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23 Oral Diagnosis > 9 - Treatment Planning Phases > Flashcards

9 - Treatment Planning Phases Flashcards

1
Q

what phase:

evaluate patient fitness for tx

A

systemic phase

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2
Q

what phase:

tx of patient cheif complaint (unless purely anesthetic unless patient of record) (if so they will not return until they have another acute complaint

A

acute phase

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3
Q

what phase:

Completion of treatment initiated in the Acute Phase and/or treatment of large carious lesions with Silver Diamine Fluoride
(SDF) if long intervals between treatments of caries or Radiation Caries anticipated

A

disease control

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4
Q

what phase:

Oral Surgery (lose the losers, allows healing prior to interim
prosthesis)

A

disease control

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5
Q

what phase:

Caries Control Phase 1 (D2 and D3 lesions)

A

disease control

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6
Q

what phase:

Periodontics (Comprehensive Perio Exam) including Initial Periodontal Therapy and initial occlusion evaluation related to Secondary Occlusal Trauma

A

disease control

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7
Q

what phase:

Caries Control Phase 2 (D1 lesions if not amenable to remineralization therapy or minimally invasive surgical treatment which would also be included in this phase)

A

disease control

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8
Q

what phase:

Endodontics: asymptomatic teeth or teeth with pulp exposures
from Caries Control Phase 1

A

disease control

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9
Q

what phase:

Re-evaluation of plaque control and periodontal status

A

disease control

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10
Q

what phase:

Interim Prostheses
Orthodontics
Occlusion Analysis/TMD Therapy

A

disease control

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11
Q

what phase:

Periodontal Surgery: Disease not responsive to IPT/implants
Single crowns
Replace missing teeth: fixed first, restore implants second, removable last
Aesthetics
Miscellaneous

A

definitive phase

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12
Q

what phase:

Prophylaxis or Perio Maintenance: Re-evaluate interval of recall appointments, radiographic evaluation of endodontic therapy/implants

A

maintenance phase

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13
Q

what are the phases of a treatment plan (per textbook)

A
  1. systemic phase
  2. acute phase
  3. disease control phase
  4. definitive phase
  5. maintenance phase
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14
Q

what are the treatment plan phases (per axium)

A
  1. acute phase
  2. disease control phase
  3. definitive phase
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15
Q

what phase:

good oral hygiene instructions

A

disease control

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16
Q

what is the managing of comprehensive dental treatment in the context of patient’s general health

A

ssystemic phase

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17
Q

what is the rationale for systemic phase

A

A. Recognize signs and symptoms of undiagnosed disease and physician referral for diagnosis
B. Limit or modify dental treatment depending on findings
C. Prevent in office emergencies: medical consults for ASA class III or IV (see table
5-1 for ASA classifications_
D. Prevent post-op complications resulting from dental treatment

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18
Q

what is the best way to avoid in office emergency

A

medical history

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19
Q

you must evaluate the relationship between systemic health and ___

A

dental treatment

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20
Q

are certain procedures indicated to alleviate able to exacerbate systemic disorders?

A

YES! sometimes not treatment is the best treatment

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21
Q

what is the focus on whole patient with the goal of delivering dental care safely and comfortably?

A

systemic procedures

A. Postpone or limit treatment if patient has
serious systemic disease
B. Physician consultation - uncontrolled
diabetes, hypertension, etc.

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22
Q

how do complete stress management

A

Anxiolytics, inhalation analgesia, short appointments

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23
Q

in NE, you can prescribe anxiolytic drug, but what can you not use at same time?

A

nitrous oxide

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24
Q

what are the anxiolytic drugs that can be used? what are the instructions/dosage?

A
  1. Xanax 1 mg. h.s., then 1 tab 1 hour prior to the appointment
  2. Valium 5 mg. same instructions, but it has a lot longer half-life
  3. Both require a driver for the patient
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25
Q

what are the majority of drug classes that we Rx? what are others

A

antibiotics and analgesics

others: premedication (artificial or porcine heart valves, and possible prosthetic joints)

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26
Q

where do you position the patient in the dental chair

A

where comfortable for the patient

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27
Q

what conditions can affect patient position in chair

A

pregnancy
congestive heart failure
spinal conditions
pulmonary conditions

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28
Q

you should regularly review patient health history for changes. what do you look for?

A
  1. new medical diagnoses
  2. updated medications
  3. flag patient records for pre-med, allergies, life-threatening conditions
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29
Q

what phase is diagnosis and tx modalities solving urgent patient needs

A

acute phase

30
Q

what is incapacitating and possibly life threatening

A

acute phase - emergency problem

31
Q

what does not requires immediate attention (although pt may think it does)

A

acute phase - urgent problem

32
Q

is pain an emergency problem?

A

NO!

33
Q

if an infection in canine fossae that extends to and includes swelling of lower eyelid, this can lead to what?

