# Developing the Treatment plan. **DENT 4215- Introduction to Clinical Dental Practice** - Manorika Ratnaweera **DENT 4215- Introduction to Clinical Dental Practice** - Manorika Ratnaweera **Acknowledgement of country** The University of Western Australia acknowledges that its campus is situated on Noongar land, and that Noongar people remain the spiritual and cultural custodians of their land, and continue to practise their values, languages, beliefs and knowledge. Artist: **Dr Richard Barry Walley OAM** **Acknowledgement of country** The University of Western Australia acknowledges that its campus is situated on Noongar land, and that Noongar people remain the spiritual and cultural custodians of their land, and continue to practise their values, languages, beliefs and knowledge. Artist: **Dr Richard Barry Walley OAM** **Learning outcome** 3. Compose and implement initial treatment Plans to prepare patients for further dental treatment. **Learning outcome** 3. Compose and implement initial treatment Plans to prepare patients for further dental treatment. Learning objectives 1. Develop fundamental knowledge necessary to begin creating treatment plans for patients 2. Documenting treatment plans **CURA USG ENERGY WISDOM** THE UNIVERSITY OF WESTERN AUSTRALIA Learning objectives 1. Develop fundamental knowledge necessary to begin creating treatment plans for patients 2. Documenting treatment plans <table> <tr> <td><b>Information gathering</b></td> <td>→</td> <td>• Patient history<br>• Radiographic examination<br>• Clinical examination<br>• Diagnostic aids</td> </tr> <tr> <td>↓</td> <td></td> <td>→ Evaluation of findings</td> </tr> <tr> <td>←</td> <td>→</td> <td>Significant findings</td> </tr> <tr> <td>↑</td> <td>→ Risk analysis</td> <td>→ Comprehensive diagnosis</td> </tr> </table>  - Information gathering - Patient history - Radiographic examination - Clinical examination - Diagnostic aids - ↓ Evaluation of findings - ← Significant findings - ↑ Risk analysis → Comprehensive diagnosis Flowchart illustrating a diagnostic process. The diagram consists of rectangular boxes connected by blue arrows indicating the flow of information and analysis. The top box is labeled 'Information gathering' which points to a larger box listing four bullet points: 'Patient history', 'Radiographic examination', 'Clinical examination', and 'Diagnostic aids'. This group leads down to 'Evaluation of findings'. An arrow from this evaluation box points left to 'Significant findings'. From 'Significant findings', an arrow points up to 'Comprehensive diagnosis' (in red text) and another arrow points right to 'Risk analysis'. A final arrow connects 'Risk analysis' back towards the comprehensive diagnosis path. # Diagnosis * **Definitive diagnosis:** When several findings point clearly to a specific disease entity * **Differential diagnosis:** when the findings suggest several possible conditions, the process of distinguishing among the list of possibilities * **Tentative diagnosis:** When the diagnosis is uncertain, but it is prudent to begin some type of treatment #### Diagnosis - **Definitive diagnosis:** When several findings point clearly to a specific disease entity - **Differential diagnosis:** when the findings suggest several possible conditions, the process of distinguishing among the list of possibilities - **Tentative diagnosis:** When the diagnosis is uncertain, but it is prudent to begin some type of treatment | Comprehensive diagnosis list | | --- | | Patient modifiers | Practitioner modifiers | | --- | --- | | • Interest in OH | • “Ideal treatment plan” | | • Can afford | • Removing disease | | • Regular attender | • Correct treatment for each problem | | • Lack of interest in OH | • In a correct sequence | | • Cannot afford | • Select best material | | • Fear of dentistry | • Efficient in time | | • Poor motivation | Informed consent | | | Treatment plan(s) |  **Patient modifiers:** - Interest in OH - Can afford - Regular attender - Lack of interest in OH - Cannot afford - Fear of dentistry - Poor motivation **Practitioner modifiers:** - "Ideal treatment plan" - Removing disease - Correct treatment for each problem - In a correct sequence - Select best material - Efficient in time Informed consent Treatment plan(s) A flowchart illustrating the clinical workflow for creating a treatment plan. The diagram begins at the top with 'Comprehensive diagnosis list' and flows downwards through 'Treatment objectives'. In the middle section, two columns of modifiers branch out: 'Patient modifiers' (listing factors like interest in OH, affordability, attendance, fear, and motivation) and 'Practitioner modifiers' (listing goals such as ideal treatment plans, disease removal, correct