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dthy 363 chapter 10 and 11

Terms in this set (67)

what are the THREE fundamental diagnostic questions used to formulate periodontal diagnosis?
1. Does the clinical assessment indicate health or disease?

2. Is the disease gingivitis or periodontitis?

3. What type of gingivitis or periodontitis?
what should the decision be based off of to determine health or disease?
signs of inflammation
signs vs. symptoms
signs
-observed & measured by the CLINICIAN

symptoms
-noted by the PATIENT
gingivitis vs. periodontitis
gingivitis
-no attachment loss

periodontitis
-attachment loss
-bone loss seen on radiographs
what is clinical attachment loss (CAL)?
the extent of periodontal support that has been destroyed around the tooth

-can be a positive or negative number
-calculated by taking the probing depth minus FGM
how many phases are there in the periodontal treatment plan?
5 phases
Assessment Phase and Preliminary Therapy; Emergency Therapy
-data collection
-care for immediate treatment needs
-comprehensive clinical periodontal assessment
Nonsurgical Periodontal Therapy; Phase I
-all non-surgical procedures (instrumentation)
-intensive care and educational measures
-minimize impact of local contributing factors
-also called initial therapy, bacterial control, anti-infective therapy (patient education, removal of calculus, therapy, etc.)
-evaluation of response to non-surgical treatment (4-6wk follow up)
Surgical Therapy; Phase II
-periodontal surgery, placement of implants, root canal therapy
-NOT needed for all patients
Restorative Therapy; Phase III
-splinting of teeth
-restorations
-replacement of missing teeth
Periodontal Maintenance; Phase IV
-all measures used to keep periodontitis under control
-maintain teeth functioning throughout life
-goal is to prevent recurrence of disease
what is VITAL to a treatment plan development?
communication and patient involvement!
shared decision making
-collaborative process that recognizes the patient's right to make decisions about their care after being fully informed about options
-this is appropriate where there is more than one reasonable option
characteristics of shared decision making
-develop partnership w/ patient
-establish patient preferences
-respond to patients ideas/expectations
-identify best choices for treatment after research
-allow reflections
-develop care plan in partnership
-document agreed-upon periodontal care plan
why does the patients preference matter?
-all choices come with pros and cons
-several options lead to different outcomes
-when the patient participates in decision-making, they are more likely to follow through
shared decision making facilitates a trusting relationship between _______ and ______. what is increased?
clinician and patient increases patient & provider satisfaction
systemic review
-summarizes results of available carefully designed health care studies
-provides a high level of evidence on effectiveness of health care interventions
-nonprofit organization
evidence-based information
-systemic approach to clinical problem solving
-allows integration of best available research evidence with clinical expertise and patient values
"SHARE" approach to engage patients in making informed decisions regarding recommended dental care
Seak
Help
Assess
Reach
Evaluate
SEEK your patient's participation
-summarize the periodontal condition and clearly describe to the patient
-ask for participation
-include family/caregivers in convo.
-remind patient that input is important

"I want to go over all the options so we can decide together what is best for you"
HELP your patient explore and compare treatment options
-avoid technical talk when explaining options
-clearly present benefits of each option
-provide evidence-based tools
-evaluate patients understanding
ASSESS your patient's values and preferences
-ask your patient what is most important to them
-encourage dialog on what matters most to the patient
-listen to the patient
-show empathy & interest
-agree on what is important

"As you think about your options, what matters most to you?"
REACH a decision with the patient
-ask the patient if they are ready to decide
-confirm their decision
-assist patient to follow-through decision
-assist in removing any barriers to implementing the decision

""Now that we've discussed your treatment options, what treatment do you think is right for you?"
EVALUATE your patient's decision
-make plans to review postponed treatment
-monitor extent of treatment
-revisit the decision with the patient if anything changes

"Lets review how things are going for you in 3 months"
informed consent
the process of communication between patient and health care provider:

-must be voluntary
-demonstrate they are legally able to provide consent
-according to "reasonable patient standard"
informed consent
patients voluntary agreement to proposed treatment after achieving an understanding of:

