Diagnosis and Treatment Planning in Dentistry - E-Book

Stephen J. Stefanac, Samuel P. Nesbit

• Publisher: Mosby
• Year: 2015
• ISBN:
  9780323287319
• Edition: 3
• Topic: Medicina
• Subtopic: Odontología

Develop your skills in evaluation and dental treatment planning for all types of patients! Diagnosis and Treatment Planning in Dentistry, 3rd Edition provides a full-color guide to creating treatment plans based on a comprehensive patient assessment. Using evidence-based research, this book shows how risk assessment, prognosis, and expected treatment outcomes factor into the planning process. New chapters cover patient diagnosis and team-based treatment planning, and a new Evolve website includes videos and decision-making algorithms. Written by experienced dentistry educators Stephen Stefanac and Samuel Nesbit, this book is the only dental resource that combines patient examination and oral diagnosis with treatment planning.

• Clear, logical organization builds your understanding with sections on comprehensive patient evaluation, key treatment planning concepts, a detailed review of the five phases of planning treatment and guidelines for selecting the appropriate plan of care, and care planning for patients with special needs.
• In Clinical Practice boxes highlight situations that may be faced by the general dentist.
• What's the Evidence? boxes cite research articles affecting clinical decision-making and treatment planning strategies.
• Ethics in Dentistry boxes address ethical issues you may encounter in treatment planning.
• Review exercises in each chapter let you apply concepts to clinical practice.
• Expert authors and contributors provide a current, authoritative resource for effective treatment planning.
• Key Terms and a Glossary highlight and define important terminology.
• Evidence-based coverage demonstrates how to use research and clinical evidence in making treatment planning decisions.

• NEW Common Diagnoses in Dentistry chapter provides guidelines to making an accurate patient diagnosis prior to beginning treatment.
• NEW Interprofessional Treatment Planning chapter describes dental care in the context of a team-based collaborative approach, so that the dental treatment plan aligns with the overall treatment goals of the patient.
• NEW! Full-color photographs illustrate clinical principles and pathologies, and a colorful design highlights key content.
• UPDATED content reflects advances in dental techniques, materials, and patient treatment options based on research, clinical experience, and current literature.
• NEW resources on an Evolve website include videos and decision-making algorithms.

Section 1

Patient Examination and Diagnosis

Outline

1. Patient evaluation and assessment

2. Common diagnoses in dentistry

TitleChap

Chapter 1

Patient evaluation and assessment

Stephen J. Stefanac, Margherita Fontana

Outline

Overview of the Diagnostic Process

Information Gathering

Patient History

Clinical Examination

Radiographic Examination

Other Diagnostic aids

Documentation

http://evolve.elsevier.com/Stefanac/diagnosis/

Accurate diagnostic information forms the foundation of any treatment plan. This information comes from several sources: the patient history and physical examination, the clinical and radiographic examination, and other diagnostic sources. The dentist must critically analyze the information before recommending treatment options to the patient. The goal of this chapter is to discuss both the types of data that the dentist in general practice typically collects and the ways in which the dentist evaluates and documents this information in preparation for creating a treatment plan. There are several types of examinations (Box 1-1), and the focus of this chapter is on the comprehensive assessment of a patient.

BOX 1-1

Common Types of Examinations

The dentist should be able to provide several types of examinations for adolescent and adult patients. Most new patients to a dental office without urgent concerns will require a comprehensive examination before beginning treatment. A comprehensive examination includes a review and analysis of the patient’s health history and chief concerns, radiographic examination of the teeth and surrounding tissues, and clinical evaluation of the intraoral and extraoral hard and soft tissues. A periodic examination is performed at regular intervals, commonly during recall visits, for patients who have had a comprehensive or prior periodic examination. Activities include updating general and oral health histories and examination of extraoral hard and soft tissues. A problem-focused examination is limited to evaluating a specific problem or concern presented by the patient—for example, the evaluation of pain, swelling, broken teeth, or damaged restorations.

Overview of the diagnostic process

The diagnostic process is begun by gathering information about the patient and creating a patient database that will serve as the basis for all future patient care decisions. Although the components of each patient’s database vary, each includes pieces of relatively standard information, or findings, that come from asking questions, reviewing information on forms, observing and examining structures, performing diagnostic tests, and consulting with physicians and other dentists.

Findings fall into several categories. Signs are findings discovered by the dentist during an examination. For instance, the practitioner may observe that a patient has swollen ankles and difficulty in breathing when reclined, signs suggestive of congestive heart failure. Findings verbally revealed by the patients themselves, usually because they are causing problems, are referred to as symptoms. Patients may report such common symptoms as pain, swelling, broken teeth, loose teeth, bleeding gums, or esthetic concerns. When a symptom becomes the motivating factor for a patient to seek dental treatment, it is referred to as the chief complaint or chief concern. Patients who are new to a practice or presenting for emergency dental care often have one or more chief concerns (Figure 1-1).

FIG 1-1​This patient reported symptoms of tooth pain and bleeding gums. Many signs—dark teeth, receding gingival tissue, and poor oral hygiene—suggest serious dental problems.

The clinician must evaluate findings individually and in conjunction with other findings to determine whether the finding is significant. For example, the finding that a patient is being treated for hypertension may be not be significant alone, but when accompanied by another finding of blood pressure measuring 180/110 mm Hg, the level of importance of the first finding increases. Questions arise as to whether the patient’s hypertension is being managed appropriately or whether the patient is even taking the prescribed medication regularly. Obviously, further questioning of the patient is in order, generating even more findings to evaluate for significance. The process of differentiating significant from insignificant findings can be challenging for dental students and recent graduates. For example, a student may believe a dark s...