Download Pit and Fissure Sealants: An Overview

Earn
1 CE credit
This course was
written for dentists,
dental hygienists,
and assistants.
Pit and Fissure Sealants:
An Overview
A Peer-Reviewed Publication
Written by Heidi Emmerling Muñoz, PhD and Jan Carver Silva, RDH, MSHS
Abstract
The dental profession has long regarded dental sealants
as a primary element in the prevention of dental caries.
Sealants provide a physical barrier between the spaces
created by anatomical pits and fissures of posterior teeth
and the cariogenic bacteria, thereby halting incipient lesions
and preventing cavitation. Proper techniques must be
implemented when placing sealants for optimal retention and
patient safety. Patients must understand that sealants are
one element for overall preventive dentistry. This article will
review the epidemiology and efficacy of sealants; indications
for use; the various types and categorization of sealants;
characteristics for successful sealants; proper placement
procedures for pit and fissure sealants; sealant maintenance;
and factors to teach patients.
Educational Objectives:
At the end of this self-instructional
educational activity, the participant
will be able to:
1. Describe the basic placement of
pit and fissure sealants.
2. Discuss the clinician’s role
in optimizing best practices
and safe use of pit and fissure
sealants.
3. Educate patients on the role of
dental sealants in an effective
caries prevention program.
Author Profile
Heidi Emmerling Muñoz, PhD is a professor of English at Cosumnes River College. Prior
to her current role, Dr. Muñoz served as interim director and professor of dental hygiene
at Sacramento City College. Dr. Muñoz is a frequent contributor to RDH Magazine and
has written articles and columns for a variety of publications. She can be reached at
[email protected]
Jan Carver Silva, RDH, MSHS is a professor of dental hygiene at Carrington College
California, Sacramento campus. Ms. Carver Silva served as a California Dental Hygienists’
Association delegate and Vice President of the Sacramento Valley Component. She has
contributed to RDH Magazine and can be reached at [email protected]
Author Disclosure
Heidi Emmerling Muñoz, PhD and Jan Carver Silva, RDH, MSHS have no commercial ties
with the sponsors or providers of the unrestricted educational grant for this course.
Go Green, Go Online to take your course
Publication date: Oct. 2013
Expiration date: Sept. 2016
Supplement to PennWell Publications
PennWelldesignatesthisactivityfor1ContinuingEducationalCredit.
DentalBoardofCalifornia:Provider4527,courseregistrationnumberCA#01-4527-13086
“ThiscoursemeetstheDentalBoardofCalifornia’srequirementsfor1unitofcontinuingeducation.”
ThePennWellCorporationisdesignatedasanApprovedPACEProgramProviderbythe
AcademyofGeneralDentistry.Theformalcontinuingdentaleducationprogramsofthis
programproviderareacceptedbytheAGDforFellowship,Mastershipandmembership
maintenancecredit.Approvaldoesnotimplyacceptancebyastateorprovincialboardof
dentistryorAGDendorsement.Thecurrenttermofapprovalextendsfrom(11/1/2011)to
(10/31/2015) Provider ID# 320452.
This educational activity was developed by PennWell’s Dental Group with no commercial support.
This course was written for dentists, dental hygienists and assistants, from novice to skilled.
Educational Methods: This course is a self-instructional journal and web activity.
Provider Disclosure: PennWell does not have a leadership position or a commercial interest in any products or
services discussed or shared in this educational activity nor with the commercial supporter. No manufacturer or
third party has had any input into the development of course content.
Requirements for Successful Completion: To obtain 1 CE credit for this educational activity you must pay the
required fee, review the material, complete the course evaluation and obtain a score of at least 70%.
CE Planner Disclosure: Heather Hodges, CE Coordinator does not have a leadership or commercial interest with
products or services discussed in this educational activity. Heather can be reached at [email protected]
Educational Disclaimer: Completing a single continuing education course does not provide enough information
to result in the participant being an expert in the field related to the course topic. It is a combination of many
educational courses and clinical experience that allows the participant to develop skills and expertise.
Image Authenticity Statement: The images in this educational activity have not been altered.
Scientific Integrity Statement: Information shared in this CE course is developed from clinical research and
represents the most current information available from evidence based dentistry.
