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  • 1. PIERCE COLLEGE CLINICAL RESTORATIVE DENTISTRY DENTAL HYGIENE PROGRAM COURSE SYLLABUS - Course Title: CLINICAL RESTORATIVE DENTISTRY I-III (Dent. 237, 247, 257) Course Description: Clinical instruction and practice in the placement and finishing of amalgam and tooth colored restorations and related procedures. Credits: 2 Credits Class Time: Thursday, 1:00 pm - 5:00 pm, and other times as arranged Instructors: Sheila Norton, RDH, BS - Course Lead, Course Instructor Keavin McIntosh, DDS - Supervising Dentist, Course Instructor-Pierce College clinic Kathy Bassett RDH, BS ME - Course Instructor Dr Wendy Walsh-Supervising Dentist, Course Instructor –Olycap clinic I. MATERIALS OF INSTRUCTION: 1. All text and handout materials from the Preclinical Restorative sequence of courses. 2. Clinical Restorative Dentistry Syllabus, Pierce College Dental Hygiene Program 3. Other handouts and research materials as assigned. II. COURSE INSTRUCTIONAL GOALS: Upon successful completion of the course, the student should be able to: 1. Follow all policies and procedures of the Pierce College Dental Hygiene Program. 2. Perform acceptable patient treatment in restorative dental procedures as specified in the Clinical Restorative Dentistry Syllabus. 3. Complete the treatment of a specified minimum number of patients requiring restorative treatment in cooperation with the clinic dentist and staff. 4. Complete and self-evaluate a minimum number of specified restorations on a dentoform model. 5. Maintain all patient charts, including fees, documentation and follow-up for completed treatment at the end of each quarter. 6. Utilize 100% of assigned clinic time in patient treatment, dentoform work and peer support. 7. Practice and demonstrate proficiency with nitrous oxide administration and with all emergency equipment and procedures. 1
  • 2. 8. Build skills and prepare for Western Regional Restorative Examination. III. BEHAVIORAL OBJECTIVES: Given discussion, visual aids, typodont and patient practice activities, the student should be able to (and will be expected to): 1. Practice clinical restorative procedures and skills on dentoforms. Completing required restorations at a clinically “Acceptable” level (AIS as defined on evaluation form), specified required amalgam and composite resin restorations on dentoform model at and “Improvable” to “Acceptable” level. 2. Practice restorative procedures and skills on patients at a clinically “Improvable” to “Acceptable” level, as determined under close supervision of course instructors. 3. Perform assistance tasks with restorative patients as part of the “dental team” with a classmate. 4. Participate in problem solving situations related to the practice of restorative dentistry and clinical course goals with instructors and classmates. 5. Demonstrate proficiency, as demonstrated by proper functioning, of the dental unit, equipment operation and maintenance, dental materials manipulation and designated subjects. 6. Perform specified duties and demonstrate organizational and leadership skills as Restorative Assistant and Clinic Assistant when assigned, to include proper set-up and storage of clinical restorative materials. 7. Review and be familiar with information from Material Safety Data Sheets (MSDS) for all applicable products used in class. 8. Demonstrate proficiency in: * Preparing for patient care * Performing necessary clinical unit and equipment maintenance, sanitization and disinfection * Instrument management and sterilization * Demonstrating proper patient and operator positioning 9. Participate 100% of the time, in all seminar/discussion sessions, outside preparation for lab and clinic. Attendance is mandatory for all clinic/lab sessions. 10. Demonstrate professional and ethical behavior at all times . 11. Adhere to the Standards of Applied Dental Hygiene Practice, Principles of Ethics of the American Dental Hygiene Association; the Pierce College Student Conduct code; the Pierce College Dental Hygiene Department Infection Control Manual policies, published Clinic Policy and Procedures; and general course instructional goals and objectives. 12. Respect, understand and maintain the policies established by the Department and College to protect the safety of patients, students, faculty and staff at all times. 13. Complete and self evaluate amalgam and composite resin restorations on a dentoform model. 14. Appoint and perform delegated treatment for a specified number of restorative patients in cooperation with the dentist. 2
