preventive dental sciences department pediatric dentistry

1

Preventive Dental Sciences Department Pediatric Dentistry Division

(PDS 615)

Clinical Evaluation Manual-Part 1

Student name: ………………………………… Computer #: ………………………………..

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Preventive Dental Sciences Department Pediatric Dentistry Division

Table of Contents 1. MPE Forms

1.1. MPE Point System

1.2. MPE Student Copy

1.3. Assisting form

2. Finished Case Evaluation

2.1. Finish Case Form

3. Competency Exam Forms

3.1. Clinical Competency Exam Form for Examination & Treatment

Planning

3.2. Clinical Competency Exam for Diet Evaluation

3.3. Clinical Competency Exam for Formocresol Pulpotomy

3.4. Clinical Competency Exam for Stainless Steel Crown Restoration

3.5. Clinical Competency Exam for Local Anesthesia

3.6. CCE Student’s copy

4. MPE Evaluation Forms

4.1. MPE Evaluation for Examination & Treatment Planning

4.2. MPE Evaluation for Oral Hygiene Instruction

4.3. MPE Evaluation for Prophylaxis & Topical Fluoride Application

4.4. MPE Evaluation for Rubber Dam Isolation

4.5. MPE Evaluation for Local Anesthesia

4.6. MPE Evaluation for Fissure Sealant

4.7. MPE Evaluation for Preventive Resin Restorations

4.8. MPE Evaluation for Cavity Preparation and Restoration

4.9. MPE Evaluation for Stainless Steel Crown/Strip Crown/Class IV Permanent

4.10. MPE Evaluation for Formocresol Pulpotomy

4.11. MPE Evaluation for Extraction of Primary Teeth

4.12. MPE Evaluation for Diet Evaluation

4.13. MPE Evaluation for Space Analysis

4.14. MPE Evaluation for Space Maintainer I (Band’s Selection and Impression)

4.15. MPE Evaluation for Space Maintainer II (Appliance Fitting and Cementation)

5. Other Forms

5.1. Arabic Consent

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1. MPE Forms

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Department of Preventive Dental Sciences

Pediatric Dentistry (PDS 615)

MINIMAL PROCEDURE EXPERIENCES

The student is required to collect a minimum of 80 points. Maximum point to be graded – 130.

The points are distributed as: Points Points

Exam and T.P. 5 Class III 3 OHI First 2 Pulpotomy 4 Extra 1 Extraction (Exfoliating) 1 Prophy/fluoride First 2 “ (Normal) 2 Extra 1 Space Maintainers (Band Selection) 1 Pit and Fissure sealant 2 “ (Impression) 1 Class I /PRR 3 “ (Cementation) 1 Partial Impression (RPD Impression) 1 ” (RPD delivery) 2 Class II 4 Pulpectomy 5 SSC 4 Space analysis 3

Class V 3 Diet evaluation (basic food group + plaque forming sweet) 4

Buccal or lingual pit 1 Direct pulp capping in Permanent 3 CSC/Composite build up 4 Indirect pulp capping in Permanent 3

Excavation & Temporization (rampant caries)

1/quadrant

Each student should do at least:(Mandatory) 2 Exam and T.P. 1 Class III or V or build up 2 OHI 1 Space Analysis 2 SSC 1 Space Maintainer 2 Pulpotomy 1 Diet Evaluation 2 Extraction

Each student should not exceed more than: 4 Exam and T.P., 4 Prophy / Fl. , 8 Fissure sealant, 2 space analysis, 2 diet analysis ( extra work from the above categories will be accepted but not given grades)

NOTE: Supervisor will mark the procedures considering time, infection control, file, behavior management. Failing to do any mandatory procedure will be recorded as minus ½ of the grades of that procedure (e.g.

missing SSC will be -20).

ssssss

Form 1.1

5 Extra points above the 80 points 4 the grades of this procedure will be added to the total grades.

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Department of Preventive Dental Sciences Pediatric Dentistry (PDS 615)

MINIMAL PROCEDURE EXPERIENCES (Minimum of 80 points is required)

Student Name : Computer No. :