Known Benefits and Limitations of the Data: The information presented in this educational activity is derived
from the data and information contained in reference section. The research data is extensive and provides direct benefit
to the patient and improvements in oral health.
Registration: The cost of this CE course is $20.00 for 1 CE credit.
Cancellation/Refund Policy: Any participant who is not 100% satisfied with this course can request a full
refund by contacting PennWell in writing.
Educational Objectives
At the end of this self-instructional educational activity, the
participant will be able to:
1. Describe the basic placement of pit and fissure sealants.
2. Discuss the clinician’s role in optimizing best practices
and safe use of pit and fissure sealants.
3.Educate patients on the role of dental sealants in an
effective caries prevention program.
Abstract
The dental profession has long regarded dental sealants as a
primary element in the prevention of dental caries. Sealants
provide a physical barrier between the spaces created by anatomical pits and fissures of posterior teeth and the cariogenic
bacteria, thereby halting incipient lesions and preventing
cavitation. Proper techniques must be implemented when
placing sealants for optimal retention and patient safety.
Patients must understand that sealants are one element for
overall preventive dentistry. This article will review the epidemiology and efficacy of sealants; indications for use; the
various types and categorization of sealants; characteristics
for successful sealants; proper placement procedures for
pit and fissure sealants; sealant maintenance; and factors to
teach patients.
Epidemiology and Efficacy
Dental caries is a problem for individuals of all ages. 23% of
adults between the ages of 20-64, have untreated decay. Additionally, 23% of children ages 2-11 have untreated dental
caries. The occlusal surfaces of teeth contain deep pits and
small fissures, making these areas difficult to clean. The occlusal surfaces account for up to 90% of all caries in school aged
children.3 The teeth at highest risk for caries are the permanent first and second molars.4 Dental sealants are a means to
prevent caries by painting thin resin coatings on the pits and
fissures of the occlusal tooth surfaces. Pit and fissure dental
sealants have reduced caries over 70%.5
Sealants work by means of simply providing a physical
barrier between the susceptible pit and fissures of a tooth and
the cariogenic bacteria. If the bacteria cannot penetrate the
tooth, bacteria cannot cause decay.6
Indications for Use
Candidates for sealants are determined based on caries risk.
Risk factors include xerostomia from medications or other
etiologies, orthodontics, and presence of incipient enamel
lesions. In high risk individuals, all noncavitated posterior
permanent teeth should be sealed upon eruption.7 Evidence
shows that placement of pit-and-fissure sealants in teeth
with incipient carious lesions significantly reduces the rate
of cavitation progression. The fears that dental practitioners
have that “sealing in” bacteria within an incipient lesion will
result in rapid cavitation are unfounded. A systematic review
by Griffiin et al. found that sealing of non-cavitated caries in
96 | rdhmag.com
permanent teeth resulted in a ten percent annual reduction in
caries progression over unsealed teeth.8
Contraindications for pit and fissure sealant placement
include radiographic evidence of proximal dental caries, pit
and fissures that are well coalesced and self-cleansing, and low
caries risk.9
Categorization of Pit and Fissure Sealants
Pit and fissure sealants can be categorized by type (glass ionomer versus resin), polymerization (auto or self-cure versus
photo or light cure polymerization) and filler. Self-cure sealants come in 2 parts. When they are mixed, they polymerize
(harden). The advantage of self-cure sealants is that no special
equipment is required. The disadvantages are that mixing is
required, and working time is limited because polymerization
begins when the material is mixed. The light cured sealants
harden when exposed to a curing light. The advantages are
that no mixing is required and there is increased working time
due to control over the start of polymerization. The disadvantages of light cure sealants are the extra costs and disinfection
time required for the curing light, protective shields, and/or
glasses.9
Pit and fissure sealants can be filled, unfilled, or can have a
color. Filled sealants contain particles made of glass or quartz
to increase the strength and resistance to wear, including occlusal forces. Sealants with fillers tend to be more viscous and
therefore the flow is affected. Unfilled sealants are clear and
do not contain the glass or quartz particles, therefore, they are
less resistant to wear. Unfilled sealants may not require occlusal adjustment when placed, so this is an advantage during
school and community health programs where sealants are
placed. Sealants can be clear, tinted, or opaque. The purpose
of a colored sealant is quick identification for evaluation during maintenance assessment. Colored sealants do not differ in
retention.9
Characteristics of Successful Pit and Fissure
Sealants
The ideal sealant material is effective, easy to use, longlasting, and safe. A majority of sealants in clinical use are
made of BPA (bisphenol A-glycidyl methylacrylate). There
is some controversy about the presence of BPA because it
replicates estrogen, which may lead to hormonal reactions in
the patient. Though small amounts of BPA have been found
in the saliva of some patients immediately after sealant placement containing BPA, there have been no findings of systemic
BPA or increased estrogen production as a result of the low
levels of BPA found in dental sealants.10, 11 As a precaution,
the air-inhibited layer (the oily surface residue on the surface
of a newly-placed sealant) should be removed with gauze immediately after curing.
