Guidelines for: INTEGRATED CASE PRESENTATIONS

Purpose and Goals The purposes of this valuable presentation are: To provide a forum for sharing the learning experiences of the clinic and to discuss the problems/issues encountered in treatment planning while integrating basic science knowledge into best patient care practices. To give students additional experience in presenting cases, with emphasis on comprehensive examination, history taking, diagnosis and treatment planning, critical thinking and evidence-based dentistry. To expose the students to a patient pool greater than that of the patients assigned to them. Selection of Cases It is preferable to select cases which will provide a valued learning experience to the group. It is not required that all of the treatment be performed by the student presenter. However, the D4 student must have participated in the treatment and treatment planning, and must exhibit thoroughness and understanding, and demonstrate evidence-based dentistry and critical thinking in documenting and presenting the case. Records and Information For these cases you will need the following pre-treatment records: Complete history Hard tissue charting Periodontal charting, including any re-evaluations Appropriate radiographs for radiographic projection during the presentation, including any pre-op original films of the CC, or chief complaint. 5. Study models: One set should be articulated in proper relation on a semi-adjustable articulator. Both casts should be properly trimmed, with clear details of the hard and soft tissue, and finished in the same manner required by the orthodontic department for permanent models. These models are meant to be circulated to the class for better understanding of the case. If the case requires a diagnostic wax-up for treatment planning purposes, this wax-up should also be brought to the case presentation. 6. Photographic images of the dentition Front view Right lateral (mirror) Left lateral (mirror) Palatal-maxilla (mirror) Mandible (mirror) and mandibular posterior lingual right and left (mirror) Close-up of specific photographs of points of interest or special procedures as the case is treated, and of the completed case, when possible. Photographs should be clear and properly cropped. All case presentations must include slides of study models in different profiles, i.e. Occlusal, anterior and buccal views Each student will prepare at least 2 treatment plans (see examples below). *Ultimate Treatment Plan- This may be considered as absolutely the best that dentistry could provide for the patient if there were no confounding medical, financial, or hygiene issues. This assumes that the patient is healthy enough to withstand all the procedures you will do for him/her without financial restriction, and if the patient demonstrates excellent oral hygiene. *Ideal Treatment Plan- This may be very similar to the Ultimate Treatment Plan, but may need modification because of medical or hygiene constraints. This will be the plan best tailored to give the patient the finest that dentistry can offer and one that is likely to succeed in that persons mouth. Financial restrictions are not considered. *Realistic Treatment Plan- This plan considers the entirety of the patients problem list when developing a treatment plan. This plan is one the patient can AFFORD. The Realistic Treatment Plan may represent compromises from the ideal plan, for example removable prosthodontics instead of implants or bridges. *Stabilizing Treatment Plan- This is a minimalist plan, generally driven by patient finances, but one that recognizes that the patients future financial status, health, attitude about the importance of his/her dentition may improve. This is a plan which ensures that urgent dental needs will be resolved until such time as the patient has the desire to proceed toward establishing the best form, function, and esthetics. The number of slides should not exceed 25. Each slide will be viewed for 30 seconds to a minute. Deadlines The D4 case (chart, radiographs and casts) must be brought to your GPD OR his/her designee eight weeks prior to the presentation for review and approval. The D4 powerpoint presentation must be brought to your GPD/designee six weeks prior to the presentation 24 1. 2. 3. 4.

1. 2. 3.

for review and assignment of basic science (D1), pathology (D2) and Evidence Based literature search (D3). HIPPA must be adhered to throughout the presentation. Make sure to delete the patients name from any documentation, and block out the patients eyes in photographs. You must obtain a signed release from the patient before taking any photographs. The signed release should be presented to the GPD prior to presentation of the case. The D4 case, presented in PowerPoint format to the Group Practice Director six weeks prior to the actual presentation, will be utilized by the D1, 2 and 3 students for the preparation of their PowerPoint presentations. Each D1 and D2 student shall complete his/her assigned presentation slides based upon the subject as assigned by the Basic Science/Clinical Mentor (BS/C Mentor). The presentations should be no more than 3-5 slides each and take approximately five minutes each to present. The D3 student will create a PICO question based upon the case presentation and search for two pieces of significant literature on the subject to answer the PICO question utilizing the highest levels of evidence to best answer the question. The assigned D3 student shall provide his/her group of D1, D2 and D4 students in his/her group the PDF of the selected articles no less than 1 week before the presentation. The D3 student shall prepare a 10 minute presentation on the two pieces of literature including search strategy, a summary of the articles and an analysis of the literature utilizing the short LAF and SAPL, presenting the clinical significance of these articles. The D4 student should receive the contents of the D1, 2 and 3 case presentations no less than one week prior to the scheduled case presentation and integrate the four case presentations into one cohesive case presentation. The D4 student shall serve as the coordinator of these events. The D1/2 presentation should be incorporated into the presentation after the risk assessments and diagnosis are presented. The D3 PICO question and literature analysis will be made prior to the presentation of the treatment plans. All students attending the session will submit an LAF summary of each of the articles findings and, utilizing SAPL skills, include the clinical significance of these articles.

