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DA (Can) > Dental Emergencies & Records (Review: Outcome 4 & 3) > Flashcards

Dental Emergencies & Records (Review: Outcome 4 & 3) Flashcards

1
Q

What is the importance of medical history?

A
  • Various medical conditions can affect the state of oral tissues, increase risk of medical emergency, or cause a need for modification to dental treatment
  • As a D.A., required to identify and understand various medical conditions in order to prevent potential medical emergencies, better understand oral findings, and modify treatment
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2
Q

Significance of Medical history

A
  • Oral conditions reflect the general health of a patient
  • Dental procedures may complicate or be complicated by existing pathologic or physiologic conditions in the body
  • General health factors influence response to treatment (tissue healing) - influence outcome of dental care
  • State of patient’s health is constantly changing and must be updated continually
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3
Q

What are the items to be included in the medical history?

A
  • Conditions that may complicate certain kinds of dental or dental hygiene treatment
  • Conditions or diseases that require special precautions or premedication before treatment
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4
Q

Cardiovascular Disease

A
  • Heart disease
  • Involves disease of the heart and blood vessels
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5
Q

What conditions are included in cardiovascular disease?

A
  • Arrhythmias
  • High blood pressure
  • Congenital heart defects
  • Coronary artery disease (arteriosclerosis, atherosclerosis)
  • Heart attack (myocardial infarction)
  • Angina pectoris
  • Congestive heart failure
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6
Q

Infective Endocarditis

A

A microbial infection of the heart valves or endocardium

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7
Q

What are the clinical considerations for cardiovascular disease?

A
  • Avoid stressful, lengthy appointments
  • Access vital signs before treatment; consider monitoring throughout procedure
  • Dentist may use psychotropic premedication and nitrous oxide to help relieve stress
  • Consider the use of supplemental oxygen throughout procedure
  • Dentist may consult with patient’s cardiologist about use of prophylactic sublingual nitroglycerin immediately after treatment
  • Epinephrine and other vasoconstrictors can be administered within limits to patients with mild to moderate CVD
  • Seated patients are more comfortable in a semi-supine rather than supine position
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8
Q

Respiratory Disease

A

Medical conditions that affect the lungs and someone’s ability to breath

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9
Q

What conditions are included in Respiratory Disease?

A
  • Asthma
  • Acute bronchitis
  • Pneumonia
  • Tuberculosis
  • Chronic obstructive pulmonary disease (COPD) - Emphysema, chronic bronchitis
  • Cystic fibrosis
  • Sinusitis
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10
Q

What are the clinical considerations for Respiratory Diseases?

A
  • Dental chair position
  • Some procedures may be contraindicated (ultrasonic and air polishers)
  • Nitrous oxide contraindicated
  • Potential medical emergency
  • Reduction or no aerosol agents
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11
Q

Hematological Diseases

A

Bleeding disorders that can result from inherited genetic defects or be acquired due to use of anticoagulant medications or medical conditions (e.g. live dysfunction, chronic kidney disease, and autoimmune disease

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12
Q

What are some examples of hematological diseases?

A
  • Bleeding or coagulation disorders (Hemophilia A, von Willebrand disease)
  • Anemia
  • Sickle cell disease
  • Polycythemias
  • Disorders of white blood cells
  • Platelet disorders
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13
Q

What are the clinical considerations for Hematological diseases?

A
  • Antibiotic premedication may be required
  • May be immunosuppressed (risk of infection)
  • Increased bleeding associated with dental procedures
  • Potential emergency
  • May require special measures
  • May see oral lesions
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14
Q

Communicable Diseases

A

Diseases that can be transferred from one individual to another regardless of the source of transfer

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15
Q

Examples of Communicable diseases

A
  • Hepatitis
  • HIV/AIDS
  • Infectious Mononucleosis
  • STI’s
  • Herpes
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16
Q

Examples of Endocrine Conditions

A
  • Hyperthyroidism = overactive thyroid gland
  • Hypothyroidism = underactive thyroid gland, produces fewer hormones than usual

*Thyroid gland regulates metabolism in body cells and stimulates the passage of calcium into bones from blood

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17
Q

Clinical considerations for Hyperthyroidism

A
  • An accurate and current medical history and medical consultation are essential
  • Hyperthyroid patients who are not being treated are highly sensitive to epinephrine and other amine anesthetics
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18
Q

