RECORDER OF PRACTICE - subject DENTISTRY practical training PERIODONTOLOGY I – III
Practice conditions:
Practical exercises should be attended with sufficient time reserve, it is necessary to comply with prescribed clothing, shoes, wear visibly
personal visiting card; it is required to follow internal rules of practical exercises, hygiene regulations, PPE (protective equipment),
OSH (occupational safety and health), ensure safety of the patient and personnel. It is mandatory to keep ethical codex of the student of dentistry,
medical secrets and collegiate behavior.
Any discrepancies should be reported to supervisor of practical exercises.
Supervisor has responsibility for the student during time of practical exercise and has right to expel him in case of failure to fulfill basic
obligations.
List of mandatory tasks: (subjects Periodontology 1 +2 +3)
a) Complex periodontological examination: 2
b) Control periodontological examination: 2
c) Complex/control examination of oral mucosae: 1
d) Removal of tartar (possible to complete on another department and within summer holiday practical exercise): 10
e) Subgingival treatment (sextant): 1
f) Description of OPG picture above the scope of a, b: (possible to complete on another department and within summer holiday practical
exercise): 5
g) Therapeutic periodontology plan above the scope of a, b: (possible to complete on another department and within summer holiday practical
exercise): 5
Record of examinations will be checked during the final practical exam from periodontology in the 5th
year.
With my signature I honestly declare, that I will approach responsibly to fulfill given criteria and I will supply truthful information.
In Brno on: __________________ Student signature:______________________________
RECORDER OF PRACTICE - subject DENTISTRY practical training PERIODONTOLOGY I – III
Date
The patient ( name, year of
birth) Dg.
code
Student
signature
Signature and
stamp of doctor