Pediatric Dentistry Grade Sheet

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PEDIATRIC DENTISTRY GRADE SHEET
Student's Name:
Procedure Code:
Student #:
Points:
Chart #:
Tooth #:
Date:
______
Surface:
_
_____________
RESTORATIVE
SEALANT
Unaccept.
Accept
Superior
1. Knowledge of Protocol
1. Knowledge of Protocol
2. Preparation of Material
2. Preparation of Material
3. Cavity Preparation
3. Inclusion of all pits and grooves
4. Caries Excavation
4. Surface/voids
5. Restoration
5. Retention
___
___
6. Occlusion
6. Removal of excess/occlusion
_______________________________________________________________________________________________________
EVALUATION VISIT
1. Health History
2. Tooth Identification
3. Oral Diagnosis (clinical and radiographic)
4. Treatment Planning
5. Preventive Procedure
6. Knowledge of Protocol
_____________
7. Proper Infection Control Procedures Followed
8. Appropriate use of time
9. Behavior management technique
10.Completion of patient records
PROFESSIONALISM
COMMENTS:
GRADE:
FACULTY SIGNATURE:

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