- ,: • ........

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i

DUH CENTRAL L1BffARY

SAN LAlAilO COMPOUND Ir\ANIIJ

! STANDA~
~OR,
Ule SG 00
i DENT L E.~\"" H
. SERV\Ce,S I

1115.44
S123 ..

. -- --- -

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 i
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DOH CENT~Al lIBRAR'f
FOREWORD ~llN ~A2MO COMPOUND MAHII.'
I
M; rl<> '-Zwo in +,no hi story picountry haA tI\o Pi lipino
~Q

child been given so ~h conaern and attention than now. In the

Child and Youth Welfare Code enunciated by his Excellency,
fERDINAND E. MARCOS last December 10, 1974 herein quoted:
"The child is one cf the most important asset of the
nation. Every effort should be :exerted to promote hi s .
welfare and enhance his opportunity for a useful and
happy life" and furtheli he stated: ''Every child has
the right to the care, assistance and protection of the
state ••••• ". "It shall be the responsibi li ty of the
health, welfare and educational entities to assist the'
parents in looking aft~r the health of the child".
. ., ;
By this token, the Ministries of Health and Education and
Culture have joined hands to muster their resources and reinforce
each other. to spread the umbrella of health protection to the
Filipino child and youth. Withiri the interlocking relationships
of two governmental agencies considered most significant is ~e
Memorandwi of Agreemept entered4into by the Ministry of~HealtH
with the M~nistry of ~ducation and Culture to formulate a dental
health program gUideline and a minimum standards for Public
SchQ.ol Dental Haa Lth. ,Services, The Standards Divi si0t! of the Bu- .
reau of Dental Health Services with the cooperation of the
School Dental Healtp Sllrvices of the Ministry of Educpti9n and
Culture as implemeniors of the program and users of the standards,
formulated the 'guidelines and standards.
• further by
The Bureau of Dental Health Services has taken a step
including the out-of-school youth into its National Dental Health
Program and by directing stronger emphasis towards the pre-school
child to give more meaning to the Code.

It goes wi thout saying that the Standards of Dental Health

Services Manual is only as good as its relevance and timeliness but
must be responsive ~ th the changes and circumstances in time hence
allowing certain fleXibility.

This humble piece of work, a product of cooperative efforts,

is sincerely dedicated to the Public School Dentist, the School
Health Administrators and the young people they serve.

JUNE 1980 GUI LlE.RNO F. JULI A!'K)

Director

Department of Health

1 I/~1~l l liJIII/!! /1/1

D516
H15.44 5t231 Standards for public school denial health services
 AO<N:lWLElXlEivENTS
.
The preparation of the minimum standard of dental health ser-
vices for public schools is an investment of resources both material
and human talents but more significantly is the sincerity, goodwill
and openness that flowed into the work so necessary to bridge the
understanding among the working group drawn from the Ministries of
Health and Education and Culture.
Pursuant to Section 14 of '"Letter of Implementation No. 8 rela-
tive to Part XVI of Presidential Decree No.1 on Health and in ac-
cordance with the Memorandum of Agreement between the Ministry of
Health and the Ministry of Education and Culture signed on July 9,
1979, the Standards Division of the Bureau of Dental Health Services
formulated a minimum standard for public school dental health ser-
vices.
This piece of work could not have been put together had it not
been for the ,collective efforts of a number of people who worked in
earnest to see this manual in its final form. Foremost among those
who gave encouragement and support are the ulini sters of both the
Ministries of Health and Education and Culturel
<XlNSULTATIVE STAFF I
GUILlERIvD F. JULIAtD, DDM, MPH, csso II SILVINA LAYA, ssi, MA, MPA
Director Executive Director
Bureau of Dental Health Services School Health & Nutrition Center
Ministry of Health Ministry 'of Education & Culture

PACIENCIA L. MIRAVIlE, DDM, MPH ABE. LARIX) IE lEON, DMD

Dental Health Advi ser Senior Education Researcher
Office of the l~inister Secretary, Council on Dental
Ministry of Health Education
Ministry of Education & Culture
S1'EERII-I::> <XlMMITlEE I

MANtEL L. GARCIA, DDM, CPH - - - - - - - Chairman

Chief, Standards Division
Bureau of Dental Health Services
Ministry of Health
LUIS ALFIIER, DMD, DDPH - - - - - - - - Co-Chairman
Chief, Dental Service Officer I
Ministry of Education & Culture
LYDIA P. VILLAFANIA, DDM - - - - - - - - Rapporteur
Supervising·Staff Dentist
(School Dental Health Services)
StandardS Division
Bureau of Dental Health Services
Ministry of Health
 - 2 -

Ministry of Education a. Culture: Mipistry of Healthl

.. ROlXlLR:> DE GUIA, DMD
Senior Training Officer
BE.NI1l)A T. O)RPUS DDM, CPH
Chief, 'Research i5! vision
Bureau of Dental Health Services
ALBINO GIEVARA, DMD, CPH . VICIDR R. VAI.l:EZ, DDM, CPH, DDPH
Supervising Dentist Chief, Dental Prosthetic Labora-
tory Licensure Section
Standards Division
Bureau of Dental Health Services
OONIFACIO CABIGTING, DMD MARCE.LINA T. PANGAN, DDM
Supervising Dentist Supervising Staff Dentist
Region 3 (Hospital Dental Services)
Standards Di vi sion
Bureau of Dental Health Services
ESTRliLLA SABJ\RRE. DMD FELICITAS E.. ALCANTARA, DDA4 CPH.M:lH
Senior Dentist Supervising Staff Dentist
Region 4 (Occupational Dental Health Ser-
vices)
Standards Division
Bureau 0 f Dental Health Services
LILIA A. DlMAGIBA, DDM,01Ed, DDPH
Staff Denti st
Standards Division
Bureau of Dental Health Services
All Regional Dental Coordinators
& Supervising Dentists

TYPISTS:
Mr. SAMroN F. ESIDLAS
Clerk II

Mrs. ERLINDA C. ALVIE'.NID

Clerical Aide
 TABlE OF (DN1E.N1.S

FORE-WORD • • • • • • • • • • • • • • • • • • • •• Hi
Ao<r-oWLEIX;E.r£NT • • ...
• • • • • • • • • •• v
s:.CTION 1.
Title • • • • • . .... . . .. .... . ..... 1

. . . . . . . . . . . .. . . . . . . .
s:..CTrON 2. • •
Scope ••••• ~ 1
s:.CTrClN 3.
Definition of Terms •• · . . . . . . • • • • • • • • • •
• • • 1
s:.CTrON 4.
Type, Scope, Quality of Dental Health
Services and Priorities • • • • • • • • • • • • • • • • • • • • 7
s:.CTION 5.
Qualification, Recruitment. Selection,
Appointment, Promotion and Assignment of
Dental Personnel • . . . . . • . . . . . . • . . . • . . . . 10
s:.CTrON 6.
Dental Training Policies . . • • • • • • • • • • • • • • • • • 16
s:.CTrON 7.
Requisition, Procurement and Distribution
of Dental Equipment, Supplies and Materials • • • • • • • • • • 17
s:.CTION 8.
Professional Logistics • • • • . • • • • • • • • • • • . • • • 20
s:.CTION 9.
Standard Methods of Recording and Reporting • • • • • • • • • • 25
s:.CTrON 10.
BUdget Preparation for Public Schools Dental Services • • • • • 30
s:.CTION 11.
Dental Research Projects • • • • . . • • • • • . • . • • . • • 31

fo
 - 2 -

s:.CI'ION 12.
Evaluation Procedures . . . . . . . .. . . . . . . . . . .. . 32
reCTION 13,
Effectivity ••..••...•••.••••••• • • • • 34
APPENDICES
Appendix 1 - Levels of Dental Care
Appendix 2 - Minimum Standard Dental Equopment end Instrumonts
Appendix 3 - Schedule for Maintenance Care of Equipment
Appendix 4 & 4 A - Standard Arrangement of School Dental Clinic
Appendix 5 - Minimum Standards for Medicines, Dental
Supplies and Materials
Appendix 6 - Amendment to Section 622 of the Service Manual
Relative to Relation to Sexes
Appendix 7 - Permission Slip
Appendix ~ - Technic for Certain Clinical Procedures
Appendix 9 BOOS Form I
Appendix 10 - Instruction for Accomplishing BDHS Revised Form I
Appendix 11 - Criteria for the Assessment and Recording of
Oral Diseases (WHO Technical Report Series No. 242)
Appendix 12 - Dental Diseases and Services Report Format
. Appendix
AppendiX
12-A - Instruction for Accomplishing BDHS Form 2
13 - Report of Dental Medicines and Supplies
AppendiX 14 - Monthly Narrative Report of Rural/City/Provincial
Dentists
AppendiX 15 - Referral Slip
r.El.oRANDUM OF AGREE,ENT IEW/EEN mE t.oH and r.EC
 Republic of the Philippines
Ministry of Health
OFFICE OF THE MINISJER
Man i 1 a

June 13, 1980

ADMINISTRATIVE ORDER
NO. 90-B, s. 1980
10 The Technical Staff, Bureau Directors, Chiefs
of Offices, Regional Health Directors, Pro-
vincial Health Officers, City Health Officers,
Chiefs of Hospitals and all others concerned.

SUBJECT Policies. Standards and Guidelines for Public

Schools Dental Health Services

Pursuant to Section 14 of Letter of Implementation No. 8 relative to

Part XVI ·of Presidential Decree No.1 on Health and in accordance with
the Memorandum Agreement between the Ministry of Health and the Mi-
nistry of Education and Culture signed on July 9, 1979 and for effective
functional supervision and coordination of public schools dental health
program wi til the total health program of the Ministry of Health and
the Regional Health Offices, the policies, standards and guidelines
for Public Schools Dental Health Services are hereby prescribed and
promulgated for strict compliance of all concerned•

. Section 1. Ii tle. - It shall be known as Policies, Standards and

Guide lines for Public Schools Dental Health Services.
Section 2. Scope. - The policies, standards and gUidelines embodied
herein shall apply to public schools in· the Philippines required to
provide dental health services to pupils andVor students.
Section 3. Definition of Terms. -
3.1 Common Terminologies:
3.1.1 Dental Health Services - refers to all categories of acti-
, vi ties provided by the Rural, Hospi tal, Public and Pri vate
Schools, and Occupational Dental Health Services.
3.1.2 Direct Services - refers only to a particular type of
service directly provided by a dentist and shall exclude
referred case s,

3.1.3 Standard - is a yardstick, an accepted norm which is set

up and established by authority, (the Bureau of Dental .
Health Services) from which to measure and compare per-
formance or service in order to regulate and improve
quality. This shall refer to the minimum standard re-
quirements enumerated in this order.
 - 2 -

• 3.1.4 Quill ty - is the chllracter, nature and attribute of an

item that describes or measures its standards of ex-
cellence. For purposes of evaluation in dental public
health, quality and quantity always go together.
3.1.4.1 Quality of dental care in dental public health
is measured in terms of the dimensions which
are prerequisites of the end products.
3.1.5 Quantity - is a measure, dimension or aspect of an
activity, structure and item expressed in number, amount
and volume.

3.1.6 Dental Public Health - is the science and art of pre-

venting and controlling dental diseases and promoting
dental health through organized community efforts.

3.1.7 Preventive Services - consists of measures that are

instituted before any clinical signs or ~. of dental
diseases ap~! These refer to the ~ary.level of pr~
. n ana
3.1.8 ~tR Promo 10n lnc~u~s tJfe~ication ~easures
ude e th an & spe C pr'~:I..tlDe

which contribute to the protection and maintenance of

total health of the community to its maximum potential.
3.1.9 Specific protection includes measures that are applied
to prevent or intercept the onset of a particular dental
or oral disease or condition.
Example: Fluoridization, Fluoridation, (Preventive
Orthodontics) Mouthguards for athletes,
specific protection against occupational
diseases affecting the oral cavity in
industries, some being defined as followsl

3.1.9.1 Fluoridization - is the topical application

of fluoride solution on the coronal surface
of the tooth to reduce incidence of new carious
lesions using accepted technics.
3.1.9.2 Fluoridation - is the introduction of fluoride
ion in the communal water supply in amount
sufficient enough to reduce incidence of dental
caries and not to produce objectionable
mottling.
3.1.9.3 Preventive Orthodontics - is action taken to
preserve the integrity of what appears to be
normal occlusion at a specific time or anything
that would change the normal course of events.
Exan pl es Placement of space maintainers and
restoration of proximal caries •
•1.13.1.10 Curative Services are remedial measures applied to arrest
the progress of a dental disease andVor correct abnormal
oral condition in order to restore health. Theso services
include fillings, extraction, etc,
 - 3 -

3.1.11 Emergency Dental Treatment - means any treatment of

dental ailment or condition that may impair the academic
activity of the students during school hours.
3.1.12 Dental or Oral Examination - is the chacking of the
oral cavity by school ?eQtist t9 detect and diagn9se
oral diseases and cond~t~ons, w~th the use of pla~n
mouth mirror and explorer under good natural daylight
or artificial light.
3.1.13 Dental Prophylaxis - refers to scaling of calculus
anq(or debris when present and polishing of the teeth
to smoothen rough surfaces and remove stains with the
use of prophylactic brush or rubber cup and a cleansing
agent.
3.1.14 Fillings - refer to restored cavities with permanent
filling material unless otherwise specified as tem-
porary fillings.
3.1.15 Exodontia - is that branch of oral surgery which deals
with the removal of tooth.
3.1.16 Dental Caries - (clinical caries) is the stage of
cavitation in the process of dental caries, charac-
terized by undermined enamel or a breakdown in the
walls of the pits and fi·ssures and softened cavi ty
floor detec ted by the use of plain mouth mirror, No. 1
explorer under natural or artificial light.
3.1.17 Chairside InGtruetion • cQnsists of oral and written
advise given to the indiv1dual patient concurrent with
dental treatment or consultation and includes infor-
mation to promote his oral health. It als0 includes
pre-operative and post-operative instruction and
advice to achieve full cooperation of the patient
with regard to the dental treatment given.
3.1.18 Oral Hygiene - refers to the general care exercised
to amintain optimum oral health. It includes among
others, too~hbrushing, flossing, gum massage, use of
detersive food and usc of mouthwashes.
3.1.19 A Dental Case - refers to a person registered and given
dental service in a dental clinic.

3.1.20 Evaluation - is a process of measuring the effective-

ness of any effort of the service in terms of input
and output as in dimension of quality and quantity.
"It· reveals the strength and weakness of a program,
performances, methods and technics, and provides in-
formation in revising specific objectives, developing
new learning experience and improving methods and
materials, equipment and finances".
 - 4 -

3.2 Terminologies applicable to the operational use of Public Schools

Dental Health Services:

3.2.1 Public School Dental Health Services - refers to all the

activities of the public school dentists in promoting and
maintaining the dental health of school children and/or
students.
3.2.2 Public School Dentist - (Dentist I) Dentist employed by
the government to render dental health services to school
children and/or students in public schools.
3.2.3 Pre-grade School Children - refers to children below
seven years old schooling in public school preparatory
to admission for Grade I.
3.2.4 Class A - Children having no dental defects, but needing
only prophylaxis and advice.
3.2.~ Class B - Children having minor dental defects.
3.2.6 Class C - Children with serious dental defects.
3.2.7 Nutrition Education - is a tool/vehicle that trnaslates
and brings nutrition knowledge into practice by the
learners or population.
3.2.8 Public Schools - All schools (elementary, secondary
and tertiary levels) funded by the government, both
national or local.
3.2.9 Kindergarten Schools - all schools offering educational
instructions to children below seven years old.
3.2.10 Parents Teachers Association - an organization of parents
and teachers in a particular school whose purpose is to
find ways and means of improving school fac~lities and
classroom instruction.
3.2.11 Senior Dentist - the keyman in the management of public
schools dental health services in the provincial and/or
city level who is designated as school division dental
supcrvi sor ,

3.2.12 Public School Supervising Dentist - is a Ministry of

Education and Culture regional personnel authorized to
exercise technical supervision over public schools
dental health services.
3.2.13 Dental Health Education - is the process of transmitting
all experiences which influences knowledge, attitudes
and practices into favorable dental habits,

3.2.14 Incremental Dental Care - is complete initial dental

care to children starting at an early age level by caring
for all dental treatment needs and thereijfter by a yearly
follow-up to maintain their oral health by treating de-
fects that has occurred in time.
 - 5 -

3.2.15 Complete Dental Care - refers to the preventive and

curative services an individual needs until all his
dental defects shall have been corrected and his oral
health maintained. It shall include direct services
~. as dental prophylaxis, application of fluoride (fluo-
ridization) filling of restorable cavities and ex-
traction of unsavable teeth. It shall include further,
indirect services such as referral and follow-through
of dental clinical cases which can not be coped with
by facilities available in the public school dental
clinic. Such dental clinical cases should receive the
necessary care needed.

3.2.16 Basic Research - research directed primarily towards

developing new or full scientific knowled~e or under-
standing of the subject rather than practlcal applica-
tion thereof.

3.2.17 Applied Research - research directed towards practical

application of new knowledge.
3.2.18 Dental Epidemiological Investigation - includes studies
of the natural occurrence of dental and oral diseases and
the factors which affect the occurrence of these di-
seases in population group.

Section 4. Type. Scope. Quality of Dental Health Service and Priorities

4.1 Types of Dental Health Services
The public school dental health services shall provide promotive,
preventive and curative services to the school population. How-
ever, it shall be the responsibility of the public school dentist
that cases not within the scope of the service should be referred
and followed up to ensure that the school children actually re-
ceive the treatment they need through an effective referral and
follow-up system.
4.2 Scope of Services
The scope of direct service shall include the followingl

4.2.1 Promotive Servicesl

4.2.1.1 Promotion of oral health includes activities
in dental health education specifically in oral
hygiene, good standard of nutrition, diet plan-
ning and periodic screening and inspection thru
individual and group approaches using health
education tools and audiovisual aids such aSI
dental eXhibits, posters, slogans promoting
dental health.
 - 6 -

4.2.2 Preventive Services$

4.2.2.1 Specific Protection - examination of teeth and
investing tissues, oral prophylaxis and appli-
cation of fluorides topically or systemically
using acceptable methods, technics in routine
procedure for children in the pre-grade and
elementary; proper method of toothbrushing
should be developed as a habit in school child-
ren; dietary control for individuals with rampant
dental caries; interceptive orthodontics when in-
dicated thru referrals.
4.2.3 Curative Servicesl

4.2.3.1 Oral examination for early diagnosis and prompt

treatment of oral diseases and conditions.

4~2.3.2 Emergency Dental Treatment - refers to any treatment

of dental ailments or conditions that may impair
the academic activity of the students during
school hours.

, /
. Emergency treatment may include among othersl
a. Dental pain - treatment may be in the form
of prescription of analgesic, anodyne dress-
ing, temporary fillings, removal of temporary
or permanent fi lUng and extraction.
,
b. Temporary cementation of the dislodged fixed
bridges.
c. Traumatic injuries suffered within the school
premises (first aid treatment only).
d. Control of secondary or post-extracUon
hemorrhage.
4.2.3.3 Prompt referral and follow-through of oral cancer
and handicapping labio-lingual deviations.
4.2.3.4 Oral prophylaxis when necessary for gingivitis
or other periodontal diseases.
4.2.3.5 Prompt treatment or fillings of carious but still
restorable tooth surfaces.

