Partnerships: Calibrating Novice to Advanced Instrumentation

Transcription

1 Earn 3 CE credits This course was written for dentists, dental hygienists, and assistants. Partnerships: Calibrating Novice to Advanced Instrumentation A Peer-Reviewed Publication Written by Sharon L. Mossman, RDH, Ed.D Abstract Oral health has emerged as a nationwide concern. With our changing healthcare system, we need to explore various avenues to provide effective preventive health services and programs. Collaboration with healthcare professionals can facilitate this initiative by expanding access to dental care. Dental hygienists in community healthcare facilities can work with dental education programs to broaden oral health services. In order to align educational goals and effective patient treatment, constructive assessment tools and formal training are needed to meet our community s oral care demands. This course provides steps to implementing standardized efficient assessment and offers a guide to initiating a collaborative program with local healthcare facilities in your community. Educational Objectives At the conclusion of this educational activity participants will be able to: 1. Identify collaborative community initiatives that can improve patient care. 2. Implement a teaching protocol that encourages a multifaceted clinical experience enhancing dental hygiene students performance. 3. Design an assessment tool that calibrates students clinical evaluations at extramural clinics. 4. Employ basic and advanced instrumentation techniques to improve clinical performance. Author Profile Sharon L. Mossman, RDH, Ed.D is a clinic supervisor/faculty in the Department of Dental Hygiene at Delaware Technical Community College in Wilmington, Delaware. She has over 30 years of experience in the areas of clinical practice, education and research. She has been awarded The Excellence in Teaching Award through Delaware Technical Community College (2013); The Office of Women in Higher Education Rising Star Award (2011); and the Delaware Dental Hygienists Association Community Service Award (2011). Passionate about community service, she has participated in Operation Smile Vietnam (2008, 2009) and Remote Area Medical (2010). Mossman has several published articles in dental hygiene literature. She may be contacted at smossman@dtcc.edu. Author Disclosure Sharon L. Mossman, RDH, Ed.D has no commercial ties with the sponsors or providers of the unrestricted educational grant for this course. Go Green, Go Online to take your course Publication date: May 2015 Expiration date: April 2018 Supplement to PennWell Publications PennWell designates this activity for 3 continuing educational credits. Dental Board of California: Provider 4527, course registration number CA# This course meets the Dental Board of California s requirements for 3 units of continuing education. The PennWell Corporation is designated as an Approved PACE Program Provider by the Academy of General Dentistry. The formal continuing dental education programs of this program provider are accepted by the AGD for Fellowship, Mastership and membership maintenance credit. Approval does not imply acceptance by a state or provincial board of dentistry or AGD endorsement. The current term of approval extends from (11/1/2011) to (10/31/2015) Provider ID# This educational activity was developed by PennWell s Dental Group with no commercial support. This course was written for dentists, dental hygienists and assistants, from novice to skilled. Educational Methods: This course is a self-instructional journal and web activity. Provider Disclosure: PennWell does not have a leadership position or a commercial interest in any products or services discussed or shared in this educational activity nor with the commercial supporter. No manufacturer or third party has had any input into the development of course content. Requirements for Successful Completion: To obtain 3 CE credits for this educational activity you must pay the required fee, review the material, complete the course evaluation and obtain a score of at least 70%. CE Planner Disclosure: Heather Hodges, CE Coordinator does not have a leadership or commercial interest with products or services discussed in this educational activity. Heather can be reached at hhodges@pennwell.com Educational Disclaimer: Completing a single continuing education course does not provide enough information to result in the participant being an expert in the field related to the course topic. It is a combination of many educational courses and clinical experience that allows the participant to develop skills and expertise. Image Authenticity Statement: The images in this educational activity have not been altered. Scientific Integrity Statement: Information shared in this CE course is developed from clinical research and represents the most current information available from evidence based dentistry. Known Benefits and Limitations of the Data: The information presented in this educational activity is derived from the data and information contained in reference section. The research data is extensive and provides direct benefit to the patient and improvements in oral health. Registration: The cost of this CE course is $59.00 for 3 CE credits. Cancellation/Refund Policy: Any participant who is not 100% satisfied with this course can request a full refund by contacting PennWell in writing.

