This is the last lecture in Midterm Exam . LEC No. 3 Dear Colleagues : The Dr.

started talking about treatment planning steps and concepts , then she moved to explain some photos from the slides without any addition, Please return to slides ( from 11 to 55 ) ---------------------------------------------------------------------------------------------------------

TREATMENT PLANNING

Sequence of treatment planning when a child comes to your clinic starts with the emergency care , and then preventive care , and then any surgical treatment and endodontic treatment . After you finish everything theres a recall and review system , Your patient now has a clean mouth , no microorganisms , all restorations are done , all extractions are finished and the patient has nothing else to be done right now . But , this doesnt mean that you leave the patient . You should see the patient and reviewing him based on a review system every three months , six months .. etc , according to the case ( Check up ) , to make sure that filling are good ,no overextension , the child is brushing his teeth .. etc. So , the steps that you should follow in order to reach a treatment plan . Collect general observations: Child/parent interactions, behavior : 1st of all , you have to collect general information of the patient , actions and behaviors . So this a very important principle Address reason for presenting FIRST : when your patient asking what is the reason for his coming ? what is the problem ? Is he complaining from anything ? esthetic ? like crowding for example , color of the teeth ,or there is an ulcer or any sort of complaint . Sometimes , when there is no major complaint like pain , usually they just come for check up .
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 Start with history: Medical, dental, family, social Record past dental care

Now we move to STEPS IN DIAGNOSIS & TREATMENT PLANNING You have to Conduct head and neck exam Also to Perform a complete oral examination Use a thorough and detailed form Establish a provisional diagnosis ( preliminary Diagnosis ) , If theres some sort of gingivitis or caries or ulcer . But , sometimes you are not sure what is the cause of ulcer (caused by chemical burn ,precancerous , aphthous ulcer ) Obtain any additional tests: Radiographs, blood tests, study models, medical consults, etc.. to insure your treatment plan . Finalize diagnosis and treatment plan Present case to patient/parents : After I write my treatment plan , I usually talk to childs parents and tell them thats this is the plan , and then I start explaining to them ( procedures , type of the material I will use , cost .. ) Then we Outline recommended treatment plan Involve parents in planning , WHY ? regards the pulpotomy , the parents has to accept or refuse it ! Because the insurance about doing any procedure either pulpotomy or SSC is refered to them . Secure parental consent : The parents should sign for approval of the treatment

TREATMENT PLAN SHOULD INCLUDE THESE FEATURES

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 Treat existing problems Prevent progression of existing problems : So if the child has dental caries ,you treat the dental caries and you prevent that any carious lesion occur in the future , by insuring that your restorations are adequate and good durability. Prevent any anticipated future problems : by insuring oral hygiene instructions ,and making sure that your patient come back to review his treatment . Plan periodic exams, preventive care and treatment : Sometimes we postpone the treatment . For example we want to fissure seal the sixes (molars) when there are fully erupted . According to TREATMENT PLANNING CONCEPTS Consider behavior (eg. Desensitizing app (by starting with simple procedures) /procedure, modeling) its consider as a principle in treatment planning . Because if the child has good behavior , he will be better comfort with local anesthesia and treated in the clinic. But , if he has a very bad behavior, he has to be treated in hospital . Involve parent in treatment choices, but dont be dictated to! , the parents have no right to change your decision , they have the right to accept or refuse only ! Incorporate prevention : prevention is our GOAL ! Plan efficient use of LA

(QUADRANT THERAPY) I anesthetize the whole quadrant and I do treatment for the whole quadrant. for you as students we want you to write treatment plan as ideal as possible , but this doesnt mean that you have to do this kind of treatment in the clinic because you are still in the beginning . We just have to write the treatment plan .

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 Treat comprehensively with definitive treatment, not patchwork. You want to treat all the teeth from prevention to extraction to pulp therapy ..everything . And it has to be definitive . You have to write definitive procedures . Consider full coverage if using GA : If we are working under GA ,we usually do durable restorations and we consider full coverage like SSC . Establish a follow up/review/recall plan based on established criteria (eg. AAPD = American Academy of Pediatric Dentistry) Make referrals in writing and expect a written report back : If you want to refer a case , for example you have a patient with diabetes , epilepsy , immunosupressed and be treated in hospital , then he has a medical practitioner .

- Consider full coverage if you're using general anesthesia. This means If your treating under GA you have to do a definitive treatment to the patient in order not to repeat it again in the future . e.g if you have a case that needs pulpatomy and you did it under GA when you restore the tooth you have to put a definitive restoration ( for example stainless steel crown not composite that may fracture). -make any referral if needed ( by sending a written referral report to a specialist) and expect a written report back. for example: if your patent has diabetes or a suppressed immunity or any medical condition , then he /she will be hospitalized and treated, you have to ask the parents about the specialist (the doctor that treats your patent condition) and you have to contact (by writing a referral report) him to have his advice regarding the treatment that you are about to do, and to be aware and updated about the condition of your patent , you have to expect that the doctor will write back to you clearing the status of the patent, and what are the contraindicated procedures (e.g : local anesthesia ,general anesthesia ,

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antibiotics ).

QUADRANT THERAPY This table below shows what to do at each clinical visit:

*NOTES (about the table above) : -OHI (oral hygiene instructions) includes instruction to maintain a good oral hygiene like how to brush the teeth, what kind of toothpastes and tooth brusher to use, prescription of mouth rinses ,,,, so and so -prophylaxis paste: a special gritty toothpaste-like material , spun around on the teeth to make them shiny smooth, Polishing is done using a slow speed handpiece with a soft rubber cup, this will teach the chilled to brush his teeth, also it will allow you to examine
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the teeth properly and it will get the childe used to drilling and vibrations of the handpiece . - Dietary advices : we give the patent a diet sheet to write what he eats , and we advise him what to eat and how much ,,,,,, - We may assign another special appointment for the anterior teeth. - Remember we make FGA (fluoride gel application) at the first and the last appointments . - DONT FORGET the RECALL& REVIEW visits . - In each visit we check OHI and dietary changes.

Note: See slides (11-55) for an example of CASE PRESENTATION AND TREATMENT PLANNING https://www.dropbox.com/s/oholcb91uclax32/pedo%204.pptx

Done by : Majd M. Hidmi & Abdallah Zireeni Forgive us for any mistake --------------------------------------------------------------------------------------------------------- : " . : . : : "

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