Emergencies & Records - Week 4 PP - Outcome 4 Flashcards
(99 cards)
1
Q
Importance of a Medical History
A
- Provides information on the etiology and diagnosis of oral conditions
- Insight into psychosocial factors that may affect treatment and compliance
- Reveal medical conditions that necessitate precautions, modifications, or adaptations during treatment
- Aid in identification of unrecognized conditions
◦ Possible referrals - Understanding of general health and nutritional status
- Document for reference
- Evidence in legal issues
2
Q
Role of a Dental Assistant (w/ Medical Histories)
A
- To identify and understand various medical conditions in order to prevent potential medical
emergencies, better understand oral findings, and appropriately modify treatment in a dental clinic.
2
Q
Medically Compromised Categories
A
Category I: Healthy patients
* Category II: Medical conditions requiring scheduling changes or shorter appointments
* Category III: Medical conditions requiring significant modifications in dental treatment planning
* Category IV: Medical conditions requiring major modifications including dental treatment within the operating room
* Category V: Serious medical conditions and only limited care
3
Q
Cardiovascular Disease
A
-Heart disease is also referred to as cardiovascular disease
-Involves diseases of the heart and blood vessels
4
Q
Cardiovascular Disease
A
Heart and vascular, or cardiovascular, diseases include conditions such as:
◦ arrhythmias,
◦ high blood pressure (hypertension),
◦ congenital heart defects,
◦ coronary artery disease,
Arteriosclerosis
Atherosclerosis
◦ heart attack (myocardial infarction),
◦ angina pectoris,
◦ congestive heart failure,
◦ heart surgery/transplant, and
◦ artificial heart valves
5
Q
Infective Endocarditis
A
Is a microbial infection of the heart valves or endocardium
6
Q
Cardiovascular Diseases requiring special treatment at dentist
A
Congenital heart disease – premedication
* Infective endocarditis - premedication
* Blood pressure – anesthetics (epinephrine use),
postural hypotension, xerostomia, gingival
enlargement.
* Angina pectoris – emergency potential
* Heart diseases – breathing problems, bleeding
tendencies, use of ultrasonic (pacemakers)
* Surgically corrected – premedication?, postpone
treatment, immunosuppressants
7
Q
Gum disease is a risk factor for…
A
Gum disease is a risk factor for coronary artery disease; gum disease is a risk factor for diseases of the blood vessels and arteries; people with gum disease had a higher risk of stroke and there was a direct link between clogged arteries in the legs and gum disease
8
Q
Clinical Considerations for dental appointments
A
-Avoid stressful, lengthy appointments.
* Assess vital signs before treatment; consider monitoring throughout the procedure.
* The dentist may use psychotropic premedication
and nitrous oxide to help relieve stress.
* Consider the use of supplemental oxygen throughout the procedure.
The dentist may consult with the patient’s cardiologist about the use of prophylactic sublingual nitroglycerin immediately before treatment.
* Epinephrine and other vasoconstrictors can be administered within limits to patients with mild to moderate cardiovascular disease.
* Seated patients are more comfortable in a semisupine rather than a supine position.
9
Q
Questions to ask if patient has Angina Pectoris
A
- When was the last time you experienced angina?
- How frequently does it occur?
- What triggers your angina (Boyd and Mallonee,
2023? - Medications?
10
Q
Question to ask a patient with Hypertension
A
Tell me the things you do to manage your high blood pressure/
* Do you take any medications as prescribed by your primary care provider?
* Do you experience any side effects from your medication?
11
Q
Pacemaker
A
- External electromagnetic interferences can alter or stop a pacemaker therefore some dental equipment cannot be used.
- A physician should be consulted to ensure
patient safety
12
Q
Respiratory Disease
A
Respiratory conditions are medical conditions that affect the lungs and someone’s ability to breath.
* Common respiratory conditions include:
◦ asthma,
◦ acute bronchitis,
◦ pneumonia
◦ tuberculosis,
◦ chronic obstructive pulmonary disease (COPD),
emphysema,
chronic bronchitis
◦ cystic fibrosis and,
◦ sinusitis.
