COMPREHENSIVE CARE

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Contents

INTRODUCTION TO COMPREHENSIVE CARE

A. Comprehensive care relates to:

  • The diagnosis, prognosis, treatment and replacement of teeth to restore proper form, function, and esthetics;
  • The maintenance of the physiological integrity of the teeth in harmonious relationship with the adjacent hard and soft tissues.

Its study and practice encompass the basic clinical sciences including biology, the etiology, diagnosis, prevention, and treatment of disease and injuries of teeth, and the protection and preservation of the dental pulp and supporting tissues.

B. Scope of Care

Dental practitioners are encouraged to perform dental procedures consistent with their educational training and clinical experience. Every dental practitioner is expected to be able to recognize and effectively treat dental diseases that are commonplace and within the skills acquired by graduates of dental schools in the United States and Canada. Patients whose needs are beyond the skill set of DMD students must be referred to the Advanced Education in General Dentistry (AEGD) program, or referred to private dentists for care. Case School of Dental Medicine endorses the Certification and Acceptance Programs of the American Dental Association's Council on Dental Therapeutics and Dental Materials, Instruments, and Equipment. Instruments and materials to be used by SDM students have undergone a rigorous selection process by Department of Comprehensive Care faculty.

C. Examination and Diagnosis.

Many features of evaluation in comprehensive care are common to all dental practice. These include but are not limited to: An adequate medical and dental history with contemporaneous visual and radiographic examination provides basic information. Some indicated tests such as thermal, percussion, palpation, periodontal probing, and mobility, should be accomplished. Additional periodontal examination, transillumination, and bacteriologic testing may be indicated. All but patients with minimal restorative needs must have mounted diagnostic casts. Appropriate radiographs are necessary.

D. Treatment Planning and Records

  • Appropriate treatment is predicated on an accurate analysis of all diagnostic data. Treatment planning should include the determination of strategic importance of the dentition and supporting structures considered for treatment, risk assessment, the prognosis, and other factors.
  • Treatment records should include the chief complaints or patient comments (Subjective), the results of diagnostic tests, clinical examination, and clinical impression (Objective findings), assessment of the examination process (Assessment), and a treatment plan to correct the patient's chief complaint and subsequent findings (Plans).
  • Comprehensive care includes the evaluation of the patient's post-operative response to the clinical procedures. Clinicians should encourage patients to return at intervals appropriate for their age and disease activity levels. Recall intervals must be set in accordance with individual patient needs.

E. General Clinical Parameters

  • Students must comply with infection control in all procedures.


  • Caries control measures such as nutritional counseling, fluoride treatment, caries risk assessment and sealants, shall be used when indicated, prior to initiation of planned restorative treatment.

  • Mass excavation and temporization may be used for patients with multiple deep carious lesions and high caries activity to prevent disease progression until preventive and caries control procedures have been completed. (In such cases, crown and bridge procedures are delayed until caries is eliminated and the disease process is under control).

  • Conservative Class I and Class II direct or indirect composite or porcelain restorations may be selected for posterior teeth where esthetics is primary concern, where the preparation width is no greater than 1/3rd the B-L width, where rubber dam isolation can be achieved, where all cavosurface margins are in enamel, and where the occlusion does not contraindicate the use of these materials.

  • Full coverage is indicated on teeth that cannot be reasonably restored with direct placement materials, and/or where needed to support fixed and/or removable prostheses.

  • Glass ionomers are not to be used for tooth buildups, but may be used for cervical lesion and/or in the presence of elated caries activity.

  • Labial veneers of composite resin or porcelain may be selected to correct the esthetic problems on anterior teeth when occlusion does not contraindicate such treatment, and where there is sufficient tooth structure remaining to support the veneer.

  • Proper isolation with rubber dam must be used unless contraindicated by the clinical presentation.

  • High speed rotary instruments should be used with air/water spray.

  • All active caries and infected dentin shall be removed. Very deep caries excavation should be performed with slow speed and Hand instruments.

  • Calcium hydroxide shall be placed only above near exposures, or exposures of the pulp. The amount should not extend beyond 1.5mm of the exposure or near exposure.

GENERAL CLINICAL TOPICS

DIRECT PLACEMENT RESTORATIONS

INDIRECT PLACEMENT RESTORATIONS


Rev: 7/14/09

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