ID

1519

Description

PRL1013 - Baseline Evaluation Form Postoperative Hypersensitivity Randomized Comparative Effectiveness Research Trial (POH RCERT) Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=93FFF84B-84F7-2161-E040-BB89AD4349B9

Link

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=93FFF84B-84F7-2161-E040-BB89AD4349B9

Keywords

Versions (2)
  1. 8/27/12 8/27/12 -
  2. 1/9/15 1/9/15 - Martin Dugas
Uploaded on

August 27, 2012

DOI

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License

Creative Commons BY-NC 3.0 Legacy
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Dental Caries NCT01268605 Demographic - PRL1013 - Baseline Evaluation Form - 3153809v1.0

English

No Instruction available.

1 forms  
  1. StudyEvent: PRL1013 - Baseline Evaluation Form
    1. No Instruction available.
Header
Description

Header

Site Code
Description

PractitionersEngagedinAppliedResearchandLearningNetworkClinicalStudySiteIdentifierNumber

Data type

text

Alias
NCI Thesaurus ObjectClass
C15206
UMLS 2011AA ObjectClass
C0008972
NCI Thesaurus ObjectClass
C37901
UMLS 2011AA ObjectClass
C0205145
NCI Thesaurus ObjectClass
C52664
UMLS 2011AA ObjectClass
C1709628
NCI Thesaurus Property
C25364
UMLS 2011AA Property
C0600091
NCI Thesaurus ValueDomain
C25337
UMLS 2011AA ValueDomain
C0237753
Date of visit
Description

PatientDentistVisitDate

Data type

date

Alias
NCI Thesaurus ObjectClass
C16960
UMLS 2011AA ObjectClass
C0030705
NCI Thesaurus Property
C52654
UMLS 2011AA Property
C0011441
NCI Thesaurus Property
C25716
UMLS 2011AA Property
C0545082
NCI Thesaurus ValueDomain
C25164
UMLS 2011AA ValueDomain
C0011008
NCI Thesaurus ValueDomain
C25367
Subject ID
Description

PatientCoordinatingIdentifierNumber

Data type

text

Alias
NCI Thesaurus ValueDomain
C25337
UMLS 2011AA ValueDomain
C0237753
NCI Thesaurus ObjectClass
C16960
UMLS 2011AA ObjectClass
C0030705
NCI Thesaurus Property
C25462
UMLS 2011AA Property
C0700114
NCI Thesaurus Property
C25364
UMLS 2011AA Property
C0600091
Subject Initials
Description

PatientInitialsName

Data type

text

Alias
NCI Thesaurus ValueDomain
C25191
UMLS 2011AA ValueDomain
C1547383
NCI Thesaurus ObjectClass
C16960
UMLS 2011AA ObjectClass
C0030705
NCI Thesaurus Property
C25536
UMLS 2011AA Property
C1555582
Treatment arm
Description

ProtocolTreatmentArmAssignmentType

Data type

text

Alias
NCI Thesaurus ObjectClass
C15368
NCI Thesaurus ObjectClass
C42651
UMLS 2011AA ObjectClass
C0442711
NCI Thesaurus Property
C32141
UMLS 2011AA Property
C1140618
NCI Thesaurus Property
C25426
UMLS 2011AA Property
C1516050
NCI Thesaurus ValueDomain
C25284
UMLS 2011AA ValueDomain
C0332307
Pre-treatment Evaluation
Description

Pre-treatment Evaluation

Date of evaluation
Description

AssessmentPerformedDate

Data type

date

Alias
NCI Thesaurus ValueDomain
C25164
UMLS 2011AA ValueDomain
C0011008
NCI Thesaurus ObjectClass
C25367
NCI Thesaurus ValueDomain
C25367
NCI Thesaurus Property
C38000
UMLS 2011AA Property
C0884358
Has the patient noticed his/her sleep bruxism
Description

SleepBruxismPatientSelf-ReportPresentInd-2

Data type

text

Alias
NCI Thesaurus ObjectClass
C73425
UMLS 2011AA ObjectClass
C0037313
NCI Thesaurus ObjectClass
C73511
NCI Thesaurus Property
C25626
UMLS 2011AA Property
C0150312
NCI Thesaurus Property
C21089
UMLS 2011AA Property
C0681906
NCI Thesaurus ValueDomain
C38147
UMLS 2011AA ValueDomain
C1512698
Has the patient's partner noted the patient's sleep bruxism
Description