  • 3. 15. Display proficiency with the equipment and procedure for the use of nitrous oxide sedation and all emergency equipment items as indicated by patient needs. 16. Perform specified duties and demonstrate organizational and leadership skill as Clinic Assistant and Office Manager Assistant when assigned. IV. COURSE CONTENT Course Orientation and Review Restorative Pre-Clinic Orientation (Clinic Preparation, Restorative Equipment Issue, Materials review) Restorative Clinic Sessions (including lab and clinical patient practice) Dentoform projects, submitted with self-evaluation/evaluation sheets complete Patient procedures, submitted with charts, self-evaluation and faculty valuation complete Submission of completed final course records, to include: dentoform and clinical evaluations sheets, and Summary of AIS evaluations. V. RESTORATIVE CLINIC PROCEDURES AND REQUIREMENTS A. Clinic Schedule 1. All students are assigned to the clinic on Thursdays from 1:00 to 5:00 pm. Specific assignments will be made on the Restorative Clinic Rotation Schedule; all patients must be entered into the Restorative Appointment Book/Daily Schedule. 2. No changes will be made in the rotation assignments without the written approval of the lead dentist on the master schedule. 3. You will be allotted time for set up and clean up of your operatory site as well as for general clinic duties. It is the responsibility of the student to be ready for appointments at 1:00 pm. 4. The clinic session ends at 5:00 p.m. All patient procedures must be complete and patients dismissed by 4:30 p.m. 5. The clinic doors will close at 5:30 p.m. as per program policy. All students must vacate the clinic at this time. ___________________________________________________________________ Requirements for eligibility (or instructor recommendation) to take early WREB restorative exam: • During Fall quarter (following completion of pre-patient requirements) and through the registration deadline for April WREB, 5 “mock boards” must be passed at A/A levels in a 1 ½ hour time frame. Placing one composite restoration and one amalgam restoration, one being a maxillary and one being a mandibular restoration. 3
  • 4. • 2 or more of these pairs are to be passed in the class group test setting (3 opportunities given) • 3 of these pairs (or remainder from above) are from self directed opportunities in restorative clinic. An instructor must be advised prior to starting the exam and teeth marked. (6 sets of teeth provided) If these requirements are not met the faculty would advise waiting for the following WREB examination. B. Clinic Assignments 1. Clinician - The student is responsible for 1) appointing and managing a restorative patient with needs appropriate for this clinic, 2) coordinating the efforts of all team members (assistant, clinic assistant, and dentist) in the treatment of their patient, 3) obtaining pre-approval for treatment from the dentist and informed consent from the patient, 4) to see that all fees are paid and recorded, and that the chart entries and all paper work are submitted to the instructor by 4:45 pm of that session. Each restoration requires a separate blue Restorative Evaluation sheet (Dentoform or Clinical). 2. Peer Assistant - The student is responsible to support the operation in all phases of the patient appointment under the direction of the operator, especially regarding supplies and chair side support. The Peer Assistant may also assume the following duties: alert the instructor or dentist to operator needs, serve as a peer evaluator and peer teacher, initial management of second patient (double book), etc. Each session requires a salmon non- patient activity sheet, each assistant will make an entry on this sheet to summarize their key learning from the session as an observer/peer coach. 3. Clinic Assistants - At least 2 individuals are assigned weekly to perform general clinic assistant duties. In addition, at the beginning of each session they will put out the restorative supplies on the center island, and work with the lead instructor to restock and inventory supplies for the session. At the end of the session, they will store all supplies and equipment to their PROPER place, check that all units are off and all areas of the clinic are clean. Sterilization procedures for the next day's clinic should be carried out before clinic closing at 5:30. Each session requires a blue Restorative Clinic Assistant duty sheet. C. Patient Appointment Procedures 1. Appointment Book/Daily Schedule - This book will be kept in the clinic for students to plan their treatment schedule. Appointment slots will be listed for the entire quarter. Students may enter their patient names and procedures for the entire quarter. Time slots will be listed for 1:00, 1:30 and 2:00 seating. Please do not bring patient in early to get a head start. This only creates more waiting. Please appoint larger TxP at 1:00 and 1:30. Patient names and the TxP intended must be placed in this book as soon as 4
