Dental practice: overview of diagnosis and management
The information included in this topic is appropriate for dental practice and may not be applicable to other areas of medicine.
The general principles of managing oral and dental conditions are summarised in General principles of managing oral and dental conditions.
- Identify the disease and its cause—establish a diagnosis.
- Provide acute care.
- Address the cause to prevent recurrence.
- Address the effect of the disease.
- Restore normal function.
- Monitor healing.
- Provide ongoing monitoring and management, particularly for chronic or recurrent diseases.
The process of establishing a diagnosis begins by taking a thorough history, conducting a clinical examination, and performing diagnostic tests if appropriate (see Dental practice: examination and diagnostic tests). The clinician uses this information to establish a diagnosis, based on a knowledge of oral and dental diseases, and the systemic diseases that can manifest in the mouth. Clinicians should also consider the possibility that the patient’s symptoms may be an adverse effect of a drug.
It is usually possible to establish a diagnosis for dental problems before starting treatment (unless emergency or acute treatment is required). If the diagnosis is unclear, the clinician should either defer treatment while awaiting further information (eg test results), or refer the patient to a specialist (see Dental practice: referral).
It is essential to identify the cause of the disease because addressing the cause is an integral part (and usually the first stage) of managing the disease. The cause may be simple (eg dental caries as a cause for pulp disease) or complex (eg a systemic disease with oral manifestations). Complex conditions may require other management in addition to dental treatment, and consultation with or referral to the patient’s medical practitioner (see Dental practice: referral). Risk factors for the disease should also be identified and modified, if possible, as part of the overall management of the patient. If the cause is not addressed, full or rapid recovery may not be achievable, or an acute condition may progress to become chronic.
Once the diagnosis and cause have been established, the clinician should decide an appropriate management strategy. There is a distinction between ’management’ and ’treatment’. Treatment refers to a systematic course of medical or surgical care, whereas management encompasses the overall handling of the patient and their health issues in a sensitive manner, in addition to treatment.
Drug therapy or irreversible dental treatment should not be started until the diagnosis has been confirmed. The approach of ‘let’s try this and see if it helps’ or ‘just in case’ is not recommended—it may expose the patient to incorrect or inappropriate treatment, or mask signs or symptoms that could indicate a particular diagnosis.
Most conditions that lead patients to visit their dentist require dental or oral treatment (see Dental practice: the process of rational treatment). Drugs are usually only needed adjunctively, with consideration of the likely benefit and potential adverse effects (see Dental practice: the role of drugs).