2 Educational Objectives At the conclusion of this educational activity participants will be able to: 1. Identify collaborative community initiatives that can improve patient care. 2. Implement a teaching protocol that encourages a multifaceted clinical experience enhancing dental hygiene students performance. 3. Design an assessment tool that calibrates students clinical evaluations at extramural clinics. 4. Employ basic and advanced instrumentation techniques to improve clinical performance. Abstract Oral health has emerged as a nationwide concern. With our changing healthcare system, we need to explore various avenues to provide effective preventive health services and programs. Collaboration with healthcare professionals can facilitate this initiative by expanding access to dental care. Dental hygienists in community healthcare facilities can work with dental education programs to broaden oral health services. In order to align educational goals and effective patient treatment, constructive assessment tools and formal training are needed to meet our community s oral care demands. This course provides steps to implementing standardized efficient assessment and offers a guide to initiating a collaborative program with local healthcare facilities in your community. Instrumentation The Work Oral health is essential to overall health. As our healthcare system continues to change; we face greater demands to combat dental disease and maintain good oral health. Oral health is essential to our quality of life. A healthy dentition supports self-esteem, speech, mastication and a healthy diet. Social determinants impact the oral health of many people. A report by the U.S. Surgeon General recognizes that our nation faces a public health problem due to the lack of access to dental care. Preventive interventions remain a challenge for our communities. The Department of Health and Human Services has indicated that reducing disparities in access to effective preventive oral health services and programs will significantly improve the oral health of Americans. As dental hygienists, it is our professional responsibility to educate our patients and help them preserve their oral health. How do we meet this professional challenge? 1 Outreach programs and collaboration with healthcare professionals can broaden our scope of care. Providing dental services in hospitals, nursing homes and child care centers are avenues to meeting our community s needs. The Commission on Dental Accreditation encourages clinical enrichment experiences for dental hygiene students. These experiences enhance basic clinical education at extramural clinical facilities. However, faculty shortages and time constraints present educational challenges. Licensed dental hygienists can provide instructional support to dental programs by supervising students in affiliated institutions. This collaboration can expand access to care for individuals who face healthcare barriers. 2 Establishing Program Goals Collaboration with community healthcare providers requires developing goals and objectives that meet the needs of all program partners. Establishing a protocol that can be implemented consistently and objectively can facilitate a valuable program that assists dental educators, students, healthcare institutions and patients. Educational programs have clinical requirements that help to develop dental hygiene students skills. These skills can be improved through instructional guidance at extramural facilities. The challenge with utilizing multiple clinical sites is instituting a uniform format for evaluation. When a formal assessment process can be implemented and applied to various clinical situations, the students and the community benefit. In order to undertake a multifaceted clinical experience for students, educators must design an assessment tool with specific evaluation criteria that is objective and easy to use. 3 Creating a clinical rubric with specific criteria that assists supervisors with the assessment will help to clarify the grading scale. An adjustable scale based on the level of student competency should be incorporated into the assessment tool to equate clinical experience. Performance expectations need to be clearly defined within the rubric. The rubric should be comprehensive with guided objectives that designate acceptable levels of performance. The evaluation criteria should be precise to alleviate misinterpretation of expected outcomes, (Figure 1). 4 Formal training for clinical supervisors needs to be provided to regulate the evaluation process. A reliable process needs to be established to calibrate the application of the guidelines among faculty, supervisors and students. Each step that requires assessment of the learner s competence must be predetermined, standardized and communicated to everyone in the evaluation process. Vague or poorly written objectives create subjective assessment obstacles that impact learning outcomes. The assessment tool should be designed to offer specific, immediate feedback. Training of evaluators should emphasize systematic measures that ensure uniform application of the assessment tool. When an equitable assessment process can be implemented by several different instructors, the student benefits from various perspectives of patient treatment. 5 Calibrating Your Assessment Calibrating the use of the rubric is crucial to maintaining a valid evaluation process. Calibration helps raters determine an acceptable range of competence based on benchmark criteria. Evaluators can maintain consistency in grading when training is ongoing and held at regular intervals. Different instructors can rate the same performance within a prescribed range of acceptability. This is essential in order to improve student learning. When evaluative inconsistencies exist among raters, 2

