Public Health Dentistry

BDS Record Book

Clinical record book of undergraduate dental students in

INDIA as per the new syllabus prescribed by Dental Council
of India

Dr.KALYAN C GUNDAVARAPU
BDS., MDPH., DDPH.RCS (Eng.)
Associate Professor in Dental Public health
 Dental College & Hospital
Address

LOGO

RECORD BOOK
Name _______________________________________________

Roll No. ______________________________________________

Years of study ____________ to _____________________

The Department of Community Dentistry

2
 Dental College & Hospital
Address

LOGO

Department of Community Dentistry

This is to certify that ________________________________________

Roll no._________________, has successfully completed the various
assignments and clinical exercises in the department during his course of
study from _________ to _________.

Place: H.O.D

Date: Department of Community Dentistry

3
Introduction

The record book is required by the student in the Community Dentistry department as a record
of training and learning during BDS undergraduate program. It is used as part of the assessment
as to their suitability for the award of a BDS in the community dentistry department.

The student should maintain the record book as a part of their teaching and should update it
regularly and should be made available during their final examinations of community dentistry
practical examination for the purpose of assessment to the examiners.

Components of the Record book

The enclosed sheets are designed to provide:

• a record of different training and learning activities,

• a patient-based record of cumulative experience relevant to all areas of community
dentistry.

Training and learning activities

The record book contains a number of individual assignments to record the following training
and learning activities:

• Demographics of Country, State and District.

• Oral health diseases of public health importance.
• Preparation of oral health education material and health talk.
• WHO oral health basic survey form 1997.
• Planning a private dental clinic.
• Visit to PHC/ Water purification unit/ School/ Handicapped school.
• Indices used to measure oral diseases.
• Preventive Dentistry.
• Planning Survey.
• Comprehensive dental care.

The Department of Community Dentistry

4
 INDEX
Sl.No Assignment/ Case record Grade Signature

5
ASSIGNMENT 1

Write a brief essay on demographics of population in India or Andhra Pradesh, birth rates, morbidity,
mortality, literacy, per capita income, etc.

Aim:

The aim of the assignment is to introduce students the concepts of demographics of India.

Objectives:

By completing the assignment students should be able to

Define demographics and know the current values.

Learn the importance of demographics in dental public health.
Know the relation between the different values and how they influence health.

6
 INDIA

Total population (2005)1 1 103 371 000

% under 15 (2005)1 32

Population distribution % rural (2005)1 71

Life expectancy at birth (2004)2 62

Under-5 mortality rate per 1000 live births (2004)2 85

Maternal mortality ratio per 100 000 live births (2001-2003)3 301

Total expenditure on health as % of GDP (2004)4 4.5

General government expenditure on health as % of general

Government expenditure (2004)4 3.6

Gross National Income (GNI) per capita US$ (2005)6 720

Population living below national poverty line % (1999-2000)7 26.1

Adult (15+) literacy rate % (2000-2004)8 61.0

Adult male (15+) literacy rate % (2000-2004)8 73.4

Adult female (15+) literacy rate % (2000-2004)8 47.8

% population with access to improved drinking water source (2002)5 86

% population with sustainable access to improved sanitation (2002)5 30

Sources:
1 United Nations Population Division
2 World Health Report 2006
3 Registrar General India 2006
4 WHO data on National Health Accounts
5 Human Development Report 2005
6 World Development Indicators 2006 (World Bank)
7 Planning Commission, Government of India
8 UNESCO Institute for Statistics

7
ASSIGNMENT 2

Write a brief essay on incidence and prevalence of any common oral diseases of public health
importance and effective ways of preventing them.

Aim:

The aim of the assignment is to introduce students the concepts common oral disease of public health
importance.

Objectives:

By completing the assignment students should be able to

Define a public health problem.

Identify key oral health problems.
Learn effective ways of preventing these diseases and promoting oral health.

8
ASSIGNMENT 3

Preparation of Oral health education material and giving a health talk.

(Posters, models, slides, lectures, play acting skits etc )

1. Initially think of an ideal topic related to common oral diseases.

2. Collect the data from good source like standard textbooks and journals along with reference.
3. Analyze the collected data and come out with a rough draft.
4. Improve the rough draft keeping in mind the audience and how best you can deliver it.
5. Initial practice and delivering to group of people.

