Treatment Planning Process Flashcards by Isis Ochoa

Stepwise process of traditional model of dental treatment planning:

1.Evaluating and examining the px
2. Developing a problem list
3. Constructing a series of treatments

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Defined as integrating individual clinical expertise with the best available external clinical evidence from systemic research.

Evidence-based practice

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Integration of best research evidence with clinical expertise and px values.
Based on scientific principles and treatment regimens that have been tried, tested and proven worthy by accurate, substantiated, and reproducible studies.

Evidence-based dentistry

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Merits of Evidence-based Dentistry:

Provides the basis for moving to a specific decision (when several viable alternatives are being weighed)
Affirms or disproves the efficacy of various dental treatments
Gives compelling guidance to the px and dentist on the “treat versus not treat” question

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Limitations of Evidence-based Dentistry:

Several treatments do not have strong evidentiary support but may still be viable
Presence is insufficeint to determine the viability of many treatments
Multiple treatments need to be further analyzed
Majority of studies fail to address patient factors
Most studies on outcomes look exclusively at treatment efficacy and rarely correlate the efficacy with the px’s preferences and desires

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Focuses on determining the patient’s probability of acquiring a specific disease or condition.

RISK ASSESSMENT

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Describes the strength of the relationship between risk and future disease occurrence

DEGREE OF RISK

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Ways Risk Assessment can be a Useful Adjunct to the Dental Treatment Planning Process:

Identify if there is a need to start counseling pxs about hereditary oral conditions and diseases
To avoid an undesirable outcome ➡️ provide prophylactic intervention
For cases when delayed tx would put the px at risk for acquiring more comprehensive tx in the future ➡️ deliver early intervention
For cases when px is known to be at risk ➡️ work to eliminate recognized causes of oral conditions or diseases

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Any measure that is used to foresee an individual’s risk for a condition or disease
Related with increased probability of future condition or disease, but does not cause the disease

RISK PREDICTORS

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Condition/s for which an evident causal biologic link between the factor and the disease have been shown to be present
Best confirmed by longitudinal studies
2 Categories: Modifiable and Non-modifiable Factors

RISK FACTORS

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Pertains to identifiable conditions that (when present) are known to be associated with a higher probability of the occurrence of a particular disease
May be detected by taking a cross-sectional study

RISK INDICATORS

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Involves conducting repeated observations of the same subjects over a long period of time.

LONGITUDINAL STUDY

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Compares different population groups or a representative subset at a single point in time.

CROSS-SECTIONAL STUDY

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Categories of Conditions or Behaviors that may be Risk indicators of Oral Disease:

Hereditary conditions
Systemic disease as a risk indicator for oral health problems
Dietary and other behavioral risk indicators
Risk indicators related to stress and anxiety
Functional or trauma related conditions
Environmental risk indicators
Previous disease experience
Socioeconomic status

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Caused by an external trigger which can be short-term or long-term, but it subsided once the situation has been resolved.

STRESS

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Caused by an internal trigger that is characterized by anticipation from an unknown or poorly defined threat, which continues to persist after the concern has passed.

ANXIETY

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Pertains to a prediction of a px’s future condition based on the px’s present circumstances.
Implies the possible outcomes of a disease and the frequency with which these outcomes can be expected to occur.

PROGNOSIS

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Descriptors of Prognosis:
- highest level of certainty
- confidence level is >95%
- safe to proceed without reservation

EXCELLENT

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Descriptors of Prognosis:
- high probability of success
- confidence level is more than >80/85%
- safe to proceed with limited reservations
- recommendation with some caution
- restricted assurances

GOOD

Descriptors of Prognosis:
- reasonable but limited probability of success
- confidence level is 50-80%
- restricted assurance (if any)
- realistic discussions

FAIR

Descriptors of Prognosis:
- limited chances of success
- confidence level is <50%
- limited assurance of success

POOR/GUARDED

Descriptors of Prognosis:
- no reasonable chance of success
- confidence level is <5%
- elective treatment must not be initiated

HOPELESS

Descriptors of Prognosis:
- may imply that the available information is not enough to make a prognosis
- might also signify that prognosis remains unclear
- no assurance of success

UNCERTAIN/QUESTIONNABLE

Roles of Outcomes Measures:
HSRPPP

Helps dentists select the best treatment options to discuss with the patient
Serves as an important adjunct to the presentation of the treatment plan to the patient
Refines the list of realistic choices
Promotes the direct management of individual patient care
Provides an opportunity for the dental profession to collectively compare types of care
Presents a chance for the dental profession to mutually evaluate the effectiveness of various treatments

Reasons Dentists Disagree in Treatment Planning: LIMLUD

1. Lack of risk assessment 2. Inaccuracy of diagnostic tests 3. Misdiagnosis, missed diagnosis, and disagreement on diagnosis 4. Limited availability or use of outcomes measure 5. Uncertain diagnosis 6. Dentists’ varying interpretations on patient expectations

Essential Indicators of Test Accuracy: - Ability to correctly identify patients with the condition or disease (true positives) while minimizing the number of false negative results.

