ORAL DIAGNOSIS & TREATMENT PLANNING TEST CASE

Examination Overview

The Oral Diagnosis and Treatment Planning (ODTP) Test Case examination is completed using patient case materials modeled on the Patient Assessment and Treatment Planning (PATP) portion of the Western Regional Examining Board (WREB) licensure examination. You are given 60 minutes to assess images and patient information and to complete and submit a treatment plan for the patient.

General Information

A. An orientation will be given five minutes before the 11:00 AM scheduled examination start time in the Simulation Laboratory.

B. The examination begins promptly at 11:00 AM. No time extensions are possible if you are late or fail to complete the examination during the assigned time.

C. You may bring a pen (blue or black only), pencil and loupes to the examination; NOTHING ELSE. All electronic devices are prohibited from the examination area.

D. Communication at any time with other individuals regarding the contents of the examination during its administration, or removal or reproduction of exam materials will be considered unethical conduct. Such conduct is an automatic failure of the examination in its entirety and will be reported to the School’s Ethics Committee for disciplinary action.

Materials Provided -- DO NOT mark on any materials other than F and G

A. A completed Patient Information and Patient Medical History

Chief Concern, Significant MH, Current Medications, Dental History, Current Rx Medications, Labs if HIV+

Monitor BP w/hypertensive patients:Normal: 120/80 or lessPre-Hypertensive: 121-139/81-89Hypertensive: 140/90

*No epi retraction cord placed in patients 140/90 and aboveElective treatment delayed if greater than: 160/100

*Treatment after consult with MD – nitrous or valiumNo treatment if greater than: 180/ 110

Medical Consult Necessary in cases of:Uncontrolled HtnUncontrolled DiabetesRecent heart attack (less than 6 mos)Recent TIA or CVA/Stroke (less than 6 mos)

Heart MurmurHIV Labs that are below thresholds

HIV Labs:Platelets: above 60 K / mm 3 (250 K to 400 K). Platelet infusion.WBC: above 2 K / mm 3 (4 K to 10 K). Antibiotic Prophylaxis.Hematocrit: above 10% (40 – 50%). RBC transfusion.Hemoglobin: above 10 q / dl (12 -18 q/dl)/ RBC transfusionCD4+: above 200 / mm3 (600 – 1100). Delay if improvement expected.Viral Load: greater than 5 k copies, need to reinforce OH.

B. A completed Caries Status and Risk Assessment

Products recommended:Fluoride: High Fluoride Toothpaste, Fluoride VarnishPerio: PeridexCaries: Cari-FreeTx Rinse and Cari-Free Maintenance RinseXerostomia: Boost Spray, biotene (OTC), Xylitol gum and mints

C. A completed Periodontal Examination Record

Periodontal Diagnosis: Generalized Mild/Moderate/Severe Acute/Chronic Gingivitis/Periodontitis with Localized Mild/Moderate/Severe Acute/Chronic Gingivitis/Periodontitis

Periodontal Prognosis: Determined by Generalized bone levels, mobility, cleansability for patient (5+ mm pockets deemed uncleansable), presence of vertical defects, furcation involvement, mucogingival issues (width of attached gingiva), Homecare assessment.

Perio surgery: performed only after pt demonstrates acceptable homecare.Pocket reduction surgery, Crown lengthening, grafts

Recall:6 months:

Most pedo patients, gingivitis, health, good OH4 Months:

Moderate disease with excellent OHEarly disease with marginal OH, 4-5 mm pockets with no BOP

3 Months: Advanced condition; perio surgery will not help or indicated but not available (med, finances). Pregnant womenSmokersHigh caries rate

Poorly controlled diabetic patientsEarly to moderate disease with poor hygene

2 Months: Difficult case, advanced/active disease, furcation involvement, poor crown to root ratios, mucogingival problems

Perio prognosis for individual teeth:Excellent Good (less than 20% alveolar bone loss)Fair Guarded (20-40% alveolar bone loss)Poor Hopeless (40% alveolar bone loss)

D. Patient radiographs

Proximal Caries: E1, E2, D1, D2, D3Occlusal Caries: Not easy to determine from BW’sImpacted Molars

Bitewings diagnostic for: Interproximal cariesGeneralized bone levelsAssesement of pulp chambers

PA’s diagnostic for: Perio/endo lesions

Apical Pathology

E. Intraoral photographs of the patient

Specific esthetic concernsCurves of Wilson and SpeeEvidence of parafunction, bruxism, wear facets, erosion

F. A blank worksheet for your use (this is a non-graded form for making notes)G. A blank Treatment Plan form (to be completed and submitted for grading)

Treatment Plan

You are given 60 minutes to develop an appropriate treatment plan for the patient.