9
 HEALTH TALK
Aim:

The aim of health talk is to introduce students the concepts effective way of communicating oral
health messages to various groups of people.

Objectives:

By giving a health talk students should be able to

Define health education and oral health promotion.

Discuss the implications of this definition.
To improve the practice of chair side preventive dentistry including oral health education.
Identify key problems in delivering oral health messages.
Learn effective ways of communicating with different groups of people.

Guidelines:

Audience should be kept in mind (Age, literacy and social backdrop)

Language used should be simple with minimal scientific words
Use of scientific basis of knowledge
Should be for 4-5 minutes

Topics:

Related oral health education messages like

Prevention of dental caries

Effective ways of tooth brushing
Role of sugar in dental caries
Risk factors of oral cancer
Harmful effects of smoking
Importance of oral hygiene
Dental trauma
Diet and oral health
Fluorosis
Plaque and periodontal disease

10
ASSIGNMENT 4

Collection of data using Oral health status assessment form of, WHO (1997) basic oral health survey
methods form.

Aim:

The aim of the assignment is to introduce students WHO Basic Oral Health Survey form 1997.

Objectives:

By completing the assignment students should be able to

Understand the use of collection of data for oral health survey.

Improve the ability in filling up the survey form.
Identify key advantages and disadvantages of oral health survey form.

Oral health assessment form

The standard form for oral health assessment is designed for collection of all the information needed for
planning oral care services and thorough monitoring and re planning of existing care services.

Survey identification information

General inforamtaion
Extra-oral examination
Temporomandibular hint assessment
Oral mucosa
Enamel opacities/hvpoplasia
Dental fluorosis
CPI (periodontal status, formerly called Community Periodontal Index of Treatment Needs or
CPITN
Loss of attachment dentition status and treatment need
Prosthetic status
Dentofacial anomalies
need for immediate care and referral
Notes.

11
12
13
14
15
ASSIGNMENT 5

Write an essay on exploring and planning setting of private dental clinics in rural, semi urban and
urban locations, availability of finances for dental practices-preparing project report.

Aim:

The aim of the assignment is to introduce students how to plan before setting up a dental practice.

Objectives:

By completing the assignment students should be able to

Define planning.
Identify key aspects in setting up a dental practice.
Identify ideal location for dental practice and uses of setting up a dental practice.

Essay should include brief notes on the following.

How do you assess the need for a clinic (needs assessment)?

How do you decide if a clinic is feasible?
Whom do you want to serve?
What level of service do you want to provide?
How is facility location determined?
Facility design and construction
Equipment and Staffing
Financial feasibility
Managing clinic finances and Fundraising

16
ASSIGNMENT 6

Write a brief essay on any two of the following.

1. On visit to primary health centre to acquaint with activities and primary health care delivery.

2. On your visit to a water purification plant/ water bottling plant/ centre for treatment of
drinking water and sewage water.

3. On your visit to schools to assess the oral health status of school children, emergency
treatment and health education including possible preventive care at school.

4. On your visit to institution for the care of handicapped, physically, mentally, or medically
compromised patients.

17
ASSIGNMENT 7

INDICES

Write briefly about commonly used Indices used to measure dental diseases.

Aim:

The aim of the assignment is to introduce students how to measure dental diseases.

Objectives:

By completing the assignment students should be able to

Define Index.
Know about ideal properties of Index.
Record different dental indices on the field.

18
Patient Name Date:

Age Sex OP.No

Patient Name Date:

Age Sex OP.No

19
Patient Name Date:

Age Sex OP.No

Patient Name Date:

Age Sex OP.No

20
Patient Name Date:

Age Sex OP.No

Patient Name Date:

Age Sex OP.No

21
Patient Name Date:

Age Sex OP.No

Patient Name Date:

Age Sex OP.No

22
Patient Name Date:

Age Sex OP.No

Patient Name Date:

Age Sex OP.No

23
Patient Name Date:

Age Sex OP.No

Patient Name Date:

24
Age Sex OP.No

Patient Name Date:

Age Sex OP.No

Patient Name Date:

25
Age Sex OP.No

26
ASSIGNMENT 8

Preventive Dentistry

Write briefly about pit and fissure sealants, Atraumatic Restorative Treatment, and Topical Fluoride
application procedures.

