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 Schools 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 less Pre-Hypertensive: 121-139/81-89 Hypertensive: 140/90 *No epi retraction cord placed in patients 140/90 and above Elective treatment delayed if greater than: 160/100 *Treatment after consult with MD nitrous or valium No treatment if greater than: 180/ 110 Medical Consult Necessary in cases of: Uncontrolled Htn Uncontrolled Diabetes Recent heart attack (less than 6 mos) Recent TIA or CVA/Stroke (less than 6 mos)

Heart Murmur HIV 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 transfusion CD4+: 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 Varnish Perio: Peridex Caries: Cari-FreeTx Rinse and Cari-Free Maintenance Rinse Xerostomia: 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 OH 4 Months: Moderate disease with excellent OH Early 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 women Smokers High caries rate

Poorly controlled diabetic patients Early 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, D3 Occlusal Caries: Not easy to determine from BWs Impacted Molars Bitewings diagnostic for: Interproximal caries Generalized bone levels Assesement of pulp chambers PAs diagnostic for: Perio/endo lesions Apical Pathology E. Intraoral photographs of the patient Specific esthetic concerns Curves of Wilson and Spee Evidence 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 patients Medical and Dental History. Your recommended treatment plan MUST: A. Appropriately address the patients 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 Valves 2. Cardiac transplant with problematic valve 3. History of Infective Endocarditis 4. Congenital heart conditions: Unrepaired cyanotic heart defect CHD First 6 mos after completely repaired CHD with prosthetic device Prosthetic Joint Prophylaxis: If at increased risk, which includes: Joint replacement in last 2 years Previous prosthetic joint infections Immunocompromised Type I Diabetic Hemophiliac Amoxicillin 2 g (500 mg X 4) 30 60 min prior to invasive procedures Clindamycin 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 sensitivity Irreversible: Spontaneous pain, keeps pt up at night, thermal +++ Chronic: Draining fistula/sinus tract present. Pt had pain Necrotic: Cold relieves symptoms. Pt will present with ice

D. Contain a comprehensive, appropriately sequenced list of procedures that address the patients dental needs. Sequence of Treatment: 1. Urgent Care: Pain, CC 2. Disease Control: Periodontics Phase I: OHI, Diet Counseling, SRP/Prophy, Extractions, ITE to determine if ready for phase II perio tx Phase II if disease under control: perio surgery Gingival grafts, pocket reduction, distal wedge, crown lengthening Caries Control Occlusal Disease 3. Restorative Ortho Operative Fixed Removeable 4. Maintenance Perio 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.