PER 834: Periodontology Clinic II

Transcription

1 PER 834: Periodontology Clinic II 1. Course Directors 2. Administrative Details Robert E. Schifferle, DDS, MMSc, PhD Primary Course Designation: Clinical 318 Foster Hall Course Type: Required Department of Oral Biology Year/Semester: D3/1 (3 rd Year/Spring) Credit Hours: 1.5 Office Hours: TBD 3. Participating Faculty Dr. Bandar AlMaghrabi Dr. John Asaro Dr. Ming Shih Levine 240 Squire Hall Dr. Geraldine Napierski Dr. Renzo Nylander Dr. Eric Schroeder Dr. Bing-Yan Wang B22 Squire Hall Dr. Talal M. Zahid Dr. Joseph Zambon 222 Foster Hall Keywords Periodontics, dental prophylaxis, dental scaling, root planning, oral hygiene, tooth brushing 5. Course Meeting Days, Times & Locations Mondays, Wednesdays, and Fridays Class will meet in clinic from 9am-12pm and 1pm-4pm. 6. Course Description This clinical course is designed to increase your knowledge and improve your technical expertise in the delivery of periodontal therapy and its role in maintaining oral health. 7. Course Purpose The purpose of this course is to improve the clinical knowledge, skills, and treatment of patients in the field of periodontology for the 3rd year dental students. 8. Course Goals Increase knowledge and exposure to clinical periodontics; Improvement of diagnostic skills relevant to periodontics, e.g. probing, assessment of inflammation, mobility, recession, radiographic interpretation; Treatment plan development including appropriate diagnosis and prognosis Enhance knowledge of oral hygiene/biofilm control and topical fluoride delivery Delivery of treatment including scaling and root planing, occlusal adjustment Exposure to periodontal surgical therapy through surgical assisting PER 834 Periodontology Clinic II / Schifferle Page 1 of 7 June 15, 2010

2 9. Learning Objectives a. Ability to accurately probe periodontal pockets, assess gingival inflammation, evaluate mobility, recession, and to correctly interpret radiographs; b. Ability to develop an adequate periodontal treatment plan, including appropriate diagnosis and prognosis c. Provide preventive care including biofilm control and topical fluoride delivery d. Ability to scale and root plane leaving minimal residual plaque and calculus and causing minimal tissue trauma e. Ability to perform an occlusal adjustment f. Gain knowledge of periodontal surgical therapy through assisting g. Ability to provide nutritional counseling to high risk patients 10. Associated Competencies Learning Objective SDM Competency from Appendix 1 9a 1, 16, 17, 18, 19 9b 1, 2, 5, 13, 20, 21, 22, 23, 24 9c 1, 2, 3, 5, 11, 23, 27, 30, 36 9d 1, 2, 3, 8, 27, 30, 36 9e 1, 2, 21, 33 9f 1, 2, 23, 30 9g 1, 2, 5, 11, 16, 24, Student Evaluations Methods Grades are S/U for PER 833. Students must complete at least 40 CPU during the first semester (PER 833) and at least 40 CPU during the second semester (PER 834). A minimum of 100 CPU s are required for the Jr. year (PER ). The Grade for PER 834 will be calculated as follows: Students will be evaluated on patient treatment completed (CPU s), completion of CPE #5, written surgical assist report, and faculty evaluations. Students must complete at least 20 CPU's in periodontology during the Fall Semester to obtain an S grade. Students must have completed CPE #5 on a recall patient by the end of the Spring semester. A periodontal surgical case report must be submitted to the Periodontology department secretary () no later than the Friday before the last clinical day of the Spring Semester. The final grade in PER 834 will be based on obtaining a certain number of points. A 360 B=310 C=260 D=210 F<210 Grading Criteria Evaluation Types* % Weight Clinic Production Clinical Productivity Units 60-80% Written Report Written Assignments 5-10% CPE 1 Clinical Practical Examination 15-30% *Evaluation Types (see Appendix 2 for full descriptions) 100% 1 Please refer to section below regarding information on CPE One CPU =1 point. You will receive 60 points for passing CPE #5 in one attempt by the last clinical day of the Spring Semester. 40 points if more than one attempt and 0 points if taken after May 1, 2009 You will receive 20 points for handing in the surgical assist report on time. If >2months you receive 10 PER 834 Periodontology Clinic II / Schifferle Page 2 of 7 June 15, 2010

