Department of Periodontia & Community Dentistry

SOPs

Dept. data last updated on :30/11/2022

SOP's


STANDARD OPERATING PROCEDURE IN DEPARTMENT OF PERIODONTICS



1. SOPs for CLINICS

2. SOPs for CLINIC WORK DURING COVID

3. SOPs for OFFICE

4. SOPs for TEACHING


SOPs for CLINICS

Purpose: Todescribethe professional services offered bythedepartment ofPeriodontology


Aims:Periodontologyis that specialtyof dentistrywhichencompassesthe prevention,diagnosisand treatment of diseases of the supporting and surrounding tissues of the teeth or theirsubstitutes and the maintenance of the health, function and aesthetics of these structuresand tissues. A periodontist is a dental specialist who deals with the diagnosis, prevention, and treatment of periodontal and peri-implant diseases.


Scope:

1. Periodontal evaluation

2. Periodontal maintenance

3. Non-surgical periodontal therapy

4. Dental Crown lengthening procedures

5. Periodontal Pocket reduction procedures

6. Regenerative procedures

7. Periodontal plastics procedures

8. Ridge augmentation procedures

9. Sinus augmentation procedures

10. Gum disease laser therapy

11. Dental implants


Periodontal evaluation

 Aim: To determine if the patient have or is at risk for periodontal disease.


Every patient coming to Department of Periodontology OPD will undergo a comprehensive periodontal evaluation (CPE) to determine if the patient have or is at risk for periodontal disease. CPE can be performed by consultant and his team comprising of postgraduate students. The patient will be assessed for six areas during CPE:


1. Teeth: The healthiness of the correlation of your gums and your teeth and any restorations you might have, including dental fillings, dental implants, crowns, and dentures will be examined.

2. Plaque: The amount and location of any plaque and/or tartar will be assessed.

3. Gums: An instrument called a dental probe will be inserted into the space between tooth and gums to measure the depth of gum pockets and to see how well gums attach to your teeth. Any bleeding that occurs during theprobing process, as well as any inflammation of gums, will also be recorded.

4. Bite: occlusioni.e., bite will also be assessed. While you bite down, the consultant will look to see how your teeth fit together and for any signs of tooth movement or loose teeth. This is important because moving or loose teeth can be a sign of periodontal disease.

5. Bone Structure: Will examine the bone in and around mouth since it can be affected by periodontal disease. X-rays may be taken to help evaluate the quality of bone in your upper and lower jaw areas and to determine if any bone loss has occurred.

6. Risk Factors: the patient will be asked about a variety of risk factors for periodontal disease, including age, tobacco use, if any other family members have periodontal disease, or if you have another systemic condition that may be linked to periodontal disease, such as diabetes or cardiovascular disease.

After comprehensive periodontal evaluation, the consulting dentist will discuss the findings with the patient and explain if any treatment is needed. The consultant will then allot the patient to undergraduate / dental hygienist/ postgraduate student depending upon the treatment needed. In addition,every patient will be taught proper brushing technique& flossing.

Responsibility: Consultants, Postgraduates

Standard procedure in OPD

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Periodontal maintenance


Aim:To prevent disease in the gum tissues and bone supporting teeth.

supportive periodontal care may include:

• discussion of any changes in health history

• examination of mouth tissues for abnormal changes

• measurement of the depth of pockets around teeth

• assessment of oral hygiene habits and provision of instruction

• removal of bacterial plaque and tartar

• x-ray film studies to evaluate teeth and the bone supporting teeth

• examination of teeth for decay and other dental problems

• check-up on the way teeth fit together when you bite

• application or prescription of medications to reduce tooth sensitivity or other problems.

Responsibility: Consultants, Postgraduates, undergraduates, hygienists

Reference record: Register for consultant, Postgraduates, undergraduates, hygienists


Non-surgical periodontal therapy


Aim: to achieve periodontal health in the least invasive and most cost-effective manner.

Scaling and root planing is a careful cleaning of the root surfaces to remove plaque and calculus [tartar] from deep periodontal pockets and to smooth the tooth root to remove bacterial toxins. Scaling and root planing can be used as a stand-alone treatment, or a preventative measure. They are commonly performed on cases of gingivitis and moderate to severe periodontal disease. Scaling and root planing is sometimes followed by adjunctive therapy such as local delivery antimicrobials, systemic antibiotics, and host modulation, as needed on a case-by-case basis.

