The Lead Pipe v1.0

8/7/2019 The Lead Pipe v1.0

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ASDAUCLAChapter

Clinic&LabEducationCommittee

TTThhheeeLLLeeeaaadddPPPiiipppeee

AAACCCllliiinnniiicccGGGuuuiiidddeeeaaannndddSSSuuurrrvvviiivvvaaalllMMMaaannnuuuaaalll


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Feelingabitlostwhiletryingtotreatyourpatients?ForgetthedifferencebetweenFujiIandFujiIX?

Cantfindsomeonearoundyoutoansweryourquestions?ThisdocumenthasbeencreatedtohelpoutintimeslikethesebyservingasastudentgeneratedguidetohelpyouweaveinandoutoftheUCLADental

Clinic.Therearetonsofinstructionmanuals,handbooksanddocumentsfloatingaroundattemptingto

answerquestionsyoumayhave,butwearehopingtocondensethosethatstudentshavefoundmost

usefulintoONEClinicGuide.Astherearealwayschangesandnewprotocolsarisingintheclinic,this

documentisinherentlyanongoingproject.Ifyouhaveanysuggestionsorcorrectionspleasesubmit

them!Allcontributionsarewelcomeandstudentswillappreciateandbenefitfromthemforyearsto

come.

NinaMendoza,c/o2012ASDAClinicandLabEducationCoordinator

[email protected]


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ASDAUCLAChapter


TableofContents

Anesthesia .............................................................................................................................................. 5

AntibioticProtocol............................................................................................................................... 6

ATP:AdvancedTreatmentPlanning ............................................................................................. 7

BasicCubicleSetup............................................................................................................................13

BillingOffice.........................................................................................................................................14

BlockSchedulesWhere?When? ................................................................................................15

CashierWindow..................................................................................................................................18

ChartRequests....................................................................................................................................19

ChartReviewRecallvsActivePatient......................................................................................20

Consultations.......................................................................................................................................22

ClinicvsBlock......................................................................................................................................26

Competencies ......................................................................................................................................27

DirectProcedures ..............................................................................................................................28

Endodontics .........................................................................................................................................31FixedProcedures ...............................................................................................................................33

FujiWhat?.............................................................................................................................................36

Hygiene..................................................................................................................................................38

Implants ................................................................................................................................................39

Inactivatingvs.DischargingPatients ..........................................................................................40

InitialPerioTherapy.........................................................................................................................41

Insurance ..............................................................................................................................................43NewPatient:Screening&Radiographs......................................................................................44

NitrousOxide(N2O)..........................................................................................................................45

OralDiagnosis .....................................................................................................................................46

OralFacialPain...................................................................................................................................48


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PatientAssignment............................................................................................................................49

PaymentPlans.....................................................................................................................................51

PatientRequests.................................................................................................................................52

PediatricDentistry ............................................................................................................................53

PerioClinic ...........................................................................................................................................56

Periodicexam......................................................................................................................................58

Preventive ............................................................................................................................................59

ProphySurvivingYourFirstOne!..............................................................................................60

Radiology ..............................................................................................................................................62

RecallDentureExam.........................................................................................................................63

RestorativePrimers:HurrisealandCavityConditioner.......................................................64Requirements......................................................................................................................................65

RubberDam.........................................................................................................................................68

RyanWhitePolicy ..............................................................................................................................69

SchedulingAppointments ...............................................................................................................70

SubmittingaTreatmentPlan.........................................................................................................72

UrgentCare ..........................................................................................................................................74

QuickLinks...........................................................................................................................................76


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Anesthesia

Ifthisisthefirsttimeyouareinjectingapatient,justrelax&workupyourconfidencedontbesurprisedifyoureshaking!

- Topicalanesthetic:o Iswearbytopicalanestheticforeverythingbutpalatalinjectionso Placeitwhereyouaregoingtoinject&dontletitgetalloverinthepatientsmouth

Takeoneofthosetopicalswabs&stickitalloverinyourmouth&seehowmuchyoulikeit Eitherusethesalivaejectororplacea2x2justbehindtheswabtoabsorbexcess

o Leavethetopicalthereforawhilemaybeaslongas2minutes Youcanfillthetimegettingthingsreadywhileitdoesitsjob

- Deliverslowly:o Movetheneedleslowly&injectslowlyo Onceyoustart,watcharoundtheptseyesforwincingiftheptflinches,slowdowno Youcantake2minutestoinject,whichfeelslikeaneternity,butwillbelessirritatingtothepatient

- Tellthepttobreathethroughtheirnose&useotherformsofdistraction- Providing(near)painless,profoundanesthesiaisworthitsweightingold

- ForIAblocks,ifyouaregoingtobeworkingintheareaforawhile,give1.5-2carpuleso Thisislotsbetterthanhavingtoinjectthroughtherubberdamlaterintheappointment

- Forthemaxilla:o Youcanalmostalwaysgivelocalinfiltrationinthemaxilla,asopposedtogivingaPSA,MSA,orASAblocko Forinfiltrations,remembertoanesthetizethetooththatyouplantoclamp,notjusttheoneyouwillbe

workingono Forthepalate:

Youcanalwaysgiveagreaterpalatineinjection,OR YoucanuseDr.Hargismethod:onceyouvecompletedthebuccalinfiltration&thebuccalgingivais

numb,youcaninjectthroughthepapillafromthebuccal,whichwillprovideanesthetictothelingual

lookforblanching


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AntibioticProtocol

ProphylaxisforPatientswithJointReplacement

Amoxicillin,Clindamycin,Cephalexin

ProphylaxisforInfectiveendocarditis

Amoxicillin,Clindamycin,Cephalexin,Azithromycin

Prescriptions(for3visits):

Rx:

Amoxicillin500mg Disp:12tablets

Sig:4tablets(2g)30-60minutespriortodentalvisitandrepeatateach

appointment

Rx:

Clindamycin150mg

Disp:12capsules

Sig:4capsules(600mg)30-60minutespriortodentalvisitandrepeatateach

appointment

Rx:

Cephalexin500mg Disp:12tablets

Sig:4tablets(2g)30-60minutespriortodentalvisitandrepeatateach

appointment

Rx:

Azithromycin500mg

Disp:3tablets

Sig:1tablet30-60minutespriortodentalvisitandrepeatateachappointment


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ATP:AdvancedTreatmentPlanningFromstarttofinish

WhoneedstogotoATP?

AnythingthatsnotFastTrack.WhatsFastTrack?SeethehandoutfromDr.Woodss2nd

yearspringcourse.I

cantfindit,andyoumightnotbeabletoeither,sohereistherelevantportion:

Basically,ATPisanythingwherethetreatmentisnotsoobvious.Occasionallyyoumaytrytodoaperiodicexam

(regularconsults)andhaveitblowupintoATPbecauseatthatappointmentyoufindthattoomanythingsneed

tobereplaced.

Sobasically,itsATPifyouneedextractions(otherthan3rdmolars),morethan8fixedrestorations,replacingmore

thanonetooth,anyRPDs.ReplacingonlyonetoothcanqualifyasFastTrack.Anobviousdenturecasewhereits

clearallteethneedtobeextracted(i.e.theresonlyonecleartreatmentpathway!),canalsoqualifyforFastTrack.

ATPiswhereyougotodecidehowtoreplacemissingteeth(debatingbetweenRPDs,implants,andbridges),or

doinglarge-scalerestorations(morethan8crowns,unreasonableocclusion,severeattrition).


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WhatdoIneedtodobeforeATP?

YouneedtodoaPre-ATPappointment.BookitonGSDassuchandyouwillgeteitherperioorrestorativefaculty

coverage.Itslikeregularperio/restorativeconsults,exceptyoureprettymuchonyourown(becausethe

instructorexaminationswilltakeplaceatATP).Doyourperioprobingsandhavethecoveringperiodontistlock

yourperiochart(thisisanewadditiontotherequirementsbeforeATP;theywanttheprobingsandothermeasurementstobeaccuratesotheydonthavetoquestionthemattheATPappt).Therestorativeexamis

completedasnormal(butwithoutafacultyconsult).Ifyouaretryingtodothisinthe1.5hoursafterOD,youmay

ormaynothaveenoughtime.

YouwillalsoneedmountedcastsfortheATPappointment.Sotakeupperandloweralginateimpressions,pourin

yellowstone.(Theywilllikeitifyourmountingandcasttrimmingisnothorrid).Youcantrytocapturethe

vestibulesifyouareplanninganRPD,buttheyllprobablybefineifitsnotperfect(sinceitsjustapreliminary

studycast).Youwillprobablyneedafacebowtomountthecasts.Generally,youwillwanttohand-articulatethe

casts(becausethisismostaccurate),unlesstherearenotenoughteethtodoso.Inwhichcase,youwillneed

recordbasesandwaxrims.(Notblue-mousseorcompoundorwaxwafersoranythingelse).Moreonthat

below

IfanRPDisapossibletreatmentoption,youllwanttogetapre-ATPdesign.Thewhiteformsfordrawingthe

designareon2nd

floorinfrontoftheremovablelab.Drawyourproposeddesign,andgotoaremovableconsult

(thescheduleforthisison2nd

floornearNancysdesk).Bringthemountedcasts,aswellasthepatients

radiographs.

Thepresentation:Afteryougetyourdiagnosticinfo,prepareyourtreatmentplan(ifyourewrong,thatsfine.

ATPisnotevaluatingyouforcorrectnessbutjustforthoughtfulness).Followtheorderonthisotherhandoutfrom

Dr.Woodsspringcourse.(nextpage)Afewthingstonote:Makesuretoknowthepatientssnackinganddietary

habits,oralhygienehabits.Besuretostateplaque/marginalbleedingindicesbeforeperioprobings.Knowtheir

typeI/typeII/etcpreventive.Andtelltheoverallbigpictureoftreatmentbeforegoingintoittooth-by-tooth.

Thereareprobablymanyexamplepresentationsfloatingaround.Belowisoneexample.Ifyouneedothersjustask

aclassmatefortheirpresentation.Followingtheexamplecasepresentationonthenextpageshouldcovermost

questionsyoumaybeaskedinATP.


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PATIENTINTRODUCTION

Demographics: Age: Occupation: FinancialStatus/Insurance: Initialexamdate: WhyatUCLA:

ChiefComplaint: Originallycameinbecauseofpaininlowerleftquadrant,whichisnolongeroccurring.Ptis

concernedabouttheestheticsandlossoffunctionofhermissingposteriorteeth,andof#21in

particularasitisvisibletoptwhenshesmiles.

HPI: Ptlostrestorationon#21approximately1yearagoandhadpaininthatareaapproximately2

weekspriortoinitialexam.Ptisunawareofthehistoryoftheotherinvolvedteeth,butreports

nothavingreceiveddentalcareforabout10years.

SYSTEMIC

MHx,medications: Ptreportsnoactiveorsignificantpastmedicalproblemsandisnotcurrentlytakingany

medications.

LastBPtaken11/22/2009andwas128/82/80bpm/regularrhythm Allergies:Seasonalallergies,NKDA

DHx: Lastdentalvisitwasapproximately10yearsago. Patientreportsdissatisfactionwithpreviousdentalcareataprivatedentistassociatedwith

havingthewrongtoothpreparedandcrownedandalsoduetodifficultyachievinglocal

anesthesia.

