# Developing the Treatment plan. **DENT 4215- Introduction to Clinical Dental** **Practice** -Manorika Ratnaweera DENT 4215: Introduction to Clinical Dental Practice Presented by Manorika Ratnaweera University logo for The University of Western Australia featuring a shield emblem with text 'THE UNIVERSITY OF WESTERN AUSTRALIA'. # 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. **The University of Western Australia** 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 A black and white line art illustration depicting an Aboriginal-style painting or design. The artwork features curved lines radiating from the top right and concentric circular patterns in the lower section. A caption below reads 'Artist: Dr Richard Barry Walley OAM'. # Learning outcome **THE UNIVERSITY OF WESTERN AUSTRALIA** 3. Compose and implement initial treatment Plans to prepare patients for further dental treatment. > [img] Learning outcome 3. Compose and implement initial treatment Plans to prepare patients for further dental treatment. [img]> #### Learning Outcome 1. Compose and implement initial treatment plans to prepare patients for further dental treatment. The official logo of The University of Western Australia, featuring the university's name and crest. # Learning objectives 1. Develop fundamental knowledge necessary to begin creating treatment plans for patients 2. Documenting treatment plans #### Learning Objectives 1. Develop fundamental knowledge necessary to begin creating treatment plans for patients. 2. Documenting treatment plans. University of Western Australia institutional logo located in the top right corner. The visual consists of a shield containing three books and a swan symbol, accompanied by the text 'THE UNIVERSITY OF WESTERN AUSTRALIA'. | Flowchart | | :--- | | **Information gathering** | | $\rightarrow$ | | * Patient history | | * Radiographic examination | | * Clinical examination | | * Diagnostic aids | | $\downarrow$ | | **Evaluation of findings** | | $\leftarrow$ | | **Significant findings** | | $\uparrow$ | | **Comprehensive diagnosis** (in bold red) | | * * | **Risk analysis** |  #### Clinical Workflow - **Information gathering** - Patient history - Radiographic examination - Clinical examination - Diagnostic aids - **Evaluation of findings** - **Significant findings** - **Comprehensive diagnosis** - **Risk analysis** Flowchart illustrating the diagnostic process. The flow begins at 'Information gathering' (top left), which points to a box containing four bullet points: 'Patient history', 'Radiographic examination', 'Clinical examination', and 'Diagnostic aids'. An arrow leads down from this box to 'Evaluation of findings'. From there, an arrow points left to 'Significant findings'. Finally, arrows point upwards from 'Significant findings' to two separate nodes: 'Comprehensive diagnosis' (centered in red text) and 'Risk analysis' (on the far left). 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 6 - **Definitive diagnosis**: When several findings point clearly to a specific disease entity. - **Differential diagnosis**: When 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. The infographic outlines the process of Treatment Planning: | **Process** | | :--- | | **Comprehensive diagnosis list** | | ↓ | | **Treatment objectives** | | **<br>Patient modifiers** | **Practitioner modifiers** | | **<br>• Interest in OH** | **<br>• "Ideal treatment plan"** | | **<br>• Can afford** | **<br>• Removing disease** | | **<br>• Regular attender** | **<br>• Correct treatment for each problem** | | | **<br>• In a correct sequence** | | | **<br>• Select best material** | | **↓** | **↓** | | **<br>Informed consent** | | **↓** | | **Treatment plan(s)** |  #### Treatment Planning Process 1. **Comprehensive diagnosis list** 2. **Treatment objectives** 3. **Consider Modifiers** - **Patient Modifiers** - Interest in Oral Health (OH) - Affordability - Regularity of attendance - **Practitioner Modifiers** - "Ideal treatment plan" - Removing disease - Correct treatment for each problem - Correct sequencing - Selection of best material 4. **Informed consent** 5. **Treatment plan(s)** A flowchart diagram illustrating the process of Treatment Planning. The central vertical axis shows a sequence starting with 'Comprehensive diagnosis list' at the top, followed by 'Treatment objectives', then 'Informed consent', and finally 'Treatment plan(s)' at the bottom, connected by blue downward arrows. Flanking this central path are two columns: 'Patient modifiers' on the left (listing factors like interest in OH, affordability, regular attendance) and 'Practitioner modifiers' on the right (listing factors like ideal treatment plans, disease removal, correct sequences). A double-headed arrow connects the modifier sections to the central flow. Treatment Objectives 8  Treatment Objectives Clinical comparison photo labeled 'Treatment Objectives' showing two intraoral views side-by-side. Panel A (left) displays severe dental decay with