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  1. StudyEvent: PRL1013: Enrollment Form (ENR)
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Name
Type
Description | Question | Decode (Coded Value)
Data type
Alias
Item Group
Header Module
PractitionersEngagedinAppliedResearchandLearningNetworkClinicalStudySiteIdentifierNumber
Item
Site Code
text
C15206 (NCI Thesaurus ObjectClass)
C0008972 (UMLS 2011AA ObjectClass)
C37901 (NCI Thesaurus ObjectClass-2)
C0205145 (UMLS 2011AA ObjectClass-2)
C52664 (NCI Thesaurus ObjectClass-3)
C1709628 (UMLS 2011AA ObjectClass-3)
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-2)
C0545082 (UMLS 2011AA Property-2)
C25164 (NCI Thesaurus ValueDomain)
C0011008 (UMLS 2011AA ValueDomain)
C25367 (NCI Thesaurus ValueDomain-2)
Patient Study ID
Item
Subject ID
text
C25337 (NCI Thesaurus ValueDomain)
C2348585 (UMLS CUI-1)
C16960 (NCI Thesaurus ObjectClass)
C25462 (NCI Thesaurus Property)
C25364 (NCI Thesaurus Property-2)
Patient Initials
Item
Subject Initials
text
C25191 (NCI Thesaurus ValueDomain)
C2986440 (UMLS CUI-1)
C16960 (NCI Thesaurus ObjectClass)
C25536 (NCI Thesaurus Property)
Item Group
Inclusion Criteria
PersonReportedAgeValue
Item
Subject's age
float
C25190 (NCI Thesaurus ObjectClass)
C0027361 (UMLS 2011AA ObjectClass)
C25375 (NCI Thesaurus Property)
C0684224 (UMLS 2011AA Property)
C25150 (NCI Thesaurus Property-2)
C0001779 (UMLS 2011AA Property-2)
C25712 (NCI Thesaurus ValueDomain)
C1522609 (UMLS 2011AA ValueDomain)
ToothClinicalTrialEnrollmentNumber
Item
How many teeth are being enrolled on this protocol
float
C25337 (NCI Thesaurus ValueDomain)
C0237753 (UMLS 2011AA ValueDomain)
C15207 (NCI Thesaurus Property)
C12506 (NCI Thesaurus ObjectClass)
C0040426 (UMLS 2011AA ObjectClass)
C37948 (NCI Thesaurus Property-2)
C1516879 (UMLS 2011AA Property)
Item Group
Tooth Number With Occlusal Caries
Item
Tooth number with occlusal caries
text
C52593 (NCI Thesaurus ObjectClass)
C0011334 (UMLS 2011AA ObjectClass)
C52591 (NCI Thesaurus ObjectClass-2)
C0447303 (UMLS 2011AA ObjectClass-2)
C25626 (NCI Thesaurus Property)
C0150312 (UMLS 2011AA Property)
C25162 (NCI Thesaurus ValueDomain)
C0805701 (UMLS 2011AA ValueDomain)
C13072 (NCI Thesaurus ValueDomain-2)
C0011443 (UMLS 2011AA ValueDomain-2)
CL.2
Code List
Tooth number with occlusal caries
CL Item
1st Bicuspid (1st Premolar) Permanent Arch Upper Left (12)
CL Item
2nd Bicuspid (2nd Premolar) Permanent Arch Upper Left (13)
CL Item
1st Molar (6-yr. Molar) Permanent Arch Upper Left (14)
CL Item
2nd Molar (12-yr. Molar) Permanent Arch Upper Left (15)
CL Item
2nd Molar (12-yr. Molar) Permanent Arch Lower Left (18)
CL Item
1st Molar (6-yr. Molar) Permanent Arch Lower Left (19)
CL Item
2nd Molar (12-yr. Molar) Permanent Arch Upper Right (2)
CL Item
2nd Bicuspid (2nd Premolar) Permanent Arch Lower Left (20)
CL Item
1st Bicuspid (1st Premolar) Permanent Arch Lower Left (21)
CL Item
1st Bicuspid (1st Premolar) Permanent Arch Lower Right (28)
CL Item
2nd Bicuspid (2nd Premolar) Permanent Arch Lower Right (29)
CL Item
1st Molar (6-yr. Molar) Permanent Arch Upper Right (3)
CL Item
1st Molar (6-yr. Molar) Permanent Arch Lower Right (30)
CL Item
2nd Molar (12-yr. Molar) Permanent Arch Lower Right (31)
CL Item
2nd Bicuspid (2nd Premolar) Permanent Arch Upper Right (4)
CL Item
1st Bicuspid (1st Premolar) Permanent Arch Upper Right (5)
Item
Tooth quadrant
text