SleepBruxismOtherReportPresentInd-2

Data type

text

Alias
NCI Thesaurus ObjectClass
C73425
UMLS 2011AA ObjectClass
C0037313
NCI Thesaurus ObjectClass
C73511
NCI Thesaurus Property
C17649
UMLS 2011AA Property
C0205394
NCI Thesaurus Property
C25626
UMLS 2011AA Property
C0150312
NCI Thesaurus Property
C25375
UMLS 2011AA Property
C0684224
NCI Thesaurus ValueDomain
C38147
UMLS 2011AA ValueDomain
C1512698
Is enlargement of masseter muscle present
Description

EnlargementMasseterMusclePresentInd-2

Data type

text

Alias
NCI Thesaurus ValueDomain
C38147
UMLS 2011AA ValueDomain
C1512698
NCI Thesaurus Property
C25626
UMLS 2011AA Property
C0150312
NCI Thesaurus ObjectClass
C13074
UMLS 2011AA ObjectClass
C0024876
NCI Thesaurus ObjectClass
C73432
UMLS 2011AA ObjectClass
C1293134
Is enlargement due to sleep bruxism (If "Yes")
Description

MasseterMuscleEnlargementSleepBruxismPresentInd-2

Data type

text

Alias
NCI Thesaurus ObjectClass
C13074
UMLS 2011AA ObjectClass
C0024876
NCI Thesaurus Property
C25626
UMLS 2011AA Property
C0150312
NCI Thesaurus Property
C73425
UMLS 2011AA Property
C0037313
NCI Thesaurus Property
C73432
UMLS 2011AA Property
C1293134
NCI Thesaurus Property
C73511
NCI Thesaurus ValueDomain
C38147
UMLS 2011AA ValueDomain
C1512698
Is heavy wear of the study tooth a result of sleep bruxism
Description

ToothSleepBruxismAbrasionPresentInd-2

Data type

text

Alias
NCI Thesaurus ObjectClass
C12506
UMLS 2011AA ObjectClass
C0040426
NCI Thesaurus Property
C25626
UMLS 2011AA Property
C0150312
NCI Thesaurus Property
C73425
UMLS 2011AA Property
C0037313
NCI Thesaurus Property
C73511
NCI Thesaurus Property
C50449
NCI Thesaurus ValueDomain
C38147
UMLS 2011AA ValueDomain
C1512698
Does the patient experience jaw muscle discomfort, fatigue or pain and jaw lock upon awakening
Description

MasseterMuscleUponAwakeningDiscomfortAssessmentInd-2

Data type

text

Alias
NCI Thesaurus ObjectClass
C13074
UMLS 2011AA ObjectClass
C0024876
NCI Thesaurus Property
C25367
NCI Thesaurus Property
C50535
UMLS 2011AA Property
C0234215
NCI Thesaurus Property
C64921
UMLS 2011AA Property
C1883476
NCI Thesaurus ValueDomain
C38147
UMLS 2011AA ValueDomain
C1512698
Is the patient being treated for sleep bruxism
Description

TherapySleepBruxismAdministeredInd-2

Data type

text

Alias
NCI Thesaurus ObjectClass
C15368
NCI Thesaurus Property
C73425
UMLS 2011AA Property
C0037313
NCI Thesaurus Property
C25382
UMLS 2011AA Property
C1521801
NCI Thesaurus Property
C73511
NCI Thesaurus ValueDomain
C38147
UMLS 2011AA ValueDomain
C1512698
Evaluation Of Caries
Description

Evaluation Of Caries

Tooth quadrant
Description

ToothMouthQuadrantAnatomicSite

Data type

text

Alias
NCI Thesaurus ObjectClass
C12506
UMLS 2011AA ObjectClass
C0040426
NCI Thesaurus Property
C25341
UMLS 2011AA Property
C0450429
NCI Thesaurus Property
C12421
UMLS 2011AA Property
C0226896
NCI Thesaurus Property
C61106
UMLS 2011AA Property
C1631280
NCI Thesaurus ValueDomain
C13717
UMLS 2011AA ValueDomain
C1515974
Caries stage
Description

CariesGroupingDiagnosisCategory

Data type

text

Alias
NCI Thesaurus ValueDomain
C25372
UMLS 2011AA ValueDomain
C0683312
NCI Thesaurus Property
C15220
UMLS 2011AA Property
C0011900
NCI Thesaurus ObjectClass
C52593
UMLS 2011AA ObjectClass
C0011334
NCI Thesaurus Property
C25523
UMLS 2011AA Property
C1522242
Rank dentin caries activity
Description

