Plymouth University Peninsula School of Dentistry

Peninsula Dental Social Enterprise CIC

&

Clinical Activity Report

Academic year 2018/2019

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2

Introduction Page 3

Report objectives Page 3

Overview of clinical services Page 4

Corporate and clinical governance Page 5

Patient safety Page 6

Patient satisfaction Page 6

Well Connected Page 7/12

Student services Page 13

Specialist services Page 14

Paediatric service – Table 1. Paediatric patient numbers Page 14

PDSE Clinician Team Page 15

Community Clinic – Devonport DEF Page 15

Trainee Dental Nurse programme Page 16

Oral Health Education and Fluoride clinics Page 16

Clinical activity - data collection Page 17

Clinical activity overview Page 18

Table 2. Comparison of patient numbers year on year; Table 3. Breakdown of patients and appointments by site; Table 4. Treatment items Page 18

Postcode analysis by treatment site Derriford DEF Page 29

Postcode analysis by treatment site Devonport DEF Page 20

Postcode analysis by treatment site Exeter DEF Page 21

Postcode analysis by treatment site Truro DEF Page 22

Summary Page 23

Appendix A Page 24

Appendix B Page 25

Appendix C Page 26

Appendix D Page 27

Contents

Introduction

Peninsula Dental Social Enterprise (CIC) is committed to improving dental health in the South West. Over the past six years it has provided dental treatment, oral health education, community engagement and training to the wider community.

Under the social enterprise umbrella, PDSE provides the clinical teaching facilities for students of University of Plymouth who are studying to become dental professionals. In collaboration with Health Education England and NHS England, PDSE provides access to NHS dental care across the South West.

The four Dental Educational Facilities, situated in Plymouth, Exeter and Truro provide over 5,000 people a year access to NHS dental treatment.

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Report Objectives

• To provide an overview of service delivery for the academic year 18-19

• To provide a description of governance arrangements

• To provide clinical activity data in accordance with our education mission

Overview of Clinical Services

Throughout the academic year 2018 to 2019, PDSE has refined the service it provides with the aim of targeting areas of the community with the greatest level of need. Undergraduate dental students under the supervision of qualified professionals continue to provide dental care in line with NHS dental standards.

We operate access routes through self referral and community engagement activities, with the aim of reaching all areas of the local community.

All patients receive a triage assessment appointment, in order to assess their treatment needs and to determine their suitability for student treatment. Following this, each adult patient is provided with one course of treatment which aims to get the patient dentally fit, before being discharged and advised to seek alternative dental care provision. This aims to balance the requirements of students to treat a range of different modalities, whilst providing a fair and equitable service to local communities.

Paediatric patients are provided with routine dental care which is facilitated during the academic term by undergraduate dental students; or by one of our own Dentists or Hygiene Therapists. Routine examinations and any required treatment will be provided up until patients reach the age of 16.

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General services provided:

• A full range of primary care dental services aligned to NHS dental practice • Community engagement • Oral health education and improvement services

Specialist interest, Specialist and/or Consultant level services provided:

• Restorative dentistry (endodontics, periodontics, prosthodontics) • Minor oral surgery • Dental public health• Paediatric dentistry

Services that are not currently provided by PDSE and so are subject to external referral include orthodontics, patients requiring general anaesthesia and/or maxillofacial services and sedation services.

Corporate and Clinical Governance

PDSE promotes a strategic operational governance framework aimed at safeguarding patient safety throughout all clinical activity carried out across all four sites. The framework comprises of a multi-disciplinary team made up of Directors in Clinical Dentistry and Community-based dentistry, as well as a dedicated Clinic Manager and Clinical Governance and Operations Manager to ensure compliance with NHS, GDC and CQC regulations.

In order to ensure the delivery of high standards of care each Dental Educational Facility is led by a Consultant Clinical Lead and Clinic Team Leader. They are supported by a skilled team of dental nurses and administrators.