4.2.3.6 Extraction of unsavable teeth.

4.2.4 Referral and follow-up
The public school dentist should develop an effective
referral system for cases not within the scope of the
serVice, to include the follow-up services to ensure
.~ that children are actually seen and treated by private
dental practitioners •

..
, .
 - 7 -

4.3 Quality of Dental Care

The public school dentist shall see tc it that the quality of
service rendered in their clinics is the highest degree possible.
However, viewed in the perspective of public health, quality has
to be equated with adequacy in relation to first, second and
fourth levels of care. The :ollowing recommendations are for
the purpose of providing a guide to the agreed-upon-quality of
work tc be attained.
-.--.
4.3.1 Levels of care expe~ed from the service: Accepted ratio
of 115,000. Refer to App~ndix I.
Types of Service Level of Care Targeted Goals
10IER ACl:. GRO UP
DJR ECT ffiRVlCE

Promotion of Oral 4th level 80-100% total po-

Heal th
Specific Protection
Curative Service
pulation are given
the service
4th level 60-80% of total
population are
given the service
70-80% of '(oungest
age group pre-grad~
to 4th grade levels)
are given the ser-
vice
1st level 90-100% of all fill-
ings meets the stand-
ara requirements
2nd level 60-70% are completed
cases

REFERRE.D ~VlCE

Curative Service 2nd level 50-70% of total po-

pulation referred
are completed cases
High SchoolLeve~Vo­
cationa~College/
Universi ty
DIRECT SiRVlCE 1st level fl?il~&o~ct~tgeets
REFERRED SmvICE the standard requiremems
Curati ve Service 2nd level 40-60% of total po-
pulation referred
are completed cases
 -8-

4.4 Priori ties

Guided by the basic principles in determining priorities, i.e.
where and when the service can be most effective to the greatest
number at minimum cost, the priorities of the service are es-
tablished in the following order:

Target Groups -
a. Pre-grade school children, ages 3-6 years
b. Elementary school children
c. Secondary and vocational students

Section 5. Qualification. Recruitment. Selection. Appointment,

Promotion and Assignment of Dental Personnel

5.1 Qualifications:
5.1.1 Qualifications of a Regional Supervising Dentist:

- The same educational requirement for Senior Dentist

- At least five (5) years as Senior Dentist
- Before taking ove~ his duties, he must have satisfactorily
completed the required In-service Training COurse for
Supervising Dentist
- Must have undergone or attended a course in middle
management
- Must possess a good moral character certified by his
immediate superiors.
5.1.2 Qualifications of a Senior Dentist:
- The same educational requirements for Dentist I; satis-
factorily completed a post-graduate training on·Dental
Public Health, or its equivalent, taken in any authorized
insti tution
- At least five (5) years experience as Dentist I
- Before taking over his duties, he must have satisfactorily
completed the reqUired In-Service training course for
Senior Denti st
- l~ust have good moral character certified by his immediate
superd or-,

5.1.3 Qualifications of Public School Dentist: (Dentist I)

- Must be a graduate of a recognized dental school and have
passed the examination gi ven by the Board of Dental Exa-
miners of the Professional Regulation Commission.
Must possess the certificate of eligibility under
Republic Act 1080
Must possess proofs of his physical fitness in a health
examination performed by a governn~nt physician.
Must be of good moral character certified by at least
three me~hers of the dental profession.
I,·!ust be a bonafide member of the Philippine Dental Asso-
ciation, and the Ministry of Education and Culture Den-
tists Association
- Must have undergone at least two (2) weeks Orientation
Training given for public school dentists.
 - 9 -

5.1,4 Qualific~tions of a Dental Aidel

- A Dental Aide should be a male
He must be at least a high school graduate
He should be at least 18 years of age and not over 40 years
He should be morally and physically fit, examined and
certified by a government physician
He must have undergone orientation given for a Dental Aide.
5.2 Recrur tment:
5.2.1 Dental personnel of the Ministry of Education and Culture
shall be appointed by the i~inister of Education and Culture
Regional Director regardless of source of funds subject
to Civil Service Rules and Regulations and the Office of
Compensation and Position Classification.
5.2.2 It shall be the responsibility of th~ provincial and/or
City Schools Superintendent that only the best fitted
meeting the minimum qualification requirement Shall be
recommended for appointment and/or promotion to positions
in the school dental services subject to the approval of
the NEC Regional Director.

5.2.3 No dentist shall be appointed to the posit:on of Dental

Aide.
5.2.4 Dentist I who Inll be promoted to the rank of Senior Den-
tist or its equivalent should have completed satisfactorily
at least one-year post-graduate course in dental public
health in addition to other qualification requirements of
the position anqlor its equivalent.
5.2.5 Dentist I appointed to the position of Senior Dentist or
its equivalent without postgraduate degree in dental public
health prior to the issuance of this policy shall be re-
quired to complete satisfactorily a one-year postgraduate
course in dental public health and/or its equivalent.

5.3 Assignment of Public School Dentist-

Priority shall be given to under served and unserved areas.
5.4 The applicable provisions on qualifications, recruitments, selec-
tion and minimum qualification and training requirements for
appointment and promotion for public school dental personnel
as contained in the Standards Manual for Public School Dental
Services set forth herein and above which are not inconsistent
with the above policies shall continue to have full force and
effect.

5.5 Functions of a SuperVising Dentistl

5.5.1 Implement policies and standards
5.5.2 Establish and maintain effective working relationship
 - 10 -

5.5.3 Apprise regularly the ,~C Region~l Director on school

dental health services
5.5.4 Exercise technical supervision over school dental hoalth
services in the region
5.5.5 Evaluate standard services of the region
5.5.6 Submit regular report to the Chief Dental Service Officer,
NEC, Manila
5.5.7 Maintain a system of requisition and supply
5.5.8 Prepares and submits budgetary proposals to operate and
maintain the school dental health service and program
in his region. ~ecommend budget for the school dental
health services in the region.
5.6 Functions of a Senior Dentist:
5.6.1 Exercise technical su~rvision over all public school
dental health units operating in the division
5.6.2 Attend conferences or meetings of the division
5.6.3 Coordinata other school health program in the division

5.6.4 Acts as a Liaison Officer between the division and the

MEC Regional Office
5.6.5 Conduct and submit periodic evaluation report
5.6.6 Apprises regularly the Division Superintendent on matters
pertaining to the operation of the service and gives ad-
vice and guidance to public school dentist who encountered
problems in connection with their field service
5.6.7 Call for conference or meeting of school dental personnel
whenever necessary

5.6.8 Assess and recommend training needs

5.6.9 Advisor to school superintendent on matters pertaining to
dental health services

5.6.10 Consolidate requisition of supplies and medicines for sub-

mission to I~C Regional Office.
5.7 Functions of Public School Dentist (Dentist I)
5.7.1 Operate and maintain a dental clinic for treating school
children
5.7.2 Prepare the itinerary of visits in consultation with the
Senior Dentist to be approved by the Superintendent of Schools.
In case of any change in the schedule, senior dentist and
the office of the school superintendent shall be duly
notified
 - 11 -

5.7.3 Perform ocular inspection to children for case classification

A, B, C, to meet the following objectives:
- To give priority to those in great need of immediate
dental treatment
- To give dental inspection to all pupils in the school.
- To give dentist opportunity to visit each class and have
individual contact with each child and teachers in the
school.
5.7.4 Initiate and develop, implement and evaluate preventive
and curative programs with the help of school personnel
andVor officials.

5.7.5 Initiate and develop with the help of school personnel the
habi t of toothbrushing among school children.
5.7.6 Give routine chairside instruction to patients treated
in the school dental c Hnic
5.7.7 Provide timely dental treatment such as filling of inci-
pient but clinically detectable carious lesion and ex-
traction of unsavable teeth.
5.7.8 Initiate, develop and maintain an effective referral and
follow-up system to ensure that children are seen and
treated by the family dentist or other private
practitioners.
5.7.9 Requisition dental supplies and medicine necessary to
maintain the operation of the functional dental clinic
and Inth the view to observe economy.
5.7.10 Cooperate with other school officials in all phases per-
taining to health and organizes group discussion with
teachers and parents and provide them with authentic
dental information that will be taught to children.
5.7.11 Supervise the dental aide in the performance of his duties.
5.7.12 Coordinate with PTA Officials, civic and other professional
organization in the community and maintain a healthy
inter-personal relation with them.

5.7.13 Observe strictly the prescribed office hours and keep the
records up-to-date.

5.7.14 Evaluate the school dental health program.

5.8 Functions of a Dental Aide:

5.8.1 Assist the dentist in the clinic
5.8.2 Sterilize dental instruments
5.8.3 Take charge of safekeeping and proper storage of dental
equipment, materials and supplies.
 - 12 -

5.8.4 Maintain and keep records in order

5.8.5 Perform other duties that may be assigned by the dentist
from time to time.
Section 6. Dental Training Policies -
6.1 Training and staff development programs for public school dental
personnel shall be initiated and organized by the Dental Training
Officer of the Regional Health Office and Regional Health Training
Center, Ministry of Health.
6.2 In the absence of a I£C Dental Training Officer in the Regional
Office, the t£C Regional Director shall designate the Regional
Supervising Dentist, in addition to his regular duties, to take
charge of planning and coordinating training programs in the
regional level Inth the training staff of the Regional Health
Training Office.
6.3 Training Requirements

6.3.1 Orientation Training Course - School dental p~rsonnel

who are entering the service and those who are already
in the service but have not undergone Orientation Training
shall be required to undergo the prescribed course.

6.3.1.1 For the Senior and Regional Supervising Dentists:

1) Management of dental health program in the
public school dental health services
2
3
l Dental health program planning
Public and human relations
4) Supervisory skills
5) Duties and responsibilities of the supervisor
6) Inter-personal and inter-professional relations
7) Principles of health education and communications
8) Cultural-social changes and its implication to
dental health .
9) Research and evaluation
10) Performance Appraisal System
6.3.1.2 For Public School Dentist (Dentist I)
Period of Training
One (1) week classroom
One (1) week field training

Contents of Training Course for Public School

Dentist -
Classroom -

1) Filipino Culture and Society

2) Organizational set-up of the Ministry of Education
and.Culture/Ministry of Health
 - 13 -

Civil Service Rulos and Regulations

Roles of the Public SChool Dertal Health
Service
Basic Principles of Dental Public Health
Principles and concept of Health Education,
Methods, Tools and Approaches
7) Policies, guidelines and standards on public
school dental health services
8) Preventive Dentistry
9) Recording and Reporting System
10) Evaluation
6.3.1.3 For Dental Aidesl
1) Objectives and organizational set-up of the
service
2) Personnel Policies, Civil service Rules and
Regulations
3) Introduction to his job, duties and
standard clinic procedures
4) Working relations with school children,
dentist, personnel and parents
5) Basic dental health education and information
6) Toothbrushing technic and other preventive
measures
7) Identification use and maintenance of dental
equipment and instruments

Section 7. Requisition, ?rocuremGnt and Distribu~ion Qf Dental Eguipment.

Suppl~__a.n£Materials. -
7.1 In order to maintain adequate standards of public school dental
health services in the regional offices, the ~C Regional Director,
subject to a change of policy as enunciated by the Nlinister of
Education and Culture, shall be responsible' for the requisition,
procurement of dental equipment, supplies and materials and their
distribution in the various operating dental units within their
jurisdiction in accordance with the following guidelinesl
7.2 Requisition-

7.2.1 The M3.C Regional SUP'lrvising Dentist shall maintain a

regular schedule of requisition of dental equipment, sup-
plies and materials based on needs of the dental service
to last for at least three (3) months, as recommended by
the Senior Dentist andVor Division Dental Supervisor.

7.2.2 The type, quality and quantity of equi~nent, and instruments

to be requisitioned shall conform with the minimum standard
requirements established by the Bureau of Dental Health
Services as listed in Appendix 2, Standards Manual, BDHS,1970•

." 7.3 Procurement-

7.31. The Supply Officer of the I£C Regional Office shall be
responsible for the procurement of dental equipment,
supplies and materials in accordance with specifications
indicated in the RIV and existing rules and regulations
on audit •

•
 - 14 -

7.3.2 The NEC Regicnal Director shall create a Technical Inspection

Committee headed by the I~C Regional Supervising Dentist to
certify as to compliance with technical specifications of
dental equipment, medicines and materials procured.

7.4 Distribution-
7.4.1 Proper distribution of equopment ap.d supplies to various
dental units in the school division is the responsibility
of the Supply Officer in accordance with the di stribution
guidelines of the I~C Supervising Dentist.
7.4.2 The Senior Dentist andVor Division Dental Supervisor shall
estimate the average amount of dental medicines and supplies
consumed by the school dentist for a period of three (3)
months based on his monthly dental diseases and services
report and dental medicines and supply report.
7.5 Care of eqUipment is the responsibility of the dentist. A suggested
guide for maintenance of equipment is reco~nended to avoid disrup-
tion of service due to unexpected breakrlown (Appendix 3). Dentists
are required to order a replac emant with a re~onable tima after
discovery of loss or breakage of any instrument.
7.6 Facilities .Physical
7.6.1 Clinic space and location - Upon arrival of the dentist in
the school, he. should request the principal for a suitable
place for clinic to be ideally located in a well-ventilated
place with sufficient floor space to facilitate possible
arrangement of dental equipment according to the required
standard.
7.6.2 Physical Arrangement of the Clinic - It should conform with
the standard requirements as illustrated in Appendix 4 and
4A. Another basic requirement for a dental clinic is that
there should be sufficient and available water for washing
hands, for rinsing, cleansing and sterilizing instruments.

7.7 Medicines, Dental Supplies and Materials

7.7.1 Type, quality and quantity of medicine and dental supplies

should conform with the minimum standard requirements
(Appendix 5).
7.7.2 Requisition of Supplies ~ Requisition for supplies should
be sent to the Ii£C Regional Office twice a year, one (1)
month before the beginning of every semester.
However, the requisition may be sent at any time when
necessary. Supplies on hand should be checked periodically
to make sure that the supplies of each eSsential article
is sufficient to last until the next requisition. The
balance of supplies on hand should be placed in the column
indicated in the requisition (Form 5-A). In divisions with
two or more dentists, a consolidated requisition correspond-
ing to the exi sting number of denti sts should be forwarded
to the Regional Office approved by the Division Superinten-
dent of Schools.
 - 15 -

Section 8. Standard Operating Procedures. - It should be the standards

operating procedure for the public school dentist to provide as much of
promotive service, early diagnosis and prompt dental treatment and to
exert leadership for the coordinative relationship of all dental health
v:
, activities in the school. His activities should be guided by the pro-
fessional dimension of quality, the quality of his technics by the
technical dimension.

8.1 Professional Logistics

Basic -
The Public School Dentist should always know the type and extent
of the dental health problem of the school population. He should,
with involvement of appropriate personnel always plan and evaluate
the dental health program. He should seek ways and meanS to intro-
duce fluorides whether systematically or self-administration or
topically.
He should provide oral examination to all school children to de-
tect early carious lesion. He should be alert in the identifica-
~ion of oral cancer and handicapping labio-lingual deviations.
He should pro vi de prompt treatment of dent al di seases and condi tions.
Otherwise when not accomodated in the school dental clinic, cases
should be referred and followed through to ensure dental care for
such children by a mechanism of a referral system. He should
provide chairside instruction to each child. He should provide
content on dental health for health instruction and healthful
school living to the teachers and personnel in the lunch counter
who are directly in contact with the school children!
8.1.1 How to determine the number of patients to be treated in
each class or section.
During the ocular inspection of all pupils in a classroom,
the school dentist should classify each pupil or student
as A, S, and C, accor.ding to the seriousness of the dental
defects found. When the .iumber of working days alloted by
the school authorities concerned to any school is not ade-
quate for treatment of all school childre, the following
formula should be observedl

Multiply the average number of patients treated daily

by the actual working days alloted for the school, then
divide the product by the number of sections in the
school to get the number of patients to be treated each
section.

8.1.2 Calling of Patientsl

In order to have a continuous flow of patients,thc Dental
Aide is instructed to call five (5) pupils to start the
clinic hours in the morning. Each patient treated is sent
back to the classroom with instruction to tell the teacher
to send another five pupils for treatment. The dentist is
not allowed to treat,~ keep a patient of the opposite sex
alone in the clinic (Appendix 6).
 " 16 -
8.1.3 Inspection of children for classification of casesa
The ocular dental examination should be done in the clas6"
room. Pupils anOVor students are classified according to
three categories:
y
Class A - children having no dental defects but needing
only prophylaxis and advice.
Class B - children having dental defects
Class C - children with serious dental defects

The objectives of the above classification is to give priority

to those in great need of immediate dental treatment; to
give dental inspection to all pupils in the school and to
give the dentist opportunity to visit each class and have
individual contact with each child and teachers in the
school.

8.1.4 Permission Slips" (Appendix 7)

Before beginning the treatment, the denUst should see to it

that an adequate supply of permission slips is available.
This form could be mimeographed upon request to the Prin-
cipal or District Supervisor. The dentist should distribute
the slips in the course of his ocular inspection for the
classification of the patients. However, classroom teachers
who received permission slips prior to the visit of the
school dentist may distribute such slips to the pupils in
their school. This is done in barrio schools where the
stay of the school dentist is limited. All permission
slips Should be signed by the parents or guardi ans of the
pupils for the following reasons:

a) To bring to the parent~ attention the presence of the

viSiting dentist in the school, hence, to awaken their
. consciousness to the dental health program.
b) Some children are under the care of a private dentist
and whose parents would perhaps prefer to have their
children be attended by such dentist.

c) Parents may wish to accompany their children to the

clinic especially in cases of highly nervous children
who may refuse treatment without the presence of their
parents.
d) In case of accident, during or after treatment, which
sometimes is beyond human control, the per ~ission slip
duly signed by the parents protects the dentist from
any legal responsibility.
The signed permission slips are good for four (4) months
after which new permission slips are required. Students
.". anOVor pupils who are 21 years of age or over may sign
their permission slips. The slip should be pasted on
the upper right back of the individual dental record.
 - 17 -

8.2 Technical LogisticsI

The immediate relief of pain shall be applied before any attempt
to meet other dental health needs is made. Hereunder is the se-
quence of treatment in the management of a patient in the dental
clinic.
Pre-grade to Elementary High School to College
a. Emergency treatment a. Emergency treatment
b. Clinical examination of the b. Clinical examination
teeth and their investing' ti ssue c. Oral prophylaxis when
c. Oral prophylaxis when necessary necessary
d. Institution of fluorides d. Prompt filling of incipient
e. Prompt filling of incipient carious tooth surface
carious tooth surfaces e. Extraction of unsavable tooto
f. Extraction of unsavable tooth f. Referral and follow-up
g. Referral and follow-Up for
unaccommodated dental cases

8.3 Technics for certain clinical procedures - Refer to Appendix B

for the following I

8.3.1 Fi 11ing
8.3.2 Extrzction
... 8.3.3 Oral Examination
8.4 Other Procedures
~
V,
.0 8.4.1 Health Education - This can be implemented in two ways,
I
-" c$ 8.4.1.1 Individual instruction is given by the dentist
during the course of mouth examination or treatment.
I Such instruction shall include oral hygiene.
8.4.1.2 Group discussion is conducted by the teacher who
plays a major role in health instruction. Given
content on dental health by the dentist and equipped
with teaching methods, the teacher becomes more
effective in health education. Demonstration on
toothbrushing and mouthrinsing shall be done.
8.4.1.3 The duty of the school dentist is to organize and
conduct seminars on dental health education for
teachers and nurses and to provide them with authentic
information or content on dental health to be taught
to the children.
8.4.1.4 It is the duty of the school dentist to conduct
class-dental health talk on nutrition education,
dietary control, oral hygiene and use of fluorides
to prevent dental caries.

8.5 Referral and Follow-upl

A referral slip is issued to the pupil anq/or student after oral
examination with explicit instruction that he sees a dentist of his
choice for cases not within the scope of the public school dentist.
The referral slip properly filled by the attending dentist is re-
turned to the school dentist after completion of the treatment. The
 - 18 -

slip should be att~ched to the individual record. The cooperation

of the teachers may be sought to keep contact wi th parents thru
follow-up letters to ensure that the children seek the treatment.
The teacher also may be requested to collect back the referral slips
and submit to the school dentist.
8.6 Records I~aintenance;

Each student anq(or pupil should have an individual dental record

on the form prescribed by the Bureau of Dental Health Services com-
pletely filled for ready reference and inspection.
It should be kept in a record box provided for the purpose.
The cards should be alphabetically filed. In case no such box is
available, the dentist before leaving for the next school year shourd
wrap the record cards and turn them over to the Principal, or
Teacher-in-Charge together with a summarr statement of the work ac-
complished. Cards of pupils who are no onger in school should be
discarded.

8.7 Technical Supervision;

The Regional Supervising Dentist of the Ministry of ~ducation and
Culture shall exercise technical supervision over the dental health
service in the public schools. They shall observe the following:
•
8.7.1 For the school survey;
a) Assess existing school dental health services
b) Determine the needs of dental health service
c) Determine dental needs of school population as a basis for
program planning and evaluation.
8.7.2 In routine inspection, they shall:
a) Conduct spot inspection as to standards of recording and
reporting and other standard requirements for school
dental health services,
b) To check Form 48 and field vouchers of each school dentist,
discouraging unauthorized travel and preventing changes
of schedule without prior approval of the Divi sion Supe-
rintendent,
c) To periodically and personally inspect supplies and
equipment especially during the opening and clo sing of
the school year,
d) Extend advisory, recommendatory and consultatory services
to the school health officials on matters pertaining to
school dental health services.
8.7,3 Recommendations and Follow-up;
Recommendations shall be based on the observations and inform-
ation derived from the preceding activities. Follow-up mea-
sures shall include these steps taken to oversee recommenda-
tion to help ensure their implementation. There is a need
to inform the management of the public school about the re-
sults of such follow-up. Paramount in the process of super-
vision is the development of a school dental health program
which shall ensure optimum dental health of the school
population.
 - 19 -

Section 9. Standard Methods of Recording and Reporting. - To guide regional

offices in the collection of accurate and reliable statistical data and
other information necessary in planning, directing and evaluating public
y' school dental health programs, the standard forms and the procedure on re-
cording and reporting of dental diseases and dental health services proscxibed
by the Bureau of Dental Health Services shall be followed.