-relevant facts
-benefits of treatment
-risks involved
t/f: dental hygienists are legally responsible for treatment they provide
TRUE
t/f: without informed consent, patients can claim battery for providing treatment not agreed upon
TRUE
what happens when failure to provide sufficient information for the patient to make informed decisions?
negligence or malpractice
legal requirements to demonstrate informed consent
-periodontal diagnosis in language understood by patient
-thorough discussion of proposed periodontal treatment and benefits in language understood by patient
-patient's role and responsibilities during and after periodontal treatment
-discussion of risks and likelihood of success.
-discussion of alternative treatments
-prognosis if no treatment is provided
-documentation that the patient was encouraged to ask questions
-documentation they are of legal signing age and mentally competent
-must get their signature on the form
-witness their signature to assure it was un-coerced or voluntary
sign of periodontal disease
gingival edema
nutritional counseling occurs during which phase of managing perio patient?
phase I
restorations are placed during which phase of managing patients with periodontitis?
phase III
periodontal maintenance occurs during which phase of managing patients with periodontitis?
phase IV
extraction is painful, hopeless tooth occurs in which phase of management of periodontitis patient?
assessment/preliminary phase
t/f: axiUm informed consent would hold up under a legal review
TRUE
the S in SHARE decision making stands for:
seek participation
the H in SHARE decision making stands for:
help patients explore and compare
the A in SHARE decision making stands for:
assess patients values and preferences
the R in SHARE decision making stands for:
reach a decision with your patient
the E in SHARE decision making stands for:
evaluate your patient's decision
t/f: decision aids are written materials, videos, handouts to help patients make an informed decision
TRUE
t/f: informed consent can be written or verbal with written being the most preferred to prove consent
TRUE
t/f: although discussing the cost of treatment is not a legal requirement for informed consent, it is an important disclosure
TRUE
localized periodontitis affects
30% or less of the sites in the mouth
periodontal flap surgery or dental implant placement occur in which phase of the periodontal treatment plan?
phase II; restorative therapy
Self-care education for a patient normally provided during which phase of treatment?
phase I; nonsurgical periodontal therapy
Ongoing care at specified intervals to prevent further periodontal destruction occur at which phase of the periodontal treatment plan?
periodontal maintenance
the health history and periodontal chart/ radiographic images are collected in which phase of periodontal treatment plan
assessment phase and preliminary therapy
the key to answering the second basic diagnostic question related to assigning a periodontal diagnosis is
attachment loss
tobacco cessation counseling, nutritional counseling and correction of local risk factors occur in which phase of the periodontal treatment plan?
phase I; nonsurgical periodontal therapy
preparation of a fixed bridge or removal partial to replace a missing tooth occurs in which phase of the periodontal treatment plan?
phase III; restorative therapy
in which phase of periodontal treatment planning is scaling and root debridement and antimicrobial therapy provided?
phase I; non-surgical periodontal therapy
migration of the junctional epithelium to a position apical to the level of the CEJ is termed
attachment loss
t/f: reevaluation of results from the provided nonsurgical therapy occurs within a four to six week interval after the assessment/preliminary phase & nonsurgical periodontal therapy phase and prior to the surgical phase, if periodontal surgery is indicated.
TRUE
the natural or healthy level to the junctional epithelium in relation to the CEJ is located:
at the same level as the CEJ or coronal to the CEJ
the legal requirements to demonstrate informed consent is obtained and necessary for the patient to give informed consent
-encourage patient to ask questions with answers provided: document!
-discussed periodontal treatment and benefits
-presented periodontal diagnosis in a language easily understood by the patient
-discussed risks involved with treatment and likelyhood of success of proposed treatment
-patient signature consent form
-patient legal age, cognizant, and voluntary consent obtained
t/f: shared decision making facilities a trusting relationship between the clinician and patient and increases patient and provider satisfaction
TRUE
t/f: a dental hygienists can face a patient's claim of battery for dental services provided without the patient's consent; battery is unconsented touching
TRUE
systemic review
summarization of controlled trial study results to provide a high level of evidence on the effectiveness of health care interventions
evidence based health care
systematic approach to clinical problem solving that integrates evidence based research with clinical expertise and patient values
shared decision making
collaborative process that recognizes a patient's right to make fully, informed decisions about his or her care
patient decision aids
informative resources designed to facilitate shared decision making and patient participation
SHARE approach
five step process for shared decision making to engage patients in meaningful discussion of treatment options
informed consent
patient's voluntary agreement to proposed treatment after receiving relevant facts, benefits and risks involved
Informed consent can be obtained from a cognizant, adult patient once the diagnosis, the purpose, risks and consequences of receiving proposed treatment are discussed and agreed upon. It may be difficult to prove that consent was obtained with only verbal consent.
BOTH ARE TRUE
t/f: verbal consent is better then written consent because it can be confirmed if legal ramifications arise.
FALSE
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