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Periodontal Treatment Center

 Course Director

  • A. Stephen Polins, DDS, Periodontal Division, G-618, Department of General Dentistry, 617/638-4768. aspolins@bu.edu

Faculty

  • Dr. Fadi Farah
  • Dr. Neal Fleisher
  • Sergio Guzman
  • Dr. Sheldon Itzkowitz
  • Dr. Amir Mahoozi
  • Dr. Jacob Pourati
  • Dr. Zori Rabinovitz

Location

  • Predoctoral Dental Treatment Centers (fifth and sixth floors)


Clinic Hours

  • Designated periods of faculty coverage


Course Format and Goals

It is the goal of the Periodontal Division of the Department of General Dentistry to prepare predoctoral students for the practice of periodontics within the context of the practice of general dentistry. The course of study is designed to provide the didactic and clinical experiences to satisfy the following departmental clinical and behavioral competencies and associated subcompetencies:

1. Graduates must be competent in patient education and the prevention of oral diseases.

2. Graduates must be competent in the management of periodontal disorders throughout the lifecycle.

Utilizing knowledge, skill and attitudes gained from lectures, preclinical and clinical participation, students are expected to become competent to perform comprehensive dental and periodontal examinations and use clinical findings to arrive at an appropriate diagnosis that integrates within a comprehensive sequenced treatment plan. Upon graduation, students are expected to be competent in scaling, root planing and prophylaxis, instruction and motivation of patients in oral hygiene care and the correct evaluation of the tissue response to scaling, root planing and other adjunctive forms of initial therapy. Students will be competent to reevaluate the planned treatment in light of noted tissue changes and further dental and periodontal needs, identify further periodontal and/or periodontal-restorative treatment needs, determine whether to treat or refer for treatment and determine the appropriate recall and maintenance schedule for patients, based on initial diagnosis and response to initial treatment. Students will also be participate by assisting in a variety of periodontal surgical procedures, and may become experienced in certain periodontal surgical procedures through direct participation with clinical faculty.


Texts

  • Fundamentals of Periodontics, Wilson and Kornman, Second Edition, Required
  • Periodontal Instrumentation; Clinic Manual, Pattison & Pattison, Required


Attendance

Attendance is required in all assigned clinical sessions. Absences from assigned sessions will be excused only with documented medical excuses, documented personal emergencies or approved requests submitted in writing one week prior to the scheduled clinical sessions. In addition, any absence must be recorded with the Office of the Associate Dean for Academic Affairs or the Office of the Associate Dean for Clinical Services.


Entry Level Skills or Prerequisites

Successful completion of all second year didactic and preclinical courses are prerequisite to beginning the clinical portion of the course. The clinical portion of the course begins in the second semester of the second year, when students have patients assigned for comprehensive dental care.


Clinic Rules and Regulations

Clinic time on the fifth and sixth floor treatment centers will be coincide with all designated periods of faculty coverage.

Students are expected to familiarize themselves with all rules and regulations regarding clinical activity within the Clinic Manual, including policies regarding patient assignment, treatment planning, delivery of comprehensive care and principles of infection control. Students are expected to adhere to these principles while in the clinic. Students will have received instruction and preparation in all clinical procedures during preclinical course work and should follow this in the clinical phase of their training.

The clinic director, with the aid of the group practice deaders, will assign students patients in need of dental treatment administered within a comprehensive, sequenced treatment plan. The student is expected to achieve periodontal competency within the context of a sequenced treatment plan that represents comprehensive patient care, so that completion of all other needed dental care is assured.


Instructional Objectives

  • Report the embryologic, histologic and histopathologic aspects of the gingiva and periodontium in health and disease.
  • Evaluate the biological factors which are integral to the diagnosis, treatment planning and prognosis of a case.
  • Identify the objectives of periodontal therapy.
  • Compare and contrast the rationale as well as the limitations and objectives of all aspects of initial preparation, periodontal surgical procedures and establishment of appropriate recall and maintenance schedules .
  • Compare and contrast the surgical options available for treatment of the various stages and forms of periodontal disease.
  • Evaluate the interrelationships between periodontics and other branches of dentistry in the treatment of periodontal disease.
  • Conceptualize the indications and contraindications for periodontal surgery.
  • Compare and contrast the indications for and the techniques employed in curettage and root-planing, gingivoplasty, gingivectomy and mucogingival and periodontal plastic surgery.
  • Conceptualize the indications for, and the techniques employed, in osseous reduction and osseous addition procedures, and guided tissue regeneration.
  • Evaluate the treatment of molar furcation problems.
  • Qualify the rationale for strategic extraction's and exploratory surgery.
  • Coordinate the treatment of acute periodontal lesions and lesions which are of combined periodontal-endodontic origin.
  • Conceptualize the inter-relationships between restorative dentistry and periodontal surgery.
  • Create a mechanism of evaluating and establishing an appropriate recall and maintenance schedule for patients.
  • Compare and contrast the various systemic disease factors which can influence and manifest in the gingival and periodontal structures.
  • Evaluate the effects of trauma on the periodontium and the mechanisms of diagnosis, and, select from the treatment modalities used to stabilize an affected dentition.


Clinic Phase (years 2, 3, and 4)

The Periodontal Division of the Department of General Dentistry will utilize daily formative feedback reports, recorded within the “Clinic Journal,” to assess the students' development of competency in diagnostic skills, and to further assess the student's competency to implement, perform and evaluate appropriate periodontal therapy within the concept of a comprehensive dental treatment plan developed and delivered by a general dentist. The following eight goals include clinical procedures that represent activities determined to fulfill the Clinical and Behavioral Competencies required to achieve departmental approval for promotion and graduation.

Goal I

A. Goal I of this phase involves the history, clinical examination, diagnosis, and treatment planning and comprises the following objectives for each task:

History

1. Student should be able to discuss the patient's medical history and will identify to the instructor those facts which are relevant to dental treatment.

2. The student should be able to discuss the patient's dental history and will identify to the instructor those facts which are relevant to dental treatment.

