جامعة الملك عبد العزيز | جدة | المملكة العربية السعودية
Preventive Dental Sciences Department
Pediatric Dentistry Division
(PDS 615, 511)
Clinical Evaluation Manual-Part 2
Student name: …………………………………
Computer #: ………………………………..
Preventive Dental Sciences Department
Pediatric Dentistry Division
Table of Contents
1. Competency Evaluation Rubrics
1. Rubric for Examination & Treatment Planning
2. Rubric for Oral hygiene Instruction
3. Rubric for Prophylaxis & Topical Fluoride Application
4. Rubric for Rubber Dam Isolation
5. Rubric for Local Anesthesia
6. Rubric for Fissure Sealant
7. Rubric for Preventive Resin Restorations
8. Rubric for Cavity Preparation and Restoration
9. Rubric for Stainless Steel Crown/Strip Crown/Class IV Permanent
10. Rubric for Formocresol Pulpotomy
11. Rubric for Extraction of Primary Teeth
12. Rubric for Diet Evaluation
13. Rubric for Space Analysis
14. Rubric for Space Maintainer I (Band’s Selection and Impression)
15. Rubric for Space Maintainer II (Appliance Fitting and Cementation)
2. Oral Hygiene instruction and Diet evaluation
1. Oral Hygiene Instruction (Students Copy)
2. Dietary Evaluation Form (R4)
3. Arabic Forms
1. First Visit Introduction
2. Oral Hygiene Introduction Parents
3. Post Extraction Instruction
4. Dietary Advice Forms
5. AAPD Guideline on Caries-risk Assessment and Management for Infants, Children, and Adolescents
1. Competency Evaluation Rubrics
Pediatric Dentistry Division
Rubric for Examination & Treatment Planning
|Steps and procedures |Instructor Evaluation |
| |0 |1 |2 |
| |Not Competent |Competent |Proficient |
|1. History and Personal Data |Mistake in one or more of |Complete only Critical |Complete all the steps including|
|- Patient's complete personal data recorded |the critical steps(*) |steps* |critical steps*, |
|- All questions on the medical history answered.* | | | |
|- All questions on the dental history answered. | | | |
|- Caries risk assessment * | | | |
|2. Examination: |Mistake in one or more of |Complete Critical steps*|Complete all the steps including|
|a. Extra oral/Intra Oral |the critical steps(*) |but misdiagnosed non |critical steps*, |
|Head and neck |misdiagnosed cavitated |cavitated carious | |
|Soft Tissue Evaluation: Gingiva, mucosa, etc. |caries |lesions. | |
|Oral hygiene | | | |
|b. Occlusion and Orthodontic Evaluation / Referral | | | |
|c. Dental Charting: | | | |
|Teeth present or absent* | | | |
|Existing restorations | | | |
|Presence of dental decay * | | | |
|Fractures and developmental anomalies | | | |
|3. Radiographic Diagnosis: |Missed more than 2 |Missed 1 or 2 proximal |Did not missed any proximal |
|1. Indicated radiographs were taken* |proximal caries in dentin |carious lesion in |caries in dentin in bite wing |
|2. Examine quality of bone, tooth structure and development |in bite wing radiograph |dentin in bite wing | |
|3. Identify proximal caries in bite wing * | | | |
|4. Treatment Planning |Mistake in one or more of |Complete all critical |Complete all critical steps (*) |
|Prevention of caries is emphasized in initial appointments.* |the critical steps(*) or |steps (*) but wrongly |and non critical and currently |
|QUADRANT dentistry is one of the main emphasis points. |wrongly planned |planned restoration for |planned all restorations |
|Accurate plan for restoration* |restoration for 4 teeth or|not more than 3 teeth | |
|Appliances will be left until after all operative has been completed in that |more | | |
|arch. | | | |
|The recall period of 3 to 6 months.* | | | |
|5.Behavior guidance: |Uses none |Uses 1 or 2 |Uses 3 or more |
|TSD, distraction, positive reinforcement, voice control | | | |
|6. Presenting the case to Parents (*) |Mistake in one or more of |Complete only critical |Complete all the steps including|
|- Disclosing sufficient informative using radiographs, photographs, study |the critical steps(*) |steps (*) |critical steps*, |
|casts.* | | | |
|- Suggest treatment for the problems with benefits and risks.* | | | |
|- Alternative treatment with benefits and risks* | | | |
|- Cost | | | |
|- How many visits and lengths | | | |
|- Preventive meaning and anticipating guidelines | | | |
|- Signed consent form* | | | |
|7. Time * |> 180 min |60– 180 min |< 60 min |
Pediatric Dentistry Division
Rubric for Oral Hygiene Instructions