CariousDentinDescriptionStatus

Data type

text

Alias
NCI Thesaurus ValueDomain
C25688
UMLS 2011AA ValueDomain
C0449438
NCI Thesaurus ObjectClass
C52594
UMLS 2011AA ObjectClass
C1707305
NCI Thesaurus Property
C25365
UMLS 2011AA Property
C0678257
Visual presence of a crack(s) in the pulpal floor dentin
Description

ToothCrackDiagnosisInd-2

Data type

text

Alias
NCI Thesaurus ValueDomain
C38147
UMLS 2011AA ValueDomain
C1512698
NCI Thesaurus Property
C15220
UMLS 2011AA Property
C0011900
NCI Thesaurus ObjectClass
C12506
UMLS 2011AA ObjectClass
C0040426
NCI Thesaurus Property
C52648
UMLS 2011AA Property
C1706353
Cavity Measurements
Description

Cavity Measurements

Deepest Cavity Depth (mm)
Description

CariesPeriodontalProbeAssessmentMaximumDepthMeasurement

Data type

text

Measurement units
  • mm
Alias
NCI Thesaurus ObjectClass
C52593
UMLS 2011AA ObjectClass
C0011334
NCI Thesaurus Property
C20989
UMLS 2011AA Property
C0031809
NCI Thesaurus Property
C62058
NCI Thesaurus ValueDomain
C25209
UMLS 2011AA ValueDomain
C0242485
NCI Thesaurus ValueDomain
C25564
UMLS 2011AA ValueDomain
C0806909
NCI Thesaurus ValueDomain
C25333
UMLS 2011AA ValueDomain
C0205125
mm
Shallowest Cavity Depth (mm)
Description

CariesPeriodontalProbeAssessmentMinimumDepthMeasurement

Data type

text

Alias
NCI Thesaurus ObjectClass
C52593
UMLS 2011AA ObjectClass
C0011334
NCI Thesaurus Property
C20989
UMLS 2011AA Property
C0031809
NCI Thesaurus Property
C62058
NCI Thesaurus ValueDomain
C25209
UMLS 2011AA ValueDomain
C0242485
NCI Thesaurus ValueDomain
C25570
UMLS 2011AA ValueDomain
C1524031
NCI Thesaurus ValueDomain
C25333
UMLS 2011AA ValueDomain
C0205125
Cavity Length (mm)
Description

CariesPeriodontalProbeAssessmentLongestDiameterMeasurement

Data type

text

Alias
NCI Thesaurus ObjectClass
C52593
UMLS 2011AA ObjectClass
C0011334
NCI Thesaurus Property
C20989
UMLS 2011AA Property
C0031809
NCI Thesaurus Property
C62058
NCI Thesaurus ValueDomain
C25209
UMLS 2011AA ValueDomain
C0242485
NCI Thesaurus ValueDomain
C25285
UMLS 2011AA ValueDomain
C1301886
NCI Thesaurus ValueDomain
C25558
UMLS 2011AA ValueDomain
C1522425
Greatest Cavity Width (mm)
Description

CariesPeriodontalProbeAssessmentLongestPerpendicularDiameterMeasurement

Data type

text

Alias
NCI Thesaurus ObjectClass
C52593
UMLS 2011AA ObjectClass
C0011334
NCI Thesaurus Property
C20989
UMLS 2011AA Property
C0031809
NCI Thesaurus Property
C62058
NCI Thesaurus ValueDomain
C25209
UMLS 2011AA ValueDomain
C0242485
NCI Thesaurus ValueDomain
C25285
UMLS 2011AA ValueDomain
C1301886
NCI Thesaurus ValueDomain
C25558
UMLS 2011AA ValueDomain
C1522425
NCI Thesaurus ValueDomain
C25243
Narrowest Cavity Width (mm)
Description

CariesPeriodontalProbeAssessmentMinimumPerpendicularDiameterMeasurement

Data type

text

Alias
NCI Thesaurus ObjectClass
C52593
UMLS 2011AA ObjectClass
C0011334
NCI Thesaurus Property
C20989
UMLS 2011AA Property
C0031809
NCI Thesaurus Property
C62058
NCI Thesaurus ValueDomain
C25209
UMLS 2011AA ValueDomain
C0242485
NCI Thesaurus ValueDomain
C25285
UMLS 2011AA ValueDomain
C1301886
NCI Thesaurus ValueDomain
C25570
UMLS 2011AA ValueDomain
C1524031
NCI Thesaurus ValueDomain
C25243
Treatment
Description