9.1 Standard Dental health Record and Report Forms:

BDHS Revised Form I - Individual Dental Health Record
BDHS Form 2 - Dental Diseases and Services Report
BDHS Form 2-A - Dental Manpower Report
BDHS Form 2-B - Report of Dental Medicines and Supplies
Referral Slip - (Revised)
Monthly Narrative Report of Dentists (ReVised)
Monthly Narrative Report of Supervising And Senior Dentists
(Revi sed)

9.2 Recording:
9.2.1 Public schools dentista are required to record findings of
oral examinations and dental services rendered to the pa-
tient on BOOS Form 1 (Appendix 9). Methods and criteria
of recording in the BDHS Revised Form I are in accordance
_. with the revi sed in structions prescribed by the Bureau of
Dental Health Services (Appendix 10). Criteria for assess-
ment, diagnosis and recording of oral diseases shall conform
with World Health Organization Technical Report Series No.
242 (Appendix 11).
9.2.2 Public school dentists are required to consolidate report
of dental diseases and services in BDHS Form 2 (Appendix
12). Consolidation of Reports on Form 2 shall be in accord-
ance ¥/i. th revised instruction for using Form 2 (Appendix 12-A).
9.3 Reporting:
9.3.1 Each public school dentist shall accomplish BDHS Form 2
monthly in four (4) copies; 1 copy for his file, 1 copy
for the Division Superintendent of Schools; 2 copies for
the NEC Regional Director to be sent thru the Division Su-
perintendent of Schools, 1 copy of which is to be submitted
~o the ProvinCial Health Officer or to the City Health Officer,
~f the school is located in a city not later than the 5th
day of the succeeding month.
9.3.2 BDHS Form 2-B - Report of Dental Medicines and Supplies
(Appendix 13). Public School Dentists shall accomplish
BDHS Form 2-B monthly in four (4) copies; 1 copy for his
file, 1 copy for the Division Superintendent of Schools,
and 2 copies to be submitted together with BDHS Form 2 to
the I.EC Regional Director through proper channels.
9.3.3 Revised Narrative Report of Dentist .
Public school dentists are required to prepare and submit
a m~nthly narrative reP9rt (Refer Appendix 14) in four (4)
~op~es, ~n accordance w~th the fonnat hereto attached, to
be submitted together with BDHS Form 2, 2-B. This report
includes the total number of productive days spent by the
dentist and by the dental aide during the month. It also in-
cludes the report on all other allied activities.
 - 20 -

9.3.4 Referral Slip and Follow-up:

Revised Referral Slip Form, BDHS Form 7 (Appendix 15) shall

be used to establish an effective referral and follow-up
system. It shall be the responsibility of the dentist that
the patient referred for treatment or for other services
related to his dental health is given complete dental treat-
ment or services he needs. Report of referred patients
shall be reflected in BDHS Form 2.

9.4 Consolidation of Reports:

9.4.1 Division Offices
All dental reports received by the Su?erintendent of SchoolS
are referred to the Senior Dentist andVor Division Dental
SUpl rvisor for consolidation in accordance with the following
guidelines;
9.4.1.1 Senior Dentists and/or Division Dental Supervisor
Shall review all reports submitted by the operating
dentist to check for accuracy, consistency and com-
pleteness of the reports before consolidation.

9.4.1.2 Senior Dentists and/or Dental Supervisor shall con-

solidate reports on Dental Services in BDHS Form 2.

9.4.2 Dental '~anpower Ro port is consolidated by the Senior Dentist

and/or Division Dental Supervisor in BDHS Form 2-A.

9.4.3 Report of Dental Medicines and Supplies in BDHS Form 2-B.

Monthly Narrative Report - The Senior Dentist anq/or Division
Dental Supervisor shall review the monthly narrative report
of the dentist to take note of important items of interest
or Administrative or Technical problems requiring immediate
assi stance.
In addition to the consolidated reports, as required above,
the Senior Dentist anq/or Division Dental Supervisor shall
submit a monthly narrative report in accordance with the
format hereto attached.
Consolidated Repar ts and Nar-r-at i ve Reports of Senior Denti sts
and/or Division Dental Supervisor shall be in three (3)
copies, 1 copy for his file and 2 copies to be submitted
to the Divi sion Superintendent who wi 11 submit one copy to
the jlEC Regional Director not later than the 15th day of
each succeeding month.
9.4.7 [IEC Regional Office
Dental reports received in the t'£C Regional Office from the
provincial and city schools division be referred to the
Regional Supervising Dentist for consolidation in accordance
with the follolung guidelines:
 - 21 -

9.4.7.1 In Iv£.C Regional Office, the Regional Supervi sing

Dentist shall consolidate the following monthly
reports of Senior anqlor Division Dental Supervisorl
a)Dental Diseases and Servicos Report in BDHS Form
2, total for the region and by division.
b) Dental Manpower Report in BDHS Form 2-A, total
for the region and by division.
c) Report of Dental 1I1edicines and Supplies in
BDHS Form 2-B, total for the region and by
di vi s ion,
d) Monthly Narrative Reports of Senior Dentists -
The Regional Supervising Dentist shall review
all the narrative reports of Senior Dentist
anqlor Division Dental Supervisor to take note
of important items of interest anqlor adminis-
trative and technical problems requiring immediate
attention.
9.4.7.2 In addition to the required consolidated reports,
the Regional SuperVising Dentist shall submit a
monthly narrative report in accordance with the
format hereto attached.
9.4.7.3 The MEC Regional Director shall send the original
"- copy of the monthly, semi-annual and annual consoli-
dated reports and all other required reports to the
Minister of ~ducation and Culture.
9.5 School Health and Nutrition Center
a) All reports received by the Ministry of ~ducation and Culture
from the regional and field offices Shall be referred to the
school health end nutrition center for consolidation, analysis
and interpretation.
b) Based on the reports received from the I~C Regional offices,
the School Health and Nutritien Center shall conduct an annual
assessment of the dental health status of the country to deter-
mine the effects of dental programs and services.
c) The statistical data derived from these reports arc utilized
for developing plans and programs on dental services for im-
plementation by tho regional and field offices.
d) The same shall be the basis in the preparation of budget esti-
mates to maintain the operating units in the wEC Regional and
field offices.
e) The annual consolidated re~rt on dental diseases and services
shall be submitted to the Ministry of Education and Culture on
the 15th day of January of the next calendar year, furnishing
1 copy to the Minister of Health.

Section 10. BUdget Preparation for Public Schools Dental Services. -

Tho primary concern of a budget sustcm is the availability and use of money
to provide the services required or expected from the dental health service
for public schools. The budget process consists of four (4) phases namelyl
Department of Health

0516
H15.« St23...
 - 22 -

planning, estimating, reviewing and operating. Dental health service in

public schools is one of the basic health services and integral compgnent of
the total health program of the ,IEC school health service. The IIEC Regional
Director shall be responsible for planning, estimating, reviewing and operat-
Y ing budgetary requirements for effective administration, maintenance and
operations of school dental health services in their respective jurisdiction.

10.1 Planning-
I.EC Regional Supervd sing Denti sts shall assi st the u£.C Regional
Director in the preparation of the detailed plans for achieving
the line objective for the school dental health program. They are
expected to provide readily available information covering the pro-
jects for which they have the responsibility of operating which in-
formation normally includes analysis of current status of work and
rates of production, forecast of program for the rest of the period
and expected for the ensuing budget year, and reliable statements
to support forecasts.
10.2 Estimating-
Estimating v.hich is the normal phase of the budget process is the
responsibili ty of the liEC Regional Supervising Dentist, Estimating
is concerned \~th the determination of the amounts of their resources
and their pese costs necessary for carrying out the approved plans.
In ccordi.nat i on with the I.EC Reg Ional Budget Officer, the IJEC Regi on-
.. al Supervising Dentist shall be res?Qnsible in putting up budget
estimates corresponding to the projected plans and programs. The
t.EC Regional Supervi sing Denti st shall be responsible for wri ting
the jurisdiction, statements, must be complete, sound and adequate
since they are basic to the acceptance of the estimates during the
review phase.

, 10.3 Reviewing-

Reviewing is concerned with ascertaining whether the budget estimates

are accurate and in confermity with the prescribed guides and limits
and whether the programs and projects in the estimates are in keep-
ing with the overall needs of the r~~ion and the resources available.
Reviewing of the dental health budget is the responsibility of the
I.EC Regional Budget Officer who should schedule meeti ngs with the
I.EC Regional Supervi sing Denti st.
10.4 Operating-
Operating is the most substantial phase of the budgetary process.
It is con cerned with the actions taken to accompli sh establi shed
objectives within the available resources. Authorized appropriation
of the funds for government operation becomes the principal control-
ling instrument governing program execution during the calendar year
covered. Budget for school dental health services as in other
health services is alloted into three items of expenditures, namelyl
personal services, maintenance and operating expenses and equipment
outlay. In the allocation of the items under the maintenance and
operating expenses, the I.EC Regional Finance Officer shall consult
the NEC Regional Supervi sing Dentist, It is the responsibili ty "
therefore, of the IIEC Regional Super vi sing Denti st to apportion the
allotment for maintenance and operation expenses into three (3)
main items: 1) supplies and materials, 2) traveling expenses, and
3) sundry expenses. The appointment shall be made in such a way taht
the order of priority is in accordance vdth the above listing of
items.
 ,
- 23 -
... Section 11_ Dental Research Projects. -
L1.L Dental research activities includes:
a) Basic Research
b) Applied Research
c) Dental Epidemiological Investigations
d) Dental Surveys for collecting baseline data necessary for
program planning and evaluation
11.2 Policies and Guidelines on Dental Research Projects:
11.2.1 All dental research proposals involving any or all of
the above-mentioned researches submitted individually or
by a group of dental personnel of the I/EG.Regional Office
shall be submitted through proper channels for approval
of the Director, Bureau of Dental Health Services before
its implementation. Upon approval, the Director of the
Bureau of Dental Health Services shall return the re-
search proposal to the proponent of the study through
the Regional Health Dir~ctor concerned.

11.2.2 Administrative Supervision of dental research studies

conducted by school dental personnel of the MEG Regional
Offices sha 1 be the responsibility of the llEG ReglOnal

-
Director concerned, while the technical guidance Shall be
the responsibility of the Bureau of Dental Health Services.

11.2.3 All on-going dental health programs and pilot research

projects prior to the implementation of the policies,
standards and guidelines shall not in any way be altered
or affected.
11.2.4 Progress andVor periodic reports of dental research pro-
jects conducted by the school dental personnel of the MoG
RegicnalOffice shall be submitted to the Director, Bureau
of Dental Health Services through proper channels 1n accord-
ance with the schedule of reporting specified in the pro-
tocol of the study.

Section 12. Evaluation Procedures. -

Evaluation is the process of appraising something according to a set of

value. In public health, evaluation means setting up definite standards
and goals and determining the progress that has been made toward these goals.
It means taking stock; pausing to find out the results and progress of a
particular activity. Evaluation should include the consistent collection of
the best information and data that will serve as a basis for planning and
measuring existing programs.

The extent of items reco~nended in Sections 1-11, attained shall be evaluated

according to t~e criteria set in Appendix I.
(Levels of Dental Care)
~ 12.1 Additional Information:
Direct Services -
No. of children in the lower age
group given specific preventive Proportion given
measures x 100 = specific prevent-
Total population of this group ive measures
 - 24 -
No. of students given annual Proportion of
oral examination x 100 = school population
Total school population given annual oral
examination
No. of teeth filled during the Proportion of
academic year x 100 = needs for filling met
Total number of teeth indicated
for filling (among lower age group)
No. of teeth extracted during
the year x 100 = Proportion of needs
Total no. o~ teeth indicated for for extraction met
extraction (among lower age group)
No. of dental cases given complete Proportion given
dental care x 100 = complete dental
Total cases examined care

Referral and Follow-up Servicesl

No. of cases actually given dental Proportion of

treatment
No. of students referred to pri-
vate practitioners
No. given complete dental care
No. of referred cases actually
given dental treatment
x 100 = referred cases actually
given dental treatment
x 100 = Proportion given
complete dental care
TIlRU REFERRAIS

12.2 Additional Information:

No. of students treated per = Average number of
school year lEIITISTS fOlR. CHILD
No. of effective time (hour)
No. of students treated per day
Per school year = No. of students treated
No. of working day~school per day per school year

No. of teeth with superior and Pr~portion with both

satisfactory filline = superior and satisfactory
No. of teeth given procedure filling
Total no. of students absent
due to dental ailment per Propor-td on of student s
school year x 100 = abscn~school year due
Total no. of students absen~ to dental ailment
school year
~e~tion 13. Effectivity.-
This Administrative Order shall take effect immediately.

J. C. AZlRIN
(Deputy j,linister of Health)
Officer-in-Charge
CERTIFIED TRlE ropy:
(sso.) GREGORI A V. BAUTI sr A
Chief, Records S"ction
Ministry of Health
 APPENDIX I

A. LE.VELS or DEmAL CARE

"First level of care - quality of individual restoration in relation
to the other tissues of the mouth to normal function, and to the total
health or the individual.
a) Quality of particular services such as extraction, when no posto-
perative canplication occurs, e.g. inflammation, bleeding or dry
socket.
b). Quality or filling in relaticn to the othar tissues leading to
gingiVitis and periodontal diseases and the functicn of mastication.
"Second Level of care - concerns the mouth
a) The quality of services must be considered with regard for the
entire oral cavity.
b) The relationship of the restoration to the functioning of the
mouth or of the dentition.
c) The inter-r-elationship of restorations and periodontal treatments,
with restorative and prosthetic treatment.
d) Care an individual tooth in contrast to the needs of the entire
masticating apparatus.
"Third Level of care - concerns the individual or persons
'Disease with relationship between the dental services and the whole
person.
"Fourth Level of care - concerns the relationship between the den-
tal services given and the whole cOIlJIIunity group of popl1ation".

B. DIMmSIONS OF CARE
"F;\.rst Dimension - TEXlHNICAL DIMI!NSION is concerned with the mamer
in which preventive and treatment procedures are performed. the spe-
cific technics utilized, types 'of instruments and the way they are
used
,
and the materials and technique applied in their manipulations.

"Secaid Dimensien - PROFESSIClIAL 100ISTICS will cover decisions en

number of teeth that should be treated per visit, time spent for
each visit, the sequence by which procedures are performed, and per-
formance load relative to dental needs and popllation covered.
"Third Dimension - ORGANIZATIONAL DIMEBSION includes functions,
dentist/popllation ratio, equipnent and supplies, programs and inter-
relationships.
"Fourth Dimension - FINANCIAL nDrnllSION refers to budgetary re-
quirements to operate and maintain efficientJ¥ the service".
y CRITERIA TO MEASURE LEVELS OF QUALITY OF DliNTAL CARE
1. First Level and First Dimension of Quality
Quality of individual restoration of filling.
Superior I Perfect in all respectl cavity preparation,
c~, margins, and condensation accep-
table/exemplary.
Satisfactory I Cavity preparatialt carving. margiris, and
condensation acceptable.
Improvement Needed I Ihsufficient extention but margins and
condensation acceptable.
Unsatisfactory I If any or all of the following are observed I

1~ OVerhanging or inadequate margins

2 Presence of caries around fillings
3 Presence of caries due to lack of
extention
4 Inadequate condensation
5)) Separate or "Spot" fillings where one
continuous fillings was required.
6) Discolored fillingS, indicating possi-
bility that toat:.h was nat:. kept:. dry du-
Jl'ing filling
7) Evidence that matrix was not proper~
used
8) Faulty contact or lack of contact with
contignous tooth (Class II fillings) ,
9) presenCe of caries indicating that diag-
nosis of completion ~Ias incorrect.
Date of completion and subsequent r&-
ting mst be considered in this factor.
Quality of Extraction
Superior I Perfect in all respects; as to techniques
of block and infiltration anaesthesia and
extraction; no post operative complic&-
tion occurs. e.g. such as infection, swel-
ling, hemorrhages or dry socket; no roat:.
fragment or bone fragment left:. unremoved.
Satisfactory I Acceptable techniques of conduction and/
or infiltration anaesthesia, no post 0pe-
rative attention.
 - .3 -

unsatisfactory I Faulty techniques of conducting anaee-

thesia and/or extraction as evidenced
by all or one of the following I tID-
controlled pain during operation, trau-
ma, swelling, infection or injury of
.contiguous tissues ai'ter extraction.
2. Second Level and Second Dimension of Quality
Quality of service in terms of the entire oral cavity of the in.-
dividual. Completed treatment include meeting all needs of the
entire oral cavity, for prop,ylaxis, fillings, extractions, topi-
cal application of nuorides. All other needs not met by the ser-
vice for reasons beyond its control, i f and when met by other
sources shall conform llith the same criteria of quality.

Superior I Completed all needs for nuoride thera-

py, fillings, extraction, dental prOoo
pb;ylaxis, etc. of the entire oral cavi-
ty.
Satisfactory I Acceptably met needs for filling and
extractions, etc. of the entire oral
cavity.
unsatisfactory I Needs tor all or arvone of the follOoo
l"ling not met; needs for fillings needs
for extractions; needs for propb;ylaxis•

.3. Fourth Level and Second Dimension of Quality

Quality of service in terms of the population or canmunity being
served is determined by a set proportioo of the pop.U.atioo of
the community who received the service during a unit time of one
fiscal year.
Topical Fluoride Applicatioo
Superior I 1) All children belonging to the youngest
age group at the start of the program
received the service.
2) All children who received the first
application were given the second
application during the second year
and subsequent application ai'ter the
ensuing years until all permanent
teeth of these children shall have
been given topical applicatia1e
 .. 4 ..

Satitlfactory 1) 70-00'/0 of the youngest age grcup

received the first application du-
ring the first year.

2) 9J,.1ClO% of those given the first

application received and secorxi
application during the secorxi year
and subsequent application after
the ensuing year.
unsatisfactory I 1) 69'/0 and below of the total pop.1l&-
tion of the youngest age group did
not receive the first application
guring the first year.

2) 89'/0 and below of those given the

first application were not given
the second applicati~ during the
second year. and so In in the erPo
suing year.

- F.VALUATION OF TIlE ElCTEm STANDARD ~U:IIin'lENTS ARE MET BY TIlE

SmMCE ACCORDING TO TIlE LI1VEI.S AND DIMl!NSIONS OF
QUALITY

A four point rating scale is recanmended and shall apply for

each independent area (Neas I to VI). The scale is as tollows
With their corresponding criteria I
FAR BELOW STANDARD I when the min:iJm.un standards are met
up to 5O)t.

BEWW STANDARD I when the minimum standard15 are met

up to '1:1f. but not lesS than 51%.
UP TO STANDARD I when the min:iJm.un standards are met
up to 1~ but not less than ~
ABOVE MINnmI STANDARDI when the min:iJm.un standards requir_
ments are exceeded.