Ptreportsahxofdentalphobia.URGENT

None

PREPARATORY

Preventive MBI:35.58% PI:38.46% TypeII Highcariesriskduetovisiblecavitations,exposedroots,andinterproximalradiolucencies. Atinitialexam,ptreportedhxofbrushing1x/dayandoccasionalflossing. Txplan:

Dietanalysis Recommenduseofsugar-freexylitolgumaftereating RecommenduseofOTC0.05%NaFrinsesuchasACT1x/dayafterbrushingteethin

morning

Prescribe1.1%NaFtoothpastesuchasPrevident5000tobeusedwhilebrushingteethbeforesleeping

OHIincludingBassmethodandflossinginstruction Recommenduseofelectrictoothbrush


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Periodontal:

2-4mmgeneralizedpocketdepthsonmaxillaryandmandibularteethwith5-7mmlocalizedpocketdepthsonmaxillaryposteriorteeth.

Nofurcationinvolvementormobility. 3mmrecessionon#3lingual. Moderategeneralizedhorizontalboneloss. ModerategeneralizedBOPandinflammation. Moderategeneralizedchronicadultgingivitiswithlocalizedmoderateperiodontitisinthe

maxillaryposterior.

Txplan:2apptSc/RP.4weekperiore-eval. Endo/OralSurgery/Ortho/OrofacialPain/Esthetic:

Endoconsult: Teeth:19,28(re-treat)

Oralsurgeryconsult: Extract:

Teeth:13,15,21 Roots:30

Implantconsult:

Dependingonfinaltxplan,teeth:13,20,21,and/or30RESTORATIVE

Overalltreatmentapproach: Maxilla:Extractions,operativeandfixedtoaddressactivedentaldisease,andeither:

12-13-14FPDor singletoothimplanttoreplace13

Mandible:Extractions,operativeandfixedtoaddressactivedentaldisease,andeither: singletoothimplantstoreplace20,21and30or singletoothimplantstoreplace20and21and29-30-31FPDtoreplace30or mandibulartooth-borneRPDtoreplace20,21,and30


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Toothbytoothplan:Tooth Description Problem Plan Fee

1 Missing

2 Oamalgam FracturedMamalgam Ocomposite $99

3 PFM 3mmlingualrecession,gingival

hyperplasiaonM

4 PFM GingivalhyperplasiaonD

5 DOamalgam Mcaries MODcomposite $148

6

7 Mcaries MLcomposite $105

8 PFM OpenFmargin PFM $495

9 PFM/post/RCT OpenFmargin PFM $495

10 MLcomposite RecurrentMdecay,Ddecay ML,DLcomposite $115

11

12 DOamalgam Mcaries MODcomposite $148

13 Crownfracture/grosscaries Ext

Replacewithsingleimplant

($2,000-$2,500)or3-unit

bridge($1,485)

$125

(+?)

14 OLamalgam Mcaries MOLcomposite $148

15 Crownfracture/grosscaries Ext $125

16 etccontinueto#32

ELECTIVE

NoneMAINTENANCE

Preventive Fluoride:topicalfluoriderecommendedafterSc/Rporprophy OHIateachrecallprophy

Periodontal PhaseIinterval:3moperiorecall

Restorative(Monitor/Watch) 1yearrecallforperiodicexamandBWX


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AtATP

Ifyoudoneedtotakeawax-rimbiteregistrationduetoinsufficientteeth,youcantrytobookthepatientforan

11amor4pmATP(forexample),andbringthemintothegeneralclinicat9amor2pm.Dothewax-rims,then

finishmountingthemandibularcast.

BookanappointmentunderWWATPAM(orPM)andspecifywhetheryouwant9am,10am,or11am.(Each

appointmentisanhour).Atthetimeofthiswriting,ATPtakesplaceM/TafternoonsandThursdaymornings(but

ifyouforget,youcanalwaysjustchecktheGSDscheduleforNewRoomandseewhenATPis;theothertimes

areusuallyEstheticsclinic).RemembertoconfirmyourATPapptthedaybefore!Otherwiseitwillbedeletedand

youllbeoutofluck.

RemembertobringtheATPgradesheet(pink).Atthetimeofthiswriting,itcanbefoundon2nd

floornotwithall

therestofthepapers,butaroundtheback(closetoorthoandthebacksideofsterilization).

Sityourpatientdownanywhere,haveyourcomputerout,mountedcasts.Itcanbehandytohaveyour

presentationnotesonpaperratherthancomputer,sotheother2facultycanlookatradiographsonXDRwhile

oneisexaminingthepatient.

AttheendyouwillfilloutPREVTX1-4,andwritetheATPconsultnotes.Basicallyitshouldcontainallthefindings

&treatmentyoudiscussed.

WhatdoIdoafterATP?

IfyoutrytoaskDr.Woodsthis,hewillhandyoutheconvenienthandout(availableatyourATPappointment)with

mosteverythingspelledout.IfRPDispartofyourfinaltreatmentplan,youwillneedapost-ATPRPDdesign(by

attendingremovableconsults).DragstuffoveronGSD(justlikeanytreatmentplan),fillouttheyellowinitialplans

formandproblemlist,putthepinkgradesheetin,andsimplysubmitthecharttothechartroom(askthemto

putitinDr.Woodsbox).Toknowwhenitsdone,simplycheckGSDtoseeifthetreatmentplanhasbeenapproved(redstarsbecominggreen).Thenthechartwillbeavailableinthechartroomagain.


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BasicCubicleSetup

- Fromthecentralsterilizationarea,pickupapieceofwaxpaper- Fromthecentralislandsbackwindowarea(orfromyourhomecube),obtainthefollowing:

o ***Youcankeepallthisstuffonhandatyourhomecubeo 1bigbagfortraytable(nolongerrequiredforoperatorchair)o 1plasticlaptopbago Bluegown&facemasko High&lowspeedsuctiontips,air/watersyringetipo Patientbibo Anycottonrolls&2x2syouplantouse

Findingsupplies

- Cartsatthebackwindowincludesuchthingsas:o Impressionmaterial(alginate,polyvinyl

siloxane)&trays

o Bluecompositeo Packingcordofvarioussizes(althoughyou

shouldhaveyourowncordinthat

hemostasiskitfromUltraDent)

o Ropewax

o Greenstickcompoundo Vaselineo Matrixbandso Clearmylarstripso Bitestickso Tempbondo Matrixbuttons

- Cartintheremovableclinicincludessuchthingsas:o Pinkcompoundo Greencompoundo Disposablemirrorso Tonguebladeso PIP

o Disclosingwaxo Denturecupso Impressionmaterialo Impressiontrayso Indelibleinksticks

- Centralsterilizationwillhave:o *Basicallyforeverythingthattheclinic

doesntwantyoutosteal*

o Studentbags=bagsyoudropoffwithyournumberwrittenontop

o Restorative,perio,rubberdam,exam,ODexamcassettes

o Anyinstrumentsmissingfromanycassettes(includingrubberdamclamps)

o Fujigunso Integritymaterialo GCFujiLiningLCpasteo Endotestingsupplies(Endoice,EPT)o Endocubiclesetupstuffendofiles,gutta

percha,etc.

o Scalpels&scalpelbladeso Orthowiresfortreatmentpartialso T-barforremovingoldcrowns

o Cavitrono Electrosurgthingforelectrocauteryo *Anythingelsethatyoucantfindinthe

cabinetsatthebackwindowsORanything

youhaventheardofwhentheinstructor

asksyouDoyouhave?


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BillingOfficeBillingholds(lockedoutofchart): yourpatienthasanoutstandingbalanceandneedstopaytheirbalancebefore

youcanaccesstheirchart.Thisincludesschedulingappointments.Oncetheyhavepaidtheirbalance,gotothe

billingofficeandaskthemtounlocktheirchart.

Insurance:UCLAacceptsdirectpaymentfromonlyDeltaDental.Allotherinsurancecompaniesreimbursethe

patientafterwards.

Mail:Youcanalsofindtheboxtoputanypatientmailthatneedstogetsentoutonthecounternearthedoor.

MakesuretheenvelopeisaddressedcorrectlyandthatithasbeenstampedbyyourGPD.Nopostagerequired.

RyanWhiteForms :OncetheblueformsforyourRyanWhitepatientshavebeenfilledoutandsignedbyDr

Younai,droptheformsoffinthebillingoffice.Oncetheyareprocessedanotewillappearinthetopwindow

undertheNotestabinGSD.


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BlockSchedulesWhere?When?Throughoutyourtimeinclinic,youwillalsoneedtopayattentiontoyourassignedblockschedules.Theseareall

notedinthecalendarthatisupdatedandemailedtoyoueachquarter.Thesecalendarsarealsopostedintheclinic.ThedatesshouldalsobeblockedoutonGSDsothatyoucannotaccidentallyscheduleapatient.Itisagood

ideatochecktheseoveratthebeginningofthequartertoensureyourcalendarmatcheswithGSD.

Differentblocksmeetondifferentdaysanddifferenttimes.Somemaylasttheentireweekandothersonly20

minutesintheafternoon.ThekeyforreadingtheBlockschedulecalendarisavailableonline.

InglewoodChildrensDentalCenter (1day/weekfor1quarter):o InglewoodBlockRotationisoneofyourtwoPediatricdentalrotationsatUCLA.Theother

rotationoccursoverthecourseofaweekattheWestwooddentalclinic.Moreoftenthannot,

theInglewoodrotationwillbeyouronlyopportunitytoperformactualproceduresonchildren

patient(asopposedtoexamsandprophysattheWestwoodclinic).Theblockrotationoccursoverthecourseof1quarteronthesamedayeveryweekduringeithertheD3orD4year.Expect

tobetherefrom8:30amuntilapproximately4:30pm.

YoumaynotbecompletelysurewhattodowhenyoushowuponthefirstdayofWeek1.Ifso,readthis

shortlisttobeprepared:

o Printyour3competencyandsignaturesheets.TheseareavailableonAngel.Asmuchaswehateit,youwillbechasingthealmightysignatureforyourcompetetenciesandexperiencesat

Inglewoodaswell.

o Bringallsupplies.InglewoodClinicisverylowonsuppliesduetoalimitedbudget.Anythingyoucanbringisgoingtovastlyimproveyourexperience.Handpiecesandburblocksataminimum;

buteverythingnecessaryforacompositerestorationisabetterrecommendation.

o Showupat8:30am.Theaddressis300BuckthornSt.Inglewood,CA90301.TherewillbeanorientationduringthemorningofDay1intheToothFairyCottage(directlyacrossthestreet

fromtheactualclinic)wheretherestoftheblockwillbeexplainedtoyou.

o BrieflyreviewPedotopics.JustquicklyreviewhowtodoaClassI,ClassII,SSC,andpulpotomy.Dontspendtoomuchtimewiththesetopicsasyoumaynotbetoobusyduringyourfirstweek.

However,youmayendupdoingastainlesssteelcrownasyourfirstpediatricexperience(likeI

did);andyoullappreciatehavingbrieflyreviewedthetopics.

OralDiagnosisBlocko Thisblockiscompletedthreetimes;thefirstduringsummerof3rdyearforoneday,thesecond

timeforaweek,andthelasttimeyouarescheduledfortwodaysinoneweek.Forthisblockyou

mustshowupat9AMand2PMintheODcliniconthefirstfloor.Bringeverythingwithyouthat

youneedtocompletetheexam(thisincludes:examkit,gloves,gown,eyeprotection,masks,BP

cuff,Rxbook,computerandthenecessarycords).