SENSITIVITY

a. low sensitivity test ➡️ there are ____ false negative results b. high sensitivity test ➡️ there are ____ false negative results

a. more b. less

Essential Indicators of Test Accuracy: Ability to correctly identify individuals without the condition or disease (true negatives) while minimizing the number of false positive results.

SPECIFICITY

a. low specificity test ➡️ there are ____ false positive results b. high specificity test ➡️ there are ____ false positive results

a. more b. few

Testing error that indicates someone does not have a specific condition or disease when he/she actually has it.

FALSE NEGATIVE RESULT

Testing error that indicates someone has a specific condition or disease when he/she does not actually have it.

FALSE POSITIVE RESULT

Provides a quantifiable and standardized method for comparing treatments.

OUTCOMES MEASURES

Defined as the health state of a patient as a result of some for of medical or dental intervention.

OUTCOMES OF CARE

Presumptive explanations for varying dentists’ interpretations of patient expectations:

1. Making assumptions about the px’s wishes and listening selectively 2. May have a predetermined idea about what the ideal tx plan might be and then present that plan in a more favorable light 3. Frequent discrepancy: occurs when other practitioners will perceive a given px’s expectations differently if the px and his/her initial dentist are not in alignment about the px’s expectations a. px’s expectations before treatment and his/her satisfaction after treatment may vary significantly from those of the dentist b. px and dentist may have different view on what is considered as an acceptable result

Pertains to the resolution of the chief complaint or concern. e.g.: relieve pain or discomfort and repairing of broken tooth

SHORT-TERM GOALS

Goals that are more global and difficult to identify, especially if dentist only focuses on his/her own predetermined ideas of what the px wants or desires. e.g.: maintain oral health and keeping teeth for a lifetime

LONG-TERM GOALS

Positive Patient Modifiers:

- expressing interest in one’s oral health - ability to afford treatment - history of regular dental check up

Negative Patient Modifiers:

- fear of dental treatment - poor dental or general health - lack of motivation - destructive oral habits - time and/or financial constraints

Dentist’s Goals and Desires: MADEECC

1. Make efficient use of time allotted for each patient 2. Arrest or eliminate oral disease 3. Determine the correct treatment plan for each patient 4. Eradicate pain and discomfort 5. Ensure that the most severe problems are treated first 6. Choose the best material for a specific procedure 7. Create an ideal treatment plan

Dentist Modifiers: - factors of the treatment planning approach that can impact the goals for patient care and the type of treatment plan that he/she develops

1. Knowledge 2. Technical skills 3. Treatment planning philosophy

Techniques for Developing the Treatment Plan: (more complicated process)

1. Visioning - establishing a vision of what the px’s final condition will be when course of tx has been completed 2. Identification of key teeth - pinpointing the important teeth that can be saved or salvaged 3. Phasing procedures - treating pxs with complicated need is best accomplished by breaking the tx plan into sections since they usually grasp and easily understand complicated tx plans easily when divided into portions

Qualities of Key Teeth:

Key teeth must be: - periodontally stable - located in a favorable position in the arch - restorable

Presenting Treatment Plans and Reaching Consensus with the Patient: Educating the Patient

- begins with informing the px on their problem or diagnosis - focus on chief complaint for them to know why tx is necesarry - emphasize importance of eliminating disease and achieving oral health - use simple terminology to make them comprehend the explanation - utilize education aids to help them visualized the problems - must encourage questions to confirm if they understand what’s being said

Presenting Treatment Plans and Reaching Consensus with the Patient: Discussing Treatment Options

- dentist should have evaluated all possible tx options available - thinking in general terms facilitates this approach - px decides on general direction of tx - prognosis must be explained (for each tx and for the plan as a whole) - should be urged to ask questions

Presenting Treatment Plans and Reaching Consensus with the Patient: Divulging General Time and Fee Ranges

- pertains to reveling general cost of services, # of appointment, and length of time involved for tx - notify that more precise estimate will be available before initiating tx - this discussion can be delegated to a partner, manager, or office staff

4 Beliefs before Patients Accept Treatment:

1. They are susceptible to the specific disease that needs to be treated 2. Contracting the disease can pose serious consequences for them 3. Disease can be prevented or limited if they choose to take part in certain activities or receive tx 4. Engaging in preventive or disease-limiting activities is better than having to suffer from the disease