CLINICAL DECISION MAKING, TREATMENT PLANNING AND CASE CONSULTATION V

1. CLINICAL DECISION MAKING, TREATMENT PLANNING ANDCASE CONSULTATION V “THE CASE CONSULTATION”

2. Consultation Appointment • Prior to the Consultation Appointment, the dentist will have prepared a plan of therapy for the patient that represents her/his best judgement and recommendations as to the course of therapy to pursue to gain a level of oral health for the child commensurate with her/his understanding of the goals of the parent. • This plan will be open to revision based on the consultation with the parent and any concerns or constraints they might raise of which the dentist was previously unaware.

3. Purpose of the Consultation • To “deliberate” * with the parent regarding the problem(s) identified, the goal(s) possible, the alternatives available, and the results anticipated (prognosis). • To advise the parent of the anticipated financial investment required to achieved mutually agreed upon goals. • To gain an informed consent to care. • To “inform before you perform” (A well-known proverb among sages of practice administration.) • To educate the parent regarding the issues of oral health….the doctor as teacher. _____________________ * Reference discussion of “Deliberative Model” in CDS 828

4. THE PHYSICAL ENVIRONMENT • Ideally, the consultation (or case presentation) with the parent should be in a designated consultation/education area. • Contemporary, progressive dental practices, which place treatment planning and case presentation at the core of the administration of their practices, will create an area for education and consultation. • Such an area will include a comfortable setting for discussing the case; as well as audio-visual aids (photographs and videos), brochures, and models for education. • Many practitioners use their own offices as an area for consultation; and there are advantages of doing so, such as personalizing the setting, and thus the experience.

5. PARTICIPANTS • Obviously, one parent should be present. Most frequently this is the mother, though this is changing somewhat, with fathers or both parents being a case of increasing frequency. • The child should not be present, as s/he can disrupt the consultation by demanding the parent(s) attention. Additionally, the conversation may prove fear-promoting. The dental hygienist or assistant can take the child to the operatory to begin a discussion/demonstration of oral physiotherapy. • Some practitioners use a dental hygienists to accomplish the consultation, joining the conversation at its end to answer specific questions.

6. Format for Consultation • Introduction • Findings • Problems/Goals • Treatment Recommended • Appointments Necessary • Professional Fee • Future Considerations • Questions and Answers

7. Parents’ Notes Page • A written consultation provided to the patient at the time of the case presentation. • Ideally developed on “no carbon required” (NCR) paper, in order that a copy can be given the parent and the other placed in the record.

8. Advantages • Provides written documentation for the dental record of what information was provided to the parent. • Provides the parent with written information with which to communicate the child’s oral health circumstances with the spouse, who may not have been present. • Provides formal verification of the course of therapy the parent consented to after being informed…of informed consent.

9. Components • Findings: orofacial soft tissues, developing permanent teeth, occlusion, teeth, preventive dentistry • Problems/Goals • Treatment Planned: preventive dentistry, pulpal therapy, extractions, space management devices, restorations for primary and permanent teeth • Additional Treatment Required • Appointments Necessary • Fee • Future Considerations • Date • Signature

10. Demonstration of a Case Consultation