RATltG SCALE FOR DEI'FnIINIID EXTEm OF EF'FECTS DUE TO FROORAM

EF'FCmS AS APPLIED CN THE CGlMUNITY

Scale A"
Poor I Uhen up to ?IYfo is attained
.'\ - ..5

•
Fair I When up to 60{. not:. less than 31%
r- is attained
Good l'!hen f'!I:JJ/o but not:. less than 61% is
attained
Excellent I IJhen up to 100{. but nob ~ess than
Sl% is attained

Scale B-
Poor I \fuen up to 5% is attained
Fair I l'1hen up to '20%> but not Lass than
.&fo is attained
Good I ~Jhen up to 4C1f. but not:. Less than
21% is attained
Excellent \'!hen up to flo
or more but nat
~ss than 41 is attained

scare C -
poor I If the ratio is from 5CJf. up
Fair I If the ratio is ?IY/o up to 4CJ1!,
Good I If the ratio is 'Jfo up to 291-
EKcellent I If the ratio is from zero percent
to J4.,.
 APPENDIX 2
I~INWUM STANDARD
reNTAL EQUI PJiENT A,l[) IHSTRUuENTS
I:ESaUPTION Quantity
Sterilizer, for instrument, boiling type,
LD. Approx , 12 5/8" x 6 7/8" x 4" •• • • • • •• •• • 1
Stove, Kerosene, single burner, pressure type
for use with 01-620-00 •• II •• • ••••••••••• 1
X 1 3/8 " . . . .. . . . . . . . . .. . . ...
Basin kidney, 12 oz. (35O ml ) approx, 6 5/8" x 3 3/4"
2
Tray, instrument, shallow, 13 1/2" x 9 3/4" x 5/8" ss •• 1
Tumbler, 8 oz. approx, 2 5/8" x 4 1/4", ss , {Vollrath
No. 6848 ••.....•.........•..• 2
Lamp, alcohcl, 2 oz. (60 mL); chrome-plated brass - . •• 1
Knife, blade, surgical, detachable, No. 11 ( for 07-450-00
handle) Pkg. of 6 • • • • . . . • . • . . • • 1
Mortar & pestle, glass, 4 oz. (120 rnl) • • • • • • • • • • 1
Chair, Dental, Portable • • • • • • • • • • • • . . • • • • 1
Engine, Foot, Dental, Will motor AC, DC & foot control •• • 1
Engine belt for foot engine, replacement for 12-100-00 • • 1
Handpiece, Contra-angle "U'' for Doriot handpiece of
12-100 E.ngine . . .. •• . • . • • • • •• • • ea. 1
Burnisher, Dental, No. 27, long handle; SSt • • • 1
Burnisher, Dental, No. 33, long handle; ss • • • • • 1
Burnisher, Dental, No. 34, long handle, SSt • • •• • •• 1
Carrier, Amalgam, No. lo-A; "Gun Type" ••• •• • ••• 1
Elevator, Root, No. 341; SSt (Crane Pick) • ••• 1
Excavator, Dental, Double-end, No.5; gouge-shaped, SSt • • • 1
Excavator, Dental, Double-end, No. 17, gouge- shaped, s s, •• ,. 1
Explorer, Dental, Double-end, No.2; SSt • • • • • • • 1
Explorer, Dental, Double-end, No.5; SSt • • • • • • • • 1
Explorer, Dental, Double-end, No.6; SSt • • • • • • • • • • 1
Forceps, Tooth Extracting, No. 15; Universal, lower
1st, 2nd molars • • • • • • . • • . .. •.•• ... • 1
Forceps, Tooth Extracting, No. 24; universal, upper molars • • 1
Forceps, Tooth Extracting, No. 62; universal, upper
or lower incisors, bicuspids and deciduous ••• • • • • 1
Forceps, Tooth Extracting, No. 101; universal, upper
or lower bicuspids and deciduous • • • • • • • • • • • • • 1
Forceps, Tooth Extracting, No. 150· universal, upper
incisors, bicuspids and roots .'. • •.•.••••.• • 1
Forceps, Tooth Extracting, No. 151; universal, lower
incisors, bicuspids and roots • • . • • • . • • . . • • .. 1
Holder, Cotton, Dental, No.1; metal • • • • • • • • • • • • • 1
Instrument, Plastic Filling, Dental, Double-end No.2. as. • 1
Instrument, Plastic Filling, Dental, Double-end, Nos. 3, ss••• 1
Instrument, Plastic Filling, Dental, Double-end,No. 5, SSt • • 1
Instrument, Porcelain Filling, Dental, Double-end, No.3, 55• • 1
Mandrel, Angle Handpiece, dental screwhead, No. 303 • • • • • • 3
Mandrel, Straight Handpiece, Dental Screwhead No. 303 • • • • • 3
Mirror, Mouth Examining, 7/8" (22 mm) • • •• •••••••• 6
Mirror, Mouth Examining, 15/16" (23.8 mm) ,. • •• '• • • • • • 6
Handle, Mouth Examining Mirror, No. 15 • • • 6
PLIERS, Cotton dental, No. 311 • • • • • • • ••• •• .12
Plugger, Amalgam, Dental, Black No. I, long handle, 55. • • • 1
Plugger, Amalgam, Dental, Black No.2, long handle, SSt • • • • 1
Dampen Oi sh, Clear • • ••••.••••••••••• • .12
 - 2 -

Retainer, Matrix, Dental( Star No.8 • • • • • • • • • • • • • • 12

Tooth extraction Forcep Co whorn type) •• • • • • 1
Rongeur Porc op • • • • • • • • • •• • • • • • • • •• 1
Bands, I.latrix, Dental, assorted, star; SSt • • • • • •• 12
Double-end Scaler . . • • • • • • •• •• • ••• • 12
Slab, jAixing, L,.~"ll, No. 10; 6" X 3" X 3/4" • • • • • • • • • • 3
Spatula, Cement, Dent a L, No. 332; SSt • • • • ••• 3
Syringe, Air, Den t e l , No. 22; complete with bulb ••• •• 2
Syr i nqo , c ar-tz i djo , D0ntal Posi tive lock (Carpul e Syringe) • •• 2
Needle, f1y;X)';c'::' .• 'c, Dent a l , C:lrtridge, Disposable Type,
25 G x Ill, SSe t..~Z~ • • • • • • • • • • • • • ••••••• 1 Gross
Needle, f1y:,odcra,ic, L. ',':1!, '::&,'c':' ri3e type, 25 G x 1 5/8"; _.
SSt •• I ." • ~ ~
• • • • ~ ~ • • • • • • •doz, 1
Syringe, Water, 'Dent a I , Moffat, .10. 21F; wit" bulb • • • 2
 I

"'. APPENDIX 3

- 4 -

DAILY - 1. Contra angle and handpieoe-clean

and oil (angles are not:. to be
put Mo sterilizer): Cuspidor-
clean.
2. Shot:. off compressor at the end of
each day

WEEKLY - 1.
2.
Engine Arm Pulley - lubricate.
Arm Compressor - drain water from
tank.

MONTHLY - 1. Clean Sterilizer - be sure to use

rain water or sort water for ba1.-
ling instruments.

- 1. Dental Engine - drop oil in water

bearings and inspect brushes. If
engl.ne seems to function impro-
perly, examine brushes first.
{

STANDARD A..'ffiANG:E1';E1~T OF SCHOOL D:ENTAL CHAIR

(Tl'/O Dental Chairs & Two Dental Units)

SCALE 1:500 Mo

10 DrN'!'AL CHAIR
2. DE:ITAL UNIT
3. DID',TAL X-RAY MACillNE
40 DEtl'i' AL INSTRUMEIIIT CABINl1T
50 STI'IGLIZER
6. LAVATOI\f. HUH GOCSEl'.'ECK SPOUT & KNEE CONTROL
7. TOHEL RECEPTACLE
8. NEDICINE CABINEI'
9. OFFICE TABUS
10. OFFICE CHAIRS
11, FILING CABINET
12. DENTAL OPERJ.TING STOOL
D. OXYG:1N TANK mTH ACCESScnIES
14. '!RASH CAN
 I

'-

API:eIDIX 4-A

I ~J I'¢)
\ ~
--'
/

...---.
r "'1 '\
\.'
.:»,
,===:;-,-".
I"I

I.!:::====='~

INSTR UIifi.l'IT TABlL

1. Forceps 12. Gum Lancet

2. \' a ste Recei ver 13. Hypo. Syringe
3. Vater Syringe , 14. Dental Syringe
4. Tumbler with wood stand 15. Right Ang Le
5. Medicine Holder 16. Cotton Pliers & Mouth l~irror
a. Tine. of Decl. 17. Exp lorer
b. Aro. Spirit of Amm. 18. Sca lers
c. Sufanilamide Pow. 19. Excavators
d. Cocoa Butter 20. Gutrt apercha Plugger' '
e. Tine. of Iodine 1'1/ Aco. 21, Ama Iqarn Plugger
f. Alcohol 22. ugg-shaped Burnisher
g. Eugenol 23. Amalgam Carver
6. Bur Holder ',' [ ~ .
,7. Pumice Powder ." ,-

8. Cotton Holder I , . .• l~.!

9. Rectangular Tray
10. Elevators '
11. Scissors' 0'
, ,
'., .. ',
;
,',
 APF£NDIX 5

MINII~UM STANDARDS RlR I>£DICUES, reNTAL

..
I
.~
. " "SUPPLIES AND MA1ERIALS
•
IE SCRIPTION qUANTITY

~ Alloy, S~l~~r,~~lg~m.! B~~~~\' ,?~.Tablets per bo¥, ·30 gms. • • 2.

'. , . -- ~_ ·,--,Amalgam; COppeD; .'Dental... 3Q.gm. __oo-etle,:.• ',' •.•
Bur, Den ta l' Excavating,' 3 gross 'assoI·.tlnimt". 'in plast.i c case.. 1
. . .. .. ..
Cavity Lining ,andVarni~h'>'\\Iith thinner .• .. . . set 1
Cemeri't;' Si iica"t~~"Dcnhi, 10":2, package' ~ .•
Cement, z.) .E. Dental (Zinc Oxide. Eugenol). -' .'
• .
• .1
1
·
Cement, Zinc Pho sphate, Dental • , • • • , • • I
Cloth, Squeez e , Dental, Box of 100 , • • ";'
Cotton,' Rolls No •. ' 2: 3/8" x .1 1/2:';. box of 1,000 • • •
• , 1
I
·
Cup, Po l i shi,ng,i Rubber , Box of. 1 gross' in--plastic "!:>q x , ".
",\£,)"',.-' . ' . , _.... ~:_ d :.. • .•• ).... -.

wi th"'orie mandrel for AHP and one mandril 1 "for' SHP,,- .'. 1
Lubricari't/." AS SS;N 'l~H'andpibcl Ca'icil'~ "~~"'-~- .' ':'~'.. .:r,', ;; .;, '{. 1
l~ercury, Chernic a l Ly pure, 1/2 lb. (113.5 gm.) bottle. • 4
Oil of Cl cvas , U~P,.l oz. (30 ce.) bottle • • • , • , 1
Procaine ,. Pontoc ai ne ; Cobe f'r i.n 'Cartridge* 2 ial , .c an of. 50
Pumfce F10ur, 1 lb. (454 gm.·)· ..... ,.':', •... ~ '. • •• • •• :
. .'
'.
4
3
·
Gown • • .' ~'" ..... ',' --t ••"'.....;,;}, .•••• ', .~ ,.- • •
,.
6
'~-.' ;Surg{c'aT "1~1.:iik't·1B~,* -'<5f1t~'56"~~ ?'~~"'l-:\~"";i~)\~' t'.,.' • , 1
'Fluoride', .0,,2% • • • •: • • ~ • ' . ' " 48 gms.
Alloy,. metal - ·ioz'·<,Uver Alloy. 4 bt l s,
Cemcnt',liqlJi.dand 9?wdcr.. '.' ., , 1";
~ set
MC.rcurv· - J./? )..~.~ ._~ • " '. . . . '. . , , 2 btls •
RepelaG C2\':i ty' Lir":ing,_, l/:? QZQ ~ 1 !.:;t'l"
··'··'"-~Silicate Composdto :Resin' >-'. " 1 set
Zinc Oxide Powde r " • • '" '.. 1 pk., ,
Denatured A';"CO!lCJ., rc:-::n0d~ 1 ~F~J. tOjl~ :·CO cc , • • 2 Lt r s,
Aromatic Spirit o:;:_,~,/\;i:~',:():1ia>-- '!:V CC¢ 2 btls •
._Anesthes~. ~1~' i.~lj_.ccta;i'c, f:. '-=~o:·.i~~a.1.:'. ~O/c'an ., ~~O can s
E. u9.e1;)O_~ .. ,~~.:1 .:0 ,~'~>:~,:':'i,,~'~(~''f;.,£~:;~'~.,::,,~,.'t..,,' ~, .' , ,, . • btls. " -\
·'-;"~·,·'·AriEilgesic Tab Ie t s '.:; , ~ ~,.,. >- ; ~ '.' ".• :.. . ,:0:., ';:bl ts ,
Antihemorrhagi.c .... .' . . .'
•
.200 b t l s ,
Lysol, 1- pint . ~"'. ~,< .'~ .'
Zephiran '- Merthiolat·", .5'JO cc ,
-Pheno l, liqi..dfie'd .; 30 CG~ • • ~ :.-.
". ".

Tincture of J'.co'nit,'} -:0 50.··cc. :.".......:' :;,ll".., ~.<',_,,~_~ .... " /

Ti nc tur c of p.'·2rr5,(;_ Ch.l.oX'i',:h) .~ le:o cc , '. ~.• '
••
,,' ";'
.-. ..
,
.'

'.
... . 4 ':ltl s •.
• '.1 quart
1 btl •
2 bUs.'
• .2 b t l s ,
Sri st Lo Di 51: cup- shrl;:'c~' '6 pes. j)/bo:< . • • • 10 boxes
Celluloid St ri ps , 5G j)csit-ibox '. "•.; '<"'."~:" .~; .• ,<. . 1 box
. Cotton Ab5~rbnnt .; 1 lb. .• .. .•.
Paper Di sl: t sand • • ... . ' ,'.
.".. .••
.•.• • .
.'
1 roll
Ibex ·
Pai nt , white. ~enarne~ - 1 );~t._. _...• ' .• ~ ...~ _co': ::,.•.i: •..~.__ •..•. •• 2 cans
.' p', dr;' ", ':'>c "1·""1·b"'··;f.4,-;;o:·~.··~,r<~f ;: '.;.",.-'~.'~''';.; it·,., v,.: ·;,:,.··>..·
'1 •• •
PurnlCe 0\1 ,:"r..~.' 'h'. ':~_', "~.li-t,~--.:. i",~·.",~ ',;,.." .' ..,.. ....,'~ ~ .." • • •.'.... . • .. 6 cans
Separo-iwJ--D;"I( ".i.'lOO"pc;.··"p!bbx,·,"',-· .....•. , ....•. ;..... ,., • 5C boxes
S~cot~'~~~. 1 ~ ;'. ( C~~? ~~' ~.~i~~Q~):,,,·~-;<~·;:·:r,~:;~;·.=,,:·~,:~. ~r :'.' :.. \ , • • 1 tube
.,.;. •..:q,. ~"'''':'''"..:''''' ,.
;...... . .-.'

\
 APreNDIX 6

"BLREAU OF EDUCATION"

Manila, October 16, 1939

C I R' C U L A R
No. 59, s. 1939'
AI-ENDj,ENT TO g;CTIOI, 622 OF THE ~VlCE. IAANUAL
RELATIVE TO RELATIOI, OF SEXES

To' Di vi sian Superintendents:

Sec t Ion 622 of the .~~1::!i£9_~.J:~anual amended to read as fo Llows s

.11622. In order to protec t- themselves from imputations which

generally arise from malice!, as well as teachers and suparvi sorv
officials should never be arone in the c Las s.coou w5.th a pupil of the
oppo si te sox, Vihen it is neces s ary lor' a t.eachcr or a principal to
have a pr i 'late ccnf'crcnc e ',v:~ th a 'pupil or to q ive an oral. examination,
he should a:h·~·:.ys t ake a pr~~r:aL!ti.on to have pre serrt another person of
the same 5;_~X' zs t~IY: pupil conf'3=:'·}~I.!d ;":i t~t.. ;'It:~.3 dc(:= not apply to
pri vat o cotlfe:i.~0nc0:'; that aT.e hoi d in f u.lt vi (·r:; of oti1e~:: p,'~rsor:s out-
side trie room ... J;, !TI3.1e t.e achor or supcr,;i!;o:r:/ o ff i c i aI .shoul? not
'assign fQmaJ_8 pupil to ncIp him .i n such task as C0::"r f ) (; cir~0 P2;'")«.--s~
~ ...:
en""e.l.Lng . . . .c~", :-. ·.... ·r"
.... ·'n.'
g~.ac: ,;"1 1:, I"~"~.cor'.j .1-,10.)/'_::>1
, '... <. . . ~-- ':"r." .\.. l·:l.·~····:~··! J...JOc
c; •• rCldlJll.~J·, .d.. '... ·.1~.
~ . . !--<. and
.... ~ C,I
cleaning t[H-~ :C'001j1., V;hcro it·is noce s sar y to .ha·'n:: a mi:;lc r':::>3cb
train f emsIe ath.i.r·t;'"2S~ a \\\X1EU'l teacher shoul c !::c ;:·,3:~i~ii'!~.::d to) tak,~
care. of the girls arid should .be with t ho girls .i n t~·li]:.l· p:;·a(;tic~.1
and ~t all g?:~,}s.. Our tear:hiD9 .£0:'C0 112.5 a hi.gh reputation and this
should be :.:::::~rr!;Q.t.. ~_;4 {Jot on·.:. 1 ~~':l~'ir\s'!' !::~.::·:;(;r'F:iuct'1 ~ut 21::;0 2sai::st
any susp i c i ori of mi s(;IJ'I:dT';t,.
I
•

CE.1.EDIN:J SALV AI:OR

"D~~rGct(\r of ::dlJC2tion ti . /
I
 . APPENDIX 7

MINISTRY OF EDUCATION AND CUll'URE

Division of .-._~ _

<,

Name of SChoOl

l]WlMlS§IOO. SLIP
,.. t, " i

I Hmmc GIVE PmMISSIW To

_ _ _ _ _ _ _...;..;. TO Rl!XJEIVE DFmAL

TREAT/mIT IN THE SCHOOL DENTAL CLINIC.

Date , .
. ~ ,'. '.' ~ I ':".

Graae/~aiod

Name of Teacher

lr-
I.
 , APFENDIX. 8
....i 'IErnNIC FOR CERTAIN CLINICAL PRoCEDURES
Filling:

'y' 1. "Cavity preparation for filling should at all times be done to pro-
. vide' ext ensfon for prevention. '
2. In Class II cavities, occlusal locks should be made Wide enough for
.adcquate r o tcrrt.i on of filling. [.Iatrices and gingival wedges should
be used in the, filling of all Class II cavities.
3; In all deep cavi.ties the pulp should be protected by calcium and
zinc cement !.L1.ir.g. . ' ,
4. Cemeht,bases should be'used illldersilicate restoration.
,5. Sedative ere ssi.ng "t eropor-arv fi llings" should be reduced to the
minimum., .
6. Drvno s s of- ,the tee~h should be maintained during the treatment and
filling of cavities. ,
7. Mixing, inserting'and condensing restoration
A. Silver A~algam.
1) St:md'ard Material'~ Silver alloy and mercury U.S.P. ,that will
m'~et !\io~ 1 and N9~ 6 spec i f i cat.Lon s of the Amer i c an Derrt a l..
Association.
?)
_ ;,\n.thod - T'('jtura~:i?r. may be done e lthe r by m0l.·tar and. pes t l e
or mf.~cn.::nl~ally IHEi1g f i ve perc s o,± s iIve r 2L.oy to r:!lgnt
part s of :;l(!I'CL:.l'¥. Ccndensat i on may b'3 d";1(; cith·~!r by mecha-
l d 3.
. ' or Inano• nr e ssuro me t .10
ruc.u i-o
Pl" •
i ; Sinr(l ' t'
or• rc":s·':O.'T.'h
'
..:.0:1
shcuLd bo dOD3 at subcocuent appo rrrtrncnt ~
B. Silicate C~mGnt
Pov.der ar.d !.iq"id should meet spec i f i c a't i on I"!o. 9' of the Am8r:,can
Dent~: ,'-"soci ado", sp~tulation' f(~r ,30.se:or.ds on a s Lab coded
to lt~UF St:.:'"Iu.ld- C12 car r i ed out, an» pe l i shi nq :!1ouJri h~ "!.::lay~d
at I~ast attar "three Jays. .

Extraction:

1. "Conduc t.iorrunc irofiltrationanaesthesia should be used whenever in-

di c at ed to control ?").,,, and should be IISl1d for extr ac t ion,
2. Every permanent tco th tlv:t can not be successfully saved by direct
opcr ative treatment thru r ef eir e Is shoul d be extracted. .
Exc ep ti on s cn.Iy when 0:-L tilG .p:t:")£esr..lnnal judgement of the attending
dont ist i:1dicatc;: anothor .-: 0 l,i:(' 5(' 0-; .sct i c-n, .
3. S~.:crilizQtion of s~_frlno0s and needL:!s
AutocLavi no for 2::;" rdrJ~t(:;s at ~:5C)')F and 15 Ibs, pressure is the
safnst me'::'1od to stG:cLU,zG sy:r:inges and needles. In the 'absence
of an autoc Ievo , to~.lin9 for thirty minut e s is necessary. The
sterile guard shou ld be removed from the ,needle jU,3t prior to' use
ar. d a stm'iole ch ai » be 'mair.t~ined throughout the Lnjoc tt on,
4. All .surqi c a l procedures ,incl'udL1g extraction of rheumatic fever cases
will be referred to hospital or pri.vate practitioners with proper
referral. slip and per t i.nen t Lnfo rrna t i on,
5. After extraction, all' patients must be gi ven wri tteri instructions
concerning po st-operati ve attention, after the oral Inst.ruc tions
have been given to the patients and to the parents".

'Oral Exami nat Ionsr

mouth
With the aid of'a plain mirror and an explorer Under ordinary light,
conditions of the teeth and supporting tissues are examined and
recorded in a complete diagnostic chart indicating all existing ano-
malies and abnormali ties. '.

;
\

., .. '
j
._-(
- 2 -
Dental Prophylaxis;
The scaling of calculus when present and the subsequent mechanical
cleansing of the teeth to smoothen rough surfaces and removal of stains~
with prophylactic brush or rubber cup with a cleansing agent such as
prophylactic paste or pumic~~

Topical Application of Fluoridesl

Knutso's Technic
Muhler's Technic ,.
Iv\outhrinsing after Supervi sed Toothbrushing
Incremental Dental Care
A program of incremental 'care shall be the basis of the dental services
for children and should be extended to.the highest age possible that
logistic and dental manpower will permit.

Schedule;

First Year -' Start with -aLl the three··(3) year old children in the com-
munity. One age group is given initial care for all dental treatment
needs.
~ Second Year - Two age group~; a) one.age group, the three year old child-
ren (new) will be given initial care for all dental health needs; .
b) another age group, four-year old (the 3-year old on the first year)
wi11 be given maintenance care•.
Third Year - thre age groups; a) one age group, 3 year old children
(new) will be given initial care for all treatment needs" b) one age
group four year old (the 3 year old on the 2nd year) will be given
maintenance care, c) .one age group, f i ve year old (the four year old on
the second year) will be given maintenance C"Te,
Fourth Year - four age groups; a) o~e agc. group, three year old child-
ren (new) will be given initial cara for all treatment needs; b) one
age group, four year old (the 3 year old o~ the 3rd year) will be given
maintenance care; c) one age group, fin yee;: old (four year old on the
3rd year) will be given maintenance care; d) one age group, six year old
\~ll be given maintenance care.

Fifth Year and the next ensuing year - a) 3-year old children (n~wl year old (
(five year old on the 3rd year! will be given maintenance care; lnltlal
ca;:e, b) four year old children maintenance care; c) five year old child-
ren maintenance care; d) six year old children maintenance care.

