2.12 Fabrication of Custom Mouth Guard
Protocol: The learner must successfully demonstrate accurate construction of a maxillary customized mouthguard.
Criteria:
| Student completed procedure protocol accurately | Successful (S) |
| Student did not complete procedure protocol accurately | Unsuccessful (U) |
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Procedure Protocol |
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Complete armamentarium assembled |
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Borders of the mouth guard smooth, rounded &tapered |
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Exterior has a smooth, glossy finish |
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Mouth guard free of debris and disinfected |
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Mouth guard stored appropriately with patient’s name |
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Used mouth mirror to inspect patient’s oral cavity |
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Mouth guard covers all fully erupted functioning dentition (excluding 8s) |
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Mouth guard fits teeth securely without blanching patient’s tissues, after a maximum of 2 adjustments |
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Mouth guard trimmed around the frenum areas |
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Mouth guard trimmed within proper measurements |
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Study cast trimmed and labeled according to protocol |
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Procedure documented in patient’s chart |
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Safety measures followed |
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Infection control protocols followed |
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Demonstrates professionalism and appropriate communication skills |
