Clinical - Dental Hygienist III Syllabus for 2011-2012
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Instructor Information

Course Information

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As a student you may experience a range of issues that can cause barriers to learning, such as strained relationships, increased anxiety, alcohol/drug problems, feeling down, difficulty concentrating and/or lack of motivation. These mental health concerns or stressful events may lead to diminished academic performance or reduce a student's ability to participate in daily activities. Amarillo College offers services to assist you with addressing these and other concerns you may be experiencing. If you or someone you know are suffering from any of the aforementioned conditions, you can learn more about the broad range of confidential mental health services available on campus by calling the AC Counseling Center at 806-371-5900. The AC Counseling Center website is https://www.actx.edu/counseling/ . Also, if you are in need of social services (affordable housing, utilities, transportation, food, clothing, childcare, medical/dental/vision, legal), please call the AC Advocacy & Resource Center at 806-371-5439. The AC Advocacy & Resource Center website is https://www.actx.edu/arc

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N/A

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N/A

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Course

DHYG-2360-001 Clinical - Dental Hygienist III

Prerequisites

Prerequisites: DHYG 1261

Course Description

A health-related work-based learning experience that enables the student to apply specialized occupational theory, skills and concepts. Direct supervision is provided by the clinical professional.

Student Resources Student Resources Website

Department Expectations

\N

Occupational License Disclaimer

Hours

(3 sem hrs; 18 clinic)

Class Type

On Campus Course

Syllabus Information

Textbooks

\ 1.  Current copy of Amarillo College Dental Hygiene Program Manual

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\ 2.  Patient Assessment Tutorials:  A Step By Step Guide for the Dental Hygienist, 2nd edition, Jill Neild-Gehrig; Lippincott, Williams & Wilkins

Supplies

Each student will furnish his/her own instruments and disposable supplies.

Student Performance

Course Prerequisites

DHYG  1261

Course Description

A health-related work-based learning experience that enables the student to apply specialized occupational theory, skills and concepts.  Direct supervision is provided by the clinical professional.  (3 sem hrs; 18 clinic)

End-of-Course Outcomes

As outlined in the learning plan; Apply the theory, concepts, and skills involving specialized materials, tools, equipment, procedures, regulations, laws, and interactions within and among political, economic, environmental, social, and legal systems associated with the occupation and the business/industry and will demonstrate legal and ethical behavior, safety practices, interpersonal and teamwork skills, and appropriate written and verbal communication skills using the terminology of the occupation and the business/industry.

Clinical Dental Hygiene

Clinical Dental Hygiene is that portion of the dental hygiene curriculum focused on developing the cognitive, affective, and psychomotor skills necessary for the delivery of preventive, educational, and therapeutic services to the public.  The delivery of comprehensive care is accomplished through adherence to the process of care: assessment of patient needs, formulation of a dental hygiene diagnosis, planning for the prevention and treatment of oral disease, implementation of various dental hygiene interventions (services) and evaluation of both the patient and practitioner efforts and oral health outcomes.

Definitions

A.    Preventive Services:  Clinical methods employed by the clinician and/or patient to promote and maintain oral health.

B.    Educational Services:  Strategies developed for an individual or for groups to elicit behaviors directed toward health.

C.    Therapeutic Services:  Clinical treatment designed to arrest or manage disease and maintain oral tissues in health.

D.  Process of Care:  Systematic approach to the delivery of dental hygiene care that supports comprehensive services to meet the individual needs of all patients.  The process of care requires defined problem solving and critical thinking skills and supports evidenced-based decision-making.

E.    Dental Hygiene Diagnosis:  A statement of potential or actual patient need that can be addressed by dental hygiene intervention services or strategies.

F.    Pre-Clinic:  That portion of clinical education during which the student does not have direct and primary responsibility for providing comprehensive dental hygiene care to a patient.  The student performs selected services on a patient, a partner or a laboratory manikin, but does not necessarily provide a full range of services.

G.    Clinical Dental Hygiene:  The major portion of clinical education.  As primary provider, the dental hygiene student integrates preventive, educational, and therapeutic care in treating the patient.

H.    Fundamental Clinical Dental Hygiene Skills:  Skills routinely performed by the dental hygienist and/or taught to clinical competency in most dental hygiene programs and/or legal in most states.