Clinical Procedures Pts. File No. Faculty

Signature Date Extra Clinical Work

Procedures Pts. File no. Faculty Signature Date

Exam and T.P. 5 Diet evaluation 4

Exam and T.P. 5

OHI 2

OHI 1

Stainless Steel Crown 4

Stainless Steel Crown 4

Pulpotomy 4

Pulpotomy 4

Extraction

Extraction

Class 3/V/CSC/Build up

Space analysis 3

Space maintainer

Form 1.2

7

Clinical Procedures Pts. File No. Faculty

Signature Date

Extra Clinical Work

Procedures Pts. File no. Faculty Signature Date

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Department of Preventive Dental Science Pediatric Dentistry Comprehensive Care Clinic (PDS 615)

6th Year Assisting Requirement - Minimal of 5 sessions is required

Student’s Name:___________________________

Date Assigned

Cubicle no.

Pedo session

Faculty Signature

Form 1.3

9

2. Finished Case Evaluation

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Department of Preventive Dental Sciences

Pediatric Dentistry (PDS 615)

Finished Case Evaluation Form

Students’ Name: _______________________________________ Patients Name: ___________________________________ File No.: ____________________ Instructor’s Name: ________________________________ Date: ____________________

Case No.: 1 2 3 Case Type: Short Long A. Case is satisfactory completed: Yes No B. For long case 2 quadrants are completed at midyear: Yes No C. Record fulfillment evaluation: (only for finished cases) 1. Pre-operative photo Yes No 2. Pre-operative radiograph Yes No 3. Pre-operative casts Yes No 4. General Health Inspection Yes No 5. Dental Charting Yes No 6. Signed Treatment Plan Yes No 7. Signed consent for treatment planning Yes No 8. Signed Detailed Progress Notes Yes No 9. Post-operative photos Yes No 10. Post-operative radiographs Yes No 11. Finish case referral Yes No D. Final clinical competency evaluation: Accepted Rejected

Form 2.1

11 N.B. Progress Report should document (1) Anesthesia, (2) Procedure Done, (3) Patient Behavior (4) Next Visit N.B. Long case is for (4 SSC + 2 pulpotomy) or equivalent.

3. Competency Exam

Forms

12

Pediatric Dentistry Division Clinical Competency Examination Evaluation Form

Examination & Treatment Planning

Steps and procedures Instructor Evaluation

Weight Mark 0

Not Competent 1

Competent 2

Proficient 1. History and Personal Data - Patient's complete personal data recorded - All questions on the medical history answered.* - All questions on the dental history answered. - Caries risk assessment *

Mistake in one or more of the critical steps(*)

Complete only Critical steps*

Complete all the steps including

critical steps*,

2

2. Examination: a. Extra oral/Intra oral

Head and neck Soft Tissue Evaluation: Gingiva, mucosa,

etc. 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

Mistake in one or more of the critical steps(*) misdiagnosed

cavitated caries

Complete Critical steps*

but misdiagnosed non cavitated

carious lesions.


critical steps*,

4

3. Radiographic Diagnosis: 1. Indicated radiographs were taken* 2. Examine quality of bone, tooth structure

and development 3. Identify proximal caries in bite wing*

Missed more than 2 proximal caries in dentin

in bite wing radiograph

Missed 1 or 2 proximal

carious lesion in dentin in bite wing

Did not missed any proximal

caries in dentin in bite wing

2

4. Treatment Planning 1. Prevention of caries is emphasized in

initial appointments.* 2. QUADRANT dentistry is one of the main

emphasis points. 3. Accurate plan for restoration* 4. Appliances will be left until after all

operative has been completed in that arch.

5. The recall period of 3 to 6 months.*


or wrongly planned

restoration for 4 teeth or more

Complete all critical steps (*)

but wrongly planned

restoration for not more than

3 teeth

Complete all critical steps (*) and non critical and currently

planned all restorations

6

5.Behavior guidance: TSD, distraction, positive reinforcement, voice control

Uses none Uses 1 or 2 Uses 3 or more 1

6. Presenting the case to Parents (*) - Disclosing sufficient informative using radiographs, photographs, study 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*


