Transcript DIAGNOSIS, TREATMENT PLANNING, AND CASE CONSULTATION IV “TREATMENT PLANNING” Office Dynamics • Diagnosis Appointment • Consultation Appointment • Treatment Appointments • Post Treatment Appointment • Recall Appointment -----------------------------• Emergency.

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
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Data Collection
Interpret
Translate
Define
Generate
Analyze
Interpret
Criticize
Communicate
Implement
Evaluate
PRODUCT
FINDINGS
STATEMENT OF PROBLEM(S)
STATEMENT OF GOAL(S)
SPECIFIC LISTING OF PROBLEM(S)
TREATMENT ALTERNATIVES
TREATMENT JUSTIFICATION
SPECIFIC PLAN
OPERATIONAL TREATMENT PLAN
CONSULTATION/INFORMED CONSENT
TREATMENT
NEW FINDINGS
Defined Data Base
for the
Child Patient
• Case History
– Health History
– Dental History
• Clinical Examination
• Behavior Assessment
Supplemental Data Base
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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:
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Immediate Problems
Problems of Prevention
Problems of Rehabilitation
Problems of Maintenance
Immediate Problems
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Health Constraints
Parental Concerns
Critical/Emergency Circumstances
Problems of Diagnostic Evaluation
Management of Behavior
Problems of Prevention
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These problems relate specifically
to the etiologic factors of dental
pathology:
host
microflora
substrate
education/motivation
Problems of Pathology,
Development and
Reconstruction
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Dental Caries
Pulpal Pathology
Periodontal Disease
Craniofacial/Occusal Disharmonies
Oral Pathoses
Developmental Anomalies
Problems of Maintenance
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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
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Appointments Required
Tooth/surface/procedures/appointment
Time scheduled/appointment
Fee/Appointment
ADA Code/procedure
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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.