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Good to have phased treatment for patients with high and complex dental, medical or social needs with supporting clinical evidence
Each Course of treatment [cot] usually takes place within a year period.
First phase = intial assessment with pain relief, stabilisation of active disease and initiation of preventative measures
After this COT , the next phase is that the patient is re-assessed to see how theyve responding and a further tx plan is produced.
Some pts will require another reassessment and plan after this.
what needs to be documented?
- in phase 1 the proposed tx should be written as well as reasons for phasing the tx. Pt should be told that future tx depends on reassessment, so a detailed plan cant be given at this stage.
FP17 given in each COT. Impact on charges should also be explained.
Cot 1 = urgent treatment - dressing carious lesions, pulp extirpation, extraction of teeth, treating perio step 1
cot 2 = reassessment = definitve tx inc restorations, endo, extractions, descisions reg. further courses and timescale
cot 3 = definitive inc examination, risk asessment, prevention. [crowns, bridges, dentures, perio therapy, recall interval setting]
Nhs = each COT can be claimed separately.
secondary occlusal trauma:
Secondary Occlusal Trauma - excessive occlusal load on periodontally diseased teeth. Injury resulting in tissue changes from normal or excessive occlusal forces applied to teeth with REDUCED periodontal support.
Indicators of occlusal trauma:
1. Fremitus 7. Thermal sensitivity
2. Mobility 8. Discomfort/pain on chewing
3. Occlusal discrepancies 9. Widened PDL space
4. Wear facets 10. Root resorption
5. Tooth migration 11. Cemental tear
6. Fractured tooth
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