  • 5. they are confirmed for their appointment and no later than 11:00 am Thursday. This should be entered by the student IN PENCIL ONLY. This appointment book is kept at the DDS Desk in the clinic. 2. The Appointment - Patients are to be seated between 1:00 and 2:00 pm. This will be determined by student, patient, and procedure needs. The typical restorative appointment involving tooth preparation will be 1to 2-1/2 hours in length. Please rotate through the 1:00 spots. If you had one the week prior, your are not to have one the following week. (Your professionalism grade will be altered if not followed) 3. Second Patient (Double Book) - Several opportunities will present for treating a second patient for a "Non Prep" procedure. Details on this activity and scheduling will be presented at course orientation and seminar. 4. Dentoform Practice and Allied Activities - Students will continue with lab activities to review previously learned techniques and to practice newly introduced procedures (such as posterior composites). These procedures are to be done as operator or assistant prior to, or following, patient appointment. Specific goals are indicated under Course Requirements for each quarter. VI. CLINICAL PROCEDURES REVIEW Dental Team Procedures - Orientation for clinic will take place on the first day of class, with an additional review the week prior to patients being scheduled in clinic, this will be based on review of the appointment book for Restorative clinic. Be sure all appointments are written in the book as soon as scheduled. The clinic dentist and instructors will address students in their unit regarding unit set-up, procedures during cavity prep, and equipment needs. Topics such as positioning, preferred materials, bonding agent, bur selection, etc., will be discussed and demonstrated as needed. For Pierce College clinic units 2,3,8,9,10,11,12,13,18,19 will be designated for restorative patient care. If additional units are needed please use units 4 and 17. If you have these units for your clinic assignment and do not have a restorative patient you will need to vacate the unit! All dentoform work is to be done in the non patient units of the clinic. Please sign up for a unit as well when signing up for a patient in clinic. VII. PERFORMANCE NOTEBOOK AND DOCUMENTATION Students are expected to have their Clinic Reference book in clinic, with a section for instructions for use of all restorative materials. These instructions will be handed out in the fundamentals and/or clinic courses as the materials are introduced. Records will be kept in the Restorative section of the students performance notebook for all treatment performed and any evaluations by instructors and students. 5
  • 6. 1. Students will keep all records up to date and available in the Clinical File Cabinet on the clinic floor in designated restorative notebook. 2. All charts, self-evaluations and documentation are to be written up by the student and turned in to their instructor no later than 4:45 p.m. on each clinic day. 3. All these completed materials and course records must be available by 4:00 p.m. on the last clinic session for course evaluation. Students are responsible to turn their records in to the lead instructor. 4. All charts must be audited with one of the course instructors and completed by 5:00 p.m.on the last day of clinic each quarter. 5. Patient journals: For each clinic session a journal entry must be made with regards to your patient experience. This could include things that you learned, observed, what went well, what didn’t. This could include before and after photos. This information will be shared with other classmates the final day of clinic each quarter. The purpose of this exercise is to share your experiences as you will all have different learning experiences. 6. More information on this will be provided in course orientation and at clinic seminar. VIII. COURSE EVALUATION CRITERIA Specific "Due Dates" are given for dentoform course requirements; the student must plan their time to allow for completion of patient requirements before 4:00 on the final day of class, for each quarter. 1. To receive a passing grade in this course, the student must meet all the following requirements: a. Attend and participate in all scheduled sessions. b. Follow all program policies regarding professionalism and clinical procedures. c. Lab component: Students will be required to complete specific restorations on the dentoform at no less than an “I” score. Students are required to repeat any carving receiving an “S” score to no less than an “I” score. Students are encouraged to repeat “I” carvings to achieve an “A” score; this score will be used for the final score regardless of the number of attempts made. Each restoration requires a blue evaluation sheet with self-evaluation completed prior to submission.Each restoration requires a blue evaluation sheet with self-evaluation completed upon submission. We also encourage the use of the WREB grading form for your edification. Please observe the following points on the evaluations sheet: Acceptable = no changes or slight changes (2) Improvable = changes required and possible (1) Standard Not Met = changes required but impossible-must be redone (0) 6
