Operative Dentistry

Clinical Course Director

• Dr. John C. McManama
  

Specific Operative Treatment Center Policies

Procedures that are included in the clinical courses in Operative Dentistry (RS 630 and RS 640) are: Operative Dentistry charting, diagnosis and treatment planning, home care instruction & caries prevention, caries control, simple and complex amalgam restorations, anterior and posterior composite resin restorations.

All procedures must be properly supervised. A clinical instructor must examine the patient before the procedure starts and agree to supervise the entire session. Patients cannot be treated without the direct supervision of a clinical instructor and a patient cannot be sent home unless an instructor has examined the patient.

For every procedure, the clinic journal MUST be presented by the student to the instructor at the beginning of the session. Every procedure must be properly documented in the journal and in the patient’s chart.

Restorative Procedures for Operative Dentistry

When a patient is seen for an Operative Dentistry procedure (i.e. restoration), the following must be done:

1. All financial and record room obligations must be resolved. This patient should be “in good standing” with the School’s business office.
2. The operatory must be ready in terms of functional equipment, cleanliness and infection control.
3. the appropriate instrument cassette should have been procured from the Central Sterilization area. If there are any missing or broken instruments, the entire cassette must be returned immediately. Students are not allowed to use their own instruments on patients. In order to maintain a safe and effective protocol of infection control, students are required to use ONLY those instruments that are supplied by the school.
4. High and low speed handpieces must be lubricated and sterilized prior to each procedure. The handpieces must be in sealed sterilization bags when the instructor is called into the operatory to begin the session. The instructor must be able to confirm that the handpieces have been properly sterilized.
5. High-speed evacuator tip and saliva ejector should be in place.
6. After the handpieces have been attached to the appropriate hoses, the air-water coolant in the high-speed handpiece must be properly adjusted.
7. The patient’s chart (especially medical history and treatment plan) must have been reviewed. The radiographs MUST be in the viewbox.
8. All instruments, equipment and supplies should be positioned within easy reach of the operator (and dental assistant).
9. The student must have reviewed any medical history issues and confirmed the appropriateness of the treatment plan.
10. The student asks an instructor to supervise the procedure
11. The instructor will review the chart, review the clinic journal, examine the patient and agree to supervise the procedure.
12. The instructor will sign (initial) the treatment plan to authorize the procedure and will fill out the green requisition slip for appropriate local anesthetic.

Moisture & Contamination Control

Rubber dam isolation techniques are to be used for virtually all direct restorations. They are indicated and feasible in nearly all instances. Hole extension and clamp selection and placement is dictated by the particular procedure. This should be discussed before the procedure is started. Don’t forget to ligate clamps.

Dental Assistants

The development of skills in four-handed dentistry is an important part of the student’s dental education. Students should make arrangements with classmates to assist each other.

Amalgam Restorations

The amount of amalgam (number of pre-proportioned capsules) will be determined by the instructor AFTER evaluating the preparation. The amalgam capsules will be distributed from the supply window. There are several amalgamators at various locations on the fifth and sixth floor treatment areas. These can be wheeled in place into your Operatory and used chairside. Amalgam scraps must be disposed of properly by placing excess in the plastic containers available in every Operatory.

Composite Resin Restorations

Shade selection must be done at the beginning of the appointment. When the preparation has been completed and checked, the instructor will fill out the green requisition slip for the following items:

1. curing light (the lights are built in to the new sixth floor chairs)
2. bonding agents with directions
3. composite resin(s)

It is the student’s responsibility to ensure that unused supplies are returned to the supply window as soon as possible.

Instructor Supervision

The level of faculty supervision and the faculty’s direct involvement in the procedure will be dictated by the complexity of the procedure and the student’s level of experience. The first several times that a student performs a particular procedure will be in a “formative” format. Formative sessions are un-graded exercises in which faculty-student interaction will maximized and demonstrations are common. The clinic journal must be reviewed by the instructor PRIOR to every procedure so that the instructor will be able to tailor his/her teaching style to fit the needs of the student and the welfare of the patient. It is expected that as the student’s experience increases, there will be less demand for faculty supervision and intervention (less demonstration, more coaching). Regardless of the experience level, the student must seek the assistance of an instructor whenever there are any problems or questions during the procedure. Eventually, the student will “qualify” for SUMMATVE evaluation. The requirements for “qualifying” for summative evaluation will be announced at the beginning of every academic year.

