New PATP section in WREB exam

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Hello All WREB takers ..

As you all know by now, the 2008 WREB exam has a new section PATP (patient assessment and treatment planning) that they are testing candidates on ..

Since this would be a first for many, all those taking the first round of examinations in March 2008, please post your experiences here on the new PATP section so we know what to expect ..

Thanks and good luck for WREB 2008 ..
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thanks for bumping this back up .. i am eager to know how the PATP section goes for the early 2008 WREB test takers..

good luck to all ... cheers .....
 
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Hi, has anyone give insight on this treatment planning exam ?
I looked at the booklet with a few samples and it really makes no sense.
I am concerned about the sequence of treatment.
In one case, it lists a treatment sequence as follow
1. extraction #1 (a complaint from patient)
2. endo retreat (#19)
3. a few operative (#3,4,27)
4. extraction #29 (with referral for implant placement)
5. more operative (#30)
6. #32 extraction with OMFS
7. a bridge (#12-14)
8. crown for the endo retrat (#19)
9. implant crown #29

Does this sequence even make sense???? I don't understand why you would do an endo retreat before operative. Then, all the sudden do an extraction and go back to doing more operative. Amongst all of this, they throw in a third molar extraction.
 
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One more question---
does anyone know when you take the treatment planning section of the WREBS?
If one day is endo/clinic, second day is clinic, third day is an extra clinic day, when do they fit in this one hour exam?
 
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toysareus said:
Hi, has anyone give insight on this treatment planning exam ?
I looked at the booklet with a few samples and it really makes no sense.
I am concerned about the sequence of treatment.
In one case, it lists a treatment sequence as follow
1. extraction #1 (a complaint from patient)
2. endo retreat (#19)
3. a few operative (#3,4,27)
4. extraction #29 (with referral for implant placement)
5. more operative (#30)
6. #32 extraction with OMFS
7. a bridge (#12-14)
8. crown for the endo retrat (#19)
9. implant crown #29

Does this sequence even make sense???? I don't understand why you would do an endo retreat before operative. Then, all the sudden do an extraction and go back to doing more operative. Amongst all of this, they throw in a third molar extraction.
Click to expand...

Yeah, it's complete BS as far as I can tell. I own the treatment planning book that they use as a reference (Treatment Planning in Dentistry), and it lists the following treatment phases:

1. Systemic (gather patient info, be aware of medical hx., systemic conditions, etc.)
2. Acute (handle the patient's chief complaint)
3. Disease control (control oral disease prior to placing definitive restorations)
4. Definitive (the bulk of the treatment plan falls under this)
5. Maintenance (recall exams, etc.)

Given that, I can't make heads or tails of any of their sample treatment plans in the Candidate Guide, with the exception of the pedo treatment plan, which is simply quadrant dentistry.

Anybody have any insights?
 
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I've re-thought this a bit and determined that the extraction of #1 would fall under the acute phase. #2-4 must be the disease control phase, #5-9 would be the definitive phase of the treatment plan. Maybe it does make sense.

1. extraction #1 (a complaint from patient)
2. endo retreat (#19)
3. a few operative (#3,4,27)
4. extraction #29 (with referral for implant placement)
5. more operative (#30)
6. #32 extraction with OMFS
7. a bridge (#12-14)
8. crown for the endo retrat (#19)
9. implant crown #29
 
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Thank you,
It does make sense, but I would have put it as follows:
1. exo (chief complaint)
2. operative
3. exo 29
4. endo retreat
5. all pros

I don't know why they did the operative in different sequences???
I'm really unsure of how to sequence for this exam.
Any other tips gavin?
 
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toysareus said:
Thank you,
It does make sense, but I would have put it as follows:
1. exo (chief complaint)
2. operative
3. exo 29
4. endo retreat
5. all pros

I don't know why they did the operative in different sequences???
I'm really unsure of how to sequence for this exam.
Any other tips gavin?
Click to expand...

