Dental professionals should always be available to answer questions, but the treatment plan may be presented by a designated and dentally knowledgeable "treatment coordinator." The dentist must use their skills and knowledge to deliver the integrated treatment that will meet the patient’s expectations at the tooth level. In Chart, a planned procedure can now have the Treatment Plan phase and visit indicated to automatically organize on the patient’s Treatment Plan. Their frame of reference extends no further than the teachings at undergraduate level. A good dental treatment plan will do that and leave patients confident with the dentist they have selected for dental treatment and put a smile on their face! The aim of this chapter is to highlight the factors important in planning the endodontic management of pulpal and periradicular diseases and how to prioritize them in the context of the patient’s overall dental and oral needs. Discover the need for/value of quality records. This implies an ongoing process of information exchange and informed consent whereby the full extent of risks and benefits are shared and acted upon. The textbook depiction of treatment planning commences, Scale and polish and oral hygiene instruction, Management of carious lesions and preventive measures, Root canal treatment of teeth with apical periodontitis, Root canal retreatment of root-filled teeth with apical periodontitis, Replacement of missing teeth with fix or removable prostheses, Orthopantomogram (OPG) of difficult problems, In essence, the process consists of assessing and accounting for the relevant problems at the level of the patient (their personal perspective on health and social well-being), then at the level of oral function (eating, speaking and aesthetics), and then at the level of the tooth (specific tooth-related problems). Consideration of early replacement may have to be tempered by the psychological need to avoid loss of the tooth, as well as to delay permanent replacement during the growth phase of the individual, especially if an implant-retained crown is a possible alternative. The restorative challenges posed coupled with the desire of people to retain functional and aesthetic dentitions into later life have driven the development of the restorative subspecialities of endodontics, periodontics and prosthodontics into ever more complex scenarios. Fig. The compromised tooth may, therefore, be retained as a suitable space maintainer until a more definitive solution can be executed. The underlying rule in the appropriate utilization and coordination of the proliferating specialisms is effective and professional communication between the healthcare workers. 5.11). 5.1 Hierarchical importance of knowledge context. 5.3), so does the interaction between options for individual problems. Conscientious general dental practitioners in many countries are, therefore, faced with the prospect of making a judgement about their own knowledge and skill limitation in the context of what a colleague with specialist status may achieve. The dentist’s insight will include the state of the patient’s dentition, periodontium, the teeth (presence of caries or tooth surface loss and their pulpal and periapical status), any restorations and soft tissues. The Definitive Phase of Treatment 9. The decision-making now has to be aided by weighing the relative chances of success of the different endodontic options and, finally, also the restorative/aesthetic outcome. Temporomandibular joint (TMJ) an… Updates include additional guidance on physical distancing and how to respond to SARS-CoV-2 exposures among dental … 1 This plan includes all … The options of vital pulp therapy or root-canal treatment may be considered. This may be defined as a strategic list or maybe detailed by visit. It may not, however, serve those presenting with problems lying on the fringes of the normal distribution of the particular disease. Dental professionals should always be available to answer questions, but the treatment plan may be presented by a designated and dentally knowledgeable "treatment coordinator." The phase of assessment (establishment of a more complete picture of the problem(s) and patient compliance), therefore, often overlaps with the phases of decision making, planning and delivery of treatment (Fig. TREATMENT PLAN 2. Ask the Colgate Chatbot! Treatment planning, as the term implies, is the planning of the management of a patient’s dental and oral problems in a systematic and ordered way that assumes a complete knowledge of the patient’s needs, the precise nature of the problems and the prognoses of possible management options under consideration. Phase 2 Tx plan completed and approved. •Note: If the patient receives a prophy, exam, fluoride, and When creating a treatment plan, be sure to put the date in your description. As the number of dental problems to be addressed increases (Fig. Visualize ideal esthetics and ideal function. The sudden accumulation of such unfavourable events may prompt the patient to seek a second opinion. 