new guideline case discussion

[Guest guest]

hi,

in 3rd stage(written treatment plan)they will give you the necessary radiographs

to support your treatment plan.you can find out the multiple radiolucency in

this stage only.(vitality test on G111 mobile teeth is unlikely-i think)

written treatment plan-you can write down the radiographic features(

how it looks like,why you are suspecting this).to confirm your diagnosis(biopsy)

and to do further treatment ,refer the patient to omfs.

even for the palatal lump ,you can write your finding and according to you

finding if you suspect any salivary gland benign / malignant tumour

again refer the patient to confirm the diagnosis and further treatment.

torus-ressure the patient & explain the detail

(can we request for biopsy in special investigation part)

correct me.

[Guest guest]

Thanks Pratheba for the info,i might br wrong ,but if it is cyst then the teeth might be vital even in case of tumors they might be vital or non vital (that is what i understod recently)also my question is ; is it in our scope to specify what kind of xray(excluding maybe PA or occlusal veiw)? From: Pratheeba <pratheebat@...>

Sent: Friday, February 17, 2012 5:22 AM Subject: new guideline case discussion

hi,

in 3rd stage(written treatment plan)they will give you the necessary radiographs to support your treatment plan.you can find out the multiple radiolucency in this stage only.(vitality test on G111 mobile teeth is unlikely-i think)

written treatment plan-you can write down the radiographic features(

how it looks like,why you are suspecting this).to confirm your diagnosis(biopsy) and to do further treatment ,refer the patient to omfs.

even for the palatal lump ,you can write your finding and according to you finding if you suspect any salivary gland benign / malignant tumour

again refer the patient to confirm the diagnosis and further treatment.

torus-ressure the patient & explain the detail

(can we request for biopsy in special investigation part)

correct me.

[Guest guest]

hi,

My written treatment plan for the case. Please do make corrections and give your

opinion regarding the notes.(i have put question marks against points that i am

not sure off.)

Treatment Plan:

Treatment Options:

EMERGENCY PHASE

For Lump In Palate:

1. No Treatment

Adv: No cost.

Disadv: Possible increase in size/pain/ulceration/discomfort.

2. Oral and Maxillofacial referral- for

a. biopsy of palatal lesion.

Justification- possible salivary gland neoplasm. likely to be benign but biopsy

needed to confirm.

Adv: help identify etiology of lesion and plan treatment.

Disadv: Possibility of Mild discomfort associated with surgical procedures-

pain/bleeding/discomfort for few days.

For Periodontitis:

1. OHI+ Full mouth Scaling and polishing

Adv: help improve gingival health.

help prepare mouth for possible replacement of teeth with poor prognosis

(LL1,LL2) in future.

Disadv: May cause some bleeding.

May cause sensitivity for 2-3 days post scaling.

may increase mobility of teeth for 2-3 days post scaling.

Smoking cessation advice???

PRIMARY PHASE

1. Monitor Gingival condition, redo scaling/polishing if required.

Adv: Help stabalise oral health.

help remove plaque/calculus from areas previously covered by inflamed

gingiva.

Disadv: Same as for initial scale and polish???

For multiple radiolucencies in mandible:

1. No treatment???

Adv?? Disadv??

2. Referral to Oral and maxillofacial surgeon

Justification- To determine etiology and treatment options for lesion.

To eliminate possibility of a tumor.

To eliminate bone lesion as a possible cause of tooth mobility??

3. Referral to GP

Justification- To eliminate the possibility of a systemic bone lesion.

For mobile teeth:

1. No treatment

Adv: No cost.

Disadv: Possibility of periodontal abscess./spread of infection.

Teeth may fall off.

2. extraction of LL1, LL2 and replacement

justification:

Grade 3 mobile teeth with poor prognosis.

Adv: Prevent development of abscess/infection.

Disadv: Minor surgical procedure involving anesthesia. might experience Mild

pain/bleeding/soreness for few days after procedure.