General Clinical Grading Policy

Final Grades

BUSDM grading policy calls for the awarding of final CLINICAL grades at the end of the third and fourth academic years for the DMD students and at the end of the second year for Advanced Standing students. Any updates to clinical grade computations will be announced at the beginning of the academic year. Third year clinical grades will be based on “development” of overall clinical skills. Fourth year (and AS-2) grades will be more related to the demonstration of competency. Clinical grades and “reaching competency” are related but different. Determination of competency is an all-or-none decision made by the clinical course directors. Every DMD-4 student and every AS-2 student must reach a competency level in order to graduate but competent students can earn different grades.

Daily Clinical Feedback / Evaluation

All clinical procedures that are done in the discipline of Operative Dentistry will be either formative or summative. Formative sessions are learning sessions. Summative sessions are evaluation sessions.

What is a formative session?

Formative teaching stresses learning, not grading. The goal is to ensure that students learn as much as possible from EVERY formative session. If you compare a clinical course to a didactic course, the formative sessions are similar to the lectures, tutoring and reading assignments. The summative sessions are similar to quizzes and exams. Formative feedback must be frank, immediate and constructive. Formative sessions should include supportive discussions, probing questions, demonstration and an assumption of responsibility by the instructor. The instructors should follow an apprentice model and look for clues for when to transition into coaching and fading (this may take some time to develop these skills). The clinic journal will be used by clinical instructors as a formative teaching instrument. There will be absolutely NO grading in formative sessions.

Summative Evaluation

When a student, nearing the end of the fourth or Advanced Standing II year, can demonstrate the ability to provide patient care that consistently meets acceptable standards without the need for faculty guidance or assistance, the student will be deemed competent in that discipline. In Operative Dentistry, the mechanism of proving competence will be performance on summative evaluation exercises and performance in academic courses.

What is Summative Evaluation?

It is a test or graded exercise used by course directors to measure progress toward competency. For a student to prove that s/he is competent and to be eligible for graduation sign-out in Operative Dentistry, the student must:

1. PASS ten summative exams. The summative exams are directed by Dr. Cataldo. He is responsible for determining the format and policies of summative examinations. He will establish and publish specific information at the beginning of every academic year.
2. Pass all didactic, preclinical and clinical courses in Operative Dentistry; and
3. Be in good academic standing with the appropriate promotions committees

What do Summative Evaluations look like?

There are specific forms for summative testing. There will be clear criteria for grading moisture control, preparation, pulpal & periodontal protection, caries management, restoration insertion & finish.

Students MUST pass at least TEN exams

Students must NOT fail any more than two (if they do, they will be required to do at least five more formative sessions in either amalgam or composite resin before they are allowed to do another summative skill test.)

If students take and pass more than the ten required skill tests, their grades in clinical Operative Dentistry IV will be improved.

What is a “qualifier”?

The term "qualifier" is defined as the quantity and quality of clinical work that the student must do in order to start summative evaluation.

In order to be eligible for summative evaluation in Operative Dentistry, a student must have a notation in the clinic journal that includes Dr. McManama’s signature. To get Dr. McManama’s signature, a student must:

1. complete at least fifteen surfaces of amalgam in a formative format (documented in clinic journal) to be eligible for amalgam testing.
2. complete at least fifteen surfaces of composite resin in a formative format to be eligible for composite resin testing.

Students should bring their journal to Dr. McManama for his review. Dr. McManama will only qualify a student who has demonstrated “development toward competency”. Once a student has qualified, s/he is allowed to begin summative sessions. The student may opt to do more than the minimum number before starting summative exams. The student may start amalgam exams before s/he is ready to start resin exams and visa versa.

What is a milestone?

A milestone is simply a guide. It is a statement of how much clinical work you should have done by specific calendar dates. Periodically, mentors will meet with students to review their progress and will use established “milestones” as a guide to identify trends in student development toward competency. Course directors will give students and mentors a list of “milestones” or expectations.

Externship Procedures:
Most of the procedures done during rotations are formative in nature and must be properly documented in the clinic journal. For Operative Dentistry, if a student has qualified for summative exams, s/he is allowed to do a limited number of summative exams during the externship rotation. Specific information will be announced by Dr. Cataldo.

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