5.9). The factors influencing the decision-making process are many and can be classified into general patient factors, professional background and philosophy of the dentist, general oral and dental condition, and local factors related to the problem tooth (teeth). Fig. This book provides essential knowledge for creating treatment plans for adult dental patients. In treatment planning, the concept of phasing your treatment is not new. -"Best care" treatment plan-Alternative treatment plan-Risks-Benefits-Prognosis 2) Estimate length of time needed and cost involved 3) Predict anticipated outcomes 4) Collaborate with the dentist 5) Document and present to client and obtain consent Learn how each stage impacts treatment planning and case presentation and how they compare with Maslowâs hierarchy of needs. Such communication should be recorded in writing and formalized in letters. The end point of this is a series of conclusions about the general health of the patient and their current oral and dental problems; these will be juxtaposed with the patient’s own perception of their problem(s) and desires for correction of the same. It is therefore considered best practice to keep detailed records of initial findings, option appraisals, discussions, rationale for decisions and informed consent for treatment. 5.10d). 5.1 Hierarchical importance of knowledge context. As COVID-19 continues, the ADA is reminding dentists that dental care should continue during the resurgence phase of the pandemic. If a dentist has done their work properly, most questions center around how long treatment will take, and of course the cost. Dr. Zackary T. Faber explains why he believes being able to comprehensively treatment-plan a case is the most important principle in dentistry. Anticipation of a particular treatment outcome does not increase certainty of its achievement but careful planning with attention to detail may. The ideal treatment-planning scenario. In this diagnostic phase, a detailed systematic appraisal is made in the classical manner described in Chapter 4. To focus our dental care on moving patients toward stable oral health via the completion and tracking of treatment plan phases. â¢ âDefinitely, definitelyâ a good idea! A plan of management will have been established at the first encounter at some point in the past and, in the simplest cases, requires no more than a review (recall) to evaluate a change in overall status and provide motivation for maintenance. On the whole, this approach probably works when preceded by active learning through assessment of personal outcomes over a lengthy period. Conscientious dentists, therefore, strive for improvement throughout their professional lives in what has now become formally recognized as continuing professional development (CPD). Treatment of acute problems including incision and drainage, first stage root canal treatment, extractions, 2. Conversely, the knowledge and skills of endodontics must be deployed judiciously to ensure that the patient receives appropriate care, meaning that the specialist must also understand the broader context within which their expertise is exercised. Consider the not uncommon scenario of the pulp in a maxillary incisor of an otherwise intact dentition becoming compromised by a severe traumatic injury in a young, mature adult (Fig. It includes: 2. Implants may have a role as a third line intervention if root canal retreatment fails. Dentistry has seen incredible changes over the years, but the need for trust and support never changes. â¢ Tx Planning is a critical step in the successful treatment of children. 5.8b). Their frame of reference extends no further than the teachings at undergraduate level. Consideration of early replacement may have to be tempered by the psychological need to avoid loss of the tooth, as well as to delay permanent replacement during the growth phase of the individual, especially if an implant-retained crown is a possible alternative. Stages of Dental Care Home » Stages of Dental Care Our family dentist, Dr. Steele, provides pediatric dental care to infants and children ages 0 â 18, and helps guide expectant motherâs through their special oral health need during and post pregnancy. The options of vital pulp therapy or root-canal treatment may be considered. Management of carious lesions and preventive measures, 5. A patient's voluntary agreement to a treatment plan after details of the proposed treatment have been presented and comprehended by the patient. Treatment planning may be categorized into a very broad spectrum of complexity from simple isolated problems to those multiple problems requiring complicated multidisciplinary management. This hypothetical yet familiar illustration of operator and patient perspectives, which many will identify with, illustrates some sources of problematic communication. The “plan of treatment” to deliver the “treatment plan” will consist of checks to gauge compliance and success in pain management. Their frame of reference extends no further than the teachings at undergraduate level. 5.10a). Treatment plan 1. 5.5 Example of endodontic problems that have complex restorative implications. Think of a treatment plan like you would a well-planned vacation. In the context of a healthcare profession, the “endodontist” must, therefore be a human being first, dentist second and endodontist last (Fig. CONTENT Introduction Basic principles Phases Comprehensive treatment plan Modification Treatment planning in our context Merits of treatment planning Summary. The choice will centre on the prognosis of each treatment (based on biological factors) and the long-term benefit to the patient. Being thorough and attentive to detail communicates to patients that a dental team cares, which helps to build trust between patients and their care providers. It is not unheard of that, under some circumstances, with the passage of time, the mutually agreed plan may be forgotten or fades from memory, particularly where detailed medical or dental records are not maintained. The textbook depiction of treatment planning commences at the first encounter with the patient, when a full assessment is made of the patientâs overall dental and oral problems.In this diagnostic phase, a detailed systematic appraisal is made in the classical manner described in Chapter â¦ â¦ In essence, the process consists of assessing and accounting for the relevant problems at the level of the patient (their personal perspective on health and social well-being), then at the level of oral function (eating, speaking and aesthetics), and then at the level of the tooth (specific tooth-related problems). Their knowledge is therefore written in black and white, is clear and simple and may still serve the needs of those patients falling into the “central tendency” of disease presentation. 4. 