NATIONAL EXAMINING BOARD FOR DENTAL NURSES NATIONAL CERTIFICATE EXAMINATION

DENTAL CHARTING

108-110 LONDON STREET FLEETWOOD LANCASHIRE FY76EU www.nebdn.org.uk TEL: 01253 778417 FAX: 01253 777268

NEBDN is a limited company registered in England & Wales No. 5580200 Registered with the Charity Commisioners No. 1112331

Charting contributes to the Part A section of the examination for the National Certificate for Dental Nurses, and Part C of the Independent Assessment. In order to standardise training and assessment the following information indicates to candidates the notations they will need to know in order to complete these sections. Therefore, in the same way that there is a definitive list of items for the spotter, the notations below will become a definitive list. There are different charting systems available, this document will cover: a. b. c. United Kingdom (UK) International Dental Federation (FDI) Basic Periodontal Examination (BPE)

As the chart is probably the most important dental record of a patient's condition, it is vital that dental nurses know how to chart. NEBDN acknowledges that there are a number of systems and software used to record charting. It also recognises that there are local and regional differences in registering patient details. The following notations are to be used when completing a written chart for the National Certificate Examination, and interpreting a charting in the Independent Assessment. A chart is a diagrammatic representation of the teeth showing all the surfaces of the teeth. The charts in the examination will be used to show: Teeth present Teeth missing Work to be carried out Work completed Surfaces with cavities and restorations etc.

When charting, the mouth is looked on as being a flat line. The diagram is viewed, as you would examine the patient's mouth.

8 7 6 543 8 7 6 543

2 2

234

5 6 7 8

2 345
abCde

678

b C d

Most charts have an inner and outer grid. NEBDN has introduced a new grid, which will make clear the work that has been completed in the mouth and the work which needs to be done. An example of the grid is given below.

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f ;

';----------(

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-------f
:.~

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.:

.:

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-:..... :

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:.:

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.:

.;.

::

1
Present Dental Status and work completed

Present Dental Status and work completed

--.

r---------r

,,---------,
:----------...

'----------r
:----------...

r-------r
:--_._-_ ...

]"'-------[
"
:---_ ........

.:._--------.:..

Present Dental Status and work completed

'_-.-.-.-.-.-_-._]

r-.-.-.-

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r ':

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.-;
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r-.-.- .. '-.]
: 1

:;.-.-.- .-.-.]:
:

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................. ::."... :_._._._-_._-_-_._-_-; . ;----------; ....

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:............ ;f

'1"---- .... [
: ............ :

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1". - ---. -- -~::'
:-------...

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Present Dental Status and work completed

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:-_.. __. __.~:

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'-.... --: ----.... \'"

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The inner grid is for present dental status and work already present in the mouth. The outer grid is for work to be carried out.

In order to complete the chart accurately candidates should be able to identify and note the correct surfaces of teeth. These are:

I I I I I I I I I I I I I I

---------------------------~--------------------------I I I I I I I I I I I I I I

------------~.

-------------..
Mesial Direction

ACCEPTED NOTATIONS Incisor Teeth

Upper Right Fracture Labial Cavity Midline Palatal Cavity

Upper Left

~
Canine Present Retained C

~
I I

5j
I
Labial Restoration Root Filled Palatal Restoration Porcelain Jacket Crown

Work to be carried out

Porcelain Veneer

Palatal Restoration

B
Porcelain Bonded Crown

ta
I
Distal Cavity

Ej
Distal Restoration

8
Crown

Present status and work completed

-;-

~
Artificial Tooth Present

Tooth Rotated Distally

B B B
Mesial Restoration

I
I
I

B B 8 B
Tooth Rotated Mesially Mesial Cavity

Present status and work completed

Work to be carried out

I
Lower Right Midline Lower Left

ACCEPTED NOTATIONS Premolar and Molar Teeth

Upper Right

Mesial-Occlusal-Distal Cavity

Upper Left Midline Buccal Cavity

Work to be carried out

~
Mesial Occlusal Distal Restoration with a Buccal Extension Present status and work completed

