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Preventive Dental Sciences DepartmentPediatric Dentistry Division

(PDS 615, 511)

Clinical Evaluation Manual-Part 2

Student name: …………………………………Computer #: ………………………………..

Academic Year 2013/2014

Preventive Dental Sciences Department

Pediatric Dentistry DivisionTable of Contents

1. Competency Evaluation Rubrics1.1. Rubric for Examination & Treatment Planning1.2. Rubric for Oral hygiene Instruction1.3. Rubric for Prophylaxis & Topical Fluoride Application1.4. Rubric for Rubber Dam Isolation1.5. Rubric for Local Anesthesia1.6. Rubric for Fissure Sealant1.7. Rubric for Preventive Resin Restorations1.8. Rubric for Cavity Preparation and Restoration1.9.Rubric for Stainless Steel Crown/Strip Crown/Class IV Permanent1.10. Rubric for Formocresol Pulpotomy1.11. Rubric for Extraction of Primary Teeth1.12. Rubric for Diet Evaluation1.13. Rubric for Space Analysis1.14. Rubric for Space Maintainer I (Band’s Selection and Impression)1.15. Rubric for Space Maintainer II (Appliance Fitting and

Cementation)2. Oral Hygiene instruction and Diet evaluation

2.1.Oral Hygiene Instruction (Students Copy)2.2.Dietary Evaluation Form (R4)

3. Arabic Forms3.1.First Visit Introduction3.2.Oral Hygiene Introduction Parents3.3.Post Extraction Instruction

4. Dietary Advice Forms5. AAPD Guideline on Caries-risk Assessment and Management for

Infants, Children, and Adolescents

1. Competency

Evaluation Rubrics

Pediatric Dentistry DivisionRubric for Examination & Treatment Planning

Steps and proceduresInstructor Evaluation

0Not

Competent1

Competent2

Proficient1. History and Personal Data- Patient's complete personal data recorded- All questions on the medical history answered.*- All questions on the dental history answered.- Caries risk assessment *

Mistake in one or more of the critical

steps(*)

Complete only Critical steps*

Complete all the steps including critical

steps*,

2. Examination:a. Extra oral/Intra Oral

Head and neck Soft Tissue Evaluation: Gingiva, mucosa, etc. Oral hygiene

b. Occlusion and Orthodontic Evaluation / Referralc. Dental Charting:

Teeth present or absent* Existing restorations Presence of dental decay * Fractures and developmental anomalies


steps(*) misdiagnosed

cavitated caries

Complete Critical steps*

but misdiagnosed non cavitated

carious lesions.


steps*,

3. Radiographic Diagnosis: 1. Indicated radiographs were taken* 2. Examine quality of bone, tooth structure

and development3. Identify proximal caries in bite wing *

Missed more than 2 proximal caries in dentin

in bite wing radiograph

Missed 1 or 2 proximal

carious lesion in dentin in bite wing

Did not missed any proximal caries in dentin in bite wing

4. Treatment Planning1. Prevention of caries is emphasized in

initial appointments.*2. QUADRANT dentistry is one of the main

emphasis points.3. Accurate plan for restoration*4. Appliances will be left until after all

operative has been completed in that arch.

5. The recall period of 3 to 6 months.*


steps(*) or wrongly planned restoration for 4

teeth or more

Complete all critical steps

(*) but wrongly planned

restoration for not more than

3 teeth

Complete all critical steps (*) and non critical and currently planned all restorations

5.Behavior guidance:TSD, distraction, positive reinforcement, voice control

Uses none Uses 1 or 2 Uses 3 or more

6. Presenting the case to Parents (*)- Disclosing sufficient informative using radiographs, photographs, study casts.*- Suggest treatment for the problems with benefits and risks.*- Alternative treatment with benefits and risks*- Cost- How many visits and lengths- Preventive meaning and anticipating guidelines- Signed consent form*


steps(*)

Complete only critical steps

(*)


steps*,

7. Time * > 180 min 60– 180 min < 60 min

Form 1.1

Pediatric Dentistry DivisionRubric for Oral Hygiene Instructions

Steps and procedures

Instructor Evaluation

0

Not Competent

1

Competent

2

Proficient

1. Use a model to demonstrate the brushing

technique. *Did not use Models Used a study cast

Used the proper model

2. Technique description to child and parents

a. The student describes the technique of tooth brushing to the patient and parent adequately *.

b. Following a systematic order (starting from buccal surface of the last right maxillary tooth across the arches and ending by the lingual surface of this tooth)*

c. Supply a toothbrush and allow the child to do tooth brushing.

d. Ask the child to brush each segment (15 times)


steps (*).

Complete only critical steps (*) but not all other steps.

Complete all critical (*) and

other steps.