Treatment

Curing light output (mW/cm2 [a minimum of 400 mW/cm2])
Description

DentalCuringInstrumentationDescriptionValue

Data type

text

Alias
NCI Thesaurus ValueDomain
C25712
UMLS 2011AA ValueDomain
C1522609
NCI Thesaurus ObjectClass
C16742
UMLS 2011AA ObjectClass
C0348000
NCI Thesaurus Property
C25365
UMLS 2011AA Property
C0678257
NCI Thesaurus ObjectClass
C73513
Is patient randomized into the RMGI liner with DBA arm
Description

PatientResinModifiedGlassIonomerLinerRandomizationInd-2

Data type

text

Alias
NCI Thesaurus ValueDomain
C38147
UMLS 2011AA ValueDomain
C1512698
NCI Thesaurus Property
C25196
UMLS 2011AA Property
C0034656
NCI Metathesaurus ObjectClass
C0030705
NCI Thesaurus Property
C52585
UMLS 2011AA Property
C1709917
RMGI Liner applied and cured (If "Yes")
Description

ResinModifiedGlassIonomerLinerUseInd-2

Data type

text

Alias
NCI Thesaurus ValueDomain
C38147
UMLS 2011AA ValueDomain
C1512698
NCI Thesaurus Property
C25340
UMLS 2011AA Property
C0457083
NCI Thesaurus ObjectClass
C52585
UMLS 2011AA ObjectClass
C1709917
Self-etch dentin bonding agent (DBA) applied and cured
Description

DentalRestorationDentalBondingAgentDentalCuringPerformedInd-2

Data type

text

Alias
NCI Thesaurus ObjectClass
C60718
UMLS 2011AA ObjectClass
C0399059
NCI Thesaurus Property
C38000
UMLS 2011AA Property
C0884358
NCI Thesaurus Property
C62092
UMLS 2011AA Property
C1880280
NCI Thesaurus Property
C73513
NCI Thesaurus ValueDomain
C38147
UMLS 2011AA ValueDomain
C1512698
Hybrid resin-based composite (RBC) applied and cured
Description

DentalRestorationResin-BasedCompositePerformedInd-2

Data type

text

Alias
NCI Thesaurus ValueDomain
C38147
UMLS 2011AA ValueDomain
C1512698
NCI Thesaurus Property
C38000
UMLS 2011AA Property
C0884358
NCI Thesaurus Property
C52586
UMLS 2011AA Property
C1711229
NCI Thesaurus ObjectClass
C60718
UMLS 2011AA ObjectClass
C0399059
Restoration finished?
Description

DentalRestorationCompleteInd-2

Data type

text

Alias
NCI Thesaurus ValueDomain
C38147
UMLS 2011AA ValueDomain
C1512698
NCI Thesaurus Property
C25250
UMLS 2011AA Property
C0205197
NCI Thesaurus ObjectClass
C60718
UMLS 2011AA ObjectClass
C0399059
What is your ranking of the risk of future caries in this patient
Description

CariesRiskAssessmentStatus

Data type

text

Alias
NCI Thesaurus Property
C25367
NCI Thesaurus Property
C17102
UMLS 2011AA Property
C0035647
NCI Thesaurus ValueDomain
C25688
UMLS 2011AA ValueDomain
C0449438
NCI Thesaurus ObjectClass
C52593
UMLS 2011AA ObjectClass
C0011334
Footer Module
Description

