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As Colonel ‘Hannibal’ Smith said “I love it when a plan comes together”. For this to happen, one needs a plan in the first place! If we were going to build a house, we would consult an architect who would help us convert our vision into bricks and mortar. If he missed something out, like the ‘granny flat’ we needed, or didn’t include the cost of double glazed windows, we would be pretty upset with him. However, dentists are not always providing full treatment plans and without these, patients are left in the dark.
Dentists must be both Planners and Builders.
The beginning of a plan starts with listening to the needs of patients, and everyone is unique in their needs. We need to ask open questions and start people talking. On learning about their attitudes and knowledge level and even their ability to financially commit to treatment, we can start to formulate a plan which will be both acceptable and help them to achieve or maintain good oral health. It is important to listen, listen, listen!
It’s not a good start to dismiss a patient just because their beliefs or requirements do not suit our model of dentistry. Remember, this is just the start of negotiating an outcome that suits everyone. One you have an idea of their story, you can help them adjust this to what is clinically possible or acceptable. These days, we are asked to take a ‘holistic’ approach to treatment planning. This means taking in personal, social and religious issues as well as medical histories.
Start with the Foundations.
It’s trite to compare periodontal health to the foundations of a house – but it’s true! Any treatment plan has to start with a periodontal assessment and work to make the foundations as sound as possible. It isn’t possible to plan anything else without a projection of the support of individual teeth. A time-scale for treatment has to include enough time for stabilising any outstanding condition. Give patients a diagnosis, without which they can’t give informed consent for any treatment at all.
Once foundations are put in, or it’s assessed that good foundations are already present, you can start to plan the walls and layout of your house. What restorations are needed? What restorations are possible? Are there big spaces to fill? Show the patient a few different plans and styles to start the process of design.
Finish the Plan and Quote
Patients deserve, and need, a complete plan. For financial reasons, people need to know what their total outlay will be, this means include everything from start to finish. Include every possibility and back up each stage with xrays, a diagnosis and alternatives. Clinically, there is usually more than one way to solve a problem. Each needs to be presented with risks and prognosis.
Finally, if you don’t know what to do – refer to a specialist.
