Oral Diagnosis and Radiology

Course Director

• John F. Guarente, DMD, Assistant Dean for Patient Services and Clinical Assistant Professor

Faculty

• Mahdi Bouhmadouche, MD, DMD, DSc
• Anita Gohel, BDS, PhD
• Joseph P. Nore, DDS
• Blanca Sotomayor, DMD

Clinic Director (Oral Diagnosis)

• John F. Guarente, DMD

Location

• Rooms 101, 102, 104

Telephones

• 617/638-5266
• 617/638-4742
• 617/638-9168

Clinic Hours

• Monday: 8:30 a.m.-4:30 p.m. (morning orientation)
• Tuesday: 8:30 a.m.-4:30 p.m.
• Wednesday: 8:30 a.m.-4:30 p.m.
• Thursday: 8:30 a.m.-4:30 p.m.
• Friday: 8:30 a.m.-4:30 p.m.

Introduction

Patients presenting for treatment at Boston University Henry M. Goldman School of Dental Medicine are initially evaluated in the Oral Diagnosis Clinic. The dental needs, wishes and financial capabilities of the patient, as well as the suitability for treatment in a teaching institution are determined. If goals of the patient and school are similar, the patient will be accepted for treatment. The presence, absence, and extent of oral disease will be determined and the patient categorized according to a level of difficulty of different phases of treatment. Appropriate intraoral and extraoral radiographs will be taken to aid in the preliminary diagnostic procedures.

The case-type classification will permit the assignment of patients to appropriate student doctors for complete treatment planning, clinical treatment and post-treatment planning, clinical treatment and post-treatment case review (peer review). In all cases, patients will be assigned to student doctors with due regard for the existing level of expertise and target guidelines necessary for graduation. Students will usually treatment plan, in detail, only those patients they will be treating, and copies of final treatment sequences will be filed in the Division of Oral Diagnosis signed by oral diagnosis/mentor faculty. Upon completion of treatment, patients will receive a posttreatment examination, and the patient placed on recall.

Student Demeanor

Student dentists on rotation must appear promptly according to the times listed in the relevant sections.

Student dentists on rotation may not leave the department without permission of oral diagnosis/radiology faculty. Student dentists having received permission to be on call must leave their telephone numbers with the oral diagnosis senior administrative assistant in room G-104.

Students may not exchange assignments without permission of the department. Students must provide the name of their replacement one-week in advance of their assignment. This must be coordinated with Kim McGrath in room G-705.

Students not able to attend because of illness should report to the director of oral diagnosis as soon as possible by calling 617/638-5266 and leaving a message with Kathy Bagley (room G-104).

Student dentists are responsible for the neatness and detail with which all records are kept. Removal of records from the department is not permitted without consent.

Students must not proceed with treatment if there is a medical alert

At all times, student dentists will conduct themselves in a manner befitting the dental profession, and with due respect and concern for the patients.

Under no circumstances should patients be referred to private offices. Any student dentist found behaving in this manner would be dismissed from the department and reported to the dean.

Students must be neatly and cleanly dressed and wear a clinic jacket at all times. Jeans are not permitted in the clinic.

Students must keep the clinic clean and tidy.

Students must report equipment malfunction and damage to the clinic co-ordinator immediately.

Student dentists must wash their hands before and after patient examination, and the radiographic survey. It is required that students follow infection control guidelines.

Reception of Patients

Methods of patient presentation are by personal appearance, introduction by faculty or students, and by telephone.

The following information is required:

• Patient's name, birth date, sex, address, method of payment (MassHealth, insurance, self)
• Reason for visit or call:
• Emergency
• Diagnostic service (source of problem unknown, check-up needed, confirm previous treatment plan, etc.)
• Periodontics: gum troubles, gum boil (acute), pain
• Operative: fillings, etc.
• Crown and Bridge: capping, caps, etc.
• Endodontics: root canal therapy
• Dentures: full or partial
• Oral Surgery: extractions, wisdom teeth, etc.
• Pediatric Dentistry: Children referred to the Department of Pediatric Dentistry
• Orthodontics: Patients referred to the Department of Orthodontics
• Other: TMJ Dysfunction, cankers, ulcers, etc.

