522 Final Exam Study Guide PDF

# 522 Final Exam Study Guide ## Dentists 3 Primary Responsibilities to Every Patient - Diagnose and identify problems - Plan Treatment - Manage Treatment - Provide the Treatment - Refer ## Overview of the Treatment Planning Process - Find out what the patient wants - Determine if they...

# 522 Final Exam Study Guide ## Dentists 3 Primary Responsibilities to Every Patient - Diagnose and identify problems - Plan Treatment - Manage Treatment - Provide the Treatment - Refer ## Overview of the Treatment Planning Process - Find out what the patient wants - Determine if they are health or not - Examine and identify all problems - Identify all treatment options - Present and choose a plan with the patient - Provide treatment - Periodically evaluate outcomes of care ## Process for Patient Care - Treatment objectives are based on Dentist and Patient Modifiers and Goals ### Process for Patient Care #### Information Gathering 1. Chief Concerns and Patient Goals 2. Medical, dental, psychosocial histories 3. Clinical examination 4. Radiographic examination 5. Diagnostic aids 6. Consultation/Referral #### Evaluation of Findings & Risk Assessment - Diagnoses / Problems #### Treatment Objectives Based on Dentist and Patient Modifiers and Goals #### Sequential Treatment Plan(s) 1. Systemic phase 2. Urgent Care 3. Prevention 4. Disease control 5. Re-evaluation 6. Corrective phase 7. Maintenance/monitoring/prevention #### Patient Presentation - Treatment Plan - Prognosis - Patient's role in plan - Informed Consent #### Re-Evaluation/Modifications #### Treatment #### Re-Evaluation/Modifications #### Maintenance/Monitoring/Prevention ## Performing Diagnostic Tests - Performing diagnostic tests, and consulting with physicians and other dentists. - **Signs** are findings discovered by the dentist during an examination. - For instance, the practitioner may observe that a patient has swollen ankles and difficulty in breathing when reclined, signs suggestive of congestive heart failure. - **Symptoms** - Findings verbally revealed by the patients themselves, usually because they are causing problems, are referred to as symptoms. - Patients may report such common symptoms as pain, swelling, broken teeth, loose teeth, bleeding gums, or esthetic concerns. - **Chief Concern** - When a symptom becomes the motivating factor for a patient to seek dental treatment, it is referred to as the chief complaint or chief concern. - **Problems** - **Diagnoses** are precise terms that identify a particular disease or problem from signs or symptoms. - Examples include diabetes, caries, periodontitis, malocclusion. - Problems can defy a precise diagnosis but are important issues to be addressed when planning treatment. ## Treatment Objectives - Goals for treatment - Intent or rationale for treatment - The link between diagnoses and problems and the final treatment plan - Developed with the patient ### Treatment Objectives: Examples - The treatment objectives of Ms. Jones are to control the periodontal (gum) disease, remove decay and replace two missing lower teeth with implants. - The treatment objectives for Mr. Johnson are to remove all upper teeth because of financial limitations, fabricate a complete upper denture and restore six decayed lower teeth. ## Modifiers - Important issues\attributes of patients and dentists that affect treatment goals and objectives. ### Negative Patient Modifiers - Time and financial constraints - A fear of dentistry - Lack of motivation - Poor dental health - Destructive oral habits - Poor general health - Mouth piercings ### Positive Patient Modifiers - Good time availability - High Motivation - Adequate Financial resources ## Case #1 Ben ### Findings - **CC:** "I can't open my mouth” - 25 year old male - Facial swelling on right side - Painful right tooth for two weeks - Taking insulin - Temperature = 101° F ### Problem/Diagnosis List - Pain and swelling - Cellulitis - Irreversible pulpitis #4 - Fever - Insulin dependent diabetic - Non restorable tooth ### Patient and Dentist Modifiers - Doesn't regularly see the dentist - Has limited finances for dental care - His family dentist does not perform extractions. ### Treatment Objectives - Refer patient for removal of non restorable premolar and treat infection with antibiotics due to systemic concerns (diabetes and elevated temperature). - Patient does not wish replacement of tooth or further examination due to limited finances. ### Creating a Treatment Plan #### Treatment Planning Goals - Resolve disease - Restore function and improve appearance - Maintain health ### Sequenced Treatment Plans - **Systemic Phase** No phase, addressed at each appt - **Urgent Care Phase** 1:0 - **Disease Control Phase** 1:X - **Corrective (Definitive) Phase** 2:X - **Maintenance/Monitoring/Prevention** 3:X #### Sequencing - The ordering of individual procedures within ONE of the 4 numbered phases ### System Phase Treatment - Medical Consultation - Premedication - Stress and fear management - Prescribing or altering patient medication Special patient positioning - Urgent Phase Treatment - Treatment of pain or infection - Treating the chief concern whenever possible - Simple esthetic complaints - A Golden Rule of Treatment Planning - Resolve the chief concern as soon as possible - Or at least pay attention to it at each appointment. ### Disease Control Phase - Caries control - Periodontal disease control - Periapical disease control - Extracting hopeless/ problematic teeth - Diet and habit analysis ### Corrective or Definitive Phase - Additional periodontal treatment - Orthodontic treatment - Occlusal therapy - Oral surgery (often elective) - Elective endodontic procedures - Single tooth restorations and esthetic dentistry - Replacement of missing teeth ### Maintenance Monitoring and Prevention - Periodic recall examination - Periodontal maintenance therapy - Oral hygiene instruction - Diet evaluation - Fluoride application ### History and Information Gathering #### Tips and Concepts Related to Interviewing - Patient interaction vs conversation - When do we interview patients - Eliciting the patient's Chief Concern (CC) - When and how to use open and closed questions - Follow up on positive responses - Summarize and feed back to patient - Connected Relationship - A relationship that creates a connection between the provider and the patient - This type of relationship leads to and requires: - Trust, - respect, - openness - Honestly - Why is this Important? ### Effective diagnosis and treatment planning are dependent on accurate information gathering - Accurate information gathering is dependent on effective communication - Effective communication is greatly enhanced by a connected relationship between the provider and patient - A connected relationship greatly enhances patient compliance and acceptance of treatment ### Creating the Connection - Find out what the problem is (Patient's CC) - Encourage patient to describe the problem in his/her own words - Listen attentively without interruption - Facilitate patient's response both verbally and nonverbally. - Obtain information relative to the CC - Elicit the patient's CC - Explore the history or the problem(s) and past medical history via open and closed ended q's - Use concise, easy to understand questions - Avoid or adequately explain medical jargon - Communicate effectively with the patient - Accept the legitimacy of the patient's views (not judgmental) - Use nonverbal communication to demonstrate you are interested in the patient and are listening attentively - Understand the needs of the patient - Empathize with and support the patient - Establish a shared concern for the problem - Provide positive reinforcement for the patient's health promoting behaviors - Demonstrate caring nonverbal behavior - Respond appropriately to the patient's feelings throughout the interview - Summarize effectively for the patient - Relate the patient's chief concern - Highlight medical and dental info related to CC and provision of care - Be open to clarification and modification by patient - Identify next steps that will address the CC - Convey an attitude of empathy, reassurance and confidence ### What does this accomplish? - Better - Communication - Relationships - Patient care - Job satisfaction ### Reflections - Successful practice ### Planning - **Goals:** Anticipate and prepare for important components of the experience ### Reflections - **Goals:** Self-assessment, demonstrate achievement via artifacts, connections to course material ### Meta reflections - **Goals:** Draw connections among a variety of experiences and educational and personal goals ### Defining Reflections - "critical self-assessment" - active process - awareness of what learned, why it's important within their own learning context, and how they have applied what they have learned in their educational or life experiences. ### Evidence - Higher test scores - Greater student autonomy and responsibility in self regulated learning - Stimulates deep level learning and critical thinking - Develop self confidence - Meta analysis helps students comprehend their progress and recognize personal and professional growth - “...students have the ability but need to be taught how to think reflectively.” - “...educators can improve student outcomes by providing guidance and instruction.” ### Instructions - **DO** - Step back, explore and analyze your own role - Consider the different perspectives of others - Show awareness of social, organizational, and/or political influences - Show what you have learned in the process - **DON'T** - “Dear Diary.....” - List your actions “I did this... and this... and this" - **Proper Reflections** - Here's what I learned... - This happened when I did this... - I realized/was surprised by this... - + evidence to support ### Back to Treatment Planning - **Clinical Assessment Components** - Extra oral exam - Intra oral exam - Soft tissues - Periodontium - Hard tissues - Teeth - bone ### Accurate Clinical Assessments - **Require** - Detection of all clinically relevant conditions - Accurate description of those conditions - **Are NOT diagnoses at this time** - **ARE Findings** - **LEAD to:** - Problem lists - Diagnoses - Negotiated Planned treatment - **Why is this Important?** - Effective diagnosis and treatment planning are dependent on accurate information gathering - Accurate information gathering is dependent on effective communication and accurate clinical assessments - Accurate clinical assessment is greatly enhanced by a connected relationship between the provider and patient - A connected relationship greatly enhances patient understanding, acceptance and compliance. ### Clinical Assessment - **Extra-oral exam** - **Assess:** - Head, neck, upper torso, extremities - **Methods:** - Visual inspection and palpation - **Results:** - Give insight into potential systemic & local conditions relevant to dentistry - Circulation conditions - Growth anomalies - Muscular anomalies - **Intra oral exam** - **Assess:** - Soft and hard tissues in the mouth - **Methods** - measuring, - Visual