Footer Module

Comments
Description

ResearchCommentsText

Data type

text

Alias
NCI Thesaurus ValueDomain
C25704
UMLS 2011AA ValueDomain
C1527021
NCI Thesaurus ObjectClass
C15319
NCI Thesaurus Property
C25393
UMLS 2011AA Property
C0282411
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1 forms
  1. StudyEvent: PRL1013 - Baseline Evaluation Form
    1. No Instruction available.
Name
Type
Description | Question | Decode (Coded Value)
Data type
Alias
Item Group
Header
PractitionersEngagedinAppliedResearchandLearningNetworkClinicalStudySiteIdentifierNumber
Item
Site Code
text
C15206 (NCI Thesaurus ObjectClass)
C0008972 (UMLS 2011AA ObjectClass)
C37901 (NCI Thesaurus ObjectClass)
C0205145 (UMLS 2011AA ObjectClass)
C52664 (NCI Thesaurus ObjectClass)
C1709628 (UMLS 2011AA ObjectClass)
C25364 (NCI Thesaurus Property)
C0600091 (UMLS 2011AA Property)
C25337 (NCI Thesaurus ValueDomain)
C0237753 (UMLS 2011AA ValueDomain)
PatientDentistVisitDate
Item
Date of visit
date
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C52654 (NCI Thesaurus Property)
C0011441 (UMLS 2011AA Property)
C25716 (NCI Thesaurus Property)
C0545082 (UMLS 2011AA Property)
C25164 (NCI Thesaurus ValueDomain)
C0011008 (UMLS 2011AA ValueDomain)
C25367 (NCI Thesaurus ValueDomain)
PatientCoordinatingIdentifierNumber
Item
Subject ID
text
C25337 (NCI Thesaurus ValueDomain)
C0237753 (UMLS 2011AA ValueDomain)
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C25462 (NCI Thesaurus Property)
C0700114 (UMLS 2011AA Property)
C25364 (NCI Thesaurus Property)
C0600091 (UMLS 2011AA Property)
PatientInitialsName
Item
Subject Initials
text
C25191 (NCI Thesaurus ValueDomain)
C1547383 (UMLS 2011AA ValueDomain)
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C25536 (NCI Thesaurus Property)
C1555582 (UMLS 2011AA Property)
Item
Treatment arm
text
C15368 (NCI Thesaurus ObjectClass)
C42651 (NCI Thesaurus ObjectClass)
C0442711 (UMLS 2011AA ObjectClass)
C32141 (NCI Thesaurus Property)
C1140618 (UMLS 2011AA Property)
C25426 (NCI Thesaurus Property)
C1516050 (UMLS 2011AA Property)
C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
CL.1
Code List
Treatment arm
CL Item
Restoration With Rmgi (RR)
CL Item
Restoration With Dba (RD)
Item Group
Pre-treatment Evaluation
AssessmentPerformedDate
Item
Date of evaluation
date
C25164 (NCI Thesaurus ValueDomain)
C0011008 (UMLS 2011AA ValueDomain)
C25367 (NCI Thesaurus ObjectClass)
C25367 (NCI Thesaurus ValueDomain)
C38000 (NCI Thesaurus Property)
C0884358 (UMLS 2011AA Property)
Item
Has the patient noticed his/her sleep bruxism
text
C73425 (NCI Thesaurus ObjectClass)
C0037313 (UMLS 2011AA ObjectClass)
C73511 (NCI Thesaurus ObjectClass)
C25626 (NCI Thesaurus Property)
C0150312 (UMLS 2011AA Property)
C21089 (NCI Thesaurus Property)
C0681906 (UMLS 2011AA Property)
C38147 (NCI Thesaurus ValueDomain)
C1512698 (UMLS 2011AA ValueDomain)
CL.2
Code List
Has the patient noticed his/her sleep bruxism
CL Item
Yes (Yes)
C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)
CL Item
No (No)
C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)
Item
Has the patient's partner noted the patient's sleep bruxism
text
C73425 (NCI Thesaurus ObjectClass)
C0037313 (UMLS 2011AA ObjectClass)
C73511 (NCI Thesaurus ObjectClass)
C17649 (NCI Thesaurus Property)
C0205394 (UMLS 2011AA Property)
C25626 (NCI Thesaurus Property)
C0150312 (UMLS 2011AA Property)
C25375 (NCI Thesaurus Property)
C0684224 (UMLS 2011AA Property)
C38147 (NCI Thesaurus ValueDomain)
C1512698 (UMLS 2011AA ValueDomain)
CL.3
Code List
Has the patient's partner noted the patient's sleep bruxism
CL Item
Yes (Yes)
C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)
CL Item
No (No)
C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)
Item
Is enlargement of masseter muscle present
text
