Download Phases of the treatment plan….cont

Intra oral examination1. Soft tissue examination
2 . Hard tissue examination
Examination of soft tissues
 Mucosa
 Gingiva
 Frenal
attachments
 Floor of the mouth
 Tonsils
 Duct orifices


Mucosaulcerations

Growths

Discoloration

Manifestations of systemic
diseases
Gingiva 
Color

Contour

Stippling

Size
Frenal attachments

Maxillary labial frenum at times can be thick and
may cause midline diastema

Blanch test can be used for confirmation

Short lingual frenum can cause ankyloglossia
Floor of the mouth

Important structures seen are submandibular
gland and duct, sublingual gland and duct

Color changes are seen in hyperkeratotic
changes, inflammatory conditions, retention
cysts

Enlargement of floor of mouth usually occurs
due to cystic lesions, cellulitis
Tonsils

Size and degree of inflammation if present
should be examined
Duct orifices

Parotid gland – Stenson’s duct – opens in to
vestibule apposite to second maxillary
permanent molar

Submandibular gland- Wharton’s duct-lateral to
lingual frenum

Sublingual gland- Rivinus duct- opens in to floor
of the oral cavity
Oral hygiene appraisal



Stains
Calculus
Gingival enlargement /recession

Periodontal pocket

Bleeding on probing
Hard and soft palate

Palatal depth

Presence of swelling

Mucosal ulcerations

Color

Clefts
Examination of hard tissues

No of teeth

Type of teeth

Type of dentition

Dental caries with pulpal involvement

Attrition

Mobility of teeth


( physiological/pathological)
Grade of mobility

Occlusion
Angle’s classification
Class 1
Class 11
Class 111
Canine relationship
Deciduous occlusion
Flush terminal plane
Mesial step
distal step

Fracture teeth

Type of fracture

Fluorosis

Grade
Provisional diagnosis

A general diagnosis based on the clinical
impression without doing any laboratory
investigations
Investigations
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Radiographic investigation
Hematological investigationsBacteriological culture and sensitivity test
Vitality tests
Biopsy
Photographs
Study models
Radiographs are of two types-
1) intraoral
Intra oral periapical
Bitewing
Occlusal
2) extraoral
Intraoral radiographs
Intraoral Periapical radiographs Indications1)status of periapical region in deciduous and
young permanent teeth
2)evaluation of pulp and endodontic treatment
3)detection of developmental anomalies

4) to determine pathology involving primary
teeth
5)evaluation of status of periodontal ligament
Bitewing radiographDetection of inter proximal caries
with respect to depth and with relation to pulp

Observation of boundaries of pulp chamber and
height of pulp horn

Location of retained primary roots

Observation of relationship of apposing tooth

Observation of location and position of
permanent tooth bud and its relationship to
primary root
Occlusal radiograph
Occlusal radiograph

Evaluation of entire maxillary or mandibular arch
evaluation of cortical plate expansion
location of maxillary sinus or sub mandibular
salivary gland calculi
Extra oral films
Ortho pantomographs –
Visualization of both maxilla and mandible is
possible in one film

Useful in dental age evaluation
 eruption status of the teeth

Identification of location of the lesion in the jaws
Cephalographs

Establishment of skeletal and dental anomalies
 Evaluation of orthodontic treatment results

Useful in the study of skeletal, dental and soft
tissue structures in craniofacial region
Hematological investigations-

RBC count

Hemoglobin determination

Hemocrit count

Bleeding disorders-

Platelet count

Bleeding time

Clotting time. ...>Prothrombin time

Torniquet test
 Associated
with infections-

White cell count (WBC).

Differential count
Bacteriological culture and sensitivity test

Wound, abscess or surgical lesion cultures

Caries activity tests

Root canal cultures

Fresh moist preparations and smears

Vitality tests

Biopsy

photographs

Study models
Investigation findings

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Positive and negative findings of various
investigations should be mentioned
Differential diagnosis

“The process of listing out two or more diseases

having similar signs and symptoms out of which

only one could be attributed to patient’s
suffering”
Final diagnosis-


“a confirmed diagnosis based on all available
data”
Treatment planning
 It
is a complex process, like solving
 Abuzzal. Good and provisional treatment
 planning is very essential for providing an
 effective , and efficient treatment with
 minimum energy ,time and cost.
Treatment planning
 Objective
of planning treatment:
a. Insures the most effective treatment
for the individual patient.

b. Insures the most effective sequences
of treatment provided . i.e., preventive
or, therapeutic.
Treatment planning….cont
C. Allows the dentist to follow objectives in
each phase of the treatment.
d. Allows periodic reevaluation of treatment
progress and the necessary revision of the
treatment plan.
Treatment planning….cont
c. It Increases patient confidence in the
dentist.
d. It minimize , energy , time , and cost.
Phases of the treatment plan
Phase (1):
includes:,
* Emergency care through ,control
of chief complaint.
* Medical consultation…, if the patient
having any medical problem, which
may require the refer of the patient
to the specialists. Dental consultation.
Phases of the treatment plan….cont
* Introduction….The patient introduced
to the Dentistry , it is include management
of child’s behavioral problems.
* collecting all necessary information ( by
History, Examination, investigations and
Consultation).
Phases of the treatment plan….cont

phase ( 2)
* preventive therapy….include,
- oral hygiene, diet consoling, prophylaxis,
fluoride and fissure sealants appl.
phase (3)
* surgical & corective phase…. includes
* Excavation and temporary filling.
* Extraction of hopeless teeth.
Phases of treatment plan…cont.
* corrective therapy, includes
restoration,. amalgam, G.I, and
composite ,st .steel .crown, sp.
maintainer ,any advanced
periodontal therapy and endodontic treatment.
Phases of the treatment plan…cont
Phase ( 4).
- Rehabilitating phase….this
involve full mouth rehabilitation
i.e, final occlusal adjustment,
polishing of the restoration, oral
habit appliances, re-evaluation of
the oral health, and referral for orthodontic treatment.
Phases of the treatment plan
Phase ( 5) .
- Recall phase.
-Establishment of recall visits
or intervals.