Complete only critical steps (*)


critical steps*,

3

7. Time * > 180 min 60– 180 min < 60 min 2

Form 3.1

13

Pediatric Dentistry Division

Clinical Competency Examination Evaluation Form

Total Mark /40

Steps and procedures

Instructor Evaluation

Weight Mark 0

Not Competent

I

Competent

2

Proficient

1. Diet Evaluation

Information from the parent is accurately taken

Quality of food intake by patient was identified and described to the patient / parent. *

Cariogenic potential of the patient’s diet was

One or more Critical mistakes

(*)

Critical steps are completed

(*)

Critical steps (*) and all other

steps are completed

3

Form 3.2

14

Diet Evaluation

identified and described to the patient /parent. *

2. Recommendation to patient and parents

5 food groups was explained using the pyramid *

Recommended amounts for the child to improve nutrition

Cariogenecity of the diet was explained * Instruction about sweetened or fuzz beverages

was given Instruction about sticky solid CHO including

fruits was given * Safe snacks was suggested properly * Time for sweets intake was suggested * Encourage brushing after sweets *


(*) recommendation

is given only to the parents

Critical steps are completed

(*)

Critical steps (*) and all other

steps are completed ,

used pictures and supplied the parents

with the guide to good eating

4

3. Behavior guidance

TSD, positive reinforcement Uses none Uses 1 Uses 2 1

4. Time * < 10 minutes 10-20 minutes > 20 minutes 2

Total Mark /20

15


Formocresol Pulpotomy


Weight Mark 0

Not Competent 1

Competent 2

Proficient

1. Rubber Dam One quadrant is exposed Floss tight to clamp Allow patient breathing

Only 3 teeth are exposed, seepage

of fluids, clamp unstable

A quadrant is exposed, follow

all criteria

All criteria plus: Rubber dam is reverted and frame is not

deviated

1

2. Access and deroofing a. Complete removal of caries* b. Proper opening for access. All pulp

horns are uncovered and are readily accessible.

c. Complete removal of the coronal pulp tissue *

d. No perforation* e. Hemorrhage control *

One or more of the Critical

mistakes (*) present

Excessive bleeding

Complete removal of caries and

pulp tissue but with over

extension or sharp edges.

Slight Bleeding on removal of the wet cotton

pelete.

Complete removal of caries pulp tissue with

proper access and extension.

No signs of

Hemorrhage

4

3. Formocresol fixation and temporary restoration

Slightly damped 5 minutes Pellet removal Placement of ZOE temporary

Cotton pelete do not cover the

pulp stumps or use peletes soaked with

formocresol or without fixation

or improper consistency for

ZOE

Follow the steps but

slight bleeding on removal of the pelete, or slight soft ZOE

mix.

Follow the steps with fixation and firm consistency

of ZOE

2

4. Behavior Guidance TSD, distraction, positive reinforcement, voice control


5.Time * More than 120

min 30 min – 120

min Less than 30 min 2

Total Mark /20

Form 3.3

16


Stainless Steel Crown


Weight Mark 0

Not Competent 1

Competent 2

Proficient

1. Rubber Dam One quadrant is exposed Floss tight to clamp Allow patient breathing

Only 3 teeth are exposed, seepage

of fluids, clamp unstable

A quadrant is exposed, follow all criteria

All criteria plus: Rubber dam is reverted and frame is not

deviated

1

2. Tooth Preparation and caries removal a. Occlusal Reduction*

1-1.5mm compared to adjacent teeth Follows original anatomy

b. Proximal Reduction:* Break contacts Are covergent to occlusal/incisal End in feather-edge margin No Ledges *

c. Buccal Lingual Surfaces Bevel Removes sharp cusp tips and

roundation of line angles Bevel occlusal 1/3 of buccal and

lingual d. Complete Caries Removal* e. Avoid Damage to Adjacent Teeth *

Mistake in one or more of the

critical steps (*)

Complete only the critical

steps(*) but not all other

steps

Complete all critical (*) and

other steps 3

3. SSC Adaptation* Crown leveled with adjacent teeth * Original Contacts restored * No extensive blanching Margins 1mm subgingivally and

form smooth curve* Difficult to seat and remove No gaps at margins* Proper occlusion *