|Steps and procedures |Instructor Evaluation |
| |0 |1 |2 |
| |Not Competent |Competent |Proficient |
|1. Use a model to demonstrate the brushing |Did not use Models |Used a study cast |Used the proper model |
|technique. * | | | |
|2. Technique description to child and parents |Mistake in one or more of the|Complete only critical steps |Complete all critical (*) |
|a. The student describes the technique of tooth brushing to the patient and |critical steps (*). |(*) but not all other steps. |and other steps. |
|parent adequately *. | | | |
|b. Following a systematic order (starting from buccal surface of the last | | | |
|right maxillary tooth across the arches and ending by the lingual surface | | | |
|of this tooth)* | | | |
|c. Supply a toothbrush and allow the child to do tooth brushing. | | | |
|d. Ask the child to brush each segment (15 times) | | | |
|3. Parent’s Instruction: |Mistake in one or more of the|Complete only critical steps |Complete all critical (*) |
|a. Recommends the appropriate frequency of brushing * |critical steps (*). |(*) but not all other steps. |and other steps. Plus |
|b. Recommends appropriate toothbrush type | | |supplying pictures or |
|c. Recommends appropriate toothpaste type and amount * | | |toothbrush |
|d. The parent is responsible for tooth brushing for children (up to 8 years)| | | |
|the parent should supervise tooth brushing for (older children).* | | | |
|4. Behavior guidance: |Use none |Use 1 |Uses 2 |
|TSD, positive reinforcement | | | |
Pediatric Dentistry Division
Rubric for Prophylaxis and Topical Fluoride Application
|Steps and procedures |Instructor Evaluation |
| |0 |1 |2 |
| |Not Competent |Competent |Proficient |
|1. Prophy |Used slurry of pumice or did |Complete the steps but used |Applied the steps |
|Clean the stained surfaces by using a paste on a rotating rubber cup. |not instruct the patient on |rotating brush | |
|Caution the patient not to swallow the prophy paste and provide continual|swallowing. | | |
|use of high suction. | | | |
|2. Fluoride* |One or more mistakes of the |Complete all the critical steps (*)|Completed all the |
|Seat the patient upright* |critical steps (*) e.g did not |but used saliva ejector to remove |critical steps (*) plus|
|Teeth should be dried and free of saliva |upright in seat. |remaining APF. |using high suction in |
|Select the suitable trays. Place approximately 2.5 ml of APF gel in each | | |removing the remaining |
|tray and place the trays over the arches and squeeze the buccal and | | |APF |
|lingual surfaces. * | | | |
|Provide the patient with a saliva ejector, instruct patient to avoid | | | |
|swallowing excess fluoride and allow the trays to remain in the mouth for| | | |
|4 minutes.* | | | |
|Remove the trays and use high suction to thoroughly remove the remaining | | | |
|APF. Have the patient expectorate immediately and repeatedly for 1 | | | |
|minute. | | | |
|Instruct the patient not to eat, drink or rinse for 30 minutes after | | | |
|treatment.* | | | |
|3. Behavior Guidance |Uses none |Uses 1 or 2 |Uses 3 or more |
|TSD, distraction, positive reinforcement, voice control | | | |
|4. Time for fluoride * |> 30 min |15- 30 min |< 15 min |
Pediatric Dentistry Division
Rubric for Rubber Dam Isolation
|Steps and procedures |Instructor Evaluation |
| |0 |1 |2 |
| |Not Competent |Competent |Proficient |
| |Mistake in one or more of the |Critical steps are |Critical steps (*) and |
|1. Rubber Dam Preparation: |critical steps(*) |completed (*) |all other steps are |
|a. Punches appropriate areas | | |completed |
|b. Use appropriate clamp | | | |
|c. Has floss tied to the clamp* | | | |
|d. Punches multiples holes* | | | |
|2. Procedure: |Mistake in one or more of the |Critical steps are |Critical steps (*) and |
|a. Places clamp on appropriate tooth |critical steps(*) |completed (*) |all other steps are |
|b. Avoid tissue trauma | | |completed |
|c. One quadrant is exposed* | | | |
|d. Moisture control* | | | |
|e. Checks patient's face for clearance (breathing) * | | | |
|f. Rubber Dam is reverted | | | |
|g. frame is not deviated | | | |
|3. Behavior guidance |Uses none |Uses 1 or 2 |Uses 3 or more |
|TSD, distraction, positive reinforcement, voice control | | | |
|4.Time * |> 20 min |20 min |< 20 min |