Clinical Dental Hygiene:  Primary Educational Goals

Clinical Dental Hygiene experience provides preventive and therapeutic care according to the process of care;  assessment, dental hygiene diagnosis, planning, implementation and evaluation.  This requires critical thinking and evidenced-based decision making skills that guide the provision of dental hygiene care within a focused scope of practice.  Upon the completion of the clinical curriculum, the student will be able to:

A.     Apply the process of care to preventive and therapeutic oral health management to a diverse patient population.

B.     Assess and analyze objective and subjective patient findings to formulate an evidence-based,patient-centered dental hygiene diagnosis.

C.     Plan, implement and evaluate intervention strategies that will promote and maintain oral health including oral self care behaviors.

D.    Demonstrate knowledge of and skill in applying dental hygiene methodology of care.

E.     Apply the principles of professional and ethical behavior in providing care to individuals of all populations.

Specific Learning Objectives

1.     Collect data, record and assess a comprehensive health history, including social history.

2.     Recognize conditions that necessitate special consideration prior to or during treatment.

3.     Perform and record extraoral and intraoral examinations, clinical and radiographic assessment of the periodontium and dentition, and assessment of occlusion.

4.     Assess the need for, expose, develop, evaluate and interpret dental radiographs to support the clinical examination.

5.     Employ radiation safety principles and procedures requiring exposure to ionizing radiation.

6.     Expose and implement intraoral photography.

7.     Formulate a dental hygiene diagnosis and supportive, patient-centered dental hygiene treatment plan and case presentation.

8.    Obtain informed consent by discussing with the patient his/her oral health findings, goals and treatment strategies.

9.     Value the importance of patient centered care and concepts of health promotion.

10.    Assess, plan, implement and evaluate a dental hygiene treatment plan for the prevention and/or treatment of oral diseases.

11.    Assess the need for and perform initial and supportive periodontal therapies.

12.    Assess the need for and perform therapeutic hand and ultrasonic/sonic periodontal debridement therapies.

13.    Perform care and maintenance of procedures for dental implants.

14.    Assess the need for and perform extrinsic stain removal procedures.

15.    Assess the need for and apply adjunctive topical chemotherapeutic and controlled released agents.

16.    Assess the need for and apply pain and anxiety management strategies.

17.    Assess the need for and plan professional topical fluoride and/or self applied fluoride; apply professional topical fluoride.

18.    Apply principles of nutritional and/or tobacco cessation counseling to the management of oral health.

19.    Take impressions for, pour, and trim study models.

20.    Assess the need for and place pit and fissure sealants.

21.    Assess, plan and perform patient oral self care education.

22.    Apply standard precautions for the prevention of disease transmission.

23.    Follow all state and federal regulatory requirements when rendering patient care.

24.    Apply principles of comprehensive record keeping.

25.    Apply principles of professional and ethical behavior when providing patient care.

26.    Apply principles of evidence-based decision making.

27.    Demonstrate critical thinking and problem solving skills when providing patient care.

28.    Demonstrate professional communication skills in all aspects of patient care.

29.    Demonstrate concern and understanding of a variety of patient needs based on overall health, oral health, cultural, social and economic circumstances.

30.    Recommend a recare schedule for continued supportive care.

31.    Recommend referral for additional assessment and/or treatment.

32.    Value the importance of evaluation and monitor patient oral health.

33.    Assess overall patient satisfaction with care provided.

34.    Value the need for maintenance of thorough and accurate records.

35.    Apply the principles for maintaining comprehensive and accurate records of all information and services offered to and provided to the patient.

36.    Self-assess ability to perform dental hygiene services at a high standard of care.

37.    Value patient confidentiality and patient rights according to HIPAA guidelines.

Students Rights and Responsibilities

Student Rights and Responsibilities

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Expected Student Behavior

Student Conduct and Responsibilities

A high standard of conduct is expected of all Amarillo College students.  The Student Code of Conduct is defined in the Amarillo College Student Rights and Responsibilities publication.  The document may be located at www.actx.edu under the student tab.