3 points, if after April 25 you will receive 0 points (please see me if there is a problem). The faculty are asked twice each semester to assess the performance of some students. If a student receives unsatisfactory evaluations from 2 instructors in periodontology for the year they will lose 40 points. If more than 2 instructors, their point total will be reduced by 80 points. Example: 250 CPU = 250 points (last years average was 269 CPU) Surgery Report (on time) = 20 points CPE (passed first attempt) = 80 points Total points = 350 points, grade is B Clinical Practical Exam (CPE #5): (Must be completed by May??, 2009) You will have a CPE in supportive periodontal therapy (treatment of a recall patient). Prior to a Jr. level student taking the CPE exam, prerequisites must be met. Prerequisites for CPE #5: 6 periodontal recalls (D1110), one case-presentation (D4991) written in patient chart and reviewed by the instructor, and 2 quadrants of scaling and root planning (code D4341 or D4342). Surgical Assist A code for the surgical assist (D4390) should be entered on the Patient Financial Form to track completion of the assist. The periodontal surgical assist report should include: Jr. student name, patient number (no names HIPPA), and name of student (Sr. or Post-grad) performing the procedure, the date of procedure, the procedure, indications for this procedure, and details (anesthesia, incisions, type of flap, sutures, etc.) of the procedure at which the student assisted. This must be submitted via the Drop Box in BlackBoard for PER , no later than 4 weeks following the assist for full credit to be received. All reports must be received no later than one week prior to the last day of clinic for the Spring Semester (Friday, April 24, 2009). Periodontal Cases A periodontal case must include a case presentation (code D4991), completion of scaling and root planing, and a case evaluation (D4990.9) (scheduled 3 to 6 weeks after the completion of scaling and root planing). Code D4990 (perio case) must be checked at each visit and is marked complete at the evaluation visit. For a periodontal case the patient can present with a limited number of teeth. A case requires evidence of periodontal disease (moderate pocket depths, generalized bleeding on probing, excessive deposits of calculus), but not a minimum number of teeth. Case fees: If a patient is seen as a periodontal recall, the fee code is D1110. Some of the cases are only slightly more severe than the recalls and take about the same amount of time to treat, while other are more severe and require a much greater amount of time. To make the fees equitable, we will charge the patients in the following fashion based on an assessment by the faculty on the severity of the cases (assume 4 quadrants for the patient): Discuss this with the periodontal faculty! Quadrants with 1-3 teeth with deeper pockets use code D4342 (1-3 teeth), if there are generalized deep pocket depths for the whole quadrant use code D4341 (quadrant), charge a minimum of 2 quadrants for periodontal cases (unless patient only has a limited number of teeth). Adult prophylaxis (D1110) can not be charged along with a scaling and root planing code (if this is noted on ATF, all CPU s will be revoked for that visit). PER 834 Periodontology Clinic II / Schifferle Page 3 of 7 June 15, 2010

4 Examples: slight to moderate periodontitis bill for 2 quadrants, moderate to severe usually bill for 3 quadrants (2 quadrants, if you can complete the patient in one visit), severe bill for each quadrant (severe should take at least two visits to complete). You cannot bill for more than 2 quadrants per clinical session, although you may complete all 4 quadrants! Periodontal Codes: Please use the following codes for periodontal therapy. This will help you to receive appropriate CPU credit for the procedures that you have performed. D1110 Adult prophylaxis (includes scaling and root planing and polishing in periodontally healthy patient) D1111 Adult prophylaxis (6 teeth or less) D1204 Topical fluoride (not at time of prophylaxis) D1330 Oral hygiene instruction U Periodontal case; subcode 1, start; subcode 9, when the case evaluation is completed. U4991 Case presentation, case has been presented to the instructor prior to the start of scaling and root planing D4341 Scaling and root planing D4342 Scaling and root planing, (1 to 3 teeth with deeper pockets, but all teeth in quadrant are scaled) U Subcode 9; Case evaluation; patient is seen generally 3 to 8 weeks after completion of scaling and root planing, probing is performed and the patient s periodontal situation is evaluated for further treatment, e.g. periodontal surgery, further scaling and root planing, determination of an appropriate recall interval, etc. Please be sure to include the codes U4990 and U4991 in your treatment plans. These codes count toward your clinical productivity. Example of codes for a treatment plan for slight perio case with 2 quadrants with deeper pockets: (e.g., severe periodontitis - bill 4 quadrants) U perio case - started U4991 case presentation D1205 Topical fluoride D1330 Oral hygiene instruction D4341 scaling and root planing UR D4342 scaling and root planing LL (1-3 teeth with deeper pockets) U case evaluation Preventive Dentistry Requirements A minimum of 10 preventive dentistry CPU's during both the fall and spring semesters. Oral hygiene instruction o Must always be performed as part of prophylaxis (code 1110) and periodontal scaling and root planing (code 4341) and may be performed as indicated at other times o Code 1330 should be noted on the ATF o No patient charge for this procedure o This procedure merits 1 CPU Topical fluoride o Should be performed as part of initial treatment in adult patients who have new or recurrent caries including incipient enamel surface or root surface caries PER 834 Periodontology Clinic II / Schifferle Page 4 of 7 June 15, 2010