Clinical Examination

3. Student will identify areas of gingival health.

4. Student will identify the presence and degree of gingivitis.

5. Student will describe the degree of gingivitis.

6. Student will accurately describe the color, form and consistency of the gingiva.

7. Student will probe accurately.

8. Student will identify the pockets to the instructor.

9. Student will differentiate between pseudopockets and true pockets.

10. Student will identify areas of recession and can establish its etiology.

11. Student will identify and state the etiology of mobility patterns present.

12. Student will identify the degree and location of furcation involvement (i.e.: Class I, II or II furcation).

13. Student will identify areas of insufficient zones of attached gingiva and can establish its etiology.

14. Student will identify the presence and degree of marginal periodontitis.

15. Student can identify local etiologic factors i.e.: improper brushing techniques, habits, calculus, missing teeth, poor alignment, open contacts, etc.).

16. Student will identify wear facets.

17. Student will identify any signs of TMJ dysfunction.

Radiographic Interpretation

18. The student will identify emergency conditions (i.e.: severe caries, periapical radiolucencies, etc.).

19. The student will identify presence or absence of crestal and lateral lamina dura.

20. The student will identify abnormal PDL widths.

21. The student will identify the degree of bone loss and pattern of bone loss (i.e.: horizontal or vertical).

22. The student will identify root proximity problems.

23. The student will identify crown/root ratios.

24. The student will record unacceptable restorations.

Occlusal Analysis

25. Student will verbalize the rationale for undertaking an occlusal analysis.

26. Student will identify the inter- and intra-arch relationships (i.e.: Angle classification, crossbites, rotations, tipping, etc.) when indicated.

27. Student will accurately and consistently determine centric relation when indicated.

28. Student will guide the patient into lateral and protrusive excursions when indicated.

29. Student will identify interference's in centric relation and all excursions when indicated.

30. Student will identify the need for fabricating an acceptable occlusal appliance

Diagnosis

With all the above information, students will be expected to become competent in diagnosing the degree and location of periodontal diseases present (i.e. acute or chronic, localized or generalized, slight, moderate or severe gingivitis and/or periodontitis with primary or secondary occlusal trauma, etc.).

Treatment Plan

Third-year students will be expected to achieve competency in sequencing the ideal Phase I therapies indicated, including alternative treatment plans. They should also be able to identify areas where Phase II therapies are indicated. Fourth years will be expected to state sequentially an ideal Phase I and Phase II treatment plan with alternative treatment plans and develop recall and maintenance schedules appropriate to the case diagnosis.

Oral Hygiene Instruction

Prior to scaling and root planing the student is expected to:

31. Explain the origin, composition and significance of plaque, in lay terms, and its removal to the patient.

32. Demonstrate the proper use of the tooth brush and floss.

33. Identify areas where additional aids would be helpful (floss threader, proxabrush, stimudent, etc.)

34. Demonstrate to the patient the use of these aids.

35. Identify to the patient through the use of disclosing aids where plaque still exists.

36. Record the amount of plaque for each patient using the plaque score sheets.

Goal II

B. Goal II of this phase involves scaling, root planing (when indicated) and prophylaxis and comprises the following objectives for each treatment session:

1. The student will remove all calculus employing the proper instruments and working strokes.

2. The student will plane and smooth roots where indicated employing the proper instruments and working strokes.

3. The student will perform scaling and root planing with no tissue damage.

4. The student will remove all stain and plaque.

5. The student will recontour all rough or overhung restorations which are not to be replaced.

6. Students will take a plaque score of quadrants previously scaled at each subsequent visit for scaling and root planing and will modify the patient's hygiene technique accordingly.

Goal III

C. Goal III: Reevaluation. One to six weeks after the last visit for scaling and root planing, student will be expected to:

1. Record the plaque score and have the patient demonstrate the oral hygiene techniques that have been taught during treatment.

2. Describe soft tissue changes that have or have not occurred.

3. Describe residual soft and hard tissue problems (i.e., residual pockets, osseous craters, mucogingival problems, mobility, etc.)

4. Re-probe the patient’s dentition and establish areas in need of further Phase I or Phase II therapy.

5. Evaluate whether the patient requires further periodontal therapy and whether the patient requires referral to a specialist.

6. Describe an ideal treatment plan for the problems described above.

7. Identify any limitations to an ideal treatment plan and propose a working treatment plan.

8. Project a prognosis for the case in light of the proposed treatment plan.

Goal IV

D. Goal IV involves experience in occlusal adjustment by selective grinding and/or insertion of occlusal appliances, for those students who have assisted designated clinical faculty on two occlusal adjustments, with the following objectives:

1. Student will describe the accepted rationale for occlusal adjustment by selective grinding.

2. The student will descrbe the accepted indications for selective grinding.

3. The student will adjust the patient's occlusion so that there are not IC-RC discrepancies.

4. Student will adjust the occlusion so that there are not interference's in excursive movements.

5. Student will fabricate, adjust and insert appropriate occlusal appliances when indicated.

Goal V

E. Goal V is surgical assistance of Phase II therapy with the following objectives:

1. Student must describe the accepted rationale for the surgical procedure being performed.

2. The student must describe the surgical technique(s) employed.

3. The student will care for and properly maintain the surgical kit.

4. The student will participate in the post-operative care of the patient (suture removal, pack changes, homecare, etc.).

Goal VI

F. Goal VI involves the surgical phase of therapy (for students who have assisted on six surgical procedures at least one of which should be similar to the one he/she wishes to participate in), with the following objectives:

1. The student must familiarize himself with the surgical technique(s) indicated, either through lectures, texts or previous discussions with the instructor.

2. The student must be able to verbalize the accepted rationale for the procedure.

3. The student must describe the selected surgical technique and also be able to outline the intended procedure on the patient's study models.

4. The student will care for and properly maintain the surgical kit.

5. The student must participate manually in each phase of the procedure. Participation includes, any of the following components when indicated, pain control, soft tissue preparation, bed and donor preparation, removal of granulomatous tissue, osseous recontouring, suturing and placement of dressing.