Aim:

The aim of the assignment is to introduce students various preventive measures in dentistry.

Objectives:

By completing the assignment students should be able to

Define prevention.
Know about various methods used in prevention of dental diseases.
Gain clinical experience in performing various preventive measures.

27
 PREVENTIVE DENTISTRY

(In the department application of pit and fissure sealants, fluoride gel application procedure, ART.)

Patient Name Date

Age Sex OP.No

Preventive treatment done

Patient Name Date

Age Sex OP.No

Preventive treatment done

Patient Name Date

Age Sex OP.No

Preventive treatment done

Patient Name Date

Age Sex OP.No

Preventive treatment done

28
ASSIGNMENT 9

Write an essay on planning and conducting an oral health survey in a group of population.

Aim
Design a practical and economic sample survey design suitable for assessing oral diseases and
treatment needs for planning and monitoring oral health services.

Objectives
One should be able to define survey and design a survey.
Provide practical guidance in organizing and conducting a survey.
Understand the general principles for designing an oral health survey.

29
COMPREHENSIVE DENTAL CARE
In order to prepare the new graduates in their approach to diagnosis, treatment planning, cost of the
treatment, prevention of the treatment on schedule, recall maintenance of records etc. in a systematic
approach and maintenance of patient records as a part of clinical treatment is advised.

PATIENT RECORDS

It is understood that a certain amount of flexibility is necessary when it comes to patient records and that
dental students or practitioners must be able to exercise their judgment with respect to learning or
particular practice situations. However, the principles are the same for all patient records:

• Why did the patient come?

• What did you find out?
• What did you do?
• What was the outcome of treatment?

Patient Information
The following general information should be obtained for every patient at the initial appointment and
updated at regular intervals.

Personal details
- Name, age, sex, education, occupation, address and contact details
- For minors name of parent or legally authorized representative should also be recorded.

Medical History
A general medical history should be taken at the initial appointment to ensure that all necessary and
relevant medical information is obtained to assist in proper diagnosis and treatment, and to allow for the
provision of safe dental care.

The dentist may take the medical history orally and make appropriate notations on behalf of the patient. It
may also be necessary to obtain medical information from family members if the patient is unable to
provide it (e.g. language barrier, Alzheimer's patient).

Name and contact details of the primary physician should be recorded for further communication purpose.

Any drug allergies, current drug regimens, medical alerts or conditions pertinent to the patient's care
should be conspicuously noted on the patient record.

Following are the list of various medical conditions to be kept in mind for any dental treatment.

a. General
- serious illnesses requiring hospitalization or extensive medical care
- hospitalizations in last five years
- current medical status

30
b. Drug Therapy
- current medications (prescription and non-prescription)
- corticosteroids within last 6 months
- other

c. Sensitivities/Allergies
- skin allergies (hives, skin rash, dermatitis)
- respiratory allergies (hay fever, asthma, reactions to pollen, etc.)
- food allergies
- drug allergies
- anaphylaxis
- unusual reactions to local anaesthetic or other medications
- warnings against use of any drug or medication

d. Systems Review

i. Heart and Blood Vessels

- high blood pressure, hypertensive disease
- disorders of heart valves (heart murmur, scarlet fever, rheumatic fever, infective
endocarditis,
mitral valve problems/prolapse)
- coronary artery disease (angina pectoris, congestive heart failure, pulmonary edema,
heart
attack)
- disorders of heart rate/rhythm
- diseases of heart muscle/pericardium
- circulatory problems
- surgically corrected cardiac and vascular disease

ii. Brain and Nervous System

- stroke and vascular disorders (stroke, transient ischemic attack)
- degenerative disorders (Alzheimer's, cerebral palsy)
- infections (meningitis)
- seizures/convulsions/tics (epilepsy)
- problems of spine/peripheral nerves

iii. Blood
- anemias
- leukemias
- lymphomas
- bleeding disorders (hemophilia)

iv. Lungs and Respiratory System

- respiratory infections (bronchitis, tuberculosis)
- chronic lung conditions (asthma, emphysema, cystic fibrosis)

v. Endocrine System
- pancreatic disorders (diabetes mellitus, hyperglycemia, hypoglycemia)
- thyroid disorders (hyperthyroidism, hypothyroidism)
- malignant hyperthermia
- adrenal gland disorders
- pituitary gland disorders
- parathyroid disorders

