New York University College of Dentistry
Dental Hygiene Program, Principles of Dental Hygiene I Clinic
Clinical Competency Criteria Evaluation: Indices

Student:________________________________________ Date:______________________________

Instructor:_____________________________________ Total # of errors:______ Grade:______ Competency: Met□ Unmet□

Grade scale: Total # of errors | 0 | 1 | 2 | 3 | 4 | 5-6 | 7-8 | 9-10 | 11-12 | 13 or more | Grade | 100 | 95 | 90 | 85 | 80 | 75 | 70 | 65 | 60 | 55 |

CriteriaFaculty Directions: place check mark next to correlating error | Faculty CommentsFeedback on student performance | Preparation | | __ Properly sets up unit and appropriate instruments and supplies__ Provides patient with safety glasses and bib | _______# of errors | Positioning | | __ Reclines backrest of patient chair to be positioned for the specified arch and adjusts height of patient chair so that clinician’s elbows remain at waist level when accessing the specified treatment area__ Ensures patient’s head is even with top of head rest and asks patient to assume the head position that facilitates the clinician’s view of the specified treatment area__ Positions instrument tray within easy reach for front, side, or rear delivery __ Positions unit light at arm’s length and directs light to illuminate the specified treatment area__ Adjusts clinician chair correctly and assumes the recommended clock position__ Maintains neutral position | _______# of errors | Gingival Index (GI) | | Communication:__ States the rationale for selecting the Gingival Index__ Utilizes results and score to motivate patient and to set goals for the dental hygiene care plan | _______# of errors | Technique:__ Correctly identifies Ramfjord teeth (#3, 9, 12, 19, 25, 28) and surfaces (M, D, F, L) to be examined __ Performs GI prior to disclosing for Plaque Control Record__ Dries the gingiva with air/water syringe__ Utilizes proper use of a mouth mirror__ Uses the side of the probe to press on the gingiva to determine the degree of firmness__ Slides the probe along the soft tissue wall (circumferential stroke) subgingivally near the entrance to the gingival sulcus to evaluate bleeding __ Waits 10 seconds for a bleeding response | _______# of errors | Calculation:__ Accurately obtains and records the score__ Provides an accurate calculation and interpretation of the score | _______# of errors | Plaque Control Record (O’Leary) | | Communication:__ States the rationale for selecting the Plaque Control Record__ Utilizes results and score to motivate patient and to set goals for the dental hygiene care plan | _______# of errors | Technique:__ Applies appropriate technique for disclosing agent__ Evaluates each tooth utilizing proper use of mouth mirror | _______# of errors | Calculation:__ Accurately obtains and records the score__ Provides an accurate calculation and interpretation of the score | _______# of errors | Safety & Handling | | Any error in safety and handling considered critical, resulting in grade of zero (0).__ Infection control procedures followed pre, during and post treatment __ Dons PPE in the following sequence: facemask, safety glasses, gloves __ Handles all items with care and safety | _______# of errors | Self-Evaluation (*must be completed by student prior to performing competency): | | __ Completes self-evaluation prior to competency__ Answers all questions clearly and explains in detail | _______# of errors |