13
Q
Sleep Apnea
A
-Sleep apnea is a respiratory condition where patients stop breathing during sleep.
* It is caused by an obstruction in the airway during sleep
◦ tongue or the soft tissues of the mouth.
* Can cause serious cardiovascular problems
14
Q
Asthma - Questions to ask patient
A
Tell me about your asthma
* What symptoms do you experience?
* Are there specific triggers for an asthma attack?
* Do you have trouble breathing when laying down in a bed or in a dental chair?
* Do you take any medications?
15
Q
Clinical Considerations for Respiratory Disease
A
Dental chair position
* Some procedures may be contraindicated (ultrasonic and air polishers)
* Nitrous oxide contraindicated
* Potential medical emergency
* Reduction or no‐aerosol agents
16
Q
Hematological Diseases
A
Bleeding disorders can result from inherited genetic defects or be acquired due to use of anticoagulant medications (blood thinner) or medical conditions such as liver dysfunction, chronic kidney disease, and autoimmune disease
* Examples
◦ Bleeding or Coagulation Disorders
Hemophilia A - can be passed down on male side of family
von Willebrand disease
◦ Anemia - low blood cell count, very faint
◦ Sickle Cell Disease
◦ Thrombocytopenia - low levels of platelets, increased nose bleeds, bruise easier
◦ Disorders of white blood cells
◦ Platelet disorders
17
Q
Clinical Considerations for Hematological Diseases
A
- Consultation ‐Antibiotic premedication may be required and bleeding times
- May be immunosuppressed‐ risk of infection – need for excellent home care
- Increased bleeding associated
with dental procedures - Potential emergency
- May require special measures
- May see oral lesions
18
Q
Questions to ask patient with Hematological disease
A
- When was the diagnosis?
- What has been done to managed the blood disorder?
- Have you experienced any unusual bleeding associated with previous dental appointments
- Do you have a history of coagulation disorder
- Do you regular use aspiring? Herbal supplements? Or other medications?
19
Q
Communicable Diseases
A
Health care providers are at risk for infection with bloodborne pathogens, including hepatitis B virus, human immunodeficiency virus, and hepatitis C virus.
* Tuberculosis is caused by Mycobacterium tuberculosis
◦ persons suspected of having pulmonary or laryngeal tuberculosis should be considered
infectious if they are coughing, are undergoing cough‐inducing or aerosol‐generating procedures, or have sputum smears (saliva test) positive for acid‐fast bacilli
20
Q
Not on SAIT Medical History Form
A
- No specific section
◦ Tuberculosis
◦ Hepatitis
◦ HIV/AIDS
◦ Mononucleosis (mono)
◦ Sexually Transmitted Infections (STIs) - Supplemental medical history form if suspected
- COVID Screening and Consent Form
21
Q
Hepatitis A Virus (HAV)
A
- is present in the feces of infected persons and is most often transmitted through consumption of contaminated water or food.
- Certain sex practices can also spread HAV
22
Q
Hepatitis B virus (HBV)
A
- is transmitted through exposure to infective blood, semen, and other body fluids.
- HBV can be transmitted from infected mothers to infants at the time of birth or from family member to infant in early childhood.
- Transmission may also occur through transfusions of HBV‐ contaminated blood and blood products, contaminated injections during medical procedures, and through injection drug use.
- HBV poses a risk to healthcare workers who sustain accidental needle stick injuries while caring for infected‐HBV patients
23
Q
Hepatitis C virus (HCV)
A
Hepatitis C virus (HCV)
* is mostly transmitted through exposure to infective blood.
* This may happen through transfusions of HCV‐contaminated blood and blood products, contaminated injections during medical procedures, and through injection drug use.
* Sexual transmission is also possible, but is much less common.
24
Hepatitis D virus (HDV)
* infections occur only in those who are infected with HBV.
* The dual infection of HDV and HBV can result in a more serious disease and worse outcome
25
Hepatitis E virus (HEV)
* is mostly transmitted through consumption of contaminated water or food.
