Bachelor of Dental Surgery Clinical Logbook

FACULTY OF DENTISTRY
Assoc. Prof. Dr. KALYAN C GUNDAVARAPU

BDS., MDPH., DDPH.RCS., MBA
POLYCLINIC CLINICAL LOGBOOK
All rights reserved.
Dr. KALYAN C GUNDAVARAPU

Associate Professor in Dental Public Health

Faculty of Dentistry
E-mail: kachy@rediffmail.com
POLYCLINIC LOGBOOK
ISBN 9781370468751
PUBLISHE R: SMASHWORDS
September 2016
ACKNOWLEDGEMENTS
I am most grateful to Datuk Prof. Dr. Rohani Ramli and Prof. Frederick
Charles Smales for trusting me and giving this chance to create
Polyclinic Clinical Logbook for Undergraduate Dental Students. Both of
them have always been a driving force and a source of inspiration.
I express my gratitude to Prof. Margaret Comfort, for her support in
this project. She has done given her valuable opinion and advice.
I would like to thank all my colleagues who have given feedback on the
criteria for each specialty and have also used the book to assess the
Dental undergraduate students.
Dr. KALYAN C GUNDAVARAPU

Associate Professor in Dental Public Health

Faculty of Dentistry
E-mail: kachy@rediffmail.com
PERSONAL DETAILS
Name:
University No.:
Academic year:
Year 3:
Year 4:
Year 5:
Intake date:
Contact number:
TABLE OF CONTENTS
PERSONAL DETAILS ................................................................................................................ 3
FUNCTION ............................................................................................................................. 7
INSTRUCTIONS....................................................................................................................... 8
ASSESSMENT CRITERIA FOR CLINICAL SESSIONS ................................................................... 10
ASSESSMENT CRITERIA FOR OVERALL MODULE ASSESSMENT............................................... 11
ATTENDANCE....................................................................................................................... 13
CERTIFICATES....................................................................................................................... 19
YEAR 3 ................................................................................................................................. 23
YEAR 4 ................................................................................................................................. 29
YEAR 5 ................................................................................................................................. 35
CONSERVATIVE AND ENDODONTICS .................................................................................... 41
COMPOSITE RESTORATION ..................................................................................................................... 44
GIC RESTORATION ................................................................................................................................... 45
SILVER AMALGAM RESTORATION ........................................................................................................... 46
ROOT CANAL THERAPY............................................................................................................................ 47
POST AND CORE ...................................................................................................................................... 48
PROSTHODONTICS ............................................................................................................... 50
COMPLETE DENTURE .............................................................................................................................. 51
ACRYLIC PARTIAL DENTURE .................................................................................................................... 52
INDIRECT RESTORATION ......................................................................................................................... 53
BRIDGE .................................................................................................................................................... 54
CAST PARTIAL DENTURE.......................................................................................................................... 55
PERIODONTICS .................................................................................................................... 57
SCALING................................................................................................................................................... 58
ROOT PLANING........................................................................................................................................ 59
PREVENTIVE DENTISTRY....................................................................................................... 61
FISSURE SEALANT .................................................................................................................................... 63
TOPICAL FLUORIDE APPLICATION ........................................................................................................... 64
MISCELLANEOUS ..................................................................................................................................... 65
FUNCTION
This Clinical Logbook is to enable students to record the necessary aspects of their clinical
experience during Years 3-5 of the BDS course.
The Logbook has been designed with these learning situations in mind and should enable all
students to record daily the experience relevant to the work undertaken during the year.
The record of experience has the following functions:
1. It provides students with a personal record of all procedural and other learning
experiences, which are requirements for satisfactory completion of the clinical training
program.
2. It provides students with the basis for completing Clinical Experience Logs at the end of
a module, which are an essential requirement for assessment and subsequent credit.
3. The information will also be used by the clinical staff to monitor the clinical experience
provided for students in the various clinics.
INSTRUCTIONS
1. Fill in your personal details on the first page of your logbook at the beginning of the
academic year and attach a passport-sized photograph.
2. Polyclinic Logbooks are to be kept in an assigned storage area in the Polyclinic and must not
be removed from the clinic under any circumstances. Specialty Logbooks are to be kept in
the Oral Surgery Clinic and may be taken out for use in other clinics but must be returned
promptly at the end of the clinic.
3. When each new patient is assigned to you by your clinical teacher, enter their details in the
patient log (Fig.1) and you must obtain a staff signature. Your clinical teacher will use the
column Note to record details of any patient transfers.
S.No
1.
Reg.No.
123456
Patient Name
Kumar a/l Sivanes
Contact number
012-3456789
Date
assigned
Staff
sign.
Note
25.7.2011
Fig.1 Patient log