sequence, material selection, and time efficiency). These modifiers interact via a horizontal double-headed arrow. The flow then converges to 'Informed consent' and concludes at the bottom with 'Treatment plan(s)'. Blue arrows indicate the primary vertical progression, while a horizontal arrow connects the patient and practitioner considerations. Treatment Objectives 8  Treatment Objectives Clinical comparison figure labeled 'Treatment Objectives'. Left panel (A) shows a patient's oral cavity with severe dental caries, missing teeth, and gingival inflammation. Right panel (B) shows the same patient after treatment with restored dentition. ### Treatment Plan "...is a carefully sequenced series of services designed to eliminate or control etiological factors, repair existing damage and create a functional maintainable environment." Sturdevant 1995 - Created as a response to the problem list - The schedule and sequence of the treatment - Developing a course of action that encompasses the ramifications and sequelae of treatment to serve patients’ needs ### Slide Number: 9 #### Treatment Plan "...is a carefully sequenced series of services designed to eliminate or control etiological factors, repair existing damage and create a functional maintainable environment." Sturdevant 1995 - Created as a response to the problem list - The schedule and sequence of the treatment - Developing a course of action that encompasses the ramifications and sequelae of treatment to serve patients’ needs Treatment plan Why do we need a treatment plan? * Address patient’s problem/s * Sequence and prioritise * Estimates of costs * Informed consent * Record keeping * Medico-Legal requirement * Communication with other clinicians 10 #### Why do we need a treatment plan? - Address patient’s problem/s - Sequence and prioritise - Estimates of costs - Informed consent - Record keeping - Medico-Legal requirement - Communication with other clinicians Developing the treatment plan(s) 1. Systemic phase 2. Acute phase 3. Disease Control phase 4. Definite phase 5. Maintenance phase #### Developing the treatment plan(s) 1. Systemic phase 2. Acute phase 3. Disease Control phase 4. Definite phase 5. Maintenance phase 1. Systemic phase of treatment planning 1. To evaluate the severity and complexity of health issues and to assess how this may affect dental treatment 2. Recognize signs and symptoms of undiagnosed conditions and refer patient to physician for evaluation 3. To limit or modify dental treatment based on systemic findings 4. To prevent adverse outcomes - Emergencies in the dental office - To prevent serious postoperative complications in conjunction with dental treatment Ex: antibiotic prophylaxis for high-risk dental procedures for specific medical conditions #### Systemic Phase of Treatment Planning 1. To evaluate the severity and complexity of health issues and to assess how this may affect dental treatment 2. Recognize signs and symptoms of undiagnosed conditions and refer patient to physician for evaluation 3. To limit or modify dental treatment based on systemic findings 4. To prevent adverse outcomes - Emergencies in the dental office - To prevent serious postoperative complications in conjunction with dental treatment - Ex: antibiotic prophylaxis for high-risk dental procedures for specific medical conditions | | | | :--- | :--- | | **ASA 1** | Normal healthy person | | **ASA 2** | Well controlled DM, hypertension (HTN), asthma, mild obesity, pregnancy, smoker, extreme anxiety | | **ASA 3** | Stable angina, post MI, poorly controlled HTN, massive obesity, respiratory disease with symptoms | | **ASA 4** | unstable angina, liver failure, CCF, End stage renal disease |  | ASA Class | Description | |-----------|-------------| | ASA 1 | Normal healthy person | | ASA 2 | Well controlled DM, hypertension (HTN), asthma, mild obesity, pregnancy, smoker, extreme anxiety | | ASA 3 | Stable angina, post MI, poorly controlled HTN, massive obesity, respiratory disease with symptoms | | ASA 4 | unstable angina, liver failure, CCF, End stage renal disease | Table: A structured table displaying the American Society of Anesthesiologist (ASA) physical status classification. The table has two columns: 'ASA' and a description column. Rows include ASA 1 (Normal healthy person), ASA 2 (Well controlled DM, hypertension (HTN), asthma, mild obesity, pregnancy, smoker, extreme anxiety), ASA 3 (Stable angina, post MI, poorly controlled HTN, massive obesity, respiratory disease with symptoms), and ASA 4 (unstable angina, liver failure, CCF, End stage renal disease). • Postponing or limiting treatment -ex: uncontrolled hypertension, INR levels, antibiotics prophylaxis, unstable angina. • Consultation with