"Amarillo College expects a high standard of conduct from its students.  Students are expected to comply with the law, respect proper constitutional authority, and obey College policies, rules and regulations.  Unacceptable conduct is defined as an action or behavior that is contrary to the best interest of a fellow student or students, the faculty or staff, the College, or the teaching/learning process.  Students failing to perform according to established standards may be subject to disciplinary action.  Policies, standards, rules and regulations apply to students attending College activities whether the activity takes place on or off campus.  Each student shall be responsible for becoming knowledgeable of the contents and provisions of College policies, rules, and regulations concerning student conduct.  In some cases, individual programs may have approved policies for student conduct which also apply to student conduct in those programs.  Integrity and common sense will guide the actions of each member of the college community both in and out of the classroom.  Any student who fails to perform according to expected standards may be disciplined."

The Amarillo College Dental Hygiene Program has specific policies which apply to student conduct within the program.  These policies may be implied or written.  The course syllabus and the program manual are souces for specific student conduct policies for dental hygiene students at Amarillo College.

Professional Standards

The following are some factors which will be considered under professionalism.  Representative examples are given, but will not necessarily be limited to these examples.  The student is expected to demonstrate professional conduct and judgment.  Examples of positive professional conduct include:

1.     Student is prompt to Clinic/Rotation, both in the morning session and the afternoon session.

2.     Student is prepared for Clinic/Rotation.

3.     Student assumes responsibility for his/her own learning.

4.     Student is concerned with excellence in learning rather than just meeting minimal criteria.

5.     Student applies lecture material in the clinical setting.  The student will utilize the computer in the clinic to look up various diseases and medical conditions in which dental treatment may be altered.

6.     Student maintains his/her comoposure dealing with conflict in a constructive way.

7.     Student exhibits an attitude of respect for classmates, faculty, and staff.  If a student has a conflict with a grade given by  his/her instructor, the student must follow the grievance procedure as outlined in this course syllabus.   Faculty will not change a grade given to a student from another faculty member.

8.     Student will not be disruptive in the Clinic.  Should this occur, the student will be asked to leave the Clinic immediately.  The student will receive an absence for the day and disciplinary action may be taken.

9.     Student will not visit with other classmates during patient care.  Students who are assigned rotation duties must stay within that area of  assigned responsibility to receive credit for the rotation.  In other words, a student who is assigned a duty of DAII must stay on the clinic floor in the assigned bay and not hang out in the sterilization area or the front office.  Failure to do so will result in a 0 for the rotation.  This applies to all rotation assignments. 

10.    Student will use the light system and/or Instant Messenger  in the Clinic to summon clinical instructors and assistants.

11.    Student will accept alternate assignments as needed and have an attitude of team spirit.  Teamwork is an essential component of the dental profession.

12.    Student will be responsible for broken or damaged equipment in the Clinic.

13.    Student will not leave the clinic before 12:00 noon or 5:00 pm without permission from the faculty member supervising in his/her  clinic bay.  Should this occur, the student will receive an absence for the day and a 0 for the rotation.  Students who are assigned to the DAII rotation will be required to stay until all of the students in their assigned bay are done for the morning and/or  afternoon session.  In other words, if you are a DA II for the day, you may not leave early.  Please take this in to account when you are scheduled for a DA II rotation and make plans accordingly.

14.  In order to maximize learning, all electronic recording devices and cell phones are prohibited in this course. If a student is caught with a cell phone in hand or in a uniform pocket, or actively texting, talking, or surfing the internet during a clinic session, the student will immediately be dismissed from the Clinic and will receive a grade of “0” for the patient session or rotation, as well as an absence for the day. Those students who have children or who anticipate an emergency situation should give caretakers and family members the Office Supervisor’s phone number (806-354-6050) and have calls directed to her first. She will then act accordingly to inform the student. Patient care should not be interrupted unless a student is alerted from the Office Supervisor regarding an emergency.

15.  Your children will not be allowed in the Clinic, classroom, laboratory, or the dressing room, during any class or clinic session. No exceptions.

16.    If a student has placed a "hold" on his/her clinic schedule, the Office Supervisor will book a patient if the "hold" is not filled by 3:00 pm on the day before the scheduled appointment.  Patients who are appointed by students must have the CORRECT phone numbers and names on the schedule.    If there is not a phone number or contact information listed, the Office Supervisor will assume the patient is not coming in for his/her appointment and she will go ahead and schedule the student with another patient.    Please make sure all family, friends, etc. have the correct information if you are scheduling your own patients.  If this is not done,  you may find yourself "double" booked for the appointment and in essence will make for a longer  and more stressful day for you in clinic.