C12506 (NCI Thesaurus ObjectClass)
C0040426 (UMLS 2011AA ObjectClass)
C25341 (NCI Thesaurus Property)
C0450429 (UMLS 2011AA Property)
C12421 (NCI Thesaurus Property-2)
C0226896 (UMLS 2011AA Property-2)
C61106 (NCI Thesaurus Property-3)
C1631280 (UMLS 2011AA Property-3)
C13717 (NCI Thesaurus ValueDomain)
C1515974 (UMLS 2011AA ValueDomain)
CL.15
Code List
Tooth quadrant
CL Item
Upper Right Quadrant (Upper Right)
CL Item
Upper Left Quadrant (Upper Left)
CL Item
Lower Right Quadrant (Lower Right)
CL Item
Lower Left Quadrant (Lower Left)
DentalInstrumentationAirSpeedDescriptionValue
Item
Air velocity
float
C41136 (NCI Thesaurus ObjectClass)
C0226984 (UMLS 2011AA ObjectClass)
C16742 (NCI Thesaurus ObjectClass-2)
C0348000 (UMLS 2011AA ObjectClass-2)
C25365 (NCI Thesaurus Property)
C0678257 (UMLS 2011AA Property)
C41146 (NCI Thesaurus Property-2)
C0678536 (UMLS 2011AA Property-2)
C0001861 (NCI Metathesaurus Property)
C25712 (NCI Thesaurus ValueDomain)
C1522609 (UMLS 2011AA ValueDomain)
Item
Air stimulation pain level
text
C12506 (NCI Thesaurus ObjectClass)
C0040426 (UMLS 2011AA ObjectClass)
C25201 (NCI Thesaurus ObjectClass-2)
C1522640 (UMLS 2011AA ObjectClass-2)
C25367 (NCI Thesaurus Property)
C61406 (NCI Thesaurus Property-2)
C1948023 (UMLS 2011AA Property)
C73434 (NCI Thesaurus Property-3)
C0001861 (UMLS 2011AA Property-2)
C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)
CL.4
Code List
Air stimulation pain level
CL Item
0 (0)
C0919414 (NCI Metathesaurus)
CL Item
1 (1)
CL Item
2 (2)
C66833 (NCI Thesaurus)
C0205448 (UMLS 2011AA)
CL Item
3 (3)
CL Item
4 (4)
CL Item
5 (5)
CL Item
6 (6)
CL Item
7 (7)
CL Item
8 (8)
CL Item
9 (9)
CL Item
10 (10)
ToothRemainingColdSensitivityAssessmentInd-2
Item
Does the pain linger >4 seconds (after removal of air blast)
boolean
C12506 (NCI Thesaurus ObjectClass)
C0040426 (UMLS 2011AA ObjectClass)
C25367 (NCI Thesaurus Property)
C25201 (NCI Thesaurus Property-2)
C1522640 (UMLS 2011AA Property)
C25649 (NCI Thesaurus Property-3)
C1527428 (UMLS 2011AA Property-2)
C62180 (NCI Thesaurus Property-4)
C0009264 (UMLS 2011AA Property-3)
C38147 (NCI Thesaurus ValueDomain)
C1512698 (UMLS 2011AA ValueDomain)
Item
Cold stimulation pain level
text
C12506 (NCI Thesaurus ObjectClass)
C0040426 (UMLS 2011AA ObjectClass)
C25201 (NCI Thesaurus ObjectClass-2)
C1522640 (UMLS 2011AA ObjectClass-2)
C25367 (NCI Thesaurus Property)
C62180 (NCI Thesaurus Property-2)
C0009264 (UMLS 2011AA Property)
C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)
CL.6
Code List
Cold stimulation pain level
CL Item
0 (0)
C0919414 (NCI Metathesaurus)
CL Item
1 (1)
CL Item
2 (2)
C66833 (NCI Thesaurus)
C0205448 (UMLS 2011AA)
CL Item
3 (3)
CL Item
4 (4)
CL Item
5 (5)
CL Item
6 (6)
CL Item
7 (7)
CL Item
8 (8)
CL Item
9 (9)
CL Item
10 (10)
ToothColdSensitivityAssessmentDuration
Item
Time to cold sensation
float
C12506 (NCI Thesaurus ObjectClass)
C0040426 (UMLS 2011AA ObjectClass)
C25367 (NCI Thesaurus Property)
C25201 (NCI Thesaurus Property-2)
C1522640 (UMLS 2011AA Property)
C62180 (NCI Thesaurus Property-3)
C0009264 (UMLS 2011AA Property-2)
C25330 (NCI Thesaurus ValueDomain)
C0449238 (UMLS 2011AA ValueDomain)
ToothRemainingHotSensitivityAssessmentInd-2
Item
Does the pain linger > 4 seconds
boolean
C12506 (NCI Thesaurus ObjectClass)
C0040426 (UMLS 2011AA ObjectClass)
C25367 (NCI Thesaurus Property)
C25201 (NCI Thesaurus Property-2)
C1522640 (UMLS 2011AA Property)
