handbook.doc

THE SCHOOL OF DENTISTRYPERIODONTOLOGY

THE UNDERGRADUATE TEACHING PROGRAMMEIN Student Requirements - 2002

ENCLOSURES 1. Course requirements, aims/learning outcomes and assessment

procedures 2. Lecture programme 3. Tutorial programme4. Practical training programme5. Syllabus, including course aims and learning outcomes6. Clinical Assessment record card7. Self-Directed Learning record card8. Diagnostic abbreviation aide memoire9. Recommended reading list (Appendix I)10. Summary of lectures and tutorials (Appendix II)11. List of handouts (Appendix III)12. Recommended videos (Appendix IV)13. Computer-based learning (Appendix V)14. Student questionnaire (Appendix VI)15. Competency assessment in scaling (Appendix VII)16. Competency assessment in root planing (Appendix VIII)17. Standard operating procedure for a new patient visit

(Appendix IX)18. Standard operating procedure for root surface debridement

(Appendix X)19. How the “Entry to Finals” grade is determined (Appendix XI)

INTRODUCTIONWelcome to your Specialty Teaching course in Periodontology. The course strands across four years and comprises lectures, practical classes, tutorials and the broad clinical management of patients with gingival and periodontal diseases. The core clinical course is called Specialty Teaching (ST) and runs for three terms during 3 rd and 4th

BDS. The aims, objectives and course outcomes are detailed within this document, which defines what you as undergraduates should be competent in when you complete your ST course. Successful completion of the ST programme is necessary in order to be signed

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up in Periodontology to sit Finals. A summary flow chart is attached to enable students to quickly orientate themselves with regard to how each part of the course relates to the five- year BDS degree.

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STAFFThe tutors on the course are:-Professor I L C Chapple, BDS FDSRCPS PhDProfessor in Periodontology; Honorary Consultant in Restorative Dentistry; Head of PeriodontologyMr A Roberts, BSc BDS FDSRCPSLecturer in Periodontology; Honorary Specialist Registrar in Restorative DentistryMr M R Milward, AIBMS BDS MFGDP MFDS RCPS ILTMLecturer in Periodontology; Honorary Clinical Assistant in Restorative DentistryMr S D Loescher, BDSPart-Time Clinical Lecturer

Lectures are also given by:-Ms F Blair, BDS FDSRCS MRDRCS MScConsultant in Restorative Dentistry (Periodontology); Honorary Senior LecturerMr G Brock, BSc BDSHonorary Clinical AssistantMrs S N Noble, BDS MdentSci DGDPAssociate Specialist and Director of the School of Dental Hygiene

Tutor Hygienist staff make a very valuable contribution to the course in 2nd BDS, specifically:-Mrs E Bannister, Senior Tutor Hygienist

From time to time other staff within the School of Dentistry with appropriate expertise are invited to contribute to the programme.

The External Examiner in Final BDS Part II is Dr J Rees, Senior Lecturer/Honorary Consultant in Restorative Dentistry, Bristol Dental School.

COURSE AIMS AND LEARNING OUTCOMESThe aims and learning outcomes of the course are:-1. To provide an understanding of the range of diseases that

affect the periodontal and associated tissues, and the biological basis for those diseases.

2. To provide practical experience in preventing, diagnosing, treatment planning and managing, in their broadest sense, the most common periodontal disorders.

3. To ensure that upon qualification the graduate is fully aware of his or her limitations in managing periodontal disorders and understands how and when to refer for specialist advice.

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COURSE REQUIREMENTS

New PatientsA unique aspect of the ST course in Periodontology is that you, as students, will be expected to manage patients referred for specialist advice and care by general dental practitioners, from the patient’s first visit to the Dental Hospital to the end of the patient’s initial phase of treatment. Under the close guidance of one of the senior academic staff in Periodontology, you will be allocated around seven new patients throughout the year. The process of assessing new patient referrals is regarded as an important aspect of your training in Periodontology, since it teaches you how to examine, investigate, diagnose, treat and maintain the patient with periodontal disease in a holistic manner. A target of four new patient assessments is recommended per student before signing up for Finals, which allows for cancellations and DNAs.

Treatment PlanningStudents are expected to learn how to plan comprehensive treatment for periodontal patients, in appropriate detail, for treatment by both themselves and hygienists.

Root Surface TreatmentStudents must become competent in root surface debridement (root planing) using Gracey area-specific curettes. A target number of ten to twelve root planing sessions is used to determine whether a student has gained enough experience in this aspect of care. Students are expected to monitor their progress in terms of root surface debridement performed and new patients seen, and to alert staff at the beginning of the autumn term (September) if they forecast a shortfall in requirements. A clipboard is kept in the clinic dispensary with a “hot list” of students requiring root surface debridement experience, so that they may be prioritised in order to achieve the target. If you fail to reach the target set then you will be expected to make up your requirements in the 2 East clinic in order to be entered for Finals. Extra sessions take place on Wednesday afternoons.

Competency TestsStudents must demonstrate competence in scaling and root surface debridement by submitting themselves for a competency test in each. The tests take place in the normal clinical environment, and when the student feels prepared he or she should advise a supervising member of staff that they wish to be assessed for their scaling or root planing treatment competency. The appropriate exercise will be observed by the member of staff and marked according to criteria outlined in Appendices VII and VIII. Students will not be permitted to sit Finals until they have passed these assessments. Forms are available on the clinic, and should be completed and then given to Professor Chapple’s secretary (see Appendices VII and VIII). It is the student’s responsibility to ensure that this is done.

OSCE Examination

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The objective structured clinical examination (OSCE) is held in all subjects at the mid point of your clinical course (November, 4th Year). Students who fail the periodontal aspects of this exam will be required to demonstrate that they have remedied their lack of knowledge in the area of failure before being signed up in Periodontology for Finals. The reassessment will be by viva or a computer-based test.

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End of ST VivaVivas are held at the end of ST (December, 4 th Year) to test theoretical and applied theoretical knowledge. The viva grade contributes towards the Continual Assessment part of the course in Periodontology. Students who fail to pass this viva will be re-examined by the same method on a further occasion. The grade entered for Finals after a resit will be 50% (ie the pass mark) so as not to disadvantage students who pass at the first attempt. Students will not be allowed to sit Finals until they have passed their specialty teaching in Periodontology.

Final Year Class TestWhen you complete your ST course in Periodontology (December, 4th

Year) there are still five terms prior to sitting Finals, during which your skill and knowledge base could be weakened by absence from this specialty area. In Final Year, therefore, you rotate through a consulting clinic twice to refresh your knowledge, and at the beginning of the final term a Final Year class test is set to help you with your revision. Those who fail this test are offered support prior to sitting Finals.

