Dealing with long courses of treatment
 

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Dealing with long courses of treatment

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Dealing with long courses of treatment

 

Dealing with long courses of treatment

By Michael Watson

If you are credited with three UDAs whether you do one filling or ten, how do you treat patients with high needs and still fulfil your UDA quota? The expression ‘splitting courses of treatment’ has been used to describe a possible system of doing the fillings in ones and twos as separate courses of treatment. It sounds both unethical, illegal and probably is, as well as making a patient pay twice or more for what is in reality a single course of treatment.

On the other hand if we look at how conditions are treated by our colleagues in medicine and surgery we often see a staged approach to care. We read of people who will need ten operations to put them right. People with chronic conditions such as diabetes, asthma or arthritis will never be ‘cured’ at best they can learn to manage their condition themselves, with some help from their GP.

Yet in dentistry prescribing a course of treatment that will make the patient dentally fit is now ingrained in both profession and public. But it is out of date with modern thinking about the management of chronic disease on both sides of the Atlantic. You do not ‘cure’ an alcoholic by giving them a liver transplant; likewise you do not ‘cure’ a patient with caries and/or perio disease by giving them a course of treatment. People now talk about managing chronic disease and encouraging the patient to manage their own disease and about changing their life styles.
Seeing patients once every five years and doing 10 fillings does not cure their problem. Patients’ oral health can only be addressed by themselves. Of course dentists and other members of the team can help, but it is not something that can be cured in one course of treatment, in two visits or in three months. In many cases their course of treatment is going to last the rest of their life. In reality the periodontally compromised patient may never be ‘dentally fit’.

I ran these ideas in front of colleagues and I am indebted to Audoen Healey, who said that there were a few problems when dealing with the patient with rampant caries. He said that once the educational phase has been completed and the patient has satisfactorily modified behaviour, it is highly desirable to treat at least all the major carious lesions to prevent extension into pulp or even tooth loss.

He believes that dental disease in general should be tackled in a logical fashion, with diagnosis, patient education, disease stabilisation, monitoring and review, and only then phases of major restorative work as appropriate. These (with long term monitoring) are the parts that can be done with time.
The DoH, in its wisdom however, has decided to stick with the concept of courses of treatment, which is what UDAs are. What in effect they are doing is dividing up a 40 year programme of care into manageable chunks. If the patient has poor plaque control this may mean a new ‘course of treatment’ every three months. Or they can have a treatment plan which will be completed in two years, divided into a number of courses of treatment, not to give you more UDAs or the PCT more patient charge revenue, but because that is in the best interests of the patient.

If you have any comments on this or any other articles in this issue write in or email us on: newsdesk@dentistry.co.uk

 Posted on : Fri 3rd - Mar - 2006

 

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