3. Parent’s Instruction:

a. Recommends the appropriate frequency of brushing *

b. Recommends appropriate toothbrush typec. Recommends appropriate toothpaste type and amount *

d. The parent is responsible for tooth brushing for children (up to 8 years) the parent should supervise tooth brushing for (older children).*


steps (*).

Complete only critical steps (*) but not all other steps.

Complete all critical (*) and

other steps. Plus supplying pictures

or toothbrush

4. Behavior guidance:

TSD, positive reinforcementUse none Use 1 Uses 2

Form 1.2

Pediatric Dentistry DivisionRubric for Prophylaxis and Topical Fluoride Application



0

Not Competent

1

Competent

2

Proficient

1. Prophy Clean the stained surfaces by using a

paste on a rotating rubber cup. Caution the patient not to swallow the

prophy paste and provide continual use of high suction.

Used slurry of pumice or did not instruct the

patient on swallowing.

Complete the steps but used rotating brush

Applied the steps

2. Fluoride*

Seat the patient upright* Teeth should be dried and free of saliva Select the suitable trays. Place

approximately 2.5 ml of APF gel in each tray and place the trays over the arches and squeeze the buccal and lingual surfaces. *

Provide the patient with a saliva ejector, instruct patient to avoid swallowing excess fluoride and allow the trays to remain in the mouth for 4 minutes.*

Remove the trays and use high suction to thoroughly remove the remaining APF. Have the patient expectorate immediately and repeatedly for 1 minute.

Instruct the patient not to eat, drink or rinse for 30 minutes after treatment.*

One or more mistakes of the critical steps (*) e.g did not upright in

seat.

Complete all the critical steps (*) but used saliva

ejector to remove remaining APF.

Completed all the critical

steps (*) plus using high suction in

removing the remaining APF

3. Behavior Guidance

TSD, distraction, positive reinforcement, voice controlUses none Uses 1 or 2 Uses 3 or more

4. Time for fluoride * > 30 min 15- 30 min < 15 min

Form 1.3

Pediatric Dentistry DivisionRubric for Rubber Dam Isolation



0

Not Competent

1

Competent

2

Proficient

1. Rubber Dam Preparation:

a. Punches appropriate areas

b. Use appropriate clamp

c. Has floss tied to the clamp*

d. Punches multiples holes*

Mistake in one or more of the critical steps(*)

Critical steps are completed (*)

Critical steps (*) and all other

steps are completed

2. Procedure:

a. Places clamp on appropriate tooth

b. Avoid tissue trauma

c. One quadrant is exposed*

d. Moisture control*

e. Checks patient's face for clearance (breathing) *

f. Rubber Dam is reverted

g. frame is not deviated

Mistake in one or more of the critical steps(*)

Critical steps are completed (*)


steps are completed

3. Behavior guidance


4.Time * > 20 min 20 min < 20 min

Form 1.4

Pediatric Dentistry DivisionRubric for Local Anesthesia



0

Not Competent

1

Competent

2

Proficient

1. Behavior

TSD, positive reinforcement, voice control, distraction

Explain the procedure *Did not instruct the patient to close

his eyesDescribe the feeling *

One or more Critical mistakes (*)

All critical steps are completed (*)

All critical steps (*) and other steps are

completed

2. Pre-operative procedure

Proper positioning of the patient (supine)*

The child head is stabilized between the body and arm of the dentist.

Dry the site of injection and apply topical anesthesia *

Select the proper gauge and length (short in maxilla and 3 mm long in mandible) for the needle*




completed

3. Procedure & Effectiveness

Establish a firm hand rest during the injection

Keep syringe out of the patient vision block the patient vision by hands *

Slowly advance needle through the mucosa, deposit the LA (1ml/min) and withdraw the syringe *

Correct landmarks* Patient experiences, no pain or

discomfort during different procedures*




completed

Form 1.5

Pediatric Dentistry DivisionRubric for Fissure Sealant



0

Not Competent

1

Competent

2

Proficient

1. Rubber Dam/Cotton rolls

Isolation rubber dam is applied*

Rubber dam (fully erupted tooth) Cotton roll (partly erupted tooth)

Only 3 teeth are exposed, seepage of

fluids, clamp unstableFollow all criteria

All criteria plus: Rubber dam is

reverted and frame is not deviated

2. Prophylaxis

Tooth surface is cleaned using a fluoride-free pumice slurry and a rubber cup or brush.

Rinsed and dried.* All remaining pumice is removed*

One or more mistake in the critical steps (*)

Complete Critical

steps (*)

Complete Critical steps (*) and all other

steps.