vi. Gastrointestinal Tract

31
- esophogeal problems
- stomach problems (indigestion, ulcer, gastritis, tumor)
- disorders of small/large intestines
- liver disease (jaundice, hepatitis A/B/C, cirrhosis)
- gall bladder/bile duct disorders

vii. Genitourinary System

- kidney disorders (congenital, inherited, injury, infection, inflammation)
- bladder problems
- stones, cysts and tumors

viii. Neuromuscular/Skeletal System

- joint disorders (arthritis, rheumatism)
- muscle/tendon/soft tissue disorders
- bone disorders
- connective tissue disease

ix. Ears/Nose/Throat/Eyes
- disorders of ears
- disorders of nose/sinus
- disorders of throat
- disorders of eyes

x. Mental
- psychiatric/nervous conditions

e. Infectious Diseases
- generalized infections (AIDS, positive testing for HIV virus, infectious mononucleosis)
- common contagious diseases
- sexually transmitted diseases

f. Cancer/Radiation/Chemotherapy

g. Organ Transplants
- solid organs
- bone marrow

h. Medical Implants
- joint replacement
- heart valve replacement
- pacemaker
- indwelling catheter
- other

i. Symptoms Review
- swollen ankles - chest pains
- shortness of breath - bruise easily
- persistent cough - blood in sputum
- frequent nosebleeds - changes in appetite
- weight gain/loss - tendency to faint
- fever - pain
- temperature intolerance - troubles with hearing or balance
- dizziness - impaired vision

j. Women Only
32
 - pregnancy
- birth control pills

k. Other
- family history of diseases
- list of surgical procedures
- history of misuse, overuse or abuse of alcohol or drugs
- treatment for alcohol or drug addiction
- any other disease, condition or problem not listed
- any problem or medical condition to be discussed in private only

l. Medical History Update

The medical history should be reviewed at the time of the recall examination or more frequently if
indicated. The date of the review and any changes should be noted in the patient record and initialed by
the treating practitioner. The updated history may be signed by the patient or legally authorized
representative.

Dental History
The dental history should include documentation of aspects of personal dental health and previous dental
care that may influence the proposed dental treatment. Information obtained regarding a patient's dental
history supplements the clinical examination and assists in the planning and sequencing of dental care
that is necessary and appropriate to improve the patient's oral/dental health.

a. General
- reason for today's visit/patient's chief complaint
- perceived dental needs (straightening of teeth, closing missing spaces, improved breath
odor, etc.)
- previous dental care (radiographs, scaling, prophylaxis, restorative treatment)
- emotional concerns (fear, pain, time, money, embarrassment)

b. Specific
- pain/numbness
- sites of pain or discomfort
- bleeding gums
- difficulty or heavy bleeding following extraction
- growths/sore spots
- headaches
- frequent canker sores, fever blisters, cold sores
- jaw problems

c. Oral hygiene
- brushing
- flossing
- other aids

d. Habits
- mouth breathing
- tongue thrust
- biting lips/tongue/cheeks/fingernails
- clenching/grinding teeth
- thumb/finger sucking
- using toothpicks or other foreign objects in mouth

33
 e. Dietary
- dietary habits
- sugar intake

Clinical Examination
The clinical examination record consists of chart recordings on tooth chart which may include written
descriptions of the conditions that are present on examination of the patient. While the choice of patient
record forms is left to the individual practitioner, it is important that there is sufficient space to record all
relevant information and to update it whenever necessary. Information such as missing teeth, caries and
pocket depths can be charted directly on the tooth chart whereas other conditions such as intrinsic
staining and hypoplasia require written descriptions.

An indication of examination of neurologic changes, assessment of findings related to pain, and

evaluation of the oral mucosa should also be noted. It is important to show that all aspects of the
examination have been performed. For those patients with little or no history of dental disease and
relatively healthy oral tissues, this can be accomplished with a notation such as "within normal limits" for
most of the areas.
a. Examination of patient's chief complaint or immediate need

b. Vital Signs (respiration, pulse, blood pressure)

The necessity for recording vital signs is dependent on the complexity of the dental
treatment required, the medical history and present state of health of the patient. They
must always be taken when sedation or general anaesthesia is to be used.

c. Extraoral
- general appearance
- head
- neck
- lymph nodes, masses

d. Intraoral (Soft Tissue)

