Demographics: //
 * Age:
 * Occupation:
 * Financial Status/Insurance:
 * Initial exam date:
 * Why at UCLA:
 * // Chief Complaint: //
 * Originally came in because of pain in lower left quadrant, which is no longer occurring. Pt is concerned about the esthetics and loss of function of her missing posterior teeth, and of #21 in particular as it is visible to pt when she smiles.
 * // HPI: //
 * Pt lost restoration on #21 approximately 1 year ago and had pain in that area approximately 2 weeks prior to initial exam. Pt is unaware of the history of the other involved teeth, but reports not having received dental care for about 10 years.
 * // MHx, medications: //
 * Pt reports no active or significant past medical problems and is not currently taking any medications.
 * Last BP taken 11/22/2009 and was 128/82 / 80 bpm / regular rhythm
 * Allergies: Seasonal allergies, NKDA
 * // DHx: //
 * Last dental visit was approximately 10 years ago.
 * Patient reports dissatisfaction with previous dental care at a private dentist associated with having the wrong tooth prepared and crowned and also due to difficulty achieving local anesthesia.
 * Pt reports a hx of dental phobia.

**__ PREPARATORY __** **__ RESTORATIVE __**
 * // Preventive //
 * MBI: 35.58%
 * PI: 38.46%
 * Type II
 * High caries risk due to visible cavitations, exposed roots, and interproximal radiolucencies.
 * At initial exam, pt reported hx of brushing 1x/day and occasional flossing.
 * Tx plan:
 * Diet analysis
 * Recommend use of sugar-free xylitol gum after eating
 * Recommend use of OTC 0.05% NaF rinse such as ACT 1x/day after brushing teeth in morning
 * Prescribe 1.1% NaF toothpaste such as Prevident 5000 to be used while brushing teeth before sleeping
 * OHI including Bass method and flossing instruction
 * Recommend use of electric toothbrush
 * // Periodontal: //
 * 2-4mm generalized pocket depths on maxillary and mandibular teeth with 5-7 mm localized pocket depths on maxillary posterior teeth.
 * No furcation involvement or mobility.
 * 3 mm recession on #3 lingual.
 * Moderate generalized horizontal bone loss.
 * Moderate generalized BOP and inflammation.
 * Moderate generalized chronic adult gingivitis with localized moderate periodontitis in the maxillary posterior.
 * Tx plan: 2 appt Sc/RP. 4 week perio re-eval.
 * // Endo/Oral Surgery/Ortho/Orofacial Pain/Esthetic: //
 * Endo consult:
 * Teeth: 19, 28 (re-treat)
 * Oral surgery consult:
 * Extract:
 * Teeth: 13, 15, 21
 * Roots: 30
 * Implant consult:
 * Depending on final tx plan, teeth: 13, 20, 21, and/or 30
 * // Overall treatment approach: //
 * Maxilla: Extractions, operative and fixed to address active dental disease, and either:
 * 12-13-14 FPD or
 * single tooth implant to replace 13
 * Mandible: Extractions, operative and fixed to address active dental disease, and either:
 * single tooth implants to replace 20, 21 and 30 or
 * single tooth implants to replace 20 and 21 and 29-30-31 FPD to replace 30 or
 * mandibular tooth-borne RPD to replace 20, 21, and 30

Replace with single implant ($2,000-$2,500) or 3-unit bridge ($1,485) || $125 (+ ?) || **__ ELECTIVE __** · None **__ MAINTENANCE __** **At ATP** If you do need to take a wax-rim bite registration due to insufficient teeth, you can try to book the patient for a 11am or 4pm ATP (for example), and bring them into the general clinic at 9am or 2pm. Do the wax-rims, then finish mounting the mandibular cast. Book an appointment under WW ATP AM (or PM) and specify whether you want 9am, 10am, or 11am. (Each appointment is an hour). At the time of this writing, ATP takes place M/T afternoons and Thursday mornings (but if you forget, you can always just check the GSD schedule for “New Room” and see when ATP is; the other times are usually Esthetics clinic). Remember to bring the ATP grade sheet (pink). At the time of this writing, it can be found on 2nd floor not with all the rest of the papers, but around the back (close to ortho and the backside of sterilization). Sit your patient down anywhere, have your computer out, mounted casts. It can be handy to have your presentation notes on paper rather than computer, so the other 2 faculty can look at radiographs on XDR while one is examining the patient. At the end you will fill out PREVTX1-4, and write the ATP consult notes. Basically it should contain all the findings & treatment you discussed.
 * // Tooth by tooth plan: //
 * Tooth || Description || Problem || Plan || Fee ||
 * 1 || Missing ||  ||   ||   ||
 * 2 || O amalgam || Fractured M amalgam || O composite || $99 ||
 * 3 || PFM || 3 mm lingual recession, gingival hyperplasia on M ||  ||   ||
 * 4 || PFM || Gingival hyperplasia on D ||  ||   ||
 * 5 || DO amalgam || M caries || MOD composite || $148 ||
 * 6 ||  ||   ||   ||   ||
 * 7 ||  || M caries || ML composite || $105 ||
 * 8 || PFM || Open F margin || PFM || $495 ||
 * 9 || PFM/post/RCT || Open F margin || PFM || $495 ||
 * 10 || ML composite || Recurrent M decay, D decay || ML, DL composite || $115 ||
 * 11 ||  ||   ||   ||   ||
 * 12 || DO amalgam || M caries || MOD composite || $148 ||
 * 13 ||  || Crown fracture/gross caries || Ext
 * 14 || OL amalgam || M caries || MOL composite || $148 ||
 * 15 ||  || Crown fracture/gross caries || Ext || $125 ||
 * 16 |||||||| etc…continue to #32 ||
 * // Preventive //
 * Fluoride: topical fluoride recommended after Sc/Rp or prophy
 * OHI at each recall prophy
 * // Periodontal //
 * Phase I interval: 3 mo perio recall
 * // Restorative (Monitor/Watch) //
 * 1 year recall for periodic exam and BWX

**What do I do after ATP?** If you try to ask Dr. Woods this, he will hand you the convenient handout (available at your ATP appointment) with most everything spelled out. If RPD is part of your final treatment plan, you will need a post-ATP RPD design (by attending removable consults). Drag stuff over on GSD (just like any treatment plan), fill out the yellow initial plans form and problem list, put the pink grade sheet in, and simply submit the chart to the chart room (ask them to “put it in Dr. Woods’ box”). To know when it’s done, simply check GSD to see if the treatment plan has been approved (red stars becoming green). Then the chart will be available in the chart room again.

= =  - From the central sterilization area, pick up a piece of wax paper  - From the central island’s back window area (or from your home cube), obtain the following:  o ***You can keep all this stuff on hand at your home cube** **= Office =** **= =**
 *  o 1 big bag for tray table (no longer required for operator chair) o 1 plastic laptop bag o Blue gown & facemask o High & low speed suction tips, air/water syringe tip o Patient bib o Any cotton rolls & 2x2s you plan to use __Finding supplies__  - Carts at the back window include such things as:  o Impression material (alginate, polyvinyl siloxane) & trays o “Blue composite” o Packing cord of various sizes (although you should have your own cord in that hemostasis kit from UltraDent) o Rope wax o Green stick compound o Vaseline o Matrix bands o Clear mylar strips o Bite sticks o Tempbond (for cementing temps – hey, someone won’t know) o Matrix buttons  - Cart in the removable clinic includes such things as: <span style="line-height: normal; margin-bottom: 0in; margin-left: 0.5in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> o Pink compound o Green compound o Disposable mirrors o Tongue blades o PIP o Disclosing wax o Denture cups o Impression material o Impression trays o Indelible ink sticks <span style="line-height: normal; margin-bottom: 0in; margin-left: 0.25in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> - Central sterilization will have: <span style="line-height: normal; margin-bottom: 0in; margin-left: 0.5in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> o *Basically for everything that the clinic doesn’t want you to steal* o Student bags = bags you drop off with your number written on top o Restorative, perio, rubber dam, exam, OD exam cassettes o Any instruments missing from any cassettes (including rubber dam clamps) o Fuji guns o Integrity material (you have to have or borrow an integrity gun, sorry) o GC Fuji Lining LC paste o Endo testing supplies (Endo ice, EPT) o Endo cubicle setup stuff – endo files, gutta percha, etc. o Scalpels & scalpel blades o Ortho wires for treatment partials o T-bar for removing old crowns o Cavitron o Electrosurg thing – for electrocautery o *Anything else that you can’t find in the cabinets at the back windows OR anything you haven’t heard of when the instructor asks you “Do you have…?” **
 * Billing holds (locked out of chart): your patient has an outstanding balance and needs to pay their balance before you can access their chart. This includes scheduling appointments? Once they have paid their balance, go to the billing office and ask them to unlock their chart. Insurance : UCLA accepts direct payment from only Delta Dental. All other insurance companies reimburse the patient afterwards. Mail: You can also find the box to put any patient mail that needs to get sent out on the counter near the door. Make sure the envelope addressed correctly and that it has been stamped by your GPD. No postage required. Ryan White Forms: Once the blue forms for your Ryan White patients have been filled out and signed by Dr Younai, drop the forms off in the billing office. Once they are processed a note will appear in the top window under the “Notes” tab in GSD. **
 * Throughout your time in clinic, you will also need to pay attention to your assigned block schedules. These are all noted in the calendar that is updated and emailed to you each quarter. These calendars are also posted in the clinic. The dates should also be blocked out on GSD so that you cannot accidentally schedule a patient. It is a good idea to check these over at the beginning of the quarter to ensure your calendar matches with GSD. Different blocks meet on different days and different times. Some may last the entire week and others only 20 minutes in the afternoon. The key for reading the Block schedule calendar is available online. · Inglewood Children’s Dental Center ·  **

Oral Diagnosis Block
 * <span style="margin-bottom: 10pt; margin-left: 1in; margin-right: 0in; margin-top: 12pt; text-indent: -0.25in;"> o This block is completed three times; the first during summer of 3rd year for one day, the second time for a week, and the last time you are scheduled for two days in one week. For this block you must show up at 9AM and 2PM in the OD clinic on the first floor. Bring everything with you that you need to completed the exam (this includes: exam kit, gloves, gown, eye protection, masks, BP cuff, Rx book, computer and the necessary cords). · Oral Facial Pain Block · Oral Med Block ·  **

Oral Surgery Block (1 week)
 * <span style="margin-bottom: 10pt; margin-left: 1in; margin-right: 0in; margin-top: 12pt; text-indent: -0.25in;"> o This block is only completed once. It covers every clinic session for one week. Before the first session it may be a good idea to pick up the packet of information from the OS office on the 5th floor. This packet contains the page that requires signatures throughout the week and must be turned in after the week is over. For the first morning, meet in the OS clinic on the A level at 9AM. You can bring your backpack and leave it in the conference room. Find Dr. Hargus in the main clinic area. He prefers if you bring a pen with you as the first sessions include some note taking. o The beginning of the week is mostly spent with Dr Hargus learning instruments and tying knots. Refer to the schedule for specifics. · Oral Surgery Block (3 weeks) ·  **

Ortho Block Perio Block Radiology Block Special Patient Care Block <span style="border: initial none initial; display: block; padding-bottom: 1pt; padding-left: 0in; padding-right: 0in; padding-top: 0in;">**= =**
 * <span style="margin-bottom: 10pt; margin-left: 1in; margin-right: 0in; margin-top: 12pt; text-indent: -0.25in;"> o This block is completed 3 different times during the 3rd/4th year. On the afternoon you are scheduled, meet in the ortho clinic on te 2nd floor at 2PM. You will complete an ortho exam with a partner during the first two sessions. At your 3rd time in the clinic, you will spend the time observing the residents. This block can be completed very quickly and rarely are students still working after 3PM. · **
 * <span style="margin-bottom: 10pt; margin-left: 1in; margin-right: 0in; margin-top: 12pt; text-indent: -0.25in;"> o This block is only completed once. The block covers 4 clinic sessions: Monday AM and PM, Tuesday PM and Thursday PM. The first morning meets at 9AM in a conference room across the Perio clinic on the B level. There is an interactive lecture during this first session and the rest consist of shadowing and assisting in the perio clinic. You must be present during the entire sessions in the clinic. You will need to check in with Gwen at the front desk. Do NOT bring your backpack with you; come to the clinic with a gown, masks and eye protection and that is it. · **
 * <span style="margin-bottom: 10pt; margin-left: 1in; margin-right: 0in; margin-top: 12pt; text-indent: -0.25in;"> o This block is done once a quarter. It lasts the entire day however you will likely finish early in each session. The morning session begins at 9AM and the afternoon session at 2PM. You do not need to bring anything with you. Meet in the radiology consult room across from the OD chairs. · **
 * <span style="margin-bottom: 10pt; margin-left: 1in; margin-right: 0in; margin-top: 12pt; text-indent: -0.25in;"> o This block is only completed once. It covers Wednesday AM and PM sessions the first week and is from 8-9AM on the Wednesday of the following week. For the first session, meet in the Weintraub center on the B level across from the Prosth office. You will spend the first hour listening to the presentation given by the previous weeks group. You can leave your backpack in this room and do not need to bring anything else with you. During the second session, you will present a prepared PPT about a special care patient that you encountered during your first session. Dr Sun may be present to ‘quiz’ you on some of the more important topics so do some research. · UCLA Children’s Dental Center · Urgent Care Block · Venice Block **
 * <span style="line-height: normal; margin-bottom: 0in; margin-left: 0.25in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> - Consults refer to one of four things generally: <span style="line-height: normal; margin-bottom: 0in; margin-left: 0.5in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> o 1) Initial/periodic consultation for creating/updating treatment plans o 2) Consultation with one of the specialties (endo, oral surgery, ortho, removable) during ongoing Tx o 3) “Removable consults”, wherein you discuss RPD designs, denture setups, etc., with a removable professor <span style="line-height: normal; margin-bottom: 0in; margin-left: 0.75in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> § NOTE: you can have a ‘removable consult’ with you patient in the removable clinic (2), or a ‘removable consult’ with just the faculty in an office setting (3) <span style="line-height: normal; margin-bottom: 0in; margin-left: 0.5in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> o 4) Implant consult o NOTE: <span style="line-height: normal; margin-bottom: 0in; margin-left: 0.75in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> § In 1), 2), & 4), consults involve a discussion between you, your patient, and a clinic faculty member § In 3), it’s just you & a removable instructor, and takes place at specific times/locations away from clinic <span style="font-family: Verdana; line-height: normal; margin-bottom: 0in; margin-left: 0.25in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;">- **