Responsibility: Consultants, Postgraduates, interns, Undergraduates, Hygienists

Reference record: Register for consultant, Postgraduates, interns, Undergraduates, Hygienists



Dental Crown lengthening procedures


Aim: During the dental crown lengthening procedure, excess gum and bone tissue is reshaped to expose more of the natural tooth.

This can be done to one tooth, to even gum line, or to several teeth to expose a natural, broad smile. Crown lengthening adjusts the gum and bone level to expose more of the tooth so it can be restored.

Responsibility: Consultants, Postgraduates

Reference record: Register for consultant, Postgraduates


Periodontal Pocket reduction procedures


Aim:A periodontal pocket reduction procedure is recommended when pockets are too deep to clean with daily at-home oral hygiene and a professional care routine.

During this procedure, the operating consultant folds back the gum tissue and removes the disease-causing bacteria before securing the tissue into place. In some cases, irregular surfaces of the damaged bone are smoothed to limit areas where disease-causing bacteria can hide. This allows the gum tissue to better reattach to healthy bone.

Reducing pocket depth and eliminating existing bacteria are important to prevent damage caused by the progression of periodontal disease and to help you maintain a healthy smile. Eliminating bacteria alone may not be sufficient to prevent disease recurrence. Reduced pockets and a combination of daily oral hygiene and professional maintenance care increase chances of keeping natural teeth – and decrease the chance of serious health problems associated with periodontal disease.

Responsibility: Consultants, Postgraduates

Reference record: Register for consultant, Postgraduates

Regenerative procedures


Aim:Procedures that regenerate lost bone and tissue supporting teeth can reverse some of the damage caused by periodontal disease.

During this procedure, periodontist folds back the gum tissue and removes the disease-causing bacteria. Membranes (filters), bone grafts or tissue-stimulating proteins can be used to encourage body's natural ability to regenerate bone and tissue.

Eliminating existing bacteria and regenerating bone and tissue helps to reduce pocket depth and repair damage caused by the progression of periodontal disease.

Responsibility: Consultants, Postgraduates

Reference record: Register for consultant, Postgraduates



Periodontal plastics procedures


Aim:Procedures to cover gummy smile and recession

GUMMY SMILE OR UNEVEN GUM LINE

Teeth that look too short and smile that is too gummy or gums that cover too much of some teeth while leaving the others the right length- in such cases, dental crown lengthening might be the solution. During this procedure, excess gum tissue is removed to expose more of the crown of the tooth. Then gumline is sculpted to give new smile just the right look.

LONG TEETH/EXPOSED ROOTS

Sometimes gum recession causes the tooth root to become exposed, which makes teeth look long and can make one look older than one is. This recession can happen as a result of a variety of causes, including periodontal diseases.Gum graft surgery and other root coverage procedures are designed to cover exposed roots, to reduce further gum recession and to protect vulnerable roots from decay.

INDENTATIONS IN THE GUMS AND JAWBONE

Tooth loss can cause an indentation in the gums and jawbone where the tooth used to be. This happens because the jawbone recedes when it no longer is holding a tooth in place. Not only is this indention unnatural looking, it also causes the replacement tooth to look too long compared to the adjacent teeth.Ridge augmentation can fill in this defect recapturing the natural contour of the gums and jaw. A new tooth can then be created that is natural looking, easy to clean and beautiful.

Responsibility: Consultants, Postgraduates

Reference record: Register for consultant, Postgraduates

Ridge Augmentation

Aim:Procedure to rebuild original height and width of alveolar ridge and to help recreate the natural contour of the gums and jaw.

Sometimes when a tooth is removed, the bone surrounding the socket breaks, and it unable to heal on its own. The previous height and width of the socket will continue to deteriorate.Rebuilding the original height and width of the alveolar ridge is not medically necessary, but may be required for dental implant placement, or for aesthetic purposes. Dental implants require bone to support their structure, and a ridge augmentation can help rebuild this bone to accommodate the implant.

Responsibility: Consultants, Postgraduates

Reference record: Register for consultant, Postgraduates


Sinus augmentation procedures


Aim: To raise the sinus floor and allow for new bone formation.

