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Paediatric Dentistry Residency MDS, NUS, Updated Apr 20th 2017

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Faculty of Dentistry Division of Graduate Dental Studies

PAEDIATRIC DENTISTRY Residency Training Programme

leading to the degree of Master of Dental Surgery (MDS)

Faculty of Dentistry, 11 Lower Kent Ridge Road, Singapore 119083 Tel: (65) 67724965 Fax: (65) 67796520 Website: www.dentistry.nus.edu.sg

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MAIN CONTENT

INDEX TABLE OF CONTENT PAGE 1 Teaching Staff 1 2 Committee for Paediatric Dentistry 2 3 Introduction 3 4 Programme Aims 4 5 Programme Outline 5 6 Course Curriculum

• Didactics • Clinical Programme • Research Programme • Undergraduate Teaching • Electives

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7 Overview of Course 10 8 Weekly Timetable 11 9 Assessment 12

10 Standard Operating Procedures and Policies • Clinical Attire • Clinical Hours • Appointments and Patient Bookings • Patient Care in NUS/NUH

- License and Medical Protection - Documentation - Patient Records - Treatment Plan - Specialty Clinics: GA clinic, Multi-Disciplinary Clinic,

Inhalational Sedation Clinic - Patient Charge Forms

• Laboratory Work • Log Book • Safety and Emergencies • Conferences • Medical Leave • Vacation and Personal Leave

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11 References 21

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1. TEACHING STAFF

Programme Director: A/Professor Catherine Hong

Associate Directors: Dr Eu Oy Chu (School Dental Service, Health Promotion Board)

Dr Bien Lai (National Dental Centre)

Paediatric Dentistry Full Time Faculty (NUS):

Professor Monty Duggal

Dr Betty Mok Yuen Yue

A/Professor Catherine Hong

Dr Tong Huei Jinn

Part Time Faculty:

Dr Eu Oy Chu (School Dental Service, Health Promotion Board)

Dr Bien Lai (National Dental Centre)

Dr Sim Chien Joo (NUHS)

Dr Tang Kok Siew (NUHS)

Dr Chay Pui Ling (KK Women’s and Children’s Hospital)

Dr Ng Jing Jing

Dr Rashid Tahir

Orthodontics A/Professor Kelvin Foong (NUS)

Dr Chng Chai Kiat (KK Women’s and Children’s Hospital)

Dr Kaan Sheung Kin

Oral Surgery A/ Professor Asher Lim (NUHS)

Dr Raymond Wong (NUS)

Dr Intekhab Islam (NUS)

Basic Medical Science Course Instructors Biostatistics and GRMM Course Instructors Paediatric Medicine Rotation Clinical Supervisors


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2. COMMITTEE FOR PAEDIATRIC DENTISTRY

A/ Professor Catherine Hong (Chair)

Dr Eu Oy Chu

Dr Bien Lai

Dr Betty Mok

Dr Ng Jing Jing

Dr Rashid Tahir


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3. INTRODUCTION Paediatric Dentistry is an age dependent specialty. The discipline is very broad based and the aim of this program is for graduates to develop an understanding of all aspects of paediatric dentistry. On satisfactory completion of this 3 year course, students are awarded the Master of Dental Surgery (MDS) in Paediatric Dentistry. The program is administered by the Division of Graduate Dental Studies, Faculty of Dentistry. The clinical component of the programme will be conducted at the Faculty of Dentistry National University of Singapore, School Dental Centre (Health Promotion Board) and National Dental Centre. The didactic component will be conducted at the Faculty of Dentistry. A major part of the clinical course comprises of the routine and advanced clinical dental care of children and adolescents including those with special healthcare needs (i.e. medically, mentally, physically, socially or behaviourally disadvantaged). The trainee/resident will also participate in the after-hours emergency service. Aspects of the didactic course will be covered in formal lectures, seminars and tutorials conducted by full time teaching staff of the Discipline of Orthodontics and Paediatric Dentistry in the Faculty of Dentistry, National University of Singapore as well as part time teaching staff from other institutions and private practice. Additionally, the resident is expected to develop a further understanding and knowledge in the discipline of Paediatric Dentistry from his or her own reading and enquiry. Trainees/ residents are expected to spend additional time for research, assignments, and reports out of office hours. All residents must undertake a research project under the direction of an assigned supervisor, which is to be presented as a written dissertation and defended in an oral examination as part of the requirement for the degree of Master of Dental Surgery (Paediatric Dentistry). Trainees/ residents may also choose to read elective courses in areas outside of Paediatric Dentistry.


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4. PROGRAMME AIMS The programme aims to graduate specialists:

• Who are proficient in all areas of dentistry for children and adolescents; from birth to 18 years of age.

• With an in-depth knowledge and understanding of the basic and clinical science foundations for paediatric dental treatment and to use this to perform evidence-based clinical care.

• Who are proficient to pursue scholarly activity and/or research in paediatric dentistry. • Who will develop and maintain a desire for self-evaluation, life-long learning, and

professional growth and development. • Who will participate in and understand the value of community-based activities.