I think we have to have radiographs and other information to really address this, but according to the reference text, some of that operative would be for caries control (disease control is an actual phase of treatment) and others would be for definitive treatment.

In my mind, the only distinction would be that the disease control caries are active and perhaps causing perio concerns and the definitive ones are either recurrent around existing restorations, or no longer active decay.

I dunno, but I think additional info would help it make some sense. And, there plan isn't much different than what you proposed (they do all the prosth. last as well).
 
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Phase 1: perio, refer to OMFS
Phase 2: all restorations
Phase 3: RCT, prosth
Phase 4: perio maintenace, recall

Don't forget the maintenance if pt has perio involve. I bet you guys the xray will be so blurry, pictures poorly taken like the perio exam on computer. Good luck taking this exam. Nova exam is this weekend, stay tuned.
 
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CU is taking it this weekend as well. Will post some info when it's over. Any help from Nova or anyone else with some info would be fantastic!
 
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So, we took the PATP section today. The exam wasn't too difficult at all, although I did hear complaining from some classmates regarding one specific case where all my classmates had different tx plans. The case I had was straight forward and contained some implants, simple operative, root tip extractions. As far as I know, the sequence is easy. It seems like all the cases went a little something like...

SRP's X 4
OHI
EXT root tips

Simple operative

Refer to Ortho to open space for implants

Refer for implants

Restore Implants

Refer to OMS for 3rd's EXTs.

The case that was difficult seemed to include a similar case than mine, but the patient stated that they couldn't afford implants. So, I think this left a lot more up to the test taker to decide tx based on financial constraints (which can be pretty broad and subjective). I'm sure they will have to calibrate this portion of the exam to make it fair. After all, it is the first year so it will be interesting to see what happens.

Thanks to Nova and others who took it last week for giving us heads up. :laugh::laugh::thumbdown:
 
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Barry20 said:
imilar case than mine, but the patient stated that they couldn't afford implants. So, I think this left a lot more up to the test taker to decide tx based on financial constraints (which can be pretty broad and subjective).
Click to expand...

You may have some unhappy classmates, the candidate guide says that patient finances should NOT be taken into account when formulating the treatment plan.
 
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That was the problem. They all knew what the candidate guide said, but the case said, "I do not want implants, I cannot afford them." You would also have to throw out 3 unit FPDs due to cost. I know that one of my classmates did EXTs on teeth that had an unlikely prognosis (severe perio) and did an RPD. That's what I would have done.

I do know that one of my classmates who got this case didn't see in the patient notes where the patient stated that he didn't want implants and he ended up tx planning for implants. Read ALL the patient history notes.
 
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I had the same patient and I recommended fpd. Cost was not considered as it was not mentioned in the history (patient just didn't want implant - no reason mentioned).
 
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oletyrags said:
I had the same patient and I recommended fpd. Cost was not considered as it was not mentioned in the history (patient just didn't want implant - no reason mentioned).
Click to expand...


That makes more sense. The WREB can be fairly screwed up (I honestly think they grade randomly), but for them to specify a treatment plan option due to finances and yet explicitly state to ignore finances, would be ridiculous.
 
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ItsGavinC said:
That makes more sense. The WREB can be fairly screwed up (I honestly think they grade randomly), but for them to specify a treatment plan option due to finances and yet explicitly state to ignore finances, would be ridiculous.
Click to expand...

It is my understanding that finances/patient cooperation (pedo) are not a factor unless specifically mentioned in the history. Now the waiting begins.

Just FYI for future test takers, I did a MOD on # 4 on one of my patients and this patient had a small pit on the buccal cusp tip (not reaching the dej). During the orientation we were told that we have to treat all occlusal caries including 'qualifying' caries on cusp tips. I wasn't sure if I had to do a occlusal pit on this patient and the floor examiners were not willing to look at the tooth unless I had a modification request (ie occlusal pit). I did a modification request and I was grey carded (referred to grading examiners for review) which was subsequently denied (pink slip - 3 point loss). In hindsight, I should have made a note to the examiners saying that I was aware of the caries and was not treating it since it was not a qualifying lesion (not reached dej). I preferred to lose 3 points than have a validated caries remaining.
 
