treatment and ongoing care

Question 1

5 stages of treatment plan

Answer 1

immediate

inital/disease control

re-evaluation

reconstructive

maintenance/review

Question 2

immediate phase of treatment plan

Answer 2

• What cannot wait until tomorrow?
• Patient complaint – deal with issue in hand
  
  • Pain/trauma – analgesics prescription
  • Caries – temporary restore/dress – ZOE (Not if irreversible)
  • Extraction
  • Start RCT and out ledermix in as not able to complete at that app
  • Drain abscess – mucosa or through tooth (large facial – intra oral), may need to refer urgently to max fax if life threatening
  • Irrigate the socket
  • Perio – antibiotics, mouthwash and supragingival debridement
  • Construct temporary crown
  • Aesthetics – restore temporary filling, chips etc - not be causing pain

Question 3

initial/disease control phase of treatment plan

Answer 3

• What diseases/pathology do we need to treat?
  
  • Base for more complex treatment so in stable
    
    • Caries
    • Periodontal
    • Pulpitis/ endodontics
    • Thrush/ fungal infection/ denture stomatitis
    • Ulcers – esp if don’t heal or present for a while
    • Lichenoid reactions – may need to refer
    • Dentine hypersensitivity

Question 4

re-evaluation phase of treatment plan

Answer 4

Has treatment so far has been successful – assess Tx

• Caries treated (no more active lesions check up), ulcer healed, perio stable (plaque and gingivitis chart and pocket chart comparisons before and after)
• Pain resolved, pt comfortable and confident in their dentition

If no - more treatment of initial disease is required but what are you going to do differently to get resolution – why – missed lesion, high risk, uncooperative, cant justify same faied treatment again; event in pt life mean higher risk or more prone to disease

If yes - progress to more definitive treatment?

Question 5

reconstructive phase of treatment plan

Answer 5

• More complex (usually) restorative work which require good foundations
  
  • To enable a full dentition in pt and aesthetics
• (removable partial) Dentures, bridges, crowns, surgery – orthodontic (needs planned for after initial Tx), periapical (recurring sinus)

Question 6

maintenance phase of treatment plan

Answer 6

• Supporting your patient to maintain dental health after your treatment is complete
• Monitoring for further disease or failure of dental treatment
  
  • Keep everything stable and under control
• How often assess – depends on risk factor and complexity of Tx

Question 7

what impacts treatment plan progression

Answer 7

severity of illness

when pt needs seen - urgency

Question 8

treatment plan for:

attended in pain tooth 22

treatment needed:

• Amalgam 48
• Composite restorations 11, 21 and 22
• Crown 12
• Diet review and advice
• Oral hygiene review and advice
• Partial upper denture
• Root canal re-treat 12
• Root canal treat 22
• Root surface debridement
• Smoking cessation advice

Answer 8

immediate

• Root canal treat 22
  
  • Ask how long they’ve had pain – if long period then maybe not as urgent
• Oral hygiene review and advice
  
  • Any more treatment will last longer and less likely to fail
• Smoking cessation advice
• Diet review and advice
• Root surface debridement (supra gingival to assess pt tolerance and assist OH)
  
  • May need to temporary cover caries

Initial/disease control

• Composite restorations 11, 21 and 22
• Amalgam 48/7

Re- eval

Re-constructive

• Root canal re-treat 12
• Crown 12
• Partial upper denture
  
  • May have features made in restorations – e.g. guide planes
    
    • Pt may insist on done earlier if affecting eating

Maintenance

Question 9

treatment plan:

• Patient is concerned about the appearance of her upper canines and has just been invited to a very posh dinner in two days time and wants to look her best.

Important diagnoses

• Gross caries 15
• Root fracture 22
• Sinus 13
• Temporary crowns on 12 and 22

Treatment required

• Amalgam 17
• Bridge work 15,14,21,22,23,24
• Crowns 13, 12, 11, 23
• Definitive partial denture construction
• Extractions 15,22
• Glass ionomer 16
• Improve appearance of 13, 23
• Maintenance and review
• Non-surgical periodontal treatment
• Root canal re-treatment 13,12,23
• Root canal treatment 11
• Temporary upper partial denture

Answer 9

Immediate

• Improve appearance of 13, 23 – some composite filings (appearance only, fall out, temporary dress not treating problem only addressing appearance, has to return)
• OHI and diet advice
• Extractions 15,22
  
  • Ideally want to get unrestorable teeth out ASAP
• Temporary upper partial denture – impression needed
• Non-surgical periodontal treatment

May address sinus earlier – open and press on it so can assess by RCT that can heal

Initial/ Disease control

• Restorations simple
  
  • Glass ionomer 16
  • Amalgam 17
• Root canal re-treatment 13,12,23 advanced
• Root canal treatment 11 advanced

Re-eval

• Pocket chart and perio

Reconstructive

• Crowns 13, 12, 11, 23
• Bridge work 15,14,21,22,23,24
• Definitive partial denture construction
  
  • Check occlusion via bridge work and partial

Maintenance and review

Question 10

if treatment plan descision takes more than 1 visit then

Answer 10

If it needs more than one patient visit chances are you have to do some preparatory work between visits e.g. producing radiograph report, deciding on treatment option between visit 1 and 2 and then order of treatment between visit 2 and 3 once you have got consent for treatment plan

Think about how to present to pt the Tx beforehand so not too complicated (e.g. RCT)