The graduates from this Paediatric Dentistry programme should be experienced in:

• Diagnosis of abnormalities in general, craniofacial and dento-alveolar development. • Diagnosis of oral disease in children and adolescent. • Effective communication with family members including parents and legal

representatives of the child patient. • Formulating appropriate dental treatment plans based on the physical, behavioural and

cognitive development of children and adolescents of varying age groups (i.e. infant/ toddler, 3-6 years, 7-12 years and 13-18 years).

• Formulating appropriate dental treatment plans for children and adolescents with special healthcare needs.

• Selection and delivery of appropriate preventive, restorative and surgical interventions for dental decay in primary and immature permanent teeth.

• Selection and delivery of appropriate preventive and interceptive periodontal programmes for children and adolescents.

• Non-pharmacological and pharmacological behavioural management techniques in children and adolescent by applying the principles of child cognitive development and behavioural psychology in the dental setting.

• Hospital and operating room practice which includes dental treatment under general anaesthesia.

• Diagnosis and management of paediatric orofacial trauma. • Diagnosis of mucosal, soft and hard tissue pathology occurring in and around the mouth

from birth through adolescence. • Recognition and diagnosis of orthodontics problems in the developing occlusion; should

be proficient to plan and deliver interceptive orthodontic intervention in the primary and mixed dentition using removable or simple fixed appliances including space maintainers.

• Effective communication and collaboration in multi-disciplinary teams concerned with the welfare of children. (e.g., Cleft Lip Palate teams)

• The design and conduct of research studies.


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5. PROGRAMME OUTLINE This training programme is a full time course that extends over three calendar years (36 months) of 42 - 48 weeks per year beginning July. The total course requirement over the three years is allocated to:

• Supervised clinical training: 50 - 60% • Didactics: 15 - 20% • Research: 15 - 20% • Teaching, self-directed learning and administrative time: 5%

ENTRANCE REQUIREMENTS A candidate will be eligible for consideration for entry into specialty training in Paediatric Dentistry if he or she is a holder of a degree in Dental Surgery with two years’ experience in full-time clinical practice or a period of internship after graduation from basic dental foundation training. Holders of degrees registrable by dental boards in India, Indonesia and Philippines and other qualifications approved by the Division of Graduate Dental Studies are acceptable and can be admitted to the programme. A TOEFL score of 550- 600 or IELTS score of 7 and above is needed. CLINICAL REQUIREMENTS This requirement is fulfilled by attendance in the clinics at the Discipline of Orthodontics and Paediatric Dentistry, Faculty of Dentistry, National University of Singapore and in rotations at affiliated institutions. The teaching staff will decide if the student has shown clinical work of satisfactory variation and quality. There are credits for clinical work which is awarded for satisfactory completion of the presentation cases and satisfactory performance on clinics throughout the course. DIDACTIC REQUIREMENTS Trainees/ residents must participate in all required lectures, seminars and presentations for satisfactory completion of the course and attain the appropriate number of academic credits. RESEARCH REQUIREMENTS Trainees/ residents are required to complete a research project under the supervision of a member of the teaching staff. When a project has been decided upon, a research protocol will be submitted to the programme director. There are credits awarded for the research project. The completed project must be submitted as a well-written scientific dissertation no later than six weeks before the date of the oral examination. It is expected that each student will present a seminar on his or her research to the staff of the discipline at various times during the course and on assigned topics as required.


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6. COURSE CURRICULUM This curriculum has been developed by the local planning committee based on the i. Specialty training curriculum developed by the Specialty Advisory Committee for Paediatric Dentistry, The Faculty of Dental Surgery, The Royal College of Surgeons of England and the ii. Accreditation Standards for Advanced Specialty Education Programs in Pediatric Dentistry, Commission on Dental Accreditation, American Dental Association. DIDACTICS i. Basic Medical Science Course

a. Regional Anatomy b. Dental Anatomy and Histology c. Pathology d. Physiology

ii. MDS Biostatistics & GRMM course The aim is to provide comprehensive working knowledge of various areas of the biological sciences that interrelate to Paediatric Dentistry. The topics will include:

a. Biostatistics & Epidemiology b. Research Methodology c. Evidence Based Dentistry d. Biomedical Ethics

iii. Clinical Dental Photography iv. Basic Cardiac Life Support training v. Paediatric Dentistry Scope

a. Growth and Development: To understand the basic processes of normal growth and development and how perturbations result in abnormalities. • Principles of Mendelian Genetics in relation to patterns of inheritance, gene

expression, penetrance. • The mechanisms by which congenital abnormalities arise. • Concepts of dysmorphology including malformations, deformations and deformities • The embryological development of the head and neck, including teeth. • Effects of prematurity on metabolism and growth and development • Postnatal growth and development of the head and neck.

b. Diagnosis and Treatment Planning

• Child assessment (History taking, patient examination, assessment, diagnosis, treatment planning and prognosis for acute and chronic conditions).

• Diagnosis and treatment planning for different age groups (infant/toddler, 3-6 years of age, 7-12 years of age, 13-16 years of age) and children with special health care needs.

