Overall Classification:
UNCLASSIFIED//REL TO NATO/ISAF
1. Do no harm
2. Address patient’s chief
complaint
3. Resolve active disease
4. Prevent recurrent disease
5. Provide optimum comfort,
esthetics, and function
6. Treatment that, if
maintained, will provide the
patient many years of
trouble-free service
CFHSTC Clin Perio Crse 0013
1.
2.
3.
4.
5.
6.
7.
Examination
List the problems
Make a diagnosis
Determine the
prognosis
Develop treatment
options
Finalize treatment
plan with patient
Have patient sign
consent for treatment
CFHSTC Clin Perio Crse 0013



Grouping related problems
from problem list
Systematic approach
Record in patient’s record
Chief complaint

Remember what brought the patient in
for treatment

TRY to give the patient what they want –
not always possible
Medical history

Consult?

Modify treatment?
Clinic Findings
Oral Pathology



Evident soft-tissue abnormalities
(lumps, bumps, discolourations,
etc.)
Radiographic findings
If it does not look normal…
investigate further
◦ Consult/referral
CFHSTC Clin Perio Crse 0013
Clinical Findings
Restorative
Caries risk
Caries
Defective restorations
Oral hygiene
Pulp status (see diagram below)
Crowding
Strategic importance of tooth
◦
◦
◦
◦
◦
◦
◦

Esthetics?

Chewing?

Posterior support?
Clinical findings
Endodontics
Non-vital teeth
◦

Root canal – refer

Extraction – DT or refer
Hyper responsive to cold
testing
◦

Root canal – refer

Extraction – DT or refer
Cracked tooth
◦

Restorable?
Normal response
◦

Restorable

Non-restorable - extraction
CFHSTC Clin Perio Crse 0013
Clinical Findings
Periodontics
◦
◦
◦
◦
◦
◦
PSR
Mobility
Abscess
Bone levels
Oral hygiene
Crowding
Clinical Findings
Oral Surgery





Non-restorable teeth
Soft/hard tissue pathology
Potential extraction problems
◦ proximity to sinus or
neurovascular bundle
◦ medical concerns s/p
surgery
Residual roots
Endo treated teeth
9

“the act or art of
identifying a
disease by its signs
and symptoms”
CFHSTC Clin Perio Crse 0013

The main purpose
of a diagnosis is to
guide treatment
planning
CFHSTC Clin Perio Crse 0013

Diagnosis for
Dental Therapist:
◦
◦
◦
◦
Caries
Cracked tooth
Defective restoration
Pulpal (see next slide)
CFHSTC Clin Perio Crse 0013
PULPAL
1) Normal pulp
2) Reversible Pulpitis
3) Irreversible Pulpitis

Symptomatic or
Asymptomatic
4) Pulp necrosis
5) Previously treated
6) Previously Initiated
therapy
13
PULPAL
1) Normal pulp



No complaint
Responds to cold +/+++
Test several teeth to
determine normal for that
patient
14
PULPAL
1) Reversible Pulpitis
Pulp is inflamed but can
recover is proper
treatment is given
Patient response:





Sensitive to cold, hot,
sweets, air, etc.
Brief and not too painful
Recent restoration, caries,
root exposure, cracked
tooth
15
PULPAL
1) Irreversible Pulpitis
Pulp is inflamed and can
not be healed
Patient will usually
complain:





Spontaneous pain
Very painful to cold
Very painful to hot
Caries or restoration
Cold testing:




++ or +++ / +++
Lingering pain – 15
seconds or more
16
PULPAL
1) Pulp necrosis
Dead pulp
Patient response:








Asymptomatic
Pain to biting
Swelling
No response to
cold but it can for
multirooted teeth
Should have
obvious signs of
disease, such as
caries
Often will have
periapical lesion
17
PULPAL
1) Previously treated
2) Previously Initiated
therapy
◦
These situations need
to be referred to
Stomatologist
18
1.“The likely course
of a disease or
ailment.”
2.“The forecast of the
probable result of a
regimen of
treatment.”
CFHSTC Clin Perio Crse 0013

A forecast which is
used:
◦ For the clinician to
determine which
treatment options are
available
◦ For the patient to
determine if the
treatment is
worthwhile
CFHSTC Clin Perio Crse 0013



What determines
the functionality
of a tooth?
“The health and
vitality of the
PERIODONTIUM.”
What is the Px of
tooth 17? TX
options?