5.5). After considering all of the information the dental team has gathered, the team can begin to create an individualized dental treatment plan for each patient. Replacement of missing teeth with fix or removable prostheses, Fig. Treatment planning we learned in dental school is a great foundation from a clinical standpoint, but once youâre out in the âreal worldâ â either as an associate or in your own practice â proper â¦ 5.11 (a) Sclerosed canal in central incisor managed by apicectomy and root-end filling; (b) the treatment failed and required a further procedure when />, Only gold members can continue reading. The opportunities of specialization have allowed clinicians to develop their skills and knowledge in a restricted area of practice to a much higher level, but usually to the exclusion of other generalist skills. Their knowledge is therefore written in black and white, is clear and simple and may still serve the needs of those patients falling into the “central tendency” of disease presentation. Diagnosis and Treatment Planning in Dentistry, 3rd Edition provides a full-color guide to creating treatment plans based on a comprehensive patient assessment.Using evidence-based research, this book shows how risk assessment, prognosis, and expected treatment outcomes factor into the planning â¦ Dentistry may be viewed as a speciality of medicine, yet it is itself a diverse and broad discipline. In a Nov. 20 email to members, ADA President Daniel J. Klemmedson, D.D.S., M.D., addressed a question that has been on the minds of dentists everywhere: would the ADA once again recommend that dental â¦ In the case of complex dental problems, it may be rare for both patient and dentist to develop such complete pictures of the problems and outcomes of restorative options as early as the first consultation. These reasons need to be acknowledged and brought to the forefront of the treatment planning decision in order to ease the patientâs mind and gain his or her trust. It is not uncommon and perfectly valid for patients on long-term recall, to have the supervising dentist place individual teeth on probation to review their status at a subsequent time because of uncertainty about a diagnosis or the progression of a lesion (Fig. That specialist, such as an oral surgeon or periodontist, would become involved in helping to create the final treatment plan and in rendering treatment, if needed. In the case of simple dental problems, the dentist may be able to identify the problem efficiently, characterize it together with the patient’s needs and select the correct management option expeditiously. The patient receives a report outlining all findings and recommendations, including any options, a copy of their diagnostic photos and a written copy of the financial details of the proposed treatment. The term “provisional treatment plan” is used to describe the interim plan containing overlapping phases of diagnosis and treatment, when further information is sought to garner a clearer picture to determine a firmer action plan. Factors that may confound the process include differences in perception and expectations between the dentist and patient. Complete root canal treatments on predictably restorable teeth, 7. 5.11). A surgical approach may stand a better chance of finding the canal but may not help eradicate the major part of the infection in the root-canal system, compromising the chances of successful healing (Fig. Treatment planning, as the term implies, is the planning of the management of a patient’s dental and oral problems in a systematic and ordered way that assumes a complete knowledge of the patient’s needs, the precise nature of the problems and the prognoses of possible management options under consideration. Unfortunately, some dental practitioners take the receipt of. What does a comprehensive treatment plan really mean? Disease processes addressed by appropriate treatment and patient education. This does, however, mean that the onus of ensuring the coordinated and appropriate delivery of whole mouth and patient care rests with the referring general dental practitioner, in conjunction with other specialists and the medical practitioner where necessary. If you are concerned about the cost, many resources like the American Dental Association can help you budget for and afford treatment. The goal of this evaluation is to ensure that prior medical and dental issues are completely under control before treatment begins. The vagaries of decision making are further defined and explored by examining different case scenarios based on a relatively simple problem. â¢ It helps sequence the care with proper prioritization of the childâs dental needs. Scenario – a patient presents in pain with a poorly maintained mouth, several carious and periapical lesions and gingival inflammation. (c) maxillary incisor restored, If, under the same circumstances, the patient was younger with an incompletely formed root, the decision may now lean towards the more conservative vital pulp therapy (, (a) Traumatized maxillary incisor with an open apex, receiving pulp therapy; (b) traumatized maxillary incisor root filled following root closure, (a) Maxillary central incisors with root-canal treatment to control apical periodontitis and inflammatory resorption following traumatic injury; (b) same teeth affected by replacement resorption, were subsequently replaced with implant-retained crowns, Consider an identical scenario but where a traumatized, intact, mature, maxillary central incisor has been left untreated for years as the pulp slowly succumbs and the patient seeks attention either because of an acute infection or the discoloration caused by secondary dentine formation and/or pulp necrosis (, (a) Discoloration of tooth following trauma; (b) radiographic evidence of pulp calcification and dentine sclerosis; (c) example of sclerosed canal in maxillary incisor; (d) canal successfully negotiated and obturated, (a) Sclerosed canal in central incisor managed by apicectomy and root-end filling; (b) the treatment failed and required a further procedure when />, 18: The oral medicine and oral surgery–endo interface, 1: Introduction to endodontology and endodontics, 3: Biological and clinical rationale for vital pulp therapy, 16: The medical–endo interface and patients with special needs, 11: Management of acute emergencies and traumatic dental injuries, 4: Biological and clinical rationale for root-canal treatment and management of its failure. Visualize ideal esthetics and ideal function. In the context of a healthcare profession, the “endodontist” must, therefore be a human being first, dentist second and endodontist last (, Hierarchical importance of knowledge context, Treatment option selection and treatment planning, Treatment planning, as the term implies, is the planning of the management of a patient’s dental and oral problems in a systematic and ordered way that assumes a complete knowledge of the patient’s needs, the precise nature of the problems and the prognoses of possible management options under consideration.