Dr. Wood and the Pediatric department have organized the rotation to be very efficient and orderly. You, as a student doctor, should come to the pediatric clinic equally as prepared and organized. Organization and a little studying (reviewing) before each day will benefit your experience tremendously. Be sure to review the Orientation handout you receive the first day of this rotation. Every day, each student doctor works under the supervision of a Dental Auxiliary Utilization (DAU) assistant and a Pediatric Specialist. The faculty and staff are awesome and will teach you a lot. Don’t be scared, have fun, smile, and learn something new each day.
Overview of Rotation
The first two rotations are two weeks long, alternating morning and afternoon clinic sessions. The third rotation is one week long and includes both the morning and afternoon session each day. (No seeing “main clinic” patients during the days, so consider night clinics for your regular patients if possible). The first couple of days, during your first rotation, have been designed to gradually introduce you to the ways of the pediatric clinic and make you comfortable to see your young patients.
The pediatric clinic stresses student preparedness prior to the patient appointment. What can you do to be prepared?
- Review any PD240 topics that are relating to the treatment you are expected to do for your patient.
- Review the patient record completely (read their full history at the clinic), do not just look at previous visit
- Research any medical conditions or medications that your patient is taking and have an understanding as to how that might relate to your treatment.
- Review the proposed treatment for the day and decide if you agree with it. Be prepared to discuss your treatment rational with the faculty.
Rotation 1 (7th quarter)
- Day 1 Orientation with Dr. Wood
- DAU (Dental Auxiliary Utilization) assistant Chairside Orientation
- Review proper ergonomics and chair position
- Anesthesia Demonstration
- Introduction to Patient Charts and Patient Presentation Worksheet (PPW)
- Homework assignment to draw prep designs, review restoration of preps and sequencing
- Day 2 Turn in prep designs, discuss restoration & sequencing with your instructor (graded competency)
- Practice ergonomics and tooth preparations on YOUR pediatric typodont.*
- Class II Prep
- Stainless Steel Crown
- Infection Control
- Review Dental Chart/ PPW of FIRST patient!
- Days 3-9 See patients and be a pediatric student doctor!
- Day 10 Group Seminar
- Reflection write-ups due to Dr. Wood at least 24 hours before your seminar. Please check Canvas for form and examples.
- DAU Evaluations
- Each student gives a brief presentation on their most interesting case for the week.
Rotation 2 (8th quarter)
- Day 1-9 See patients and be a pediatric student doctor!
DAU quiz on “Dental Team Concepts” handout and dental auxiliary instruction.
- Day 10 Same as Rotation 1
What to bring (on the first day) Loupes, pediatric typodont, gown from Main Clinic
Patient Presentation Worksheet (PPW)
A worksheet that must be filled out for each patient. You should fill out as much information as possible PRIOR to the appointment. All information to complete the form is within patient axiUm chart or obtained by interviewing the guardian/patient the day of the appointment. The purpose of the PPW is to orient and prepare you for each patient. (i.e. Health history, dental management, dental history, patient behavior, treatment plan). If you have trouble finding information or need help ASK a faculty member or DAU assistant for help.
New Patient Exam
For each new patient brought to our pediatric clinic, TWO separate appointments are necessary.
- ODTP appointment
- Prevention/Prophy/Fluoride appointment (plus possible treatment)
The ODTP, Recall and Prevention Appointments
For the ODTP,/Recall/Prevention Appointment you will be provided with an “Appointment Procedures” handout which guides you through the appointment step-by-step. As reminders, these handouts are laminated and posted in each cubicle for you.
ODTP Appointment Overview
1. Before clinic, review patient chart & complete PPW. Review the diagnosis and treatment planning section of the PD240 manual.
2. In reception area, confirm that the adult is a parent/court-appointed legal guardian, update the medical history with the parent, record medical history, update the axiUm record, and have the parent sign the update In the axiUm record at the conclusion of the appointment. If you plan on taking x-rays, you must ask the parent for permission to take the x-rays.
3. In the clinic, do a quick intraoral exam. Use the quick intraoral exam to figure out which teeth are permanent vs. primary, which teeth are erupting, and which teeth are mobile. Be prepared and know your eruption sequence and which teeth you expect to see in the mouth based on your patient’s age before you come to clinic.
4. Start check with the Pediatric faculty. Review the PPW and be prepared to tell your faculty what radiographs you think are necessary. If the faculty is not available, start the soft & hard tissue charting until the faculty is available.
5. Take radiographs (if needed). While your assistant develops them, begin or complete the soft tissue exam (white form), and the hard tissue charting treatment plan worksheet (yellow form).
