Dental charting

Re: Dental charting

kim tutt — Sun, 09 May 2010 17:44:25 GMT

Pfizer have nice charts with everything on. Our nurses like it

Kim

Re: Dental charting

Louise6732 — Sun, 09 May 2010 17:09:26 GMT

Thanks for the input everyone, I did a small presentation on how to use the charts (mainly how to put it all onto the computer!) last week, everyone seemed relatively keen. I've tried it out the charts myself too, much easier than shouting out notes to the nurses!

Here's hoping it continues to go to plan :-)

Re: Dental charting

Evelyn Barbour-Hill — Wed, 05 May 2010 00:23:32 GMT

[quote user="Clive Ansell"]None of these carry out routine radiography for dental cases, and none have specific equipment or even intra-oral films; in an ideal world I feel we probably should do more of it, but on planet real world we are usually constrained by costs.[/quote]

'tain't expensive.

Re: Dental charting

Evelyn Barbour-Hill — Wed, 05 May 2010 00:14:00 GMT

As people say above, there are several ready-made charts available so use what you find suits you. I found the Denta-labels too small and crowded to get everything on - the result was a mess. These days I've actually gone on to writing it all down, in a sort of stylised tabular form, and at the moment I prefer that. One reason for having charts should be that any clinician can instantly understand what the previous one found and did, but in practice with so many different styles of doing them, personal abbreviations, appalling writing and so on, I don't think that's been achieved yet . So the main reason is to make a complete record for yourself - I challenge anyone to recall all the details of a mouth they did one week ago.

You need a chart to record a) what you found, and b) what you did: before and after, as you might say. Whether you actually give a copy to the client or not, it's a useful aide-memoire for you when you are talking the client through it all when you see them to discharge the patient, and even more when you see the patient and the client again a week later, and a month or two later to check how they are getting on with the oral hygiene.

Keep it fairly simple. Overall impression of the mouth and a summary of the general type of problem, is very useful. Then for each tooth: degree of plaque, degree of calculus, degree of gingivitis ( mild, middling, enormous, are quite enough grades for all these); mm. of gum loss, if any; mm probing depth, if any; furcation lesions grade 1 to 4 if any; fractures, defects, internal discoloration, notable misplacements or rotations; apparent absence of tooth (annotated later if tooth is "absent" because it's been broken off and the roots are still there); supernumerary teeth. If the finding is "nil" or "normal" don't write anything. If there's mild plaque all over, that's to be assumed anyway, so don't write anything. Use common sense..... if your probe goes right in just record it as 'extreme', it doesn't matter a damn whether it was 16 or 17mm. I like to highlight the obvious plaque traps where periodontal disease will be established: for instance, the interproximal space 408-409 or 108-109 are common ones. Then later when you are showing the owner how to brush you can instruct them to concentrate on those points. Record resorptive lesions, including those only detected on Xray.

Then, recording what you've done, I'd take it as given that you removed all plaque and calculus and polished, so no need to record that. Record extractions of course (possibly also the reason for extraction), and anywhere you did root-planing, or Periodontal Bactericidal Ultrasonic Debridement, or a flap procedure, etc. If you're trying to get it all on one diagram, maybe record what you found in red, and what you did in green?

I'm considerably under-impressed by those charts I have seen on "practice management systems", but the ideal for me would certainly be a charting system that I could enter directly on the computer in the operating room. No more slightly bloody bits of paper, with wet bits where the pen won't write , nothing to file, . With instruction from my brother,who understands these things, I started to write my own in Filemaker, but I never seem to get the time to work on it. I have almost definitely decided to buy the Pro Denta system marketed by Accesia. (www.accesia.se) It's Windows only, unfortunately, but I am obliged to have Windows on that computer so I can stand that.

Re: Dental charting

chrisvet — Tue, 04 May 2010 20:45:50 GMT

I use charts provided by Pfizer which have all of the things you need to chart on them. I have scanned them onto my computer so just print them off as needed, so I never run out. You need the chart by the patient, so don't use the one on our PMS. Takes a couple minutes for a nurse to do the chart. We then scan it and attach it to the clients file on the PMS so readily available when rechecked, no matter which branch the client attends. We also give the owners a hard copy.