(*) e.g. under extended

margins, the bite is opened

Only critical steps are

completed (*) but with

slight blanching

All critical steps (*) and other

steps are completed

without blanching

3

4. Cementation/Restoration: Crown seated in correct position

bucco lingually Properly remove remaining cement Adequately produced

proper contact* Proper occlusion*

One or more Critical mistakes (*) e.g. open bite

All critical steps are

completed (*) SSC: but

some cements on the crown

All critical steps (*) are

completed 1

5.Behavior guidance: TSD, distraction, positive reinforcement, voice control


6.Time * > 120 min 80 – 120 min < 80 min 1

Total Mark /20

Form 3.4

17


Local Anesthesia


Instructor Evaluation

Weight Mark 0

Not Competent

1

Competent

2

Proficient

1. Behavior

TSD, positive reinforcement, voice control, distraction

Explain the procedure * Did not instruct the patient to close his

eyes Describe the feeling *


(*)

All critical steps are completed (*)


steps are completed

1

2. Pre-operative procedure

Proper positioning of the patient (supine)* 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*


(*)



steps are completed

1

3. Procedure & Effectiveness

Establish a firm hand rest during the injection

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*


(*)



steps are completed

3

Total /10

Form 3.5

18


Student name ……………………….…….……..………….…………………………………………….

Pre-requisite - 1Treatment Planning ______ yes ______ no

Clinical competency exam for Treatment Planning

Patient name …………………………………………. File # ……………………………… date ……………………. Instructor name & signature ………………………………………….……

Pre-requisite - 1Diet Evaluation ______ yes ______ no Clinical competency exam for Diet Evaluation

Patient name …………………………………………. File # ……………………………… date ……………………. Instructor #1 name & signature …………………..……………………………………………………………………………………

Pre-requisite - 1Formocresolpulpotomy ______ yes ______ no

Clinical competency exam for Formocresol Pulpotomy

Patient name …………………………………………. File # ……………………………… date ……………………. Instructor #1 name & signature …………………..…… Instructor #2 name & signature …………………..……

Pre-requisite - 1Formocresolpulpotomy ______ yes ______ no

Clinical competency exam for Stainless Steel Crown


Pre-requisite - 1 Local Anesthesia ______ yes ______ no

Clinical competency exam for Local Anesthesia


Form 3.6 Student's copy Competency

Exam

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4. MPE Evaluation Forms

20


Minimal Procedural Experiences (MPE) Evaluation Form Examination & Treatment Planning

5th yr

6th yr

Ethical conduct and professionalism

Yes

No

Student shows respect towards staff, patients, and colleagues, student follows faculty directions, student wears appropriate professional attire, presents only his/her work (no cheating)

Infection control Yes

No

Surfaces are clean, no visible littering, disinfected, properly wrapped

Communication skills

Yes

No

Student communicates efficiently with patient and instructor using clear words and logical sequence

Knowledge Yes

No

Student knows the principles of the procedure and answers instructor’s questions correctly with justification

Clinical Procedure Evaluation: 0 = incompetent, 1 = competent, 2 = proficient


Weight Student self-evaluation Instructor evaluation

Feedback NA 0 1 2 NA 0 1 2

1. History and personal data * 2

2. Examination* 4

3. Radiographic Diagnosis * 2

4. Treatment Planning* 6

5. Behavior Guidance 1

6. Presenting the Case to Parents * 3

7. Time* 2

Note: - Steps with (*) marks are CRITICAL STEPS. This clinical procedure will not be considered an MPE if you score ZERO

in any one of them - Detailed criteria of evaluation of each clinical step are found in the corresponding RUBRIC

Accepted as MPE Faculty Stamp and Signature Date

Student Name Patient’s File No. Computer No. Pre-op approval

Form 4.1

21

Yes

No

Pediatric Dentistry Division Minimal Procedural Experiences (MPE) Evaluation Form

Oral Hygiene Instruction

5th yr

6th yr


Yes

No



No



Yes

No


Knowledge Yes

No

Student knows the principles of the procedure and material selection and answers instructor’s questions correctly with justification





1. Use Model * 2

2. Technique description to child and parent *

4

3. Parents Instruction* 3

4. Behavior * 1

Note:

- Steps with (*) marks are CRITICAL STEPS. This clinical procedure will not be considered an MPE if you score ZERO in any one of them

- Detailed criteria of evaluation of each clinical step are found in the corresponding RUBRIC


Yes

No

Student Name Patient’s File No. Computer No. Pre-op approval Serial No.