3 Figure 1 Student Name: Extramural Site/Date: Clinical Program Supervisor: Patient Name: Extramural Site Evaluator: Instrumentation Competency Tooth Range: Sextant/Quadrant (S) Clinically Acceptable (+1 point) (US) Standard Not Met (0 points) Calculus Detection Enter the tooth number and indicate the surface on that tooth where the calculus is located. M- Mesial F/B Facial/Buccal D- Distal L- Lingual Satisfactory Unsatisfactory Calculus Removal Competency Enter the tooth number and indicate the surface on that tooth where the calculus is located. M- Mesial F/B Facial/Buccal D- Distal L- Lingual Satisfactory Unsatisfactory Basic instrument dexterity and manipulation Fulcrum control Intraoral fulcrum Extraoral fulcrum Angulation Activation Coverage Basic Instrumentation Comments: S=1 US=0 Note tooth specific errors Tooth Number Surface Comments S=1 US=0 Tooth Number Surface Comments S=1 US=0 Directions: This rubric is used to determine completion of patient treatment with regards to calculus deposit removal. Calculus Detection: The tooth number should be entered into the designated box with a corresponding surface documented in the adjacent box. The student should identify the tooth number and surface with calculus accumulation. The evaluator will determine if detection has been documented correctly. This will be scored as satisfactory (for correct detection) or unsatisfactory (for incorrect detection). Calculus Competency Removal: Following scaling procedures, the calculus competency removal section will be completed by the evaluator. The tooth number and adjacent box will be used in the same manner as the calculus detection procedure. The evaluator will assess whether calculus has been completely removed (satisfactory) or if calculus is remaining (unsatisfactory). This form may be applied to patient cases with several different degrees of difficulty by utilizing it for sextant, quadrant, half mouth or full mouth debridement. The number of unsatisfactory errors will be calculated. The range of acceptable errors will be determined according to the level of clinical competency for the student. This form may be used for remediation purposes to offer debridement strategies. Completion of the scaling procedure will be determined on a graduated scale specified by the evaluator and affiliated institution. students become dissatisfied with their education, learner performance diminishes and ultimately patient care suffers. 6 Calibration can be a source of frustration for faculty members but it is essential to minimizing assessment variability. If consistent and reliable evaluation is lacking in the clinical environment, students become confused about acceptable levels of performance and progress towards competency is delayed. Novice learners are task-driven and depend on specific constructive feedback to improve their skills. They are unable to judge their own effort during performance due to a lack of knowledge. They rely on constant feedback but can become overwhelmed when evaluative analysis is inconsistent or vague. Formative evaluation should encompass verbal interactions that offer remediation strategies. A non-graded component to 3

4 Figure 2 Figure 3 Figure 4 the clinical experience complements the learning environment by offering a non-punitive aspect to assessment. It encourages problem solving and a student-friendly clinical atmosphere. 7 Evaluating Basic Instrumentation Concepts Preclinical instructions in dental hygiene schools focus on basic instrument design, proper instrument grasp, finger rest positions and fulcrum pivoting. Early clinical instruction teaches intraoral scaling fulcrums and maintaining a neutral hand-wrist-arm position during scaling in order to employ effective debridement results. Optimal debridement occurs with accurate instrument adaptation and blade activation (Figures 2, 3, 4). Clinical instruction teaches the fundamentals in instrumentation concepts that can be applicable to more advanced techniques when students are ready to diversify their skills. As students progress into productive careers, adhering to basic instrumentation concepts is important. 8 Providing a comprehensive rubric that is objective and provides helpful feedback to the students is most effective. This should be introduced in the preclinical setting in order to calibrate faculty and students with the assessment process. This same rubric can then be offered at extramural sites to calculate student progress and patient completion rates. A simple, easy to use rubric is the best approach to minimize subjectivity. It should include basic instrumentation techniques, identify the students assessment of calculus detection and distinguish the students effectiveness with calculus removal. The rubric is devised to address different levels of patient disease challenges. It may be implemented for full mouth scaling or sextant/quadrant scaling which will depend on the patient s periodontal status. This rubric may be implemented multiple times in order to facilitate patient completion. (Figure 1) This rubric may be used as a supplemental instructional tool at college-based clinics with additional evaluation tools utilized at the home clinical site. However, extramural sites may have their personal assessment process, so minimizing paperwork and improving student feedback may be the focus at these locations. Calculating patient completion rates to satisfaction may be the focus of this assessment tool. Modifications to the rubric may be applicable to individual programs. A graduated competency scale should be implemented with the assessment tool. As students progress through the clinical program, there should be an established delineation for error. This may be implemented by a point system (i.e. 1 for satisfactory; 0 for unsatisfactory) and averaged for a passing grade for a given clinical session. Or it may be implemented in a more detailed format and averaged with all sessions until the patient is completed. Basically, the same rubric may be used for multiple purposes. The dental hygiene program needs to establish how many errors are acceptable for passing and how many teeth should be completed based on the patient s dental history and the expected level of competency for the dental hygiene student. 4