1) Consults for the purpose of creating a Tx plan
 * <span style="line-height: normal; margin-bottom: 0in; margin-left: 0.5in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> o Before doing anything, you need to know whether your case is a Fast track case or an ATP case <span style="line-height: normal; margin-bottom: 0in; margin-left: 0.75in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> § For ATP cases, you need to gather pre-ATP info: <span style="line-height: normal; margin-bottom: 0in; margin-left: 1in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> · Take good impressions & records, and mount the case correctly · Gather the same perio & tooth-by-tooth restorative info as for a Fast track Tx plan <span style="line-height: normal; margin-bottom: 0in; margin-left: 1.25in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> o You do NOT need to have formal consults signed off in the consults section of GSD-ACADEMIC, because your ATP appointment is the one & only actual consultation you will enter in GSD-ACADEMIC <span style="line-height: normal; margin-bottom: 0in; margin-left: 1.25in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> o However, you can always ask instructors for advise o You should also always get your SOAP notes signed off, even for pre-ATP appts – you need to record what you did, AND you get credit for clinic attendance when you have SOAP notes signed off <span style="line-height: normal; margin-bottom: 0in; margin-left: 1in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> · For a complete list of what you need to prepare for ATP, there is a green sheet [NH1]  by the back window behind central sterilization OR the form can usually be found in the Student Lounge <span style="line-height: normal; margin-bottom: 0in; margin-left: 0.75in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> § For Fast track cases, you generally only need perio & restorative consults, but may need a specialty consult or two <span style="line-height: normal; margin-bottom: 0in; margin-left: 1in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> · If the pt needs 1+ extractions, you will need an oral surgery consult in the O .S. clinic //following// Tx plan approval by your GPD <span style="line-height: normal; margin-bottom: 0in; margin-left: 0.5in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> o Before the consult appt: <span style="line-height: normal; margin-bottom: 0in; margin-left: 0.75in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> § If you want to complete a perio consult following OD, be sure that there will be a __periodontist__ available to sign the perio consult <span style="line-height: normal; margin-bottom: 0in; margin-left: 0.5in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> o What to do during the appt: <span style="line-height: normal; margin-bottom: 0in; margin-left: 0.75in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> § Perio consult <span style="line-height: normal; margin-bottom: 0in; margin-left: 1in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> · Complete perio charting: note any missing teeth, measure sulcus periodontal probing depths, BOP, recession, attachment loss, presence & extent of plaque/calculus, health & appearance of tissues <span style="line-height: normal; margin-bottom: 0in; margin-left: 1in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> · Look at bone levels radiographically – note any general & local bone loss & possible perio lesions <span style="line-height: normal; margin-bottom: 0in; margin-left: 1.25in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> o Use bitewings, not PAs, to look at bone levels (BWX provide a more level view of bone height) <span style="line-height: normal; margin-bottom: 0in; margin-left: 1in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> · Type up your findings, assessment, and proposed plan in the consult section (see below ~30 lines) <span style="line-height: normal; margin-bottom: 0in; margin-left: 0.75in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> § Restorative consult <span style="line-height: normal; margin-bottom: 0in; margin-left: 1in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> · The wise student will have already completed a radiographic analysis, so you should already be halfway there (do radio consult before the appointment)<span style="line-height: normal; margin-bottom: 0in; margin-left: 1in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> · Perform a tooth-by-tooth exam & note anything abnormal – caries, demineralization, discoloration, chipped teeth, deep pits/fissures, current restorations, failing restorations, developmental stuff…anything worth noting · Use your best judgment to develop a plan for each tooth <span style="line-height: normal; margin-bottom: 0in; margin-left: 1.25in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> o The instructor will help you decide on the best Tx o If you disagree with the instructor, you can ask why s/he they wouldn’t do what you thought you should do <span style="font-family: Wingdings; line-height: normal; margin-bottom: 0in; margin-left: 1.5in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;">§ S/he They may actually say, “That would be another acceptable approach” OR s/he they will explain why your idea is not as great as their idea…either way you learn something <span style="line-height: normal; margin-bottom: 0in; margin-left: 1.25in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> o In terms of restorative Tx, it is best to give you patient options (e.g., gold inlay vs. amalgam) with pros & cons of each (cost, longevity, esthetics, etc) <span style="line-height: normal; margin-bottom: 0in; margin-left: 1in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> · Type up your findings, assessment, and proposed plan (see below ~20 lines) <span style="line-height: normal; margin-bottom: 0in; margin-left: 0.75in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> § Other consults <span style="line-height: normal; margin-bottom: 0in; margin-left: 1in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> · If your patient requires any additional consults, you need to obtain these prior to submitting the Tx plan <span style="line-height: normal; margin-bottom: 0in; margin-left: 0.75in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> § In any case, after completing your exam, get on the instructor ’s waitlist <span style="line-height: normal; margin-bottom: 0in; margin-left: 1in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> · In the meantime, type up your findings. Never JUST wait for an instructor…there is almost always something you can do, even if it means typing SOAPs or just educating your patient about their Tx & what they may expect <span style="line-height: normal; margin-bottom: 0in; margin-left: 0.5in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> o How to record a consult in GSD-ACADEMIC: <span style="line-height: normal; margin-bottom: 0in; margin-left: 0.75in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> § In your pt’s chart in GSD-ACADEMIC, go to the chart tab & click on the consults tab on in the lower right-hand corner. Click ‘+ 1’ or ‘ e/d pencil ’, which opens a new window. Click on the Consultations tab & then click ‘+ 1 ’ or ‘pencil’ . Be sure you check the box to add consult __without associated condition__. There is a drop-down box to select the subspecialty you are completing the consult for (e.g., ‘perio’) <span style="line-height: normal; margin-bottom: 0in; margin-left: 0.75in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> § When you’ve done that, you’ll see a new line in the consultation tab window § Double-click the consult you want to do – this opens up a blank window § In the box, you need to enter the details of the consultation: <span style="line-height: normal; margin-bottom: 0in; margin-left: 1in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> · I have learned to enter my Findings, Assessment, and Plan (basically the ‘OAP’ in SOAP) · First, you should do your evaluation & enter the info as best you can · Then the professor will evaluate the pt · Make the appropriate changes based on their findings vs. your findings · When you’ve typed it all in there correctly, close the window & click ‘complete consult’ · Once the faculty has signed it off, verify that the word ‘completed’ appears on the consult line <span style="line-height: normal; margin-bottom: 0in; margin-left: 0.75in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> § What to enter in the consult box: <span style="line-height: normal; margin-bottom: 0in; margin-left: 1in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> · Here are two examples to give you an idea of things you may include in your consult. Various instructors look for various information, but the basics apply across the board · 1) Perio: <span style="line-height: normal; margin-bottom: 0in; margin-left: 1.25in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> o “Findings: <span style="line-height: normal; margin-bottom: 0in; margin-left: 1.5in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> § (one example) Probings range 1-5mm, with several 4-5mm pockets in Max & Mand posterior, moderate BOP, 2-3mm recession on B Max molars. AL ranges 4-7mm [NOTE: AL = attachment loss, and is the sum of pocket depth + recession]. Moderate calculus levels, esp. on L of Mand anteriors, radiographic evidence of calculus in posteriors, gingiva red & puffy. <span style="line-height: normal; margin-bottom: 0in; margin-left: 1.25in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> o Assessment: <span style="line-height: normal; margin-bottom: 0in; margin-left: 1.5in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> § Generalized moderate periodontitis <span style="line-height: normal; margin-bottom: 0in; margin-left: 1.25in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> o Plan: <span style="line-height: normal; margin-bottom: 0in; margin-left: 1.5in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> § 4-quadrant Sc/RP, 3 week follow-up § 4-month recall § OHI: brushing & flossing” <span style="font-family: Symbol; line-height: normal; margin-bottom: 0in; margin-left: 1in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;">· For Dr. Lemus, she like the following format: <span style="font-family: 'Courier New'; line-height: normal; margin-bottom: 0in; margin-left: 1.25in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;">o Pt med hx & medications <span style="font-family: 'Courier New'; line-height: normal; margin-bottom: 0in; margin-left: 1.25in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;">o Periodontal Hx <span style="font-family: 'Courier New'; line-height: normal; margin-bottom: 0in; margin-left: 1.25in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;">o Findings <span style="font-family: 'Courier New'; line-height: normal; margin-bottom: 0in; margin-left: 1.25in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;">o Dx <span style="font-family: 'Courier New'; line-height: normal; margin-bottom: 0in; margin-left: 1.25in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;">o Tx <span style="font-family: Wingdings; line-height: normal; margin-bottom: 0in; margin-left: 1.5in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;">§ Including frequency of periodontal maintenance schedule <span style="font-family: 'Courier New'; line-height: normal; margin-bottom: 0in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;">o Prognosis<span style="line-height: normal; margin-bottom: 0in; margin-left: 1in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> · 2) Rest: <span style="line-height: normal; margin-bottom: 0in; margin-left: 1.25in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> o You may be able to get by without an ‘Assessment’ section, since you can basically describe what you see & what you want to do o “Findings: <span style="line-height: normal; margin-bottom: 0in; margin-left: 1.5in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> § #2 O decay § #4 M + D radiolucencies § #12 failed large MO Ag on ML aspect of marginal ridge § #19 PFM with open facial margin § #30 B pit decay <span style="line-height: normal; margin-bottom: 0in; margin-left: 1.25in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> o Plan: <span style="line-height: normal; margin-bottom: 0in; margin-left: 1.5in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> § #2 O Ag § #4 MOD Comp § #12 PFM § #19 replace PFM § #30 B Comp” <span style="font-family: Verdana; line-height: normal; margin-bottom: 0in; margin-left: 0.25in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;">- **

2) Specialty consult
 * <span style="line-height: normal; margin-bottom: 0in; margin-left: 0.5in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> o These include, but may not be limited to: oral surgery, endo, removable, perio, restorative, orofacial pain o During any given appointment, you may wish to have a consult with a professor from one of these specialties <span style="line-height: normal; margin-bottom: 0in; margin-left: 0.75in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> § Restorative, perio, & endo do not require a separate appointment § Orofacial pain consults must be scheduled in the red book found at the end o of the 1st row of cubicles in the Oral Diagnosis/Radiology clinic <span style="line-height: normal; margin-bottom: 0in; margin-left: 0.75in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> § Oral surgery consults are scheduled at the Oral surgery window on the A-level <span style="line-height: normal; margin-bottom: 0in; margin-left: 1in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> · You may be able to be seen on a walk-in basis, depending on how busy the clinic is & what your pt’s needs are <span style="line-height: normal; margin-bottom: 0in; margin-left: 0.75in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> § Removable consults (clinical) are made by appointment in GSD-ACADEMIC <span style="font-family: Verdana; line-height: normal; margin-bottom: 0in; margin-left: 0.25in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;">- **

3) Removable consult
 * <span style="line-height: normal; margin-bottom: 0in; margin-left: 0.5in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> o When you are in the process of making a removable denture (complete or partial), you must have each step signed off along the way…for both clinical stuff and labwork o So, a consult consists of you, the removable instructor, your casts, the pt’s chart, articulators, blue/red pencil, & surveyor o The instructor inspects your lab work & provides the all-important signature o NOTE: If this guide is at all helpful, I would be happy to get into all the nitty gritty concerning consults, because they are in a world of their own…some level of explanation may save you much time & embarrassment  <span style="font-family: Verdana; line-height: normal; margin-bottom: 0in; margin-left: 0.25in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;">- **

4) Implant consult ** <span style="line-height: normal; margin-bottom: 0in; margin-left: 0.5in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> o This is a special consultation with either Dr. Shah (removable) or Dr. Hewlett (restorative) <span style="line-height: normal; margin-bottom: 0in; margin-left: 0.5in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> o Here you present the case of any pt who would like implants <span style="line-height: normal; margin-bottom: 0in; margin-left: 0.5in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> o You r pt is present & you get to discuss all the details of Tx planning an implant case o NOTE: again, I would be happy to address this topic in version 2.0 of this file, if you think it’s worthwhile

<span style="border: initial none initial; display: block; padding-bottom: 1pt; padding-left: 0in; padding-right: 0in; padding-top: 0in;">=<span style="border-bottom-style: none; border-color: initial; border-left-style: none; border-right-style: none; border-top-style: none; border-width: initial; padding-bottom: 0in; padding-left: 0in; padding-right: 0in; padding-top: 0in;"> = Clinic: General clinic times are as follows unless otherwise stated: || Monday || Tuesday || Wednesday || Thursday || Friday || There is no clinic on Friday afternoons; this is why there is Tuesday night clinic. Block: You are expected to attend all block rotations. Your appointment book on GSD-Academic will be blacked out and you cannot schedule appointments to see your patients.**Block rotations**** take precedence over class and clinic. ** In the event you must switch a block, you will need to fill out a block switch form. You can get these from your GPA. To fill it out you must indicate who you are switching with, what dates you two have block, you will also need a signature from both students and the block director. Once all this is filled out, you will need to bring the form back to your GPA and they will make the switch in GSD-Academic. <span style="border: initial none initial; display: block; padding-bottom: 1pt; padding-left: 0in; padding-right: 0in; padding-top: 0in;">=<span style="border-bottom-style: none; border-color: initial; border-left-style: none; border-right-style: none; border-top-style: none; border-width: initial; padding-bottom: 0in; padding-left: 0in; padding-right: 0in; padding-top: 0in;"> = Along with obtaining the minimal clinic expereiences needed to graduate, you also have to complete a certain number of competencies. Theses are basically tests of your technique and can be completed with a number of different procedures. You get points for these as well, 5 for turning the sheet in and another 1 point for each number of the grade you are given. (3 points for a grade of 3, 4 points for a grade of 4, etc). You have to pass with a 3, 4 or 5, just like in lab. You must complete these before attempting to challenge the Restorative Dentistry Comprehensive Competency Exam. The forms can be found in the restorative office on the 3rd floor; if you are having a hard time finding a specific one, ask Derrick for help. Inform the covering faculty that you wish to complete a competency at the beginning of the appointment and confirm that your case is appropriate. Required Competencies: · Class II Amalgam (1 each) o Conservative amalgam o Large amalgam (at least 3 surfaces, may involve cusp coverage) · Class III or V composite or Class V GI (2 total) o Replacement or initial (requiring prep) · Class II Comp (2 total) · Case Restoration (any 2 of the following) o PFM o Any bonded ceramic procedure o Gold partial coverage (inlay/onlay) o FGC · Foundation Restoration (any 2 of the following) o Cast dowel core o Prefab post o Core build up (amalgam only) o Pin build up (amalgam or comp) The newest addition to this list is the treatment planning competency, which is completed with your GPD. You GPD should inform you as to when you are to complete this (it may be taken care of during a chart review). The materials for the presentation are obtained from your GPA. You will be given a set of radiographs as well as a short pt history. You must create and be prepared to present a treatment plan with any helpful visual aids or typodont examples of restorations. <span style="border: initial none initial; display: block; padding-bottom: 1pt; padding-left: 0in; padding-right: 0in; padding-top: 0in;">=<span style="border-bottom-style: none; border-color: initial; border-left-style: none; border-right-style: none; border-top-style: none; border-width: initial; padding-bottom: 0in; padding-left: 0in; padding-right: 0in; padding-top: 0in;"> = Endo Pilot Program This program was designed for us to able to take more patients thru endo treatment in the clinic and also to allow patients that may not noramly be able to afford treatment at UCLA to be taken care of by avoiding extraction of the tooth in question. Basically the patient must pay for the crown and post (or build up) BEFORE you begin the root canal. If this is done and they are accepted into the pilot program then they will received 50% off endo treatment. To begin the process you have to first find the pink fee reduction form and have it filled out by an endo faculty member as well as by Dr Goldstein (bring him receipt of payment for the crown and build-up as well). You are allowed to take a max of 2 patients through this program. **Make sure the pt understands that if the case becomes too complicated and has to be transferred to grad endo than the pilot program fee reduction can no longer be honored.
 * 9-12 || 9-12 || 9-12 || 9-12 || 9-12 ||
 * 2-5 || 2-5 || 2-5 || 2-5 ||  ||
 * || 6-9 ||  ||   ||   ||
 * || 6-9 ||  ||   ||   ||
 * || 6-9 ||  ||   ||   ||

<span style="border: initial none initial; display: block; padding-bottom: 1pt; padding-left: 0in; padding-right: 0in; padding-top: 0in;">=<span style="border-bottom-style: none; border-color: initial; border-left-style: none; border-right-style: none; border-top-style: none; border-width: initial; padding-bottom: 0in; padding-left: 0in; padding-right: 0in; padding-top: 0in;"> = Confused on which Fuji is appropriate for your case? Here’s a quick run-down on the basics: 4'30" || <span style="line-height: normal; margin-bottom: 0in; margin-left: 0.25in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;">1) loosen powder by tapping <span style="line-height: normal; margin-bottom: 0in; margin-left: 0.25in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;">2) activate capsule by pushing plunger flush with main body, place in applier and click once <span style="line-height: normal; margin-bottom: 0in; margin-left: 0.25in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;">3) mix for 10s in amalgamator (4000 rpm) <span style="line-height: normal; margin-bottom: 0in; margin-left: 0.25in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;">4) load in GC Capsule applier <span style="line-height: normal; margin-bottom: 0in; margin-left: 0.25in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;">5) 2 clicks to prime <span style="line-height: normal; margin-bottom: 0in; margin-left: 0.25in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;">6) extrude directly into restoration || 2' 0" / 4' 15"  (clinically may be less?) || <span style="line-height: normal; margin-bottom: 0in; margin-left: 0.25in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;">1) Place cavity conditioner (polyacrylic acid) 10 sec, rinse and dry but do not dessicate. <span style="line-height: normal; margin-bottom: 0in; margin-left: 0.25in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;">2) loosen powder by tapping <span style="line-height: normal; margin-bottom: 0in; margin-left: 0.25in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;">3) activate capsule by pushing plunger flush with main body, place in applier and click once <span style="line-height: normal; margin-bottom: 0in; margin-left: 0.25in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;">4) mix for 10s in amalgamator (4000 rpm) <span style="line-height: normal; margin-bottom: 0in; margin-left: 0.25in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;">5) load in GC Capsule applier <span style="line-height: normal; margin-bottom: 0in; margin-left: 0.25in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;">6) 2 clicks to prime <span style="line-height: normal; margin-bottom: 0in; margin-left: 0.25in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;">7) extrude directly into restoration || 1. Restoration of Class III, V and limited Class I cavities with **limited isolation** 2. Restoration of primary teeth.  3. Core build up.  4. Cases where a radiopaque restoration is required.  5. Geriatric applications.  6. As a **base or liner** (F- release) || LC || 10 s || 3' 15" working time
 * Fuji Type || Function || Cure || Mixing time || Setting time/ Finishing time || Mftr Instructions ||
 * Fuji I || Radiopaque GI luting cement || Self || 10 s || 2' 15"/
 * Fuji plus || Radiopaque reinforced glass ionomer luting cement || self || 10 s || Mftr:
 * Fuji II: base or liner || Radiopaque light cured reinforced glass ionomer restorative as