• Recognise how physical, behavioural and cognitive development may affect the ability of children/adolescents to accept dental care.

c. Pathogenesis, Prevention and Treatment of Oral Disease in Children and Adolescents

• To identify and assess caries risk factors. • Have knowledge and background in research and clinical studies in the usage of

sealants, preventive restorations and minimal intervention dentistry.


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• Be able to prevent and control dental caries chemically by fluoride and antimicrobial agents.

• To gain a better understanding about home care, prenatal counselling, motivating parents to take care of their children and involvement of other family members.

• To identify factors associated with periodontal diseases in children. • To understand the differences between the manifestations and development of

periodontal diseases in children and adults. • To have an in depth understanding of the pathogenesis, diagnosis and management of

periodontal diseases. • To understand the role of diet and nutrition in oral/dental health and diseases in

children. • To identify factors associated with Non-carious Tooth Surface Loss. • To have knowledge of the effects of smoking, drug, alcohol and substance abuse.

d. Restorative Techniques in Paediatric Dentistry e. Community Paediatric Dentistry

f. Management of Dento-alveolar and Maxillofacial Trauma in Children and Adolescents • Maxillofacial, soft tissue and dental/ dento-alveolar injuries

g. Behavioural Science and Behaviour Management of the Child and Adolescent

• General behavioural concepts • Child psychology • Non-pharmacologic behavioural techniques • Pharmacologic behavioural techniques

o Inhalation sedation o Other sedation techniques o General anaesthesia

h. The Development of the Occlusion and its Management

• Concepts of normal occlusion • Aetiology, classifications, diagnosis of malocclusion • Interceptive orthodontics in the areas of space maintenance, management of oral

habits, correction of anterior and posterior cross bites

i. Paediatric Oral Pathology, Oral Medicine and Oral Surgery • Oral pathology including dental anomalies • Oral medicine • Oral radiology • Management of impacted and supernumerary teeth • Paediatric forensic dentistry

j. General Paediatric Medicine

• General paediatric medicine, specifically key conditions that will make children more prone to oral/dental disease or which may complicate the delivery of oral/ dental care, and a detailed knowledge of their oral/ dental management

• Medically complex children and adolescents • Prevention and management of medical emergencies


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• Speech and language k. Multi-disciplinary and Multi-agency Collaboration in Paediatric Dentistry l. Specialist Paediatric Practice

• Practice management • Jurisprudence and risk management

vi. Didactic Format

a. Paediatric Dentistry Preparatory Course for Year 1 Residents (July, See Appendix 1 - 3) b. Tutorials/ Seminars (Weekly) Tutorials/ Seminars are the major foundation for the didactic course in this residency. This

is weekly session where Year 1 and 2 residents are expected to review the assigned Residents are expected to write abstracts for the assigned articles and other readings, which will be reviewed by the facilitating faculty member. The papers assigned for each session will be categorized by subject and this will be added to and amended as appropriate.

c. Journal Club (Monthly) This is an educational forum where faculty and all residents bring attention to articles

which they feel are significant in any aspect of care for children. These articles may be medical or dental, technique-oriented or focused on behavioural or social sciences. In addition, Journal club may also be a forum where discussion occurs on older, classic articles which are the foundation of Paediatric Dentistry or the dental/ medical sciences. Residents will be responsible for reading and critically reviewing assigned article. Residents will be challenged to think critically and to analyse the articles presented.

d. Clinical Case Presentation/ Treatment Planning Seminars (Monthly) These educational experiences will allow Y2 and Y3 residents to share significant points

which they have learned during care of or planning for treatment care of their patients. Important considerations of medical issues and treatment modifications will be discussed. In addition, there may be expanded discussion on pathological findings or conditions which are found in patients who are being treated in the clinic.

CLINICAL PROGRAM i. Outpatient Clinical Care

a. Paediatric Dentistry clinical sessions: New, Recall, Treatment b. Mixed Dentition clinic c. Multi-Disciplinary clinic d. Inhalational Sedation clinic e. Trauma clinic at Health Promotion Board (Appendix 4) f. Elective clinical programmes e.g., community outreach programmes

ii. Hospital Paediatric Dentistry

a. GA clinic b. Special Needs Clinic

iii. After Hours Emergency Department Service iv. Mandatory Rotations


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RESEARCH PROGRAM Each resident is required to initiate and complete an independent research project and/or scholarly activities which will require data collection and analysis, as well as the use of the elements of the scientific method. Residents will be required to report their results in a scientific forum. This forum may consist of a local, regional, national or international meeting, or an article submitted for publication to a refereed journal. Depending on the nature of the research project, the resident may be required to attend special courses/ attachment in relation to the project to develop adequate methodology. Residents’ research should involve literature review and critical analysis of scientific literature, experimental design, statistical analysis, and accurate reporting of findings. Research efforts are expected to be self-motivated. However, in order to provide some structure, scheduled reviews of the resident’s research progress will be performed. These reviews are intended to assist the trainees/ residents in staying on track with their research. The recommended milestone for research progression is as follows:

Milestone Timeline Research idea generation Year 1 Term 1 Protocol formulation Year 1 Term 2 -3 Ethics approval Year 1 Term 3 - 4 Project Initiation and data collection Year 1 Term 4 – Year 2 Term 1 Completion of data collection Year 2 Term 4 – Year 3 Term 1 Data Analysis Year 3 Term 1 or 2 Write up of thesis Year 3 Term 2 or 3 Defence Year 3 Term 3 or early 4

UNDERGRADUATE TEACHING The supervision of undergraduate dental students is an important component of specialist training. Senior residents (3rd year) will be involved in the supervision of third and fourth year undergraduate students. In addition to these formal teaching sessions, a senior resident in training may also be involved in the supervision and mentoring of all junior staff within the department (dental officers). ELECTIVES There will be mandatory electives (e.g., Oral Maxillofacial Surgery, Child Development Unit, National Dental Centre, KKCH rotations) that residents must attend. If schedule permits, residents may choose to take elective rotations in areas outside of Paediatric Dentistry that they may be interested in (e.g., molecular biology, microbiology, psychology, paediatric medicine, clinical disciplines in Prosthodontics, Orthodontics, Oral Medicine and Endodontics).


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7. OVERVIEW OF COURSE Year 1 Year 2 Year 3 DIDACTICS 1. Basic medical science

course 2. Clinical dental photography 3. Advanced Paediatric Dentistry preparatory course: Didactics 4. Orthodontics preparatory course 5. Seminars/ Tutorials 6. Journal club

1. Seminars/ Tutorials 2. Treatment planning sessions/ Clinical case presentations 3. Journal club

1. Treatment planning sessions/ Clinical case presentations 2. Journal club

CLINICAL 1. Advanced Paediatric Dentistry preparatory course: Technique 2. Paediatric Dentistry clinics 3. Specialty Clinics: - GA clinics - Mixed Dentition clinic - Trauma clinic - Assist in Sedation Clinic - Assist in Special Needs Clinic

1. Paediatric Dentistry clinics 2. Specialty Clinics: - Mixed dentition clinic - Trauma clinic - Sedation clinic - Special Needs Clinic 3. Rotations - NDC - OMS

1. Paediatric Dentistry clinics 2. Specialty Clinics: - Mixed dentition clinic - Trauma clinic - Sedation clinic - Special Needs Clinic 3. Rotations - Paediatric Medicine - KKCH

ASSESSMENT 1. Clinical competencies 2. End of term paper 2. End of year formal written assessment

1. Oral presentation 2. End of term paper 3. End of year formal written assessment

1. Oral presentation 2. Final year formal assessment (RCS format)

RESEARCH 1. Biostats & GRMM 2. Preparation and presentation of research protocol 3. Initiation of research project

1. Research project 2. Oral presentation of research progress

1. Oral presentation of research progress 2. Completion of research and thesis write-up

TEACH Undergraduate Teaching

ADMIN Chief Resident EMERGENCY DEPARTMENT CALL

After hours emergency department call for 3 months


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8. WEEKLY TIMETABLE YEAR 1

Monday Tuesday Wednesday Thursday Friday AM Clinical session

(NUS) Operating Theatre (NUH)/ Research

Clinical session (NUS)

Clinical session (HPB)

Didactics

PM Clinical session (NUS)

Operating Theatre (NUH)/ Research

Clinical session (NUS)/ Clinical Photograhy/ Biostats & GRMM

Clinical session (HPB)

Didactics/ Special Needs Clinic (NUH)/ Sedation clinic (NUH)

YEAR 2


(NUS)/ Elective/ Research

Operating Theatre (NDC)/ Research/ Elective

Clinical session (NUS)/ Elective

Clinical session (HPB/NDC)/ Elective/ Research

Didactics

PM Clinical session (NUS)/ Elective/ Research

Operating Theatre(NDC)/ Research/ Library/ Elective

Clinical session (NUS)/ Elective

Clinical session (HPB/ NDC)/ Elective/ Research

Didactics/ Special Needs Clinic (NUH)/ Sedation clinic (NUH)

YEAR 3


(NUS)/ Elective/ Research

Clinical session (KKCH)/ Research/ Elective

Clinical session (NUS)/ Teach

Clinical session (HPB)/ Research/ Library

KKCH/Teach/ Research

PM Clinical session (NUS)/ Elective/ Research

Clinical session (KKCH)/ Research/ Elective

Clinical session (NUS)

Clinical session (HPB)/ Research/ Library

Special Needs Clinic (NUH)/ Sedation clinic (NUH)/ Research


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9. ASSESSMENT The students’ performance and progress will be reviewed periodically by the Program Director and teaching committee at the end of every semester/ term throughout the MDS course (Appendix 5). This will be based on their performance during didactics, in the clinics and their research project and will make up their continual assessment grade. Continual assessment will account for up to 40% of the grades for the year end assessments as well as the Final MDS Examination CONTINUAL ASSESSMENT i. Didactics

a. Written assignments (e.g., End of term paper, Year-end formal written examinations) b. Oral case presentations c. Participation during didactics

ii. Clinics

a. Competency tests (Appendix 1): Technique competency tests must be completed prior to entering patient clinics; expected to be completed within the first month of residency commencement. All residents are expected to complete their clinical competencies and oral viva voce by the end of the 2nd term. Residents who have passed the clinical competencies will be allowed more autonomy during clinical sessions. Prior to that, all steps needs to be shown up to the supervisor. The competencies include the below. • Technique competency:

o Class II and Class III cavities o Stainless steel crown o Space maintainer fabrication

