Diagnosis and Treatment planning Flashcards
What are the 4 steps to make a treatment plan?
- Gather relevant information
- Establish a dental diagnosis
- Consideration of all treatment options and priorities
- Formulation of a treatment plan in consultation with the patient
What happens in Step 1?
- History
- Examination
- Special tests
What are perio disease risk factors?
- Plaque
- Host susceptibility
- Smoking
- Systemic disease
What are examples of special tests?
- Radiographs - Bitewings, Periapicals, DPT
- Diet sheets
- Double perio charts
- Plaque disclosing
- Sensibility tests
- Percussion test (TTP or NTTP)
What do u do in Step 2?
Types of Diagnosis
- Provisional
- Formed on the initial information gathered
- Still need to conduct special tests and investigate further. eg. radiographs, sensibility testing
- Differential
* A list of possible conditions or diseases that present with similar signs and symptoms - Definitive
- The final diagnosis
- An accumulation of the history, clinical examination and special investigations
It is essential that a thorough and methodical examination be carried out.
What must you do in Step 3?
Consider Treatment Options
- Consider the mouth as a whole: teeth, periodontium, soft tissues, TMJ, occlusion
- Consider the patient : Things that may influence treatment eg, medical history, dental phobia, cost/time constraints
- Treatment options must be evidence-based dentistry (EBD)
- All treatment options should be presented to the patient and the patient should be involved in deciding which is the preferred option.
- All treatment options have both advantages and disadvantages
What are some general considerations in treatment planning?
- The patient / dentist relationship – ideally there is a match between what the patient wants, and what the patient needs
- Patients understanding and attitude about dental care. Patients previous dental experiences.
- Consider a simple procedure first to gain the patients trust
- The patients age - eg young patients consider tooth eruption, deciduous/permanent teeth, larger pulp chambers etc. Older patients more at risk of periodontal disease, root caries, dentures
- Caries risk
- Patients ability to tolerate dental treatment and maintain the treatment provided eg. can lie flat, unrestricted mouth opening, ability to maintain oral hygiene.
- Patients past attendance record. Consider keeping a good attender under review, or repeat radiographs at a later date ….. but for the poor attender ???
- The patients financial considerations. Cost of treatment should be discussed at the treatment planning phase
- Your ability as an operator to perform treatment - scope of practice - scope of expertise - when to refer
What are some Specific Dental Considerations?
- Oral hygiene status, and patient cooperation and motivation
- Control of dental caries, tooth wear and periodontal disease
- Pulpal status of individual teeth
- Aesthetics of the dentition
- Restorability of the teeth
What is the aim of Step 4?
Formulate a treatment plan The aim of treatment is to provide:-
- Functional dentition
- Dentition that is free form discomfort/pain and disease
- Dentition that is aesthetically pleasing
What is the treatment plan order?
- Emergency care - pain or infection
- Prevention
- Stabilisation – manage active disease
- Restorative
- Maintenance
- Referrals
In the A&E who do we see and who don’t we see?
Who do we see?
- Accidents and emergencies - pain, swelling, bleeding , trauma , toothache
- Entry point for those seeking treatment on Student clinics
- Pain or swelling and has own GDP ‘elsewhere.’
Who don’t we see?
- Those patients who are currently registered with a GDP
- Paediatrics
Red codes will be seen First in A&E. What are these?
- Facial swelling
- Trauma
- Extreme pain
- Accidental paracetomol O/D
What is the main focus for A&E?
Emergency care is the main focus for A/E relieving the pain and/or infection trauma
- We will do a hard tissue charting and a BPE to examine the overall mouth of the patient – but then the focus is back on emergency care.
- Diagnosis – is of the presenting complaint
- Onward referral for Exam/BWs/Tx if other treatment needed
What is SCORATES?
SOCRATES is the common acronym used for pain assessment.
Site: the location of the pain
Onset: when did the pain begin
Character: how would they describe the pain? eg sharp, dull
Radiation: is the pain spreading elsewhere?
Associated features: is there anything else? eg swelling or bad taste
Time: has the pain changed over time in severity or character
Exacerbating / alleviating factors: what makes the pain better/worse
Severity: how severe is the pain – oft
What is the Pain Assessment Scale?