Pediatric Dentistry Division
Rubric for Local Anesthesia
|Steps and procedures |Instructor Evaluation |
| |0 |1 |2 |
| |Not Competent |Competent |Proficient |
|1. Behavior |One or more Critical mistakes |All critical steps are |All critical steps (*) and other|
|TSD, positive reinforcement, voice control, distraction |(*) |completed (*) |steps are completed |
|Explain the procedure * | | | |
|Did not instruct the patient to close his eyes | | | |
|Describe the feeling * | | | |
|2. Pre-operative procedure |One or more Critical mistakes |All critical steps are |All critical steps (*) and other|
|Proper positioning of the patient (supine)* |(*) |completed (*) |steps are completed |
|The child head is stabilized between the body and arm of the | | | |
|dentist. | | | |
|Dry the site of injection and apply topical anesthesia * | | | |
|Select the proper gauge and length (short in maxilla and 3 mm | | | |
|long in mandible) for the needle* | | | |
|3. Procedure & Effectiveness |One or more Critical mistakes |All critical steps are |All critical steps (*) and other|
|Establish a firm hand rest during the injection |(*) |completed (*) |steps are completed |
|Keep syringe out of the patient vision block the patient vision | | | |
|by hands * | | | |
|Slowly advance needle through the mucosa, deposit the LA | | | |
|(1ml/min) and withdraw the syringe * | | | |
|Correct landmarks* | | | |
|Patient experiences, no pain or discomfort during different | | | |
|procedures* | | | |
Pediatric Dentistry Division
Rubric for Fissure Sealant
|Steps and procedures |Instructor Evaluation |
| |0 |1 |2 |
| |Not Competent |Competent |Proficient |
|1. Rubber Dam/Cotton rolls |Only 3 teeth are exposed, |Follow all criteria |All criteria plus: Rubber dam|
| |seepage of fluids, clamp | |is reverted and frame is not |
|Isolation rubber dam is applied* |unstable | |deviated |
|Rubber dam (fully erupted tooth) | | | |
|Cotton roll (partly erupted tooth) | | | |
|2. Prophylaxis |One or more mistake in the |Complete Critical |Complete Critical steps (*) |
|Tooth surface is cleaned using a fluoride-free pumice slurry and|critical steps (*) |steps (*) |and all other steps. |
|a rubber cup or brush. | | | |
|Rinsed and dried.* | | | |
|All remaining pumice is removed* | | | |
|3. Sealant Application |One or more mistakes in the |Complete all critical steps (*)|Complete all critical steps |
|Sealant material is applied and cured with no voids* |critical steps(*) | |(*) and all other steps |
|The sealant material carried into the buccal and lingual grooves| | | |
|and pits.* | | | |
|Check occlusion | | | |
|4. Behavior Guidance |Uses none |Uses 1 or 2 |Uses 3 or more |
|TSD, distraction, positive reinforcement, voice control | | | |
|5. Time* |> 30 minutes |30 minutes |15 minutes |
Pediatric Dentistry Division
Rubric for Preventive Resin Restorations
|Steps and procedures |Instructor Evaluation |
| |0 |1 |2 |
| |Not Competent |Competent |Proficient |
|1. Rubber Dam |Only 3 teeth are exposed, |Follow all criteria |All criteria plus: Rubber dam |
|One quadrant is exposed |seepage of fluids, clamp | |is reverted and frame is not |
|Floss tight to clamp |unstable | |deviated |
|Allow patient breathing | | | |
|2. Prophylaxis and caries removal |One or more mistake in the |Complete Critical steps* |Complete critical steps (*) and|
|1. Tooth surface is cleaned using fluoride-free pumice |critical steps(*) | |all other steps. |
|slurry and a rubber cup, rinsed and dried.* | | | |
|2. Removal of caries from isolated pits and fissures only | | | |
|using round bur # ¼ or ½ bur in an exploratory manner.* | | | |
|3. All caries are removed * | | | |
|3. Restoration and sealant application |One or more mistake in the |Complete Critical steps* |Complete critical steps (*) and|
|a. Prepared areas are restored with composite resin.* |critical steps(*) | |all other steps. |
|b. Sealant material is applied over the restored area and to | | | |
|adjacent etched fissures and buccal and lingual grooves and | | | |
|light cured. * | | | |
|c. The sealed surface explored and with no voids*. | | | |
|d. Rubber dam removed and occlusion evaluated | | | |
|4.Behavior guidance |Uses none |Uses 1 or 2 |Uses 3 or more |
|TSD, distraction, positive reinforcement, voice control | | | |
|5. Time* |60 min |40 min |30 min |
