Paediatric Dentistry Clinic Orientation¹

Faculty Leadership and Coordination

Dr Lisa Bowdin
BSc, D Clin Dent (Paed Dent), MRACDS
Specialist Paediatric Dentist
DMD Course Coordinator
Senior Lecturer, Paediatric Dentistry
UWA Dental School

Paediatric Dentistry at Ohcwa

Highgate Primary School Patient Demographics

Children from Highgate Primary School, generally aged 5–13 years.
These patients do not require a concession card for eligibility.
Transported to OHCWA via bus for routine maintenance and dental treatment.

Highgate Dmd Clinic²

Waitlist and Specialist Referral Patients

Patients referred to OHCWA for specialist paediatric treatment, up to 16 years of age.
Referrals may originate from anywhere in the community or across the state.
Eligibility requires a valid health care card or pension card.
These patients may be seen in the DMD Clinic during school holiday periods.

Highgate Clinic³

Clinic Scheduling and Student Roles

Patients are transported to OHCWA by bus in two distinct groups:
- First patient session: 9:00 am – 10:15 am
- Second patient session: 10:15 am – 11:30 am
Students work in pairs; each student treats one patient and assists for the other.
DMD4 students typically handle more complex treatments and share procedures such as Bitewing radiographs (BWs) and Fissure Sealants (FS).
If a scheduled patient is absent from school, the bus driver will bring a reserve patient.

Patient Attendance and Documentation

Children usually attend on their own, though occasionally a parent may be present.
Required documentation in the “Documents” tab:
- Consent: Verify that the consent form is signed and uploaded.
- Medical History: Must be completed by parents. Note that a separate Titanium medical history form is not required for these patients.

Treatment Options⁴

Staged Treatment Approach

Treatment is delivered in stages, moving from the least invasive to the most invasive procedures to gradually introduce the child to the dental environment.

Standard Treatment Plan Components

Examination (clinical and radiographic)
Oral hygiene instruction and dietary advice
Prophylaxis and fluoride varnish application
Fissure sealants
Direct intracoronal restorations

Specific advanced procedures require explicit additional consent from parents or guardians:

Stainless steel crowns
Pulpotomy
Hall Technique crowns
Extractions

Specialist Referrals

OHCWA Specialist Referral: Available for paediatric dentistry, orthodontics, etc., provided the patient meets OHCWA eligibility requirements.
Private Specialist Referral: An option for patients regardless of OHCWA eligibility.

Standard Clinic Protocol

Session Preparation

Arrive at 8:00 am.
Review patients booked into your assigned chair:
- Planned treatment.
- Past treatment history.
Check the documents tab for:
- Valid consent.
- Current medical history.

Start of Session⁵

Case Presentation

Present cases at the huddle for group discussion.
Receive ATS (Authority to Supervise).

During Appointment⁶

Patient Arrival and Allocation

Children will be brought in from the bus by the Dental Clinic Assistant (DCA) and allocated to cubicles.
You will be notified at this point if you have a reserve patient.

Patient Identification and Initial Assessment

Confirm the child’s name and date of birth (if they know it), or other identifying details such as the parent’s name.
- Note: Many children speak English as a second language.
Ask the child about their teeth.
- If there are any changes or a new presenting complaint, speak to the tutor before proceeding.

Examination and Diagnostics⁷⁸⁹

Clinical Assessment

Complete the examination following the established notes template.
Have the examination checked by a tutor and confirm if additional diagnostics are required.

Diagnostic Procedures

Perform additional diagnostics as needed (e.g., photographs, radiographs).
Standard bitewings typically involve 2x size 0 sensors with foam tabs instead of a Rinn holder.
Older children may tolerate a Rinn holder.

Treatment Planning and Preventive Care

Develop a treatment plan and have it checked by a tutor.
Provide oral hygiene instruction and dietary advice.
Perform clinical procedures if indicated and time allows:
- Scale and clean.
- Fluoride varnish application.
- Fissure sealants.

(Page contains no legible text content; only image placeholders provided in source)

Base Charting

(Page contains no additional text content beyond the subheading; only image placeholders provided in source)

Frankl Behaviour Rating¹⁰

Recording Behaviour

Make a note of the child’s behaviour using the Frankl Behaviour Rating. This can be noted for the entire appointment or for individual tasks (e.g., (+) for the examination, (—) for bitewing radiographs).

Frankl Scale Definitions

Definitely Negative (—)
- Refusal of treatment, crying forcefully, fearful, or any other overt evidence of extreme negativism.
Negative (-)
- Reluctant to accept treatment, uncooperative, some evidence of negative attitude but not pronounced (e.g., sullen, withdrawn).
Positive (+)
- Acceptance of treatment. At times cautious, willingness to comply with the dentist, at times with reservation, but the patient follows the dentist’s directions cooperatively.
Definitely Positive (++)
- Good rapport with the dentist, interested in the dental procedures, laughing and enjoying the situation.

At End of Appointment¹¹

Session Conclusion

Complete the appointment by 10:00 am so the child is ready for the bus.
Prepare for the second appointment scheduled for 10:15 am.

Duty of Care and Supervision

You maintain a duty of care for the child and must supervise them until they leave.
Keep the child in your cubicle, or in an adjacent cubicle with a friend.
Accompany the child to the bathroom if required (male staff/students with male patients, female with female).
If a parent is present, they may return to the waiting room with the child to wait for the bus.

Documentation and Administration

Complete all written notes, base charting, and the treatment plan in Titanium.
Ensure the appointment is charged through by a tutor.
Complete PebblePad entries for the patient if time allows.