In the most common sinus augmentation procedure, a small incision is made on the premolar or molar region to expose the jaw bone. A small opening is cut into the bone, and the membrane lining the sinus is pushed upward. The underlying space is filled with bone grafting material, either from your own body or from a cadaver. Sometimes, synthetic materials that can imitate bone formation are used. After the bone is implanted, the incision is stitched up and the healing process begins. After several months of healing, the bone becomes part of the patient’s jaw and dental implants can be inserted and stabilized in this new sinus bone.

Responsibility: Consultants with Postgraduates

Reference record: Register for consultant


Gum disease laser therapy


Aim:Lasers can be used to treat periodontal disease.

Current controlled studies have shown that similar results have been found with the laser compared to specific other treatment options, including scaling and root planing alone.A variety of procedures can be performed using laser technology, such as a frenectomy, osseous surgery, and gum grafting. There are numerous advantages to using laser therapy.

Responsibility: Consultants with Postgraduates

Reference record: Register for consultant


Dental implants


Aim:To replace missing or un-restorable teeth.

This procedure is a team effort between periodontist and restorative dentist. To determine where and how implant should be placed. Depending on specific condition and the type of implant chosen, a treatment plan tailored to meet the patient needs.

Responsibility: Consultants

Reference record: Register for consultant, Postgraduates


SOPs for CLINIC WORK DURING COVID

• Observe social distancing measures at all times (minimum 2 meters)

• Clear safety standards for PPE & IPC

• Appropriate sequencing and scheduling, management, discharge and referral of patients,

• Only non AGP care to be given with appropriate PPE (eye protection, surgical masks, disposable apron & gloves)

• Intervention to minimum, to reduce exposure risk

• Using one-way entry/exit for patient flow

• Cleaning and decontamination of area before and after every patient daily


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PPE: personal protective equipment

IPC: infection prevention & control

AGP: aerosol generating procedures

SOPs for OFFICE


 Official Working Hours 8:00 AM – 4:00 PM

 Maintaining records of all the documents received and dispatched from the department

 To put up all the receiveddocuments before the chairman

 To carry out the duty in accordance with the comments of the chairman.

 To make arrangements for the exams conducted in the department

 Filing documents in their respective files (Office file/Personal file/Circular file/ Notice Board file/ PG file/NAAC/IQAC/File for Minutes of BOS).

 To maintain all the details of purchases and expenditure made by the department.

 The following record registers are maintained by the office

Official Work Records

1. Register for received documents

2. Register for dispatch documents

3. Register for departmental meetings

4. Register for BOS

5. Register of leave record of teaching & non-teaching

6. Register for attendance of teaching, non-teaching, post graduates, undergraduates, interns & hygienists

7. Register for duty of teaching & non-teaching during holidays

Clinical Work Records

1. Register for general patient registration in UG CLINIC

2. Register for student patient registration in UG CLINIC

3. Register for patient record in PG CLINIC

4. Register for daily work done record of Consultants, Postgraduates, Undergraduates, Interns, Hygienists

5. Register for equipment allocation to consultants & postgraduates

Financial Records

1. Register for purchase committee meetings

2. Register for immovable assets

3. Register for record of all the instruments in the department

4. Register for record of repair of various items

5. Register for day-to-day expenses

6. Register for consumables items

7. Register for Bank related work TA, DA.

8. Indent book register



SOPs for TEACHING

Aims:To ensure that the learning environment of its dental education program is conducive to the ongoing development of explicit and appropriate professional behaviours in its dental students and faculty.

 Professionals demonstrate adherence to the highest standards of personal, professional, and academic honesty and integrity.

 To periodically evaluate the learning environment in order to: a) identify positive and negative influences on the maintenance of professional standards b) implement appropriate strategies to enhance positive and mitigate negative influences c) identify and promptly correct violations of professional standards

 To not allow our conduct to negatively impact on others' learning or clinical activities

 To not discriminate against students on the basis of such grounds as age, race, colour, ancestry, place of origin, ethnicity, political beliefs, religion, marital status, family status, physical or mental disability, sex, sexual orientation or gender identity

 To communicate respectfully with others both verbally and in writing

 To respect the privacy and confidentiality of those to whom we owe that duty

Undergraduate teaching:

1. Lectures: it’s the main mode is theoretical teaching for undergraduate students. The course work is divided among all the faculty members in the beginning of the session according to their respective thrust areas. The teaching schedule for the entire session is passed by the members of the BOS of the department.