Tooth Instanding

Implant

Palatal Restoration

Fissure Sealant

Tooth Missing Space Closed

aTI
~
Distal-Occlusal Restoration

~
ID

Present status and work completed

~
Occlusal Restoration

[Jd
Lingual Restoration

~
Mesial-Occlusal Porcelain Inlay

Tooth Outstanding

aTI
~
Tooth Fractured

~
Roots Retained

Work to be carried out

~
Disto-Occlusal Restoration to be replaced
I

Lower Right

Midline

Lower Left

ACCEPTED NOTATIONS Premolar and Molar Teeth

Upper Right
Midline

Upper Left Tooth to be extracted

Work to be carried out

[g(]
Bridge Pontic Tooth Drifting Mesially Full Gold Crown Present ~ ~ ~
<0

Preventive Resin Restoration

Present status and work completed

Tooth Drifting Distally

Bridge Abutment

Present status and work completed

~ Distal-Occlusal Temporary Dressing

~ Mesial Restoration

~ Distal Restoration

~ Distal-Occlusal Gold Inlay

~ Tooth Partially erupted

~ Tooth recently Extracted

Work to be carried out

~ Occlusal Buccal Cavity

~ Mesial Cavity

Lower Right

Midline

Lower Left

a. b. c. d. e. f. g. h. i. j. k. I. m. n. o. p. q. r. s.

Upper right second molar has a mesio-occlusal Upper right first molar has a disto-occlusal Upper right first premolar is for extraction Upper right canine has a buccal restoration

cavity

temporary dressing

Upper right central incisor is an abutment for a cantilever Maryland bridge Upper left central incisor is a Maryland bridge pontic Upper left lateral incisor has a fracture on the incisal edge Upper left second premolar needs a root filling Upper left second molar has preventive resin restoration (PRR) occlusally Upper left third molar has a fissure sealant restoration Lower left third molar has been recently extracted Lower left first molar has a lingual restoration to be replaced Lower left first premolar has a bonded porcelain crown Lower right lateral incisor has a mesial restoration and a separate distal cavity Lower right first premolar is missing Lower right second premolar has rotated mesially Lower right first molar has an MOD porcelain inlay Lower right second molar has a full restoration gold crown Lower right third molar is partially erupted

FEDERATION DENTAIRE INTERNATIONAL NOTATION (FDIl TWO DIGIT CHARTING SYSTEM

In this system the quadrant symbol is replaced by a number. The quadrant number is the first digit while the second number identifies the individual tooth.

a. b. c. d. e. f. g. h.
I.

18 is partially erupted 17 has an occlusal restoration 16 has an occluso-palatal filling

14 is missing and the gap has closed 13 has a porcelain jacket crown in place 12 has a fracture of the incisal edge 21 needs distal and palatal restorations 24 is root filled with an occlusal restoration 25 has a mesial-occlusal 26 to be extracted 28 is unerupted 38 is missing 37 has an occlusal cavity 34 has a full gold crown 32 has a distal and labial restorations 41 has mesial and lingual cavities 44 has a mesial-occulsal-buccal 48 has been recently extracted cavity restoration present

j. k. I. m. n. o. p. q. r.

This index is used with the BPE probe formerly known as the CPITN. The periodontal probe is introduced into the gingival sulcus and a light probing pressure is used around the buccal and then lingual/palatal surfaces. The mouth is divided into sextant (no 8's) represented by a single box chart for each sextant.
17-14 47 - 44 13 - 23 43 - 33 24 - 27 34 - 37

BPE Code

Criteria

Healthy periodontal tissues No bleeding after gentle probing Bleeding after gentle probing Black band remains completely visible (probing depth up to 3.5mm) No calculus or defective margins detected Black band remains completely visible (probing depth up to 3.5mm) Calculus or other plaque retention factor detected Black band partially visible in deepest pocket (shallow pocket up to 5mm) Black band not visible in pocket (deep pocket of more than 5.5mm) Furcation involvement Gingival recession added to probing gives depth of 7mm or more

3
4

PERIODONTAL DIAGNOSIS AND TREATMENT PLAN

POCKET DEPTH

POCKET DEPTH

POCKET DEPTH

POCKET DEPTH

ERUPTION DATES

Tooth

Letter

Upper eruption date months 10 11 19 16 29

Lower eruption date months 8 13 20 16 27

Central incisor Lateral incisor Canine First molar Second molar

A B
C

Tooth

Letter

Upper eruption date years 7 to 8 8 to 9 10 to 12 9 to 11 10 to 11 6 to 7 12 to 13 18 to 25