6. Student will be responsible for communicating with the patient, scheduling and directing post-operative care of the procedure (suture removal, dressing changes post-operative instructions, prescribe medication when indicated, etc.).

Goal VII

G. Goal VII involves post-surgical management, with the following objectives:

1. Student will be responsible for directing the post-operative care of the assigned procedure (suture removal, dressing changes, post-surgical complications).

2. The student must accurately evaluate the healing process.

3. The students must accurately assess the results of the surgical procedures.

Goal VIII

H. Goal VIII involves the periodic recall and maintenance visits the patient has scheduled when active periodontal treatment is completed. It is divided into two components:

1. Recall examination which includes all objectives of Goal III.

2. Scaling and prophylaxis which includes all objectives of Goal II.

Methods of Evaluation

Clinical Phase (Third and Fourth Years)

Students will use the “Clinic Journal” for each clinical session and feedback collected during all formative sessions will identify progress in the application of the knowledge, skills and attitude associated with each goal or goals represented. Periodically, the information recorded in the “Clinic Journal” will be processed by the Group Practice Leaders, and, each student will be advised of progress towards competency. Competency is expected to be achieved in all of the previously outlined goals before promotion and graduation will be recommended.

ACHIEVING COMPETENCY

Student evaluation is based on evaluating each students’ progress toward competency, as defined within the statements of Clinical and Behavioral Competencies and accepted by the School of Dental Medicine. This progress is recorded as the unique and individual knowledge, skills and attitude that the student demonstrates at each clinical appointment.The competency based learning and evaluation system increases the focus of student-patient-faculty interaction by not only focusing on the student's ability to complete clinical procedures in an independent, consistent and quality manner, but by further encouraging critical thinking, communication, self evaluation and quality assurance, by providing each student the opportunity to evaluate his/her performance during and after each appointment.

Entries in the “Clinic Journal” will describe each student's performance and the degree of faculty assistance and direction needed for the student to accomplish any intended procedure. The entries in the “Clinic Journal” will provide each student, clinical faculty and the Offices of Clinical Services and Academic Affairs with cumulative information regarding individual progress towards the achievement of competence in each division of the Department of General Dentistry. This feedback will also provide students and clinical faculty the opportunity to initiate appropriate corrective measures when needed, and encouragement to continue towards the achievement of clinical competency. Students will also be expected to maintain an up to date divisional “Periodontal Patient Progress Report” that will track each assigned patient through all aspects of periodontal treatment and record dates of service and patient status throughout the student's clinical years. The course director will periodically request the report, and will use the recorded information to determine student compliance in providing ongoing evidence to support promotion and graduation.

Promotion from third to fourth year will be recommended when each student demonstrates clinical progress towards achieving competency. Student progress towards the goal of consistent, independent, quality periodonl treatment within the context of a comprehensive treatment plan developed and administered by a general dentist will be evaluated. Clinical experiences gained during the third year will concentrate on the development of baseline learning experiences that will contribute to reaching competency in the fourth year. Third year progress will focus on the student's ability to demonstrate achievements for Goals 1, 2, 3 and 5 (Goals 4, 6, 7 and 8 as encountered) as described within this document and supported by the all of the listed Clinical and Behavioral Competencies.

The assessment of progress towards competency and promotion from year three to year four is based upon each student:

  • Presenting completed documentation(*) that all dentulous patients assigned have been diagnosed and treatment planned, following all published guidelines of the comprehensive care system, and demonstrates the knowledge, skills and attitude to accomplish this goal in a consistent, independent, quality manner.
    • *Completed documentation consists of patient records properly recorded and signed by faculty, entries in the “Clinic Journal” and the “Periodontal Patient Progress Report”, and, confirmation that all procedures have been paid for.
  • Presenting completed documentation that periodontal treatment plans for initial therapy for all dentulous patients have been followed in a properly sequenced and timely manner and demonstrates the knowledge, skills and attitude to accomplish this goal in a consistent, independent, quality manner.
  • Presenting completed documentation that all assigned dentulous patients who have completed initial therapy are reevaluated in a properly sequenced and timely manner, that all necessary entries are recorded in the patients' record and identifies the results of treatment, present treatment status and need for further treatment and/or referral and demonstrates the knowledge, skills and attitude to accomplish this goal in a consistent, independent, quality manner.
  • Presenting completed documentation that prior to participating in any planned surgical treatment modality for any assigned patient and demonstrates the knowledge, skills and attitude to assist in a range of surgical procedures in a consistent, independent, quality manner.
  • Presents documentation that any diagnosed and planned periodontal surgical therapy has been referred and/or completed in a properly sequenced and timely manner for all assigned patients and demonstrates the knowledge, skills and attitude to accomplish this goal in a consistent, independent, quality manner.
  • Completing all required Clinical Performance Examinations at or above the minimum acceptable grade of 75

It must be noted that all treatment is always provided under the direct supervision of clinical faculty. Independent treatment by students is always supervised.

Milestones

Milestones are provided as a guide for assessing individual progress towards clinical competency in periodontology. The numerical milestones cited are indicators of practice and learning opportunities that document movement towards consistent, independent, quality patient treatment. Milestones may vary from student to student since they are estimates of formative progress, including: learning progress, ability to self evaluate, patient management, time management and appropriate patient assignment. They are helpful references for student and faculty evaluation of patient assignment, timeliness of treatment and progress towards graduation. Students are encouraged to engage in as many clinical experiences as possible to provide formative progress and increased opportunities to achieve clinical competency.

Third year

 

Nov

Mar

Jul

Dx & TP'g

5

8

11

Prophylaxis

4

7

10

Quadrant Tx

0

4

7

Reevaluation

2

5

10

Recall

0

0

4

Sx Assists

0

2

5

Qualifiers and Clinical Performance Tests

Qualifiers are formative stage procedures that provide evidence of patterns of readiness for summative evaluation or grading. When completed, formative stage procedures may be considered as qualifiers when the combined judgment of the student, and two faculty members who are familiar with the student's performance agree.