3. Sealant Application

Sealant material is applied and cured with no voids*

The sealant material carried into the buccal and lingual grooves and pits.*

Check occlusion

One or more mistakes in the critical steps(*)

Complete all critical steps (*)

Complete all critical steps (*) and all other

steps


TSD, distraction, positive reinforcement, voice control


5. Time* > 30 minutes 30 minutes 15 minutes

Form 1.6

Pediatric Dentistry Division Rubric for Preventive Resin Restorations



0

Not Competent

1

Competent

2

Proficient

1. Rubber Dam

One quadrant is exposed Floss tight to clamp Allow patient breathing


fluids, clamp unstableFollow all criteria



2. Prophylaxis and caries removal

1. Tooth surface is cleaned using fluoride-free pumice slurry and a rubber cup, rinsed and dried.*

2. Removal of caries from isolated pits and fissures only using round bur # ¼ or ½ bur in an exploratory manner.*

3. All caries are removed *

One or more mistake in the critical steps(*)


Complete critical steps (*) and all other

steps.

3. Restoration and sealant application

a. Prepared areas are restored with composite resin.*

b. Sealant material is applied over the restored area and to adjacent etched fissures and buccal and lingual grooves and light cured. *

c. The sealed surface explored and with no voids*.

d. Rubber dam removed and occlusion evaluated

One or more mistake in the critical steps(*)


Complete critical steps (*) and all other

steps.

4.Behavior guidance

TSD, distraction, positive reinforcement, voice control


5. Time* 60 min 40 min 30 min

Form 1.7

Pediatric Dentistry Division Rubric for Cavity Preparation and Restoration


0Not Competent

1Competent

2Proficient

1. Rubber Dam One quadrant is exposed Floss tight to clamp Allow patient breathing


fluids, clamp unstable

A quadrant is exposed, follow all criteria



2. Cavity design and caries removala. Preparation outline is rounded with no sharp

angles.b. Groove extensions on buccal and lingual are no

closer than 1.25 or 1.5mm the buccal or lingual surface, depending on the tooth.

c. Occlusal depth is 1.5 mm in non carious areas.d. Buccal and lingual walls are slightly undercut.Class I:1. Extension at mesial or distal margin is no closer than 1.25 mm to proximal surface.2. Mesial (or distal) wall is vertical or slightly divergent, depending on the extent of the caries.Class II:1. Isthmus (is) 1/3 intercuspal distance.*2. Gingival wall is wide enough to support the smallest condenser.3. Each indicated cavity wall visibly clears the adjacent tooth, but extends no farther than buccal or lingual line angles.4. Buccal and lingual walls converge and paralleling respective external surface of the tooth.Class III:a. Incisal extensions is within 1 mm of incisal edge *b. Depth of axial wall 0.75-1mmClass V:Undercut incisal and gingival wall within maximum and minimum ranged. All caries and defective areas are removed.*


steps(*) e.g soft caries was left with no

intension of pulp capping.

Complete Critical steps* with proper

retention and resistance forms. Plus

cavity is not completely smooth.

Proper extension outline, convenience,

resistance and retention forms. Floor and walls are smooth with complete critical

steps (*).

3. Gingiva and adjacent tooth are un damaged

Injury to the gingiva causing extensive bleeding, enamel

and/or to adjacent tooth

Slight gingival controlled bleeding, no

injury to adjacent tooth

No injury to gingiva or adjustment tooth

4. Restoration: All margins should be completely restored and

closed with no excess. The original surface anatomy is restored: * The surface should be smooth and

homogeneous with no voids.

Presence of fracture voids or under

restoration

Proper anatomy and contour but may have

premature contact

Proper anatomy and contact



6. Time*Class IClass IIClass IIIClass V

> 45 minutes> 90 minutes> 60 minutes> 30 minutes

30-45 minutes60-90 minutes45-60 minutes15-30 minutes

< 30 minutes< 60 minutes< 45 minutes< 15 minutes

Pediatric Dentistry Division

Form 1.8

Form 1.9

Rubric for Stainless Steel Crown/Strip Crown/Class IV Permanent


0Not Competent

1Competent

2Proficient

1. Rubber Dam One quadrant is exposed Floss tight to clamp Allow patient breathing

Only 3 teeth are exposed, seepage of fluids, clamp unstable

A quadrant is exposed, follow all criteria

All criteria plus: Rubber dam is reverted and frame is not deviated

2. Tooth Preparation and caries removal a. Occlusal Reduction /Incisal Reduction *

1-1.5mm compared to adjacent teeth Follows original anatomy (except with pulpotomy)

b. Proximal Reduction:* Break contacts Are covergent to occlusal/incisal End in feather-edge margin No Ledges *

c. Buccal Lingual Surfaces and BevelSSC:

Removes sharp cusp tips and roundation of line angles

Bevel occlusal 1/3 of buccal and lingualStrip:

Reduce labial and lingual surfaces 0.25 mm*Class IV:

