The University of Western Australia **Paediatric Dentistry:** **Clinic Orientation** **Dr Lisa Bowdin** BDSc, DClinDent (Paed Dent), MRACDS Specialist Paediatric Dentist DMD Course Coordinator Senior Lecturer, Paediatric Dentistry UWA Dental School #### Clinical Instruction and Coordination **Dr Lisa Bowdin** BDSc, DClinDent (Paed Dent), MRACDS - Specialist Paediatric Dentist - DMD Course Coordinator - Senior Lecturer, Paediatric Dentistry - UWA Dental School **Paediatric Dentistry at OHCWA** **Highgate DMD Clinic** * Children from Highgate Primary School * Generally, ages 5-13 years * Transported to OHCWA by bus * Routine maintenance and treatment * Do not have to hold a concession card **Waitlist Patients** * Referred to OHCWA for specialist paediatric treatment * May be any age up to 16 years * May be referred from anywhere in the community (and state!) * May be seen in DMD Clinic during school holidays * Need to be eligible for treatment at OHCWA – health care card or pension card #### Highgate Primary School Patient Profile - **Student Demographics** - Children attending Highgate Primary School. - Generally aged between 5 and 13 years. - These patients do not require a concession card for eligibility. - **Clinical Scope** - Routine maintenance and dental treatment. - Patients are transported to OHCWA via bus. #### Waitlist and Specialist Patients - **Referral Source and Eligibility** - Patients referred to OHCWA for specialist paediatric treatment. - Referrals are accepted from across the community and the state. - Eligibility requires a valid health care card or pension card. - **Patient Demographics and Scheduling** - Includes children and adolescents up to 16 years of age. - These patients may be seen in the DMD Clinic during school holiday periods. # Highgate Clinic • Transported to OHCWA by bus in two groups: - First patient - 9am – 10:15am - Second patient - 10:15am – 11:30am - Each student takes one patient and assists for the other. - DMD4 = more complex treatment. Share procedures like BWs, FS • If planned patient is absent from school, bus driver will bring a reserve patient • Child usually on own, sometimes with a parent • **Documents** tab: - Consent (check is uploaded and signed) - Medical history (completed by parents) - Do not need separate medical history Titanium form _figures/img_a5418cabc88b3fc4.webp) _figures/img_c79f440c7cea22f0.webp) #### Transport and Session Scheduling Patients are transported to OHCWA by bus in two distinct groups: 1. First patient session: 9:00 am – 10:15 am 2. Second patient session: 10:15 am – 11:30 am #### Student Responsibilities - Each student is assigned one patient for treatment and acts as an assistant for the other session. - DMD4 students handle more complex treatments and share procedures such as Bitewings (BWs) and Fissure Sealants (FS). - If a scheduled patient is absent from school, the bus driver will bring a reserve patient to ensure clinical time is utilized. #### Clinical Attendance and Documentation - **Attendance** - Children usually attend the clinic on their own, though occasionally a parent may be present. - **Titanium Records and Documentation** - Navigate to the **Documents** tab to verify records. - Ensure the Consent form is signed and correctly uploaded. - Review the Medical History completed by parents. - Note: A separate Titanium medical history form is not required if the parental form is present. Clinical photo showing two young boys at a dental clinic. One boy in a black hoodie is standing and examining the mouth of another boy in a yellow shirt who is seated or leaning forward. This image illustrates the student-assisted patient scenario described in the text ('Each student takes one patient and assists for the other'). Photo of a white shuttle bus parked outdoors with 'ORAL HEALTH CENTRE OF WESTERN AUSTRALIA' printed on the side. This visual corresponds to the logistical details regarding transport to OHCWA by bus mentioned in the text. # Paediatric Clinic Protocol ## Start of Session: - Arrive at 8am - Review patients booked into your chair - Planned treatment - Past treatment - Check documents tab for: - Consent - Medical history - Present cases at huddle for group discussion - Receive ATS The University of Western Australia #### Session Commencement - Arrive at 8:00 am. - Review patients assigned to your chair, specifically checking: - Planned treatment protocols. - Past treatment history. - Verify the documents tab for essential records: - Signed consent forms. - Updated medical history. #### Case Presentation and Huddle - Present cases during the morning huddle for group discussion. - Receive ATS (Assessment of Training/Skills) guidance. # Paediatric Clinic Protocol ## During Appointment: - Children will be brought in from bus by DCA and allocated to cubicles - If you have a reserve patient you will be notified at this point - Confirm child’s name and date of birth (if they know), or other detail like parent’s name - Many children speak English as second language - Ask child about their teeth - If any changes or new presenting complaint, speak to tutor before proceeding <div style="text-align: right; margin-bottom: 20px;"><b>THE UNIVERSITY OF WESTERN AUSTRALIA</b></div> #### Patient Arrival and Identification - Children will be transported via bus by the Dental Clinic Assistant (DCA) and allocated to specific cubicles. - Notification regarding reserve patients will be provided at this