C38147 (NCI Thesaurus ValueDomain)
C1512698 (UMLS 2011AA ValueDomain)
C25626 (NCI Thesaurus Property)
C0150312 (UMLS 2011AA Property)
C13074 (NCI Thesaurus ObjectClass)
C0024876 (UMLS 2011AA ObjectClass)
C73432 (NCI Thesaurus ObjectClass)
C1293134 (UMLS 2011AA ObjectClass)
CL.4
Code List
Is enlargement of masseter muscle present
CL Item
Yes (Yes)
C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)
CL Item
No (No)
C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)
Item
Is enlargement due to sleep bruxism (If "Yes")
text
C13074 (NCI Thesaurus ObjectClass)
C0024876 (UMLS 2011AA ObjectClass)
C25626 (NCI Thesaurus Property)
C0150312 (UMLS 2011AA Property)
C73425 (NCI Thesaurus Property)
C0037313 (UMLS 2011AA Property)
C73432 (NCI Thesaurus Property)
C1293134 (UMLS 2011AA Property)
C73511 (NCI Thesaurus Property)
C38147 (NCI Thesaurus ValueDomain)
C1512698 (UMLS 2011AA ValueDomain)
CL.5
Code List
Is enlargement due to sleep bruxism (If "Yes")
CL Item
Yes (Yes)
C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)
CL Item
No (No)
C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)
Item
Is heavy wear of the study tooth a result of sleep bruxism
text
C12506 (NCI Thesaurus ObjectClass)
C0040426 (UMLS 2011AA ObjectClass)
C25626 (NCI Thesaurus Property)
C0150312 (UMLS 2011AA Property)
C73425 (NCI Thesaurus Property)
C0037313 (UMLS 2011AA Property)
C73511 (NCI Thesaurus Property)
C50449 (NCI Thesaurus Property)
C38147 (NCI Thesaurus ValueDomain)
C1512698 (UMLS 2011AA ValueDomain)
CL.6
Code List
Is heavy wear of the study tooth a result of sleep bruxism
CL Item
Yes (Yes)
C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)
CL Item
No (No)
C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)
Item
Does the patient experience jaw muscle discomfort, fatigue or pain and jaw lock upon awakening
text
C13074 (NCI Thesaurus ObjectClass)
C0024876 (UMLS 2011AA ObjectClass)
C25367 (NCI Thesaurus Property)
C50535 (NCI Thesaurus Property)
C0234215 (UMLS 2011AA Property)
C64921 (NCI Thesaurus Property)
C1883476 (UMLS 2011AA Property)
C38147 (NCI Thesaurus ValueDomain)
C1512698 (UMLS 2011AA ValueDomain)
CL.7
Code List
Does the patient experience jaw muscle discomfort, fatigue or pain and jaw lock upon awakening
CL Item
Yes (Yes)
C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)
CL Item
No (No)
C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)
Item
Is the patient being treated for sleep bruxism
text
C15368 (NCI Thesaurus ObjectClass)
C73425 (NCI Thesaurus Property)
C0037313 (UMLS 2011AA Property)
C25382 (NCI Thesaurus Property)
C1521801 (UMLS 2011AA Property)
C73511 (NCI Thesaurus Property)
C38147 (NCI Thesaurus ValueDomain)
C1512698 (UMLS 2011AA ValueDomain)
CL.8
Code List
Is the patient being treated for sleep bruxism
CL Item
Yes (Yes)
C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)
CL Item
No (No)
C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)
Item Group
Evaluation Of Caries
Item
Tooth quadrant
text
C12506 (NCI Thesaurus ObjectClass)
C0040426 (UMLS 2011AA ObjectClass)
C25341 (NCI Thesaurus Property)
C0450429 (UMLS 2011AA Property)
C12421 (NCI Thesaurus Property)
C0226896 (UMLS 2011AA Property)
C61106 (NCI Thesaurus Property)
C1631280 (UMLS 2011AA Property)
C13717 (NCI Thesaurus ValueDomain)
C1515974 (UMLS 2011AA ValueDomain)
CL.9
Code List
Tooth quadrant
CL Item
Lower Left Quadrant (Lower Left)
CL Item
Lower Right Quadrant (Lower Right)
CL Item
Upper Left Quadrant (Upper Left)
CL Item
Upper Right Quadrant (Upper Right)
Item
Caries stage
text
C25372 (NCI Thesaurus ValueDomain)
C0683312 (UMLS 2011AA ValueDomain)
C15220 (NCI Thesaurus Property)
C0011900 (UMLS 2011AA Property)
C52593 (NCI Thesaurus ObjectClass)
C0011334 (UMLS 2011AA ObjectClass)
C25523 (NCI Thesaurus Property)
C1522242 (UMLS 2011AA Property)
CL.10