Each site has nominated leads for areas such as radiography, infection control and safeguarding who receive additional training to enhance their skill sets and ensure high standards to care.

All PDSE policies are accessible to everyone via the website and are continually reviewed and updated to ensure compliance with regulation and policy.

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Quality Assurance Framework

PDSE is committed to ensuring the highest standard of service delivery throughout the Dental Education Facilities. PDSE aims to satisfy the requirements of our students, as well as exceeding the expectations of our patients, through the quality of service that we provide.

In order to achieve the high standards of service expected and to ensure continuous improvement PDSE has established a structured quality management framework, which is embedded into every aspect of the organisation.

The PDSE quality management framework fundamentally consists of three principle elements:

Strong governance – to define organisational aims and translate them into action;

Robust systems of assurance – to ensure effective operations;

Culture of improvement – to demonstrate continual achievement.

Further details are available on the PDSE website http://peninsuladental.org.uk/wp-content/uploads/2019/05/Quality-Assurance-Framework-Statement-of-Compliance-2019.pdf

Patient Safety

Patient safety remains the cornerstone of all clinical activity undertaken. PDSE ensures that all staff and students understand the importance of effective incident reporting through comprehensive training at induction and periodic updates. The online incident reporting system adopted by PDSE enables all incidents to be appropriately assessed and analysed. This allows for any trends to be identified and the necessary level of action to be implemented as swiftly as possible.

PDSE promotes the awareness of patient safety through the monthly publication of the Patient Safety and Quality Bulletin and Clinical Dashboard.

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Data Security and Protection Toolkit

In May 2018 PDSE successfully completed the Data Security and Protection Toolkit demonstrating that it is compliant with the National Data Guardian’s (NDG) data security standards.

Patient Satisfaction

PDSE prides itself on achieving patient satisfaction and is continually looking for innovative ways of capturing patient feedback. All patients are encouraged to complete the Family and Friends Feedback asking; “How likely are you to recommend the Peninsula Dental Social Enterprise to your friends and family if they needed similar care or treatment?” Throughout the academic year 2018 to 2019 PDSE received 3141 patient feedbacks, the highest recorded so far.

Progress

Mandatory evidence items provided: 70 out of 70

Assertions confirmed: 38 out of 38

PDSE has had another successful year working in partnership with Well Connected, to facilitate a number of community engagement projects providing dental education and support to local communities, that include:

• Provision of oral health resources

• Help and advice to signpost members of the public to a range of dental providers including the Dental School

• Development of programmes aimed at enhancing general knowledge of the importance of good oral hygiene

• Outreach and community engagement activities

Over the last year, the following programmes have been delivered:

Inter Professional Engagement

The Inter Professional Engagement module is an opportunity for dental and hygiene therapy students to explore population health, health improvement and work with community-based organisations and linking this with their academic and clinical learning expertise.

Working closely with the modules leads we support:7

IPE1: This year 84 students met with 18 organisations; they spent some time finding out more about their allocated organisation and carried out a mini interview with a key person from the organisation. This was an opportunity to discuss the links and impacts of health improvement initiatives and well-being etc.

Students are asked to share information about their organisation with each other at a formal event with the module lead and Well Connected representatives, they must also submit a written and reflective report which helps to increase insight, empathy and understanding.

IPE2: Builds knowledge and awareness as students are asked to deliver a community-based outreach project working with an allocated organisation. Students work in their Enquiry Based Learning groups [EBL] to devise and deliver a meaningful project for the organisation they are working with.

The module is split into 4 ‘milestones’ and encourages students to think outside of the box to deliver a relevant and enjoyable session for their host organisation; they are supported by a Programme Officer and academic tutors who mentor them through the various stages of the module.

During 2018/19 10 EBL groups [70 students] focused on the following areas:

Dementia awareness: working with the Dementia Friendly City Co-ordinator for Plymouth City Council and a local architect, students developed a Dementia Toolkit which covers, ‘people, policy and place’.

