lecture 6 - diagnosis and treatment planning Flashcards
- Act or process of identifying or determining the nature and cause of a disease or injury through evaluation of patient history, examination, and review of laboratory data.
DIAGNOSIS
o On first impression or complaint of the patient.
- Tentative Diagnosis
o Final identification of disease after a series of examination
o Example: Palpation, percussion, radiograph, thermal test
- Definitive Diagnosis
- Is the prediction of the probable outcome of the treatment; final results or effect of the treatment.
Prognosis
- Series of treatment that has to be done and planned according to the diagnosis of the case of the patient.
Treatment plan
- The reason that the patient seeks care, as described in the patients own words.
Chief complaint
- The purpose of dental treatment is to respond to a patient’s needs, both the _______________ by the patient and those demonstrated through a _______________ and patient interview.
- The delineation of each patient’s uniqueness occurs through the ________________ and ______________________ process.
needs perceived
clinical examination
patient interview
diagnostic clinical examination
- ___________________, past and present should be noted since such may affect the treatment plan that favorable for the individual.
- _________, current medication, family history may need remedial attention prior to and after dental treatment.
- The ________________, particularly past experiences with removable partial denture contribute valuable data which if overlooked can result in treatment failures.
Serious illnesses
Allergies
past dental history
Psychological Make-Up of Patient (4)
(1) Philosophical
(2) Exacting
(3) Hysterical
(4) Indifferent
- Easiest to treat
- Well adjusted and easygoing
- Accept their share of responsibilities and recognizes the need for replacement of missing teeth
- They have the role in maintaining their dental health
- Easily adjust to any properly constructed denture
- Does not present problems for the dentist
Philosophical Patient
- Precise in everything they do
- Can only be satisfied by perception
- Many demands, dentist needs to explain the treatment step by step in details
- Additional appointments is needed, due to the dentists needs extreme care, effort and patience
- High expectation, difficult to treat
- If satisfied they become your supporter and valuable asset in your practice
Exacting Patient
- Emotionally unstable
- Excessively apprehensive to dental treatment
- Complaint without justification
- They were never be able to wear the prosthesis
- Cannot accept responsibilities for any dental problems
- With chronic and debilitating disorder (depression)
- They are made to be aware that their dental problems is related to their systemic diseases
- Psychiatric and medical treatment is very useful
- Unless mental attitude of patient is change, possibility for success in treatment is poor
Hysterical Patient
- Lack of motivation and care to oral health
- Uncooperative, ignore instructions given
- No concern in their appearance
- Prognosis of RPD is poor
Indifferent Patient
4 Important Points of Patient Interview (UADE)
(1) Understanding patient’s desires or chief complains regarding their condition.
(2) Ascertaining the patient’s dental needs through a systematic interview process.
(3) Developing a treatment plan that reflects the best management and desires.
(4) Executing appropriately sequenced treatment with planned follow-up.
Provision of the best care for a patient may involve _______________, ______________________, and the dentist must be prepared to help patients decide the best treatment option given his or her individual circumstances.
no treatment
limited treatment or extensive treatment
- Patient present for professional evaluation:
o To address some ___________________that requires correction.
o To ________ optimum oral health.
perception of an abnormality
maintain
- The interview is an opportunity to develop ________ with the patient and it involves listening to and understanding the patient’s chief complaint or concern about their oral health
rapport
- To ensure thoroughness, the dentist should follow a sequence that follows: (4)
- Chief Complaint and It’s History
- Medical History Review
- Dental History Review
- Patient Expectations
- _____________________
o We should carefully consider what the patient needs to hear from us.
o Gives structure to a process where the provider and the patient identify together the best course of care.
Shared Decision Making (communication model)
Objectives of Prosthodontic Treatment (4)
- Elimination of disease
- Preservation, restoration & maintenance of the health of the remaining teeth and oral tissues
- The selected replacement of lost teeth
- Restoration of function in a manner that ensures optimum stability and comfort in an
esthetically pleasing manner
- A __________________ should precede any treatment decisions.
- It should include visual and digital examination of the teeth and surrounding tissues with a mouth mirror, explorer and periodontal probe.
- Conducting the ____________ of critical teeth.
- Examination of ______correctly oriented on a suitable articulator.
complete oral examination
vitality tests
casts
Sequence for Oral Examination
- ______ of pain and discomfort and ____________ by placement of temporary restorations.
- Thorough and complete ______________.
- Complete intraoral ____________
- ___________________________to be mounted for occlusal examination.
- _________ of teeth, investing structures, and residual ridges
- _____________ of remaining teeth.
- Determination of ___________________ of the mouth to locate ________________ of lingual mandibular major connectors.
Relief
caries control
oral prophylaxis
radiographic survey
Impression for accurate diagnostic casts
Examination
Vitality tests
height of floor
inferior borders
should be an accurate reproduction of all the potential features that aid diagnosis.
diagnostic cast
- These include the teeth locations, contours, and occlusal plane relationship, the residual ridge contour, size & mucosal consistency, and the oral anatomy delineating the prosthesis extensions. _______________________________________________________
(vestibules, retromolar pads, pterygo-maxillary notch, hard/soft palatal junction, floor of the mouth and frenum)
PURPOSE OF THE DIAGNOSTIC CASTS
* Used to supplement the oral examination by permitting a view of the occlusion from the _________, as well as from the buccal aspect.
lingual
PURPOSE OF THE DIAGNOSTIC CASTS
* Analysis of the existing occlusion is made possible when opposing casts are ___________, as is a study of the possibilities for improvement by ______________, ________________, or both.
occluded
occlusal adjustment
occlusal reconstruction
PURPOSE OF THE DIAGNOSTIC CASTS
* Used to permit a ________________ of the dental
arch that is to be restored by means of a removable partial denture.
topographic survey
PURPOSE OF THE DIAGNOSTIC CASTS
* Used to permit a logical and _________________ to the patient or present and future restorative needs, as well as of the hazards of future neglect.
comprehensive presentation
- Occluded and individual diagnostics casts can be used to point out to the patient.