, .
 -~,
- FILE NO._ _
BDHS REVISED FORM I
.,.-." -- -. :- . ,
. ~.".'
......
"
.:
(Surname)
.•.
~.'", "-: ," .
"JMiddl~ rlamel ' ..
.HOSPITAL I MUNlel~AL.ITY SCHOOL IF1RM·

.. _OUT-PATIENT
REPUBLIC OF THE PHILIPPINES
.. . ;-IIII.PATIENT MiNISTRY OF HEALTH' .
. ,- BUREAJJ OF DENTAL HEALTH SERVICES
DENTAL. HEALTH RECORD
C)ATE OF BIRTIi _ _- - - -_ _ OCCUPATION _
~DDRfSS _ CIVIL STATUS
OPERATION
CONDITION
52 51 61 62 63 64 65'

18 26 27 28
. !

CONDITION
i OPERATION.
(LABIO - BUCCAL)

RIGHT LEpr
85 84 83 82 81 ~I. 12 13 7A m'
CONDITION
PPERATION

DATE OF EXAMINAnON.
AGE LAST: 81RTHDAY ,
PRESENCE OF DEfHAL CARRIES Y III Y NY N Y NY Ny NY N
~~ESENCE OF GINGIVITIS IY N Y NY N Y NY N Y N Y N
__ .~SENCE OF PERIODONTAL POCKET y N r"
IJ rv Ii I y -tJ y N y .. y IN
PRESENCE Of ORAL CEBRlS y N y f'j!Y N Y NY N Y Iv IN
:,PRESENCE. OF CALCULUS Y N y N Y N y N r:Y 1-.1 IV IV N
PRESENCE·: OF NEOPLASM y « y \II Y N Y N 'VN Y YIN
:PRESENCE OF DENTO:" FACI ~ ANOMALY Y ·N y N Y N Y N Y N Y NY N
T !p IT p T P T P T P IT PT Ip
~ I--NU~ F T EOFffi P~EI\l T
12
::> . CARl Sl~ C TEP FOR FILL lNG
.0 . rl\D :c." C Ti=t1 FOR FXTRllCTt(\N
.T . -..
u ,
.1"0 ...... ..
::x:: ~ :;;-;c Toe tl. C> II: C. .. ,
b ..
~LEDcI ~ DE C:TORI=J)
~"
e Tr\"TAL I! DI\I F TE:ETH· .
FL1JoRIr I\PP rc IITION
TXAMINE Q
 - 1--------- ----------.. --------------- ---- --r---
DNrE DIAG:TOSIS
I Dl~o:AIL SERVICf'"
m':iIDEREIJ I LOCfo:IOH
r.)-h"' ipT..:~.:::H
I
OPERb.TOR
I CREC'
BY;
,

I
I I

I
! I

I
I
I

I
!
I

.. I
II

I
I

I
- I

J
<,
Cerise free tooth
Caries indicated for e"trcction
P
I
Pontic
Inlay (oount as filled or resto~Gd)
.D
It -
Caries indioated for filline
Root Frac;rnent
1" - Filled or Ilestored Tooth
oPER.A.T);.Cil
00
• :,:is£ing due to c~:t"ies *A AmalsaI:l Filline
.;.0
U
- ~.:iscing due to other ccuses
Unerupted to~th
*B
X
Synthetic l'oroelcin, Ceme nt
Extraoted due to Caries
G Gold Cro..-m XO Rxtrc.oted due to other CC.U:::6S
J Jacket Cl'own EJ;,SCELLJ.:.IEOUS
1.JJ Abutment TP TeI:lpora~y Filling
FiC - Fixed BridGe Y - Yes
rrr
' ,
S
Removable BridGe
Silioate Filling
U -- lTo
Also oonsidered as oondition
*
 APPENDIX 10
INsrRUCrION FOR ACXlMPLISUNG BOOS REVI$D FORM I
(INDIVIDUAL IEI~TAL HEALTH RECDRO)

BDHS Revised Form I has two uses, namely;

1. To record the findings of the oral exarninations done on each new pa-
tient and if the subsequent yearly oral examination given to a re-
,gistrant of derrt a l health programs•.

2. To record restorative, surgical procedures and other services given

to the pat i ont ,

The form is div:d.'dinto three par t s s (1) identification, (2) oral

health status of the patient and (3) dental services rendered to the
patient.
The FDI tooth numoer i nq c ,:,oem (two digi t) is .adoptod, to conform with
In1:ernational· St andarrts ,

I. IDENTIFICATION

1. Name of Petier.t - to be ~Titten in block lette~s.

2. File No. - E"ch patien'c re'Jistered and examined is given a
·file ntu:1be:- in chr ono Ioo Lcal order. The pa't i en t is given his
;,·il::~. nU-::P0r to f2cili.tato loca.t.:ing his record when DD comes.
br. ~k "fo:l" anot.t:0.r t re atmcnt , . The nU::1b0!':'ng is done -by qr ado
in t... Iernont ar y schools and by yc ar i!~ c aae of higD. school s ,
.cl11.1ugi:;s an6 u:l~,vOJ~.si t).es~·· •.
..,
vn
--. •• ' ;.. 1\.. • . . '
..... l·,.y-·- in case t.h e exemi nat ron was
done in a c i tY1 \"rrJ,7.r: t..
h9
namo of th':' cl ty.
'4 • .I,~.11.'1:(:ir(11ity/l~~ovir:ce - l'Jri teo tho .name of the municipality
. and Pj~ .:,-i nc e yJ~ere "tr.G CX€I!7!.1.r-• at.i.on V.JD!? conduc tc d,
·5. HO$~-!i tal - In caso the cxa:1)ina~;i()n was done :i.:~ a hospi t21 write
U,l8 nao,e ,of "the ho sp.i tel.

6c Ir: and D)..r~.,P.::ri~L?nt - Check ·l~b(.' square to .1IvJic,;'!ts'. ~\ilFJ~:~:~:l" ir. or.
()ut~,·patIerrt ,
,7. Barrio/B,Jl:'an903Y N6.• /Schr;c.l/Occurational Establi shmcrrt .., Hri te
t th", " "\ of . the "I=\-,.,...~"~--:-0 , V_,
" ~ n,Jmt,.; 1,. ':'.
.... .,... .....
_.\:",_,.
P·..,........
. <:l
,..'9"Y i1u'~'e1'
L,~, .'~,.'-
.\:.
,...~ ....
diU, -:- U.J- ,~ J. , or C'c"u-·
i.:r.",O()' . ~»
'

pat i ona l 0stacL. shf;,;e2"l"~; wller,,:: tne cxauuuat i on was 'CC:1CU:::;tG·':;'.

8, Popul at i on GrO!Ji)' - CheCI( -::he square t'o indicate tne populo tl on
9!-'~li) the patl.on.t bclori02~ This is dorie after corrp 1xt i n2 ri,;n
on his l~s·t ;,ir"tr-~de.y 3:id Gl~ssiifiBd as f o Ll.ov.s ;
i-',-e ..scnco l 2 to (- yoars old
SCi>::,ol crri Ldr-en. 'I to ~4 years old
F..:-e··:"l,:rt.aJ.5 .15 to 44 years old
J~diJ.lt!1 15 to 65 & over
9. Date of i::Lrth - lVri te the month, day and year vynC:1 the patient
was born. .G:lt thi s Lnf crmat i on from the patient· or from the
.p8r~nt. or 9ua~jian accompanying the. child.
10. Address - Write the number of the.house, the name.of the.street,
barrio and rnurrl c i pa H ty where the patient resides.
11. Sex - Chock square to indicate wnether male or f emal e,
12. i:kc'.Ipat.ion - i'1dicate whe.ther farmers, laborer, employee,
school chi ld,. dopenderrt , etc.
II. ORAL HE.ALTH STATUS

The specific dental diseases and conditions incluged in this :record

. are ·dental· caries, periodontal diseases, calculus, neoplasm and
handicapping dento-facial anomalies.
 - 2..;
•
-./, 1. Dental Caries -

Using the appropriate symbols in the legends, record the cOndition

of e~ch tooth present as diagnosed during the oral examination in
the b lank space for condition corrcspondig to each tooth' which is
nlp:<,,"sl'llter1'by a circle 3:1d number-ed in accordance with the' two
diqi t G)'stsm. The circle is divided into five \5) parts repre-
's'mtj.nD t.hQ five tooth surfaces, n ame Lvs 1) occlusal, 2) nesial,
3) eli s ca l , 4) labi.o··buccal and 5) lingual surfaces. When a
tooth is not p:::cs'"nt during the time of exami natd on , it 'is re-
COJ.'Cta:i {)i thr~r <;:5 rd,5sir.g due to" car i o s , or mi ssing due to 'other .
C<:USG5 0:::' u;')Qn.:pt"d to,)t"!; using the sppr'cprd-at e symbo l s in the
l£'gcncL.. Y:hcn a tOQth. .ls":folJ.nd wi th clinical caries but not'filled
01"' rl?st:-,:!.'c:d q t:iO uje(Jct Ioc at i on of the CE1:i:'ioU5 lesion i·s not cd by
o!Jtli:lir.'j tti:2 tGvth s\~rfai>} or. sur f ac c invcl\r'~do ,(See cxal~:91.e).
'If_ 'r~"-"~V"'l~-\)
~L.t.... c .. G.
~r.. ":-'il;,-~(l
__. 1/". \-,n t· ,~:....;:..'·.·,1,.~-:-
1 _ _ '", ·,ri···· _·.l ... l.~.j _ ~~i·11;··,~ ~r"'.r·~
... - - ••• 1,,'.) ,.I,.~ .. ;.:..~,., ....
......; r1c..... <.:;'·-11 ..,
1~1~."

tht:: tooth ':;Ul':fiJ.::0 0:::' ~~,:';.:~iacC's in.volved" ,~l'!ri to t:-i{;' .t~tt.,;:.·":'· ,G at

tho.:: r;;i(J612 o f tb.? cil'clc-.:ropi."esc·nting tlv) toqth wl th 9010. ~=;:c:)wn
and X(-iCDrC~ the car:diti(J:~ rlS cari e s-.. fr"1(.' vA~3n ih(~ .crO!:":l Vias :Jl::J(:od
fOl~ ~J~:~;'Uw:tic ;J1.il"fJoses~ If t.:·IO p.::tie,-d; ir:.fcr:·G::;-d the der.t is t that
-I:.ht· qold Cj'()W:1 wit. plo.,::<~·d fd=tH:: thu toot;) \'1,=),S fil1ed~ r(~c:':)i.'d tho
'C(J;1c;iJ~i0~ as filled '~:a<n;h ',\YlG;,' tht1"C ::3 :.~{.; 55.yn of ~';-~'::0!1':IG:~'Y ca...,
,'1:1
_
· ...~:'.".
;;>
T~:' e'.. ro '0-' ". ,.G
_ . . ., •• C·.-f.. (lIt
~""r".'.,,"::1
.a c 1'" .l.... ·t,\,·+-'·.),~
,,) v'" "'~" ~ ... ' •.,{, ~'(' ...:,--:,
"".r"~J..:.~: \,).\ ~ '1~ ·J.i(~"':'
'...
{;,.)ll{&":''''~, •. ~
···--l·r.,... (l~,... ,,~..J ;:-
1::,1.1,.1,: ... BE- ..H~ .... a".;;.) .. OJ,. f':}j-~n"" "l~ .:;-,.,.: .~.,+~~ ti
";_" .. l : ) 0,. . . ~ ...... , .... \ __'.• ;.y ....'...on .:".
!Jl. ,:.\:, .•. ,t. ' c 'c:..~'.~.''1
-i., U IU~~
b~-o "iof -crln tc'o·t:~ shows ':..;~t~Jns of dE;:~t.:::~l~:;t.i(jn of ·tl),'~: 1;:1·:;,·::n:..;lifll
·:··l.:'C:,.'I·~::>.·'·
'''-' •..•• , .... \"J·4·t)rij~
"... ... 10." • . .1 .. anv
oJ _I, ·;~·c'·. ofL v-··tir,~''''·~l
.;l._.P_ ._\"'l. r- "}'.,:io=
' : '.... , "'';I '''''~i'':-'''a'
_ .........\ .•••. '+l"'e
,,~ co tv d J.\. _
'. ·.t

tiO!1r as c i
s r e f:Cf.,~·,
s rJ;·j, t o J ,T~ tile mic:,iL,:~
" l , : , t t e r o f .1.1
t h 0 c i r c

r0;J8::,entin? i;tw tooth :N~. th j ack {?t (;::p','in and :!'C'(;'.~r d ·;:.h,,; \.";;.'~l;.i=i t~ :")(.1
as ·'filled ~::r ~'0st.Or:·'~o b~'~,n9 the; ~r:Y"J.'0~·:!'i:::t(; Eyri:lm::.\: Vl:d.t:): ~(:ti:tn~s'
... ' ";':A~r:;i: "th,u ::dddlc: of t.hQ ci:rclf;~ !"{·;?.rf)5(';~:tj,ng the tooth !.1se-:i e s :in
abut.neut fo..:.:' fij\f.~d or l"':'2r:IG··::1hJ.(! b:f:I::~9n ~nd r:;:'\:0::-0 ttl';! CG!:di -tinn
a'l c,:l"ci'(:s fT.~:,e \',:T10n no c l inicc I carJ.~)s is dGtl:ct;~,:L \'~:H'm c.linL:'Cll
c~~Tics is dl~:'~\?ct(:d :'ccoxc th~ c,·mdit.ion Git.h,:~:: as.(~~c~y'::d fOJ: t':i)J.....
3S ·the
,.
\'.'ri te lc1:i:Gr p in the c ir c Io ··l~~r:L~·G\;~n·tin:l a. pon t i c and r ...ccox-d t!"'ln
conc~ition of 1:-11.(; t:~")~~l es ,:r;'::;sinq ch,\{) rc c ar io s ()1: IT!i~j3inq dur; to
'h .. ,~ ':.j.- - " . , .".' . • !-...,. ".".: . . .,., ,-" ,.,.... ,~ ;., :~_.I.~.' .....}.... '".
(n:.J:~'1· r:E-~:.1!:~(;$ ~;:, ,.. l,~ .c::~;."\. \;:.).) ~.A.? ·., ....,.• r3 .,1:.: eJ)l)"'0t-' J.c.~I... ';... :;!'IT.~~" ..•. ;;:)
' •.
:l,;j
-{--1_
...:\(;
1 .... ~~ 'i .--:;,..." "'~: 1.: "..
_e~;'i:.,1:.~ ·.~.u.. r.~,n,.\.\- i.J\.i':,,~·
F""·~ ". ,'1.:\ - l'-"l"':"! ':, ·,~""'~1'"
..·I.·.• .J..J.C .....•. \~...
';",\." ,.,.... : . . ""
:,.~11:;; " ...~;D ..n .. 1.. ,.1. "~_.l t. ...

~-.h(; :::f.·JP~!:·I.;~],i3i~, ·Syr,l::-o.~· -.f'.XC fiz·::~rl brid~:;;Jo . ~-A~:1kf:! ·z~ :"J Lf i~.1. ..:".~J.(:
',.sb(r.',:.~rn tn0; ·'.;t;.;::;tb '.v::.th 1·(~n;c·~~.:dJJ0 bI'i':,~A':~ iind. v:::'"1 tc ~hr: .':Ii\),r-orn~.iate
,
E~'::lbo 1.1 ,'".",i'

.. :'

:>c '

..
 3 -
--.J 2~ Date of Examination - On -the first column, record the month, day and,
year when the first oral examina t.i on was pcrf orrnad, Dates of subse-
quent yearly examinations are -rcco::-o8d on the next columns.
3. Age Last Bi):'thday - 'T;1is is the age' of the child on his last birthday
_..,J at the time of the exami na tron,
4. Presence of dEmtal c~ries-!'.ncircl() Y, if patient has one or the
more ,t:cQ}'ed, mi ssing and filled temporary and permanent teeth.
Enc i rc Le N H noqat i v«,
5. Present-a of gingivit:'.s - E.ncircle Y when there is' eVidence of any
ono 6,: mor" of -,he following signsl - rudnc s s , sl-Ielling, ulceration
and blE'~)dir:g around one or. more teeth. Enc i rc Ie' N if Ncgati ve,
6. Pr-esence of p'3:,-ioGont.al pocket. - Enc i rc Ic Y if periodontal pocket is
pr e serrt dfc~ti"g' one 0:- more teeth as cvt denc ed by destruction of the
epi thC'l~~;il ott~.il:~:il(~nt. .1.~nci.T:Gle N if r·~0Ciat.i.v e,

7. Pr o scnc e of 0::01 dobr i s .., Enc i rc l e Y.if or-a l debris. is present as

evi dcnccc by ~'oft :f:}rl~ign m(rtter ·con~~i.stin0 of f{)ljc:i:1! bac terLe rind
f '008.,1 1 (:;'1::"1 V.31'Ylr:g
- •
an cot. , , ',.0
or"r rorn {!T.'a-~n.• sn- V~;~l + ,"Co gruc!\/, -
or~nJ'.!.: en
th e
surfacos of one or mO:CG of the follo\',':1.n.g tf,::eth,!
BUCGill ·S1.-, !\r:0 <:' UP?~I'" r:S~qht fJ.ts·t r,10J.;~:"
Labial 'stJrface UPtx'r :::-j,ght central incisor
T..1.n~Ju.;11 S'.l::faS8 L:PIJ f2r 1,,}~.:-c. :~i:r.:3t mol ar
LL1:)'..w l ~~n"~::Ic.c ·... 9 10v,;,)1"' r1.~;ht :i:·:.i.,~~t :-no1::l1:
. .1,o·...;{;:: lef+. c:::r1"t:;:·~J.. in.:-.i:~o:.:'; end :th~
lO1.·I~:''' .1c::f.~ :Cj.Tst r!I~J.~{C
8.' Presence of calculus - End.rc Io ':[ if defini'cs h,,):'d dE!P(",i':s ,,):'0
found on C(t!~ or fi:U:C:2 to!~'~~1~ G;:(".i~.':~J.0 t~ if N(.;';:.3i:i~/eo

·~r:;t;~~l: ~~~:;i~g:~~:~~;~1:~~;~~~~:~l~J~[g~~~~~~.:~:~c~;;P(;t~~;?-Jr-~t0GX!;;~;g:ec!
9. ,

10. ?~~;S~1;(~(' .. ~f ~;;,r2~~:f(1~~.:~.l,:.r:n?m~?:!~_: )~C~~i.:r~~~

diJC·r:;·J_Y Lv f.L~.,"?,·... ,,,,~ 04-E.,-jJ.'-"e ......'-l::dt..~.·;-L .. ,1
r
.. ~'•• C.1
j;f ~~~h . . ~l~~~~:~"'~Ct::;:i.~~. ,
OG,_ ..... ··-.~c: •.•.-.d..;. ,..:10f:kl.·.y
Inc Judc s ei ~:hs:.:, o"f; uf t.he: i0l,~, .)\·"ir.(;~ c)'·;:ft (-,?oInt:)? C.!.0:'~:t l:~p~
~~.~?;~l~~!~~i ~~::J.~ ~~~~~~~~~.:it;;~~ S~~tlO!~-:~~~~ .~ ~(.~~~ ~;~~~r; j P~J;~;:.;~l~;i ;~f~·:::;dl~I.:~;;:';';m~:
if th·.J c;isfigU::':'(:,lh::~nt cs: fU;ICU.01l2,1 d~":~.:cct is o:c is "db~ ~'1~ 'LD b.:~ 2.f:
nt
obs-J;a~J.i:: t.o the .r:':;b,2:"!'t'S Fh'![~j,C:.l. 0:( e.no t.i onnI '.'V:j}.l.wbt:.'~,;~-~J" .
11. Toc th Count .. Count 8·:~sh tc"..Y:b. as a 'Nhols. l-l':,5.t and'l1(\-j; '+;h,~) !:".lfr:bs:~" of
c ari ous sur f acc s 'Ei l l.cd .()::' indjJ:llt~8. :::~j~: '.f~.1.J.irige
12. Nu.fflJ)Or c f .Ti.~(: th [lrE ::';H~ t ... CC:'EI t '3!~\J j:-(~~cl.7.'d the' tot a 1 nUL::.'J.;'.r of tpfj·.:;h,
r-1T.t.~sent sQp:;r;3.·:>~l'l fr}:.: :.":fj,pOi.,.ry a,:(1 ;X;?:;!~2:D.·~.;r.:t tcsth" J\ t(.i(';·~h is
r:.ons~.ri{~.r;~d F~=-f:::;'~:'!r~ 'i~i·\·.;:·: j po:-'i::,(;:; of tho? '.~:·0wn c s.n ,jlr:;d')Y bt~ ,:,!·:::e:'1
2r:d o:i0 ~.cc ':;)t:L
13.' Cari'2;s :t":r<::(; ·TQ(:t.h·:... C;-l:..~nt 2:-.d :r~Go:::-d 5\,~p2~::'a'~~:;,ly i.. c~, tG!!"lPGj,·::i~."Y
and P02IT:I~-;!!ent :.\:':::Y:,:i tiOi"i u:':o iric lude only ti1()::;'i;.! ..·.!.i t.h 11~') ,,,,;·,;i(h.::{)·:.:,~
o? c lxr.i.c al c,;.,;:'i'::'!stI C1.:.l1ic..:;.1. C;;';I"}'(~S is qofineo{,' f·j,!; th~~ ~Yi.J..t~LJ~(~
o~.:' T0Gc.-r.dir.:9'1 3:"', :.:\ ';2.vi~)' ;:-ositi\',~ly (li;::0.r:cs::d by ~.1o·;.ltb :~j.?.rDr <'ind
prd,Y~ ~:,x;3;nin03tiono J.
14. CC::i.'j.es indicE,}ted fo:. filli.r.q - COl-tnt 2~d record sep8.rately fG:r,t.::~m­
pora:,:'y i-:·nd p'-:::rlJJ':~!l'~ilt ~r-:;cth.,· A too';:h is cOI:'sidered 'j,ndic~:.tt'!d inc-':',;a-
ted for: filling .'/h001 clinica-l Gari~:!3 :1'::$ dav:;;1.':);Jcd without j.nvoJ.\~0-
. m0nt c';:: 'i:hE: pulp, Inr;luda i~. :::h(~ cuur\t t00:t[~ 'I'li. th permiloE;n"t iiLU.nqs
but. "'iith s'3ccor.d22'y cari0us 12sio:lS triO te.Gth with t9i11por;u"',/ f:.J.lings,
,
- ~- 15. Car:!.Gs j.~"'ldrc,:,)·:~ad IDr 0:<i:.I'ctction - A 'teat.;), is
c',)ns:ld('l'(~d ir~d3.G:.tc(i
for ex't:~2ction \"!ht~n it is vn5nvabl(~. A tocth .~ s co:\.s:.dr-:·!'.::d llns~v0b1e
whoS':l it C<1r: ;10 ;'ong8:::' be r0s'to:tcd because 'of badly}n:c>!..';on (bwn s:.~r.""
f':'G~~s and involvement of tne puJ.p as a r0sult of G5J'ic.:s v GO\lnt ;.)nd
rec'ord 9,~ptiri-rtely for te:nporary Clod per-mar'lent tee tIl snd 5.n.:: 1ude
filled teeth but u~s2vaole as a result of caries. Root fragments
aro not includad here.
o
 'Root fragment ~ Count and record separately for temporary and
permanGnt teeth andcoQ~t OQly for l,holo tooth units. and not per
.root f r aqment,
Missing due to caries ~ Count and record separately for permanent
dentition only and include missing teeth and pontics.· Do not in-
clude un0.ript~d teeth here.
FiLl.ed 0; Restorod - Count and record separately for temporary
arid .pcrmanerrt teeth (include teeth with permanent fi lling such
as amalgam, silicate and cementi teeth with inlays, jacket, crown
and gnld crown that do not requlre further restorative procedures.
Do not count orthodontic retainers as'filled 'or restored.
19. Total ef df and Di,~ teeth - Add the total. number of decayed,
missing and filled teeth separately.for temporary and permanent
t oe th, . .
20. Examiner - Write cleurlj the name of examiner in the space pro-
. vidor! for.