OralFacialPainBlock OralMedBlock(atthistime,thisblockhasbeeneliminated) OralSurgeryBlock(1week)


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o Thisblockisonlycompletedonce.Itcoverseveryclinicsessionforoneweek.BeforethefirstsessionitmaybeagoodideatopickupthepacketofinformationfromtheOSofficeonthe5

th

floor.Thispacketcontainsthepagethatrequiressignaturesthroughouttheweekandmustbe

turnedinaftertheweekisover.Forthefirstmorning,meetintheOSclinicontheAlevelat9

am.Youcanbringyourbackpackandleaveitintheconferenceroom.FindDr.Hargisinthemain

clinicarea.Heprefersifyoubringapenwithyouasthefirstsessionsincludesomenotetaking.o ThebeginningoftheweekismostlyspentwithDrHargislearninginstrumentsandtyingknots.

Refertothescheduleforspecifics.

OralSurgeryBlock(3weeks):o Thisblockconsistsofa3-weekrotation,whichyouhavetheoptionofchoosingbothtimeand

place(sortof).Yourclasswilldecidehowtocreatealotterysystemtoenableadraftforpicking

yourtopchoice.Youcanchoosefrom4differentclinicsandblocksoftimethroughoutyour4th

year.Someblocksalsoextendintothebreakstolimittheamountoftimeyouareoutofthe

generalclinic.Theclinicstochoosefromare:UCLA/Harbor,VASepulveda,WestLAandMLKCare

Center.

OrthoBlocko Thisblockiscompleted3differenttimesduringthe3

rd

/4

th

year.Ontheafternoonyouarescheduled,meetintheorthocliniconthe2

ndfloorat2pm.Youwillcompleteanorthoexamwith

apartnerduringthefirsttwosessions.Atyour3rd

timeintheclinic,youwillspendthetime

observingtheresidents.Thisblockcanbecompletedveryquicklyandrarelyarestudentsstill

workingafter3PM.

PedoBlock(3days)o ThisblockoccursduringWinterorSpringquarterofyourthirdyear.Itoccupies6clinicsessions

duringoneweek.YoumustmeetinthePedoclinicstarting9AMonMondaymorning.Theblock

continuesthruTuesdayafternoon,Wednesdayisoptional,andfinishesonThursday.Thereare

severaldocumentsyoushouldbringtogetsignedduringthisweektoproveattendanceand

competency.TheseareexplainedinmoredetailinthePediatricsection.

PerioBlock(4sessionsinoneweek)o Thisblockisonlycompletedonce.Theblockcovers4clinicsessions:MondayAMandPM,

TuesdayPMandThursdayPM.Thefirstmorningmeetsat9AMinaconferenceroomacrossthe

PerioclinicontheBlevel.Thereisaninteractivelectureduringthisfirstsessionandtherest

consistofshadowingandassistingintheperioclinic.Youmustbepresentduringtheentire

sessionsintheclinic.YouwillneedtocheckinwithGwenatthefrontdesk.DoNOTbringyour

backpackwithyou;cometotheclinicwithagown,masksandeyeprotectionandthatisit.

RadiologyBlocko Thisblockisdoneonceaquarter.Itlaststheentireday,howeveryouwilllikelyfinishearlyin

eachsession.Themorningsessionbeginsat9AMandtheafternoonsessionat2PM.Youdonot

needtobringanythingwithyou.MeetintheradiologyconsultroomacrossfromtheODchairs.

SpecialPatientCareBlock(1session+1earlymorning)o Thisblockisonlycompletedonce.ItcoversWednesdayAMandPMsessionsthefirstweekandis

from8-9AMontheWednesdayofthefollowingweek.Forthefirstsession,meetinthe

WeintraubcenterontheBlevelacrossfromtheProsthoffice.Youwillspendthefirsthour

listeningtothepresentationgivenbythepreviousweeksgroup.Youcanleaveyourbackpackin

thisroomanddonotneedtobringanythingelsewithyou.Duringthesecondsession,youwill

presentapreparedPPTaboutaspecialcarepatientthatyouencounteredduringyourfirst


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~17~

session.DrSunmaybepresenttoquizyouonsomeofthemoreimportanttopicssodosome

research.

UrgentCareBlock VeniceBlock(1day/weekfor1quarter)

o ThisblocklastsanentirequarterandiseitherWinterorSpringof3rdyear,orSummerorFallof4

th

year.YourspecificdaywillbesometimeTuesThurs.Youmustreportfororientationat7:50AMonyourfirstdayofblock.Theoreticallyyouonlyneedtobringtheequipmentfromyour

cubiclethatyouneedfortheappointmentsyouhavescheduled,howeveryoumayalwaysbe

givenanurgentcareatthelastminuteandsoyouwanttomakesureyourprepared.Theclinicis

nearthecornerofRoseandLincoln.TheentrancetotheclinicandtheparkinglotisonRose.


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ASDAUCLAChapter


CashierWindowThecashierwindowiswhereyoushouldideallybegineveryappointment.Itcanbefoundtotherightofthechart

roomwindowonthemainfloorinthepatientwaitingarea.Itsalwaysimportanttotryandgetyourpatienttopay

beforetreatmentisstarted!Thiswillsaveyoualotofheadachedowntheroad!

Cashierhoursare:Mon,Wed,Thurs,Frifrom8am-5pmandTuesfrm8am-8pm Cashierphone#is(310)825-5253 Thewalk-Inaddressis714TivertonDrive

Whensendingyourpatienttothewindow(orwhenaccompanyingthemthere)itisimportanttotellthecashier

thepatientschartnumber(justhandthemthechart)aswellasthechargefortheday.Thepatientscanalsodo

thisontheirownontheirwayoutattheendoftheappointmentaslongastheyhavethisinformation.

Acceptableformsofpaymentincludecash,personalcheckswithpreprintednameandaddress(thisincludes

moneyordersandcashierchecks),andcreditcardsandATMcardswiththeVisa,Mastercard,AmericanExpressor

Discoverlogos.

Patientscanalsocalloverthephonetocompleteapayment.Theyneedtoknow:

Chartnumber Amttobepaid Creditcardnumber Expirationdate Card-holdersname Zipcode Contactphonenumber

Ifyouareunsurewhatyourpatientowes,checktheirrecordsonGSDbyclickingonthemoneysymbolatthetop

ofthescreen.Ifyouhaveayfurtherquestions,theBillingOfficewillansweranyquestionsyouhave.


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ChartRequestsChartscanberequestedfromtheChartRoom,whichisfound,totheleftoftheCashierWindowonthemainfloor

oftheclinicinthepatientwaitingarea.

Chartroomhours:M-F7:30am-12pmand1pm-5pmaswellasTuesuntil8pm Havechartnumberreadytoenterontherequestsheetalongwithpatientinitialsanddentalstudent#

andinitialsTheywillcheckthisoffastheysignthechartouttoyou

Rushhoursare8am-10amand1pm-3pm Max2chartsduringrushhourandmax4duringnormalhours

WhatifIneedmorethan4charts?

Ifyouhaveachartreviewandneedmorethan4charts:o PrintyourpatientlistfromAcademicSystemo Highlightthechartsyouneed

Thosewithcode07forrecallchartreview Allotheractivepatientsfortheregularchartreview Writeyourname,student#andchartreviewdateandtimeatthetopofthepaper

Turnthisintothechartroom24hrsbeforeyourchartreviewandtheywillcreateastackwhichyoucanpickupthenextday

EXCEPTION!IfyourchartreviewisonaMonday,turninthechartrequestlistonThursdayWheredoIreturnthecharts?

Chartscanbereturnedanytimeduringregularbusinesshoursthroughthewindow,butitismucheasiertosimplydropthemintheslotsfounddirectlytotheleftofthewindow

Afterclosinghours,chartsshouldbereturnedonlytothedropbox IfyouhavealargechartthatdoesNOTfitintooneoftheslots,ithasbeensaidthatyouareallowedto

keepthechartovernight,HOWEVERyoucanusuallysidethewindowsopentothechartroomwindow

andsetthechartonthecounterinsidethewindowbeforeclosingthem

Whatifmypatientrequestsacopyoftheirrecords?

YoucanreferyourpatienttoAjaStanleywhoiscustodianofrecords:

1stFloorLabby,Room10-138,Window#5

ph#(310)825-3195

fax#(310)825-7620

ObtaintheAuthorizationformandprovidepatientwiththisinpersonorbyemail,faxorsnailmail.Informyour

patientthatthereisa$15chargeeachforwritten/computerizedandbillingrecordsorsinglesheet/pageofxrays.

Requestswilltakeupto7daysfromthetimepaymentiscollected.


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ChartReviewRecallvsActivePatientEveryquarter(fromsummertospringofyour3rdyear)youmustcompleteoneRecallChartReviewandone

regularChartReview.TherecallchartreviewisconductedwithyourGPAandmayberelativelyshort.Theother

chartreviewisdonewithyourGPDandisscheduledusuallywithinthefirstfewdaysofthequarter.

RECALLCHARTREVIEW

Thisisconductedtoensurethatrecallpatientsarebeingtakencareof.SeeyourGPAsometimeatthebeginning

ofthequartertoschedulethisappointment.PrintyourlistofpatientsfromAcademicReportandhighlightthose

thatarerecall(shouldhavea07code).

Beforeshowinguptoyourchartreview,youshouldlookoverthepatientschartonGSDandentersome

informationintotheNotessectionoftheirchart.Basicallythisshouldrecordwhentheirnextpreventiveand

consultationappointmentsshouldbedone.Anexamplenoteentrymaybe:

RecallChartReviewDueDates:

PE:7/19/11

Prophy:8/8/11

BWX:7/19/11

FMX:7/19/13

OD:1/24/14

Ifthisisadenturerecallpatient(code09),youonlyneedtodocumentthenextexamandODdates.Ifthenew

entrynoteswillnotreflectachangefromthelastrecallchartreview,youmayenter:

RecallChartReview:

Statusunchangedseenoteson(includedate)

Youcanfindthisinformationinanumberofplaces:

ThelastsetofconsultscanbefoundbyfirstgoingtotheCharttabandclickingonProblemLists/Consultstab;thenclickthepencilorplussigntoseealistofcompletedconsultswithassociated

dateandnotes(thisisalsowhereyoushouldfindtheperiorecallinterval)

ThelastcleaningmaybefoundbyfirstgoingtotheCharttabandclickingontheH;sortthelistbydateandscrolluntilyoufindthelastentryfor:1110BProphylaxisAdult.Determinethedateforthenext

prophybyaddingtheappropriaterecallinterval(3/4/6mos)tothedateofthelastprophy. TofindthelastODyoucanlookeitherontheDetailstabintheboxlabeledNextODWorkUporby

lookingundertheCharttabandlookingforthelatestgreenODtabtofindthedateofthelast

appointment

Tofindthelastradiographs,lookundertheCharttabandfindtheredRadiographtabtofindthexraytabCompletethisforeveryrecallpatientunderyourname,gatherthechartsfromthechartroomandtakethesewith

youtomeetwithyourGPA.


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ACTIVEPATIENTCHARTREVIEW

Whilethisappointmentcanbemorerigorousandstressfulthantherecallchartreviewthepreparationissimilar.

Beforeyourscheduledtime,makesureyouhavereviewedallyouractivepatients.Youshouldbelookingforthings

like:

Medicalissuesandlabslipsupdatedrecently(andmakesureyouhaveathoroughunderstandingoftheissuesinvolvedwhentreatmentthispatient,ifany)

OD/PEcurrent Radiographscurrent Treatmentplanscreatedwithin10-11mos Allsignatureontreatmentplanpresent Allconsultssignedforandcompleted Allappointmentschargedout(youshouldnotbegettinganyDailyUnchargedSummariesemails) Nosignificantamountofmoneydueonthepatientsaccount

ItsalwaysagoodthingtomeetupwithyourCPCteamtogooverpatientstomakesureeveryoneontheteamisfamiliarwithcurrenttreatmentplans.Aslongasyoupreparethingsshouldgosmoothly.


