Department of Periodontia & Community Dentistry

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

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

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.