3. Impressions for immediate dentures post extraction.

SECONDARY PHASE:

Replacement Options:

1. Removable Partial denture- options

1. Acrylic

adv: Low cost

easy fabrication

disadv: takes time to adjust to acrrylic denture.

speech difficulty for few days.

might feel altered taste sensation

needs to be removed and cleaned daily

2. Co-Cr Partial denture

adv: lighter than acrylic

better adjustment

disadv: needs to be removed and cleaned daily.

2. Fixed Partial denture- (requires good periodontal condition)

options-

1. resin retained partial denture

1. Single- (LL1,LL2-pontic, LL3,LR1-abutment)???

2. Two separate- (LL1-pontic, LR1 abutment, LL2 pontic, LL3 abutment)

adv: minimal reduction of supporting tooth.

fixed to teeth so don't require removal

better tolerated than removable dentures

lower cost than other fixed options.

disadv: Might debond.

Longevity 4-5 years.

(do you think option of two separate cantilevers should be given?? what will

be the advantages of such an option??)

2. Fixed-fixed partial denture.

LL1, LL2-Pontic

LL3, LR1- abutment

Adv: Longevity 10-15 years.

Fixed to teeth, no removal required.

better tolerated than removable dentures

Disadv: require reduction of adjacent teeth for support.

higher cost compared to previous options

Risks: 20-30% chance of abutments developing pulpal damage, requiring RCT in

future.

3. Implants

Adv: Success rate 95-97% mandible.

Fixed in bone.

Disadv: Will involve minor surgical procedure to place implant- possible

complications- bleeding/pain/soreness/difficult eating for few days after

procedure.

Waiting period of 4-6 months before placement of log-term restoration on

implant, during which temp denture will have to be worn.

Risks:

Smoking may reduce success rate.

Diabetes may reduce success rate.

MAINTENANCE PHASE:

1. review oral Hygiene

2. review Restorative work

3. Review lump on palate.

This is my first attempt at writing a treatment plan. Please make

additions/corrections etc. Also, is there anything else that should be done for

the lump in palate or mandibular radiolucencies??

Regards,

Smriti

>

> Thanks Pratheba for the info,

> i might br wrong ,but if it is cyst then the teeth might be vital even in case

of tumors they might be vital or non vital (that is what i understod

recently)also my question is ;  is it in our scope to specify what kind of

xray(excluding maybe PA or occlusal veiw)?

>

>

>

>

> ________________________________

> From: Pratheeba <pratheebat@...>

>

> Sent: Friday, February 17, 2012 5:22 AM

> Subject: new guideline case discussion

>

>

>  

> hi,

> in 3rd stage(written treatment plan)they will give you the necessary

radiographs to support your treatment plan.you can find out the multiple

radiolucency in this stage only.(vitality test on G111 mobile teeth is

unlikely-i think)

> written treatment plan-you can write down the radiographic features(

> how it looks like,why you are suspecting this).to confirm your

diagnosis(biopsy) and to do further treatment ,refer the patient to omfs.

>

> even for the palatal lump ,you can write your finding and according to you

finding if you suspect any salivary gland benign / malignant tumour

> again refer the patient to confirm the diagnosis and further treatment.

> torus-ressure the patient & explain the detail

>

> (can we request for biopsy in special investigation part)

> correct me.

>

[Guest guest]

Hi SmritiI think it looks pretty okay on the whole except for a couple of changes that i can think of. firstly at rcs college we were told that perio is never an emergency and its the first thing that comes in the primary/stabilisation phase. so perio should be put in primary phase.IF there is accompanying sensitivity then we can apply desensitising agents and varnish to relieve sensitivity in the emergency phase.

in primary phae deal with perio as followsexplain periodontitis and role of diabetes and smokingcollect additional data (bleeding index, fuull mouth six point pocket chart, plaque and debris index)

carry out supra and subgingival scalingeducate oral hygiene maintainance.then in the maintainance phasereview  and monitor oral hygiene and reinforce oral hygiene instructions where necessary.

In case of the option for implants i think we also need to mention the referral to a restorative specialist with special interest in implantology.Kind regardsJasmine.

On Fri, Feb 17, 2012 at 5:03 PM, doc_smriti <doc_smriti@...> wrote:

 

hi,

My written treatment plan for the case. Please do make corrections and give your opinion regarding the notes.(i have put question marks against points that i am not sure off.)

