Treatment plan Flashcards
What is a treatment plan
A detailed plan with information about:
*A patient’s disease
*The goal of treatment
*The treatment options for the disease
*Possible side effects
*Expected length of treatment and likelihood of success
Will a treatment plan include costs and follow up care
Yes they may include this information
Why should every conversation with a patient be documented
To protect yourself medically and legally if something were to go wrong or accusations be made
Why do we need a treatment plan
Allows us to structure our patient’s care and carry it out in a logical ordered way
Protects us medico-legally by documenting
-Disease
-Treatment options
-Informed consent
How do you start a treatment plan
Diagnosis/complaint
What is the aim of the listening phase
To gather:
-C/O
-HPC
-DH
-MH
-SH
-FH
What comes after the listening phase
Clinical exam
What initial steps should be undertaken in the initial clinical exam
Extra-oral exam
Intra-oral exam
Dental chart
Basic periodontal exam
What things should you look out for in the clinical tests
Is the tooth sensitive to air from the 3in1?
Tender to percussion (TTP)
Mobility
Presence of sinus
Pocket Depth
What is the provisional diagnosis
The dentist has recognized tell-tale aspects of the history which lead him/her to believe a certain problem is likely to exist
That can be further clarified by asking more specific questions the dentist knows to be relevant
The examination has revealed a probable cause of the problem and confirmed the dentist’s suspicions
Special investigations add to the evidence and confirm the diagnosis
What special investigations can a dentist undertake
Radiographs
-Aid with a dental or periodontal diagnosis, screening assessment.
Diet Diary
-Caries risk assessment
Photographs
-Pre-treatment record, evidence of disease, referral aid.
Sensibility Testing
-To determine the vitality of the pulp
Study models
-Review occlusion, monitor non-carious tooth surface loss, plan treatment, referral aid.
What problems can come from clinical exam
Poor aesthetics
Missing teeth
Loose dentures
Fractured restoration
What diseases may be diagnosed in a clinical exam
Caries
Gingivitis
Periodontal Disease
Apical Periodontitis
Toothwear
35 year old male who is a new patient and has been an irregular dental attender and is in pain
Medically he is fit and well.
Smokes 10 cigarettes a day and consumes 21 units of alcohol a week.
Scaffolder and drinks a glass bottle of IrnBru over the course of the day .
Smoker - oral cancer
Irnbru - caries
Pain - something wrong
Irregular attendance - poor dental health
What are the considerations to take into account when deciding between composite and amalgam
Caries risk assessment - leaking composite could lead to secondary caries
Size/Design of cavity - amalgam is harder in greater areas
Moisture Control - composite might not set right with severe moisture (gingivitis could pose an issue for this)
Aesthetics - amalgam may be seen on an upper 6th, composite may look better
Cost - composite on posterior teeth (80-100 pounds) not covered by NHS
Patient Preference
How to take a pain history
S - site
O - onset
C - character
R - radiates
A - associated symptoms
T - time/duration
E - exacerbating/reliving factors
S - severity?
WHAT ARE THE NEXT STEPS TO THIS DIAGNOSIS
S - lower left (37)
O - had attended emergency dentist several months ago. Pain has returned and much worse.
C - constant dull ache
R - sore all along jaw line
A - tired from being kept awake last night
T - constant
E - sore with hot/cold and to bite on, not helped by painkillers
S - 9/10
Tooth 37
Tender to Percussion? (Yes)
Sensitive to cold air? (Yes)
Any Sinus present? (No)
Is the tooth mobile? (Mildly)
Pocketing on probing? (No)
Provisional Diagnosis of symptomatic irreversible pulpitis 37.
What are the purpose of sensitivity tests
Indirectly determine the state
of pulpal health by assessing the reaction of the nerves within the dental pulp
What are some sensitivity tests
Electric Pulp Testing
Ethyl Chloride
Warm Gutta Percha
What are the treatment options for irreversible pulpitis
Extraction?
Cheaper (£20)
Single visit
Risk of post op complications
Left with a gap
Drifting/tilting/overeruption of adjacent teeth
Restorative options for space?
Root canal treatment?
More Expensive (>£100)
Multiple Visits
Success rate
What to restore the tooth with
-Direct filling (composite or amalgam)
-Indirect filling (crown or an onlay)?
What is a BPE
“The BPE is a simple and rapid screening tool that is used to indicate the level of further examination needed and provide basic guidance on treatment needed. These BPE guidelines are not prescriptive but represent a minimum standard of care for initial periodontal assessment. BPE should be used for screening only and should not be used for diagnosis.”
35 year old male who is a new patient and has been an irregular dental attender and is in pain
Diagnosis:
High Caries Risk
Poor Oral Hygiene
Smoker
Generalized gingivitis
Caries 26
Symptomatic Irreversible Pulpitis 37
Asymptomatic Irreversible Pulpitis 46 & 47
High Caries Risk
Poor Oral Hygiene
Smoker
Generalized gingivitis
Caries 26
Symptomatic Irreversible Pulpitis 37
Asymptomatic Irreversible Pulpitis 46 & 47
WHAT DO WE DO FIRST
Immediate
Initial or Disease Control/Management
Re-Evaluation
Reconstructive or Rehabilitation
Maintenance
What is classed as immediate treatment
Pain management
-Pulp extirpation or extraction
Management of presenting complaint
-Recementing a lost crown
-Replacing a lost restoration in an aesthetic area
What disease management and control should be addressed
What disease do we have?
Think about prevention as well as treatment
How could we identify the source or cause of caries
Review Diet
Review Oral Hygiene
Provide preventative advice
Fluoride prescription?
How can caries be treated
Do nothing?
Is the tooth restorable?
-No – plan for a dental extraction
-Yes
Direct restoration?
Pulpal involvement?
Indirect restoration?
What does Re-evaluation involve
Checking if our treatment has been successful
Is more treatment of initial disease required?
Can we progress to more difficult treatment?
What disease control measures can we do
Prevention - oral hygeine, diet
Direct Restorations
Extractions
Hygiene Phased Therapy/PMPR (professional mechanical plaque removal)
What is the Re-constructive phase
More complex restorative work such as crown & bridge work, root canal treatment or dentures.
Good foundations needed to provide complex treatment
When do we begin the restorative stage
Stable caries
Extractions complete
Healthy base to build on
Pain managed
No further immediate treatment required
What materials can be used for a removable partial denture
ACRYLIC
Cheap
Instant fit
Doesn’t involve preparation of adjacent teeth
Easy to add to
COBAL CHROME
More expensive than acrylic
Period of healing required
May need to prep teeth for rest seats
Cannot always add
What fixed options could a patient opt for after extraction
BRIDGE
Affordabilty?
Utilises adjacent teeth
Delayed placement following extractions
Will fail if preventive measures not taken.
IMPLANT
Cost
Patient selection
No preparation of adjacent teeth
Invasive procedure
Failure rate? - unstable periodontal disease (wont work)
What is involved in the maintenance stage
How often do we want to see the patient again?
This is often determined by the periodontal health and we follow the BSP guidelines.
How do you manage time with a complex diagnosis
You cannot always diagnose, consider treatment options decide upon a treatment plan and decide upon the order the treatment in one patient visit
If it needs more than one patient visit chances are you have to do some preparatory work between visits eg 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