* HEV is a common cause of hepatitis outbreaks in developing parts of the world
vaccine developed but not as available as others
26
Communicable Diseases
-Hepatitis B/C HIV‐ precaution against needlestick injury
* Tuberculosis‐ infectivity risk
* STI’s‐ infectivity risk
* Herpes – postpone routine care when oral lesions are present - cold sores are not allowed!!! they will spread
* HIV/AIDS – may present with oral lesions
27
If a patient indicates having COVID‐19 on the medical history form what questions would you ask?
* When did you have COVID‐19 and what treatment was involved?
* Do you experience any long term effects of COVID‐19?
* How does this affect your daily
activities?
* Are you taking any medications to manage the long term effects?
* Have you been vaccinated?
28
Stroke indicators
F- face drooping
A - arms - can they lift?
S - speech - slurred?
T - time - give medication asap
29
Cardiovascular Disease (CVD)
Cardiovascular diseases (CVD) include conditions and diseases that affect the heart and blood vessels. These are conditions in which physical and emotional stresses can cause the heart to work harder and therefore require more oxygen. CVD includes the abnormal function of the blood vessels and disease of the heart muscle. They may include the following:
1. Congenital heart disease
2. Rheumatic Fever
3. Mitral Valve Prolapse
4. Hypertension
5. Ischemic Heart Disease
6. Angina Pectoris
7. Myocardial Infarction (heart attack)
8. Congestive Heart Failure
9. Cardiac Arrhythmias
10. Artificial (Prosthetic) Heart Valve
11. Heart Surgery/Transplant
30
What is Congenital Heart Disease
Anomalies of the anatomic structure of the heart or major blood vessels that occur while the heart is developing
Caused by genetic and/or environmental factors
Common types of defects ventricular septal defect, atrial septal defect pulmonary stenosis, and patent duct arteriosis
31
Questions to Ask & Significances - Congenital Heart Disease
-What is the nature of the condition?
-Medical consultation may be required with the patient's physician prior to beginning dental treatment.
-What is the degree of disability produced by it?
-Antibiotic prophylaxis may be required prior to dental treatment
32
What is Rheumatic Fever
is a complication following rheumatic fever that may result in permanent heart damage
33
What is Mitral Valve Prolapse?
damage to the mitral valves, the closure of the value is imperfect and oxygenated blood can backflow or regurgitate
34
What is hypertension?
an abnormal elevation of arterial pressure
Hypertension refers to high blood pressure against the arterial walls which increases the pressure on the heart due to elevated arterial blood pressure. It can be caused by arteriosclerosis, a systemic infection (i.e. inflammation of the kidney or pregnancy), or even emotional stress unrelated to a physical abnormality. It is not a cause of death but indicates that something is physically or emotionally wrong.
35
Questions to Ask & Significance - Hypertension
-Do you know if you have high blood pressure?
-When was your blood pressure last evaluated by a medical doctor?
-What is your blood pressure reading? Is it controlled?
-Are you taking high blood pressure medication?
Significance:
-This may lead to a need to consult a physician or postpone a dental treatment until the hypertension is under control.
-May require the use of a local anesthetic with less or no vasoconstrictor so that the patient's blood pressure does not increase anymore.
-Schedule early morning & short appointments
-Patient may require sedation
-Antihypertensive medications can have side effects affecting dental treatment (i.e. postural hypotension, syncope, depression) or oral tissues (xerostomia)
-Antihypertensive medications may interfere with other drugs prescribed in dentistry.
36
What is Ischemic Heart Disease
This is a common degenerative disease that arises from a reduction or stoppage of blood supply to the myocardium (the heart muscle). As a result, there is decreased blood flow through the blood vessels and increased pressure on the walls of the blood vessels (peripheral resistance) that may be caused by:
Atherosclerosis:
is an inflammatory disease of medium and large arteries in which artheomas (fatty deposit or plaque) are deposited and thicken the layer of the involved blood vessel (Boyd & Mallonee, 2023). As a result, these coronary artery walls become narrower and blood flow is reduced through them. This may lead the patient to experience:
Angina pectoris
Myocardial infarction (heart attack)
Congestive heart failure
37
What is Angina Pectoris
chest pain caused by a reduction of blood flow to the heart
38
What is myocardial infarction?