20" curing time

1.8 mm curing depth || <span style="line-height: normal; margin-bottom: 0in; margin-left: 0.25in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;">1) Prep: excessive mechanical retention not necessary (ionic bonding) <span style="line-height: normal; margin-bottom: 0in; margin-left: 0.25in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;">2) Place cavity conditioner (polyacrylic acid) 10 sec, rinse and dry but do not dessicate. <span style="line-height: normal; margin-bottom: 0in; margin-left: 0.25in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;">3) activate capsule by pushing plunger flush with main body, place in applier and click once <span style="line-height: normal; margin-bottom: 0in; margin-left: 0.25in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;">4) mix for 10s in amalgamator (4000 rpm) <span style="line-height: normal; margin-bottom: 0in; margin-left: 0.25in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;">5) extrude cement directly into preparation <span style="line-height: normal; margin-bottom: 0in; margin-left: 0.25in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;">6) contour and shape <span style="line-height: normal; margin-bottom: 0in; margin-left: 0.25in; margin-right: 0.55in; margin-top: 0in; text-indent: -0.25in;">7) light cure 20s with 470 nm wavelength. Layer if deeper than 1.8mm <span style="line-height: normal; margin-bottom: 0in; margin-left: 0.25in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;">8) Finish under water spray with superfine diamond, silicone point, polishing strips. || 1. Class I and II restorations in **deciduous** teeth. 2. Non-load bearing Class I and Class II restorations in permanent teeth. 3. **Intermediate restorative and base material** for heavy stress situation in Class I and Class II cavities using **sandwich** laminate technique. 4. **Class V** and root surface restorations. 5. Core build-up. || self || 10s || 2'00" working time
 * Fuji IX || Radiopaque light cured reinforced glass ionomer restorative

2'20" setting time

6'00" finishing time || <span style="line-height: normal; margin-bottom: 0in; margin-left: 0.25in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;">1) Prep: excessive mechanical retention not necessary (ionic bonding) <span style="line-height: normal; margin-bottom: 0in; margin-left: 0.25in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;">2) Place cavity conditioner (polyacrylic acid) 10 sec, rinse and dry but do not dessicate. <span style="line-height: normal; margin-bottom: 0in; margin-left: 0.25in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;">3) activate capsule by pushing plunger flush with main body, place in applier and click once <span style="line-height: normal; margin-bottom: 0in; margin-left: 0.25in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;">4) mix for 10s in amalgamator (4000 rpm) <span style="line-height: normal; margin-bottom: 0in; margin-left: 0.25in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;">5) extrude cement directly into preparation <span style="line-height: normal; margin-bottom: 0in; margin-left: 0.25in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;">6) contour and shape <span style="line-height: normal; margin-bottom: 0in; margin-left: 0.25in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;">7) finish 6 minutes after start of mixing ||

<span style="border: initial none initial; display: block; padding-bottom: 1pt; padding-left: 0in; padding-right: 0in; padding-top: 0in;">=<span style="border-bottom-style: none; border-color: initial; border-left-style: none; border-right-style: none; border-top-style: none; border-width: initial; padding-bottom: 0in; padding-left: 0in; padding-right: 0in; padding-top: 0in;"> Hygiene = Once you have completed all the prophies (not S/RP) you care to do (at least 10), you may schedule all of you prophies with the hygiene students. <span style="font-family: Verdana; line-height: normal; margin-bottom: 0in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;">- You can refer your patients to hygiene students by using one of two options: <span style="font-family: 'Courier New'; line-height: normal; margin-bottom: 0in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;">o 1) email the following info to: __hygienewest@yahoo.com__ <span style="font-family: Wingdings; line-height: normal; margin-bottom: 0in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;">§ Pt name, chart number, pt contact number, Tx plan for the hygiene appt, your name & contact info <span style="font-family: 'Courier New'; line-height: normal; margin-bottom: 0in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;">o 2) enter the patient info into the hygiene referral book found on the 2nd floor behind the GPA’s desk <span style="font-family: Verdana; line-height: normal; margin-bottom: 0in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;">- NOTE: For hygiene to see/Tx the pt, your perio consult must be up-to-date, i.e., you must have a perio consult in the computer that occurred in the past 1 year. If it’s not, you will get a call/email that your pt cannot be seen until perio is updated. One personal  __[NH2]__   suggestion: I like to clean the teeth of each new patient, rather than refer to hygiene. A prophy is a relatively non-intrusive way to begin Tx. I think it helps lay a good foundation for any additional Tx All appointments involving implants are done Wednesday mornings in the removable clinic with Dr. Shah. When you schedule the appointment, you must indicate in the notes section that you have an implant case and need to work with Dr. Shah. Need to have pano and Implant Info Sheet Implant consults: Wednesday afternoon with Dr. Hewlett Thursday afternoon with Dr. Shah  We need some help filling out this section! If you have anything to add please find your nearest ASDA cabinet member to submit!

<span style="border: initial none initial; display: block; padding-bottom: 1pt; padding-left: 0in; padding-right: 0in; padding-top: 0in;">= = <span style="line-height: normal; margin-bottom: 0in; margin-left: 0.25in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> - 1-appt perio therapy <span style="line-height: normal; margin-bottom: 0in; margin-left: 0.5in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> o Aka: “cleaning” = “prophy” = “phase I, 1-appointment prophy” <span style="line-height: normal; margin-bottom: 0in; margin-left: 0.5in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> o A multi-appointment cleaning is called scaling & root planing, and usually should involve anesthetizing one or more quadrants to allow you to plane the roots. See below for more info. <span style="line-height: normal; margin-bottom: 0in; margin-left: 0.5in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> o Things you should have: <span style="line-height: normal; margin-bottom: 0in; margin-left: 0.75in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> § Basic cubicle setup (see below) <span style="line-height: normal; margin-bottom: 0in; margin-left: 0.75in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> § Perio kit (yours or check one out from central) <span style="line-height: normal; margin-bottom: 0in; margin-left: 0.75in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> § Slowspeed handpiece w/ straight attachment or prophy attachment<span style="line-height: normal; margin-bottom: 0in; margin-left: 0.75in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> § Prophy cup & paste <span style="line-height: normal; margin-bottom: 0in; margin-left: 0.5in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> o Tips: <span style="line-height: normal; margin-bottom: 0in; margin-left: 0.75in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> § Use sharp instruments <span style="line-height: normal; margin-bottom: 0in; margin-left: 1in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> · Sharpen before the patient arrives <span style="line-height: normal; margin-bottom: 0in; margin-left: 1in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> · Don’t over sharpen – just a few strokes should do the trick <span style="line-height: normal; margin-bottom: 0in; margin-left: 1in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> · Check for sharpness on the white suction tip – a sharp instrument will peel off plastic like peeling a potato <span style="line-height: normal; margin-bottom: 0in; margin-left: 0.75in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> § Only remove the calculus – save the //root planing// for patients who need //root planing// <span style="line-height: normal; margin-bottom: 0in; margin-left: 0.75in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> § Move around as little as possible & trade instruments out as few times as possible: <span style="line-height: normal; margin-bottom: 0in; margin-left: 1in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> · Follow a planned routine, such as: Max anteriors B then L, UR B & UL L, UR L & UL B, LR B, LL L, LR L, LR B, Mand anteriors L then B <span style="line-height: normal; margin-bottom: 0in; margin-left: 1.25in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> o By working on UR buccal & UL lingual, you can stay in the same position & use the same instruments in the same orientation <span style="line-height: normal; margin-bottom: 0in; margin-left: 1in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> · Also, follow a routine for each posterior quadrant, such as: all the midfacial or midlingual, then all the mesial proximal surfaces, then all the distals <span style="line-height: normal; margin-bottom: 0in; margin-left: 1in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> · Move the patient: “Look toward me” & “Look away from me” work great from the 8-9 o’clock position <span style="line-height: normal; margin-bottom: 0in; margin-left: 1in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> · Also, use the fewest number of instruments as possible – consider eliminating the use of the 11-12, or slowly become comfortable with the Universal <span style="line-height: normal; margin-bottom: 0in; margin-left: 0.75in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> § After you’ve done a few cleanings with hand tools only, check out a Cavitron. Ask someone how to set it up, and just let it work its magic. It works kind of like a Universal that makes like a million tiny strokes a second. Things go much more quickly with the Cavitron. You should always follow up with an explorer to check for spots you missed. <span style="line-height: normal; margin-bottom: 0in; margin-left: 0.5in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> o Administrative stuff: <span style="line-height: normal; margin-bottom: 0in; margin-left: 0.75in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> § Start checks: <span style="line-height: normal; margin-bottom: 0in; margin-left: 1in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> · Before getting a start check, review the previous perio charting, med Hx, date of last prophy or ScRP, etc. <span style="line-height: normal; margin-bottom: 0in; margin-left: 0.75in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> § Perio signature: <span style="line-height: normal; margin-bottom: 0in; margin-left: 1in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> · Perio signatures can only be obtained from __Periodont____ists__. Their faculty coverage varies by day and group. You can obtain a copy of the perio coverage for a given quarter from your group practice administrator. <span style="line-height: normal; margin-bottom: 0in; margin-left: 0.25in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> - 2- or 4-appt perio therapy <span style="line-height: normal; margin-bottom: 0in; margin-left: 0.5in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> o Aka: ScRP, S/RP, quad scaling, scaling and root planing, deep cleaning (don’t call it that) <span style="line-height: normal; margin-bottom: 0in; margin-left: 0.5in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> o Differences between 1-appt & multi-appt cleanings <span style="line-height: normal; margin-bottom: 0in; margin-left: 0.75in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> § ScRP requires a follow-up appt usually 3-6 weeks following Tx to reassess the tissue health <span style="line-height: normal; margin-bottom: 0in; margin-left: 0.75in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> § You usually use anesthetic. If the patient can’t feel it, then you probably aren’t working hard enough <span style="line-height: normal; margin-bottom: 0in; margin-left: 1in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> · You need to really get in there & remove all that subgingival calculus <span style="line-height: normal; margin-bottom: 0in; margin-left: 0.75in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> § There’s a lot of blood, and that’s okay. Keep a bunch of 2x2s handy for ScRP. <span style="line-height: normal; margin-bottom: 0in; margin-left: 0.75in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> § You generally won’t be able to finish all 4 quadrants in one session, especially when you are anesthetizing <span style="line-height: normal; margin-bottom: 0in; margin-left: 0.5in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> o Be sure you clean each quadrant thoroughly…if you don’t, the gums will not be healthy at the F/U [NH3]  appt <span style="line-height: normal; margin-bottom: 0in; margin-left: 0.5in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> o If you have time, you can do the opposing quadrant on the same side. It’s usually no problem sending a patient home with the whole left OR right side numb, but it’s generally NOT okay to send the patient home with a whole arch numb. <span style="line-height: normal; margin-bottom: 0in; margin-left: 0.5in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> o Use the perio probings to your advantage. Often these patients have many 4s, 5s, or deeper. Scale accordingly. <span style="line-height: normal; margin-bottom: 0in; margin-left: 0.25in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> - Follow-up appointment <span style="line-height: normal; margin-bottom: 0in; margin-left: 0.5in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> o After the appropriate healing time after ScRP, see the patient again to follow up on their perio health. <span style="line-height: normal; margin-bottom: 0in; margin-left: 0.5in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> o This appt involves complete probings & re-eval of all perio tissues <span style="line-height: normal; margin-bottom: 0in; margin-left: 0.75in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> § It is essentially like doing a new perio consult <span style="line-height: normal; margin-bottom: 0in; margin-left: 0.5in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> o If the pt is in the clear, you can get a signature & move on <span style="line-height: normal; margin-bottom: 0in; margin-left: 0.5in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> o If not, you may still get a signature after scaling in select areas or you may need you do more extensive treatment & have another follow up appt later on <span style="line-height: normal; margin-bottom: 0in; margin-left: 0.25in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> - Referring to hygiene : <span style="line-height: normal; margin-bottom: 0in; margin-left: 0.5in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> o You can refer your patients to hygiene students by using one of two options: <span style="line-height: normal; margin-bottom: 0in; margin-left: 0.75in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> § 1) email the following info to: hygienewest@yahoo.com <span style="line-height: normal; margin-bottom: 0in; margin-left: 1in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> · Pt name, chart number, pt contact number, Tx plan for the hygiene appt, your name & contact info <span style="line-height: normal; margin-bottom: 0in; margin-left: 0.75in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> § 2) enter the patient info into the hygiene referral book found on the 2nd floor behind the GPA’s desk <span style="line-height: normal; margin-bottom: 0in; margin-left: 0.5in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> o NOTE: For hygiene to see/Tx the pt, your perio consult must be up-to-date, i.e., you must have a perio consult in the computer that occurred in the past 1 year. If it’s not, you will get a call/email that your pt cannot be seen until perio is updated. <span style="line-height: normal; margin-bottom: 0in; margin-left: 0.5in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> o One personal [NH4]  suggestion: I like to clean the teeth of each new patient, rather than refer to hygiene. A prophy is a relatively non-intrusive way to begin Tx. I think it helps lay a good foundation for any additional Tx.

<span style="border: initial none initial; display: block; padding-bottom: 1pt; padding-left: 0in; padding-right: 0in; padding-top: 0in;">=<span style="border-bottom-style: none; border-color: initial; border-left-style: none; border-right-style: none; border-top-style: none; border-width: initial; padding-bottom: 0in; padding-left: 0in; padding-right: 0in; padding-top: 0in;"> = All insurance companies (except Delta Dental), patients must pay the full fee and the insurance company will reimburse the patient. All fee schedules can be requested from the Chart Room.

DELTA DENTAL: UCLA only deals with Delta Dental directly. For patients that have Delta Dental, you can ask them to pay only the portion of the procedure that Delta does not cover. For ALL other insurance plans, the patient must pay up front and inform them that they will receive their refund directly from their insurance company in the mail and not through UCLA.

MEDICAL/DENTICAL: Check MediCal/DentiCal eligibility at the billing office at the beginning of each month. Patients with MediCal receive courtesy fees that existed with DentiCal. Only extractions are covered by DentiCal due to a federal mandate. However, radiology is no longer covered for adults, nor do they receive a fee reduction for radiographs. Furthermore, DentiCal coverage is only applied to children under the age of 21. DentiCal will cover radiographs for eligible children under the age of 21.

RYAN WHITE PATIENTS: Ryan White pts are allowed up to $1,500.00 to spend on dental treatment per year. Fee reduction forms may be found in Marisa’s office (Dr. Goldstein’s assistant) and must be approved and signed by Dr. Younai prior to the procedure. Once signed, take fee reduction to the billing office.

UCLA DENTAL STUDENTS: Most procedures are approximately 50% off.

