protocols for success
John C. Cranham, DDS
ONE OF THE GREATEST CHALLENGES we face as general dentists is the myriad
of dental problems that walk through our front door: esthetic problems, occlusal
problems, patients who desire the replacement of multiple missing teeth, structural
problems with teeth, periodontal disease, and caries. To solve these varying
problems predictably, it important that we start with all of the data necessary to
make a complete diagnosis, and then have a systematic protocol to create a
complete, properly sequenced treatment plan.
Treatment planning workflows can be reliable tools to
predictably solve the specific problems of each individual
patient. All too often, dentists become focused on the
execution of the treatment without having treatment goals
in place that are specific enough and, therefore, no clear
end point. Treatment plans without a clear end point lead
to incomplete treatment, which then leads to unpredictable
results and unmet patient expectations.
ALWAYS BEGIN WITH COMPLETE DATA
Every patient who enters a dental practice should be evaluated for any dental disease that could break down the
dentition or threaten the patient’s overall health. One must
determine if caries, periodontal disease, TMJ problems,
occlusal disease, sleep apnea, and oral cancer are present.
If the screening evaluation turns up a positive response for
any of these problems, additional information needs to be
gathered. If the patient desires to have elective cosmetic
procedures or wants to replace missing teeth with dental
implants, additional information will need to be gathered
to make a complete diagnosis and treatment plan. The key
is to create a protocol for each type of patient in your
practice to ensure that all necessary data is obtained. When
we combine complete, accurate data with a programmed
approach to treatment planning, the results we obtain will
be predictable, optimal, and consistent. In this article, I
will discuss five areas we can focus on.
GENERAL DENTAL PROBLEMS
In dental school, we were taught how to treat general dental
problems caused by microorganisms and structural problems with individual teeth so that patients can achieve
optimal oral health. The key to successfully treating these
general problems is having time to do a thorough tooth-by-tooth examination, looking at a full set of properly taken
x-rays, and probing six points around each tooth. Optimal
oral health includes creating a mouth that is healthy to
maintain. That means patients should be able to clean
every surface of every tooth, and they should know how
to properly clean those teeth. To that end, we must address
any pockets 4 mm and larger, carious lesions, open margins
on crowns or fillings, as well as plaque that is not adequately
removed by our patients.
A general dental examination should include a full series
of radiographs, oral cancer screening, sleep apnea screening, TMJ/occlusal evaluation, full periodontal probing, and
a tooth-by-tooth restorative examination. Biologic problems
and structural problems with individual teeth can be diagnosed and treatment planned at the same appointment.
More complex issues will require that additional data be
collected, which can be obtained at the initial visit or at a
separate “advanced records appointment,” which will be
discussed later in this article.
ESTHETIC PROBLEMS BEYOND CHANGING
Patients who desire to change their smile should have the
same screening as general dental patients, plus a full series
of photographs and an occlusal analysis. In our training at
The Dawson Academy, we take 21 photographs, 12 of which
are used by the American Academy of Cosmetic Dentistry.
Properly taken photographs are critical to assess current
tooth position and determine the options that would be
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