Patient care in TOO

The treatment course in the TOO project is twofold. In the first part, the patient receives anxiety treatment in a multidisciplinary treatment team consisting of a psychologist, dentist/dental nurse and dental secretary at TKmidt. The anxiety treatment is normally carried out using cognitive behavioral therapy and exposure therapy. The patient learns to understand their anxiety reactions, gains knowledge about dentistry and is exposed to various elements of the dental treatment situation. In addition, a coping plan is drawn up in consultation with the patient. Dental treatment that may be carried out in the first part of the treatment course is only as part of the exposure therapy.

The second part of the treatment consists of oral rehabilitation (dentistry) in dental treatment teams consisting of dentist/dental hygienist and dental secretary in public and private clinics who have completed courses for dental teams. The dental team prepares a treatment plan in accordance with the health directorate's supervisor “Good clinical practice”. As a general rule, the oral rehabilitation should be carried out within 12 months after transfer to the dental team TOO. In the case of major rehabilitations, the time period can be extended after discussion with the multidisciplinary team at TKmidt. Patients who at the time of transfer do not need dental treatment are granted 4 hours for relationship building, review of coping plan as well as clinical examination during a 6-month period.

The competence center carries out some oral rehabilitation in its own organization. These are mainly patients in need of dental treatment under general anesthesia, as well as patients in need of specialist treatment.

If additional anxiety treatment is needed, the patient may be referred to the multidisciplinary team for assessment. This does not trigger the right to new oral rehabilitation covered by TOO funds.

TOO does not offer emergency dental treatment until the patient is included in the TOO project. Patients in urgent need of treatment are cared for by referrals until they are included in the project. If the patient has made contact with TOO, they are referred to dental teams who have taken courses and who have good knowledge of how to care for anxious patients. They will, until they are included in the project, even have to cover expenses in case of emergency dental treatment. If an urgent dental treatment need arises after the patient is included in TOO, the patient is treated by a dental team or multidisciplinary treatment team by appointment and the cost is covered by TOO funds.

Competency requirements for dental teams

To be a dental team in the TOO project, team members must have knowledge of, and interest in, trauma and odontophobia. The patients' coping plan is central to their treatment and dental teams must have knowledge of different coping strategies and commit to including them in their dental treatment.

In order to qualify as a dental team TOO, it is a requirement that one has attended the “courses for dental teams” offered by the Competence Centre. It is an advantage, but not a requirement to have completed the Nophobia exam. There is also the possibility of hospitalization at TKmidt, which can also qualify for approval as a dental team in TOO.

Choosing a Dentist Team

The following criteria in order of priority are taken as a basis for selecting a dental team:

A patient who is referred TOO the offer by his or her regular dentist will be returned to him if this is a mutual wish of both the patient and the dentist and the dentist has attended a course under the auspices of TOO TKmidt.

Dentist team in geographical proximity to the patient's place of residence. Capacity in the dentistry team.

Dental rehabilitation

The costs associated with oral rehabilitation are covered by government grants for the project. The subsidy regulation lays down guidelines on the use of tariffs; “When purchasing services by private persons, it is assumed that the prices for the individual treatment are not higher than the prices at the county council's own operation”. Trøndelag County Municipality's public tariffs therefore form the basis for the oral rehabilitation. TKMIDT's tariffs, as a county municipal enterprise, form the basis for the use of tariffs in case of need of treatment with a specialist in the rehabilitation phase.

Regular national calibration meetings are conducted to ensure an equal level of treatment for TOO patients nationally.

When starting in a dental team, some time will be spent on relationship building, reviewing the coping plan, examining, preparing a treatment plan and reviewing it with the patient, as well as preparing cost estimates. For this, up to 4 hours can be used using Trøndelag County Municipality's tariff 905. For private dental teams, it is requested to create a tariff called 905 under various text in Opus. This facilitates the understanding of transmitted cost estimates and invoices.

A written application for rehabilitation is requested prior to commencement of treatment if the treatment includes;

• Any kind of fixed prosthetics,
• Any type of advanced removable prosthetics (combination works = fixed and removable prosthetics in combination)
• Endodontic treatment distal to tooth number 5 (on pillars with good prognosis)

Pain and infection treatment can be started without application.