New Patient: Radiographs and S creening & Radiographs <span style="line-height: normal; margin-bottom: 0in; margin-left: 0.25in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> - Six patients are screened by a group practice director (GPD) Monday thru Thursday from ~7:45-9:00 or ~12:30-2:00 <span style="line-height: normal; margin-bottom: 0in; margin-left: 0.25in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> - The GPD looks at each pt for ~10 minutes to decide generally what the pt needs & explain the clinic process briefly <span style="line-height: normal; margin-bottom: 0in; margin-left: 0.5in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> o The purpose of the exam is to determine if the patient’s case is suitable for a dental student as well as to make the pt aware of the policies we have at UCLA and our expectations of the patients to adhere to them <span style="line-height: normal; margin-bottom: 0in; margin-left: 0.25in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> - The overall possible Tx needs are noted on a white form that gets a blue form stapled on top of it <span style="font-family: Verdana; line-height: normal; margin-bottom: 0in; margin-left: 0.25in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;">- If accepted, the patient will go to the cashier’s window to pay $110 <span style="font-family: 'Courier New'; line-height: normal; margin-bottom: 0in; margin-left: 0.5in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;">o $70 for an FMX <span style="font-family: 'Courier New'; line-height: normal; margin-bottom: 0in; margin-left: 0.5in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;">o $40 for Initial OD and Periodic Exam<span style="line-height: normal; margin-bottom: 0in; margin-left: 0.25in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> - This will then be delivered to a student in the rotating file on your GPA’s desk. An email will also be sent to you.

<span style="border: initial none initial; display: block; padding-bottom: 1pt; padding-left: 0in; padding-right: 0in; padding-top: 0in;">=<span style="border-bottom-style: none; border-color: initial; border-left-style: none; border-right-style: none; border-top-style: none; border-width: initial; padding-bottom: 0in; padding-left: 0in; padding-right: 0in; padding-top: 0in;"> = Follow these steps to complete an appointment for a patient choosing nitrous: 1. A few days to a week before the apt, go to the back of central and tell them you want nitrous. They will give you a little sheet to fill out. Fill it out and give it back to them. 2. The day of the apt, have the pt pay $40 at the billing office. 3. Grab the receipt from the pt and go to the back of central. 4. Show them the receipt and they will give you a tank of nitrous. 5. You can then use the nitrous on your pt. 6. Turn in the nitrous to the back of central after your apt is over. 7. Make sure to have your nitrous sheet signed off by your covering faculty at end of apt for nitrous credit.

<span style="border: initial none initial; display: block; padding-bottom: 1pt; padding-left: 0in; padding-right: 0in; padding-top: 0in;">=<span style="border-bottom-style: none; border-color: initial; border-left-style: none; border-right-style: none; border-top-style: none; border-width: initial; padding-bottom: 0in; padding-left: 0in; padding-right: 0in; padding-top: 0in;"> = <span style="line-height: normal; margin-bottom: 0in; margin-left: 0.5in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;">1. This is the 1st appointment you schedule for your patient after assignment <span style="line-height: normal; margin-bottom: 0in; margin-left: 1in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;">a. Be sure your pt understands what the OD exam is, because sometimes they confuse OD with the brief screening exam done by the group directors at their very first visit <span style="line-height: normal; margin-bottom: 0in; margin-left: 1in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;">b. You can schedule the OD appt with Linda or Lorraine in the clinic lobby, or at the New Patient window, which is opposite the chartroom window on GSD-ACADEMIC. a. To schedule a new patient OD exam, you need to have the blue assignment form, which you pick up at your GPA’s desk <span style="line-height: normal; margin-bottom: 0in; margin-left: 1in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;">c. Appointment time options are: 9AM, 10:30AM, 2PM or 3:30PM

<span style="line-height: normal; margin-bottom: 0in; margin-left: 1in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;">d. These appointments are expected to last ~1-1.5 hours <span style="line-height: normal; margin-bottom: 0in; margin-left: 1in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;">e. If you schedule at 9:00 or 2:00, you can usually make it upstairs in time to conduct one or more consults i. When scheduling consults after OD, make sure there will be enough faculty coverage for what you want to do. You must check with your GPA regarding scheduling clinic space for consults or pre-ATP <span style="line-height: normal; margin-bottom: 0in; margin-left: 1.5in; margin-right: 0in; margin-top: 0in; text-indent: -1.5in;"> i. For details regarding consults, see the __ Consults __. <span style="line-height: normal; margin-bottom: 0in; margin-left: 1.5in; margin-right: 0in; margin-top: 0in; text-indent: -1.5in;"> ii. If the pt has a complicated medical hx, you must schedule for 9 AM or 2 PM so there will be enough time to complete the OD (this will be noted on the blue introductory form). <span style="line-height: normal; margin-bottom: 0in; margin-left: 0.5in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;">2. The actual OD exam is performed by a student on block <span style="line-height: normal; margin-bottom: 0in; margin-left: 1in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;">a. The patient’s assigned student should be there for the exam, so s/he they will know s what’s going on <span style="line-height: normal; margin-bottom: 0in; margin-left: 0.5in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;">3. Tips for speeding up the OD appt (regardless of whether you are doing the OD or if you are assisting the block student): <span style="line-height: normal; margin-bottom: 0in; margin-left: 1in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;">a. Be sure you’ve reviewed the patient’s chart (i.e., the health questionnaire & radiographs) <span style="line-height: normal; margin-bottom: 0in; margin-left: 1in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;">b. Find a block student & let Susan aware know that your patient is present and that it appears that a block student is available <span style="line-height: normal; margin-bottom: 0in; margin-left: 1in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;">c. When you seat the patient, have him/her sign the DMF form <span style="line-height: normal; margin-bottom: 0in; margin-left: 1.5in; margin-right: 0in; margin-top: 0in; text-indent: -1.5in;"> i. __Place__ __the__ __DMF__ __form__ __in__ __the__ __chart__ __one__ __page__ __ahead__ __of__ __the__ __salmon-colored__ __Progress__ __notes__ <span style="line-height: normal; margin-bottom: 0in; margin-left: 1in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;">d. The student NOT doing the exam should look up any meds while the block student is asking questions <span style="line-height: normal; margin-bottom: 0in; margin-left: 1in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;">e. When the block student puts the gloves on, offer to type their findings into the computer <span style="line-height: normal; margin-bottom: 0in; margin-left: 1in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;">f. Spend time with the important stuff <span style="line-height: normal; margin-bottom: 0in; margin-left: 1.5in; margin-right: 0in; margin-top: 0in; text-indent: -1.5in;"> i. Inquire well about past illnesses & current conditions – get all the info you need <span style="line-height: normal; margin-bottom: 0in; margin-left: 1.5in; margin-right: 0in; margin-top: 0in; text-indent: -1.5in;"> ii. Use the medications the pt is taking as your guide <span style="line-height: normal; margin-bottom: 0in; margin-left: 2in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;">1. E.g., if they are taking Atenolol, you should be sure you ask about Hypertension, even if they didn’t mention it <span style="line-height: normal; margin-bottom: 0in; margin-left: 1.5in; margin-right: 0in; margin-top: 0in; text-indent: -1.5in;"> iii. Ask appropriate follow-up questions <span style="line-height: normal; margin-bottom: 0in; margin-left: 1in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;">g. Don’t spend extra time on the ‘easy stuff’ <span style="line-height: normal; margin-bottom: 0in; margin-left: 1.5in; margin-right: 0in; margin-top: 0in; text-indent: -1.5in;"> i. I am yet to have a patient fail the sensory nerve exam – you remember: “Is this soft or sharp?” <span style="line-height: normal; margin-bottom: 0in; margin-left: 2in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;">1. So, don’t spend 5 minutes testing V1, V2, and V3 <span style="line-height: normal; margin-bottom: 0in; margin-left: 2in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;">2. Just as a side note, use the same method for the sharp & soft…don’t brush the cheek with the soft & poke with the sharp, get it? <span style="line-height: normal; margin-bottom: 0in; margin-left: 1.5in; margin-right: 0in; margin-top: 0in; text-indent: -1.5in;"> ii. Be brief with your examination of the teeth themselves (attrition, erosion, abfraction) <span style="line-height: normal; margin-bottom: 0in; margin-left: 2in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;">1. There will be plenty of time for a tooth-by-tooth exam upstairs <span style="line-height: normal; margin-bottom: 0in; margin-left: 2in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;">2. E.g., don’t worry if there is 2 or 2.5 mm recession on the MB aspect of #14 <span style="line-height: normal; margin-bottom: 0in; margin-left: 1in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;">h. Be aware of the faculty & the other patients being examined <span style="line-height: normal; margin-bottom: 0in; margin-left: 1.5in; margin-right: 0in; margin-top: 0in; text-indent: -1.5in;"> i. Case-in-point: if two other groups are waiting for the instructor & you are __almost__ finished, put your name on the list <span style="line-height: normal; margin-bottom: 0in; margin-left: 2in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;">1. By the time s/he is they are available, it’s your turn <span style="line-height: normal; margin-bottom: 0in; margin-left: 2in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;">2. At the same time, don’t start a list until you are ready…be reasonable & considerate of your classmates <span style="line-height: normal; margin-bottom: 0in; margin-left: 1.5in; margin-right: 0in; margin-top: 0in; text-indent: -1.5in;"> ii. Fill out everything __before__ the instructor sees your patient <span style="line-height: normal; margin-bottom: 0in; margin-left: 2in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;">1. Complete the Specialty tab section in GSD-ACADEMIC <span style="line-height: normal; margin-bottom: 0in; margin-left: 2in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;">2. Do your SOAP notes for the session <span style="line-height: normal; margin-bottom: 0in; margin-left: 2in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;">3. Fill out the beige page of the patient chart (on the left under the HIPAA form) <span style="line-height: normal; margin-bottom: 0in; margin-left: 0.5in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;">4. At the end of the OD exam, you must get the chart cleared by Irene before leaving the OD clinic <span style="line-height: normal; margin-bottom: 0in; margin-left: 1in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;">a. Otherwise, you will not have access to the chart when you go upstairs for consults <span style="line-height: normal; margin-bottom: 0in; margin-left: 1in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;">b. Make sure the DMF form is in the right place…one page ahead of the salmon-colored Progress notes <span style="line-height: normal; margin-bottom: 0in; margin-left: 0.5in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;">5. If a periodic exam is done in addition to the 3 yr OD, the total cost is only $25 and covers both the OD exam and the periodic exam. They are NOT two separate charges.

When you are in OD, they have a specific format that most faculty members like to see in your SOAP Notes. It is posted on the wall in most of the cubicles. CC: whatever they complain of Last dental visit: || Allergies: Meds: BP = --/--, HR(reg/irreg), RR EOE: IOE: Hard tissue: Soft Tissue: Note any findings like lesions or sores on the mucosa, or bands of discoloration along teeth. (-) EOE cancer screening Oral hygiene: poor, moderate, good. Mild, moderate, severe plaque. || Pt can proceed to consults. || Discussed with patients what to expect when being treated here at UCLA. Pt left satisfied. ||
 * S || -- year old m/f presents for initial exam and OD workup (or 3yr OD recall)
 * O || Reviewed medical history which was notable for…otherwise NSF and NKDA.
 * A || Healthy pt with minor dental precautions suitable for comprehensive dental care.
 * P || Completed initial assessment/3 year OD recall exam including procuring the health hx, a review of systems, obtaining the vital signs and an extra and intra oral exam. Oral cancer screening completd.
 * NV || Perio and rest consults / Pre ATP ||

<span style="border: initial none initial; display: block; padding-bottom: 1pt; padding-left: 0in; padding-right: 0in; padding-top: 0in;">=<span style="border-bottom-style: none; border-color: initial; border-left-style: none; border-right-style: none; border-top-style: none; border-width: initial; padding-bottom: 0in; padding-left: 0in; padding-right: 0in; padding-top: 0in;"> = We need some help filling out this section! If you have anything to add please find your nearest ASDA cabinet member to submit!

 <span style="border: initial none initial; display: block; padding-bottom: 1pt; padding-left: 0in; padding-right: 0in; padding-top: 0in;">=  Assignment   = <span style="line-height: normal; margin-bottom: 0in; margin-left: 0.25in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> - You will receive patient assignments in one of two three ways: <span style="line-height: normal; margin-bottom: 0in; margin-left: 0.5in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> o 1) New patient assignment from you group director <span style="line-height: normal; margin-bottom: 0in; margin-left: 0.5in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> o 2) Greenslip someone you know <span style="font-family: 'Courier New'; line-height: normal; margin-bottom: 0in; margin-left: 0.5in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;">o 3) Pt transfer for whatever reason <span style="line-height: normal; margin-bottom: 0in; margin-left: 0.25in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> - For new pt assignments, you will get an email from your GPD or GPA (G.P. Administrator) <span style="line-height: normal; margin-bottom: 0in; margin-left: 0.5in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> o You will also get the aforementioned blue form with white page stapled behind it <span style="line-height: normal; margin-bottom: 0in; margin-left: 0.75in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> § Pick up the form at your GPA’s desk <span style="line-height: normal; margin-bottom: 0in; margin-left: 0.75in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> § The blue page has the pt name, chart #, and phone # <span style="line-height: normal; margin-bottom: 0in; margin-left: 0.75in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> § The white page describes the likely overall Tx needs (operative, fixed, endo, perio, etc) <span style="line-height: normal; margin-bottom: 0in; margin-left: 1in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> · This page may indicate that your pt needs ATP (What’s ATP? see below)<span style="line-height: normal; margin-bottom: 0in; margin-left: 0.5in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> o You can also determine the patient’s needs in GSD-ACADEMIC under the ‘Patients’ tab <span style="line-height: normal; margin-bottom: 0in; margin-left: 0.75in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> § Click on the chart tab, then find the gray Misc. tab next to the red Radiology tab <span style="line-height: normal; margin-bottom: 0in; margin-left: 0.75in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> § The Misc. tab has a series of notes from the initial pt screening, indicating the overall probable needs of your pt <span style="line-height: normal; margin-bottom: 0in; margin-left: 0.5in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> o Use the two above sources of info to determine if your patient needs ATP <span style="line-height: normal; margin-bottom: 0in; margin-left: 0.5in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> o Your GPD may also add notes to this blue page indicating whether the patient is to be shared with another member of your CPC team as well as whether the patient may require ATP. <span style="line-height: normal; margin-bottom: 0in; margin-left: 0.5in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> o Once you are given notice you must attempt to call your patient within 48 hours. <span style="line-height: normal; margin-bottom: 0in; margin-left: 0.5in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> o Radiology consultation should be done prior to perio/restorative consults. <span style="line-height: normal; margin-bottom: 0in; margin-left: 0.25in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> - **ATP vs. Fast track** <span style="line-height: normal; margin-bottom: 0in; margin-left: 0.5in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> o **ATP** = Advanced Treatment Planning <span style="line-height: normal; margin-bottom: 0in; margin-left: 0.75in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> § This is a session wherein you meet with a restorative instructor, a perio instructor, and a removable instructor <span style="line-height: normal; margin-bottom: 0in; margin-left: 0.75in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> § By having input from all three areas, you can, in theory, create a better treatment plan <span style="line-height: normal; margin-bottom: 0in; margin-left: 0.75in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> § Prior to the ATP appt, you need properly mounted casts, and have completed your own ‘pre-ATP workup’ <span style="line-height: normal; margin-bottom: 0in; margin-left: 1in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> · Pre-ATP refers to the gathering of info you would use for consults (tooth-by-tooth exam, perio charting, proposed RPD designs, if applicable) + impressions & records (facebow, interocclusal record) <span style="line-height: normal; margin-bottom: 0in; margin-left: 0.75in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> § ATP cases do not require any consults other than the ATP consult itself <span style="line-height: normal; margin-bottom: 0in; margin-left: 0.75in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> § More detail is found below in the section for //Consultations// <span style="line-height: normal; margin-bottom: 0in; margin-left: 0.5in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> o **Fast** **track**: <span style="line-height: normal; margin-bottom: 0in; margin-left: 0.75in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> § These pts have more straightforward cases, so they do not require ATP <span style="line-height: normal; margin-bottom: 0in; margin-left: 0.75in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> § Following OD, you obtain any necessary consultations (restorative, perio, endo, etc .) prior to submitting the treatment plan to be approved by your GPD. <span style="line-height: normal; margin-bottom: 0in; margin-left: 0.5in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> o Follow Dr. Woods’ guidelines [NH5]  for what constitutes an ATP vs. Fast track patient <span style="line-height: normal; margin-bottom: 0in; margin-left: 0.75in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> § This info is found on a pink Tx planning form [NH6]  at the back windows in the clinic behind central sterilization or in the Student Lounge <span style="line-height: normal; margin-bottom: 0in; margin-left: 0.75in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> § The Fast track criteria are as follows: <span style="line-height: normal; margin-bottom: 0in; margin-left: 1in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> · Simple to intermediate perio needs (no anticipated extractions, other than 3rd molars) <span style="line-height: normal; margin-bottom: 0in; margin-left: 1in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> · Eight or fewer fixed units (“simple” 3-unit bridge O.K.) <span style="line-height: normal; margin-bottom: 0in; margin-left: 1in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> · No partial dentures <span style="line-height: normal; margin-bottom: 0in; margin-left: 1in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> · Reasonable occlusion <span style="line-height: normal; margin-bottom: 0in; margin-left: 1in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> · No TM disorder or significant attrition <span style="line-height: normal; margin-bottom: 0in; margin-left: 0.25in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> - You are expected to call the pt within 48 hours of receiving notification of pt assignment <span style="line-height: normal; margin-bottom: 0in; margin-left: 0.5in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> o As soon as you can, check out the pt’s chart & look at the radiographs, so you know what you’re dealing with <span style="line-height: normal; margin-bottom: 0in; margin-left: 0.5in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> o Speak with your group director about doing a radiographic consult as soon as you get the chart <span style="line-height: normal; margin-bottom: 0in; margin-left: 0.25in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> - Contact the pt & introduce yourself, indicating that you’d like to schedule their 1st appt as soon as possible <span style="line-height: normal; margin-bottom: 0in; margin-left: 0.5in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> o Plan ahead so you can offer the pt two or three available times for the OD appt (don’t call it OD) <span style="line-height: normal; margin-bottom: 0in; margin-left: 0.75in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> § See next section: ‘ Scheduling A a ppointments ’ for more info <span style="font-family: 'Courier New'; line-height: normal; margin-bottom: 0in; margin-left: 0.5in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;">o My experience is that the pts Patients are usually not fully aware of how the clinic works <span style="font-family: Wingdings; line-height: normal; margin-bottom: 0in; margin-left: 0.75in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;">§ I have found i I t may help s to explain that there is a Tx planning phase of up to 3 appts before beginning actual Tx, and that this phase is important to determine all of the pt’s needs so we can give them the best Tx possible (help them see that it is in their own best interest) <span style="line-height: normal; margin-bottom: 0in; margin-left: 0.75in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> § Tell them that the first exam is a review of their overall health & medications, and includes an oral cancer screening <span style="line-height: normal; margin-bottom: 0in; margin-left: 1in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> · Explain that the exam lasts about 1-1.5 hours <span style="line-height: normal; margin-bottom: 0in; margin-left: 0.75in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> § If you can schedule a 9:00 or 2:00 OD appt (see below), then tell them that following the first exam, you plan to go into the clinic to examine their teeth & gums and take impressions of their teeth, if necessary. <span style="line-height: normal; margin-bottom: 0in; margin-left: 1in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> · Caution when attempting this as it depends a lot on how busy OD is as many appoints can extend further than 1.5hrs. <span style="line-height: normal; margin-bottom: 0in; margin-left: 0.75in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> § If the pt needs ATP, consider informing them that there will be another exam, wherein you will meet with three instructors from different specialties to determine their needs & plan their case