Summative evaluations are graded performances that follow appropriate formative experiences and qualifying steps. When applied as a clinical performance test, the evaluation will be based upon independent student performance as determined by faculty observation. Clinical performance tests will be repeated to measure consistent performance over time, and will be administered by designated faculty.

Since clinical performance tests are expected to display independent knowledge, skill and behavior, patients will never be placed at risk. If faculty intervention is required during the exercise it will not qualify as a clinical performance test. Any unsuccessful performance will require that the clinical performance test be repeated. If more than one unsuccessful performance is recorded, remedial formative sessions will be required.

 

Qualifiers

Clinical Performance Tests

Dx & TP'g

6

2

Prophylaxis

7

3

Quadrant Tx

5

2

Reevaluation

6

3

Grades for the third year will be determined based on each individual's progress towards reaching competency in clinical periodontology. Grades will range from “A” through “F”, and will generally reflect the following levels of accomplishment:

“A” will indicate that the student has exhibited outstanding levels of the knowledge, skills and attitude necessary to consistently perform periodontal procedures integrated into a comprehensive dental treatment plan that require critical thinking, communication, self evaluation and quality assurance. This level of achievement will be determined when the student performs at or above 90% on all required Clinical Performance Examinations and has provided proper documentation that at least 90% of all assigned patients have completed Goal 1, Goal 2 and Goal 3, in a timely manner within a comprehensive sequenced treatment plan recorded and supervised by clinical faculty.

“B” will indicate that the student has exhibited superior levels of the knowledge, skills and attitude necessary to consistently perform periodontal procedures integrated into a comprehensive dental treatment plan that require critical thinking, communication, self evaluation and quality assurance. This level of achievement will be determined when the student performs at or above 80% on all required Clinical Performance Examinations and has provided proper documentation that at least 80% of all assigned patients have completed Goal 1, Goal 2 and Goal 3, in a timely manner within a comprehensive sequenced treatment plan recorded and supervised by Clinical faculty.

“C” will indicate that the student has exhibited the average levels of the knowledge, skills and attitude necessary to consistently perform periodontal procedures integrated into a comprehensive dental treatment plan that require critical thinking, communication, self evaluation and quality performance. This level of achievement will be determined when the student performs at or above 75% on all required Clinical Performance Examinations and has provided proper documentation that at least 70% of all assigned patients have completed Goal 1, Goal 2 and Goal 3, in a timely manner within a comprehensive sequenced treatment plan recorded and supervised by Clinical faculty.

“D” will indicate that the student has exhibited minimal levels of the knowledge, skills and attitude necessary to consistently perform periodontal procedures integrated into a comprehensive dental treatment plan that require critical thinking, communication, self evaluation and quality assurance. This level of achievement will be determined when the student performs below 75% on all required Clinical Performance Examinations and has provided proper documentation that 60% or less of all assigned patients have completed Goal 1, Goal 2 and Goal 3, in a timely manner within a comprehensive sequenced treatment plan recorded and supervised by Clinical faculty.

“F” will indicate that the student has consistently exhibited inadequate levels of the knowledge, skills and attitude necessary to perform periodontal procedures integrated into a comprehensive dental treatment plan that require critical thinking, communication, self evaluation and quality assurance. This level of achievement will be determined when the student performs below 60% on all required Clinical Performance Examinations and has provided proper documentation that 50% or less of all assigned patients have completed Goal 1, Goal 2 and Goal 3, in a timely manner within a comprehensive sequenced treatment plan recorded and supervised by Clinical faculty.

Graduation

Graduation for fourth year students will be recommended when each student demonstrates his/her ability to consistently display the knowledge, skills and attitudes required by the new graduate to begin independent, unsupervised general dental practice and consistently provide patients with quality care. Graduation will be recommended after continued demonstration of achievement in Goals 1, 2, 3 and Goal 8 for all comprehensive care patients. In addition, demonstration of achievement in Goals 4, 5, 6 and 7 as previously outlined in this document and supported by the Clinical and Behavioral Competencies listed below is expected for each student

Graduation for Advanced Standing II students will be the same as those for fourth year students. Graduation will be recommended when each student demonstrates his/her ability to consistently display the knowledge, skills and attitudes required by the new graduate to begin an independent, unsupervised general dental practice and will include achievement in Goals 1, 2, 3 and Goal 8 for all comprehensive care patients. In addition, demonstration of achievement in Goals 4, 5, 6 and 7 as previously outlined in this document and supported by the listed Clinical and Behavioral Competencies is expected from each student.

Graduation will be recommended when a student:

  • Presents completed documentation that all diagnosed and treatment planed initial periodontal therapy has been completed in a properly sequenced and timely manner, that appropriate recall and maintenance schedules have been established and recorded for all patients and demonstrates the knowledge, skills and attitude to accomplish this goal in a consistent, independent, quality manner.
  • Presents completed documentation that periodic reevaluation and recall and maintenance visits have been completed in a properly sequenced and timely manner for all assigned comprehensive care patients and demonstrates the knowledge, skills and attitude to accomplish this goal in a consistent, independent, quality manner.
  • Presents completed documentation that prior to participating in any planned surgical treatment modality for any assigned patient and demonstrates the knowledge, skills and attitude to assist in a range of surgical procedures in a consistent, independent, quality manner.
  • Presents documentation that any diagnosed and planned periodontal surgical therapy has been referred and/or completed in a properly sequenced and timely manner for all assigned patients and demonstrates the knowledge, skills and attitude to accomplish this goal in a consistent, independent, quality manner.
  • Completes all required Clinical Performance Examinations at or above the minimum acceptable grade of 75

It must be noted that all treatment administered is always under the direct supervision of clinical faculty. Independent treatment by students is always supervised.