5.2). Other restorative factors may not come into the equation at this stage but will be discussed with the patient. Further personal experience and development may lead to recognition of rarer presentations as well. Dentistry has seen incredible changes over the years, but the need for trust and support never changes. Table 4. This hypothetical yet familiar illustration of operator and patient perspectives, which many will identify with, illustrates some sources of problematic communication. The phase of assessment (establishment of a more complete picture of the problem(s) and patient compliance), therefore, often overlaps with the phases of decision making, planning and delivery of treatment (, Interrelationship between assessment and decision making, planning and delivery of treatment, Even under the best set of circumstances, the most complete and definitive picture of the problems may not be reached because of deficiencies in diagnostic certainty and prognostic data on treatment outcomes. Apart from feasibility, the cost and long-term priorities of the patient have to be weighed. To that end, practices may differ in what information they deem necessary to create a good treatment plan. A “definitive treatment plan” emerges as the information becomes more complete and the wishes of the patient and dentist crystallize into a more concrete, mutually acceptable proposal. Log In or, Click to share on Twitter (Opens in new window), Click to share on Facebook (Opens in new window), Click to share on Google+ (Opens in new window), Overall health and oral care of patients and the role of endodontics within it, Dentistry may be viewed as a speciality of medicine, yet it is itself a diverse and broad discipline. Scale and polish and oral hygiene instruction, 3. Many dental or oral problems may be managed in different ways depending on the judgement about the presence, progression and morbidity of the disease, the options available for management and the needs of the patient. The dentist must understand clearly (defining the problem) what the patient expects at the first level. Active engagement in CPD is mandatory in some countries but not all. For … Fig. CDC has updated the Interim Infection Prevention and Control Guidance for Dental Settings During the COVID-19 Response with additional guidance and clarification for dental care during the COVID-19 pandemic. In the matter of the former problem, it has to be established whether the operator is confident of locating the canal using a conventional coronal approach (Fig. Diagnosis and Treatment Planning in Dentistry, 3rd Edition provides a full-color guide to creating treatment plans based on a comprehensive patient assessment.Using evidence-based research, this book shows how risk assessment, prognosis, and expected treatment outcomes factor into the planning … 5.1). CONTENT Introduction Basic principles Phases Comprehensive treatment plan Modification Treatment planning in our context Merits of treatment planning Summary. Fig. Informed Refusal A patient's decision to refuse recommended treatment after all options, potential risks, and potential benefits have been thoroughly explained. Such a plan of action is not uncommon both in unrestored mouths and in those that are heavily restored and on the borderland of catastrophic transition to a different, perhaps partially edentulous state. In the case of simple dental problems, the dentist may be able to identify the problem efficiently, characterize it together with the patient’s needs and select the correct management option expeditiously. Honest and critical recognition of personal limitation is a key aspect of any governance structure that enables either further appropriate personal development or referral. Treatment plan 1. It is not unheard of that, under some circumstances, with the passage of time, the mutually agreed plan may be forgotten or fades from memory, particularly where detailed medical or dental records are not maintained. However, the recognition and management of the, Conversely, the knowledge and skills of endodontics must be deployed judiciously to ensure that the patient receives appropriate care, meaning that the specialist must also understand the broader context within which their expertise is exercised. Under these circumstances, the sudden precipitation of a pulpal or periapical problem may be managed in isolation as long as there are no complex restorative implications (Fig. 5.8a) in order to aid completion of root formation and improve the long-term restorative prognosis (Fig. Dentists are trained to recognize the majority of commonly presenting oral problems and to manage them appropriately through a process of selecting the right course of treatment for each patient. All rights reserved. The Maintenance Phase of Care Part III: Planning Treatment for Patients with Special … On the whole, this approach probably works when preceded by active learning through assessment of personal outcomes over a lengthy period. A patient's voluntary agreement to a treatment plan after details of the proposed treatment have been presented and comprehended by the patient. The ways in which these may be resolved are numerous, even forming the basis for practice-marketing strategies. Once the treatment is completed, the patient will be recruited to a recall system to evaluate and maintain the work. Clear and effective communication is the key to arriving at a mutually satisfactory treatment plan. 5.7 (a) Traumatized maxillary incisor; (b) maxillary incisor following endodontic treatment. Root canal retreatment of root-filled teeth with apical periodontitis, 9. This may have the overall effect of either complicating management or simplifying it because more radical solutions (such as extraction) become more appropriate. How much will it cost (including any insurance coverage). Planning for failure should be considered as part of the overall long-term treatment plan. The true scale of difficulty in treatment planning is only truly appreciated by those conscious and conscientious enough to endeavour to improve the service delivered to their patients. Gauge compliance in home-care and gingival health with further oral hygiene instruction as necessary, 5. The patient receives a report outlining all findings and recommendations, including any options, a copy of their diagnostic photos and a written copy of the financial details of the proposed treatment. The last option also requires a consideration of the alternative restorative options. Further personal experience and development may lead to recognition of rarer presentations as well. Always seek the advice of your dentist or other qualified healthcare provider with any questions you may have regarding a medical condition or treatment. Despite this, dedicated, active practice, with continuous proactive personal development may propel a dentist to the state of mastery of their field relative to contemporary knowledge. 