Diagnosis & Treatment Planning Diagnosis The determination of the nature of a disease (GPT-8) Diagnosis in complete prosthodontics is important because it enables the dentist to estimate the degree of success to be expected from the treatment.(DeVan 1942). Treatment planning The Sequence of procedures planned for the treatment of a patient after diagnosis (GPT-8) Treatment planning means developing a course of action that encompass the ramification and sequelae of treatment to serve the patient’s need. Treating the patient for a complete denture health is an extremely complex and challenging procedure that must be altered to meet the biological, anatomical, psychological, technical and instructional needs of the individual. The complex nature of complete denture treatment demands thorough systematic and unhurried approach to diagnosis. Interview Personal background, experiences, expectations Medical history Dental history Examination - Diagnosis - Prognosis Treatment Plan Dental Procedures
Name: Name should be asked to enter it in the record. Addressing patient with namebrings him some confidence and psychological security. It also give an idea about thepatient`s family and community.Age: Younger patients usually have better health, neuromuscular control andadaptive capacity, and therefore have a more favorable prognosis. Older people remain alert and continue to have sound judgement; however, amodest decrease in mental agility occurs. After the age of 70 there is slight impairmentof the abilities to learn and to memorise. With increasing age there is a progressive lossof neurones and synapses in the cerebral cortex. As a result there is a slowing of thecentral processing facility with a consequential lengthening of reaction times andresponse to sensory stimuli. Within the sensory system, age brings about a deterioration of the senses of smelland taste, the former being more affected. Hearing is impaired in approximately 25% ofpeople over the age of 65 and in 80% of those in the age range 75–79 years. With respect to the motor system, there tends to be impairment of balance andsome postural tremor, indicating deterioration of cerebellar function and of theextrapyramidal system. The elderly are less precise in controlling the contraction ofmuscles, such as the masseter muscles. It takes more time and effort before newdentures can be controlled automatically. Of course, an elderly patient has a great dealof experience to fall back on and if a new task is given which utilises previouslyacquired skills, so that difficulties will be minimised. However, problems are morelikely to arise if the new task is more demanding than declining abilities are able tocope with. For example, previous denture experience can be of the greatest assistancewhen having to cope with new dentures, providing that major changes to the design ofthe dentures have not been introduced. Research has shown that the masseter and medial pterygoid muscles suffer adecrease in cross-sectional area and in muscle density as a consequence of advancingage; the decrease is more apparent in edentulous people. Such changes might, inindividual cases, be responsible for complaints of difficulty in eating and of eating more
slowly than the rest of the family. Of course, such a conclusion can be drawn only afterdenture design causes have been eliminated. Age brings about some deterioration of the denture-bearing tissues. Theepithelium becomes thinner, the connective tissue is less resilient and the ability of themucosa to heal is impaired. Osteoporosis is a common problem in old age, particularly affectingpostmenopausal women, occurring in about one-third of women over 60. Not only isthe skeleton affected, but the lower jaw will show a decrease in bone density. Theseverity of osteoporosis is related not only to hormonal changes but also to long-termcalcium deficiency and to loss of normal function. Regarding the latter point, it wouldbe reasonable to suggest that the edentulous state adversely affects normal function ofthe mandible. There is no evidence to suggest that the rate of salivary secretiondecreases with age, but normal salivation can be adversely affected by drug therapy.Gender: Men are usually better patients as they are occupied with their work and haveless time to fret about their dentures. Women tend to scrutinize their dentures and aremore particular about esthetics. Nearly always, the most difficult patients are the pre-menopausal and post-menopausal women as they often have psychological problemsand symptoms such as dry mouth, burning sensations, loquacious, vague pains, etc.Occupation: Gives an idea of value that the patient has in his /her oral health, esthetics andother qualities desired in a denture. Stressful employment often complicates theadjustment to wearing dentures (example- bruxing).
PERSONALITY ASSESSMENTHouse’s psychological classifications:Philosophical: patient willingly accepts the dentist’s judgement without question. Theypay attention and follow instructions. Ideal attitude for successful treatment providedthe biomechanical factors are reasonable They have the best prognosis (80-85%).Exacting: Patient is methodical, precise and demanding. They ask a lot of detailedquestions and like each step explained in detail. They have an excellent prognosis ifintelligent and understanding. Often dissatisfied with past treatment, doubt the abilityof the practitioner to satisfy him or her , and wants written guarantees or remark on noadditional charge. Once satisfied the exacting patient become practitioners greatsupport.Hysterical: Patients who are emotionally unstable and unfit to wear dentures. Theyblame the world for their present condition. They’re never satisfied and alwayscomplaining. Theyusually have bad results with previous treatments.Often in poorhealth, severely resorbed ridges and other unfavorable conditions. Submit to treatmentas a last resort and has negative attitude. Have unrealistic expectation and think worldis against them. Poor prognosis.Indifferent: Patient has a low motivation and desire for dental care. They show littleappreciation for the dentist’s efforts and will give up easily if problems areencountered. Patient not concerned with appearance , often go without denture foryears or Wear poor or worn out denture far beyond serviceability. Such patient haveno desire to wear denture and do not value the effort or skills of the dentist.
Winkler described four traits that characterize the ideal patients response: Realizes the need for the prosthetic treatment. Wants the prosthesis. Accepts the prosthesis. Attempts to use the prosthesis. This patient corresponds to Houses philosophical mind patient. Other classification Cooperative they may or may not recognize the need for denture but they are open minded and amenable to suggestions Apprehensive Even thought the patient realize the need for dentures they have some irrational problems , which cant be overcome by ordinary explanation. Uncooperative These patient present themselves usually upon urged by relatives or friends . General attitude is negative An extreme difficult group of denture bearersCOSMETIC INDEXCLASS I High cosmetic index They are more concerned about the treatment and wonder if the expectation are fulfilled.
CLASS II Moderate cosmetic index They are patient with nominal expectation.CLASS III Low cosmetic index Patient are nor bothered about treatment and aesthetics. Indifferent , uncooperative and little value of prosthodontist efforts.CHIEF COMPLAINT It should be recorded in patient`s own words. It give idea about patient`s psychology. Patient should be questioned regarding chief complaint because to asses whether patients expectation are realistic or attainable . It also provide information about patient`s mental attitude.HISTORY OF PRESENT ILLNESS. A person may visit the dental office for the first time for a denture to be made or mayhave been wearing a denture.