You should only consider the patient information presented. DO NOT presume any findings exist that are not readily discernible. Not every surface of every tooth will be visible on the radiographs and photographs. Pit and fissure caries cannot be explored and should NOT be assumed present unless obvious cavitation is noted on the patient photographs, or occlusal caries is discernible on the radiographs.

You are encouraged to develop a problem list on the worksheet prior to formulating your final treatment plan.

Patient compliance is to be considered good, unless otherwise specifically noted in the patient’s Medical and Dental History.

Your recommended treatment plan MUST:

A. Appropriately address the patient’s chief complaint or concern, if any.

Pain: Urgent Care is first priority

B. Include appropriate treatment modifications if there are medical or psychological conditions that affect the delivery of dental care to the patient. You are expected to provide the appropriate medication, time interval, and dosage.

AHA Guidelines for Prophylaxis:1. Artificial Heart Valves2. Cardiac transplant with problematic valve3. History of Infective Endocarditis4. Congenital heart conditions:

Unrepaired cyanotic heart defect CHDFirst 6 mos after completely repaired CHD with prosthetic device

Prosthetic Joint Prophylaxis: If at increased risk, which includes:Joint replacement in last 2 yearsPrevious prosthetic joint infections ImmunocompromisedType I DiabeticHemophiliac

Amoxicillin 2 g (500 mg X 4) 30 – 60 min prior to invasive proceduresClindamycin 600 mg (150 mg X 4) 30 – 60 min prior to invasive procedures (pen allergy)

C. Recommend additional diagnostic tests or specialist referrals as part of the treatment plan, if indicated.

Implant: Immediate or delayed (3-4 mos mandible, 6 mos maxilla)Endo: HCC, Vitality testing, symptoms

Reversible: Thermal ++, percussion and palpation sensitivityIrreversible: Spontaneous pain, keeps pt up at night, thermal +++Chronic: Draining fistula/sinus tract present. Pt had painNecrotic: Cold relieves symptoms. Pt will present with ice

D. Contain a comprehensive, appropriately sequenced list of procedures that address the patient’s dental needs.

Sequence of Treatment:1. Urgent Care: Pain, CC2. Disease Control:

PeriodonticsPhase I: OHI, Diet Counseling, SRP/Prophy, Extractions, ITE to determine if ready for phase II perio txPhase II if disease under control: perio surgeryGingival grafts, pocket reduction, distal wedge, crown lengthening

Caries ControlOcclusal Disease

3. RestorativeOrthoOperativeFixedRemoveable

4. MaintenancePerio Recall

E. Include the recommendation of an appropriate maintenance care interval following completion of active treatment. See perio section…

F. Include the prognosis for the recommended treatment plan.

Excellent, Good, Fair, Guarded, Poor, Hopeless

G. Be legible and sufficiently organized to be readily interpreted by Examiners.

Complete the final treatment plan in blue or black ink ONLY.

With regard to dental restorations, provide tooth number, restoration, and, where appropriate, the specific surface(s) involved. It is NOT necessary to specify the restorative material. For example, “MOD” is adequate, instead of “MOD amalgam or composite; “onlay” or “crown” is adequate, instead of “gold crown” or “PFM crown”.

You are encouraged to only use abbreviations that are universally understood. Abbreviations that are not understood by the exam reviewer will result in deduction of points.

The Treatment Plan form, non-graded worksheet and all provided patient materials MUST be inserted into the original packet envelope and returned to the proctor by the end of the 60 minute examination time. If you submit any examination materials after the conclusion of the allotted time, you examination score will be zero.