The longer the sealant is retained, the more effective it is
at protecting the tooth from decay.6 Recent research shows no
significant difference in sealant retention between glass ionoRDH | October 2013
mer and resin-based sealants.12, 13 Likewise, there is no significant difference in retention between autopolymerized and
light-polymerized resin-based sealants.14 All current sealant
materials appear to be equally retentive if applied correctly.
The use of a primer and bonding layer prior to placement of
the sealant has shown inconsistent results regarding sealant
retention.15-17
Application Techniques
Good application technique is essential for increasing retention of sealants. It is generally recommended to treat each
quadrant separately, to use four-handed technique with an assistant18, and to follow the manufacturer’s recommendations.
The techniques of application vary slightly among available
products, but we present the general techniques.
The patient should wear safety glasses to provide protection from the chemicals and curing light. Once the patient is
prepared, the surface of the tooth must be cleaned. Cleaning
the tooth surface permits maximum contact of the etch and
the sealant with the enamel surface. Cleaning by toothbrushing alone has been shown to be as effective as handpiece prophylaxis in promoting sealant retention, which can reduce the
cost of materials needed for the procedure.9, 14 The use of air
abrasion followed by acid etching, as opposed to acid etching
alone, has been shown to increase sealant retention.19
Next, the tooth is etched with phosphoric acid according to
the manufacturer’s directions. The acid can be in liquid (good
flow but hard to control), gel (increased visibility but difficult
to rinse), or semi-gel form (tinted with good visibility, control
and rinses well) with a concentration of 15%-50% depending
on the manufacturer. The purpose of the etching is to create
microscopic pores into which the sealant material can flow,
increasing retention. Etching time varies from 15-60 seconds,
depending on the product.
When using a liquid etch, a small brush, sponge, or cotton pellet is used to apply the etchant. It is important to apply
continuously throughout this step and to keep the surface
moist. It is also important to dab or pat the etchant on the
tooth rather than rubbing the etchant. The action of rubbing
rather than dabbing the acid etchant can damage the enamel
rods.20
When using a gel or semi-gel, the etchant is applied with
a manufacturer-supplied syringe or cannula. Care must be
taken when etching the tooth so as not spill or touch the phosphoric acid on the patient’s soft tissue. Acid burns can result
if care is not taken.
After acid etching, the tooth must be rinsed and dried
thoroughly for 15-20 seconds. A properly etched and dried
tooth will have a chalky appearance. If it does not, then the
etching should be repeated. Resin-based sealants require an
absolutely dry surface until polymerization is complete. Proper isolation through the use of a rubber dam or an absorbent
cellulose triangle and cotton rolls placed over the Stensen’s
duct is essential to avoid salivary contamination of the sealRDH | October 2013
ant site. Salivary contamination during placement is the most
common reason for sealant failure.
Glass ionomer sealants have the advantage of not needing
a dry field to be effective. In fact, the application procedure for
glass ionomers can involve pressing a saliva-moistened finger
onto the occlusal surface to push the sealant material into the
pits and fissures.
The sealant material is then carefully placed into the prepared pits and fissures. It is important not to over-manipulate
the product as this can result in bubbles. Disposable instruments are supplied by the manufacturer. All areas should be
covered without overfilling to minimize occlusal adjustment.
After placement, the material is left in place for 10 seconds
prior to curing to allow optimum penetration into the pores.
Curing time is usually 20-30 seconds, depending on the
manufacturer. Longer curing time is related to increased retention.9 Glass ionomer sealants do not require light curing,
however they will set faster with usage of a curing light.
