Pediatric DentistryTraining Module

Training and Calibration Guidelinesfor The Arizona School of Dentistry &

Oral HealthUpdated : 5/5/2009

Preclinical Exercises

Preclinical Pediatric Dentistry Preclinical Exercises

• #J – OL/L amalgam• #S – Do and #T MO amalgam• Adaption of a T-band for class II preparation• #K – SSC, #L – DO composite• #A – SSC, #B – pulpotomy and SSC• #F – strip crown• #E – SSC

Preclinical Exercises

#J OL/L amalgam

#S DO and #T MO amalgam

Adaption of T Band for Class II restorations

Preclinic Exercises

#K SSC, #L DO Composite #A SSC, #B Pulpotomy/SSC

#F Strip Crown

#E SSC Incisal/Lingual reduction for 1 mm clearance Interproximal reduction to allow for close adaption Similar to strip crown without a groove

Daily Clinical

Protocols

Daily Clinical Protocols • Students expected to arrive on time in the Pediatric

clinic. • All patients are scheduled by the Pediatric clinic

assistant and students are not assigned pediatric patients to their family of patients.

• The students should thoroughly review the chart prior to treatment.

• The faculty hold seminars and discuss Tx planning, behavior management, charting and Tx sequencing among other topics.

Daily Clinical Protocols Examination:• Medical and dental Hx.• Evaluation of hard and soft tissues. • Radiographs are based upon individual need and

taken only when a diagnostic yield is expected.• Caries Risk Assessment.• Occlusal analysis and need for orthodontic

assessment.• Other specialty consultations are requested, if

needed.

Daily Clinical Protocols Tx Plan Formulation:• “Worst first” approach• Quadrant dentistry/arch dentistry• Selective non-invasive procedures introduce the

patient to the dental environment• Caries Risk assessment and Preventive follow-up

Daily Clinical Protocols Behavior Management:• Tell, Show, Do• Positive Reinforcement/Ignoring Negative• Nitrous Oxide• Voice control• Modeling• Distraction• Papoose board used as needed – parents may or

may not be in the operatory during procedures

Daily Clinical Protocols Materials:• Local Anesthetics – Lido 2% with epi (max single

dose 4.4 mg/kg/2mg/lb [300 mg], septo 4% w/ epi• Amalgams – Dispersalloy• Composites – Dyract, Esthet-X micro hybrid and

composite, Clinpro Sealant• Matrix and Wedging – T bands, Palodent matrix,

Tofflemier matrix bands

Daily Clinical Protocols Stainless Steel Crowns:• Occlusal reduction, interproximal and B/L reduction

to allow for proper adaption of the crown• 1 – 1.5 mm of occlusal clearance and no cervical

ledge to prevent seating• Use 6888-012 flame diamond and 909-040 wheel

diamond, 330 and 169L• Adapt 3M Ion primary molar crowns• Crimping pliers/Howe pliers for contouring• Cement with glass ionomer luting cement

Daily Clinical Protocols

Pulp Therapy for Primary/Immature Permanent Teeth:• Protective base – Fuji GI liner• Indirect pulp cap• Direct pulp cap (permanent only) MTA or CaOH

Daily Clinical Protocols Pulpotomy Primary:• Access pulp chamber – 330 or 169 carbides• Remove pulp tissue - #4 or #6 round burs• Formocreosol or Ferric sulfate to fix tissue• IRM or Tempit in pulp chamber• Condense wet cotton pellet or amalgam condenser• Pulpectomy Primary – 30+ Vitapex, ZOE

Daily Clinical Protocols

Space Maintainers:• Band and Loop• Lower lingual holding arch• Transpalatal arch/Nance appliance

Daily Clinical Protocols

Pediatric Burs:• 331/2, 34, 35SS, 330, 556SS, 556, 169, 169L• #2, #4, #6, #8 round• 6358-023 football diamond, 6888-012 pointed

tapered diamond, 909-040 wheel diamond, 6858-014 pointed taper diamond, 7901 flame carbide, 7408 football carbide

Assessment of Student

Performance

Pediatric Dentistry Clinical Requirements

Essential Experiences = EE• 100 Procedures to include at least 1 space main.• 1 Pulpotomy• 1 SSCCompetency Assessments = CA• 1 Pediatric Class II composite or amalgam• 2 Case-based Tx plans – 1 comprehensive exam and