Attendance at LecturesAttendance at lectures in Periodontology is regarded as compulsory and is recorded. As mature adults you are expected to take responsibility for your own learning, and if a student misses a lecture he or she will be expected to learn that material from the recommended text books. A student who misses lectures and fails examinations will not be looked upon sympathetically.

The Place for Handouts in PeriodontologyHandouts are prepared and regularly updated as supplements to formal lectures. The role of the handout is to permit students to concentrate on the lecture itself without having to continually make notes. Lecture handouts provide a skeleton course only and are to be supplemented by tutorials and private study.

Final Continual Assessment GradeThis is the grade you take into your Finals examination in Periodontology. It takes into account (a) Plaque Project grades; (b) scaling excercise; (c) lecture attendance; (d) the number of new patients seen; (e) the number of root planing treatments done; (f) performance in the OSCE; (g) the quality of your work in the Periodontology area as graded on a session-by-session basis on the OMR form; and (h) the final end of ST viva. Your practical work will have been formally assessed in the areas of scaling and root planing by competency tests. It is suggested that you undertake your scaling competency during Terms 8 or 9 and your root surface debridement competency during Terms 9 or 10. The result will be entered on your blue card and you will not be allowed to sit Finals until you have passed both of these. A summary of how the Finals grade in Periodontology is achieved is shown in Appendix XI.

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THE OPTICAL MARK READER (OMR) FORMThe periodontal OMR has been specifically designed to take into account undergraduate activity in the 2 East clinical area. The form is divided into the following sections: (i) patient and operator details; (ii) appointment type; (iii) basic and advanced examination findings; (iv) diagnosis; (v) treatment planning; (vi) site-specific/tooth-specific/quadrant- or sextant-specific treatments; and (vii) recalls and grading students. Students must fill in the diagnostic section at the first visit, but at subsequent visits only the relevant section needs completing (ie treatment planning or treatment performed; it is not necessary to duplicate a previous week’s information). The form is then signed and handed in. It is necessary to duplicate BPE, plaque and bleeding scores in the patient’s notes on an appropriate pro-forma.

INSTRUMENT SUPPLY AND CARE OF SURGERIESIn the Periodontal clinic instruments are provided sharp, sterilised and in special trays. The trays are designed to encourage an organised treatment philosophy and to reduce the risk of needlestick injury. The dental nurses will autoclave instruments for you but you should secure instruments in the correct order within the trays, keep your surgery clean and work within “zones”. The latter include areas of asepsis where instrument trays are placed, areas in which to write notes and separate areas to wash and dry hands. Please treat the equipment as if it were your own. You should clean your unit after each patient. If you fail to do so you will receive a D grade for that session’s work. Each student must have their unit “signed off” by a dental nurse prior to leaving the clinic.

There are three levels of instrumentation:-1. Exam packs should contain a mirror, WHO probe, pocket measuring

probe with “Williams markings” and straight, sharp probe.2. Scaling packs should contain a mini sickle scaler, a universal Columbia

curette and double-ended sickle scaler.3. Root surface treatment packs contain a pocket measuring probe, ODU-

11/12 explorer and Gracey 1-2, 7-8, 13-14, 15-16 curettes.

Ultrasonic instruments are also provided for gross scaling and gross root surface treatment. The broader TF-3, TF-10 and TF-1000 tips are in your kits for scaling only. The slimline tips (in packs of three) are available for root surface treatment on request from the nursing staff.

MAKING APPOINTMENTSThis is the responsibility of the student. New patients will be booked for you but follow-up appointments for treatment should be booked on the computer by the student. Please ensure that appointments are entered on the computer before you give patients an appointment slip - this will prevent double booking. At each session you should check your next session (two weeks later) to ensure that you have both slots filled; if you

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have not, ask Waiting List Office for a new patient. You should book sufficient appointments on block to complete the patient’s treatment.

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CASE NOTE TRACKINGIt is most important that patients’ case notes are tracked on the computer system from one location to another. It is your responsibility to ensure that each set of case notes you deal with is tracked, so if you don’t know how to do this please seek assistance from a dental nurse or receptionist.

THE RESERVE STUDENTThe reserve system exists because patients treated in the periodontal area are referred by their GDPs and we are contracted to provide a high quality service. In the event of student illness the reserve student will see the absent student’s patients, to maintain the contracted service. Where the reserve is not actively involved in a patient’s treatment, he or she is expected to chart and aspirate for colleagues (which still provides valuable experience) or to watch one of the educational videos or CAL programs in the Tutorial Room. Students may also practice taking each other’s blood pressure and use the reference papers provided in the Tutorial Room. On occasion, the reserve student may be released to go to the library.

SELF-DIRECTED LEARNINGA wealth of self-directed learning material is present within the Tutorial Room for students to access. This should be used when patients fail to attend or cancel, or when you are a reserve. You must complete a pink card (which records what you have done) and present this at your final viva.

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LECTURES IN PERIODONTOLOGYTerm 2 1. An Overview of Periodontology Prof I L C

ChappleTerm 5 2. The Importance of, and Methods of, Plaque

ControlMrs Bannister

Term 6 3. Introduction to the Plaque Project Prof I L C

Chapple 4. What Inflammatory Periodontal Disease Is and

How to Recognise ItProf I L C Chapple

5. Indices Used in the Recognition of the Periodontal Diseases and in Monitoring Treatment Outcome/Progress

Prof I L C Chapple

6. Scaling Techniques Mrs E Bannister

7. Instrument Sharpening Mrs S L Noble 8. The Aetiology of Plaque-Associated Diseases (I)

- The Role of Local Risk FactorsMr G Brock

9. The Aetiology of Plaque-Associated Diseases (II) - The Role of Systemic Risk Factors

Mr G Brock

10. The Plaque Project - How to Prepare Your Reports

Mr A Roberts

11. The Pathogenesis of Plaque-Associated Diseases (I) - The Role of Bacterial Pathogens

Prof I L C Chapple

12. The Pathogenesis of Plaque-Associated Diseases (II) - The Role of the Host Response

Prof I L C Chapple

13. The Plaque Project - Data Presentation Mr A Roberts

Term 7 14. The Effect of Smoking on Periodontal Diseases Mr A Roberts 15. The Impact of Periodontal Infections on

Coronary Heart DiseaseProf I L C Chapple

Term 8 16. Root Surface Treatment and the Ultrasonic and

Sonic Scaler (Information on Area-Specific Curettes)