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oletyrags said:
It is my understanding that finances/patient cooperation (pedo) are not a factor unless specifically mentioned in the history. Now the waiting begins.

Just FYI for future test takers, I did a MOD on # 4 on one of my patients and this patient had a small pit on the buccal cusp tip (not reaching the dej). During the orientation we were told that we have to treat all occlusal caries including 'qualifying' caries on cusp tips. I wasn't sure if I had to do a occlusal pit on this patient and the floor examiners were not willing to look at the tooth unless I had a modification request (ie occlusal pit). I did a modification request and I was grey carded (referred to grading examiners for review) which was subsequently denied (pink slip - 3 point loss). In hindsight, I should have made a note to the examiners saying that I was aware of the caries and was not treating it since it was not a qualifying lesion (not reached dej). I preferred to lose 3 points than have a validated caries remaining.
Click to expand...

It is my understanding that those cuspal caries are part of the occlusal surface. What makes the lesion qualifying isn't the occlusal surface, it's the lesion to the DEJ proximally, so if the occlusal (cuspal too!) caries are only into enamel, or into dentin, it doesn't matter--it all must be removed.

The candidate guide spells this out: "All caries on the occlusal surface must be restored... Cusp tips (Class VI) are considered part of the occlusal surface.
 
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If possible, I would restore the cusp tip before hand so only have to deal with the class II on exam day. I did that for my class II composite. No worry about extra modification request. But some people may not have a chance to treat the patient before hand so.........
 
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ItsGavinC said:
It is my understanding that those cuspal caries are part of the occlusal surface. What makes the lesion qualifying isn't the occlusal surface, it's the lesion to the DEJ proximally, so if the occlusal (cuspal too!) caries are only into enamel, or into dentin, it doesn't matter--it all must be removed.

The candidate guide spells this out: "All caries on the occlusal surface must be restored... Cusp tips (Class VI) are considered part of the occlusal surface.
Click to expand...

If that is the case I am not sure why I was asked to leave it alone. Probably the examiners felt that it had a chance for re mineralization.
 
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oletyrags said:
If that is the case I am not sure why I was asked to leave it alone. Probably the examiners felt that it had a chance for re mineralization.
Click to expand...

It's not fair to take points off if the lesions can be re-mineralization. It highly depends on patient. What if the patient drink coke all day and does not use fluoride toothpaste or live in a non-fluoridated water area? I have lots of those patients come in daily and I would recommend restore them. Because otherwise, once I see those lesions again in 3 months, they sure are near the pulp horn already. Juice drinkers' lesions sure go pretty deep very fast
 
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Thanks to all for thier input on the PATP section of the WREB .. I wish you all good luck on your results ..

As more and more people keep taking the PATP and posting their reviews on here, it should give the future test takers a pretty decent idea of what to expect ..

Thanks again and hope to see more reviews on the PATP section on here ..
 
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Barry20 said:
So, we took the PATP section today. The exam wasn't too difficult at all, although I did hear complaining from some classmates regarding one specific case where all my classmates had different tx plans. The case I had was straight forward and contained some implants, simple operative, root tip extractions. As far as I know, the sequence is easy. It seems like all the cases went a little something like...

SRP's X 4
OHI
EXT root tips

Simple operative

Refer to Ortho to open space for implants

Refer for implants

Restore Implants

Refer to OMS for 3rd's EXTs.

The case that was difficult seemed to include a similar case than mine, but the patient stated that they couldn't afford implants. So, I think this left a lot more up to the test taker to decide tx based on financial constraints (which can be pretty broad and subjective). I'm sure they will have to calibrate this portion of the exam to make it fair. After all, it is the first year so it will be interesting to see what happens.

