Transcript Factors that influence treatment plans

Dr Asmaa Faden
Treatment Planning Concepts
The Dentist’s goal is to provide the best dental
treatment for each patient individually
- Gathering of Information
- Diagnosis
Treatment Planning Concepts
Treatment Plan is a strategy that may
be changed OR adjusted according to
the patients needs.
Time is needed for a successful
treatment
Prognosis
Format of Treatment Plans
Treatment Plans
General Format
Flexible Format
Format of Treatment Plans
I-General Format
Phase I
(Priority Tx)
Phase II
(Disease Control)
Phase III
(Restoring Function & Aesthetic)
Phase IV
(Re-evaluation & Re-Call)
Format of Treatment Plans
II- Flexible Format
- A rigid Tx. Plan is not suitable for All Patients
- New information during Tx.
-Tx. Plan needs modification or changes
Format of Treatment Plans
Phase I (Priority Care)
- Eliminate Pain and manage acute infections.
- If possible manage C.C.
1- Tx. of pulpally involved teeth (extraction or ER Endo).
2- Placement of Temp. restorations in teeth that have Caries near to the
Pulp.
3- Tx. of painful periodontal conditions (ANUG or Pericoronitis).
4- Diagnosis and management of suspicious bony or mucosal lesions.
5- Temp. restorations for rampant caries or caries approaching the pulp.
Format of Treatment Plans
Phase II (Disease Control)
- To control all disease processes BUT not to eradicate All
diseases.
1- Management of the C.C (if not completed in Phase I).
2- Oral hygiene instructions.
3- Most Oral Surgery.
4- Periodontics.
5- Endodontics.
6- Orthodontics.
7. Occlusal analysis.
Format of Treatment Plans
Phase III (Restoration of Function &
Aesthetics)
- Eliminate the remaining areas of decay.
- Restore the mouth to full function and aesthetics through
restorative & prosthodontics procedures.
1- Placement of amalgam or tooth-colored restorations.
2- Accomplishing all procedures necessary prior to prosthodontics.
3- Placement of crowns and fixed bridges.
4- Delivery of complete or removable partial dentures.
Format of Treatment Plans
Phase IV (Re-evaluation & Re-call)
* On completion of treatment, the patient should be re-evaluated to:
- Determine that all procedures have been completed.
- No additional treatment is indicated.
* Follow-up appointments to re-evaluate
- Endo. or perio. Treatment
* Routine re-call examinations (Check-ups).
Factors that influence treatment plans:
1- The patient’s Health
2- The patient’s Age
3- The patient’s expectations
4- Psychological Factors
5- Existing Dental Conditions
6- The Operator’s philosophy
7- The Prognosis
8- Emergency Treatment
9- Financial Considerations
Factors that influence treatment plans
1- The patient’s Health
• The medical health status of a patient may necessitate
modifications, e.g., prophylactic antibiotics.
•Precautions may include necessary medications prior to
the dental treatment, e.g., diabetic patient or patient with
heart problem.
•Modifications of treatment planned, e.g., one quadrant
per appointment.
Factors that influence treatment plans
2- The patient’s Age
•Chronologic age is a rough indicator of physiologic age,
considering the physical & emotional maturity of the
patient.
•Age can indicate the relative size of the pulp chamber.
Factors that influence treatment plans
3- The patient’s expectations
•Many factors influence the patient's expectations
regarding the dental care (Attitudes, past experiences,
financial concerns).
•Sometimes, the patients desires may be attainable or
unrealistic
•As the patient ages, list of priorities may differ.
Factors that influence treatment plans
4- Psychological Factors
•Modifications to the treatment plans according to the
patients personality may be needed.
•Treatment plan must be designed and presented to
motivate the patient to accept optimal care.
•The Chief Complaint should be managed first, to help
establish that the dentist is listening and cares.
Factors that influence treatment plans
5- Existing Dental Conditions
•The dentist should first determine a diagnosis, which
includes factors such as, the presence and absence of
caries and periodontal diseases, the location and
numbers of missing teeth.