<span style="border: initial none initial; display: block; padding-bottom: 1pt; padding-left: 0in; padding-right: 0in; padding-top: 0in;">=<span style="border-bottom-style: none; border-color: initial; border-left-style: none; border-right-style: none; border-top-style: none; border-width: initial; padding-bottom: 0in; padding-left: 0in; padding-right: 0in; padding-top: 0in;"> = Requests for new patients must be made through your GPD. Group A is the only group that should still be using patient request forms, which can be obtained from the GPA in group A. If you feel you have the time for an additional patient, mention this to your GPD and the appropriate action will be taken. If you are in group C, the GPD is aware of the procedures that you still need to graduate and so will help to find a patient that will specifically fill those needs.

<span style="border: initial none initial; display: block; padding-bottom: 1pt; padding-left: 0in; padding-right: 0in; padding-top: 0in;">=<span style="border-bottom-style: none; border-color: initial; border-left-style: none; border-right-style: none; border-top-style: none; border-width: initial; padding-bottom: 0in; padding-left: 0in; padding-right: 0in; padding-top: 0in;"> = We need some help filling out this section! If you have anything to add please find your nearest ASDA cabinet member to submit!

 <span style="border: initial none initial; display: block; padding-bottom: 1pt; padding-left: 0in; padding-right: 0in; padding-top: 0in;">= = <span style="line-height: normal; margin-bottom: 0in; margin-left: 0.25in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> - You probably have several patients in need of a periodic exam now or in the near future. What’s a periodic exam? <span style="line-height: normal; margin-bottom: 0in; margin-left: 0.5in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> o This is an exam that generally involves new perio & restorative consults, and any additional consults, as necessary. <span style="line-height: normal; margin-bottom: 0in; margin-left: 0.5in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> o Perio: just like for a new patient <span style="line-height: normal; margin-bottom: 0in; margin-left: 0.5in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> o Rest: you usually will only need new BWX (and perhaps some select PAs) to re-evaluate the teeth. You will do an intraoral tooth-by-tooth exam as well, and complete the consult as usual. <span style="line-height: normal; margin-bottom: 0in; margin-left: 0.25in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> - If everything goes quickly, and the pt needs only a 1-appt prophy from the perio standpoint, you may be able to do it during the appt as well. <span style="line-height: normal; margin-bottom: 0in; margin-left: 0.25in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> - If the pt has new Tx needs, you should submit a new Tx plan (all on a new Tx plan tab). <span style="line-height: normal; margin-bottom: 0in; margin-left: 0.5in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> o This is true even if the pt has ongoing Tx needs. Just include any unfinished, but still necessary, treatment items in the new plan. Submit it & have it approved as you would a new Tx plan.

<span style="border: initial none initial; display: block; padding-bottom: 1pt; padding-left: 0in; padding-right: 0in; padding-top: 0in;">=<span style="border-bottom-style: none; border-color: initial; border-left-style: none; border-right-style: none; border-top-style: none; border-width: initial; padding-bottom: 0in; padding-left: 0in; padding-right: 0in; padding-top: 0in;"> = We need some help filling out this section! If you have anything to add please find your nearest ASDA cabinet member to submit! <span style="border: initial none initial; display: block; padding-bottom: 1pt; padding-left: 0in; padding-right: 0in; padding-top: 0in;">=<span style="border-bottom-style: none; border-color: initial; border-left-style: none; border-right-style: none; border-top-style: none; border-width: initial; padding-bottom: 0in; padding-left: 0in; padding-right: 0in; padding-top: 0in;"> =  Must be completed by SPRING QUARTER of THIRD YEAR: · Complete 40 preventive points – 10 points per quarter should be achieved each quarter otherwise student will receive CD until the requirements are met. If the requirement is not met by the end of Spring quarter, student will receive a NP. · OHI Competency – This must be completed on one of your patients. Once you know your patient will come in for their clinic time, make an appointment with Ms Solomon on Mon/Thurs or Dr Spolsky Mon 2-5PM. You should have prepared a patient hand mirror (NOT our clinical mouth mirrors), typodont or other model and your “Chairside Instructor” book. Must be completed by WINTER QUARTER of FOURTH YEAR: · Complete 40 additional preventive points – These are on top of the 40 previously mentioned. Take note that extra points from third year are NOT carried over into fourth year. · Preventive Tx Plan Competency – This should ideally be done during an ATP appointment. This involves dragging over the PREVTX1-4. PREVTX1-3 should be completed before coming to ATP or before approval of Fast Track Tx Plan. PREVTX4 is completed AFTER getting rest/perio consults. The items checked off should appear under the Preventive tab on the right side and should then be dragged into the Preparatory section of your treatment plan. In ATP, Dr Spolsky will sign off the preventive tx plan and on the clinic floor any restorative faculty member can sign this off. What counts as preventive points? · PREVTX1-4 – This can only be completed 1x/year for each patient so check to see when the last time it was done · OHI – This can be dragged over at every appointment as every appointment should end with a brief review on the topics that apply to your patient · Tobacco Counseling · Nutritional Counseling The table on the following pages can be used to assist in determining what is an appropriate recommendation for your patients



<span style="border: initial none initial; display: block; padding-bottom: 1pt; padding-left: 0in; padding-right: 0in; padding-top: 0in;"> =<span style="border-bottom-style: none; border-color: initial; border-left-style: none; border-right-style: none; border-top-style: none; border-width: initial; padding-bottom: 0in; padding-left: 0in; padding-right: 0in; padding-top: 0in;"> =

1. Making an appointment for an FMX at the radiology department (PRIOR to the appointment). BWX do not require appointments, they can be taken on walk-in appointments. Schedule FMX radiology appointment approximately 1 hr prior to OD/PE. 2. FMX’s are needed every 3 to 5 years, BWX every year. The first step is to have a faculty member sign the patient’s “Radiology Exposure Record” which is found in the very end of their patient folder. 3. Get a care slip from the radiology department. Bring the care slip and the patient to billing and have the patient pay for it. 4. Bring patient back to radiology department with care slip, receipt, and chart.

RYAN WHITE: For a patient on the Ryan White fund, you will need to have Dr. Younai sign the blue fee-reduction form and then you will have to bring it to the Billing office. Lynn will do her magic thang and give you a form to bring to Oral Radiology along with the patient’s chart.

MEDI-CAL & DENTI-CAL: For patients with Medi-Cal/Denti-Cal under the age of 21, check eligibility with the Radiology department or Billing office at the beginning of each month. Radiographs are no charge to Medi-Cal eligible patients.

NO FMX APPOINTMENT: If radiology is full and or you forgot to schedule a FMX radiology appointment, you can take the pt up to 2ndor 3rd floor and take the FMX yourself.

<span style="line-height: normal; margin-bottom: 0.1pt; margin-left: 0.5in; margin-right: 0in; margin-top: 0.1pt; text-indent: -0.25in;"> · FMX: $70 <span style="line-height: normal; margin-bottom: 0.1pt; margin-left: 0.5in; margin-right: 0in; margin-top: 0.1pt; text-indent: -0.25in;"> · BWX: $33 <span style="line-height: normal; margin-bottom: 0.1pt; margin-left: 0.5in; margin-right: 0in; margin-top: 0.1pt; text-indent: -0.25in;"> · PA: $18 - first one <span style="line-height: normal; margin-bottom: 0.1pt; margin-left: 1in; margin-right: 0in; margin-top: 0.1pt; text-indent: -0.25in;"> o $8 - each additional radiograph <span style="line-height: normal; margin-bottom: 0.1pt; margin-left: 0.5in; margin-right: 0in; margin-top: 0.1pt; text-indent: -0.25in;"> · Pano: $70

RADIOLOGY CONSULTS: Schedule an appointment (1hr long) in Radiology room (appointment book can be found taped to desk). Check out a pt chart (with relatively complex dental treatment) and fill out green Radiology worksheet (also found in Radiology room). Know density, contrast, resolution and normal anatomical structures. Tuesdays – are done by Dr. Rappeport. Two consults must be done each quarter.

 <span style="border: initial none initial; display: block; padding-bottom: 1pt; padding-left: 0in; padding-right: 0in; padding-top: 0in;"> = xam  = <span style="line-height: normal; margin-bottom: 0in; margin-left: 0.25in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> - This involves a review of the pt’s oral health habits, with any necessary OHI re-instruction <span style="line-height: normal; margin-bottom: 0in; margin-left: 0.25in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> - Re-educate the pt regarding maintenance of the denture & the edentulous ridges <span style="line-height: normal; margin-bottom: 0in; margin-left: 0.25in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> - Discuss any complaints the pt may have <span style="line-height: normal; margin-bottom: 0in; margin-left: 0.25in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> - Perform a soft tissue exam, take x-rays if needed, and inspect the dentures <span style="line-height: normal; margin-bottom: 0in; margin-left: 0.5in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> o Check denture fit & occlusion <span style="line-height: normal; margin-bottom: 0in; margin-left: 0.5in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> o Look for signs of any ulcerations, fibrous tissue, redness, fungal infections, etc. <span style="line-height: normal; margin-bottom: 0in; margin-left: 0.25in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> - Inquire regarding the pt’s masticatory function, use the denture, concerns, etc.

<span style="border: initial none initial; display: block; padding-bottom: 1pt; padding-left: 0in; padding-right: 0in; padding-top: 0in;"> =<span style="border-bottom-style: none; border-color: initial; border-left-style: none; border-right-style: none; border-top-style: none; border-width: initial; padding-bottom: 0in; padding-left: 0in; padding-right: 0in; padding-top: 0in;"> =

 <span style="border: initial none initial; display: block; padding-bottom: 1pt; padding-left: 0in; padding-right: 0in; padding-top: 0in;"> =<span style="border-bottom-style: none; border-color: initial; border-left-style: none; border-right-style: none; border-top-style: none; border-width: initial; padding-bottom: 0in; padding-left: 0in; padding-right: 0in; padding-top: 0in;"> =

For patients in your team that are HIV+ and have been approved for the Ryan White program, there are a couple extra things that must be done at each appointment. These patients do not pay for most routine work (Ryan White covers most procedures outside of esthetic work). Before the appointment, find one of the blue forms in Marisa’s office. The form has spaces to fill out for your name, the patients name and number etc. It also has a few lines for the procedure you are planning on completing. Because there are only a few spaces it is recommended that you do one of these for each appointment or a small group of appointments to keep the paperwork from getting lost and prevent the patient from being accidentally charged. Enter the procedure name and code as well as the price. The reduction is the total of the procedure and the cost to the patient should be 0. This form is then taken to Dr Younai to be approved. For most basic things she will sign it without looking at the chart, but bring it with you just in case. She can be hard to find sometimes so do this ahead of time so that things are taken care of before the patients appointment. On the day of the appointment, turn the blue form into the billing office. They will set the paper aside to be entered into GSD after charges have been completed. If the patient is having radiographs taken downstairs in radiology, bring them a copy of the form as a substitute for payment slip.

 <span style="border: initial none initial; display: block; padding-bottom: 1pt; padding-left: 0in; padding-right: 0in; padding-top: 0in;"> =  Appointments   = <span style="line-height: normal; margin-bottom: 0in; margin-left: 0.25in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> - Schedule as far in advance as possible <span style="line-height: normal; margin-bottom: 0in; margin-left: 0.5in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> o You can schedule for up to 3 weeks in advance. What does that mean? <span style="line-height: normal; margin-bottom: 0in; margin-left: 0.75in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> § You can schedule as early as Sunday evening at 7:00pm for the upcoming 3 weeks. <span style="line-height: normal; margin-bottom: 0in; margin-left: 1in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> · If today is Sunday, 7/22 4/4, at 7pm you can request appointments for tomorrow through Friday, 4/22 8/10 . <span style="line-height: normal; margin-bottom: 0in; margin-left: 1in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> · But, until next Sunday, 7/29 4/11, you cannot request any appointments beyond Friday 8/10 4/22 . Makes sense? //*Short of providing an GSD-ACADEMIC tutorial session,// I included here are a few tips on scheduling below. You need to be aware of four things: 1) Your schedule, 2) Faculty coverage, 3) Cubicle availability, and 4) Patient schedule. I p P ut patient ’s schedule last, because you should have a pretty good idea of the other three prior to calling the patient. <span style="line-height: normal; margin-bottom: 0in; margin-left: 0.25in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> - Your schedule: <span style="line-height: normal; margin-bottom: 0in; margin-left: 0.5in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> o Keep track of it somehow: paper or electronic <span style="line-height: normal; margin-bottom: 0in; margin-left: 0.75in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> § For example, you might choose to use a PDA or PDA i phone with Microsoft Outlook (or whatever program you like ) <span style="line-height: normal; margin-bottom: 0in; margin-left: 0.25in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> - Faculty coverage: <span style="line-height: normal; margin-bottom: 0in; margin-left: 0.5in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> o With the new ability to access GSD-ACADEMIC remotely (from __your__ laptop anywhere w/ internet), you can monitor clinic availability <span style="line-height: normal; margin-bottom: 0in; margin-left: 0.5in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> o Things to consider: <span style="line-height: normal; margin-bottom: 0in; margin-left: 0.75in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> § Faculty coverage is limited by section: <span style="line-height: normal; margin-bottom: 0in; margin-left: 1in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> · Restorative: 8 ?? appts/session/instructor – sorry, I don’t know what the limit is <span style="line-height: normal; margin-bottom: 0in; margin-left: 1in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> · Perio: 11 ?? appts/session/instructor – sorry, I don’t know what the limit is <span style="line-height: normal; margin-bottom: 0in; margin-left: 1in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> · Removable: it has its own clinic, but it’s something like 15-25 cubes/session, depending on the day <span style="line-height: normal; margin-bottom: 0in; margin-left: 1in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> · OD: 6
 * you can even sync your iphone with Microsoft Outlook

appts/session (9:00, 10:30, 2:00, and 3:30) <span style="line-height: normal; margin-bottom: 0in; margin-left: 1in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> · ATP: you aren’t allowed to do ATP until Fall of your 3rd year, but it’s 3/hr x 3 hours = 9 per half day <span style="line-height: normal; margin-bottom: 0in; margin-left: 1.25in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> o Currently, ATP is offered Monday afternoon, Tuesday afternoon, and Thursday morning <span style="line-height: normal; margin-bottom: 0in; margin-left: 0.75in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> § How to check availability in your section: <span style="line-height: normal; margin-bottom: 0in; margin-left: 1in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> · Login to GSD-ACADEMIC <span style="line-height: normal; margin-bottom: 0in; margin-left: 1in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> · Click on File > Appointments > then select your Group (A, B, C, or D). This will bring up a window with all the availability for your group – for morning appts (above) & afternoon (below). Find your cube number to look at your home cube availability. You can plan ahead by changing the date on the upper left. <span style="line-height: normal; margin-bottom: 0in; margin-left: 1.25in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> o Count the number of yellow boxes for restorative, violet /cyan boxes for perio, & pink boxes for consults

