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Oral Diagnostic

Oral Diagnostic. Communication in the dental office . Anamnesis , status assessment and documentation of data. Dr Bródy Andrea Semmelweis University Or al Diagnostic Department. Further procedure. Main complain General health status assessment ( family and social anamnesis )

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Oral Diagnostic

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  1. OralDiagnostic Communicationinthedentaloffice. Anamnesis, status assessment and documentation of data. DrBródy Andrea SemmelweisUniversity OralDiagnosticDepartment

  2. Further procedure • Main complain • General health status assessment (family and socialanamnesis) • Mouthhygienehabits • Clinicalexamination • extraoral • Intraoral teeth oralcavity and mucosa

  3. Main complain • The reason, whypatientcametous complain, control, need • Must clarify

  4. Good anamnesis • Important in theallthethree main steps of thepatienttreatment: diagnose, treatment, prognosis • Main key of theanamnesis – goodcommunicationskill

  5. DiagnoseGathering information • Verbal questioning and filling out a questionnaire, preferably without errors and misses • Sort theinformation– onlytherelevantinformationhelpthediagnosticprocess • Havetopercievetheanswer! analyzing more questions summarize Let’s play

  6. Youare a 40 years old womanwith a family, youhaveahusband, twochildren and a motherinlawlivingwithyou. Youareworkingata multinationalcompany, and youneed a carforwork. The companywillpayallcosts, fuel, garage, soyoudon’tcaretheconsumption. No problemifit is expensive, youhavemoney. Youwanttobuy a newcar, a bigone, becauseyouhavetodeliverbigboxesthroughoutthe country. Youhavetoworkinwinteralsoonbadroads,and liketo drive fast, and interestedto go sometimesforoffroadcompetitions. Of courseyouwillbringthechildrenalsowiththiscartotheschool and for shopping. Soyouwanttobuy a big, quicklandroverwithfourwheel drive, with a strongengine. Yourfavouritecolor is theblack. Highprice and fuelconsumption is no problem.

  7. Youare a dentist. No wife, butyouhavealwaysgirlfriends. Youhave a smallsonwho is livingnotwithyou, butyouwanttobringhimalsowiththethecarwhen he visitedyou. Youareveryactiveinthenight, liketodrink, and thanyouget a taxi. That’swhythecar is nottooimportantforyou, youwanttouseitonlyinthe city for shopping and manageyourmatters. Soyouwanttobuy a used, cheap, smallcarforeasy parking withlowfuelconsumption. Yourwouldlike a redone, becausethat is yourfavouritecolor.

  8. The model of mutuality • Both thedoctor and patientareincontrol of thesituation • The doctorplacestheexpectations of thepatientintothescopeofhisexpertise • The patientreceivesfull and understandableinformation • The patient is an activeparticipantinthetreatment Thismodelensuresthe right diagnosis and successfultreatment.

  9. Obstructing factors (noise) • Dueto a previousbadexperiencethepatient is notsincere • The patientdoesnotknowthesignificance of earlierdiseases, treatmentortakenmedicine • The patient is ashamed – e.g. alcoholabuse, or is afraid of theconsequences – e.g. Drugs • The patient is notabletogivethenecessaryinformation • Sometimesthere is no explanation

  10. Factors of efficacy (decrease the noise) Important communication skills in doctoral work • General speech skill • Good question’sskill • The ability to listen to others – effectivelistening • Tactfulness, using the right expressions • Decoding of non-verbalsigns

  11. Verbalcommunication • Open question: thepatienttellsustheinformationwithherownwords • Closedquestion: previouslygivenoptionsforanswers • Leadingquestion – theinformationreceivedmay be misleading • Applyingopen and closedquestionningtechniques: weaimfromopentoclosedquestionning • Payattentiontothelanguageuse! • weshouldusemedicalterminologyaslittleaspossible • payattentiontotheexpressionsused

  12. Non-verbal communication • Non-verbal channels – body posture, movements, mimicry • Non-verbal communication often gives more precise information • Itsuggeststhatthe partner is notsincereorsatisfiedifthewords and gesturesormimicryreferto a differentmeaning.