C25649 (NCI Thesaurus Property-3)
C1527428 (UMLS 2011AA Property-2)
C62181 (NCI Thesaurus Property-4)
C2350229 (UMLS 2011AA Property-3)
C38147 (NCI Thesaurus ValueDomain)
C1512698 (UMLS 2011AA ValueDomain)
Item
Gingival index
text
C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)
C25367 (NCI Thesaurus Property)
C32677 (NCI Thesaurus ObjectClass)
C0017562 (UMLS 2011AA ObjectClass)
CL.8
Code List
Gingival index
CL Item
Normal Appearance, No Bleeding (Normal appearance, no bleeding)
CL Item
Mild Inflammation; Slight Change In Color And Mild Edema (Mild inflammation; slight change in color and mild edema)
CL Item
Moderate Inflammation; Redness, Edema And Glazing; Bleeding On Probing (Moderate inflammation; redness, edema and glazing; bleeding on probing)
CL Item
Severe Inflammation; Marked Redness And Edema; Ulceration; Spontaneous Bleeding (Severe inflammation; marked redness and edema; ulceration; spontaneous bleeding)
Item Group
Inclusion Criteria
PermanentToothDentitionAssessmentInd-2
Item
Does the subject have solely adult dentition
boolean
C38147 (NCI Thesaurus ValueDomain)
C1512698 (UMLS 2011AA ValueDomain)
C25367 (NCI Thesaurus Property)
C13072 (NCI Thesaurus ObjectClass)
C0011443 (UMLS 2011AA ObjectClass)
C33313 (NCI Thesaurus ObjectClass-2)
C0348070 (UMLS 2011AA ObjectClass-2)
PermanentToothCariesPresentInd-4
Item
Are all protocol teeth permanent posterior teeth and present withthe clinical diagnosis of new Class I caries extending into dentinwith or without radiographic confirmation
boolean
C12506 (NCI Thesaurus ObjectClass)
C0040426 (UMLS 2011AA ObjectClass)
C0205355 (NCI Metathesaurus ObjectClass)
C25626 (NCI Thesaurus Property)
C0150312 (UMLS 2011AA Property)
C52593 (NCI Thesaurus Property-2)
C0011334 (UMLS 2011AA Property-2)
CL356172 (NCI Metathesaurus ValueDomain)
ClinicalStudyNoOtherToothEligibilityDeterminationInd-2
Item
Are these the only teeth that meet the eligibility criteria
boolean
C17649 (NCI Thesaurus ObjectClass)
C0205394 (UMLS 2011AA ObjectClass)
C49487 (NCI Thesaurus ObjectClass-2)
C1298908 (UMLS 2011AA ObjectClass-2)
C15206 (NCI Thesaurus ObjectClass-3)
C0008972 (UMLS 2011AA ObjectClass-3)
C12506 (NCI Thesaurus ObjectClass-4)
C0040426 (UMLS 2011AA ObjectClass-4)
C25171 (NCI Thesaurus Property)
C0013893 (UMLS 2011AA Property)
C38147 (NCI Thesaurus ValueDomain)
C1512698 (UMLS 2011AA ValueDomain)
PersonToothIncludeClinicalTrialEligibilityCriteriaInd-2
Item
Are these the only teeth that will be treated (will receive restoration) at this time
boolean
C25190 (NCI Thesaurus ObjectClass)
C0027361 (UMLS 2011AA ObjectClass)
C12506 (NCI Thesaurus Property)
C0040426 (UMLS 2011AA Property)
C16112 (NCI Thesaurus Property-2)
C1516637 (UMLS 2011AA Property-2)
C74521 (NCI Thesaurus Property-3)
C2700399 (UMLS 2011AA Property-3)
C38147 (NCI Thesaurus ValueDomain)
C1512698 (UMLS 2011AA ValueDomain)
Item Group
Inclusion Criteria (cont.1)
Item
Is/Are the radiographic depth(s) of the lesion(s), when visible, less than or equal to half the Dento-Enamel Junction (DEJ) to the pulp
text
C3824 (NCI Thesaurus ObjectClass)
C0221198 (UMLS 2011AA ObjectClass)
C12506 (NCI Thesaurus ObjectClass-2)
C0040426 (UMLS 2011AA ObjectClass-2)
C20989 (NCI Thesaurus Property)
C0031809 (UMLS 2011AA Property)
C25648 (NCI Thesaurus Property-2)
C0439849 (UMLS 2011AA Property-2)
C79874 (NCI Thesaurus Property-3)
C2699427 (UMLS 2011AA Property-3)