Treatment Plan:

Treatment Options:

EMERGENCY PHASE

For Lump In Palate:

1. No Treatment

Adv: No cost.

Disadv: Possible increase in size/pain/ulceration/discomfort.

2. Oral and Maxillofacial referral- for

a. biopsy of palatal lesion.

Justification- possible salivary gland neoplasm. likely to be benign but biopsy needed to confirm.

Adv: help identify etiology of lesion and plan treatment.

Disadv: Possibility of Mild discomfort associated with surgical procedures- pain/bleeding/discomfort for few days.

For Periodontitis:

1. OHI+ Full mouth Scaling and polishing

Adv: help improve gingival health.

help prepare mouth for possible replacement of teeth with poor prognosis (LL1,LL2) in future.

Disadv: May cause some bleeding.

May cause sensitivity for 2-3 days post scaling.

may increase mobility of teeth for 2-3 days post scaling.

Smoking cessation advice???

PRIMARY PHASE

1. Monitor Gingival condition, redo scaling/polishing if required.

Adv: Help stabalise oral health.

help remove plaque/calculus from areas previously covered by inflamed gingiva.

Disadv: Same as for initial scale and polish???

For multiple radiolucencies in mandible:

1. No treatment???

Adv?? Disadv??

2. Referral to Oral and maxillofacial surgeon

Justification- To determine etiology and treatment options for lesion.

To eliminate possibility of a tumor.

To eliminate bone lesion as a possible cause of tooth mobility??

3. Referral to GP

Justification- To eliminate the possibility of a systemic bone lesion.

For mobile teeth:

1. No treatment

Adv: No cost.

Disadv: Possibility of periodontal abscess./spread of infection.

Teeth may fall off.

2. extraction of LL1, LL2 and replacement

justification:

Grade 3 mobile teeth with poor prognosis.

Adv: Prevent development of abscess/infection.

Disadv: Minor surgical procedure involving anesthesia. might experience Mild pain/bleeding/soreness for few days after procedure.

3. Impressions for immediate dentures post extraction.

SECONDARY PHASE:

Replacement Options:

1. Removable Partial denture- options

1. Acrylic

adv: Low cost

easy fabrication

disadv: takes time to adjust to acrrylic denture.

speech difficulty for few days.

might feel altered taste sensation

needs to be removed and cleaned daily

2. Co-Cr Partial denture

adv: lighter than acrylic

better adjustment

disadv: needs to be removed and cleaned daily.

2. Fixed Partial denture- (requires good periodontal condition)

options-

1. resin retained partial denture

1. Single- (LL1,LL2-pontic, LL3,LR1-abutment)???

2. Two separate- (LL1-pontic, LR1 abutment, LL2 pontic, LL3 abutment)

adv: minimal reduction of supporting tooth.

fixed to teeth so don't require removal

better tolerated than removable dentures

lower cost than other fixed options.

disadv: Might debond.

Longevity 4-5 years.

(do you think option of two separate cantilevers should be given?? what will be the advantages of such an option??)

2. Fixed-fixed partial denture.

LL1, LL2-Pontic

LL3, LR1- abutment

Adv: Longevity 10-15 years.

Fixed to teeth, no removal required.

better tolerated than removable dentures

Disadv: require reduction of adjacent teeth for support.

higher cost compared to previous options

Risks: 20-30% chance of abutments developing pulpal damage, requiring RCT in future.

3. Implants

Adv: Success rate 95-97% mandible.

Fixed in bone.

Disadv: Will involve minor surgical procedure to place implant- possible complications- bleeding/pain/soreness/difficult eating for few days after procedure.

Waiting period of 4-6 months before placement of log-term restoration on implant, during which temp denture will have to be worn.

Risks:

Smoking may reduce success rate.

Diabetes may reduce success rate.

MAINTENANCE PHASE:

1. review oral Hygiene

2. review Restorative work

3. Review lump on palate.

This is my first attempt at writing a treatment plan. Please make additions/corrections etc. Also, is there anything else that should be done for the lump in palate or mandibular radiolucencies??

