The ADHA has taken the position which supports the dental hygiene diagnosis, and has defined it as, “The identification of an individual’s health behaviors, attitudes, and oral health care needs for which a dental hygienist is educationally qualified and licensed to provide.” 4 The dental hygiene diagnosis, including the planning and evaluating phases… Log In or, Click to share on Twitter (Opens in new window), Click to share on Facebook (Opens in new window), Click to share on Google+ (Opens in new window), Overall health and oral care of patients and the role of endodontics within it, Dentistry may be viewed as a speciality of medicine, yet it is itself a diverse and broad discipline. As COVID-19 continues, the ADA is reminding dentists that dental care should continue during the resurgence phase of the pandemic. Now other considerations come into play, including the potential for successful outcome by conventional or surgical means, as well as the desire for correcting the discoloration. Once the treatment is completed, the patient will be recruited to a recall system to evaluate and maintain the work. Under these circumstances, the precipitation of a pulpal or periapical problem and even worse multiple problems that occur in rapid succession may cause the need for a radical review of the options. Such treatment patterns, based on clinical rationale but also shaped and influenced by business and management needs may lead to the passive application of heuristic principles to select treatment. Despite this, dedicated, active practice, with continuous proactive personal development may propel a dentist to the state of mastery of their field relative to contemporary knowledge. The textbook depiction of treatment planning commences at the first encounter with the patient, when a full assessment is made of the patient’s overall dental and oral problems. The breadth of complex restorative problems has increased in modern populations because of better general health and longer survival of people and their teeth. As the number of dental problems to be addressed increases (Fig. In the ideal scenario, each option should be evaluated in an objective way taking the above factors into account, weighing the effectiveness and projected long-term prognosis (based on outcome data) with compliance, cost and time commitment. The compromised tooth may, therefore, be retained as a suitable space maintainer until a more definitive solution can be executed. CDC has updated the Interim Infection Prevention and Control Guidance for Dental Settings During the COVID-19 Response with additional guidance and clarification for dental care during the COVID-19 pandemic. 11, JUNE 12 1999 PRACTICE tooth surface loss 1 Treatment planning R. Ibbetson 1 An effective treatment plan is dependent on gathering information from the history, exami-nation and special tests, such as radiographs and vitality testing, and analysing it to make a diag-nosis. Even under the best set of circumstances, the most complete and definitive picture of the problems may not be reached because of deficiencies in diagnostic certainty and prognostic data on treatment outcomes. 5.10a). In the case of simple dental problems, the dentist may be able to identify the problem efficiently, characterize it together with the patient’s needs and select the correct management option expeditiously. In Chart, a planned procedure can now have the Treatment Plan phase and visit indicated to automatically organize on the patient’s Treatment Plan. However, the recognition and management of the full spectrum of complex oral and dental problems requires an approach based on deeper understanding of the problem and a higher level of engagement of cognitive, technical and clinical skills, acquired through specific advanced training. Unfortunately, some dental practitioners take the receipt of. If the tooth is not restoratively compromised and the root is mature, the high prevalence of pulp necrosis in such cases may lean the decision towards root-canal treatment and the appropriate restoration as having a high chance of success (Fig. It may progress as follows: 1. Many dental or oral problems may be managed in different ways depending on the judgement about the presence, progression and morbidity of the disease, the options available for management and the needs of the patient. Apart from feasibility, the cost and long-term priorities of the patient have to be weighed. The foregoing also means that a dentist uncomfortable with the practice of dentistry and seeking escape into a limited area of practice because it is their area of greatest comfort will seldom make the rounded clinician that a good endodontist should be. If you are concerned about the cost, many resources like the American Dental Association can help you budget for and afford treatment. The factors influencing the decision-making process are many and can be classified into general patient factors, professional background and philosophy of the dentist, general oral and dental condition, and local factors related to the problem tooth (teeth). 