II I. [ENTAL SO nvr Cl'. S RF.Nl1'.RED

All den t a.l services 9i von to the patient are recorded at 'the back of
Fo rm' I t. ·~;!Y.'i"~,in0 dowr, 'the di aqno s i s , det.e i 1 5 of ·se~.vi(:9 rende;.~cd, tooth
nu.:lbe~'~ ;l,.:ccl:cdinJ to tV-It') di.oi t Sy;~tS-iTI; ~):\··';!sc:ri;.rt~on:. r,~f2r!'als and c!(~'~e
o f .I.;~
.... ,. . + ;"'.p; 1 n.,+,
t) OJ. ,.,,.,' .. rJ +.• ~ ·.....11-.:-.5"
....-H .1 ..... \ • .r~I.,J_.~ 0 ..o" \..1."....., ,J.I. '_-': ,.1'-' ... l o·"o)r.
Lv '\ \ 1' ' ~, ..~. ,1-·"1'-' ':" c'~·"'(\"'<,"'l·"C·]·(>-
.. J. ,'__ .1. . . . I n-
'0;.1., ••

dicr-.:ti.ng the:, 6.;lte \.A.h0.11 t;:,€at1j"i8,r;'~ V.:2~ ;x:X'f(;~~mGci·,3r.;; (~!Jl';' siqneo ;):'/
the·(k~llt.ist~ Iht! lest co.l urcn .nav 'be; 1.!s~:!;j i.N "dhJ d,:~:;+.ir:·c :Y::~ :h..:~ St.l.-
pervi -s(}r'~ At any :timr:1 dL1:':'~n~ an i1'1;;!X~:::~ion.; the ?c:"".TIl!;, ~;i1[);_\16 bc~ ,
aVEli.l--.;bl-::: t\Xf.' f;h(~.ckircg i:;y -trL:: .sup6rio::- 0f:Zil.:;ers, The dn!"~:3:1. s2!'\;ic~-'!s
pe:d.·<.J:~'m~·:~c. on ·ChB i);.ltic~~l·:: is also rccoI'(kh..~ at. ·:-,h'..1 ~:::;.~':w t. :~;i"~'J\:: (;f t:'~B
s ame f..or;-'h

1. Fll.~ori,(b I\?plicatior. .~ t:~,co7.'d the date when f Luor i dc so Lut I on 'is

a~)pliad. and '~.i. . . ,e n~:I!.lb(~r of' .3?plic2'l:ion.
2. Opcraci on .~. A ·r::,~;~,-i:rat,ivG c r su;.. . ,yi.r~al procudure pc::::'fo:,.med on 03'.,,:h
t()o't'~ ~)y thu clcnt~1" st i s J~Qcol'dcd on the ~::).:Jr;k.· ~:;rli::('.;;'~ :~'Cl~ ol>tr;,',t:LiJ:l
cOJ:'T\~'s;x)r~:).ir;I:J to. tho .r.~~n~tiGl.:J.a:::- teeth t:c'catcr:l u::-ing <~:J;J"'~:)?ti~'L:1
,~Yi~~':l(;;l:~ :i..l1-,-:hc .l..l:Q,~n?~ . . .~:11.y c~:~pl?~e~ . t,r~'~tm.-·:n~~sl tL~;, t!Jc:.'t(::·?-:~·.
,....c;fli:H8 ·..CO" l".L G~l.:1J~:~:~, L'·.<f.el:;, 0 1.~"l':: I'~;S1..l..'r::l t..10i1 o,' _~o.: L- -co:) tr: ·SlJ:l>.
o,·,j·' ,.,,· ~I ... _C'l.l.. ·~:··11.· ',-:') ...... '1- ., . . . ' ..~ t· .(:- ........ 1
f a ... Q~.· \.1~11
".··.)cc
1,;, _:1-,..::I'·:..~'~ 1-1 .:-.inj tldt .. ". .1.~ .? \~.:. ex't.,.3· ~10n l),. I"'\lsa/u..;.",~
toc)th., . i\ tr~l1lP;.:;J:JI'Y f:i.11i.r:S c'on:; 0:. a t.oo th is' r.ot co:·:sidr::::(·;0. as
cC!f,pl:':;'l·.c:d t::-::Q"t:n':::ii:,,' .th?::'G:fG::-S'~ shc ul d' not he :r:-''::(~Ordf;d 5~r~ tho
Sp2G8 cf ('P!~:r.~~~:~:~r. .... J:~~ ~.~ ~~:~~~~·~'~;':i,,~:$.. a ~C:'v~::: O~ -;;;::.,~=\C~~<" p;:?~.
of !:~'~'i:'El L.· A....... "" a pr.. .l.:TId:l('f." .!' ,L.l..l. 2.~ ~:J 1 B (.Olr:pJ..~ ... ed ') 5'1 r:d.t..' the Q_C"~.:;:j

0~~?~;Ei)E~~~~:~~tt~"r~~~;~~~;~t;
".~'::<'
..
(;;1~~~A1'~~~;(~h f;j~·'~~:~2)'~;i~~~;:.
l.o""J~~ V~ .....: .... 8 .1. ,Jr.l \,1>..:. th.]
S:--,2G .. :.\..... O..:".;}dt. ..... C;! aliO pJ.'.~~r'; ':;'.i. .'1, OJ/.
'c{~r~·t>rr cf the circle r op;..'~:,sc~tin'] thG tooth (~;ctraGt:::(\~
L:ix,Jmple:

Opcr ation
Coni.;U tion

'y_.

After tho denti st has extracted No. 16 write X on the space 'for
operation and writo X on the conter of the· circle (No. 16); Write
 - 5 -
·A on.the space for operation after a tooth indicated for filling
has been HUed with amalgam and shade area in the circle indicat~
ing filling performed on No. 14.

o
 APreNDIX 11
CRI1ERIA FOR TI1P. ASs:.SSt.IJNT AND RECDRDING OF O~AL
, DlSOA:£S (WHO 1F.OliUCAL w:.FORT !ERIES 1'0. 242)

rEFINITIONS, '

Dental Caries - Dental caries is defined as a localized, posterupti~e, pa-

.~)
, thological process,of external origin involving softening of the hard
tooth tis:;ue ar.d proceeding to the formation of a cavity•.
Clinic a l Carlos - Clinical cades is definod, for the purpose of recording, ,
an a c,w5.-tv d5.s~.~nosQd bv mouth mirror and p."obed examination. It must
be emphasi;":(~d th<..;t c Lirri c e I caries is a sta9u in the process of 'dental
· ccr i os , D2l1t2J cara c s proceeds from ,a microscopic lesion, which can
not be po ai t i ve Iy diog"OSi,C\ by present clinical methods, to a cavity
(or c Li ni c a I c3r1.es) whi~h ceo bo di aqno se'd prJ::.'.itiva!y. 'Among these
are! \';:-01 to ,nd/cr 'c.hell:'! spot ss di sco Iorcd or rou';jh spots; hard stained
· pi t s or ±.~. SSl.lJ:~S in eilnm<.)l \'ldGn 'Cu"tch un ~~xi)lQ.T.'(~r but do not have do-
+e~t,.,'}-,l,·
... '" u .... ·:~()':;·tD~l"'(lt
...
~'1 J.
-":·1·{1·';···
.• ~....
o r- ·U"Ci~'1"'-;'11'·'··O"
I"y fl. ··...
..,." "'.' " A "'·:1a ; ..,, 1 ('~~
.l.1 ,1'~ J. ~ ·i)re-I.~(":
U
.. '''I'1 i.n
c..1'._C',Jr,.
'~l
Q
_.
, ••';. •• __ ';1 ~

the wall s' of trh': pi t q~' fi 55,'J].'CS ...

Ufo c ari es o~~pC:ri.p~1ca .. Past .c,:'Ji.'.ies and 0xiz'tir.9 G15.rlic;;:.l c,:r{cs tcg(:thf!r
· (':onst~.t:.lt{J the 15.fo c.n-ics G).:l.:~l"'5.f~nG<:tl Thi s rnav .be (}xpr'8~s:.~.d ;J:, t ho .
.~. ~:l'"n oT
_~ . . .+~1:'l
. n·:.~l-<·-;"'·o;::
:.~
;.'.J•• J•./',': ... J. "'1"'''''1\!~\'~ r-ri -"':r'("
1,~.:V"'.i·'~\...\~
'., •• :;).)..... -r~IJ .;:~ 11 "r: +--:..1',",
...
~d u".~' <1._ ~.':'..I ~;~.I"..:l,o

Prevale:";G0 0'; G.linL.~;;tl C?:t'lCS ... 1112 sis tl10 tl'.!n'll' uSI:1d t,') 0:,:;.)::"';)3:: trh' f ro-
quonr;y ox c Li rrlc.i l dent a I c cr i e s in (~x:i.d.::~:n~.0 ,,·t ~i P2I'ticl.\L3l' po:!.nt
of tim;-~~ WhH:1 t):o .,.; :--1•. ·T:l "i."\V};"'''' i ~ C'<·....
. . r...
#\. _.'#< ,,~• •·1·'··""'S~I·.,4
.. - ...
"'C: '-n- .1-"""1.:.... , ':·\'-l(·· cli.::~lC~Fl~ 11.,,·t-~)r
...........'
·~ ~
''';;0,$.,:,\
~,I '# .' . .;,. '.01,""

shculc bo t~1,; n'.Jr."!i>:tr c~~ ps.'::'~;cn exaf:d.n::~ct.,

t.. ..~'"' "'\•. .,V~.r: r-' .. J.;. 11..•
...., \.lr.r..l.·,l,l\.;·~,~
I nCll d cnv\:' 0,..,.;
~,..
,J..
C~d.LJ.~"
. . . :~,.. - 'l"ld c ~
...... ~S
t'n.,: ~l.~~." '~'~:l' ·~o ex-
f::
l,.,-: ..&-I.I .1.....·.\
1

P~(!:~
·of ~h0
...... m,:"
!~es~l'~?Cl~~~·~:~·::~ n.~·w,..~.:vi, t~e~~~f~~::,:<du~i rl~ ~ .~~::~~
... 1. l., (.. us t .. ,~k~;'1 t\_· I·'.~i)r(;ss J.• ".,.·.v_,t,,-.;. (leo q.. :"'\.~pl~I':Jl-;
p~::;:'i0d
,':1~1n :.1iJ 1
!',1'~n p2l." r,::-:rSOil"
•

T:1I,' at: t:Jd 1 i. ode); t c b\~ U5CC! is determined by the purpo se of the SUl":i:J\:
and shl'.\u.'..(i bo.. th::l't OfF: ','::i.ich fuLfi Ll s ,":)nd' purpose of t no s:.tr':V(:y ·in tlK~
s .j.,' ...... 'n
... n:-I'."~""l' a-r '\'~' 1,~R .. 1 . ~,.,.., .. : : ' - ' . rr;"
I.,O.~,. l.:(.'~110..l!t ....." '-or.. , .'.O._J. ).,'~\;:
.. 0 ....
, .• r1,! _"
~,-1.:·,
ro. ... ,..1
t.1' .... .)·~.. \., \...t.-.;; ,"'.--j#,:I·:';".IC
•. .J.j":) ......).:.,:•..:. "".c.:
was ~,'Ni'l::'D 31.: many 1.:1(lj,\>!:S::l i'C, ~~i'';::~ cL'nsl·jQl'ati'm only te· tho$~.· r:;(;~rt ~1P;:)'!.'O­
pri.o.t(i -:OJ.' d!-!nt~l public r~{;!~d,th. sqJ:VD ....~o Th~.se Lndi.c es 3(~r'/S ti''Ki :.urposf;s"

The first ptt?"'POSC is to provide a moasur o of ·the prova i enc e .of c Hni c al
c ar i e s , of tc-0th f.llissir:g du!~ to, car i e s or xi Ll sd t{-,\eth in t!::crns of the pro-
por t i on of ·pC.r.'S(inS i1:::·f0C-c.::d;. ", Tho :.;~lculr.';:inn of ·tlV.:1S(;1 Lndi co s i;)vQlv,(~s. a
CO'Jc:'t of th(· Lii.uo1t::.1X' Df pCrS{lnS v•.;,.th cno or norc cavities \cliz1icBl c;::r.-i~s) t
wi.th Ofl\: O~: IJic·r':~ t:.::·c"t.h j11issin9 b\::C2US~J of c?:~-l~)s~ a:' w:i.th one O:C ;:10::8
t~,,~t~l fj,lL;~(\\l Tnt}S1] !\l\inbcrs ,::1:::12 divic;~0r::1 b).: thg !1iEnbcr of persons ey.'Jr.i~.ncd
multil"li{~d by leO;., T~·p:: :cn51""1.tir~9 f5.fiur0~ 8X'C t~lz; poi.nt ()!"'<?va10nC0 ::'~~lt'2S
""in{c"'1
o f .#J.. ... l ,... ,U_ f""~'."';~lS
.,(.1 ....'.l~. ~ ,.r.
.J:, ·... t::.':>..l...
.'~,_.~ .'1
l c·'J·'~S'j~·~
II . .;:;,.,.• ,J~j '~l'l'~ +0
~\\:, . . . .r.~·",i":lS
. .:..J._:" c-.~., .. 'C~·l'-.(l
'1·\.-1 0'::: j. ......L'.: • • , J..~:,(.'1-h
I,,~,,~ •• ~.,'

Such rates should b~ e;{pr,,~ssE:d sp\:::ii":i.cally fo}: 'eSic and opt.~on~lJ.y io . .~

sex eth:-dc gro'_!ps" Tbey s:1c,uld als'o'be calcuiztcd separ~1"('~~ly for ~)r:'.I!1ary·
and periTI211t:nt to·.;th\) P:..'cval(~nc."1 I'<1tcs of t:l.is type will p~:c\'idc l;1ns:,~0r
to the followin9 q'.l(:stions: Vlhat propor'tion of the people rcciuire treat-
mcnt foT. clinical caries? What proportion of tho peoplu have tectil 'mi ss-
1ng bocnuso of caries" What prooorticn of the people have teeth filled?
What proportion of the. . . . are caries-free?,
people .
 - 2 -
, ,~ -Measurement of Intensi ty -
>
The second purpose is to measure the intensity or extent of dental
caries in terms of the,number of teeth aff~ctcd per person. The indices
which' the Cammi ttse r ccornmends arc the Di\'lF index and the df index. These
~ are definod as follows: '
The D:"j:,' i.nr1~x i~ the average number of permanent teeth per person
which nrc ';8.~2yed (D,I, missing bec auso of c ar i es (;,1), -o'r filled (F)., It'
"is a quantit2'ti.vc0x"ression of tho lifetime c ar i os experience of the
permanent te'),th. h the c aIc ul at i on of the DMF index, the numerator is
the total nU"1be:::, 0: J)i~lF teui:h· end tho denominator ".1 s the total persons
.. cxami ned,

The df index is a quanti tati ve expression of primary teeth which

arc decayed (d) or f:lll'Jd, (flo In the calculation of the index the
num·Jxo:3.tor is the t.o ts I numbor of p:~':~mal"'Y teeth which h::1V(~ c lin.i.Gal cart es
or which h svo b{~p.n f iLl cd, ..r!1~~ d0!"lOmincrtul' is thr: tot:ll nUl;'l0-::::r:' af r.~r-
sons ej(a]~inod.n )

As it' is difficult to dHf'n'entiate b;~tv:een <I rni 5sinq primary tooth

which has b~~cn exfo Li ctcd nrrtura Ll y and a fi!ifiS::':1g !·)r.·i~:l;:jX'~1 tooth ~\'[d.ch
h as bC~1i1' Io st' b2C(lUS~';: o i' ccrl e o ; the Ccmi:li ttl~0 :.>~Co!1!r:1Qnd8d the .df in:'lex
as l';l~;i.n~J thfJ b:::st :Jnthod of iiSSGst.ii19 Gt:~~~,·~::, e:-.:.p(;}:'i,;:n·:0 in qr.-:m~,~:,:,· tf:8"th.
HOV1c'lG::", ror' " 1 0.X' reasons
[.131' t :'...CU ' , , may '
1"4 D::;:. "..H..)._O
C2S1:... 1 1 '
'CC' z" ,
nc zuce .:e::. ' assess-
'

ment 0:- p:ci:n'ury ·:'.~wth lost b(:C<1:jS8 'of C::.i!'::.'3S"

+. In both t hc Dr~iF and df indices a t ccth 5,5 CI"'):);":'l:od only onc c , If A

tooth i5 both fi~led 3:16 cnr i.ous it 'i's C~lurrt:r.d 2~ dacavcd ..
]1"10 main adv,;nt,J~;0. of' 'i:h(:! indi ce s r!,~cc>m\;J'~!lc:1Gd by th::.: Cor.u~i·1:·t"'~2 :~'s.
their f l:1:;.;J.bi Ii ty. ~h-lGn it is d(·: !;i !'~d T,,") mo e sure t.h'S· cx tcrrt ( I f cr.r 3.(;:';
e xpor i once in a populB.+~iot1s th(: D:'d~' 2.nd df: indic:-.:s c an b:.:~ uSl:d ,~D d.;f~!1\;~j.

It is al.so pcssible to usa the· cornponerrt s o f o?ch ind8;:' to PJ:"J\:i',jc

addi t i one I inf').~"rna';:..i.on· of \:i:i:'ClC -i;lcal iffipG,.~·i:rmc~: ill pl.::ln0ir.i';-~ ::nd uv;,;l·.J.'=!~:trtg
d(~ntal iJub~ic h:J;j ltb p:a:'~r;:r2i:lml:?...

TI1e moan numocr o:f;ti~cth Pf~:!,' per-son vrhi ch rGquir~ f.illing C;):"; b::~ (:.1~.­
. c ul atcd by divid::nD t/~(.: nll(.1bc;·:I of. D o:r.' 6. ':~(j;,:t:1 by 'ttif) nUii~b0r of r)C':~'..~,s~.:-::s
exarci nod..