After the sealant is placed, the occlusion should be checked
and adjusted as necessary. Unfilled sealants often adjust on
their own to the patient’s bite, however filled sealants are
harder and more resistant to the patient’s natural occlusion
and should be adjusted at the time of placement.9
A new entry into the sealant market is giomer, a resin
that contains glass ionomer fillers. While all sealant materials release fluoride initially, only giomer has the advantage of
being able to continuously recharge and release fluoride over
its life. This enables remineralization to occur.21 In addition,
giomer is able to buffer acid to neutral, providing another
defense against decay.22 Giomer has the further advantage
of requiring fewer steps to apply than most other materials.
After cleaning and isolating, the self-etching primer is applied
using a microbrush and gently air dried after 5 seconds; no
rinsing is required. Next the sealant is applied with a syringe
and light-cured.
Sealant Maintenance
Sealants should be re-examined every appointment and at
least every six months for defects. Sealants can last years,
depending on the product and placement. If a sealant needs
to be replaced, it is essential to re-etch. Maintenance of existing sealants includes avoiding use of an air-powder polisher
on intact existing sealants during maintenance appointments,
as sealant wear increases with time of exposure to air-powder
polisher abrasion.9
Factors to Teach the Patient
Although pit and fissure sealants are extremely effective at
preventing decay, the clinician should emphasize that sealants are one piece of the entire preventive program. The other
parts of the caries preventive program that patients should be
aware of include a low sugar diet, use of fluoride, and biofilm
control. Patients should also be educated as to how pit and fissure sealants prevent dental caries, the need for examination
rdhmag.com | 97
of the sealant at frequent, scheduled appointments, and need
for replacement when indicated.
Conclusion
Caries is a problem for patients of all ages. Along with proper
diet, fluoride, and biofilm control, pit and fissure sealants
should be considered as part of an overall preventive program
rather than an isolated procedure. The dental sealants bond
to the etched enamel and seal the pits and fissures, preventing
bacteria from initiating the decay process. Ideally, high-risk
patients should have sealants placed on all posterior permanent teeth upon eruption. Proximal caries or self-cleansing
pits and fissures are contraindications for dental sealants.
The dental practitioner should be familiar with the various
categories of sealants and the specific application methods for
each product. Meticulous care should be used when placing
sealants, especially limiting saliva contamination and using a
four-handed technique with an assistant. With proper placement and maintenance, sealants can last years.
References
1. “Dental Decay (Tooth Decay) in Adults (Age 20-64)” National
Institute of Dental and Craniofacial Research. NIH. 25 March
2011.
2. “Dental Decay (Tooth Decay) in Children (Age 2-11)”
National Institute of Dental and Craniofacial Research. NIH.
25 March 2011.
3. Kaste LM, Selwitz RH, Oldakowski RJ, Brunelle, JA, Winn
DM, Brown LJ. Coronal caries in the primary and permanent
dentition of children and adolescents 1-17 years of age: United
States, 1988-1991. J Dent Res 1996;75 (Spec No):631-41.
4. “Community and Other Approaches to Promote Oral Health
and Prevent Oral Disease” Oral Health in America: Surgeon
General’s Report. NIDC. 25 March 2011.
5. Llodra JC, Bravo M, Delgado-Rodriguez M, Baca P, Galvey
R. Factors influencing the effectiveness of sealants—a metaanalysis. Community Dent Oral Epidemiol 1993;21(5):261-8.
6. National Institutes of Health (NIH). Consensus Development
Conference Statement. Dental sealants in the prevention of
tooth decay. J Dent Educ 1984 48(2 Suppl):126-31.
7. Beauchamp J, Caufield PW, Crall JJ, Donly K, Feigal R, Gooch
B, Ismail A, Kohn W, Siegal M, & Simonsen R. Evidencebased clinical recommendations for the use of pit-and-fissure
sealants: a report of the American Dental Association Council
on Scientific Affairs . J Am Dent Assoc. 2008;139(3):257-68.
8. Griffin SO, Oong E, Kohn W, Vidakovic B, & Gooch BF. CDC
Dental Sealant Systematic Review Work Group, et al. The
effectiveness of sealants in managing carious lesions. J Dent
Res 2008;87(2): 169–174.
9. Wilkins E. (2013). Clinical practice of the dental hygienist, 11th
ed. Philadelphia: Lippincott Williams and Wilkins, 2013.
