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Flashcards in Treatment Planning Deck (17):

What grading is used to determine whether a person/child is medically fit for treatment in clinic, on which part of the scale are they treatable?

-ASA score (american society of anaesthiology)

Class I: no organic, physiological, biochemical, or psychiatric disturbance

Class II: mild to moderate systemic disturbance, e.g. mild diabetes, moderate anaemia, mild asthma, not disabling

(class I and II can be treated, goes up to class V in terms of condition severity)


What is generally the age at which you can do treatment in the chair?

3 years old, below this refer for GA


What should you try to test a child's ability to receive treatment?

Take B/W's


T/F you can start treatment on children without x-rays?



What factors should be taken into account for treatment planning?

-SE status
-Co-operation levels


What should you do to determine how aggressively you want to treat a child?

-Take into account patient factors
-e.g. if irregular attender, frequent FTA's, place stainless steel crown over enamel lesion (in 6 months time that lesion could hit pulp)
-if regular attender, motivated, follows instructions, then duraphat and monitor


T/F School dental service will not allow RA in the x-ray room



What is dental fatigue, and how many appointments does it take to start being significant?

-Decrease in cooperation as the appointments go on due to child getting tired of visiting/sick of treatment
-Usually starts become significant at the 4th appointment
-Especially prevalent if child is already struggling at the first appointment to take B/W's
-If child is already struggling at the beginning, put patient on waiting list for GA even if you are going to do a second appointment attempt-->they can always get taken off later but reduced waiting time by 2 months
*Keep in mind that in private practice if need to come back several time for RA appointments, cheaper to do GA (in public government covers it so not an issue), especially with time taken off work


What are some predictors for a child being unable to cope with treatment?

-Unable to take radiographs
-Multiple extensive treatment
-Multiple visits for treatment
-Possibility of behaviour deterioration from child's demeanour


T/F you should continuously talk about prevention even as you are donig treatment



Which appointments should you keep the simple procedures for?

First: introduce atraumatic experience
Last: leave pleasant memory


In what order should you do impressions on children?

-Older: Lower (comfortable) first
-Younger: Upper (uncomfortable) first, so finish on something that is not as bad


What are some ways to deal with dental fatigue?

-Book for non-invasive appointment in between (e.g. on 3rd appointment book for 15 minute prophy)

-Schedule longer appointemnt intervals (e.g. once every 3 weeks rather than once a week)


What are the recall periods for SADS?

-Low risk: 24 months
-Medium risk: 18 months
-High risk: 12 months (if necessary, 3-6 month fluoride recalls e.g. while waiting for GA)


What are the advantages and disadvantages of having parents in the waiting room?

-Increases coping effect of child + feeling of security

-May increase management problems
-may disrupt procedure
-may project anxiety onto child


Further notes:

-D with caries into dentine and abscess-->extract + space maintainer

-D with caries into dentine and some shadowing (think of a cavity the size of a slot prep in permanent tooth)-->likely to have reached pulp thus pulpotomy

-D with caries into dentine not reached pulp, same size as previous scenario: if tooth needs to be kept for long time stainless steel crown especially if high risk, else RMGIC (keep in mind if filling falls out and child does not complain parents may not notice), also high restoration failure rate in SADS clinics (so they don't last long)
-Small occlusal: (if rest of mouth is non-carious) restore with CR or RMGIC

-If small restoration (appears to be in enamel in radiograph-->probably just hit DEJ clinically) but need to keep tooth for a while and already had a failed restoration + use stainless steel crown, applies even more so if patients high risk


When should you consider pulpotomy?

-When judging on x-ray, remember caries will be more extensive in real life, if taking this into account likely to be close to pulp plan for a pulpotomy