DENTISTRY ON BEHAVIOUR MANAGEMENT, History, examination, risk assessment and treatment planning, History, examination, risk assessment and treatment planning, CONSENT, HISTORY, EXAMINATION, FURTHER INVESTIGATIONS, RISK ASSESSMENT,

1. History, examination, risk
assessment and treatment planning
by Dr. Zainab Mohammed Al-Tawili 1

2. • CONSENT:
• Consent to examination, investigation, or treatment is fundamental to the provision of dental care.
• A signature on a consent form is consent when the patient/parent has been given and understood
the relevant information.
• UK defines a child is less than 16 years old.
• Gllick argues that under the age of 16yrs a child is presumed incompetent and subject to the Gllick
test of competence ( an example of being adult perspective).
• If a child is considered to be Gillick competent, his or her consent will be valid.
• Gllick test of competence:” a competent child is one who achieves a sufficient understanding &
intelligence to enable him or her to make a wise choice in his or her own interest”
• In an emergency, it is justifiable to treat a child without the consent, e.x.: avulsed tooth, the parent
should be contacted before proceeding to other forms of treatment.
by Dr. Zainab Mohammed Al-Tawili 2

3. • A complete case history should consist of:
• Personal details.
• Presenting complaint(s).
• Social history.
• Medical history.
• Dental history.
by Dr. Zainab Mohammed Al-Tawili 3

4. • General examination:
• Height:
• (child who exhibit less than3-5 cm growth per year should be referred to a pediatrician for further
investigation)
• Weight:
• (looking for obesity or malnutrition or underlying endocrine disorder)
• Skin-look:
• ( search for physical abuse signs, or systemic disease signs)
• Hands:
• (assess for evidence of digit sucking or nail biting, warts, finger clubbing, abnormal nail, or finger
morphology)
by Dr. Zainab Mohammed Al-Tawili 4

5. • The head and neck examination:
• Head:
(assess shape, size, asymmetry)
• Ears:
(morphology, presence of hearing aids)
• Skin:
(scars, bruising, lacerations, pallor, birthmarks, contagious infections)
by Dr. Zainab Mohammed Al-Tawili 5

6. • The head and neck examination:
• Temporomandibular joint:
(pain, crepitus , deviation, or restricted opening)
• lymph nodes:
(lymphadenopathy is common in children, due to frequent viral infections, so palpate for
enlarged LN.)
• Lips:
(note the presence of cold sores , swelling, or abnormal colorings)
by Dr. Zainab Mohammed Al-Tawili 6

7. • Intraoral examination:
• Soft tissues:
(noting any color changes, ulceration, swelling, or other pathology, abnormal frenal attachment, saliva).
• Gingival and periodontal tissues
(check for color change, swelling, ulceration, spontaneous bleeding, or recession , assess the oral
cleanliness).
• Teeth:
(assess teeth eruption sequence, tooth's condition, structure, and shape).
• Occlusion:
(provide an early prompt as to the need for interceptive orthodontic treatment)
by Dr. Zainab Mohammed Al-Tawili 7

8. • Radiographs:
• every radiographic investigation should be clinically justified and have a clear
diagnostic purpose.
• Radiographs may be indicated in order to facilitate:
• Caries diagnosis;
(bitewing the best for interproximal caries, in case with close contact patients, especially high
caries risk individuals).
• Trauma diagnosis;
(patients who have sustained facial or dental trauma).
by Dr. Zainab Mohammed Al-Tawili 8

9. • Radiographs:
• Radiographs may be indicated in order to facilitate:
• Orthodontic treatment planning;
(a panoral radiograph is usually mandatory prior to any orthodontic treatment other radiographs used due to
need)
• Identification of any abnormalities in dental development;
(The panoral radiograph provides the optimum overall assessment of normal or abnormal dental
development).
• Detection of any bony or dental pathology.
(periapical radiograph for localized pathologies, panoral radiograph for pathology involves more than one
quadrant or has extensive bony involvement).
by Dr. Zainab Mohammed Al-Tawili 9

10. • Risk assessment is simply an assessment of the likelihood of disease or condition developing in an individual patient.
I. Caries:
• Very simply, children may be categorized as low, moderate, or high caries risk according to the following criteria:
• •low risk:
• intact dentition, good oral hygiene, well-educated affluent family background, good dietary control, and use of fluoride regimens;
• •moderate risk:
• 1-2 new lesions per year, poor oral hygiene, and non-optimum fluoride use;
• •high risk:
• three or more new lesions per year, poor oral hygiene and dietary control, significant medical history, immigrant status, poverty,
low education, and poor uptake of fluoride regimens.
by Dr. Zainab Mohammed Al-Tawili 10

11. II. Periodontal disease:
• Uncommon in children, but risk factors will increase the likely to occur, those are:
• Smoking.
• Diabetes.
• Plaque accumulation (unreliable).
• Family history (genetic factors).
• Hormonal changes around puberty.
• Low vitamin C or calcium intake.
• Socio-economic Status
by Dr. Zainab Mohammed Al-Tawili 11

12. III. Erosion:
• •intake of more than 6 carbonated drinks weekly is associated with moderate erosion
risk.
• •intake of more than 14 carbonated drinks weekly is associated with high erosion risk.
• Other factors associated with erosion are:
• Intake of more than two citrus fruits daily.
• Frequent sports participation.
• Eating disorders.
• Gastric reflux, rumination.
by Dr. Zainab Mohammed Al-Tawili 12

13. IV. Orofacial trauma:
• orofacial trauma cannot be prevented, as it usually results from an unavoidable accident!!
• Trauma risk factors:
• An overjet of >9 mm .
• Contact sports.
• Previous dental trauma.(there is a significant risk of sustaining further trauma!).
• Children with motor disabilities.
• Neurological disabilities.
• Age(peak ages for sustaining orofacial trauma are around 1-2 years and 8-10 years).
• Gender(boys are more at risk than girls)
by Dr. Zainab Mohammed Al-Tawili 13

14. by Dr. Zainab Mohammed Al-Tawili 14
History and
examination
Assessment of treatment needs
Vs.
Likely patient/parent co-operation
Discu
ss
Parents.
Dental/medical
specialist
Management of acute
dental problems
Assessment of patient
cooperation.
Discussi
on Parent
s
Patien
t
Initia
l
treat-
ment
acclimatization
Preventive
advice
stabilization
Definitive
Treatmen
t
Restoratio
n/
Extraction.
preventio
n
Aesthetic
consideratio
n
Discussi
on
Patien
t
Parent
s
Recall according to risk
assessment

15. by Dr. Zainab Mohammed Al-Tawili
15
We want our
patient to leave
us in a happy
frame of mind.

16. Reference:
by Dr. Zainab Mohammed Al-Tawili 16