10.Söderholm K-J & Mariotti A. Bis-gma–based resins in
dentistry: are they safe? J Am Dent Assoc. 1999 130(2): 201209.
11.Fung E, Ewoldson N, St. Germain H, Marx, D. Miaw C-L,
Siew C, Chou H-N, Gruninger, & Meyer D. Pharmacokinetics
of bisphenol a released from a dental sealant. J Am Dent
Assoc. 2000 131(1): 51-58.
12.Antonson S, Antonson D, Brener S, Crutchfield J, Larumbe
J, Michaud C, Yazici AR, Hardigan P, Alempour S, Evans D,
& Ocanto R. Twenty-four month clinical evaluation of fissure
sealants on partially erupted permanent first molars: Glass
98 | rdhmag.com
ionomer versus resin-based sealant . J Am Dent Assoc. 2012
143(2): 115-122.
13. Seth S. Glass ionomer cement and resin-based fissure sealants
are equally effective in caries prevention. J Am Dent Assoc
2011 142(5): 551-552.
14.Houpt M, Fuks A, Shapira J, Chosack A, & Eidelman E.
Autopolymerized versus light-polymerized fissure sealant.
1987 115(1): 55-56.
15.Nazar H, Mascarenhas AK, Al-Mutwa S, Ariga J & Soparker
P. Effectiveness of fissure sealant retention and caries
prevention with and without primer and bond. Med Princ
Pract 2013;22:12–17.
16. Feigal RJ, Musherure P, Gillespie B, Levy-Polack M, Quelhas I,
& Hebling J. Improved sealant retention with bonding agents:
a clinical study of two-bottle and single-bottle systems. J Dent
Res. 2000 Nov;79(11):1850-6.
17.Hebling J& Feigal RJ. Use of one-bottle adhesive as an
intermediate bonding layer to reduce sealant microleakage on
saliva-contaminated enamel. Am J Dent. 2000 Aug;13(4):18791.
18.Griffin S, Jone K, Kolvic Gray S, Malvitz D, & Gooch B.
Exploring Four-Handed Delivery and Retention of ResinBased Sealants. J Am Dent Assoc 2010 141(6): 696-698.
19.Yazici AR, Kiremitici A, Celik C, Ozgunaltay G, & Dayangac
B. JADA Continuing Education: A two-year clinical evaluation
of pit and fissure sealants placed with and without air abrasion
pretreatment in teenagers. J Am Dent Assoc 2006 137(10):
1401-1405.
20.Pinkham JR, Casamassimo PS, Fields HW, McTigue DJ,
& Nowak A. (2005). Pediatric dentistry: Infancy through
adolescence, 4th ed. St. Louis: Elsevier Saunders. 2005.
21.Shimazu, K., Ogata, K., & Karibe, H. Evaluation of the ionreleasing and recharging abilities of a resin-based fissure
sealant containing S-PRG filler. Dent Mater J. 2011;30:923-927
22.Wang, Y., Kaga, M., Kajiwara, D., Minamikawa, H., Kakuda,
S., Hashimoto, M., & Yawaka, Y. Ion release and buffering
capacity of S-PRG filler-containing pit and fissure sealant in
lactic acid. Nano Biomed. 2011;3:275-281.
Author Profile
Heidi Emmerling Muñoz, PhD is a professor of English
at Cosumnes River College. Prior to her current role, Dr.
Muñoz served as interim director and professor of dental
hygiene at Sacramento City College. Dr. Muñoz is a frequent
contributor to RDH Magazine and has written articles and
columns for a variety of publications. She can be reached at
[email protected]
Jan Carver Silva, RDH, MSHS is a professor of dental hygiene at Carrington College California, Sacramento campus.
Ms. Carver Silva served as a California Dental Hygienists’
Association delegate and Vice President of the Sacramento
Valley Component. She has contributed to RDH Magazine
and can be reached at [email protected]
Author Disclosure
Heidi Emmerling Muñoz, PhD and Jan Carver Silva, RDH,
MSHS have no commercial ties with the sponsors or providers
of the unrestricted educational grant for this course.