2. Clinical demonstrations: undergraduate students must be exposed to different clinical procedures through appropriate demonstrations by faculty members.

3. Problem based learning: it mainly includes clinical teaching. Every faculty member on his/her OPD day must take at least 45 minutes of clinical teaching mainly based on a particular clinical problem and then outlining the etiology, pathogenesis and management of that particular problem.

Post-graduate teaching:

1. Seminars: one seminar presentation is to be done by one post-graduate student every week on his/her respective turn. The topics for the seminars are decided by the BOS every year at the beginning of the session for the entire session.

2. Journal Clubs: one article from reputed journals is discussed once a week

3. Group discussion: conducted once a week in which all the postgraduate students and faculty members participate

4. Case Discussions: postgraduate students present their clinical case work in front of the faculty members for discussion and critical appraisal.

5. Pre-clinical & clinical demonstrations: postgraduate students are trained on models for mastering different incision and suturing techniques. The consultants demonstrate all the surgical techniques on selected cases to the postgraduate students.




FIRE FIGHTING AND USE OF FIRE EXTINGUISHERS

Safe Operating Procedure

FIRE SAFETY – GENERAL PREVENTION AND EXTINGUISHERS

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This SOP provides general information on fire prevention, as well as detailed information regarding fire extinguisher classification, type, size, location, and use. Other EHS SOPs provide information regarding fire safety related to specific materials, such as flammable liquids, compressed gases, pyrophoric chemicals, etc.

Fire Prevention

 Keep hallways, corridors, and exit areas clear of items that impede egress in an emergency (i.e., chairs, tables, boxes, equipment, etc).
 Properly store combustible items. Do not accumulate unnecessary cardboard boxes, chemicals, and paper products.

 When stacking or storing items on shelves, the top of the items must be a minimum of 18” below sprinkler head deflectors.
 Avoid storage of flammable liquids outside of a flammable storage cabinet. See EHS SOP, Storage and Use of Flammable and Combustible Liquids for more information.

 Properly store compressed gas cylinders.
 Segregate chemicals by hazard class. See EHS SOP, General Guidance for Chemical Storage for more information.
 Purchase equipment that is approved by a testing organization, .
 Keep electrical equipment, cords, and plugs in good condition. Arrange for an authorized factory representative or electrician to replace electrical cords or plugs that are in poor condition (i.e., frayed, cracked insulation, loose prongs, etc.).
 Do not overload electrical outlets.
 Report loose electrical wall receptacles, missing outlet faceplates, and exposed wires to the Building Maintenance Reporter (BMR)/ Electricity department of university.
 Disconnect electrical equipment that could possibly overheat when unattended.
 Keep fire extinguishers charged, stored in their designated location, and ensure annual inspection.
 When using a space heater, allow a minimum of three (3) feet between the heater and combustible materials.
 Turn off the electrical and heat-producing appliances at the end of the day.

  • Refrain from open flames (i.e. candles, sterno burner, incense burner, etc.) unless they arean

    integral part of the work activity (i.e., Bunsen burners in laboratories, torches in welding shops,

    etc.). Do not leave open flames unattended.

  • Do not store or use ordinary combustibles (i.e., papers, napkins, cloths, etc.) or flammable/

    combustible solvents (e.g.,aerosols, paints, etc.) in the vicinity of open flames or hot surfaces.

  • Know how to safely exit the work area if a fire should occur. Have at least two (2) exit routes in

    mind and walk through them to assure your safe response. Always observe a fire alarm.

    Convene in the predetermined safe gathering location.

  • Use appropriately designed tools for handling hot equipment or surfaces (don’t improvise with

    dish towels, rags, etc.).

    CALL EMERGENCY NUMBER 100/101/112

Classes of Fires

The Fire Protection Association categorizes fires by class. Newer fire extinguishers use a picture/ labeling system to designate which types of fires they are to be used on. Older fire extinguishers are labeled with colored geometrical shapes with letter designations. Icons for both are shown below. Many extinguishers are designed for more than one type of fire and will therefore be labeled with more than one designator.

Class A – Trash, Wood, Paper
Class A fires involve ordinary combustible materials--paper, wood, fabrics, rubber, and many plastics. Quenching by water or insulating by a multipurpose (ABC) dry chemical agent is e
ffective.