physician -Presidenting or altering patient medication -Managing Hypertension -When systemic disease suspected in dental office • Stress Management (cardiac disease, diabetes, unstable angina, adrenal disorders) • Positioning the patient in dental chair - Postponing or limiting treatment (e.g., uncontrolled hypertension, INR levels, antibiotic prophylaxis, unstable angina) - Consultation with physician - Prescribing or altering patient medication - Managing hypertension - When systemic disease suspected in dental office - Stress Management (cardiac disease, diabetes, unstable angina, adrenal disorders) - Positioning the patient in dental chair <table> <tr> <th>Little to no risk</th> <th>Oral examination, radiographs, study models</th> </tr> <tr> <th>Low risk</th> <th>Local anesthesia, simple restoration, prophylaxis, asymptomatic endodontic, simple extraction, orthodontic</th> </tr> <tr> <th>Medium risk</th> <th>Symptomatic endodontic, multiple extraction, single implant, deep scaling and root planning</th> </tr> <tr> <th>High risk</th> <th>Extensive surgical, multiple implant, G/A</th> </tr> </table>  <table> <tr> <th>Little to no risk</th> <th>Oral examination, radiographs, study models</th> </tr> <tr> <th>Low risk</th> <th>Local anesthesia, simple restoration, prophylaxis, asymptomatic endodontic, simple extraction, orthodontic</th> </tr> <tr> <th>Medium risk</th> <th>Symptomatic endodontic, multiple extraction, single implant, deep scaling and root planning</th> </tr> <tr> <th>High risk</th> <th>Extensive surgical, multiple implant, G/A</th> </tr> </table> A table titled 'Risk categories for selected dental procedures'. It contains four rows categorizing dental procedures by risk level: Little to no risk (Oral examination, radiographs, study models), Low risk (Local anesthesia, simple restoration, prophylaxis, asymptomatic endodontic, simple extraction, orthodontic), Medium risk (Symptomatic endodontic, multiple extraction, single implant, deep scaling and root planning), and High risk (Extensive surgical, multiple implant, G/A). # 2. Acute phase of treatment planning * Acute phase of care incorporates diagnostic and treatment procedures aimed at solving urgent oral problems. * Patients who may need acute care - Those under active treatment - On maintenance recall - New to dental practice - Returning to practice after being away for some length of time 2. Acute phase of treatment planning * Acute phase of care incorporates diagnostic and treatment procedures aimed at solving urgent oral problems. * Patients who may need acute care - Those under active treatment - On maintenance recall - New to dental practice - Returning to practice after being away for some length of time # **Difference** **between** **emergency** **problem** and **urgent** **problem** ### • *Emergency* problem: incapacitates the patient and has the potential to become a life-threatening condition **Ex:** Swelling, systemic infection, trauma to face or jaws ### • *Urgent* problem: does not require **immediate** attention but the dentist or the patient thinks should be attended to “**now**” or “**soon**” **Ex:** Mild to moderate pain without active infection **Difference** **between** **emergency** **problem** and **urgent** **problem** ### • *Emergency* problem: incapacitates the patient and has the potential to become a life-threatening condition **Ex:** Swelling, systemic infection, trauma to face or jaws ### • *Urgent* problem: does not require **immediate** attention but the dentist or the patient thinks should be attended to “**now**” or “**soon**” **Ex:** Mild to moderate pain without active infection Common acute problems and diagnoses **Complaint of pain** * pulpal or periapical origin * associated with periodontal tissues * -periodontal abscess * -NUG * associated with tooth eruption or pericoronitis * associated with previous dental treatment * Other sources of pain: * -Herpetic ulcers * -traumatic ulcers * -stomatitis * -TMJ disorders * -trigeminal neuralgia * -acute sinusitis. * -Complaint of swelling * -Aesthetic complaints * -Traumatic injury * Trauma to teeth/soft tissues * Jawbone fractures * Osteomyelitis * -Other forms of oral pathology- * lesions that require * biopsy, consultation or referral Common acute problems and diagnoses **Complaint of pain** * pulpal or periapical origin * associated with periodontal tissues * -periodontal abscess * -NUG * associated with tooth eruption or pericoronitis * associated with previous dental treatment * Other sources of pain: * -Herpetic ulcers * -traumatic ulcers * -stomatitis * -TMJ disorders * -trigeminal neuralgia * -acute sinusitis. * -Complaint of swelling * -Aesthetic complaints * -Traumatic injury * Trauma to teeth/soft