Heart attack - results from a sudden reduction or stop of coronary blood flow
39
Questions to Ask & Significance - Myocardial Infarction
Questions:
-When did the heart attack occur?
Dental treatment should be postponed for the patients’ health and safety if the heart attack occurred less than 6 months ago. If dental treatment is absolutely necessary, modifications to treatment must be made to decrease stress on the patient (i.e. shorter appointment(s))
-What medications are being used?
Identifies the degree of control of the condition
– better prevents/prepares the dental team for a medical emergency. If the patient is on nitroglycerin, ask them to place it in a convenient location prior to beginning treatment – in case it needs to be used.
-Investigate if the patient is using anticoagulants?
Dental treatments that will likely cause a lot of bleeding will require modifications in an attempt to control and decrease bleeding, especially if anticoagulants are being used.
The patient’s physician will need to be consulted prior to surgical dental treatment.
40
What is Congestive Heart Failure
an abnormality in cardiac function that causes an inability or failure of the heart to pump blood at a rate necessary to meet the oxygen needs of the body (Boyd & Mallonee, 2023).
It is not a disease but rather a symptom of an underlying cardiovascular problem such as valvular deformity, coronary atherosclerotic heart disease or hypertensive disease.
41
Questions to Ask & Significance
Do you experience shortness of breath upon mild exercise?
Do you have swollen ankles or edema? Do you sleep on two or more pillows?
May identify underlying CHF.
May require consultation with a physician prior to dental treatment to determine the severity of the condition.
Some physicians may recommend antibiotic prophylaxis
Patient positioning may need to be modified during dental treatment (keep patient in a semi-upright position to limit the collection of fluids in the lungs)
Keep dental appointments short.
Ensure that supplemental oxygen is available for use if required.
42
What is Cardiac Arrhythmias?
an interruption of heart impulses that cause a delay or block resulting in an abnormal heart rhythm or arrhythmia (Boyd, Mallonee & Wyche, 2021).
pacemakers are devices implanted beneath the skin of the upper chest or abdomen with pacing wires extending into the myocardium. It is most commonly used to correct arrhythmias.
43
Questions to Ask & Significance - for Cardiac Arrhythmias
-Do you have heart arrhythmia? If so, is it controlled? Do you require a pacemaker?
Frequently related to heart failure or coronary artery disease. This should prompt us to prevent or prepare for a potential medical emergency.
Local anesthetic containing a vasoconstrictor must not be used as vasoconstrictors can exaggerate the arrhythmias.
Do you know the cause of your heart arrhythmia?
-Heart arrhythmias are often related to stress, anxiety, physical activity, and hypoxia. In regards, the dental team would need to decrease the stress of the patient to prevent a potential medical emergency.
Are you taking any antiarrhythmic drugs?
-Some antiarrhythmic drugs may have oral or other side effects.
Do you have a pacemaker?
-External electromagnetic interferences can alter or stop a pacemaker therefore some dental equipment cannot be used. However, newer models have a special shield that limits these electromagnetic interferences. A physician should be consulted to ensure patient safety.
44
What is an Artificial (Prosthetic) Heart Valve?
An artificial heart valve is a device used to replace a heart valve if one of the four heart valves malfunctions.
45
Questions to Ask & Significance - for Artificial Heart Valve
Do you require antibiotic prophylaxis before a dental appointment?
-To prevent infective endocarditis
What kind of prosthesis is being worn?
-Provides insight into the heart condition and if further precautions may be required.
What is the physical status of the patient?
- This can help determine the length of an appointment, comfort, and maybe even the possible need for antibiotic prophylaxis for the patient prior to and during their dental treatment.
Is the patient on anticoagulant medication?
-Dental treatments that will likely cause a lot of bleeding will require modifications. To control and decrease bleeding, the patient’s physician will need to be consulted prior to surgical dental treatment.
46
Heart Surgery / Transplant
This is a very general term that may include any procedure from implantation of a pacemaker to a valve replacement to “coronary artery bypass graft surgery” to a heart transplant.
