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

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Versions (2) ▾
  1. 8/27/12
  2. 1/9/15
Uploaded on:

January 9, 2015

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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

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  1. StudyEvent: PRL1013 - Baseline Evaluation Form
    1. No Instruction available.
Header
Treatment arm
Pre-treatment Evaluation
Has the patient noticed his/her sleep bruxism
Has the patient's partner noted the patient's sleep bruxism
Is enlargement of masseter muscle present
Is enlargement due to sleep bruxism (If "Yes")
Is heavy wear of the study tooth a result of sleep bruxism
Does the patient experience jaw muscle discomfort, fatigue or pain and jaw lock upon awakening
Is the patient being treated for sleep bruxism
Evaluation Of Caries
Tooth quadrant
Caries stage
Rank dentin caries activity
Visual presence of a crack(s) in the pulpal floor dentin
Cavity Measurements
mm
Treatment
Is patient randomized into the RMGI liner with DBA arm
RMGI Liner applied and cured (If "Yes")
Self-etch dentin bonding agent (DBA) applied and cured
Hybrid resin-based composite (RBC) applied and cured
Restoration finished?
What is your ranking of the risk of future caries in this patient
Footer Module

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