5 o o Code 1204 should be noted on the ATF for topical fluoride treatments for adults. The adult prophylaxis code D1110 will be charged separately at that visit This procedure merits 1 CPU credit Tobacco counseling o Should be performed as part of initial treatment in patients, who indicate tobacco use on their medical or dental histories o Code D1320 Nutritional counseling o Performed on patient presenting with rampant caries o See handouts o Code D o This procedure merits 4 CPU Q and A. During Perio Clinic. Q. What should I do first when I see a patient for periodontal therapy in the clinic? A. Update and review the medical history. Inform the instructor of your goals for the daily clinical period. If there is a question about their medical history check this with your instructor and/or ODS faculty. With the instructors OK, you will generally proceed to probe and evaluate the periodontal tissues. Then have the instructor evaluate the patient to confirm your diagnosis. Do this prior to disclosing for the plaque index. After the instructor has evaluated the patient, proceed with your treatment of the patient as discussed with the instructor. This generally will be plaque index, oral hygiene instruction, and scaling and root planing. Check with the instructor prior to polishing. Set up an appropriate recall interval, sign charts, ATF & recall check list. Q. How do I know if the patient should be seen as a periodontal case? A. This depends on an assessment using your clinical charting and consultation with the instructor. If there is bleeding on probing, but pockets depths less than 4 mm, the patient could be seen as a gingivitis case (if severe enough), but they will probably be seen as a recall (D1110). If pocket depths are >4 mm, you should consult with your periodontal instructor for further evaluation. For example, if only slight periodontitis, the patient could be a case with credit for two quadrants of scaling and root planing (D4341 or D4342). Q. How long should a recall or a case take? A. This depends on both the patient and the student. With most patients, a recall should be completed in one visit. A case will generally take from 4 to 6 appointments. The first appointment for a case will involve obtaining data for the case presentation, which will be at either the 1st or 2nd visit. Quadrant scaling usually starts on the 2nd visit. It may take one 3 hr appointment to scale and root plan one to two quadrants depending on level of anesthesia, pocket depths, amount of calculus, and student skill level. 12. Learning Resources Prior and current didactic courses and previous clinical experience. 13. Instructional Media a. Instructional Modes: Verbal Auditory 5% Visual 5% Psychomotor or Tactile 90% b. Instructional Tools: Handouts/Manuals c. Instructional Methods: Clinical teaching PER 834 Periodontology Clinic II / Schifferle Page 5 of 7 June 15, 2010

6 14. Course Schedule *All classes are located in clinic every Monday, Wednesday, and Friday from 9am-12pm and 1pm-4pm. 15. Course Policies & Procedures Policies and procedures of the course are written in accordance with the Faculty Handbook and Academic Policies. Course Policies are written to clarify expectations of the course director regarding attendance, behavior, grading, academic integrity, professionalism, disabilities, remediation, etc. Refer to the student handbook for more detailed information A. Course Failure and Remediation Students who earn an "F" grade in this course may be given the opportunity to remediate. Remediation will be permitted only at the discretion of the School of Dental Medicine's Executive Council. B. Disabilities This institution supports the goals and requirements of Section 504 of the Rehabilitation Act of 1973, which mandates academic adjustments, commonly called reasonable accommodations, be provided for students with documented disabilities. If you have a disability and may require some type of instructional and/or examination accommodation, please contact me early in the semester so that I can provide or facilitate in providing accommodations you may need. If you have not already done so, you will need to contact the Disability Services office, the designated office on campus to provide services for students with disabilities. The office is located at 25 Capen Hall and the telephone number is (716) C. Attendance As described in the student handbook, "attendance at scheduled classes, laboratory sessions, clinical assignments and examinations is mandatory. Absence can negatively affect both knowledge and grades. Students are expected to arrive on time to class. Late arrival is disruptive for both students and faculty, and interferes with effective learning. Absences fall into two general categories: planned and unplanned. Please review the student handbook for how to proceed in these instances, and advise me accordingly, or the Office of Student Affairs if there is an emergency or medical illness. D. Canceled Classes If, for any reason, a scheduled session is not held, the scheduled event will occur at the next session unless otherwise announced. E. Course Evaluation Comprehensive evaluation of this course will be administered online at the end of the course through the Office of Academic Affairs. Eliciting feedback and constructive criticism is important so that Course Directors may take action to improve the course. Students are expected to participate fully in this important process. F. Changes in the Course No changes have occurred since the last time the course was offered. G. Distractions in the Classroom/Behavioral Expectations As students in a health professions school, students are expected to display conduct consistent with their status as entering members of the profession. Specifics of expected conduct are listed in both the university "Student Conduct Rules, University Standards and Administrative Regulations" and in the School of Dental Medicine "Student Handbook". In recent years, cell phones, pagers, and other electronic devices have been sources of disruption in classrooms. All electronic devices except those specifically required by the course director or lecturer are not permitted in class. If these devices go off during class, the student with the device will be asked to leave. PER 834 Periodontology Clinic II / Schifferle Page 6 of 7 June 15, 2010

7 H. Professional Conduct The University has a responsibility to promote academic honesty and integrity and to develop procedures to deal effectively with instances of academic dishonesty. Students are responsible for the honest completion and representation of their work, for the appropriate citation of sources, and for respect for others academic endeavors. By placing their name or student identifier on quizzes and examinations, students certify that the work is theirs and theirs alone. Students may not refer to any material or look at other student's papers during quizzes or examinations. Students observed so doing will receive a grade of zero for that quiz or examination. In addition, such incidents of academic dishonesty will be addressed as described in the university "Student Conduct Rules, University Standards and Administrative Regulations" the complete text of which can be found at and as described in the School of Dental Medicine Student Handbook, the complete text of which can be found at: PER 834 Periodontology Clinic II / Schifferle Page 7 of 7 June 15, 2010