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Clinical practice > Treatment plan > Flashcards

Treatment plan Flashcards

1
Q

What is a treatment plan

A

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​

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2
Q

Will a treatment plan include costs and follow up care

A

Yes they may include this information

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3
Q

Why should every conversation with a patient be documented

A

To protect yourself medically and legally if something were to go wrong or accusations be made

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4
Q

Why do we need a treatment plan

A

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

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5
Q

How do you start a treatment plan

A

Diagnosis/complaint

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6
Q

What is the aim of the listening phase

A

To gather:
-C/O
-HPC
-DH
-MH
-SH
-FH

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7
Q

What comes after the listening phase

A

Clinical exam

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8
Q

What initial steps should be undertaken in the initial clinical exam

A

Extra-oral exam
Intra-oral exam
Dental chart
Basic periodontal exam

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9
Q

What things should you look out for in the clinical tests

A

Is the tooth sensitive to air from the 3in1?​

Tender to percussion (TTP)​

Mobility​

Presence of sinus​

Pocket Depth

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10
Q

What is the provisional diagnosis

A

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

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11
Q

What special investigations can a dentist undertake

A

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.

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12
Q

What problems can come from clinical exam

A

Poor aesthetics​

Missing teeth​

Loose dentures​

Fractured restoration

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13
Q

What diseases may be diagnosed in a clinical exam

A

Caries​

Gingivitis​

Periodontal Disease​

Apical Periodontitis​

Toothwear

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14
Q

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 .

A

Smoker - oral cancer
Irnbru - caries
Pain - something wrong
Irregular attendance - poor dental health

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15
Q

What are the considerations to take into account when deciding between composite and amalgam

A

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

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16
Q

How to take a pain history

A

S - site​

O - onset​

C - character​

R - radiates​

A - associated symptoms​

T - time/duration​

E - exacerbating/reliving factors​

S - severity?​

17
Q

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​

A

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.

18
Q

What are the purpose of sensitivity tests

A

Indirectly determine the state​
of pulpal health by assessing the reaction of the nerves within the dental pulp

19
Q

What are some sensitivity tests

A

Electric Pulp Testing​

Ethyl Chloride​

Warm Gutta Percha

20
Q

What are the treatment options for irreversible pulpitis

A

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)?

21
Q

What is a BPE

A

“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.”

22
Q

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

A

Immediate​

Initial or Disease Control/Management​

Re-Evaluation​

Reconstructive or Rehabilitation​

Maintenance

23
Q

What is classed as immediate treatment

A

Pain management​
-Pulp extirpation or extraction​

Management of presenting complaint​
-Recementing a lost crown​
-Replacing a lost restoration in an aesthetic area

24
Q

What disease management and control should be addressed

A

What disease do we have?​

Think about prevention as well as treatment

25
Q

How could we identify the source or cause of caries

A

Review Diet​

Review Oral Hygiene ​

Provide preventative advice​

Fluoride prescription?

26
Q

How can caries be treated

A

Do nothing?​

Is the tooth restorable?​
-No – plan for a dental extraction​
-Yes​

Direct restoration?​
Pulpal involvement?​
Indirect restoration?

27
Q

What does Re-evaluation involve

A

Checking if our treatment has been successful​

Is more treatment of initial disease required?​

Can we progress to more difficult treatment?

28
Q

What disease control measures can we do

A

Prevention - oral hygeine, diet

Direct Restorations​

Extractions​

Hygiene Phased Therapy/PMPR (professional mechanical plaque removal)

29
Q

What is the Re-constructive phase

A

More complex restorative work such as crown & bridge work, root canal treatment or dentures.​

Good foundations needed to provide complex treatment

30
Q

When do we begin the restorative stage

A

Stable caries
Extractions complete
Healthy base to build on
Pain managed
No further immediate treatment required

31
Q

What materials can be used for a removable partial denture

A

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

32
Q

What fixed options could a patient opt for after extraction

A

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)

33
Q

What is involved in the maintenance stage

A

How often do we want to see the patient again?

This is often determined by the periodontal health and we follow the BSP guidelines.

34
Q

How do you manage time with a complex diagnosis

A

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

Clinical practice (8 decks)

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