Plymouth Community Homes: meeting with residents who live in housing provided by Plymouth’s largest social housing provider, students had the opportunity to discuss the impact of housing and health.

Barnardo’s: students worked alongside childcare providers as well as children and parents to raise awareness of oral health and the importance of establishing effective routines during the early years.

Brook Green School: students had an opportunity to meet with children with moderate learning, behaviour and social needs. They considered the most effective ways of sharing key oral health messages and breaking down some of the barriers which impact on ‘going to the dentist’.

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Better Futures: students held ‘drop in’ workshops for adults with a learning disability. The focus was on changing barriers and perceptions, discussing oral health advice, and effective handwashing.

Hamoaze House: students used a Christmas themed activity session to share oral heath advice for people recovering from an addiction.

Wellbeing Hub: working alongside ‘social prescribers’ students delivered ‘dental champion’ training and a community dental ‘drop in’ information session.

Scott Medical & Healthcare College: students delivered a health themed workshop for Year 9 students who are interested in a career in dentistry. This was an opportunity to raise the profile of dentistry as a carer choice and share key oral health messages.

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Family Intensive Intervention Project: students invited families who are supported by FIIP to the Devonport Dental Education Facility to find out more about accessing dental care, key oral health messages etc.

Plymouth Music Zone: students delivered a musical themed workshop to children in Year 3&4 at Mount Wise Primary School. Using the pentatonic scale they creatively shared key oral health messages during this fun and engaging workshop.

IPE Symposium: this is an opportunity to celebrate and showcase the students projects and for them to present their projects to their peers, an invited audience and an expert panel.

Open Wide and Step Inside

Developed to provide effective oral health advice and support for young children [aged 5-7 years] and their families. During 2018/19 the programme was delivered in 27 schools located in neighbourhoods across Plymouth which experience health inequality.

This year we have engaged with more than 2,000 children. The fun, contemporary oral health improvement programme includes a 15-minute animated film and resources for:

Schools: teachers classroom toolkit, children's workbook and story book.Children: an oral health goody bag containing toothbrush, fluoride toothpaste, a 2-minute timer, top tips card and story book.

The evaluation of the programme demonstrates that more than 80% of children recall the key oral messages 3 months later.

The programme has been improved and enhanced during the past 6 years; it now offers the complete solution for early years settings to deliver relevant advice and guidance for children and their families.

The project is now available commercially as a joint venture between PDSE and Well Connected; a website has been created which provides potential customers with advice and information: www.openwidestepinside.co.uk

Supervised Toothbrushing

The programme has been delivered in partnership with Plymouth City Council as part of the Child Poverty Action Plan. The plan covered three years from 2016 - 2019 and our activities were delivered during a specific time-period between April 2017 and July 2018.

The main focus of this work was to:

• Establish supervised brushing programmes in schools and nurseries, which are located in areas where high numbers of children are admitted to Derriford hospital for tooth extraction under general anaesthetic.

• Deliver training to a range of workers who engage with families and children in a variety of settings e.g. sports clubs, charities, health visitors, school nurses etc.

The aim of this approach was 3-fold:

• Establish regular tooth-brushing sessions in early years settings

• Simplify oral health prevention messages

• Encourage early years’ settings to include oral health activities in existing themes

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Outcomes:

41 primary schools and 22 nurseries [total 63] were invited to register an interest.22 primary schools and 10 nurseries [total 32] accepted the invitation. 19 primary schools and 9 nurseries have established regular brushing sessions within the school day. [total 28]At the end of the programme:3,093 children were taking part in regular supervised toothbrushingactivities250 people had undertaken ‘dental champion’ training.

PDSE has agreed to provide 12 months funding to continue the established toothbrushing programmes, this has enabled staff to receive refresher training, supplied resources for settings and provided children with oral health goody bags to encourage them to brush regularly at home.

