The 2003 CDC guidelines address educating and protecting dental healthcare personnel; preventing transmission of bloodborne pathogens (including postexposure management); hand hygiene; personal protective equipment; contact dermatitis and latex hypersensitivity; sterilization and disinfection of patient-care items; environmental infection control (encompassing operatory surface management and medical waste); dental unit waterlines, biofilm, and water quality; dental handpieces and other devices that attach to dental unit airlines and waterlines; radiology; aseptic technique for parenteral medications; disposable devices; oral surgical procedures; handling biopsy specimens; infection control for the dental laboratory; tuberculosis in dentistry; and program evaluation. The document also discusses pre-procedural mouthrinses, laser/electrosurgery plumes and surgical smoke, and prion diseases such as Creutzfeldt-Jakob disease. However, because of insufficient scientific evidence or lack of consensus regarding the efficacy of potential interventions, CDC currently designates these topics as unresolved issues.
Generally, the plan for the patient’s treatment is completed on the second patient visit (twenty-eight, or 60 percent) following a screening appointment. Approximately one-third completed a plan during the first patient visit (fourteen, or 30 percent). The re-maining schools finalized the plan during the third visit after the initial screening appointment (eleven,or 23 percent).
Treatment planning is a critical aspect of clinical education in the dental school curriculum. It is surprising, therefore, that so little attention has been given to this subject in the dental literature. The importance of treatment planning is reinf orced in the standards and the tests that clearly present methods and necessity for treatment planning. However, there is minimal evidence about how these treatment planning courses have been evaluated, how they were incorporated into the curriculum, or how they
have been integrated into treatment planning in the academic clinical setting. The purpose of this study was to survey and profile current treatment planning processes in U.S. dental schools. A questionnaire consisting of twenty-nine items relating to treatment plan preparation, process, and outcomes was mailed to fifty-four U.S. dental schools. The primary topics included patient assignments, treatment planning, plan sequencing, plan presentation, informed consent, and plan modifications. Forty-seven of
the fifty-four U.S. dental schools (87 percent) completed and returned the surveys. Profiling the treatment planning process in dental schools reveals many similarities. Typically, the schools screen patients prior to assignment to students and expect the student diagnostician to complete the planning process as well as comprehensive care. The patient’s welfare is the primary determinant of the content of the plan in 92 percent of U.S. dental schools. Secondly, though current accreditation standards a
reconcentrated on competencies, the treatment plans are influenced by quantitative requirements. Third, the plan is usually completed during the second patient visit after screening. Fourth, the approaches vary among the schools when a multidisciplinary or complex treatment plan is appropriate. Some depend on a panel of experts, whereas others do not have interactive planning with specialists. A significant number of schools decentralize treatment planning and delegate part of the plan to disciplines or group practice leaders. Fifth, the treatment plans and treatment risks are presented in accordance with the intent of the accreditation guidelines; however, fewer than half the schools explain the risk of procedures to patients at the time of plan presentation. Finally, plans change frequently, but the modifications are generally considered to be minor.
Profiling the treatment planning process in dental schools reveals many similarities. Typically,the schools screen patients prior to assignment to students and expect the student diagnostician to complete the planning process as well as comprehensive care. The outcome of screening is to assess patients and identify those whose needs correspond to the educational and service missions. In the general context, this information identifies patients whose needs are within the scope of services provided within the predoctoral program and within the range of the students’ ability. As a result, dental faculty are able to protect the patients by ensuring that beginning student dentists are not expected to address complex medical and dental problems beyond their ability and knowledge. Furthermore, the information from screening provides a categorization of patient needs to provide students with balanced educational experiences in the development of competence.
The diagnostic process does not stop with oral diagnosis, but of necessity includes the ultimate optimally planned and sequenced treatment for each patient. The comprehensive plan addresses all problems and is most strongly influenced by patient needs and requests rather than the students’ or curricular expectations to fulfill quantitative guidelines.