stage. - Confirm the child's identity by asking for their name and date of birth (if known), or alternative details such as a parent's name. - Note: Many children may speak English as a second language. #### Initial Assessment - Inquire with the child about their teeth. - If there are any changes or new presenting complaints, consult with a tutor before proceeding with treatment. # Paediatric Clinic Protocol **During Appointment:** * **Bold** Complete examination – follow notes template * Have examination checked by tutor and confirm additional diagnostics required * **Bold** Additional diagnostics: photographs, radiographs etc * Usual bitewings = 2x size 0s with foam tabs instead of rinn holder * If older may tolerate rinn holder * Treatment plan – have checked by tutor * Oral hygiene instruction, dietary advice * Scale and clean, fluoride varnish, fissure sealants etc. if indicated and time available #### Examination and Diagnostics - Complete a comprehensive examination following the provided notes template. - Have the examination reviewed by a tutor to confirm if additional diagnostics are required. - Perform additional diagnostics as needed (e.g., photographs, radiographs). - Standard bitewings typically utilize two size 0 sensors with foam tabs rather than a Rinn holder. - Older children may tolerate a Rinn holder if appropriate. #### Treatment Planning and Preventative Care - Develop a treatment plan and have it verified by a tutor. - Provide oral hygiene instruction and dietary advice. - Perform clinical procedures if indicated and time permits, including: - Scale and clean. - Fluoride varnish application. - Fissure sealants. Paediatric Clinic Protocol - Clinical Notes - Base charting and written notes _figures/img_8a6b86df374220f3.webp) _figures/img_37cba17fbfe91dfa.webp) _figures/img_6b560114ecb84c4d.webp) #### Documentation Requirements - Complete clinical notes including: - Base charting. - Detailed written notes. Dental base chart showing tooth positions with color-coded markings (yellow, blue, red) indicating treatment status or conditions. Includes a digital interface header with appointment details: 'Episode 2147505', date '13/10/16', and clinical notes referencing pain management, referrals, and diagnostic findings. Intraoral clinical photograph of the maxillary arch showing multiple carious lesions, particularly on posterior teeth, consistent with the OCR note mentioning '54 and 64 abscessed'. Intraoral clinical photograph of the mandibular arch showing anterior crowding, open bite, and possible crossbite — aligning with OCR mention of 'Class I, Anterior open bite, Cross bite'. Tongue is visible for spatial context. # Base Charting _figures/img_a9acf92028f5cbd4.webp) #### Base Charting Complete the base charting for the patient as part of the clinical record. Screenshot of the 'Titanium Oral Health Management' software interface demonstrating a 'Base Charting' view. The image displays a complex data table listing dental procedures with columns for procedure codes (e.g., 99113), descriptions (e.g., 'Specialist Periodontal Exam'), and numerical values. A red-highlighted row labeled 'Episode 214/502' is visible in the main list. On the right side, there is a sidebar menu containing categories such as 'BASE', 'ENDS', and 'COPULATED'. A yellow arrow annotation points to the bottom-right corner of the screenshot. # Paediatric Clinic Protocol * Make a note of the child's behaviour using the Frankl Behaviour Rating * Can note for the whole appointment, or individual tasks e.g. (+) for exam, (--) for BWs **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 i.e. sullen, withdrawn. **Positive (+)** acceptance of treatment. At times cautious, willingness to comply with the dentist, at times with reservation but patient follows the dentist's directions cooperatively. **Definitely positive (++)** good rapport with the dentist, interested in the dental procedures, laughing and enjoying the situation. #### Frankl Behaviour Rating Scale Record the child's behaviour using the Frankl Behaviour Rating. This can be applied to the overall appointment or specific tasks (e.g., positive for the exam, definitely negative for bitewings). 1. **Definitely Negative (--)** - Refusal of treatment, forceful crying, fear, or other overt evidence of extreme negativism. 2. **Negative (-)** - Reluctant to accept treatment; uncooperative. Evidence of a negative attitude that is not pronounced (e.g., sullen or withdrawn). 3. **Positive (+)** - Acceptance of treatment. May be cautious or have reservations, but willing to comply with directions and cooperate with the dentist. 4. **Definitely Positive (++)** - Good rapport with the dentist; interested in the dental procedures. Laughing and enjoying the situation. # **Paediatric Clinic Protocol** **At End of Appointment:** * Need to complete appointment by 10:00am so child is ready for the bus * You still have **duty of care** of the child and need to watch them until they leave * Keep child in your cubicle, or in an adjacent cubicle with a friend * Accompany child to the bathroom if they need to go (male with male, female with female) * If parent present, they can return to the waiting room with the child to wait for bus * Complete all written notes, base charting and treatment plan in Titanium * Have appointment charged through by tutor * Complete PebblePad for patient if time allows * Prepare for second appointment at 10:15am _figures/img_96e10a9c79e30460.webp) #### Conclusion