{"id":376,"date":"2012-02-27T15:28:25","date_gmt":"2012-02-27T21:28:25","guid":{"rendered":"http:\/\/allisonwatts.com\/blog\/?p=376"},"modified":"2020-12-24T16:01:34","modified_gmt":"2020-12-24T22:01:34","slug":"creating-successful-treatment-plan-full-mouth-rehabilitation-dental-patient","status":"publish","type":"post","link":"https:\/\/allisonwatts.com\/creating-successful-treatment-plan-full-mouth-rehabilitation-dental-patient\/","title":{"rendered":"Creating A Successful Treatment Plan For A Full Mouth Rehabilitation Dental Patient"},"content":{"rendered":"
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Successfully Treatment Planning A Dental Patient
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by Allison Watts, DDS
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Before you begin treatment planning a case, you definitely want to do this! <\/span><\/span><\/strong><\/p>\n

It’s called diagnosing. <\/strong> I am not trying to be a smarty-pants. We so often (myself included) just jump straight to treatment planning\/problem solving before we really make a diagnosis\/define the problems. Also, we don’t just want to start giving the patient solutions for problems we<\/u> think they have; we want to help the patient become aware of their own problems and hopefully have them ask for the solutions. <\/em><\/span><\/span><\/p>\n

As we’ve worked our way to this point, we have collaborated with our patient <\/strong>so that they are able to choose the treatment that is best for THEM. I truly believe that once the patients understand and “own” their problems as well as the risks, benefits, and outcomes of treatment, they will make the best decision for themselves. It is also very important that they know what will happen if they don’t treat their problems.<\/strong><\/span><\/em><\/span> <\/span><\/p>\n

Have you gotten all of the data and records you need?<\/strong><\/em> If I’m doing significant dentistry on a patient, I will likely have the following records: FMX, full set of diagnostic photos, pano, mounted models and possibly esthetic measurements and a model of a mock up or “trial smile”, as we like to call it. <\/span><\/span><\/p>\n

For a proper diagnosis and treatment plan, most of the time you MUST have photography and you MUST have mounted models!<\/b>  The photography is useful in diagnosis, treatment planning, patient education\/case acceptance, and case documentation.  The models are invaluable for esthetic diagnosis and treatment planning and occlusal information.  I recommend mounting models in centric relation, as that is the most predictable starting point to work from. <\/em><\/span><\/span><\/p>\n

I often have dentists call me for help with treatment planning<\/strong> with some photos of a pretty debilitated patient with missing teeth, occlusal plane problems, and gingival level problems.  We can begin to talk about some possibilities, but I always recommend they get a set of properly mounted models, with a corrected facebow and centric relation mounting before we make any decisions.  Once we have that, and nice diagnostic photographs, we can begin to start to treatment plan the case. <\/span><\/span><\/div>\n
Along with records, I’ve also completed <\/strong>a comprehensive exam, including an esthetic evaluation (this may be done from photos), a TMJ\/occluso-muscle exam, a dental exam, periodontal exam and soft tissue and oral cancer exam. I’ve spoken with the patient and collaborated with them, educating them along the way. The treatment plan we come up with will not be a surprise and I actually create the “final” treatment plan in the room, during the consultation (or review of findings) with the patient.  By the time we get to this point, this is our 3rd<\/sup> or 4th<\/sup> time to be together so there is already a relationship built. <\/span><\/span><\/div>\n
For more details on relationship-building, <\/strong><\/em><\/span><\/span><\/div>\n
review these previous articles:<\/strong><\/em><\/span><\/span><\/div>\n
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The New Patient Visit<\/span><\/span>
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Communication and<\/span><\/span> <\/span><\/strong> <\/span>Relationships<\/span><\/strong><\/span> <\/span>
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Building Trust With New Dental Patients
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All the data we have, as well as what the patient has told us about what they want, will be used to make diagnoses and create a treatment plan and treatment sequence<\/b>. Depending on the case size and complexity, I may give them the treatment plan the same day as the exam. <\/span><\/span><\/p>\n

