4-Checklist

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Date: ____________ Name: _______________

Practice: __________________ Position: ________________

[ ]	1. Gather materials for giving oral hygiene instructions:
	[ ] Basic Oral Hygiene module on the computer [ ] Internet connection for taking pretest and post-test [ ] Water and sink and rinsing cup [ ] Hand--held mirror and mounted mirror [ ] 2-Tone Disclosing Solution and Q-tips [ ] Soft Toothbrush [ ] Dental floss [ ] Floss threader

[ ]	2. Explain to your patient that you are going to review how to care for the mouth so that your patient will not have bad breath, not develop cavities, and not develop gum disease.

[ ]	3. Have your patient take the short Basic Oral Hygiene (BOH) pretest in the ITI Online Account for the practice.

[ ]	4. Have your patient watch Chapters 1 through 4 on the BOH module if your patient needs to know about a healthy mouth, plaque, decay and decalcification, and gum disease.

[ ]	5. Have your patient use a q-tip and disclose the plaque on his or her teeth with the 2-Tone disclosing solution and rinse.

[ ]	6. Using the hand mirror, have your patient point out to you the disclosed plaque areas in his or her mouth.

[ ]	7. Play the appropriate movies on brushing, using Chapter 5 if your patient does not have braces and Chapter 7 if your patient does have braces.

[ ]	8. Have your patient brush guiding his or her hand to do it properly, if necessary.

[ ]	9. Play the appropriate movies on flossing, using Chapter 6 if your patient does not have braces and Chapter 7 if there are braces.

[ ]	10. Have your patient floss throughout the mouth with your help coaching him or her.

[ ]	11. Have your patient disclose again and rinse.

[ ]	12. Both of you check for plaque and have your patient remove it if there is any.

[ ]	13. Discuss with your patient what you have covered and verbally quiz your patient.

[ ]	14. Have your patient take the BOH post-test that is appropriate for his or her age and with or without braces at the ITI Online Account for your practice. Print the Certificate when your patient passes the post-test.

[ ]	15. Give your patient a reward for doing well and make complete notes on the Treatment Card. At the next appointment review oral hygiene procedures and reward your patient if oral hygiene levels are improved and if there is no gingivitis.

[ ]

1. Gather materials for giving oral hygiene instructions:

[ ]

2. Explain to your patient that you are going to review how to care for the mouth so that your patient will not have bad breath, not develop cavities, and not develop gum disease.

[ ]

3. Have your patient take the short Basic Oral Hygiene (BOH) pretest in the ITI Online Account for the practice.

[ ]

4. Have your patient watch Chapters 1 through 4 on the BOH module if your patient needs to know about a healthy mouth, plaque, decay and decalcification, and gum disease.

[ ]

5. Have your patient use a q-tip and disclose the plaque on his or her teeth with the 2-Tone disclosing solution and rinse.

[ ]

6. Using the hand mirror, have your patient point out to you the disclosed plaque areas in his or her mouth.

[ ]

7. Play the appropriate movies on brushing, using Chapter 5 if your patient does not have braces and Chapter 7 if your patient does have braces.

[ ]

8. Have your patient brush guiding his or her hand to do it properly, if necessary.

[ ]

9. Play the appropriate movies on flossing, using Chapter 6 if your patient does not have braces and Chapter 7 if there are braces.

[ ]

10. Have your patient floss throughout the mouth with your help coaching him or her.

[ ]

11. Have your patient disclose again and rinse.

[ ]

12. Both of you check for plaque and have your patient remove it if there is any.

[ ]

13. Discuss with your patient what you have covered and verbally quiz your patient.

[ ]

14. Have your patient take the BOH post-test that is appropriate for his or her age and with or without braces at the ITI Online Account for your practice. Print the Certificate when your patient passes the post-test.

[ ]

15. Give your patient a reward for doing well and make complete notes on the Treatment Card. At the next appointment review oral hygiene procedures and reward your patient if oral hygiene levels are improved and if there is no gingivitis.