47
Questions to Ask & Significance - or Heart Surgery/Transplant
When was your heart surgery/transplant?
-Dental treatment should be avoided for the first six months after heart surgery/transplant as the condition is not stable.
-Depending on the state of the patient after a heart surgery/transplant, some physicians will recommend antibiotic prophylaxis for these patients prior to dental treatment.
48
Respiratory dieseases
Respiratory diseases are diseases affecting the chest or lungs.
49
What is Tuberculosis?
Tuberculosis (TB) is an infectious disease caused by aerobic bacterium (mycobacterium tuberculosis) that causes lesions in a number or organs including:
Lungs
Bone of the mandible
Dorsum of the tongue; the lips, mucosa, gingiva
Mode of transmission:
Airborne – aerosols
Asymptomatic (a carrier of TB - determined via the Mantoux test)
50
Questions to ask & Significance
Do you experience:
Night sweats?
Swollen lymph nodes?
Blood spectrum?
What is the current treatment?
This can indicate the stage/degree of infection. If a patient has active TB dental treatment must be postponed as the patient will need to be quarantined.
51
What is Emphysema?
Emphysema is a pulmonary disorder that obstructs airflow. Alveolar walls are destroyed causing the distention of the air spaces distal to the terminal bronchioles. The primary cause is exposure to tobacco and pollutants.
52
Questions to Ask & Significance - for Emphysema
How severe is your emphysema?
-Modifications to dental treatment may be required (i.e. patient positioning or adjusting appointment length)
Are you taking any medications for emphysema?
-Medications can have effects on oral tissues (i.e. xerostomia) that may require modification to home-care.
Medications prescribed for dental treatment may be at risk of drug interactions.
53
Blood Disorders
Blood disorders is a broad term that can encompass various types of bleeding disorders.
54
What is Hemophilia?
Hemophilia is a congenital genetic (usually only affecting males) blood coagulation disorder. The most common form of this disorder is characterized by a prolonged coagulation time and a tendency to bleed.
55
Effects of Hemophilia on Dental Treatment
Even minor dental procedures that may cause bleeding can be a risk for these patients. A physician may need to be consulted prior to dental treatment – antibiotic prophylaxis may berecommended.
The administration of a regional nerve block that can cause aspiration of blood should be avoided. The dentist should try alternative pain control techniques.
56
What is Amenia?
Anemia is the reduced volume of red blood cells or the quantity of hemoglobin in the blood. It is not a disorder but a symptom of a disorder.
57
Amenia may cause...
Cause more difficulty during stressful dental procedures
Increase a patient’s susceptibility to chock when additional loss of blood occurs during a surgical procedure.
Cause oral manifestations of the disease:
Pale tongue
Fiery-red burning tip of tongue
Gingivitis
58
Questions to Ask & Significance - for Hemophilia
Have you ever had a blood transfusion? Do you have frequent nose bleeds?
Have you ever had any complications following tooth extractions?
Do you bleed excessively when cut shaving or by a similar injury?
-May indicate dyscrasia (a pathological condition of the blood)
Do you bruise easily?
When you experienced a “bleeding problem”:
What caused it?
How long did the bleeding last?
What type of treatment was provided, if required? Do you bruise easily?
-Gives insight on a patient’s “bleeding disorder”
-May require a consult with a physician with lab tests prior to dental treatment if there is a suspected blood disorder.
-May require modification to treatment.
59
Communicable diseases
Communicable diseases are diseases that can be transferred from one individual to another regardless of the source of transfer.
60
Human Immunodeficiency Virus (HIV-1)
Human Immunodeficiency Virus (HIV-1) can cause AIDS. This disease can range from mild to severe abnormalities in the immune response.
61
Oral Manifestations of HIV-1
Many HIV-1 infected individuals may present with many head and/or neck manifestations including:
Leukoplakia
Necrotizing ulcerative gingivitis (NUG)
Increased periodontal infections
Oral candidiasis (fungal infections)
Oral lesions and ulcerations (more prone to them)
Caries due to medication-induced xerostomia.
