1. FORMULATING A DENTAL TREATMENT PLAN
DR TASHNIM BAGUS
DEPT. OF PAEDIATRIC & RESTORATIVE DENTISTRY
SCHOOL OF ORAL HEALTH SCIENCES
UNIVERSITY OF THE WITWATERSRAND.

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

3. DENTAL TREATMENT AND PLANNING
AN ART
DEVELOP TALENT
A SCIENCE
TAUGHT

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

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

6. HISTORY(CONT)
SOCIO-ECONOMIC
HABITS
CULTURAL / CUSTOMS

7. B) EXAMINATION 1) EXTRA ORAL EXAMINATION – EOE SYMMETRY ( Facial )
LIPS
LYMPH NODES
TMJ

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

9. C) SPECIAL INVESTIGATIONS
RADIOGRAPHS
VITALITY TESTS
STUDY MODELS
DIET ANALYSIS
OTHER ( Blood Tests )

10. 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

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

12. DENTAL CHARTING (cont)
B) CONSERVATION CHARTING –
( Tooth )
-caries
-existing restorations

13. DENTAL CHARTING (cont)
TOOTH NOTATION SYSTEMS
1) Palmer System
2) FDI System-(Federation Dentaire Internationale)

14. Dental Charting(cont)
TOOTH NOTATION (cont)
3) US Tooth Notation System
4) Letters & Numbers Tooth Notation System

15. 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

16. 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!

17. TREATMENT PLANNING (cont)
REMEMBER!!
KEEP YOUR TREATMENT PLAN
S - SIMPLE
A AFFORDABLE
A ADAPTABLE

18. GOD GIVEN TEETH DESTRUCTION RESTORATION SUCCESS FAILURE
RISKS vs BENEFITS!

19. TREATMENT PLANNING(cont)
DATA COLLECTION
ORGANISATION & VISUALISATION
TREATMENT OPTION
IDEAL Rx REALISTIC Rx
PLAN PLAN

20. 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!

21. 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

22. 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

23. TREATMENT SEQUENCING (cont)
3. LOW PRIORITY TREATMENT
- Endodontic therapy
- restoration of carious lesions
- temporary splinting
- re-evaluation

24. TREATMENT SEQUENCING (cont)
4. MAINTENANCE
-3/12
-6/12
* CONTINUED REASSESSMENT AND RE-EVALUATION!

25. 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 !

26. TREATMENT SEQUENCING
SEQUENCE OF “TX” CAN BE BROKEN INTO STAGES…

27. TX SEQUENCING 1. STABILIZATION 2. REASSESSMENT 1
3. PRELIMINARY RESTORATIVE PHASE
4. REASSESSMENT 2
5. DEFINITIVE RESTORATIVE PHASE
6. REASSESSMENT 3
7. MAINTENANCE

28. 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 )

29. 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

30. 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

31. TX SEQUENCING 7. MAINTENANCE RECALLS – EVERY 6 WEEKS 3 MONTHS
6 MONTHS ETC…

32. TX SEQUENCING STABILIZATION REASSESSMENT 1
PRELIMINARY RESTORATIVE PHASE
REASSESSMENT 2
DEFINITIVE RESTORATIVE PHASE
REASSESSMENT 3
MAINTENANCE

33. TREATMENT OPTIONS ORTHODONTICS PERIO / MFOS OCCLUSION RESTORATIVE
& TMJ
PROSTHODONTICS
ENDODONTICS