Patient Evaluation and Monitoring

Question 1

What does a pre-anesthetic assessment evaluation include?

Answer 1

Complete medical/dental history
Physical examination
Psychological examination

Question 2

What does complete medial/dental history include

Answer 2

1) current conditions
2) past conditions
3) OTC drugs, supplements
4) adverse rxns to meds
5) problems with previous dental tx

-Evaluate concomitant meds (2+ meds taken on the same day)
-Record pt’s medical status
-Record pt’s response to LA
-Record pt’s fear

Question 3

What does physical examination include?

Answer 3

1) Visual exam: observe pt’s posture, movement, speech, skin, etc
2) Take BP (LA increase BP)
3) Take pulse and RR (stress increases both)
4) Record patient’s weight (used to determine MRD of LA) (**decrease MRD for overweight children –> immature liver)

Question 4

What do local anesthetics do to blood pressure

Answer 4

increase it

Question 5

What does BP of 140-159/90-94 mean?

Answer 5

Consider N2O for stress reduction

Question 6

What does BP of 160-199/95-114 mean?

Answer 6

Retake then refer to med consult before treatment

Question 7

What does BP of >200/>115 mean?

Answer 7

Retake then refer for immediate med consult

Question 8

What are acceptable HRs?

Answer 8

Adult: 60-100
child: 75-100
Toddler: 120-160

Question 9

What are acceptable RRs?

Answer 9

Adult: 12-20
Child: 18-30
Toddler: 25-32

Question 10

What does physchological exam include

Answer 10

1) Dental Phobia: unfounded fear of dental tx
2) Clinical signs of moderate anxiety:
-stiff posture
-nervous “play”
-“white knuckle” syndrome
-sweating
-“too cooperative”
-nervous conversation
-quick answers
3) Stress Reduction Protocol
-adequate pain control
-decrease pain of an injection
-select LA of appropriate duration

Question 11

What does stress do to the body

Answer 11

Decreases pain reaction threshold

Question 12

What are clinical signs of moderate anxiety

Answer 12

Stiff posture, nervous play, white knuckle syndrome (more common in men), sweating, too cooperative, nervous conversation, quick answers

Question 13

What is the stress reduction protocol

Answer 13

Adequate pain control
Decrease pain of injection
Select LA of appropriate duration

Question 14

When do you do risk assessment

Answer 14

After medical/dental history, physical exam and pshycological evaluation - data is reviewed

Question 15

During risk assessment what do you review data to determine?

Answer 15

1. Safety for dental treatment
2. Modifications to dental tx if needed
3. Need for LA
4. Selection of specific LA if needed

Question 16

What does risk assessment include?

Answer 16

A —> antibiotics, anesthesia, anxiety, allerfu
B —> bleeding
C —> chair positioning
D —> drugs, devices
E —> equipment, emergencies

Question 17

What is fear

Answer 17

An unpleasant often strong emotion caused by anticipation or awareness of danger

6-14% of population avoid dental care because of fear

Question 18

What’s the difference between fear and anxiety?

Answer 18

Fear is short lived, disappearing when threat or danger passes

Anxiety is not eliminated as easily and tends to be a learned response from personal experience or from experience of others

(Anxiety = anticipation/thought of dentistry, fear = reaction in dental office)

Question 19

Common origins of dental fear

Answer 19

-Painful or negative dental experience
-Severe discomfort
-Stories
-Negative portrayals
-Depersonalization
-Pain
-Fear of injections
-Loss of control
-Loss of personal space