A

cavernous sinus thrombosis (could be fatal)
requires immediate refferal to oral surgeon or ER

34
Q

what are comprehensive care patients

A

identify urgent problems likely to become emergencies and sequence them early in the treatment plan

35
Q

what are limited care patients

A

sporadic care usually modified by finances, fear, mobility, healthy concerns, low dental IQ

36
Q

what histories are needed and not needed for patient eval

A

NEED: health and medication history
NOT NECESSARY: dental history and psycho-social history

37
Q

5 components of clinical exam

A
  1. Health status and ASA classification
  2. Oral cancer screening
  3. Vital signs - pulse and blood pressure baselines
  4. Area of chief concern
  5. Examination of contiguous tissues
38
Q

what are different diagnostic tests and techniques

A
  1. Inspection
  2. Palpation
  3. Percussion - primary technique to determine periapical inflammation
  4. Periodontal probing
  5. Tooth mobility
  6. Pulp testing - hot, cold, electronic (EPT determines only whether tooth is vital or not)
  7. Radiographic (Table 6-1)
39
Q

what is primary technique to determine PA inflammation

A

percussion

40
Q

what test is use to detect hot, cold, electronic (EPT determines whether or not tooth is vital or not)

A

pulp testing

41
Q

what is called by cold or air, not lingering or spontaneous, brief

A

reversible pulpitis

42
Q

what is prolonged pain, may be spontaneous, may interfere with sleep, lingering or delayed response to cold

A

irreversible pulpitis

43
Q

what is prolonged dull or throbbing ache, raidograph demonstrated widening of PDL, pain to mastication or percussion, vitality may be begative

A

symptomatic apical perio

44
Q

what is simlar to AP, but with subperiosteal or intraoral swelling, positive palpation,r adiographically simiilar to AP or with PA radiolucency

A

apical abscess

45
Q

what this

A

apical periodontitis

46
Q

what this

A

apical abscess

47
Q

what is diffuse, firm swelling with fever, malaise; CAUTION - canine fossae
cavernous sinus thrombosis, sublingual - Ludwig’s Angina Danger Space

A

cellulitis

48
Q

what is a localized pointing abscess

A

parulis

49
Q

what is purulent drainage, not likely to be painful, may determine origin with gutta percha point

A

sinus tract (fistula)

50
Q

what is usually associated with large intracoronal restoration in posterior tooth

A

cracked tooth syndrome

51
Q

it is critical to determine whether or not which lesions came first?

A

endo or perio

52
Q

what problem:

No abnormal probing depths, no attachment loss, edema,
inflammation, hemorrhage upon manipulation, heavy plaque with or without
calculus

A

pain associated with periodontal tissues - GINGIVITIS

53
Q

what problem:

Vital pulp, lateral periodontal swelling, abnormal probe
depth present, exudate present, often initiated by a foreign body (often :
popcorn hull)

A

pain associated with periodontal tissue - PERIO ABSCESS

54
Q

what problem:

HIV mediated, painful, rapid loss of
periodontal attachment, characterized by soft tissue necrosis absent pocket
formation

A

pain associated w/ periodontal tissues - NECROTIZING ULCERATIVE PERIODONTITIS

55
Q

what problem:

patient usually stressed, painful, inflammation, hemorrhages easily, punched out interdental papillae with pseudomembrane that is grayish in color

A

pain associated with periodontal tissues - NECROTIZING ULCERATIVE GINGIVITIS (used to be called acute nug)

56
Q

what this

A

parulis

57
Q

what is this

A

lateral periodontal abcess

58
Q

what this

A

necrotizing ulcerative gingivitis

59
Q

what this

A

necrotizing ulcerative periodontitis

60
Q

what are pains assocaited w/ tooth eruption

A
  1. traumatized operculum vicious cycle may lead to:
  2. Pericornitis - operculum infected, constitutional symptoms may develop, may develop trismus if involved with a third molar
61
Q

what is pain associated with previous dental treatment

A
  1. Extraction - alveolar osteitis - dull ache radiating to ear, no clot resistance present, 95% are mandibular molar extraction sites
  2. Prosthesis ulceration
  3. Deep restorations - pulpitis
  4. Intracoronal or extracoronal restorations - if recently placed and experiencing pain to cold and/or mastication
    rule out hyperocclusion first
62
Q

what are other sources of oral pain

A
  1. ulcers
  2. stomatitis
  3. TMD
  4. neural origin
  5. sinusitis
63
Q

what are herpes, apthous, traumatic, herpes zoster, immunocompromised or medication induced, pemphigus examples of

A

ulcers

64
Q

what is neuralgia, neuritis, hyperesthesia, parasthesia examples of

A

neural origin of oral pain

65
Q

what oral pain is caused by pain in maxillary posterior teeth, may change with head position, may have bad odor and/or discharge, radiograph of maxillary sinus will appear cloudy, this diagnosis is outside of the prevue of dentistry

A

sinusitis

66
Q

if patient has complaint of swelling, what should you check for?

A

lympadenopathy - infection or malignany, infection is the usual case

67
Q

what are the different types of infective swelling

A
  1. Periapical - necrotic pulp - do pulp tests
  2. Periodontal - lateral periodontal abcess
  3. Pericoronal - erupting tooth - acute pericornitis
68
Q

what are examples of swelling not associated with teeth

A

Cysts, tumors (benign or malignant), granulomatous lesions, hyperplasias ,
sialolyths - may cause salivary gland swelling

69
Q

what are examples of tooth injuries

A

fractures, avulsion, displacement

70
Q

what are examples of traumatic injuries

A
  1. tooth
  2. soft tissue
  3. boney injuries
71
Q

what are examples of soft tissue injuries

A

laceratins and contrusion - DO NOT MAKE PERM REPAIR TO LACERATIONS INVOLVING VERMILION BORDER OF LIP. REFER TO PLASTIC SURGEONS

72
Q

continue slide 31

A

23 Oral Diagnosis (13 decks)

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