•The dentist should consider what possible treatment for
the existing condition.
•Finally, the dentist decides which treatment option will
provide the best long-term prognosis.
Factors that influence treatment plans
6- The Operator’s philosophy
•In a situation when the dentist is given the choice
between 2 treatment alternatives, he/she is most likely to
choose the option that is consistent with her/his
philosophy of dental care with which he/she has the most
successful outcomes.
•In other cases, when treatment is beyond the ability of the
dentist the case is usually referred to a dental specialty
practice (Ortho, Endo…….)
Factors that influence treatment plans
7- The Prognosis of Proposed Dental Treatment
•The dental treatment plan should be designed with a
definitive goal concerning the longevity of the care
(Timing).
•The amount of time needed to provide comprehensive
care for one patient may not be acceptable to another.
•Generally, the prognosis for any dental reconstruction
should be at least 5 years (with the exception of
transitional dental appliances).
Factors that influence treatment plans
7- The Prognosis of Proposed Dental Treatment, cont’d
* Four levels of prognosis can be identified to make an accurate
predictions concerning the longevity of treatment plans
1- Teeth with Stable Prognosis: have no major problems, can be
maintained by Pt. indefinitely
2- Teeth with Guarded Prognosis : have problems that may
render them poor candidates for indefinite retention, but can
rely on them for an adequate length of time.
Factors that influence treatment plans
7- The Prognosis of Proposed Dental Treatment, cont’d
* Four levels of prognosis can be identified to make an accurate
predictions concerning the longevity of treatment plans
3- Teeth with Diminished Prognosis: have predictive longevities
of approximately 1 to 5 years or they are incapable of
contributing a dependable amount of support for dental
appliances.
4- Teeth with Hopeless Prognosis : are defined as teeth that
cannot be maintained and are indicated for removal.
Factors that influence treatment plans
8- Emergency Treatment
• Emergency patients may have severe pain and may insist
on extraction of teeth rather than other alternatives such
as RCT, which may result in loss of useful tooth.
•To avoid this, many dentists recommended conservative
treatment to relieve pain and to delay definitive care.
•Decisions can then be decided by the patient after a
thorough diagnosis and formulation of treatment
alternatives
Factors that influence treatment plans
9- Financial Considerations
•Financial factors should not affect the dentist’s
formulation of the best dental treatment plan.
•Modifications may be made to the plan to make it less
expensive, or to deliver only the initial phase of care and
to postponed other phases.
Alternative & Tentative Treatment Plans
Treatment plan for the patient is an OPINION of what the dentist
thinks is best for the patient.
This is because:
•The formulation of a professional opinion is the “service“
dentists provider patients.
•The dentist should not be offended if patients seek a second
opinion.
•More than one way exists to plan treatment for a patient, many
of them are acceptable.
Alternative Treatment Plans
- Alternative treatment plans are developed mainly to
provide the patient with options when finances are a
concern.
- Alternatives to treatment may be limited to
elimination of diseases, or use of different types of
treatment.
- The dentist should present the plan that is in the
patients best interest regardless to financial cost.
Alternative Treatment Plans
- Alternative treatment plans are sometimes a
necessity, but the dentist should develop other
treatment options that provide the patient with the
highest level of possible care and the best long-term
dental health potential.
Tentative Treatment Plans
- Some dental diagnosis are so complex that no
definitive treatment can be planned until the result of
intermediate therapy is determined.
-These require a tentative treatment plan, which are
vague but crucial in situations since they determine
whether the patient chooses sophisticated or
expensive treatment.
Tentative Treatment Plans
-Simple tentative plans that involve only one or two
areas of questionable treatment are much like
definitive plans and are easily explained to the
patient.
-Complex tentative plans require a great deal of
explanation (advanced periodontitis with
questionable prognosis on several potential abutment
teeth)
fixed, partial or complete dentures????
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