Diabetes Mellitus

A

A disease characterized by a sustained high blood glucose level resulting from an absolute or relative lack of insulin. There are 2 classifications:

1) Type 1 = absolute insulin deficiency
2) Type 2 = pancreatic insulin secretion may be low, normal, or higher than normal, but the patient exhibits an insulin resistance that impairs the use of insulin

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19
Q

Clinical Considerations for Diabetes Mellitus

A
  • Minimize stress by keeping appointments short and schedule them in mid-morning
  • Use sedation techniques (e.g. administration of nitrous oxide or oral diazepam)
  • Instruct patients to maintain normal dietary intake before dental appointments
  • Minimize risk of infection
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20
Q

Examples of Gastrointestinal Conditions

A

Ulcers
- xerostomia
- effects on teeth

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21
Q

Examples of Urinary Conditions

A

Renal (Kidney disorders)
- monitor blood pressure
- bleeding tendencies
- poor healing
- susceptible to infection
- stress tolerance decreased

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22
Q

Examples of Neurologic Disorders

A
  • Alzheimer’s disease (loss of memory and impairs judgment, comprehension, and intellect. Anxiety, depression and emotional disturbances can occur over time)
  • Seizures (abrupt suspension of motor, sensory, behavioral, or bodily function at any time)
  • Stroke (unilateral weakness or paralysis of face and limbs, slurring, loss of speech)
  • Multiple Sclerosis (progressive weakness, unsteady gait, and paralysis)
23
Q

Clinical considerations for Alzheimer’s Disease

A
  • Try to complete treatment during early stages of the disease
  • Expect to treat these patients for xerostomia due to drug therapy
  • Emphasize good home care and frequent visits
  • Understand that, in later stages, dentures may not be tolerated
24
Q

Clinical considerations for seizures

A
  • Emphasize good home care and frequent visits
  • Expect gingival hypertrophy if patient’s drug therapy includes dilantin
  • Before treatment, question the patient about skipping medications, recent stress and fatigue, pain, and alcohol consumption
25
Q

Clinical considerations for seizures

A
  • Prednisone and muscle relaxants can be prescribed to help control muscle spasms during dental appointments
  • If wheelchair-bound, patients may be more comfortable if allowed to remain in the wheelchair during treatment
26
Q

Clinical considerations for stroke

A
  • Schedule patients for mid-morning appointments and add at least 10 minutes to appointment for additional communication and explanation of instructions
  • Toothbrushing and flossing modifications may need to be introduced for home care
  • Caregiver may need to become more involved with home care routines
27
Q

Arthritis and Rheumatoid Arthritis

A

Arthritis = chronic or acute inflammatory condition of a joint(s)

Rheumatoid arthritis = chronic immunologic systemic disease-causing inflammation of the joints brought on by an unknown cause
- often accompanied by pain, stiffness, or limitation of movement in the affected joint

28
Q

Clinical considerations for arthritis

A
  • Schedule patients in the morning and keep appointments short
  • The disease can limit patient’s ability to open the mouth or chew comfortably
29
Q

Cancer

A

Occurs when normal cells are transformed into malignant ones
- as cancer cells increase, the mass of abnormal tissue forms until it takes over the host site

30
Q

Clinical considerations for cancers

A
  • Xerostomia, oral mucosistis/stomatitis
  • Infections (bacterial, viral, fungal), bleeding
  • Trismus (inability to open the mouth completely)
  • Radiation caries, loss of taste
31
Q

Allergies

A

A condition in which the body reacts to an antigen
- most reactions can be managed by having the patient take an over-the-counter medication or prescribed mediation that reduces the symptoms of allergy

  • If the reaction goes beyond this type of management, the allergy becomes a life-threatening emergency
32
Q

Clinical considerations for allergies

A
  • Complete a thorough medical history to determine specific allergens
  • Pay special attention to latex and dental material use
  • Have EpiPen available for possible emergency
33
Q

Bacteremia

A

Presence of bacteria in the blood stream

34
Q

What conditions required antibiotic prohylaxis?

A

Heart conditions and Joint replacements (immunocompromised patients)

35
Q

What procedures and events do not need prophylaxis?

