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PRETREATMENT CONSIDERATION

DR.AHMEDIBRAHIM AL-JOBORY

B.D.S.,M.SC. CONSERVATIVE DEPARTMENT

Pretreatment consideration consisting of:

1. Patient assessment:

A.Medical review .

B.Affective sociological and psychological review.

C.Dental history.

2.Patient examination and diagnosis:

A.Discuses of clinical and radiographic examination of teeth and periodontium. B.Clinical examination of soft tissue and occlusion.

C.Examination and diagnosis of patient in pain .

3.Treatment plane :

Discussion of previous types of treatment plans and indication for operative treatment.

The dentist must always evaluate the patient systemic and affective status, as well as the condition of

teeth, periodontium, occlusion and facial structure ; because the health of one can directly affect the

health of another.

PATIENT ASSESSMENT

Medical review

The dentist must identify any disease.

Older patient have significant change in behavior, diet, systemic health and certain medication and illness may alter oral physiology; oral hygiene and dental care. There are series of normal physiological change that may occurs in older patient that should not be mistake for pathological condition; like: attrition, abrasion, pulp anatomy, change in color, change in gingiva.

Affectivesociological and psychological review

Occupation, Financial situation, education and habit.

Dental history

1.Past dental history:

It give information about patient problems and treatment and may lead to identification of other problems such as food impaction, area of pain and broken restoration.

2.Patient present problem ͞Chief Complement C.C."

The patient guided to discuses all aspect of the current problem including : onset, duration and related factors.

PATIENT EXAMINATION AND DIAGNOSIS

Examination

͞Is the process of observation both normal and abnormal condition".

Diagnosis

͞Is a determination and judgment of variation from normal". So this included examination and diagnosis of problems in teeth, restoration, periodontium, soft tissue, occlusion and also radiographic examination of teeth and restoration. The clinical examination is performed in a systematic fashion in dry, clean, well illuminated mouth, prober instruments such as mirror and periodontal probe.

1)Clinical examination of (caries)

1.Visual change.

2.Tactile sensation.

3.Radiographic.

Caries tend to occurs bilaterally and an adjacent proximal surfaces. Caries examination not only by dental probe, but also change in color and translucency. If probe placed in a pit and fissure provides tug-back or resistance to remove.

2)Clinical examination of (amalgam restoration)

Clinical evaluation of amalgam restoration required visual observation, application of tactile sensation with explorer, use of dental floss and radiographic in dry, clean and well lighted field. Deficiencies may be occurred when amalgam evaluated:

1.Amalgam blues.

2.Proximal overhang.

3.Marginal ditching.

4.Voids .

5.Fracture line.

6.Improper anatomical contour.

7.Marginal ridge incompatibility.

8.Improper proximal contacts.

9.Recurrent caries.

3)Clinical examination of (Cast restoration)

Should evaluated clinically in the same manner of amalgam restoration.

4)Clinical examination of (tooth-colored) restoration

Esthetics is very important, if the filling has dark marginal staining or discolored and the patient unhappy, the restoration should be change.

5)Clinical examination of additional defects

A.Hypocalcified area----localized white area resulted from childhood, fever, truma and fluorosis. B.Abrasion: abnormal mechanical wear of the tooth structure because of brushing or chewing on pen. C.Attrition: abnormal mechanical wear of incisal or occlusal tooth structure.

D.Fracture lines: visible with advance age.

6)Radiographic examination of tooth and restoration

X-Ray device is essential in dental office which used to evaluation of teeth, caries, restoration and any abnormalities. Panoramic film, posterior bite wing and periapical film for identify the following:

1.Proximal caries.

2.Improper contour.

3.Over hangs.

4.Recurrent caries.

5.Pulpal abnormalities such as: pulp stone and internal resorption.

6.Periapical abscesses.

7.Impacted 3rdmolar and supernumerary teeth.

8.Bone level

7)Adjunctive aids for exanimation teeth and restoration

1.Percussion test.

2.Palpation.

3.Thermal test.

4.Electric pulp tester.

The positive result in one test should not be consider enough, but help in diagnosis.

8)Clinical examination of periodontium

1.Depth of sulcus.

2.Gingiva color or texture: normal gingiva are light pink, firm, knife edge and stippled surface.

3.Gingival pocket or hemorrhage.

4.Gingival recession and tooth mobility.

9)Examination of patient in pain:

The problem can be identified and treated by information from patient him self and also from clinical examination with appropriate test.

The patient asked to describe the problem:

1.Onset and duration of pain.

2.Stimuli causing the pain.

3.spontaneity of pain.

4.Intensity of the pain.

5.Factors that relieve the pain.

TREATMENT PLAN

Treatment plan ͞Is the process of scheduling the need procedure in a time". Certain treatment must naturally follow others in a logical order:

1)Control phase : it means :

1.Eliminate pain.

2.Eliminate active caries and inflammation.

3.Remove errors such as over hang.

4.Eliminate potential cause of disease such as impacted 3rdmolar.

5.Preventive dentistry instruction.

Example for control phase: extraction, periodontal scaling, occlusion adjustment and endodontics treatment.

2)Holding phase

Is a time between control phase and definitive phase that allows for resolution of inflammation and time for healing.

3)Definitive phase

After the dentist decided the treatment and determine the need for further care, this may includes endodontics, periodontics, orthodontics, oral surgery and operative dentistry procedure prior to fixed or removal prosthetic treatment.

4)Maintenance phase

This include regular recall examination of patients.

THANKS

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