multiple carious lesions and missing teeth; Panel B (right) shows the same patient post-treatment with restored dentition and improved occlusion. # 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 sequalae of treatment to serve patients’ needs #### Definition According to Sturdevant (1995), a 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." #### Rationale - Created as a response to the problem list. - Defines the schedule and sequence of the treatment. - Develops 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 #### Purpose of 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 #### Phases of Treatment Planning 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 #### Goals of the Systemic Phase 1. Evaluate the severity and complexity of health issues and assess their impact on dental treatment. 2. Recognize signs and symptoms of undiagnosed conditions and refer the patient to a physician for evaluation. 3. Limit or modify dental treatment based on systemic findings. 4. Prevent adverse outcomes: - Manage emergencies in the dental office. - Prevent serious postoperative complications (e.g., antibiotic prophylaxis for high-risk procedures in 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 | **Systemic phase** American society of Anesthesiologist (ASA) physical status classification   #### ASA Physical Status Classification - **ASA 1**: Normal healthy person. - **ASA 2**: Well controlled Diabetes Mellitus (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, Congestive Cardiac Failure (CCF), End stage renal disease. A structured table titled 'American society of Anesthesiologist (ASA) physical status classification'. It categorizes patients into four levels: ASA 1 for a normal healthy person; ASA 2 for well-controlled conditions like diabetes and hypertension; ASA 3 for unstable angina or respiratory disease with symptoms; and ASA 4 for severe conditions such as liver failure and end-stage renal disease. A dark grey chevron-shaped graphic containing the text 'Systemic phase', serving as a visual label or header for the accompanying classification table. System phase: outcomes - Postponing or limiting treatment -ex: uncontrolled hypertension, INR levels, antibiotics 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 #### Management Outcomes - **Postponing or limiting treatment**: Required for conditions such as uncontrolled hypertension, specific INR levels, need for antibiotic prophylaxis, or unstable angina. - **Consultation with physician**: - Prescribing or altering patient medication. - Managing Hypertension. - When systemic disease is suspected during a dental visit. - **Stress Management**: Critical for patients with cardiac disease, diabetes, unstable angina, or adrenal disorders. - **Patient Positioning**: Adjusting the dental chair position based on systemic needs. # Risk categories for selected dental procedures <table> <tr> <td>Little to no risk</td> <td>Oral examination, radiographs, study models</td> </tr> <tr> <td>Low risk</td> <td>Local anesthesia, simple restoration, prophylaxis, asymptomatic endodontic, simple extraction, orthodontic</td> </tr> <tr> <td>Medium risk</td> <td>Symptomatic endodontic, multiple extraction, single implant, deep scaling and root planning</td> </tr> <tr> <td>High risk</td> <td>Extensive surgical, multiple implant, G/A</td> </tr> </table>  #### Risk Categories for Dental Procedures - **Little to no risk**: Oral examination, radiographs, study models. - **Low risk**: Local anesthesia, simple restoration, prophylaxis, asymptomatic endodontics, simple extraction, orthodontics. - **Medium risk**: Symptomatic endodontics, multiple extractions, single implant, deep scaling and root planning. - **High risk**: Extensive surgical procedures, multiple implants, General Anesthesia (G/A). A table categorizing dental procedures by risk level. It contains four rows: '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 #### Overview of Acute Phase - Incorporates diagnostic and treatment procedures aimed at solving urgent oral problems. - **Target Patient Groups**: - Those under active treatment. - Patients on maintenance recall. - New patients to the practice. - Patients returning after a significant absence. # 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 - **Emergency Problem**: Incapacitates the patient and has the potential to become a life-threatening condition. - *Examples*: Swelling, systemic infection, trauma to face or jaws. - **Urgent Problem**: Does not require immediate attention, but the dentist or patient believes it should be attended to soon. - *Example*: 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 ### Traumatic injury * Trauma to teeth/soft tissues * Jawbone fractures * Osteomyelitis ### Other forms of oral pathology- * lesions that require biopsy, consultation or referral #### Complaint of Pain - Pulpal or periapical origin. - Associated with periodontal tissues (e.g., periodontal abscess, NUG). - Associated with tooth eruption