Extend preparation (Bevel) 2 mm beyond fracture line*

d. Complete Removed Caries * e. Avoid Damage to Adjacent Teeth *


steps (*)

Complete only the critical

steps(*) but not all other steps

Complete all critical (*) and other steps

3. SSC or CSC Adaptation* Crown leveled with adjacent teeth * Original Contacts restored * No extensive blanching Margins 1mm subgingivally and form smooth

curve*SSC: Difficult to seat and remove

No gaps at margins Proper occlusion *

One or more Critical mistakes

(*) e.g. under extended margins, the bite is opened

Only critical steps are

completed (*) but with slight

blanching

All critical steps (*) and other steps are completed without

blanching

4. Cementation/Restoration:Correct position Bucco lingually*

SSC Properly remove remaining cement Adequately produced proper occlusion and

contact*Strip/Class IV:

Composite restoration after acid etching Excess composite is removed before curing Strip form is removed and with no voids Proper composite shade*

One or more Critical mistakes (*) e.g. open bite

Strip/Class IV: Voids or deficient

areas

All critical steps are completed

(*) SSC: but some cements

on the strip crown lingual

finishing is needed

All critical steps (*) are completed



6.Time * Strip SSC Class IV

> 120 min> 120 min> 100 min

90-120 min80 -120 min90-100 min

< 90 min< 80 min< 90 min

Pediatric Dentistry DivisionRubric for Formocresol Pulpotomy Form 1.10



0

Not Competent

1

Competent

2

Proficient

1. Rubber Dam

One quadrant is exposed Floss tight to clamp Allow patient breathing

Only 3 teeth are exposed, seepage

of fluids, clamp unstable

A quadrant is exposed, follow

all criteria



2. Access and deroofing

a. Complete removal of caries*b. Proper opening for access. All pulp horns

are uncovered and are readily accessible.

c. Complete removal of the coronal pulp tissue *

d. No perforation*e. Hemorrhage control*

One or more of the Critical mistakes

(*) present

Excessive bleeding

Complete removal of

caries and pulp tissue but with over extension or sharp edges.

Slight Bleeding on removal of the wet cotton

pelete.

Complete removal of caries pulp tissue with

proper access and extension.

No signs of Hemorrhage

3. Formocresol fixation and temporary restoration

Slightly damped 5 minutes Pellet removal Placement of ZOE temporary

Cotton pelete do not cover the pulp

stumps or use peletes soaked

with formocresol without fixation

improper consistency for

ZOE

Follow the steps but slight

bleeding on removal of the

pelete, slight soft ZOE mix.

Follow the steps with fixation firm

consistency of ZOE



5.Time * > 120 min 30- 120 min < 30 min

Pediatric Dentistry DivisionRubric for Extraction of Primary Teeth


0Not Competent

1Competent

2Proficient

1. Pre-operative precautions Radiographic revision before

extraction* Sensation and noises associated

with extraction is explained Unfolded gauze (5x5 cm) is placed

over the tongue and cover the oropharynx *


steps (*) or extract in full supine position

without gauze protection

Complete only critical steps (*) but not other

steps


steps*

2. Procedurea. A straight or periosteal elevator is used to free the attached gingiva.b. Firm apical pressure is applied while in mandible supporting the mandible, initial luxution is toward the buccal side.For Molars: hold the pressure momentarily to expand the alveolar plate, return lingually and hold to expand the alveolar plate.

Alternate the buccal and lingual movements. When adequate freedom of movement, deliver the tooth to the buccal side, with slow, firm, continuous pressure.

For Anteriors: A rotative force is applied along the tooth’s long axis, delivering it through its path of least resistance.c. The buccal and lingual plated of the alveolar bone is molded into normal conformity with digital pressure.d. Folded sterile gauze is placed over the wound. Time*

Mobile Tooth Long rooted tooth

Molar Interior

Did not follow the steps or long time for

extraction.

6-10 minutes

> 15 minutes> 10 minutes

Follow the steps and extraction time was

relatively short

5 minutes

10-15 minutes6-10 minutes

Follow the steps and extract in a very short

time.

3 minutes

< 10 minutes< 6 minutes

3. Post operative instruction Bite on the gaze for 30 minutes * Do not rinse forcibly for 24 hours* Eat cold food Do not use straw Do not bite on lip or cheek * Do not play with the wound Written instruction is given* Gauze is given


steps (*)

Complete only critical steps (*)

Complete all the steps including critical (*)

and gave extra gauze.