4. During clinic sessions keep your logbook along with the patient folder in the operating bay.
Before starting a procedure fill in the patient details on the appropriate Procedure Sheet
(Fig.2). Each stage on the Procedure Sheet should be graded and signed by your Clinical
Teacher immediately after it has been checked.
Patient Name
Date
Kumar a/l Sivanes
28.07.2011
Registration Number
Age
123456
Tooth or teeth number
28
Type
15 and 25
Sex
Male
Female
Class 1
Fig.2 - Procedure Sheet
5. At the end of each session, fill in the Session Log (Fig.3) to record details of the procedure(s)
undertaken and insert the page number of each Procedure Sheet used as a cross reference.
The Session Log must be graded and signed by your Clinical Teacher before you leave the
clinic
S.No
Date
Reg.No
Procedure
Pg.No
Grade
Staff sign.
1.
21.07.2011
123456
Composite restoration
Fig. 3 - Session Log
116
good
6. At the end of each module, complete the Clinical Log Summary (Fig. 3) by filling in the
number of procedures done throughout the module and the number of grades obtained for
each procedure. Then record your overall experience by adding the module totals to the
number of procedures done earlier in the course. Logbooks must then be submitted for
review and assessment.
S.No
1
2
3
Procedure
Oral diagnosis
Amalgam restoration
Class I
Class II
Class III & IV
Class V
GIC restoration
CLINICAL LOG SUMMARY

GRADES OBTAINED
Module
Total
Poor
Fair
Good
V.Good
2
7
5
2
4
4
2
1
1
3
2
3
2
Overall
Total
4
14
9
0
0
1
8
2
Fig. 4 - Clinical Log Summary

7. Fill in a single Procedure Sheet if two or more procedures of the same type are carried out
on one patient during a single clinical session. All procedures will be counted separately on
the Clinical Log Summary.
8. Clinical teachers may make suggestions for improvement on the Procedure Sheets. In
addition to covering the areas of knowledge, clinical skills and professional behavior,
comments may be made about three other skills, namely communication, management and
leadership skills. These additional areas will be included in the end of module assessments.
9. Student clinic absences must be recorded in the attendance log (Fig.5). Enter the date of
any approved leave and obtain a signature by your clinical teacher for that session. If a
student is absent without permission , this will be recorded in the attendance log by the
group teacher.
Signature of staff
S.No
Date
Reason
1
25.7.2011
Approved leave
Fig. 5 - Clinical Log Summary

10. Finally make sure that your logbooks are kept up to date and all entries are made
accurately. The two logbooks will be used in determining the fulfillment of clinical
requirements for graduation in Year 5.
ASSESSMENT CRITERIA FOR CLINICAL SESSIONS

1. Clinical skills
Very good
Good
Fair
Poor
A satisfactory
performance
achieved with or
without some staff
guidance; worked
mostly in an efficient,
safe, careful and
responsible manner.
An adequate
performance
achieved but with
minor deficiencies
requiring some staff
guidance; worked
frequently in an
efficient, safe, careful
and responsible
manner.
Unsatisfactory
performance with
obvious deficiencies
intervention; worked
occasionally in an
efficient safe, careful
and responsible
manner.
Good
Displays a
satisfactory level of
knowledge of the
procedure and can
apply this
knowledge
satisfactorily to
most aspects of
clinical situation .
Fair
Displays an
adequate level of
knowledge of the
procedure and can
apply this
knowledge
satisfactorily to
some aspects of the
clinical situation.
Poor
Displays an
inadequate level of
knowledge of the
procedure and is
unable to apply
much knowledge to
the clinical
situation.
3. Professionalism*
Very good
Good
Acts in a
Acts in a
professional
professional
manner all the time. manner most of the
time.
Fair
Acts in a
professional
manner frequently.
Poor
Acts in a
professional
manner
occasionally.
An above average
performance achieved
without staff
guidance; worked
throughout in an
and responsible
manner.
2. Knowledge
Very good
Displays a deep
level of knowledge
of the procedure
and can easily apply
this knowledge to
all aspects of clinical
situation .
*Includes appearance, demeanour, attitude to patients and staff and compliance with clinic
protocols.
10
ASSESSMENT CRITERIA FOR OVERALL MODULE ASSESSMENT