Pediatric Dentistry Division
Rubric for Cavity Preparation and Restoration
|Steps and procedures |Instructor Evaluation |
| |0 |1 |2 |
| |Not Competent |Competent |Proficient |
|1. Rubber Dam |Only 3 teeth are exposed, |A quadrant is exposed, follow |All criteria plus: Rubber dam |
|One quadrant is exposed |seepage of fluids, clamp |all criteria |is reverted and frame is not |
|Floss tight to clamp |unstable | |deviated |
|Allow patient breathing | | | |
|2. Cavity design and caries removal |Mistake in one or more of the |Complete Critical steps* with |Proper extension outline, |
|Preparation outline is rounded with no sharp angles. |critical steps(*) e.g soft |proper retention and resistance |convenience, resistance and |
|Groove extensions on buccal and lingual are no closer than 1.25 or|caries was left with no |forms. Plus cavity is not |retention forms. Floor and walls|
|1.5mm the buccal or lingual surface, depending on the tooth. |intension of pulp capping. |completely smooth. |are smooth with complete |
|Occlusal depth is 1.5 mm in non carious areas. | | |critical steps (*). |
|Buccal and lingual walls are slightly undercut. | | | |
|Class I: | | | |
|1. Extension at mesial or distal margin is no closer than 1.25 mm| | | |
|to proximal surface. | | | |
|2. Mesial (or distal) wall is vertical or slightly divergent, | | | |
|depending on the extent of the caries. | | | |
|Class II: | | | |
|1. Isthmus (is) 1/3 intercuspal distance.* | | | |
|2. Gingival wall is wide enough to support the smallest condenser.| | | |
|3. Each indicated cavity wall visibly clears the adjacent tooth, | | | |
|but extends no farther than buccal or lingual line angles. | | | |
|4. Buccal and lingual walls converge and paralleling respective | | | |
|external surface of the tooth. | | | |
|Class III: | | | |
|a. Incisal extensions is within 1 mm of incisal edge * | | | |
|b. Depth of axial wall 0.75-1mm | | | |
|Class V: | | | |
|Undercut incisal and gingival wall within maximum and minimum | | | |
|range | | | |
|d. All caries and defective areas are removed.* | | | |
|3. Gingiva and adjacent tooth are un damaged |Injury to the gingiva causing |Slight gingival controlled |No injury to gingiva or |
| |extensive bleeding, enamel |bleeding, no injury to adjacent|adjustment tooth |
| |and/or to adjacent tooth |tooth | |
|4. Restoration: |Presence of fracture voids or |Proper anatomy and contour but |Proper anatomy and contact |
|All margins should be completely restored and closed with no |under restoration |may have premature contact | |
|excess. | | | |
|The original surface anatomy is restored: * | | | |
|The surface should be smooth and homogeneous with no voids. | | | |
|5.Behavior guidance: |Uses none |Uses 1 or 2 |Uses 3 or more |
|TSD, distraction, positive reinforcement, voice control | | | |
|6. Time* |> 45 minutes |30-45 minutes |< 30 minutes |
|Class I |> 90 minutes |60-90 minutes |< 60 minutes |
|Class II |> 60 minutes |45-60 minutes |< 45 minutes |
|Class III |> 30 minutes |15-30 minutes |< 15 minutes |
|Class V | | | |
Pediatric Dentistry Division
Rubric for Stainless Steel Crown/Strip Crown/Class IV Permanent
|Steps and procedures |Instructor Evaluation |
| |0 |1 |2 |
| |Not Competent |Competent |Proficient |
|1. Rubber Dam |Only 3 teeth are exposed, |A quadrant is exposed, |All criteria plus: Rubber dam |
|One quadrant is exposed |seepage of fluids, clamp |follow all criteria |is reverted and frame is not |
|Floss tight to clamp |unstable | |deviated |
|Allow patient breathing | | | |
|2. Tooth Preparation and caries removal |Mistake in one or more of |Complete only the |Complete all critical (*) and |
|a. Occlusal Reduction /Incisal Reduction * |the critical steps (*) |critical steps(*) but |other steps |
|1-1.5mm compared to adjacent teeth | |not all other steps | |
|Follows original anatomy (except with pulpotomy) | | | |
|b. Proximal Reduction:* | | | |
|Break contacts | | | |
|Are covergent to occlusal/incisal | | | |
|End in feather-edge margin | | | |
|No Ledges * | | | |
|c. Buccal Lingual Surfaces and Bevel | | | |
|SSC: | | | |
|Removes sharp cusp tips and roundation of line angles | | | |
|Bevel occlusal 1/3 of buccal and lingual | | | |
|Strip: | | | |
|Reduce labial and lingual surfaces 0.25 mm* | | | |
|Class IV: | | | |