Regards,

Smriti

>

> Thanks Pratheba for the info,

> i might br wrong ,but if it is cyst then the teeth might be vital even in case of tumors they might be vital or non vital (that is what i understod recently)also my question is ;  is it in our scope to specify what kind of xray(excluding maybe PA or occlusal veiw)?

>

>

>

>

> ________________________________

> From: Pratheeba <pratheebat@...>

>

> Sent: Friday, February 17, 2012 5:22 AM

> Subject: new guideline case discussion

>

>

>  

> hi,

> in 3rd stage(written treatment plan)they will give you the necessary radiographs to support your treatment plan.you can find out the multiple radiolucency in this stage only.(vitality test on G111 mobile teeth is unlikely-i think)

> written treatment plan-you can write down the radiographic features(

> how it looks like,why you are suspecting this).to confirm your diagnosis(biopsy) and to do further treatment ,refer the patient to omfs.

>

> even for the palatal lump ,you can write your finding and according to you finding if you suspect any salivary gland benign / malignant tumour

> again refer the patient to confirm the diagnosis and further treatment.

> torus-ressure the patient & explain the detail

>

> (can we request for biopsy in special investigation part)

> correct me.

>

[Guest guest]

Hi Jasmine..

Thanks a lot for your opinion and additions. They are very helpful. but I just

felt that since the patient's chief complaint was wobbly teeth something should

be done on the day. What do u think??

the explanation will have to be covered while talking to the patient during the

last 10 min according to the new guidelines.

All other investigations bleeding index/full mouth charting extra will have to

be asked for before writing the treatment plan.

And yes, we do need to mention the specialist referral for implants.. forgot to

write that!! Thanks again!

Regards,

Smriti

> > >

> > > Thanks Pratheba for the info,

> > > i might br wrong ,but if it is cyst then the teeth might be vital even

> > in case of tumors they might be vital or non vital (that is what i

> > understod recently)also my question is ;Â is it in our scope to specify

> > what kind of xray(excluding maybe PA or occlusal veiw)?

> > >

> > >

> > >

> > >

> > > ________________________________

> > > From: Pratheeba <pratheebat@>

> >

> > >

> > > Sent: Friday, February 17, 2012 5:22 AM

> > > Subject: new guideline case discussion

> > >

> > >

> > > Â

> > > hi,

> > > in 3rd stage(written treatment plan)they will give you the necessary

> > radiographs to support your treatment plan.you can find out the multiple

> > radiolucency in this stage only.(vitality test on G111 mobile teeth is

> > unlikely-i think)

> > > written treatment plan-you can write down the radiographic features(

> > > how it looks like,why you are suspecting this).to confirm your

> > diagnosis(biopsy) and to do further treatment ,refer the patient to omfs.

> > >

> > > even for the palatal lump ,you can write your finding and according to

> > you finding if you suspect any salivary gland benign / malignant tumour

> > > again refer the patient to confirm the diagnosis and further treatment.

> > > torus-ressure the patient & explain the detail

> > >

> > > (can we request for biopsy in special investigation part)

> > > correct me.

> > >

> >

> >

> >

>

[Guest guest]

Hi guysthank you Smriti for the case,time and treatment palnning)) it is excellent job!I would add Treatment Options:

> > EMERGENCY PHASE

> > For Lump In Palate:

> > 1. No Treatment

> > Adv: No cost.

> > Disadv: Possible increase in size/pain/ulceration/discomfort,MALIGNANCYIf you send the pt to the specialist,you still need to do something,coz he has more problems,i would go for additional investigations and scale and polish-to address pt concerns.maybe I am wrong... SincerelyLyudmyla From: doc_smriti <doc_smriti@...> Sent: Friday, 17 February 2012, 19:37 Subject: Re: new guideline case

discussion

Hi Jasmine..

Thanks a lot for your opinion and additions. They are very helpful. but I just felt that since the patient's chief complaint was wobbly teeth something should be done on the day. What do u think??

the explanation will have to be covered while talking to the patient during the last 10 min according to the new guidelines.

All other investigations bleeding index/full mouth charting extra will have to be asked for before writing the treatment plan.

And yes, we do need to mention the specialist referral for implants.. forgot to write that!! Thanks again!