Since we are talking about larger cases here, such as full mouth rehabilitations<\/strong>, we will not give it to them in the first visit. As I mentioned above, they will probably not get the treatment plan until the third or fourth visit. Sometimes it’s wise to give them a ballpark if they are ready and sometimes it takes years until they are even willing to have a conversation and have bite records to find out possible treatment options. <\/span><\/span><\/p>\n

In diagnosis and treatment-planning<\/strong>, we use EFSB<\/strong><\/span> as our framework, which is the facially-generated model taught by Frank Spear<\/strong><\/span>.  Esthetics, Function, Structure, Biology<\/strong><\/span> is the order that we diagnose and treatment plan. I have had a couple of teachers say reverse the order when working through the diagnosis: Biology, Structure, Function, Esthetics. <\/span><\/span><\/p>\n

Some other points in diagnosis and treatment planning<\/span><\/span><\/strong>: <\/span><\/span><\/strong><\/em>urgent care may need to be done in order to make a diagnosis and decide your long-term treatment plan. A waxup may need to be done in the diagnosis and treatment-planning phase to make final treatment decisions. Also, provisionalization of some sort may be necessary to help in finalizing the plan. <\/span><\/span>After diagnosis and treatment planning, the procedures need to be sequenced properly.  <\/span><\/span><\/strong><\/em><\/p>\n

I believe excellent diagnosis, treatment planning and sequencing are the most valuable services we provide for our patients. <\/strong> I have a nice form I have created that will walk you step-by-step through this diagnosis and treatment-planning process.  I would be happy to share it with you, just email me at insights@allisonwatts.com<\/a> <\/strong>and ask for the diagnosis and treatment-planning sheet. <\/span><\/span><\/p>\n

I will usually take some time (most of it is on the bite records) without the patient in the office<\/strong> to review all the records as well as their history and our notes from the exam. Then I create an ideal treatment plan—what I would want in my own mouth.  I will get an idea of the number of hours it will take and a close idea on the fee and the general sequence. I already know if and how the treatment could be phased for them. <\/span><\/span><\/p>\n

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I believe it’s better for the patient to decide what they want long-term and then do it slowly than to compromise their treatment because they can’t do it all right now. Ultimately, none of that is my decision… I only have to know where I will draw the line ethically so that I am not doing something that will “hurt” them in the long run (or short-term!). <\/span><\/span>
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I will go into the consult room with an idea of the way I think things will go and my recommendations, but<\/strong> as the patient and I discuss it and look over their records, the proposed plan could change. I do encourage them to look at what they really want, rather than base the treatment on cost as oftentimes we can help them figure out how to pay for it. They may decide to phase it or just do part or they may want to go as fast as possible. <\/span><\/span><\/p>\n

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*I believe it is much better to set the fee by the hours the treatment will take whenever possible.  Each office has an hourly amount it needs to make to survive and an hourly amount it needs to thrive—it’s important to know those numbers. <\/i><\/strong> Patients generally accept the fees and pay them gladly if you believe in yourself and if you are good at building value for what you do.<\/span><\/span><\/p>\n<\/blockquote>\n

I hope this helps. Let me know if there’s something you want to hear about.  You can leave a comment or question below, or connect with me on my Facebook Page.<\/b><\/a> I will be more than happy to assist in any way that I can!<\/span><\/span><\/div>\n

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Yours for a future of fulfilling practice,<\/span><\/span><\/strong><\/div>\n

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  Successfully Treatment Planning A Dental Patient by Allison Watts, DDS   Before you begin treatment planning a case, you definitely want to do this!  It’s called diagnosing.  I am not trying to be a smarty-pants. We so often (myself included) just jump straight to treatment planning\/problem solving before we really make a diagnosis\/define the problems. Also, […]<\/p>\n","protected":false},"author":1,"featured_media":377,"comment_status":"closed","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_et_pb_use_builder":"","_et_pb_old_content":"","_et_gb_content_width":"","_cloudinary_featured_overwrite":false,"footnotes":""},"categories":[310,22,25,4,23,27,28],"tags":[12,58,41,129,132,113,134,63,131,30,130,133,128],"yoast_head":"\nCreating A Successful Treatment Plan For Dental Patients - Full Mouth Rehabilitation<\/title>\n<meta name=\"description\" content=\"Typically dentists go straight to treatment planning before really defining a patient's problem. 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