<span style="font-family: 'Courier New'; line-height: normal; margin-bottom: 0in; margin-left: 1.25in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;">o Subtract the number of boxes from how many the faculty can cover <span style="font-family: Wingdings; line-height: normal; margin-bottom: 0in; margin-left: 1.5in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;">§ Eg. There are 2 restorative faculty and you count 10 yellow squares. The 2 restorative faculty can cover 16 students. They can cover 6 more students. <span style="font-family: Wingdings; line-height: normal; margin-bottom: 0in; margin-left: 1.5in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;">§ See “ Waitlist ” to see if you will get a cube. <span style="line-height: normal; margin-bottom: 0in; margin-left: 1in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> · You can do the same thing for Removable, OD workup, ATP (under ‘New room’), & Endo <span style="line-height: normal; margin-bottom: 0in; margin-left: 1in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> · Some GPAs will also put the number of students the covering faculty will take in parenthesis and also may make a note when one faculty member is full. <span style="line-height: normal; margin-bottom: 0in; margin-left: 0.25in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> - Cubicle availability <span style="line-height: normal; margin-bottom: 0in; margin-left: 0.5in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> o Home cubes mean that your home cube is assigned to whoever signs up first in your home cube. Short of writing down an unwritten rule, you may want to check with your CPC mates before scheduling the home cube. You should also note that 4th Years do __not__ have priority in scheduling the home cube, and I know I said that you should schedule far in advance & stay ahead of the herd, but communication & cooperation with your CPC mates will make clinic life happier. You will hopefully find that the home cube is fairly available due to your teammate’s blocks, removable, ATP, and lab time. <span style="line-height: normal; margin-bottom: 0in; margin-left: 0.5in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> o If your home cube __is__ booked by your 4th Year, you can only request a cube 48 hours in advance. That means for a Wednesday appointment, you can submit the request on Monday. For a Monday, request it on Thursday. Check back by the end of the day you submitted the request to see if you have the cube. By knowing the availability of faculty coverage, you will have a better idea of your chances of getting a cube. still submit requests for a cubicle. In the notes section of your request, include your home cube number. Your GPA will schedule you for another cube if there will be enough faculty coverage.

<span style="border: initial none initial; display: block; padding-bottom: 1pt; padding-left: 0in; padding-right: 0in; padding-top: 0in;"> =  a Treatment Plan   = <span style="line-height: normal; margin-bottom: 0in; margin-left: 0.25in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> - To create a new Tx plan: <span style="line-height: normal; margin-bottom: 0in; margin-left: 0.5in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> o Dr. Woods’ course should have given you some good info on how to fill out the forms in the paper chart. Here is some info on how to go from consults to a Tx plan in GSD-ACADEMIC <span style="line-height: normal; margin-bottom: 0in; margin-left: 0.5in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> o In the Chart tab, right click on one of the colored tabs in the middle of the screen <span style="line-height: normal; margin-bottom: 0in; margin-left: 0.75in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> § Select ‘Add treatment plan’ – this opens a small new window <span style="line-height: normal; margin-bottom: 0in; margin-left: 0.75in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> § Click on the icon with the little lines on the right of the ‘Title’ box <span style="line-height: normal; margin-bottom: 0in; margin-left: 0.75in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> § Select ‘Fast track’ or ‘ATP’, depending on the case <span style="line-height: normal; margin-bottom: 0in; margin-left: 0.75in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> § Click OK – don’t worry about the other boxes <span style="line-height: normal; margin-bottom: 0in; margin-left: 0.75in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> § Now you should have a new tab – orange for Fast track OR brown for ATP <span style="line-height: normal; margin-bottom: 0in; margin-left: 0.5in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> o Open up one of the consults as described previously <span style="line-height: normal; margin-bottom: 0in; margin-left: 0.5in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> o Click ‘Make a pop-up note’, which creates a little yellow Post-It note <span style="line-height: normal; margin-bottom: 0in; margin-left: 0.75in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> § This will allow you to see your planned Tx from the consults from the main Chart tab window <span style="line-height: normal; margin-bottom: 0in; margin-left: 0.5in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> o Close the consult windows <span style="line-height: normal; margin-bottom: 0in; margin-left: 0.5in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> o In the upper half of the new Tx plan Tab (orange or brown), drag your Tx items into the appropriate places. For instance, for the #4 MOD composite above, open ‘Operative’ from the drop-down menu in the window on the right. Find 3-surface posterior composite. Drag it to your Tx plan, and place it under the Restorative heading (SUPREM). For perio stuff, find the procedure & drag it under Preparatory. If you feel so inclined, you can double-click on the word Maintenance & enter ‘4-month perio recall’ into the small window that opens up & close the window. Now you can easily see what your recall frequency is for perio. <span style="line-height: normal; margin-bottom: 0in; margin-left: 0.5in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> o One important thing: you should rearrange all the treatment items you dragged into the window to create a Tx //sequence// – prioritize. <span style="line-height: normal; margin-bottom: 0in; margin-left: 0.75in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> § This means if you are planning to do the huge MODBL amalgam before the #6-11 veneers, then put them in that order <span style="line-height: normal; margin-bottom: 0in; margin-left: 0.25in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> - To submit a Tx plan: o Once you have everything in the treatment plan just where you want it, right click on the orange or brown bar immediately below the tab of the same color, and click ‘Submit for TPC approval’ § This submits your Tx plan to either your group director OR Dr. Woods § You will receive no indication that your Tx plan has been successfully submitted…just trust your clicking ability <span style="font-family: 'Courier New'; line-height: normal; margin-bottom: 0in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;">o Meet with your GPD to discuss tx plan. They will approve (hopefully) and print out 2 copies of the tx plan: 1 for the chart (GPD signs this copy), and 1 for the patient to take home. <span style="line-height: normal; margin-bottom: 0in; margin-left: 0.5in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> o For ATP cases, drop off your pt’s chart to the chartroom <span style="line-height: normal; margin-bottom: 0in; margin-left: 0.75in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> § When you drop it off, say “Please put this in Dr. Woods’ pile” (or something like that) <span style="line-height: normal; margin-bottom: 0in; margin-left: 0.75in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> § You can check back after a few days for ATP cases to see if the Tx plan has been approved [NH7] <span style="line-height: normal; margin-bottom: 0in; margin-left: 0.75in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> § I like to check in GSD-ACADEMIC…if all the red dots next to the items of your Tx plan have turned green, it’s been approved <span style="line-height: normal; margin-bottom: 0in; margin-left: 0.5in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> o For Fast track, you are required to review your Tx plan in person with your GPD <span style="line-height: normal; margin-bottom: 0in; margin-left: 0.25in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> - Adding procedures to existing Tx plans mid-treatment: <span style="line-height: normal; margin-bottom: 0in; margin-left: 0.5in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> o Let’s say your MODBL amalgam has recurrent decay and you & the restorative instructor decide to change it to a PFM <span style="line-height: normal; margin-bottom: 0in; margin-left: 0.5in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> o You can drag over the code for PFM, but the dot next to it will be red (which means it is unapproved) <span style="line-height: normal; margin-bottom: 0in; margin-left: 0.5in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> o The floor instructor must sign off the procedure before you can drag it into the Appointment <span style="line-height: normal; margin-bottom: 0in; margin-left: 0.75in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> § After adding the procedure, right click the Tx plan & click “Faculty sign off” (__NOT__ ‘Submit for TPC approval’) <span style="line-height: normal; margin-bottom: 0in; margin-left: 0.75in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> § When the instructor signs it off, the red dot should turn blue <span style="line-height: normal; margin-bottom: 0in; margin-left: 0.75in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> § You can always drag procedures with blue or green dots into the current appointment with your SOAP notes <span style="line-height: normal; margin-bottom: 0in; margin-left: 0.5in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> o So, in review: <span style="line-height: normal; margin-bottom: 0in; margin-left: 0.75in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> § Red dot: __NOT__ signed off by anyone <span style="line-height: normal; margin-bottom: 0in; margin-left: 0.75in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> § Blue dot: floor instructor approved it <span style="line-height: normal; margin-bottom: 0in; margin-left: 0.75in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> § Green dot: Dr. Woods or Group director approved it <span style="line-height: normal; margin-bottom: 0in; margin-left: 0.5in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> o One note for anyone with a more thorough group director: <span style="font-family: Wingdings; line-height: normal; margin-bottom: 0in; margin-left: 0.75in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;">§ My Some group director s like s to see a signed restorative consult whenever changes to the Tx plan have been made <span style="line-height: normal; margin-bottom: 0in; margin-left: 0.75in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> § To do this, just add a new restorative consult in the Problem list/consult section in the lower right-hand side of the Tx plan screen, enter the consult details, and have the floor instructor sign it off <span style="line-height: normal; margin-bottom: 0in; margin-left: 0.75in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> § Use discretion in how & when you ask floor instructors to sign things off…it may be all you can do to get the procedure changed from a red dot to a blue dot…some may be less willing to sign off a whole restorative consult on top of the faculty sign off of the Tx plan, and your SOAP notes for the day.