Lower eruption date years 6 to 7 7 to 8 9 to 10 9 to 11 9 to 11 6 to 7 11 to 12 18 to 25

Central incisor Lateral incisor Canine First premolar Second premolar First molar Second molar Third molar

1 2 3

4
5 6 7 8

Each question is followed by 4 alternatives of which one is correct. Please mark with a cross in the box at the right hand side, the answer which you consider to be the best one, for example:The colour of a Nitrous Oxide cylinder is:(a) red (b) blue (c) white (d) black (a)

D D

(b) ~
(c)

(d)

~'(~~
Please note: More than one cross to each question will invalidate your answer.

~~

1. What are blood platelets concerned with? (a) haemostasis (b) immunity (c) transport of oxygen (d) removal of bacteria from the blood stream
(a)

(b)
(c)

(d)

D D D

2. What is gamma irradiation used to do? (a) take radiographs (b) solidify fissure sealants (c) sterilise instruments and materials (d) cure composite resins (a) (b)
(c)

(d)

D D D

3. What may rheumatic fever cause damage to? (a) the cardiac septum (b) the heart valves (c) the coronary arteries (d) the cardiac sphincter (a) (b)
(c)

D D D

(d)

(a) Indicators (b) Ionising (c) Injuries (d) Indicating

(a) (b) (c) (d)

D D D D

5. What is a pontic? (a) a type of orthodontic bracket (b) a suspended unit of a bridge (c) an artificial tooth on a denture (d) a type of crown
(a)

(b)
(c)

(d)

D D D D

(a) aorta (b) pulmonary artery (c) pulmonary vein (d) vena cava

(a) (b) (c) (d)

0 0 0 0

7. What may an occlusal radiograph be used to assess? (a) interproximal caries (a) (b) (c) (d)

(b) root canal length (c) a periapical abscess (d) an impacted canine tooth

D D D

8. What may aggresive tooth brushipg cause? (a) erosion (b) hyperplasia (c) attrition (d) abrasion
(a)

D D D

(b) (c) (d)

(a) cellulose matrix (b) siqveland matrix (c) tofflemire matrix (d) ivory matrix

(a) (b) (c) (d)

D D D D

10. At what age does a lower permanent central incisor normally erupt? (a) 5 years (b) 7 years (c) 9 years (d) 11 years (a) (b) (c) (d)

D D D

(a) reactionary haemorrhage (b) secondary haemorrhage (c) regressive haemorrhage (d) primary haemorrhage

(a) (b) (c) (d)

D D D D

12. What were Adams Universal pliers designed to do? (a) cut an arch wire (b) hold an orthodontic bracket (c) shape an arch wire (d) place a separator (a) (b)
(c)

(d)

D D D D

(a) metronidazole (b) iodine (c) penicillin (d) nystatin

(a) (b) (c) (d)

D D D D

(a) pulpectomy (b) alveolectomy (c) apicectomy (d) gingivectomy

(a) (b) (c) (d)

D D D D

(a) gold (b) cobalt chromium alloy (c) stainless steel (d) none of these

(a) (b) (c) (d)

D D D D

1. 2. 3. 4. 5.

At what age does the tooth marked 'A' normally erupt? What is tooth marked 'A' in the FDI charting system? How many roots does tooth '1\ normally have? How many root canals does tooth 'A' normally have? Occasionally an extra tooth may be present in the area marked 'B'. What is this extra tooth called?

. . . .

8.

Which tooth does the tooth marked

'c'

replace?

. .

At what age does that tooth normally erupt? 9. Sometimes the tooth marked

'c'

is not present; this condition is called:

4. Fissure sealants are placed on the of posterior teeth.

surfaces

6. When used as a lining dentine formation.

promotes secondary

Record all the following information on the chart below. All teeth are present unless otherwise stated.

NB
Treatment completed should be charted in the inner grid Treatment to be carried out should be charted on the outer grid

NATIONAL EXAMINING BOARD FOR DENTAL NURSES NATIONAL CERTIFICATE

PART B
This part contains 5 questions.You ~ answer .E.Q.!J.B of these questions in the answer book provided. All questions carry equal marks.