Regards,

Smriti

> > >

> > > Thanks Pratheba for the info,

> > > i might br wrong ,but if it is cyst then the teeth might be vital even

> > in case of tumors they might be vital or non vital (that is what i

> > understod recently)also my question is ;Â is it in our scope to specify

> > what kind of xray(excluding maybe PA or occlusal veiw)?

> > >

> > >

> > >

> > >

> > > ________________________________

> > > From: Pratheeba <pratheebat@>

> >

> > >

> > > Sent: Friday, February 17, 2012 5:22 AM

> > > Subject: new guideline case discussion

> > >

> > >

> > > Â

> > > hi,

> > > in 3rd stage(written treatment plan)they will give you the necessary

> > radiographs to support your treatment plan.you can find out the multiple

> > radiolucency in this stage only.(vitality test on G111 mobile teeth is

> > unlikely-i think)

> > > written treatment plan-you can write down the radiographic features(

> > > how it looks like,why you are suspecting this).to confirm your

> > diagnosis(biopsy) and to do further treatment ,refer the patient to omfs.

> > >

> > > even for the palatal lump ,you can write your finding and according to

> > you finding if you suspect any salivary gland benign / malignant tumour

> > > again refer the patient to confirm the diagnosis and further treatment.

> > > torus-ressure the patient & explain the detail

> > >

> > > (can we request for biopsy in special investigation part)

> > > correct me.

> > >

> >

> >

> >

>

[Guest guest]

hi Smritiyes, i think you are right but I am not sure about one thing. When we have to talk to the patient we are not going to tell him/her specifically that " i will be doing treatment in emergency, primary , secondary and maintainance phases " . we will just expalin what needs to be done and what are the options available and what i will do today " (which will be emergency phase). its only the writing part where we need to mention the phases.

as far as the indices are concerned, i dont think so that they form part of special investigations because if u are diagnosing the patient for the first time, then you will take all the indices after diagnosis. the main purpose behind which is to get a  record base to which you can refer back in future (maintainance and recall phase) to judge the progression of the disease.

so i think we will explain the perio problem, bone loss, smoking and diabetes effect on gums as usual and the tell the patient " coming to the treatment of the problem, i will do a thorugh basic check of your teeth and gums to check the extent of damage. i willl do that by putting a small instrument between your teeth and gums which might cause a bit of discomfort but if needed i will rub a gel on your gums before doing that to numb them up. then i will do a professional cleaning up of your teeth.... "  

in short i think these indices are part of treatment rather than special investigations because bpe scores are enough to tell the diagnosis of periodontitis. I have seen dentists following this procedure. they take indices, do deep scale and polish and call back the patient after 3 mnths and then take indices again to check areas of improvement. but i dont know if this procedure is valid for our new guidelines????? 

this is what i think but someone who has attended the rcs course in march can tell us exactly.regardsjasmineFri, Feb 17, 2012 at 7:37 PM, doc_smriti <doc_smriti@...> wrote:

 

Hi Jasmine..

Thanks a lot for your opinion and additions. They are very helpful. but I just felt that since the patient's chief complaint was wobbly teeth something should be done on the day. What do u think??

the explanation will have to be covered while talking to the patient during the last 10 min according to the new guidelines.

All other investigations bleeding index/full mouth charting extra will have to be asked for before writing the treatment plan.

And yes, we do need to mention the specialist referral for implants.. forgot to write that!! Thanks again!

Regards,

Smriti

> > >

> > > Thanks Pratheba for the info,

> > > i might br wrong ,but if it is cyst then the teeth might be vital even

> > in case of tumors they might be vital or non vital (that is what i

> > understod recently)also my question is ;Â is it in our scope to specify

> > what kind of xray(excluding maybe PA or occlusal veiw)?

> > >

> > >

> > >

> > >

> > > ________________________________

> > > From: Pratheeba <pratheebat@>

> >

> > >

> > > Sent: Friday, February 17, 2012 5:22 AM

> > > Subject: new guideline case discussion

> > >

> > >

> > > Â

> > > hi,

> > > in 3rd stage(written treatment plan)they will give you the necessary

> > radiographs to support your treatment plan.you can find out the multiple

> > radiolucency in this stage only.(vitality test on G111 mobile teeth is

> > unlikely-i think)

> > > written treatment plan-you can write down the radiographic features(

> > > how it looks like,why you are suspecting this).to confirm your

> > diagnosis(biopsy) and to do further treatment ,refer the patient to omfs.