62
Management Suggestions for HIV-1
Update medical history
Infection control as per standard precautions
o A dental care team may not refuse treatment to patients with HIV as there will be legal ramifications.
Be aware of breathing difficulties as these patients are prone to pneumonia
Contraindications to medications
63
Questions to ask & significance - for HIV-1
When was this diagnosed?
-Can aid in determining the stage/degree of the disease
What medications are you taking for HIV?
-Medications can have effects on oral tissues (i.e. xerostomia) that may require modification to home-care
Are you experiencing any current symptoms?
-This may require a need to modify dental treatment to increase patient safety and comfort
64
What is Hepatitis ?
Hepatitis is a viral infection causing inflammation of the liver. It is an occupational hazard for healthcare workers.
65
Hepatitis A
Occurs more often in children and young adults
Route of transmission:
Fecal-oral
Waterborne or foodborne
Blood (rare)
66
Hepatitis B
Can cause serious cirrhosis and liver cancer leading to death
Route of transmission:
Blood and other bodily fluids
67
Hepatitis C
Onset may be insidious (no clinical symptoms)
Chronic liver disease (more common than Hepatitis B)
Transmission
Percutaneous exposure to blood and plasma
68
Hepatitis D (Delta Hepatitis Virus)
Severe form of hepatitis – high mortality rates
Immunization is available
Route of transmission:
Multiple exposure to hepatitis B
69
Hepatitis E
Common in developing countries
Route of transmission:
Fecal-oral
70
Questions to Ask & Significance - for Hepatitis
When was the blood test completed that revealed positive results?
What is the age of onset?
-Identifies the condition so that the dental team may provide the appropriate care.
What type of hepatitis is it?
-Identifies the condition so that the dental team may provide the appropriate care.
Are you taking any medications for it?
- May affect oral tissues
-May cause drug-to-drug interactions with dental drugs
Are there any complications from it?
-Identifies the condition so that the dental team may provide the appropriate care.
71
Infectious Mononucleosis
Mononucleosis is an acute, febrile, infectious disease caused by the Epstein-Barr virus that is predominant in children and young adults. The disease begins with a gradual or abrupt onset.
Signs and symptoms include:
Oral signs and symptoms are often the first clinical symptoms:
Petechiae
Sore throat (Pharyngitis and tonsillitis are common)
Acute gingivitis and acute stomatitis
Jaundice
Ulcerations of oral tissues
Headache, chills, cough, angina
Enlarged lymph nodes, beginning with cervical lymph nodes
A skin rash can occur on occasion.
Treatment
There is no specific treatment for mononucleosis except for bed rest, and proper diet. Most patients recover within 2-4 weeks with no complications.
72
Endocrine Conditions
Diabetes Mellitus
Hyperthyroidism
Hypothyroidism
73
Diabetes Mellitus
A disease characterized by a sustained high blood glucose level resulting from an absolute or a relative lack of insulin. There are 2 classifications of this disease.
74
Diabetes Mellitus Type 1
Type I - occurs when there is an absolute insulin deficiency. Usually arises in childhood or puberty, but may occur at any age. Accounts for 5% to 10% of those with diabetes. Can also be referred to as Insulin-dependent diabetes mellitus (IDDM), juvenile diabetes, and juvenile-onset diabetes.
75
Diabetes Mellitus Type 2
Type II – occurs when the pancreatic insulin secretion may be low, normal, or even higher than normal, but the patient exhibits an insulin resistance that impairs the use of insulin. Onset is typical after 30 years of age, but may occur at any age and accounts for 90% to 95% of all patients with diabetes. Can also be referred to as non-insulin-dependent diabetes mellitus (NIDDM), adult-onset diabetes.
76
What is Hyperthyroidism
Occurs when the thyroid gland is considered to be overactive. The thyroid gland regulates metabolism in body cells and stimulates the passage of calcium into bones from the blood.
77
What is Hypothyroidism
Occurs when the thyroid gland is underactive and produces fewer hormones than usual.
78
Questions to Ask & Significance - For Endocrine Conditions
Have you experienced any sensitivities to local anesthetics?