 <span style="border: initial none initial; display: block; padding-bottom: 1pt; padding-left: 0in; padding-right: 0in; padding-top: 0in;"> = = <span style="line-height: normal; margin-bottom: 0in; margin-left: 0.25in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> - Operative <span style="line-height: normal; margin-bottom: 0in; margin-left: 0.5in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> o Generally speaking, always be doing something: <span style="line-height: normal; margin-bottom: 0in; margin-left: 0.75in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> § While the topical is taking effect, load the syringe <span style="line-height: normal; margin-bottom: 0in; margin-left: 0.75in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> § While the local anesthetic is setting in, get your rubber dam ready to go <span style="line-height: normal; margin-bottom: 0in; margin-left: 0.75in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> § While waiting for the instructor, type your SOAP notes <span style="line-height: normal; margin-bottom: 0in; margin-left: 0.5in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> o Start check: <span style="line-height: normal; margin-bottom: 0in; margin-left: 0.75in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> § You should be familiar with the following: <span style="line-height: normal; margin-bottom: 0in; margin-left: 1in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> · Current medical Hx – look in the chart <span style="line-height: normal; margin-bottom: 0in; margin-left: 1in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> · Treatment plan & your plan for the appointment <span style="line-height: normal; margin-bottom: 0in; margin-left: 1in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> · Radiographs <span style="line-height: normal; margin-bottom: 0in; margin-left: 1in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> · NOTE: the more prepared & confident you are, the better the faculty interaction. You will be able to work more independently, yet get the help you need when you need it. <span style="line-height: normal; margin-bottom: 0in; margin-left: 0.5in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> o Anesthesia: <span style="line-height: normal; margin-bottom: 0in; margin-left: 0.75in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> § If this is the first time you are injecting a patient, just relax & work up your confidence…quit shaking <span style="line-height: normal; margin-bottom: 0in; margin-left: 0.75in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> § Topical anesthetic: <span style="line-height: normal; margin-bottom: 0in; margin-left: 1in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> · I swear by topical anesthetic for everything but palatal injections <span style="line-height: normal; margin-bottom: 0in; margin-left: 1in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> · Place it where you are going to inject & don’t let it get all over in the patient’s mouth <span style="line-height: normal; margin-bottom: 0in; margin-left: 1.25in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> o Take one of those topical swabs & stick it all over in your mouth & see how much you like it <span style="line-height: normal; margin-bottom: 0in; margin-left: 1.25in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> o Either use the saliva ejector or place a 2x2 just behind the swab to absorb excess <span style="line-height: normal; margin-bottom: 0in; margin-left: 1in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> · Leave the topical there for awhile – maybe as long as 2 minutes <span style="line-height: normal; margin-bottom: 0in; margin-left: 1.25in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> o You can fill the time getting things ready while it does its job <span style="line-height: normal; margin-bottom: 0in; margin-left: 0.75in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> § Deliver slowly: <span style="line-height: normal; margin-bottom: 0in; margin-left: 1in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> · Move the needle slowly & inject slowly <span style="line-height: normal; margin-bottom: 0in; margin-left: 1in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> · Once you start, watch around the pt’s eyes for wincing…if the pt flinches, slow down <span style="line-height: normal; margin-bottom: 0in; margin-left: 1in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> · You can take 2 minutes to inject, which feels like an eternity, but will be less irritating to the patient <span style="line-height: normal; margin-bottom: 0in; margin-left: 0.75in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> § Tell the pt to breathe through their nose & use other forms of distraction <span style="line-height: normal; margin-bottom: 0in; margin-left: 0.75in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> § Providing (near) painless, profound anesthesia is worth its weight in gold <span style="line-height: normal; margin-bottom: 0in; margin-left: 0.75in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> § For IA blocks, if you are going to be working in the area for awhile, give 1.5-2 carpules <span style="line-height: normal; margin-bottom: 0in; margin-left: 1in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> · This is lots better than having to inject through the rubber dam later in the appointment <span style="line-height: normal; margin-bottom: 0in; margin-left: 0.75in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> § For the maxilla: <span style="line-height: normal; margin-bottom: 0in; margin-left: 1in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> · You can almost always give local infiltration in the maxilla, as opposed to giving a PSA, MSA, or ASA block <span style="line-height: normal; margin-bottom: 0in; margin-left: 1in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> · For infiltrations, remember to anesthetize the tooth that you plan to clamp, not just the one you will be working on <span style="line-height: normal; margin-bottom: 0in; margin-left: 1in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> · For the palate: <span style="line-height: normal; margin-bottom: 0in; margin-left: 1.25in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> o You can always give a greater palatine injection, OR… <span style="line-height: normal; margin-bottom: 0in; margin-left: 1.25in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> o You can use Dr. Hargis’ method: once you’ve completed the buccal infiltration & the buccal gingiva is numb, you can inject through the papilla from the buccal, which will provide anesthetic to the lingual – look for blanching <span style="line-height: normal; margin-bottom: 0in; margin-left: 0.5in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> o Rubber dam: <span style="line-height: normal; margin-bottom: 0in; margin-left: 0.75in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> § Use lubrication (shaving cream), but not too much <span style="line-height: normal; margin-bottom: 0in; margin-left: 1in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> · I keep my lubricant in a monojet syringe so the patient doesn’t know I am using shaving cream <span style="line-height: normal; margin-bottom: 0in; margin-left: 1in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> · A little bit goes a long way <span style="line-height: normal; margin-bottom: 0in; margin-left: 0.75in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> § Before placing the clamp, ensure the gingiva is numb by using an explorer <span style="line-height: normal; margin-bottom: 0in; margin-left: 1in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> · I like to push the curved end of the Shepherd’s hook against the buccal mucosa (the round part, not the tip) <span style="line-height: normal; margin-bottom: 0in; margin-left: 1in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> · I ask if the patient feels pushing or poking (if they say poking, they’re crazy, because you are pushing the round part against the gums) <span style="line-height: normal; margin-bottom: 0in; margin-left: 1in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> · Then use the tip of the Shepherd’s hook & poke the gums…ask again, “pushing or poking” <span style="line-height: normal; margin-bottom: 0in; margin-left: 1.25in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> o If ‘pushing’, then you’re okay; if ‘poking’, then wait another minute or so, or re-inject <span style="line-height: normal; margin-bottom: 0in; margin-left: 1in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> · Check both the buccal __and__ palatal/lingual gingiva <span style="line-height: normal; margin-bottom: 0in; margin-left: 0.75in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> § Other considerations <span style="line-height: normal; margin-bottom: 0in; margin-left: 1in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> · Check the pt’s contacts – the tighter, the more inclined you should be to ask a neighbor to floss for you <span style="line-height: normal; margin-bottom: 0in; margin-left: 1in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> · Plan where you will anchor the rubber dam <span style="line-height: normal; margin-bottom: 0in; margin-left: 1in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> · Once you place the clamp, verify that the patient is ‘okay’ (no poking) <span style="line-height: normal; margin-bottom: 0in; margin-left: 1in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> · Before placing the dam, be sure you have everything you need for the rest of the appointment <span style="line-height: normal; margin-bottom: 0in; margin-left: 1.25in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> o Don’t leave the patient under a rubber dam while you hunt after supplies <span style="line-height: normal; margin-bottom: 0in; margin-left: 0.75in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> § Flossing down the rubber dam <span style="line-height: normal; margin-bottom: 0in; margin-left: 1in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> · It’s best to ask another student to help out…it only takes a couple of minutes & is much easier than doing it alone <span style="line-height: normal; margin-bottom: 0in; margin-left: 1in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> · Attempt to slip the dam through the contacts without floss…anterior teeth usually go through more easily <span style="line-height: normal; margin-bottom: 0in; margin-left: 1in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> · If not, use your hands to stretch the dam over a contact & ask the other person to floss one side, then the other <span style="line-height: normal; margin-bottom: 0in; margin-left: 1.25in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> o Be careful not to bunch up the rubber dam material over the occlusal/incisal embrasure <span style="line-height: normal; margin-bottom: 0in; margin-left: 1in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> · Once you have the rubber dam through a few contacts, set the Young frame & finish the rest of them <span style="line-height: normal; margin-bottom: 0in; margin-left: 1.25in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> o I truly is useful to invert the rubber dam to better control the moisture <span style="line-height: normal; margin-bottom: 0in; margin-left: 1.25in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> o Taking an extra 30 seconds up front may save a lot of hassle near the end of the appointment <span style="line-height: normal; margin-bottom: 0in; margin-left: 0.5in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> o Preparation: <span style="line-height: normal; margin-bottom: 0in; margin-left: 0.75in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> § Before you drill, verify you are on the correct tooth, doing the correct restoration, for the right reason <span style="line-height: normal; margin-bottom: 0in; margin-left: 1in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> · Check the chart, the radiograph, then the pt’s mouth just to be sure <span style="line-height: normal; margin-bottom: 0in; margin-left: 0.75in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> § Control the water <span style="line-height: normal; margin-bottom: 0in; margin-left: 1in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> · You only have two hands – decide how you are going to see what you’re doing, do what you’re doing, and keep the water out of the way <span style="line-height: normal; margin-bottom: 0in; margin-left: 1in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> · Sometimes it’s best to use direct vision & hold the hi-volume suction <span style="line-height: normal; margin-bottom: 0in; margin-left: 1in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> · Sometimes it’s best to just place the saliva ejector near the clamp so you can hold the mirror with your free hand <span style="line-height: normal; margin-bottom: 0in; margin-left: 1in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> · Sometimes the pt is willing & able to hold the suction where you want it <span style="line-height: normal; margin-bottom: 0in; margin-left: 1in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> · Sometimes you could really use an assistant <span style="line-height: normal; margin-bottom: 0in; margin-left: 0.75in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> § Be aggressive (but don’t drill for oil) <span style="line-height: normal; margin-bottom: 0in; margin-left: 1in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> · Go ahead & step down on the pedal <span style="line-height: normal; margin-bottom: 0in; margin-left: 1.25in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> o You will find that it beats preparing the tooth one enamel rod at a time <span style="line-height: normal; margin-bottom: 0in; margin-left: 1in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> · Just be careful about your pulpal depth (in both pulpal & axial directions), especially with deep caries <span style="line-height: normal; margin-bottom: 0in; margin-left: 1.25in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> o Remember the anatomy of the pulp chamber & check your radiographs <span style="line-height: normal; margin-bottom: 0in; margin-left: 0.75in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> § Prep to ideal, then have the instructor take a look <span style="line-height: normal; margin-bottom: 0in; margin-left: 1in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> · Tell them that you wanted them to take a look before you extend your prep <span style="line-height: normal; margin-bottom: 0in; margin-left: 1in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> · The instructor will appreciate your ability to do a nice, ideal prep, even if the caries if going to change all that <span style="line-height: normal; margin-bottom: 0in; margin-left: 0.75in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> § Caries control <span style="line-height: normal; margin-bottom: 0in; margin-left: 1in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> · Make any major design changes with the high speed <span style="line-height: normal; margin-bottom: 0in; margin-left: 1in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> · Remove caries with a spoon or round bur on slowspeed <span style="line-height: normal; margin-bottom: 0in; margin-left: 1.25in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> o Use as large a round bur as will fit comfortable in the area <span style="line-height: normal; margin-bottom: 0in; margin-left: 1.5in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> § If you think about it, it makes the broadest cutting area – less chance of punching into the pulp <span style="line-height: normal; margin-bottom: 0in; margin-left: 1.25in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> o You can always use caries indicator (e.g., Snoop) to see if caries is still present <span style="line-height: normal; margin-bottom: 0in; margin-left: 1.5in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> § Just apply w/ a microbrush, rinse/dry & inspect the tooth <span style="line-height: normal; margin-bottom: 0in; margin-left: 1.25in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> o Look for caries on the axial wall, anywhere along the DEJ, and under the cusps in your proximal extensions <span style="line-height: normal; margin-bottom: 0in; margin-left: 0.5in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> o Restoration: <span style="line-height: normal; margin-bottom: 0in; margin-left: 0.75in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> § Bases & liners <span style="line-height: normal; margin-bottom: 0in; margin-left: 1in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> · If the instructor says: “Use a little glass ionomer to line the prep”, s/he probably means using a little Vitrebond or Fuji II LC to line a deep preparation <span style="line-height: normal; margin-bottom: 0in; margin-left: 1.25in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> o Vitrebond is a powder & liquid mixture that you light cure <span style="line-height: normal; margin-bottom: 0in; margin-left: 1.25in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> o Vitrebond may no longer be available, but many professors will refer to it <span style="line-height: normal; margin-bottom: 0in; margin-left: 1.5in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> § The replacement is GC Fuji lining LC paste, which comes in a blue tube <span style="line-height: normal; margin-bottom: 0in; margin-left: 1.75in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> · You each have your own metal dispenser <span style="line-height: normal; margin-bottom: 0in; margin-left: 1.5in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> § Dispense the two liquids, mix with a spatula on a mixing pad, and apply with a small hand instrument to just barely line the area of interest <span style="line-height: normal; margin-bottom: 0in; margin-left: 1.5in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> § Light cure <span style="line-height: normal; margin-bottom: 0in; margin-left: 1in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> · For a base, you would use a more substantial amount of Fuji II LC <span style="line-height: normal; margin-bottom: 0in; margin-left: 1.25in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> o You also light cure the Fuji II LC <span style="line-height: normal; margin-bottom: 0in; margin-left: 1in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> · After applying a base or liner, remove any excess (don’t let it touch the margin of your prep) <span style="line-height: normal; margin-bottom: 0in; margin-left: 0.75in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> § Amalgam <span style="line-height: normal; margin-bottom: 0in; margin-left: 1in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> · Complete the preparation & have it checked off <span style="line-height: normal; margin-bottom: 0in; margin-left: 1in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> · Place any liners, as instructed by the covering faculty <span style="line-height: normal; margin-bottom: 0in; margin-left: 1in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> · Place a matrix band for class II restorations – wedge interproximally to close the gingival margin <span style="line-height: normal; margin-bottom: 0in; margin-left: 1.25in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> o Use the ball burnisher to burnish in the area of the planned contact <span style="line-height: normal; margin-bottom: 0in; margin-left: 1in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> · Clean & dry the tooth – be sure there is no blood entering the prep from the gums <span style="line-height: normal; margin-bottom: 0in; margin-left: 1in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> · Note: Some professors will have you etch, prime & bond prior to placing the amalgam <span style="line-height: normal; margin-bottom: 0in; margin-left: 1in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> · Get all your amalgam instruments lined up <span style="line-height: normal; margin-bottom: 0in; margin-left: 1in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> · Mix the amalgam (11-14 sec) <span style="line-height: normal; margin-bottom: 0in; margin-left: 1.25in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> o From here on out, you need to work fairly quickly to prevent the amalgam from setting too quickly <span style="line-height: normal; margin-bottom: 0in; margin-left: 1in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> · For class II restorations, place the amalgam in the box & condense into the ‘corners’ well <span style="line-height: normal; margin-bottom: 0in; margin-left: 1in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> · Continue, just as you learned from Dr. Wong <span style="line-height: normal; margin-bottom: 0in; margin-left: 1in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> · It’s okay (and often necessary) to mix more amalgam <span style="line-height: normal; margin-bottom: 0in; margin-left: 1in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> · Condense quickly & firmly <span style="line-height: normal; margin-bottom: 0in; margin-left: 1in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> · Condense the marginal ridges well, then finish condensing into the occlusal portion <span style="line-height: normal; margin-bottom: 0in; margin-left: 1.25in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> o Remove occlusal flash & carve in some rough anatomy <span style="line-height: normal; margin-bottom: 0in; margin-left: 1.25in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> o If the marginal ridges have set well, you will be less likely to fracturing the marginal ridge when you remove the matrix band (trust me, it’s no fun to remove an otherwise great restoration & start over) <span style="line-height: normal; margin-bottom: 0in; margin-left: 1in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> · Carefully remove the wedge(s) & matrix band <span style="line-height: normal; margin-bottom: 0in; margin-left: 1in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> · Carve the marginal ridges to the correct height (usually to the height of the adjacent marginal ridge) <span style="line-height: normal; margin-bottom: 0in; margin-left: 1in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> · Finish interproximally w/ an interproximal carver or explorer <span style="line-height: normal; margin-bottom: 0in; margin-left: 1in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> · Finish occlusal anatomy <span style="line-height: normal; margin-bottom: 0in; margin-left: 1in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> · Check the proximal contact with floss prior to removing the rubber dam <span style="line-height: normal; margin-bottom: 0in; margin-left: 1.25in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> o No contact = start over <span style="line-height: normal; margin-bottom: 0in; margin-left: 1in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> · Get it looked at by the professor before removing the rubber dam <span style="line-height: normal; margin-bottom: 0in; margin-left: 1in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> · Remove the rubber dam & check the occlusion – have the patient tap lightly if you suspect the occlusion is high <span style="line-height: normal; margin-bottom: 0in; margin-left: 1in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> · Adjust with hand instruments, if possible (I told you to work quickly) <span style="line-height: normal; margin-bottom: 0in; margin-left: 1in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> · When you see the patient next time, polish your beautiful restorations!!! <span style="line-height: normal; margin-bottom: 0in; margin-left: 0.75in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> § Composite <span style="line-height: normal; margin-bottom: 0in; margin-left: 1in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> · Be sure to select the appropriate shade __before__ placing the rubber dam – write down the chosen shade <span style="line-height: normal; margin-bottom: 0in; margin-left: 1in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> · Place a sectional matrix (kidney bean shaped matrix) with a plastic wedge & BiTine ring <span style="line-height: normal; margin-bottom: 0in; margin-left: 1.25in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> o The BiTine ring will provide some separation of adjacent teeth, which aids in establishing proximal contact <span style="line-height: normal; margin-bottom: 0in; margin-left: 1.25in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> o Be sure to burnish the contact area well to ensure you develop a good contact <span style="line-height: normal; margin-bottom: 0in; margin-left: 1in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> · Verify you have total moisture control prior to restoring <span style="line-height: normal; margin-bottom: 0in; margin-left: 1.25in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> o Ensure the gingival margin is sealed <span style="line-height: normal; margin-bottom: 0in; margin-left: 1in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> · Etch/rinse/dry, prime/air thin, bond/air thin, light cure <span style="line-height: normal; margin-bottom: 0in; margin-left: 1in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> · Place a small amount of composite – work in increments <span style="line-height: normal; margin-bottom: 0in; margin-left: 1in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> · For class II restorations <span style="line-height: normal; margin-bottom: 0in; margin-left: 1.25in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> o Force composite into one ‘corner’, then light cure <span style="line-height: normal; margin-bottom: 0in; margin-left: 1.25in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> o Repeat for the other ‘corner’ <span style="line-height: normal; margin-bottom: 0in; margin-left: 1.25in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> o Finally, fill the rest of the box & light cure – this improves your chances of making a good contact <span style="line-height: normal; margin-bottom: 0in; margin-left: 1in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> · Incrementally complete the restoration <span style="line-height: normal; margin-bottom: 0in; margin-left: 1in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> · General tips: <span style="line-height: normal; margin-bottom: 0in; margin-left: 1.25in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> o Be careful not to overfill…it’s better to light cure it where you want it, not overfill & drill away excess <span style="line-height: normal; margin-bottom: 0in; margin-left: 1.25in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> o Remember the shape of your prep…it’s easy to lose sight of where you are going <span style="line-height: normal; margin-bottom: 0in; margin-left: 1.25in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> o You can dip your applicator (IPC, football burnisher, etc) in bonding agent to make the composite less sticky <span style="line-height: normal; margin-bottom: 0in; margin-left: 1in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> · Finishing <span style="line-height: normal; margin-bottom: 0in; margin-left: 1.25in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> o One tip is to use a disposable #12 blade (the blade curves ‘inward’) to remove flash (generally from the gingival & proximal extensions) <span style="line-height: normal; margin-bottom: 0in; margin-left: 1.25in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> o Inspect the tooth for areas of flash…distinguish between tooth & composite…remove any & all flash <span style="line-height: normal; margin-bottom: 0in; margin-left: 1.5in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> § Try a 7404 or 7901 on your highspeed drill <span style="line-height: normal; margin-bottom: 0in; margin-left: 1.25in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> o Check the occlusion & make appropriate adjustments <span style="line-height: normal; margin-bottom: 0in; margin-left: 0.75in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> § Glass Ionomer (Fuji IX, Fuji II LC) <span style="line-height: normal; margin-bottom: 0in; margin-left: 1in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> · This is usually used either as a permanent restoration for class V lesions or as a temporary fix <span style="line-height: normal; margin-bottom: 0in; margin-left: 1in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> · GI works pretty well in areas where moisture control is an issue <span style="line-height: normal; margin-bottom: 0in; margin-left: 1in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> · Sometimes in class V lesions, if you __cannot__ place a 212 clamp, the professor will have you ‘retract’ the gingiva by packing cord & using cotton rolls and an assistant, where possible <span style="line-height: normal; margin-bottom: 0in; margin-left: 1in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> · The GI bonds directly to tooth structure, so you don’t etch/prime/bond <span style="line-height: normal; margin-bottom: 0in; margin-left: 1in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> · Finish as you would a composite restoration