Early Years Packs

Oral health information pack aimed at young families were developed

and shared with the Family Nurse Partnership; Banardo’s Children

Centre; Mount Wise Dental Practice and Hartley Dental Practice.

The pack contains a variety of oral health resources and activities:

• Well Connected cover sheet

• Brushing song sheet: Wheels on the Bus created by dental students

as part of their 2017/18 IPE2 module

• Posters for staff notice board – oral health tips; communication ;

dental access advise.

Feedback received demonstrated that the information was of highest

value in community-based organisations, enabling them to encourage

positive conversations about oral health when they meet with clients

and during group activities. Dental practices have not used the material

in the same way, they have chosen to display information on notice

boards rather than use on a 1-1 basis.

These materials are continuing to be developed and will be available for

partner groups via the Well Connected website. 11

Milfields Inspired

This programme is in its 6th year of delivery and aims to highlight the different career options to Year 5/6 children who attend primary schools in the Stonehouse neighbourhood. The objective is to encourage children to maintain their academic achievements as they transition to secondary education.

194 children from 6 different schools visited the Devonport Dental Education Facility for a dental themed activity session which included:

• clinical activities using Bob in the Box• exploring the impact of sugar on dental health• learning about how to prevent dental decay• introducing the dental team and the various roles and career

choices available

Children were asked to rate the visit, their responses indicated that:

- Loved it = 90% - Hmm not sure = 7%- Not for me = 3%

Dental Ambassadors

The programme was delivered for the second time, through DartingtonLifeworks College with 8 young people taking part. The cohort contained a range of learning needs, with some participants displaying challenging behaviours.

The continued development of resources which aid effective teaching, along with the use of creative and engaging activities has resulted in excellent participation and engagement from all participants.

An addition to the programme this year is to focus one session on infection control using the Public Health England e-Bug resource.

The feedback from staff is encouraging as handwashing is an area of concern for the team. This topic is to be developed within the programme with the ambition to build a stand-alone programme with the e-Bug materials.

A bespoke newspaper was created, the ‘Dartington Dental Mail,’ to use as the evaluation.

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The Dental Ambassadors Graduation took place at the Derriford DEF, where Patrick Allen, Managing Director of dental company Henry Schein, attended to present the Ambassadors with their certificates.

Health Futures Bite Size

Working with colleagues from Better Futures, a series of 3 workshops were delivered across the year in different community venues.

In total 75 adults with additional learning needs took part. Feedback was excellent, comments included:

‘Was very interesting to see how much sugar is in the drinks’

‘I really liked the toothbrush demonstration!’

BDS (Bachelor of Dental Surgery)

There were 289 students enrolled on the BDS programme for the academic year 2018-2019.

BSc (Hons) Dental Therapy and Dental Hygiene

The BSc (Hons) Dental Therapy and Dental Hygiene programme has continued to increase in size, with this academic year finishing with a total of 53 students.

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Programme Cohort Student No.

Year 1 BDS 62

Year 2 BDS 55

Year 3 BDS 57

Year 4 BDS 58

Year 5 BDS 57

Year 1 DTH 24

Year 2 DTH 14

Year 3 DTH 15

Academic Year 2018/2019 - Total Cohorts

The success of this academic year was recognised by the entire final year cohorts achieving graduation status.

Specialist Services

Academic staff continue to provide direct care to patients in PDSE. The sessions can be observed by students for teaching purposes and are led by specialist and consultant level staff. Internal referrals are made when:

• The patient’s treatment need or history is too complex for students to manage

• Where treatment has run into technical difficulties

• The treatment needs to be completed in a short time period

In addition to this, staff provide consultant opinions and assessments to aid student treatment planning and to advise on complex cases. Care is provided at tier two and three in the following disciplines supported by PDSE staff.

• Periodontology

• Prosthetics

• Endodontics

• Restorative

• Minor oral surgery

At present PDSE supports level two and level three clinical services to prevent patients being referred out of the school to local intermediate and tertiary services.