Milestones

Milestones are provided as a guide for assessing individual progress towards clinical competency in periodontology. The numerical milestones cited are indicators of practice and learning opportunities that document movement towards consistent, independent, quality patient treatment. Milestones may vary from student to student since they are estimates of formative progress, including: learning progress, ability to self evaluate, patient management, time management and appropriate patient assignment. They are helpful references for student and faculty evaluation of patient assignment, timeliness of treatment and progress towards graduation. Students are encouraged to engage in as many clinical experiences as possible to provide formative progress and increased opportunities to achieve clinical competency.

Fourth Year

 

Dec

May

DX & TP'g

13

15

Prophylaxis

12

14

Quadrant Tx

9

12

Reevaluation

12

14

Recall

7

12

Sx Assists

7

9

Mock Board

0

1

Qualifiers and Clinical Performance Tests

Qualifiers are formative stage procedures that provide evidence of patterns of readiness for summative evaluation or grading. When completed, formative stage procedures may be considered as qualifiers when the combined judgment of the student, and two faculty members who are familiar with the student's performance agree.

Summative evaluations are graded performances that follow appropriate formative experiences and qualifying steps. When applied as a clinical performance test, the evaluation will be based upon independent student performance as determined by faculty observation. Clinical performance tests will be repeated to measure consistent performance over time, and will be administered by designated faculty.

Since clinical performance tests are expected to display independent knowledge, skill and behavior, patients will never be placed at risk. If faculty intervention is required during the exercise it will not qualify as a clinical performance test. Any unsuccessful performance will require that the clinical performance test be repeated. If more than one unsuccessful performance is recorded, remedial formative sessions will be required.

 

Qualifiers

Clinical Performance Tests

TX & TP'g

10

1

Prophylaxis

11

2

Quadrant Tx

8

4

Reevaluation

10

2

Recall

7

3

Mock Board

0

1

Grades for fourth year and ASII students will be based on each individuals’ progress towards reaching competency in clinical periodontology. Grades will range from “A” through “F” and will generally reflect the following levels of accomplishment.:

“A” will indicate that the student has exhibited outstanding levels of the knowledge, skills, attitude, critical thinking, communication and self evaluation required to begin the independent, unsupervised quality oriented practice of general dentistry. This level of achievement will be determined when the student performs at or above 90% on all required Clinical Performance Examinations and has provided proper documentation that at least 90% of all assigned patients have completed Goal 1, Goal 2, Goal 3 and Goal 8, in a timely manner within a comprehensive sequenced treatment plan recorded and supervised by Clinical faculty.

“B” will indicate that the student has exhibited superior levels of the knowledge, skills, attitude, critical thinking, communication and self evaluation required to begin the independent, unsupervised quality oriented practice of general dentistry. This level of achievement will be determined when the student performs at or above 80% on all required Clinical Performance Examinations and has provided proper documentation that at least 80% of all assigned patients have completed Goal 1, Goal 2, Goal 3 and Goal 8, in a timely manner within a comprehensive sequenced treatment plan recorded and supervised by Clinical faculty.

“C” will indicate that the student has exhibited average levels of the knowledge, skills, attitude, critical thinking, communication and self evaluation required to begin the independent, unsupervised practice of general dentistry. This level of achievement will be determined when the student performs at or above 75% on all required Clinical Performance Examinations and has provided proper documentation that at least 70% of all assigned patients have completed Goal 1, Goal 2, Goal 3 and Goal 8, in a timely manner within a comprehensive sequenced treatment plan recorded and supervised by Clinical faculty.

“D” will indicate that the student has exhibited minimal levels of the knowledge, skills, attitude, critical thinking, communication and self evaluation required to begin the independent, unsupervised practice of general dentistry. This level of achievement will be determined when the student performs below 75% on all required Clinical Performance Examinations and has provided proper documentation that 60% or less of all assigned patients have completed Goal 1, Goal 2, Goal 3 and Goal 8, in a timely manner within a comprehensive sequenced treatment plan recorded and supervised by Clinical faculty.

“F” will indicate that the student has consistently exhibited inadequate levels of the knowledge, skills and attitude required to begin the independent, unsupervised practice of general dentistry. This level of achievement will be determined when the student performs below 60% on all required Clinical Performance Examinations and has provided proper documentation that 50% or less of all assigned patients have completed Goal 1, Goal 2, Goal 3 and Goal 8, in a timely manner within a comprehensive sequenced treatment plan recorded and supervised by clinical faculty.


Remedial Criteria

Students are advised by faculty of clinical progress through the process of daily formative feedback at each clinical exercise. Since dialogue is an essential component to developing competency, the opportunity for interactive learning is integral to each clinic session. If clinical performance is not progressing towards competency as determined daily formative reports and or acceptable completion of Clinical Performance Examinations, the course director will direct the student to focus on areas that need remediation during future clinical and/or preclinical exercises. Further, remedial help will be available at any time during the course.

The following delineation of specific competencies related to clinical periodontology are provide as a reference for students daily self assessment towards overall achievement of departmental competency.


Clinical and Behavioral Competencies

III. Graduates must be competent in patient education and the prevention of oral diseases.

A. Educate patients concerning the etiology and control of oral diseases, oral habits and conditions.

Knowledge

  • Recognize gross, histologic and histopathologic morphology of normal, healthy teeth, and supporting tissues
  • Recognize oral health and etiology of patients oral disease
  • Recognize etiology and extent of oral habits and conditions
  • Identify and understand the role of contributing etiologies for a patient's periodontal problems and relate them to primary, predisposing, modifying and perpetuating
  • Understand proper motivational technique for educating patients
  • Recognize pharmacologic agents which impact on an individuals oral health status
  • Recognize agents used to identify etiologic factors

Skill

  • Explain to patient the etiology and prevention of oral disease
  • Motivate and encourage patient to assume appropriate responsibility for their oral health
  • Provide patient with a strategy to control adverse oral habits
  • Identify and understand role of contributing etiology including effects of various pharmacologic agents
  • Properly record plaque index, bleeding index, loss of attachment, mobility, recession, furcation problems
  • Demonstrate the proper use of the toothbrush, floss and any additional aid helpful to the patient's individual periodontal condition
  • Demonstrate the use of disclosing agents to identify areas of plaque accumulation
  • Provide each patient with a customized plaque control program appropriate for the patients diagnosed state