Prof I L C Chapple

17. Acute Periodontal Disorders Prof I L C Chapple

18. Antimicrobial Plaque Control (I) - The Role of Antimicrobial Therapy in the Management of Human Periodontal Diseases

Mr M R Milward

19. Antimicrobial Plaque Control (II) - The Role of Antiseptic Therapy in the Management of Human Periodontal Diseases

Mr M R Milward

20. The Relationship Between Periodontology and Fixed/Removable Prosthodontics

Mr M R Milward

21. The Relationship Between Periodontology and Mr M R

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Orthodontics Milward

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Term 9 22. The Role of Surgery in Periodontol Care (I) -

Flap ProceduresProf I L C Chapple

23. The Role of Surgery in Periodontal Care (II) - Periodontal Plastic Surgery (Mucogingival Surgery) and Complications of Surgery

Prof I L C Chapple

24. Tissue and Bone Regeneration Procedures Prof I L C Chapple

25. Gingival Overgrowth Prof I L C Chapple

26. Periodontal/Endodontic Lesions and Furcation Management

Mr A Roberts

27. Occlusal Considerations in Periodontal Care Mr A Roberts 28. Aggressive Periodontitis Mr A Roberts 29. Desquamative Gingivitis and its Management Prof I L C

Chapple 30. The Aetiology and Management of Gingival

Recession and Root SensitivityMr A Roberts

31. Epulides Prof I L C Chapple

Term 1032. The Dental Hygienist - Legal Status and Role

within the Dental TeamMrs E Bannister

Term 11 33. Oral Health and HIV Infection (I) Prof I L C

Chapple 34. Oral Health and HIV Infection (II) Prof I L C

Chapple 35. Specialist Therapy Outcomes, Maintenance and

Refractory DiseasesMr A Roberts

36. Recent Advances in Periodontology and Future Areas of Periodontal Interest

Prof I L C Chapple

Term 12 37. Osseointegrated Implants (I) - Case Selection

and Treatment Planning for Single Tooth Replacement Using the Bränemark System

Prof I L C Chapple

38. Osseointegrated Implants (II) - Stage 1 and 2 Surgery and Outline Prosthetic Stages for Single Tooth Replacement Using the Bränemark System

Prof I L C Chapple

Term 14Special Study Module (see separate information sheet)

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TUTORIALS IN PERIODONTOLOGY

1. 2 East clinic orientation, blue cards, OMR forms etc.

2. Natural history of periodontal diseases, site specificity etc.

3. Indices and their limitations - diagnostic methods, probing, CPITN etc.

4. Radiological diagnostic session plus X-ray reporting (to be supported by CAL program).

5. Classification of the gingival and periodontal diseases.

6. Revision of rationale for treatment - root surface debridement, fine scaling etc, including ultrasonic instrumentation.

7. Microbiology of periodontal diseases.

8. Immunopathology of periodontal diseases.

9. Use of systemic and topical antimicrobials.

10. Management of medically compromised patients - steroid covers, antibiotic covers, transplant patients, HIV patients and handicapping conditions.

11. Revision tutorial and the training, role and legal status of the dental hygienist.

12. Completion of blue cards and signing off for completion of Prescribed Teaching.

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PRACTICAL TRAINING COURSE IN PERIODONTOLOGY

Term 41. Cross-Sectional Study

With Periodontology and Dental Public Health (including periodontal indices/CPITN). Three clinical sessions during which students gain their first experience of working on a patient and learn to use key clinical indices for monitoring periodontal status.

Term 51. Oral Hygiene Instruction Exercise (Weeks 13, 15 and 17)

During this session students are taught recommended methods of oral hygiene and how to give advice and demonstrate these to patients, as appropriate to the individual patient’s needs.

Term 61. Plaque Project

Five-week longitudinal gingivitis study (see separate handout).

2. Polishing SessionThe year is divided in half and students work in pairs on each other. This session prepares the student for polishing in Clinical Practice.

3. Scaling Session with Phantom HeadsPerformed by dividing the year into six groups, with students working in pairs in the clinical setting. This session prepares the student for scaling in Clinical Practice.

4. Scaling Session on ColleaguesThe year is divided in half and students work in pairs. This session aims to provide a smooth transition from phantom head to colleague to patient, and prepares the student for scaling in Clinical Practice.

Term 81. Root surface treatment demonstration via CCTV.

2. Clinic orientation and phantom head practical instruction in the correct use of ultrasonics and Gracey curettes for root surface debridement. This occurs during Weeks 1 and 2 of your Specialty Teaching course.

3. New patients, review patients and treatment patients - starts Weeks 3 and 4 and continues until the end of the year.

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SYLLABUS FOR THE CORE COURSE IN PERIODONTOLOGY

On completion of the core course in Periodontology, students will be able to demonstrate understanding of :-

1.1 Their limitations on qualification and when, how and to whom to refer patients for further diagnosis and/or treatment.

1.2 The development and normal anatomy and physiology, including the defence mechanisms, of the oral and periodontal tissues.

1.3 The role of microbial plaque in the causation of periodontal diseases; the variations in bacterial plaque, with time and position on the tooth surface; and those factors which may predispose to the deposition and retention of microbial plaque and calculus.

1.4 The role of risk factors, including systemic disease, hormonal factors, drugs and disorders of the immune mechanism, in modifying the course of periodontal diseases.

1.5 The epidemiology of periodontal diseases.

1.6 When and how to use special tests, including haematological examination, clinical chemistry and microbiological investigation, and how to interpret the results.

1.7 When and how to use appropriate radiographic examination and how to interpret the results.

1.8 When and how to use chemical methods of plaque control and to understand the limitations of mouthwashes.

1.9 How air and ultrasonic scalers work, and to be aware of their limitations.

1.10 Local analgesia as appropriate for periodontal treatment.

1.11 Root surface management in periodontal diseases and the healing of inflammatory lesions following treatment.

1.12 The management of patients whose medical status requires special consideration and for whom routine dental treatment may present a hazard, including those who may need antibiotic cover for treatment.

1.13 The diagnosis and management of patients who have acute periodontal disorders comprising those of physical, chemical, bacterial, mycotic and viral origin.

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1.14 The treatment needs of those who have handicapping conditions.

1.15 The principles of and indications for periodontal surgery in the treatment of periodontal diseases.

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1.16 The healing of wounds as appropriate to periodontal treatment.

1.17 The principles of treatment of advanced lesions and the diagnosis and treatment of periodontal/endodontic lesions and furcation involvement.

