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 DEVELOP TALENT A SCIENCE TAUGHT

DATA COLLECTION A) HISTORY B) EXAMINATION C) SPECIAL INVESTIGATIONS

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, it’s 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 FAILURE RISKS vs BENEFITS!

TREATMENT PLANNING(cont) DATA COLLECTION ORGANISATION & VISUALISATION TREATMENT OPTION IDEAL Rx REALISTIC Rx PLAN 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 3. PRELIMINARY RESTORATIVE PHASE 4. REASSESSMENT 2 5. DEFINITIVE RESTORATIVE PHASE 6. REASSESSMENT 3 7. MAINTENANCE

TX SEQUENCING 2. REASSESSMENT 1 * ORAL HYGIENE 1.STABILIZATION RELIEVE PAIN – TEMPORARY RX PERMANENT RX EXTRACTION 2. REASSESSMENT 1 * ORAL HYGIENE * ASSESS TEMPORARY RX – IS IT RESPONDING- EG. REVERSIBLE PULPITIS ( ? INDIRECT PULP CAP / OR RCT )

TX SEQUENCING 3. PRELIMINARY RESTORATIVE PHASE PERFORM URGENT RX FIRST. * COMPLETE ALL PROCEDURES THAT ARE NECESSARY. * WAIT FOR HEALING. 4. REASSESSMENT 2 ORAL HYGIENE CHECK FOR NEW DISEASE – EG BROKEN RESTORATIONS

TX SEQUENCING 6. REASSESSMENT 3 CHECK ORAL HYGIENE POLISH AMALGAMS 5. DEFINITIVE RESTORATIVE PHASE * SCALE AND POLISH * FLUORIDE RX * FISSURE SEALANTS ETC * COMPLETE ALL RESTORATIONS 6. REASSESSMENT 3 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