DH+Diagnosis+Impact+on+Treatment+Options

Dental Hygiene Diagnosis Impact on Treatment Options __Diagnosis impact on treatment planning __ Disease classification distinguishes the various conditions affecting the periodontium and it facilitates treatment planning. Several classifications are used based on clinical manifestations, including: * Location * Degree of tissue change or loss and, * Rate of destruction

__Periodontitis can be classified into three major types based on: __
 * Clinical
 * Radiographic
 * Historical and
 * Laboratory characteristics

Classification of periodontal diseases facilitates treatment alternatives and therapeutic outcomes. **Chapter 7, pages 101 - 108**, has quick references of the classifications of periodontal diseases and conditions. In general these diseases fall into three broad categories: 1. Gingival diseases 2. Various types of periodontitis 3. Periodontal manifestations of systemic diseases

__Proper diagnosis of periodontal disease determines: __
 * <span style="font-family: "Times New Roman","serif"; font-size: 16px;">Identify type
 * <span style="font-family: "Times New Roman","serif"; font-size: 16px;">Extent
 * <span style="font-family: "Times New Roman","serif"; font-size: 16px;">Distribution
 * <span style="font-family: "Times New Roman","serif"; font-size: 16px;">Severity and
 * <span style="font-family: "Times New Roman","serif"; font-size: 16px;">Provides understanding of cause & pathologic process

__<span style="font-family: "Times New Roman","serif"; font-size: 16px;">To obtain the diagnosis, the dental hygienist must analyze and evaluate the patient’s: __
 * <span style="font-family: "Times New Roman","serif"; font-size: 16px;">Case history
 * <span style="font-family: "Times New Roman","serif"; font-size: 16px;">Clinical signs & symptoms
 * <span style="font-family: "Times New Roman","serif"; font-size: 16px;">Results of various tests (probing, mobility, radiographs, blood tests, & biopsies.)
 * <span style="font-family: "Times New Roman","serif"; font-size: 16px;">Findings must correlate and provide meaning for the patient (role of systemic diseases, conditions, behavioral factors. Does the patient require tx modifications and special precautions.)

__<span style="font-family: "Times New Roman","serif"; font-size: 16px;">Tools for Determining Diagnosis: __ <span style="font-family: "Times New Roman","serif"; font-size: 16px;">1. Overall appraisal of patient <span style="font-family: "Times New Roman","serif"; font-size: 16px;">2. Medical history & Risk Assessment (patient & family hx) <span style="font-family: "Times New Roman","serif"; font-size: 16px;">3. Dental history (patient & family hx) <span style="font-family: "Times New Roman","serif"; font-size: 16px;">4. Radiographic interpretation <span style="font-family: "Times New Roman","serif"; font-size: 16px;">5. Casts <span style="font-family: "Times New Roman","serif"; font-size: 16px;">6. Clinical photographs <span style="font-family: "Times New Roman","serif"; font-size: 16px;">7. Extra & Intra Oral examination <span style="font-family: "Times New Roman","serif"; font-size: 16px;">8. Periodontal examination & Prognosis <span style="font-family: "Times New Roman","serif"; font-size: 16px;">9. Nutritional status <span style="font-family: "Times New Roman","serif"; font-size: 16px;">10. Laboratory tests

<span style="font-family: "Times New Roman","serif"; font-size: 16px;">ALL of these combined are what make an IMPACT on treatment planning; on the ability of the dental hygienist to treatment plan effectively and have it be patient centered. <span style="font-family: "Times New Roman","serif"; font-size: 16px;">What happens next after the DIAGNOSIS is made? The dental hygienist has the ability to provide a patient centered treatment plan that is customized to their oral health needs.

__<span style="font-family: "Times New Roman","serif"; font-size: 16px;">The Treatment Plan: __
 * <span style="font-family: "Times New Roman","serif"; font-size: 16px;">Blueprint for case management
 * <span style="font-family: "Times New Roman","serif"; font-size: 16px;">Procedures required to establish and maintain oral health
 * <span style="font-family: "Times New Roman","serif"; font-size: 16px;">Treatment encompasses therapeutic objectives according to patient oral health needs; based on diagnosis, disease severity, and other factors.
 * <span style="font-family: "Times New Roman","serif"; font-size: 16px;">Reasoned decision
 * <span style="font-family: "Times New Roman","serif"; font-size: 16px;">Techniques to reach objective

<span style="font-family: "Times New Roman","serif"; font-size: 16px;">The **goal of the treatment plan** is to **eliminate gingival inflammation** and **correct** the **conditions** that **cause** and **perpetuate it**.

__<span style="font-family: "Times New Roman","serif"; font-size: 16px;">Considerations for treatment planning: __
 * <span style="font-family: "Times New Roman","serif"; font-size: 16px;">Extracting or preserving teeth. Removal, retention, of temporary retention of one or more teeth is important for the overall tx plan. Proper function and esthetics are important, may require interdisciplinary consultation with specialists.
 * <span style="font-family: "Times New Roman","serif"; font-size: 16px;">Occlusal relationship, systemic conditions, and supportive periodontal care

__<span style="font-family: "Times New Roman","serif"; font-size: 16px;">Therapeutic Procedures __ <span style="font-family: "Times New Roman","serif"; font-size: 16px;">Phase I – nonsurgical phase <span style="font-family: "Times New Roman","serif"; font-size: 16px;">Phase II – surgical phase <span style="font-family: "Times New Roman","serif"; font-size: 16px;">Phase III – restorative phase <span style="font-family: "Times New Roman","serif"; font-size: 16px;">Phase IV – maintenance phase

__<span style="font-family: "Times New Roman","serif"; font-size: 16px;">Explaining the treatment plan to the patient: __ <span style="font-family: "Times New Roman","serif"; font-size: 16px;">1. Be specific, explain exactly what conditions are & how they are treated, & prognosis after tx. <span style="font-family: "Times New Roman","serif"; font-size: 16px;">2. Begin discussion on a positive note. Long-term service expected and every effort will be made to retain as many teeth as possible. <span style="font-family: "Times New Roman","serif"; font-size: 16px;">3. Present the entire tx plan as a unit. Do not let the pt assume that there are procedures that they can pick and choose to do or not do. <span style="font-family: "Times New Roman","serif"; font-size: 16px;">4. Explain that not taking action and not proceeding with proposed tx plan is unadvisable. Emphasize the importance of eliminating disease and that maintaining disease may have severe life-threatening risk factors, such as cardiovascular disease, pulmonary disease and stroke.