1. Clinical skills
Very good
An above average
without staff guidance;
worked throughout in an
efficient, safe, careful and
responsible manner.
Fair
Poor
A satisfactory
with or without some
staff guidance; worked
mostly in an efficient,
safe, careful and
responsible manner.
Good
An adequate
but with minor
deficiencies requiring
some staff guidance;
worked frequently in an
and responsible manner.
Unsatisfactory
performance with
obvious deficiencies
intervention; worked
occasionally in an
efficient safe, careful and
responsible manner.
Good
Displays a satisfactory
level of knowledge of
the procedure and can
apply this knowledge
satisfactorily to most
aspects of clinical
situation .
Fair
Displays an adequate
the procedure and can
apply this knowledge
satisfactorily to some
aspects of the clinical
situation.
Poor
Displays an inadequate
the procedure and is
unable to apply much
knowledge to the
clinical situation.
Good
Acts in a professional
manner most of the
time.
Fair
manner frequently.
Poor
manner occasionally.
2. Knowledge
Very good
Displays a deep level of
knowledge of the
procedure and can
easily apply this
knowledge to all
aspects of clinical
situation .
3. Professionalism*
Very good
manner all the time.
*Includes appearance, demeanour, attitude to patients and staff and compliance with clinic protocols.
4. Communication
Very good
Communicates well
with patients and the
dental team all the
time.
Good
Communicates well
dental team most of
the time.
5. Management and Leadership

Very good
Good
Displays very good
Displays good
management skills and management skills and
leads the dental team
in an appropriate
in an appropriate
manner all the time.
manner most of the
time.
11
Fair
Communicates well
dental team
frequently.
Poor
Communicates well
dental team
occasionally.
Fair
Displays adequate
management skills and
frequently in an
appropriate manner.
Poor
Displays inadequate
management skills and
occasionally in an
appropriate manner.
12
ATTENDANCE
POLYCLINIC
CLINICAL LOGBOOK
13
14
ATTENDANCE
Year 3
Absence or Approved leave
S.No
Date
Reason
15
Signature of staff
ATTENDANCE
Year 4
S.No
Date
Reason
16
Signature of staff
ATTENDANCE
Year 5
S.No
Date
Reason
17
Signature of staff
18
CERTIFICATES
POLYCLINIC
CLINICAL LOGBOOK
19
20
CERTIFICATES
CERTIFICATE OF SATISFACTORY COMPLETION OF THIS LOGBOOK FOR YEAR 3
We certify that:
Name: ..........................................................................................................................................................
has satisfactorily completed this Logbook as required under the BDS regulations.
Signatures: ..................................................................................... Date: ................................

We certify that:
Name: ..........................................................................................................................................................
Signatures: ..................................................................................... Date: ................................

We certify that:
Name: ..........................................................................................................................................................
Signatures: ..................................................................................... Date: ................................
21
22
YEAR 3
POLYCLINIC
CLINICAL LOGBOOK
SESSION LOG
CLINICAL EXPERIENCE LOG
OVERALL ASSESSMENT
23
24
SESSION LOG
YEAR 3
S.No
Date
Reg. No.
Clinical Procedure
25
Pg. No.
Grade
Staff
Sign.
SESSION LOG
YEAR 3
S.No
Date
Reg. No.
Clinical Procedure
26
Pg. No.
Grade
Staff
Sign.
CLINICAL EXPERIENCE LOG FOR YEAR 3
SUMMARY
S.No
1
2
3
4
5
6
7
8
9
10
Procedure
Amalgam restoration
Class I
Class II
Class III & IV
Class V
GIC restoration
Class V
Complete denture
Acrylic partial denture
Hand scaling
Ultrasonic scaling
Minimal Intervention restoration
Fissure sealant
Topical fluoride application
Poor
GRADES OBTAINED
Fair
Good
V.Good
Total number of clinical sessions worked
Total number of patients treated
Total missed appointments by patients
Total number of absences or leave
Signature of the student
Signature of staff
27
Total
OVERALL ASSESSMENT FOR YEAR 3

