treatment planning Flashcards
what is a treatment plan? what is it based on? what does it include?
T.P is a BLUE PRINT for case management.
It is based mainly upon your Prognosis but also depends upon the patient’s own wishes, local, behavioral and systemic factors.
It includes ALL procedures required for regaining oral health. (creating a well functioning dentition in a healthy periodontal environment)
Is a treatment plan a fixed or rigid guide?
It is NOT a fixed or rigid guide.
Can be (at times, may HAVE to be!) modified at any point during treatment.It is flexible.
what should you do before beginning treatment?
DO NOT begin treatment without first establishing AND presenting your T.P to your patient.
why should you present your findings ?
Because you need the written informed consent of the patient first!
Exception,
When managing an oral emergency. [treat the symptomatic problem first.E.g. Pain/swelling
Even then, get a verbal consent and always check the medical status first! Diseases/Medications/Recent surgeries.
Pre-medicate if needed!
Stop Medications if necessary….
Consult with Physician if in doubt.
what is the first step of the therapy?
INITIAL THERAPY (I.T)
RATIONALE: To eliminate or control the PRIMARY [plaque biofilm], local aggravating and SYSTEMIC/BEHAVIORAL risk factors involved in the etiology and progression of periodontal diseases.
what are the sequences in I.T. (initial therapy)?
EMERGENCY [Symptomatic].
Initiate Plaque Control Program.
Scaling, Root Planing, Polish.
Control/eliminate local aggravating factors such as cervical caries, defective restorations/prosthesis.
Counseling (smoking/chronic stress), consult with MD is needed.
what should you do after 4-6 weeks following I.T.?
Make an appointment for EVALUATION of I.T.
Done after 4-6 weeks following I.T
Purpose? To ascertain the response of YOUR treatment and the PATIENT’S home PC.
how is the evaluation of the I.T. assessed?
Assessed by
- TISSUE RESPONSE. (re- check)
- ATTITUDE RESPONSE. (ask them if they remember what you told them about the conditions, quiz the pt. Request the pt to demonstrate how they brush/floss etc.
During evaluation of I.T, if some sites have NOT improved.. You have 2 or 3 options…????
1/ Back to square one [I.T] – to ensure that the primary and all local aggravating factors have been controlled and/or
2/ perhaps consider treating these sites with non surgical treatment modalities such as
light activated therapy (Periowave) or medications (minocycline or PerioStat) and/or3/ Attempt surgery.
what should you do before scheduling surgery?
However, before scheduling surgery, always ensure that…* PC is satisfactory.* Pt is well motivated.* No contraindications for the procedure.
After surgery schedule a post-op visit 1 week, then 3-6 months.
what should you do if the periodontal health ahs been restored (the disease has been eliminated or well controlled/stabilized) and if our patient requires any restorative (operative, fixed, removable) work [not necessarily labeled as a local aggravating factor/s),?
these may be done now
PHASE 3:
What should you do Once the clinical state has improved/stable ……and all ACTIVE Tx is completed?
Your patient should be seen once every3 or / 6 / 8/ 12 months-depends on how bad the periodontal status was, at baseline.
Known as MAINTENANCE Therapy.
If there was no need for any restorative work, then MT (maintenance therapy) will be phase 3.
what is maintenance therapy for?
RATIONALE: To ensure that your patient maintains a state of periodontal health after ALL ACTIVE treatment has been completed.
MT is a life long involvement with your patient!
what are the special problems in TP?
LOCAL
High frenum.
Prominent Ext.Oblique Ridge.
Some teeth are mobile (patient does not want them extracted).
Orthodontic appliances.
SYSTEMIC/BEHAVIORAL
Smoking. Under chronic (long term) stress. Not well motivated. Does not have a good dental IQ. Not very compliant. [e.g. Not follow your PCI, not keep appointments]. Poor attitude.
Medical Disorders; Hemophilia Diabetes Epilepsy Leukemia Cardiac Physically, mentally challenged These may cause to alter your ideal TP.
Ongoing Medical Therapy;
Medications that increase the risk of bleeding during surgery: Anti coagulants.
Medications that can cause gingiva to enlarge: Dilantin,Cyclosporin A.
Medications that can cause some xerostomia. ( be familiar with the drugs that cause this)
Bisphosphonates (osteoradio necrosis?)
May cause you to alter your TP.
As a dentist, you may be the first person to detect/suspect
Oral carcinoma
Diabetes
Leukemia
(you would refer any of these three to physician)
This would alter your TP
again why present the case/TP to your patient?
So that your patient can make an INFORMED CONSENT whether to accept or reject your proposed plan.
Get into the habit of informing your patient about their oral problem/s in simple terms (avoid using jargon unless you have explained what they mean) - (etiology, progression, consequences of not following the TP and at times, your treatment!, diagnosis, prognosis, TP, cost, time etc.).
Hone your COMMUNICATION SKILLS!