5.6b) and placed on continuing review until a mutually agreed decision can be reached with regards to which of the previously discussed restorative options to pursue. Treatment planning strategies are presented to help with balancing the ideal with the practical, with emphasis placed on the central role of the patient — whose needs should drive the treatment planning process. A plan of management will have been established at the first encounter at some point in the past and, in the simplest cases, requires no more than a review (recall) to evaluate a change in overall status and provide motivation for maintenance. Root canal treatment of teeth with apical periodontitis, 6. Patient’s visit a dentist for their esthetic enhancement, malocclusal problems, correction or replacement of missing tooth, facial dental treatment, oral dental treatment and other requirements. Replacement of missing teeth with fix or removable prostheses, Fig. Under these circumstances, the precipitation of a pulpal or periapical problem and even worse multiple problems that occur in rapid succession may cause the need for a radical review of the options. Stages of Dental Care Home » Stages of Dental Care Our family dentist, Dr. Steele, provides pediatric dental care to infants and children ages 0 – 18, and helps guide expectant mother’s through their special oral health need during and post pregnancy. The factors influencing the decision-making process are many and can be classified into general patient factors, professional background and philosophy of the dentist, general oral and dental condition, and local factors related to the problem tooth (teeth). The patient receives a report outlining all findings and recommendations, including any options, a copy of their diagnostic photos and a … Watch how Dr. Chotiner simplifies the dental treatment planning process with his 3 Step process. The dentist must gauge the problems correctly, as well as the patient’s attitude, motivation and compliance. The choice will centre on the prognosis of each treatment (based on biological factors) and the long-term benefit to the patient. Their knowledge is therefore written in black and white, is clear and simple and may still serve the needs of those patients falling into the “central tendency” of disease presentation. For example, in periodontics, after the initial examination and diagnosis, phase 1 therapy often involves a sanative phase of basic scaling and root planning, a review of oral hygiene and an identification and modification of risks factors. 2. The intellect and skills of such practitioners may consequently be stunted from flowering into their full potential. If you are concerned about the cost, many resources like the American Dental Association can help you budget for and afford treatment. Conversely, the knowledge and skills of endodontics must be deployed judiciously to ensure that the patient receives appropriate care, meaning that the specialist must also understand the broader context within which their expertise is exercised. Scenario – a patient presents in pain with a poorly maintained mouth, several carious and periapical lesions and gingival inflammation. In this course, Dr. Frank Spear discusses four stages of a dental practice: Survival, growth, profit and transition. Orthograde retreatment is also cost-effective, if a root-canal treatment subsequently fails, but surgical retreatment is not. • It saves time and energy. First, the dentist surgically places the implant into the jawbone. Anticipation of a particular treatment outcome does not increase certainty of its achievement but careful planning with attention to detail may. Being thorough and attentive to detail communicates to patients that a dental team cares, which helps to build trust between patients and their care providers. 11, JUNE 12 1999 PRACTICE tooth surface loss 1 Treatment planning R. Ibbetson 1 An effective treatment plan is dependent on gathering information from the history, exami-nation and special tests, such as radiographs and vitality testing, and analysing it to make a diag-nosis. Management of carious lesions and preventive measures, 5. The dentist will have been trained, by necessity, to recognize only the commonly presenting tendencies in each disease. In the case of simple dental problems, the dentist may be able to identify the problem efficiently, characterize it together with the patient’s needs and select the correct management option expeditiously. While some cases can be completed in one or two visits, there are several reasons that patients or clinicians may opt for phasing treatment over an extended period of time. The Disease Control Phase of Treatment 8. Difficulties are often caused by the contradictory desires, requirements and perceptions of both dentist and patient. Dentists are trained to recognize the majority of commonly presenting oral problems and to manage them appropriately through a process of selecting the right course of treatment for each patient. Financial