Referrals and treatment planning Flashcards
Treatment planning - approach
History and examination Preliminary investigation Differential diagnosis Specific investigations e.g. mouth swab sent to microbiology lab to confirm infectious bacteria. Definitive diagnosis- ideally !! List in a logical progression – strategy Carry out treatment
Preliminary data
Patient demographics must be assembled
Name, address, DOB, telephone numbers
Arrange patients to come earlier to do paperwork
You should convey that the team is caring, working in a calm, unhurried and clean environment
History taking
Chief complaint and wishes
Medical history
Dental history
Social history
Chief complaint and history
Open questions “what is the main reason for you coming to see me today?” rather than “Are you having any problems?”
Open questions “is there anything that bothers you about the teeth?”
“If there was one thing you could change about your teeth (mouth) what would it be?”
Medical history
You should ensure the patients understands why this information is necessary
Often standard forms are used, ensure they ask pertinent questions
Dental history
Insight into pts’ attitudes to dentistry
Regular or irregular attender?
Warning signs patient who has seen several dentists over the past few years
E.g. Bad debts, holding dentists /DCP in low regard
Patients with unrealistic time expectations
Patients who just know you can do something for them
Care should be taken before accepting a patient for any complex treatment
Patients who cannot remember the names of past dentists
Value of previous dental records. You only examine a patient at one point in time.
Old records: Radiographs and study casts can provide an insight into the rate of progression of disease.
Change or lack of change in bone levels, enamel caries, wear facets and recession.
Social history
Smoking habits Ask have you previously smoked Alcohol consumption-precipitating factor for oral cancer in smokers; excessive alcohol consumption, particularly binge drinking associated with erosive dental problems Occupation (educational and intelligence) level, potential levels of stress and availability for treatment. Personal situation- marital status Family contacts Stress history e.g. CO..sore ulcers Family history
Clinical examination
Extraoral aspects
Intraoral structures
Screening to assess needs for specialised examination and tests
General dental examination – Preliminary extra-oral observations (eye contact, breathless, sweating, complexion healthy? Are they clean and neat?)
Extraoral head and neck exam
Symmetry
Muscles
Glands
TMJ
Glands - nodes
Submental nodes
Submandibular nodes
Middle jugular nodes
Lower jugular nodes
Intraoral examination
A systematic approach recommended. These should consist of:
Soft tissues
Teeth
Periodontium
Soft tissues
Lips Cheeks Lateral border of tongue Hard and soft palate (throat) Floor of mouth
Floor of mouth
With tongue elevated inspect floor of mouth for -changes in colour, texture -swelling -other surface abnormalities All abnormalities should be palpated
Concerns intra-orally
Cancer of the tongue
Hairy leukoplakia
Teeth
Missing teeth Tipping Over-eruption Spacing Existing restorations Defective restorations Caries Excessive non-carious structure loss (occlusal wear, abrasion, erosion or trauma
