Diagnosis and Treatment Planning
Diagnosis and Treatment Planning underpins every other NZDREX domain: examiners test whether you can gather information, interpret it correctly and sequence care safely rather than jump to a procedure. Expect history-taking, special tests, radiographic justification, problem lists, treatment sequencing and consent.
Core rules
- Use a fixed sequence: chief complaint and its history, medical and social history, extraoral examination, intraoral soft and hard tissue examination, special tests, then radiographs only if they will change management.
- Pulp sensibility tests (cold, electric) assess nerve response, not blood supply. Compare with adjacent and contralateral teeth and always interpret alongside percussion, palpation, probing and bite tests.
- Image selection is a test item: bitewings for interproximal caries, periapicals for apical status and individual roots, OPG for broad screening, CBCT only where 2D is inadequate.
- Write a problem list, then a plan ordered as emergency relief, disease control, definitive care and maintenance. Give alternatives, risks and costs, and record the agreed plan.
Worked example
A patient has a six-week dull ache in the mandibular left quadrant, worse on chewing, no response to cold on 36, tender to percussion, 5 mm probing mesiobuccally, and normal responses on 35 and 37. The diagnosis is symptomatic apical periodontitis with a suspected crack or fracture, not simply "needs root canal". Next steps are bite tests, transillumination, periapical imaging and, if the fracture is equivocal, small-field CBCT. The plan explains diagnostic uncertainty and offers endodontic and restorative options versus extraction.
Traps
- Prescribing antibiotics for localised pulpitis or an abscess without drainage.
- Overlooking anticoagulants, bisphosphonates or poorly controlled diabetes before surgery.
- Recording a plan that ignores the patient's stated priorities, then losing marks for consent.