EPA 4B: Deliver Preventive Care – Procedures
SCOPE OF WORK: This activity includes emphasizing prevention to reduce the development of disease and to minimize the progression of disease. In addition, this activity conducts appropriate follow- up to build a long-term relationship with patients and their caregivers.
Domains of Competence
- Professionalism and Ethics
- Person-Centered Care
- Health Promotion
- Critical Thinking and Decision Making
- Biomedical Science Application
- Self-Assessment
Knowledge
- Indications and contraindications for preventive procedures including biopsychosocial parameters of care and application of evidence
- Technical standards for preventive procedures (see rubrics)
- Properties, selection, and use of biomaterials relevant to applicable procedures and the patient
- Infection control, patient safety, and comfort
- Awareness of complications or contingencies that may arise during or following treatment
- Strategies, techniques, and instrumentation to perform the procedure
- Ergonomics and four-handed dentistry
- Required documentation of non-surgical and surgical procedures in electronic patient record (EPIC Wisdom)
Skills
- Apply evidence and critical thinking to material and treatment selection
- Apply principles of health promotion and person-centered care in the planning and execution of all preventive procedures
- Provides patient care in a safe and comfortable manner using proper infection control
- Utilizes appropriate instrumentation and ergonomically sound technique
- Performs preventive procedures according to acceptable criteria outlined in the rubrics
- Performs treatment systematically and efficiently
- Identifies new relevant information that arises during the procedure and discerns when to modify the technique or treatment
- Informs the patient regarding contingencies that arise during treatment, post operative instructions, and problems that may arise following treatment
- Accurately self-assess technical and non-technical aspects of treatment performed on a patient
- Properly documents information in electronic patient record (EPIC Wisdom)
| Deliver Preventive Care – Prophylaxis |
Meets Expectations of the Graduate
|
Progressing
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Below Expectations
|
Critical Error
|
|---|---|---|---|---|
| ISOLATION AND TISSUE MANAGEMENT | Excellent tissue management | Slight tissue damage | Moderate tissue damage | Severe tissue damage requiring a suture and/or loss of papilla |
| CALCULUS IDENTIFICATION | All calculus correctly identified | 90-95% of sites correctly identified | 75-90% of sites correctly identified | < 75% of sites correctly identified |
| CALCULUS AND PLAQUE REMOVAL | All calculus removed | 90-95% of plaque/calculus removed | 75-90% of detectable calculus removed | < 75% of detectable calculus removed |
| STAIN REMOVAL | All stain removed | 90-95% of sites with stain removed | 75-90% of sites with stain removed | < 75% of sites with stain removed |
| Deliver Preventive Care – Fluoride |
Meets Expectations of the Graduate
|
Progressing
|
Below Expectations
|
Critical Error
|
|---|---|---|---|---|
| ISOLATION AND TISSUE MANAGEMENT |
Excellent tissue management/retraction with moisture control Tooth/teeth properly dried in all quadrants |
Good tissue management/retraction Tooth/teeth not properly dried in one quadrant |
Saliva contamination/inadequate moisture control Teeth were not dried on 2+ quadrants |
Tissues were not isolated/teeth not dried, or poor moisture control resulting in fluoride ingestion and contamination |
| APPLICATION | Proper technique (amount and placement) and fluoride remaining on teeth | Proper technique (amount and placement) and majority of fluoride remaining on tissue | Inappropriate technique (amount and placement) fluoride on soft tissue not teeth | Fluoride was not applied during the appointment or placement not targeted to teeth in 3-4 quadrants fluoride on soft tissue not teeth |
| Communication (Post-Op Instructions) | Provides evidence-based information to the patient appropriate for the fluoride type | Lacks minor element in discussing instructions | Lacks major elements in discussing instructions, not individualized | Fails to provide post-op instructions to patient/caregiver, or inaccurate information that may result in harm |
| Deliver Preventive Care – Periodontal Maintenance |
Meets Expectations of the Graduate
|
Progressing
|
Below Expectations
|
Critical Error
|
|---|---|---|---|---|
| ISOLATION AND TISSUE MANAGEMENT | Excellent tissue management | Slight tissue damage | Moderate tissue damage | Severe tissue damage requiring a suture and/or loss of papilla |
| Calculus Identification | All calculus correctly identified | 90-95% of sites correctly identified | 75-90% of sites correctly identified | < 75% of sites correctly identified |
| Removal of Plaque and Calculus | All plaque and calculus removed | 90-95% of plaque/calculus removed | 75-90% of plaque/calculus removed | < 75% of plaque/calculus removed |
| STAIN REMOVAL | All stain removed | 90-95% of sites with stain removed | 75-90% of sites with stain removed | < 75% of sites with stain removed |
| Local Medication Delivery | Appropriate delivery of local medication | Appropriate delivery of local medication and suboptimal post-op instruction | Inappropriate delivery of local medication and/or suboptimal instruction | Inappropriate delivery of local medication, delivery to the wrong site, no post-op instruction |
| Deliver Preventive Care – Sealant |
Meets Expectations of the Graduate
|
Progressing
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Below Expectations
|
Critical Error
|
|---|---|---|---|---|
| ISOLATION AND TISSUE MANAGEMENT | Correct method of isolation. Excellent tissue management with no visible contamination | Correct method of isolation with incorrect size/fit of devices. Good tissue management resulting in mild or no contamination | Incorrect method and size/fit of isolation devices. Questionable tissue management resulting in moderate contamination |
No isolation Poor tissue management resulting in severe/excessive contamination or material contact with skin |
| Preparation | ||||
| Prophylaxis | All surfaces had prophylaxis, no residual pumice/plaque, surfaces rinsed properly | All surfaces had prophylaxis. Mild-to-moderate residual plaque/pumice | Not all surfaces had prophylaxis and plaque still visible. Not all surfaces cleaned correctly— severe residual plaque/ pumice | No prophylaxis. Severe plaque visible |
| Etchant | Etchant applied in all surfaces with correct timing and visual appearance of ‘chalky white’ | Etchant applied in all surfaces with incorrect timing | Etchant not applied in all surfaces and incorrect timing | No etchant applied |
| Adhesive | Adhesive applied in all surfaces followed by a thin layer of air | Adhesive applied in all surfaces but in incorrect amount or not followed by a thin layer of air | Adhesive not applied in all surfaces and/or not followed by a thin layer of air | No adhesive applied |
| Restoration | ||||
| Surface Quality | All surfaces are properly sealed with no voids. Properly cured and all surfaces are smooth | All surfaces are sealed but with minimal roughness detected. | Undercured. At least half of surfaces are rough. At least 1 surface not sealed. | Undercured. All surfaces are rough. Not all surfaces sealed. Excessive voids detected. |
| Marginal Integrity | Adequate retention with no flash | Adequate retention with minor flash | Partial retention—requires partial replacement and/or moderate flash | Sealant not retained—requires total replacement. Excessive/severe presence of flash |
| Occlusal Function | Ideal occlusion maintained with no need of occlusion adjustment | Minor over-contour that requires minimal occlusal adjustment | Moderate over-contour that still requires occlusal adjustment | Severe over-contour requiring occlusal adjustment |