Dental Treatment Planning: Strategies and Considerations

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1
9/11/2024
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PROF. M.HAMAM
FACULTY.KSU.EDU.SA/PROF.HAMAM
 
Treatment  planning
 
Oral diagnosis,Oral Medicine & Treatment Planning
GARY  C. COLEMAN
 
 
Definition
It is the formulation of a strategy to solve  as many of the patient’s dental problem as
possible .
The dentist must consider the following :-
1-  Diagnostic finding indicative of dental problems .
2- Possible solution to these problems.
3- The preference  of the patient while designing the best  possible treatment approach.
 
 
Listing the identified problems and their possible solutions.
The chief complaint
Such as ( pain , acute infection , bleeding and traumatic injury  )
Palliative care , to control the symptoms of a diagnosed problem .
                             ( pain killer , medication ,  antibiotic )
 1-Curative  treatment :
 a- Definitive treatment
        ( extraction , pulp  exacerbation )
      b- less urgent chief complaint  )
        ( loss restorations , pulpitis ,carious lesion )
           Zinc  oxide & eugenol cements
      c-  Cleaning  or replacing of missing teeth, can be delayed until a
definitive treatment plan is formulated
 
 
2-Medical status
Compromised  cardiovascular function , asthma , epilepsy , bleeding disorders ,
pregnancy , diabetes ,
Medical consultation
Uncontrolled  patient , ( past medical history ),
Undiagnosed  medical conditions
Laboratory  investigation  to confirm the dentist suspicion 
( undiagnosed diabetes )
3- Dental disease and conditions
Periodontitis , ( dental prophylaxis , plaque control , periodontal surgery )
Degenerative dental lesions
Carious  teeth
Pulpitis
Complications of eruption  ( orthodontic treatment  - extraction )
Missing teeth ( fixed or removable  prosthesis )
 
Determination of dental treatment goals
 
Some times , technically superior treatment plan fails
because  :-
The patients will 
refuse
 the treatment if the 
expense
 is
excessive and the procedures 
ignore
 the patient’s 
preference
An 
alternative plan 
formulated with primary
considerations for cost limitation ( lower priority )
The 
priority
 considerations that are most appropriate for
patient ( 
dental treatment goals 
) .
The dentist’s perspective  
& the 
patient’ perspective
determine these goals during the 
case presentation 
.
 
 
The patient’s perspective
1- Chief complaint .
2- The patient’s 
chief complaint 
should become the
dentist’s 
chief treatment priority 
.
3-  The patient ‘s dental expectations.
Financial  limitations .
Some patients  accept  dental treatment plan  
without  asking  the
cost  
& other  patients  prefer to keep dental 
expenses to a minimum 
.
There  are  times  when even minimal care is beyond the patient's means.
 
 
The patient’s dental altitudes
The patient’s confidence ( requires time ) .
The dentist’s knowledge ( positive experiences ) .
Early stage ( dentist – patient relationship ) become confrontational &
counterproductive 
→→→ this situation may require delaying treatment planning
until a stronger dentist – patient relationship emerges .
Alterations in treatment plans to accommodate ( fear of pain , gagging – emotional responses)
 ( premedication – sedation – Nitrous oxide – appointment times  & numbers )
 
 
The Dentist ‘s Perspective
A- the patient’s dental condition
B- prognosis
C- potential complications of dental treatment
       *  C. denture – partial  denture 
→→ gagging sensation.
         *  Infected endocarditits
       d-  Referral for specialty treatment
         e- Financial considerations  ( third parties such as  dental insurance )
 
Specific Dental Treatment Goals 
( emergency , comprehensive dental treatment )
     a- Emergency dental treatment
         extraction , palliative pulpotomy , periodontal infection control ,
            less urgent dental problems ( ill-fitting removable partial denture )
    b-  limited treatment plans in certain circumstances ( a patient might request that an
anterior tooth be restored before a special event such as a family gathering )
 
 
Dental disease control  treatment
This  treatment  goal reflects 
agreement 
 between the 
dentist 
&
 patient
that  all identified  problems 
cannot
 be solved  because of limitations
      Such as 
money
 or available  
time 
.
Tentative  dental  treatment  .
The goal of the tentative  treatment plan is to specify  initial  disease
       
control procedures  for cases  
in which the 
initial treatment  
outcome
cannot  be confidently predicted .
       * 
Tentative  treatment 
are useful in cases of advanced 
 periodontitis
and  in cases of 
extensive carious lesions
 and 
missing teeth 
( potential
of abutment teeth to function ).
       