Thanks to Nova and others who took it last week for giving us heads up. :laugh::laugh::thumbdown:
Click to expand...

Would you do operative before the extraction of root tips? Also, does extraction of impacted wisdoms really fall into the last phase of treatment (after implants have been restored)?
Thank you!
 
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Did they have any really medically compromised pts that required modification to treatment or were they really evaluating your ability to formulate a treatment plan? Also, I heard some story where you had to prescribe Ab prophylaxis on a peds pt that required you to calculate dosage for the Rx. Any truth to that?
 
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pts218 said:
Also, I heard some story where you had to prescribe Ab prophylaxis on a peds pt that required you to calculate dosage for the Rx. Any truth to that?
Click to expand...

40mg/kg of Amoxicillin or 20mg/kg of Clinda, then divided into 3 equal doses/day. If you reach the adult dosing, just give them the adult dose.
 
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ItsGavinC said:
It is my understanding that those cuspal caries are part of the occlusal surface. What makes the lesion qualifying isn't the occlusal surface, it's the lesion to the DEJ proximally, so if the occlusal (cuspal too!) caries are only into enamel, or into dentin, it doesn't matter--it all must be removed.

The candidate guide spells this out: "All caries on the occlusal surface must be restored... Cusp tips (Class VI) are considered part of the occlusal surface.
Click to expand...
Just curious... What if you have a MO on #3 then?... If there is any hint of staining on the distal pit of the occlusal surface, should you drill this out all the way to the dentin and fill with a small amalgam? (I assume you don't want to disturb the ridge if it really is a small pit). If there is no radiographic caries on the radiograph, it seems a little much, but I guess maybe just for the exam's sake maybe you have to do it?
 
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Miss Mammelon said:
Just curious... What if you have a MO on #3 then?... If there is any hint of staining on the distal pit of the occlusal surface, should you drill this out all the way to the dentin and fill with a small amalgam? (I assume you don't want to disturb the ridge if it really is a small pit). If there is no radiographic caries on the radiograph, it seems a little much, but I guess maybe just for the exam's sake maybe you have to do it?
Click to expand...

This is different than what you might do in reality, but prior to the exam I would remove the stain on the distal pit and fill it with a resin. You can then do the MO for the exam. This only works if there is sound tooth structure between the distal pit and the MO caries.

If there isn't sound tooth structure, you may be looking at an MOD, depending on whether or not the distal ridge is compromised from removing the distal pit caries.
 
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ItsGavinC said:
This is different than what you might do in reality, but prior to the exam I would remove the stain on the distal pit and fill it with a resin. You can then do the MO for the exam. This only works if there is sound tooth structure between the distal pit and the MO caries.

If there isn't sound tooth structure, you may be looking at an MOD, depending on whether or not the distal ridge is compromised from removing the distal pit caries.
Click to expand...

This is very true and great advice. However, remember that the test is very subjective. A classmate of mine restored the D pit on #14 prior to the exam. He did the MO on test day and the lesion went into the transverse ridge so he asked for a Mod to include the D and making the prep an MOD. He said there was clearly less than 1mm of sound tooth structure between the MO and the D pit. Anyway, they rejected the Mod and told him not to go through the ridge.

Anyone get their results yet?
 
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Can anyone tell me about pediatrics as far as treatment planning is concerned?
If a patient needs extractions, operative, pulpotomies with SSC and space maitanence, in what order would you put these?
I am not strong in pediatrics so any help is appreciated
Thank you!
 
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toysareus said:
Can anyone tell me about pediatrics as far as treatment planning is concerned?
If a patient needs extractions, operative, pulpotomies with SSC and space maitanence, in what order would you put these?
I am not strong in pediatrics so any help is appreciated
Thank you!
Click to expand...