1. Define 'chronic gingivitis'. How does dental plaque contribute to this condition? Describe the ways in which plaque is controlled.

2. The following are all basic first aid procedures. Write short notes on how the dental nurse would: (a) (b) (c) check a pulse clear and open an airway deal with a fainting patient

3. List the reasons why a tooth may require root filling. Outline the stages involved in a root canal treatment on an upper incisor tooth with a periapical abscess.

4. Describe how the following materials may be used in the dental surgery: (a) (b) (c) alginate glass ionomer gutta percha

5. A grossly carious upper first permanent molar tooth is to be surgically extracted. (a) list the nerves that will need to be anaesthetised (b) outline the role of the dental nurse during this procedure (c) what post-operative instructions should be given to the patient?

NATIONAL EXAMINING BOARD FOR DENTAL NURSES NATIONAL CERTIFICATE

This part contains 5 questions.You nmst answer FOUR of these questions in the answer book provided.

1. Write short notes on each of the following: a) b) c) fire precautions in the dental practice reasons for root filling a tooth bitewing radiographs

2. What factors should the dentist take into consideration when assessing a patient for the construction of a chromium cobalt partial denture? List the surgery stages in the construction of such a denture.

3. Why is moisture control important in dental procedures? Describe the techniques used by the dental nurse and the dentist in achieving moisture control during dental procedures.

4. Write short notes on each of the following: a) b) c) systemic fluoride oral health instruction for patient undergoing fixed orthodontic treatment dental plaque

5. List the different ways the airway may be obstructed in an unconscious patient. Assume you are alone and describe in detail the basic life support procedures to be carried out on an adult patient who has a suspected cardiac arrest in the dental surgery.

NATIONAL EXAMINING BOARD FOR DENTAL NURSES NATIONAL CERTIFICATE

This part contains 5 questions.You musi answer FOUR of these questions in the answer book provided.

1. Describe the process by which dental caries takes place and outline its progression from the enamel through to the pulp. Discuss the factors which would have an effect on how fast this process could take place in an individual.

2. List 3 filling materials available to restore a permanent tooth. Indicate the advantages and disadvantages of one of these materials. Describe the role of the dental nurse during the placement of a permanent restoration.

3. Write short notes on: (a) enamel (b) bitewing radiographs (c) denture stomatitis

4. List the general contents of atypical local anaesthetic cartridge. State the methods of injection that can be used to gain dental local anaesthesia. Describe how the anaesthetic equipment should be handled and disposed of after use.

5. Define the term 'sterilisation'. Explain in detail how you would ensure that the risk of cross-infection in the dental surgery is reduced to a minimum.

NATIONAL EXAMINING BOARD FOR DENTAL NURSES NATIONAL CERTIFICATE

This part contains 5 questions. Please answer ONLY FOUR of these questions in the answer book provided.

1. Define 'chronic gingivitis' How does dental plaque contribute to this condition? Describe the ways in which plaque is controlled.

2. List 5 types of dental radiograph and explain when each may be used. What faults could occur during the taking and processing of the film, and how may these faults have been caused?

3. List the different ways the airway may be obstructed in an unconscious patient. Describe in detail the basic life support procedures to be carried out on an adult patient who has a suspected cardiac arrest in the dental surgery.

4. Write notes, including the advantages and disadvantages of each method, on: (a) autoclave sterilisation (b) sodium hypochlorite disinfection Give examples of their uses.

5. A grossly carious upper first permanent molar tooth is to be surgically extracted. List the instruments to be set out by the dental nurse. What advice should be given to a patient for post operative care?

NATIONAL EXAMINING BOARD FOR DENTAL NURSES NATIONAL CERTIFICATE

This part contains 5 questions. Please answer ONLY FOUR of these questions in the answer book provided.

1. Describe the procedure of, and the role of the dental nurse in, restoring an anterior tooth with a light cured composite. What precautions should be taken to protect the patient and the dental team during this procedure?

2. Outline how, in the dental workplace, the following health & safety issues should be managed: a) fire safety b) a patient who has slipped on a wet floor c) disposal of clinical waste

3. List the instruments for a routine root filling procedure. A dentist drops a hand file whilst undertaking endodontic treatment on a patient, and its location is not immediately obvious. a) What action would the dental team take immediately at the time of and after the event? b) How could this be avoided?

