General Information
Relevance date:These instructions will apply to the National Dental Specialty Examination (NDSE) conducted beginning in 2011. See the RCDC website for instructions for examinations conducted on earlier or later dates.
Periodontics in Canada
Periodontics is the specialty of dentistry concerned with the diagnosis, prevention, and treatment of diseases and conditions of the supporting and surrounding tissues of the teeth or their substitutes and the maintenance of the health, function and aesthetics of these structures and tissues.
Examination Information
Examination Structure
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Component
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Element
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Date
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Component I (Written Exam)
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Paper I – 3 hours
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January 13, 2011
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Paper II – 3 hours
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Component II
(Clinical Documentation and Oral Examination) |
Critical Review of Clinical Documentation
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Due: March 25, 2011
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Oral Examination A
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June 3-20, 2011
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Oral Examination B
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Oral Examination
(Oral Medicine and Oral Pathology) |
Passing Scores
· Candidates must achieve a passing score on both Component I and Component II to be successful in the NDSE in Periodontics.
· A candidate must pass Component I to qualify for Component II.
· To pass Component II candidates must receive a passing score in Oral Examinations A and B.
The written component of the NDSE in Periodontics is divided into two papers, both to be completed over one day.
The oral component of the NDSE in Periodontics is divided into four parts:
i. Critical review of submitted clinical documentation.
ii. Oral Examination A: case scenarios as presented by the examining team
iii. Oral Examination B: case scenarios as presented by the examining team
iv. Oral examination of the candidate’s abilities in Oral Pathology and Oral Medicine.
*NOTE: Submitted clinical documentation will be graded for quality and completeness. The candidate can expect a reduction in their overall score on Component II as a consequence of any shortfall from the guidelines or absence of required documentation. Consistency between documents (photographs, radiographs, charts, written reports) will be carefully scrutinized and graded. (For examples: i) the location of the gingival margin at a given site as charted, photographed, and reported must be verifiable and consistent with each document, and ii) an apparent discrepancy between radiographic appearance and charted clinical probing depths must be addressed in the written report.)
Any queries about the requirements for the Review of Clinical Documentation should be directed to the RCDC prior to submission.
Components
COMPONENT I: The Written Examination
The written component will be comprised of two (2) papers, each of three (3) hours duration. The papers will consist of short answer questions. Topics for the written examination can include the following:
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· Oral Medicine and Oral Pathology
· Anatomy & Embryology
· Periodontal Biology & Physiology
· Immunology & Microbiology
· Periopathology & Radiology
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Clinical Therapeutics
Implantology
Anxiety & Pain Management
Medically Compromised Patients & Medical Emergencies
Pharmacology
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COMPONENT II: Oral Examination and Clinical Documentation
The examination dates for Component II will be determined following completion of the written examinations and the publishing of the written component results, and will be based on the number of candidates challenging Component II. These dates may fall anywhere within the indicated window and are fixed once set. The RCDC cannot accommodate requests for exceptions, other than in the case of religious or special needs that have been indicated before the date has been set.
The Oral Exam
Two (2) Examiners conduct the Oral Examination and grade the candidate’s performance independently.
i. Both Oral A and Oral B involve case scenarios in Periodontics presented to the candidate.
ii. Case scenarios used in the oral exam are realistic situations covering a sampling of these topics: treatment of periodontal disease, mucogingival surgery, pre-prosthetic surgery, implantology, periodontic-endodontic considerations, minor tooth movement, treatment of the medically compromised patient, anxiety management and the various forms of conscious sedation. Emphasis will be given to intravenous sedation techniques.
iii. The Oral Pathology and Oral Medicine Oral Examination will take one hour. Candidates are presented with colour slides or digital images and questioned on their interpretation of findings in Oral Pathology, Oral Medicine, and subsequent case management.
Critical Review of Clinical Documentation
Identifying Information:
All material submitted as part of the Critical Review of Clinical Documentation must be free of any form of identifying logo, text or information regarding your office, university or any other institution from which you may have obtained the material. Patients must not be identified by name or initials. Use ID numbers when referencing the patient in any documentation. Full-face photographs that could identify the patient must have the eyes blacked-out.
All documentation must be submitted for grading and received at least three months prior to the date of the planned oral examination. The submission will consist of the following:
· High-resolution digital photographs
· Periodontal Charts (PDF | JPG)
All submitted material remains the property of the Royal College of Dentists of Canada and may be used as an examination resource.