Comprehensive  dental plan
It is goal is the decision by the patient  & dentist to plan the procedures
necessary to solve all patient ‘s  dental problems
 
 
Case  presentation
Presentation of diagnostic  findings
Presentation  of planned  treatment
Preliminary  treatment  plan
Alternative  treatment plan
Consequences of  treatment
Questions and  clarification
Reassessment  of treatment  goals
 
Setting priorities
 
The optimal treatment sequence  .
Rearrange all the treatment  procedures necessary to solve the patient ‘s
      Problem in the most logical treatment sequence .
Pretreatment phase
Physician  communication , medical & dental consultations .  lab. Investigation ,
radiograph , study models ,( before active treatment )
Phase  1
Control pain & acute infection .
Extraction of painful teeth .
Incision and drainage of abscess.
Management of traumatic injuries.
Pulpectomy
Excavation of deep carious lesions
Sedative temporary restoration .
Pulp capping procedures .
Biopsy of any lesion
 
 
Phase 11 
:- 
Treatment to control active disease ( preparatory
phase )
Scaling ,root planning and oral hygiene instruction .
Decayed removal of extensive carious lesions
Extraction of destroyable teeth .
Endodontic  procedures .
Surgical periodontal therapy .
Phase 111 
:- Restoration of esthetics and function
Operative dental restoration
Orthodontic treatment .
Prosthodontic  treatment
 
 
Phase  IV : 
Re-evaluation of treatment . ( to confirm that )
Treatment in progress
No new lesions have developed
Appliance
Follow up of home care
Phase V :  -   
 Recall
The  early identification of new lesions and oral conditions
Re-evaluate past dental treatment .
Treatment  options  for  non-dental oral problems
It depends on systemic conditions
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Prof.M.Hamam

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Dental treatment planning involves formulating a strategy to address various dental problems based on diagnostic findings, solutions, and patient preferences. This process includes identifying issues, offering solutions, considering medical status, and setting treatment goals to ensure effective care and patient satisfaction. Collaboration between dentists and patients is crucial for successful treatment outcomes.


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  1. 9/11/2024 1

  2. Treatment planning Oral diagnosis,Oral Medicine & Treatment Planning GARY C. COLEMAN PROF. M.HAMAM FACULTY.KSU.EDU.SA/PROF.HAMAM

  3. Definition It is the formulation of a strategy to solve as many of the patient s dental problem as possible . The dentist must consider the following :- 1- Diagnostic finding indicative of dental problems . 2- Possible solution to these problems. 3- The preference of the patient while designing the best possible treatment approach.

  4. Listing the identified problems and their possible solutions. The chief complaint Such as ( pain , acute infection , bleeding and traumatic injury ) Palliative care , to control the symptoms of a diagnosed problem . ( pain killer , medication , antibiotic ) 1-Curative treatment : a- Definitive treatment ( extraction , pulp exacerbation ) b- less urgent chief complaint ) ( loss restorations , pulpitis ,carious lesion ) Zinc oxide & eugenol cements c- Cleaning or replacing of missing teeth, can be delayed until a definitive treatment plan is formulated