Attitude

  • Responsibility for patient health in relation to complete and thorough evaluations.
  • Responsibility to make patient's compliant to supportive procedures
  • Recognition of limitations of knowledge and skill
  • Provide an accurate self assessment focusing on performance and learning

B. Provide health education designed to motivate patients to assume appropriate responsibility for their oral health.

Knowledge

  • Describe the pathogenesis of periodontal diseases
  • Recognize the need for appropriate levels of plaques control
  • Understand the proper techniques employed for daily home care
  • Identify and understand the role of contributing etiologies for a patient's periodontal problems and relate them to primary, predisposing, modifying and perpetuating
  • Understand proper motivational technique for educating patients
  • Relate knowledge of dental implant and peri-implant health vs. breakdown

Skill

  • Review and update medical and dental history
  • Compare results of clinical examination with previous findings
  • Perform and record extra oral examination
  • Perform and record dental examination
  • Perform and record periodontal examination
  • Perform and record dental implant and peri implant examination
  • Take and interpret radiographs as indicated
  • Inform patient of current status and alternatives in treatment if needed
  • Explain to patient the etiology and prevention of oral disease
  • Motivate and encourage patient to assume appropriate responsibility for their oral health
  • Provide patient with a strategy to control adverse oral habits
  • Motivational technique to encourage compliance
  • Identify and understand role of contributing etiology including effects of various pharmacologic agents
  • Properly record plaque index, bleeding index, loss of attachment, mobility, recession, furcation problems
  • Demonstrate the proper use of the toothbrush, floss and any additional aid helpful to the patient's individual periodontal condition
  • Demonstrate the use of disclosing agents to identify areas of plaque accumulation
  • Provide each patient with a customized plaque control program appropriate for the patients diagnosed state

Attitude

  • Responsibility for patient health in relation to complete and thorough evaluations.
  • Responsibility to make patient's compliant to supportive procedures
  • Recognition of limitations of knowledge and skill
  • Provide an accurate self assessment focusing on performance and learning

C. Develop individualized preventative plans for patients.

Knowledge

  • Describe the pathogenesis of periodontal diseases
  • Recognize the need for appropriate levels of plaque control
  • Understand the proper techniques employed for daily home care
  • Recognize new disease activity
  • Recognize medical conditions with oral implications
  • Recognize pharmacological agents with implications for oral health care
  • Recognize medical conditions with general health implications for oral health care
  • History of particular of periodontal disease and its potential for recurrence
  • Proper selection and use of armamentarium for scaling and prophy
  • Knowledge of adjunctive antimicrobial agents ie application and effect
  • Knowledge of proper customized interval for maintenance therapy
  • Knowledge of updating radiographs based on ADA and FDA protocols
  • Knowledge of dental implant and peri implant health vs. breakdown
  • Deviation from health for all oral tissues
  • Understand radiographic interpretation of periodontal and dental disease

Skill

  • Develop diagnosis
  • Motivational technique to encourage compliance
  • Review and update medical and dental history
  • Compare results of clinical examination with previous findings
  • Perform and record extra oral examination
  • Perform and record dental examination
  • Perform and record periodontal examination
  • Perform and record dental implant and peri implant examination
  • Take and interpret radiographs as indicated
  • Inform patient of current status and alternatives in treatment if needed
  • Consult with other health care practitioners as needed
  • Perform appropriate scaling/root planing/prophylaxis as indicated
  • Develop and utilize an accurate computer based patient reminder system
  • Oral cancer screening

Attitude

  • Minimize the recurrence and progression of periodontal diseases in patients who have been previously treated for gingivitis and periodontitis
  • Reduce the incidence of tooth loss by monitoring the dentition and any prosthetic replacements of the natural teeth
  • Increase the probability of locating and treating in a timely manner, other diseases or conditions found within the oral cavity
  • Provide an accurate self assessment focusing on performance and learning

D. Provide child, adolescent, and adult prophylaxis.

Knowledge

  • Implications of patient's systemic and oral health on procedures planned.
  • Implications and indications for the type and use of dental anesthetic.
  • Biologic implications for the use of dental instrumentation.
  • Rationale for the indicated procedure/s
  • Proper indication for and use of armamentarium (selection)
  • Properly maintain dental instruments
  • Differentiate & identify types of periodontal diseases
  • Knowledge of dental implant and peri-implant health vs. breakdown
  • Management of oral tissues.
  • Pain control management
  • Potential complications during and following procedures
  • Informed consent
  • Legal responsibilities for patient records
  • Understanding of the limitations of the procedure
  • Infection control
  • Oral hygiene instruction (see III)
  • How to identify plaque
  • Understand rationale and dosage of systemic and topical fluoride
  • Understand rationale for sealants in dental treatment

Skill

  • Interview and review with patient medical history, past dental history
  • Obtain appropriate anesthesia and control anxiety
  • Accurately probe and record around all teeth
  • Detect supragingival and subgingival calculus with an explorer and air syringe
  • Interpret radiographic findings relative to: calculus detection, periodontal disease and any other findings which may affect or limit treatment
  • Diagnose periodontal diseases
  • Properly instrument all tooth surfaces
  • Properly manage adjacent tissue
  • Properly remove staining
  • Properly use disclosing solution
  • Discuss with patient the significance of oral hygiene (see III)
  • Provide appropriate post treatment instructions to the patient
  • Prepare accurate and complete records of care provided
  • Proper chair/light position of patient and operator
  • Implement universal infection control procedures
  • Maintain adequate shape and sharpness of instruments
  • Proper technique for application of topical fluoride
  • Ability to write an appropriate dosage prescription for systemic fluoride

Attitudes

  • Responsibility for patient's health in relation to complete and thorough evaluation of procedure
  • Responsibility for patent's health in relation to not causing problems or exacerbate existing problems
  • Responsibility to make patient's compliant to supportive procedures
  • Recognition of limitations of knowledge and skills
  • Provide accurate self assessment focusing on performance and learning

E. Assess periodically and monitor compliance with the patients preventative plan, including the recording of appropriate indexes.

