Treatment Planning

	Theory and Practice of Pediatric Dentistry

Lecture Overview

	Developing Tx Plans
	Advantages
	Considerations during Tx Planning
			Quadrant Dentistry
			Local Anesthesia
			Incipient Lesions
			Priorities
			External Factors
	Presentation to Parents
	Referrals

Tx Planning in Pediatric Cases

	Initiated only after a complete & comprehensive diagnosis is obtained.
	Caries Risk Assessment
			Clinical, historical and social risk factors are used to determine if the child is likely to have caries or not.
	Anticipatory Guidance
			Co-active counseling prior to the event happening.
	Diagnosis
			Medical Record
			Clinical Exam
			Radiographic Exam

Development of Tx Plans

	Most critical step in the successful future management of the child and parent.
	A poorly developed Tx Plan
			Disorganized
			Inefficient
			Dissatisfaction
			Confusion

Advantages of Developing a Tx Plan

	Sequences the care.
	Allows for prioritization of care.
	Elimination of the need for repeated decision making for each appointment.
	Saves time
			Shortens the chair time
			Allows the dental assistant to be prepared in advance
			Provides for an estimate for the time required for the appointment
			Fee arrangements can be made in advance

Quadrant Dentistry in Children

	Essential for many reasons
			Allows for effective use of the appointment time
			Allows for effective use of LA
			Since caries progresses very quickly in the primary dentition, allows for the teeth to be treated in a timely fashion

Anteriors versus Posteriors Consideration

	May want to restore the anterior teeth last.
	Anterior teeth are primarily for esthetic purposes.
	Posterior teeth are of greater importance in mastication, space maintenance, vertical dimension and are retained for a much longer time.

Emergency versus Non-Emergency Visit

	The first priority is always to get the child out of pain if that is what the child presents with.
	Trauma seen immediately after it happens is another condition that requires treatment immediately.

Local Anesthesia Considerations

	If the case has minimal needs, consider complete arch or half mouth restorations.
	Maxillary local infiltrations may be easier to ease a patient in to if they have never had any dental procedure before.
	Avoid bilateral mandibular blocks in young children.

Incipient Lesion Considerations

	If the tooth is going to exfoliate within a year, then do not restore.
	Child’s past dental experience.
	Parent and child cooperation.
	Caries active child must have the incipient lesions restored.

Determination of Tx priorities

	Emergencies always get priority!
			Minimally necessary Tx to relieve the pain and infection
	Plaque-control program should be instituted
			Plaque removal
			Diet counseling
			Topical Fluoride
			Education on home oral hygiene care
	Restorative Tx completed
	Prosthodontic or Orthodontic Tx completed if necessary
	Recall visit schedule decided and followed

External Factors Influencing Parental Acceptance

	Dental I.Q.
	Interest level
	Past Experiences
	Finances
	Availability for appointments
	Social and Medical Problems

Tx Plan Presentation to the Parents

	Good communication in a manner that the parent can understand
	Do not criticize the parent for the child’s condition
	Relaxed and informative environment
	Use of visual Aids
	Accurately inform the parent of
			Dental needs of the child
			Restorative procedures
			Amount of time required
			Total cost
			Preventive measures necessary to maintain the completed Tx.

Referrals

	Proper referrals should not be considered an admission of incompetence but a realization that the child’s need may be best handled elsewhere.
	80% of children are excellent patients.
	There may be some instances when you may want to refer a child to a Pediatric DDS
			Your comfort level working with children
			Very young children (<2 yrs with rampant caries needing hospitalization)
			Developmental disturbances affecting the oral cavity
			Medically compromised children
			Congenitally and Developmentally handicapped conditions
			Severe management problem patients

The Referral Process

	Discuss the rationale for referring with the parent.
	Have the receptionist contact the specialist’s office and make the appointment.
	Communicate with the child specialist.
	Forward records and radiographs.
	Your office should receive some communication of the patients condition etc.

Summary

	Tx Planning is a critical step in the successful treatment of children.
	It helps sequence the care with proper prioritization of the child’s dental needs.
	It saves time and energy.
	“Definitely, definitely” a good idea!