arrangement and treatment planning for patients in a dental practice is a critical component of overall practice management. The end point of this is a series of conclusions about the general health of the patient and their current oral and dental problems; these will be juxtaposed with the patient’s own perception of their problem(s) and desires for correction of the same. However, the recognition and management of the full spectrum of complex oral and dental problems requires an approach based on deeper understanding of the problem and a higher level of engagement of cognitive, technical and clinical skills, acquired through specific advanced training. Colgate Reaches Children in Need Across the Globe With the Power of a Bright Smile. Updated August 28, 2020. Develop your skills in evaluation and dental treatment planning for all types of patients! To focus our dental care on moving patients toward stable oral health via the completion and tracking of treatment plan phases. The term “provisional treatment plan” is used to describe the interim plan containing overlapping phases of diagnosis and treatment, when further information is sought to garner a clearer picture to determine a firmer action plan. A treatment plan should answer some important questions to make patients feel comfortable proceeding: Comprehensive treatment plans are always presented at a separate visit called a diagnostic consultation. The textbook depiction of treatment planning commences at the first encounter with the patient, when a full assessment is made of the patient’s overall dental and oral problems. 1 Urgent, 1 or 2 Up to £56.30 CoT 2 Reassessment phase As COVID-19 continues, the ADA is reminding dentists that dental care should continue during the resurgence phase of the pandemic. 5.6 (a) Symptomless 25 has been reviewed for some time and now has a sinus; (b) the same 25 has been retreated and is now under review to assess healing before making a decision about restorative options. Such treatment patterns, based on clinical rationale but also shaped and influenced by business and management needs may lead to the passive application of heuristic principles to select treatment. • “Definitely, definitely” a good idea! The typical pattern of clinical behaviour in the primary care (practice) setting is that recognition of a problem will lead to the triggering of a set treatment protocol. … 5.2 Interrelationship between assessment and decision making, planning and delivery of treatment. © YYYY Colgate-Palmolive Company. Decision-making for them is a matter of following the simple heuristic decision-tree delivered as expedient undergraduate teaching. It may not, however, serve those presenting with problems lying on the fringes of the normal distribution of the particular disease. 5.9). Problems in the oral cavity can lead to (or be caused by) medical problems. Fig. Every dental office has its own way of operating and treating patients. 5.4 Example of endodontic problem managed in isolation, Fig. Treatment of acute problems including incision and drainage, first stage root canal treatment, extractions, 2. delivery of the planned treatment in an effective and efficient sequence. The breadth of complex restorative problems has increased in modern populations because of better general health and longer survival of people and their teeth. Some patients may be physically unable to sit in the dental chair for extended periods of time. The options available to treat endodontic problems include dentine and pulp protection, vital pulp therapy, root canal treatment, root canal retreatment or periradicular surgery (including root-end management, root repair, root resection or extraction). The vagaries and subtleties that lead to differences in management approach may cause patient dissatisfaction, which sometimes (and in contemporary society increasingly frequently) leads to legal action. Learn how each stage impacts treatment planning and case presentation and how they compare with Maslow’s hierarchy of needs. General Dental Practitioner Oral Health Educator Dental Nurse Prevention of Periodontal Disease Dental Hygienist Dental Therapist Secondary Care Consultant in Restorative Dentistry High Street specialist In Periodontology. Also, find out the characteristics of the profit stage and how to overcome profit barriers. Unfortunately, some dental practitioners take the receipt of their practising licence as the end of formal professional development. Consider an identical scenario but where a traumatized, intact, mature, maxillary central incisor has been left untreated for years as the pulp slowly succumbs and the patient seeks attention either because of an acute infection or the discoloration caused by secondary dentine formation and/or pulp necrosis (Fig. If a patient has a significant concern, such as pain, this need is addressed prior to initiating dental hygiene treatment. The Acute Phase of Treatment 7. In essence, the process consists of assessing and accounting for the relevant problems at the level of the patient (their personal perspective on health and social well-being), then at the level of oral function (eating, speaking and aesthetics), and then at the level of the tooth (specific tooth-related problems). It may progress as follows: 1. Implants may have a role as a third line intervention if root canal retreatment fails. Conscientious dentists, therefore, strive for improvement throughout their professional lives in what has now become formally recognized as continuing professional development (CPD). The tooth in Figure 5.6a has been retreated (Fig. A dental practice may start every adult patient's first visit with an interview