Dental Office Time Management and Patient Care Series: Automatic treatment planning!


Imagine that you want to fly to L.A.:  You open your smartphone and click “fly to L.A.”  The app notes your location, driving time to the airport, provides flight options, accesses your award mileage program, rents a car, reserves your favorite hotel and makes dinner reservations in L.A. The software knows your preferences for traveling times, price range, seating preferences, special dietary needs and presents communication options for clients in L.A.  You are pleased but not surprised.

Now imagine that you want to create a treatment plan for a patient:  You chart caries on ten teeth, two abscesses, four missing teeth and twelve existing restorations. Does anything else happen? Nope. Why?  Because current clinical features are two-dimensional and stunt our expectations of how software can actually help dentists be better dentists.

What would be better? After charting existing findings, multiple treatment options should be created including even the most advanced multidisciplinary plans. This should happen automatically and instantly. If the dentist has previously installed their own preferences for managing commonly charted findings, these plans will reflect their judgment and be easily customized.

Why does this not happen? Here are four reasons:

FIRST: There are at least 46 anomaly and pathology presentations in the oral cavity that should be chartable (see below). But existing software only provides about half of these. Therefore, software cannot act on existing findings to create treatment plans automatically because it cannot even provide the ability to fully chart existing findings.

Hard tissue (teeth) findings

  1. Missing teeth
  2. Impacted teeth
  3. Existing implant
  4. Pain
  5. Missing crown
  6. Ongoing orthodontic treatment
  7. Metal surface based restorations
  8. Tooth colored surface based restoration
  9. Crown restoration
  10. Veneer
  11. Fixed prosthetic
  12. Removable prosthetic
  13. Complete prosthetic
  14. Caries
  15. Incipient caries
  16. Recurrent caries
  17. Fracture
  18. Wear facet
  19. Hypocalcification
  20. Root surface caries
  21. Root tips remaining
  22. Non-carious cervical lesions
  23. Radiolucent lesion
  24. Radioopaque lesion
  25. Existing endodontic care
  26. Ankylosis
  27. Widened periodontal ligament space
  28. Existing post in canal space
  29. Internal root resorption
  30. External root resorption
  31. Root fracture
  32. Supernumerary tooth
  33. Multiple occlusal schemes

Periodontal tissue findings

  1. Bleeding
  2. Plaque
  3. Gingival margin relative to CEJ
  4. Pocket depth relative to gingival margin
  5. Attached gingival deficiency
  6. Calculus
  7. Suppuration
  8. Fremitus
  9. Defective margin
  10. Marginal ridge discrepancy
  11. Open contact
  12. Mobility
  13. Furcation involvement

SECOND: After charting existing findings, software should allow the clinician to choose from treatment plan options:

  1. Create treatment based on “surface defined restorations”
  2. Extract remaining teeth and add complete maxillary/mandibular denture
  3. Full mouth crown and bridge rehabilitation
  4. Cosmetic – All veneers on anterior teeth and crowns on posterior teeth
  5. Manage all lesions with higher tier restorations
  6. Surgery/implant solution – (plot all extractions, surgery, bone preservation, prosthetic codes, interim restorations, work up appointments, follow up appointments, consultations and lab procedures)
    1. Fixed implant retained prosthesis
    2. Removable implant retained prosthesis
    3. replace missing teeth with implant
  1.  Create treatment plan with least expensive choices
  2.  Create treatment plan with high caries risk modifications
  3.  Create a treatment plan based on insurance benefits for insurance policy “XYZ.”

THIRD: Charting takes too long the way existing software is designed. Charting each finding on each tooth one at a time requires shifting from one discipline (button icon) to another before moving to the next tooth. If a tooth presents with mobility and a composite restoration and an alloy and a fracture and caries one may have to click up to 20 times to chart these findings. A new approach to charting is required where one views the entire oral cavity and charts by grouped anomalies and pathologies and charts by groups:

  1. Chart all missing teeth
  2. Chart all existing alloys
  3. Chart all existing composites
  4. Etc.

The system is much faster and takes into consideration the reason for charting in modern times.

FOURTH: The understanding of the need for charting is antiquated. Charting of existing findings is no longer done just to record existing findings because today there are many ways to do this e.g. radiographs, images, CBCT, study models, caries detecting systems, “Google glasses” examinations, chart notes.

Charting should be done to initiate the resolution of problems. The preferences of the clinician should be installed in the system, the preferences of the patient should be known and the evidence-based literature for resolving issues should be known. Taken together these parameters should automatically guide the treatment planning as it responds to highest skills of the doctor as a diagnostician. Any system that does not do this is behind the times.

The body of dental clinicians should have higher expectations of dental software vendors. Treatment planning software features should at least be as powerful as the apps on your smartphone.