(A breakdown of consultant and specialist level care can be seen in appendix A)

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Paediatric Service

PDSE has continued to provide dental care to paediatric patients across the Peninsula. Unlike adult patients who are provided with one course of treatment, paediatric patients are retained as patients with PDSE up until they either reach the age of 16, or until they have completed any

treatment that they have been referred for i.e. orthodontics.

Student assessment requirements requires that paediatric patients are categorised by the two age groups below.

Table 1. Paediatric patient numbers

The overall number of paediatric patients treated during the academic year has risen slightly.

However there has been a shift in age ranges, with a greater amount of under 12’s being seen and a slight reduction in 13-16 year olds, when compared to last year.

2017/2018 2018/2019

0-12 years 1118 1302

13-16 years 290 235

Total 1408 1537

PDSE Clinician Team

The PDSE Clinician Team has continued to grow and at present includes one full time Dentist, currently completing the second year of a postgraduate Restorative MSc, along with two part-time Dentists and two part-time Hygiene Therapists.

The multi disciplinary team continue to significantly improve the patient care pathway by treating patients that may be too complex for students and by reducing waiting times for patients.

Notable areas of improvement following the rationalisation of processes and procedures include:

• Triage assessment processes

• Patient pathways

• Paediatric treatment

• Emergency support

(Please see Appendix B for a breakdown of clinical activity)

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PDSE Community Clinic

The Community Clinic based at the Devonport Dental Education Facility began in January 2018 to provide care for patients suffering from extreme social vulnerability and has continued to develop as demand for the service has increased.

So far fifty one patients have been seen at the Community Clinic, the majority of patients have high treatment needs and complex social histories. This is facilitated by our full time PDSE Dentist and twenty of these patients have had their treatment plans completed.

The treatment ranges from emergency interventions to relieve pain and infection, to full dental assessments and the delivery of all treatment needed. (Please see Appendix C for a breakdown)

Trainee Dental Nurse Programme

The PDSE Trainee Dental Nurse Programme has continued to develop throughout 2018/2019, with an additional two Trainee Dental Nurses commencing their studies in March 2019. This cohort are based at the Exeter DEF and are completing a web based NEBDN course.

The two Apprentice Dental Nurses based at the Devonport DEF have now completed 18 months of their 2 year placement and are on track to qualify in 2020.

PDSE is currently planning to recruit additional Trainee Dental Nurses throughout the coming academic year.

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Oral Health Education (OHE) and Fluoride Clinics

A new initiative began in September 2018 utilising the wider dental team to provide ‘prevention’ clinics comprising OHE and fluoride application across the Plymouth facilities.

This programme is facilitated by a Dental Nurse who has completed the post-qualification in OHE and competencies in Fluoride application and plaque indices.

Overall 321 patients were treated on the clinics, providing support during summer break at Devonport DEF and to the final year paediatric clinics at Derriford DEF.

A full breakdown of treatment provided is demonstrated in the graph below.

0

10

20

30

40

50

60

70

80

90

Adults Paediatrics

Fluoride Varnish OHI Plaque Indices

Clinical Activity – Data Source Collection

As an organisation, PDSE recognises the fundamental requirement to provide accurate clinical data.

PDSE is committed to streamlining reporting methods of clinical activity, to ensure that all data sources are utilised effectively. The strategy for achieving this objective commenced in September 2018, with an organisation wide upgrade of ICT hardware and the clinical software programme.

Since this time, date collection methods and clinical activity recording processes have been continually reviewed and restructured, with the aim of improving the accuracy of data reporting.

Over the last 12 months significant amendments to policy and process have been implemented in areas such as record management and patient pathways. Owing to the enormity and complexity of this task, it remains ongoing.

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There are a number of extenuating factors that must be considered when analysing the clinical activity:

• The largest proportion of clinical output is produced from undergraduate student activity and therefore is a by product of dental education. It is not possible for this to be considered against NHS standard performance measures.