Simil~~:.1.y, th:.) rll,~:m ·nt.u:lb'Jr ·O!( t.co th w:-dch h;;'le alr-e adv bC.'J~n fj Ll ed
is th'\ l"l:m:~.:·.·_~
... :!- of ',-;' O"....:_ ':-o,·~·l.Jl
'•.'.
.I ...... " .... l.. ••• " .
~li '_d .4(~d !1'''- t~·i0 nl.Iij;ba:t'
, •••.• :- ~''"', . ' ... . , . .
"':'lr~on" e>..·.. 1 1 i ' ~JI
of t--'....
'0- .... ' : : ....... ; ,..

thl~ mo:n !lurJr)~r of p(:"c~ll:.:\n"::nt tt;('Jtn .'/vTlJ:r.::l': ,~J. m:t::',:3l,',1.9 f'::I'-;Call~~O ,,1 81.::Tl\~S ... ~
tho ntll'nh~~:::, c,:~ M' tb~tj"l di v::"'icd b~: t;i(~ nt\:'fl)(~J: oi: P(::4~'~cns aX:.1ii:in.:dto .

. '.1

'Th~3 in;:icsn::fJ or" clinical caries in permanont teeth can be dG"b~rmined

by conducting' tViO survoys sopar at od by a spncj.fif.:d in-curval of _~iri1:':: (usua l Ly
) '~1
one -"/(Ja'r.. i \G' d"· ;.. " "1:,)8 me~--!rl ;1l!nr":-IJ'::',
l rr2:rI~rK;,I.;;~ .vf:\.Vl':::iJr;; "- _,'til.' t 'Cf?'C~'i
0::' n'" " oS'"
... '1~.1n
'\
fi::'st ;:;nd second (;:~;;~li1_in.::;tior: i s t~iG inci1.kirlC-G· of dant.al c;:;ries for t l1iJ ,
5p(~ci:fiQd p{:::d.()d o:~ timoc' Tnis fi~Yl:r(.. c(',n bn adjust-3d nrithmctiCZll.ly so
that the incl(1oncn cai'"! b,) e;~p:t0sS29 uS thl~ mC;'Jll'!1um'ber 0';: newly ',kcay~')
p(j:t'm~ncnt b.:;.;~."Ch. per person ;A:'\l~ '/"Jo:~~

When a90" 5p"cific Di)I' ratC:5 are use'd 'i t is possi;Yle to estimate the
incidcnr;o of clinic31 'carios in· porm2~cnt teeth ootwccn any two a905, for
example frum 6 to 7 years, by sLlbtrc:c.ting th9 m'?~n n'.n:~ber ,.)f Dll1F tDt":th pe,r'
porson at 'the ,Y0ui190r Jge (6) from the mean nL:mber' pi. ['f;P' tcoth per per son
'at the higher age (7) •

•
 .: 3 -

_..j The incidence of clinical caries in primary teAh 'can be calculated

-, in a simi Iar way for childicn under 6 years of age. In older chi Idron ,
however,' the calculation is coup.Li c at ed by the natural exf o Id atd on of
, primary teeth.

'~'. Dl~ and df 5111'f<:1oe Indices -

The Committee conside,cd that although indices in 'which the unit of

countinC] I s a tooth stJ,f~ce may be .va Iuab Ie for highly specialized studies,
they or- no t suit,,):)!.c fOl' lise, in, dental surveys for general public health
purposes.

It has been shown t hat there is a c Io se as soc Let i cn between the age
speci.f.i c pt~:rc(!ntagC' of
chi l dr on wi tl"t one 07' mc·r."p. [I"lt" pcrmaoe:lt tr:eth and
.the ,age-spceifj.c mean nUt~1b0r cf D"IF p,!rmansntt::lGth per child, T-il 5 con-
cept is of f undamerrt a I impc;rtancr.: b0c.au5 it c::/':'3bIi shes that tht? simple
1
;;

count of POl' scms' wi th cno 01'. Ulo:r.e DN':F tn~.:rth p::-ovi do 5 a VAlid a SS(~ ssment
of total caries nxpc:ci~nl,.~(·~ F'.TI:-th·.:::r woxk is 'r9qui:::ed y however, to dt:'t0~­
mine tho v~:!j~i;:;bi]j.ty -in this J:'1~J.~r!~ionsh:i.p. in difi.l;r~n't :n~Qt~u.

1£11:I0D OF F~X""j1l.[~,i.t'~TIOH~

The .appropri at e method 01:' examination fo:~: pUblic hA.?,lt.h survovs In- ..
valves tht: usc of 9000. n~:ti..t7."n], d~'I"i.iQht 02.' 2rtificial 1~.9~1't pL::dn ~!l0:Jth .
..... r:dr.rol's 3t'~d sh,J:'p pr\/b!:'s. a,Jdiogt"'aph5 ;:.X'(; not :cccomT:':~nd\::d fc.~': use in
thi o typc; of H}:,]f:ii i)(j"t'lo:'J ;:-:8(; 2tJ~~0 of ti~0 i:r:j)r':'lc t5.r;::lbi Ii ty or mav.i:)~J the::l
a st:lildal'o ~~eq;..:i}':ecne!ytc
Ti--,:"'l
... \. '0";"""'0'
~ <.:: ~ of.. .a.1'p.
~ cLl ni ca
~. I Ily.aml"l'''ticn
~• • 1 • • (' .• 1. "11"11
Y deccr.. .-l •'" P,')'l
!'-' 1.\" • .I"h~
t.. .. +, •..,.::. '" i:...r:.
~· "I.t'~-

data' to be co.l};~ctcd(,l" If it is to be .lir:l~.tcrJ to ? dt"!.ti:.rmin.ation of 'th<:;

proport i.cn of t~(~ P~PJ.1l;.I.tj.c:n wi':;h 1.)~1~ 01' ~;~lf)r(:: D:At: 'of df. '~eo"th ~P0i.:lt :
prcva Icncc l';rb~), t11e;! t~10 o:(<-~m].ni.-,~tlon or 0:.1C;-·1 pHrson \II::.i.l bf: "\;t;;".crnln·'3.t<:Q.
as soon RS \)11U ,]ff(~,:t~Jd t0o·~h ~s dote::tedc. In t no so who aPI~a;:-t'tntJi er c
C.1Ti":s-f:r.(:ti~ c',:ch t'Joth :i. c. caJJ~fl.!ll'i e):.r'lm~~~~d tl) c,:~nfiZ'm tf:f: d! ~iUD() si s"
On the o thc.r h;.);)~t if ·the i!!r.:,:'m· ,)l..tijb(~r o'r n\tS or df tGr) th ~l€r pt~r5L'n is
to be dr-:t.~:;rrj:inDdt th1?:1 o ach tooth (:f c;:.;ch ::'8rs:)n nV.lf,t be ~·;xc\r:dn(.;;.ltl

. In :')X"(k~l' to Cl'3twr.mi:-"I'J the !lg'~" spcc i r i e percf:ntagf:: of per-sons wi th

one or :1'iljr.:1 D:AF OJ" df "t(:(,:,th i.t is nscc s sm-v o~11y to r;':~0:'d .\o\!hothcr uno or
mare p··:~"r::llancnt. t.D{;!tb' sr o ~::f0CtGd, cr. WhCl.t:1'~:::- one or mor e p:i::lary teeth
ar e.• ~ffr.J"';·':"J·
c. __ "' ...... Ti-.; C ;,"" c"II:-' rucor ccd
-Ij .•.(:_._,.~.~~, l..,,; '1n+""~-;
~.).~.,(C ·'9 'a '"1·
•• ~· .......,_,t I,.<,n. '1)"Y'~O
.... '!J. \',/)" .. nI v,1..t1,' 0 "'1-'''-
priat~ l:>lot:k.~ (sa;::- <.1180 :~~nr:x l)~ .
,-';"'-r
df t'3ethi
D!JiF' tc:at.h,;
Hone
Ncor:
L2I I
One or more if'-,
One or rnoro 1...-..1
t.......'..
In order to de tcrini nc the DMF,07.' df r ate s DJsed on the <ixilnli:l'ltiOn
of each tooth. it.i S nocv saary to rccor-d t'ho nUlibor of permanent t{~~d:h
v.hich· arc D, kl or F and ·th(~ total D!\.i!?, and the numbar of dec:i.(h:oiJs teeth
which 'IN d or f and tho total df.'
,;.-
Decayed: Primary I / Permanent '1
fIli ss:i.ng; Permanent; "--'
l 7 I
Fi 11.od: Primary CJ Pen121Kn t D
 - 4 -

ORAL HYGIENE INI:EX

I. FOR ORAL ILBRIS

Or~l debris is the soft foreign matter on the surface of the teeth
consisti~9 of mucin, bacteria, and food, and varying in color from
grayi 511 w;·,i to to .green or. orange.

There arc six segments to score, 'each to be r cpro scritcd by a .tooth.

Such tooth surf3ccs ~re: the upper right first molar' buccal surface,
the upper right central incisor labial slITface and the upper left first
mo Lar- L i n q u a I . ~~:1T.·fi:1CG a n d t h o I o w c r r i g h t f i r s t m o l a r " l i n g u ' a l s u r f a c o ,

lower lei't ccnt:ral incisor labial surface arid the lower left first
moluT'lingu,::J sur fac e , .

. Scores:
o ., No debri s or stain pr o serrt
1 ., a) Soft debris covering not more than the gingival third of
the teeth 5:";::'£3C01/ or ,"
!;.) Extrinsic stains ar-o present ·~~.Ii thout 'other debr i s covering
i110J~C
than sur f aco area c ovorod . .
:1 Scft do:::-'x'l s 'covering .noro than two...·"thirds of tr.e p.xpos0d SL:!'::a:: c.
~
,', Soft dL~3r:i. s C6v8~:ing mor e tha:1 tv~'O'" t~li rdG O, ./.' t~!~· i2:.;;.:·osac SIJ.!:'f a6e,
'"
~

II. CALCUWS
Dont a I caIculus is defined as a d0pcsit. of inorgo.rd:. s~J.ts cornposed
pr-IrnariLy of calciu:', c arbcnata and pho sphate mi:'::~~0 v/i.th ruo')" dnb.r:is~
bc,ctoX'.iJ and df'sq!J,S[:i'3t~d c~':i.thel:i.aJ. CG-lJ;;,-; Th8.l:C ;;.1:['("; '"~;NO r.l~!ln t"':)<:'~$
of don t a I c a Ic ulus di:ff']:.:'ent:.. a tod prim.:lr~.ly by .Lo,:; a:t:5.on on "(,he- ·;:r;Gtf:.
in ~:Jl~t.iqn to t.~i? ·rreu· ~:ri.~(~i"0.1 f:lr.I:r9 j n':~
';fI"
'1) Sd 1)I ' 1l- 'j i :1g i v a ] calculus 'dcnoto s the so deposits lOG2.t.cd ocr:luD81
,~,o til?: i'1',::'3 gi . . tSi·./\31. rni~~Lcgin. and u sua l l.y wh.i·;;0 to ycll.e iNigl1 ';1;'0\',';)
o.n c:).tor 1
2) S'.lb-~~in9i\:e.l c a Ic ulus denotes .thosp. dcpo sd ts locatt!0 G·p.tCf1.l1~'
for)
"'" +~"'l~ _ .... G ·....,l·q,..d,~~l
1..:. ... yrnc.:. .• '~, ..... m'~"''''~l'
~:,. "-' ';c:u'~'''ll'''ll'(J'n''
,.'l'.'..1_,.l, and u_ .... " • I •• br own
C i to
... '.,.l.~.,:",
'."_ •.
~

in cc Ior , d1.1C t r) :f.!"cl:Jsi(~n o f blood' r:\j.9f1'!~)ntc..

Only de f i ni. tl.~ deposits vi" h,:rd c c l c ulus .shou.ld hn r-or.or dod, 'Us:inn
the t(.;et~! cr.d suri ac o as those in sGG:::,.lng t he oral d.:::b:t...: ,i~ tho
SQI:1i) -
fCU.l)'.'~iilg G(';;GJ:(~S "ll"1:1 ;;r:;.tZ:,7.·:~a ~'l.'J:'::-: uS(ld ±'c+' s.:";orinq GalGu:u.i:,;J

score s ;
o- No c aIcu lus
1. Su;;r"·.·.9ingIvd calculus covering not ,;!or'= than one..-t.hi i-d-of .
thf"l expc sad tooth sL~cfac~~
2 ,. Sup:('a~,gi~1g:ival c alc uIuo
covnrl nq mor-e t h en one-third 'Jf the
Oj~pos'::("i.~ut·iac~~; ar~(j/o:,
the pr0!:!2~':';G.of individual flecJ:s of
sun,..g5.rlgi v;31 c a Ir.u.l us m:-o\L"1d the cm:vic<ll por t i on of tho too th,
3 - Sup::a:",gingivc:l. c?lculus covering rnore than two-thirds of the
8Xr)()SGC t.coto su:cfIJc\:! anc:jo'r a con ti.nuous ne avv ben of sub-
ginsiv31 c a lr.u Ius ar ound the c ervi.c e I portion of the te,,:th.

~-.
III.' <Xlj,WUTING Tift.'.. HlDEX
I
The oral dcbr-i s scores arc totaled and divided· by the number of curf ace s
scored •
...- The c aIcu Ius score is determined .similarly.

The debris and calculus scores are then added to. give examinees oral
hygiene index.
 - 5 -
SIGNIFICANT FEATUHI:'.S OF ORAL CAHCER.

Site 2!£riiJ.f.2il! Features IAanner of Detection

Face
Parotid and other·
salivary glands
Jaws and temporo-
mandibular joint s
Neck and cervical
lymph nodes
Lips and co=ners
of the mouth . bleedbg on palpation
Mucous.membTanos
of the 1:i ps and
ch~~:<s
Crusts, fissures, leukoplakia Visual inspection
and abnormalities
Small nodule. or area of irregular Palpation of parotid
in duration bimanual palpation
of other glands
Pain and detection of irregular Symptomalogy and
dcstru,"tion of bone in the ra- rad~ograph~c exami-
diograph nation
Nodular mass or enlarged cervical Palpation
nodes
Blisters, ulcers, persistent sores ,' Visual inspection
and palpOltion
Ulcer at i cn , induration, and V.i sual Ln spec t i on
Leu'cop Laki a and palpation

Tongue and floor Ulc ar at ion , immobili ty tra.mor ,: 'I V:i. sua I inspection
. of .the mO·~..rt:, t endarr
.dt
'·s ~ ..j.~.
... t: 1;;.;) ;1::.;)-~l'T"~~ lC\ --:'\ ~ ~ • .-.
u..1>;;:~:, ;;J,''':''--l~D':J and. ~)c.lpatio:1
ar.d acnozto a). 1 ties 0:c s~·J:l1~~:":l.i..;.3.:ty
duct .
Tonsils . Ul cer at i on or r.n largemert 't
Sof t and hard C10fts~ ul~er~tion1
palate uVula sv..'('J.l~ng! cieio;:-mi ty
mation
Posterior pharvn-: Ulcer at ion , m2SSGSS, fi 3S1.11:es , Vi sun I ~.n~pe: tion
geal wall cxudata , J.~~d 21tt):::,ed 2PP'2d:'fl~1{:9
or r.n.:ri:';:l''::8
Gingival and 70- Ul\.8ratio~~ blcBding, hyper91a~is Vi !Jtl.u.~. inspec tLon
tromolar a~~B.:J or: atropll"j s a:13 de ep g:l.ngi val and r- 3..lpa&t5.o:;
c:;:-eV2GdS

AlveolJr bone and I~oc,e tssth in a circumsr-rib8d Test foT.' mobility

~:::.':'~.:l \11.':" t!.~lOi..it pf)::-iCc!o:l':a.l d::,s-:~asc; and '::OI:!p.l'2tG :ca(},~.(.~,'·
i::...""~.'~~(.~ul~T d'7:s·t.rui~ti0r: 0::: bor;e graphic. nxomi nat.Lon
. 5~;0l1 in t;'~2 r adi oqr aph

,>-
 i .....'
',' ; ~,
-~ . ' . .~-
l1S Form 2 DENTAL DiSL;ASGS AiID ScilVICi;;S Kc..i.pRT APi-ENDIX 1/,f 13
onth 6f ' :
uarter .. : Froin...._..,-_, to
emi-Ailnual: 'Prom . , to
_ 19
19
Mun;
. City
'-Province _
RUral
Ho sp i tal
~. City:"
Provincial g'
nnua I : 'Prom " ,t.o--'--- 19_ Reg io"":n:-a"';l"'":H:;"e-a:"'l:"':t:;"h--=O":f":il':"'c -e-:"'.N:'"o-.----..;.......,..-- ~~~.~~~ l.iunicipa 1 .
P'Jer.Center .
Pub. sen, .'
,
'. Pre-Sehool
'. r.re-
'Nat a l s ~a~
.GRAND
, .
. :rOTAL 2';;5 6 ~otal '7 8 9 10 11 12 13 14' Total 15-.44 15-,
-~OlAL NO. OF ?ATWNT5 ATI;,iiucu to
I. PERroN GIVf.N s:.RVIG:'.S (A;B.C.D.E) .'

·A. ORAL Examfnat Lon

, '---g-. I'revent~ve servtce s
.' • r luor~oe I nerapy .
z, uenta! :~rophy!ax~.s
C. Other Treatment for: ..
1. G~no~vi t~ s
2. ?eriodontal Pockets
3. Apical & Alveolar Abscess ,
'---
4. Per i ccronf ti II . . ,
5. Or a L'Suroer v . .

.0 .• ' emergency I reatment

.,. G1ven ?rescri;:Jtion' "
D. X-Ray.
1i. 'Referral s
1. f' T P T PT PT P T PT P T P T P T P T P
II. A. Fillinqs: . Total
l~ Permanent Fi 11ino s: Total
a'.' Amaloam
b. Silicate
Cement
,- . ?
'f"
. 'Pi 11ino s
T
.

B. Extraction: Total ..
,IlL U~NTAL HEALIH ::>11\1 u::>
A.I. No~ with Dental· Caries
2. No.· with Ginoivihs .
3 •. No. Wl th ,i-'er~o(jonta! i-ocxe t s
,4 Nn. ,"; 'h Or-a I Dehri s
5 No: wi h Calculus
Ii ..n 'h ()r~ 1 I\l,,~~ h ern - '.
7. No. ....i th Dento-facial Anoma Hes
B. Teeth affected wlDental Caries !Total! ,
1. No~ of dfteeth .' ,
.2. Nn. of DlAF teeth - -
!
 APPENDIX 12-A
INSTRUCTION FOR ACCXlI~PLISHIN::; BDHS FORM 2

BDHS Form 2 is the standard form in reporting dental diseases and dental
BOOS Form 2 Ls the standard form in reporting dental diseases and dental
.:;
\
services by population groups and Dy specific· age. The same form is used
for consolidating reports on a monthly, quarterly, semi-annual and annual
basis by muui c i pa H t.y, by province and by region.

It is accomplish~d by consolidating data ·on dental diseases derived from

the front pa:Je of 31)f!S Form I and consolidating data onderital services
der I ved ::rom t.he b.:1GK page of the same f orm,

Uses:

BDHS Form·2 has teo (2) main uses namely:

1. Providc'"quar.titativB data to ans~·~te!'. the following que st Ions
\"lhat oropor t i on of tile popul at rou wi 11 r(;qlllr-: ur-e atmon t for dental
and oral di se e se s? .
2. Provide (JU~:1-: :itc~··ive data en the dental service 5 provided to meet
the sn necch.... , . .

lDstrlJc.:U.9!l.~ ;

1 •. I~unicipality - print the name of themuniciclality whirt> the data was

c.ollth:tF:dQ Wh~tl mor-e t.:1Q.!1 cno muni·::i pali ty '.'if.:r.:f2 ·vi s.i.t.cd -j~J:d.:1g th~
rnonth .. c separ e t e rcpor t should be made ict: ~acrl muni~ip.1.1.ity~
P •
2 .rOV1.:1G~ . t t1..,~.C n~~nn 0 ...r:· .1-h·
- pr:q) .' <0... .....
....C pro.v~nc ,-"'.;.~
;·11.,; t' ~l.. [,1'......
.. ,. ..n '·l",';~,·"'.~l·i.:, •
_.·1..-;"..:_ ... \,1 J,S
~.ocated.~
3. City",:. p.=int the name of tbe city wh!2:re the data was col l ec ted, Appli-
'"1(" cable f o r city derrc i st , city ho spi t.e I G·:~i1-:is-t. . p!'i"'~3';:e sr.hoc I den t i s t
• and incust:rial derrt ist wbsro thr;;, OI2:1ta'l cl"i:1i-:; is Locatrsd Ln th~~ c ity,
4. Re~iional ;'h;;:-dth O::fir:.c: No, •
5• . lliior:th ~n(l Year' - pr].nt the M';:l~J(lf "the month and date and a 1"',';]1'5 ir.di-
cate be> year.·
6 • . Quartcr.- print the months. f rorn the ·start. and end of the ql..!~::tor
and year.
7. S..;;:ni--a:1:1ual - prirlt the mor ths from the st-art and end of t~e six-month
period 3!"Hi y~ar"
8 e . ;\:101...:21 .. [Trit~t tb.=: months f!"om tho scar t and end of twelve r:1O~ths
period and yi;:·c;J."
9" Chnck on lvone :;)qU.3~:-C to indicate t.ho c2ItegoX":' of d8nt1 st submitting
the r~'r:;o:ct M

The ccnsu l t.at i on and treatment is counted as (1) the total number of
pe r sons rC!Jis-r'::r~:d, cxarnine d and atter.ci8d to .and (2) the total number
of t eeth. examined and t:t0i.'.t2d during tht) morrth,
1. Per sons-:
The tote:! count of persons rogi sterad and given, 1) oral cxamina-
tiorq 2)· prevcr.ti vc s8,rvicE:::i' 3) other t r e a tmcn t j 4) X.. r.<1'!.' .
and 5) refH?:.:-ecl to other c en te L clinics or 6t:1Br health ag':!;"l~~ies
for t roatmerrt or. diagnostic services wrrich are no t wi thin the
scope and facilities of direct se~vice.
 - 2 -

'~' A. Oral Examination, -'the total count of persons registered and given oral
examination during the month.