C32453 (NCI Thesaurus Property-4)
C0011429 (UMLS 2011AA Property-4)
C32505 (NCI Thesaurus Property-5)
C0011350 (UMLS 2011AA Property-5)
C25180 (NCI Thesaurus ValueDomain)
C1522602 (UMLS 2011AA ValueDomain)
CL.13
Code List
Is/Are the radiographic depth(s) of the lesion(s), when visible, less than or equal to half the Dento-Enamel Junction (DEJ) to the pulp
CL Item
Yes (Yes)
C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)
CL Item
No (No)
CL Item
Not Visible, But Confirmed Clinically (Not visible, but confirmed clinically)
Item
Tooth Number
text
C13072 (NCI Thesaurus ObjectClass)
C0011443 (UMLS 2011AA ObjectClass)
C25337 (NCI Thesaurus Property)
C0237753 (UMLS 2011AA Property)
C25700 (NCI Thesaurus Property-2)
C0449913 (UMLS 2011AA Property-2)
C25162 (NCI Thesaurus ValueDomain)
C0805701 (UMLS 2011AA ValueDomain)
C13072 (NCI Thesaurus ValueDomain-2)
C0011443 (UMLS 2011AA ValueDomain-2)
CL.14
Code List
Tooth Number
CL Item
3rd Molar (wisdom Tooth) Permanent Arch Upper Right (1)
CL Item
Lateral Incisor Permanent Arch Upper Left (10)
CL Item
Cuspid (canine/eye Tooth) Permanent Arch Upper Left (11)
CL Item
1st Bicuspid (1st Premolar) Permanent Arch Upper Left (12)
CL Item
2nd Bicuspid (2nd Premolar) Permanent Arch Upper Left (13)
CL Item
1st Molar (6-yr. Molar) Permanent Arch Upper Left (14)
CL Item
2nd Molar (12-yr. Molar) Permanent Arch Upper Left (15)
CL Item
3rd Molar (wisdom Tooth) Permanent Arch Upper Left (16)
CL Item
3rd Molar (wisdom Tooth) Permanent Arch Lower Left (17)
CL Item
2nd Molar (12-yr. Molar) Permanent Arch Lower Left (18)
CL Item
1st Molar (6-yr. Molar) Permanent Arch Lower Left (19)
CL Item
2nd Molar (12-yr. Molar) Permanent Arch Upper Right (2)
CL Item
2nd Bicuspid (2nd Premolar) Permanent Arch Lower Left (20)
CL Item
1st Bicuspid (1st Premolar) Permanent Arch Lower Left (21)
CL Item
Cuspid (canine/eye Tooth) Permanent Arch Lower Left (22)
CL Item
Lateral Incisor Permanent Arch Lower Left (23)
CL Item
Central Incisor Permanent Arch Lower Left (24)
CL Item
Central Incisor Permanent Arch Lower Right (25)
CL Item
Lateral Incisor Permanent Arch Lower Right (26)
CL Item
Cuspid (canine/eye Tooth) Permanent Arch Lower Right (27)
CL Item
1st Bicuspid (1st Premolar) Permanent Arch Lower Right (28)
CL Item
2nd Bicuspid (2nd Premolar) Permanent Arch Lower Right (29)
CL Item
1st Molar (6-yr. Molar) Permanent Arch Upper Right (3)
CL Item
1st Molar (6-yr. Molar) Permanent Arch Lower Right (30)
CL Item
2nd Molar (12-yr. Molar) Permanent Arch Lower Right (31)
CL Item
3rd Molar (wisdom Tooth) Permanent Arch Lower Right (32)
CL Item
2nd Bicuspid (2nd Premolar) Permanent Arch Upper Right (4)
CL Item
1st Bicuspid (1st Premolar) Permanent Arch Upper Right (5)
CL Item
Supernumerary 3rd Molar (wisdom Tooth) Permanent Arch Upper Right (51)
CL Item
Supernumerary 2nd Molar (12-yr. Molar) Permanent Arch Upper Right (52)
CL Item
Supernumerary 1st Molar (6-yr. Molar) Permanent Arch Upper Right (53)
CL Item
Supernumerary 2nd Bicuspid (2nd Premolar) Permanent Arch Upper Right (54)
CL Item
Supernumerary 1st Bicuspid (1st Premolar) Permanent Arch Upper Right (55)
CL Item
Supernumerary Cuspid (canine/eye Tooth) Permanent Arch Upper Right (56)
CL Item
Supernumerary Lateral Incisor Permanent Arch Upper Right (57)
CL Item
Supernumerary Central Incisor Permanent Arch Upper Right (58)
CL Item
Supernumerary Central Incisor Permanent Arch Upper Left (59)
CL Item
