Privileging - Dentist and Dental Hygienist

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Check the boxes next to the privileges you seek.

Oral examinationIntraoral radiographsExtraoral radiographsPulp vitality testsDiagnostic castsDiagnostic laboratory testDental sealantsOral prophylaxisOral hygiene instructionsSpace maintainersTopical fluoride applicationOperative restorativesStainless steel crownsAnterior root canal therapyBicuspid root canal therapyMolar root canal therapyEndodontic surgeryPulpotomyPulpectomyBleaching of discolored teethMucogingival surgeryOsseous surgeryOsseous graftFree soft-tissue graftSplintingOcclusal adjustment - limitedOcclusal adjustment - completeSpecial periodontal appliancesPeriodontal scaling and root planningGingival curettageGingival flap procedureComplete denturesImmediate denturesPartial denturesObturator for cleft palateOverdenture complete/partialRelines and repairs to denturesCrownsBridgesRoots and coreBridge repairsRoutine tooth extractionSurgical extraction of erupted toothSurgical extraction tissue impactionSurgical extraction bone impactionSurgical extraction impaction requiring section of toothResidual root recovery by surgeryOral antral fistula closureTooth replantationSurgical exposure of impacted of unerrupted tooth to aid eruptionBiopsy of oral tissues - hardBiopsy of oral tissues - softAlveoloplasty per quadrant in conjunction with extractionsRemoval of lesion by physical methodsMaxilla closed reduction teeth immobilizedMandible closed reductionAlveolus stabilization of teeth, splintingClosed reduction of TMJ dislocationFrenulectomyEstablish emergency airwaySuturing of traumatic wounds - intraoralSuturing of traumatic wounds - extraoralExtraction of a permanent tooth for orthodontic treatmentPharmacological anxiety controlConscious sedationOral conscious sedationIM conscious sedationRectal conscious sedationIV sedationPrescription of Schedule III-V substancesPrescription of Schedule II substancesMedical translation (enter language)

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Comments/concerns:

I attest that I have appropriate training, competence, experience, and comfort level for each privilege requested.

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