The Health Directorate's supervisor “Good clinical practice” is based on the planning, and the plan should be evaluated according to 9 issues mentioned below. The Nemd, consisting of a dentist with expertise in implant prosthetics, a dentist with experience from a multidisciplinary treatment team, a periodontist and a TOO coordinator (dental health secretary) as an administrative resource, assesses the treatment plan on the basis of the following issues:

1. Is the treatment according to Good Clinical Standards?
2. Have alternative treatment proposals been made?
3. What assessments were the basis for the therapist/patient to choose the appropriate treatment proposal?
4. Has it been considered how long the treatment should take?
5. Has the therapist made any reservations in the treatment plan?
6. Does the cost estimate match the current rates?
7. Is the patient considered fit to carry out the treatment?
8. Is it considered that the patient has the necessary capacity and will for self-care/hygiene to attend to the treatment?
9. Is it considered that the patient is capable of follow-up treatment as well as future maintenance?

The application must contain sufficient information to give the applicant a good basis for assessment, including x-rays, written assessment of health/compliance and other relevant information such as clinical photographs. Implants are not the primary treatment chosen under TOO auspices. In special cases, implants may still be considered, for example, single-tooth implants in the front of the upper jaw in which neighboring teeth are intact. It is a prerequisite that the patient can carry out the insertion of implants, as well as the prepping and cementing of crowns, and bridging in the awake state to ensure that the patient is able to attend to the treatment solution in the future.

For patients with particularly high treatment needs or challenging anxiety problems, it may be difficult to provide a complete cost estimate when initiating oral rehabilitation. In these cases, dental teams may submit for approval a cost estimate of an initial phase (e.g., for pain relief and infection elimination), and then the final treatment plan/cost estimate.

Billing

Processing is billed on an ongoing basis.

Invoice is sent to:
Competence Centre Dental Health Mid Trøndelag FKF
Central invoice receipt, distribution number 2289
PO Box 12
7400 Trondheim

NB: Remember to mark invoice with TOO journal no. You can find this in a reference from TKmidt.

Invoice with specification is sent to our postal address:

Dentistry Competence Centre Mid Trøndelag FKF
V/too
Professor Broch's Street 2
7030 Trondheim

Closing

Not all patients have an effect of anxiety treatment. This may, for example, be due to another mental or somatic disorder or stressful life situation. According to the grant regulations of the Directorate of Health, patients who do not respond to treatment will be terminated from the TOO project.

The oral rehabilitation for these patients will in some cases have to be carried out under general anesthesia. Patients who do not respond to treatment may be referred to the TOO offer for anxiety treatment at a later date if their life situation should change and conditions are better suited to benefit from the treatment.

Not met

Evasion is a core symptom of anxiety and we will always make attempts to reconnect the patient to treatment. Both reported cancellations and unreported cancellations should be addressed with the patient. We want to help the patient through their treatment, but time and time again offering new hours when the patient cancels helps strengthen the patient's avoidance urge and increases the chance of this strategy being used again. We therefore wish that repeated cancellations are also addressed with the patient, as there may be signs of evasion and may lead to discontinuation of treatment.

If a patient fails to attend the scheduled time, they can be billed TOO TKmidt. After the first non-meeting, the dentist should inform the patient of the consequences of not showing up, as well as inform TOO TKmidt that the patient does not show up. A patient who for the second time does not attend the scheduled appointment without having announced a cancellation is initially excluded from further treatment in the project and notification of this is sent TOO TKmidt. Patients are well aware of this from the multidisciplinary treatment at TKmidt.

The patient is discharged from the TOO project when the dentition is fully rehabilitated according to the treatment plan. We remind you that rehabilitation, as a rule, should be carried out within 12 months. Patients with periodontitis are rehabilitated on an equal basis with other patients before discharge. The maintenance phase is not covered by TOO funds. After finishing the dental treatment, the dental team sends a brief epicrisis to TOO TKmidt. Patients are formally discharged from the project by psychologist at TKmidt. By the way, see “Guidelines for writing out TOO” for further information.

After discharge from the TOO project, the patient can choose to continue with the dental team as a regular paying patient. It is expected that patients will still have some anxiety associated with the dental treatment situation upon discharge. Increased time use is not uncommon and can be agreed with, and billed, the patient. Regular follow-up care is also important in the future to prevent relapse.

If you have any questions, please feel free to contact us at TOO at TKmidt.

Reimbursement of travel expenses

Travel expense reimbursement form for TOO patients in dental teams.