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ASDAUCLAChapter


Consultations

Consultsrefertooneoffourthingsgenerally:

1)Initial/periodicconsultationforcreating/updatingtreatmentplans2)Consultationwithoneofthespecialties(endo,oralsurgery,ortho,removable)duringongoingTx

3)Removableconsults,whereinyoudiscussRPDdesigns,denturesetups,etc.,witharemovableprofessor

NOTE:youcanhavearemovableconsultwithyoupatientintheremovableclinic,oraremovable

consultwithjustthefacultyinanofficesetting

4)Implantconsult

PREATPCONSULT

ThisistheappointmentpriortotheATPapptthatyouwillhaveonthesecondfloor.Thisappointmentdoesnot

requirefacultycoverageexplicitly,howeveryoudoneedtohavetheperiochartlockedbyfloorcoverage.Consult

tabsshouldNOTbecreatedastheconsultisdoneofficiallyintheATPappt.SOAPnotesshouldbewrittenand

signedoff.ThisisexplainedinfurtherdetailintheATPsection.

Duringtheappointmentyouneedtogatherallthesameinformationasisobtainedintraditionalrestorativeand

perioconsults.However,inadditionyoumustalsoobtainaccurateimpressionsofyourpatienttocreatestone

modelstomountandbringtoATP.Thesecastsshouldbemountedaccuratelywithafacebowrecord.Theycanbe

handarticulatedifthepatienthasenoughremainingdentitiontocreatesolidocclusion.Ifthisisnotthecase,wax

rimsshouldbecreatedandalsobroughttoATP.

Ifyouneedmoreguidanceinregardstowhatinformationtoobtain,followtheATPpresentaiontguidelineorfind

thegreensheetbehindcentraloutliningthesameinformation.Ifanobvioustreatmentplanisntpresentingitself

toyouduringtheappointment,youcanalwaysaskfacultyiftheywillgivesomeadviceastohowtoproceed.

FASTTRACKCONSULT

ForFastTrackcases,yougenerallyonlyneedperio&restorativeconsults;additionalspecialtyconsultsaresometimesneededaswell.

o Iftheptneeds1+extractions,youwillneedanoralsurgeryconsultintheOSclinicfollowingTxplanapprovalbyyourGPD

WHERETOENTERCONSULTNOTES:

o InyourptschartinGSD-ACADEMIC,gotothecharttab&clickontheconsultstaboninthelowerright-handcorner.Click+orpencil,whichopensanewwindow.ClickontheConsultationstab&thenclick

+orpencil.Besureyouchecktheboxtoaddconsultwithoutassociatedcondition.Thereisadrop-

downboxtoselectthesubspecialtyyouarecompletingtheconsultfor(e.g.,perio).

o Whenyouvedonethat,youllseeanewlineintheconsultationtabwindow.o Double-clicktheconsultyouwanttodothisopensupablankwindow.o Inthebox,youneedtoenterthedetailsoftheconsultation.o Whenyouvetypeditallintherecorrectly,closethewindow&clickcompleteconsult.o Oncethefacultyhassigneditoff,verifythatthewordcompletedappearsontheconsultline.


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~23~

PERIOCONSULT

o Completeperiocharting:noteanymissingteeth,measureperiodontalprobingdepths,BOP,recession,attachmentloss,presence&extentofplaque/calculus,health&appearanceoftissues

o Lookatbonelevelsradiographicallynoteanygeneral&localboneloss&possibleperiolesions Usebitewings,notPAs,tolookatbonelevels(BWXprovideamorelevelviewofboneheight)

o Exampleconsultnotes(tobetypedupbeforefacultycomesoverandapprovedbythemaftertheirassessment):

PtInformation:

Typeofexam(initialvs.periodic) CC SignificantMedicalcomplications Lastdentalvisit/cleaning HxPerio/OS Restorativeexperience

RadiographicFindings

DescriptionofCalculusfindings DescriptionofBoneLoss(GenvsLoc;mild(


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ASDAUCLAChapter


RESTORATIVECONSULT

o Thewisestudentwillhavealreadycompletedaradiographicanalysis,soyoushouldalreadybehalfwaythere(doradioconsultbeforetheappointment)

o Performatooth-by-toothexam&noteanythingabnormalcaries,demineralization,discoloration,chippedteeth,deeppits/fissures,currentrestorations,failingrestorations,developmentalstuffanything

worthnoting

o Useyourbestjudgmenttodevelopaplanforeachtooth TheinstructorwillhelpyoudecideonthebestTx Ifyoudisagreewiththeinstructor,youcanaskwhytheywouldntdowhatyouthoughtyoushould

do

Theymayactuallysay,ThatwouldbeanotheracceptableapproachORtheywillexplainwhyyourideaisnotasgreatastheirideaeitherwayyoulearnsomething

IntermsofrestorativeTx,itisbesttogiveyoupatientoptions(e.g.,goldinlayvs.amalgam)withpros&consofeach(cost,longevity,esthetics,etc)

o Exampleconsultnotes(tobetypedupbeforefacultycomesoverandapprovedbythemaftertheirassessment):

PtInfo:

TypeofExam(initialvs.periodic) CC SignificantMedicalcomplications Restorativeexperience

ToothbytoothFindings(indecorder)

1-32radiographicandclinicalfindings(specify) i.e.#14crownhasradiographicopenmarginandclinicaldecayatmargin #21incipientocclusaldecay

ToothbytoothTxplan(indec.Order)

1-32:mentionallteethinfindings(includingwatch) i.e.#14PFMCrowninformptofcrownlengtheningorendopossibility #21watch

Re-Eval:

BWXevery12mo,FMXevery3years


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SPECIALTYCONSULT

o Theseinclude,butmaynotbelimitedto:oralsurgery,endo,removable,perio,restorative,orofacialpaino Duringanygivenappointment,youmaywishtohaveaconsultwithaprofessorfromoneofthese

specialties

Restorative,perio,&endodonotrequireaseparateappointment Orofacialpainconsultsmustbescheduledintheredbookfoundattheendofthe1strowofcubicles

intheOralDiagnosis/Radiologyclinic OralsurgeryconsultsarescheduledattheOralsurgerywindowontheA-level

Youmaybeabletobeseenonawalk-inbasis,dependingonhowbusytheclinicis&whatyourptsneedsare

Removableconsults(clinical)aremadebyappointmentinGSD-ACADEMIC

ENDOCONSULT

o Ifyouareconcernedwiththevitalityofatooth,gathersomeinformationbeforepresentingtoendofaculty:

Testforpalpation/percussion,coldtestandEPTo Bringthisinformationalongwiththeradiographtotheendoclinicandpresnto Exampleconsultnotes(tobetypedupbeforefacultycomesoverandapprovedbythemaftertheir

assessment):o Exampleconsultnotes(tobetypedupbeforefacultycomesoverandapprovedbythemaftertheir

assessment):

PtInfo:

TypeofExam(initialvs.periodic) Chiefcomplaint SignificantMedicalcomplications

TestResults:

Palpation/percussion(+/-),coldtest,EPTresults

Radiographstaken:

Assessmentofprognosisofthetooth

Proposedtxplan Needforpermanentrestoration Needforfurtherconsultsingeneralorgradendoclinic

REMOVABLECONSULT

o Whenyouareintheprocessofmakingaremovabledenture(completeorpartial),youmusthaveeachstepsignedoffalongthewayforbothclinicalworkandlabwork

o So,aconsultconsistsofyou,theremovableinstructor,yourcasts,theptschart,articulators,blue/redpencil,&surveyor

o Theinstructorinspectsyourlabwork&providestheall-importantsignature

IMPLANTCONSULT

o ThisisaspecialconsultationwitheitherDr.Shah(removable)orDr.Hewlett(restorative)o Hereyoupresentthecaseofanyptwhowouldlikeimplantso Yourptispresent&yougettodiscussallthedetailsofTxplanninganimplantcase


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~26~

ClinicvsBlockClinic:

Generalclinictimesareasfollowsunlessotherwisestated:

Monday Tuesday Wednesday Thursday Friday

9-12 9-12 9-12 9-12 9-12

2-5 2-5 2-5 2-5

6-9

ThereisnocliniconFridayafternoons;thisiswhythereisTuesdaynightclinic.

Block:

Youareexpectedtoattendallblockrotations.YourappointmentbookonGSD-Academicwillbeblacked

outandyoucannotscheduleappointmentstoseeyourpatients.Blockrotationstakeprecedenceoverclassand

clinic.Intheeventyoumustswitchablock,youwillneedtofilloutablockswitchform.Youcangetthesefrom

yourGPA.Tofillitoutyoumustindicatewhoyouareswitchingwith,whatdatesyoutwohaveblock,youwillalso

needasignaturefrombothstudentsandtheblockdirector.Onceallthisisfilledout,youwillneedtobringthe

formbacktoyourGPAandtheywillmaketheswitchinGSD-Academic.


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~28~

DirectProcedures

Operative:

oGenerallyspeaking,alwaysbedoingsomething: Whilethetopicalistakingeffect,loadthesyringe Whilethelocalanestheticissettingin,getyourrubberdamreadytogo Whilewaitingfortheinstructor,typeyourSOAPnotes

o Startcheck: Youshouldbefamiliarwiththefollowing:

CurrentmedicalHxlookinthechart Treatmentplan&yourplanfortheappointment Radiographs NOTE:themoreprepared&confidentyouare,thebetterthefacultyinteraction.Youwillbe

abletoworkmoreindependently,yetgetthehelpyouneedwhenyouneedit.

Preparation:

o Beforeyoudrill,verifyyouareonthecorrecttooth,doingthecorrectrestoration,fortherightreason Checkthechart,theradiograph,thentheptsmouthjusttobesure

o Controlthewater Youonlyhavetwohandsdecidehowyouaregoingtoseewhatyouredoing,dowhatyouredoing,

andkeepthewateroutoftheway

Sometimesitsbesttousedirectvision&holdthehi-volumesuction Sometimesitsbesttojustplacethesalivaejectorneartheclampsoyoucanholdthemirrorwith

yourfreehand

Sometimestheptiswilling&abletoholdthesuctionwhereyouwantit Sometimesyoucouldreallyuseanassistant

o Beaggressive(butdontdrillforoil) Goahead&stepdownonthepedal

Youwillfindthatitbeatspreparingthetoothoneenamelrodatatime

Justbecarefulaboutyourpulpaldepth(inbothpulpal&axialdirections),especiallywithdeepcaries Remembertheanatomyofthepulpchamber&checkyourradiographs

o Preptoideal,thenhavetheinstructortakealook Tellthemthatyouwantedthemtotakealookbeforeyouextendyourprep Theinstructorwillappreciateyourabilitytodoanice,idealprep,evenifthecariesifgoingtochange

allthat

o Cariescontrol Makeanymajordesignchangeswiththehighspeed Removecarieswithaspoonorroundburonslowspeed

Useaslargearoundburaswillfitcomfortableintheareao Ifyouthinkaboutit,itmakesthebroadestcuttingarealesschanceofpunchingintothe

pulp

Youcanalwaysusecariesindicator(e.g.,Snoop)toseeifcariesisstillpresento Justapplyw/amicrobrush,rinse/dry&inspectthetooth

