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Chapter 19 Problem-/Evidence-Based Treatment Planning (Problem-Based…
Chapter 19 Problem-/Evidence-Based Treatment Planning
Key Words
Informed consent
A written agreement by patients to voluntarily have treatment performed on them or to participate in a study.
Problem-based
In reference to learning.. Learning that is driven by a question or problem and uses various methods of inquiry research to address the question or problem
Prognosis
A prediction or forecast of the course and outcome of a disease
Risk Assessment
Pertaining to periodontal risk assessment. Is a tool to help you understand whether you are a risk for developing a periodontal disease
Treatment planning
The act of making a list of treatment that the patient needs
Key Points
Evidence- based periodontal treatment based on dental literature focuses on the recognition of risk, prognosis, and treatment factors
The evidence-based approach is a good model for evaluating the results of periodontal therapy; however, as is the case in many biomedical fields, research is limited.
Problem-based learning identifies a patient's dental problems
The ideal goal of periodontal therapy is to restore the periodontium destroyed by disease to a comfortable and functional state of health
Periodontal treatment involves ongoing care and demands continued reassessments
Problem-Based Learning (PBL) Approach
PBL- introduced the student to a technique for developing an individualized treatment plan for each patient
PBL - identifies significant problems form the patient MHx and DHx from which a differential dental diagnosis will be made for each sign and/or symptom on the problem list
Problem List
guide to develop a treatment plan and a comanagement or a referral system
AAP developed practice parameters on the diagnosis and treatment of periodontal disease
Periodntitis
For many years, Inevitable result of poor oral hygiene along with uncontrolled dental plaque biofilm and calculus accumulation
Nonspecific plaque hypothesis
Recent Decades
Microbial species whose presence tends to signal a greater likelihood of progressive periodontal destruction
Procedures aimed at species will improve clinical outcomes
Frontline periodontal therapy remains largely nonspecific in design
Perio disease- Young people, refractory disease, special situations, periodontal therapy aimed at specific putative periodontal pathogens
Goals of Periodontal Therapy
Ideal goal to restore periodontium to a comfortable and functional state of health for the balance of the patient's life
Aims to prevent the imitation, progression, or recurrence of periodontal disease
Arrestive periodontal therapy
Periodontal Therapy: Ongoing Care
Management demands continued reassessment and adjustments to ongoing care
Are necessary because periodontal care is not permanent in the sense that many other highly successful dental therapies are considered permanent
Chronic periodontitis
The only permanent perio end point is tooth loss
No single perio treatment produces ideal outcomes for all patients
Thorough daily oral hygiene
In periodontal maintenance programs
Every 2-3 month appointment
Not engaged in thorough daily oral hygiene
Or, demonstrate signs of periodontal attachment loss
Professional maintenance intervals will be shorter
Frequent reexaminations, reevaluations and adjustments are necessary for many years
Practitioners need to comply within their ethical/dental/medical/legal responsibilities and refer a patient out when necessary
Or provide comparable periodontal care
Or partner with a specialist
Rapid Dental Hint
Developing the problem list, solutions, and expected outcomes not only addresses the clinical concerns of the patient but also helps identify the patient's subjective concerns
Tailor the appointment to the needs of the patient. Certain procedures may or may not be provided based on the individual's presentation at the time
Problem List
Will identify the pt's problem by reviewing the chief complaint and medical, social(habit), and dental histories.
For each problem identified
A solution should be written
An expected outcome
Prognosis
Any major concerns addressed
Risk Assessment for Periodontal Diseases
Important aspect of treatment planning
To determine either predisposition for developing periodontal conditions for susceptibility
Clinician subjectively interprets the findings to determine diseases susceptibility
An objective, computer based tool could result in more uniform and accurate periodontal clinical decision making, improved oral health, reduction in the need for complex therapy, and reduction in healthcare costs.
Oral Health Information Suite (PreViser Corp)
Uses a periodontal risk calculator (PCR)
Predicts future periodontal status with a high level of accuracy and validity
Clinically validated periodontal disease risk and severity analysis
Suggested treatment options for a patient, are calculated by entering 23 data points
Risk reported in numeric scale
1 more item...
Treatment planning
Data analyzed to create a comprehensive plan
Patient Co-management and Referral to a Periodontist
Guidelines for Referral and Co-managment
Phases of Treatment
Phase I: Nonsurgical/Initial Preparation
Disease Control
Phase II: Periodontal Surgery
Phase III: Restorative Care
Phase IV: Maintenance Care
Informed Consent
Treatment Guidelines
Periodontal Health
Gingival Diseases
Dental Plaque-Induced Gingivitis
Non-Plaque-Induced Gingival Diseases
Drug-Induced Gingival Disease
Periodontitis
Necrotizing Periodontal Diseases
Peri-Implantitis
Prognosis
Adjunctive Treatment
Antimicrobials
Geriatric Patients
Plaque Control
Xerostomia
Treatment Considerations
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Treating my first three patients has provided me a small sample size of the different treatment needs of each patient
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Im sure as my patient cases become more complex I will have a more verse idea about treatment planning with several different treatment conditions
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I believe treating these more complex case will also provide more fulfillment in the end by creating a lasting impression on an individual as well as placing them journey towards a health