Re: Dental charting

Rob Loxley — Tue, 04 May 2010 18:16:27 GMT

Are you running computerised notes - if so then see what charting options are provided by the software and use those. If using paper notes, then I'd suggest the self-adhesive Dentalabels - available from Vet Instrumentation - to stick to the notes. There are some PDF charts on the Petsmile website: http://www.petsmile.org/vets/dental_charts.html

Re: Dental charting

Clive Ansell — Sun, 02 May 2010 18:56:59 GMT

I just don't find the need too, and in most cases generalised anaesthesia and generalised pre/peri/post analgesia with opiates and/or nsaid's seem to be sufficient for most routine dental procedures. If I were to carry out particularly complex, lengthy or difficult extractions, or for patients where nsaid's are contraindicated I may use regional analgesia.

A dental extraction done well and with no complications is not that painful. I have recently had one of my own wisdom teeth extracted with the use of a local block, but no post operative analgesia at all after the local had worn off after 3-4 hours

There is a cost issue too. Although the materials for regional analgesia are not that expensive, one still has to factor in time and expertise, and there is a pressure form clients, and from within the profession, to carry out dental procedures as cheaply as possible in many cases

Re: Dental charting

Lucie Allcutt — Sun, 02 May 2010 17:27:08 GMT

[quote user="Clive Ansell"]

I went through a phase as a newish grad, when I started working towards a certificate in anaesthesia, of using local and regional anaesthesia for dentals, but I haven't done so now for ages. I don't know anyone else that does routinely.

[/quote]

Why is that? Do you feel there is no benefit or is it a time/money/practice policy issue? In my (very limited!) experience it seems a quick and cheap way to enhance analgesia.

Re: Dental charting

Michael Woodhouse — Sun, 02 May 2010 17:01:22 GMT

[quote user="Clive Ansell"]

Sorry, I see what you mean. I'm using IE which should open links in a new tab (or new window) and not lose the original page.

Try it now. I have edited the hyperlink; click "insert/edit link" (picture of chain) then in the target box select "open link in new window"

[/quote]

Good man Clive!

Re: Dental charting

Clive Ansell — Sun, 02 May 2010 13:07:56 GMT

[quote user="Michael Woodhouse"]

[quote user="Clive Ansell"]

If using IE, just right click then click "open in new tab" or "open in new window" - simples.

Yes, I found it to be 10 hours of good practical and useful cpd.

[/quote]

I know how to do it (use FF BTW) it's just irritating losing the page I was on when I click the links. More confusingly some seem to open a new tab!

[/quote]

Sorry, I see what you mean. I'm using IE which should open links in a new tab (or new window) and not lose the original page.

Try it now. I have edited the hyperlink; click "insert/edit link" (picture of chain) then in the target box select "open link in new window"

Re: Dental charting

Michael Woodhouse — Sun, 02 May 2010 13:01:36 GMT

[quote user="Clive Ansell"]

If using IE, just right click then click "open in new tab" or "open in new window" - simples.

Yes, I found it to be 10 hours of good practical and useful cpd.

[/quote]

I know how to do it (use FF BTW) it's just irritating losing the page I was on when I click the links. More confusingly some seem to open a new tab!

Re: Dental charting

Clive Ansell — Sun, 02 May 2010 12:40:13 GMT

If using IE, just right click then click "open in new tab" or "open in new window" - simples.

Yes, I found it to be 10 hours of good practical and useful cpd.

Re: Dental charting

Michael Woodhouse — Sun, 02 May 2010 12:31:31 GMT

Good link Clive!

Arlo - could we have links opening in a new window, please?

Re: Dental charting

Clive Ansell — Sun, 02 May 2010 11:18:52 GMT

I work as a locum on a regular basis in five practices, plus many others. None of these carry out routine radiography for dental cases, and none have specific equipment or even intra-oral films; in an ideal world I feel we probably should do more of it, but on planet real world we are usually constrained by costs.

Two of the five practices use dental charts, but I cannot really see why as the charts are filed and not used or referred to again. Some clients like to have a copy, but others couldn't care less.

For those that haven't found it, there is some online dental cpd , which I found detailed and useful.

Re: Dental charting

Lucie Allcutt — Sat, 01 May 2010 22:50:01 GMT

I'm not in practice yet (I graduate May 29th!!) but I did a two week externship at a dental practice with board-certified veterinary dentist Dr. Bellows and I have found his website to be extremely helpful

http://www.dentalvet.com/Encyclopedia/M04967.htm

He goes into charting here, and there are feline and canine dental charts you can print out.

He is also a big advocate of taking full mouth radiographs as part of routine oral assessment and has trained his technicians to get full mouth rads in 10 minutes or less (he has a nomad and digital sensors). He also uses local blocks whenever he is going to extract anything (we do at my University as well).