Knowledge

  • Describe the pathogenesis of periodontal diseases
  • Recognize the need for appropriate levels of plaques control
  • Understand the proper techniques employed for daily home are
  • Recognize new disease activity
  • Recognize medical conditions with oral implications
  • Recognize pharmacological agents with implications for oral health care
  • Recognize medical conditions with general health implications for oral health care
  • History of particular of periodontal disease and its potential for recurrence
  • Proper selection and use of armamentarium for scaling and prophylaxis
  • Knowledge of adjunctive antimicrobial agents – application, effect and limitations
  • Knowledge of proper customized interval for maintenance therapy
  • Knowledge of updating radiographs based on ADA and FDA protocols
  • Knowledge of dental implant and peri-implant health vs. breakdown
  • Deviation from health for all oral tissues
  • Understand the use of plaque index, bleeding index and any other measures for assessing attachment loss
  • Understand the rationale for microbial monitoring

Skill

  • Develop diagnosis
  • Motivational technique to encourage compliance
  • Review and update medical and dental history
  • Compare results of clinical examination with previous findings
  • Perform and record extra oral examination
  • Perform and record dental examination
  • Perform and record periodontal examination
  • Perform and record dental implant and peri implant examination
  • Take and interpret radiographs as indicated
  • Inform patient of current status and alteration in treatment if needed
  • Consult with other health care practitioners as needed
  • Perform appropriate scaling/root planing/prophylaxis as indicated
  • Develop and utilize an accurate computer based patient reminder system
  • Oral cancer screening
  • Take and interpret plaque index and bleeding index
  • Utilize and interpret microbial monitoring

Attitude

  • To minimize the recurrence and progression of periodontal disease in patients who have been previously treated for gingivitis and periodontitis
  • Reduce the incidence of tooth loss by monitoring the dentition and any prosthetic replacements of the natural teeth
  • To increase the probability of locating and treating in a timely manner, other diseases or conditions found within the oral cavity
  • Provide accurate self assessment focusing on performance and learning

F. Manage effectively the patient recall system.

Knowledge

  • Describe the rationale for frequency of maintenance therapy, based on specific needs of individual patient.
  • Recognize motivational and behavioral techniques employed to gain patient compliance
  • Understand the various systems available for tracking a patient for timeliness of recall visit

Skill

  • Diagnosis and treatment plan a patient for proper interval of recall visits
  • Employ motivational and behavioral techniques to gain patient compliance with recall
  • Establish and maintain a monitoring system for patient compliance utilizing plaque scores, bleeding index, attachment loss, disease activity, mobility, recession tooth loss, etc

Attitude

  • To minimize the recurrence and progression of periodontal disease in patients who have been previously treated for gingivitis and periodontitis
  • Reduce the incidence of tooth loss by monitoring the dentition and any prosthetic replacements of the natural teeth
  • To increase the probability of locating and treating in a timely manner, other diseases or conditions found within the oral cavity
  • Responsibility to make patient compliant to supportive procedures
  • Provide accurate self assessment focusing on performance and learning

VI. Graduates must be competent in the management of periodontal disorders throughout the life cycle.

A. Diagnose the presence of periodontal disease and include appropriate intervention, including referral to a specialist when indicated in the patient’s comprehensive treatment plan.

Knowledge

  • Describe gross, histologic, and histopathologic morphology of normal, healthy teeth, and supporting tissues
  • Describe oral health and etiology of patients oral disease
  • Describe etiology and extent of oral habits and conditions
  • Identify and understand the role of contributing etiologies for a patient's periodontal problems and relate them to primary, predisposing, modifying and perpetuating
  • History of particular of periodontal disease and its potential for recurrence
  • Implications of patient's systemic and oral health on procedures planned.
  • Implications and indications for the type and use of dental anesthetic.
  • Biologic implications for the use of dental instrumentation.
  • Rationale for the indicated procedure
  • Differentiate between the various levels of periodontal health and disease
  • Understand the impact of patient compliance on long term periodontal health
  • Recognize systemic risk factors and its affect on therapeutic outcomes
  • Potential complications during and following procedures
  • Understand limitations of previous treatment and need for further treatment.
  • Refer patients with moderate to severe generalized periodontal disease activity
  • Refer patients for localized treatment related to moderate to severe periodontitis, or the need for crown lengthening
  • Refer patients for implant, endodontic, orthodontic or prosthodontic consultation and treatment when the standard of care required to treat the patient directs that a referral be made

Skill

  • Perform and record extra oral examination
  • Perform and record dental examination
  • Perform and record periodontal examination
  • Perform and record dental implant and peri implant examination
  • Take and interpret radiographs as indicated
  • Inform patient of current status and alteration in treatment if needed
  • Identify and understand role of contributing etiology including effects of various pharmacologic agents
  • Properly record plaque index, bleeding index, loss of attachment, mobility, recession, furcation problems
  • Diagnosis and treatment plan a patient
  • Consult with other health care practitioners as needed

Attitude

  • To minimize the recurrence and progression of periodontal disease in patients who have been previously treated for gingivitis and periodontitis
  • Reduce the incidence of tooth loss by monitoring the dentition and any prosthetic replacements of the natural teeth
  • To increase the probability of locating and treating in a timely manner, other diseases or conditions found within the oral cavity
  • Recognition of limitations of knowledge and skills
  • Provide accurate self assessment focusing on performance and learning