1.18 The aetiology and mechanism of gingival recession and when treatment is necessary.

1.19 The mechanisms of hypersensitivity of exposed dentine and how this may be managed.

1.20 The principles of tissue regeneration techniques.

1.21 The role of occlusal overload as a co-destructional factor in periodontal diseases, and to know when and how to treat abnormal occlusal contacts by selective grinding and soft and hard occlusal guards. Also, to know when not to treat such abnormalities.

1.22 The relationships between Periodontology and Prosthetic Dentistry, and how partial dentures may adversely affect the periodontal tissues.

1.23 The relationship between Periodontology and Conservative Dentistry, and how fillings, crowns and bridges may adversely affect the periodontal tissues.

1.24 The relationship between Periodontology and Orthodontics, including the special oral hygiene needs of patients undergoing orthodontic treatment and the principles of treatment of adult patients with deep overbites, or whose upper incisors have started to drift.

1.25 Periodontal diseases occurring in children and adolescents, including acute herpetic gingivostomatitis, gingivitis artefacta and early-onset forms of periodontitis.

1.26 The training, role and legal standing of the dental hygienist.

1.27 The principles of management of aggressive forms of periodontitis, desquamative gingivitis, epulides and neoplasms.

1.28 Recent research findings in relation to periodontal diseases and their management.

1.29 The principles of the indications, contraindications, limitations, surgical and prosthetic principles of placing osseointegrated implants.

1.30 The need for maintenance, hygiene and scaling procedures around osseointegrated implants.

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1.31 How to scale and polish osseointegrated implants.

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On completion of the core syllabus students will be able to demonstrate competence in:-

2.1 Communicating effectively with patients and taking a relevant history.

2.2 Explaining to patients what periodontal disease is, what causes it and how it may be prevented and treated.

2.3 Motivating patients to attend for dental care and to carry out a good standard of home care.

2.4 Recognising periodontal health and diagnosing the different types of gingivitis and periodontitis.

2.5 Screening their patients for periodontal diseases using the Basic Periodontal Examination.

2.6 Giving instructions in oral hygiene to all their patients as appropriate to their needs.

2.7 Disclosing and polishing teeth and removing supragingival and subgingival calculus using mechanical and hand instruments.

2.8 Monitoring their patients’ progress using appropriate indices.

2.9 Working at all times to avoid risk of cross-infection.

2.10 Charting and assessing patients with advanced periodontal disease, including the measurement of pockets where appropriate.

2.11 Applying special tests, such as vitality testing.

2.12 Taking and interpreting radiographs as appropriate.

2.13 Using ultrasonic scalers.

2.14 Using local analgesia as appropriate to periodontal treatment.

2.15 Carrying out root surface debridement using appropriate instruments and instrumentation.

2.16 Diagnosing patients whose periodontal tissues have been affected by variations from the normal in host resistance.

2.17 Prescribing appropriate antibiotic cover for patients as necessary.

2.18 Dealing with complications following periodontal surgery.

2.19 Diagnosing and managing patients with acute periodontal disorders comprising those of physical, chemical, bacterial, mycotic and viral

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origin, and prescribing drugs as appropriate.

2.20 Diagnosing accurately acute lateral and apical abscesses and treating these accordingly.

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2.21 Diagnosing periodontal/endodontic lesions and at least initiating appropriate treatment.

2.22 Diagnosing pain caused by exposed hypersensitive dentine and being able to deal with this effectively.

2.23 Examining the occlusion and recognising normal and abnormal contacts and function.

2.24 Recognising and correcting iatrogenic disease caused by partial dentures, and being able to design partial dentures so that their iatrogenic potential is minimal. Also, bearing in mind the role of Periodontology in the design, preparation and maintenance of overdentures.

2.25 Recognising and correcting iatrogenic disease caused by fillings, crowns and bridges, and being able to restore teeth so that damage to the periodontal tissues is minimal.

2.26 Planning treatment for patients who have multiple restorative needs.

2.27 Dealing with the special oral hygiene needs of patients undergoing orthodontic treatment.

2.28 Dealing with the adult patient who has a traumatic overbite insofar as arrest of periodontal disease is concerned, and similarly in treating periodontitis in the patient whose upper incisors have started to drift, but in both these cases knowing that the patient may need to be referred for specialist treatment.

2.29 Recognising aggressive periodontitis in children and knowing that these patients need to be referred for specialist treatment.

2.30 Prescribing, clearly and concisely, treatment for the dental hygienist to carry out.

2.31 Prescribing as appropriate antifungal, antibacterial and antiviral drugs in the treatment of periodontal diseases.

2.32 Maintaining and sharpening hand instruments.

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PLAGIARISM

The University takes a very serious view of plagiarism and cheating in examinations, and your attention is drawn to notices to that effect posted in various parts of the School.

The Periodontal Specialist Teaching area takes a similar view in respect of plagiarism in any piece of written work, whether or not it forms part of a degree examination. Whereas it is realised that occasionally sources cannot be properly acknowledged, every effort must be made to reference written work fully.

DUE DILIGENCE

Students who fail to attend key lectures, or whose practical performance places patients at risk in the opinion of supervising staff, may be asked to withdraw from the specialty clinic until such time as they can demonstrate an appropriate level of knowledge and competence.

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Appendix I

RECOMMENDED READING LIST

Essential ReadingClinical Periodontology and Implant Dentistry, 3rd EditionJan LindheMunksgaard, 1998

Outline of PeriodonticsManson J DWright, 2000

Recommended ReadingA Colour Atlas of Dental Medicine, Part I, Volume I: Periodontology (2nd Edition)Rateitschak K H et alStuttgart, New York: Thieme 1989

Pathology of Periodontal DiseaseEds: Williams D M, Hughes F J, Odell E W & Farthing P MOxford Medical Publications, 1992

Self-Assessment Picture Tests in Dentistry - PeriodontologyGlenwright H D & Strahan J DWolfe Publications, 1994

Glickman’s Clinical Periodontology (8th Edition)Eds: Carranza & NewmanSaunders, 1995

The Periodontium and Orthodontics in Health and DiseaseEds: Heasman P A, Millett D T & Chapple I L COxford Medical Publications, 1996

Periodontal Surgery: A Clinical AtlasSato NQuintessence Publishing, 2000

Periodontics: Current Concepts and Treatment StrategiesGalgut P N, Dowsett S A & Kowolik MJMartin Dunitz, 2001

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Appendix II

SUMMARY OF LECTURES AND TUTORIALS

LECTURES

1. An Overview of PeriodontologyThis lecture aims to introduce preclinical students to the subject of Periodontology and to provide a summary view, in its broadest sense, of the scope of the subject. The overview given relates the importance of preclinical studies to the biological processes that are involved in periodontal diseases.