RDH | October 2013
Notes
Online Completion
Use this page to review the questions and answers. Return to www.ineedce.com and sign in. If you have not previously purchased the program select it from the “Online Courses” listing and complete the online purchase. Once
purchased the exam will be added to your Archives page where a Take Exam link will be provided. Click on the “Take Exam” link, complete all the program questions and submit your answers. An immediate grade report will be
provided and upon receiving a passing grade your “Verification Form” will be provided immediately for viewing and/or printing. Verification Forms can be viewed and/or printed anytime in the future by returning to the site, sign
in and return to your Archives Page.
Questions
1. Dental caries is a problem for patients in
which age group?
a.
b.
c.
d.
Children under age 10
Children and young adults aged 11-20
Adults over 20
All of the above
6. Sealant retention can be enhanced by:
a. Use of four-handed technique when placing
sealants
b. A licensed dentist widening the fissures with a bur
c. Administration of local anesthetic
d. Removal of the air-inhibiting layer after placement
11. After cleansing the tooth, prior to
placing the sealant, the tooth is carefully
etched with:
a. Hydrochloric acid
b. Phosphoric Acid
c. Hydrogen peroxide
d.Fluoride
2.The teeth at highest risk for caries
are:
7. Which of the following can be used to
clean the tooth prior to acid etching?
12. What is the concentration of the etchant?
3. All of the following are characteristics of
ideal sealant material EXCEPT:
8. The most common reason for resin-based
sealant failure is:
13. The proper sequence for placing resinbased sealants is:
4. Recent research shows which type of
sealant has the highest retention?
9. How are sealants categorized?
14. Contraindications for pit and fissure
sealants include:
a.
b.
c.
d.
Permanent first molars
Permanent second molars
a and b
None of the above
a.Effective
b.BPA-free
c. Easy to use
d. Long lasting
a. Glass ionomer
b.Resin
c. Light polymerized
d. None of the above; they are all equal
5. Which of the following is a concern
among some people specific to BPA in
sealants?
a.
b.
c.
d.
Fluoride toxicity
Lack of retention
Adverse hormonal reactions
Sealing in bacteria
RDH | October 2013
a.
b.
c.
d.
A toothbrush
A handpiece
An air polisher
All of the above can be used
a. Placement on an incipient lesion
b. Lack of occlusal adjustment
c. Salivary contamination
d. None of the above
a.Composition
b.Polymerization
c.Filler
d. All of the above
10. What types of filler are used in sealants?
a.Color
b.Quartz
c.Nothing
d. All of the above
a.10%
b.75%
c.83%
d. 15%-50% depending on the manufacturer
a.
b.
c.
d.
a.
b.
c.
d.
Etch, dry, place, clean, rinse, occlusal adjustment
Rinse, etch, dry, place, occlusal adjustment, clean
Clean, dry, rinse, place, etch, occlusal adjustment
Clean, etch, rinse, dry, place, occlusal adjustment
Radiographic evidence of proximal caries
Incipient decay
Self-cleansing pits and fissures
a and c
15. Sealants should be re-examined:
a.Annually
b. At every appointment, or every 6 months
c. Every 3 months
d. It is unnecessary if placed properly
rdhmag.com | 99
ANSWER SHEET
Pit and Fissure Sealants: An Overview
Name:
Title:
Specialty:
Address:E-mail:
City:
State:ZIP:Country:
Telephone: Home (
)
Office (
Lic. Renewal Date:
) AGD Member ID:
Requirements for successful completion of the course and to obtain dental continuing education credits: 1) Read the entire course. 2) Complete all information above. 3)
Complete answer sheets in either pen or pencil. 4) Mark only one answer for each question. 5) A score of 70% on this test will earn you 1 CE credit. 6) Complete the Course
Evaluation below. 7) Make check payable to PennWell Corp. For Questions Call 216.398.7822
If not taking online, mail completed answer sheet to
Educational Objectives
1. Describe the basic placement of pit and fissure sealants.
2. Discusstheclinician’sroleinoptimizingbestpracticesandsafeuseofpitandfissuresealants.
3. Educatepatientsontheroleofdentalsealantsinaneffectivecariespreventionprogram.
Course Evaluation
1. Were the individual course objectives met?Objective #1:
Objective #3:
Yes
Yes
No
No
ObjectiNo
vYees
#2:
Academy of Dental Therapeutics and Stomatology,
A Division of PennWell Corp.