tissues * Jawbone fractures * Osteomyelitis * -Other forms of oral pathology- * lesions that require * biopsy, consultation or referral # Treatment planning for acute phase * Short term therapies within your competency * Long term implications of the short-term therapies or options * Factors influencing treatment decisions: -Professional factors -Patient factors and modifiers -Combination factors Treatment planning for acute phase * Short term therapies within your competency * Long term implications of the short-term therapies or options * Factors influencing treatment decisions: -Professional factors -Patient factors and modifiers -Combination factors **Acquiring CONSENT for acute care** * Informed consent for an acute care treatment plan requires that the patient must be fully aware of: 1. The diagnosis 2. All reasonable treatment options 3. Risks and the benefits of each option 4. Nature of the recommended treatment 5. Costs of that treatment – present & future. **Acquiring CONSENT for acute care** * Informed consent for an acute care treatment plan requires that the patient must be fully aware of: 1. The diagnosis 2. All reasonable treatment options 3. Risks and the benefits of each option 4. Nature of the recommended treatment 5. Costs of that treatment – present & future. Referral/Deferral * The problem or the offending tooth cannot be identified. * The patient has a compromising systemic condition that precludes treatment at this time. * **The patient has an active infection** * Patient is unwilling or unable to provide consent to treatment * In some situations, it is not only prudent but also preferable to prescribe medications rather than initiate treatment Referral/Deferral * The problem or the offending tooth cannot be identified. * The patient has a compromising systemic condition that precludes treatment at this time. * **The patient has an active infection** * Patient is unwilling or unable to provide consent to treatment * In some situations, it is not only prudent but also preferable to prescribe medications rather than initiate treatment # 3. Disease control ## phase of treatment ### planning - Eradicate active disease and infection - Arrest occlusal, functional, and esthetic deterioration - Address, control or eliminate causes and risk factors for future disease. - The disease control phase is indicated in a patient with high risk factors for that particular disease. 3. Disease control phase of treatment ### planning - Eradicate active disease and infection - Arrest occlusal, functional, and esthetic deterioration - Address, control or eliminate causes and risk factors for future disease. - The disease control phase is indicated in a patient with high risk factors for that particular disease. # Disease control phase * Also called Stabilisation phase * Not necessary when * oral disease is **controlled** * oral disease will be **eliminated** during definitive treatment. * Includes plans for * **Management** of active disease or infection * **Stabilization** of disease/teeth status prior to definitive reconstruction * **Modify/Eliminate** risk factors that predispose the patient to the development of recurrent oral disease. Disease control phase * Also called Stabilisation phase * Not necessary when * oral disease is **controlled** * oral disease will be **eliminated** during definitive treatment. * Includes plans for * **Management** of active disease or infection * **Stabilization** of disease/teeth status prior to definitive reconstruction * **Modify/Eliminate** risk factors that predispose the patient to the development of recurrent oral disease. # Disease control phase - Address the patient’s chief complain as early in the plan as possible - Sequence by priority—preferably treating the most severe and urgent needs first = provisional / protective restorations - Sequence by quadrant/sextant - Integrate periodontal therapy into the disease control phase plan - Keep definitive phase options open with minimalist treatment in the disease control phase. = Generally, however, only those procedures necessary to arrest the deterioration and prevent further infection should be undertaken in the disease control phase. Disease control phase - Address the patient’s chief complain as early in the plan as possible - Sequence by priority—preferably treating the most severe and urgent needs first = provisional / protective restorations - Sequence by quadrant/sextant - Integrate periodontal therapy into the disease control phase plan - Keep definitive phase options open with minimalist treatment in the disease control phase. = Generally, however, only those procedures necessary to arrest the deterioration and prevent further infection should be