Code List
Caries stage
CL Item
Visual Change In Enamel Or Cementum (Visual change in enamel or cementum)
CL Item
Localized Enamel Breakdown, Loss Of Cementum, Dentin Shadow (Localized enamel breakdown, loss of cementum, dentin shadow)
CL Item
Distinct Cavity With Visible Dentin, Extensive Lesion (Distinct cavity with visible dentin, extensive lesion)
Item
Rank dentin caries activity
text
C25688 (NCI Thesaurus ValueDomain)
C0449438 (UMLS 2011AA ValueDomain)
C52594 (NCI Thesaurus ObjectClass)
C1707305 (UMLS 2011AA ObjectClass)
C25365 (NCI Thesaurus Property)
C0678257 (UMLS 2011AA Property)
CL.11
Code List
Rank dentin caries activity
CL Item
Soft, Serous (Soft, serous)
CL Item
Soft, Dry (Soft, dry)
CL Item
Soft, Dry, Granular (Soft, dry, granular)
CL Item
Leathery (Leathery)
CL Item
Firm But Discolored (Firm but discolored)
Item
Visual presence of a crack(s) in the pulpal floor dentin
text
C38147 (NCI Thesaurus ValueDomain)
C1512698 (UMLS 2011AA ValueDomain)
C15220 (NCI Thesaurus Property)
C0011900 (UMLS 2011AA Property)
C12506 (NCI Thesaurus ObjectClass)
C0040426 (UMLS 2011AA ObjectClass)
C52648 (NCI Thesaurus Property)
C1706353 (UMLS 2011AA Property)
CL.12
Code List
Visual presence of a crack(s) in the pulpal floor dentin
CL Item
Yes (Yes)
C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)
CL Item
No (No)
C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)
Item Group
Cavity Measurements
CariesPeriodontalProbeAssessmentMaximumDepthMeasurement
Item
Deepest Cavity Depth (mm)
text
C52593 (NCI Thesaurus ObjectClass)
C0011334 (UMLS 2011AA ObjectClass)
C20989 (NCI Thesaurus Property)
C0031809 (UMLS 2011AA Property)
C62058 (NCI Thesaurus Property)
C25209 (NCI Thesaurus ValueDomain)
C0242485 (UMLS 2011AA ValueDomain)
C25564 (NCI Thesaurus ValueDomain)
C0806909 (UMLS 2011AA ValueDomain)
C25333 (NCI Thesaurus ValueDomain)
C0205125 (UMLS 2011AA ValueDomain)
CariesPeriodontalProbeAssessmentMinimumDepthMeasurement
Item
Shallowest Cavity Depth (mm)
text
C52593 (NCI Thesaurus ObjectClass)
C0011334 (UMLS 2011AA ObjectClass)
C20989 (NCI Thesaurus Property)
C0031809 (UMLS 2011AA Property)
C62058 (NCI Thesaurus Property)
C25209 (NCI Thesaurus ValueDomain)
C0242485 (UMLS 2011AA ValueDomain)
C25570 (NCI Thesaurus ValueDomain)
C1524031 (UMLS 2011AA ValueDomain)
C25333 (NCI Thesaurus ValueDomain)
C0205125 (UMLS 2011AA ValueDomain)
CariesPeriodontalProbeAssessmentLongestDiameterMeasurement
Item
Cavity Length (mm)
text
C52593 (NCI Thesaurus ObjectClass)
C0011334 (UMLS 2011AA ObjectClass)
C20989 (NCI Thesaurus Property)
C0031809 (UMLS 2011AA Property)
C62058 (NCI Thesaurus Property)
C25209 (NCI Thesaurus ValueDomain)
C0242485 (UMLS 2011AA ValueDomain)
C25285 (NCI Thesaurus ValueDomain)
C1301886 (UMLS 2011AA ValueDomain)
C25558 (NCI Thesaurus ValueDomain)
C1522425 (UMLS 2011AA ValueDomain)
CariesPeriodontalProbeAssessmentLongestPerpendicularDiameterMeasurement
Item
Greatest Cavity Width (mm)
text
C52593 (NCI Thesaurus ObjectClass)
C0011334 (UMLS 2011AA ObjectClass)
C20989 (NCI Thesaurus Property)
C0031809 (UMLS 2011AA Property)
C62058 (NCI Thesaurus Property)
C25209 (NCI Thesaurus ValueDomain)
C0242485 (UMLS 2011AA ValueDomain)
C25285 (NCI Thesaurus ValueDomain)
C1301886 (UMLS 2011AA ValueDomain)
C25558 (NCI Thesaurus ValueDomain)
C1522425 (UMLS 2011AA ValueDomain)
C25243 (NCI Thesaurus ValueDomain)
CariesPeriodontalProbeAssessmentMinimumPerpendicularDiameterMeasurement
Item
Narrowest Cavity Width (mm)
text
C52593 (NCI Thesaurus ObjectClass)
C0011334 (UMLS 2011AA ObjectClass)
C20989 (NCI Thesaurus Property)
C0031809 (UMLS 2011AA Property)
C62058 (NCI Thesaurus Property)
C25209 (NCI Thesaurus ValueDomain)
C0242485 (UMLS 2011AA ValueDomain)
C25285 (NCI Thesaurus ValueDomain)
C1301886 (UMLS 2011AA ValueDomain)
C25570 (NCI Thesaurus ValueDomain)