Clinic Tip: When taking x-rays, remember the Tell-Show-Do technique to make sure that your patient is comfortable with the x-ray sensor in his/her mouth before you place it there. Patients also get a sticker after taking x-rays.
6. Review radiographs and determine the appropriate treatment plan.
Clinic Tip: Remember, always treatment plan a stainless steel crown if the marginal ridge is broken down, or the decay extends beyond the proximal line angles.
7. Call over the faculty for a final check to review hard tissue exam, radiographs and treatment recommendations and sequencing. Your DAU assistant will enter the final treatment In the axiUm record. Now is your patient’s chance to get something from the toy chest!
8. Present the treatment plan to your patient’s parents in the operatory or the prevention room. Make sure to explain the treatment and the sequence. Explain that the treatment and fees may change based on the child’s intraoral condition, but that the parent will be consulted before any other treatment is rendered.
9. Have the parent sign the treatment plan In the axiUm record.
10. Take the parent to the front desk to handle payments and scheduling the next appointment.
11. Return to the operatory to disinfect and prepare for your next patient!
Clinic Tip: Remember, the appointments are only 1 hour long, so you must be prepared mentally and be efficient with your time.
Prevention Appointment Overview
This is the second appointment for a new patient of the pediatric clinic. The goal of this appointment is to teach patient and parent about nutrition, diet, decay process, effective home preventive care. This appointment lasts about 20 minutes and takes place in the special Prevention area. (Following the prevention session, you may be treating the patient in that same clinic period, depending on the patient’s treatment plan.)
Topics you will discuss are:
- Perio disease/ Caries Process
- Disclosing/ Plaque Index Record
- Brushing / Flossing Instruction
- Specific prevention treatment plan developed for your patient
There is an initial prevention plan the axiUm records that you can use as an outline.
Recall Appointment Overview
The recall appointments are similar to the ODTP appointment except that the patient is a patient of record, and you must also clean his/her teeth and give a fluoride treatment. You will do this after you have decided on a tentative treatment plan and sequence. Here are the steps to keep you on track (see
the ODTP appointment protocol for more details):
Complete a PPW.
- Interview the parent in reception area.
- Quick intraoral exam.
- Start check with faculty. Review PPW and tell faculty what radiographs are needed. Take the radiographs.
- Complete Hard Tissue Charting.
- Review radiographs, propose a treatment plan and sequence.
- Disclose the patient’s teeth and record a plaque index.
- Give oral hygiene instruction (OHI). Use the toothbrush to demonstrate the proper brushing technique and also floss the patient’s teeth.
- Remove any calculus and prophy your patient’s teeth.
- Confirm all plaque and calculus has been removed, then perform a topical fluoride treatment.
- The fluoride tray should stay in place for 1 minute, with the patient holding the suction “Mr. Thirsty” in between the trays.
- Now you are ready to call over the faculty for the final check.
- Present treatment plan to the parent.
- Have the parent sign the treatment plan in the axiUm record.
- Take the patient to the front desk for payment and appointment scheduling.
- Return to disinfect the operatory.
- Clinic Tip: Make sure your patient is upright when you give them the fluoride tray, and be sure to insert the saliva ejector between the trays After treatment, remember to tell the patient not to eat, drink or rinse for 30 minutes, and then reiterate this to the parents.
Each restorative procedure is explained in the Pediatric Course Manual (PD240), so review each pertinent procedure the night before your appointment. You should be prepared to discuss the procedure with your faculty and demonstrate that you understand the course material.
Dr. Seth Reder’s (Class of 2005) Helpful Hints!
When a patient is misbehaving I like to say to the patient in a polite tone, “Johnny/ Jane this is not how boys/girls your age usually act. You’re a big boy/girl, right? Can you show me how boys/girls your age should act?” —This phrase may seem funny; but I really find it effective. Be confident and honest with your patient. Preparation prior to procedures precipitates confidence.
A DAU assistant will be with you for every procedure. They have a lot of knowledge, experience, and are tremendously helpful. Be very respectful to them and don’t forget to say “thank you!” The faculty and DAU assistants will be grading you on ergonomics, so be mindful of your seating position, your movements and the four-handed dentistry principles. Make sure to review the handouts you are given the first day of the rotation. They explain everything in detail and there is even a cheat sheet for drawing your homework assignment on the first day! Note: Your pediatric course manual (PD240) and handouts are an essential resource for diagrams, flow charts, pictures, and other information to refresh your mind about the various procedures performed in our clinic! Review them the night before.