Professional Behavior Around Patients

First and foremost confidentially and compassion are at the cornerstone of care.  Students are not to discuss private information regarding their patient with classmates.  This is only to be discussed with the supervising faculty and/or attending dentist.  All patients should be treated with the utmost professional respect.  Any inappropriate behaviour demonstrated by patients should be immediately brought to the supervising faculty's attention.  As a matter of courtesy, patients should be addressed by their last name.  Students must be professional and courteous at all times with patients, fellow students, staff and faculty.  Personal conversations with classmates must be kep to a minimum.  Students should avoid comments such as, "I've never seen this much calculus!" and "I've never used the air polisher".  If a student is unsure about a procedure, students should not discuss insecurity in front of the patient.  Students should speak with their faculty discreetly away from the chair.

Electronic and Recording Devices

In order to maximize learning, all electronic recording devices and cell phones are prohibited in this course. If a student is caught with a cell phone in hand or in a uniform pocket, or actively texting, talking, or surfing the internet during a clinic session, the student will immediately be dismissed from the Clinic and will receive a grade of “0” for the patient session or rotation, as well as an absence for the day. Those students who have children or who anticipate an emergency situation should give caretakers and family members the Office Supervisor’s phone number (806-354-6050) and have calls directed to her first. She will then act accordingly to inform the student. Patient care should not be interrupted unless a student is alerted from the Office Supervisor regarding an emergency.

Mailboxes

Each student is assigned a mailbox located inside the student locker room.  Students are required to check their mailbox daily for various communication from faculty.

Bulletin Board

First and second year dental hygiene students have designated areas on a common bulletin board in the student locker room where various announcements may be posted.

Emergency Contacts

Phone numbers that family members may use to reach students only in case of emergencies are as follows:

Dental Hygiene Office Supervisor:    354-6050

Amarillo College Police:                     371-5163

Academic Grievance Procedure

A student who has a grievance concerning an academic course in which he/she is enrolled in is directed to appeal in the following order to the:  (1) Instructor  (2) Department Chair/Program Director  (3) Dean of Health Sciences  (4)   Vice President of Academic Affairs  (5) College President

Grading Criteria

Evaluation Criteria

A student will be evaluated as follows:  7 point deduction per error on the process and end product evaluations.  Sealant placement will be graded as either competent or incompetent.  Radiographs will be evaluated as outlined in the Program Manual, and must be critiqued and turned in to be graded within 2 weeks.  If not graded within 2 weeks of being exposed, a 0 will be added to your average radiographic grade.  Half of the required radiographs of each category, (2) must be completed by the last clinic day in October or points will be deducted from your final clinic grade.  One point will be deducted per radiographic (set) not turned in and passed on time.  (October)  

 

A.  Clinical competency is obtained successfully by completing procedures in the following categories:

Process Evaluation to include:

Assessment

Diagnosis

Planning

End Product Evaluation to include:

Implementation

Evaluation

Adjunct Procedures

Sealants

Radiographs

Desensitization

Application of Chemotherapeutic Agents

Periodontal Assessment

Periodontal Re-evaluation of Oral and Perio Status

Case Presentation ( This will be a scored activity  and the student must achieve a minimum of 75% in order to meet the course requirement)

Calculus Detection

Rotations

Mock Board Patient Experience

Intra-Oral Video Exam

Patient Photos

Ethics Modules (which will also include graded quizzes over information presented in afternoon report)

 

B.  Minimum Number of Successful (75% or greater) Learning Experiences for Clinc III

10    Patients with Case Difficulty Index Case A

     (10 Process Grades and 10 End Product Grades)

 

8    Patients with Case Difficulty Index Case B

     (8 Process Grades and 16 End Product Grades, will be graded by the arch or half-mouth)

 

2    Patients with Case Difficulty Index Case C

     (2 Process Grades and 8 End Product Grades; 8 quadrants)

 

2    Patients with Case Difficulty Index Case D

     ( 2 Process Grades and 8 End Product Grades; 8 quadrants)

 

1    Child Patient  ( age 11 and under)

     ( 1 Process Grade and 1 End Product Grade)

 

1    Adolescent Patient ( age 12 through 18)

     ( 1 Process Grade and 1 End Product Grade)

 

1    Adult Patient ( age 19 and up)

     ( 1 Process Grade and 1 End Product Grade)

 

1   Special Needs Patient

     ( 1 Process Grade and 1 End Product Grade)

 

1   Periodontal Assessment ( Must be on a Case Difficulty Index Case C or D)  Complete the Perio Exam in Eaglesoft which includes noting all periodontal readings, bleeding, suppuration, furcation involvement, mobility, clinical attachment loss (CAL), clinical descriptors, and periodontal diagnosis.  Faculty will evaluate each periodontal probe reading to help student assess probing accuracy.