Special Patient Populations

Patients referred to OHCWA for specialist paediatric treatment may be seen in the DMD Paediatric Clinic during school holidays for their initial consultation.

Appointment Logistics

Patients will be brought directly to the appointment by their family.
Verify whether the person present is the legal parent or guardian.
The referral document is saved in the “Documents” tab.
Radiographs sent with the referral may be located in the “Documents” tab or within Sidexis.

Off Waitlist Patients¹²

Clinical Procedures and Billing

Treatment plans are usually complex and must be completed in consultation with a tutor.
All treatment plan discussions should be held with a tutor present.
Charge code 016 (consultation by referral) for the initial appointment, rather than an 011.

Corpa and Depa Procedures¹³¹⁴

CORGA refers to Comprehensive Oral Rehabilitation under General Anaesthesia.

DEGA refers to Dental Extractions under General Anaesthesia.

General Anaesthesia Preparation¹⁵

Initial Measurements

Record the weight and height of the child at the start of the appointment as you bring them into the clinic.
Scales and measuring equipment are located in the hallway outside Clinic 5.

Documentation and Waitlist

An estimate must be signed electronically by the legal guardian, and a copy provided to them.
Consult with your tutor regarding adding the patient to the General Anaesthesia (GA) waitlist.

Pop-Up Note Requirements

Include the following details in the Pop-Up Notes:

Type of GA (e.g., CORGA or DEGA)
Estimated duration of GA (e.g., 120 min)
Patient height (e.g., 120 cm)
Patient weight (e.g., 20 kg)

Forms for General Anaesthesia¹⁶

Patients requiring treatment under General Anaesthesia (GA) require multiple forms for Perth Children’s Hospital (PCH) and/or Southbank Day Surgery.

Form Completion Guidelines

Assist the family in completing all necessary paperwork.
Do not assume the parent is literate; write the information for them to ensure the form is correct and legible.
These are legal documents. If a mistake is made:
- Draw a single line through the error.
- Initial the change.
- Write the correct information clearly.
Leave the UMRN (Hospital Record Number) field blank.

Department of Communities Patients¹⁷

Children may be under the care of the Department of Communities (Child Protection). In these instances, the Director is their legal guardian. The child may reside with a parent, extended family member, foster family, or in residential care.

Key Contacts for the Child

Carer: This may be a foster parent, extended family member, or parent.
DCP Case Manager: The assigned manager from the Department.
Legal Guardian: The Director of the Department of Communities.

If a child under the care of the Department of Communities (DCP) requires treatment, you must write a formal letter to the Department of Communities to request legal consent.

Behaviour Management

Implementation Guidelines

Knee to Knee Technique¹⁸

The clinician and parent sit facing each other with knees touching to create a stable platform for the child.
A towel or pillow may be placed on the lap to increase comfort.
Ensure the parent is fully briefed on the technique and their role before beginning the procedure.

Desensitisation¹⁹

Strategies for a Positive Experience

The primary goal is to ensure a positive appointment for the child to build long-term confidence.
Adjust the dental chair to an upright or semi-reclined position to help the child feel less vulnerable.
Start with easy, non-invasive treatments first to build rapport and trust.

Enhancing Control²⁰

Empowering the Patient

Provide the child with small, manageable choices to increase their sense of autonomy.
Examples include allowing the child to choose which color or style of sunglasses they would like to wear during the procedure.

Positive Reinforcement²¹

Rewarding Cooperative Behaviour

Always provide positive reinforcement at the conclusion of the appointment.
Offer a sticker to the patient as a reward for their cooperation.
Boxes of stickers are located in Clinic 5 for clinician use.

Original PDF page 1: DMD3 Clinic Orientation (1), p.1 ↩
Original PDF page 2: DMD3 Clinic Orientation (1), p.2 ↩
Original PDF page 3: DMD3 Clinic Orientation (1), p.3 ↩
Original PDF page 4: DMD3 Clinic Orientation (1), p.4 ↩
Original PDF page 5: DMD3 Clinic Orientation (1), p.5 ↩
Original PDF page 6: DMD3 Clinic Orientation (1), p.6 ↩
Original PDF page 7: DMD3 Clinic Orientation (1), p.7 ↩
Original PDF page 8: DMD3 Clinic Orientation (1), p.8 ↩
Original PDF page 9: DMD3 Clinic Orientation (1), p.9 ↩
Original PDF page 10: DMD3 Clinic Orientation (1), p.10 ↩
Original PDF page 11: DMD3 Clinic Orientation (1), p.11 ↩
Original PDF page 12: DMD3 Clinic Orientation (1), p.12 ↩
Original PDF page 13: DMD3 Clinic Orientation (1), p.13 ↩
Original PDF page 14: DMD3 Clinic Orientation (1), p.14 ↩
Original PDF page 15: DMD3 Clinic Orientation (1), p.15 ↩
Original PDF page 16: DMD3 Clinic Orientation (1), p.16 ↩
Original PDF page 17: DMD3 Clinic Orientation (1), p.17 ↩
Original PDF page 18: DMD3 Clinic Orientation (1), p.18 ↩
Original PDF page 19: DMD3 Clinic Orientation (1), p.19 ↩
Original PDF page 20: DMD3 Clinic Orientation (1), p.20 ↩
Original PDF page 21: DMD3 Clinic Orientation (1), p.21 ↩

Quartz 4

Explorer

DMD3 Clinic Orientation (1)_formatted_text

Paediatric Dentistry Clinic Orientation1