assessment, palpitation, probing, radiographs - **Results:** - Information gathered will allow for accurate identification of problem lists and diagnoses for patients ### Diagnostic Aids - **Casts** - Study casts - Diagnostic casts - Occlusal Splints - Caries excavation - Consultants - Medical lab tests - **Keeping Track of it All:** - Examination Worksheet - Vital Signs - Extra oral soft tissue - Intra oral soft tissue - Occlusion - Other radiographic finding ### Treatment Plan Worksheet - Clinical Assessment - Existing conditions and restorations - Radiographic findings on teeth - Treatment Plan - Chief Concern - Treatment Objectives - Problems - Modifiers - Diagnoses - Planned treatment and sequencing ### What does this accomplish? - Better Organization - More thorough examinations - More comprehensive treatment plans - Better patient care - Successful practice ### Diagnosis vs problem - **Diagnosis** - Precise - Often expressed in scientific terms - Describe significant variations from normal - Definitive - Differential - Working or tentative - **Problem** - Less precise - Not expressed in scientific terms. - Significant condition that will affect treatment - Common types: - Dental fear - Poor oral hygiene - Limited finances ### Effective Diagnoses and Problems list - Require accurate clinical assessments - Detection of all clinically relevant conditions - Accurate description of those conditions - Can be influenced by goals and modifiers - Patient - DDS - Are essential to achieving an Effective Negotiated Treatment Plan ### Why are these important? - Effective diagnosis and problem lists lead to: - Better organization - Improved professional competency - Better patient education - End result is a better negotiated treatment plan - A connected relationship greatly enhances this process. ### Treatment Objectives - The intent or rational for the treatment - Individual diagnosis - Overall treatment plan - Influenced by: - Patient - Goals and desires - Modifiers ### Goals and Modifiers - **Patient:** - **Goals:** - Resolution of CC - Oral health - Esthetics - Function - **Modifiers** - Interest in oral health - Motivation - expectations - **Dentist** - **Goals** - Disease control - Ideal treatment. - Meet patient's wishes - **Modifier** - Knowledge - Technical skills - Treatment philosphy ### Important Concepts involved in the Treatment Planning - The patient is a major partner in the plan - There is usually more than one solution to a particular problem - There are often key areas to be considered - Ex. key teeth - Each treatment is associated with a diagnosis ### Diagnosis- Treatment Connection - Premise: No treatment should be provided unless there is an appropriate diagnosis associated - Result: Improved patient understanding of treatment - Improved care - Quality of care provided - Time it takes to provide the care - Improved risk management ### Phasing - Logical sequencing of treatment - At U of M: 5 phases – 7 categories ### Systemic Phase - Systemic Phase - Urgent Care Phase (Acute) - Disease Control Phase - Prevention - Disease control - Re-evaluation - Corrective Phase (Definitive Treatment Phase) - Maintenance/ Monitoring / Prevention Phase ### Systemic Phase - (Phase 0: Seq. X) - Purpose: Manage the patient's general and psychological health before or during treatment - Information source: Health history and general interactions with patient - Examples: SBE prophylaxis, avoiding allergens (latex) ### Urgent Care Phase - (Phase 1: Seq. 0) - Purpose: Resolve symptomatic problems a patient may have - Information source: Health Hx, Clinical Exam, Radiographs - Examples: Extractions, Endo, Prescriptions for pain and infection ### Prevention/Disease Control Phase - (Phase 1: Seq. X) - Purpose: Control active oral disease and infection, stop occlusal and esthetic deterioration and manage risk factors - Findings: Health Hx, Perio Chart, Clinical and Radiographic - Information source - Examples: Oral health instruction, caries risk assessment, extraction of hopeless teeth ### Corrective Phase - (Phase 2: Seq. X) - Purpose: Rehabilitate the patient's oral condition including appearance and function. - Information source: Health Hx, perio chart, clinical and radiographic findings - Examples: Orthodontics, crowns implants bridges. ### Maintenance Phase - (Phase 3: Seq. X) - Purpose: Periodically reevaluate the patient and provide supportive care - Information source: Health Hx, Perio Chart, Clinical and Radiographic - Examples:Periodic Exams, Perio Maintenance Treatment, Fluoride Application ### Sequencing - Organizes treatment into a logical sequence - Organized by phase - Procedures can be sequenced within each phase - Can have from none to many sequences - Often group multiple treatments of equal importance in one sequence. ### Mident Phasing and Sequencing | Tx Phase | Phase # | Sequence # | Description | |---|:---:|:---:|:---:| | Systemic | 0 | 1 | Medical Consult | | Systemic | 0 | X | Systemic Treatment | | Urgent | 1 | 0 | Acute Care Treatment | | Prevention/Disease Ctrl | 1 | X | Disease Ctrl/Treatment | | Corrective | 2 | X | Corrective Treatment | | Maintenance | 3 | X | Maintenance Treatment | ### Often are interchanged - A problem is a condition that needs to be treated (generally) - A modifier is a condition that may affect how the patient's treatment is delivered ### Common Modifiers - Dental Fear - Psychological problems - Age - Young - Old - Personal factors - Transportation - Finances schedule ### Challenge - Not figuring out the problem or modifiers but how best to treat the patient.