 

1    Periodontal Re-evaluation of Oral and Perio Status Patient  ( must be a moderate or severe periodontal classification.  You must have completed the scaling and root planing of at least two quadrants within the last month.)  Complete the Perio Exam in Eagle Soft which includes noting all periodontal readings, bleeding, suppuration, furcation involvement, mobility, clinical attachment loss (CAL), clinical descriptors, and periodontal diagnosis.

 

1    Calculus Detection  (one quadrant)

 

1    Case Presentation  (2 weeks after the completion of the Periodontal Re-evaluation of Oral and Perio Status of a patient.  Student must make a minimum grade of 75% on the case presentation to meet competency requirement. 

 

1    Mock Board Patient Experience.  In order for the student to count the Mock Board Patient Experience as a competency, the patient MUST meet Board Criteria and the student must achieve a minimum of 75% on the skill evaluation.  If a student fails the Mock Board Exam, he/she will be required to remediate on a typodont and/or clinical patient by the end of the semester with his/her clinical advisor.  Remediation must be completed and documented in order to pass Clinc III.

 

Conversion of type A-D in requirements:

1 type B patient to 2 type A patients

1 type C patient to 3 type A patients

1 type D patient to 4 type A patients

1 type C patient to 1 type B patient

1 type D patient to 2 type B patients

1 type D patient to 1 type C patient

 

C.     Grade Percentages (Point Weights)

Process:

50 percentage points earned from the following categories:

Assessment

Diagnosis

Planning

End Product:

50 percentage points earned from the following categories:

Implementation

Evaluation

 

D.    Adjunct Procedures

 

16    Sealants

 

4     FMX  (Competency Level of 75% or above)

 

4      Horizontal BWX  ( Set of 4 at a Competency Level of 75% or above)

 

4      Panoramic Radiographs  (Competency Level of 75% or above)

 

1     Calculus Detection  (1 quadrant)

 

1     Desensitization  Ex: Administration of Fluoride Varnish

 

2     Application of Chemotherapeutic Agents  Ex:  Arestin

 

 

Patient Photos:  All new patients must have the patient series of 4 photos found under the Patient Record completed.  No credit will be given for a new patient check-in if the photographs are not taken.

 

Intraoral Video Exam - All C and D patients must have an Intraoral Video exam completed.  No credit will be given for a C or D patient if the intraoral video is not completed. 

 

Rotations

 

Ethics Modules  7 and 8  and will also include  graded quizzes over information presented in afternoon report.

 

In addition to treating patients at the Amarillo College Dental Hygiene Clinic, the students must participate in the following rotations:

 

Office Assistant

Dental Assistant I

Dental Assistant II

Screening

Wyatt Dental Clinic, On Site Clinical Enrichment Rotation

Veteran's Hospital, Clincal Enrichment Rotation

 

To determine the clinic grade, the average of all process and end product (to include radiographs and rotation assignments)  grades will be multiplied by the point weight for each clinic.  Add up the percentage points for both clincal areas  ( process and end product) to determine the final clinic grade for the semester.

Critical Errors may drop a student's grade.  Examples of critical  errors may include:  breach of infection control, critical Medical History error, unprofessional conduct toward a patient, student, or faculty/staff member, a breach of confidentiality, leaving the clinic early without permission, not charging and/or paying the appropriate fees for services rendered,  etc.  The result of performing a critical error will result in a 0 percent credit for the patient (s).

 

The final course grade will be computed as follows:

A = 93-100%

B = 83-92%

C = 75-82%

F = Below 75%

Note: A grade of "D" is not possible in this course.