Class B - Liquids, Grease
Class B fires occur in flammable liquids--gasoline, oils, greases, tars, paints, lacquers, and flammable gases. Dry chemicals and carbon dioxide agents extinguish these fires.

Class C - Electrical Equipment
Class C fires take place in live electrical equipment--motors, generators, switches, and appliances. Nonconducting extinguishing agents such as dry chemicals or carbon dioxide are required to extinguish them. Fire extinguishers for the protection of delicate electronic equipment shall be selected from types specifically listed and labeled for Class C.

Class D - Combustible Metals
Class D fires occur in combustible metals such as magnesium, titanium, zirconium, sodium, lithium, and potassium. Sodium carbonate, graphite, bicarbonate, sodium chloride, and salt- based chemicals extinguish these fires. There is no picture designator for Class D extinguishers.

Class K - Cooking Oil Fires.
Class K fires occur in cooking appliances that use combustible cooking media (vegetable or animal oils and fats).

Types of Fire Extinguishers

 Multipurpose Dry Chemical for Class A, B, and C Fires. The monoammonium phosphate agent is inexpensive and electrically nonconductive but leaves a powdery residue that can damage equipment. This type of extinguishing agent is not good for hidden fires.
 Water for Class A Fires. This type of extinguishing agent is not appropriate for areas with Class C hazard potential because water will conduct electricity.

 CO2 for Class B and C Fires. Carbon dioxide is a colorless, odorless gas that leaves no messy residue to damage equipment. This type of extinguishing agent is good for reaching hidden fires, however, the heavy vapor settles out, limiting the total discharge range to approximately 8 ft. (2.4 m). Carbon dioxide may also cause thermal (cold) and static (shock) damage.

 Dry Chemical for Class B and C Fires. The potassium bicarbonate and sodium bicarbonate extinguishing agents are extremely effective against Class B fires and are electrically nonconductive. They are considered non-toxic and cleanup may be accomplished with a vacuum cleaner or broom and dustpan.

 Dry Chemical for Class D Fires. Extinguishing agents include sodium carbonate, salt, graphite, bicarbonate- and sodium chloride-based chemicals. These agents are not equally effective on all combustible metal fires. Be sure the extinguishing agent chosen will be effective on the combustible metal present, as using the wrong extinguishing agent can increase or spread the fire.

 Wet Chemical for Class K Fires. Potassium acetate is the agent specifically listed and labeled for use on Class K fires. Portable Class K fire extinguishers are intended to supplement automatic fire extinguishing systems.

Ratings of Fire Extinguishers

The fire rating of an extinguisher provides a guide to its extinguishing ability.,

Class A and Class B fire extinguishers carry a classification on their nameplates that consists of a numeral followed by a letter. The numeral indicates the approximate relative fire extinguishing capacity of the extinguisher on the class of fire, which is identified by a letter. For example, a 4-A extinguisher has approximately twice the extinguishing capacity as 2-A extinguisher.

Class C and D extinguishers carry only the symbol and have no numerical rating. Fire extinguishers and extinguishing agents for use with Class D hazards shall be of types approved for use on the specific combustible metal hazard. This should be detailed on the fire extinguisher nameplate.

Location of Fire Extinguishers

Fire extinguishers are required to be conspicuously located where they will be readily accessible and immediately available in the event of fire. Preferably, they shall be located along normal paths of travel, including exits from areas. Extinguisher placement must fulfill both distribution and travel distance requirements. Fire extinguishers must not be obstructed or obscured from view. In large rooms, and in certain locations where visual obstructions cannot be completely avoided, means shall be provided to indicate the extinguisher location.

Scattered or widely separated hazards must be individually protected. A fire extinguisher in the proximity of a hazard shall be carefully located to be accessible in the presence of a fire without undue danger to the operator. Portable fire extinguishers must be installed securely on the hanger, or in the bracket supplied by the extinguisher manufacturer, or in a listed bracket approved for such purpose, or placed in cabinets or wall recesses.

Number of Fire Extinguishers Needed

The number of extinguishers needed is determined by the authority having jurisdiction (usually the local or state fire marshal). This determination is based on the rapidity with which a fire may spread, the intensity of the heat that may develop, the travel distance (actual walking distance) from any point to the nearest fire extinguisher, and the accessibility of the fire.

Use of Extinguishers

Any person who is designated or intends to use a fire extinguisher must be trained in its use.

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HOW TO USE FIRE EXTINGUISHER