ASPECT OF CARE: ENDODONTIC, NON-SURGICAL OBTURATION
1. INDICATOR STATEMENT:
There is radiographic evidence of adequate obturation of
canal(s)
2. DEFINITION OF TERMS:
Obturation: The three-dimensional filling of the pulp chamber and root canal system
with a YVFWC program approved filing material (usually gutta percha and sealer).
Adequate obturation of the canal: There is general agreement that the ideal location of the apical
determination of the root canal filling materials at the dentinocemental junction, which is just short of
the radiographic apex, so as not to impinge on the periapical tissue. The most desirable presenting root
canal obturation is a homogeneously dense filling extending 0.5 to 1 mm short of the radiographic
apex. Ideally, the entire root canal space should be obturated with uniform density without voids as
potential areas of recontamination and infection. Underextension of the root canal filling material can
result by failure to fit the master gutta percha point accurately or from, a poorly prepared canal. Gross
overextension can lead to symptoms and treatment failure.
3. RATIONAL:
A. This indicator is useful to measure success in the non-surgical treatment of root canals. Outcomes
will be monitored by periapical radiographs following treatment, clinical examination and the
absence or presence of symptoms at the recall exams. Unless a dense, well-adapted root canal
filling is achieved, the prognosis may be in jeopardy.
B. References: Pathways to the Pulp, 6th edition. Cohen, S. and Burns, R. C.
Endodontics, 4th edition. Ingle, J. and Bakland, L.
4.
DESCRIPTION OF INDICATOR POPULATION:
A. N = Records of completed non-surgical endodontic treatment presenting with unacceptable root
canal obturation
B. D = Records of completed non-surgical endodontic treatment reviewed
C. Threshold = no more than 20% of the # of D will be recorded as N
5. UNDERLYING FACTORS:
A. Patient factors: Patient’s inability to cooperate; severe debilitating disease; calcified or unnegotiable
canals; canals with severe curvatures or dilacerations
B. Equipment factors: malfunctioning x-ray equipment; malfunctioning radiographic developing
equipment;
ASPECT OF CARE: OPERATIVE DENTISTRY- INTERPROXIMAL OVERHANGS
6. INDICATOR STATEMENT:
All restorations placed at our clinics since the last exam (within
6 months) show no interproximal overhangs.
7. DEFINITION OF TERMS:
A interproximal overhang is defined as any restorative material which appears to be overextended
beyond the radiographic margins of the tooth prep. In general, there should be a smooth transition of
dental restorative material and tooth surface at the proximal step of a restoration.
8. RATIONAL:
C. This indicator is useful to measure the success and quality of the restorations placed at our clinics.
Overhangs can be caused by a number of factors including, poor placement of interproximal
wedges, no wedging, improper preparation of the tooth. Overhangs prohibit proper flossing of the
interproximal tooth surfaces and trap food debris and plaque leading to gingivitis and periodontal
disease.
References: Operative Dentistry 2nd Edition; H. William Gilmore, Melvin R. Lund
9.
DESCRIPTION OF INDICATOR POPULATION:
D. N = Records of charts that show even one restoration placed in our clinics since the last exam
that shows evidence of interproximal overhangs
E. D = Records of charts reviewed
F. Threshold = no more than 10% of the # of D will be recorded as N
10. UNDERLYING FACTORS:
C. Patient factors: Patient’s inability to cooperate; severe debilitating disease;
D. Equipment factors: none
CLINICAL OUTCOME MEASURES INDICATOR FORM
YVFWC Dental Department
Aspect of Care: Operative Dentistry- Interproximal Overhangs
Dental Clinic: _________________________
Date: _________________
1. Number of charts reviewed with interproximal restorations and an exam done within
6 months. (D) ________
2. Number of reviewed charts with at least one restoration showing an overhang. (N)
________
3.
Threshold % N/ D = ________
4. Threshold will be achieved if no more than 10% of the # of D were recorded as N.
Was the Threshold achieved?
YES
NO
5. Record the chart #s of those charts recorded as N:
______________________________________________________________________________________
Post Treatment Infection Tracking Policy
The Yakima Valley Farm Workers Clinic Dental Program has developed the following
policy to better track and provide earlier treatment for post treatment infections: All oral
surgery, endodontic and periodontal surgery procedures will be followed up with a
phone call to the patient with-in 3 days. If problems are noted, the dentist will take
appropriate measures to resolve the situation. The individual dentist will be responsible
To enact this policy the following procedures will be in effect:
1. Each dentist will keep a daily log of all oral surgery, endodontic and periodontal
surgery procedures (see Post Treatment Log).
2. The dentist will have his/ her assistants call each patient and ask if there are any
problems with pain or swelling and record findings in the Post Treatment Log.
3. Charts of those patients should not be filed until the patient has been contacted and
the appropriate chart entry of the call has been made.
4. The assistant will notify the dentist if the patient indicates that they are having
problems. The dentist will take appropriate measures to address the patients
concerns.
5. At the end of the week the lead dentist will collect the Daily Procedure Tracking Logs
for the dentists and file them in a permanent folder.
POST-TREATMENT COMPLICATIONS LOG
Dental Clinic _______________________
Complete a log entry any time a patient presents for emergency care complaining of care that was done in
one of the YVFWC dental clinics.
Patient name
chart #
date of complaint
patient complaint (brief explanation)
1.
________________________________________________________________________________
2.
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3.
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4.
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5.
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6.
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20. ________________________________________________________________________________
POST TREATMENT LOG
CLINIC _____________________
Patient Name
Phone #
Date
of service
DENTIST________________________
Procedure
date called
Patient condition
1.
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2.
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3.
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4.
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5.
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