Clinical skills
Poor
Fair
Good
V.Good
Overall quality of clinical work

Appropriate amount of clinical work
Knowledge
Knowledge underpinning clinical procedures
Knowledge of supporting sciences
Professionalism
Appearance, demeanour
Attitude to patients and staff
Adherence to infection control policy and clinical protocols
Improvement based on reflection of own actions
Communication
Communicates well with patient and members of dental team
Management and Leadership

Prepared for clinical session
organized and work efficiently
Good time management skills
Good team work and leadership as appropriate
Quality of record keeping
Suggestions for improvement
Group Teacher 1 sign
28
Date
YEAR 4
POLYCLINIC
CLINICAL LOGBOOK
SESSION LOG
OVERALL ASSESSMENT
29
30
SESSION LOG
YEAR 4
S.No
Date
Reg. No.
Clinical Procedure
31
Pg. No.
Grade
Staff
Sign.
SESSION LOG
YEAR 4
S.No
Date
Hosp.
No.
Clinical Procedure
32
Pg. No.
Grade
Staff
Sign.
SUMMARY
S.No
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
Procedure
Amalgam restoration
Class I
Class II
Class III & IV
Class V
GIC restoration
Class V
RCT: Single rooted tooth
RCT: Multi rooted tooth
Complete denture
Indirect restoration
Bridge
Cast partial denture
Ultrasonic scaling
Root planing
Fissure sealant
Miscellaneous
Poor
GRADES OBTAINED
Fair
Good
V.Good

Verified by staff
33
Overall
Total

Clinical skills
Poor
Fair
Good
V.Good

Knowledge
Professionalism
Communication

34
Date
YEAR 5
POLYCLINIC
CLINICAL LOGBOOK
SESSION LOG
OVERALL ASSESSMENT
35
36
SESSION LOG
YEAR 5
S.No
Date
Reg. No.
Clinical Procedure
37
Pg. No.
Grade
Staff
Sign.
SESSION LOG
YEAR 5
S.No
Date
Reg. No.
Procedure
38
Pg. No.
Grade
Staff
Sign.
SUMMARY
S.No
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
Procedure
Amalgam restoration
Class I
Class II
Class III & IV
Class V
GIC restoration
Class V
RCT: Single rooted tooth
RCT: Multi rooted tooth
Complete denture
Indirect restoration
Bridge
Cast partial denture
Ultrasonic scaling
Root planing
Fissure sealant
Miscellaneous
Poor
GRADES OBTAINED
Fair
Good
V.Good

Verified by staff
39
Overall
Total

Clinical skills
Poor
Fair
Good
V.Good

Knowledge
Professionalism
Communication

40
Date
CONSERVATIVE
AND
ENDODONTICS
POLYCLINIC
CLINICAL LOGBOOK
COMPOSITE RESTORATION
GIC RESTORATION
SILVER AMALGAM RESTORATION
ROOT CANAL THERAPY
POST AND CORE
41
42
43
CONSERVATIVE & ENDODONTICS
Patient Name
Date
Registration Number
Age
Tooth number
Male
Type of cavity design and ICDAS code
Number of times procedure is done before
First time
Once
Two to four times
Sex
Five to nine
More than nine
COMPOSITE RESTORATION
Poor
Fair
Good
V.Good
Local anesthesia administration

Rubber dam application
Cavity preparation
Base / Liner
Restoration
Finishing
Knowledge
Professionalism
Overall grade
Overall difficulty of case
Simple
Intermediate
Difficult
Signature of staff
Date
44
Not
applicable
Female
Patient Name
Date
Registration Number
Age
Sex
Male
Tooth number
Type of cavity
First time
Once
Two to four times
Five to nine
More than nine
GIC RESTORATION
Poor
Fair
Good
V.Good

Cavity preparation
Base / Liner
Restoration
Finishing
Knowledge
Professionalism
Overall grade
Simple
Intermediate
Difficult
Signature of staff
Date
45
Not
applicable
Female
Patient Name
Date
Registration Number
Age
Sex
Male
Tooth number
Type of cavity
First time
Once
Two to four times
Five to nine
More than nine
SILVER AMALGAM RESTORATION