5 Licensed dental hygienists offer real world experiences but may not meet educational methodology requirements for program accreditation approval. Therefore, workshops with extramural personnel to calibrate rubric implementation are important to validate extramural assessment and statistics. This may be applied in a variety of ways. It may be implemented to assess patient completion statistics or advise students about remediation strategies to improve clinical skills. 9 Progressing from Basic to Advanced Instrumentation Today s dental healthcare profession provides preventive, educational and therapeutic services which have improved our patients overall health. More adults have their full dentition due to an increased awareness of oral conditions and a decrease in carious lesions. However, many still suffer from periodontitis. Tooth retention can present multiple challenges even for the skilled clinician who may be faced with narrow periodontal pockets, furcations or other difficult anatomical conditions. Dental hygienists have an array of instruments from which to choose in order to provide optimal care but also need to consider ergonomic strategies that will help them continue in a productive career. 10 Advanced instrumentation techniques incorporate critical thinking strategies that consider various factors such as; tooth morphology, instrument selection, reinforced fulcrums and multiple stroke techniques. The overall goal of varying instrumentation techniques is effective deposit removal. These techniques can be taught to dental hygiene students as they progress through their clinical education. Multiple instrument designs offer various clinical options. It is important to adhere to basic scaling techniques that do not compromise the blade-tooth adaptation and a controlled working stroke when diversifying the students scaling approaches. Diversifying instrument selection and instrumentation techniques minimizes the number of strokes and the efficiency of lifting deposits off the teeth. Modifying techniques optimizes scaling performance while promoting occupational health and career longevity by reducing muscle fatigue and injury. 11 Anatomical Considerations and Instrument Design Anatomical considerations with periodontally compromised teeth include: insufficient furcation width, extensive root trunk length and/or limited bone support with possible mobility. All these conditions need to be considered in the treatment planning and overall periodontal prognosis. Dental hygiene students need to be trained in selecting instruments that adapt to the anatomical deviations and offer the best stroke control to access deposits for debridement. Calculus removal using hand-activation, sonic, magnetostrictive and piezoelectric instrumentation have produced positive results. Precision thin ultrasonic tips have been effective in accessing calculus in deeper pockets and furcation areas. Studies have shown that ultrasonic debridement also reduces the time needed for hand-activated instrumentation. This treatment plan strategy Figure 5 Figure 6 Figure 7 5

6 Figure 8 can reduce patient discomfort and clinician fatigue while still offering optimal patient care. 12 There are a variety of shapes and sizes of periodontal scalers and curettes that help hygienists navigate the mouth. The selection options may be overwhelming to dental hygiene students as they familiarize themselves with instrument choices. Each instrument is characterized by blade length and width, shank curvature and the location of the cutting edge. Other considerations are rigidity, handle size and weight of the instrument. Also, curette design may slightly differ from one manufacturer to another. These factors offer many options to provide patient treatment efficiently with more comfort for both the patient and the hygienist. When selecting an armamentarium, the hygienist needs to consider instrument type, anatomical challenges and the amount and consistency of the deposit. Dental hygiene faculty/supervisors can provide valuable guidance to students with instrument selection that can promote success in clinical performance. 13 With instrumentation, blade length and width play a significant role in areas with narrow pockets, root concavities, line angles and facial/lingual surfaces. The blade width encompasses both the frontal and lateral face of the tip and it is characterized by angles varying from degrees. The blade length is represented in several designs. Mini blades are half the length and 10 percent thinner than standard blades. Micro-mini blades are mini blades with a blade width that is 20 percent thinner. Mini blade designs are effective for deposit removal in furcation regions allowing access to tight concavities and leverage in stroke activation due to their thinner shape. 14 Blade angulation varies between universal curettes and beveled cutting edge designs. Universal curettes provide two straight parallel cutting edges and a blade face that is at a 90 degree angle. This is time-efficient for patient treatment and effective in a variety of clinical situations. Gracey designs feature the offset face of the blade with a lower cutting edge. This unique design offers easy access to periodontal pockets with minimal tissue distention. Shank extension and curvature also play a significant role in instrument selection. Shorter shanks are designed for shallow pockets while longer shanks improve access to deeper areas. Shank curvature offers alternative fulcrum choices while still maintaining a terminal shank that is parallel to the long axis of the tooth. Blade activation can be applied with adequate wrist motion and permits the use of multidirectional strokes to remove 15, 21 deposits and root plane surfaces. Instrument Selection Student instrument kits typically offer a variety of instrument types. When academic programs collaborate with extramural sites, students should have access to instrument designs with which they are familiar. As they progress through their clinical experience, new instruments can be gradually incorporated. Monitoring blade adaptation is crucial as new instruments are introduced. Intraoral finger rests ideally allow correct positioning of the lower shank to the tooth and adequate wrist motion. However, complicated periodontal cases may compromise proper blade adaptation with intraoral fulcrums when there are furcationally-involved teeth, deep pockets or developmental anomalies. Advanced fulcrum techniques can be used to preserve fundamental scaling concepts and maintain a neutral wrist position that reduces muscle strain and offers optimum blade activation. 