Lookforcariesontheaxialwall,anywherealongtheDEJ,andunderthecuspsinyourproximalextensions

Restoration:

o Bases&liners Iftheinstructorsays:Usealittleglassionomertolinetheprep,s/heprobablymeansusingalittle

VitrebondorFujiIILCtolineadeeppreparation

Vitrebondisapowder&liquidmixturethatyoulightcure Vitrebondmaynolongerbeavailable,butmanyprofessorswillrefertoit


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~29~

o ThereplacementisGCFujiliningLCpaste,whichcomesinabluetube Youeachhaveyourownmetaldispenser

o Dispensethetwoliquids,mixwithaspatulaonamixingpad,andapplywithasmallhandinstrumenttojustbarelylinetheareaofinterest

o Lightcure Forabase,youwoulduseamoresubstantialamountofFujiIILC

YoualsolightcuretheFujiIILC Afterapplyingabaseorliner,removeanyexcess(dontletittouchthemarginofyourprep)

Amalgam:

o Completethepreparation&haveitcheckedoffo Placeanyliners,asinstructedbythecoveringfacultyo PlaceamatrixbandforclassIIrestorationswedgeinterproximallytoclosethegingivalmargin

Usetheballburnishertoburnishintheareaoftheplannedcontacto Clean&drythetoothbesurethereisnobloodenteringtheprepfromthegumso Note:Someprofessorswillhaveyouetch,prime&bondpriortoplacingtheamalgamo Getallyouramalgaminstrumentslinedupo Mixtheamalgam(11-14sec)

Fromhereonout,youneedtoworkfairlyquicklytopreventtheamalgamfromsettingtooquicklyo ForclassIIrestorations,placetheamalgaminthebox&condenseintothecornerswello Continue,justasyoulearnedfromDr.Wongo Itsokay(andoftennecessary)tomixmoreamalgamo Condensequickly&firmlyo Condensethemarginalridgeswell,thenfinishcondensingintotheocclusalportion

Removeocclusalflash&carveinsomeroughanatomy Ifthemarginalridgeshavesetwell,youwillbelesslikelytofracturingthemarginalridgewhenyou

removethematrixband(trustme,itsnofuntoremoveanotherwisegreatrestoration&startover)

o Carefullyremovethewedge(s)&matrixbando Carvethemarginalridgestothecorrectheight(usuallytotheheightoftheadjacentmarginalridge)o Finishinterproximallyw/aninterproximalcarverorexplorero Finishocclusalanatomyo Checktheproximalcontactwithflosspriortoremovingtherubberdam

Nocontact=startovero Getitlookedatbytheprofessorbeforeremovingtherubberdamo Removetherubberdam&checktheocclusionhavethepatienttaplightlyifyoususpecttheocclusionis

high

o Adjustwithhandinstruments,ifpossible(Itoldyoutoworkquickly)o Whenyouseethepatientnexttime,polishyourbeautifulrestorations!!!

Composite:

o Besuretoselecttheappropriateshadebeforeplacingtherubberdamwritedownthechosenshadeo Placeasectionalmatrix(kidneybeanshapedmatrix)withaplasticwedge&BiTinering

TheBiTineringwillprovidesomeseparationofadjacentteeth,whichaidsinestablishingproximalcontact

Besuretoburnishthecontactareawelltoensureyoudevelopagoodcontacto Verifyyouhavetotalmoisturecontrolpriortorestoring

Ensurethegingivalmarginissealedo Etch/rinse/dry,prime/airthin,bond/airthin,lightcureo Placeasmallamountofcompositeworkinincrementso ForclassIIrestorations

Forcecompositeintoonecorner,thenlightcure Repeatfortheothercorner Finally,filltherestofthebox&lightcurethisimprovesyourchancesofmakingagoodcontact

o Incrementallycompletetherestorationo Generaltips:


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~30~

Becarefulnottooverfillitsbettertolightcureitwhereyouwantit,notoverfill&drillawayexcess Remembertheshapeofyourprepitseasytolosesightofwhereyouaregoing Youcandipyourapplicator(IPC,footballburnisher,etc)inbondingagenttomakethecompositeless

sticky

o Finishing Onetipistouseadisposable#12blade(thebladecurvesinward)toremoveflash(generallyfrom

thegingival&proximalextensions) Inspectthetoothforareasofflashdistinguishbetweentooth&compositeremoveany&allflash

Trya7404or7901onyourhighspeeddrill Checktheocclusion&makeappropriateadjustments

GlassIonomer(FujiIX,FujiIILC)

o ThisisusuallyusedeitherasapermanentrestorationforclassVlesionsorasatemporaryfixo GIworksprettywellinareaswheremoisturecontrolisanissueo SometimesinclassVlesions,ifyoucannotplacea212clamp,theprofessorwillhaveyouretractthe

gingivabypackingcord&usingcottonrollsandanassistant,wherepossible

o TheGIbondsdirectlytotoothstructure,soyoudontetch/prime/bondo Finishasyouwouldacompositerestoration


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Endodontics

1. Endoconsultsareobtainedfromthefacultyintheendocliniconthe3rdfloor.Theydonotneedtobescheduledinadvanced;justwalkuptothefacultyandaskforaconsult.MakesuretocreateaconsultnoteonGSDandgetitsignedoff.

2. AppointmentsintheendoclinicaremadeonGSDandneedtobeconfirmedby8:00AMonthedayoftheappointment.Toconfirm:right-clickonthescheduledappointmenttoeditappointmentnoteandwrite

Confirmed.AppointmentsarescheduledbyLindaandLorraineatthe1stfloorinformationdesk,talkto

themconcerninganyissuesyouhave.

ENDODONTICREQUIREMENTS:

YouwillberequiredtopurchasetheEndoClinicmanualduringyourfirstclinicalendocourse.Thismanualgoes

overtheendorequirementsingreaterdepth,buttheoverallendograduationrequirementsareasfollows.

Minimumof3PATIENTCases(1anteriortooth,1premolartooth,and1molartooth) Minimumof3ANY-TYPECases(maybepatientcasesorsubstitutionslistedbelow)

o 2molarTYPODONTcases=1ANY-TYPEcaseo 3EMERGENCYcases=1ANY-TYPEcase

Minimumof1EMERGENCYcase(pulpectomy/pulpotomy/otheremergencyprocedure) Minimumof2RECALLevaluationsofpreviouslytreatedendocases PortfolioReflectiveEssay(500-1000words)tobewrittenaftercompletionofallotherrequirements.The

essayshouldbeacritiqueandreflectionofallcompletedcases.

PAPERWORKANDDOCUMENTATION:

Documentationforpatientcases,typodontcases,emergencycases,andgradendoreferralformscanbefoundin

theendocliniconthe3rd

floor.Aftereachcaseiscompleted,makephotocopiesofyourdocumentationformsand

thenturninthemanilaenvelopepackettoSusanLeeinroomA3-078.

ENDOAPPOINTMENTCHECKLIST:

Showupearly!Cubiclepreparationforendoproceduresismoreinvolvedandtimeconsumingthanotherprocedures.Dontforgettoplacebarriersonthex-raymachineheadandendomicroscope.

Bringyourhandpieces,endoburblock,rubberdampunch,apexlocator,glassslab,sealer,hanautorch,andlighter.Fingerspreadersandrotaryinstrumentationequipmentmayalsobeusefultobring.

Obtainanendopatienttray(orendotypodonttray)fromCentralServices;itwillcontaintherestoftheequipmentneededforyourRCTprocedure.Cavit,IRM,additionalx-rayfilms,etc.arefoundinCentral

Services,butnotparttheendotray.

Photosarelocatedonthefarwalloftheclinicbythewindowstoassistyouwithcubicleset-up.

REFERRALTOGRADENDO:

FordifficultcasesthatneedtobereferredtoGradEndoforcompletion,filloutaGradEndoReferralForm(found

intheendoclinic)andobtainthenecessarysignatures.GradEndoappointmentsarescheduledwithWalteronthe

3rd

floorinfrontoftheendoclinic.

ENDOPILOTPROGRAM:

Thisprogramwasdesignedforustoabletotakemorepatientsthruendotreatmentintheclinicandalsotoallow

patientsthatmaynotnormallybeabletoaffordtreatmentatUCLAtobetakencareofbyavoidingextractionof


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~32~

thetoothinquestion.Basicallythepatientmustpayforthecrownandpost(orbuildup)BEFOREyoubeginthe

rootcanal.Ifthisisdoneandtheyareacceptedintothepilotprogramthentheywillreceive50%offendo

treatment.

Tobegintheprocessyouhavetofirstfindthepinkfeereductionformandhaveitfilledoutbyanendofaculty

memberaswellasbyDr.Goldstein(bringhimreceiptofpaymentforthecrownandbuild-upaswell).

Youareallowedtotakeamaxof2patientsthroughthisprogram.

**Makesuretheptunderstandsthatifthecasebecomestoocomplicatedandhastobetransferredtogradendo

thanthepilotprogramfeereductioncannolongerbehonored.


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FixedProcedures

Startcheck&anesthesia:o Followthesameprotocolasforoperative

Prep:

o Therearemanydifferentprepsyouwilldo,eachwithitsownspecialconsiderationsduringthepreparation,impression,&cementation.Dr.Morganspowerpointsprovidedveryusefulreviewsofthese

considerations&Ijustdontgetpaidwellenoughtoreviewallthatinthisdocument.Iwillgiveone

exampleofasingleunitPFMprep.

Hereisalsoabriefnoteaboutbridges(fixedpartialdentures): Forbridges,youmayneed2-3apptsforpreparation&impressiontaking.Theyousendthecase

tothelabtogetametalframework.Youwillneedtogothroughcastingcontrolthenmakean

apptfortheframeworktry-in.Ifeverythingisgood,yousenditback&thelabwillbake

porcelainontotheframework.Youthengothroughcastingcontrolagain&scheduleanapptfor

cementation.

o Suppliesyoullneed: Basiccubiclesetup Highspeed&Fixedburblock Slowspeedw/straightattachment&Acrylicburblock Rubberdamcassette Restorativecassette Packingcord Hemostaticagent(HemoginorViscostat) Impressionguns,light&heavybodyPVS Stentofappropriatequadrant Suppliesformakingatemporarycrown Floss,articulatingpaper Emorytray TempBond,spatula&mixingpad

o Drilling Discussthedesignbeforebeginning.Doesthepatientpreferaporcelainmarginonthebuccal,isthe

patientokaywithalingualmetalmargin?

Selecttheshade:havethepthelpdecidebetweentwoshadesitgivesthemsomeownershipinthefinaloutcome

Usearubberdam,untilyouarereadytofinishthemargins&verifyocclusalreduction Preparethetoothwiththefinaldesigninmind

Mostofushaveatendencytounderreduce,especiallyontheaxialwallonthebuccal&theocclusalreductionofthelingualcusps

Dontlosetrackofwhereyouaregoingfollowtheshapeoftheadjacentteeth&getyourcusptipsinline

ReducewithconfidenceusethehighspeedatfullspeedjustdontreducetoomuchImpression

o Packingcord Cordispacked~5-10minutespriortoimpressiontaking,and/ortogiveyouabetterviewofthe

marginforfinalrefinementofyourprep

Tips HereisthebesttipIcangive:useeven,firmpressure,ratherthanshort,abruptjabbing

movements

Bepatient&deliberateburythecordwithauthorityhelpthecorddoitsjob!