Poor
Fair
Good
V.Good

Cavity preparation
Base / Liner
Filling
Finishing
Knowledge
Professionalism
Overall grade
Simple
Intermediate
Difficult
Signature of staff
Date
46
Not
applicable
Female
Patient Name
Date
Registration Number
Age
Sex
Male
Tooth number
Female
Single rooted tooth

Multi rooted tooth

Once
First time
Two to four times
Five to nine
More than nine
ROOT CANAL THERAPY

Poor
Fair
Good
V.Good
Not
applicable
Date
_______
_______
_______
_______
_______
_______
_______
_______
_______
_______
_______
_______

Access opening
Pulp extripation
Canal length determination
Cleaning and shaping of canals
Master cone selection
Obturation
Filling
Patient education
Knowledge
Professionalism
Sign.
_______
_______
_______
_______
_______
_______
_______
_______
_______
_______
_______
_______
_______
Overall grade
_______

Simple
Intermediate
Difficult
Signature of staff
Date
47
Patient Name
Date
Registration Number
Age
Sex
Male
Tooth number
Female
Single rooted tooth

Multi rooted tooth

Once
First time
Two to four times
Five to nine
More than nine
POST AND CORE

Poor
Fair
Good
V.Good
Not
applicable
Date
_______
_______
_______
_______
_______
_______
_______
_______
_______
_______
_______
_______
GP retrieval
Post space preparation
Trial of post
Luting of post
Core build up
Tooth preparation
Impression
Temporary crown
Insertion of crown
Patient education
Knowledge
Professionalism
Sign.
_______
_______
_______
_______
_______
_______
_______
_______
_______
_______
_______
_______
_______
Overall grade
_______

Simple
Intermediate
Difficult
Signature of staff
Date
48
49
PROSTHODONTICS
POLYCLINIC
CLINICAL LOGBOOK
COMPLETE DENTURE
ACRYLIC PARTIAL DENTURE
INDIRECT RESTORATION
CAST PARTIAL DENTURE
50
Patient Name
Date
Registration Number
Age
Sex
Male
Female
COMPLETE DENTURE
Poor
Fair
Good
V.Good
Not
applicable
Date
_______
_______
_______
_______
_______
_______
_______
_______
_______
_______
_______
_______
_______
_______
_______
_______
_______
_______
_______
Diagnosis
Selection of tray
Primary impression [Upper]
[Lower]
Border molding [Upper]
[Lower]
Secondary impression[Upper]
[Lower]
Facebow transfer
Jaw relation
Teeth selection
Articulation
Teeth setting
Try In
Insertion
Patient education
Knowledge
Professionalism
Review visit
Sign.
_______
_______
_______
_______
_______
_______
_______
_______
_______
_______
_______
_______
_______
_______
_______
_______
_______
_______
_______
_______
Overall grade
_______

Simple
Intermediate
Signature of staff
Difficult
Date
51
PROSTHODONTICS
Patient Name
Date
Registration Number
Age
Sex
Male
Female
Type
ACRYLIC PARTIAL DENTURE

Poor
Fair
Good
V.Good
Not
applicable
Date
_______
_______
_______
_______
_______
_______
_______
_______
_______
_______
_______
_______
_______
_______
_______
_______
Diagnosis
Case selection
Selection of tray
[Lower]
Design
Secondary impression[Upper]
[Lower]
Jaw relation
Teeth selection
Try In
Insertion
Patient education
Knowledge
Professionalism
Review visit
Sign.
_______
_______
_______
_______
_______
_______
_______
_______
_______
_______
_______
_______
_______
_______
_______
_______
_______
Overall grade
_______

