This document discusses treatment planning in dentistry. It explains that treatment planning involves developing both short and long-term strategies to address a patient's dental needs holistically, while also gaining their cooperation. Treatment plans should be separated into phases including systemic care, acute issues, disease control, definitive treatment, and maintenance. When presenting plans, dentists should ensure patients understand all diagnosis, alternatives, risks, costs and provide opportunities for questions. Informed consent must be obtained that documents all discussed aspects of the proposed treatment plan.

1. Treatment Planning
Lecturer of Oral Medicine, Periodontology and Diagnosis, (MIU)
PHD of Oral Medicine, Periodontology and Diagnosis, (Ain Shams University)
Laser Fellow-Ship, Aachen Laser Center, Germany
Dr. Tarek Mahmoud Eltayeb

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3. • Having established the patient’s comprehensive diagnosis list, the
dentist is prepared to begin developing a treatment plan.
• It is important to differentiate between a treatment plan that focuses
on treatment at the individual tooth level, and a plan that formulates a
long-term strategy involving decisions about treating teeth in the
context of the rest of the dentition, and about managing the rest of the
dentition in the context of the masticatory system and the individual.

4. • To be successful, any treatment plan must incorporate short-term,
medium-term and long-term views, and must take a holistic view
of the patient as a person with specific needs and not just a ‘mouth
to be fixed’ or a ‘case to be treated’ in a predetermined manner.
• Successful treatment planning requires adequate knowledge,
communication skills, clinical skills, and common sense.

5. • Clinical judgement requires practical experience, including observation of
your own treatment failures, which may also be related in some instances to
insufficient patient cooperation and motivation.
• The experienced dentist is also aware that treatment planning cannot occur
in a vacuum and must involve the patient. This means educating patients
about their problems and making them partners in determining both the
general direction and the specific elements of a proposed treatment plan.

6. • This includes :
Developing treatment objectives,
Separating treatment into phases,
Presenting the treatment plan to the patient,
Sequencing procedures,
Consulting with other practitioners,
Obtaining informed consent.

7. • When preparing to treat a patient with complex needs, the dentist may
find it advantageous to break the treatment plan into segments, or phases.
• Sorting treatment into phases helps the clinician organize the plan and
improves the overall prognosis of the case. In addition, patients understand a
complicated treatment plan more easily when it is separated
into segments.

8. The FIVE general categories of phasing are:
I. Systemic phase
II. Acute phase
III. Disease control phase
IV. Definitive treatment phase
V. Maintenance care phase.

9. (I) Systemic Phase

10. (I) Systemic Phase
•The systemic phase of treatment involves a thorough
evaluation of the patient’s health history and any procedures
necessary to manage the patient’s general and psychological
health before or during dental treatment.

11. •This may include consultation with other health
providers, antibiotic prophylaxis, stress and fear
management, avoidance of certain medications and
products (e.g., latex), and any other precautions
necessary to deliver treatment safely to patients with
serious general health problems.

12. (II) Acute Phase

13. (II) Acute Phase
• The purpose of an acute phase of treatment is to resolve any
symptomatic problems with which a patient may present. Any
number of patient problems may require attention during this phase.
Common complaints include pain, swelling, infection, broken teeth,
and missing restorations.

14. • Possible acute phase treatments include extractions, endodontic
therapy, initial periodontal therapy, placement of provisional
(temporary) or permanent restorations, and repair of prostheses.
• The dentist may also choose to prescribe medications to control pain
and infection.
• Acute phase procedures are often provided before a comprehensive
treatment plan is created.

15. (III) Disease Control Phase

16. (III) Disease Control Phase
• The goal of the disease control phase is to control active oral disease
and infection, stop occlusal and esthetic damage, and manage any
risk factors that cause oral problems.
• For many patients, this means controlling dental caries and arresting
periodontal disease before deciding how to rebuild or replace teeth.

17. Common procedures during the disease control phase include
•Oral hygiene instruction,
•Scaling and root planing,
•Caries risk assessment and prevention,
•Endodontic therapy,
•Extraction of hopeless teeth, and
•Operative treatment to eradicate dental caries.

18. •A disease control only phase can be valuable when the
dentist is uncertain about disease severity, available
treatment options, or patient commitment to treatment.

19. •The outcomes of the disease control phase are
evaluated with a post-treatment assessment
examination before proceeding with definitive
treatment procedures. If the patient’s dental disease is
not controlled, or if the patient wishes to limit
treatment, he or she may enter a holding period and
not proceed to definitive treatment.

20. (IV) Definitive Treatment Phase

21. (IV) Definitive Treatment Phase
•Aims to rehabilitate the patient’s oral condition and
includes procedures that improve appearance and
function.

22. • Examples of definitive treatment procedures include the following:
1) Additional periodontal treatment, including periodontal
surgery.)
2) Orthodontic treatment and occlusal therapy.
3) Oral surgery (elective extractions, preprosthetic surgery,
and orthognathic surgery).
4) Elective (non-acute) endodontic procedures.

23. 5) Single tooth restorations.
6) Replacement of missing teeth with fixed or
removable prosthodontics, including implants.
7) Cosmetic or esthetic procedures (composite
bonding, veneers

24. (V) Maintenance Care Phase
•Check-up every 6 months
•Periodic hard and soft tissue examinations,
•Periodontal maintenance treatment,
•Application of fluoride,
•Oral hygiene instruction.

25. Presenting Treatment Plan
and
Reaching Consensus With The Patient

26. 1. Sit facing the patient at eye level while presenting the
plan.
2. Have the patient sitting upright; never present a
treatment plan with the patient in a reclining position.
3. Use language that the patient can understand.

28. 4. Avoid using threatening or anxiety-producing terms.
5. Talk to the patient; don’t preach. Be aware of your body
language.
6. Do not overwhelm the patient with the minute details.
7. Ask the patient to repeat information back to you to confirm
understanding of the treatment plan.
8. Use casts, wax-ups, images, and radiographs to emphasize
keypoints.

29. Obtaining informed consent

31. Obtaining informed consent
The dentist must have described and discussed all diagnosis and
problems, treatment alternatives, and the advantages and
disadvantages of each alternative.
The dentist must disclose:
1. The nature of the condition being treated (i.e., the
diagnosis and problem list)

32. 2. The proposed treatment.
3. Any risks involved in undergoing the proposed treatment.
4. Any potential complications or side effects.
5. Any consequences or risks of not undergoing the proposed
treatment.
6. Any alternative procedures that might be used.
7. The prognosis for the treatment.

33. • When obtaining informed consent, the dentist should use lay terms to the
extent possible.
• In addition, the patient must be given the opportunity to ask, any questions
regarding the intended treatment. It may be helpful to draw sketches or use
casts and radiographs to assist in the explanation and to add these to the
patient record. Patients should also be provided with information about the
cost for treatment.

34. Treatment Plan Documentation

35. Treatment Plan Documentation
Two treatment plans must be documented
I) Active treatment plan
II) Perpetual treatment plan

36. • The active treatment plan is typically a list of disease control and definitive
procedures sequenced in the order in which they will be provided.
• The perpetual plan addresses patient concerns, issues, and needs that will remain
relevant beyond the completion of the active plan and that may continue for the
life of the doctor-patient relationship.
• Perpetual treatment plans commonly include specific systemic and maintenance
procedures and actions.

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