|Extend preparation (Bevel) 2 mm beyond fracture line* | | | |
|d. Complete Removed Caries * | | | |
|e. Avoid Damage to Adjacent Teeth * | | | |
|3. SSC or CSC Adaptation* |One or more Critical |Only critical steps are |All critical steps (*) and other|
|Crown leveled with adjacent teeth * |mistakes (*) e.g. under |completed (*) but with |steps are completed without |
|Original Contacts restored * |extended margins, the bite |slight blanching |blanching |
|No extensive blanching |is opened | | |
|Margins 1mm subgingivally and form smooth curve* | | | |
|SSC: Difficult to seat and remove | | | |
|No gaps at margins | | | |
|Proper occlusion * | | | |
|4. Cementation/Restoration: |One or more Critical |All critical steps are |All critical steps (*) are |
|Correct position Bucco lingually* |mistakes (*) e.g. open bite|completed (*) SSC: but |completed |
|SSC | |some cements on the | |
|Properly remove remaining cement | |strip crown lingual | |
|Adequately produced proper occlusion and contact* |Strip/Class IV: Voids or |finishing is needed | |
|Strip/Class IV: |deficient areas | | |
|Composite restoration after acid etching | | | |
|Excess composite is removed before curing | | | |
|Strip form is removed and with no voids | | | |
|Proper composite shade* | | | |
|5.Behavior guidance: |Uses none |Uses 1 or 2 |Uses 3 or more |
|TSD, distraction, positive reinforcement, voice control | | | |
|6.Time * |> 120 min |90-120 min |< 90 min |
|Strip |> 120 min |80 -120 min |< 80 min |
|SSC |> 100 min |90-100 min |< 90 min |
|Class IV | | | |
Pediatric Dentistry Division
Rubric for Formocresol Pulpotomy
|Steps and procedures |Instructor Evaluation |
| |0 |1 |2 |
| |Not Competent |Competent |Proficient |
|1. Rubber Dam |Only 3 teeth are exposed, |A quadrant is exposed, |All criteria plus: Rubber dam |
|One quadrant is exposed |seepage of fluids, clamp |follow all criteria |is reverted and frame is not |
|Floss tight to clamp |unstable | |deviated |
|Allow patient breathing | | | |
|2. Access and deroofing |One or more of the |Complete removal of |Complete removal of caries pulp |
|Complete removal of caries* |Critical mistakes (*) |caries and pulp tissue |tissue with proper access and |
|Proper opening for access. All pulp horns are uncovered and are readily |present |but with over extension |extension. |
|accessible. | |or sharp edges. | |
|Complete removal of the coronal pulp tissue * |Excessive bleeding | |No signs of Hemorrhage |
|No perforation* | |Slight Bleeding on | |
|Hemorrhage control* | |removal of the wet | |
| | |cotton pelete. | |
|3. Formocresol fixation and temporary restoration |Cotton pelete do not cover|Follow the steps but |Follow the steps with fixation |
|Slightly damped |the pulp stumps or use |slight bleeding on |firm consistency of ZOE |
|5 minutes |peletes soaked with |removal of the pelete, | |
|Pellet removal |formocresol without |slight soft ZOE mix. | |
|Placement of ZOE temporary |fixation improper | | |
| |consistency for ZOE | | |
|4. Behavior Guidance |Uses none |Uses 1 or 2 |Uses 3 or more |
|TSD, distraction, positive reinforcement, voice control | | | |
|5.Time * |> 120 min |30- 120 min |< 30 min |
Pediatric Dentistry Division
Rubric for Extraction of Primary Teeth
|Steps and procedures |Instructor Evaluation |
| |0 |1 |2 |
| |Not Competent |Competent |Proficient |
|1. Pre-operative precautions |Mistake in one or more of the |Complete only critical steps |Complete all the steps including|
|Radiographic revision before extraction* |critical steps (*) or extract in|(*) but not other steps |critical steps* |
|Sensation and noises associated with extraction is explained |full supine position without | | |
|Unfolded gauze (5x5 cm) is placed over the tongue and cover the |gauze protection | | |
|oropharynx * | | | |
| | | | |
|2. Procedure |Did not follow the steps or long|Follow the steps and extraction|Follow the steps and extract in |
|a. A straight or periosteal elevator is used to free the |time for extraction. |time was relatively short |a very short time. |
|attached gingiva. | | | |
|b. Firm apical pressure is applied while in mandible | | | |
|supporting the mandible, initial luxution is toward the buccal | | | |
|side. | | | |
| | | | |
|For Molars: hold the pressure momentarily to expand the alveolar| | | |