16 The dental hygiene student should first select curettes that are tailored to the needs of the patient. Patient cases that have moderate to heavy calculus would benefit from ultrasonic scaling, rigid shanks and a broad spectrum of blade designs. A varied armamentarium will help the clinician alternate working strokes between smaller powerful pull strokes for calculus removal and lighter lateral pressure to smooth root surfaces. When intraoral fulcrums compromise ideal blade adaptation and a neutral wrist position, advanced finger rest positions may be implemented. These may include opposite arch fulcrums, cross arch fulcrums, finger on finger stabilization and basic extraoral hand/finger positions. Students will need assistance with implementing these advanced techniques into their clinical experience. Formative assessment in a grade-friendly format will encourage student performance and clinical competence in diversifying effective techniques. 17 Alternative Fulcrum Techniques Figure 5 demonstrates the use of the opposite arch fulcrum concept for the mandibular right quadrant. A firm fulcrum in the maxillary arch allows the instrument shank to be parallel with the mandibular posterior tooth and offers leverage for the working stroke and proper blade activation. The clinician sits at the 10 to 11 o clock position to stabilize the fulcrum and improve the line of vision. A cross arch fulcrum can be implemented when limited opening is an obstacle in generating the stroke motion. Additionally, when working in the mandibular arch where accessibility is a challenge, standing may improve the clinician s visibility and blade adaptation. 18 Finger on finger stabilization may also be an option to reinforce fulcrums (Figure 6). The non-dominant hand may assist 6

7 the dominant hand during scaling. This may be accomplished by having the non-dominant index finger support and guide the instrument shank. Increased stability and control enhances the working stroke, thus strengthening lateral pressure and improving calculus removal. This finger assist strategy secures instrument control and reduces the chance of instrument slippage. 16 Another obstacle that clinicians face is limited wrist motion due to an anatomical situation. When ideal blade adaptation and angulation are difficult to achieve with intraoral fulcrums, extraoral fulcrums may offer a viable solution to enhance scaling procedures. Extraoral fulcrums can offer stability by maximizing the surface area and they allow for an extended grasp of the instrument handle. Implementing extraoral fulcrums into clinical education should be done only after students have grasped the basic concepts of instrumentation. Extraoral fulcrums shift the fulcrum pressure from the tooth to pressure against the face in order to maintain stroke control. Instrumentation of maxillary molar regions can be difficult when patient/ operator positioning is compromised or there are soft tissue interferences. Clinicians often compensate for limited wrist motion by using a finger-flexing activation that separates the finger grasp from the intraoral fulcrum. This results in a less powerful stroke minimizing control of the instrument. 19 Figure 7 demonstrates a stable extraoral hand rest for scaling the buccal of the maxillary right quadrant. The clinician s fingers stabilize against the cheeks, jaw and chin. This allows the terminal shank to be parallel to the tooth and maintain a neutral hand position. Whether the clinician is using a universal curette or a curved shank that is area-specific, the hand position can easily pivot to access posterior teeth with ease. Once the clinician has established a comfortable fulcrum which offers a range of motion, instrument selection can be varied to meet specific anatomical needs. Curettes with elongated shank designs can provide access for molar regions or extension into furcations. The accentuated shanks of area-specific curettes may help with malpositioned teeth and mini-bladed or micromini bladed curettes provide a unique design to access root concavities. 20 Figure 8 shows the extraoral fulcrum for the buccal of the maxillary left quadrant. Here the clinician stabilizes the working stroke with a hand rest on the cheek and chin area to provide additional support. Now the stroking motion incorporates the arm, wrist and hand in a unified motion. The stability that is acquired by these alternative fulcrums minimizes clinician fatigue that can occur with the repetitive physical demands of instrumentation. Control of the instrument also builds confidence with the patient and helps to reduce stress during clinical procedures. 17 There are a multitude of options available to the clinician to enhance instrumentation techniques. Teaching these various techniques and strategies improve the student s clinical experience and having feedback from several instructors complement their education. Clinical instruction can be enhanced by using the ideas discussed in this course. Utilizing an assessment rubric to support these instructional strategies will offer uniformity to the educational design. Each hygienist should examine instrument design choices and build armamentarium that supports a variety of scaling situations. These techniques will enrich the educational experience, guide students towards advanced instrumentation strategies and improve patient care. 22 Bibliography 1. US Department of Health and Human Services, Public Health Service, Office of the Surgeon General. Oral health in America: A report of the Surgeon General. Rockville, MD: National Institutes of