Overall prognosis
◦ Look at all the teeth
◦ Dental Therapist
should consult with
Stomatologist

Individual teeth
◦ Several criteria to
consider
◦ Keep overall
prognosis in mind



Percentage of bone
loss
Probing depth
Mobility





Root form
Pulpal involvement
Caries
Strategic value
Therapist knowledge
and skill

To determine if
bone has been lost:
◦ Draw a line between
Cementoenamel
Junctions
◦ Healthy bone should
have solid white line
2mm below that line
CEJs
connected
CFHSTC Clin Perio Crse 0013


Many different
prognoses used
Some prognoses
used in dentistry:
◦
◦
◦
◦
◦
Good
Fair
Poor
Questionable
Hopeless
CFHSTC Clin Perio Crse 0013

Prognoses
suggested for
Dental Therapists
◦ Restorable
 Dental therapist
 Refer
◦ Hopeless
 Non-restorable
 Extraction:
 Dental therapist
 Refer
CFHSTC Clin Perio Crse 0013

Hopeless prognosis
◦ Inadequate
attachment to
maintain tooth in
health, comfort, and
function
Over 90% attachment loss!

Hopeless prognosis according to Becker,
Becker, Berg – need 2 or more of the
following
1)
2)
3)
4)
5)
6)
7)
Greater than 75% bone loss
Greater than 8 mm probing depth
Class III furcation
Class III mobility *
Poor C:R ratio
History of repeated periodontal abscess
Close root proximity with minimal
interproximal bone and evidence of
horizontal bone loss
This is very difficult!
As concluded by McGuire
(1991):
“…it was found that
projections were ineffective
in predicting any prognosis
other than good, and that
prognoses tended to be
more accurate for single
rooted teeth than for multirooted teeth.”

88.2% (209 of 237) of
questionable and 59.5% (22
of 37) of hopeless teeth
survived 15 years during
regular SPT in a dental
school department. Graetz
C, et al
◦ J of Clin Perio 2011
Aug;38(8):707-14.
Treatment compartmentalized
in phases:
1. Emergency / Urgent care
2. Systemic problems
management
3. Preparatory/ hygienic/
diagnostic work-up/
disease control
4. Re-evaluation
5. Corrective restorative
6. Maintenance
31

Emergency Treatment
focuses on:
◦
◦
◦
◦

Bleeding
Swelling
Pain
Trauma
Majority of treatment for
Dental Therapist will be
Emergency Treatment
32
Systemic Management
A. Review of past medical history
B. Determination of medical risk
status
C. Impact of health on treatment
D. Need for medical consultation
E. Drug interactions and side
effects
F. Consider stress reduction
protocol
CFHSTC Clin Perio Crse 0013
Disease Control
A. Extract non-restorable teeth
B. Restore carious teeth and
replace
defective
restorations
DT to REFER
C. Endodontics to rectify disease
process
◦ defer elective/pre-emptive
endo (i.e., for pros
expediency)
CFHSTC Clin Perio Crse 0013
Disease Control
DT to REFER
D. Periodontal disease arrested
- scaling and root planing, reeval and possibly surgery
(pocket reduction)
E. Address other pathologic
conditions
◦ biopsy prn, candida rx, etc
CFHSTC Clin Perio Crse 0013

Steps 4 to 6 beyond
scope of this course
CFHSTC Clin Perio Crse 0013
Overall Classification:
UNCLASSIFIED//REL TO NATO/ISAF