DIAGNOSIS, TREATMENT PLANNING,

AND CASE CONSULTATION IV

“TREATMENT PLANNING”

Office Dynamics

• Diagnosis Appointment• Consultation Appointment• Treatment Appointments• Post Treatment Appointment• Recall Appointment------------------------------• Emergency Appointment

Explicating the Process

PROCESS PRODUCT• Data Collection FINDINGS• Interpret STATEMENT OF PROBLEM(S)• Translate STATEMENT OF GOAL(S)• Define SPECIFIC LISTING OF PROBLEM(S)• Generate TREATMENT ALTERNATIVES• Analyze TREATMENT JUSTIFICATION• Interpret SPECIFIC PLAN• Criticize OPERATIONAL TREATMENT PLAN• Communicate CONSULTATION/INFORMED

CONSENT• Implement TREATMENT• Evaluate NEW FINDINGS

Defined Data Base for the

Child Patient

• Case History– Health History– Dental History

• Clinical Examination• Behavior Assessment

Supplemental Data Base

• Radiographs• Diagnostic Casts• Clinical Photographs• Space Analysis• Dietary Analysis• Pulpal Vitality Tests• Water Analysis for Fluoride Content• Laboratory Blood Studies• Consultation with other Health Care

Professionals

FINDINGS

• The results of all of the information gathered through the defined and supplemental data bases is referred to as the FINDINGS.

• FINDINGS have been called the “focal point of oral diagnosis.”

Four Dimensions of Oral Health Problems

• FINDINGS from the information gained patient’s data bases are interpreted into problems of oral health in one of four dimensions: – Immediate Problems– Problems of Prevention– Problems of Rehabilitation– Problems of Maintenance

Immediate Problems

• Health Constraints• Parental Concerns• Critical/Emergency

Circumstances• Problems of Diagnostic

Evaluation• Management of Behavior

Problems of Prevention

These problems relate specifically to the etiologic factors of dental pathology:

• host• microflora• substrate• education/motivation

Problems of Pathology, Development and

Reconstruction

• Dental Caries• Pulpal Pathology• Periodontal Disease• Craniofacial/Occusal Disharmonies• Oral Pathoses• Developmental Anomalies

Problems of Maintenance

Oral health must be maintained, once gained. Key concepts at this level of problem definition and resolution are:

• Review• Education/Motivation• Periodic Evaluation• Monitoring Unresolved Problems

Advantages of A Treatment Plan

• Diagnostic decisions are made at one time; thus avoiding “rediagnosing” each appointment.

• Valuable chair time is saved as the dentist already knows what is to be done and can begin

immediately.• Permits the receptionist to arrange a series of

appointments of the correct length.• Permits the dental assistants to prepare the

required instruments and materials ahead of time.• Provides a basis for developing a case

consultation with the parent…an imperative!

Components of a Treatment Plan

• Appointments Required• Tooth/surface/procedures/

appointment• Time scheduled/appointment• Fee/Appointment• ADA Code/procedure

TREATMENT

PLANNING

FORM

Variables in Treatment Planning

• Patient Management: It is wise to begin with simple, shorter procedures and move to the more complex and time-consuming ones.

• Urgency: Some treatment must be performed as soon as possible to prevent further complications from developing.

Variables in Treatment Planning (continued)

• Convenience: Completing quadrants of work at one time is sound economics and is easier to accomplish when compared to a single tooth approach.

• Prerequisite Treatment: Occasionally one procedure must be accomplished before another can be performed. This must be provided for in the treatment plan.

Guidelines in

Treatment Planning

The ability to design rational operational treatment plans is developed through experience. These guidelines (not rules) should prove helpful in gaining wisdom.

Guidelines

• Provide apprehensive children with one brief, relatively easy restorative experience before challenging them with longer, more difficult, procedures.

• Plan by quadrant, finishing one quadrant before proceeding to the next.

• One can exercise better control over the child during anesthesia when treating the left quadrants, if right-handed. Begin on this side, all other things being equal, particularly with the child with questionable levels of cooperation.

Guidelines (continued)

• Mandibular block injections provide anesthesia for both the labial and lingual soft tissues, thus reducing the potential for unintended pain/discomfort. Anesthetizing maxillary quadrants generally requires more penetrations of the mucosa, and frequently a palatal injection. All other things being equal, start in the mandibular.

Guidelines (continued)

• Treat the most urgent needs first.• Give special attention to

sequencing extractions and space management appliances. Usually the bands should be adapted and impressions made the appointment before the extraction(s) in order that the appliance can be placed immediately.

Guidelines (continued)

• Within the constraints of other guidelines, reserve treating the maxillary anterior area until last. Anesthesia in this area is difficult to administer without some discomfort.

• Accomplish as much of the treatment required in a quadrant at one time, thus reducing the number of appointments and injections required.

Guidelines (continued)

• Plan for the worst and hope for the best. It is then reasonable to expect you can remain faithful to the treatment plan. If it is not possible to determine which treatment will be most appropriate until initiating treatment, plan for the more extensive and expensive one. Parents will never object to the deletion of treatment, but may become skeptical with additions in the course of therapy.

Guidelines (continued)

• Adhere to the treatment plan to the extent possible. Your assistant is also following the treatment plan and preparing instrument trays and the operatory accordingly. Arbitrary deviations create confusion at the beginning of an appointment; wasting time, potentially creating friction, and detracting your attention from the child.

Guidelines (continued)

• Complete treatment with a favorable experience for the child. A Post Treatment Appointment to polish restorations, reinforce preventive strategies, and to evaluate the treatment provided and its success in achieving the original goals of therapy meet this requirement well.