Health, National Institute of Dental and Craniofacial Research; 2000, p Commission on Dental Accreditation, Retrieved November 15, 2014, from 3. Hauser, A., & Bowen, D. Primer on preclinical instruction and evaluation. Journal of Dental Education, (3), O Donnell, J., Oakley, M., Haney, S., O Neill, P., & Taylor, D. Rubrics 101: A primer for rubric development in dental education, (9), Licari, F.,Knight, W., & Guenzel, P. Designing evaluation forms to facilitate student learning. Journal of Dental Education, (1), Jacks, M., Blue, C., & Murphy, D. Short- and long-term effects of training on dental hygiene faculty members capacity to write SOAP notes. Journal of Dental Education, (6), Garland, K., & Newell, K. Dental hygiene faculty calibration in the evaluation of calculus detection. Journal of Dental Education, (3), Strange, B. (n.d.). Back to basics. Retrieved November 11, 2014, from back-to-basic.html 9. Laughter, L. (n.d.). The changes over 20 years. Retrieved November 12, 2014, from issue-1/columns/the-changes-over-20-years.html 10. Pattison, A., Pattison, G., & Matsuda, S. Changing the rules. Dimensions of Dental Hygiene, (5), Chismark, A., & Millar, D. (n.d.). Scaling and exercise strategies to prevent hand, wrist, and arm injuries. Retrieved November 12, 2014, from features/scaling-and -exercise-strategies-to-prevent-hand-wrist-andarm-injuries.html 12. Silva, L., Hodges, K., Calley, K.,& Seikel, J. A comparison of dental ultrasonic technologies on subgingival calculus removal: A pilot study. Journal of Dental Hygiene, (2), Dos Santos, K., Pinto, S., Pochapski, M., Wambier, D., Pilatti, G., & Santos, F. Molar furcation entrance and its relation to the width of curette blades used in periodontal mechanical therapy. International Journal of Dental Hygiene, , Kiehl, N. Instrumenting periodontally involved anterior teeth. Dimensions of Dental Hygiene, (11), 26, Scaramucci, M. The versatility of the universal curet. Dimensions of Dental Hygiene, (2), 32, 36, Millar, D. Reinforced periodontal instrumentation and ergonomics. Journal of California Dental Hygienists Association, (3), Cosaboom-FitzSimons, M., Tolle, S., Darby, M., & Walker, M. Effects of 5 different finger rest positions on arm muscle activity during scaling by dental hygiene students. Journal of Dental Hygiene, (4), Nguyen, M., & Pattison, A. Activate alternative fulcrums. Dimensions of Dental Hygiene, (5), 24, 26, Pattison, A., Matsuda, S., & Pattison, G. Extraoral fulcrums. Dimensions of Dental Hygiene, (10), 20, Kunselman, B., & Scaramucci, M. Make the most out of your modified gracey curets. Dimensions of Dental Hygiene (11), Pattison, A., & Matsuda, S. Technique focus mini-bladed gracey curets. Dimensions of Dental Hygiene, (2),

8 22. Leiseca, C. (n.d.). How not to overwork you hands. Retrieved November 14, 2014, from issue-5/features/how-not-to-overwork-your-hands.html Author Profile Sharon L. Mossman, RDH, Ed.D is a clinic supervisor/ faculty in the Department of Dental Hygiene at Delaware Technical Community College in Wilmington, Delaware. She has over 30 years of experience in the areas of clinical practice, education and research. She has been awarded The Excellence in Teaching Award through Delaware Technical Community College (2013); The Office of Women in Higher Education Rising Star Award (2011); and the Delaware Dental Hygienists Association Community Service Award (2011). Passionate about community service, she has participated in Operation Smile Vietnam (2008, 2009) and Remote Area Medical (2010). Mossman has several published articles in dental hygiene literature. She may be contacted at smossman@dtcc.edu. Author Disclosure Sharon L. Mossman, RDH, Ed.D has no commercial ties with the sponsors or providers of the unrestricted educational grant for this course. Online Completion Use this page to review the questions and answers. Return to and sign in. If you have not previously purchased the program select it from the Online Courses listing and complete the online purchase. Once purchased the exam will be added to your Archives page where a Take Exam link will be provided. Click on the Take Exam link, complete all the program questions and submit your answers. An immediate grade report will be provided and upon receiving a passing grade your Verification Form will be provided immediately for viewing and/or printing. Verification Forms can be viewed and/or printed anytime in the future by returning to the site, sign in and return to your Archives Page. Questions 1. Social determinants that impact our nation s overall health include: a. Access to health care b. Lack of dental care c. Poor mastication issues d. Poor nutrition 2. Collaboration with healthcare professionals can broaden the scope of dental care through: a. Individual scholarships b. Community outreach programs c. Library resources d. Self-assessment strategies 3. A challenge that faces dental hygiene schools with establishing clinical enrichment experiences at partnering facilities is: a. Setting goals and objectives b. Accreditation program restrictions c. Faculty shortages d. Healthcare barriers 4. Establishing a protocol with community healthcare providers requires: a. Aligning specific adjunctive dental services with training personnel b. Focus on informative lectures to deal with dental emergencies c. Developing goals and objectives that meet the needs of program partners d. Implementation of nutritional analysis procedures 5. Implementing a formal assessment process at partnering facilities can be accomplished by: a. Communicating the program goals with written instructions b. Having students utilize self-assessment strategies for evaluation c. Implementing a pre-test and post-test process for clinical supervisors d. Using an assessment tool with specific evaluation criteria 6. A valid evaluation process can be maintained at extramural clinical facilities by: a. Pilot testing a clinical rubric b. Disseminating written guidelines to faculty and students c. Providing formal training for all clinical supervisors d. Maintaining communication via 7. Creating a