  • 7. Grade point Fall 2 (13 rests ) Winter 2 (8 rests) Spring 2 (12 rests) 4.0 11-13 A’s 7-8 A’s 8 A’s 3.5 9-10 A’s 6 A’s 7 A’s 3.0 5-8 A’s 4-5 A’s 5-6 A’s 2.5 1-4 A’s 1-3 A’s 3-4 A’s 2.0 All I’s All I’s 1-2 A’s 1.5 All I’s Each “S” lowers grade one level d. Clinical Component: Students will be required to complete a specific number of restorations or surfaces each quarter. Daily AIS scores on the blue Restorative Clinic evaluation form will be use for a portion of the final course grade according to the Clinic AIS Criteria. Self-Evaluation of each task applied during the appointment must be complete BEFORE submitting the form for faculty feedback. Clinical requirements accepted will be passed on Clinical Production Difficulty points as follows: Small pit/fissure restorations 0.5 points Class V restorations 0.5 - 1 point (Based on faculty discretion - ie: include line angles, sub gingival, requiring cord) Occlusal restorations 1 point 2 Surface restorations 2 point (matrix needed) 3 Surface restorations 3 pints (matrix needed) Students are reminded to watch for opportunities for both composite and amalgam restorations to full fill their 2-Year Requirements over the course of the year. Be sure to review the Restorative page of your requirements. IX. QUARTERLY REQUIREMENTS - See table of requirements for assigned preps Fall Quarter Lab component: 7
  • 8. Prior to seeing clinical patients the following restorations must be completed and graded at an A or I level. Composites Amalgams #9M #14 MO # 3 MO #30 MO #19 MO #9 F (hold for DHYG 234 lab) #13 DO The remainder of the dentoform restorations are due on or before the last clinic session. Composites Amalgams #30 MO* #3 MO* #14 MO* #19 MO* # 5 DO #30 MOD *-graded using WREB grading criteria for self eval and instructor eval Clinical Component: No less than 3 restorations, totaling no less than 3 clinical difficulty points. These may be either composite and/or amalgam. This must be two or more patients. This minimum will reflect a 3.5 for the production grade. For each additional production point, 0.1 will be added to the final course grade. To be “eligible” to schedule a clinical patient, the student must complete assigned dentoform teeth at no less than an “I” score and demonstrate an MSA, PSA and IA injection at an A or I level during the assigned lab practice session. Students MUST be able to discuss landmarks, drug and needle selection, rationale for selected injection, structures to be anaesthetized and structures at the deposition site. During the injection students must verbally report: when at the Penetration site, when performing Aspiration, when at terminal Depth and Angle. Case Selection: Students are expected to schedule procedures reflective of an introductory skill level. If a significant amount of instructor assistance is required to complete the restoration, productions points will be adjusted. Winter Quarter Lab component: In Winter quarter you will have the opportunity to give yourself 4 -“mock boards”. There are four set of WREB teeth provided and you may plan to take 1- 1/2 hours to time yourself and complete these 8
  • 9. restorations of WREB pairs. An instructor is required to be notified and teeth checked. Required is one upper and one lower per session as that is typical of the board. Practice away!!! Lab component: Half of these restorations must be completed and submitted for grading no later than the end of the 5th week of the quarter. Amalgams: Composites: 3 MO 3 MO 14 MO 14 MO 19 MO 19 MO 30 MO 30 MO 8 and 24 MIL (from 244) #18 MO and #19 DO amalgams placed and carved together during 244’s first class session. # 9D and #10 M composites placed together (can be completed in restorative clinic) #14 DO and #15 MO composites placed together #30 DO and #31 MOD amalgams placed and carved together *These four pairs of restorations must be placed and submitted with both preps in place throughout the entire procedure. These will be graded P/F. Wait to start these restorations until after explanation in DH 217’s first lecture. These pairs of restorations are P/F with the emphasis on embrasure contour and contact position. We will also be evaluating anatomy etc. A failing grade will require redoing both restorations so evaluate them carefully before submitting!! March 12th- Mock Board session for restorative and anesthetic and mock anesthetic written exam (NO RESTORATIVE PATIENTS) Students are expected to complete these restorations throughout the quarter and submit for evaluation and feedback If all requirements are held and submitted on the final day of the course, the student’s grade in professionalism will be reduced. Clinical Component: No less than 5 restorations, totaling no less than 5 clinical difficulty points. These may be either composite and/or amalgam. This must be two or more patients. For each additional production point, 0.1 will be added to the final course grade. To receive a 4.0 in the production section, at least 5 additional points beyond the course minimum must be completed. Spring Quarter 9
