indications and contraindications key points Flashcards
broad indication categories
medical
psychosocial
dental
medical indications
conditions aggravated by stress of dental tx
- IHD
- hypertension
- asthma
- epilepsy
- psychosomatic illness (somatoform disorders)
- UC, Crohns etc
conditions which affect cooperation
- mild/mod movement or LDs - not severe as they need
to understand what will happen
- spasticity disorders (CP) - midazolam muscle relaxant
- Parkinsons (reduce movements)
psychosocial indications
phobias - things in mouth - dental procedures - drills - needles - need for IV but many pts more anxious about needles in mouth gagging persistent fainting idiosyncrasy to LA - faint/unwell
dental indications
difficult/unpleasant procedures - surgical ext 8s - ortho ext - implants = may not be dentally anxious
phobia
an irrational and uncontrollable fear, related to a specific object or situation
persistent, despite avoidance of the provoking stimulus
has direct effect on pts lifestyle
broad contraindication categories
medical
dental
social
medical contraindications
severe or uncontrolled systemic disease (midazolam suppresses CNS) severe mental/physical disability severe psychiatric problems narcolepsy poorly-controlled hypothyroidism
medical contraindications for IV
intracranial pathology COPD (resp depressant) myaesthenia gravis (muscle relaxant so may stop breathing) hepatic insufficiency (long recovery) pregnancy and lactation
medical contraindications for IHS
blocked nasal airway COPD pregnancy - single exposure fine - staff can't do it while pregnant - repeated exposure is the issue
dental contraindications
procedure too difficult for LA alone
procedure too long
spreading infection - airway threatening, limits LA
procedure too traumatic
social contraindications
unwilling - only works for pt who wants tx but is too anxious to cope uncooperative unaccompanied children <12 for IV extremes of age (>65s) - react unusually
advantages
reduce dentist and staff stress reduce pt stress fewer medical incidents more productive appts provide complete tx for more difficult pts - if GA would just have to do exts
disadvantages
training and equipment required
recovery time and aftercare