4. Define the term 'infection control' . Describe the importance of hand and eye protection for the oral health care team within the dental surgery.

5. Write short notes on: a) types of dentures b) calculus c) an angina attack

NATIONAL EXAMINING BOARD FOR DENTAL NURSES NATIONAL CERTIFICATE

This part contains 5 questions. Please answer ONLY FOUR of these questions in the answer book provided.

1. Briefly outline the clinical stages in the construction of full/full (complete) dentures. At the fit stage what instructions would you give a patient about the care of full/full dentures?

2. Write short notes on the following: a) b) c) the main differences between primary (deciduous) and secondary (permanent) teeth dentine dental handpiece maintenance

3. List the reasons for root filling a tooth. What is meant by the term apicectomy procedure on a tooth? and why may it become necessary to perform this

Describe the chairside role of the dental nurse during an apicectomy.

4. List the signs and symptoms of the following medical emergencies and explain the actions a First Aider should take in the management of the conditions: a) b) c) simple faint asthmatic attack epileptic seizure

5. Write short notes on dental caries under the following headings: a) b) c) cause diagnosis prevention

NATIONAL EXAMINING 60ARD

FOR DENTAL NURSES

NATIONAL CERTIFICATE

This part contains 5 questions. Please answer ONLY FOUR of these questions in the answer book provided.

1. List the ways in which mercury can enter the body. What precautions could you take to prevent thishappening? What action would you take to deal with a small spillage of mercury?

2. A grossly carious upper first permanent molar tooth is to be surgically extracted. (a) List the instruments and outline the role of the dental nurse in this procedure. (b) What post-operative instructions should be given to the patient?

3. Write short notes on: (a) enamel (b) bitewing radiographs (c) denture stomatitis

4. You are requested to give oral health care advice to the parent or guardian of a six-year-old patient. List the four main messages which you would give to them and explain the significance of each.

5. Why is moisture control important in dental procedures? Describe the techniques used by the dental nurse and the dentist in achieving moisture control during dental procedures.

The Spotter Test in the National Certificate Examination ensures that a qualified dental nurse is able to identify items commonly used in dental practice. The 20 items will be selected from the list below and the candidate will be expected to use the precise terminology indicated in order to gain the available marks. Where the description of an item has two words separated by an oblique line (eg clear/transparent) either is acceptable. The list has been compiled from a list of requirements for a vocational training practice, as described in four of the major dental catalogues. Items which can vary in appearance have been omitted .

Dentate Edentulous

. Disposable Metal

Burs
Round Flat fissure Tapered fissure Flame Pear Bud Inverted cone Steel Diamond Tun,gsten Carbide/TC Friction grip/FG Latch griplLG Strai,ght hand piece/HP Acrylic Pear Bud

Fin er s reader Flat lastic instrument Forceps: Lower molar Lower molar, childrens Lower roots Upper incisor/straight Upper left molar Upper right molar U er roots Cou lands chisel Crown form: polycarbonate acetate/clear/transparent aluminium stainless steel C ers elevator Curette scaler

Le Cron carver Luxator Matrix strip, clear/transparent Mauns wire cutters Mitchells trimmer Modelling wax Molar orthodontic band Molar rubber dam clamp Moore's mandrel Mouth prop Needle holders Occlusal x-ray film packet Orthodontic bracket Paper point Paste filler, rotary/spiral Periapical x-ray film packet Periodontal hoe Periosteal elevator Plastic wedge Pocket mask Polishing/finishing strip Pop-on mandrel Push scaler

Radiation monitoring badge Red ribbon wax Root canal hand file Rubber cup, latch griplLG Rubber dam clamp forceps Rubber dam frame Rubber dam punch Sickle probe Siqveland matrix retainer Stainless steel mixing spatula Suture needle and silk Teeth: Lower deciduous molar Lower permanent molar Lower permanent incisor Upper first premolar Upper deciduous molar Upper permanent molar Tissue dissecting forceps Toftlemire matrix retainer Wards carver Warwick James elevator Wax knife Willis bite gauge Wooden wedge