9 - Treatment Planning Phases Flashcards
what phase:
evaluate patient fitness for tx
systemic phase
what phase:
tx of patient cheif complaint (unless purely anesthetic unless patient of record) (if so they will not return until they have another acute complaint
acute phase
what phase:
Completion of treatment initiated in the Acute Phase and/or treatment of large carious lesions with Silver Diamine Fluoride
(SDF) if long intervals between treatments of caries or Radiation Caries anticipated
disease control
what phase:
Oral Surgery (lose the losers, allows healing prior to interim
prosthesis)
disease control
what phase:
Caries Control Phase 1 (D2 and D3 lesions)
disease control
what phase:
Periodontics (Comprehensive Perio Exam) including Initial Periodontal Therapy and initial occlusion evaluation related to Secondary Occlusal Trauma
disease control
what phase:
Caries Control Phase 2 (D1 lesions if not amenable to remineralization therapy or minimally invasive surgical treatment which would also be included in this phase)
disease control
what phase:
Endodontics: asymptomatic teeth or teeth with pulp exposures
from Caries Control Phase 1
disease control
what phase:
Re-evaluation of plaque control and periodontal status
disease control
what phase:
Interim Prostheses
Orthodontics
Occlusion Analysis/TMD Therapy
disease control
what phase:
Periodontal Surgery: Disease not responsive to IPT/implants
Single crowns
Replace missing teeth: fixed first, restore implants second, removable last
Aesthetics
Miscellaneous
definitive phase
what phase:
Prophylaxis or Perio Maintenance: Re-evaluate interval of recall appointments, radiographic evaluation of endodontic therapy/implants
maintenance phase
what are the phases of a treatment plan (per textbook)
- systemic phase
- acute phase
- disease control phase
- definitive phase
- maintenance phase
what are the treatment plan phases (per axium)
- acute phase
- disease control phase
- definitive phase
what phase:
good oral hygiene instructions
disease control
what is the managing of comprehensive dental treatment in the context of patient’s general health
ssystemic phase
what is the rationale for systemic phase
A. Recognize signs and symptoms of undiagnosed disease and physician referral for diagnosis
B. Limit or modify dental treatment depending on findings
C. Prevent in office emergencies: medical consults for ASA class III or IV (see table
5-1 for ASA classifications_
D. Prevent post-op complications resulting from dental treatment
what is the best way to avoid in office emergency
medical history
you must evaluate the relationship between systemic health and ___
dental treatment
are certain procedures indicated to alleviate able to exacerbate systemic disorders?
YES! sometimes not treatment is the best treatment
what is the focus on whole patient with the goal of delivering dental care safely and comfortably?
systemic procedures
A. Postpone or limit treatment if patient has
serious systemic disease
B. Physician consultation - uncontrolled
diabetes, hypertension, etc.
how do complete stress management
Anxiolytics, inhalation analgesia, short appointments
in NE, you can prescribe anxiolytic drug, but what can you not use at same time?
nitrous oxide
what are the anxiolytic drugs that can be used? what are the instructions/dosage?
- Xanax 1 mg. h.s., then 1 tab 1 hour prior to the appointment
- Valium 5 mg. same instructions, but it has a lot longer half-life
- Both require a driver for the patient
what are the majority of drug classes that we Rx? what are others
antibiotics and analgesics
others: premedication (artificial or porcine heart valves, and possible prosthetic joints)
where do you position the patient in the dental chair
where comfortable for the patient
what conditions can affect patient position in chair
pregnancy
congestive heart failure
spinal conditions
pulmonary conditions
you should regularly review patient health history for changes. what do you look for?
- new medical diagnoses
- updated medications
- flag patient records for pre-med, allergies, life-threatening conditions
what phase is diagnosis and tx modalities solving urgent patient needs
acute phase
what is incapacitating and possibly life threatening
acute phase - emergency problem
what does not requires immediate attention (although pt may think it does)
acute phase - urgent problem
is pain an emergency problem?