Course  Remediation Policy

If a student fails to attain the required minimum requirements for Clinic III and has less than 3 absences during the semester, an "I (incomplete) may be given.  The "I" (Incomplete) will be removed and a grade of "C" will be given for the course after the student completes the required work.

If an "I" is received in the first (spring) semester, it must be removed by the end of the first four weeks of the following second (summer) semester.  If an "I" (incomplete) is received in the summer session, it must be removed during the fall session before the student can register for the subsequent academic year.  If a student fails to remove the "I" grade from his/her record in the allotted time, a grade of "F" will be posted automatically.  No "I"s can be given the final semester before graduation.

Attendance

\ Course Meeting Days and Times

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\ Clinic:  Monday & Wednesday  8:30 - 5:00 p.m.

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\            Tuesday, Thursday        8:30 a.m. - 12:00 p.m.

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\            Friday                          8:30 -12:00 p.m.

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\   Jones Hall

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\    Room 112

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\   Afternoon Report  Wednesday  3:00 - 5:00 pm

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\    Jones Hall

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\    Room 111

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\ Attendance Policy

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\ "Regular attendance is necessary for satisfactory achievement.  Therefore, it is the responsibility of the student to attend class in accordance with the reqirements of the course as established by the instructor."  (Amarillo College Student's Rights and Responsibilities Publication)

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\ Due to the tremendous amount of information contained in this course, the student who plans to succeed should also plan to attend all course sessions regularly and promptly. 

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\ The student who plans to succeed should also plan to attend all clinic sessions regularly and promptly. 

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\ Without question, the clinical faculty expects each student to be present at each clinic/rotation session.  Unfortunately, no one has ever developed a short cut which will replace hours of actual experience needed to master a new skill;  therefore, students must be present to acquire the specific knowledge in this subject.  Attendance records will be kept on a daily basis during the semester.  Any absence from the clinic or scheduled rotations must be reported to the Dental Office Supervisor first.  The office number is 354-6050.  Any absence from the V.A. must also be called in and reported by the student to the V.A.  The V. A. number is 355-9703 ext 7888.  Students are required to complete a minimum number of clinic hours and requirements in order to graduate from the dental hygiene program.  All students MUST CORRECTLY clock in and clock out to monitor accurate clinic time and absences.

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\ The Office Supervisor is also responsible for all clinic schedule changes for patients.  Students are required to take any patient given to them regardless of the situation.  Refusing to treat a patient will result in dismissal from the clinic and disciplinary action will be taken.  The clinic setting is to prepare the student for the "real world" of work.  In a private office, a dental hygienist would never be allowed to tell a dentist he/she does not want to see a patient or does not have time to see a patient without disciplinary action being taken and most likely termination of an employee occurring.  Absences will be monitored and evaluated to determine your final clinic grade.  Beginning with the 2nd absence, 2 points will be deducted from the final grade; after the 3rd absence, 3 points will be deducted; after the 4th absence, 4 points will be deducted.  On the occurence of the 5th absence, the student will be required to repeat Clinic III.  Attendance will be taken at the beginning of each clinic and rotation session.    In order to pass the course, a student must achieve a final grade of 75% AND meet the Minimum required competencies set for Clinic III.  In clinic, students will clock  in by 8:45 am and  clock out at 12:00 pm.  After lunch, students must clock  in at 12:45 pm and clock out at 5:00 pm as a record of their attendance.  In the event of an extenuating circumstance and a student requests to leave the clinic before the times listed above, PERMISSION MUST be given by the STUDENT'S INSTRUCTOR in his/her clinic bay BEFORE the student can leave.  This applies to all ROTATIONS  as well.  If  a faculty member has not signed off that the student had special permission to leave early, the student will receive a grade of O for the day. 

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\ A student will receive 2 bonus points to the final clinic grade for perfect attendance.

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\ Example for Bonus Points:

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\ Student has a final clinic average of 91% = B

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\ Student attends all scheduled clinics and passes all rotations.

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\ Final Clinic Grade = 93% = A

Calendar

Additional Information

\ Criteria for Case Presentation
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\ (A student must achieve a grade of 75% or higher to fulfill clinic requirement)

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\ Purpose

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\ The purpose of this periodontal case development and documentation is to provide upper level dental hygiene students the opportunity to select a periodontally involved patient and complete the case documentation, treatment, and post-therapy evaluation for discussion and learning purposes.