1. ,No. vnth dental caries - is the total number of persons examined

A
with one or more decayed, missing and filled teeth on the tempcrary
''( and on the permanent dentition •
•
2. No. with gingi vi ti s - is the total number of persons examined wi th
gingivitis.
3. No. with periodontal pockets - is the total number of persons with
per.i odont a I pocke ts ,
4, No, wi~h or~l dobris - is the total number of persons examined with
oral decr i s ..
5. No. w:;__th c a l.c u Ius - is the t.otal number of persons examined with cal-
c:"'111.15(,
6. No" 'Ni-en ne op l ;),,;;[a ,-' ir; th(: total number of por sons examined vrith
signi:f:ll;ant :\.~3':-.:..'.r8s o{ ')X'8,J. concor (St~...; p~ t40 ~5t;jndard i!.J!~l..1al).
7. No. :"11U: d?n:;':(j~>4'2~~.al a'::10i;J3:~j-~~ - ..i~3. tr,l~3 totz~.. ~.t;:r';:';::c .?f persons
cxarunco \V;. tr. handi capp i nq Clf;rrCO-I2.Clu~ c:10ii!:J 11CS ;1cl.:'(.:::.ng t::-eatmQnt.
B. Preventive Services
1. Flu·~::·~>.~? T~.i.:lI:·?,p·{ .. is tne total nurnbaz- of children given topical
ap;;~:c:lti\..~: l,f fhlcct<.id du:ti:-19 the m',)i1I",h (net t.:"lC !lumber of fluoride
appLic;;tiol1)0
2. Dental Prcphy.l?~is tho total num:ll~.x of per. sen..'; ql'lP';".. denta 1 prophy-
1axi s ('.:.omplcte) c
c. Other tr.-::ai;ments f:.):t .- is the i.'J:t1t o~: tb·~ total nLl.;i'lF.J.' of per-sons given
treatrrl\';r~"i: fOl'~ J.) <Ji:-~;::5.\i"itif,;, 2) peri cdcrrt a I ~!is~e)cs~,:~~ :.l.);G~l .li:ld
'.,~ •.. , ...
ai\J:~Ol.dJ.. ~~","c.,~"
c ... ·;.>c,~·.);)~ "J
1 -l-~n""''''''''''''~l'o
p ~:.:... ~_ ...... ~~_ ...... , 5\'
... "'~_,:1,,
,~_ .. ,.,''J'')
.;)v.l .......
j'.!.: ~
"j
:...:
....... A.-~'(,."
.'1"'_'... ;:,,; .,,'1
<:=.':'1'"
ca~G.;; C'ln d ,.,\
i / ,-<.:,~
:jJ. V.;;:., ,....~>C_.....
p c"> •• , . ; • .:..
~h.1.0nS~
~

D. X-ray - numbE:t' of p0I'$OnS given r adi oqr aphi c exemi nat i.on and diagnosis
of the tQ,-3th or the 0I'61 c avi ty and ass':'1cia"t.:yj parte ,
E. Ref err a Ls ,.. nurrher of per sons rcxerrr:d t.o other d·~r;tal clini c s or health
foci I iti.e s :for tT.'catmc;·rt anJ/ 0:0:- di aqnos ' i c servl ce s.
2. Teeth af f ccted wi th delltcd c ar i os s
The total number 0-" a) decayed and filled temporary teeth (df teeth) and
b) decayed, missing and fi J.1.00 perrnanen t teeth (Df;';F t e c th},
A. Fi lling s e
Tho total count of permanent and temporary fi l l Lnqs, The figures are
do ~· ·~ ..,c j '-ro'" -;~'nn
'-'_(..~, ~( ~ )~"
..... t, ..... r.. "ale>
l",~.~:~ I-" ,., 0'': +h~
,'• ."••
<.;;·•• \;; -ir"'1',r;'j"a
....~.
1
Dent.a l Hoa I thI ......
.~ R"-ord
,' •
>,; ... ' . . . . .1, "'~:l'~'ct, 'C, ..

1) PI.;'rl7!~n2:lt Fi 11ing s;: Total cou~r~~ed s(lp.~ratclyon thE t.enocr arv

ap""
, "i '\'
C~1 l'hc
",. f)·':\· 1:':11":::-. .... ".
,:..,['fj'{~d(",,:~:'...
51..",.' t,.;;:8,t,', CoS
J.1
... ":"h'"
r- -(•.0 ~.,,;).1 l...,.:" ,~
.l. ~ .:I.}, amc.
:':'11,'
~. 'a;n,
'-) c.:'··
I..l -+n
.)~J..:,I O·,,~!
~. \ '~,l,.,....r-~·+
l.,.,/ ... 1 1.:
L~..,1I;~;j"" IJ...l._..1.ng
Se -1'~'
,_}~_ .
::.: l 1n c c,
..!.,lg,..... _ ...
~ ~ 2_50 1, -'. d
d..1'::,.I..1·/e
from the bflCk p~:g"'-J of the Iridi vi dua l Dcn ta l r{calth F:.0cQrd~
2), Temporary fj. Lli nq s are consolidated separ ate Iy on the t emporary
and perrnanorrt :\tw;·~'1. {:io~<)
B. Extrac.t:lor.,' t o t a I number of Cl:t::-ar.:tions counted separately on the
tempcr,n.'y and pcrrnanon t t,.v:,th .
3. rota..1- n:;'11h.':t, of fi~.Lin~s and ~;{tract.io:1s - is the sum total of
temp0£31'y ~l;:,d p~rmnf~~"i~;.. tC0--;h f:;,J.18d and 8:-:tx·i:v;:t.:.:d.
<'
reNTAL H':.ALTH. EDUGATIGl'J', .. is couated as one aGti.vi t.y when it. j.B p lenned ,
orgar"iized and attenchd by no Les s t.han fi ve per-sons Ln a class, 0::' CO:1-
f erenca, or demon~tl:'ation or f.ilm showing etc.
 - 3 -

-.{ III. STUDIES (J)NDUC1ED Ai'lD (J)IIIPLE1ED - is the total, number of studies COn~
ducted and completed. A study is counted as one activity when i {'i 5
organized study on a particular area on dental public health guided
by a pro toco L, duly approved by the Bureau of Dental Health Services.
The study is considered completed when the fingings have been sub-
,~
, jec~~,d to statistical analysis, interpreted and submitted as an un-
pub Ix shed or publi shed report.
IV. 1RAINING CXlURc.ES ATIENIXD - is the total number of training courses
attended. Tr a i rri nq is counted as one acti vi ty where the rental person-
001 has taken a formal o~ informal session on subject or course rele-
vant to th',;l por-f ormanon of hi 5 duties.
V. SUf£llVISIOi·j CONDUC1ED ~ is the total number of suocr-vi sion conducted.
App.li.cab Le ::")l~ S;?n~o1.' DS,"\"ti st , City Head r):~nti st and Supervi sing Den-
tist. A supervi si or, is c ourrtod as OIl'? e:;tivi't.y whcr o technic a l Guid-
ance has been g1.ven to subcrdin;-jte par scn.ie I (dept:]l unit or p::rS"ul1).

VI. OTHEll ACn VITIE S;

a. St~:f meetings and conf er-once s - counted as the r.umber of meetings

ox' r.cflf8:"'~;:1Ge
2'i;tend~d by health per sonr.e l -3$ c a l led by higher
2U{;~K~-r·Li".YlI

b. R"~POTts pr eparod And SL'.biTIi t t ed ~ (";o~:t,-:d ."15 th~; rJUi£1~~cr of required

reports prepared and SU£Jll~ittf:d to hiCJh{:::." ~!uth('\:':':Lt.t&~ r-,j.ther daily,
rnorrtn ly , scmostra l 01' YE<iJ:ly repol'ts~
c. Trave I ... 7his r ofer s to the nUrnr;8I' (J! t ravo l in'·.m.l'.;itiJ ~:'Ggu.l2r
duties end o thcr t~3v01 such as from (,f:~iGia 1 :d:;J-i:i,,:r; to P:r:,,)·.:incial
Hoa Lth Office, Fr ov.lnc i a I Cap i t al , Cour.t nz~ari;·;gs,:, 3~ttir.':i SL1.p,-
pLios!, etc.
d. Others -' this ro:,fE.T85 to activities other than regular duties pp.r-
f orrne d in compl t anc 2 Vii th as s icmnen t gi vun by h.i9h~~::t authori t~ 95
such 2.S~ c arnpai qn :fo:~" sr!aitary toilets, nut.r t t.i on , aducat i on ,
Lrnunt z a t ion , home vi sr t , etc. This should be s!-,,,~ifi0d i,n the
r eport ,
Other remarks,
Statement of problems r.0edir.g urgent attention of superiors.
 ,
APFENDIX 13
Republic of the Philippines
Inini str-y of Hea Lth
I1'.NTAL HEALTH s:'.RVlCES
Regional Health Office No.

(Headquarters)
Rural
Hospital
PrivO,te School
Occupational Establi shmcrrt
City
Provincial
i>lunicipal
Puer. Center
R
LJ
R'.'.P)P-T OF !JOinAL liEmCINES AND SUPPLIES ;=OR THE
iiDNTH OF s 19

1·.lunidpali ty . _
Province _--_..._------
City --_.__...._.-_._------ Di strict __._. .-'-- _

,.-
-,
Print Name/Signature

D ate
 APF£NDIX - 14
liDNTHLY NARRATIVE RERlRT OF RlRAI/CITY/
PROVIdCIAL LENTI srs
I. Date and name of municipalities and barrios visited, indicating
population of each and distance of the barrios from poblacion.
II. Dent nl Health Education Activities to include topics discussed,
number of sessions, number of audience per session, type of audience.
III. Others
a. Activities with other health units project (specify) indicating
the tHb, date and place where the activity was performed;
bo Staff conferences o. seminars indicating date, place and title
of. the conference"
IV. Tr a irrl nq Att.cl~:icci

a. Name of COUI'S0
b, Dat c/p Lac e
c. Spon~,o:rin9 agency
V. A datai Icd description of any item of Lnter e s t espec!.ally those
i rrtcndcd for publication.
VI. Prob Lerns
Admini s t r a t i ve
Technii":<ll
RCC01i88!1Cations - Solutions to problems that could b."} cota5:1cd
frem local resources.

VI r. Number of produc t i 'Ie days

Dcnti st . _
Dental !d du

Name of Dentist

--------.-_ ---_ --
*Except No, I, other items sn a l I apply for ho spdta l , private schools,
public schoo l.s ar:c, c.ccupet ionaI dontist s.
 BOOS Form 2-C APPENDIX 15
REFERRAL SLIP

-" •.. .,.- ..

. Ru~al/!iosPital/School/or Occupational Establishment -Den ta I Services

Dr •
.~
\

I have the honor to refer to you;

Name _ _ _ _ _ _ _ _ Age_ _. Sex Civil Status -:'-:'_-'--'--'-

Address _ __._ _ Occupation, Bationali ty-,-c-_ _
Guardian-lir needsd)
Referred to.
Health Centp:;- (Spe-:ify) ._.._._.
Ho spi iii 1 • . ._....
School
O'thcr ss
....-. __...
(Sp;.!cifYJ _
-\-~-,.~-----_._._._-_._-._._---_._._~--

_ ... .. .

Print Hamc!Signatu:,c

~----_._-

L\; .3:'0 i'.!,1ti on

.-'. NO'!E. To be de tachcd and sent back to the r,d2::-.tir.g aqcnc y af t ar th" necessary
tre~tmenc h~s been performed.

Out 0
Dr.
--'--_._-_._.-.--
This is to certify that - - - - - - r . ; - - :
(Name of Patient)
has been referred to this offi.c" on ----;-:c-
(D a t e)
and upon examination f'ound the £0 Ilowir.g !

B. SERVICES REi·JG:~IEi.)::
No. of permanon t t ec th filled ?jo~of tCi-~orary teeth f i Ll cd ..,...,,-__
No, of pe rmcncnt tG8"th t~X·;.:!'dC:(::I~._ No" of tornpcrary toeth ext.r act od _
OtbG'rs~
RElJIARKS:

Print Nam~!Si9natu~0 Designaticn

Address •

',.
 ,

Republic of the Philippines

Man i 1 a
, ,
l£uDRANDU"l AGREEJ£NT
'./
,
This Memorandum of Agreement, made and entered into by and
between:
The IAinistry of Health represented herein by Honorable Mini ster
CLEiiENTE S. GATIAAITAN; and
The ulinistry of Education and Culture represented herein by
Honorable ;IJini ster JUAN L. MANLEL; .

_-_._-
I'IITNE S3'. TH
...
WHEREAS, Rp.pubHc Act requires private schools, colleges and
uni ver ai t i.s s in the Philippines to provide medical"and dental service
fo:!:' pupi J. sand st.uderrt s ;

WHEREAS, Section 2 of Reoub Li c Ad 951 states that it shall be

the duty or the Bureau of Hea'J.th to is~ru18s and regulations relative
to th13 medical and dont al service which private schools, colleges and
uni ver s i ti~s sh aI I p~:'Gvide;

W!-['REAS, Executive Order No._31., -,oat!",:! Ju.1.y 27.., 19~6 implementing

R.A. 3814 created the Bureau of Dental E'oal't:,Smicef in the fAinistry
of Health assigning thereto fur.ctions ir. h,'! implementation of dental
services;
•
W}-EREAS, Administrative O:>,_der R-ll, s. ],953, amended by Abinistra-
tive Order No. H6, s, 19".'9; Adminislrat-iv'J GInter No. ,UG,> s, 1970,
amended by Administrative Order No. 255, s. 1975, all of the IAinistry ,
of Health and Circular No , 6, s, -19700f the IAinistry of Education and
CuI ture prescribed r-ulos" af!d" regulations' and standard requirements of
the private school dental service; ,
WHEPEAS, undsr Presidential Dec!ee No. 1 dated September 24, 1972
reorgar.izing the E","cutive Branch of the National Government one of the
functions of the Bureau of Dental Health Sorv i c o s is to provide guide,·
lines and s tandaro s for d8:1tal health services;

ViHEREAS, Sect;icn 14 of Letter of Implementation No.8 relative

to Part XVI of r·.D~ No , 1 0:1 H0alth states that one of t.hc functions
of the St.ancia::-ds Divi.3iGf1 G! thr] BUr~2.r.l .jf DC'mt2:1 Hea lth Services is
to dcvo Icp s tandar d s :-..~~.la~i V'2: to the main tencr-ce ;,;'.::d rmprovemorrt of
derrt a.l h8;j.~ th S(~.~v.i(;e.3 ir:: puc li c and p:.ci'lat.e scr.co i s ,

VJ;·E.R.oAS( ;)',I;:sua:ot. to R,.A" 2706 da te d J,13r,~h 10, 1917 pr i vat s schools

grant0u qove rnmen t au-:'hc!':} ty and/or r ecoqnt t i cn are under the aomi nt s-
trati ve super-vi sian and c orrt ro I of the Mini stry of Educ at i on and
Clllture~

WHr:,REAS, pur suarrt to Excc ut.i ve Order No. J5 dated ALgust 28, 1946,
the I~cdica.l and Dental 50;:""ic8s of '&2 Burc au of Public Schools was
created and granted author i toy for the coJ.lcction of fifty centavos
vo Iuntary ccntibut i.on r rcra each school chi Idi
WHEPEAS, pursuant to FLA. 2620 dated May 23, 1960, the funding of
the i~edical and Dental Services of the Bureau of Public Schools was
nationalized, and as such health services in public schools are under
the administrative supervision and control of the I,\inistry of Education
and Culture;
 - 2 -
WHEREAS, the objective is an efficient and effective implementation
of dental standards in public and private schools in the spirit of
cooperation and coordination, there is a need to define the juris-
dictional areas of responsibili ty of the Ministry of Health and the
M~nistry of Education and Culture;

NOW, THEREFORE, for and in consideration of the foregoing, the

parties hereto agree, as they do hereby agree, to· delineate their
respective areas of responsibility in accordance with the following
guidelines and conditions:

1. The IAinistry of Health, thru its authorized agency, sha l Ls

a. develop and enforce dental standards for private and public schools,
co Lleq s s and uni ver ai t i e s under certain conditions with respect to
t ypo , scope, qu,:ll:i.ty. of (~0!ntal servi ce s , dental manpower- qualifica-
tion and trz:i'n5.::? r cqui r omerrt s , dont a l clinic facilities, equip-
mont and supp Lie s , technics of dcnt al clinical procedures, dental
reco:tds and repcrts, salary ocalcs and cos~ of operations of dental
sl?,,:,vices;
b. take appropriate ac~ion rc~ardir.g violation of rules and regulations
v/i'th re spoc t to s t andar d requirements mentioned above, furni shing
tho iiJinist:>:y of Educ at.Lon and Cul turc Roq i on a I Office concerned with
a ccpy of aa i d action;
c. exercise technical supervision Insoro:::' 3-'5 pr iv rt.e schoo I dental
service is con ccrncdj exorc i se f unct ionaI supcr vi s ton in the
c a se of public schools;
d. i!1:i. ti ate ~ urg2'1i zo and conduc t apprcpr i at o tra irdr~g cc ur S(~ s such
as the Basic Training Course for private and public school dental
sor vi c o ;
e. extend accreditation to reorganiz~ 2ducation21/training institutions
to complement training courses conduc tcd other than than the Basic
Training Cours8 for Private and Public Sooool Dentists;
f. maintain close coor-d.inat i on with the Ministry o·f Education and
Culture thru its authcrib)d agency insofar as the determinaticna of
coverage of "n educational institution and dentist-employer rela-
tions arc concerned;

2. The H-i'iist'r"~ (.of Fdu:';otinr: z1nd CU.ltl1J>~) t hru its author ized agency
sh~lj·;· --.-

2:. deti=:.'ITI.ii1C the (':0-'181'<3.90 ()~ pri vat c schoo i s , 801h::g05 and uni vcrsi ties
ir~sofi1r as crnp l.ovmen t of Q der.t i s t and employment Gondit~.(,n3
',n.oree-x ar c COI.c~~l:r;o-j~

b. onf'orce and take appropr i etc action 0"

any violation of the require-
ments mcnt i oncd above f urni shing the Regional Health Office concerned
wi th a copy of said action; .
c. require the pro sentat i on of the cort.i f ic ate of accreditation issued
b'y' the j.!tJni str'y of Hea Ith' a s a pro-xequi si t.e to the issuance of a
pc:rm.i t ·..\nr.Vo:-...-- r ec cqrri t5.orl for the opar at i on of private schools,
,,
coiroqo +.
s a.: dur.1VCrSJ.....lOS;
" -

-.- d. main':'iin t.cchrric a I super-vi sion and control of the public school
derrt aI. service;
e. maintain close ceordination wi th the Ministry of Health thru its
authorized agency in relation to its function of setting up pro-
fessional dental health standards;
)0-
 - 3 -

f. render full support and cooperation in the dissemination of

information relative to policies, gUidelines and standards
of school dental services.

Each agency shall i ssue its own ;;11ni stry Order, after mutual
consultation, prescribing guidelines in the implementation of their
respective responr,ibilities as herein agreed upon.
This AGREEilENT shall take effect upon its signing and shall be
in full forc~ ar.d effect unless amended or terminated by mutual agree-
ment of the contracting agencies.

Thi s illomerandl1~ Agrc0rr.ent supersede s the Memerandum Agreement signed

by the S"DC pQrties o~ OCtOD0r. 10, 1978,

19.7..(L in the

i~INIS1RY OF HEALTr! MINISffiY OF EDUCATION s CULTURE

By:

(S::;H~D) ! ....,_..... n)
( ..C;.(:"~ l ....
.
ClE.I/ENTE S. GATiMITAN, M.D., M.P.H. JU.tl·! L-: I:IANLEL
Minister Minister

SIGNED IN TIil:. FP.E9'.NCE OF:

( SIGi'ED) ( SIGNED)
GUILLERi/O F. JULIAm,!1p.M,MPH,CE9) II :~dDNIO G.· DUMLf()
Direc tor. BUt"G311 of L::Qn tal Health Dir8~tor, 8ureau of Higher
Sorvi ce s Education

( SIGNED) (SIGif:..D)
ANmSS ASI STIN MWDA SlJL\RIA
Direc"i:or. Bureau of S2condary Dir.Gctor, Bureau of Elementary
Educ at i on Education

,....-
\
 Department of Health

IIIIlllIIIllill1 iiIlilllli :1:>. '

. "
0516'
~"';;";,;.' .~.

. ,
,
H15.44 51231 Standards forpUblic scboot dental hea\\hservices
.,
.~ ..