2. The Importance of, and Methods of, Plaque ControlThis lecture is given in conjunction with practical instruction by the School of Dental Hygiene. It defines plaque control and the detection and removal of plaque, and includes details of recommended toothbrushes and brushing techniques. All common forms of plaque control are discussed, including devices used, and a worksheet tests the student’s knowledge and understanding at the end of the excercise.

3. Introduction to the Plaque ProjectThis lecture introduces the Plaque Project, which is a longitudinal study that runs during Term 6. The lecture outlines the project aims, objectives and structure, and relates them to the CSS project from Term 4. A laboratory-based method of predicting clinical gingival inflammation is introduced and volunteers sought for the Plaque Project.

4. What Inflammatory Periodontal Disease Is and How to Recognise ItThis lecture introduces the structure of the periodontal tissues and relates this to definitions of gingivitis and periodontitis. These two broad groups of diseases are classified and differentiated, and signs of healthy and diseased tissues are described. The theories of the natural history of periodontal disease are discussed and some simple clinical definitions are given at the end.

5. Indices Used in the Recognition of the Periodontal Diseases and in Monitoring Treatment Outcome/ProgressThis lecture is given as part of the Cross-Sectional Study (CSS) project during the Introduction to Clinical Dentistry, Part I module, Term 4. It introduces key indices used in periodontal diagnosis and monitoring and outlines the limitations of those indices. A slide sequence and video are shown for the CPITN (or BPE) screen and credit card aide memoires are handed out to students for this index.

6. Scaling Techniques

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This lecture covers the principles of scaling teeth and root surfaces. It outlines the mechanical, ultrasonic and hand instrumentation employed and the techniques recommended. The lecture is in preparation for the practical scaling exercises that take place during Term 6.

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7. Instrument SharpeningMany dental techniques involve cutting. The importance and methods of sharpening hand instruments are covered in this lecture. Both mechanical and hand sharpening methods are discussed and details on technique and frequency are outlined. A supporting video is available.

8. The Aetiology of Plaque-Associated Diseases (I) - The Role of Local Risk Factors

This lecture outlines plaque retention factors in their broadest context. It covers iatrogenic factors, both fixed and removable, and anatomical factors that may be localised to the crown or root, or may involve larger groups of teeth or soft tissues. Management of these factors is also discussed.

9. The Aetiology of Plaque-Associated Diseases (II) - The Role of Systemic Risk Factors

This lecture discusses the importance of certain systemic medical conditions and how they impact on periodontal disease and management of that disease. It also makes the point that periodontal diseases themselves are now recognised risk factors for other systemic diseases, such as cardiovascular disease and low birth weight in the newly-born.

10. The Plaque Project - How to Prepare Your ReportsAs implied by the title, this session covers in detail the requirements for analysing and reporting data from the Plaque Project (Term 6). The process of preparing reports for marking is covered and tips are given about how to best interpret, analyse and present your reports. A critique of the scientific methodology is also asked for.

11. The Pathogenesis of Plaque-Associated Diseases (I) - The Role of Bacterial Pathogens

This lecture outlines the mechanisms by which pathogenic bacteria cause disease (including adherence, evasion of host defences, symbiotic relationships etc). It also indicates how bacteria are able to produce toxins, enzymes, sulphur compounds etc and what the effects of those “virulence factors” are on the periodontal tissues. The role of bacteria in stimulating and damaging the host response is alluded to and the specific, non-specific and environmental plaque hypotheses are discussed.

12. The Pathogenesis of Plaque-Associated Diseases (II) - The Role of the Host Response

This lecture outlines the immune-inflammatory interactions that lead to periodontal tissue damage as a side effect of their activity. It emphasises the significant nature of this component of tissue damage and gives a model for demonstrating how complement, immune responses, phagocytes (PMNLs) and the enzymes/oxygen radicals they produce can cause tissue destruction

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13. The Plaque Project - Data PresentationAs indicated in the title, this lecture presents data and statistical analysis for the Plaque Project. It is also a summing up session in which the limitations of existing methods of periodontal diagnosis are covered. Reports are collected for marking at this session.

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14. The Effect of Smoking on Periodontal DiseasesThis lecture looks at the role of smoking as a risk factor for periodontal diseases. The effects of smoking on the various inflammatory processes involved in periodontitis are discussed, as well as the influence of smoking on the periodontal structures and its effects on wound-healing following periodontal therapy.

15. The Impact of Periodontal Infections on Coronary Heart DiseasePeriodontal disease and cardiovascular disease have many common risk factors. Evidence is emerging that periodontal infections may be a significant risk factor for cardiovascular diseases, specifically stroke and fatal and non-fatal coronary events. This lecture presents data from a series of studies that address the link between periodontal disease and cardiovascular disease and asks students to form their own view. Potential pathogenic mechanisms whereby periodontal pathology may lead to cardiovascular pathology are also discussed.

16. Root Surface Treatment and the Ultrasonic and Sonic ScalerThis lecture defines the term “root surface debridement” and differentiates it from scaling. The indications for root surface treatment are described and the different types of instrumentation are indicated. The principles of technique are described and the instrumentation process is related to management of endotoxins. Endotoxins are defined and their role in periodontal disease pathogenesis outlined. Mechanical and hand instrumentation is described and the complications of root planing listed. A handout is available separately on ultrasonic instrumentation.

17. Acute Periodontal DisordersThis lecture lists the acute conditions that affect the gingival and periodontal tissues. It outlines bacterial, viral and mycotic infections as well as those caused by trauma and chemical factors. The rarity of acute periodontitis is discussed and examples of necrotising periodontitis and the lateral periodontal abscess are given. The signs, symptoms and management of the lateral periodontal abscess are also discussed.

18. Antimicrobial Plaque Control (I)- The Role of Antimicrobial Therapy in the Management of Human Periodontal Diseases

This lecture gives the indications and contraindications for using antimicrobial agents in periodontal disease management. The role and limitations of systemic antimicrobial therapy are explained and examples of regimes for different conditions are given. The role and limitations of local drug delivery systems are also described, including indications, advantages and disadvantages of LDD systems. The difference between sustained/slow release and controlled release is explained and examples given. This lecture is reinforced by a tutorial.