A
  • Routine anesthetic through non-infected tissues
  • 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 mucosa
36
Q

Antibiotic Prophylaxis

A

Medical histories must be carefully reviewed for any medical condition(s) which may put the patient at risk to infection by bacteriemia associated with dental procedures that involve the manipulation of gingival tissue, periodontal and periodical tissues and incision of the mucosa

37
Q

What is a health history?

A

A collection of patient information that includes:
- personal history
- medical/health history
- dental history

38
Q

What is the importance of a medical history?

A
  • Prevents medical emergencies
  • Assists in dental diagnosis
  • Guides dental treatment
  • To recognize signs and symptoms of different conditions and diseases
  • Directs possible need for referrals
39
Q

How do dental healthcare workers obtain a patient’s health history?

A
  • Questionnaire to be answered by the patient
  • Interviews the patient and asks follow-up questions
  • Observes the patient
40
Q

Signs

A

Objective, observable evidence of an illness or disorder
- a physical manifestation of a disorder that is apparent to a trained healthcare provider and sometimes to the patient
- example: swelling, sweating, twitching

41
Q

Symptoms

A

Any change in the body or its function that is perceived by the patient; subjective experience of a disease or disorder
- examples: pain, numbness, nausea, headache

42
Q

Legal and Ethical Responsibilities of health history

A
  • The patient health history is a legal contract obliging the patient to report any changed their health or medications
  • A date and signature of the patient (parent/guardian) and the dentist or dental hygienist is a MUST for the document to be considered legal
43
Q

Advantages of a questionnaire & interview for health history

A
  • Time saving: long-term
  • Consistent
  • Patient may disclose more information
  • Legal document with patient’s signature
  • Educate patient
  • Convey relationship of oral and general health
  • Personal contact develops rapport
44
Q

What does the personal history contain?

A

Contains the patient’s personal information:
- full name
- date of birth
- contact information (telephone number, email addresses, emergency contacts)
- physicians contact information
- previous dentist contact information

45
Q

What is the importance of a personal history?

A
  • Essential for appointment planning, booking, and insurance requirements
  • Possible consultations with all healthcare providers
  • Age (legal considerations, treatment planning)
  • Personal medical emergency contact
46
Q

What is dental health history?

A

Information about the patient’s previous dental treatment and care and how the patient feels about dentistry and how important dental care is to him or her

47
Q

What does the dental history identify?

A
  • Current dental concerns
  • Previous dental care
  • Adverse effects related to dental care
  • Personal attitude and daily oral hygiene care
48
Q

What are the questions presented on a dental history?

A
  • Time frame of last appointments?
  • Reason for present appointments?
  • How often do you brush/floss your teeth?
  • Do you wear a removable appliance?
  • Do you have any concerns with your teeth, gums, or jaw?
49
Q

What is the objective of the medical history?

A

To determine whether the patient has any conditions and/or diseases that may:

  • complicate certain kinds of dental and dental hygiene
  • require special precautions or premedication before treatment
  • require medicating drugs that may influence or contraindicate certain procedures
  • have gender or ethnic/racial influences that increase the risk for systemic and oral disease
  • have allergic or untoward reactions to
  • manifest in the oral cavity
  • that may be communicable and endanger the dental healthcare professional
  • influence the physiologic state of the patient
50
Q

What are the common investigating questions for medical history?

A
  • When?
  • What?
  • Why?
  • How was it resolved?

Main rule: A patient’s positive response must be investigated further

51
Q

What is a medical alert(s)?

A

Conditions that
- require special precautions
- may contraindicate treatment
- may complicate treatment
- risk a medical emergency

52
Q

SAIT Medical Alerts

A
  • Only the supervising dentist/dental hygienist cant designate a patient record/chart as a medical alert
  • if a student suspects a possible medical alert (MA), they are to red star the condition on the “Patient history note page”

-The supervising dentist/DH will note the MA by placing a red star next to the MA on the medical and dental history form and by writing MA on the upper right corner of patient chart in red pen

  • A red tab will also be placed on the chart, 3 slots from the tag color coded to indicate the patient’s first letter of their last name
  • MA designation must reflect a potential medical emergency during the procedure or must have an impact on dental treatment
  • The MA will be recorded in the patient’s electronic file
53
Q

When should a health history be updated?

A
  • Must be done every appointment
  • Have there been any changes in your health, such as any serious illnesses, hospitalization, or new allergies? if yes, please specify
  • Are you taking any new medications or has there been any change in your medications? If yes, please specify

DA (Can) (21 decks)

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