PBL on Toothache

PROBLEM-BASED LEARNING ON TOOTHACHE

Trigger 1

Patient with complaint of “Toothache”

Questions:

1. What is “The Health Problem”?

2. What are the possible causes of “The Health Problem”?

Organs/tissues involved General condition/disorder Specific condition/disease

(e.g. trauma, cancer, infection)

___________________ __________________________ _____________________

___________________ __________________________ _____________________

___________________ __________________________ _____________________

3. What do you think are the more common/least common general and specific condition causing the health problem?

General condition/disorder Specific condition/disease

More common __________________________ _____________________

__________________________ _____________________

Least common __________________________ _____________________

__________________________ _____________________

4. Select one common general or specific condition and diagram the pathophysiology

leading to the health problem.

Trigger 2

Pertinent history

Age, sex / Chief complaint / When noted / Associated symptoms

25y.o./Female/Toothache/Noted 2 days prior/ No associated symptoms

Toothache apparently at the right lower jaw area.

Physical examination:

No gross abnormalities noted within the mouth and on the teeth.

Positive tenderness on the right lower molars, more on the 3^rd, when pressure is

applied by biting.

Questions:

1. What is your primary and secondary diagnosis?

Primary diagnosis: _____________________________________________

Secondary diagnosis: ___________________________________________

2. What are the bases for your primary and secondary diagnoses?

Demonstrate use of pattern recognition with pathophysiology and

prevalence.

Signs/Symptoms/Pathophysiology Prevalence data

Primary diagnosis

Secondary diagnosis

3. Do you need more data (sign/symptom) to firm up your primary and secondary

diagnoses?

If yes, what? How will it firm up your diagnosis?

[ Data asked for either not available or normal. Facilitator may supply other data.]

4. Do you need a paraclinical diagnostic procedure?

If yes, why? If no, why?

Demonstrate use of

1. certainty/uncertainty of primary and secondary diagnoses

2. plan of management for primary and secondary diagnoses

3. others

5. If you need a paraclinical diagnostic procedure, what will you recommend? Why?

Give at least 3 options and then compare using benefit, risk, cost, and

availability factors. Then select one demonstrating priority on the primary

diagnosis. Shotgun policy is NOT acceptable.

Benefit Risk Cost Availability

Option 1

Option 2

Option 3

6. Suppose the patient agreed to your recommendation of the paraclinical diagnostic

procedure and suppose it was done.

What results will firm up your primary diagnosis?

What results will make you shift to your secondary diagnosis as the primary

diagnosis?

Trigger 3.

A paraclinical diagnostic procedure was done.

An X-ray was done.

[Here is the picture/reading/result of the paraclinical diagnostic procedure.]

Report: “1-cm radiolucency near the root of the right 3^rd lower molar.

Questions (as applicable):

1. Examine the result of the paraclinical diagnostic procedure and then interpret.

Decide whether the result is informative or non-informative.

Informative, why? Non-informative, why?

2. After the paraclinical diagnostic procedure, what is now your primary and secondary

diagnosis? Why?

Demonstrate use of pattern recognition with pathophysiology and prevalence.

Diagnostic Procedure/Signs/Symptoms/Pathophysiology Prevalence data

Primary diagnosis

Secondary diagnosis

3. Do you need to firm up your diagnosis before you proceed to treatment?

If yes, how?

What data do you need?

History?

Physical exam?

Other diagnostic procedure?

Observation and monitoring?

[Data asked for either not available or normal. Facilitator may supply other data.]

4. What is your pretreatment primary and secondary diagnoses?

5. State the goals of treatment for your primary diagnosis?

6. Decide on a treatment modality after comparing the options based on benefit, risk,

cost, and availability factors.

Benefit Risk Cost Availability

Nonoperative

(Specific procedure in mind)

Operative

(Specific procedure in mind)

8. Describe the things need to be done during the pretreatment, intratreatment, and posttreatment phase.

7. Decide how you would evaluate the results or outcome of your proposed treatment.

Trigger 4

The diagnosis of the patient’s health problem is

DENTOALVEOLAR ABSCESS, right 3^rd lower molar

Questions:

1. Advice the patient and relatives on the pathophysiology of the disease. Use diagram.

2. Advice the patient and relatives on screening of the disease.

3. Advice the patient and relatives on early detection of the disease.

Criteria to be used in evaluation of report:

Clear

Adequate in terms of content

Answers to the questions

Presence of references

Within the prescribed length (not more than 10 pages of short bond papers)

ROJ@17apr29