FORMULATING A DENTAL TREATMENT PLAN

DR TASHNIM BAGUS
DEPT. OF PAEDIATRIC & RESTORATIVE DENTISTRY SCHOOL OF ORAL HEALTH SCIENCES UNIVERSITY OF THE WITWATERSRAND.

INTRODUCTION

BEING A DIAGNOSTICIAN IS PART OF THE SKILL OF A GOOD CLINICIAN! THE CLINICIAN SHOULD ACQUIRE THE FUNDAMENTALS IN GATHERING & INTERPRETING CLINICAL INFORMATION.

DENTAL TREATMENT AND PLANNING

AN ART

A SCIENCE

DEVELOP TALENT

TAUGHT

HISTORY

MAIN COMPLAINT M/C HISTORY OF MAIN COMPLAINT- HMC PAST DENTAL HISTORY- PDH GENERAL MEDICAL HISTORY- GMH

HISTORY(CONT)

SOCIO-ECONOMIC HABITS CULTURAL / CUSTOMS

B) EXAMINATION
1) EXTRA ORAL EXAMINATION EOE

SYMMETRY ( Facial ) LIPS LYMPH NODES TMJ

B) EXAMINATION
2) INTRA ORAL EXAMINATION - IOE Oral mucosa colour , texture , DMS Tongue Periodontium Teeth Occlusion Prosthesis (if any)

C) SPECIAL INVESTIGATIONS

RADIOGRAPHS VITALITY TESTS

STUDY MODELS
DIET ANALYSIS OTHER ( Blood Tests )

C) SPECIAL INVESTIGATIONS

RADIOGRAPHS - panelipse X-ray bitewing radiographs periapical radiographs VITALITY TESTS - electric pulp testing thermal tests percussion palpation colour presence of a sinus test cavity prep

DENTAL CHARTING

A) PERIODONTAL CHARTING - plaque indices - probing depths - bleeding points - gingival level - tooth mobility

DENTAL CHARTING (cont)

B) CONSERVATION CHARTING ( Tooth ) -caries -existing restorations

DENTAL CHARTING (cont)

TOOTH NOTATION SYSTEMS 1) Palmer System

2) FDI System-(Federation Dentaire Internationale)

Dental Charting(cont)

TOOTH NOTATION (cont) 3) US Tooth Notation System

4) Letters & Numbers Tooth Notation System

Treatment Planning
Treatment planning is the key factor which separates a technician from a professional. It can be the stimulating challenge which changes the drudgery of a patchwork practice into an orderly and logical progression of comprehensive treatment. Hocott 1984

TREATMENT PLANNING(cont)

Basic Principles - educate and advise patients - be open and honest - afford patient opportunity to make well informed decisions Importantly, its their required Rx your plan is based upon!

TREATMENT PLANNING (cont)

REMEMBER!!
KEEP YOUR TREATMENT PLAN
S - SIMPLE A AFFORDABLE

A - ADAPTABLE

GOD GIVEN TEETH

DESTRUCTION RESTORATION SUCCESS RISKS vs BENEFITS! FAILURE

TREATMENT PLANNING(cont)
DATA COLLECTION ORGANISATION & VISUALISATION

TREATMENT OPTION
IDEAL Rx PLAN REALISTIC Rx PLAN

TREATMENT PLANNING (cont)

IDEAL Rx PLAN -attitude -desire -finances -health -other modifying factors WILL THE END JUSTIFY THE MEANS? ?should Rx be undertaken? ?chance of success over a long period?

REALISTIC Rx PLAN Rx sequencing

Treatment
Maintenance NB!!continued reassessment at EACH stage!

MODIFYING FACTORS IN Rx PLANNING PROCESS

1. Quality of life 2. Prognosis without Rx 3. Patient attitude 4. Iatrogenic potential 5. Expected duration & prognosis 6. Possibility for repair 7. Dentist and lab limitations 8. Flexibility 9. Benefits vs Costs+Risks 10.Primary complaint 11. Referral Possibility

TREATMENT PLANNING (cont)

TREATMENT SEQUENCING 1. EMERGENCY Rx - m/c - drainage & Rx of dental abscess

2. HIGH PRIORITY Rx - extraction of hopelessly involved teeth - caries control - coronal scaling & polishing+OHI - pulpotomies and pulp extirpations

TREATMENT SEQUENCING (cont)

3. LOW PRIORITY TREATMENT - Endodontic therapy - restoration of carious lesions - temporary splinting - re-evaluation

TREATMENT SEQUENCING (cont)

4. MAINTENANCE -3/12 -6/12 * CONTINUED REASSESSMENT AND RE-EVALUATION!

TREATMENT PLAN(TX)

TX SHOULD TAKE THE PATIENT AND DENTIST TO THE POINT WHERE DISEASE IS CONTROLLED AND THE DENTITION IS FUNCTIONAL , STABLE AND ACCEPTABLY AESTHETIC !

TREATMENT SEQUENCING

SEQUENCE OF TX CAN BE BROKEN INTO STAGES

TX SEQUENCING
1.STABILIZATION

2. REASSESSMENT 1 * ORAL HYGIENE * ASSESS TEMPORARY RX IS IT RESPONDING- EG. REVERSIBLE PULPITIS ( ? INDIRECT PULP CAP / OR RCT )

RELIEVE PAIN TEMPORARY RX PERMANENT RX EXTRACTION

TX SEQUENCING

3. PRELIMINARY RESTORATIVE PHASE

4. REASSESSMENT 2

PERFORM URGENT RX FIRST. * COMPLETE ALL PROCEDURES THAT ARE NECESSARY. * WAIT FOR HEALING.

ORAL HYGIENE CHECK FOR NEW DISEASE EG BROKEN RESTORATIONS

TX SEQUENCING

5. DEFINITIVE RESTORATIVE PHASE

6. REASSESSMENT 3

* SCALE AND POLISH * FLUORIDE RX * FISSURE SEALANTS ETC * COMPLETE ALL RESTORATIONS

CHECK ORAL HYGIENE POLISH AMALGAMS

TX SEQUENCING

7. MAINTENANCE RECALLS EVERY 6 WEEKS 3 MONTHS 6 MONTHS ETC

TX SEQUENCING

STABILIZATION REASSESSMENT 1 PRELIMINARY RESTORATIVE PHASE

REASSESSMENT 2
DEFINITIVE RESTORATIVE PHASE REASSESSMENT 3 MAINTENANCE

TREATMENT OPTIONS
ORTHODONTICS

PERIO / MFOS

OCCLUSION RESTORATIVE & TMJ PROSTHODONTICS ENDODONTICS