19. Antimicrobial Plaque Control (II)- The Role of Antiseptic Therapy in

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the Management of Human Periodontal DiseasesThis lecture outlines the difference between antiseptic and antibiotic therapies and gives the aims of anti-plaque agents. The limitations of such preparations are given and examples of anti-plaque agents are described. Time is spent on Chlorhexidine, its mode of action, benefits, uses and side effects .

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20. The Relationship Between Periodontology and Fixed/Removable ProsthodonticsThis lecture covers the problems associated with placement of subgingival restoration margins, and also reinforces the importance of the correct sequence of treatment when treatment-planning periodontal and restorative therapy. Choice of restorative material, restoration contour and the role and problems of the electrosurgery unit are alluded to. Occlusal considerations and bridge design (pontic design) are discussed and the problems caused by removable prostheses listed and discussed. Finally, overdentures and denture maintenance are covered.

21. The Relationship Between Periodontology and OrthodonticsThis lecture completes certain aspects of the previous lecture and moves on to the perio/ortho interface. Periodontal care during orthodontic treatment is discussed and the periodontal problems caused by deep, traumatic overbite are outlined, including potential methods of management. The patient whose upper anterior teeth have drifted is also discussed, as is the need for fixed or permanent retention of the final result.

22. The Role of Surgery in Periodontal Care (I) - Flap ProceduresThis lecture lists surgical procedures commonly performed on the periodontal tissues. The aims and indications of periodontal surgery are discussed, as are contraindications. Principles of flap design and closure are enumerated. Healing of surgical wounds in this complex is discussed and surgical dressings are also described.

23. The Role of Surgery in Periodontal Care (II) - Periodontal Plastic Surgery (Mucogingival Surgery) and Complications of Surgery

Periodontal plastic surgery is rarely performed today, but the principles and types of surgery are alluded to. Indications are given and surgery defined. Examples of the more common procedures are given and the lecture ends by describing general complications of periodontal surgery.

24. Tissue and Bone Regeneration ProceduresThis lecture defines the terms “repair” and “regeneration” and outlines the importance of periodontal regeneration in relation to wound healing. The terms “reattachment” and “new attachment” are defined and barrier membrane techniques described, with clinical examples. Non-membrane techniques currently available, including bioceramics and Emdogain, are discussed and the lecture ends with a look into the future potential of growth factors.

25. Gingival OvergrowthThe classification, aetiology and management of the many different causes of gingival overgrowth are given in this lecture. The differences between the terms “hypertrophy”, “hyperplasia” and “overgrowth” are explained and their management, both non-surgical and surgical, is covered. Emphasis is placed upon the

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aetiology and management of drug-induced gingival overgrowth.

26. Periodontal/Endodontic Lesions and Furcation ManagementThis lecture looks at the advanced periodontal lesions, specifically periodontal/endodontic lesions and furcation lesions. The various lesions are classified and their aetiology discussed. Measurement and investigative techniques are outlined, as are the principles of management.

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27. Occlusal Considerations in Periodontal CareThis lecture outlines the important role of occlusal factors and occlusal trauma in periodontal disease pathogenesis. The terms “primary” and “secondary” occlusal trauma are defined and the methods and implications of managing these conditions are covered. Terminology is explained and the effects of occlusal trauma, its recognition and treatment are described.

28. Aggressive PeriodontitisThis lecture covers the chronic early-onset diseases and relates this terminology to more traditional terminology. It covers the epidemiology, microbiology, immunology and clinical signs and symptoms of AP, and outlines the principles of managing this complex group of disorders.

29. Desquamative Gingivitis and its ManagementThis very important lecture reinforces the need for careful soft tissue examination. It explains the clinical term “desquamative gingivitis” and outlines the range of underlying disorders that may be associated with its presentation. Appropriate investigations for these conditions are described and the clinical management of options for these conditions is briefly alluded to.

30. The Aetiology and Management of Gingival Recession and Root Sensitivity

This lecture discusses the incidence and causes of dentine sensitivity and gingival recession. The use of desensitising agents is discussed, along with the range of treatments available. Mechanisms of sensitivity are outlined and the most likely theory is described.

31. EpulidesThe epulides are defined and classified, and clinical and histopathological features are briefly described. The difference between an epulis and gingival hyperplasia is covered and the management, both non-surgical and surgical, of epulides is described.

32. The Dental Hygienist - Legal Status and Role within the Dental TeamThe dentist’s responsibility in writing prescriptions for hygienists, and how best to employ them in team work. The legal standing of the dental hygienist will be outlined, including the range of procedures a hygienist is permitted to perform. The DARG report will also be discussed.

33. Oral Health and HIV Infection (I)The first of two lectures discusses the epidemiology and demographics of HIV disease, with up to date information. The lecture progresses to cover the aetiology and pathogenesis of the disease and how the immune function defects are manifest. A classification of oral lesions is made and a start is made on defining the oral lesions, their presentation, significance, appearance and

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management given.

34. Oral Health and HIV Infection (II)This lecture follows on from the previous lecture on the same subject and completes the overview of oral lesions in HIV disease. The indications and range of antiretroviral therapies are covered, and how these therapies may affect the oral tissues. The lecture ends by defining the importance of the dental hygienist in managing HIV and AIDS patients, and needlestick injuries are discussed with regard to risk, incidence and prophylactic measures/therapy necessary after sustaining an injury.

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35. Specialist Therapy Outcomes, Maintenance and Refractory DiseasesThe key outcomes of specialist periodontal therapy are defined here, along with what and how to look for these outcomes. The significance of clinical findings is explained and how to decide what to do next. The lecture leads naturally on to the nature, diagnosis and management of refractory periodontitis - does it exist and, if so, what is the likely cause of it?

36. Recent Advances in Periodontology and Future Areas of Periodontal InterestThis lecture is aimed at covering recent developments in the fast-moving and rapidly changing areas of periodontal diagnosis and therapeutics. Its content cannot be defined because it varies from year to year by its very nature.

37. Osseointegrated Implants (I) - Case Selection and Treatment Planning for Single Tooth Replacement Using the Bränemark SystemThis lecture covers the indications for dental implants and the importance of careful case selection and case planning. The principles of different implant-retained protheses are alluded to and the cautions and contraindications are also mentioned.

38. Osseointegrated Implants (II) - Stage 1 and 2 Surgery and Outline Prosthetic Stages for Single Tooth Replacement Using the Bränemark SystemThe second of two lectures on this subject focuses on the single tooth replacement and outlines the surgical and prosthetic principles of placing and restoring osseointegrated implants. This lecture is supported by a surgical video demonstrating the Bräenemark system.