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~34~

Dryaroundthetoothbeforepackingcorditseemstohandlebetterifthefieldisdry YoumightwanttosoakthecordinHemoginpriortopacking(checkitoutfromcentral)this

preventsbleeding

o Hemecontrol=controllingblood Bloodwillruinyourimpression Besurebloodisundercontrolbeforemixingtheimpressionmaterials

o Takingtheimpression Getyouimpressionsuppliesready TryintheEmorytraytoensuretheptcanbitdowncomfortably

Takenoteofwherethehabitualbiteisyoullwantthepttorepeatthispositionduringtheimpression

Besuretorinse&dryeverything Placecottonrolls,whereappropriate Dependingontheretractiontechniqueyouused,removethecord(s),ifnecessary Rinse/dry&checkforblood Ifnobleeding,haveyourassistantfillthesmallsyringewithlightbodywhileyoukeepthefield

clean/dry

Oncetheassistanthandsyouthelightbody,s/hefillstheemorytrayasyouinject Injectintothesulcusallthewayaroundthetooth Leavethetipinthematerialtoavoidairentrapment Coverthewholetooth&theocclusalofadjacentteeth

Takethetrayfromtheassistant,positionthetray&havetheptbitedownslowlyintothehabitualposition

Holdthejawfor7-8minuteswhiletheimpressionsetsup Havetheptopenabruptlytoreleasetheimpression Takecareofthepatient(rinse,suction,napkin,etc)priortoinspectingtheimpression Inspecttheimpressionandlookforthefollowing:

Canyouseetheprepsmarginallthewayaroundthetooth? Youhavematerialextendingbeyondthemarginallthewayaroundthetooth? Doyouhaveblebs,bubbles,orareaswherethelight&heavybodydidnotflowtogether? Didbloodgetincorporatedintotheimpression?

Temporizationo Youshouldbepreparedtomakeatemporaryaccordingtothediscretionoftheinstructor.Although

usingIntegrityisfairlycommonduetoitsfavorablesetuptime,dontforgethowtotemporizelikeyou

didinlab

o Indirectmethod(Jetacrylic) Youshouldallknowhowtodothis

o Directmethod(Integrity) Thekeyhereistoremovethestentbeforethetempsetsup InjectIntegrityintothestent&squishthewholethingontothetooth After~45sec,removethestent&placeitonthetoothagain(akapumpthetemporary) Afteranother~30-45seconds,removeitagain&seeifitissettingup Waitforthematerialtosetupmorecompletelybeforetrimming Trimasusual

o Directmethod(Jetacrylic) Askyourprofessorthistakesalittlemoreskill

o Note:besureyouadjusttheptsocclusiontopreventlossofthetempbetweennow&cementation Also,ensureyouhavegoodproximalcontactsthatwillholdthespaceforagoodfitofyourfinal

crown

o Labslipo Thelabslipshouldincludeclearinstructionswithregardsto:

Buccal&lingualmargindesign Shade


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ASDAUCLAChapter


~35~

o Includeyourcontactinfo(phonenumber)incasethelabhasanyquestionso Fillouttheupperleftboxo Ontheupperright,checktheboxesindicatingwhatyouaresubmitting(inthiscase,justthedouble-bite

impression)

o Havetheinstructorsigntheslipo Dontforgettohavetheinstructorsignyourrestorativecardaswello Turninthelabslip&doublebiteimpressiontoMarissainDr.Goldsteinsoffice

BesuretogetabillingsignaturepriortoturningthecaseinCastingControl

o AfteryoupickupthecasefromMarissa,signupforacastingcontrolappointmentinthe3rdfloorlabo Takealookatthecrownonadieundermagnificationpriortocastingcontrol,soyouareawareofany

potentialissues

o Youwilllookatthecasesimultaneouslywiththeprofessorunderamicroscopeo Aftergettingasignature,yourereadytocementthecrown!!!

Cementationappt

o Whatyoullneed: Fujigun FujiIorFuji+

Fuji+setsupfaster,whichcanbegoodorbad Highspeed&Porcelainburblock Floss,articulatingpaper,shimstock

o Afterstartcheck,removethetemp&cleanoffthecement Iftheptcanhandleit,donotgiveanesthesia,becausetheirabilitytosensetheocclusioncanbevery

valuable

o Placeanopen2x2atthebackofthemouththispreventsobviouscomplicationso Try-in:

Tryonthecrownwithoutapplyingpressure Lookforareasthatbind,preventingcompleteseating Proximalcontactsarethemostlikelyproblemarea

Placeonefingeronthepartiallyseatedcrown&flossthrougheachcontact,lookingforshreddingofthefloss

Iftheflosssnapsthrough,itisagoodcontact Theintagliosurfaceisthenextareaofconcern

YoucancheckoutFit-checker,whichisapowder/liquidsiliconemixturethatshowsareasthatneedtobereducedfromthemetalundersideofthePFM

Oncethecrownseatsperfectly&themarginsareallclosed,checktheocclusion Makeadjustmentsextraorally,asnecessary

Aftereverythingisready&theinstructortakesapeek,youcancementthePFMo Rinse/drytheareao Placecottonrolls,asneededo MixFuji&applytotheundersideofthePFM,justcoatingallsurfaces(dontsimplyfillthewholecrown

withFuji)

o Placethecrown&seatitdownallthewayhaveacottonrollreadyforthepttobitedownono Havetheptbitedownforseveralsecondso Havetheptopen&removeanygrossexcessbynowthematerialshouldberubberyo Holdthetoothdown&flossthrougheachcontactwithapieceofflossthatyouhavetiedasingleknotin

Theknothelpsforceexcessmaterialoutoftheproximalarea Pulltheflossthroughtheembrasure,notbackthroughthecontactocclusally Useanexplorertoremoveanyremainingcement

o Re-checkocclusion,polishasnecessaryo Getyourcardsigned


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~36~

FujiWhat?FujiType Function Cure Mixing

time

Setting

time/

Finishing

time

MftrInstructions

FujiI RadiopaqueGIlutingcement Self 10s 2'15"/

4'30"

1) loosenpowderbytapping2) activatecapsulebypushing

plungerflushwithmainbody,

placeinapplierandclickonce

3) mixfor10sinamalgamator(4000rpm)

4) loadinGCCapsuleapplier5) 2clickstoprime6) extrudedirectlyinto

restoration

Fujiplus Radiopaquereinforcedglassionomerlutingcement

self 10s Mftr:2'0"/

4'15"

(clinically

maybe

less?)

1) Placecavityconditioner(polyacrylicacid)10sec,rinse

anddrybutdonotdessicate.

2) loosenpowderbytapping3) activatecapsulebypushing

plungerflushwithmainbody,



5) loadinGCCapsuleapplier6) 2clickstoprime7) extrudedirectlyinto

restorationFujiII:

baseor

liner

Radiopaquelightcured

reinforcedglassionomer

restorativeas

1.RestorationofClassIII,V

andlimitedClassIcavities

withlimitedisolation

2.Restorationofprimary

teeth.

3.Corebuildup.[weare

taughtthatthisisano-noas

itlacksthemechanical

characteristicsneededto

servethispurpose]4.Caseswherearadiopaque

restorationisrequired.

5.Geriatricapplications.

6.Asabaseorliner(F-

release)

LC 10s 3'15"

working

time

20"curing

time

1.8mm

curing

depth

1) Prep:excessivemechanicalretentionnotnecessary(ionic

bonding)



3) activatecapsulebypushingplungerflushwithmainbody,



5) extrudecementdirectlyintopreparation

6) contourandshape7) lightcure20swith470nm

wavelength.Layerifdeeper

than1.8mm

8) Finishunderwaterspraywithsuperfinediamond,silicone

point,polishingstrips.


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ASDAUCLAChapter


FujiIX Radiopaquelightcured

reinforcedglassionomer

restorative

1.ClassIandIIrestorationsin

deciduousteeth.

2.Non-loadbearingClassI

andClassIIrestorationsin

permanentteeth.

3.Intermediaterestorative

andbasematerialforheavy

stresssituationin

ClassIandClassIIcavities

usingsandwichlaminate

technique.

4.ClassVandrootsurface

restorations.

5.Corebuild-up.

self 10s 2'00"

working

time

2'20"

setting

time

6'00"

finishing

time

1) Prep:excessivemechanicalretentionnotnecessary(ionic

bonding)



3) activatecapsulebypushingplungerflushwithmainbody,



5) extrudecementdirectlyintopreparation

6) contourandshape7) finish6minutesafterstartof

mixing

FujiLiner

LC

Radiopaque,light

curedresin-modifiedglassionomerliningcementused

asabaseorlinerinprepared

cavities.Donotuseaspulp

cap(CaOHinstead).

Light 10s

(hand)

2'15"

workingtime

20"curing

time

1.3mm

depthof

cure

1) Prep:standard.DeepprepsindicatedforFujiliner.Removesurfacemoisture,do

notdessicate.

2) makesurepistonisretractedintodispenser

3) Load"PastePak"cartridgeintodispenser

4) slidereleaseleverforwarduntilitstops

5) bleedpastes6) depresslevertodispense

pastesontomixingpad;level

andcutoffextrudedmaterial

fromtipsbymovingcartridge

touprightpositiononpad.

7) Mixthoroughlywithlappingstrokesfor10secondsusing

plasticspatula

8) workingtimeis2'15"(highertemperatures=lessworking

time)

9) transfercementtopreparationusingsyringeor

otherplacementinstrument

coveringdentineuptoDEJ

10) Lightcurewithlightascloseaspossibletosurface(20s)11) Preptoideal,andproceed

withstandardrestorative

techniques.


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ASDAUCLAChapter


Hygiene1 HygieneStudentswillemailtheDentalStudentsintheirCPCTeam

2 HygieneStudentswillgetnamesofpatientsfromtheirDentalStudentswhoaredueforhygieneservices.

HygieneStudentmustobtainthefollowinginformationoneachpatientfromthatDentalStudent:

Patientname ChartNumber PatientsTelephoneNumber Servicesdue(quads,prophy,periomaintenace,etc.)

IfHygieneStudentwillnotbeatUCLApriortotheappointment,DentalStudentmustalsofurnishthe

HygieneStudentwiththefollowinginformation:

DateoflastODappt. DateoflastPeriodicExam DateoflastHygieneServices,andtypeofservicethatwasperformed SpecialInformation(pre-med,medicalaccommodations,etc.)

Note:HygieneStudentswillberequiredtodismissanypatientthatpresentsforhygieneservicesthatisnotup-to-

dateonODorPeriodicExam.GPAswillbenotifiedifpatientsarereferredtoHygieneStudentswhoarenot

up-to-date.

3 HygieneStudentwillcallPatientandofferavailabledatesandtimes,andchooseadate/timetoappointthe

patient.HygieneStudentmustletpatientknowthatallhygieneappointmentsmustbeself-paid(cash,

check,creditcard,etc.)priortothestartoftheappointment,billingwilloccurlater,andinsurancewillbe

reimbursedaccordingtoUCLAsbillingpolicies.TheonlyexceptionisapatientwithDeltaDentalwhoslast

prophywasover6monthsago.

HygieneStudentwilladvisepatientofthefollowing:

Clearlycommunicatedateandtimeofappointmentwiththepatient Advisethattheappointmentwillbeforthefullmorning/afternoon Remindofpre-med(ifapplicable) Remindthatappointmentmustbeself-paidpriortostart Askpatienttoarrive15minutespriortostart(8:00amor1:00pm) AdvisepatienttocalltheUCLASchoolofDentistry,310-206-3904orthehygienestudentdirectlyifthey

needtocancel.