B. Perform a dental prophylaxis, scaling and root planing.

Knowledge

  • Implications of patient's systemic and oral health on procedures planned.
  • Implications and indications for the type and use of dental anesthetic.
  • Biologic implications for the use of dental instrumentation.
  • Rationale for the indicated procedure, ie, prophylaxis, scaling, root planing, curettage
  • Proper indication for and use of armamentarium (selection)
  • Properly maintain dental instruments
  • Differentiate & identify types of periodontal diseases
  • Management of oral tissues.
  • Pain control management
  • Potential complications during and following procedures
  • Informed consent
  • Legal responsibilities for patient records
  • Understanding of the limitations of the procedure selected
  • Infection control
  • Plaque identification and oral hygiene instruction (see III)
  • Knowledge of dental implant and peri-implant health vs. breakdown

Skill

  • Interview and review with patient medical history
  • Obtain appropriate anesthesia and control anxiety
  • Accurately probe around a tooth
  • Detect supragingival and subgingival calculus with an explorer and air syringe
  • Interpret radiographic findings relative to calculus detection, periodontal diseases, and other findings that may limit treatment
  • Diagnose periodontal diseases
  • Properly instrument all tooth/root surfaces, ie, prophylaxis, scaling, root planing, curettage
  • Proper choice of instruments and techniques for treatment of implants and peri-implant tissues
  • Manage adjacent tissue
  • Properly remove staining
  • Use of disclosing solution
  • Discuss with patient the significance of oral hygiene (see III)
  • Provide appropriate post treatment instructions to the patient
  • Prepare accurate and complete records of care provided
  • Proper chair/light position of patient and operator
  • Infection control
  • Maintain adequate shape and sharpness of instruments

Attitudes

  • Responsibility for patient's health in relation to complete and thorough evaluation of procedure
  • Responsibility for patent's health in relation to not causing problems or exacerbate existing problems
  • Responsibility to make patient's complaint to supportive procedures
  • Recognition of limitations of knowledge and skills
  • Provide accurate self assessment regarding performance and learning

C. Evaluate the results of periodontal treatment.

Knowledge

  • Differentiate among the various levels of periodontal health and disease
  • Understand the impact of patient compliance on long term periodontal health
  • Recognize systemic risk factors and its affect on therapeutic outcomes
  • Potential complications during and following procedures
  • Understand limitations of previous treatment and need for further treatment.

Skill

  • Utilize experience and scientific knowledge to assess oral health status
  • Utilize plaque index, and bleeding index to assess levels of gingival inflammation and home care of patient
  • Utilize periodontal probe to assess probing depths and levels of attachment gain/loss following treatment and relate to properly positioned and exposed radiographs
  • Identify degree of mobility and the amount of recession present on a tooth
  • Prepare accurate and complete records of care provided
  • Evaluate need for any additional therapy and utilize referral mechanism if indicated
  • Utilize proper infection control procedures

Attitude

  • Recognize limitation of knowledge and skill
  • Responsibility for patients health and well being in relation to causing new problems or exacerbating existing problems
  • Responsibility to provide oral health care of the highest quality possible under existing circumstances
  • Provide accurate self assessment focusing on performance and learning

D. Establish and monitor an appropriate maintenance program

Knowledge

  • Understand the pathogenesis of periodontal diseases
  • Recognize the need for appropriate levels of plaque control
  • Understand the proper techniques employed for daily home care
  • Recognize new disease activity
  • Recognize pharmacological agents with implications for oral health care
  • Recognize medical conditions with general health implications for oral health care
  • Understand history of particular form of periodontal disease and its potential for recurrence
  • Proper selection and use of armamentarium for scaling, root planing and prophylaxis
  • Knowledge of adjunctive antimicrobial agents – application and effect
  • Knowledge of proper biologically customized interval for maintenance therapy
  • Knowledge of updating radiographs based on ADA and FDA protocols
  • Knowledge of dental implant and peri implant health vs. breakdown
  • Recognize deviation from health for all oral tissues
  • Recognize legal responsibility for patient records and informed consent
  • Recognize limitations of procedures

Skill

  • Develop diagnosis
  • Motivational technique to encourage compliance
  • Review and update medical and dental history
  • Compare results of clinical examination with previous findings
  • Perform and record extra oral examination
  • Perform and record dental examination
  • Perform and record periodontal examination
  • Perform and record dental implant and peri implant examination
  • Take and interpret radiographs as indicated
  • Inform patient of current status and alteration in treatment if needed
  • Consult with other health care practitioners as needed
  • Perform appropriate scaling/root planing/prophylaxis as indicated
  • Develop and utilize an accurate computer based patient reminder system
  • Oral cancer screening

Attitude

  • To minimize the recurrence and progression of periodontal diseases in patients who have been previously treated for gingivitis and periodontitis
  • Reduce the incidence of tooth loss by monitoring the dentition and any prosthetic replacements of the natural teeth
  • To increase the probability of locating and treating in a timely manner, other diseases or conditions found within the oral cavity
  • Provide accurate self assessment focusing on performance and learning


Continuing Care Protocol

Continuing care during and after active therapy is an integral part of comprehensive dental treatment. The initial continuing care interval is established at the time of reevaluation after initial therapy. Subsequent continuing care intervals will be established as diagnosis dictates.

It is the student doctor's responsibility to be familiar with the patients medical history and any precautions that need to be taken. It is BUSDM‘s policy that patient medical histories be updated and reviewed by faculty annually or as often as necessary.

All “Sequenced Comprehensive Treatment Plans” must be reviewed, updated and signed by the appropriate faculty at least once a year. The appropriate consultation forms must be completed. For instance, if a patient seen for a continuing care/recall appointment has been absent from the school for more than one year, a “Periodontal Examination“ form instead of a “Continuing Care” form must be completed as part of the consultations.

Additional/alternative treatment plans can be added to the “Sequenced Comprehensive Treatment Plan” and must be signed by the appropriate faculty.

If a patient seen during continuing care rotation requires additional treatment, the patient may be assigned to the student seeing the patient for the continuing care appointment. This student will continue the patient care until time of graduation. If the “Sequenced Comprehensive Treatment Plan” is completed at this point, the patient will be reassigned to the continuing care service. If the “Sequenced Comprehensive Treatment Plan” is incomplete at this point, the patient will be reassigned to a junior student.

[Draft: 6-04]

 

 

 

 

 

 



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