4. Behavior guidance:TSD, distraction, positive reinforcement, voice control


Form 1.11

Pediatric Dentistry DivisionRubric for Diet Evaluation



0

Not Competent

I

Competent

2

Proficient

1. Diet Evaluation

Information from the parent is accurately taken

Quality of food intake by patient was identified and described to the patient / parent. *

Cariogenic potential of the patient’s diet was identified and described to the patient / parent. *


Critical steps are completed

(*)


steps are completed

2. Recommendation to patient and parents

5 food groups was explained using the pyramid *

Recommended amounts for the child to improve nutrition

Cariogenecity of the diet was explained * Instruction about sweetened or fuzz

beverages was given Instruction about sticky solid CHO including

fruits was given * Safe snacks was suggested properly * Time for sweets intake was suggested * Encourage brushing after sweets *


recommendation is given only to the

parents

Critical steps are completed

(*)


steps are completed , used

pictures and supplied the

parents with the guide to good

eating

3. Behavior guidance

TSD, positive reinforcementUses none Uses 1 Uses 2

4. Time * < 10 minutes 10-20 minutes > 20 minutes

Form 1.12

Pediatric Dentistry DivisionRubric for Space Analysis


0Not Competent

1Competent

2Proficient

1. TimeProcedure was completed in 20 minutes

> 20 minutes 20 minutes < 20 minutes

2. Case selection

1. The case is not indicated for space analysis2. Some of the incisors are primary3. Any of the 1st permanent molars did not erupt yet or extracted.4. Complete primary or permanent dentitions

1. The case is indicated for space analysis.2. All upper and lower incisors are permanent.3. 1st permanent molars are present.4. Mixed dentition5. Some teeth are fractured

1. The case is indicated for space analysis.2. All upper and lower incisors are permanent.3. 1st permanent molars are present.4. Mixed dentition

3. Teeth measurements:a. Sum of lower incisors (32,31,41,42)interred in the form*

b. Sum of upper 11,12 and 21,22*

c. Space needed was identified by using the sum of 31, 21, 41, 42*

a. Too much variation in the sumOr not interred in its place in the treatment formb. Too much variation in the measurements of 11,12 or 21, 22c. The sum of upper incisors was usedor misidentified for any of the sum of upper 345or misplacement of the sums of either lower or upper 345 in the form

Some variations in the measurements with 80% accuracy and

completed measurement entered

in the form.

Correctly identified the sum of lower 345

and placed in its position in the form.

Measurement were 80% to 100% alemate and computed

measurementInterred in its place in

the form

Correctly identified the sum of lower 345

and placed in its position in the form.

4. Detect space deficiency Alignment of incisors were

considered MD dimension of central and

lateral on each of right, left upper and lower arch were computed.

The sum was recorded by polygauge.

The anterior end of the polygauge was placed on the midline model.

A scratch on model corresponds to the distal end of the polygauge was placed on the correct position on the arch (teeth).

Space available is recorded Space from the scratch to

measial of the 6 was correctly measured

Measurements were recorded on the arch circumference.

Measurements other than the sum of MD width of central and lateral incisors were used in its quadrant.Or miscomputation of the corrected teethOr misrecording the

sum of the polygauge.Or a scratch on the

model correspond to distal was placed

either too bucally or lingually

Space not correctly measured

Or measurements were taken too far either bucally or

lingually

Space needed was subtracted for space

Some variations in the measurements with

80% accuracy.

Some variations in the measurements with

80% accuracy.

All steps were correctly followed

Total was not recorded

All steps were followed with 80-100% accuracy.

All steps were followed with 80-100% accuracy.

All measurement were recorded

Form 1.13

Arch length deficiency were calculated

Subtract space available from space needed and placed in the form for each quadrant.

Negative, position or 0 measurements were recorded for each quadrant

Total was calculated for the arch

availableOr miscalculated

Pediatric Dentistry DivisionRubric for space maintainers I

(Band/s selection and impression)

Steps and Procedure


0Not Competent

1Competent

2Proficient

1) Band/s selection

1. Adaptation *

2. Size

-Band is not subgingivallyOr - occlusal to the

marginal ridge.Or – injuries conflicted to the gingiva or soft tissue

- size is too big with spaces all around

Band is 1mm subgingivally but not

gingival to the marginal ridges.

- size is slightly big (tip of an explorer)

-Band is 1mm subgingivally and 1mm gingival to the marginal

ridges.

-The band/s are well adapted on the molar/s with no spaces, tightly or

snugly fitted.

2) Impression and band placement

1) Impression details

2) Band is placed correctly in the impression.

-The space maintainer area and the abutments

are ill defined

- acceptable impression after 3 trials

Or Band is misplaced.

