Tripod of Treatment Planning Part 2 - Restoring Excellence

Tripod of Treatment Planning Part 2

Cases

Dec 17
Tripod of Treatment Planning

The Tripod of Treatment Planning: Part 2

What does the patient have?

Navigation is a simple concept. Know where you want to go. And know where you are. Simple. But not always easy.

Once you have established what the patient wants we know where we want to go.

Now we need to work out where we are starting from.

In a specialist practice, it's easier to get into a methodical routine, because your patients fall into a much narrower band. For instance, it's pretty easy to do a full mouthperio chart on every single patient when you area periodontist. But perhaps not if you are an endodontist.

So our difficulty in general practice is that we have such a varied group of patients come through the door. It can be hard to take the time to look at the whole situation carefully.

At this point, you need to decide on what sort of practice you want. There is no one sort that is ideal. However, a large part of how your practice turns out will be determined by how you run your first appointment.

If your first appointment is a rush to do a single procedure to fix a single problem, then your first appointment will be profitable, but probably lead tomore single visit emergency type appointments.

If your first appointment is spent discussing the patient's overall condition, thenyou first appointment will probably not be profitable, but the cases you will do more comprehensive dentistry over time.

We generally do that latter. However, to bring the time down to manageable levels weutilise very well trainedauxillaries.

1. Typing notes. Your staff should be trained to start typing every time you start speaking. Don't just do a summary of the conversation at the end of the day when you forget, but document the entire conversation. They should be trained to break conversations down and put things like "diagnosis...." and "treatment options; 1..... 2.... 3..." etc. If you do this, not only will your notes be more comprehensive than they are now, but they will take you no time at all.

We demonstrate this during the RETP (Rapid Efficient Treatment Planning) course.

This is theback bone of doing a comprehensive exam in a realistic general practice time frame.

2. Photography. Every patient. Every time. Do a standard set of photographs. Full face. Occlusal. Smiles left, front, right. Retracted. Even for toothaches.

Once again, if you are really time poor, train your staff to take these. Remember that all the photographs you seeme post are taken by my staff.

3. Radiographs. I get an OPG on every patient. So from this, I can quickly decide where to direct intra-oral radiography.Usually I snap bitewings. Then I takePA's of any teeth that are suspect of endo problems. I use two staff during this time. One takes the films out to the scanner. The other types my radiograph report which I dictate orally. Bone levels. Caries. Endo etc.

4. Headache history - helps determine various parts of bruxism.

5. Anterior temporalis - sore to palpation?

6. TMJ, pain to palpation on opening closing and any clicks or other vibrations.

7. Lymph nodes, saliva gland palpation.

8. Soft tissue assessment (cancers etc)

9.Perio diagnosis. I probe just about everyinteproximal area as a screen. From this and the OPG, I decide a diagnosis and then whether to do full recordedperio charting.

10. Ortho diagnosis. Class 1,2,3. Crowding etc etc.

11. Occlusal diagnosis. Wear. Parafunctional pattern. Risk. Cracks/fractures.

12. Commentary about teeth (note that it is last as it is thelest important). I do not do a traditional reading out the teeth that are present.

Charting of restorations and missing teeth is done from the OPG and the photos. My staffare trained to start doing this for me, and I just quickly check that it is right. Further, if a forensic request comes in, the photographs will be much more accurate than a charting ever will be.

Now, because of the way I use staff, and because I do the same routine every time, it does not take very long.

During RETP, I demonstrate thislive with one of my assistants typing the notesunto the lecture screen. The photos I usually do in about 90 seconds. And the exam I timed at about 2 minutes forty at the last course I ran.

Why is speed important? Because if I tell you to do something that takes 40 minutes, there is no way that most of you can integrate it into your practice without going broke.

But most of you can take about 2 minutes longer to do a really thorough exam.

There are some cases where I will prescribe further records such as ortho models, lateralcephs, CBCT, mounted models.

But I don't do them on every patient in a general practice. It's overkill.

And now....you know where you are starting from.

To Read The Tripod of Treatment Planning Part 1 click here.

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About the Author

Dr Lincoln Harris has been completely focused on excellence and quality from the beginning of his career as a dentist. He established the first private dental practice in Bargara – Harris Dental Boutique in 2000. Since graduation he has trained extensively in Aesthetic Implant Techniques and Full Mouth Rehabilitation to attain immense skill and knowledge. With his vast dental knowledge Dr Harris coaches and trains dentists from all over the world on complex aesthetic dentistry, surgical techniques and business management. Dr Harris is the founder of RIPE. Restorative Implant Practice Excellence: Full Protocol group an international forum of over 70,000 members worldwide. The purpose of the group is to share information and excellence in the dental industry. He has also lectured in multiple cities throughout Australia, North America, Asia, Singapore, United Kingdom and Europe.