|plate, return lingually and hold to expand the alveolar plate. | | | |
|Alternate the buccal and lingual movements. When adequate | | | |
|freedom of movement, deliver the tooth to the buccal side, with | | | |
|slow, firm, continuous pressure. | | | |
|For Anteriors: A rotative force is applied along the tooth’s | | | |
|long axis, delivering it through its path of least resistance. | | | |
| | | | |
|c. The buccal and lingual plated of the alveolar bone is molded | | | |
|into normal conformity with digital pressure. | | | |
|d. Folded sterile gauze is placed over the wound. | | | |
|Time* | | | |
|Mobile Tooth | | | |
|Long rooted tooth | | | |
|Molar | | | |
|Interior |6-10 minutes |5 minutes |3 minutes |
| | | | |
| |> 15 minutes |10-15 minutes |< 10 minutes |
| |> 10 minutes |6-10 minutes |< 6 minutes |
|3. Post operative instruction |Mistake in one or more of the |Complete only critical steps |Complete all the steps including|
|Bite on the gaze for 30 minutes * |critical steps (*) |(*) |critical (*) and gave extra |
|Do not rinse forcibly for 24 hours* | | |gauze. |
|Eat cold food | | | |
|Do not use straw | | | |
|Do not bite on lip or cheek * | | | |
|Do not play with the wound | | | |
|Written instruction is given* | | | |
|Gauze is given | | | |
|4. Behavior guidance: |Uses none |Uses 1 or 2 |Uses 3 or more |
|TSD, distraction, positive reinforcement, voice control | | | |
Pediatric Dentistry Division
Rubric for Diet Evaluation
|Steps and procedures |Instructor Evaluation |
| |0 |I |2 |
| |Not Competent |Competent |Proficient |
|1. Diet Evaluation |One or more Critical |Critical steps are |Critical steps (*) and |
|Information from the parent is accurately taken |mistakes (*) |completed (*) |all other steps are |
|Quality of food intake by patient was identified and described to the patient | | |completed |
|/ parent. * | | | |
|Cariogenic potential of the patient’s diet was identified and described to the| | | |
|patient / parent. * | | | |
|2. Recommendation to patient and parents |One or more Critical |Critical steps are |Critical steps (*) and |
|5 food groups was explained using the pyramid * |mistakes (*) recommendation |completed (*) |all other steps are |
|Recommended amounts for the child to improve nutrition |is given only to the parents | |completed , used |
|Cariogenecity of the diet was explained * | | |pictures and supplied |
|Instruction about sweetened or fuzz beverages was given | | |the parents with the |
|Instruction about sticky solid CHO including fruits was given * | | |guide to good eating |
|Safe snacks was suggested properly * | | | |
|Time for sweets intake was suggested * | | | |
|Encourage brushing after sweets * | | | |
|3. Behavior guidance |Uses none |Uses 1 |Uses 2 |
|TSD, positive reinforcement | | | |
|4. Time * |< 10 minutes |10-20 minutes |> 20 minutes |
Pediatric Dentistry Division
Rubric for Space Analysis
|Steps and procedures |Instructor Evaluation |
| |0 |1 |2 |
| |Not Competent |Competent |Proficient |
|1. Time |> 20 minutes |20 minutes |< 20 minutes |
|Procedure was completed in 20 minutes | | | |
|2. Case selection |1. The case is not indicated for |1. The case is indicated for space |1. The case is indicated for space |
| |space analysis |analysis. |analysis. |
| |2. Some of the incisors are |2. All upper and lower incisors are|2. All upper and lower incisors are|
| |primary |permanent. |permanent. |
| |3. Any of the 1st permanent molars|3. 1st permanent molars are |3. 1st permanent molars are |
| |did not erupt yet or extracted. |present. |present. |
| |4. Complete primary or permanent |4. Mixed dentition |4. Mixed dentition |
| |dentitions |5. Some teeth are fractured | |
|3. Teeth measurements: |a. Too much variation in the sum | |Measurement were 80% to 100% |
|a. Sum of lower incisors (32,31,41,42) |Or not interred in its place in |Some variations in the measurements|alemate and computed measurement |
|interred in the form* |the treatment form |with 80% accuracy and completed |Interred in its place in the form |
| |b. Too much variation in the |measurement entered in the form. | |
| |measurements of 11,12 or 21, 22 | | |
|b. Sum of upper 11,12 and 21,22* | | | |
| |c. The sum of upper incisors was |Correctly identified the sum of |Correctly identified the sum of |
