CODHA



MOUNTAIN FAMILY HEALTH CENTERSSMILES DENTAL PROGRAMITR PLACEMENT PROTOCOLAs a SMILES grantee, we have agreed to the following protocol in our SMILES locations: All ITR restorations (or Protective Restorations in permanent teeth) will be prescribed by a SMILES supervising Dentist Only. ITR will not be prescribed if caries is within 2mm of pulp.No interproximal ITR’s will be prescribed or placed, unless the adjacent tooth is missing, access is excellent and a matrix band is not required. Generally, local anesthesia is required to place a matrix band, especially on a primary tooth, and local anesthesia is not allowed by the ITR state guidelines. Separate informed consent is signed by caregiver before procedure is done.Only hand instruments will be used to excavate soft decay and food debris. After the excavation is complete and most of the reachable soft decay is removed, tooth conditioning gel is applied. A Glass Ionomer (Fuji-9) capsule is immediately placed in the triturator (mixer).While the Fuji 9 is mixing, the assistant suctions for the DH while the gel is rinsed off. Tooth is given a quick puff of air to reduce excess water present. DO NOT DRY TOOTH COMPLETELY.The mixed Fuji-9 capsule is quickly loaded into the carrier syringe, and the tip is placed into the deepest part of the cavity. The Fuji-9 is placed within 30 seconds of mixing if possible.The goal is to completely fill the cavity, but not overfill it. If it is a large ITR, very gentle digital pressure is used with a wet gloved finger and patient is immediately asked to bite hard, so occlusal adjustment will not be necessaryIf the lesion is very small, or tooth has other deep grooves, firm digital pressure with the pinkie finger is used to press the Fuji-9 as deeply as possible into small lesion and surrounding grooves. In effect, the Fuji -9 is functioning as a sealant in these deep grooves.After placement is complete, take gloves off and complete the record keeping. 5 minutes setting time is ideal. After setting for 5 minutes, check occlusion with blue articulation paper and ask patient to bite hard to ensure Centric Occlusion is achieved. Take close up photo to see if any blue marks are present on ITR material.If ITR is in occlusion, may use slow speed handpiece and polishing stone to adjust high spot.Do not adjust occlusion on natural tooth surface. Stay on ITR surface only. After occlusal marks are removed on ITR, check again with blue paper and repeat occlusal adjustment until ITR is not in occlusion. Occlusal Contact on natural tooth only.NOTE: The sooner you can get the restoration placed, condensed with a wet gloved finger, and have the patient bite down hard, the less you will need to adjust occlusion. If there are any voids noted, repeat the gel, rinse, and use a new capsule to fill void and recheck occlusion. NOTE: ITR’S will not be placed on teeth with spontaneous pain. If tooth is mildly sensitive to hot, cold, or sweets, it is appropriate to place ITR and follow up tooth w/ periodic radiographs.After appointment is completed, patient (or care giver) is given ITR Card which has State Guideline required information which follows on next page: (should be bilingual for parent)Your Child has received a temporary filling which must be followed and possibly replaced at the discretion of a dentist.Please contact our office at (phone number) if your child has any problems with the new temporary filling. Please leave a message, with name and contact phone.Our office is located at (office address) and our hours are (hours of operation).Our supervising Dentist is Dr. (name) and he/she is a Colorado licensed Dentist.Our school based SMILES clinic is pleased to have the opportunity to serve you. Your child will be referred to a dentist if needed, and you will be contacted for any follow up visits.FOLLOW UP AFTER PLACEMENT OF ITR:Caregiver is contacted via phone the day of the procedure or next day following.Caregiver is informed of information on ITR card.Caregiver is asked how tooth is doing following procedure.Caregiver is reminded to call if any questions or symptoms arise.Tooth is followed with a radiograph at next scheduled visit, or acute visit if tooth becomes symptomatic. All visits/phone calls are documented properly in EDR, and ITR is followed at every subsequent visit to confirm its status. Glass Ionomer material may be added at following visits if tooth is asymptomatic, and there is a small part of ITR missing, just as would be done to “touch up” sealants when needed. ................
................

In order to avoid copyright disputes, this page is only a partial summary.

Google Online Preview   Download