  • 10. Lab component: Spring Quarter restorations are designed to challenge you with quadrant dentistry, cusp build-ups and paired restorations. Groups of restorations should be done in one session to simulate actual quadrant dentistry. Embrasures and proper proximal contours are required for passing. These will be submitted and graded together. REQUIRED RESTORATIONS COMPOSITES-6 total AMALGAMS-6 total The following are to be done together 5 MOD 2 MO 14 MOD 3 MOD *3 MO 4 MOD *19 MO 5 DO Composite pair: 19 MODBL+cusp 29 DO *14 MO 30 MO With notification of passing of WREB restorative board, #14 MO amalgam, #3 MO and #19 MO composite only can be replaced by a one-point restoration beyond the required 10 points. These restorations can also be switched out for more challenging (and interesting) cusp replacement restorations if you prefer. It is our expectation that these restorations should be completed in 3 sessions if planned for. If you utilize the 1st year dental hygiene students as assistants you will have ample time to complete patient requirements in 6 sessions As with Winter quarter, students are expected to complete there restorations throughout the quarter and submit for evaluation and feedback If all requirements are held and submitted on the final day of the course, the student’s grade in Professionalism will be reduced. Clinical Component: No less than 5 restorations, totaling no less than 10 clinical difficulty points. This may be two or more patients. For each additional production point, 0.05 will be added to the final course grade. To receive a 4.0 in the production section, at least 10 additional surfaces beyond the course minimum must be completed. X. FINAL COURSE GRADING Assessment for this course is based on the following: 10
  • 11. 1. Professionalism - based on cooperation, leadership, patient management, rapport, and attitude. Evaluation of total process as noted on daily evaluation forms, daily AIS scores in Practice Management, CA duty, attendances and participation will be included in this section. This will also include patient journal entries and participation in final discussion of patient treatment situations. 2. Production - based on outcomes for all treatment rendered. Evaluation of final product outcomes as noted on daily evaluation forms as daily AIS scores in Production/Outcomes will be included in this section. 3. Lab Skill Assessment - based on dentoform work. Final AIS scores for each assigned dentoform tooth will be included in this section. A decimal grade will be assigned based on the above for each course in the DH 237, 247, 257 sequence. Please note the following regarding evaluation distribution for the final grade: Total Point Fall Winter Spring Distribution Professionalism 20 20 20 Production 20* 40* 60* Lab Skills 60 40 20 * For Fall, Winter and Spring quarters 100% = 3.5. Additional Production points beyond the minimum required needed to achieve a course grade above 3.5 ACCESS AND DISABILITY SERVICES Pierce College: Students with disabilities who believe they may need academic adjustments, auxiliary aids or services to fully participate in course activities or meet course requirements are encouraged to register with the Access and Disability Services (ADS) Office, Room 300K in the Cascade Building. You may also call the ADS Office to make an appointment to meet with the ADS Coordinator at (253) 964-6526 or 964-6527. Students requesting accommodations must obtain the “Approved Quarterly Academic Adjustments, Auxiliary Aids or Services” (green) form provided by ADS. Peninsula College: “The ADA is designed to ensure that students with disabilities have an equal opportunity to access academic programs and successfully complete their studies.” Peninsula College is committed to providing accessibility to all students. For more information, please contact the Student Development Center. Your information will remain strictly confidential. If you require accommodations based on a documented disability, emergency medical information to share, or special 11
  • 12. arrangements in case of an emergency evacuation, please make an appointment with me as soon as possible or feel free to contact the Student Development Center at 417-6340. Security Emergency Procedures for Classrooms Call 911 and then Campus Safety in response to an imminent threat to persons or property. In the event of an evacuation (intermittent horns & strobes), gather all personal belongings and leave the building using the nearest available safe exit. Be prepared to be outside for one hour and stay a minimum of 200 feet from any building or structure. So long as it is safe to do so students are expected to stay on campus and return to class after evacuations that last less then 15 minutes. Do not attempt to re-enter the building until instructed by an Evacuation Director (identified by orange vests) or by three horn blasts or bell rings. Please notify the nearest Campus Safety Officer or Evacuation Director of any one left in the building or in need of assistance. Fort Steilacoom Campus Safety (253) 964-6751 Puyallup Campus Safety (253) 840-8481 12