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Application of Pit and Fissure Sealants A Certification Course for Dental Assistants Course Description This two day course meets Texas State Board of Dental Examiners Rule 114.3 which states that a dental assistant wishing to obtain certification must complete a minimum of 16 hours of clinical and didactic education in pit and fissure sealants taken through a CODA accredited dental hygiene program approved by the Board. Course of instruction includes: Microbiology and infection control Patient management and medical emergency considerations Dental anatomy, sealant products, techniques and placement and Ethics and jurisprudence related to pit and fissure sealants The laboratory and clinical portions of the course will provide the participant with: Experience in securing a dry field Ergonomic considerations Placement of dental sealants with light and chemical cured products on extracted teeth in a laboratory setting Placement of at least (6) pit and fissure sealants and topical fluoride on a patient that has been prescreened for sealant placement Please Note: PARTICIPANTS MUST PROVIDE THE PATIENT Rule 114.3 also states that dental assistants must also: Have at least two years of dental assisting experience, and show successful completion of current course in basic life support (AHA, ARC). Applicant must have proof of malpractice insurance (may be obtained through Seabury & Smith (1-800-503- 9230) and current CPR certification. Presenters provide a friendly and relaxing learning environment. Special attention is given to the hands-on instruction. Date: January 17-18, 2013 Location: The University of Texas Health Science Center at San Antonio Program Time: 8:00AM- 4:00PM Tuition: $495, includes lab, clinical, handouts and study materials Credit: 16 hour certification course You may print the follow registration form, complete and fax to 210-567-3830, or send by mail with payment to: UT Health Science Center at San Antonio Department of Dental Hygiene 7703 Floyd Curl Dr, MSC 6244 San Antonio, TX 78229-3900 January 17-18, 2013 Name ____________________________________________________________________ License # _________________________________________________________________ (c/o) Dr. __________________________________________________________________ Office Address _____________________________________________________________ Suite No. _________________________________________________________________ City, State, Zip _____________________________________________________________ Office Phone ( ) __________________________________________________________ Home Address _____________________________________________________________ City, State, Zip _____________________________________________________________ Home Phone ( ) __________________________________________________________ E-Mail Address: ____________________________________________________________ Enclosed (payment to UT Health Science Center San Antonio): Amount: $_________________ VISA MasterCard Check Card Number ______________________________________________________________ Exp. Date ________________________ 3 digit CVV Code ______________ Card Holder Name _________________________________________________________ ALSO NOW AVAILABLE — IN-OFFICE TRAINING: In-office training provides the lecture, laboratory and clinical sessions conducted in the convenience of your dental office. Minimum 10 participants. For more information call Tina Stein at 210 567-3855 or email firstname.lastname@example.org.