that takes into consideration the patient's dental and medical history (and desired outcomes). That specialist, such as an oral surgeon or periodontist, would become involved in helping to create the final treatment plan and in rendering treatment, if needed. In any case, the options will be discussed with the patient and, after appropriate dialogue, negotiation and clarification, a mutually agreed choice of treatment or “treatment plan” will emerge (Box 5.1). These reasons need to be acknowledged and brought to the forefront of the treatment planning decision in order to ease the patient’s mind and gain his or her trust. In general dental practice, where a patient has often been under long-term care by a particular practice or dentist, the majority of interactions with the patient are part of continuing care. Stabilize carious lesions in conjunction with scale and polish and reinforcement of oral hygiene instruction, 4. In simple terms, this means that the dentist should be well versed in all aspects of dentistry, understanding the role of each aspect in overall patient management, as well as being aware of potential overlaps and interactions between the subdisciplines. The general dental practitioner with a special interest in endodontics will have the advantage that they will grasp both the broader aspects of the patients’ needs, as well as be able to deliver a higher level of care in endodontics, albeit perhaps not at a specialist level. -"Best care" treatment plan-Alternative treatment plan-Risks-Benefits-Prognosis 2) Estimate length of time needed and cost involved 3) Predict anticipated outcomes 4) Collaborate with the dentist 5) Document and present to client and obtain consent In the event that the traumatic injury in such circumstances is accompanied by severe coronal tooth fracture, the restorative prognosis may be further jeopardized (Fig. A plan of management will have been established at the first encounter at some point in the past and, in the simplest cases, requires no more than a review (recall) to evaluate a change in overall status and provide motivation for maintenance. A central pillar of clinical governance is the responsibility on each dentist to engage in ongoing personal development. Dentistry may be viewed as a speciality of medicine, yet it is itself a diverse and broad discipline. What does a comprehensive treatment plan really mean? A plan is then made of the sequence in which treatment will be executed, called the “plan of treatment” (Box 5.2). Now other considerations come into play, including the potential for successful outcome by conventional or surgical means, as well as the desire for correcting the discoloration. Conscientious dentists, therefore, strive for improvement throughout their professional lives in what has now become formally recognized as continuing professional development (CPD). In the case of complex dental problems, it may be rare for both patient and dentist to develop such complete pictures of the problems and outcomes of restorative options as early as the first consultation. Treatment planning we learned in dental school is a great foundation from a clinical standpoint, but once you’re out in the “real world” – either as an associate or in your own practice – proper … Factors such as technical feasibility, cost and time involved, dentist’s preferences based on their skills and knowledge, and the patient’s age, means, wishes and compliance in oral care may all play a part in determining the final outcome. This does, however, mean that the onus of ensuring the coordinated and appropriate delivery of whole mouth and patient care rests with the referring general dental practitioner, in conjunction with other specialists and the medical practitioner where necessary. The precise nature of the previous mutually agreed treatment plan might not be fully appreciated in the absence of accurate and detailed records. Diagnosis and Treatment Planning in Dentistry, 3rd Edition provides a full-color guide to creating treatment plans based on a comprehensive patient assessment. Unfortunately, some dental practitioners take the receipt of. Under these circumstances, the sudden precipitation of a pulpal or periapical problem may be managed in isolation as long as there are no complex restorative implications (, Example of endodontic problem managed in isolation, Example of endodontic problems that have complex restorative implications, It is not uncommon and perfectly valid for patients on long-term recall, to have the supervising dentist place individual teeth on probation to review their status at a subsequent time because of uncertainty about a diagnosis or the progression of a lesion (, dental strategy for the patient, with major implications of time and cost. In the context of a healthcare profession, the “endodontist” must, therefore be a human being first, dentist second and endodontist last (Fig. Carry out periapical surgery, if necessary, 8. Review prognosis of treated teeth, design definitive removable or fixed prosthesis and decide on teeth requiring cast restorations (compliance should be absolute at this stage). It includes: 2. It’s important to consider the reasons why a patient may be hesitant to agree to comprehensive or restorative treatment. Factors that may confound the process include differences in perception and expectations between the dentist and patient. The dentist must be aware of the potential for such problems and be prepared to take appropriate action to circumvent them. Fig. This book provides essential knowledge for creating treatment plans for adult dental patients. 5.10a). 