Treatment planning processes in dental schools

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 reinforced 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 are concentrated 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.