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					    THE SEVEN PS
         OF
TREATMENT PLANNING
    Ghil Dentistry
    Chief of Dentistry
     Man Yong Kim DDS

            Ghil
The U. S. military patient
 classification system used for
 triage of patients is an effective
 way of determining the priority of
 patients for treatment.
 It can also be used as a guide for
 treatment planning of individual
 patients:
Class V : Patients requiring emergency,
            Pain-relieving treatment
Class IV : Patients with urgent prosthetic
            needs for work or eating
Class III : Patients with serious conditions
            requiring urgent treatment
Class II : Patients requiring routine
            elective treatment
Class I : Patients requiring no treatment
Class V : Patients requiring emergency,
            Pain-relieving treatment
Class IV : Patients with urgent prosthetic
            needs for work or eating
Class III : Patients with serious conditions
            requiring urgent treatment
Class II : Patients requiring routine
            elective treatment
Class I : Patients requiring no treatment
One philosophy of dental care is
that dentists have a responsibility
for their patients’ health, and
restoring their oral health is more
important than satisfying the
patients’ immediate personal
wishes.
• Patient‘s Wish   •   Doctor’s preference
• Patient’s Want   •   Doctor’s philosophy
• Patient’s Need   •   Doctor’s personality
                   •   Doctor’s chracter
An understanding of treatment
planning principles will help the
dentist to develop a systematic
plan for each patient so that
everyone --the dentist, the
patient and the office staff--
knows exactly what the
treatment sequence will be.
It is assumed that a careful
history and oral exam will be
performed for each patient as a
basis for establishing the
treatment plan.
             I
PREVENTIVE DENTISTRY EDUCATION
             AND
          TREATMENT
• Routine for all patients :
    XR’s, cleaning, OHI (Oral Hygiene Instruction),
   Fluoride Treatment ( younger patients).
   Insurance in U. S. often covers at 100%, and
   Medicaid and other programs require it.


• OHI includes telling, showing, teaching, testing,
   review.


• “OHI has a longer lasting result than
    treatment.”
• “Patients in pain are not good
  candidates for education.”

• “Patients may be upset to get a
   lecture when they came for
   treatment.”

• Some education can be done while
  waiting for XR’s and anesthesia.
        II
PATIENT PREFERENCE
• An important part of history taking is CC .
  The patient’s symptoms (or reason for coming) in their
  own words.
• “Try to satisfy the CC on the first appointment if
   at all possible.”
• “If patients get what they want on the first
  appointment, they will not be encouraged to
  come back for further treatment.”
      - Bate treatment
•“If patients are satisfied with the
 treatment on the first visit, they will be
 encouraged to come back for further
 treatment.”
• “For walk-in emergency patients, take
 an XR and extract the tooth.”
• For urgent prosthetics, temporary
 crowns, bridges, flippers can be done
 on the first appointment.
      III
PAIN ELIMINATION
•Elimination of pain is usually the
 patient’s preference.
•For patients in severs pain,
 anesthetize and medicate as
 soon as possible.
•Dentists are inclined to
 mechanical intervention, but
 medication,physiotherapy,
 counseling, etc.
  May sometimes be appropriate.
•Elimination of pain is usually the
 patient’s preference.
•For patients in severs pain,
 anesthetize and medicate as
 soon as possible.
•Dentists are inclined to
 mechanical intervention, but
 medication,physiotherapy,
 counseling, etc.
  May sometimes be appropriate.
•Use of a long-lasting local
 anesthetic (Duranest/Etidocaine
 HCI 1.5%) gives 3-5 hours total
 anesthesia, and 7-9 hours soft
 tissue anesthesia, and will
 eliminate the pain until the
 results of treatment have taken
 effect.
        IV
PATHOLOGY ELIMINATION
• May have been eliminated by patient
 preference of Pain elimination .
•“ A Doctor of Dental Surgery must strive to
 return the patient to a state of health by
 eliminating all pathology from the oral
 cavity.”
•“No elective of cosmetic treatment
 should be done until after all
 pathology has first been eliminated
 or treatment has begun.
• Patients are often not concerned
 about treatment to eliminate
 pathology because it is often
 asymptomatic: gingivitis,
 periodontitis, apical abcesses,
 retained roots, soft tissue impacted
 teeth, etc.
Principles/applications
1. Treat acute marginal gingivitis with
 good oral hygiene before doing
 operative or crown and bridge
 (especially Class V cervical decay) .

2. Perio : Should completed hygienic
 phase before perio surgery, C&B, etc.
  This consists of removal of all local
 factors, good oral hygiene, healthy
 marginal gingivae.
3. Treat caries as a disease process, not
 just filling cavities. Healing of caries
 requires good oral hygiene, proper
 diet, fluoride, treatment restorations
 (glass ionomer good), mouthwashes,
 etc.
4. Extractions should be delayed until
 good oral hygiene has healed the
 marginal gingivitis, or the patient can’t
 brush well.
5. Before starting treatment on any tooth,
 ask four questions:
   1) Is the tooth restorable?
       (especially depth of gingival
         margins.)
    2) Is the periodontium healthy or can
       it be made so?
    3) Can endodontics be successfully
       done of needs?
    4) Is this tooth essential for prosthetic
       reasons ?
6. If patient refuses treatment to
 eliminate pathology, document it
 carefully in the patient’s record, with
 their signature if necessary.
   V
OPERATIVE
A. Stop the caries process by fill up all
   the cavities.
B. “Fill all carious lesions before starting
    prosthetics.” (for dental students?)
C. “Restore abutment teeth, take
    impressions, and do other
    restorations while waiting for lab
    work to be done.”
D. Quadrant operative vs one-at-a-time?
   Efficiency vs patient finances.
    VI
PROSTHETICS
A. Begin elective prosthetics after
   patient factors have been solved :
   oral hygiene, appointment-
   keeping, finances, etc.
 B. Can speed up prosthetic
   treatment by doing scaling and
   root planing of abutment teeth on
   first appointment
C. Do anterior crowns and bridges
  after good oral hygiene has
  caused gingivae to shrink and
  recede, or else the gingival
  margins will show later.
D. Design partial denture framework
  before starting any restoration of
  abutments .
  VII
PAYMENT
A. Make a definite plan ( or plans, eg.
   Plan A, plan B, etc.) : Treatment,
    sequence by appointment
   fees, payment, schedule, etc
B. “Patients are upset not by the
    amount of the fee, but because of a
    lack of understanding about the
    fees up front.”
C. Payment possibilities :
   1. For routine treatment, pay-as-
      you-go.
   2. Prosthetics : 1/2 at time of
                    impression,
                    1/2 at time of setting
C. Payment possibilities :
   3. Make discount rule
      - family
      - friend
      - poor patient
      - strategic person
Thank you for your attention

				
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posted:4/19/2012
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