-Uncontrolled hyperthyroidism can cause a sensitivity to epinephrine and other anesthetics.
79
Ulcers
The presence of stomach or intestinal ulcers may indicate acute or chronic anxiety and the possible use of medications such as tranquilizers and antacids.
Knowledge of which drugs are being taken is important before administration of any additional medications is considered (i.e. Aspirin – due to its effects on the GI tract)
80
Questions to Ask & Significance - for Ulcers
Do you have frequent indigestion?
Do you vomit frequently?
-May aid in the identification and understanding of decalcified teeth due to regurgitated stomach acid.
Are there foods you cannot eat?
Do you have difficulty swallowing?
-May aid to identify peptic ulcers, gall bladder problems, anxiety, or pharyngeal carcinoma.
81
Renal (Kidney) Disorders
Renal disorders may be congenital or caused by disease or injury.
82
Questions to Ask & Significance - for Renal (Kidney) Disorders
Do you have anemia?
-The symptoms should be investigated as the patient’s homeostasis can be a concern for a potential medical emergency. A consult with a physician may be required prior to dental treatment.
Are you on any medications? If so, what are they?
-Patients with renal disorders will have problems excreting drugs therefore all medications and dosage must be investigated and understood.
-Gives an idea of what form and how controlled the renal disorder is as some forms of chronic renal disorders may require antibiotic prophylaxis. A consult with a physician may be required prior to dental treatment.
Do you urinate frequently?
- This may require modifications to treatment (i.e. shorter appointments or longer appointments with a lot of breaks)
83
Multiple Sclerosis (M.S.)
Multiple sclerosis is a disabling disease of the central nervous system. It is characterized by widespread patches of demyelination (the outer covering of nerve fibers) followed by scarring. Signs and Symptoms may include: blurred and double vision, extreme fatigue, loss of balance and problems with coordination, stiffness of muscles, speech problems, bladder and bowel problems, short term memory problems, partial or complete paralysis
84
Questions to Ask & Significance - for Multiple Sclerosis
What was the age of diagnosis?
Are you taking any medication for it? What is the degree of severity?
Is there paralysis and/or blindness symptoms?
-Aids in the modification of dental treatment
-Morning appointments
-Avoid long appointments as the patient tires more easily.
· Caution involuntary muscle spasms
i.e. explaining treatment procedures more thoroughly if the patient has blindness
-Aids in the modification of home care techniques (i.e. electric toothbrush vs. a manual toothbrush due to decreased dexterity)
85
Arthritis and Rheumatoid Arthritis
Arthritis is a chronic or acute inflammatory condition of a joint(s).
Rheumatoid arthritis is a chronic immunologic systemic disease-causing inflammation of the joints brought on by an unknown cause. It is often accompanied by pain, stiffness, or limitation of movement in the affected joint.
86
Questions to Ask & Significance - Arthritis
Are you taking any medications for this condition?
-This may identify the chronic use of: Aspirin or other NSAIDs that can alter blood clotting factors.
-Decrease stress during dental treatment as these patients cannot tolerate stress well. These patients may require medication to the dosage of corticosteroids prior to dental treatment
The use of corticosteroids may mask
signs and symptoms of infections.
87
Cancers
Cancer occurs when normal cells are transformed into malignant ones. As cancer cells increase the mass of abnormal tissues forms until it takes over a host site.
Cancers are classified based on:
The origin of the tissue involved
Type of cell from which they arise
88
Cancer Treatment & Side Effects
Cancer is treated in different methods depending on the location, size, and treatment objectives. The different methods include:
Surgery
Chemotherapy
Radiation therapy
Hematopoietic cell transplantation
Hormone therapy
Or a combination of the above
Common oral side effects of certain cancer therapies include:
Xerostomia, Oral mucosistis/stomatitis
Infections (bacterial, viral, fungal), Bleeding
Trismus (inability to open the mouth completely)
Radiation caries, Loss of taste
89
Questions to Ask & Significance - for Cancer
What type of cancer is it?
Where was/is the malignancy? What is the prognosis?
What are the past/current and purposed therapy?
Are you under the care of an oncologist?