4 TheHygieneStudentwillberesponsibleforschedulingtheHygieneappointment.

5 OncetheGPAhasconfirmedthattheappointmenthasbeenscheduled,HygieneStudentwillcontactthe

DentalStudenttoletthemknow.

6 IfaDentalStudentencountersdifficultycommunicatingwiththeirassignedHygieneStudent,theyshould

contactWLACInstructorNatashaKerllenevichatkerllen@wlac.eduor310-210-3294(textingisokay).Ifa

HygieneStudentencountersdifficultycommunicatingwiththeirassignedDentalStudent,theyshould

contacttheirCPCTeamsGroupPracticeAdministrator.

WestLosAngelesCollege,February2011


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ImplantsAllappointmentsinvolvingimplantsaredoneWednesdaymorningsintheremovableclinicwithDr.Shah.When

youscheduletheappointment,youmustindicateinthenotessectionthatyouhaveanimplantcaseandneedto

workwithDr.Shah.

NeedtohavepanoandImplantInfoSheet.

Implantconsults:

WednesdayafternoonwithDr.Hewlett

ThursdayafternoonwithDr.Shah

Weneedsomehelpfillingoutthissection!IfyouhaveanythingtoaddpleasefindyournearestASDAcabinetmembertosubmit!


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ASDAUCLAChapter


~40~

Inactivatingvs.DischargingPatients Therearetwowaysyoucanremoveapatientfromactivestatus(otherthanplacingthemonrecall)dependingon

whetherthepatientplansonreturningtotheclinicinthenearfuture.

Inactivation:Thisisforpatientsthatforsomereasoncannotcomeintoclinicforashortamountoftime.Thiscan

beforvariousreasonssuchasbeingoutoftownforamonthormoreorperhapsthepatientcannotpayfortheir

treatmentuntiltheysaveup.WriteanoteundertheNotestabinthepatientsfileonGSDadtakethechartto

yourGPA.YourGPAshouldhavethelettersappropriatetosendtothepatienttoinformthemoftheirstatusatthe

clinic.Fillouttheletters,addresstheenvelopesandgivethechart(withonecopyofthelettertoyourGPA).The

originalletteristhenmailedtothepatient.Thereareinstructionsforthepatienttofollowwhentheyareableto

returntotheclinicandcontinuewiththeirtreatment.

Discharge:Thisoptionisforpatientsthatdonotwishtoreturntotheclinic.Thismaybeapatientthatwas

recentlyassignedbutneverreturnedastudentsphonecallorsomeonethatdecidesthattheclinicisnotappropriateforthem.Studentsmayalsodischargepatientsthatarebeingdifficultbutthisrequiresmoreworkon

thestudentsendtodocumentthingsthataresaidandtheactionsthataretaken.Aletterisdraftedandmailedout

withthehelpofyourGPD.IfthesepatientswishtoreturntotheUCLAclinictheyhavetobegintheprocessfrom

step#1(screening).Youmustinformthepatientthatifdischarged,theymaynotbeacceptedasapatientifthey

wishtoreturnlater.


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~41~

InitialPerioTherapy1-apptperiotherapy

o Aka:cleaning=prophy=phaseI,1-appointmentprophyo

Amulti-appointmentcleaningiscalledscaling&rootplaning,andusuallyshouldinvolveanesthetizingoneormorequadrantstoallowyoutoplanetheroots.Seebelowformoreinfo.

o Thingsyoushouldhave: Basiccubiclesetup(seebelow) Periokit(yoursorcheckoneoutfromcentral) Slowspeedhandpiecew/straightattachmentorprophyattachment Prophycup&paste

o Tips: Usesharpinstruments

Sharpenbeforethepatientarrives Dontoversharpenjustafewstrokesshoulddothetrick Checkforsharpnessonthewhitesuctiontipasharpinstrumentwillpeeloffplasticlikepeeling

apotato

Onlyremovethecalculussavetherootplaningforpatientswhoneedrootplaning Movearoundaslittleaspossible&tradeinstrumentsoutasfewtimesaspossible:

Followaplannedroutine,suchas:MaxanteriorsBthenL,URB&ULL,URL&ULB,LRB,LLL,LRL,LRB,MandanteriorsLthenB

o ByworkingonURbuccal&ULlingual,youcanstayinthesameposition&usethesameinstrumentsinthesameorientation

Also,followaroutineforeachposteriorquadrant,suchas:allthemidfacialormidlingual,thenallthemesialproximalsurfaces,thenallthedistals

Movethepatient:Looktowardme&Lookawayfrommeworkgreatfromthe8-9oclockposition

Also,usethefewestnumberofinstrumentsaspossibleconsidereliminatingtheuseofthe11-12,orslowlybecomecomfortablewiththeUniversal

Onebigpieceofadvice:checkoutaCavitronanduseit!Asksomeonehowtosetitup,andjustletitworkitsmagic.ItworkskindoflikeaUniversalthatmakeslikeamilliontinystrokesasecond.Things

gomuchmorequicklywiththeCavitron.Youshouldalwaysfollowupwithanexplorerand/orhand

instrumentstocheckforspotsyoumissed.

o Administrativestuff: Startchecks:

Beforegettingastartcheck,reviewthepreviousperiocharting,medHx,dateoflastprophyorScRP,etc.

Periosignature: Periosignaturescanonlybeobtainedfromperiodontistsorhygienists.Aperiosignaturemay

comein2possibleforms:electronicorhand-written.Thehand-writtensignatureisgivenonthe

patientsprintedtreatmentplanform.Electronicperiosignaturesaredraggedoverandsigned

offlikeanyotherprocedure(findthecodeinthePeriodontalsectionofproceduresinGSD).

YoumusthaveaperiosignaturepriortobeginninganyIndirectrestorativeworkwithyourpatient.

2-or4-apptperiotherapy

o Aka:ScRP,S/RP,quadscaling,scalingandrootplaning,deepcleaning(dontcallitthat)o Differencesbetween1-appt&multi-apptcleanings

ScRPrequiresafollow-upapptusually3-6weeksfollowingTxtoreassessthetissuehealth Youusuallyuseanesthetic.Ifthepatientcantfeelit,thenyouprobablyarentworkinghardenough

Youneedtoreallygetinthere&removeallthatsubgingivalcalculus Theresalotofblood,andthatsokay.Keepabunchof2x2shandyforScRP.


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ASDAUCLAChapter


~42~

Yougenerallywontbeabletofinishall4quadrantsinonesession,especiallywhenyouareanesthetizing

o Besureyoucleaneachquadrantthoroughlyifyoudont,thegumswillnotbehealthyattheF/Uappto Ifyouhavetime,youcandotheopposingquadrantonthesameside.Itsusuallynoproblemsendinga

patienthomewiththewholeleftORrightsidenumb,butitsgenerallyNOTokaytosendthepatient

homewithawholearchnumb.

o Usetheperioprobingandradiographstoyouradvantage.Oftenthesepatientshavemany4s,5s,ordeeper.Scaleaccordingly.- Follow-upappointment

o AftertheappropriatehealingtimeafterScRP,seethepatientagaintofollowupontheirperiohealth.o Thisapptinvolvescompleteprobings&re-evalofallperiotissues

ItisessentiallylikedoinganewperioconsultandyouwillcompleteanewconsultsintheConsultssection

o Iftheptisintheclear,youcangetasignature&moveono Ifnot,youmaystillgetasignatureafterscalinginselectareasoryoumayneedyoudomoreextensive

treatment(e.g.periosurgery)&haveanotherfollowupapptlateron

Referringtohygiene:

o YoucanreferyourpatientstohygienestudentsbyusingfollowingthedirectionsoutlinedintheHygeinesectionofthismanual.


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ASDAUCLAChapter


~43~

Insurance Allinsurancecompanies(exceptDeltaDental),patientsmustpaythefullfeeandtheinsurancecompanywill

reimbursethepatient.AllfeeschedulescanberequestedfromtheChartRoom.

DELTADENTAL:UCLAonlydealswithDeltaDentaldirectly.ForpatientsthathaveDeltaDental,youcanaskthem

topayonlytheportionoftheprocedurethatDeltadoesnotcover.ForALLotherinsuranceplans,thepatientmust

payupfrontandinformthemthattheywillreceivetheirrefunddirectlyfromtheirinsurancecompanyinthemail

andnotthroughUCLA.

MEDICAL/DENTICAL: CheckMediCal/DentiCaleligibilityatthebillingofficeatthebeginningofeach

month.PatientswithMediCalreceivecourtesyfeesthatexistedwithDentiCal.Onlyextractionsarecoveredby

DentiCalduetoafederalmandate.However,radiologyisnolongercoveredforadults,nordotheyreceiveafee

reductionforradiographs.Furthermore,DentiCalcoverageisonlyappliedtochildrenundertheageof

21.DentiCalwillcoverradiographsforeligiblechildrenundertheageof21.

RYANWHITEPATIENTS: RyanWhiteptsareallowedupto$1,500.00tospendondentaltreatmentperyear.FeereductionformsmaybefoundinMarissasoffice(Dr.Goldsteinsassistant)andmustbeapprovedandsignedby

Dr.Younaipriortotheprocedure.Oncesigned,takefeereductiontothebillingoffice.

UCLADENTALSTUDENTS:Mostproceduresareapproximately50%off.


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ASDAUCLAChapter


~44~

NewPatient:Screening&Radiographs

- Sixpatientsarescreenedbyagrouppracticedirector(GPD)MondaythruThursdayfrom~7:45-9:00amor~12:30-2:00pm- TheGPDlooksateachptfor~10minutestodecidegenerallywhattheptneeds&explaintheclinicprocess

briefly

o ThepurposeoftheexamistodetermineifthepatientscaseissuitableforadentalstudentaswellastomaketheptawareofthepolicieswehaveatUCLAandourexpectationsofthepatientstoadhereto

them

- TheoverallpossibleTxneedsarenotedonawhiteformthatgetsablueformstapledontopofit- Ifaccepted,thepatientwillgotothecashierswindowtopay$110

o $70foranFMXo $40forInitialODandPeriodicExam

- ThiswillthenbedeliveredtoastudentintherotatingfileonyourGPAsdesk.Anemailwillalsobesenttoyou.


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ASDAUCLAChapter


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OralDiagnosis

1. Thisisthe1st

appointmentyouscheduleforyourpatientafterassignmenta. BesureyourptunderstandswhattheODexamis,becausesometimestheyconfuseODwiththe

briefscreeningexamdonebythegroupdirectorsattheirveryfirstvisit

b. YoucanscheduletheODapptonGSD-ACADEMIC.c. Appointmenttimeoptionsare:9AM,10:30AM,2PMor3:30PMd. Theseappointmentsareexpectedtolast~1-1.5hourse. Ifyouscheduleat9:00or2:00,youcanusuallymakeitupstairsintimetoconductoneormore

consults

i. WhenschedulingconsultsafterOD,makesuretherewillbeenoughfacultycoverageforwhatyouwanttodo.Fordetailsregardingconsults,seetheConsultssectionofthis

manual.

ii. Ifthepthasacomplicatedmedicalhx,youmustschedulefor9AMor2PMsotherewillbeenoughtimetocompletetheOD(thiswillbenotedontheblueintroductoryform).