clinical rubric with specific criteria assists with the evaluation process. The rubric should offer: a. Subjectivity in grading to alleviate testing error b. A grading scale equitable to the learner s experience c. Identification of obstacles that impact learning outcomes d. Adjustable grading for students needing remediation 8. The clinical assessment tool should be designed to: a. Define terminology specific to the clinical environment b. Classify the severity of the disease process c. Explain step-by-step procedures d. Offer specific, immediate feedback 9. Calibration among evaluators helps to maintain consistency in grading when: a. Different instructors rate the same procedures consecutively b. Training is ongoing and held at regular intervals c. Evaluative analysis is variable and flexible d. Evaluators adjust scoring to the learner s personal challenges 10. Calibration of evaluative measures reduces inconsistencies in grading which: a. Minimizes assessment variability b. Broadens the learner s experience c. Reduces excessive instructional explanations d. Delays progress towards clinical competency 11. Novice learners benefit from formative evaluation that offers: a. Recognition of their repeated clinical errors b. Verbal interactions that provide remediation strategies c. Strategies that focus on institutional practices d. Self-identification of clinical errors 8

9 12. A graduated competency scale should be implemented in the assessment tool in order to: a. Assess student progress during different stages of the learner s education b. Provide leniency in the overall grading c. Allow for remediation strategies to be implemented d. Allow for evaluators preferences and areas of expertise 13. Clinical instruction teaches the fundamentals in instrumentation concepts focusing on: a. Varied instrument set-ups and diversity in patient clinical cases b. Accumulating research articles to support new techniques c. Primarily explorer and probing techniques d. Basic instrument design, proper instrument grasps and fulcrums 14. Advanced instrumentation offers various techniques that helps the clinician with: a. Improving patient awareness of oral health b. Increasing awareness of oral conditions c. Effective deposit removal d. Improving instrument grasp and leverage 15. Periodontal scalers and curettes have a variety of shapes and are characterized by: a. Manufacturer and instrument weight b. Blade design and shank curvature c. Rigidity and instrument weight d. Shank length and curvature 16. Advanced fulcrumming techniques are used to: a. Maintain blade activation with a neutral wrist motion b. Access furcationally-involved teeth c. Increase lateral working strokes for debridement d. Replace intraoral finger rests 17. Effective instrumentation strategies incorporate anatomical considerations, instrument design and: a. Rigid and mini bladed design instruments b. Mini-bladed instruments and universal curettes c. Alternative fulcrums and stroke techniques d. Thin blade design and rigid instruments 18. Mini-blade instruments have blades that are shorter and thinner than standard instrument blades. They are effective for deposit removal in: a. Anatomical areas that have tight concavities b. Posterior regions with extensive root exposure c. Lingual areas with open embrasure spaces d. Buccal surfaces of premolar teeth 19. The universal design of a curette refers to: a. The material composition of the instrument b. The shank curvature c. Diameter of the handle d. The two parallel cutting edges of the blade 20. Gracey design instruments feature a blade with a lower cutting edge which: a. Offers access to periodontal pockets with minimal tissue distention b. Encourages inadvertent curettage c. Is designed for increased leverage in anterior regions d. Are effective in stroke activation due to the thinner blade design 21. Mini-blade instruments have blades that are shorter and thinner than standard instrument blades. They are effective for deposit removal in: a. Anatomical areas that have tight concavities b. Posterior regions with extensive root exposure c. Lingual areas with open embrasure spaces d. Buccal surfaces of premolar teeth 22. Curettes with elongated shank designs provide: a. Better clearance around crowns b. Greater access into deep periodontal pockets c. A lighter weight instrument for soft deposit removal d. A handle that is shorter in length 23. Rigid dental instrument designs offer: a. Advanced blade sharpness b. Superior tactile sensitivity c. Easier access to interproximal areas d. Reduced shank flexibility for heavy deposit removal 24. During instrumentation, novice clinicians may compensate for limited wrist motion due to anatomical situations by: a. Utilizing finger-flexing activation of the instrument b. Incorporating scaling instruments with curved shanks c. Limiting scaling techniques to ultrasonic scaling only d. Incorporating lighter weight instruments to reduce fatigue 25. Academic programs teach basic instrumentation techniques which emphasize: a. Proper instrument grasp and blade-tooth adaptation b. Debridement techniques limited to hand scaling c. Root planing tooth surfaces with magnetostrictive instrumentation d. Accessing narrow periodontal pockets with sonic instrumentation 26. Extraoral fulcrums may be utilized to improve instrument shank alignment and adapt the instrument blade in areas such as: a. Maxillary posterior regions b. Mandibular posterior regions c. Maxillary anterior regions d. Mandibular anterior regions 27. Finger on finger stabilization is used to: a. Reduce wrist fatigue b. Increase stroke stability c. Limit the working stroke d. Limit wrist motion 28. Opposite arch fulcrums are used when: a. Application of the stroke force is compromised b. Ideal blade adaption cannot be achieved with an intraoral fulcrum c. Gracey instruments are the ideal instrument choice d. Stroke motions requires lateral pressure 29. Extraoral fulcrums help to maintain stroke control by: a. Alleviating soft tissue interferences b. Shifting fulcrum pressure from the tooth to the cheek/chin area c. Reducing leverage for blade activation d. Encouraging a finger-flexing activation of the instrument 30. A cross arch fulcrum can be implemented when: a. Furcation involvement complicates subgingival access b. The clinician requires a firmer grasp of the instrument c. The instrument design limits access to distal surfaces d. Limited opening is an obstacle for adequate stroke motion 9