> > >

> > > even for the palatal lump ,you can write your finding and according to

> > you finding if you suspect any salivary gland benign / malignant tumour

> > > again refer the patient to confirm the diagnosis and further treatment.

> > > torus-ressure the patient & explain the detail

> > >

> > > (can we request for biopsy in special investigation part)

> > > correct me.

> > >

> >

> >

> >

>

[Guest guest]

Hi SmritiSorry i just read the guidelines again. it mentions full mouth periodontal charting as a special investigation. So you are right. pls ignore my previous mail.regardsJasmine

On Fri, Feb 17, 2012 at 8:56 PM, jasmine chopra <contactjasmine288@...> wrote:

hi Smritiyes, i think you are right but I am not sure about one thing. When we have to talk to the patient we are not going to tell him/her specifically that " i will be doing treatment in emergency, primary , secondary and maintainance phases " . we will just expalin what needs to be done and what are the options available and what i will do today " (which will be emergency phase). its only the writing part where we need to mention the phases.

as far as the indices are concerned, i dont think so that they form part of special investigations because if u are diagnosing the patient for the first time, then you will take all the indices after diagnosis. the main purpose behind which is to get a  record base to which you can refer back in future (maintainance and recall phase) to judge the progression of the disease.

so i think we will explain the perio problem, bone loss, smoking and diabetes effect on gums as usual and the tell the patient " coming to the treatment of the problem, i will do a thorugh basic check of your teeth and gums to check the extent of damage. i willl do that by putting a small instrument between your teeth and gums which might cause a bit of discomfort but if needed i will rub a gel on your gums before doing that to numb them up. then i will do a professional cleaning up of your teeth.... "  

in short i think these indices are part of treatment rather than special investigations because bpe scores are enough to tell the diagnosis of periodontitis. I have seen dentists following this procedure. they take indices, do deep scale and polish and call back the patient after 3 mnths and then take indices again to check areas of improvement. but i dont know if this procedure is valid for our new guidelines????? 

this is what i think but someone who has attended the rcs course in march can tell us exactly.regardsjasmineFri, Feb 17, 2012 at 7:37 PM, doc_smriti <doc_smriti@...> wrote:

 

Hi Jasmine..

Thanks a lot for your opinion and additions. They are very helpful. but I just felt that since the patient's chief complaint was wobbly teeth something should be done on the day. What do u think??

the explanation will have to be covered while talking to the patient during the last 10 min according to the new guidelines.

All other investigations bleeding index/full mouth charting extra will have to be asked for before writing the treatment plan.

And yes, we do need to mention the specialist referral for implants.. forgot to write that!! Thanks again!

Regards,

Smriti

> > >

> > > Thanks Pratheba for the info,

> > > i might br wrong ,but if it is cyst then the teeth might be vital even

> > in case of tumors they might be vital or non vital (that is what i

> > understod recently)also my question is ;Â is it in our scope to specify

> > what kind of xray(excluding maybe PA or occlusal veiw)?

> > >

> > >

> > >

> > >

> > > ________________________________

> > > From: Pratheeba <pratheebat@>

> >

> > >

> > > Sent: Friday, February 17, 2012 5:22 AM

> > > Subject: new guideline case discussion

> > >

> > >

> > > Â

> > > hi,

> > > in 3rd stage(written treatment plan)they will give you the necessary

> > radiographs to support your treatment plan.you can find out the multiple

> > radiolucency in this stage only.(vitality test on G111 mobile teeth is

> > unlikely-i think)

> > > written treatment plan-you can write down the radiographic features(

> > > how it looks like,why you are suspecting this).to confirm your

> > diagnosis(biopsy) and to do further treatment ,refer the patient to omfs.