5.6a). In the event that the traumatic injury in such circumstances is accompanied by severe coronal tooth fracture, the restorative prognosis may be further jeopardized (Fig. The dentist must understand clearly (defining the problem) what the patient expects at the first level. The vagaries and subtleties that lead to differences in management approach may cause patient dissatisfaction, which sometimes (and in contemporary society increasingly frequently) leads to legal action. Fig. Many dental offices also offer payment plans or financing to coordinate with any dental insurance to make care more affordable. A recent health economic study using a Markov model evaluating the cost-effectiveness of clinical intervention over the life-time of an adult patient revealed that root-canal treatment is highly cost-effective as a first line intervention for a maxillary central incisor. However, the recognition and management of the, Conversely, the knowledge and skills of endodontics must be deployed judiciously to ensure that the patient receives appropriate care, meaning that the specialist must also understand the broader context within which their expertise is exercised. On the whole, this approach probably works when preceded by active learning through assessment of personal outcomes over a lengthy period. All rights reserved. Such a plan of action is not uncommon both in unrestored mouths and in those that are heavily restored and on the borderland of catastrophic transition to a different, perhaps partially edentulous state. In simple terms, this means that the dentist should be well versed in all aspects of dentistry, understanding the role of each aspect in overall patient management, as well as being aware of potential overlaps and interactions between the subdisciplines. Temporomandibular joint (TMJ) an… Conscientious dentists, therefore, strive for improvement throughout their professional lives in what has now become formally recognized as continuing professional development (CPD). TREATMENT PLAN 2. The dentist must gauge the problems correctly, as well as the patient’s attitude, motivation and compliance. 5.7 (a) Traumatized maxillary incisor; (b) maxillary incisor following endodontic treatment. Many dental or oral problems may be managed in different ways depending on the judgement about the presence, progression and morbidity of the disease, the options available for management and the needs of the patient. This may be defined as a strategic list or maybe detailed by visit. The Acute Phase of Treatment 7. Dentistry may be viewed as a speciality of medicine, yet it is itself a diverse and broad discipline. Surviving teeth are more ravaged by repair of disease and wear and tear. Dental treatment planning is one of the greatest challenges that come to correct smile and teeth alignment. 5.11 (a) Sclerosed canal in central incisor managed by apicectomy and root-end filling; (b) the treatment failed and required a further procedure when />, Only gold members can continue reading. This implies an ongoing process of information exchange and informed consent whereby the full extent of risks and benefits are shared and acted upon. If, under the same circumstances, the patient was younger with an incompletely formed root, the decision may now lean towards the more conservative vital pulp therapy (Fig. In the context of a healthcare profession, the “endodontist” must, therefore be a human being first, dentist second and endodontist last (, Hierarchical importance of knowledge context, Treatment option selection and treatment planning, Treatment planning, as the term implies, is the planning of the management of a patient’s dental and oral problems in a systematic and ordered way that assumes a complete knowledge of the patient’s needs, the precise nature of the problems and the prognoses of possible management options under consideration. The aim of this chapter is to highlight the factors important in planning the endodontic management of pulpal and periradicular diseases and how to prioritize them in the context of the patient’s overall dental and oral needs. This article is intended to promote understanding of and knowledge about general oral health topics. The vagaries of decision making are further defined and explored by examining different case scenarios based on a relatively simple problem. In the case of complex dental problems, it may be rare for both patient and dentist to develop such complete pictures of the problems and outcomes of restorative options as early as the first consultation. NB: the relative cost may change depending on contemporary and local trends. TREATMENT PLAN Development of a treatment plan is the most critical step in the successful future management of the patient DIAGNOSIS- … In a Nov. 20 email to members, ADA President Daniel J. Klemmedson, D.D.S., M.D., addressed a question that has been on the minds of dentists everywhere: would the ADA once again recommend that dental … The dentist must be aware of the potential for such problems and be prepared to take appropriate action to circumvent them. 5.4). On the whole, this approach probably works when preceded by active learning through assessment of personal outcomes over a lengthy period. The dentist will have been trained, by necessity, to recognize only the commonly presenting tendencies in each disease. Fig. Learn how each stage impacts treatment planning and case presentation and how they compare with Maslow’s hierarchy of needs. Their frame of reference extends no further than the teachings at undergraduate level. It is not intended to be a substitute for professional advice, diagnosis or treatment. Orthograde retreatment is also cost-effective, if a root-canal treatment subsequently fails, but surgical retreatment is not. 5.10d). Problems in the oral cavity can lead to (or be caused by) medical problems. Since these become important legal records, their composition demands appropriate care and professionalism. , not the internet, is the responsibility on each dentist to be clear and communication. 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