• Clinical activity is reported by academic year, not financial year.

• Clinical activity data is gathered from two main sources, that operate independently from each other;

a. the dental software system (Carestream Dental) operated by PDSE;

b. the electronic assessment database (ADB) operated by the University of Plymouth. The ADB provides a validated real-time overview of each student’s clinical progress.

• It has been identified, that replicating aspects between the two systems would streamline data reporting and so are working towards achieving this aim.

Clinical Activity Overview – Academic Year 2018/2019

The clinical data presented above has been sourced from the Carestream dental software system and represents the sum of clinical activity completed by all providers, across all four sites.

The annual summary comparison (Table 2) indicates that during the academic year 2018/2019 there has been a reduction in the number of patients treated but an increases in attended appointments, when compared to 2017/2018. This is also reflected in the breakdown of appointments by site (Table 3) and is directly attributed to the refining of patient management processes, such as the PDSE failure to attend policy and the discharge of historical patients, creating a more resilient patient database.

Treatment items provided (Table 4) represents the total of the top *16 treatment items recorded on the Carestream software system by all student cohorts and PDSE clinicians. This total does not include the treatment items completed by Academics, due to the specialist nature of the items provided. However due to the differences in reporting, it is not possible to provide a direct comparison with last academic year.

A full breakdown of treatment items provided can be found in Appendix D 18

DEF Patients Treated AppointmentsAttended

Derriford 1,395 9,628

Devonport 1,259 6,413

Exeter 810 4,623

Truro 782 5,784

TOTAL 4,245 26,448

Table 3 - Breakdown of patients and appointments by site

Academic year 2017/2018

Academic Year 2018/2019

Number of patients treated 5,441 4,245

Number of appointments attended 19,994 26,448

Table 2 - Summary comparison year on year

Table 4 - Treatment items provided

Academic year 2018/2019

Treatment items provided* 41,521

Postcode analysis by DEFThe following provides an overview of postcode analysis of patients treated in Derriford DEF throughout the academic year 2018/2019 and the total number of appointments attended.

Derriford DEF 1593 patients, 9481 appointments

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TR:13 PL:1526

TQ:36

EX:18

Devonport DEF 1557 patients, 6353 appointments

Postcode analysis by DEFThe following provides an overview of postcode analysis of patients treated in Devonport DEF throughout the academic year 2018/2019 and the total number of appointments attended.

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TR:4

EX:12

PL:1561

TQ:25

Exeter DEF 1020 patients, 4475 appointments

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Postcode analysis by DEFThe following provides an overview of postcode analysis of patients treated in Exeter DEF throughout the academic year 2018/2019 and the total number of appointments attended.

EX:860

TQ:106

PL:47

TR:7

Truro DEF 976 patients, 5828 appointments

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Postcode analysis by DEFThe following provides an overview of postcode analysis of patients treated in Truro DEF throughout the academic year 2018/2019 and the total number of appointments attended.

PL:204

TR:767

EX:5

TQ:2

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Summary

PDSE CIC continues to make a significant contribution in improving oral health across the Peninsula completing over 26,000 patient appointments throughout the year.

The last 12 months has been a period of significant change and new initiatives, most notably the upgrade of our patient software system and record management systems. PDSE is now working to align processes for recording clinical activity.

Another significant area of change has been focused towards patient waiting list management. The aim of this is to direct services towards the greatest area of need and PDSE specifically recruits patients who do not currently have access to an NHS dentist.

Over the next 12 months, PDSE is excited to be expanding our clinic services, supporting an increasing number of undergraduate students as well as working in partnership with Well Connected to further develop social impact across Devon and Cornwall

PDSE continues to build on strong partnerships with the local NHS, public health, specialist dental providers in primary and secondary care and community dental services. The current partnership with NHS England is fundamental to PDSE continuing to provide a comprehensive NHS care service to patients treated in the dental education facilities across the region.