> > >

> > > even for the palatal lump ,you can write your finding and according to

> > you finding if you suspect any salivary gland benign / malignant tumour

> > > again refer the patient to confirm the diagnosis and further treatment.

> > > torus-ressure the patient & explain the detail

> > >

> > > (can we request for biopsy in special investigation part)

> > > correct me.

> > >

> >

> >

> >

>

[Guest guest]

hi in your treatment options fixed -FPD(2nd) what type of material you are going to use?is it all-ceramic, or the matel ceramic?do we need to mention about that? and the cast of the implants?correct me if i am wrong. Thanks & Regards,Padma From: doc_smriti <doc_smriti@...> Sent: Friday, 17 February

2012, 17:03 Subject: Re: new guideline case discussion

hi,

My written treatment plan for the case. Please do make corrections and give your opinion regarding the notes.(i have put question marks against points that i am not sure off.)

Treatment Plan:

Treatment Options:

EMERGENCY PHASE

For Lump In Palate:

1. No Treatment

Adv: No cost.

Disadv: Possible increase in size/pain/ulceration/discomfort.

2. Oral and Maxillofacial referral- for

a. biopsy of palatal lesion.

Justification- possible salivary gland neoplasm. likely to be benign but biopsy needed to confirm.

Adv: help identify etiology of lesion and plan treatment.

Disadv: Possibility of Mild discomfort associated with surgical procedures- pain/bleeding/discomfort for few days.

For Periodontitis:

1. OHI+ Full mouth Scaling and polishing

Adv: help improve gingival health.

help prepare mouth for possible replacement of teeth with poor prognosis (LL1,LL2) in future.

Disadv: May cause some bleeding.

May cause sensitivity for 2-3 days post scaling.

may increase mobility of teeth for 2-3 days post scaling.

Smoking cessation advice???

PRIMARY PHASE

1. Monitor Gingival condition, redo scaling/polishing if required.

Adv: Help stabalise oral health.

help remove plaque/calculus from areas previously covered by inflamed gingiva.

Disadv: Same as for initial scale and polish???

For multiple radiolucencies in mandible:

1. No treatment???

Adv?? Disadv??

2. Referral to Oral and maxillofacial surgeon

Justification- To determine etiology and treatment options for lesion.

To eliminate possibility of a tumor.

To eliminate bone lesion as a possible cause of tooth mobility??

3. Referral to GP

Justification- To eliminate the possibility of a systemic bone lesion.

For mobile teeth:

1. No treatment

Adv: No cost.

Disadv: Possibility of periodontal abscess./spread of infection.

Teeth may fall off.

2. extraction of LL1, LL2 and replacement

justification:

Grade 3 mobile teeth with poor prognosis.

Adv: Prevent development of abscess/infection.

Disadv: Minor surgical procedure involving anesthesia. might experience Mild pain/bleeding/soreness for few days after procedure.

3. Impressions for immediate dentures post extraction.

SECONDARY PHASE:

Replacement Options:

1. Removable Partial denture- options

1. Acrylic

adv: Low cost

easy fabrication

disadv: takes time to adjust to acrrylic denture.

speech difficulty for few days.

might feel altered taste sensation

needs to be removed and cleaned daily

2. Co-Cr Partial denture

adv: lighter than acrylic

better adjustment

disadv: needs to be removed and cleaned daily.

2. Fixed Partial denture- (requires good periodontal condition)

options-

1. resin retained partial denture

1. Single- (LL1,LL2-pontic, LL3,LR1-abutment)???

2. Two separate- (LL1-pontic, LR1 abutment, LL2 pontic, LL3 abutment)

adv: minimal reduction of supporting tooth.

fixed to teeth so don't require removal

better tolerated than removable dentures

lower cost than other fixed options.

disadv: Might debond.

Longevity 4-5 years.

(do you think option of two separate cantilevers should be given?? what will be the advantages of such an option??)

2. Fixed-fixed partial denture.

LL1, LL2-Pontic

LL3, LR1- abutment

Adv: Longevity 10-15 years.

Fixed to teeth, no removal required.

better tolerated than removable dentures

Disadv: require reduction of adjacent teeth for support.

higher cost compared to previous options

Risks: 20-30% chance of abutments developing pulpal damage, requiring RCT in future.