• Oral Viva Voce • Clinical competency:

o Examination, diagnosis and treatment planning of a complex case o Topical and local anaesthetic techniques o Rubber dam placement o Class II cavity o Indirect Pulp Cap o Stainless steel crown o Pulpotomy/ pulpectomy o GA consultation

b. Schedule Residents are required to keep a log book of all the patients that they have treated and

submit the log book for review every semester (every 2 terms). There is a minimum breadth of clinical paediatric dentistry that should be completed for

graduation; however residents are expected to complete well above the minimum requirements. In addition to the quantity of work completed, residents will be also be evaluated on their quality of work. • Scope of work

o Treatment of infected pulps of primary teeth with pulpotomy or pulpectomy techniques with a minimum follow up period of 6 months.

o Comprehensive care showing complex restorative and preventive treatment without sedation or general anaesthesia with minimum follow up period of 6 months.


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o Comprehensive care showing complex restorative and preventive treatment using sedation or general anaesthesia

o Dental management of patients with dental alveolar trauma, or simple oro-facial trauma, followed for a period of at least one year.

o Dental management of patients with special healthcare needs o Dental management of patients within Paediatric Dentistry in conjunction with

another specialty e.g., Orthodontics, Oral Surgery, Prosthodontics etc.

c. Assistantship: Year 1 residents must have ≥2 GA assistantships and ≥2 Nitrous Oxide sedation assistantships prior to managing a GA/ Nitrous Oxide sedation case as operator.

d. Organisation and record management e. Professionalism (e.g., patient management, teamwork, responsibility)

iii. Research (e.g., reaching milestones) Continuous unsatisfactory performance in any one of the above areas may result in failure to progress to senior years or termination from the course.

YEAR END ASSESSMENT All trainees/ residents will assessed annually at the end of their first, second and third year. A satisfactory performance (pass mark: 50%) in these examinations is required. i. First year: 3 hour written paper of short answer questions and essays ii. Second year: 3 hour written paper of short answer questions and essays iii. Final year: Students will only be allowed to write the final year examination after having met

the requirements set by the program committee. a. Examination schedule: Two three hour written papers of multiple choice questions, short

answer questions and essays. b. Oral viva voce: One and a half hour oral examination with two members of the teaching

staff and an external examiner in Paediatric Dentistry from another institution. • A 30 minute structured oral examination related to diagnosis and treatment planning

for a paediatric patient for two simulated Paediatric Dentistry case studies. • A 30 minutes structured oral examination based on FOUR fully documented case

histories each describing a paediatric patient personally treated by the candidate. 1. The case history should describe comprehensive care for a child in the primary or

mixed dentition stage of development 2. The case history should describe comprehensive care for a child with a medical

mental or physical impairment in the primary or mixed dentition stage of development. The history should show the special approaches which have been used to render and keep the child in good oral health in relation to the impairment. This history should show evidence of follow up care.

3. The case history should describe the management of a child or adolescent who has suffered complicated trauma to the permanent anterior teeth

4. The case history should describe the management of a complex problem within Paediatric Dentistry possibly in conjunction with another specialty such as Orthodontics, Restorative Dentistry, Oral Medicine or Oral Surgery.


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• A structured 30 minutes oral examination on any aspect of Paediatric Dentistry as outlined in the course curriculum.

AWARD OF MASTER OF DENTAL SURGERY (PAEDIATRIC DENTISTRY) Trainees/ residents who display a satisfactory performance (pass mark: 50%) in the final year examination and are successful in their thesis defence will be awarded the degree of Master of Dental Surgery in Paediatric Dentistry.


