FORMULATING A
DENTAL TREATMENT
PLAN
DR TASHNIM BAGUS
DEPT. OF PAEDIATRIC & RESTORATIVE
DENTISTRY
SCHOOL OF ORAL HEALTH SCIENCES
UNIVERSITY OF THE WITWATERSRAND.
INTRODUCTION
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BEING A DIAGNOSTICIAN IS PART OF
THE SKILL OF A GOOD CLINICIAN!
THE CLINICIAN SHOULD ACQUIRE
THE FUNDAMENTALS IN
GATHERING & INTERPRETING
CLINICAL INFORMATION.
DENTAL TREATMENT AND
PLANNING
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AN ART
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A SCIENCE
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DEVELOP TALENT
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TAUGHT
HISTORY
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MAIN COMPLAINT – M/C
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HISTORY OF MAIN COMPLAINT- HMC
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PAST DENTAL HISTORY- PDH
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GENERAL MEDICAL HISTORY- GMH
HISTORY(CONT)
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SOCIO-ECONOMIC
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HABITS
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CULTURAL / CUSTOMS
B) EXAMINATION
1) EXTRA ORAL EXAMINATION – EOE
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SYMMETRY ( Facial )
LIPS
LYMPH NODES
TMJ
B) EXAMINATION
2) INTRA ORAL EXAMINATION - IOE
 Oral mucosa – colour , texture , DMS
 Tongue
 Periodontium
 Teeth
 Occlusion
 Prosthesis (if any)
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C) SPECIAL INVESTIGATIONS
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RADIOGRAPHS
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VITALITY TESTS
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STUDY MODELS
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DIET ANALYSIS
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OTHER ( Blood Tests )
C) SPECIAL INVESTIGATIONS
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•
RADIOGRAPHS - panelipse X-ray
bitewing radiographs
periapical radiographs
VITALITY TESTS - electric pulp testing
thermal tests
percussion
palpation
colour
presence of a sinus
test cavity prep
DENTAL CHARTING

A) PERIODONTAL CHARTING
- plaque indices
- probing depths
- bleeding points
- gingival level
- tooth mobility
DENTAL CHARTING (cont)
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B) CONSERVATION CHARTING –
( Tooth )
-caries
-existing restorations
DENTAL CHARTING (cont)
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TOOTH NOTATION SYSTEMS
1) Palmer System
2) FDI System-(Federation Dentaire
Internationale)
Dental Charting(cont)

TOOTH NOTATION (cont)
3) US Tooth Notation System
4) Letters & Numbers Tooth Notation
System
Treatment Planning
“Treatment planning is the key factor which
separates a technician from a professional.
It can be the stimulating challenge which changes
the drudgery of a patchwork practice into an
orderly and logical progression of
comprehensive treatment.”
Hocott 1984
TREATMENT PLANNING(cont)
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Basic Principles
- educate and advise patients
- be open and honest
- afford patient opportunity to make
well informed decisions — Importantly,
it’s their required Rx your plan is based
upon!
TREATMENT PLANNING (cont)
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REMEMBER!!
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KEEP YOUR TREATMENT PLAN
S - SIMPLE
A -
AFFORDABLE
A - ADAPTABLE
GOD GIVEN TEETH
DESTRUCTION
RESTORATION
SUCCESS
RISKS vs BENEFITS!
FAILURE
TREATMENT
PLANNING(cont)
DATA COLLECTION
ORGANISATION & VISUALISATION
TREATMENT OPTION
IDEAL Rx
PLAN
REALISTIC Rx
PLAN
TREATMENT PLANNING
(cont)
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IDEAL Rx PLAN
-attitude
-desire
-finances
-health
-other modifying factors
WILL THE END JUSTIFY
THE MEANS?
?should Rx be undertaken?
?chance of success over a
long period?
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REALISTIC Rx PLAN
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Rx sequencing
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Treatment
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Maintenance
NB!!continued reassessment
at EACH stage!
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MODIFYING FACTORS IN Rx
PLANNING PROCESS
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1. Quality of life
2. Prognosis without Rx
3. Patient attitude
4. Iatrogenic potential
5. Expected duration & prognosis
6. Possibility for repair
7. Dentist and lab limitations
8. Flexibility
9. Benefits vs Costs+Risks
10.Primary complaint
11. Referral Possibility
TREATMENT PLANNING (cont)
TREATMENT SEQUENCING
1. EMERGENCY Rx
- m/c
- drainage & Rx of dental abscess

2. HIGH PRIORITY Rx
- extraction of hopelessly involved teeth
- caries control
- coronal scaling & polishing+OHI
- pulpotomies and pulp extirpations
TREATMENT SEQUENCING
(cont)
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3. LOW PRIORITY TREATMENT
- Endodontic therapy
- restoration of carious lesions
- temporary splinting
- re-evaluation
TREATMENT SEQUENCING
(cont)
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4. MAINTENANCE
-3/12
-6/12
* CONTINUED REASSESSMENT AND RE-EVALUATION!
TREATMENT PLAN(TX)

“TX” SHOULD TAKE THE PATIENT AND
DENTIST TO THE POINT WHERE
DISEASE IS CONTROLLED AND THE
DENTITION IS FUNCTIONAL , STABLE
AND ACCEPTABLY AESTHETIC !
TREATMENT SEQUENCING
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SEQUENCE OF “TX” CAN BE BROKEN
INTO STAGES…
TX SEQUENCING
1.STABILIZATION
•
•
•
RELIEVE PAIN –
TEMPORARY RX
PERMANENT RX
EXTRACTION
2. REASSESSMENT 1
* ORAL HYGIENE
* ASSESS TEMPORARY
RX – IS IT
RESPONDING- EG.
REVERSIBLE
PULPITIS ( ?
INDIRECT PULP CAP
/ OR RCT )
TX SEQUENCING
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3. PRELIMINARY
RESTORATIVE
PHASE
PERFORM URGENT RX
FIRST.
* COMPLETE ALL
PROCEDURES THAT
ARE NECESSARY.
* WAIT FOR HEALING.
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4. REASSESSMENT 2
•
ORAL HYGIENE
•
CHECK FOR NEW
DISEASE – EG
BROKEN
RESTORATIONS
TX SEQUENCING
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5. DEFINITIVE
RESTORATIVE PHASE
* SCALE AND POLISH
* FLUORIDE RX
* FISSURE SEALANTS ETC
* COMPLETE ALL
RESTORATIONS
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6. REASSESSMENT 3
•
CHECK ORAL
HYGIENE
•
POLISH AMALGAMS
TX SEQUENCING
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7. MAINTENANCE
RECALLS – EVERY 6
WEEKS
3 MONTHS
6 MONTHS ETC…
TX SEQUENCING
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STABILIZATION
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REASSESSMENT 1
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PRELIMINARY RESTORATIVE PHASE
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REASSESSMENT 2
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DEFINITIVE RESTORATIVE PHASE
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REASSESSMENT 3
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MAINTENANCE
TREATMENT OPTIONS
ORTHODONTICS
PERIO /
MFOS
OCCLUSION
RESTORATIVE
& TMJ
PROSTHODONTICS
ENDODONTICS