TUTORIALS

1. Clinic OrientationThis full session is dedicated to introducing the 2 East clinical area, including surgeries and equipment, and forms that require completion. The types and range of patients to be managed is explained and students’ conduct and activity discussed. Root surface debridement instrumentation is demonstrated and a video shown to reinforce this. Phantom head work is performed in pairs to ensure that students learn correct working positions for root surface treatment.

2. Natural History of Periodontal Diseases and Site SpecificityThis session discusses the basic differences between gingivitis and periodontitis. The natural history of both these broad groups of diseases is discussed and the site-specific nature of periodontitis and its implications for therapy are reinforced.

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3. Indices and Their LimitationsThis tutorial covers the role of indices and their importance in periodontal diagnosis and monitoring of patients’ progress. The limitations of indices are discussed and medico-legal aspects of their use in dental practice are covered. Their role in patient motivation, target setting and decision making with regard to treatment planning is also discussed. The benefits and limitations of the BPE are also covered.

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4. Radiological Diagnostic SessionThis session discusses the appropriateness of different radiographic views in different clinical situations. It also explains how to analyse radiographs systematically and logically and the importance of report-writing in the patients’ clinical notes. The limitations of radiographs are also discussed.

5. Classification of Gingival and Periodontal DiseasesAs indicated by the title, this session covers current thoughts on disease classification. It outlines the relationship between traditional and current classification systems and criticises the basis for classifying disease in the manner currently employed in Periodontology. Alternative classifications are also discussed.

6. Revision of Rationale for TreatmentThis session outlines the logic of staged treatment plans and emphasises how long therapy can take to complete. The “outcomes” of initial therapy are discussed, as are how such outcomes are used to plan subsequent treatment. Time is spent discussing the concept of one-stage therapy and indications/contraindications for periodontal surgery.

7. Microbiology of Periodontal DiseasesThis session begins by classifying organisms in a basic manner and the terms “pathogen”, “opportunistic pathogen” and “commensal organism” are explained. Other terms such as “facultative anaerobe” are explained and the stratification of organisms thoughout the periodontal pocket discussed. The different plaque hypotheses are covered and the limitations of existing microbiological diagnostic techniques explained. This session also introduces DNA probes and checkerboard technology.

8. Immunopathology of Periodontal DiseaseIn this session, students are asked to interactively build a model system for basic immune/inflammatory interactions that contribute to periodontal tissue destruction. Complement is discussed in terms of bridging the innate and acquired immune responses, and the role of movement of the PMNL across vessel walls into tissues is also covered. Receptors and cytokines are introduced at the end of the session.

9. The Use of Systemic and Topical AntimicrobialsThis tutorial reinforces the lecture on this extensive topic. The indications/contra-indications and advantages/disadvantages of systemic and local drug delivery are discussed, with particular emphasis on bacterial transmission within communities and the problems presented by bacterial resistance. The role of antimicrobials is put firmly in its place.

10. Management of Medically-Compromised PatientsThis session concentrates on the specific issues involved in treating

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patients who have undergone different types of organ transplantation and those with HIV disease. Antimicrobial and steroid covers are discussed, as are INR results and how they relate to platelet levels in patients with liver disease.

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11. Revision TutorialThis tutorial is student-led and is aimed at answering difficulties and queries students may have on lecture material or previous tutorials. Some dedicated time is also given to explaining the role, remit and legal status of the dental hygienist as a very valuable member of the dental team.

12. Completion of Blue Cards and Course RequirementsThis session reinforces student requirements and ensures that students have acquired all the quantitative data needed for awarding the final grade in Periodontology.

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Appendix III

LIST OF HANDOUTS

1.

Overview of the Clinical/Academic Course in Periodontology

Prof I L C Chapple

2.

The Importance of, and Methods of, Plaque Control Mrs E Bannister

3.

The Plaque Project Mr A Roberts

4.

What Inflammatory Periodontal Disease Is and How to Recognise It

Prof I L C Chapple

5.

Indices Used in the Recognition of the Periodontal Diseases and in Monitoring Treatment Outcome/Progress

Prof I L C Chapple

6.

Scaling Techniques Mrs E Bannister

7.

Instrument Sharpening Mrs S L Noble

8.

The Aetiology of Plaque-Associated Diseases (I) - The Role of Local Risk Factors

Mr G Brock

9.

The Aetiology of Plaque-Associated Diseases (II) - The Role of Systemic Risk Factors

Mr G Brock

10.

The Pathogenesis of Plaque-Associated Diseases (I) - The Role of Bacterial Pathogens

Prof I L C Chapple

11.

The Pathogenesis of Plaque-Associated Diseases (II) - The Role of the Host Response

Prof I L C Chapple

12.

The Effect of Smoking on Periodontal Diseases Mr A Roberts

13.

The Impact of Periodontal Infections on Coronary Heart Disease

Prof I L C Chapple

14.

Root Surface Treatment and the Ultrasonic and Sonic Scaler (Information on Area-Specific Curettes)

Prof I L C Chapple

15.

Acute Periodontal Disorders Prof I L C Chapple

16.

Antimicrobial Plaque Control (I) – Antibiotics Mr M R Milward

17.

Antimicrobial Plaque Control (II) – Antiseptics Mr M R Milward

18.

The Relationship Between Periodontology and Fixed/Removable Prosthodontics

Mr M R Milward

19.

The Relationship Between Periodontology and Orthodontics

Mr M R Milward

20.

Periodontal Surgery (I) - Flap Procedures Prof I L C Chapple

21.

Periodontal Surgery (II) - Periodontal Plastic Surgery (Mucogingival Surgery) and Complications of Surgery

Prof I L C Chapple

22.

Tissue and Bone Regeneration Procedures Prof I L C Chapple

23.

Gingival Overgrowth Prof I L C Chapple

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24.

Periodontal/Endodontic Lesions and Furcation Management

Mr A Roberts

25.

Occlusal Considerations in Periodontal Care Mr A Roberts

26.

Aggressive Periodontitis Mr A Roberts

27.

Desquamative Gingivitis and its Management Prof I L C Chapple

28.

Gingival Recession and Root Sensitivity Mr A Roberts

29.

Epulides Prof I L C Chapple

30.

The Dental Hygienist - Legal Status and Role within the Dental Team

Mrs E Bannister

31.

Oral Health and HIV Infection Prof I L C Chapple

32.

Specialist Therapy Outcomes, Maintenance and Refractory Diseases

Mr A Roberts

33.

Osseointegrated Implants (I) - Case Selection and Treatment Planning for Single Tooth Replacement Using the Bränemark System

Prof I L C Chapple

34.