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10. STANDARD OPERATING PROCEDURES Postgraduate students/ trainees are expected to devote their efforts towards obtaining a sound academic foundation in Paediatric Dentistry and a high level of expertise in Paediatric Dentistry clinical techniques. They are, therefore, discouraged from engaging in part-time dental practice or working for external examinations other than the Membership in Paediatric Dentistry of the Royal College or other examinations approved by the Discipline of Orthodontics and Paediatric Dentistry. Leave to take other examinations will not normally be granted. Absence or extended illness may result in time being added to the course. Time may also be added if all requirements are not fulfilled, or the Paediatric Dentistry teaching staff feel the trainee/ resident has not reached the required standard and further clinical experience may be of benefit. Periods of unscheduled time are established for self-study/ library usage and carrying out research related activities; however you are expected to be available and contactable between 8.00am to 5.30pm (5.00pm on Fridays) during regular term time. The training programme may require postgraduate students to participate in monthly evening seminar(s), and take emergency department Paediatric Dentistry call, as directed by the programme director or head of the Discipline of Orthodontics and Paediatric Dentistry. CLINICAL ATTIRE You are expected to adhere to the Faculty of Dentistry clinic attire. Please refer to the Faculty of Dentistry Clinical Manual (2014) Section C.1. for further details. CLINIC HOURS In all three years, postgraduate students/ trainees will commence their studies usually on the first Monday in July (may change based on university schedule) and the year ends on June 30th. The clinic official opening hours are 8.00am to 5.30pm from Mondays to Thursdays and 8.00am to 5.00pm on Fridays during regular school session. APPOINTMENTS AND PATIENT BOOKING The first appointment of the day will be at 815 am and the latest appointment of the day will be no later than 430pm. Residents are expected to be punctual for clinical sessions. They should aim to be in the clinic at least 10 - 15 minutes prior to the start of their patient clinical sessions (this is to give adequate time for preparation and setting up of instruments). Please refer to Section C. of the Faculty of Dentistry Clinical Manual 2014 for details. New patient appointments for Pediatric Dentistry and Special Needs Clinics (75 minutes for first year residents, 45 - 60 minutes for senior residents) will be made by the reception for FOD Grad Clinic and NUH Dental Center 1. Subsequent appointments are to be made by the resident themselves. Calling of patients by the front desk is not applicable for Mixed Dentition cases. For these cases, residents should obtain their mixed dentition cases from the Pedo WL book; which is kept in the cabinet at the NUS Grad Clinic reception. Residents are expected to record in the Pedo WL book that they have taken the case and are expected to call the patient within a month of taking on the case. As a guide, the duration of visits should be as follows: restorative visit: 60 - 90 minutes, post-operative visit: 30 minutes, treatment planning session for mixed dentition cases: 60 - 90


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minutes, adjustment of orthodontic appliance: 45 - 60 minutes. Should there be changes in the schedule (e.g., examination break, elective rotations) and patients are already booked in, residents are expected to reschedule the patients themselves. It is the responsibility of the postgraduate student to ensure that the patients are scheduled and reviewed in an appropriate and timely manner. Please do all bookings at least 3 working days in advance to allow tracing of hard-copy case notes and timely deployment of available clinical support manpower. The following deadlines for booking are to be adhered to:

Clinic Session Booking Deadline Monday AM & PM Wednesday 200pm week before Wednesday AM & PM Monday 0815am same week

If seeing patients on urgent basis, clinician is to note that hard-copy case notes may not be on-hand if not kept at FOD Level 2 Dental Records Office. They will have to work

• only from on-line notes (TITANIUM, CPRS / Centricity); and • hard copy x-rays will not be available.

PATIENT CARE IN NUS/NUH i. License and Medical Protection It is mandatory for all trainees/ residents to have a valid dental license and Medical Protective Insurance throughout their course of study. ii. Documentation (Please refer to Section D3 and D6 of the Faculty of Dentistry Clinical Manual 2016 for details)

• Consent form: Verbal and written informed consent should be taken for all patients under the age of 18 years of ages for males (if serving National Service) and 21 years of age for females.

• Documentation of cases: Where children are selected as possible presentation cases, duplicate pre-treatment reference models should be requisitioned and stored separately from those in regular use. These models will be used for presentation purposes, if required. Patients should be photographed before treatment commences and a check made that appropriate radiographs are available. Trainees/ residents should make every effort to have all presentation cases started before the end of the first year to ensure that sufficient post-operative follow-up time is available.

iii. Patient records All patient paper and electronic records/notes are to be kept accurate, current and completed on the same day that the patient was seen. It is essential that good records are obtained at the outset for all cases being treated by postgraduate students so that the absence of satisfactory initial records will not eliminate any case from possible use as a "presentation case" in the final examination. Clinical records and models are also legal documents and therefore must show an accurate record of all treatment carried out. On all official forms (i.e. X-ray form, consent form, charge form, 4 page E&D), the following must be indicated:

• Sticker of Patient’s name and NRIC • Clinician’s stamp


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It is the clinician’s responsibility to ensure that all JCI forms are updated and inserted in the hard copy case notes.

• Medical History – to be updated on annual basis. • Photography Consent – has 3 months validity and if expired, needs to be retaken. • Outpatient Assessment Checklist – every visit

If the hard copy case notes are not on hand at the visit, these forms are to be updated as soon as the case notes are obtained later. In addition to electronic charting on titanium, postgraduate students are expected to complete the hard copies (refer to Appendix 6) for the following:

• All new patients: 4 page Examination and Diagnosis Charting hard copy form. Subsequent charting updates can be done electronically.

• All patients: Sequential treatment plan must be completed for any treatment plan that requires more than a single visit.

• Dental Trauma patients: o NUS Grad Clinic: Acute trauma assessment form completed

• Mixed Dentition Orthodontic cases: o Residents should keep track of their cases, and should have only 5-6 active cases

(in NUS Grad Clinic) at any one time. o Orthodontic Examination and Diagnosis Charting form (PG) must be completed. o Residents are expected to pour up diagnostic models for the first 5 cases

themselves. o Residents are expected to fabricate removable appliances for the first 3 cases

themselves. iv. Treatment plan All treatment plans should be approved and signed by faculty prior to execution. Residents are allowed to block 1 hour of their mixed dentition clinical sessions to go through the treatment plans for their mixed dentition orthodontic cases with the assigned orthodontic faculty member. v. Multi-Disciplinary Clinic (Appendix 7) This clinic involves and exposes the resident to multi-disciplinary dental management of paediatric patients with complex dental treatment. This will include conditions such as Residents will participate in the NUHS Multi-disciplinary Clinic for Dental related conditions such as Hypodontia, Amelogenesis imperfecta, Dentinogenesis imperfecta and cleidocranial dysplasia etc. vi. Treatment under General Anaesthesia (GA) (Appendix 8) The processes and paperwork to be completed for referral of patient for treatment under GA at NUH includes the following:

• Complete internal Referral Form (Appendix 8.1): This is a checklist of information required.