of Appointment - Appointments must be completed by 10:00 am to ensure the child is ready for bus transport. - Maintain duty of care until the child departs: - Keep the child in your cubicle or an adjacent cubicle with a friend. - Accompany the child to the bathroom if necessary (same-gender supervision required). - If a parent is present, they may wait with the child in the waiting room for the bus. #### Administrative Completion - Finalize all written notes, base charting, and treatment plans in Titanium. - Ensure the appointment is charged through by a tutor. - Complete PebblePad entries for the patient if time allows. - Prepare the workstation for the second appointment scheduled for 10:15 am. Text-based procedure steps outlining the 'At End of Appointment' protocol for a Paediatric Clinic. The text details duties such as completing appointments by 10:00am, maintaining duty of care (keeping children in cubicles or accompanying them to bathrooms), managing parent interactions, and administrative tasks like charting in Titanium. **Off-Waitlist Patients** • **Referred to OHCWA** for specialist **paediatric treatment** • May be seen in DMD Paediatric Clinic during school holidays for their initial consultation • Will be brought directly to the appointment by family ○ Need to check if it is parent or guardian present • Referral will be saved in documents tab • Any radiographs sent with referral may be in documents tab or Sidexis • Treatment plans usually complex – to complete with tutor • Treatment plan discussions to be held with tutor • Charge an **016** (consultation by referral) for the initial appointment, not an **011** <div style="text-align: center;"><strong>THE UNIVERSITY OF WESTERN AUSTRALIA</strong></div> #### Initial Consultation Process - Patients are referred to OHCWA specifically for specialist paediatric treatment. - Initial consultations may occur in the DMD Paediatric Clinic during school holidays. - Patients are brought to the appointment by family; verify if the accompanying adult is the legal parent or guardian. #### Referral and Documentation Review - The referral document is located in the documents tab. - Radiographs sent with the referral may be found in the documents tab or within Sidexis. #### Treatment Planning and Billing - Treatment plans are usually complex and must be completed in conjunction with a tutor. - All treatment plan discussions must be held with a tutor present. - Charge an **016** (consultation by referral) for the initial appointment rather than an **011**. **Off-Waitlist Patients** CORGGA = Comprehensive Oral Rehabilitation under General Anaesthesia _figures/img_71472771e4315057.webp) _figures/img_0877f45282819913.webp) #### CORGGA Definition - **CORGGA**: Comprehensive Oral Rehabilitation under General Anaesthesia Clinical photo of the maxillary arch (upper jaw) showing multiple teeth with visible decay and restorations. The image is part of a comparison for 'Off-Waitlist Patients' undergoing CORGA (Comprehensive Oral Rehabilitation under General Anaesthesia). Clinical photo of the maxillary arch post-treatment, showing restored teeth including metallic crowns on posterior teeth. This image is paired with the first photo to demonstrate the outcome of CORGA procedures. # Off-Waitlist Patients DEGA = Dental Extractions under General Anaesthesia _figures/img_e4df8867bafbdd91.webp) _figures/img_1cf84756787844ac.webp) #### DEGA Definition - **DEGA**: Dental Extractions under General Anaesthesia Clinical photo of the upper dental arch showing multiple severely decayed teeth with extensive caries and discoloration, likely in a patient prioritized for off-waitlist DEGA treatment. Clinical photo of the same or similar upper dental arch post-extraction, showing empty sockets and surgical sites consistent with Dental Extractions under General Anaesthesia (DEGA). **Off-Waitlist Patients** - Take weight and height of child at start of the appointment as you bring them in (scales etc located in hallway outside Clinic 5) - Estimate to be signed electronically by legal guardian, and copy given to them - Patient to be added to GA waitlist – ask tutor - Pop-Up Notes – time of GA, type of GA, height and weight - E.g. 120min CORGA. Height=120cm. Weight=20kg. #### Physical Measurements - Record the weight and height of the child at the start of the appointment as they are brought in. - Scales and measurement equipment are located in the hallway outside Clinic 5. #### Administrative Requirements - The treatment estimate must be signed electronically by the legal guardian, and a copy must be provided to them. - Consult with a tutor regarding adding the patient to the General Anaesthesia (GA) waitlist. #### Pop-Up Note Documentation Include the following details in the Pop-Up Notes: - Type of GA (e.g., CORGA) - Estimated time of GA (e.g., 120min) - Height (e.g., 120cm) - Weight (e.g., 20kg) **Off-Waitlist Clinic** • Patients requiring treatment under GA will need multiple forms completed for Perth Children’s Hospital (PCH) and/or Southbank Day Surgery. • Help the family fill in the forms * Do not assume parent is literate – write out the form for them so it is correct and legible * This is a legal document – if you make a mistake draw a single line through it, initial it, and write correct words * UMRN is the hospital record number – leave this blank _figures/img_ec77631aa1fa4e08.webp) #### Hospital Referral Paperwork - Patients