Cuspid (canine/eye Tooth) Permanent Arch Upper Right (6)
CL Item
Supernumerary Lateral Incisor Permanent Arch Upper Left (60)
CL Item
Supernumerary Cuspid (canine/eye Tooth) Permanent Arch Upper Left (61)
CL Item
Supernumerary 1st Bicuspid (1st Premolar) Permanent Arch Upper Left (62)
CL Item
Supernumerary 2nd Bicuspid (2nd Premolar) Permanent Arch Upper Left (63)
CL Item
Supernumerary 1st Molar (6-yr. Molar) Permanent Arch Upper Left (64)
CL Item
Supernumerary 2nd Molar (12-yr. Molar) Permanent Arch Upper Left (65)
CL Item
Supernumerary 3rd Molar (wisdom Tooth) Permanent Arch Upper Left (66)
CL Item
Supernumerary 3rd Molar (wisdom Tooth) Permanent Arch Lower Left (67)
CL Item
Supernumerary 2nd Molar (12-yr. Molar) Permanent Arch Lower Left (68)
CL Item
Supernumerary 1st Molar (6-yr. Molar) Permanent Arch Lower Left (69)
CL Item
Lateral Incisor Permanent Arch Upper Right (7)
CL Item
Supernumerary 2nd Bicuspid (2nd Premolar) Permanent Arch Lower Left (70)
CL Item
Supernumerary 1st Bicuspid (1st Premolar) Permanent Arch Lower Left (71)
CL Item
Supernumerary Cuspid (canine/eye Tooth) Permanent Arch Lower Left (72)
CL Item
Supernumerary Lateral Incisor Permanent Arch Lower Left (73)
CL Item
Supernumerary Central Incisor Permanent Arch Lower Left (74)
CL Item
Supernumerary Central Incisor Permanent Arch Lower Right (75)
CL Item
Supernumerary Lateral Incisor Permanent Arch Lower Right (76)
CL Item
Supernumerary Cuspid (canine/eye Tooth) Permanent Arch Lower Right (77)
CL Item
Supernumerary 1st Bicuspid (1st Premolar) Permanent Arch Lower Right (78)
CL Item
Supernumerary 2nd Bicuspid (2nd Premolar) Permanent Arch Lower Right (79)
CL Item
Central Incisor Permanent Arch Upper Right (8)
CL Item
Supernumerary 1st Molar (6-yr. Molar) Permanent Arch Lower Right (80)
CL Item
Supernumerary 2nd Molar (12-yr. Molar) Permanent Arch Lower Right (81)
CL Item
Supernumerary 3rd Molar (wisdom Tooth) Permanent Arch Lower Right (82)
CL Item
Central Incisor Permanent Arch Upper Left (9)
CL Item
Second Molar Primary Arch Upper Right (A)
CL Item
Supernumerary Second Molar Primary Arch Upper Right (AS)
CL Item
First Molar Primary Arch Upper Right (B)
CL Item
Supernumerary First Molar Primary Arch Upper Right (BS)
CL Item
Canine(cuspid) Primary Arch Upper Right (C)
CL Item
Supernumerary Canine(cuspid) Primary Arch Upper Right (CS)
CL Item
Lateral Incisor Primary Arch Upper Right (D)
CL Item
Supernumerary Lateral Incisor Primary Arch Upper Right (DS)
CL Item
Central Incisor Primary Arch Upper Right (E)
CL Item
Supernumerary Central Incisor Primary Arch Upper Right (ES)
CL Item
Central Incisor Primary Arch Upper Left (F)
CL Item
Supernumerary Central Incisor Primary Arch Upper Left (FS)
CL Item
Lateral Incisor Primary Arch Upper Left (G)
CL Item
Supernumerary Lateral Incisor Primary Arch Upper Left (GS)
CL Item
Canine (cuspid) Primary Arch Upper Left (H)
CL Item
Supernumerary Canine (cuspid) Primary Arch Upper Left (HS)
CL Item
First Molar Primary Arch Upper Left (I)
CL Item
Supernumerary First Molar Primary Arch Upper Left (IS)
CL Item
Second Molar Primary Arch Upper Left (J)
CL Item
Supernumerary Second Molar Primary Arch Upper Left (JS)
CL Item
Second Molar Primary Arch Lower Left (K)
CL Item
Supernumerary Second Molar Primary Arch Lower Left (KS)
CL Item
First Molar Primary Arch Lower Left (L)
CL Item
Supernumerary First Molar Primary Arch Lower Left (LS)
CL Item
