Developing a Tx strategy in Clinical Dentistry

Question 1

How to gather reason for attendance?

Answer 1

How did this pt get to us?
Who referred?
Why they referred?
Diagnosis made by the referring dentist?
What does the referrer want you to do?
When were they referred?

Question 2

How to record the pt complaint?

Answer 2

Why the pt has come to the surgery?

Record in the pts own words

Question 3

What makes up the assessment?

Answer 3

History, clinical exam and special investigations

Question 4

How to take a history? Steps?

Answer 4

Careful and accurate
Structured approach
Use headings:
1. Reason for attendance
2. PC
3. HPC
4. Other PC and HPC
5. RMH
6. RDH
7. Pt expectations
8. SH

Question 5

How to take a clinical exam?

Answer 5

General exam
Intraoral - soft tissues, BPE, full dental chart
- Endodontics: clinical status of actual tooth in question
- Prosthodontics: occlusion, wear, denture stability and retention

Question 6

What do the special investigations consist of?

Answer 6

Pulpal status - sensibility and percussion testing
Occlusion - ICP, Centric relation, First contacts in CR, TSL
Radiographs - appropriate to condition, reported, compare to previous radiograph
Perio assessment - 6 point chart, indices: plaque, BOP, mobility, furcation
REPORT ON SPECIAL TESTS

Question 7

What does the assessment lead to?

Answer 7

A diagnosis (a recognised condition = chronic gingivitis (not calculus)
OR differential diagnosis = addressed in T.S

Question 8

What is a prognosis based on?

Answer 8

Individual and specific risk factors
Ability to institute prevention and maintenance
Operative considerations

Question 9

What makes up a prognosis?

Answer 9

Condition listed in the diagnosis (chronic periodontitis): likely outcome based on current status (poor)
Rationale based on risk factor (as pt smokes)

Question 10

What forms the T.S?

Answer 10

Diagnosis and prognosis

Question 11

What should the T.S have?

Answer 11

Establish aim of tx and convey this to pt - ‘end point of care’
Aim should be revised after the review of outcomes stage
1st = emergency
2nd stage = stabilise disease and structure
3rd = pt centred review of outcomes and consider plan for restoration of structure, aesthetics and missing teeth
4th = T.P for advanced restorative care (new AIM and ensure pt understands this), prognosis and consideration of meeting pt expectations
5th = evaluate outcomes
6th = establish maintenance plan - pt takes responsibility

Question 12

What is the aim of a T.S?

Answer 12

Functional, disease free and structurally sound dentition that can be maintained effectively in a durable and predictable manner