Simple
Complex
Signature of staff
Date
52
PROSTHODONTICS
Patient Name
Date
Registration Number
Age
Sex
Male
Tooth number
Female
Type of restoration
Inlay
Onlay
Crown
INDIRECT RESTORATION
Date
_______
_______
_______
_______
_______
_______
_______
_______
_______
_______
_______
_______
_______
_______
_______
_______
_______
_______
_______
Poor
Fair
Good
Not
V.Good applicable
Knowledge
Professionalism
Sign.
_______
_______
_______
_______
_______
_______
_______
_______
_______
_______
_______
_______
_______
_______
_______
_______
_______
_______
Overall grade
_______
Preliminary impression
Study model-2 sets
Face-bow transfer
Occlusal records
Mounting on a semi-adjustable articulator
Occlusal assessment
Design
Mock preparation
Putty Index
Tooth preparation
Retraction cord
Impression
Provisional restoration
Try-in of final restoration
Final restoration check
Patient education

Simple
Intermediate
Signature of staff
Difficult
Date
53
PROSTHODONTICS
Patient Name
Date
Registration Number
Age
Sex
Male
Tooth number
Female
Type of restoration
Conventional
Adhesive
BRIDGE
Date
_______
_______
_______
_______
_______
_______
_______
_______
_______
_______
_______
_______
_______
_______
_______
_______
_______
_______
_______
_______
Poor
Fair
Good
Not
V.Good applicable
Knowledge
Professionalism
Sign.
_______
_______
_______
_______
_______
_______
_______
_______
_______
_______
_______
_______
_______
_______
_______
_______
_______
_______
_______
Overall grade
_______
Preliminary impression
Study model-2 sets
Face-bow transfer
Occlusal records
Mounting on a semi-adjustable articulator
Occlusal assessment
Design
Mock preparation
Template for provisional bridge
Putty Index
Tooth preparation
Retraction cord
Impression
Provisional restoration
Try-in of final restoration
Final restoration check
Patient education

Simple
Intermediate
Signature of staff
Difficult
Date
54
PROSTHODONTICS
Patient Name
Date
Registration Number
Age
Sex
Male
Female
Type
CAST PARTIAL DENTURE

Date
_______
_______
_______
_______
_______
_______
_______
_______
_______
_______
_______
_______
_______
_______
_______
_______
Diagnosis
Selection of tray
[Lower]
Surveying and design
Mouth preparation
Secondary impression [Upper]
[Lower]
Altered cast
Frame work try in
Facebow transfer
Jaw relation
Teeth selection
Try In
Insertion
Patient education
Knowledge
Professionalism
Review visit
Sign.
_______
_______
_______
_______
_______
_______
_______
_______
_______
_______
_______
_______
_______
_______
_______
_______
_______
_______
_______
_______
Overall grade
_______
_______
_______
_______
Poor
Fair
Good
V.Good
Not
applicable

Simple
Intermediate
Signature of staff
Difficult
Date
55
PROSTHODONTICS
56
PERIODONTICS
POLYCLINIC
CLINICAL LOGBOOK
SCALING
ROOT PLANING
57
Patient Name
Date
Registration Number
Age
Sex
Male

Once
Two to four times
Five to nine
More than nine
SCALING
Hand
Ultrasonic
Poor
Fair
Good
V.Good
Supra-gingival (Upper jaw)

Supra-gingival (Lower jaw)
Sub-gingival (Upper jaw)
Sub-gingival (Lower jaw)
Polishing
Oral hygiene instructions
Knowledge
Professionalism
Overall grade
Simple
Intermediate
Difficult
Signature of staff
Date
58
Not
applicable
Female
PERIODONTICS
Patient Name
Date
Registration Number
Age
Sex
Male
Sextant

Once
Two to four times
Five to nine
More than nine
ROOT PLANING
Poor
Fair
Good
V.Good
Periodontal assessment
Instrumentation
Root planing efficiency
Post operative instructions
Knowledge
Professionalism
Overall grade
Simple
Intermediate
Difficult
Signature of staff
Date
59
Not
applicable
Female
PERIODONTICS
60
PREVENTIVE DENTISTRY
POLYCLINIC
CLINICAL LOGBOOK
MINIMAL INTERVENTION RESTORATION

FISSURE SEALANT
TOPICAL FLUORIDE APPLICATION
61
Patient Name
Date
Registration Number
Age
Tooth number
Male
Type of cavity design and ICDAS code

Once
Sex
First time
Two to four times
Five to nine
More than nine
MINIMAL INTERVENTION RESTORATION