or pericoronitis. - Associated with previous dental treatment. - Other sources: Herpetic ulcers, traumatic ulcers, stomatitis, TMJ disorders, trigeminal neuralgia, acute sinusitis. #### Complaint of Swelling and Trauma - Aesthetic complaints. - **Traumatic injury**: - Trauma to teeth/soft tissues. - Jawbone fractures. - Osteomyelitis. - **Other oral pathology**: Lesions requiring 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 #### Planning Considerations - Focus on short-term therapies within practitioner competency. - Consider long-term implications of short-term options. - **Influencing Factors**: - 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. #### Informed Consent Requirements Patients must be fully aware of: 1. The diagnosis. 2. All reasonable treatment options. 3. Risks and benefits of each option. 4. Nature of the recommended treatment. 5. Present and future costs of 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 #### Criteria for Referral or Deferral - The problem or offending tooth cannot be identified. - Systemic conditions preclude immediate treatment. - **The patient has an active infection.** - Patient is unwilling or unable to provide informed consent. - Situations where prescribing medication is preferable to initiating immediate 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. #### Objectives - Eradicate active disease and infection. - Arrest occlusal, functional, and esthetic deterioration. - Address, control, or eliminate causes and risk factors for future disease. *Note: This phase is indicated for patients with high risk factors for specific diseases.* ### 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. #### Stabilization Phase Overview This phase is also known as the Stabilization Phase. It is not necessary when oral disease is already controlled or will be eliminated during definitive treatment. #### Components - Management of active disease or infection. - Stabilization of disease and tooth status prior to definitive reconstruction. - Modification or elimination of risk factors predisposing the patient to 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. #### Sequencing and Strategy - Address the patient’s chief complaint as early as possible. - Sequence by priority, treating severe and urgent needs first. - Utilize provisional or protective restorations. - Sequence treatment by quadrant or sextant. - Integrate periodontal therapy into this phase. - Keep definitive phase options open by using minimalist treatment to arrest deterioration and prevent further infection. # 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  #### Phase Structure 1. **Education** - Aetiology and prevention. - Patient roles and responsibilities. - Oral hygiene products (type, technique, frequency). - Smoking cessation (Ask, Assess, Assist). - Chemotherapeutics. 2. **Non-Surgical Periodontal Therapy (NSPT)** - Plaque control. - Debridement and prophylaxis. - Risk factor management. - Review and referral if required. 3. **Caries Management** 4. **Remineralisation Therapy** 5. **Defective Restorations** 6. **Extraction/Referral** Illustration of a dental professional in a blue cap and white coat standing next to a large cartoon tooth inside a pink dental chair. The background includes a small plant on a cabinet and a monitor displaying a tooth icon. # 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 #### Caries Control Protocol - Caries activity tests, diagnosis, and risk assessment. - Oral prophylaxis. - Oral self-care coaching. - Saliva substitutes or stimulation. - Remineralisation (in-clinic and home care). - Chemotherapeutics. - Diet and nutrition analysis (e.g., food diary focusing on frequency and duration of acids/sucrose). - Restoration of 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   #### Risk Assessment Tools - **Caries Risk**: CAMBRA. - **Periodontal Risk**: Perio-tools PRA. - **Oral Cancer Risk**: Contemporary Oral Medicine (2018) guidelines. - **Tooth Wear Risk**: Basic Erosive Wear Examination (BEWE). Title text 'Oral disease risk status' presented as the main heading of the slide. A bulleted list table categorizing oral disease risks (Caries, Periodontal, Oral cancer, Tooth wear) and providing corresponding assessment tools or reference links for each category. 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. #### Purpose of the Holding Phase - Provides time between the control and definitive phases for the resolution of inflammation and healing. - Reinforces home care habits. - Assesses motivation for further treatment. - Re-evaluates initial treatment and pulpal responses before beginning definitive care. 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. #### Core of the Treatment Plan Before engaging in definitive treatment, the practitioner must affirm: - Disease is controlled. - All reasonable treatment options and costs have been discussed. - Informed consent has been obtained. # 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 1. **Periodontal Therapy**: Surgical or other advanced interventions. 