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\ Audience

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\ The audience for the case presentation will be a student's peers and faculty.  All case presentations will be presented two weeks after the completion of the Post-therapy Assessment appointment.

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\ Goal or Expected Outcome

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\ This exercise will provide students with the opportunity to work through a difficult periodontal case, actually implementing treatment and evaluating the efforts of their treatment.  The exercise provides students with the opportunity to share their case, strategies, and ideas with classmates.  As a result of this exercise, the overall goal is to provide valuable learning experiences and increase understanding of the variety and complexity of treating periodontal cases.  Ideally this exercise benefits the student developing the case and the students who view the case presentation.

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\ Patient Selection Guidelines

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\ The patient selected must present with active periodontal disease and a plan for periodontal therapy.  Ideally, the patient should present with some unique case feature(s), treatment, or outcome aspect that provides learning opportunities.  Students need to complete the assessment, planned treatment, and post-therapy evaluation on the patient to complete case documentation and presentation requirements for this course.

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\ Case Documentation Guidelines

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\ Section 1:  Patient information

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\ This section is intended to introduce the patient to the audience.  Thorough summaries of each of these components provide relevant background information that may affect oral health outcomes.

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\ Demographics and Health History Assessment

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\      a.     Patient profile:  summary of basic information about the patient

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\      b.     Patient's chief concern (cc): summary of primary purpose of the dental visit

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\      c.     Health History:  comprehensive summary of health related findings

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\      d.     Dental History:  comprehensive summary of dental related findings

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\      e.     Diet History:  comprehensive summary of diet-related findings

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\      f.     Health beliefs and behaviors: summary of behavioral characteristics noted during discussion and treatment

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\ Section II:  Clinical Assessment

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\ Thorough summaries of each of these components provide descriptive information about the case.

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\      a.     Extraoral exam:  summary of findings

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\      b.     Intraoral exam:  summary of findings

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\      c.     Current dental conditions:  summary of existing restorations, occlusal classification, dental caries risk assessment, or edentulous conditions

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\      d.     Radiographic exam:  summary of periodontal, restorative, and pathologic findings

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\      e.     Periodontal exam:  general summary of periodontal status including probing depths, furcation involvement, mobility, clinical attachment loss, gingival description, American Academy of Periodontology (AAP) classification and bleeding index

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\ Specific guidelines for clinical evidence:

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\ Clinical evidence is intended to provide visual or tangible representation of the patient's clinical findings.  Clinical accuracy and thoroughness provide visual information and clinical data relating directly to the case.

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\      a.     Intraoral photographs.  Includes all photos necessary to adequately provide documentation and visualization of patient's existing gingival and periodontal condition.

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\      b.     Intraoral radiographs.  Based on diagnostic need of patient; must be of diagnostic quality and mounted correctly.

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\              1.     Current or previous complete radiographic series.  Include all radiographs necessary to adequatelly assess the patient's oral health status

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\              2.      Current bite-wing series (vertical or horizontal).  Includes radiographs that appropriately assess the proximal status of all teeth

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\      c.     Complete an accurate dental and periodontal chart.

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\              1.     Existing restorations

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\              2.     Existing pathologic condition

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\              3.     Probe depths (PD).  Initial visit, post therapy follow-up visit

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\              4.     Clinical attachment levels

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\              5.     Gingival recession.  Clinician should draw in gingival margin and identify mucogingival discrepancies when applicable

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\              6.     Furcations.  Presence, location, and extent properly identified

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\              7.     Mobility.  Classified as I, II, or III

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\              8.     Bleeding.  Noted on chart and summarized as a percentage score

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\              9.     Exudate.  Presence and types determined

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\             10.    Presence and distribution of plaque biofilm and calculus.  Plaque index (PI) summarized as a percentage score

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\             11.    Gingival description.  Color, contour, consistency, location, and extent of involvement (mild, moderate, or severe)

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\      d.      Oral health management by risk assessment.  Completed and assessed according to oral risk assessment guidelines;  identifies systemic and oral behavioral risk factors that may contribute to periodontal condition or may influence periodontal therapy.

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\ Section III:  Planning Phase

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\ Thorough summaries of each of these components provide insight strategies in therapy and patient instruction.

