Referrals and treatment planning

Question 1

What is treatment planning?

Answer 1

Narrowing down your patients symptoms into possible diagnosis so you can formulate a series of investigations, and/or treatment strategies that will benefit them.

Question 2

How to approach a treatment plan?

Answer 2

History and examination
Preliminary investigation
Differential diagnosis
Specific investigations e.g. mouth swab sent to microbiology lab to confirm infectious bacteria.
Definitive diagnosis- ideally !!
List in a logical progression – strategy
Carry out treatment

Question 3

Preliminary data

Answer 3

Patient demographics must be assembled
Name, address, DOB, telephone numbers
Arrange patients to come earlier to do paperwork
Convey that the team is caring, working in a calm, unhurried and clean environment

Question 4

Steps of history taking?

Answer 4

Chief complaint and wishes - open qs
Medical history
Dental history
Social history

Question 5

What to ensure whilst taking a med history?

Answer 5

Pt understands why this info is necessary

Question 6

Importance of taking someone’s dental history?

Answer 6

Insight into patients attitudes to dentistry
Regular or irregular attender?
Warning signs patient who has seen several dentists over the past few years
E.g.. Bad debts, holding dentists /DCP in low regard
Pts with unrealistic time expectations
Care taken before accepting a pt for complex treatment
Pts who cannot remember names of previous dentists
Value of previous dental records
Radiographs and study casts - progression rate
Change/lack of change in bone levels, caries, wear facets and recession

Question 7

What to involve in the social history?

Answer 7

Smoking habits
Ask have you previously smoked
Alcohol consumption-precipitating factor for oral cancer in smokers; excessive alcohol consumption, particularly binge drinking associated with erosive dental problems

Occupation - intelligence level, stress and availability
Family contacts
Stress history
Family history

Question 8

Steps of a clinical examination?

Answer 8

Extraoral aspects
Intraoral structures
Screening to assess needs for specialised exam and tests
General dental exam - preliminary extraoral observations (eye contact, breathless, sweating, look healthy? clean?)

Question 9

Steps of an extraoral exam?

Answer 9

Symmetry
Muscles
Glands - submental nodes and submandibular nodes, middle jugular nodes and lower jugular nodes
TMJ

Question 10

Steps of an intraoral exam?

Answer 10

Soft tissues - lips, cheeks, tongue, hard palate, soft palate, floor of mouth (changes in colour, texture, swellings)
Teeth
Periodontium

Question 11

How to examine the teeth?

Answer 11

Missing teeth
Tipping
Over-eruption
Spacing
Existing restorations
Defective restorations
Caries
Excessive non-carious structure loss (occlusal wear, abrasion, erosion or trauma

Question 12

How to examine the periodontium?

Answer 12

Periodontal probing depths
Assessment of nobilities
Assessment of recession >1mm
Bleeding on probing
Fremitus (functional contact mobilities)

Question 13

What do you need to see on radiographs?

Answer 13

Enamel decalcifications depth/penetration
Proximity to the pulp
Bone topography
Root length and apices
Endentulous areas/retained roots
Root canal fillings
Bone support
Status and proximity of large existing restorations

Question 14

What are active problems? Examples?

Answer 14

Active problem is the one that will be addressed within the present treatment plan
E.g. Missing tooth
Fractured tooth
Unhappy with aesthetics
Localised gingivitis

Question 15

What are inactive problems? Example?

Answer 15

An inactive problem is a variance from the norm, which is to be monitored but does not need active treatment within the present treatment plan
E.g. Bilateral TMJ joint click
Unerupted wisdom teeth

Question 16

What do treatment options depend on?

Answer 16

Clinicians obligation to present all the options outlining the ‘pros’  ‘cons’
Likely longevity (Evidence based)
Cost
Invasiveness/reversibility
Success rates (EBD)
Possible complications/treatment time
Time involved number of visits
Influence on quality of life

Question 17

What should the sequence of treatment be?

Answer 17

1. Relief of pain and other emergencies
2. Cause-related therapy (diet advice, OHI)
3. Reassessment
4. Basic corrective care (Placement of plastic restorations)
5. Reassessment
6. Preconstructive therapy (crown lengthening)
7. Reconstructive therapy (crowns & Bridges)
8. Recall and maintenance

Question 18

Examples of medico-legal issues?

Answer 18

Negligence - duty of care
Degree of skill the law requires
Skills and experience
Accepting referrals and referral of pts
Nature of the contract
Consent
Risk management
Dental records

Question 19

What to ensure with written referrals?

Answer 19

Addressee info
Who later is from
Date
Pt details - DOB, contact address, hospital no
Clear summary of problem/why I'm referring
Sign and date
Include MH, SH, meds
GP contacts/telephone no