-The space maintainer area and the abutments are

well defined

- acceptable impression at 2nd

trialBand is placed

correctly in its place but not stabilized to

the impression

-The space maintainer area and the

abutments are well defined

- acceptable impression from the

first trialBands is placed

correctly in its place and stabilized in the

impression 3. ) Behavior guidance: TSD, distraction, positive reinforcement, voice control


4. )Time *

1 Band2 Bands


15-20 minutes25-30 minutes

15 minutes25 minutes

Form 1.14

Pediatric Dentistry DivisionRubric for space maintainers II

(Appliance fitting and cementation)

Steps and Procedure


0Not Competent

1Competent

2Proficient

1. Appliance fitting (General) *

The appliance is placed in patient mouth.

-Appliance is activeOr - occlusal interferenceOr - blanching due to impingement on mucosa

-Bands are in proper position-Appliance is passive-No occlusal interference- but with slight impingement on mucosa

-Band fits tightly-Appliance is passive-No occlusal interference-wire not impinge on gingiva, B. mucosa or tongue

2. Appliance fitting (Specific)

Band and loop

Lingual arch

Nance or TPA

- Loop is too narrow buccolingually

Or - Mesial end of loop do not contact adjacent tooth at

contact area,Or - Wire pressing on gingival

tissue

-Rests on incisal edge of incisors or press on gingival

papillae

-Acrylic button in rugae area anterior to the junction of

horizontal & vertical components of hard palate, or

in the soft palate.

- Loop is not wide enough-Mesial end of loop

contacts only small part of contact area

- Wire parallel to edentulous ridge & 1mm

off gingival tissue

-Rests on cingula of incisors on gingival papillae without pressure before adjustment

to proper position

-The arch is well adapted to the palate

-acrylic button in rugae area at the junction of horizontal & vertical

components of hard palate

- Loop wide enough (8mm) buccolingually

- Mesial end of loop contacts adjacent tooth at contact area- Wire parallel to edentulous

ridge & 1mm off gingival tissue

-Rests on cingula of incisors slightly above gingival papillae

3. Cementation *

-The appliance is not in its proper positionor- a lot of remaining cement is left.

-The appliance is in its proper position- negligible amount of cement is left

-The appliance is in its proper position- all remaining cements were removed

4. Behavior guidanceTSD, distraction, positive reinforcement, voice control


5. Time *- Band loop- Others


15-20 minutes45 minutes

15 minutes30in

Form 1.15

2. Oral Hygiene Instruction and Diet

Evaluation

Department of Preventive Dental SciencesPediatric Dentistry (PDS 615)

Academic Year 2013-2014

ORAL HYGIENE INSTRUCTION (Students Copy)

1. The student describe the technique of toothbrushing to the patient and parent and demonstrate it on a model.

Techniques of toothbrushing:

a) Scrubing technique for the primary dentitionb) Roll technique for the mixed dentitionc) Bass technique for the permanent dentition

2. Supply a toothbrush and allow the child to do toothbrushing following a systemic order (starting from buccal surface of the last right maxillary tooth and ending by the lingual surface of this tooth) scrub each segment 15 times.

3. Give instructions to the parent and recommendations about toothbrush and toothpaste.

a) Brush twice daily.b) The parent is responsible for toothbrushing for children till 7 or 8 years old.c) The parent should supervise toothbrushing for older children.d) Toothbrush should be

Soft Straight flat trim, non serrated and have 3 rows of bristles Oral B # 20, 25 or 30 or Jonhson and Johnson (Reach)

e) Fluoride containing toothpaste such as:

Crest Colgate Aim Aquafresh…..etc.

Form 2.1

KING ABDULAZIZ UNIVERSITY

Faculty of Dentistry

Pediatric Dentistry

DIETARY EVALUATION FORM

Dietary Evaluation Yes Sometimes NoBASIC FOODS

Does your child have 2 pieces (5 ounces) daily of meat, chicken, fish, eggs, or beans? (One piece = 2-3 ounces like the size of a bar of soap or the inside of your palm).Does your child have 2 1/2 cups daily of vegetables?(Like broccoli, sweet peas, carrots, bean sprouts, spinach, celery, etc.) (One cup equivalent = 1 cup cooked or fresh veg. like the size of a computer mouse or 2 cups of leafy veg.)Does your child eat 1 1/ 2 cups daily of fruit? (Like mango, banana, apple, grapes, orange, kiwi, etc.) (One cup = 1 medium size fruit like the size of a tennis ball, 1/2 cup dried fruits, 1 cup fresh 100% juice)Does your child eat 6 pieces daily of grains? (like bread, pasta/noodles, rice. Tortillas, cereal, crackers) (One piece = 1 slice of bread or ½ cup cooked Cereal/rice/pasta) (like the size of the small fist, 4 crackers, 2 heaping tablespoons cooked rice)Does your child have 3 cups daily of milk or milk products? (like low fat milk, 1%, skim/fat-free, cheese, yogurt, soy milk) (One cup = 1 cup (250 ml) of milk or yogurt, 2 slice processed cheese)

DIET SCORE: 5=Excellent, 4=Fair, <4=Needs ImprovementDoes your child eat spread cheese on regular bases?