You should ideally do all restorations and extractions by quadrants, regardless of what the treatment is.

I would do this:

visit 1: OHI and prophy to evaluate behavior, any needed consults (such as ortho, especially if you see any crazy teeth orientation on the radiographs)
2: quadrant 1
3: quadrant 2
4: quadrant 3
5: quadrant 4
6: any maint. (additional OHI) or referrals (such as refer to ortho for interceptive or oral surgery for mesiodens, etc.)

That's pretty much it. The order that you do things in each quadrant shouldn't really matter for the purpose of the WREB. If you extract a posterior tooth, you'll need a space maintainer if the permanent tooth isn't going to be in within the next 6 months or so (evaluate from the images and patient's age). The candidate guide example didn't list what type of space maintainer was being used (band and loop, Nance, lower lingual, etc.), but just listed "space maintainer," so I don't think you need to specify the type.
 
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GavinC- in pediatrics is it always like that?
You do quadrant dentistry, no matter how large decay may be in some teeth?
I thought it was similar to adults where you'd do restorative or extractions first followed by endo (assuming the endo is not a chief complaint), prosth.
So if a child needs a pulpotomy, SSC, and regular fillings, you just go by quadrant?
 
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Just did the wreb- sooo tired. Many of us got a pedo case. I was expecting an adult case, so it was a little surprising to see a kid's picture when I opened up the exam!
 
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toysareus said:
GavinC- in pediatrics is it always like that?
You do quadrant dentistry, no matter how large decay may be in some teeth?
I thought it was similar to adults where you'd do restorative or extractions first followed by endo (assuming the endo is not a chief complaint), prosth.
Click to expand...

Yep, it's always like that for primary dentition. With mixed dentition it is typically still like that, unless they have issues that need other specialties. I would still do quadrant dentistry, and refer for any endo or OS that may need to be done. The point at which I would do that would depend on the patient's chief complaint.

If the chief complaint is pain for the pat 3 months on #3, and the radiograph shows decay in into the pulp, I would address that tooth first (probably a pulpotomy then refer to endo for RCT). After that, quadrant dentistry.

So if a child needs a pulpotomy, SSC, and regular fillings, you just go by quadrant?
Click to expand...

Yes, you go by quadrant, regardless of whether the quadrant has extractions, fillings, pulpotomies and SSCs or sealants. The order that you do it during the appointment has a methodology to it, but the WREB isn't asking for you to order the treatments at each visit.
 
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hi, congratulations oletyrags.
i am new member here .
i have a problem, i did'nt write toefl. now the problem is which one is best to write first either toefl or nbde.
some of my friends told me there is sufficient time to write toefl after nbde.
is it right. plz suggest me which one is better
 
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How much time does it take to get the results? Does it always takes 4 weeks to get the result!!!!
 
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rdsd said:
hi, congratulations oletyrags.
i am new member here .
i have a problem, i did'nt write toefl. now the problem is which one is best to write first either toefl or nbde.
some of my friends told me there is sufficient time to write toefl after nbde.
is it right. plz suggest me which one is better
Click to expand...

I am not sure how I can help. It doesn't matter which one you complete first. TOEFl shouldn't take much time to prepare but expires 2 years after the exam so plan accordingly.
 
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I- Pcte simokes 2or more?/day (tobacco cesation counseling)
Other habits( identifying the conseq and encouragingmchanges in behavior)
HBP (referral to physician)

II- Tto complain pcte
If not complaint (OHI, prophy,S/RP (depends rx and period...chart))
Tto of many activ caries or faulty rest (direct,indirect,onlay..)
Root canal therapy (If have rl apical and not complain)
Post and core if need
CROWNS,VENEERS,FPD OR RPD
EXT 1.16.17.32
 
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can anyone tell me about CSW?I registered for WREB recently and I still haven't received my package so I have no idea when and where I should take CSW!!!
 
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