- ____________ may be fabricated on the diagnostic casts for final impressions.
- May be used as a constant reference as the work progresses. _______________ should become a permanent part of the patients record.
Individual trays
Unaltered casts
- For Diagnostic purposes, casts should be related on an anatomically appropriate articulator. To best understand the role of occlusion, that may have a factor in the design and functional stability of the removable partial denture.
- This become increasingly important as the prosthesis replaces more teeth.
- If the patient presents with a harmonious occlusion and the edentulous span is a tooth-bound space, _______________ is generally all that is required.
simple hand articulation
- The information gathered in the patient interview and clinical examination provides the basis for establishing whether treatment is indicated, and if so, what specific treatment should be considered.
- _________________ treatment option can be considered, and financial implications need to be considered against long-term expectations if the best decision is to be reached.
More than one
- The _________________ serves as the basis for decisions that will ultimately identify the suggested treatment.
interpretation of these diagnoses
- The condition of the supporting bone must be evaluated, with specific attention to reduced bone support and mobility patterns recorded.
- Oral hygiene habits must be determined, and efforts made to educate the patient relative to plaque control.
Periodontal Considerations
- The need for protective restorations must be considered.
Caries Risk Assessment Considerstions
- An ________________ is required to ensure that an appropriately stable base of sound teeth and/or residual ridge(s) is provided to maximize prosthesis function and patient comfort.
evaluation of the prosthesis (Teeth & Residual Ridges)
- Grossly displaceable soft tissue covering basal seat areas and hyperplastic tissue should be removed to provide a firm denture foundation.
- _____________ should be removed if they will interfere with the optimum location of a lingual bar connector or a favorable path of placement.
- Any other areas of bone prominence that will interfere with the path of placement should be removed also.
Mandibular tori
- The goal of artificial tooth placement is to harmonize with the functional parameters of the existing occlusion providing _______________________.
- The dentist must decide whether it is best to accept and maintain the existing occlusion or to attempt to improve on it by means of ________________ and/or restoration of occlusal surfaces.
bilateral, simultaneous functional contact
occlusal adjustment
- There may be a need to restore modification spaces with _______________ rather than include them in the removable partial denture, especially when dealing with isolated abutment teeth.
fixed restorations
- Occasionally, orthodontic movement of malposed teeth followed by retention through the use of fixed partial dentures makes possible a better removable partial denture design mechanically and esthetically than could otherwise be used
Orthodontic Treatment
- One of the criteria used to determine the use of the lingual bar or linguo-plate is the ________________ of the patient’s mouth when tongue is elevated.
height of the floor
Tooth Alteration (T.A.P.)
- Surveying
- Guide Plane Preparation
- Tooth Re-contouring
- Dimpling / Grooving / Rest Seat
- One of the more difficult decision to make for the partially edentulous patient involves making the choice of a complete denture over a removable partial denture.
- Many factors need to be considered when one is making such a decision, these generally fall under the categories of ___________ factors, factors of ________________, and _______________ factors.
tooth-related
comparative functional expectations between prosthesis
patient-specific
- Tooth bounded edentulous regions (FPD or RPD)
FPD
- Modification spaces (anterior / posterior) (FPD/ RPD)
FPD
- Replacement of unilaterally missing molars (shortened dental arch) (FPD/ RPD)
FPD
- Distal extension situation (FPD/ RPD)
RPD
- After recent extractions (FPD/ RPD)
RPD
- Long span
RPD
- Need for effect of bilateral stabilization (RPD/FPD)
RPD
- Excessive loss of residual bone (FPD/ RPD)
RPD
- Unusually sound abutment teeth (FPD/ RPD)
RPD
- Abutments with guarded prognosis (FPD/ RPD)
RPD
- Economic considerations (FPD/ RPD)
RPD
- More accurate than resins ________
- Cleanliness of the metal base maintains healthy oral tissues.
- Metal alloys can be much thinner than resins and still have adequate strength and rigidity.
- ___________ as temperature is transmitted through the base maintaining health of the tissue
- Most common metal used are __________ and _________.
Metal
Thermal conductive
nickel chromium
cobalt chromium
- The cast framework offers significant advantage over the all acrylic-resin removable partial denture.
- Practically all cast frameworks for removable partial dentures are made from a cobalt-chromium alloy or nickel-chromium.
- The popularity of ________ alloys has been attributed to their low density (weight), high modulus of elasticity (stiffness), low material cost, & resistance to tarnish
Co-Cr
Disadvantages of Metal
- Expensive
- Time consuming
- Technique sensitive (casting)
- Visible metal clasp (esthetic)
- Heavy weight
- Brittle
- Difficulty in relining & repairing
Disadvantages of PMMA
- Brittleness
- Allergy to MMA Monomer
- High porosity
- Irritation of mucosa
- Foul smell
- Difficult to insert in undercut areas
- Dimensional changes
- Needs denture adhesives
- Complicated processing
what to identify in Chief of Complaint
o Function
o Esthetics
o Function and Esthetics
what to ask in History of Present Illness (HPI)
- What
- When
- Where
- Why
other documents for treatment planning (2)
dental chart
data privacy and consent form