undertaken in the disease control phase. **Disease Control Phase – Structure** ## 1. **Education** - Aetiology, prevention and home treatment for dental conditions - Patients roles and responsibilities - Oral hygiene product education/advice (Type,tech, freq) - Smoking cessation (ask, assess, assist) - Chemotherapeutics ## 2. **NSPT** - Plaque control - Debridement, prophy - Manage risk factors - Review, referral to periodontist if required ## 3. **Caries management** ## 4. **Remineralisation therapy** ## 5. **Defective restorations** ## 6. **Extraction/referral**  **Disease Control Phase – Structure** 1. **Education** - Aetiology, prevention and home treatment for dental conditions - Patients roles and responsibilities - Oral hygiene product education/advice (Type,tech, freq) - Smoking cessation (ask, assess, assist) - Chemotherapeutics 2. **NSPT** - Plaque control - Debridement, prophy - Manage risk factors - Review, referral to periodontist if required 3. **Caries management** 4. **Remineralisation therapy** 5. **Defective restorations** 6. **Extraction/referral** Cartoon illustration of a dental professional standing next to a large tooth character inside a dental chair. The dentist is wearing a white coat and blue cap, smiling while holding the tooth's hand. The tooth has a happy expression with rosy cheeks. In the background, there is a dental cabinet with drawers, a potted plant, an X-ray monitor showing a molar, and a dental lamp. Disease control – Caries Management System • Basic caries control protocol -Caries activity tests, diagnosis and risk assessment -Oral prophylaxis -Oral self care instructions/coaching -Saliva substitutes/stimulation -Remineralisation (in clinic and home care) -Chemotherapeutics -Diet/nutrition analysis -Food diary – look at freq & duration (acids and sucrose) -Restore carious lesions -Sealants on susceptible pits and fissures. -Reassessment Disease control – Caries Management System • Basic caries control protocol -Caries activity tests, diagnosis and risk assessment -Oral prophylaxis -Oral self care instructions/coaching -Saliva substitutes/stimulation -Remineralisation (in clinic and home care) -Chemotherapeutics -Diet/nutrition analysis -Food diary – look at freq & duration (acids and sucrose) -Restore carious lesions -Sealants on susceptible pits and fissures. -Reassessment # Oral disease risk status * **Caries** risk – CAMBRA * **Periodontal** risk - **http://www.perio-tools.com/PRA/en/index.asp** * **Oral cancer** **risk** - Oral Mucosal Malignancies, Contemporary Oral Medicine. 2018:1249–1436. * **Tooth wear** risk -BEWE **http://www.erosivetoothwear.co.uk/page/knowledge_base** Oral disease risk status * **Caries** risk – CAMBRA * **Periodontal** risk - **http://www.perio-tools.com/PRA/en/index.asp** * **Oral cancer** **risk** - Oral Mucosal Malignancies, Contemporary Oral Medicine. 2018:1249–1436. * **Tooth wear** risk -BEWE **http://www.erosivetoothwear.co.uk/page/knowledge_base** - Re-Evaluation phase (Holding phase) - the **time** between the control and definitive phases that allows for resolution of inflammation and time for **healing**. - Home care habits are reinforced, motivation for further treatment is assessed, and initial treatment and pulpal responses are re-evaluated before definitive care is begun. - Re-Evaluation phase (Holding phase) - the **time** between the control and definitive phases that allows for resolution of inflammation and time for **healing**. - Home care habits are reinforced, motivation for further treatment is assessed, and initial treatment and pulpal responses are re-evaluated before definitive care is begun. 4. Definitive phase of treatment - Core of treatment plan. - Before engaging in definitive phase treatment, the practitioner should affirm that: - Disease controlled. - All reasonable definitive phase treatment options and costs evaluated and discussed with the patient. - Informed consent with the patient. 4. Definitive phase of treatment - Core of treatment plan. - Before engaging in definitive phase treatment, the practitioner should affirm that: - Disease controlled. - All reasonable definitive phase treatment options and costs evaluated and discussed with the patient. - Informed consent with the patient. Common definitive phase treatment 1. Periodontal therapy -surgical /other 2. Orthodontic treatment 3. Restorative Dentistry - multi surface restorations / Indirect restorations - occlusal assessment and treatment - esthetical procedures 4. Endodontic procedures –elective 5. Extractions (3rd Molar) and pre-prosthetic procedures 6. Prosthodontics assessment and treatment - Replacement of missing teeth - Indication for the need of a crown, bridge, implant, dentures - Denture assessment and treatment 7. Specialist care Common definitive phase treatment 1. Periodontal therapy -surgical /other 2. Orthodontic treatment 3. Restorative Dentistry - multi surface restorations / Indirect restorations - occlusal assessment and treatment - esthetical procedures 4. Endodontic procedures –elective 5. Extractions (3rd Molar) and pre-prosthetic procedures 6. Prosthodontics assessment and treatment - Replacement of missing teeth - Indication for the need of a crown, bridge, implant, dentures - Denture assessment and treatment 7. Specialist care **Restoring individual teeth** * Involve patient/parent in decision making * Clinicians’ role to determine reasonable and feasible treatment options * Professional considerations * Diagnosis * Prognosis (Is a prediction, estimation of the likelihood of a favorable outcome for a disease; could be: Excellent, Good, Favorable, Unfavorable, Poor) * Likelihood of remineralisation * Caries risk status * Disease control phases * Cost, patient expectations * Materials, outcomes, implications **Restoring individual teeth** * Involve patient/parent in decision making * Clinicians’ role to determine reasonable and feasible treatment options * Professional considerations * Diagnosis * Prognosis (Is a prediction, estimation of the likelihood of a favorable outcome for a disease; could be: Excellent, Good, Favorable, Unfavorable, Poor) * Likelihood of remineralisation * Caries risk status * Disease control phases * Cost, patient expectations * Materials, outcomes, implications **Orthodontic treatment** * Dentist role to identify if referral for orthodontic assessment is required. * Usually, elective treatment * Aesthetic or function * Malocclusions * Impacted teeth * Anterior open bite * Skeletal abnormalities * Referral for orthodontic assessment by an orthodontist. **Orthodontic treatment** * Dentist role to identify if referral for orthodontic assessment is required. * Usually, elective treatment * Aesthetic or function * Malocclusions * Impacted teeth * Anterior open bite * Skeletal abnormalities * Referral for orthodontic assessment by an orthodontist. • Periodontist: Dentists should be able to identify if referral to a periodontist is required • Prosthodontist: Fixed prosthodontics, removable prosthodontics, Implants • Paedodontist: Dentists should be able to identify if referral to a paedodontist is required • Special care dentist: Dentists should be able to identify if referral to a specialist is required • Other specialists • Periodontist: Dentists should be able to identify if referral to a periodontist is required • Prosthodontist: Fixed prosthodontics, removable prosthodontics, Implants • Paedodontist: Dentists should be able to identify if referral to a paedodontist is required • Special care dentist: Dentists should be able to identify if referral to a specialist is required • Other specialists 5. Maintenance phase - The long-term success or failure of the plan depends on it. - **Prevention of future problems is the guiding principle of the maintenance phase, and it is the responsibility of the entire dental team.** - Made on an individual basis - Is made at the conclusion of the disease control phase of treatment and definitive phases - Can be modified 5. Maintenance phase - The long-term success or failure of the plan depends on it. - **Prevention of future problems is the guiding principle of the maintenance phase, and it is the responsibility of the entire dental team.** - Made on an individual basis - Is made at the conclusion of the disease control phase of treatment and definitive phases - Can be modified # Rationale for including a maintenance phase in the treatment plan **Purpose of maintenance phase**: - Ensure long term oral health - Optimum function - Favorable esthetics for the patient. - Maintain stable clinical attachment levels (Lang & Tonetti, 2003) **Benefits of maintenance phase** - Address issues that remain unresolved after the definitive phase of treatment Rationale for including a maintenance phase in the treatment plan **Purpose of maintenance phase**: - Ensure long term oral health - Optimum function - Favorable esthetics for the patient. - Maintain stable clinical attachment levels (Lang & Tonetti, 2003) **Benefits of maintenance phase** - Address issues that remain unresolved after the definitive phase of treatment | Elements for post treatment assessment | | | Patient concerns/expectations met | | | Patient response to treatment | | | Medical and Medication History update | | | Clinical examination, re-evaluation, diagnosis | Check notes from last exam | | Update radiographs | Based on need or protocol | | Periodontal condition | | | Occlusal /functional status | | | Caries/restorative condition of teeth | | | Disease risk | *Status and severity* | | Risk factors | *Predisposing and modifying* | | Preventive recommendations, motivation | *In clinic and at home remin, smoking cessagtion, OHE* | | Remaining or new treatment required | *May include retreating* | | Re-establish recall interval | based on risk and need |  | Elements for post treatment assessment | | | Patient concerns/expectations met | | | Patient response to treatment | | | Medical and Medication History update | | | Clinical examination, re-evaluation, diagnosis | Check notes from last exam | | Update radiographs | Based on need or protocol | | Periodontal condition | | | Occlusal /functional status | | | Caries/restorative condition of teeth | | | Disease risk | *Status and severity* | | Risk factors | *Predisposing and modifying* | | Preventive recommendations, motivation | *In clinic and at home remin, smoking cessagtion, OHE* | | Remaining or new treatment required | *May include retreating* | | Re-establish recall interval | based on risk and need | Table titled 'Elements for post treatment assessment'. The table lists key components of a post-treatment dental evaluation. It includes rows for Patient concerns/expectations met, Patient response to treatment, Medical and Medication History update, Clinical examination/re-evaluation/diagnosis (with note to check notes from last exam), Update radiographs (based on need or protocol), Periodontal condition, Occlusal/functional status, Caries/restorative condition of teeth, Disease risk (status and severity), Risk factors (predisposing and modifying), Preventive recommendations/motivation (in clinic and at home remin, smoking cessation, OHE), Remaining or new treatment required (may include retreating), and Re-establish recall interval (based on risk and need). # Treatment (Plan) outcomes > Patient + clinician = disease is controlled, dentition is functional, stable and of acceptable aesthetics > Specific tangible results of treatment > Closely linked to: -risk assessment and prognosis determination  Treatment (Plan) outcomes > Patient + clinician = disease is controlled, dentition is functional, stable and of acceptable aesthetics > Specific tangible results of treatment > Closely linked to: -risk assessment and prognosis determination A stacked diagram consisting of three rounded rectangular blocks representing the hierarchy of 'Treatment (Plan) outcomes'. The top orange block defines the goal: 'Patient + clinician = disease is controlled, dentition is functional, stable and of acceptable aesthetics'. The middle reddish-brown block states: 'Specific tangible results of treatment'. The bottom grey block indicates these are 'Closely linked to: -risk assessment and prognosis determination'. # Summary ## I. Systemic treatment A. Consultation with patient's healthcare provider B. Premedication C. Stress and fear management D. Special positioning of the patient E. Any necessary treatment considerations for systemic disease 38  Summary I. Systemic treatment A. Consultation with patient's healthcare provider B. Premedication C. Stress and fear management D. Special positioning of the patient E. Any necessary treatment considerations for systemic disease 38 Cartoon photo depicting a dental procedure scene. It features the character Mr. Bean seated in a dentist's chair, extending his hand towards a dentist who is holding dental tools connected by a red cord. The image visually demonstrates the 'Special positioning of the patient' mentioned in section D of the summary text. # Summary ## II. Acute treatment A. Emergency treatment for pain or infection B. Treatment of the urgent chief complaint when possible <img>Dentist cartoonist holding a giant tooth pincers "That came as a shock to everyone" - evlad.com ending of page (39)<img>  Summary II. Acute treatment A. Emergency treatment for pain or infection B. Treatment of the urgent chief complaint when possible <img>Dentist cartoonist holding a giant tooth pincers "That came as a shock to everyone" - evlad.com ending of page (39)<img> Dentist cartoon showing a dentist holding giant tooth pincers with a large tooth inside. The patient is sitting in the dental chair looking shocked. Summarizes disease control in dentistry including caries removal, extraction, periodontal care, caries control, and endodontic therapy, accompanied by a cartoon on the right showing a patient in a dental chair responding "GAH, HUH... YOUR TEETH? GAH." to the dentist asking "Do you floss?", with a cartoonish dental light in the top right. Summary III. Disease control A. Caries removal to determine restorability of questionable teeth B. Extraction of hopeless or problematic teeth 