7: Oral Health Needs, Treatment Planning and Appointments

CHAPTER 7 Oral Health Needs, Treatment Planning and Appointments

Chapter points

• This chapter covers the requirements of the NEBDN syllabus Section 7: Assessing patients’ oral health needs and treatment planning.

Introduction

A dental workplace should have a written protocol for:

• The length of appointments required for different procedures
• What to do if a patient arrives late
• What to do if a patient does not attend
• What to do if emergency treatment is needed
• What to do if families want appointments together.

One way of organising appointments is to leave an ‘emergency slot’ at the end of each session. This session allows:

• Catch-up time if the clinician is running late
• Seeing an emergency patient
• Seeing a patient who has arrived late for an appointment, as long as:

image The patient rang to inform the practice of the reason for delay
image The prescribed treatment for the appointment can still be carried out
image The treatment of other patients is not delayed.

If it is feasible, another patient could be seen in the late patient’s slot and the late patient asked to wait.

Patient record cards

In NHS practices, clinical records are kept on form FP25. In other dental workplaces other suitable cards can be used.

Patient records should always be:

• Accurate
• Truthful
• Up to date (in correct date order)
• Treated with confidentiality (see Subchapter 3.2).

Records must not be altered after any request for access (see Chapter 3) has been received.

Patient records should include the following:

• Patient details:

image Last name
image First name
image Birth date
image Address
image Home, mobile and work telephone number
image Practice or hospital reference number
image Occupation
image General medical practitioner
image General dental practitioner (if patient is being seen in hospital)
image Medical history (this should be reviewed at each recall appointment – see Chapters 2 and 6)
image Initial dental charting.

• Record of:

image Dental charting
image Previous dental treatment received
image Discussions about treatment received and recommendations
image Laboratory work details and shade nos. if relevant
image Any requests for private care
image Charges, payments and method of payment
image Failed or cancelled appointments
image Treatments advised but refused by patient
image Referrals and outcomes
image Prescriptions
image Post-operative instructions.
image Complaints/other letters
image Consent forms
image Medical history forms
image X-rays or other imaging scans
image Referral letters
image Replies to referral letters
image Treatment plans.

Term to Learn

Imaging scans: Besides the more common radiographs (X-rays), some patients may require other scans such as CT (computed tomography) or MRI (magnetic resonance imaging) or ultrasound (US).

Terminology

Dental terminology is covered in detail in Chapter 4.2. The following list summarises some key terms:

• Enamel – this is the outer covering of the tooth (it is not sensitive)
• Dentine – this is the next layer (it is sensitive)
• Pulp – the innermost layer of the tooth (it is very sensitive)
• Clinical crown – the part of the tooth visible in the oral cavity.

Surfaces of the Tooth

The various surfaces of a tooth are called by specific names (Box 7.1 and Figure 7.1).

BOX 7.1 Surfaces of the Tooth

• Mesial – surface nearest the midline.
• Distal – surface furthest away from the midline.
• Occlusal – the biting surface of the premolars and molars.
• Incisal – the biting edge of the incisors and canines.
• Palatal – the surface nearest the palate.
• Lingual – the surface nearest the tongue.
• Buccal – the surface of the premolars and molars nearest the cheeks.
• Labial – the surface of the incisors and canines nearest the lips.
• Cervical – the part of any surface nearest the gingival margin.

image image

FIGURE 7.1 (A) The surfaces of the teeth. (B) The surfaces of teeth as appearing on a dental chart.

Dental charting

Dental and periodontal charting is the ‘recording of clinical details of a patient’s dentition and surrounding tissues’. As a part of the dental clinical team, you will be required to know how to complete a dental chart. Box 7.2 lists the main reasons for doing dental charting.

BOX 7.2 Why do Dental Charting?

A record of the condition of the patient’s teeth and surrounding tissues provides:

• Basic information for dental treatment planning
• Evidence in medico-legal cases
• Evidence in cases of identification of a dead person.

It is vital therefore that dental charting is accurate.

Dental charting includes:

• State of the dentition:

image Caries
image Restorations
image Missing or malpositioned teeth
image Implants
image Teeth to be extracted.

• Periodontal problems:

image Pocket depth
image Bleeding sites
image Clinical attachment levels (see below)
image Furcation (root) involvement
image Mobile teeth.

• Other dental conditions:

image Erosion
image Abrasion
image Attrition
image Developmental anomalies
image Prostheses.

Key Point

Charting provides a pictorial description of the health of a patient’s mouth.

Term to Learn

Furcation: the area where the root of multi-rooted teeth divides into two or more roots.

How to Chart

The teeth present in each quadrant of the mouth and their condition is recorded. You need to record these in relation to the patient’s left or right side. That is, with the patient sitting in the dental chair, a tooth on the patient’s left side (your right side) is recorded as on the ‘left’ on the chart.

Key Point

Remember while charting, the dental chart is opposite to your left and right.

Most dental charts consist of a diagrammatic representation of all the teeth with surfaces shown as flat (Figure 7.2). Imagine the face is divided into four equal parts (quadrants):

• A line straight down />

Related posts:

  1. 16: Dental Emergencies
  2. 12: Dental Drugs, Materials, Instruments and Equipment
  3. 4: Anatomy and Physiology
  4. 2: Medical Emergencies and First Aid in the Dental Surgery
  5. 13: Pain and Anxiety Control
  6. 10: Surgical Procedures

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Jan 8, 2015 | Posted by in Dental Nursing and Assisting | Comments Off on 7: Oral Health Needs, Treatment Planning and Appointments

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