- lips
- mucosa
- palate
- tori
- tongue
- floor of mouth
- pharynx/tonsils
- saliva

e. Temporomandibular Structures
- jaw joint and/or masticatory muscle tenderness/soreness
- maximum mouth opening
- range of jaw movement (right and left lateral)
- presence of clicking and/or crepitus

f. Occlusion
- centric relation/centric occlusion
- right lateral excursion
- left lateral excursion
- protrusive
- midline relationships
- classification
34
 - overbite/overjet
- crossbite
- crowding
- swallowing patterns

g. Status of Dentition
- missing teeth
- caries
- sensitive teeth
- developmental anomalies (enamel hypoplasia, fluorosis, intrinsic staining)
- regressive changes (abrasion, attrition, cervical wear, erosion, wear facets)
- malpositions (tipping, plunger cusps, rotations)

h. Periodontal
- oral hygiene (brushing, flossing, other)
- deposits (plaque, calculus, stain)
- tissues (color, size, position, shape, consistency, texture)
- bleeding, exudate

- mucogingival junction (attachment, frenum pull)

- mucosa
- probing and recording depths of sulci and pockets

i. Investigations

Results of blood investigations and radiographs taken were taken note of.

Diagnosis and Treatment Plan

The diagnosis is made from the review of the baseline data collected and recorded during the clinical
examination and supplemented by necessary radiographs, diagnostic study casts and/or results of any
tests or consultations. Where possible, the diagnosis should be stated specifically (e.g. generalized adult
periodontitis) as this is the information that must be communicated to the patient.

Treatment plan
The treatment plan is a list of recommended services to be performed. The treatment plan should be
supported by a complete and accurate clinical record and take into account the relative urgency and
severity of the patient's condition. In addition to the recommended treatment, any alternatives, including
no treatment, should be listed on the record and discussed with the patient. The patient's choice of
treatment should be recorded along with the estimated costs.

Clinical record/ treatment performed

Progress notes describe the services rendered for the patient and should provide a complete and
comprehensive description of the completed and scheduled dental care. In addition, the notes should
include explanations or rationale for treatment where appropriate. Any limitations and/or unexpected
outcomes should also be noted. There are certain minimum requirements for the recording of progress
notes which include:
- Date and particulars of each professional encounter with the patient,
35
- Radiographs (number and type) Diagnostic study casts
- Clinical findings, diagnoses and assessments
- Procedures performed including methods and materials used (e.g. type of gold, porcelain,
composite, liners, bases)
- Local anaesthetics used including type and quantity
- Medication given to or taken by patient
- Advice given by or on behalf of dentist including pre- and post-treatment instructions or
reference to
handout given
- Referrals to other health professionals for examination, tests, consultation or treatment and the
results of
such referrals

36
Personal Details

Name:

OP No.: Age: Sex:

Education: Occupation:

Address and contact details:

Medical History

Name and contact details of primary physician

Dental History

a. Chief complaint

b. Specific history

c. Oral hygiene

d. Habits

e. Dietary

37
Clinical examination
a. Examination of patient's chief complaint or immediate need

b. Vital Signs (respiration and pulse)

c. Extraoral
- general appearance - head
- neck - lymph nodes, masses

d. Intraoral (Soft Tissue)

- lips - mucosa
- palate - tori
- tongue - floor of mouth
- pharynx/tonsils - saliva

e. Temporomandibular Structures
- jaw joint and/or masticatory muscle tenderness/soreness
- maximum mouth opening
- presence of clicking and/or crepitus

f. Occlusion
- overbite/overjet - crossbite
- crowding - classification

g. Status of Dentition

38
Decayed, missing, and filled teeth; sensitive teeth; developmental anomalies(enamel hypoplasia, fluorosis, intrinsic staining);
regressive changes (abrasion, attrition, cervical wear, erosion, wear facets); malpositions (tipping, plunger cusps, rotations)

h. Periodontal
- oral hygiene
- deposits (plaque, calculus, stain)
- tissues (color, size, position, shape, consistency, texture)
- bleeding, exudate
- mucogingival junction (attachment, frenum pull)

Provisional diagnosis

Investigations

Diagnosis

Treatment plan

39
Clinical record
Date Clinical record/Treatment performed Signature

______________________________________________________________________________
40