Canine (cuspid) Primary Arch Lower Left (M)
CL Item
Supernumerary Canine (cuspid) Primary Arch Lower Left (MS)
CL Item
Lateral Incisor Primary Arch Lower Left (N)
CL Item
Supernumerary Lateral Incisor Primary Arch Lower Left (NS)
CL Item
Central Incisor Primary Arch Lower Left (O)
CL Item
Supernumerary Central Incisor Primary Arch Lower Left (OS)
CL Item
Central Incisor Primary Arch Lower Right (P)
CL Item
Supernumerary Central Incisor Primary Arch Lower Right (PS)
CL Item
Lateral Incisor Primary Arch Lower Right (Q)
CL Item
Supernumerary Lateral Incisor Primary Arch Lower Right (QS)
CL Item
Canine (cuspid) Primary Arch Lower Right (R)
CL Item
Supernumerary Canine (cuspid) Primary Arch Lower Right (RS)
CL Item
First Molar Primary Arch Lower Right (S)
CL Item
Supernumerary First Molar Primary Arch Lower Right (SS)
CL Item
Second Molar Primary Arch Lower Right (T)
CL Item
Supernumerary Second Molar Primary Arch Lower Right (TS)
Item
Tooth quadrant
text
C12506 (NCI Thesaurus ObjectClass)
C0040426 (UMLS 2011AA ObjectClass)
C25341 (NCI Thesaurus Property)
C0450429 (UMLS 2011AA Property)
C12421 (NCI Thesaurus Property-2)
C0226896 (UMLS 2011AA Property-2)
C61106 (NCI Thesaurus Property-3)
C1631280 (UMLS 2011AA Property-3)
C13717 (NCI Thesaurus ValueDomain)
C1515974 (UMLS 2011AA ValueDomain)
CL.15
Code List
Tooth quadrant
CL Item
Upper Right Quadrant (Upper Right)
CL Item
Upper Left Quadrant (Upper Left)
CL Item
Lower Right Quadrant (Lower Right)
CL Item
Lower Left Quadrant (Lower Left)
BitewingRadiographDiagnosticImagingAssessmentDate
Item
What was the date of theradiograph (If yes, - Referring Question is in prior Module Is/Are the radiographic depths of the lesions, when visible, less than or equal to half the Dento-Enamel Junction DEJ to the pulp?)
date
C25164 (NCI Thesaurus ValueDomain)
C0011008 (UMLS 2011AA ValueDomain)
C20989 (NCI Thesaurus Property)
C0031809 (UMLS 2011AA Property)
C16502 (NCI Thesaurus ObjectClass)
C0011923 (UMLS 2011AA ObjectClass)
C62057 (NCI Thesaurus ObjectClass-2)
C1879851 (UMLS 2011AA ObjectClass-2)
Item Group
Inclusion Criteria (cont.2)
ToothNaturalPresentInd-2
Item
Is/Are the protocol tooth/teeth in occlusion with a natural tooth
boolean
C38147 (NCI Thesaurus ValueDomain)
C1512698 (UMLS 2011AA ValueDomain)
C25626 (NCI Thesaurus Property)
C0150312 (UMLS 2011AA Property)
C12506 (NCI Thesaurus ObjectClass)
C0040426 (UMLS 2011AA ObjectClass)
C85060 (NCI Thesaurus Property-2)
C0205296 (UMLS 2011AA Property-2)
Resin-BasedCompositeTherapyStandardPerformedInd-2
Item
Would a resin-based composite restoration be the standard of care for the lesion(s)
boolean
C15368 (NCI Thesaurus ObjectClass)
C52586 (NCI Thesaurus ObjectClass-2)
C1711229 (UMLS 2011AA ObjectClass)
C38000 (NCI Thesaurus Property)
C0884358 (UMLS 2011AA Property)
C44275 (NCI Thesaurus Property-2)
C1442989 (UMLS 2011AA Property-2)
C38147 (NCI Thesaurus ValueDomain)
C1512698 (UMLS 2011AA ValueDomain)
ToothNoPulpitisPresentInd-2
Item
Is/Are the protocol tooth/teeth free of evidence of a pulpitis (no report of lingering pain associated with any stimulus)
boolean
C12506 (NCI Thesaurus ObjectClass)
C0040426 (UMLS 2011AA ObjectClass)
C25626 (NCI Thesaurus Property)
C0150312 (UMLS 2011AA Property)
C49487 (NCI Thesaurus Property-2)
C1298908 (UMLS 2011AA Property-2)
C52595 (NCI Thesaurus Property-3)
C0034103 (UMLS 2011AA Property-3)
C38147 (NCI Thesaurus ValueDomain)
