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/Institutions/University-of-Maryland-School-of-Dentistry/json/Clinic-Manual/Advanced-Education-in-General-Dentistry.json

Introduction to Treatment Planning Technical Criteria

Format for Comprehensive Treatment Plan Work Up

I. History (S)

1. Chief Complaint (CC)
   1. It should be a symptom - record the patient’s impression of disease/problem in his/her own words.
2. History of Present Illness (HPI)
   1. Record details of chief complaint and related complaints - history of chief complaint.
3. Past Medical History (PMH)
   1. Record health history of systemic conditions, injuries, and hospitalizations in detail - medical consultation is present, if indicated.
      1. Childhood diseases
      2. Serious illnesses/transfusions
      3. Family health history which may bear on patient’s present or future health status
   2. Allergies and sensitivities
   3. Current medications
   4. Review of systems (ROS)
4. Environmental/social history
   1. Describe in detail any environmental factors that could impact on diagnosis and treatment planning, i.e., alcohol intake, tobacco usage, vocation, finances, etc.
5. Dental History
   1. Describe in detail the patient’s awareness of and involvement in previous dental treatment.
   2. Family dental health history (parents, siblings, spouse, children)
   3. Oral hygiene habits

II. Examination - Findings; list problems requiring attention, all of these must be addressed in TX sequence; charting must be complete - (O)

1. List general observations and systemic findings - age, vital signs, skin, limbs, development nutrition.
2. Record oral and extraoral findings: perform a thorough examination of the head, neck, face, and oral tissues.
   1. Head, neck, eyes, ears, nose, skin and secretions
   2. Lips, oral mucus, palate, pharynx, tongue and floor of mouth
   3. Gingival - color, texture, consistency, contour, amount of keratinized tissue, bleeding; details of periodontal condition on appropriate form
   4. Occlusion/musculature - a general statement of condition; details on appropriate form
   5. Dentition - a general statement of condition; details on appropriate form
   6. Oral hygiene - a general statement of condition; details on appropriate form
3. Radiographic Findings
   1. Obtain indicated radiographs which my include the following:
      1. periapical films (full mouth survey)
      2. posterior bitewing films
      3. panoramic film
      4. any necessary supplemental films
4. Microscopic - if indicated, obtain a phase contrast evaluation of microflora

   NOTE: The case is mounted on an articulator, all required radiographs, laboratory and clinical tests are obtained.

III. Diagnosis - (A)

1. List disease processes and abnormalities that address all pertinent findings.
   1. Systemic diagnosis
   2. Dental diagnosis

IV. Treatment Objectives - (A)

1. Make a general statement of the desired goals of treatment taking into account the findings, the patient’s situation and the resources of the practitioner. List considerations:
   1. Patient health
   2. Patient desires
   3. Patient age
   4. Patient financial restraints
   5. Prognosis (long and short term)
   6. Provider skills
2. Devise ideal (long-term) treatment objectives and immediate objectives (if applicable) that will support the ideal; formulate a segmented (progressive) treatment plan. Discuss all treatment options with the patient.
3. All fees for all treatment must be listed when the treatment plan is presented to the patient.

V. Planned Treatment Sequence - (P)

(The Written Treatment Plan)

1. A planned, well organized sequence of treatment is listed according to treatment phases that addresses all diagnosis and pertinent findings; materials to be used and alternate treatment plans are listed; best treatment plan for that individual patient is presented.
2. Order of treatment (Enter Each Phase - e.g., If N/A Enter “Phase 1 - N/A”)
   1. Systemic phase

      Systemic health considerations. Consult with physician when in doubt. Determine need for premedication, diet, precautions to protect patient and dental team, etc.

   2. Acute Urgent phase

      Treat problems of acute pain, bleeding, lost restorations, etc.

   3. Disease Control Hygienic phase (most import phase - steps necessary to control disease) for this specific patient generally in the order listed:
      1. Patient education and instruction in plaque control; fluoride program
      2. Biopsies if necessary
      3. Preliminary gross scaling - if necessary
      4. Caries control, and endodontic therapy
      5. Extraction of hopeless teeth. Temporary CPD’s and RPD’s if needed.
      6. Root planning
      7. Maintain plaque control
      8. Preliminary occlusal adjustment if indicated
      9. Minor tooth movement/orthodontic treatment
      10. Occlusal splints if indicated
      11. Definitive occlusal adjustment when necessary
      12. Continuous evaluation of oral hygiene and tissue response, and reassessment of the entire treatment plan
   4. Definitive/Corrective phase: correct environment to allow patient to maintain good oral hygiene
      1. Hemisections with temporary splinting
      2. Periodontal surgery, bone and soft tissue grafting
      3. Treatment of hypersensitive teeth
      4. Implants
      5. Restorative dentistry (should wait at least two months following extensive surgery)
      6. Recheck and refine occlusion
   5. Maintenance phase:
      1. Re-examine for effectiveness of plaque control, recurrence of periodontal disease, caries, and occlusal problems: reinforce oral hygiene instruction, perform prophylaxis including topical fluoride application. Recall based on the specific patient’s needs.
      2. Complete periodic radiographic survey of the dentition if indicated. Compare with prior radiographs
      3. Recheck prosthetic treatment
      4. Treatment of any active periodontal disease
      5. Treatment of recurrent carious lesions
      6. Endodontic therapy if pulpal and/or periapical lesions have developed or not resolved
      7. Replacement of restorations which no longer satisfy health, function or esthetic requirements
      8. Make new occlusal splints when old ones are broken down, worn out or lost

VI. Prognosis

1. State a prediction, based on an educated calculation, of the response of hard and soft tissue to the treatment planned, both long and short term.

VII. Signing the Treatment Plan

1. The patient must sign the treatment plan prior to any treatment being rendered. This is to establish that the patient accepts the treatment plan. The resident and faculty member should also sign the treatment plan.