| |used |lower 345 and placed in its |lower 345 and placed in its |
| | |position in the form. |position in the form. |
|c. Space needed was identified by using the sum of 31, |or misidentified for any of the | | |
|21, 41, 42* |sum of upper 345 | | |
| | | | |
| |or misplacement of the sums of | | |
| |either lower or upper 345 in the | | |
| |form | | |
|4. Detect space deficiency |Measurements other than the sum of| | |
|Alignment of incisors were considered |MD width of central and lateral |Some variations in the measurements|All steps were followed with |
|MD dimension of central and lateral on each of right, |incisors were used in its |with 80% accuracy. |80-100% accuracy. |
|left upper and lower arch were computed. |quadrant. | | |
|The sum was recorded by polygauge. | | | |
|The anterior end of the polygauge was placed on the |Or miscomputation of the corrected| | |
|midline model. |teeth | | |
|A scratch on model corresponds to the distal end of the | | | |
|polygauge was placed on the correct position on the arch|Or misrecording the sum of the | | |
|(teeth). |polygauge. | | |
| | | | |
|Space available is recorded |Or a scratch on the model | | |
|Space from the scratch to measial of the 6 was correctly|correspond to distal was placed | | |
|measured |either too bucally or lingually | | |
|Measurements were recorded on the arch circumference. |Space not correctly measured | | |
| | |Some variations in the measurements|All steps were followed with |
|Arch length deficiency were calculated |Or measurements were taken too far|with 80% accuracy. |80-100% accuracy. |
|Subtract space available from space needed and placed in|either bucally or lingually | | |
|the form for each quadrant. | | | |
|Negative, position or 0 measurements were recorded for | |All steps were correctly followed | |
|each quadrant |Space needed was subtracted for |Total was not recorded | |
|Total was calculated for the arch |space available | |All measurement were recorded |
| |Or miscalculated | | |
Pediatric Dentistry Division
Rubric for space maintainers I
(Band/s selection and impression)
|Steps and Procedure |Instructor Evaluation |
| |0 |1 |2 |
| |Not Competent |Competent |Proficient |
|Band/s selection | | | |
| | |Band is 1mm subgingivally but |-Band is 1mm subgingivally and 1mm|
|Adaptation * |-Band is not subgingivally |not gingival to the marginal |gingival to the marginal ridges. |
| |Or - occlusal to the marginal ridge. |ridges. | |
| |Or – injuries conflicted to the | | |
| |gingiva or soft tissue | | |
| | | | |
| | | |-The band/s are well adapted on |
| | |- size is slightly big (tip of|the molar/s with no spaces, |
|Size |- size is too big with spaces all |an explorer) |tightly or snugly fitted. |
| |around | | |
|Impression and band placement | | | |
| | | | |
|Impression details |-The space maintainer area and the |-The space maintainer area and|-The space maintainer area and the|
| |abutments are ill defined |the abutments are well defined|abutments are well defined |
| | | | |
| | | | |
| | |- acceptable impression at 2nd|- acceptable impression from the |
| |- acceptable impression after 3 |trial |first trial |
|Band is placed correctly in the impression. |trials |Band is placed correctly in |Bands is placed correctly in its |
| |Or Band is misplaced. |its place but not stabilized |place and stabilized in the |
| | |to the impression |impression |
| 3. ) Behavior guidance: |Uses none |Uses 1 or 2 |Uses 3 or more |
|TSD, distraction, positive | | | |
|reinforcement, voice control | | | |
| 4. )Time * | | | |
| | | | |
|1 Band |> 20 minutes |15-20 minutes |15 minutes |
|2 Bands |> 30 minutes |25-30 minutes |25 minutes |
Pediatric Dentistry Division
Rubric for space maintainers II
(Appliance fitting and cementation)
|Steps and Procedure |Instructor Evaluation |
| |0 |1 |2 |
| |Not Competent |Competent |Proficient |
|Appliance fitting |The appliance is placed in patient mouth. |
|(General) * | |
| |-Appliance is active |-Bands are in proper position |-Band fits tightly |
| |Or - occlusal interference |-Appliance is passive |-Appliance is passive |
| |Or - blanching due to impingement on |-No occlusal interference |-No occlusal interference |
| |mucosa |- but with slight impingement on |-wire not impinge on gingiva, B. mucosa|
| | |mucosa |or tongue |