5.11 (a) Sclerosed canal in central incisor managed by apicectomy and root-end filling; (b) the treatment failed and required a further procedure when />, Only gold members can continue reading. Application: All dentists Exceptions: None Supporting Information: HRSA has the following treatment plan completion (Phase I) expectations for dental care: 20-30% Poor 30-50% Average … Your dentist, not the internet, is the best resource for finding out the fee for a procedure. Since these become important legal records, their composition demands appropriate care and professionalism. 5.9 (a) Maxillary central incisors with root-canal treatment to control apical periodontitis and inflammatory resorption following traumatic injury; (b) same teeth affected by replacement resorption, were subsequently replaced with implant-retained crowns. Complete root canal treatments on predictably restorable teeth, 7. The dentist must, A plan is then made of the sequence in which treatment will be executed, called the “, Treatment of acute problems including incision and drainage, first stage root canal treatment, extractions, Immediate denture if necessary, oral hygiene instruction, diet instruction and fluoride mouthwash, Stabilize carious lesions in conjunction with scale and polish and reinforcement of oral hygiene instruction, Gauge compliance in home-care and gingival health with further oral hygiene instruction as necessary, Provide definitive plastic restorations for carious teeth in order of priority dependent on presence of sensitivity and integrity of temporary restorations, Complete root canal treatments on predictably restorable teeth, Carry out periapical surgery, if necessary, Review prognosis of treated teeth, design definitive removable or fixed prosthesis and decide on teeth requiring cast restorations (compliance should be absolute at this stage), The reality of practice, informed consent and medical records, In general dental practice, where a patient has often been under long-term care by a particular practice or dentist, the majority of interactions with the patient are part of continuing care. Variations inherent in dentists’ philosophy, knowledge, experience, skills and judgement can give rise to differences in treatment planning between clinicians. Many dental or oral problems may be managed in different ways depending on the judgement about the presence, progression and morbidity of the disease, the options available for management and the needs of the patient. Medical and dental evaluations – Dental and physical problems tend to go hand in hand. A carefully considered dental treatment plan should be the starting point for care in any dental office. The outcome of such an analysis, though, is likely to be different depending upon the exact details of the situation. Explore why 90% of mistakes occur not during the restorative phase, but rather during the treatment planning process. Defining a treatment plan for the periodontal patient is a process that requires the assessment, preventive, therapeutic, and evaluative skills of the dental hygienist and the dentist.The treatment plan is the blueprint for management of the dental case and is an essential aspect of successful therapy. If, under the same circumstances, the patient was younger with an incompletely formed root, the decision may now lean towards the more conservative vital pulp therapy (Fig. First, it may allow the patient to financially manage the ideal treatment plan. In the ideal scenario, each option should be evaluated in an objective way taking the above factors into account, weighing the effectiveness and projected long-term prognosis (based on outcome data) with compliance, cost and time commitment. NB: the relative cost may change depending on contemporary and local trends. It's important for a dentist to be clear and thorough at a consultation, so patients don't leave feeling confused. After considering all of the information the dental team has gathered, the team can begin to create an individualized dental treatment plan for each patient. 5.10 (a) Discoloration of tooth following trauma; (b) radiographic evidence of pulp calcification and dentine sclerosis; (c) example of sclerosed canal in maxillary incisor; (d) canal successfully negotiated and obturated, Fig. If not, injudicious dentine removal may result in compromised restorability of the tooth. Small changes to the situation may be managed by minimal intervention and a “patchwork” approach but this also demands a more vigilant rather than complacent review strategy. Their frame of reference extends no further than the teachings at undergraduate level. In addition, the absence of access to the pulp chamber also compromises the chances of internal bleaching of the tooth to help correct the discoloration. This article is intended to promote understanding of and knowledge about general oral health topics. TREATMENT PLAN Development of a treatment plan is the most critical step in the successful future management of the patient DIAGNOSIS- … Phases Bands Patient Charges as at 2017/18 rates CoT 1 Urgent treatment unless the patient wishes to have a full examination and treatment plan, and enter into the phased treatment pathway. Their knowledge is therefore written in black and white, is clear and simple and may still serve the needs of those patients falling into the “central tendency” of disease presentation. Treatment required prior to Phase 3 treatment is now completed. 