Poor
Fair
Good
V.Good
Caries excavation
Isolation
Base / Liner
Restoration
Finishing
Knowledge
Professionalism
Overall grade
Simple
Intermediate
Difficult
Signature of staff
Date
62
Not
applicable
Female
Patient Name
Registration Number
Date
Tooth number
Age
Sex
Male
Female
FISSURE SEALANT
Poor
Fair
Good
V.Good
Not
applicable
Caries risk assessment

Isolation
Acid etch, rinse and dry
Sealant application
Occlusion check
Knowledge
Professionalism
Overall grade
Signature of staff
Date
Patient Name
Registration Number
Date
Tooth number
Age
Sex
Male
FISSURE SEALANT
Poor
Fair
Good
V.Good

Isolation
Acid etch, rinse and dry
Sealant application
Occlusion check
Knowledge
Professionalism
Overall grade
Signature of staff
Date
63
Not
applicable
Female
Patient Name
Date
Registration Number
Age
Sex
Male
Female

Poor
Fair
Good
V.Good
Not
applicable

Tray selection
Isolation
Application
Patient education
Knowledge
Professionalism
Overall grade
Signature of staff
Date
Patient Name
Date
Registration Number
Age
Sex
Male

Poor
Fair
Good
V.Good

Tray selection
Isolation
Application
Patient education
Knowledge
Professionalism
Overall grade
Signature of staff
Date
64
Not
applicable
Female
Patient Name
Date
Registration Number
Age
Sex
Male
Female
Procedure
MISCELLANEOUS
Poor
Fair
Good
V.Good
Overall grade
Signature of staff
Date
Patient Name
Date
Registration Number
Age
Sex
Male
Procedure
MISCELLANEOUS
Poor
Fair
Good
V.Good
Overall grade
Signature of staff
Date
65
Female

Bachelor of Dental Surgery Clinical Logbook

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Bachelor of Dental Surgery Clinical Logbook

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FACULTY OF DENTISTRY

Assoc. Prof. Dr. KALYAN C GUNDAVARAPU

POLYCLINIC CLINICAL LOGBOOK

All rights reserved.

Dr. KALYAN C GUNDAVARAPU

Associate Professor in Dental Public Health

Dr. KALYAN C GUNDAVARAPU

Associate Professor in Dental Public Health

Fig.1 Patient log

Kumar a/l Sivanes

Fig. 3 - Session Log

CLINICAL LOG SUMMARY

Fig. 4 - Clinical Log Summary

Fig. 5 - Clinical Log Summary

ASSESSMENT CRITERIA FOR CLINICAL SESSIONS

ASSESSMENT CRITERIA FOR OVERALL MODULE ASSESSMENT

5. Management and Leadership

Signatures: ..................................................................................... Date: ................................

CERTIFICATE OF SATISFACTORY COMPLETION OF THIS LOGBOOK FOR YEAR 4

Signatures: ..................................................................................... Date: ................................

CERTIFICATE OF SATISFACTORY COMPLETION OF THIS LOGBOOK FOR YEAR 5

Signatures: ..................................................................................... Date: ................................

CLINICAL EXPERIENCE LOG FOR YEAR 3

Total number of clinical sessions worked

Total number of patients treated

Total missed appointments by patients

Total number of absences or leave

Signature of the student

OVERALL ASSESSMENT FOR YEAR 3

Overall quality of clinical work

Management and Leadership

Suggestions for improvement

Group Teacher 1 sign

Group Teacher 2 sign

CLINICAL EXPERIENCE LOG FOR YEAR 4

Total number of clinical sessions worked

Signature of the student

OVERALL ASSESSMENT FOR YEAR 4

Overall quality of clinical work

Management and Leadership

Suggestions for improvement

Group Teacher 1 sign

Group Teacher 2 sign

CLINICAL EXPERIENCE LOG FOR YEAR 5

Total number of clinical sessions worked

Signature of the student

OVERALL ASSESSMENT FOR YEAR 5

Overall quality of clinical work

Management and Leadership

Suggestions for improvement

Group Teacher 1 sign

Group Teacher 2 sign

CONSERVATIVE & ENDODONTICS

Number of times procedure is done before

Two to four times

More than nine

Local anesthesia administration

Suggestions for improvement

CONSERVATIVE & ENDODONTICS

Number of times procedure is done before

Two to four times

More than nine

Local anesthesia administration

Suggestions for improvement