C1512698 (UMLS 2011AA ValueDomain)
PatientFutureFollow-upInd-2
Item
Is the subject available for contact for at least four weeks post-treatment
boolean
C38147 (NCI Thesaurus ValueDomain)
C1512698 (UMLS 2011AA ValueDomain)
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C67527 (NCI Thesaurus Property)
C0016884 (UMLS 2011AA Property)
C16033 (NCI Thesaurus Property-2)
C1522577 (UMLS 2011AA Property-2)
ConsentFormPatientResponsiblePersonSignedInd-2
Item
Has the subject signed and dated the IRB-approved informed consent form or assent form for individuals under 18 years old
boolean
C16468 (NCI Thesaurus ObjectClass)
C0009797 (UMLS 2011AA ObjectClass)
C16960 (NCI Thesaurus Property)
C0030705 (UMLS 2011AA Property)
C25657 (NCI Thesaurus Property-2)
C1273518 (UMLS 2011AA Property-2)
C25679 (NCI Thesaurus Property-3)
C38147 (NCI Thesaurus ValueDomain)
C1512698 (UMLS 2011AA ValueDomain)
InformedConsentFormSignedDate
Item
Date of signed, witnessed, and dated informed consent/assent
date
C25164 (NCI Thesaurus ValueDomain)
C0011008 (UMLS 2011AA ValueDomain)
C25367 (NCI Thesaurus ValueDomain-2)
C16468 (NCI Thesaurus ObjectClass)
C0009797 (UMLS 2011AA ObjectClass)
C25679 (NCI Thesaurus Property)
Item Group
Exclusion Criteria (all Responses Must Be Checked "no" To Be Eligible)
PatientPeriodontalDisorderDiagnosisInd-3
Item
Is/Are the protocol tooth/teeth periodontally involved (mobility of 2 or greater or inflamed gingival tissues)
boolean
C38148 (NCI Thesaurus ValueDomain)
C1512699 (UMLS 2011AA ValueDomain)
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C15220 (NCI Thesaurus Property)
C0011900 (UMLS 2011AA Property)
C63743 (NCI Thesaurus Property-2)
C0031090 (UMLS 2011AA Property-2)
DentalRestorationPresentInd-2
Item
Does/Do the protocol tooth/teeth have existing restoration(s)
boolean
C38147 (NCI Thesaurus ValueDomain)
C1512698 (UMLS 2011AA ValueDomain)
C25626 (NCI Thesaurus Property)
C0150312 (UMLS 2011AA Property)
C60718 (NCI Thesaurus ObjectClass)
C0399059 (UMLS 2011AA ObjectClass)
ToothCrackFracturePresentInd-2
Item
Has/Have the protocol tooth/teeth been clinically assessed to be fractured
boolean
C12506 (NCI Thesaurus ObjectClass)
C0040426 (UMLS 2011AA ObjectClass)
C25626 (NCI Thesaurus Property)
C0150312 (UMLS 2011AA Property)
C52648 (NCI Thesaurus Property-2)
C1706353 (UMLS 2011AA Property-2)
C50777 (NCI Thesaurus Property-3)
C0040441 (UMLS 2011AA Property-3)
C38147 (NCI Thesaurus ValueDomain)
C1512698 (UMLS 2011AA ValueDomain)
AbutmentPresentInd-2
Item
Is/Are the protocol tooth/teeth an abutment(s) for a removable partial denture
boolean
C38147 (NCI Thesaurus ValueDomain)
C1512698 (UMLS 2011AA ValueDomain)
C25626 (NCI Thesaurus Property)
C0150312 (UMLS 2011AA Property)
C66853 (NCI Thesaurus ObjectClass)
C0545406 (UMLS 2011AA ObjectClass)
DentalProfessionalPracticeDentalCalculusPeriodontiumDiagnosisInd-2
Item
Does/Do the protocol tooth/teeth have subgingival calculus(eligible if removed during the treatment visit)
boolean
C41136 (NCI Thesaurus ObjectClass)
C0226984 (UMLS 2011AA ObjectClass)
C52673 (NCI Thesaurus ObjectClass-2)
C0033284 (UMLS 2011AA ObjectClass-2)
C15220 (NCI Thesaurus Property)
C0011900 (UMLS 2011AA Property)
C60715 (NCI Thesaurus Property-2)
C0011330 (UMLS 2011AA Property-2)
C33304 (NCI Thesaurus Property-3)
C0031093 (UMLS 2011AA Property-3)
C38147 (NCI Thesaurus ValueDomain)
C1512698 (UMLS 2011AA ValueDomain)