1 dental emergency exam

Faculty Assessment of Student Performance

• Faculty should consult the Clinical Procedure Guide Book (CPGB) for the clinical technical criteria for assessing each clinical procedure. Link to CPGB:

G:\Dental\CPAF's_CLINICAL GUIIDEBOOK

• On site faculty should utilize electronic CPAFs for pediatric assessment. Electronic CPAF can be accessed at:

https://asd.icedentalsystems.com/

• External site faculty should utilize the daily CPAF. Link: G:\Dental\CPAF's_CLINICAL GUIIDEBOOK\CPAFS Versions 4.07

• Hard copy CPAF for pediatrics is also available. Link:

G:\Dental\CPAF's_CLINICAL GUIIDEBOOK\CPAFS Versions 4.07

D1351 SealantD1351 EE = A, CA = 5,4 EE = I, CA = 3,2 EE = U, CA = 2,1Procedure and Surface Preparation

Appropriate sealant product selected. Tooth surface clean and free from debris

Failure to review Med and Dent Hx. Failure to clean surfaces in preparation for sealant

Inappropriate understanding of what is involved and how procedure is done

Isolation Tooth is adequately isolated to prevent contamination

Loss of isolation No isolation

Etch/rinse/isolate Tooth etched appropriately & rinsed

Incomplete etch or contamination of site

No etch

Sealant placement/cure Appropriate amount of sealant applied and allowed to cure for appropriate amount of time

Inappropriate amount, too much, too little, requiring adjustment through further care

Inability to complete procedure

Sealant adhered Sealant checked for complete adherence. Tooth restored to ideal occlusion w/o assistance

Incomplete retention of sealant material

No retention of sealant material

D2150 CL II AmalgamD2150 EE = A, CA = 5,4 EE = I, CA = 3,2 EE = U, CA = 2,1Outline Form and Extension

Outline does not weaken the tooth, no demineralization

Over prepared or extended when caries and anatomy does not dictate

Grossly over prepared or extended ORPreparation of wrong tooth

Proximal & gingival extension is optimalOptimal treatment of fissuresOblique ridge of upper second primary or permanent molar nor transverse ridge of lower are not crossed unless undermined by cariesProximal cavosurface angles at 90 degrees

D2150 CL II AmalgamD2150 EE = A, CA = 5,4 EE = I, CA = 3,2 EE = U, CA = 2,1Internal Form Proximal walls are

convergent occlusallyOver prepared or deeper than necessary

Pulpal exposure when none should have occurred

Portions of the prep that extend into the buccal and lingual grooves should slightly divergePulpal floor, 1mm, free of defects, uniform depth, internal line angle slightly rounded, axio-pulpal line angle is rounded, gingival floor 1 – 1.5 mm wide – M-DRetention features (grooves) ideally placed, if necessaryNo fragile or unsupported enamel

D2150 CL II AmalgamD2150 EE = A, CA = 5,4 EE = I, CA = 3,2 EE = U, CA = 2,1Operative Environment Rubber dam is optimal,

preparation is dryPoorly adapted dam Failure to use dam

Adjacent tooth contact is not damagedAmalgam material is handled in a safe mannerMatrix band and wedge used appropriately

Anatomical Form Restores harmonious form of existing toothProximal contour returns proper shape and positionOptimal contact will allow lightly waxed floss to pass with proper resistance

D2150 CL II AmalgamD2150 EE = A, CA = 5,4 EE = I, CA = 3,2 EE = U, CA = 2,1Margins No excess or deficiency

at any marginExcessive or deficient margin that can be improved without new restoration

Excessive or deficient margin that requires new restoration

Finish, Function & Damage

Smooth surface, no pits, voids or irregularities

Damage to adjacent tooth which is noted but is managed with minimal involvement

Damage to adjacent tooth causing loss of tooth structure and necessitating a restoration

Examples of CL II Amalgam PrepsProximal walls are convergent occlusally, portions of the prep extend into buccal and lingual grooves, pulpal floor is flat and uniform depth, gingival floor is 1 – 1.5 mm wide mesiodistally. Acceptable

Assuming a small interproximal lesion, just inside the DEJ. The size and axial depth of the box would rate this Improvable. If there was a pulpal exposure, it would be Unacceptable