2. **Orthodontic Treatment**. 3. **Restorative Dentistry**: - Multi-surface or indirect restorations. - Occlusal assessment and treatment. - Esthetic procedures. 4. **Endodontic Procedures**: Elective cases. 5. **Oral Surgery**: Extractions (e.g., 3rd molars) and pre-prosthetic procedures. 6. **Prosthodontics**: - Replacement of missing teeth. - Crowns, bridges, implants, or dentures. 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 #### Restorative Decision Making - Involve patient/parent in decisions. - Determine feasible treatment options based on: - Diagnosis and Prognosis (Excellent, Good, Favorable, Unfavorable, Poor). - Likelihood of remineralisation. - Caries risk status. - Results of disease control phases. - Cost and patient expectations. - Materials and long-term implications. <th>Orthodontic treatment</th> - <th>Dentist</th> 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 Referrals - The dentist identifies the need for referral for assessment. - Often elective, focusing on aesthetics or function. - **Indications**: Malocclusions, impacted teeth, anterior open bite, or skeletal abnormalities. # Other referrals * 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 #### Specialist Disciplines - **Periodontist**: For advanced periodontal needs. - **Prosthodontist**: Fixed/removable prosthodontics and implants. - **Paedodontist**: Specialized pediatric care. - **Special Care Dentist**: For patients with specific systemic or physical needs. - **Other Specialists**: As identified by the general dentist. 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 #### Principles of Maintenance - Long-term success depends on this phase. - **Guiding Principle**: Prevention of future problems. - Responsibility of the entire dental team. - Intervals are determined on an individual basis at the conclusion of the disease control and definitive phases. - Plans can be modified over time. **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 - **Purpose**: - Ensure long-term oral health. - Maintain optimum function. - Provide favorable aesthetics. - Maintain stable clinical attachment levels. - **Benefits**: Addresses issues that remain unresolved after the definitive phase. <table> <thead> <tr> <th colspan="2">Elements for post treatment assessment</th> </tr> </thead> <tbody> <tr> <td colspan="2">Patient concerns/expectations met</td> </tr> <tr> <td colspan="2">Patient response to treatment</td> </tr> <tr> <td colspan="2">Medical and Medication History update</td> </tr> <tr> <td>Clinical examination, re-evaluation, diagnosis</td> <td>Check notes from last exam</td> </tr> <tr> <td>Update radiographs</td> <td>Based on need or protocol</td> </tr> <tr> <td colspan="2">Periodontal condition</td> </tr> <tr> <td colspan="2">Occlusal /functional status</td> </tr> <tr> <td colspan="2">Caries/restorative condition of teeth</td> </tr> <tr> <td>Disease risk</td> <td><i>Status and severity</i></td> </tr> <tr> <td>Risk factors</td> <td><i>Predisposing and modifying</i></td> </tr> <tr> <td>Preventive recommendations, motivation</td> <td><i>In clinic and at home remin, smoking cessagtion, OHE</i></td> </tr> <tr> <td>Remaining or new treatment required</td> <td><i>May include retreating</i></td> </tr> <tr> <td>Re-establish recall interval</td> <td>based on risk and need</td> </tr> </tbody> </table>  #### Post-Treatment Assessment Elements - **Patient Review**: Verify concerns/expectations are met and assess response to treatment. - **History Update**: Medical and medication history. - **Clinical Exam**: Re-evaluation of diagnosis; check previous notes. - **Radiographs**: Updated based on protocol or clinical need. - **Condition Assessment**: - Periodontal condition. - Occlusal and functional status. - Caries and restorative condition of teeth. - **Risk Management**: - Disease risk (status and severity). - Risk factors (predisposing and modifying). - Preventive recommendations (in-clinic/home remineralisation, smoking cessation, OHE). - **Future Planning**: - Identify remaining or new treatment needs. - Re-establish recall intervals based on risk. A structured table titled 'Elements for post treatment assessment'. The table lists key components of a dental follow-up visit in the left column (e.g., 'Patient concerns/expectations met', 'Clinical examination, re-evaluation, diagnosis', 'Disease risk') and provides corresponding notes or details in the right column (e.g., 'Check notes from last exam', 'Status and severity'). It serves as a checklist for clinical evaluation. 