Dental Treatment Planning

Dental treatment planning is a dental contract. Before treatment can begin, a dentist must have a patient's valid consent. This is usually a signature on the treatment plan. For the consent to be valid, the purpose, likely side-effects and risks must be discussed, along with treatment alternatives.

Consenting to Treatment

Dental Treatment Planning - The Problem List

Dental treatment planning outlines the way a dentist will approach the work that is needed. It should include both goals and alternative treatment options and is administered in sequences or stages. It is always a work in progress and can be changed or modified at any time.

Dental treatment planning uses a combination of patient data:

• Medical History
• Dental History
• Psychological Status
• Personal Habits, History and Expectations

Medical History


A full medical history is essential for dental treatment planning. Since medical conditions can influence many aspects of treament, certain conditions may require a referral to a specialist or that treatment be performed in consultation with a medical practitioner or hospital specialist. It is important to let your dentist know about changes to your medical status during the course of treatment. Failure to disclose critical information could be harmful to your health.


Dental History


A person's dental history and attendance pattern may also be used in dental treatment planning. It may be used by a dentist to assess a patient's behavior towards dentistry and their oral health. An example of this would be the dentist seeing areas of a patient's mouth that has been left untreated for a long period of time. In this case, the dentist may plan to monitor the patient before beginning extensive dental treatment. For patients missing teeth, the dentist may inquire about the teeth, as a way to determine the existence of a dental disease.

Psychological Status


An assessment of a dental patient's pychological status can also provide further information when dental treatment planning. A history of a mental disorder may limit treatment options and necessitate a dentist developing an interim plan as treatment progresses. The patient's mental illness may also need to be confirmed and/or discussed with other health care personnel.


Personal Habits, History and Expectations


Patient habits (e.g., substance abuse), often are confirmed by clinical examinations, may be suspected during the treatment planning process and may require further investigation, before treatment can begin.

The occupation, employment status, economic status, social status, and patient's attitude to dental treatment can also influence treatment plan options.

As a dental patient, while your ability to pay should be considered during the treatment planning stage, ones economic status should not lead to "second-rate" treatment. Consider several of the treatment options. The one you decide should be both realistic and affordable.

Once all of the information has been collected, the dentist will create the patient's treatment planning problem list. From this list, he/she will then begin the process of outlining some solutions.

Dental Treatment Planning - The Solutions List

When dental treatment planning, dentists generally begin with the most complex problem, then divide it into small sequential stages. But, priority is always given to urgent matters and issues that are potentially harmful to a patient's health. This is followed by the removal and/or control of pathological factors (e.g., cavities). Treatments which create oral health and maintain general health are always considered a priority after pain relief.

As a dental patient, you should be encouraged to feel like you are participating in the treatment planning process. Your dentist should use phrases such as "Tell me about...", "How do you feel about..." in order to elicit more information regarding your attitude and wishes. They should be facilitating a rapport with you. In this way, an effective relationship may be established between you and the dentist, leading to optimum exchange of information.

Note: One of the methods dentists use to gain insight into the dental patient is to use a questionnaire. Questionnaires designed to collect patient information can assess the patient's perception of almost anything - their attitude toward dentists or their oral health status. Any information you provide to the dentist should be treated confidentially.

Dental Treating Planning - Presenting the Plan

Based upon the factors outlined above, ideally, the dentist should present you with at least three (3) treatment plan options. These treatment plans should be based primarily on the economical factors. Lets call them Ideal, Best and Cost Conscious treatment plans. While the terms used may vary, the concept is the same. Each treatment plan should be examined, with one chosen by the patient. Having alternative treatment plans allows the dental patient to choose the best plan that addresses ones particular circumstance.

Ideal Treatment Plans: for dental patients who are not too concerned with costs. They are able to pay for their care out of pocket with out worry. Implants and cosmetic procedures (veneers, laminates, invisalign braces), are usually their expected outcome.

Best Treatment Plans: designed for patients who have insurance and can afford to pay out of pocket expenses. Reconstructive work may be their primary needs with a cosmetic or a implant procedure being part of their treatment outcome.