3. Implants

Adv: Success rate 95-97% mandible.

Fixed in bone.

Disadv: Will involve minor surgical procedure to place implant- possible complications- bleeding/pain/soreness/difficult eating for few days after procedure.

Waiting period of 4-6 months before placement of log-term restoration on implant, during which temp denture will have to be worn.

Risks:

Smoking may reduce success rate.

Diabetes may reduce success rate.

MAINTENANCE PHASE:

1. review oral Hygiene

2. review Restorative work

3. Review lump on palate.

This is my first attempt at writing a treatment plan. Please make additions/corrections etc. Also, is there anything else that should be done for the lump in palate or mandibular radiolucencies??

Regards,

Smriti

>

> Thanks Pratheba for the info,

> i might br wrong ,but if it is cyst then the teeth might be vital even in case of tumors they might be vital or non vital (that is what i understod recently)also my question is ;Â is it in our scope to specify what kind of xray(excluding maybe PA or occlusal veiw)?

>

>

>

>

> ________________________________

> From: Pratheeba <pratheebat@...>

>

> Sent: Friday, February 17, 2012 5:22 AM

> Subject: new guideline case discussion

>

>

> Â

> hi,

> in 3rd stage(written treatment plan)they will give you the necessary radiographs to support your treatment plan.you can find out the multiple radiolucency in this stage only.(vitality test on G111 mobile teeth is unlikely-i think)

> written treatment plan-you can write down the radiographic features(

> how it looks like,why you are suspecting this).to confirm your diagnosis(biopsy) and to do further treatment ,refer the patient to omfs.

>

> even for the palatal lump ,you can write your finding and according to you finding if you suspect any salivary gland benign / malignant tumour

> again refer the patient to confirm the diagnosis and further treatment.

> torus-ressure the patient & explain the detail

>

> (can we request for biopsy in special investigation part)

> correct me.

>

[Guest guest]

Hi,

Thank you all so much for ur time and effort.. I agree with you, This is only

for the written section of the treatment plan, the verbal part will be the same

as always. The confusion regarding special investigations is probably because in

the exam we get a hypothetical situation and everything is to be covered in less

than an hour.

Regarding materials- metal/metal-ceramic, I am not sure if they should be

mentioned in the written treatment plan.

Regards,

Smriti

> >> > > >

> >> > > > Thanks Pratheba for the info,

> >> > > > i might br wrong ,but if it is cyst then the teeth might be vital

> >> even

> >> > > in case of tumors they might be vital or non vital (that is what i

> >> > > understod recently)also my question is ;Â is it in our scope to

> >> specify

> >> > > what kind of xray(excluding maybe PA or occlusal veiw)?

> >> > > >

> >> > > >

> >> > > >

> >> > > >

> >> > > > ________________________________

> >> > > > From: Pratheeba <pratheebat@>

> >> > >

> >> > > >

> >> > > > Sent: Friday, February 17, 2012 5:22 AM

> >> > > > Subject: new guideline case discussion

> >> > > >

> >> > > >

> >> > > > Â

> >> > > > hi,

> >> > > > in 3rd stage(written treatment plan)they will give you the necessary

> >> > > radiographs to support your treatment plan.you can find out the

> >> multiple

> >> > > radiolucency in this stage only.(vitality test on G111 mobile teeth is

> >> > > unlikely-i think)

> >> > > > written treatment plan-you can write down the radiographic features(

> >> > > > how it looks like,why you are suspecting this).to confirm your

> >> > > diagnosis(biopsy) and to do further treatment ,refer the patient to

> >> omfs.

> >> > > >

> >> > > > even for the palatal lump ,you can write your finding and according

> >> to

> >> > > you finding if you suspect any salivary gland benign / malignant

> >> tumour

> >> > > > again refer the patient to confirm the diagnosis and further

> >> treatment.

> >> > > > torus-ressure the patient & explain the detail

> >> > > >

> >> > > > (can we request for biopsy in special investigation part)

> >> > > > correct me.

> >> > > >

> >> > >

> >> > >

> >> > >

> >> >

> >>

> >>

> >>

> >

> >

>