THINGS TO DO BEFORE TX PLANNING APPOINTMENT The diagnosis includes making decisions at the time about what treatment is needed in most cases. You and the clinical faculty should decide at the diagnosis appointment what is to be done: what is defective or not. This may sound like an obvious point but it frequently doesn’t happen. Your diagnosis and decisions for treatment must be accurate before you can create a rational treatment plan. 1.
Can this patient be adequately treated in the pre-doctoral clinic? If so, what are the skills needed and who will supervise? If not, make the appropriate referral to one of our other treatment areas (Grad Perio, AEGD, Faculty Practice, etc) or to outside practice.
2.
Get all consults before - ask the faculty who does your diagnosis first to see if a specialist consult is needed (at the diagnosis appointment). Most of the time a specialty consult is not needed. Consults must be documented in the record.
3.
Discuss with the patient their wants and needs in light of what was found at the diagnosis appointment (esthetics, finances, time, etc.) Ask the diagnosis faculty to help with this at the diagnosis appointment.
4.
In advanced/difficult cases where some procedures must be done to determine what is even possible (O+R’s and extractions, teeth with questionable periodontal prognosis, etc.) you may do a Preliminary Treatment Plan. This treatment plan will include the Systemic Phase, Acute Phase and the Disease Control and Re-evaluation/Posttreatment Assessment sections of your treatment plan outline. This will allow you to get a better idea of what the patient's options are and will avoid a lot of guesswork and treatment plans that have multiple deletions and additions. Once you have completed your Preliminary Treatment Plan you should have a solid basis for further treatment. The Preliminary Treatment Plan would take you through items 1, 2, and 3 on your Treatment Plan Outline.
5.
Bring to the treatment planning appointment: a. Study models:
Should be mounted with a facebow transfer if extensive (3 units or more) crown and bridge work and for removable partial dentures. Partial denture design must be done and approved before the treatment planning appointment.
b.
(a) Problem List/Problem Plan Form - with overall sequencing done for each procedure and sequencing done within each section.
Work sheets:
(b) Treatment Plan - all areas listed on outline even if nothing is done in that area - write N/A. c. Patient record:
Treatment Planning
good quality radiographs; all sections approved in computer; any consults ordered and completed.
6/2/2011
PROBLEM LIST/PROBLEM PLAN FORM
Prob. #
Problem List
Problem Plan (Procedure)
Seq. #
TIME NEEDED (appts. & time between appts.
TOTAL ESTIMATED TIME OF TREATMENT TOTAL FEE
TREATMENT OBJECTIVES: PROGNOSIS OF TREATMENT: PATIENT MODIFIERS:
Treatment Planning
6/2/2011
FEE
TREATMENT PLAN OUTLINE PATIENT NAME
STUDENT NAME
1
PRELIMINARY TREATMENT, SYSTEMIC PHASE:
Systemic disease-referral, consultation, prescribing/altering medication, premedication etc.
2
PRELIMINARY TREATMENT, ACUTE PHASE:
Pain, swelling, traumatic injury, (replacement of missing teeth in some cases)
3A PRELIMINARY TREATMENT, DISEASE CONTROL:
Includes O&R’s, endodontics, transitional prosthesis, scaling and root planing, prophylaxis, extraction of hopeless/ nonfunctional teeth, caries control protocol, restoration of carious lesions, etc.
3B RE-EVALUATION ALL OF THE ABOVE IS PART OF A PRELIMINARY TREATMENT PLAN 4
DEFINITIVE PHASES
4A PERIODONTICS: 4B
OPERATIVE:
4C
ORTHODONTICS:
4D
CROWN AND BRIDGE:
4E
REMOVABLE PROSTHETICS:
5A EXIT EXAM / POST TREATMENT ASSESSMENT/COMPLETED PATIENT 5B MAINTENANCE PHASE:
Treatment Planning
recall interval /continuing issues to follow
6/2/2011