  13. Problems in communication • Too little information provided to the patient • Impatience, trepidity • Doctors often interrupt the patients right after the first sentence – in average, after 18 seconds! • The patients could not finish 98% of the interrupted sentences later either • In 94% of the cases interruption ended up in the doctor controlling the conversation. • Patients don’t manage to tell 54% of their symptoms at all Information loss

  14. Results of badcommunication • Patientdon’tunderstandtheir status • Theyarenotcooperate • Changefor an otherdentist • Cancelthetherapy • Has thelawon Lost of trust

  15. Anamnezis Anamnesticdata

  16. Is the information received always realistic?

  17. Contraindications relating with general health status Treatment is contraindicated in case of • Acute infective diseases • Patient in need of hospitalization • Mental disorders in need of sedatives • Antikoagulant therapy • Severe allergic reaction to earlier dental treament with unknown origin Must find the solution!

  18. We never know which case will bring unexpected complications

  19. Status assessment

  20. Physical examination • The dentist examines the patient using his/her senses Inspection, palpation, percussion, bimanual, bilateral, etc.

  21. Assessment of the function • sensitivity trial – indicates the reaction of the pulpa (the response of the sensor nerves to external stimulus) • occlusion • atypicalocclusionalconnection • salivaryglandfunction

  22. Infectioncontrol Dentaloffice is highriskforinfection • Protectiveequipmentshould be worn – mask, glasses, gloves, rubberdamisolation • Protectpatientagainstnosocomialinfection – desinfection of contaminatedsurfaces

  23. DIAGNOdent • Red laser beam – the fluorescece of thecarious tissue is stronger • False result is frequent – dentalplaque, fillings, food remains (especially green), reminarilizedenamel, – may only be used on thoroughly washed teeth • May be used in approximately 2 mm depth • Only forfissurcariesexamination

  24. DIAGNOcam • Works on similar principles as the DIAGNOdent, but the signal is received by a camera so theaproximalcariouslesions are also visible (caries affected areas are darker)

  25. Supplementary diagnostic examinations • Radiology • Clinical laboratory • Microbiological

  26. Documenting the data

  27. Documentation • „The medical documentation contains the data concerning the examination and treatment of the patient. The documentation tasks should be carried out in a manner that ensures the data properly reflect the course of the treatment.” • Records the relevant data • Protects the patients from repeated examinations • Official source of data – legal problems

  28. Shouldnot be possibletoalterorchangeinformationwithoutdetection–photo, video • Dates is important • Both thedoctor and patientshouldsigned • To be preservedfortheobligatoryperiod (5-10 years) • Has to be storedseparately, safely

  29. Registration obligation • Personal data, anamnesis, status, diagnosis, risk factors, treatments and their results • Date, signature • Documents signed by the patient They were informed of the treatment and have accepted it • It is advised to enclose the findings and x-ray records too • Ambulant diary • Financial regulations

  30. Treatmentsheet– Containstheoriginal status, thetreatmentplan, thespecificdataconnectedtothetreatment, dates, call-backs – withthewrittenconsent of thepatient • Ad hoc/casualdocumentation– e.g. certification • Consultationrequestingform, referral– additionalexaminationsbyexpertinstitutes

  31. Referring and consultation

  32. Consultation • Communication between two experts • The consultant is the expert advisor of the doctor performing the treatment – does not actively take part in the treatment • Gives his expert opinion in writing regarding the specific problem and the recommended treatment Refers the patient back to his dentist

  33. Process of the consultation • Transfer of relevant information (only such information) and importantevidenceshave to be summarized with technical terms – they must be provided • It covers the • Diagnosis • Proposed measures • Prognosis • May be obligatory

  34. Consultation requesting form Contains the identification data of the patient • The opinion and evaluation of the doctor • Documentation • What we expects from the consultation – only opinion or active participation • Warning regarding certain risks • The identification of the dentist • Via telephone: fast and efficient in simple cases but may lead to legal problems • The patient may need to be accompanied if there is a dangerous complication • The number of diagnostic interventions must be minimized

  35. Thank you for your attention brody.andrea@gmail.com

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