Preparing a Case Study Report for Publication
This outline is intended to support our members in their efforts to share their experiences in Pediatric
Sedation Dentistry with their colleagues. The format will help you put together a report ready for
submission to the DOCS Digest. The editors of the digest will aid you in formulating the final copy.
Please send via e-mail along with 2-6 digital photos. Inter oral images are preferred.
Age:
Gender:
The parent/s report that the child has the following dental condition as a reason to seek dental care. (main
complaint or behavioral issue):
This patient is receiving sedation care because of (parental desire, child fear, parental or child time
constraints—please be specific in patient needs. Describe level of fear/anxiety/etc.):
Significant patient acknowledged medical history by parent/s (include medications, conditions, etc.):
ASA Classification, Physical evaluation with tonsil classification:
Dental History (discuss past experiences, current anxieties, unique features and result):
Initial treatment provided (exam, x-rays, etc):
Diagnosis:
DOCS Case Study Form for Publication
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Write “Yes” or “No” next to all that apply.
Yes or No: A treatment plan was devised to address all of the patient’s oral disease as well as cosmetic
needs. Please explain the plans:
Yes or No: Due to the patient’s high level of anxiety, all treatment was planned under oral sedation.
Yes or No: The patient consented to the treatment plan. Make any notes to prognosis or adjustments to the
treatment plan here:
Yes or No: Medical consults were obtained (where necessary) and a pre-sedation work-up, including cross
referencing of the patient’s medications with the sedative drugs, pre-operative blood pressure,
heart rate, and oxyhemoglobin saturation as measured with a pulse oximeter was performed.
Yes or No: Pre-operative and post-operative instructions were reviewed as well as written consent
obtained for both dental care and sedation care.
Additional Notes:
Describe drug protocols including medications used and level of sedation achieved:
Describe the patient’s response to sedation:
Describe post-treatment initial treatment follow up and results. Was the parent pleased with
sedation treatment?:
DOCS Case Study Form for Publication
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If a second sedation appointment was needed, describe subsequent dental treatment plan and sedation plan
and note any significant facts:
Summarize results and any significant notes:
Cite references:
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REMEMBER: Attach Photos (2 required: intra oral preferred) X-rays and before and after photos
Yes or No: Do you give your permission to DOCS to edit and arrange this patient’s information as needed
for appropriate length and to create interest within the study?
To submit your case study, write 500-1000 words summarizing the data outlined above. Send the
article and photos to membership@docseducation.com
DOCS Case Study Form for Publication
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