<span style="line-height: normal; margin-bottom: 0in; margin-left: 0.25in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> - Fixed <span style="line-height: normal; margin-bottom: 0in; margin-left: 0.5in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> o Start check & anesthesia: <span style="line-height: normal; margin-bottom: 0in; margin-left: 0.75in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> § Follow the same protocol as for operative <span style="line-height: normal; margin-bottom: 0in; margin-left: 0.5in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> o Prep/impression appointment: <span style="line-height: normal; margin-bottom: 0in; margin-left: 0.75in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> § There are many different preps you will do, each with its own special considerations during the preparation, impression, & cementation. Dr. Morgan’s powerpoints provided very useful reviews of these considerations & I just don’t get paid well enough to review all that in this document. I will give one example of a single unit PFM prep. <span style="line-height: normal; margin-bottom: 0in; margin-left: 1in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> · Here is also a brief note about bridges (‘fixed partial dentures’): <span style="line-height: normal; margin-bottom: 0in; margin-left: 1.25in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> o For bridges, you may need 2-3 appts for preparation & impression taking. The you send the case to the lab to get a metal framework. You will need to go through casting control then make an appt for the framework try-in. If everything is good, you send it back & the lab will bake porcelain onto the framework. You then go through casting control again & schedule an appt for cementation. <span style="line-height: normal; margin-bottom: 0in; margin-left: 0.75in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> § Supplies you’ll need: <span style="line-height: normal; margin-bottom: 0in; margin-left: 1in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> · Basic cubicle setup <span style="line-height: normal; margin-bottom: 0in; margin-left: 1in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> · High speed & Fixed bur block <span style="line-height: normal; margin-bottom: 0in; margin-left: 1in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> · Slow speed w/ straight attachment & Acrylic bur block <span style="line-height: normal; margin-bottom: 0in; margin-left: 1in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> · Rubber dam cassette <span style="line-height: normal; margin-bottom: 0in; margin-left: 1in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> · Restorative cassette <span style="line-height: normal; margin-bottom: 0in; margin-left: 1in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> · Packing cord <span style="line-height: normal; margin-bottom: 0in; margin-left: 1in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> · Hemostatic agent (Hemogin or Viscostat) <span style="line-height: normal; margin-bottom: 0in; margin-left: 1in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> · Impression guns, light & heavy body PVS <span style="line-height: normal; margin-bottom: 0in; margin-left: 1in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> · Stent of appropriate quadrant <span style="line-height: normal; margin-bottom: 0in; margin-left: 1in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> · Supplies for making a temporary crown <span style="line-height: normal; margin-bottom: 0in; margin-left: 1in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> · Floss, articulating paper <span style="line-height: normal; margin-bottom: 0in; margin-left: 1in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> · Emory tray <span style="line-height: normal; margin-bottom: 0in; margin-left: 1in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> · TempBond, spatula & mixing pad <span style="line-height: normal; margin-bottom: 0in; margin-left: 0.75in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> § Preparation <span style="line-height: normal; margin-bottom: 0in; margin-left: 1in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> · Discuss the design __before__ beginning. Does the patient prefer a porcelain margin on the buccal, is the patient okay with a lingual metal margin? <span style="line-height: normal; margin-bottom: 0in; margin-left: 1in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> · Select the shade: have the pt help decide between two shades – it gives them some ownership in the final outcome <span style="line-height: normal; margin-bottom: 0in; margin-left: 1in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> · Use a rubber dam, until you are ready to finish the margins & verify occlusal reduction <span style="line-height: normal; margin-bottom: 0in; margin-left: 1in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> · Prepare the tooth with the final design in mind <span style="line-height: normal; margin-bottom: 0in; margin-left: 1.25in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> o Most of us have a tendency to underreduce, especially on the axial wall on the buccal & the occlusal reduction of the lingual cusps <span style="line-height: normal; margin-bottom: 0in; margin-left: 1.25in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> o Don’t lose track of where you are going – follow the shape of the adjacent teeth & get your cusp tips in line <span style="line-height: normal; margin-bottom: 0in; margin-left: 1.25in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> o Reduce with confidence…use the high speed at full speed…just don’t reduce too much J <span style="line-height: normal; margin-bottom: 0in; margin-left: 0.75in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> § Impression <span style="line-height: normal; margin-bottom: 0in; margin-left: 1in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> · Packing cord <span style="line-height: normal; margin-bottom: 0in; margin-left: 1.25in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> o Cord is packed ~5-10 minutes prior to impression taking, and/or to give you a better view of the margin for final refinement of your prep <span style="line-height: normal; margin-bottom: 0in; margin-left: 1.25in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> o Tips <span style="line-height: normal; margin-bottom: 0in; margin-left: 1.5in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> § Here is the best tip I can give: use even, firm pressure, rather than short, abrupt jabbing movements <span style="line-height: normal; margin-bottom: 0in; margin-left: 1.5in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> § Be patient & deliberate – bury the cord with authority – help the cord do its job! <span style="line-height: normal; margin-bottom: 0in; margin-left: 1.5in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> § Dry around the tooth before packing cord – it seems to handle better if the field is dry <span style="line-height: normal; margin-bottom: 0in; margin-left: 1.5in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> § You might want to soak the cord in Hemogin prior to packing (check it out from central) – this prevents bleeding <span style="line-height: normal; margin-bottom: 0in; margin-left: 1in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> · ‘Heme’ control = controlling blood <span style="line-height: normal; margin-bottom: 0in; margin-left: 1.25in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> o Blood will ruin your impression <span style="line-height: normal; margin-bottom: 0in; margin-left: 1.25in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> o Be sure blood is under control before mixing the impression materials <span style="line-height: normal; margin-bottom: 0in; margin-left: 1in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> · Taking the impression <span style="line-height: normal; margin-bottom: 0in; margin-left: 1.25in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> o Get you impression supplies ready <span style="line-height: normal; margin-bottom: 0in; margin-left: 1.25in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> o Try in the Emory tray to ensure the pt can bit down comfortably <span style="line-height: normal; margin-bottom: 0in; margin-left: 1.5in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> § Take note of where the habitual bite is…you’ll want the pt to repeat this position during the impression <span style="line-height: normal; margin-bottom: 0in; margin-left: 1.25in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> o Be sure to rinse & dry everything <span style="line-height: normal; margin-bottom: 0in; margin-left: 1.25in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> o Place cotton rolls, where appropriate <span style="line-height: normal; margin-bottom: 0in; margin-left: 1.25in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> o Depending on the retraction technique you used, remove the cord(s), if necessary <span style="line-height: normal; margin-bottom: 0in; margin-left: 1.25in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> o Rinse/dry & check for blood <span style="line-height: normal; margin-bottom: 0in; margin-left: 1.25in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> o If no bleeding, have your assistant fill the small syringe with light body while you keep the field clean/dry <span style="line-height: normal; margin-bottom: 0in; margin-left: 1.25in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> o Once the assistant hands you the light body, s/he fills the emory tray as you inject <span style="line-height: normal; margin-bottom: 0in; margin-left: 1.5in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> § Inject into the sulcus all the way around the tooth <span style="line-height: normal; margin-bottom: 0in; margin-left: 1.5in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> § Leave the tip in the material to avoid air entrapment <span style="line-height: normal; margin-bottom: 0in; margin-left: 1.5in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> § Cover the whole tooth & the occlusal of adjacent teeth <span style="line-height: normal; margin-bottom: 0in; margin-left: 1.25in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> o Take the tray from the assistant, position the tray & have the pt bite down slowly into the habitual position <span style="line-height: normal; margin-bottom: 0in; margin-left: 1.25in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> o Hold the jaw for 7-8 minutes while the impression sets up <span style="line-height: normal; margin-bottom: 0in; margin-left: 1.25in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> o Have the pt open abruptly to release the impression <span style="line-height: normal; margin-bottom: 0in; margin-left: 1.25in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> o Take care of the patient (rinse, suction, napkin, etc) prior to inspecting the impression <span style="line-height: normal; margin-bottom: 0in; margin-left: 1.25in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> o Inspect the impression and look for the following: <span style="line-height: normal; margin-bottom: 0in; margin-left: 1.5in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> § Can you see the prep’s margin all the way around the tooth? <span style="line-height: normal; margin-bottom: 0in; margin-left: 1.5in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> § You have material extending beyond the margin…all the way around the tooth? <span style="line-height: normal; margin-bottom: 0in; margin-left: 1.5in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> § Do you have blebs, bubbles, or areas where the light & heavy body did not flow together? <span style="line-height: normal; margin-bottom: 0in; margin-left: 1.5in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> § Did blood get incorporated into the impression? <span style="line-height: normal; margin-bottom: 0in; margin-left: 0.75in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> § Temporization <span style="line-height: normal; margin-bottom: 0in; margin-left: 1in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> · You should be prepared to make a temporary according to the discretion of the instructor. Although using ‘Integrity’ is fairly common due to its favorable setup time, don’t forget how to temporize like you did in lab <span style="line-height: normal; margin-bottom: 0in; margin-left: 1in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> · Indirect method (Jet acrylic) <span style="line-height: normal; margin-bottom: 0in; margin-left: 1.25in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> o You should all know how to do this <span style="line-height: normal; margin-bottom: 0in; margin-left: 1in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> · Direct method (Integrity) <span style="line-height: normal; margin-bottom: 0in; margin-left: 1.25in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> o The key here is to remove the stent __before__ the temp sets up <span style="line-height: normal; margin-bottom: 0in; margin-left: 1.25in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> o Inject Integrity into the stent & squish the whole thing onto the tooth <span style="line-height: normal; margin-bottom: 0in; margin-left: 1.25in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> o After ~45 sec, remove the stent & place it on the tooth again (aka ‘pump’ the temporary) <span style="line-height: normal; margin-bottom: 0in; margin-left: 1.25in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> o After another ~30-45 seconds, remove it again & see if it is setting up <span style="line-height: normal; margin-bottom: 0in; margin-left: 1.25in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> o Wait for the material to setup more completely before trimming <span style="line-height: normal; margin-bottom: 0in; margin-left: 1.25in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> o Trim as usual <span style="line-height: normal; margin-bottom: 0in; margin-left: 1in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> · Direct method (Jet acrylic) <span style="line-height: normal; margin-bottom: 0in; margin-left: 1.25in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> o Ask your professor…this takes a little more skill <span style="line-height: normal; margin-bottom: 0in; margin-left: 1in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> · __Note__: be sure you adjust the pt’s occlusion to prevent loss of the temp between now & cementation <span style="line-height: normal; margin-bottom: 0in; margin-left: 1.25in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> o Also, ensure you have good proximal contacts that will hold the space for a good fit of your final crown <span style="line-height: normal; margin-bottom: 0in; margin-left: 0.75in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> § Lab slip <span style="line-height: normal; margin-bottom: 0in; margin-left: 1in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> · The lab slip should include clear instructions with regards to: <span style="line-height: normal; margin-bottom: 0in; margin-left: 1.25in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> o Buccal & lingual margin design <span style="line-height: normal; margin-bottom: 0in; margin-left: 1.25in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> o Shade <span style="line-height: normal; margin-bottom: 0in; margin-left: 1in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> · Include your contact info (phone number) in case the lab has any questions <span style="line-height: normal; margin-bottom: 0in; margin-left: 1in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> · Fill out the upper left box <span style="line-height: normal; margin-bottom: 0in; margin-left: 1in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> · On the upper right, check the boxes indicating what you are submitting (in this case, just the double-bite impression) <span style="line-height: normal; margin-bottom: 0in; margin-left: 1in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> · Have the instructor sign the slip <span style="line-height: normal; margin-bottom: 0in; margin-left: 1in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> · Don’t forget to have the instructor sign your restorative card as well <span style="line-height: normal; margin-bottom: 0in; margin-left: 1in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> · Turn in the lab slip & double bite impression to Marissa in Dr. Goldstein’s office <span style="line-height: normal; margin-bottom: 0in; margin-left: 1.25in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> o Be sure to get a billing signature prior to turning the case in <span style="line-height: normal; margin-bottom: 0in; margin-left: 0.5in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> o Casting control <span style="line-height: normal; margin-bottom: 0in; margin-left: 0.75in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> § After you pick up the case from Marissa, sign up for a casting control appointment in the 3rd floor lab <span style="line-height: normal; margin-bottom: 0in; margin-left: 0.75in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> § Take a look at the crown on a die under magnification prior to casting control, so you are aware of any potential issues <span style="line-height: normal; margin-bottom: 0in; margin-left: 0.75in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> § You will look at the case simultaneously with the professor under a microscope <span style="line-height: normal; margin-bottom: 0in; margin-left: 0.75in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> § After getting a signature, you’re ready to cement the crown!!! <span style="line-height: normal; margin-bottom: 0in; margin-left: 0.5in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> o Cementation appt <span style="line-height: normal; margin-bottom: 0in; margin-left: 0.75in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> § What you’ll need: <span style="line-height: normal; margin-bottom: 0in; margin-left: 1in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> · Fuji gun <span style="line-height: normal; margin-bottom: 0in; margin-left: 1in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> · Fuji I or Fuji + <span style="line-height: normal; margin-bottom: 0in; margin-left: 1.25in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> o Fuji + sets up faster, which can be good or bad <span style="line-height: normal; margin-bottom: 0in; margin-left: 1in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> · High speed & Porcelain bur block <span style="line-height: normal; margin-bottom: 0in; margin-left: 1in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> · Floss, articulating paper, shim stock <span style="line-height: normal; margin-bottom: 0in; margin-left: 0.75in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> § After start check, remove the temp & clean off the cement <span style="line-height: normal; margin-bottom: 0in; margin-left: 1in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> · If the pt can handle it, do not give anesthesia, because their ability to sense the occlusion can be very valuable <span style="line-height: normal; margin-bottom: 0in; margin-left: 0.75in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> § Place an open 2x2 at the back of the mouth…this prevents obvious complications <span style="line-height: normal; margin-bottom: 0in; margin-left: 0.75in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> § Try-in: <span style="line-height: normal; margin-bottom: 0in; margin-left: 1in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> · Try on the crown without applying pressure <span style="line-height: normal; margin-bottom: 0in; margin-left: 1in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> · Look for areas that bind, preventing complete seating <span style="line-height: normal; margin-bottom: 0in; margin-left: 1in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> · Proximal contacts are the most likely problem area <span style="line-height: normal; margin-bottom: 0in; margin-left: 1.25in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> o Place one finger on the partially seated crown & floss through each contact, looking for shredding of the floss <span style="line-height: normal; margin-bottom: 0in; margin-left: 1.25in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> o If the floss snaps through, it is a good contact <span style="line-height: normal; margin-bottom: 0in; margin-left: 1in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> · The intaglio surface is the next area of concern <span style="line-height: normal; margin-bottom: 0in; margin-left: 1.25in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> o You can check out ‘Fit-checker’, which is a powder/liquid silicone mixture that shows areas that need to be reduced from the metal underside of the PFM <span style="line-height: normal; margin-bottom: 0in; margin-left: 1in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> · Once the crown seats perfectly & the margins are all closed, check the occlusion <span style="line-height: normal; margin-bottom: 0in; margin-left: 1.25in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> o Make adjustments extraorally, as necessary <span style="line-height: normal; margin-bottom: 0in; margin-left: 1in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> · After everything is ready & the instructor takes a peek, you can cement the PFM <span style="line-height: normal; margin-bottom: 0in; margin-left: 0.75in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> § Rinse/dry the area <span style="line-height: normal; margin-bottom: 0in; margin-left: 0.75in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> § Place cotton rolls, as needed <span style="line-height: normal; margin-bottom: 0in; margin-left: 0.75in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> § Mix Fuji & apply to the underside of the PFM, just coating all surfaces (don’t simply ‘fill’ the whole crown with Fuji) <span style="line-height: normal; margin-bottom: 0in; margin-left: 0.75in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> § Place the crown & seat it down all the way…have a cotton roll ready for the pt to bite down on <span style="line-height: normal; margin-bottom: 0in; margin-left: 0.75in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> § Have the pt bite down for several seconds <span style="line-height: normal; margin-bottom: 0in; margin-left: 0.75in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> § Have the pt open & remove any gross excess…by now the material should be rubbery <span style="line-height: normal; margin-bottom: 0in; margin-left: 0.75in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> § Hold the tooth down & floss through each contact with a piece of floss that you have tied a single knot in <span style="line-height: normal; margin-bottom: 0in; margin-left: 1in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> · The knot helps force excess material out of the proximal area <span style="line-height: normal; margin-bottom: 0in; margin-left: 1in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> · Pull the floss through the embrasure, not back through the contact occlusally <span style="line-height: normal; margin-bottom: 0in; margin-left: 1in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> · Use an explorer to remove any remaining cement <span style="line-height: normal; margin-bottom: 0in; margin-left: 0.75in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> § Re-check occlusion, polish as necessary <span style="line-height: normal; margin-bottom: 0in; margin-left: 0.75in; margin-right: 0in; margin-top: 0in; text-indent: -0.25in;"> § Get your card signed

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Periodontics Handbook <span style="border: initial none initial; display: block; padding-bottom: 4pt; padding-left: 0in; padding-right: 0in; padding-top: 0in;"> SPECIAL THANKS Sean Young for his informal guide to entering the clinic Will Trevor?? Dr. Jeff Goldstein?? Chuck Carlson Nathan Hansen

[NH1] Make hyperlink to this sheet

[NH2] Sean Young

[NH3] Follow up (not fuck you)

[NH4] Sean Young

[NH5] Make hyperlink to this guidline

[NH6] Make hyperlink to this form

[NH7] Is this what you do??