1. Possible provisional replacement of teeth C. Periodontal disease control 1. Oral hygiene instruction 2. Initial therapy a. Scaling and root planning, prophylaxis b. Controlling other contributing factors (1) Replace defective restorations, remove caries (2) Reduce or eliminate parafunctional habits, smoking D. Caries control 1. Caries risk assessment 2. Provisional (temporary) restorations 3. Definitive restorations (i.e., amalgam, composite, glass ionomers)  Summarizes disease control in dentistry including caries removal, extraction, periodontal care, caries control, and endodontic therapy, accompanied by a cartoon on the right showing a patient in a dental chair responding "GAH, HUH... YOUR TEETH? GAH." to the dentist asking "Do you floss?", with a cartoonish dental light in the top right. Summary III. Disease control A. Caries removal to determine restorability of questionable teeth B. Extraction of hopeless or problematic teeth 1. Possible provisional replacement of teeth C. Periodontal disease control 1. Oral hygiene instruction 2. Initial therapy a. Scaling and root planning, prophylaxis b. Controlling other contributing factors (1) Replace defective restorations, remove caries (2) Reduce or eliminate parafunctional habits, smoking D. Caries control 1. Caries risk assessment 2. Provisional (temporary) restorations 3. Definitive restorations (i.e., amalgam, composite, glass ionomers) Cartoon figure showing a dentist sitting on a rolling stool next to a dental chair where a patient is reclining. The dentist holds a tool near the patient's mouth and asks 'Do you floss?'. Speech bubbles show the patient responding with confusion: 'GAH HUH...', 'YOUR TEETH?', and 'GAH.'. A cartoonish dental light hangs in the top right corner. summarizes definitive treatment steps: - A. Advanced periodontal therapy - B. Stabilize occlusion (vertical dimension of occlusion, anterior guidance, and plane of occlusion) - C. Orthodontic and/or orthognathic surgical treatment - D. Occlusal adjustment - E. Esthetic dentistry (i.e., tooth whitening, esthetic restorations) - F. Definitive restoration of individual teeth (direct/indirect) 1. For endodontically treated teeth 2. For key teeth 3. Other teeth - G. Elective extraction of asymptomatic teeth - H. Replacement of missing teeth 1. Fixed partial dentures, implants 2. Removable partial dentures 3. Complete dentures - I. Posttreatment assessment  summarizes definitive treatment steps: - A. Advanced periodontal therapy - B. Stabilize occlusion (vertical dimension of occlusion, anterior guidance, and plane of occlusion) - C. Orthodontic and/or orthognathic surgical treatment - D. Occlusal adjustment - E. Esthetic dentistry (i.e., tooth whitening, esthetic restorations) - F. Definitive restoration of individual teeth (direct/indirect) 1. For endodontically treated teeth 2. For key teeth 3. Other teeth - G. Elective extraction of asymptomatic teeth - H. Replacement of missing teeth 1. Fixed partial dentures, implants 2. Removable partial dentures 3. Complete dentures - I. Posttreatment assessment A cartoon figure depicting a dental patient sitting in a chair with an open mouth while a dentist wearing a surgical mask examines the teeth. The caption at the bottom reads: 'I NEVER TRUSTED A MAN WHO WEARS A MASK.' This visual serves as a humorous illustration related to definitive treatment or dentistry.  Black-and-white line drawing cartoon by Cheney. A large, menacing robotic medical device with multiple articulated arms (including a drill-like tool) hovers over a patient in a dentist's chair. The doctor is seated nearby. The caption below reads: "First, let's get you nice and numb for this procedure." This figure illustrates the concept of 'Periodic visits' under 'Maintenance therapy' from the slide text. **No dental care and treatment** **even when provided by a** **clinically competent dentist,** **however excellent in a** **technical sense, has any real** **value unless it serves the best** **interest of the** **patient..**  **No dental care and treatment** **even when provided by a** **clinically competent dentist,** **however excellent in a** **technical sense, has any real** **value unless it serves the best** **interest of the** **patient..** Clinical photo showing a cartoon patient with red hair and braces in a dental chair, mouth wide open, accompanied by a dentist figure standing behind. The image illustrates the context of dental care and treatment. Reference • Stefanac, S. & Nesbit, S. (2024). Diagnosis and Treatment Planning in Dentistry (4th Ed.). Mosby Elsevier Reference • Stefanac, S. & Nesbit, S. (2024). Diagnosis and Treatment Planning in Dentistry (4th Ed.). 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