DRINKS

Does your child drink any of these drinks MORE than 1 time per day BETWEEN MEALS?

Regular soda-pop (Coke/Pepsi, Sprite, Mountain Dew, lemon or orange soda, etc.)Juice or drinks (Juice = fresh, frozen, canned, or natural or artificial fruit juice.) (Sun top, Tang, Vimto …..etc)Sports or energy drinks, or flavored waters? (Powerade, Gatorade, Redbull, Rockstar, Propel, etc.)Any drink WITH added sweeteners (sugar, honey, molasses) (like hot chocolate, tea or coffee (including iced), etc.)Does your child SIP slowly on any of the above rather than just drinking it?If your child usually have MORE than 1 time between meals of any of the above drinks each day, how many per day usually

2 3 4 or more

NAME: CHART#:

Date: AGE:

Form 2.2

Dietary Evaluation Yes Sometimes No

SNACKS AND DESSERTS

Does your child eat any of these foods MORE than 1 time per day BETWEEN MEALS ONLY AS SNACKS

Cake/pastry(cake, cupcakes, donuts, cookies, pies, sugared cereal, muffins, moon cakes, Konafa, Maamoul, Massoub…… etc.)Candy (like: chocolate, caramel, or other candies)

Lollipops or hard candies (i.e.: Skittles, Starbursts, Jolly Ranchers)Packaged Cereals or crackers

Does your child usually have MORE than 1 snack between meals each day?If yes, how many per day usually 2 3 4

On a regular basis: Which of the following snacks does your child eat MOST often? (you can indicate more than one)

A. Fruit like: Apple slices, banana or orange

B. Cheese and crackers or Peanut butter toast

C. Potato chips/graham crackers/cookie/cake

D. Lollipop or Candy bar like Snickers

E. Fruit roll-up or Dried fruits like dates

F. Other

If other, Please Explain:

CARIOGENIC SCORE: 15 No =Excellent, 13 No =Good, <13 No =Needs Improvement/Increased Risk

3. Arabic Forms


قسم طب أسنان األطفال

: معلومات هامة لولي أمر الطفل

إن األطفال الذين تكون تج]]ربتهم األولى م]]ع ط]بيب األس]نان تجرب]]ة س]عيدة يكون]]ون على األرجح متفهمون ومتعاونون في نواحي صحة الفم عندما يكبرون . و أول زيارة لطبيب األسنان لها أهمي]]ة: كبرى في اكتساب هذا التفهم ولهذا السبب أحب توضيح اآلتي

معظم في ضرورية أشعات أي أخذ ويتم الطفل ولثة أسنان فحص يتم األولى الزيارة في

وشيقة . مناسبة الزيارة تكون الحاالت لهم األهل ولكن األطفال مع التعامل في الخبرة ذوي من العيادة هذه في العاملين جميع إن

األهل من المطلوب كل ، األسنان عالج تجاه الطفل في اإليجابية الروح خلق في كبير دور

أناس سيرى الزيارة هذه في أنه للطفل يوضحوا أن و طبيعية بطريقه يتصرفوا أن

كبيرة . أهمية له سيكون معنا وتعاونكم وسليم صحيح جسم على المحافظة في يساعدوه

. يتبع أن يجب سليما نموا اإلنسان ينمو لكي أنه وتذكروا بالتقدير وسيقابل العالج في

يجب سليما نموا أسنانه تنموا لكي وكذلك ، والرياضة والنوم األكل في السليمة العادات

بإنتظام األسنان طبيب وزيارة األسنان وتنظيف األكل في السليمة العادات على المحافظة

للطبيب . الطفل زيارة عند تفصيليا ذلك توضيح وسيتم

،،، نشكركم ونقدر لكم حسن تعاونكم

[[[[[[[[[[[[[[[[[[[[[[[[[[[[[[[[[[[[[[[[

Form 3.1



:تعليمات تنظيف الفم والتغذية

1.( كولجيت، ً مثال الفلورايد مادة على يحتوي أسنان معجون مع أسنان فرشاة أستعمل

. مباشرة( النوم قبل المساء وفي الصباح في األقل على ً يوميا مرتين كرست

من .2 بالفرشاة األسنان سطوح من مسطح كل دعك .20-15يجب ً جيدا ً دعكا مرة

3. ( دون لألطفال بالنسبة األسنان بين ما لتنظيف السني الخيط أن 9استعمل يجب سنوات

) بالخيط الطفل أسنان بتنظيف كبير شخص يقوم

خالل .4 الفرشاة استعمال من التمكن عدم حالة في شئ أي تناول بعد بالماء ً جيدا نمضمض