5.5 Example of endodontic problems that have complex restorative implications. The ideal treatment-planning scenario. Small changes to the situation may be managed by minimal intervention and a “patchwork” approach but this also demands a more vigilant rather than complacent review strategy. In simple terms, this means that the dentist should be well versed in all aspects of dentistry, understanding the role of each aspect in overall patient management, as well as being aware of potential overlaps and interactions between the subdisciplines. In treatment planning, the concept of phasing your treatment is not new. Variations inherent in dentists’ philosophy, knowledge, experience, skills and judgement can give rise to differences in treatment planning between clinicians. The intellect and skills of such practitioners may consequently be stunted from flowering into their full potential. The foregoing also means that a dentist uncomfortable with the practice of dentistry and seeking escape into a limited area of practice because it is their area of greatest comfort will seldom make the rounded clinician that a good endodontist should be. The goal of this evaluation is to ensure that prior medical and dental issues are completely under control before treatment begins. The nature of this next encounter, in all likelihood with somebody with a different philosophical perspective, may raise different opinions about the previous management. 5.6a). It is therefore considered best practice to keep detailed records of initial findings, option appraisals, discussions, rationale for decisions and informed consent for treatment. The vagaries of decision making are further defined and explored by examining different case scenarios based on a relatively simple problem. The … At these recall reviews, note will be taken of any changes and dealt with according to a preplanned scheme for dealing with failure. 5.10d). In the context of a healthcare profession, the “endodontist” must, therefore be a human being first, dentist second and endodontist last (, Hierarchical importance of knowledge context, Treatment option selection and treatment planning, Treatment planning, as the term implies, is the planning of the management of a patient’s dental and oral problems in a systematic and ordered way that assumes a complete knowledge of the patient’s needs, the precise nature of the problems and the prognoses of possible management options under consideration. (c) maxillary incisor restored. 552 BRITISH DENTAL JOURNAL, VOLUME 186, NO. The latter situation describes the not uncommon condition of an ageing or restoratively ravaged dentition, where one further change could precipitate a radical review of the overall dental strategy for the patient, with major implications of time and cost. The opportunities of specialization have allowed clinicians to develop their skills and knowledge in a restricted area of practice to a much higher level, but usually to the exclusion of other generalist skills. 5.8 (a) Traumatized maxillary incisor with an open apex, receiving pulp therapy; (b) traumatized maxillary incisor root filled following root closure, Fig. A cost–benefit analysis should be performed to aid the decision-making process as illustrated in Table 5.1. Tracking Phase 1 Treatment Completion • Create a dummy code in your EDR that will signify that phase 1 treatment is complete •Phase 1 treatment is complete when the patient has no active dental disease in their mouth; or when that disease is being actively managed. It is not intended to be a substitute for professional advice, diagnosis or treatment. Such communication should be recorded in writing and formalized in letters. Clear, logical organization builds your understanding with sections on comprehensive patient evaluation, key treatment planning concepts, a detailed review of the five phases of planning treatment and guidelines for selecting the appropriate plan of care, and care planning for patients with special needs. The Systemic Phase of Treatment 6. 5.3 Orthopantomogram (OPG) of difficult problems. Dental treatment planning is one of the greatest challenges that come to correct smile and teeth alignment. Many dental offices also offer payment plans or financing to coordinate with any dental insurance to make care more affordable. They then may get a comprehensive dental clinical examination, a full set of X-rays, an oral cancer exam, diagnostic and intraoral photographs, complete periodontal charting and other exams, if needed. • It helps sequence the care with proper prioritization of the child’s dental needs. It is exemplified by the realization of the conscientiously developing dentist that the more they begin to understand the more they realize the extent of their knowledge limitation. The ADHA has taken the position which supports the dental hygiene diagnosis, and has defined it as, “The identification of an individual’s health behaviors, attitudes, and oral health care needs for which a dental hygienist is educationally qualified and licensed to provide.” 4 The dental hygiene diagnosis, including the planning and evaluating phases… Where there are such complex restorative implications, the lack of insight or desire (on the part of the dentist) to tackle them may influence outcome of the endodontic problem (Fig. Apply a step-by-step process for treatment planning any restorative case from simple to complex. Following history and examination, the treatment plan is as follows but beyond pain management is conditional on compliance. 5.5). You would no sooner pack some clothes, get into the car and take off for a trip with no chosen destination than you should begin any dental treatment without a clear idea of where you are headed! Recognition of personal limitations in knowledge and skills, or seeking appropriate referral, is the key to finding a solution. Think of a treatment plan like you would a well-planned vacation. The “plan of treatment” to deliver the “treatment plan” will consist of checks to gauge compliance and success in pain management. 