Form 4.2

22


Prophylaxis and Topical Fluoride Application

5th yr

6th yr


Yes

No



No



Yes

No


Knowledge Yes

No






1. Prophy 1

2. Fluoride* 2

3. Behavior guidance 1

4. Time for Fluoride* 1




Yes

No


Form 4.3

23


Rubber Dam Isolation

5th yr

6th yr


Yes

No



No


Communication skills Yes

No


Knowledge

Yes

No Student knows the principles of the procedure and material selection and answers instructor’s questions correctly with justification





1. Rubber Dam Preparation * 1

2. Procedure* 2


4. Time * 1




Yes

No


Form 4.4

24


Local Anesthesia

5th yr

6th yr


Yes

No



No



No


Knowledge Yes

No






1. Behavior * 1

2. Pre-operative procedure * 1

3. Procedure & Effectiveness* 3




Yes

No

Student Name Patient’s File No. Computer No. Pre-op approval Serial No. Quadrant/Tooth No.

Form 4.5

25


Fissure Sealant

5th yr

6th yr


Yes

No



No



No


Knowledge - Etching time and

steps - Bonding under

sealant

Yes

No


Effective Local Anesthesia

Yes

No

Patient experiences, no pain or discomfort during different procedures





1. Rubber Dam/Cotton rolls 1

2. Prophylaxis 1

3. Sealant Application * 1


5. Time * 1




Yes

No

Student Name Patient’s File No. Computer No. Pre-op approval Serial No. Tooth No.

Form 4.6

26


Preventive Resin Restorations

5th yr

6th yr


Yes

No



No



No


Knowledge - Acid etching steps

and Technique

Yes

No



Yes

No






1. Rubber Dam 2

2. Prophylaxis and caries removal * 3

3. Restoration and sealant application * 3


5. Time * 1




Yes

No


Form 4.7

27


Minimal Procedural Experiences (MPE) Evaluation Form Cavity Preparation and Restoration

5th yr

6th yr

Cavity Prep: Class I Class II Class III Class V

Type of restoration: Amalgam Composite G.I. Temporary


Yes

No



No



No


Knowledge Yes

No



Yes

No






1. Rubber Dam 1

2. Cavity Design and caries removal * 3

3. Gingiva or adjacent tooth are undamaged 1

4. Restoration* 2


6. Time* 2




Yes

No


Form 4.8

28


Stainless Steel Crown/Strip Crown/Class IV Permanent

5th yr

6th yr

Type of restoration: SSC Strip Crown Class IV


Yes

No



No



Yes

No


Knowledge Yes

No



Yes

No Patient experiences no pain or discomfort during different procedures


Steps and procedures Weight Student self-evaluation Instructor evaluation


1. Rubber Dam 1

2. Tooth Preparation and caries removal* 3

3. SSC /CSC adaptation * 3

4. Cementation* /Composite restoration * 1


6. Time* 1




Yes

No


Form 4.9

29


Formocresol Pulpotomy

5th yr

6th yr


Yes

No



No



Yes

No


Knowledge Yes

No



Yes

No






1. Rubber Dam 1

2. Access and deroofing* 4

3. Formocresol Fixation and temporary restoration

2


5. Time* 2




Yes

No


Form 4.10

30


Extraction of Primary Teeth

5th yr

6th yr


Yes

No



No



Yes

No


Knowledge Yes

No



Yes

No






1. Pre-operative Precautions * 2

2. Procedure * 5

3. Post operative Instruction* 2





Yes

No


Form 4.11

31


Diet Evaluation

5th yr

6th yr


Yes

No



No



No


Knowledge Yes

No

Student knows the principles of the procedure and answers instructor’s questions correctly with justification





1. Diet Evaluation * 3

2. Recommendation to patient and parents *

4


4. Time * 2




Yes

No


Form 4.12

32


Space Analysis

5th yr

6th yr


Yes

No


Knowledge Yes

No



Steps and procedures Student self-evaluation Instructor evaluation


1. Time *

2. Case Selection

3. Teeth measurements *

4. Detect space deficiency *




Yes

No


Form 4.13

33


Space Maintainers I (Band/s Selection and Impression)