Do you have any residual effects from treatment?
Aids in the identification and understanding of oral conditions
Allows for appropriate dental treatment planning
May require consultation with their oncologist or physician.
o In between treatments?
Requires a possible need for pre-medication of dental treatment.
Xerostomia
o Caries reduction plan
90
The following procedures and events do not need antibiotic prophylaxis:
routine anesthetic through noninfected tissue
dental radiographs
placement of removable prosthodontic or orthodontic appliances
adjustment of orthodontic appliances
placement of orthodontic brackets
shedding of deciduous teeth
bleeding from trauma to the lips or mucous
91
The antibiotic prophylaxis guideline recommends that only individuals with the greatest risk of developing infective endocarditis should receive short-term preventive antibiotics before dental procedures. The individuals with the greatest risk include those with:
Artificial heart valves
A history of infective endocarditis
Certain specific, serious congenital (present from birth) heart conditions, including:
Unrepaired or incompletely repaired cyanotic congenital heart disease, including those with palliative shunts and conduits.
A completely repaired congenital heart defect with prosthetic material or device, whether placed by surgery or by catheter intervention, during the first six months after the procedure.
Any repaired congenital heart defect with residual defect at the site or adjacent to the site of a prosthetic patch or a prosthetic device.
A cardiac transplant that develops a problem in a heart valve.
92
Antibiotic Prophylaxis to Prevent Joint Infection
Patients with prosthetic joint implants, prophylactic antibiotics are not routinely recommended prior to dental procedures to prevent prosthetic joint infection.
For patients with a history of complications associated with their joint replacement surgery who are undergoing dental procedures that include gingival manipulation or mucosal incision, prophylactic antibiotics should only be considered after consultation with the patient and orthopedic surgeon.
Clinical Reasoning for the Recommendation:
There is evidence that dental procedures are not associated with prosthetic joint implant infections.
There is evidence that antibiotics provided before oral care do not prevent prosthetic joint implant infections.
There are potential harms of antibiotics including risk for anaphylaxis, antibiotic resistance, and opportunistic infections like Clostridium difficile.
The benefits of antibiotic prophylaxis may not exceed the harms for most patients.
The individual patient’s circumstances and preferences should be considered when deciding whether to prescribe prophylactic antibiotics prior to dental procedure
93
What are the 3 types of blood disorders?
a. Anemia
b. Leukemia
c. Hemophilia
94
Cardiovascular disease (CVD) includes conditions and diseases affecting the..
the heart and blood vessels.
95
What is hypertension and why is assessing a patient’s blood pressure at a dental visit become an essential step in patient assessment prior to treatment?
Hypertension means an abnormal elevation of arterial blood pressure; it is often called the “silent killer.” Hypertension is responsible for more deaths from CVD than any other modifiable risk factor.
Early detection, with referral for additional diagnosis and treatment when indicated, can prove to be lifesaving for certain people.
Knowledge of the health problems of patients is needed to ensure it is safe to provide treatment, such as administration of local anesthesia, and to minimize risk for medical emergencies.
96
_____________ is a microbial infection of the heart valves or endocardium with a high
mortality rate.
Infective endocarditis
97
A patient indicates that she has had prophylactic antibiotics given for a dental appointment in the past. What do we do to identify the reason for this precaution? How should we proceed?
Reviewing the patient’s medical history is imperative (important)
Special content: specific questions need to be directed to elicit any history of congenital heart defects, cardiac transplant, presence of prosthetic valves, acquired valvular defects, or previous episodes of IE.
Consultation with the patient’s primary care provider: consultation is necessary for all patients with a history of heart defects and any other conditions suggesting the need for prophylactic antibiotic premedication.
Withhold instrumentation: the use of a probe or explorer subgingivally during the assessment of the patient should be delayed until medical clearance is obtained for high‐risk individuals
98
A patient indicates that they have a bleeding disorder. What clinical considerations are there in providing care?
a. Antibiotic premedication may be required
b. May be immunosuppressed‐ risk of infection
c. Increased bleeding associated with dental procedures
d. Potential emergency
e. May require special measures
f. May see oral lesions