requiring treatment under GA require multiple forms for Perth Children’s Hospital (PCH) and/or Southbank Day Surgery. - Assist the family in completing these forms: - Do not assume the parent is literate; write out the form for them to ensure it is correct and legible. - These are legal documents. If a mistake is made, draw a single line through it, initial the change, and write the correct information. - Leave the UMRN (hospital record number) blank. The official logo of The University of Western Australia, featuring a shield with a swan and the university name. # Department of Communities * Children may be under the care of the Department of Communities (child protection) * In this case, the Director is their legal guardian * May still live with a parent or extended family member, foster family, or residential care * Each child will have * A carer – foster parent, extended family member, parent * A DCP case manager * A legal guardian – Director of Department of Communities * If a child under the care of DCP requires treatment, you need to write a letter to the Department of Communities requesting consent _figures/img_03f2ead6bbc11a80.webp) #### Guardianship and Care Arrangements Children under the care of the Department of Communities (child protection) are subject to specific legal and administrative protocols: - The Director of the Department of Communities serves as the child's legal guardian. - Living arrangements for these children vary and may include: - Biological parents or extended family members - Foster families - Residential care facilities #### Key Contacts for the Child Every child under the care of the Department of Communities will have the following designated individuals: 1. **Carer:** This may be a foster parent, extended family member, or parent. 2. **DCP Case Manager:** The assigned professional managing the child's welfare. 3. **Legal Guardian:** The Director of the Department of Communities. #### Consent for Treatment If a child under the care of the Department of Communities (DCP) requires dental treatment, practitioners must initiate the following protocol: - A formal letter must be written to the Department of Communities to officially request consent for the proposed treatment. University logo: The University of Western Australia crest with a shield containing a swan and the motto 'Terra Australis Incognita'. **Behaviour Management** • Knee to knee technique • Can place towel or pillow on lap • Brief parent on technique before starting _figures/img_1d9940c144f0bd58.webp) #### Knee-to-Knee Technique - Utilize the knee-to-knee positioning for the examination. - A towel or pillow may be placed on the lap for comfort. - Ensure the parent is fully briefed on the technique before commencing. Clinical photo demonstrating the 'Knee to knee technique' for behaviour management. A dental professional (wearing black scrubs and headlamps) is examining a child's mouth while the child lies across the lap of another person (likely a parent or guardian) who is wearing a high-visibility jacket. The text on the slide mentions placing a towel or pillow on the lap and briefing the parent before starting. ### Behaviour Management #### Desensitisation - Want a positive appointment - May have chair upright or semi-reclined - Easy treatment first ### #### The University of Western Australia - Image showing a child brushing teeth with a stuffed dinosaur _figures/img_28a889a3294f774e.webp) _figures/img_8a936d17fbcced6b.webp) #### Desensitisation Strategies - Focus on achieving a positive appointment outcome. - The dental chair may be positioned upright or semi-reclined to increase patient comfort. - Prioritise easy, non-invasive treatments first to build confidence. #### Oral Hygiene Instruction - Use of props, such as a stuffed dinosaur, to demonstrate proper tooth brushing techniques to the child. Clinical photo showing a healthcare worker interacting with a young child outdoors. The worker is holding a blue stuffed dragon toy while the child holds a yellow toothbrush, demonstrating a desensitisation technique for dental care. Clinical photo of a young girl sitting upright in a semi-reclined blue dental chair, brushing a green stuffed dinosaur's teeth. This illustrates the 'Desensitisation' strategy mentioned in the text: maintaining an upright/semi-reclined position and using easy treatment (toothbrushing) first. Behaviour Management • Enhancing control o Give small choices, such as which sunglasses to wear The University of Western Australia VITAM EX CLU|ERE AR TES SEEK WISDOM Choice! _figures/img_2f0fb753110af4e0.webp) _figures/img_84beae771c0affe5.webp) #### Enhancing Patient Control - Provide the patient with small choices to empower them during the visit, such as selecting which sunglasses to wear. Photo of a pair of pink cat-eye sunglasses with dark lenses, presented as one option in a choice scenario. Photo of a pair of white flower-shaped sunglasses with gradient lenses, presented as the second option for comparison. # Behaviour Management - **Positive reinforcement** - Don't forget a sticker at the end of the appointment! Boxes of stickers are in Clinic 5. _figures/img_8d5466937a90e3ea.webp) Clinical photo demonstrating positive reinforcement in a dental setting. A young child sits on a blue dental chair holding a sticker while an adult male smiles beside them, illustrating the reward system mentioned in the text. 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