clinical decision making in periodontitics - periodontitis

Question 1

what is clinician decision making?

Answer 1

process where all members of the dental team used the information gathered during the comprehensive diagnosis periodontal assessment to arrive at an appropriate diagnosis and identify the treatment strategies that meet the individual of the patients

Question 2

list the three fundamental diagnostic questions when assigning a periodontal diagnosis

Answer 2

1. does the clinician assessment indicate health or disease: health and disease
2. is the disease gingivitis or periodontitis
3. what type of gingivitis or periodontitis?

Question 3

list and describe the phase of the treatment planning

Answer 3

urgent: addressing the immediate chief complain or urgent needs identified
control phase: aims to eliminate active disease such as caries and inflammatory, remove conditions preventing maintenance, eliminate potential causes of disease and begin preventive dentistry activities
reevaluation; aims to reduce oral disease and stabilise oral health
denfitive phase; involve referring to specialist such as orthodontics, endodontics, periodontal and prosthodontics treatment, determine for further care, the patients enters denfitive phase treatment.
maintanace phase: regular examinations that may reveal the need for adjustment to prevent future breakdown and provide an opportunity to reinforce home care.

Question 4

define and explain share decision making

Answer 4

it is a collaborative process the patient’s right to make a decision about their care after being fully informed about option.
by sharing expertise, so the clinician and patients sharing expertise for taking decision. clinician expertise - diagnosis of condition, disease etiology, prognosis, treatment options, outcome probability. patient’s expertise - experience of conditions, circumstances, attitude to risk, values and preferences
shared decision making have 5 essential steps;
1. seek (describe what is going on and invite them to motivated them to participate, make clear that that input in making decision)
2. help (evaluate the patients understanding and avoid technical jargon when explaining option),
3. asess the patients values and preferences (you want to know what are their priority and important to them, and listen to the patients)
4. reach (ask the patient if their already ready to decide and confirm their decision, asset patient to follow through with decision)
5.evaluate (review their decision and make plans to review any postponed treatment, revisit the decision if anything change or other option are needed

Question 5

describe good practice for gaining informed patient consent

Answer 5

1. provide information in a way they can understand before asking for their consent
2. give the patients enough time to ask questions and make informed decisions
3. act according to capacity to the patient’s capacity for decision making and consent, including when caring for children and young people based on their maturity and capacity to understand and the nature of the proposed care.
4. get informed consent from the patient or where the patient does not have the capacity, from their parent, carer, guardians or other substitute decision maker before carrying out any examination or investigation, providing treatment. when obtaining informed consent you should include information on material risk and expected outcomes and take into account any advance care directive (or similar)
5. get financial consent by discussing the fees in a manner appropriate to the professional relationship and addressing the costs of all required services and get general agreement about the level of treatment to be provided, before the service is provide
6. inform your patients of the benefits, as well as associated cost or risk. when referring them for further investigation or treatment, which they may wish to clarify before proceeding
7. document consent appropriately, including considering the need for written consent for procedures which are higher risk or may results in serious injury or death

Question 6

describe good practice for gaining informed patient consent

Answer 6

1. provide information in a way they can understand before asking for their consent
2. give the patients enough time to ask questions and make informed decisions
3. act according to capacity to the patient’s capacity for decision making and consent, including when caring for children and young people based on their maturity and capacity to understand and the nature of the proposed care.
4. get informed consent from the patient or where the patient does not have the capacity, from their parent, carer, guardians or other substitute decision maker before carrying out any examination or investigation, providing treatment. when obtaining informed consent you should include information on material risk and expected outcomes and take into account any advance care directive (or similar)
5. get financial consent by discussing the fees in a manner appropriate to the professional relationship and addressing the costs of all required services and get general agreement about the level of treatment to be provided, before the service is provide
6. inform your patients of the benefits, as well as associated cost or risk. when referring them for further investigation or treatment, which they may wish to clarify before proceeding
7. document consent appropriately, including considering the need for written consent for procedures which are higher risk or may results in serious injury or death

Question 7

does the clinician assessment indicate health or disease?

Answer 7

decision should be based on signs of inflammation. signs - disease can be observed and measure by clinician . symptoms are noted by the patient (some patients are unaware of disease)

Question 8

is disease gingivitis or periodontitis?

Answer 8

gingivitis - no loss of attachment
periodontitis - loss of attachment

Question 9

what types of gingivitis or what types of periodontitis?

Answer 9

grading and staging
perio classification

note ; important to write the stage, grading and extent for your notes and other clinician to review the documentation

Question 10

what is treatment planning>

Answer 10

is a sequential outline of measures to be carried out by the treating practitioner and patient to eliminate disease and restore a health oral environment.
coordinate and sequences all treatment and education.
estimates length of time required for comprehensive treatment.
communication with patient is vital.
patient consent for proposed treatment must be obtained

Question 11

what are the four steps for development of treatment for patient

Answer 11

examination- diagnosis and identifying modifiable risk factors
decision to recommended
identification of treatment alternatives
selection of the treatment with patients involvement.