|Appliance fitting | | | |
|(Specific) | | | |
| | | | |
|Band and loop |- Loop is too narrow buccolingually |- Loop is not wide enough |- Loop wide enough (8mm) buccolingually|
| |Or - Mesial end of loop do not contact |-Mesial end of loop contacts only |- Mesial end of loop contacts adjacent |
| |adjacent tooth at contact area, |small part of contact area |tooth at contact area |
| |Or - Wire pressing on gingival tissue |- Wire parallel to edentulous ridge |- Wire parallel to edentulous ridge & |
| | |& 1mm off gingival tissue |1mm off gingival tissue |
| |-Rests on incisal edge of incisors or | | |
| |press on gingival papillae |-Rests on cingula of incisors on |-Rests on cingula of incisors slightly |
| | |gingival papillae without pressure |above gingival papillae |
| | |before adjustment to proper position| |
|Lingual arch | | | |
| | | | |
| |-Acrylic button in rugae area anterior to| | |
| |the junction of horizontal & vertical |-The arch is well adapted to the | |
| |components of hard palate, or in the soft|palate | |
| |palate. |-acrylic button in rugae area at the| |
| | |junction of horizontal & vertical | |
|Nance or TPA | |components of hard palate | |
|3. Cementation * |-The appliance is not in its proper |-The appliance is in its proper |-The appliance is in its proper |
| |position |position |position |
| |or- a lot of remaining cement is left. |- negligible amount of cement is |- all remaining cements were removed |
| | |left | |
|4. Behavior guidance |Uses none |Uses 1 or 2 |Uses 3 or more |
|TSD, distraction, positive reinforcement, | | | |
|voice control | | | |
|5. Time * | | | |
|- Band loop |> 20 minutes |15-20 minutes |15 minutes |
|- Others |> 45 minutes |45 minutes |inutes |
1. Oral Hygiene Instruction and Diet Evaluation
Department of Preventive Dental Sciences
Pediatric Dentistry (PDS 615)
ORAL HYGIENE INSTRUCTION (Students Copy)
1. The student describe the technique of toothbrushing to the patient and parent and demonstrate it on a model.
Techniques of toothbrushing:
a) Scrubing technique for the primary dentition
b) Roll technique for the mixed dentition
c) Bass technique for the permanent dentition
2. Supply a toothbrush and allow the child to do toothbrushing following a systemic order (starting from buccal surface of the last right maxillary tooth and ending by the lingual surface of this tooth) scrub each segment 15 times.
3. Give instructions to the parent and recommendations about toothbrush and toothpaste.
a) Brush twice daily.
b) The parent is responsible for toothbrushing for children till 7 or 8 years old.
c) The parent should supervise toothbrushing for older children.
d) Toothbrush should be
▪ Soft
▪ Straight flat trim, non serrated and have 3 rows of bristles
▪ Oral B # 20, 25 or 30 or Jonhson and Johnson (Reach)
e) Fluoride containing toothpaste such as:
▪ Crest
▪ Colgate
▪ Aim
▪ Aquafresh…..etc.
Pediatric Dentistry
DIETARY EVALUATION FORM
|Dietary Evaluation |Yes |Sometimes |No |
|BASIC FOODS |
|Does your child have 2 pieces (5 ounces) daily of meat, chicken, fish, eggs, or beans? | | | |
|(One piece = 2-3 ounces like the size of a bar of soap or the inside of your palm). | | | |
|Does your child have 2 1/2 cups daily of vegetables? | | | |
|(Like broccoli, sweet peas, carrots, bean sprouts, spinach, celery, etc.) (One cup equivalent = | | | |
|1 cup cooked or fresh veg. like the size of a computer mouse or 2 cups of leafy veg.) | | | |
|Does your child eat 1 1/ 2 cups daily of fruit? (Like mango, banana, apple, grapes, orange, | | | |
|kiwi, etc.) (One cup = 1 medium size fruit like the size of a tennis ball, 1/2 cup dried fruits,| | | |
|1 cup fresh 100% juice) | | | |
|Does your child eat 6 pieces daily of grains? (like bread, pasta/noodles, rice. Tortillas, | | | |
|cereal, crackers) (One piece = 1 slice of bread or ½ cup cooked Cereal/rice/pasta) (like the | | | |
|size of the small fist, 4 crackers, 2 heaping tablespoons cooked rice) | | | |
|Does your child have 3 cups daily of milk or milk products? (like low fat milk, 1%, | | | |
|skim/fat-free, cheese, yogurt, soy milk) (One cup = 1 cup (250 ml) of milk or yogurt, 2 slice | | | |
|processed cheese) | | | |
| | | | |
|DIET SCORE: 5=Excellent, 4=Fair, ................
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