NO!
if an infection in canine fossae that extends to and includes swelling of lower eyelid, this can lead to what?
cavernous sinus thrombosis (could be fatal)
requires immediate refferal to oral surgeon or ER
what are comprehensive care patients
identify urgent problems likely to become emergencies and sequence them early in the treatment plan
what are limited care patients
sporadic care usually modified by finances, fear, mobility, healthy concerns, low dental IQ
what histories are needed and not needed for patient eval
NEED: health and medication history
NOT NECESSARY: dental history and psycho-social history
5 components of clinical exam
- Health status and ASA classification
- Oral cancer screening
- Vital signs - pulse and blood pressure baselines
- Area of chief concern
- Examination of contiguous tissues
what are different diagnostic tests and techniques
- Inspection
- Palpation
- Percussion - primary technique to determine periapical inflammation
- Periodontal probing
- Tooth mobility
- Pulp testing - hot, cold, electronic (EPT determines only whether tooth is vital or not)
- Radiographic (Table 6-1)
what is primary technique to determine PA inflammation
percussion
what test is use to detect hot, cold, electronic (EPT determines whether or not tooth is vital or not)
pulp testing
what is called by cold or air, not lingering or spontaneous, brief
reversible pulpitis
what is prolonged pain, may be spontaneous, may interfere with sleep, lingering or delayed response to cold
irreversible pulpitis
what is prolonged dull or throbbing ache, raidograph demonstrated widening of PDL, pain to mastication or percussion, vitality may be begative
symptomatic apical perio
what is simlar to AP, but with subperiosteal or intraoral swelling, positive palpation,r adiographically simiilar to AP or with PA radiolucency
apical abscess
what this
apical periodontitis
what this
apical abscess
what is diffuse, firm swelling with fever, malaise; CAUTION - canine fossae
cavernous sinus thrombosis, sublingual - Ludwig’s Angina Danger Space
cellulitis
what is a localized pointing abscess
parulis
what is purulent drainage, not likely to be painful, may determine origin with gutta percha point
sinus tract (fistula)
what is usually associated with large intracoronal restoration in posterior tooth
cracked tooth syndrome
it is critical to determine whether or not which lesions came first?
endo or perio
what problem:
No abnormal probing depths, no attachment loss, edema,
inflammation, hemorrhage upon manipulation, heavy plaque with or without
calculus
pain associated with periodontal tissues - GINGIVITIS
what problem:
Vital pulp, lateral periodontal swelling, abnormal probe
depth present, exudate present, often initiated by a foreign body (often :
popcorn hull)
pain associated with periodontal tissue - PERIO ABSCESS
what problem:
HIV mediated, painful, rapid loss of
periodontal attachment, characterized by soft tissue necrosis absent pocket
formation
pain associated w/ periodontal tissues - NECROTIZING ULCERATIVE PERIODONTITIS
what problem:
patient usually stressed, painful, inflammation, hemorrhages easily, punched out interdental papillae with pseudomembrane that is grayish in color
pain associated with periodontal tissues - NECROTIZING ULCERATIVE GINGIVITIS (used to be called acute nug)
what this
parulis
what is this
lateral periodontal abcess
what this
necrotizing ulcerative gingivitis
what this
necrotizing ulcerative periodontitis
what are pains assocaited w/ tooth eruption
- traumatized operculum vicious cycle may lead to:
- Pericornitis - operculum infected, constitutional symptoms may develop, may develop trismus if involved with a third molar
what is pain associated with previous dental treatment
- Extraction - alveolar osteitis - dull ache radiating to ear, no clot resistance present, 95% are mandibular molar extraction sites
- Prosthesis ulceration
- Deep restorations - pulpitis
- Intracoronal or extracoronal restorations - if recently placed and experiencing pain to cold and/or mastication
rule out hyperocclusion first
what are other sources of oral pain
- ulcers
- stomatitis
- TMD
- neural origin
- sinusitis
what are herpes, apthous, traumatic, herpes zoster, immunocompromised or medication induced, pemphigus examples of
ulcers
what is neuralgia, neuritis, hyperesthesia, parasthesia examples of
neural origin of oral pain
what oral pain is caused by pain in maxillary posterior teeth, may change with head position, may have bad odor and/or discharge, radiograph of maxillary sinus will appear cloudy, this diagnosis is outside of the prevue of dentistry
sinusitis
if patient has complaint of swelling, what should you check for?
lympadenopathy - infection or malignany, infection is the usual case
what are the different types of infective swelling
- Periapical - necrotic pulp - do pulp tests
- Periodontal - lateral periodontal abcess
- Pericoronal - erupting tooth - acute pericornitis
what are examples of swelling not associated with teeth
Cysts, tumors (benign or malignant), granulomatous lesions, hyperplasias ,
sialolyths - may cause salivary gland swelling
what are examples of tooth injuries
fractures, avulsion, displacement
what are examples of traumatic injuries
- tooth
- soft tissue
- boney injuries
what are examples of soft tissue injuries
laceratins and contrusion - DO NOT MAKE PERM REPAIR TO LACERATIONS INVOLVING VERMILION BORDER OF LIP. REFER TO PLASTIC SURGEONS
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