2. TheactualODexamisperformedbyastudentonblocka. Thepatientsassignedstudentshouldbetherefortheexam,sotheywillknowwhatsgoingon

3. TipsforspeedinguptheODappt(regardlessofwhetheryouaredoingtheODorifyouareassistingtheblockstudent):

a. Besureyouvereviewedthepatientschart(i.e.,thehealthquestionnaire&radiographs)b. Findablockstudent&letSusanknowthatyourpatientispresentandthatitappearsthata

blockstudentisavailable

c. Whenyouseatthepatient,havehim/hersigntheDMFformi. PlacetheDMFforminthechartonepageaheadofthesalmon-coloredProgressnotes

d. ThestudentNOTdoingtheexamshouldlookupanymedswhiletheblockstudentisaskingquestions

e. Whentheblockstudentputsthegloveson,offertotypetheirfindingsintothecomputerf. Spendtimewiththeimportantstuffi. Inquirewellaboutpastillnesses&currentconditionsgetalltheinfoyouneed

ii. Usethemedicationstheptistakingasyourguide1. E.g.,iftheyaretakingAtenolol,youshouldbesureyouaskabout

Hypertension,eveniftheydidntmentionit

iii. Askappropriatefollow-upquestionsg. Dontspendextratimeontheeasystuff

i. Iamyettohaveapatientfailthesensorynerveexamyouremember:Isthissoftorsharp?

1. So,dontspend5minutestestingV1,V2,andV3ii. Bebriefwithyourexaminationoftheteeththemselves(attrition,erosion,abfraction)

1. Therewillbeplentyoftimeforatooth-by-toothexamupstairs2. E.g.,dontworryifthereis2or2.5mmrecessionontheMBaspectof#14


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ASDAUCLAChapter


h. Beawareofthefaculty&theotherpatientsbeingexamined

i. Case-in-point:iftwoothergroupsarewaitingfortheinstructor&youarealmostfinished,putyournameonthelist

1. Bythetimetheyareavailable,itsyourturn2. Atthesametime,dontstartalistuntilyouarereadybereasonable&

considerateofyourclassmates

ii. Fillouteverythingbeforetheinstructorseesyourpatient1. CompletetheSpecialtytabsectioninGSD-ACADEMIC2. DoyourSOAPnotesforthesession3. Filloutthebeigepageofthepatientchart(ontheleftundertheHIPAAform)

4. AttheendoftheODexam,youmustgetthechartclearedbyIrenebeforeleavingtheODclinica. Otherwise,youwillnothaveaccesstothechartwhenyougoupstairsforconsultsb. MakesuretheDMFformisintherightplaceonepageaheadofthesalmon-coloredProgress

notes

5. Ifaperiodicexamisdoneinadditiontothe3yrOD,thetotalcostisonly$25andcoversboththeODexamandtheperiodicexam.TheyareNOTtwoseparatecharges.

WhenyouareinOD,theyhaveaspecificformatthatmostfacultymembersliketoseeinyourSOAPNotes.Itis

postedonthewallinmostofthecubicles,sononeedtomemorizenow.

S --yearoldm/fpresentsforinitialexamandODworkup(or3yrODrecall)

CC:whatevertheycomplainof

Lastdentalvisit:

O ReviewedmedicalhistorywhichwasnotableforotherwiseNSFandNKDA.

Allergies:

Meds:

BP=--/--,HR(reg/irreg),RR

EOE:

IOE:

Hardtissue:

SoftTissue:Noteanyfindingslikelesionsorsoresonthemucosa,orbandsofdiscolorationalongteeth.

(-)EOEcancerscreening

Oralhygiene:poor,moderate,good.

Mild,moderate,severeplaque.

A Healthyptwithminordentalprecautionssuitableforcomprehensivedentalcare.

Ptcanproceedtoconsults.

P Completedinitialassessment/3yearODrecallexamincludingprocuringthehealthhx,areviewofsystems,

obtainingthevitalsignsandanextraandintraoralexam.Oralcancerscreeningcompletd.

DiscussedwithpatientswhattoexpectwhenbeingtreatedhereatUCLA.Ptleftsatisfied.

NV Perioandrestconsults/PreATP


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~48~

OralFacialPain

Weneedsomehelpfillingoutthissection!IfyouhaveanythingtoaddpleasefindyournearestASDAcabinetmembertosubmit!


49/78

ASDAUCLAChapter


~49~

PatientAssignment

- Youwillreceivepatientassignmentsinoneofthreeways:o 1)Newpatientassignmentfromyougroupdirectoro 2)Greenslipsomeoneyouknowo 3)Pttransferforwhateverreason

- Fornewptassignments,youwillgetanemailfromyourGPDorGPA(G.P.Administrator)o Youwillalsogettheaforementionedblueformwithwhitepagestapledbehindit

PickuptheformatyourGPAsdesk Thebluepagehastheptname,chart#,andphone# ThewhitepagedescribesthelikelyoverallTxneeds(operative,fixed,endo,perio,etc)

ThispagemayindicatethatyourptneedsATPo YoucanalsodeterminethepatientsneedsinGSD-ACADEMICunderthePatientstab

Clickonthecharttab,thenfindthegrayMisc.tabnexttotheredRadiologytab TheMisc.tabhasaseriesofnotesfromtheinitialptscreening,indicatingtheoverallprobableneeds

ofyourpt

o UsethetwoabovesourcesofinfotodetermineifyourpatientneedsATPo YourGPDmayalsoaddnotestothisbluepageindicatingwhetherthepatientistobesharedwith

anothermemberofyourCPCteamaswellaswhetherthepatientmayrequireATP.

o Onceyouaregivennoticeyoumustattempttocallyourpatientwithin48hours.o Radiologyconsultationshouldbedonepriortoperio/restorativeconsults.

- ATPvs.Fasttracko ATP=AdvancedTreatmentPlanning

Thisisasessionwhereinyoumeetwitharestorativeinstructor,aperioinstructor,andaremovableinstructor

Byhavinginputfromallthreeareas,youcan,intheory,createabettertreatmentplan PriortotheATPappt,youneedproperlymountedcasts,andhavecompletedyourownpre-ATP

workup Pre-ATPreferstothegatheringofinfoyouwoulduseforconsults(tooth-by-toothexam,perio

charting,proposedRPDdesigns,ifapplicable)+impressions&records(facebow,interocclusal

record)

ATPcasesdonotrequireanyconsultsotherthantheATPconsultitself MoredetailisfoundbelowinthesectionforConsultations

o Fasttrack: Theseptshavemorestraightforwardcases,sotheydonotrequireATP FollowingOD,youobtainanynecessaryconsultations(restorative,perio,endo,etc.)priorto

submittingthetreatmentplantobeapprovedbyyourGPD.

o FollowDr.WoodsguidelinesforwhatconstitutesanATPvs.Fasttrackpatient ThisinfoisfoundonapinkTxplanningformatthebackwindowsintheclinicbehindcentral

sterilizationorintheStudentLounge

TheFasttrackcriteriaareasfollows: Simpletointermediateperioneeds(noanticipatedextractions,otherthan3rdmolars) Eightorfewerfixedunits(simple3-unitbridgeO.K.) Nopartialdentures Reasonableocclusion NoTMdisorderorsignificantattrition

- Youareexpectedtocalltheptwithin48hoursofreceivingnotificationofptassignment


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ASDAUCLAChapter


~50~

o Assoonasyoucan,checkouttheptschart&lookattheradiographs,soyouknowwhatyouredealingwith

o Speakwithyourgroupdirectoraboutdoingaradiographicconsultassoonasyougetthechart- Contactthept&introduceyourself,indicatingthatyoudliketoscheduletheir1stapptassoonaspossible

o PlanaheadsoyoucanofferthepttwoorthreeavailabletimesfortheODappt(dontcallitOD) Seenextsection:SchedulingAppointmentsformoreinfo

o Patientsareusuallynotfullyawareofhowtheclinicworks ItmayhelptoexplainthatthereisaTxplanningphaseofupto3apptsbeforebeginningactualTx,

andthatthisphaseisimportanttodeterminealloftheptsneedssowecangivethemthebestTx

possible(helpthemseethatitisintheirownbestinterest)

Tellthemthatthefirstexamisareviewoftheiroverallhealth&medications,andincludesanoralcancerscreening

Explainthattheexamlastsabout1-1.5hours Ifyoucanschedulea9:00or2:00ODappt(seebelow),thentellthemthatfollowingthefirstexam,

youplantogointotheclinictoexaminetheirteeth&gumsandtakeimpressionsoftheirteeth,if

necessary.

CautionwhenattemptingthisasitdependsalotonhowbusyODisasmanyappointscanextendfurtherthan1.5hrs.

IftheptneedsATP,considerinformingthemthattherewillbeanotherexam,whereinyouwillmeetwiththreeinstructorsfromdifferentspecialtiestodeterminetheirneeds&plantheircase


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ASDAUCLAChapter


~51~

PaymentPlansPatientseligibilityforMonthlyPaymentPlan

Thepatientsaccountmustbecurrentandingoodstanding Thetotalcostoftreatmentmustbeatleast$500.00 ThepatientorguarantormustbeabletoprovideavalidUSDriversLicenseorpictureIDandCreditCard

Requirements

Thepatientstreatmentplanmustbesignedbythestudent,patientandthegroupdirector PaymentplanisfortheGeneralClinicOnly.Forotherclinicssuchas: Implantcenter OralSurgery Pedo Endo OFP AEGD

**Pleasecontacttheirrespectivecoordinators

Procedurescantbeginuntilapaymentplanhasbeenarranged Subsidiesanddiscountscannotbeusedforpaymentplans Thestudentwillchoosethetreatmentforwhichthepaymentplanwillbeneededanddiscusswiththe

patient

ThestudentmustbringthepatientscompletetreatmentplantoPaymentcoordinatorfewdaysinadvance

Breakdownofthepaymentplanwillbegiventothestudent.Studentisresponsibletocontactthepatient:

Discussthebreakdownandthe25%downpayment Discusstherequirements Setanappointmentwithpatient Notifyandsetanappointmentwithcoordinator

Patient/Guarantorisrequiredtofilloutandsignthepaymentplanform.

Appointmentday

Patient/GuarantorneedstobringvalidUSDriversLicenseorpictureID,andcreditcard. 25%initialdownpaymentofthetotalcostofthetreatmentuponsigningthepaymentplanform.Down

paymentcanbepaidwith:cash,check,creditcardorATMCard

Theremainingbalancewillbedividedinto: 3monthsMinimumtotalcostis$1,500orless 6monthsMaximumtotalcostismorethan$1,500 Monthlyinstallmentswillbeautomaticallyprocessedevery15thoftheeachmonth.Ifthe15thfallsona

weekendorholiday,paymentwillbeprocessed2dayspriororaftertheduedate.

AnydeclinedCreditCardswillautomaticallybesuspendedandremovefromthemonthlyinstallmentplan.Guarantormustnotifytheclinicassoonaspossibleiftherearechangesontheaccount(i.e.credit

cardhasbeenreportedlost/stolen).

Forotherquestionsand/orconcernspleasesee: AnetHaratunianFirstfloorlobbyroom10-139

Contact#(310)825-7363

[email protected]

Hours:Mon-Frifrom7:30am-4pm


52/78

ASDAUCLAChapter


~52~

PatientRequestsRequestsfornewpatientsmustbemadethroughyourGPD.GroupAistheonlygroupthatshouldstillbeusing

patientrequestforms,whichcanbeobtainedfromtheGPAingroupA.Ifyoufeelyouhavethetimeforanadditionalpatient,mentionthistoyourGPDandtheappropriateactionwillbetaken.

IfyouareingroupC,theGPDisawareoftheproceduresthatyoustillneedtograduateandsowillhelptofinda

patientthatwillspecificallyfillthoseneeds.

8/7/2019 The Lead Pi

Documents

The Lead Pipe v1.0