P.O. Box 116, Chesterland, OH 44026
or fax to: (440) 845-3447
For IMMEDIATE results,
go to www.ineedce.com to take tests online.
Answer sheets can be faxed with credit card payment to
(440) 845-3447, (216) 398-7922, or (216) 255-6619.
Payment of $20.00 is enclosed.
(Checks and credit cards are accepted.)
Pleaseevaluatethiscoursebyrespondingtothefollowingstatements,usingascaleofExcellent=5toPoor=0.
2. To what extent were the course objectives accomplished overall?
5
4
3
210
3. Please rate your personal mastery of the course objectives.
5
4
3
210
4. How would you rate the objectives and educational methods? 5
4
3
2
10
5. How do you rate the author’s grasp of the topic?
5
4
3
2
10
6. Please rate the instructor’s effectiveness.
5
4
3
2
10
7. Was the overall administration of the course effective?
5
4
3
2
10
8. Please rate the usefulness and clinical applicability of this course. 5
4
3
210
9. Please rate the usefulness of the supplemental webliography. 5
4
3
2
10
10. Do you feel that the references were adequate?
Yes
11. Would you participate in a similar program on a different topic?
If paying by credit card, please complete the
following:
MC
Visa
AmEx
Discover
Acct. Number: _______________________________
Exp. Date: _____________________
Charges on your statement will show up as PennWell
No
Yes No
12. If any of the continuing education questions were unclear or ambiguous, please list them.
___________________________________________________________________
13. Was there any subject matter you found confusing? Please describe.
___________________________________________________________________
___________________________________________________________________
14. How long did it take you to complete this course?
___________________________________________________________________
___________________________________________________________________
15. What additional continuing dental education topics would you like to see?
___________________________________________________________________
AGD Code 257
___________________________________________________________________
PLEASE PHOTOCOPY ANSWER SHEET FOR ADDITIONAL PARTICIPANTS.
COURSE EVALUATION and PARTICIPANT FEEDBACK
We encourage participant feedback pertaining to all courses. Please be sure to complete the survey included with the
course. Please e-mail all questions to: [email protected].
INSTRUCTIONS
All questions should have only one answer. Grading of this examination is done manually. Participants will receive
confirmation of passing by receipt of a verification form. Verification of Participation forms will be mailed within
two weeks after taking an examination.
COURSE CREDITS/COST
All participants scoring at least 70% on the examination will receive a verification form verifying 1 CE credit. The
formal continuing education program of this sponsor is accepted by the AGD for Fellowship/Mastership credit.
Please contact PennWell for current term of acceptance. Participants are urged to contact their state dental boards
for continuing education requirements. PennWell is a California Provider. The California Provider number is 4527.
The cost for courses ranges from $20.00 to $110.00.
PROVIDER INFORMATION
RECORD KEEPING
PennWell is an ADA CERP Recognized Provider. ADA CERP is a service of the American Dental Association to assist
dental professionals in identifying quality providers of continuing dental education. ADA CERP does not approve
or endorse individual courses or instructors, nor does it imply acceptance of credit hours by boards of dentistry.
PennWell maintains records of your successful completion of any exam for a minimum of six years. Please contact
our offices for a copy of your continuing education credits report. This report, which will list all credits earned to
date, will be generated and mailed to you within five business days of receipt.
Concerns or complaints about a CE Provider may be directed to the provider or to ADA CERP at www.ada.org/
cotocerp/.
Completing a single continuing education course does not provide enough information to give the participant the
feeling that s/he is an expert in the field related to the course topic. It is a combination of many educational courses
and clinical experience that allows the participant to develop skills and expertise.
The PennWell Corporation is designated as an Approved PACE Program Provider by the Academy of General
Dentistry. The formal continuing dental education programs of this program provider are accepted by the AGD
for Fellowship, Mastership and membership maintenance credit. Approval does not imply acceptance by a state
or provincial board of dentistry or AGD endorsement. The current term of approval extends from (11/1/2011) to
(10/31/2015) Provider ID# 320452.
Customer Service 216.398.7822
CANCELLATION/REFUND POLICY
Any participant who is not 100% satisfied with this course can request a full refund by contacting PennWell in writing.
IMAGE AUTHENTICITY
The images provided and included in this course have not been altered.
© 2013 by the Academy of Dental Therapeutics and Stomatology, a division of PennWell
PITFIS1113RDH