5th yr

6th yr

Appliance: Band and Loop Lingual Arch Nance TPA


Yes

No



No



Yes

No


Knowledge Yes

No




Weight Student self-evaluation Instructor evaluation Feedback

NA 0 1 2 NA 0 1 2

1. Band/s Selection 3

2. Impression and Band Placement 3


4. Time * 2




Yes

No


Form 4.14

34


Minimal Procedural Experiences (MPE) Evaluation Form Space Maintainers II (Appliance Fitting and Cementation)

5th yr

6th yr

Appliance: Band and Loop Lingual Arch Nance TPA


Yes

No



No



Yes

No


Knowledge Yes

No



Steps and procedures Weight

Student self-evaluation Instructor evaluation


1. Appliance fitting (General) * 3

2. Appliance fitting 3

3. Cementation * 2


5. Time* 1




Yes

No


Form 4.15

35

5. Other Forms

36

ARABIC CONSENT FORM

االووقائي قسمم علوومم ططبب االأسنانن جامعة االملكك عبدد االعززیيزز فاللططبب االأطط شعبة ططبب االأسنانن كلیية

------------------------------------------االى وولي اامرر االططفلل االصحي االتارریيخ

.حدد علمي االأسئلة على جمیيع أأجبتت عنن لقدد ووفعالة. بططرریيقة آآمنة لتووفیيررعنایية أأسنانن لططفلي ضرروورريي االصحي االتارریيخ ااني أأعي بأنن

أيي تغیيیيرر ب أأخططرركمم ووسووفف. ططفلي عنن كلل ما تحتاجوونھه أأنن تسألوواا ططبیيببفاني آآذذنن لكمم مززیيدد منن االمعلووماتت٬، ااذذاا كانتت ھھھهناكك حاجة إإلىبالعلاجج. ددوویيتھه قبلل االبددءأأ وو ووضع ططفلي االصحي في

علاججاال خططة _________________٬، وواالتي تتضمنن: ططفلي ططبیيبب أأسنانن االتي ااقتررحھها خططة االعلاجج تماما أأفھهمم ااني

____________________________________________________________

____________________________________________________________

ووأأنا . االلتي قدد تتررتبب على االعلاججاالمضاعفاتت االمشاكلل االمحتملة وو٬، فضلا عنن عامة علاججاال ااعتباررااتتمناقشة خططة االعلاجج شررحتت لي لا تقتصرر على: تشملل٬، وولكنھهااالمشاكلل قدد وو االمضاعفاتت االمحتملة أأفھهمم أأنن

____________________________________________________________

____________________________________________________________

ااني . االعلاجج االشاملل لضمانن نجاحح إإضافي أأوو بددیيللفي االمستقبلل٬، قدد تنتج ظظررووفف تستددعي علاجج االعلاجج٬، وو أأثناء ووبعدد بأنھه ااني أأعيإإلى سارریية االمفعوولل ھھھهذذهه االموواافقة. لططفليمصلحة في أأنھه شعررتمم إإذذاااالموواادد االمستخددمة االعلاجج أأوو في أأيي تعددیيلاتت أأعططیيكمم االموواافقة على

.صووررةة كتابیية في ما أألغیيھها أأجلل غیيرر مسمى

منن جانبي. االمتفقق علیيھه االمووصى بھه وو االعلاجج لأددااء جمیيع منن االمووظظفیينن االمعیينن أأوو االشخصص ططفلي ططبیيبب أأسنانن أأفووضض

ووأأنا أأفھهمم. ھھھهذذاا االنمووذذجج محتوویياتت ووددررااسةقررااءةة كاملة لاالفررصة اال٬، _____________________________٬، قدد أأتیيحتت ليمع االعلمم اانن لأغررااضض تعلیيمیية. االصحیيةمعلووماتھه فاني موواافقق على علاجج ططفلي وو ااستخدداامم ھھھهذذاا االنمووذذجج منن خلالل تووقیيعي على أأنھه

منن االززیياررااتت لاكمالل علاجھه. ----------------االططبیيبب قدد ااخبررني اانن االعلاجج یيحتاجج االى عدددد

____________________ االتارریيخ ____________________٬، یيعاالتووق

Form 5.1


preventive dental sciences department pediatric dentistry

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