5.10c), which would improve the chances of success (Fig. Treatment planning is a critical aspect of clinical education in the dental school curriculum. A surgical approach may stand a better chance of finding the canal but may not help eradicate the major part of the infection in the root-canal system, compromising the chances of successful healing (Fig. The goal is … A number of potential problems, not causing current difficulties will, therefore have been identified but a mutually agreed decision made between patient and dentist to leave the tooth/teeth alone and periodically review them. A recent health economic study using a Markov model evaluating the cost-effectiveness of clinical intervention over the life-time of an adult patient revealed that root-canal treatment is highly cost-effective as a first line intervention for a maxillary central incisor. Develop your skills in evaluation and dental treatment planning for all types of patients! It is therefore important that a rational analysis of the situation is performed conscientiously and difficult restorative decisions taken promptly as necessary, rather than procrastinating to another time when the situation is likely to be worse. Provide definitive plastic restorations for carious teeth in order of priority dependent on presence of sensitivity and integrity of temporary restorations, 6. As an example, consider the various presentations of an endodontic problem associated with a maxillary central incisor in an otherwise intact dental arch. Ethical and Legal Issues in Treatment Planning Part II: Phases of the Treatment Plan 5. Treatment planning is an essential component of clinical practice. Treatment planning may be categorized into a very broad spectrum of complexity from simple isolated problems to those multiple problems requiring complicated multidisciplinary management. The situation, however, must be clearly recognized and understood by both the patient and dentist using the so-called informed consent approach. It is not uncommon and perfectly valid for patients on long-term recall, to have the supervising dentist place individual teeth on probation to review their status at a subsequent time because of uncertainty about a diagnosis or the progression of a lesion (Fig. Implant. On radiographic examination, it is found that the canal is sclerosed (Fig. A number of different solutions will be possible for management of each of the patient’s problems but the specific treatment options selected will be dictated by the particular effects of interaction of these problems on the patient’s desires, which may include their well-being, aesthetic demands, and functional requirements (eating, speaking, socializing). At its most complex, treatment planning is a challenging, complicated and rewarding decision-making process for both the clinician and patient that involves a two-way dialogue (interrogation and negotiation), leading preferably to short-, medium-, and long-term goals for the management of the patient’s dentition. 5.10b) and only evident in the apical third of the root associated with a periapical lesion. The typical pattern of clinical behaviour in the primary care (practice) setting is that recognition of a problem will lead to the triggering of a set treatment protocol. The dentist will have been trained, by necessity, to recognize only the commonly presenting tendencies in each disease. In the case of complex dental problems, it may be rare for both patient and dentist to develop such complete pictures of the problems and outcomes of restorative options as early as the first consultation. Using evidence-based research, this book shows how risk assessment, prognosis, and expected treatment outcomes factor into the planning … The dentist must gauge the problems correctly, as well as the patient’s attitude, motivation and compliance. Weighing of prognosis and relative cost of endodontic and restorative options (based on average figures). On the whole, this approach probably works when preceded by active learning through assessment of personal outcomes over a lengthy period. Example of potential Bands and Patient Charges generated from phased treatment. 5.7b,c). 5.8b). ; In Clinical Practice boxes … The dentist and patient will need to have a clear and open discussion (dialogue and negotiation) about concordance between the desired and the possible, at the second level. Active engagement in CPD is mandatory in some countries but not all. In this diagnostic phase, a detailed systematic appraisal is made in the classical manner described in Chapter 4. Additionally, if the dentist feels that a patient's case is complex and will rise to an "interdisciplinary" level involving multiple specialists, then they might also refer the patient to another practitioner. 5.4). Ideological, philosophical, financial, medico-legal and indemnity frameworks have, therefore guided the development of a referral culture for specific items of care. Decision-making for them is a matter of following the simple heuristic decision-tree delivered as expedient undergraduate teaching. Despite this, dedicated, active practice, with continuous proactive personal development may propel a dentist to the state of mastery of their field relative to contemporary knowledge. Such treatment patterns, based on clinical rationale but also shaped and influenced by business and management needs may lead to the passive application of heuristic principles to select treatment.

phases of dental treatment planning

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