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 Outcomes - **Goal**: Patient + Clinician collaboration resulting in controlled disease, functional dentition, stability, and acceptable aesthetics. - **Tangible Results**: 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  #### I. Systemic Treatment - A. Consultation with patient’s healthcare provider - B. Premedication - C. Stress and fear management - D. Special positioning of the patient - E. Treatment considerations for systemic disease Illustrative cartoon photo depicting a dental treatment scenario relevant to the text's point 'Special positioning of the patient'. It shows a dentist leaning over a patient seated in a reclined dental chair, demonstrating the physical posture required for oral procedures. Summary **II. Acute treatment** * **A.** Emergency treatment for pain or infection * **B.** Treatment of the urgent chief complaint when possible The text on the slide only makes sense in the context of the figure. Per instructions, treat the whole page as a figure: wrap a single brief description in tags and output NOTHING ELSE.  #### II. Acute Treatment - A. Emergency treatment for pain or infection - B. Treatment of the urgent chief complaint when possible Medical cartoon illustrating acute treatment. A patient sits in a dentist's chair while the doctor holds large forceps, displaying an unusually long, curved tooth (a wisdom tooth). The caption 'That came as a shock to everyone...' humorously demonstrates the concept of urgent chief complaint treatment. # 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) E. Replace or repair defective restorations F. Endodontic therapy for pathologic pulpal or periapical conditions G. Stabilization of teeth with provisional or foundation restorations H. Posttreatment assessment  #### III. Disease Control - **A. Restorability**: Caries removal to determine status of questionable teeth. - **B. Extractions**: Removal of hopeless or problematic teeth (including provisional replacement). - **C. Periodontal Control**: - Oral hygiene instruction. - Initial therapy (scaling, root planning, prophylaxis). - Controlling contributing factors (replacing defective restorations, managing habits/smoking). - **D. Caries Control**: - Risk assessment. - Provisional and definitive restorations. - **E. Repair**: Replace or repair defective restorations. - **F. Endodontics**: Therapy for pathologic pulpal or periapical conditions. - **G. Stabilization**: Use of provisional or foundation restorations. - **H. Post-treatment assessment**. Cartoon figure illustrating the importance of oral hygiene instruction in disease control. The image depicts a dentist examining a patient's teeth with an overhead dental light and sink visible. Speech bubbles show the dentist asking 'Do you floss?' and the patient responding dismissively ('Gah huh... Your teeth? Gah'), humorously highlighting the need for patient compliance in periodontal care. Summary IV. Definitie treatment A. Advanced periodontal therapy B. Stabilise 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 l. Posttreatment assessment  #### IV. Definitive Treatment - A. Advanced periodontal therapy. - B. Occlusal stabilization (vertical dimension, anterior guidance, plane of occlusion). - C. Orthodontic and/or orthognathic surgical treatment. - D. Occlusal adjustment. - E. Esthetic dentistry (whitening, restorations). - F. Definitive restoration of individual teeth (direct/indirect). - G. Elective extraction of asymptomatic teeth. - H. Replacement of missing teeth (fixed partial dentures, implants, removable dentures). - I. Post-treatment assessment. Cartoon illustration depicting a dental treatment scenario. A dentist wearing a white coat and face mask stands over a patient in a green chair under an overhead light. The caption below reads: 'I NEVER TRUSTED A MAN WHO WEARS A MASK.' This visual humorously addresses the concept of trust or concealment during medical procedures. Summar y V. Maintenance therapy A. Periodic visits “First, let’s get you nice and numb for this procedure.” —CHENEY— 42  #### V. Maintenance Therapy - A. Periodic visits Satirical cartoon showing a large industrial drilling rig with mechanical arms hovering over two people sitting in chairs. Caption reads: 'First, let’s get you nice and numb for this procedure.' Artist signature 'CHENEY' is visible at the bottom left. 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. Scene from an animated movie depicting a dental setting. A young girl with red pigtails sits in a dentist's chair with her mouth wide open and braces visible, looking shocked. A male dentist stands behind her holding a bag of extracted teeth. The background includes a 'Your Teeth' educational poster on the wall. This visual demonstrates the concept that technical dental procedures must serve the patient's best interest. # Reference - Stefanac, S. & Nesbit, S. (2024). *Diagnosis and Treatment Planning in Dentistry* (4th Ed.). Mosby Elsevier  - Stefanac, S. & Nesbit, S. (2024). *Diagnosis and Treatment Planning in Dentistry* (4th Ed.). Mosby Elsevier A bibliographic reference entry formatted as a table row. It lists the authors Stefanac, S. & Nesbit, S., publication year (2024), title 'Diagnosis and Treatment Planning in Dentistry' (4th Ed.), and publisher Mosby Elsevier. 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