) ( ً مثال المدرسة ساعات النهار

5.- ( حلويات مثل الرئيسية الوجبات بين تتناولها التي المأكوالت كمية من التقليل يجب

) بالنسبة- الخفيفة الوجبات تناول ويراعي البيبسي مثل الغازية والمشروبات بسكويتات

( أو فاكهة مثل لألطفال مفيد غذاء على تحتوي أن على النهار خالل فقط مرتين لألطفال

) جبن أو خضار

األسنان .6 وحهن الفم لفحص أشهر ستة كل مرة األسنان طبيب زيارة على الحرص

. التسوس ضد لتقويتها بالفلورايد

أن .7 يالحظ ولم التعليمات هذه تتبع لم وإذا الطبيب قبل من النظافة تعليمات شرح سيتم

. الطفل عالج متابعة لعدم آسفين فسنضطر الفم صحة في تحسن هناك

Form 3.2


جامعة الملك عبد العزيز

كلية طب األسنان


تعليمات ما بعد الخلع

( لمدة الشاش قطعة على مباشره( .30الضغط الخلع بعد دقيقة ( بعد الخلع مكان النزف استمر القماش ( 30إذا من قطعة أو الشاش من قطعة ضع دقيقة

مدة ) عليها واضغط اخرى ( .20نظيفة دقيقة اقرب الى وتوجه عليها واضغط الشاش من قطعة ضع كبيرة بكميات النزف استمر إذا

مستوصف . او مستشفى ( خالل المضمضة الخلع ( .24عدم بعد ساعة. تراكم اذا وبلعه ، اللعاب بصق عدم) ( هرش او عض او قرص المخدرة للمنطقة الطفل لمس عدم مراقبة اهمية. الخلع يوم في ساخنا شرابا تناول عدم. ) بارد ) أو حار غير دافئ طعام تناول بإمكانك ) من ) ابتداء يوميا مرات ثالث صغيرة ملح ملعقة ربع فيه مذاب كأس دافئ بماء تمضمض

الخلع . بعد الثاني اليوم الخلع مكان في اخر شي أي او باللسان اللعب عدم المسكن استعمال بعد األلم استمر وإذا لأللم مسكن تناول بإمكانك الشديد األلم حالة في

الطبيب . راجع ( لمدة الخد على ثلج كيس ضع الخلع مكان انتفاخ أي حصل نصف ( 10إذا كل في دقائق

ساعة .

---------------------------------

Form 3.3

4. Dietary Advice Forms

تقرير عن أكل الطفل

االسiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiم / ................................................التاريخ / .....................

طفلك ، وقد تبين اآلتي: كل تم الكشف عن أ

1(........................................................: والبقول مجموعةاللحوم2(....................................................: ومشتقاته الحليب مجموعة3(......................................................: والحبوب الخبز مجموعة4(...........................................................: الخضروات مجموعة5(...............................................................: الفواكه مجموعة

الدسiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiم٬الحلويiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiاتوالزيوت:....................................................

وعليه اآلتي:

العصيرات )1 وشرب والسكريات الحلويات أكل الوجبة يفضل أثناء. الوجبات بين من بدال

معصور )2 طبيعي بعصير العصير استبدال مع يفضل المنزل في.الوجبة

3( : الحلويات عن االبتعاد يفضل السكاكر تناول في الرغبة عند.تعلقوالتي المطاطية باألسنان

األسنان )4 تفريش والفاكهة يجب والسكريات الحلويات أكل بعد. بها المتعلقة الرواسب إلزالة

العصائر .)5 شرب بعد بالماء المضمضة يجبالجبن )6 من بقطعة الوجبة إنهاء المأكوالت ٬يفضل أو المكسرات

على يحتوي او السكر من خالي لبان مضغ أو النخالة على المحتوية.Xylitolمادة

الكالسيوم )7 على يحتوي ال الكاسات نسبة ٬الجبن على يحتوي إنماالدهون من الجامد ٬عالية الجبن من أخر بنوع استبداله يفضل لذا

الشيدر وليس ٬مثل بالكاسيوم الغنية وغيرها الفيتا أو القشقوانالمصنعة.

غالبا )8 وسكر ماء عن عبارة هي العلب استبدالها ٬عصيرات يفضل. المنزل في معصور طبيعي بعصير

يوم )9 كل الرياضة أو الحركي النشاط من نوع أي زيادة يفضل. أكثر أو لساعة

مالحظiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiات........................................................................................................................................................................

....................................

5. AAPD Guideline on Caries-risk Assessment

and Management for Infants, Children, and

Adolescents

Documents

and 6th year... · Web viewإن جميع العاملين في هذه العيادة من ذوي الخبرة في التعامل مع الأطفال ولكن الأهل لهم دور