General Information
The Critical Review of Clinical Documentation will derive from patients treated by the candidate during graduate studies or subsequent to the completion of graduate studies. In extenuating circumstances, the Chief Examiner may authorize material to be provided to the candidate by the RCDC should that the candidate not have records from patients they have treated.
i. The patient documented must be of sufficient complexity so as to test the clinical competence of the candidate. A rationale for the treatment modalities is required, as well as an objective critique of the goals achieved.
ii. The patient should exhibit generalized severe disease in both arches and should present with at least two molar teeth, which must be present after treatment.
iii. Documentation will be in electronic storage format (CD, DVD, portable external drive) and will consist of a written report, periodontal charts*, digital (or digitized) radiographs and photographic images.
iv. Documentation must be completed up to a minimum of four months following surgical treatment. Longer-term documentation is encouraged, if available.
v. Periodontal Charts can be downloaded from this website as a .PDF file.
vi. As an aid in preparation, the College provides a checklist of criteria used by NDSE Examiners to grade the submitted Clinical Documentation.
The Written Report
The submitted clinical documentation will include a Written Report detailing the:
· Medical history
· Extraoral history and findings
· Intraoral history and findings
· Clinical findings to include oral hygiene proficiency and compliance, bleeding on probing, purulence, mobility, furcation involvement, probing depths, gingival recession, laboratory test results, and attachment levels pre-treatment, post-initial therapy and post-treatment (where applicable)
· Diagnosis
· Etiology
· Prognosis (Short-term, long-term, with/without treatment, individual, overall)
· Treatment plan and therapy, to include objectives and goals
· Evaluation of the results achieved from therapy
· Scheduled maintenance programs, if applicable
The Written Report will be graded on the basis of accuracy, readability (grammar, spelling, sentence structure, etc.), and succinctness. Consistency with the radiographs, photographs, and charts will form an important part of the grade.
Photography
Teeth and tissues are to be dried before photographing so that saliva, blood and other material do not obscure the views. All photographs must be of high resolution, well lit, and in good focus. The quality of the intraoral photographs will be graded. It is expected that intraoral photographs will be taken using intraoral mirrors to ensure quality, clarity and proper angulation. Mirror view photographs will be displayed as if looking directly at the tissues (non-mirror image).
Pre-treatment, post-initial therapy and post-treatment digital photographs (or 35 mm colour transparencies copied as high-resolution digital images) are required as follows:
· At least three (3) facial views, one (1) showing the anterior teeth and tissues and one (1) each for the left and right posterior regions
· Palatal/lingual maxillary/mandibular views demonstrating all teeth (anterior and posteriors)
· The submitted report must include at least one sextant of periodontal surgery. Documentation shall include digital photographic images of the surgical procedure(s) (see Surgery 1; Surgery 2; Surgery 3)Still black slides in each of these files, which record high-quality buccal/labial and lingual views of the following:
· Immediate pre-surgical presentation
· Incision design prior to flap reflection
· Flap reflection, surgical debridement and osseous architecture before resection or regeneration
· Presentation of the surgical site after resective or regenerative procedure, if performed
· Presentation of the flaps sutured in place
· Post-operative healing, to include a one- or two-week post-operative view and a four-week post-operative view.
Radiographs
Thorough radiographic documentation of the patient is required prior to treatment and at any appropriate time prior to treatment or thereafter. All radiographs must be of high diagnostic quality, appropriately mounted, clearly labelled, and dated. Radiograph quality will be graded. Radiographic interpretation by the candidate will be graded from the Written Report. If traditional film radiology is employed, the candidate must prepare high quality digital images made from the radiographs. Radiographic images will be submitted as follows:
· Complete dentition periapical views
· Posterior bitewing views, preferably with vertical orientation
· Panoramic view
· Post-treatment periapical radiographs of surgical sites taken at least six months post-operatively
· Additional views as appropriate
Image Index
An index of the submitted photographs and radiographs (i.e. a numbered and descriptive list of images) is required.
Periodontal Charting
General
Detailed Periodontal Charting is required for the pre-treatment, post-initial therapy (pre-surgical) and final (at least four months post-surgical) stages of treatment.
