Practitioner ID
Restoration (unique) ID
Practitioner-patient ID
Original visit date - month
Original visit date - year
Q1: Patient gender
Q3: Patient ethnicity
Q5: Patient have dental insurance
RESTORATION NUMBER (1-4 )
Q6: TOOTH NUMBER (TREATED Today-Y0)
Q7: Bef today, Rest surface: Occlusal or Incisal
Q7: Bef today, Rest surface: Mesial
Q7: Bef today, Rest surface: Distal
Q7: Bef today, Rest surface: Buccal or Facial
Q7: Bef today, Rest surface: Lingual or Palatal
Q8: Bef today, Rest material: Amalgam
Q8: Bef today, Rest material: Direct composite resin
Q8: Bef today, Rest material: Glass ionomer
Q8: Bef today, Rest material: Ceramic or porcelain
Q8: Bef today, Rest material: Cast gold or other metal
Q8: Bef today, Rest material: Combined metal/ceramic
Q8: Bef today, Rest material: UNKNOWN
Q9: Treatment on Tooth Today (Baseline-Y0)
Q10: Surfaces rest/repair today: Occlusal or incisal
Q10: Surfaces rest/repair today: Mesial
Q10: Surfaces rest/repair today: Distal
Q10: Surfaces rest/repair today: Buccal or facial
Q10: Surfaces rest/repair today: Lingual or palatal
Q11: Material used rest/repair today: Amalgam
Q11: Material used rest/repair today: Direct composite resin
Q11: Material used rest/repair today: Glass ionomer
Q11: Material used rest/repair today: Ceramic or porcelain
Q11: Material used rest/repair today: Cast gold/any cast metal
Q11: Material used rest/repair today: Combined metal/ceramic
Q11: Material used rest/repair today: Temporary
Q12: Base, lining/bonding used Today: None
Q12: Base, lining/bonding used Today: Resin based
Q12: Base, lining/bonding used Today: Glass ionomer
Q12: Base, lining/bonding used Today: CAOH-based cement/liner
Q12: Base, lining/bonding used Today: Varnish
Q12: Base, lining/bonding used Today: Other
Q13: Used rubber dam during restorative procedure
Q14: Same dentist placed original rest replaced/repaired today
Q15: Main reason repair/replace restoration today
Q16: What led to dx 2ndary caries: Probing with dental explorer
Q16: What led to dx 2ndary caries: Radiographs
Q16: What led to dx 2ndary caries: Experience based on appearance
Q16: What led to dx 2ndary caries: Discolored margin of restoration
Q16: What led to dx 2ndary caries: Frank or definite caries cavitation
Q16: What led to dx 2ndary caries: Presence soft, discolored dentin/enamel
Q16: What led to dx 2ndary caries-exploratory prep to inspect lesion
Q17: Location 2ndary caries to existing restoration
REGION: Designation for regional coordinators
Practice-patient identifier (YR01)
Year 1 - Restoration Tooth Number
Year 1 - Restoration Tooth Surface(s)
Year 1 - Visit date: month
Year 1 - Visit date: year
Q1. Y1 dentist is same as original
Q2. Y1. Restoration status: Since the last time
Q3. Y1. Visit due to problem with restoration
Q4. Y1. Restoration condition acceptable
Q4. Y1. Adjust or polished accetable restoration
Q5. Y1 Tx plan: Repair defective part
Q5. Y1 Tx plan: Replace entire restoration
Q5. Y1 Tx plan: Requires endodontics
Q5. Y1 Tx plan: Extract tooth
Q5. Y1 Tx plan: Other Tx
Q6. Y1 Main reason repair/replace restoration
Year 1 follow-up visit
Tooth surface -Y2 composite
Patient ID
Y2 Tooth number
Year 2 - Visit date: month
Year 2 - Visit date: year
Q1. Y2 dentist is same as original
Q2. Y2. Restoration status: Since the last time
Q3. Y2. Visit due to problem with restoration
Q4. Y2. Restoration condition acceptable
Q4. Y2. Adjust or polished accetable restoration
Q5. Y2 Tx plan: Repair defective part
Q5. Y2 Tx plan: Replace entire restoration
Y2 Follow-up visit
Tooth surface -Y3 composite
Year 3 - Visit date: year
Y3 Tooth number
Year 3 - Visit date: month
Q1. Y3 dentist is same as original
Y3 Follow-up visit
BUSYNESS (WORKLOAD) OF PRACTICE
GENDER OF PRACTITIONER
HISPANIC ETHNICITY OF PRACTITIONER
Q2:Patient age trunc (at 15 and 90 years)
Q4: Patient race (1=white, 2=Black/AA, 3=Other)
General practitoner (1-y 0-n)
Race of practitioner
Decade dentist graduated
# Patient visit/week - quartiles