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\      a.     Rationale for case selection:  summary

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\      b.     Treatment goals and desired outcome:   summary

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\      c.     Initial therapeutic strategy:  must accurately reflect patient's chief complaint, treatment needs, psychosocial needs, and/or pain management.

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\      d.     Prevention education strategy:  oral healthcare aids to be introduced (when and why)

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\      e.     Instrumentation strategy:  must accurately reflect patient's needs and operator skill level.

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\      f.     Discussion points with patient:  possible therapeutic alternatives, potential complications, expected results, patient's responsibility in treatment outcomes, and consequence of no treatment

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\      g.     Consent:  informed and/or written consent of treatment strategies

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\ Section IV:  Implementation Phase

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\ Thorough summaries of each of these components provide descriptive information about the actual therapeutic and preventive care of the patient during the implementation phase:

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\      a.     date of appointment and number of appointments in series:  necessary to provide information on spacing interval of treatment and  timeline of therapy

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\      b.     Actual service completed or treatment performed:  what was actually accomplished on this date and appointment number

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\      c.     Treatment revisions with rationale:  identifies changes in treatment plan and discusses reasons why changes to original therapeutic strategies were implemented

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\      d.     Patient care:  identifies how the patient is responding to care and answer questions such as the following:  Is the patient more or less motivated?  Is the patient evaluating or noticing his/her own progress and healing?  Is the patient having postoperative pain or sensitivity, and is that concern being addressed during the appointment?

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\      e.     Self care:  summarizes patient's progress with preventive education plan and discusses rationale for home care aids being introduced or changed to meet therapeutic and psychosocial goals

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\ Section V:  Post treatment assessment  (4 to 6 weeks)

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\ The clinician should thoroughly describe the patient's post therapy clinical evaluation findings.  Summaries of each of these components provide descriptive information about the therapeutic and preventive outcomes and identify future needs of the patient, as follows:

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\      a.     Intraoral photographs:  as indicated

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\      b.     Review of chief complaint, health history, and extraoral/intraoral exam, summary of health history update, and changes in extraoral/intraoral exam.  Whether completed care addressed goals, risks, and patient concerns; summary of health history update; and changes in extraoral/intraoral exam noted

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\      c.     Periodontal examination.  Summary of PDs, bleeding on probing (BOP), PI, and gingival description

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\      d.     Oral home care outcomes.  Summary of patient's understanding and effectiveness of oral hygiene, current recommendations based on caries management by risk assessment, biological indicators (Bls), PI, PDs and gingival description

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\      e.     Therapeutic outcomes.  Summary of effectiveness of previously performed periodontal therapy and assessment of patient's response

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\      f.     Discussion points with patient.  Based on results of examination, status of patient's disease, therapeutic alternatives, potential complications, expected results, and patient's responsibilities regarding treatment; explanation of consequences of no treatment

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\      g.     Future care recommendations.

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\              1.    Indications for referrals.  Clinician should specify referral protocol

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\              2.    Active therapy continued.  Possible need for further active therapy, in which dental caries or periodontal management might include antimicrobial therapy (site-specific or systemic) or further therapeutic strategy for continued active therapy

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\              3.    Dental caries management and periodontal maintenance therapy, maintenance of a healthy periodontium

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\  Section VI:  Student Evaluation of Therapeutic and Preventive Outcomes

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\ This section is intended to provide the student an opportunity to discuss planning, implementation, and evaluation of the therapeutic and preventive strategies as applied to the case.  Supporting documentation from current scientific literature may be introduced at this time to validate the therapeutic strategies.  Thorough summaries of each of these components provide self evaluation opportunities and appraisal of lessons learned, as follows;

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\       a.    What we learned from treating this case?   (summary)

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\      b.     Which modifications would enhance treatment outcomes?   (summary)

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\ Section VII:  Study Questions and Answers

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\ A minimum of three study questions will need to be included in every section.  This exercise is intended to identify discussion topics and items of clinical interest that may be addressed with the case.  Evidence-based support for therapeutic strategies may be considered to encourage decision-making skills based on current scientific literature.  ( Three questions  from each of the three sections are developed that can be drawn from the case as a learning or discussion point.)

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\ An example of a case study presentation for the student to follow is found in Mosby's Dental Hygiene Concepts, Cases, and Competencies, 2nd Edition, 2008, page 430-435.

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