Appendix A: Consultant / Academic Clinical activity - Academic Year 2018/2019

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ConsultantReview/Opinion

FixedProsthodontics

Removable Prosthodontics

Periodontology Minor Oral Surgery

Endodontics

Diagnostic 84 Composite Restorations

7 Partial Acrylic Dentures

3 Chronic periodontitis

5 Extraction 4 Single Rooted 1

Denture Review

1 Amalgam Restorations

7 Full Acrylic Dentures

2 Flap surgery 1 Surgical Extraction

8 Multiple Rooted

1

Implant Review

3 Temporary Restorations

10 Partial Metal Dentures

5 Bone graft 0 Bone surgery 2 Retreatment 0

Perio Review 3 Implant retained crown

1 Denture repair/addition/ reline

2 Issue of prescription

2 Flap surgery 1 TOTAL: 2

Review / 2nd

Opinion10 Bridges 3 Implant retained 1 TOTAL: 8 Suture care 3

TOTAL: 101 Implant placement

1 Retainer 2 Issue of prescription

3

TOTAL: 29 Splint 5 TOTAL: 21

TOTAL: 20

Appendix B: Treatment items provided by PDSE Clinicians – Academic year 2018/2019

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PDSE DentistsPDSE Hygienists and Therapists

Total

Acrylic Denture 58 / 58

Metal Denture 19 / 19

Bridges 14 / 14

Crowns 27 / 27

Endo 30 / 30

Extractions 198 14 212

Restorations 436 144 580

Fissure Sealants 42 107 149

Radiographs 277 112 389

Scale and Polish 54 90 144

Exam 362 172 534

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Item Amount

Courses of treatment completed 20

Exam 49

Recall Exam 7

Emergency appointment 33

OHI 60

S&P 24

Periodontal treatment 18

Restorations 121

Crowns 1

RCT 2

XLA 139

Full Dentures 11

Partial Dentures 17

Appendix C: Community Clinic Statistics January 2018 – April 2019

Appendix D: Breakdown of treatment items provided by cohort – academic year 2018/2019

YR 5 BDS R4 YR 5 BDS ADB

1971 1504163

966 11801157 1125

849 978295 317

4162 20953009 3016163 248

94 11745 52

249 300199 279952 881

18 18

27

ExamBPE

OHIS+PFluoride Varnish

F/S

RadiographsRestorationsAcrylic

Chrome Bridge

CrEndo

XLA

Veneer

Exam

BPE

OHI

S+P

Fluoride Varnish

F/S

Radiographs

Restorations

Acrylic

Chrome

Bridge

Cr

Endo

XLA

Veneer

YR 4 BDS R4 Yr 4 BDS ADB

1246 1217329

1104 1506717 844

841 908299 311

2385 1161

1949 1921150 257

31 3713 1563 63

35 64589 590

0 0

YR 3 BDS R4 Yr 3 BDS ADB

716 796142458 867555 586

197 25577 83

994 598

514 69635 46

17 2514 1147 40

7 9172 212

0 0

YR 2 BDS R4 Yr 2 BDS ADB

527 504284673 823900 785

112 11641 27

916 407

506 4871 3

0 10 00 0

1 285 520 0

YR 1 BDS R4 Yr 1 BDS ADB

197 9107141 9137 7

17 22 7

196 1

11 10 0

0 00 00 0

0 04 00 0

DTH YR 3 R4 DTH YR 3 ADB

648 1045

119

1024 1823806 1165378 582

190 251872 541

657 804

48 0

YR 2 DTH R4 Yr 2 DTH ADB274 282

128

369 425249 212156 17464 94

369 157144 114

0 00 0

0 00 0

1 95 0

0 0

YR 1 DTH R4 Yr 1 DTH ADB75 9

37

60 1057 810 03 0

87 318 4

0 00 0

0 00 0

0 00 0

0 0