One (1) original and two (2) colour hard copies of the Periodontal Chart will be submitted for grading. Colour digital scanned copies may also be submitted in addition to the hard copies. Grading will be based on completeness, neatness, accuracy, and overall consistency with the written report, photographs, and radiographs. (For example, the level of the gingival margin as charted for a given site is consistent with the photography.)
Instructions for Completion of Periodontal Charts
Red, green, black and blue markers or pens will be needed to complete the charts. Click here for an example of how to complete the Periodontal Charts. Consider the horizontal lines in the area of the tooth roots to be 2 mm apart.
i. Measurements in millimetres of probing depth (PD), recession (REC), and clinical attachment level (CAL) should be entered in black ink in the boxes associated with each tooth as per:
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PD
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• Probing depth is recorded in millimetres measuring from the GM to the base of pocket/sulcus
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REC
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• The distance from the cementoenamel junction (CEJ) to the gingival margin (GM) is recorded. When the GM is apical to the CEJ, enter a positive number (e.g. 1). When the GM is coronal to the CEJ, enter a negative number (e.g. –2).
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CAL
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• The clinical attachment level from CEJ to the base of pocket/sulcus is recorded. This may be measured directly or calculated from GM-CEJ and PD.
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Three measurements on the facial and three measurements on the lingual are required for each tooth. When dental implants are present, the restoration margin will be considered the CEJ.
ii. Plaque and/or calculus are recorded by placing a blue dot above the number for the probing depth for that site.
iii. Purulence (PUR) is recorded by placing a black dot above the number for the recession (REC) for that site.
iv. Presence of bleeding on probing (BOP) is recorded by placing a red dot above the number for clinical attachment loss (CAL) for that site.
v. Missing teeth, or portions of teeth, should be coloured in solidly in black.
vi. Impacted and/or unerupted teeth should be outlined in black.
vii. Dental implants that replace missing teeth should be indicated by a heavy black outline surrounding diagonal black lines reflecting the relative implant size and shape. Write “DI” in black in the space above or below the appropriate tooth number boxes.
viii. The gingival margin (GM), relative to the cementoenamel junction (CEJ), is drawn in blue.
ix. Only those probing depths (PD) greater than 4 mm are to be drawn vertically in red along the appropriate tooth surface.
x. Areas where the zone of keratinized gingiva is less than 2 mm are recorded by placing a green asterisk between the box for the REC measurement and the drawing of the tooth or implant.
xi. Root canal fillings are recorded with a heavy blue line in the root(s) of the appropriate teeth.
xii. An open blue circle at the tooth apex should be used to record a periapical radioluscency.
xiii. Caries and/or overhanging restorative margins are recorded with a jagged red line on the appropriate tooth surfaces.
xiv. Open or loose tooth contacts are recorded with a jagged blue line through the appropriate contact area.
xv. Specify the mobility classification or measurement system used in the space provided. Mobility scores greater than zero (0) should be recorded in blue in the occlusal surface drawing of the appropriate teeth.
xvi. Specify the furcation involvement grading system used in the space provided. Furcation involvement should be marked in red adjacent to the appropriate tooth surface according to the following scheme:
Grade I 
Grade II 
Grade III 
Resubmissions for Re-Sit (Oral) Candidates
The weighting of the Critical Review of Clinical Documentation in the overall scoring of the oral examination suggests that unsuccessful candidates should consider submission of documentation from a different patient to re-sit the examination. For this reason, the candidate is strongly encouraged to prepare documentation for several patients in preparation for this exam. Nevertheless, candidates who are unsuccessful in the oral examination (Component II) may choose to:
i. Submit the same documentation, unchanged;
ii. Submit documentation from the same patient, with changes;
iii. Submit documentation from a different patient for review (recommended).
Please Note: The PowerPoint presentations are available in read-only format only. Upon opening them, you will be prompted by PowerPoint to enter a password to modify. Please use the Read only option.
Periodontal Case Report Example (PDF)
Candidates' Documentation Grading Checklist (PDF)
Surgery 1 Example (PPT)
Surgery 2 Example (PPT)
Surgery 3 Example (PPT)
Initial Presentation Example (PPT)
Re-evaluation Example (PPT)
Final Presentation Example (PPT)
Image Index (example) (PDF)
Blank Periodontal Charts (PDF)