Instructions to Patients

1. Initial Visit
• The first visit usually consists of two phases: preliminary screening and appropriate radiographs.
• If the patient had a recent series of radiographs, they should bring the radiographs with them to the initial visit. The films will be evaluated for quality and quantity by radiology/oral diagnosis faculty and will be supplemented where necessary.
• The visit may take up to two hours or more depending on clinic flow.
2. Appointments for radiographs and consultations are scheduled at the central appointing area on the first floor or by calling 617/638-4700.
3. Certain fees (registration fee, radiology, oral diagnosis, consultation) are involved in the preliminary diagnostic procedures, and are payable in advance. A fee, payable in advance, is also charged for emergency service. These fees are not refundable. Preliminary examination or the taking of radiographs in no way binds the School of Dentistry or assures the patient of assignment for treatment.
4. Method of Payment: In advance: cash, check, credit card, MassHealth card

Appointments

All patients register at the first floor reception desk.

Emergency

• Services provided Monday-Friday, 9:00 am to 1:00 pm for new patients, patients of record may present at any time during normal clinical hours.

Oral Diagnosis Screening

• The student on oral diagnosis rotation directs the preliminary screening sessions under the supervision of a faculty member for oral diagnosis.
• The total time involved is approximately two hours.

Radiology

Usually radiographic surveys are taken during the initial visit. If not, appointments may be made at the first floor reception desk.

• Students wishing to take radiographs on their own patients outside their rotation times may stop by the clinic to ascertain the availability of chair time. The clinic will try to accommodate each student at that time.
• Special radiographs are made by arrangement with radiology faculty.
• Each patient must have radiographic permission by a Boston University faculty dentist.
• All films must be paid for in advance; the record of the receipt must be presented when the patient comes to the clinic.

Radiology Clinic

Personnel

Radiology faculty will supervise all technical details of patient and radiographic management. Students should not hesitate to ask for help when any problem arises

Rotations

Radiology Rotation Manual

• Predoctoral students rotate through two one-week rotations during their first and third years.
• First-year Advanced Standing students rotate through the Division of Radiology for a five hour rotation. Second-year Advanced Standing students complete a one-week sessions.
• Rotation lists are the responsibility of the clinic coordinator in consultation with the chairperson of the Division of Oral Diagnosis and Radiology. These will be provided to the students prior to the start of the academic year.

Grading

• The student is evaluated on radiographic technique and on the interpretation of full mouth surveys via competency based evaluation form.
• Students who do not achieve competency will meet with the chairperson to define the remediation process.

Objectives of Radiographic Screening

• To provide radiographic surveys on patients that will be screened in oral diagnosis
• To instruct students in radiographic techniques and in interpretation of normal and pathological radiographic structures

Radiographic Procedures

• The student will collect the patient’s requisition sheet and record from the radiology desk and invite the patient into the radiology operatory.
• The patient will be comfortably seated and the lead apron and collar placed.
• The students must follow infection control procedures wearing gloves and a mask.
• On completing the survey, the student will raise the tube away from the patient and dismiss the patient.
• With clean gloves on, the student remove the protective barrier then proceed to the darkroom to process the films.
• When the films are mounted, the record should be returned to the oral diagnosis desk or to the student dentist requesting the films who will inform the patient of the radiographic findings.

Processing

The darkroom, Room 102, is across the hall from the Division of Radiology. The revolving light-tight door allows one to enter to process films.

The hours for processing are:

• Monday-Thursday 9 a.m.-5 p.m.
• Friday 9 a.m.-4:30 p.m.

1. Before processing, the dental student will confirm that only the safety lights are on and the door of the darkroom is locked from the inside.
2. Films are processed in the automatic processor, each being fed in one at a time and four across in sequence.
3. Remove the lead foil and place in the proper recycling receptacles. Discard the outer wrapper.
4. Mount the films. Any undiagnosable films, which the radiology and OD faculty indicates, should be retaken. No retakes will be exposed without corrective assistance and authorization from the faculty.

Duplicating

Films, which need to be duplicated, should be given to the following people or departments:

• MassHealth: Mr. Larry Dix
• Insurance: Sherri Myra
• Postdoctoral: second-floor desk
• Patients: Finance Office

These requests will be brought to the Division of Radiology. Radiology personnel will have the duplicates processed within one to two days. Film will be provided for duplicating radiographs for the Finance Office and for predoctorate student needs. Duplicate film for postdoctoral needs is supplied by the respective departments.

Procedures for Taking Radiographs in the Division of Oral Diagnosis/Radiology

Radiographs are exposed according to the protocol found in the Radiation Manual

• Student must present patients to radiology with reviewed medical history, signed radiographic permission form, and receipt.
• All efforts will be taken to seat the patient as soon as possible. If there is a wait, the patient should wait in the reception room.
• If the students on rotation are busy, the student dentist treating the patient should be ready to take the films themselves.
• Do not take radiographs in unauthorized radiology units.
• No retakes are to be exposed without corrective assistance and authorization from the faculty.