C1524031 (UMLS 2011AA ValueDomain)
C25243 (NCI Thesaurus ValueDomain)
Item Group
Treatment
DentalCuringInstrumentationDescriptionValue
Item
Curing light output (mW/cm2 [a minimum of 400 mW/cm2])
text
C25712 (NCI Thesaurus ValueDomain)
C1522609 (UMLS 2011AA ValueDomain)
C16742 (NCI Thesaurus ObjectClass)
C0348000 (UMLS 2011AA ObjectClass)
C25365 (NCI Thesaurus Property)
C0678257 (UMLS 2011AA Property)
C73513 (NCI Thesaurus ObjectClass)
Item
Is patient randomized into the RMGI liner with DBA arm
text
C38147 (NCI Thesaurus ValueDomain)
C1512698 (UMLS 2011AA ValueDomain)
C25196 (NCI Thesaurus Property)
C0034656 (UMLS 2011AA Property)
C0030705 (NCI Metathesaurus ObjectClass)
C52585 (NCI Thesaurus Property)
C1709917 (UMLS 2011AA Property)
CL.13
Code List
Is patient randomized into the RMGI liner with DBA arm
CL Item
Yes (Yes)
C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)
CL Item
No (No)
C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)
Item
RMGI Liner applied and cured (If "Yes")
text
C38147 (NCI Thesaurus ValueDomain)
C1512698 (UMLS 2011AA ValueDomain)
C25340 (NCI Thesaurus Property)
C0457083 (UMLS 2011AA Property)
C52585 (NCI Thesaurus ObjectClass)
C1709917 (UMLS 2011AA ObjectClass)
CL.14
Code List
RMGI Liner applied and cured (If "Yes")
CL Item
Yes (Yes)
C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)
CL Item
No (No)
C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)
Item
Self-etch dentin bonding agent (DBA) applied and cured
text
C60718 (NCI Thesaurus ObjectClass)
C0399059 (UMLS 2011AA ObjectClass)
C38000 (NCI Thesaurus Property)
C0884358 (UMLS 2011AA Property)
C62092 (NCI Thesaurus Property)
C1880280 (UMLS 2011AA Property)
C73513 (NCI Thesaurus Property)
C38147 (NCI Thesaurus ValueDomain)
C1512698 (UMLS 2011AA ValueDomain)
CL.15
Code List
Self-etch dentin bonding agent (DBA) applied and cured
CL Item
Yes (Yes)
C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)
CL Item
No (No)
C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)
Item
Hybrid resin-based composite (RBC) applied and cured
text
C38147 (NCI Thesaurus ValueDomain)
C1512698 (UMLS 2011AA ValueDomain)
C38000 (NCI Thesaurus Property)
C0884358 (UMLS 2011AA Property)
C52586 (NCI Thesaurus Property)
C1711229 (UMLS 2011AA Property)
C60718 (NCI Thesaurus ObjectClass)
C0399059 (UMLS 2011AA ObjectClass)
CL.16
Code List
Hybrid resin-based composite (RBC) applied and cured
CL Item
Yes (Yes)
C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)
CL Item
No (No)
C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)
Item
Restoration finished?
text
C38147 (NCI Thesaurus ValueDomain)
C1512698 (UMLS 2011AA ValueDomain)
C25250 (NCI Thesaurus Property)
C0205197 (UMLS 2011AA Property)
C60718 (NCI Thesaurus ObjectClass)
C0399059 (UMLS 2011AA ObjectClass)
CL.17
Code List
Restoration finished?
CL Item
Yes (Yes)
C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)
CL Item
No (No)
C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)
Item
What is your ranking of the risk of future caries in this patient
text
C25367 (NCI Thesaurus Property)
C17102 (NCI Thesaurus Property)
C0035647 (UMLS 2011AA Property)
C25688 (NCI Thesaurus ValueDomain)
C0449438 (UMLS 2011AA ValueDomain)
C52593 (NCI Thesaurus ObjectClass)
C0011334 (UMLS 2011AA ObjectClass)
CL.18
Code List
What is your ranking of the risk of future caries in this patient
CL Item
High (High)
C25227 (NCI Thesaurus)
C0205250 (UMLS 2011AA)
CL Item
Moderate (Moderate)
CL Item
Low (Low)
C54722 (NCI Thesaurus)
C0205251 (UMLS 2011AA)
Item Group
Footer Module
ResearchCommentsText
Item
Comments
text
C25704 (NCI Thesaurus ValueDomain)
C1527021 (UMLS 2011AA ValueDomain)
C15319 (NCI Thesaurus ObjectClass)
C25393 (NCI Thesaurus Property)
C0282411 (UMLS 2011AA Property)
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