  5. 2-Medical status Compromised cardiovascular function , asthma , epilepsy , bleeding disorders , pregnancy , diabetes , Medical consultation Uncontrolled patient , ( past medical history ), Undiagnosed medical conditions Laboratory investigation to confirm the dentist suspicion ( undiagnosed diabetes ) 3- Dental disease and conditions Periodontitis , ( dental prophylaxis , plaque control , periodontal surgery ) Degenerative dental lesions Carious teeth Pulpitis Complications of eruption ( orthodontic treatment - extraction ) Missing teeth ( fixed or removable prosthesis )

  6. Determination of dental treatment goals Some times , technically superior treatment plan fails because :- The patients will refuse the treatment if the expense is excessive and the procedures ignore the patient s preference An alternative plan formulated with primary considerations for cost limitation ( lower priority ) The priority considerations that are most appropriate for patient ( dental treatment goals ) . The dentist s perspective & the patient perspective determine these goals during the case presentation .

  7. The patients perspective 1- Chief complaint . 2- The patient s chief complaint should become the dentist s chief treatment priority . 3- The patient s dental expectations. Financial limitations . Some patients accept dental treatment plan without asking the cost & other patients prefer to keep dental expenses to a minimum . There are times when even minimal care is beyond the patient's means.

  8. The patients dental altitudes The patient s confidence ( requires time ) . The dentist s knowledge ( positive experiences ) . Early stage ( dentist patient relationship ) become confrontational & counterproductive this situation may require delaying treatment planning until a stronger dentist patient relationship emerges . Alterations in treatment plans to accommodate ( fear of pain , gagging emotional responses) ( premedication sedation Nitrous oxide appointment times & numbers )

  9. The Dentist s Perspective A- the patient s dental condition B- prognosis C- potential complications of dental treatment * C. denture partial denture gagging sensation. * Infected endocarditits d- Referral for specialty treatment e- Financial considerations ( third parties such as dental insurance ) Specific Dental Treatment Goals ( emergency , comprehensive dental treatment ) a- Emergency dental treatment extraction , palliative pulpotomy , periodontal infection control , less urgent dental problems ( ill-fitting removable partial denture ) b- limited treatment plans in certain circumstances ( a patient might request that an anterior tooth be restored before a special event such as a family gathering )

  10. Dental disease control treatment This treatment goal reflects agreement between the dentist & patient that all identified problems cannot be solved because of limitations Such as money or available time . Tentative dental treatment . The goal of the tentative treatment plan is to specify initial disease control procedures for cases in which the initial treatment outcome cannot be confidently predicted . * Tentative treatment are useful in cases of advanced periodontitis and in cases of extensive carious lesions and missing teeth ( potential of abutment teeth to function ). Comprehensive dental plan It is goal is the decision by the patient & dentist to plan the procedures necessary to solve all patient s dental problems

  11. Case presentation Presentation of diagnostic findings Presentation of planned treatment Preliminary treatment plan Alternative treatment plan Consequences of treatment Questions and clarification Reassessment of treatment goals

  12. Setting priorities The optimal treatment sequence . Rearrange all the treatment procedures necessary to solve the patient s Problem in the most logical treatment sequence . Pretreatment phase Physician communication , medical & dental consultations . lab. Investigation , radiograph , study models ,( before active treatment ) Phase 1 Control pain & acute infection . Extraction of painful teeth . Incision and drainage of abscess. Management of traumatic injuries. Pulpectomy Excavation of deep carious lesions Sedative temporary restoration . Pulp capping procedures . Biopsy of any lesion

  13. Phase 11 :- Treatment to control active disease ( preparatory phase ) Scaling ,root planning and oral hygiene instruction . Decayed removal of extensive carious lesions Extraction of destroyable teeth . Endodontic procedures . Surgical periodontal therapy . Phase 111 :- Restoration of esthetics and function Operative dental restoration Orthodontic treatment . Prosthodontic treatment

  14. Phase IV : Re-evaluation of treatment . ( to confirm that ) Treatment in progress No new lesions have developed Appliance Follow up of home care Phase V : - Recall The early identification of new lesions and oral conditions Re-evaluate past dental treatment . Treatment options for non-dental oral problems It depends on systemic conditions

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