• Discuss tentative treatment plan, estimated cost, pre and post GA instructions (Appendix 8.2) with patient/ legal guardian.

• Obtain informed consent for operation from parent/legal guardian. (Green Form: Must be handwritten in same color ink, no short form, no name stamps, no patient stickers allowed)

• Refer to staff nurse or assigned nurse for financial counselling and paperwork to be signed by parent/legal guardian.


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• Assess need for referral to Anaesthesia Outpatient Consult Clinic (AOCC) and if needed to ask the staff nurse (at Level II FOD Grad Clinic) to make appointment for patient. (Appendix 8.3)

• If AOCC report indicates that a pediatric intensive care unit bed is needed for the patient after GA treatment, please arrange for one at least 4-6 weeks prior to GA date. (Appendix 8.4)

• Assess need for Medical Social Worker involvement if financial aid is requested. (Appendix 8.4)

• Set GA surgery date and location of surgery (Main Building OT versus Medical Center OT) and enter into Titanium. o For GA appointments made more than 3 months from date of consultation, please

make another appointment 2 to 4 weeks before GA date to update oral findings/ treatment plan and re-sign consent form.

o Please do not book a GA appointment if patient seems reluctant and need time to discuss with family members.

o For cases requiring follow up with other disciplines e.g., OMS, medical consults, MSW, please log into the green record book kept in the NUS Grad Clinic Level II.

• To go through patient information brochures o Prep Guide for Day Surgery o Knowing your Rights and Responsibilities o Map: Directions to location of surgery

• JCI Forms e.g., F1-100, Pre-admission forms, Patient and Family Education

The completed paper work (except for the patient brochures which are given to the patient) together with the folder should be given to the assigned faculty member 2 weeks before the scheduled GA date. Please refer to the attached appendix 8.3 for GA work flow. vii. Resident on GA Clinic Rotation (Appendix 8.5 – 8.8) Residents who are rotating through GA clinic must present all the upcoming cases for their month of rotation with a faculty member (Dr C Hong/ covering faculty) 2-4 weeks before the scheduled cases during the patient case conference session scheduled on Wednesday morning from 8am - 9am. The presentation should include a short report on need for any pre-operative GA workup e.g., AOCC and tentative treatment plan. For cases when Dr Tong HJ/Dr Tang KS/ Dr Sim CJ is the attending faculty, please email them a copy of the Powerpoint presentation (of what was presented during the patient care conference) at least 1 week before the GA scheduled appointment. In addition, residents rotating through GA clinic should uncheck the “Send SMS Reminder” in Titanium under the “Detail” tabs for patients scheduled for GA clinic at least 1-2 weeks prior to the scheduled date. The SMS reminder is an automated system whereby SMS reminders are sent to patient to attend clinic in outpatient Dental Center 1 based on their time and date of their Titanium appointment (Placeholder PG-GA under the Pedo appointment book); this confuses patients with the instructions given for GA appointment i.e. to be at Medical Center Plaza at the scheduled time (e.g., 700am for their GA appointment if 1st case) Should radiographs be required when the child is under GA, please refer to the following document found in NUHS intranet: http://nhgintrvpweb03/nhg_edcs/repository//Documents/NUH%20QEHS/Current/Standard%20Operating%20Procedures%20(SOP)/AMS/DEN/NUH-SOP-AMS-DEN-021/NUH-SOP-AMS-DEN-021.doc

http://nhgintrvpweb03/nhg_edcs/repository/Documents/NUH%20QEHS/Current/Standard%20Operating%20Procedures%20(SOP)/AMS/DEN/NUH-SOP-AMS-DEN-021/NUH-SOP-AMS-DEN-021.doc�




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viii. GA Audit Meetings GA audit meetings are a JCI requirement and will occur on a monthly/ bimonthly basis with the entire NUHS Paediatric Dentistry team. The primary purpose of these meetings is to audit any clinical problems that may have arisen during or after GA treatment. First and second year residents are expected to be present at these meetings. Residents may be called upon to briefly comment on their patient cases that they will treat or have treated under GA during these meetings. ix. Treatment under inhalational sedation (NUH) Residents needing to schedule patients for inhalational sedation over at NUH will need to obtain approval by supervising faculty member at the time of indication. Once date of inhalational sedation appointment is confirmed, resident is to touch base with supervising faculty member (to refer to schedule for the term) for the inhalation sedation appointment at least a week in advance. Please refer to the following document found in the NUHS intranet for more details on Standard Operating Procedures: http://nhgintrvpweb03/nhg_edcs/repository//Documents/NUH%20QEHS/Current/Standard%20Operating%20Procedures%20(SOP)/MCP/DEN/NUH-SOP-MCP-DEN-012/NUH-SOP-MCP-DEN-012.doc x. Patient charge forms (NUS/NUH) Patients should be charged for clinical procedures in a timely and accurate manner. If clinician anticipates working overtime (lunch hour or evening) and there is a need to raise a charge form for payment, please do this at least 30 min before the end of session so that the reception counter can process this. LABORATORY WORK For Paediatric Dentistry, Orthodontics and Endodontic technique work, please refer to the appendix 1 and 2 for the requirements and appendixes 2 and 3 for list of instruments to be collected from the various staff in charge. Laboratory work arising from the patient care during Paediatric Dentistry Graduate clinic at FOD Level 2 is managed by the following technicians.

Technician Type of Laboratory Work Ms. Ng Chor Eng Orthodontics* impression and appliance fabrication Mr. Mohd Khair Prosthodontic appliance fabrication

*Residents are expected to perform their own laboratory work (e.g., diagnostic models and appliances) for the first 5 appliances that they indicate, prior to sending work out to the laboratory (unless otherwise instructed by attending faculty) LOG BOOK (Appendix 9) Trainees/ residents are required to keep a log book of all the patients that they have treated and submit the log book for review every term. There is a set template in EXCEL spreadsheet already created for this purpose. Please request a copy from the chief resident for that term. Please abide by the following naming system when saving your log books EXCEL files; “Returns_AYXXXXTX_yourinitials_dateofsubmission”: e.g. Returns_AY1516T2_RC_13Jan1 • If doing returns for 2 terms: Returns_AY1617T1&2_RC_13jan16 • If doing return for entire year: “Returns_AY1617_RC_XXXX” • If doing returns for 3 years: “Returns_All_RC_XXXX”

http://nhgintrvpweb03/nhg_edcs/repository/Documents/NUH%20QEHS/Current/Standard%20Operating%20Procedures%20(SOP)/MCP/DEN/NUH-SOP-MCP-DEN-012/NUH-SOP-MCP-DEN-012.doc�




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SAFETY AND EMERGENCIES Please refer to the Faculty of Dentistry Clinical Manual 2014 Section F.1. to F.4. with regards to the protocols for emergency dental care, medical safety and emergencies, general infection control practices, and laboratory safety. CONFERENCES Trainees/ residents are encouraged to attend relevant international/ regional conferences. They are encouraged to present the findings of their research projects or to make clinical case poster presentations, and to enter for the young student researcher prize competitions at these meetings. MEDICAL LEAVE It is understood that illnesses are neither planned nor intentional. However, as in any occupation, only a limited number of days are expected to be taken as sick leave. Trainees/ residents who are absent for long periods due to ill health may be required by the program director to defer or redo part of the training program. VACATION AND PERSONAL LEAVE (Appendix 10) There will be a mandatory 4 week vacation annually based on the university calendar. Additional vacation time may be scheduled which will vary between academic years. Approval for additional leave (up to 5 days) from clinical duties outside of this allocated vacation time must be sought from the programme director. The leave application form may be found in DENNET under Academic Matters/Timetables n Lectures n Guidelines/ Division of Graduate Dental Studies/ Form- Application for Variable of Conference Leave. When approved, it is the responsibility of the resident to block out their patient treatment sessions affected and reschedule patients as needed. If a student is on leave during their duty week then it is their responsibility to make arrangements with one of their co-residents to cover their duties.


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11. REFERENCES 1. Paediatric Dentistry; Richard R Welbury, Monty S Duggal, M.T. Hosey. Oxford University

Press. 3rd edition (2005). 2. Dentistry for the child and adolescent; Jeffrey A. Dean. David R Avery, Ronald E.

McDonald. Mosby; 9th edition (2010) 3. Pediatric Dentistry: A Clinical approach. Goran Koch, Sven Poulsen. Wiley Blackwell. 2nd

edition (2009). 4. Pediatric dentistry: Infancy through adolescence; Jimmy Pickham, Paul Casamassimo,

Henry W. Fields, Dennis J. McTique, Arthur Nowak. Mosby; 4th edition (April 8th, 2005) 5. Contemporary orthodontics; William R. Proffit, Henry W. Fields Jr., David M. Sarver.

Mosby; 4th edition (2006) 6. Dental management of the medically compromised patient; James W. Little, Craig Miller,

Nelson L. Rhodus, Donald Falace. Mosby, 6th edition (March 25, 2002) 7. Textbook and color atlas of traumatic injuries to the teeth ; J.O. Andreasen and F.M.

Andreasen Copenhagen: Munksgaard, 2007 4th Ed 8. Restorative techniques in Paediatric Dentistry. Duggal MS, Curzon MEJ, Fayle SA,

Toumba KJ, Robertson AJ. Taylor & Francis Ltd, 2nd edition (2002). 9. http://www.aapd.org/policies/ 10. http://bspd.co.uk/Resources

http://www.aapd.org/policies/�

http://bspd.co.uk/Resources