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FORMULATING A DENTAL TREATMENT PLAN

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!

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FORMULATING A DENTAL TREATMENT PLAN

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

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

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

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

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

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

  9. 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

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

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

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

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

  14. 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

  15. 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!

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

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

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

  19. 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! TREATMENT PLANNING (cont)

  20. 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

  21. 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

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

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

  24. 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 !

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

  26. 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

  27. 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

  28. 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

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

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

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

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