10 ANSWER SHEET Partnerships: Calibrating Novice to Advanced Instrumentation Name: Title: Specialty: Address: City: State: ZIP: Country: Telephone: Home ( ) Office ( ) Lic. Renewal Date: AGD Member ID: Requirements for successful completion of the course and to obtain dental continuing education credits: 1) Read the entire course. 2) Complete all information above. 3) Complete answer sheets in either pen or pencil. 4) Mark only one answer for each question. 5) A score of 70% on this test will earn you 3 CE credits. 6) Complete the Course Evaluation below. 7) Make check payable to PennWell Corp. For Questions Call Educational Objectives 1. Identify collaborative community initiatives that can improve patient care. 2. Implement a teaching protocol that encourages a multifaceted clinical experience enhancing dental hygiene students performance. 3. Design a formative assessment tool that calibrates students clinical evaluations at extramural clinics. 4. Employ basic and advanced instrumentation techniques to improve clinical performance. Course Evaluation 1. Were the individual course objectives met? Objective #1: Yes No Objective #2: Yes No Objective #3: Yes No Objective #4: Yes No Please evaluate this course by responding to the following statements, using a scale of Excellent = 5 to Poor = To what extent were the course objectives accomplished overall? Please rate your personal mastery of the course objectives How would you rate the objectives and educational methods? How do you rate the author s grasp of the topic? Please rate the instructor s effectiveness Was the overall administration of the course effective? Please rate the usefulness and clinical applicability of this course Please rate the usefulness of the supplemental webliography Do you feel that the references were adequate? Yes No 11. Would you participate in a similar program on a different topic? Yes No 12. If any of the continuing education questions were unclear or ambiguous, please list them. 13. Was there any subject matter you found confusing? Please describe. 14. How long did it take you to complete this course? 15. What additional continuing dental education topics would you like to see? COURSE EVALUATION and PARTICIPANT FEEDBACK We encourage participant feedback pertaining to all courses. Please be sure to complete the survey included with the course. Please all questions to: hhodges@pennwell.com. INSTRUCTIONS All questions should have only one answer. Grading of this examination is done manually. Participants will receive confirmation of passing by receipt of a verification form. Verification of Participation forms will be mailed within two weeks after taking an examination. COURSE CREDITS/COST All participants scoring at least 70% on the examination will receive a verification form verifying 3 CE credits. The formal continuing education program of this sponsor is accepted by the AGD for Fellowship/ Mastership credit. Please contact PennWell for current term of acceptance. Participants are urged to contact their state dental boards for continuing education requirements. PennWell is a California Provider. The California Provider number is The cost for courses ranges from $20.00 to $ PLEASE PHOTOCOPY ANSWER SHEET FOR ADDITIONAL PARTICIPANTS. If not taking online, mail completed answer sheet to Academy of Dental Therapeutics and Stomatology, A Division of PennWell Corp. P.O. Box 116, Chesterland, OH or fax to: (440) For immediate results, go to to take tests online. Answer sheets can be faxed with credit card payment to (440) , (216) , or (216) Payment of $59.00 is enclosed. (Checks and credit cards are accepted.) If paying by credit card, please complete the following: MC Visa AmEx Discover Acct. Number: Exp. Date: Charges on your statement will show up as PennWell AGD Code 495 Moss515DIG 10 Customer Service Provider Information PennWell is an ADA CERP Recognized Provider. ADA CERP is a service of the American Dental association to assist dental professionals in identifying quality providers of continuing dental education. ADA CERP does not approve or endorse individual courses or instructors, not does it imply acceptance of credit hours by boards of dentistry. Concerns or complaints about a CE Provider may be directed to the provider or to ADA CERP ar org/cotocerp/ The PennWell Corporation is designated as an Approved PACE Program Provider by the Academy of General Dentistry. The formal continuing dental education programs of this program provider are accepted by the AGD for Fellowship, Mastership and membership maintenance credit. Approval does not imply acceptance by a state or provincial board of dentistry or AGD endorsement. The current term of approval extends from (11/1/2011) to (10/31/2015) Provider ID# RECORD KEEPING PennWell maintains records of your successful completion of any exam for a minimum of six years. Please contact our offices for a copy of your continuing education credits report. This report, which will list all credits earned to date, will be generated and mailed to you within five business days of receipt. Completing a single continuing education course does not provide enough information to give the participant the feeling that s/he is an expert in the field related to the course topic. It is a combination of many educational courses and clinical experience that allows the participant to develop skills and expertise. CANCELLATION/REFUND POLICY Any participant who is not 100% satisfied with this course can request a full refund by contacting PennWell in writing. Image Authenticity The images provided and included in this course have not been altered by the Academy of Dental Therapeutics and Stomatology, a division of PennWell