Format Do Not Use the patients name. Initials are acceptable (for example; Mr. F is a 60 year old Caucasian male.) Block out the patients eyes in all pictures that include the face. You should know your case well, so please look at your audience, speak to your audience and try not to read from your slides. 1. Chief Complaint (CC): *Dental - what brought the patient to the clinic (in his/her own words). 2. Dental History: *Present dental history - chronologic description of the patients chief complaint *Past dental history - past dental visits, reasons for any extraction(s), previous treatment, home care, etc., problems in dental care. 3. Medical History * Present illness (HPI) - note any illnesses, or medications being taken. Create a chart of dosage, contraindications, oral and medical implications and drug interactions. *Past medical history (PMI) - note significant medical findings, including hospitalizations, drug reactions, and allergies. A brief description of positive medical findings with diagnosis and evaluation of the severity of the disease should be presented, including how the medical condition will affect the dental treatment. Students are expected to know the usual signs, symptoms and treatment of the disease or disorder. Students will be expected to start their presentation with a differential diagnosis and justification for each item, and to arrive at the best possible designation of the single or multiple disease states afflicting the patient. *Review of systems (ROS) - highlight any pertinent positive or negative findings. 4. Family and Social History *Medical history of parents and siblings, health habits, employment, insurance, etc. 5. Examination *Extraoral - note any abnormalities in: Blood pressure Gait, posture, speech, etc. Head and neck symmetry, masses, abnormal skin color, eyes. Palpate salivary glands, cervical nodes, thyroid, musculature, etc. *Intraoral- Develop a systematic approach. Note abnormalities or WNL re: Palate soft, hard Pharynx tonsils, etc. Buccal mucosa Orifices of parotids Fauces, retromolar pads, tuberosities Tongue, all surfaces, lingual tonsils (use 2X2 gauze to examine) Floor of mouth palpate and look 25

Orifices of submaxillary glands Periodontium Teeth be systematic, all surfaces a) count teeth; b) chart restorations and lesions; c) contact areas; d) overhangs; e) mobility; f) vitality; and g) wear facets Occlusion Iatrogenic dentistry 6. Discussion of Radiographic examination *Hard tissue lesions discernible on radiograph should be discussed. Students will be expected to evaluate these. 7. Determination of patients Risk of Disease *A description of the factors and indicators of patient risk found in the patients review of health history and clinical examination. Present a list of categories of all the observed problems 8. Diagnosis Medical- pertinent medical findings Dental- caries, periodontal disease, (give ADA Classification), prognosis, etc.

9. Final Treatment Plan This plan should be a comprehensive, sequential listing of all treatment to be performed. It should include all phases of dentistry and should correlate the necessary treatment and medical socioeconomic factors. There should be a sequential listing showing the order in which the various portions of the treatment plan are to be performed. This is the recommended treatment plan for the patient. In addition, present an ideal treatment plan in which financial constraints are not taken into consideration. Additional alternative treatment plans can be presented if desired. The cost of each plan using the clinic fees and ADA codes should be included. A treatment time estimate with approximate number of visits should also be provided.

Use of time Forty minutes will be allotted for each presentation per group. Approximately 15 minutes of this time should be used for the presentation of the case, including existing conditions and history. Approximately 5 minutes will be utilized for the medical condition(s), and 10 minutes for dental diagnosis, x-ray interpretation, slides, etc., 5 minutes each will be spent in the presentation of the two basic science D1 and D2 presentations, 10 minutes will be utilized by the D3 student to present the PICO and literature analysis and 5 minutes for presentation of proposed treatment plans. The remaining time will be used for questions and discussion. All students attending the session must critically appraise the articles, using their SAPL and the LAF appraisal tools which are to be handed in at the start of the presentation. The D3 student will grade the LAF forms submitted for each presentation.

Grading The quality of the slides, handout, x-ray and models, as well as the quality of content, clarity and organization of the presentation will be taken into account for grading (see following page). Assistance with case selection can be obtained by consulting with your GPD. Within one week of the presentation, a compact disk containing the powerpoint of the case and grade sheets completed by the GPD. must be submitted.

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