Please be advised that the main goal of the radiology faculty is to maintain high quality and to insure the patient’s safety and instruct the student. The radiology staff is available for education and assistance.

Special Procedures

• Special radiography will be arranged for, and performed by, the radiology faculty.
• The student may take emergency films after consultation with and arrangement by, the radiology faculty.
• Pediatric dental radiography is handled by special arrangement with the Department of Pediatric Dentistry.

Use of Radiographic Equipment

The same oral diagnosis/radiology protocol applies (i.e., check medical history, use of lead apron, use correct settings of radiology equipment, radiographic permission, entry in the patient's chart, etc.) for all clinical areas.

First Floor

• Room 101 can be used under the direction of radiology staff.
• Radiology Room 7 in Room 102 is for panoramic and cephalometric films.
• Radiology Rooms 9 and 10 in Room 114 is limited to the predoctoral endodontic department

Second Floor

• The X-ray equipment in the postdoctoral endodontic department is used only for endodontics patients.
• The X-ray equipment in the implant department is used only for implant patients.
• The X-ray equipment in the periodontal department is used only for periodontal and recall patients.

Fourth Floor

• The X-ray equipment in the Department of Oral and Maxillofacial Surgery is used only for oral surgery patients.

Fifth/Sixth Floor

• The X-ray unit in the predoctoral clinic is used only for updating radiographs and single films for diagnostic purposes.

Seventh Floor

• The X-ray equipment in AEGD is for AEGD patients only.
• The X-ray equipment in the hygiene clinic is used only for hygiene patients.

Oral Diagnosis Clinic

Screening and Preliminary Diagnosis

Oral Diagnosis Rotation Manual

Screening and Diagnosis

• Fourth-year DMD student or second-year Advanced Standing student

Supervisory Personnel

• Chairperson, Department of Diagnostic Sciences and Patient Services
• Faculty

Rotation

• Screening rotations take place Monday - Friday, 9 a.m. to 4:30 p.m.;
• Rotation lists may be obtained from the department chairpersons involved in the screening process or Clinic Coordinator of Oral Diagnosis.

Objectives of Preliminary Screening

• Identification of chief complaint.
• Identification of referral source.
• Selection and acquisition of suitable patients for treatment in both predoctoral and postdoctoral areas of the School
• Involvement of student doctors in a process of rapid preliminary patient assessment, a function they will be called upon to do daily during their professional lives.
• Preliminary classification of patients according to given guidelines so that patient assignment to student doctors may be effectively accomplished.
• Assessment of suitability of patients for a teaching institution.
• Instructions to patients on the general modus operandi of our institution; i.e., an approximate length of time involved in therapy, continual instructor review of treatment, quality control.

Guidelines for Preliminary Screening of Patients in Oral Diagnosis/Radiology

• All patients presenting to the Division of Oral Diagnosis and Radiology undergo a preliminary screening.
• The patient is seated in the preliminary screening room.
• The preliminary screening is performed by a fourth-year predoctoral student under the supervision of a supervising faculty dentist.
• Preliminary screening consists of identifying the chief complaint, evaluating the medical and dental histories, taking the blood pressure, performing a preliminary examination of hard and soft tissues, and evaluating the suitability of the patient for treatment at the school. This data is placed in the permanent patient record on the treatment record.
• If the patient presents with significant medical problems, all alerts are properly ordered and recorded in the patient record folder.
• Signature of instructor.
• Always adhere to infection control protocol outlined in the Infection Control Manual.

Patient Types

The typing of patients is somewhat flexible because patient needs and financial situations change.

• Type I. Simple restorative and preventive needs; patients with minor periodontal needs (prophylaxis); simple oral surgery (third molar extractions) Routine direct restorations (amalgams and composite resins).
• Type II. Patients with more involved restorative needs (1-5 single units of crowns, inlays or onlays with no significant periodontal involvement); complex esthetic cases (veneers); "simple" partial dentures; Simple to moderately involved perio cases (isolated procedures and routine initial preparation); some complete dentures; root canals; relatively routine restorative cases.
• Type III. Patients with moderate to advanced periodontal problems; any fixed bridgework or more than 5 single units of casting; complex partial dentures that are dependent on a perio prognosis; a single complete denture that opposes a complex arch; complicated restorative case.
• Type IV. Complicated cases referred to the postdoctoral programs.

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