Osseointegrated Implants (II) - Stage 1 and 2 Surgery and Outline Prosthetic Stages for Single Tooth Replacement Using the Bränemark System

Prof I L C Chapple

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Appendix IV

RECOMMENDED VIDEOS

1. CPITN2. Sharing Care3. Instrument Sharpening4. The Design Features and Use of Gracey Curettes5. The Inverse Bevel Flap6. Performing a Biopsy7. Guided Tissue Regeneration8. Osseointegrated Implants

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Appendix V

COMPUTER-BASED LEARNING

1. Comprehensive Care of the Periodontal Patient2. Radiology 3. Clinical Case CAL Program – Advanced.

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Appendix VI

STUDENT QUESTIONNAIRE

Students are requested to respond to each of the following questions: SA = strongly agree; A = agree; N = neutral; D = Disagree; SD = strongly disagree. The results are scored in the same manner as the University-wide questionnaire.

SA A N D SD1 The Periodontology lectures helped

me to understand the subject2 The Periodontology lectures

provided good coverage of the subject matter

3 The Periodontology Oral Hygiene exercise helped me learn how to convey this information to my patients

4 The polishing exercise was helpful as an introduction to polishing on patients

5 The scaling exercises were useful to me before scaling my first patients

6 The clinic orientation and phantom head root surface treatment session was a useful introduction to Specialty Teaching in Periodontology

7 The termly feedback session on my progress helped me focus my activities the next term

8 The Periodontology tutorials helped me to understand the clinical relevance of lectures

9 Teachers in Periodontology made clear the subject matter that would form the basis of the end of specialty viva

10 There was sufficient recommended reading

11 The recommended reading was pertinent to the course

12 The mix of tutorials, lectures, practical classes and clinics was about right

13 Periodontology teaching staff were helpful

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14 There were sufficient handouts in the periodontal course

15 The Periodontology handouts were useful

16 There was an adequate supply of periodontal textbooks in the library

17 I would like to do the special study module in Periodontology in my final year

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Appendix VII

THE PERIODONTAL UNITCLINICAL COMPETENCY ASSESSMENT

STUDENT...................................... SUPERVISOR.......................................

TASK: Supragingival scale

OBJECTIVE: To ensure that the student can remove supragingival deposits using appropriate instrumentation with an atraumatic technique.

ASSESSMENT

Check PMHCorrectly identifies depositsSelects correct instrumentsDemonstrates correct technique for instrumentationComplete removal of supragingival depositsAtraumatic techniqueManagement of haemorrhageAppropriate interaction with chairside assistantGood postureAppropriate organisation of ongoing care

Yes / NoYes / NoYes / NoYes / NoYes / NoYes / NoYes / NoYes / NoYes / NoYes / No

GRADE:

Staff signature .......................................................

Date:

STUDENT COMMENTS:

Student signature ..................................................

Date:

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Appendix VIII

THE PERIODONTAL UNITCLINICAL COMPETENCY ASSESSMENT

STUDENT...................................... SUPERVISOR.......................................

TASK: Root surface instrumentation - root surface debridement

OBJECTIVE: To safely, efficiently and effectively debride the root surface.

ASSESSMENT

Detailed pocket chart done/availableCheck PMHCorrectly locates depositsExplores root morphologyAppropriate analgesiaSelects correct instrumentsInteraction with chairside assistantDemonstrates correct technique for instrumentsComplete removal of subgingival depositsAbsence of soft tissue traumaAbsence of root surface traumaManagement of haemorrhageGood postureCorrect discharge advice to patient

Yes / NoYes / NoYes / NoYes / NoYes / NoYes / NoYes / NoYes / NoYes / NoYes / NoYes / NoYes / NoYes / NoYes / No

GRADE:

Staff signature .......................................................

Date:

STUDENT COMMENTS:

Student signature ..................................................

Date:

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Appendix IX

STANDARD OPERATING PROCEDURE FOR A NEW PATIENT VISIT

Items 1 to 6 should take no more than an hour

1. Introduce yourself to the patient.

2. Explain that the session is for an assessment only and that they are likely to be here for the whole morning/afternoon.

3. Read the referral letter carefully.

4. Commence history: perform reason for attendance (RFA), patient complains of (PCO) and medical history (MH).

5. Get MH signed by a member of staff.

6. Perform the rest of the history before presenting the patient to the member of staff.

7. Perform a BPE screen, mobility, teeth present and note furcations and recession.

8. Suggest to the member of staff what radiographs (if any) are required and justify this decision.

9. Inform the patient how to get to the X-Ray Department and ask them to return to the second floor reception desk with their radiographs.

10. Write a radiographic report in the notes and get this checked (this allows discussion of the diagnosis and treatment plan).

11. Explain the radiographs to the patient.

12. Make the appropriate appointments for the patient.

13. Ensure that the notes are placed in the member of staff’s in-tray for a letter to be written.

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Appendix X

STANDARD OPERATING PROCEDURE FOR ROOT SURFACE DEBRIDEMENT

1. Recheck MH.

2. Inform patient regarding the likelihood of recession and hot and cold sensitivity.

3. Ensure radiographs and detailed pocket chart (DPC) are available.

4. Check that pocketing is still present and explore the root surfaces for detectable deposits.

5. Local anaesthetic (LA) as appropriate.

6. 10ml Chlorhexidine rinse for one minute.

7. Ensure that anaesthesia has been achieved.

8. Commence instrumentation using ultrasonics (half power and fine water spray).

9. Proceed to Gracey area-specific curettes.

10. Check root planed areas with ODU explorer to ensure complete debridement.

11. Finally, irrigate pocket with ultrasonics to remove dislodged debris from pocket.

12. Inform patient regarding aftercare etc.

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Appendix XI

HOW THE ENTRY TO FINALS GRADE IS DETERMINED

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BDS UNDERGRADUATE COURSE SUMMARY - PERIODONTOLOGY

YEAR AUG SEPT OCT NOV DEC JAN FEB MAR APR MAY JUN JUL

1st BDS

2nd BDS Cross-SectionalStudy

Cross-SectionalStudy

Oral HygieneExercise

*

Oral HygieneExercise

*

Plaque Project

**

Plaque Project PolishingExcercise Scaling Excercise

*****

Plaque Project

Scaling Excercise

*** **

3rd BDS

*** ** ** * * ** **

4th BDS

* **OSCE

End of Specialty Viva

** *** ** *

5th BDSSpecial Study Module

Special Study Module

Special Study Module

Class Test

= Specialty clinical teaching, 2E clinic* = Lectures in Periodontology

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