IntraoralApplianceOrthodonticTreatmentPatientUseInd-2
Item
Is the subject undergoing active orthodontic treatment other than the use of a retainer
boolean
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C64248 (NCI Thesaurus ObjectClass-2)
C0204193 (UMLS 2011AA ObjectClass-2)
C62543 (NCI Thesaurus ObjectClass-3)
C0441330 (UMLS 2011AA ObjectClass-3)
C25340 (NCI Thesaurus Property)
C0457083 (UMLS 2011AA Property)
C38147 (NCI Thesaurus ValueDomain)
C1512698 (UMLS 2011AA ValueDomain)
DentalWhiteningUseInd-2
Item
Is the subject currently enrolled or have they completed in the past month a tooth bleaching program
boolean
C38147 (NCI Thesaurus ValueDomain)
C1512698 (UMLS 2011AA ValueDomain)
C94591 (NCI Thesaurus ObjectClass)
C25340 (NCI Thesaurus Property)
C0457083 (UMLS 2011AA Property)
PersonClinicalStudyAgentHypersensitivityExclusionCriteriaInd-2
Item
Has the subject had a prior reaction or have an inability to tolerate any of the dental products being used (such as severe topical or hypersensitivity reaction)
boolean
C25190 (NCI Thesaurus ObjectClass)
C0027361 (UMLS 2011AA ObjectClass)
C3114 (NCI Thesaurus Property)
C0020517 (UMLS 2011AA Property)
C1708 (NCI Thesaurus Property-2)
C0450442 (UMLS 2011AA Property-2)
C15206 (NCI Thesaurus Property-3)
C0008972 (UMLS 2011AA Property-3)
C25370 (NCI Thesaurus Property-4)
C0680251 (UMLS 2011AA Property-4)
C38147 (NCI Thesaurus ValueDomain)
C1512698 (UMLS 2011AA ValueDomain)
PatientPre-existingConditionImpairmentConsentInd-2
Item
Is the subject under treatment for medical disorders including dementia, Parkinson's disease, severe depression, severe anxiety, and any other medical condition that, in the opinion of the P-I, would affect the subject's judgment of post-operative hypersensitivity and/or ability to understand the informed consent process
boolean
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C54056 (NCI Thesaurus Property)
C0521987 (UMLS 2011AA Property)
C21055 (NCI Thesaurus Property-2)
C0684336 (UMLS 2011AA Property-2)
C25460 (NCI Thesaurus Property-3)
C1511481 (UMLS 2011AA Property-3)
C38147 (NCI Thesaurus ValueDomain)
C1512698 (UMLS 2011AA ValueDomain)
PatientOtherDentalClinicalStudyEnrollmentInd-2
Item
Is the subject in another ongoing dental research study
boolean
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C17649 (NCI Thesaurus Property)
C0205394 (UMLS 2011AA Property)
C41136 (NCI Thesaurus Property-2)
C0226984 (UMLS 2011AA Property-2)
C15206 (NCI Thesaurus Property-3)
C0008972 (UMLS 2011AA Property-3)
C37948 (NCI Thesaurus Property-4)
C1516879 (UMLS 2011AA Property-4)
C38147 (NCI Thesaurus ValueDomain)
C1512698 (UMLS 2011AA ValueDomain)
Item Group
Footer Module
Item
Preferred method of contact
text
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C25461 (NCI Thesaurus ObjectClass-2)
C0337611 (UMLS 2011AA ObjectClass-2)
C16847 (NCI Thesaurus Property)
C0449851 (UMLS 2011AA Property)
C42711 (NCI Thesaurus Property-2)
C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
CL.31
Code List
Preferred method of contact
CL Item
E-mail (E-mail)
C25170 (NCI Thesaurus)
C0013849 (UMLS 2011AA)
CL Item
Telephone (Phone)
C25395 (NCI Thesaurus)
C0039457 (UMLS 2011AA)
Research Comments
Item
Comments
text
C25704 (NCI Thesaurus ValueDomain)
C0947611 (UMLS CUI-1)
C15319 (NCI Thesaurus ObjectClass)
C25393 (NCI Thesaurus Property)
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