Diagnosis & Treatment Planning

Question 1

What are assumptions of treatment planning?

Answer 1

-best dentistry=least dentistry
-always do what is in the best interest of patient
-make sure patient understands treatment
-make sure patient can take care of treatment

Question 2

What is a treatment plan?

Answer 2

The sequential guide for the patient’s care as determined by the dentist’s diagnosis

Question 3

Things that needs to be done before treatment planning:

Answer 3

-chief complaint
-med history
-dental history
-radiographs
-head, neck, and oral cancer exam
-perio exam
-hard tissue exam
-occlusal exam
-diagnostic exam
-consults if needed

Question 4

What is a chief complaint?

Answer 4

• a subjective statement made by a patient describing the most significant or serious symptoms or signs of illness or dysfunction that caused him or her to seek dental care
  *always written in the patients own words

Question 5

types of dental chief complaints:

Answer 5

-fractured tooth
-pain/swelling
-exudate/bleeding
-cosmetic
-teeth cleaning

Question 6

medical history:

Answer 6

an account of all medical events and problems a person has experienced
*important tool in the management of the patient

Question 7

what are we looking for in med history?

Answer 7

-chronic conditions
-acute conditions

Question 8

examples of chronic conditions:

Answer 8

-diabetes
-high blood pressure
-high cholesterol
-thyroid conditions
-heart conditions
-liver conditions
-kidney conditions
-neurological/mental health conditions
-lung conditions
-auto immune diseases
-cancer
-HIV
-etc…

Question 9

examples of acute conditions:

Answer 9

-Bell’s Palsy
-cold
-flu
-covid
-upper resp. infection
-trauma
-appendicitis
-ear infections
-etc…

Question 10

Which are you more likely to see in the dental practice: acute or chronic conditions?

Answer 10

chronic

Question 11

dental history:

Answer 11

written documentation of a patients oral health covering all particulars of disease and therapy

Question 12

Should you ask close-ended questions?

Answer 12

most of the time no but sometimes it is necessary to direct the patient

Question 13

examples of dental close-ended questions:

Answer 13

-are you in pain?
-did you want your teeth cleaned?
-do you want a partial to replace these teeth?
-are you in good health?
-do you take any medications?

Question 14

examples of dental open-ended questions:

Answer 14

-how did you lose your tooth?
-tell me about your last dental visit.
-what brought you in today?
-why did you decide against a root canal?
-what is hurting you today?

Question 15

What radiographs would you take for an edentulous patient?

Answer 15

panoramic

Question 16

What radiographs would you take for a partially edentulous patient? (less than 10 teeth)

Answer 16

panoramic and PAs of remaining teeth

Question 17

What radiographs would you take for a dentulous patient (no significant history of dental disease)?

Answer 17

panoramic and 2-4 BWs, isolated PAs

Question 18

What radiographs would you take for a dentulous patient (history of dental disease)?

Answer 18

FMX

Question 19

What radiographs would you take for a dentulous patient (history of dental disease, third molars)?

Answer 19

FMX and panoramic

Question 20

oral cancer screening:

Answer 20

an examination performed by a dentist or doctor to look for signs of cancer or precancerous conditions in your mouth

Question 21

What is the goal of oral cancer screening?

Answer 21

identify mouth cancer early, when there is a greater chance for a cure

Question 22

What are the diagnostic tools for an oral exam?

Answer 22

VELScope
brush biopsy

Question 23

periodontal exam:

Answer 23

examination of teeth and dental implants to evaluate the topography of the gingiva and related structures

Question 24

What are the goals of a periodontal exam?

Answer 24

• measure probing depths, the width of keratinized tissue, gingival recession, and attachment level
• to evaluate the health of the subgingival area with measures such as bleeding on probing and suppuration
• to assess clinical furcation status;
  and to detect endodontic periodontal lesions.
• Assessment of the presence, degree, and/or distribution of plaque/biofilm, calculus, and gingival inflammation

Question 25

what is evaluated during the hard tissue exam?

Answer 25

-previous dental work -positional conditions -diagnostic conditions -endodontic conditions

Question 26

What are examples of positional conditions of hard tissue?

Answer 26

* Rotated Teeth, Tipped Teeth, etc

Question 27

What are examples of diagnostic conditions of hard tissue?

Answer 27

* Caries, Defective restorations, Occlusal Wear, Abfractions/Erosions, etc.

Question 28

What are examples of endodontic conditions?

Answer 28

* Periapical Abscess, Symptomatic tooth, Sinus Tract, etc

Question 29

What are the general parts of an occlusal exam?

Answer 29

* Orthodontic Classification * Occlusal Interferences * Centric Relation

Question 30

What is an occlusal interference?

Answer 30

* Any tooth contact that inhibits the remaining occluding surfaces from achieving stable and harmonious contacts

Question 31

What are the three signs of instability?

Answer 31

1. Hypermobility of teeth not related to Periodontal disease. 2. Excessive Wear 3. Change in tooth position

Question 32

What are the five signs of stability?

Answer 32

1. Tempromandibular joints are healthy and stable 2. All teeth are firm 3. No excessive wear 4. All teeth have stayed in their present position 5. Supporting Structures are healthy

Question 33

What are the five requirements for stability?

Answer 33

1. Stable TMJ 2. Anterior guidance in harmony with mandibular function 3. Non interfering posterior teeth 4. All teeth in vertical harmony with contraction of elevator muscles. 5. All teeth in horizontal harmony with the neutral zone.

Question 34

How do you know if there are no interfereing posterior teeth?

Answer 34

1. Equal intensity contacts in Centric Relation Occlusion (CRO) or Centric Occlusion (CO) 2. Posterior disclusion when condyles leave Centric Relation

Question 35

What is the neutral zone?

Answer 35

Neutral zone definition is the area where the forces exerted by the tongue are balanced by the forces exerted by the musculature of the cheek and lips.

Question 36

When should casts be mounted using a facebow?

Answer 36

for extensive (3 units or more) crown and bridge work and for removable partial dentures.

Question 37

When is a custom guide table required?

Answer 37

anterior crowns, FPDs and/or veneers

Question 38

When should you get a consult from a specialist?

Answer 38

* Periodontal Disease * Removable Prosthodontic Treatment * Fixed Prosthodontic Treatment (but not single crowns) * Oral Lesion * Oral Surgery for Multiple Extractions