5.1 Treatment Planning

Customizing Treatment

Effective treatment of disease requires the correct diagnosis and treatment, follow-up, and the patient’s cooperation. For example, if a patient has a fingernail infection and the treatment is to scrub the nails and cuticles with a special brush and apply medication twice a day, a health professional needs to prescribe the correct medication, give understandable instructions on its use, and check the patient at proper re-evaluation intervals. The patient has to follow the directions and then return for re-evaluation to make sure the infection has cleared. Successfully treating dental caries involves the same elements. The dentist must evaluate the patient’s risk for disease, provide the correct diagnosis and treatment, and check the patient at appropriate re-evaluation intervals, all with the patient’s consent and cooperation.

Treatment for dental caries has undergone significant changes in recent years. Some lesions and deficient restorations that were once considered candidates for surgical restorative treatment can now be more effectively treated with dental sealants, fluoride, antimicrobial agents, or other preventive strategies.1

Armed with information from the examination, X-rays, dental and medical histories, and knowledge of the carious disease process, the dentist can determine the most appropriate risk category, treatment, and recall interval.

Initially, the dentist may want to refer often to the Caries Risk Classification Table when determining appropriate treatment, especially for preventive strategies. The caries risk classification table contains preventive strategies for each risk category. If a dentist is not following the preventive strategies recommended in the table, the dentist should determine why this is the case.

For example, if the patient is at low risk for dental caries, and the dentist has planned oral health education and reinforcement, professionally applied topical fluoride, home-use fluorides, chlorhexidine rinse, and gum containing xylitol, something is amiss. Either the patient is not at low risk and needs these rigorous preventive strategies, or the strategies should be less rigorous.

Similarly, a patient at high risk will need more than oral hygiene education and reinforcement, fluoride toothpaste, dental sealants, and restorative treatment to successfully treat dental caries. If this is the treatment for such a patient, the dentist should reassess the patient’s risk category and preventive strategies and revise one or both of them.

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