The Cost Conscientious Plan: for those who require basic dental work in order to have a functional mouth (being able to chew food). This plan often fits dental patients who do not have insurance or other resources that would allow them to select a more favorable procedure, a (fixed bridge) versus a (partial denture).

Note: Once you have selected and signed your treatment plan, request a copy of the document. It can be used as a reference in order to prevent misunderstandings.

Dental Treatment Planning - Treating The Patient

Once a plan is selected, it will be divided into phases. Sometimes one clinical step will be dependent on the previous step. If difficulties occur in a stage, the dentist will do a reassessment of the treatment plan.

Phases are planned in order, initially aiming to eliminate any pain or discomfort and to control active disease. The patient's response is also assessed. Assessment may include observation of the patient with regard to oral hygiene instruction or counseling to stop smoking. There may also be instances where prognosis of treatment is uncertain, in which case, treatment may stop in order to review the progress. A systematic review of progress is desirable during any course of treatment.

Dental Treatment Planning Example

Following is an example of dental treatment planning for a patient in generally good health. The patient needs to have a) a root canal and crown on tooth number 9 and b) dental fillings on tooth nos. 23 and 27. The dental treatment planning sequence would be as follows:

Stage 1 of dental treatment planning should always involve a cleaning. Cleaning can be a scaling or simple prophy and can provide the dentist further information about a tooth or area of the mouth. A new problem will be added to the treatment plan and discussed with the dental patient if necessary. During this stage, the patient is provided with oral health instruction and shown the proper techniques to use for brushing and flossing.

Because the dental patient needs dental fillings on tooth nos. 23 and 27 and the dentist believes that the caries on tooth no. 23 is very deep, the patient may be referred to an endodontist to determine if a root canal should be performed. This shows good dentistry.

Note: Although then endodontic evaluation may reveal that the filling could be done without the patient having to undergo root canal with a subsequent post/core and crown, the dentist's decision was proactive.

Many patients do not find out that they need to have more major work performed on a tooth until a procedure is being done on that tooth. In this case, proposing the evaluation, as well as providing the explanation and the possibility of additional costs, will save both the dental patient and dental provider anxiety down the line. While the dental patient waits for the evaluation on tooth no. 23, the dentist will do the filling on tooth no 27. This is to remove tooth decay and stabilize the carious lesion.

This stage involves reconstructing the tooth and often involves dental crowns, bridges and dentures. In this example, the patient needs a dental crown on tooth number 9. Also, if the endo consultation on tooth no. 23 reveals the need for a root canal, then this tooth will also move from a stage 2 to a stage 3 procedure.

This is the final stage of treatment. The dental patient is provided with post operative information - given instructions for follow up visits. They may also be given emergency information related to the dental procedure(s) that was done.

The best treatment plan for a dental patient is one that is directed to enhancing oral health, the prevention of disease and freedom from pain and discomfort. It should also fit the dental patient's needs and prove to be cost-effective. It should not be confused with an idealistic treatment plan which uses the most clinically advanced and expensive procedures.

The information on dental treating planning for the dental patient was provided by a document prepared on behalf of the British Society for Restorative Dentistry entitled "A Strategy For Planning Restorative Dental Care" by F.J.T.Burke D.D.S., M.Sc., B.D.S., M.D.S., F.D.S., M.G.D.S.R.C.S.(Edin.)(1), J.M.Grummitt L.D.S.(2), A.C.Shearer M.Sc., B.D.S., F.D.S., M.R.D.R.C.S.(Edin)(3), and N.H.F.Wilson Ph.D., M.Sc., B.D.S., F.D.S., D.R.D., R.C.S.(Edin.), F.D.S.R.C.S.(Eng.)(3)

(1) University of Glasgow Dental School, 378 Sauchiehall Street, Glasgow G2 3JZ, UK.
(2) Compton Acres Dental Practice, Nottingham NG2 7RS, UK.
(3) University Dental Hospital of Manchester, Higher Cambridge Street, Manchester M15 6FH, UK.