indications and contraindications key points Flashcards

1
Q

broad indication categories

A

medical
psychosocial
dental

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2
Q

medical indications

A

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)

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3
Q

psychosocial indications

A
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
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4
Q

dental indications

A
difficult/unpleasant procedures
 - surgical ext 8s
 - ortho ext
 - implants
 = may not be dentally anxious
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5
Q

phobia

A

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

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6
Q

broad contraindication categories

A

medical
dental
social

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7
Q

medical contraindications

A
severe or uncontrolled systemic disease (midazolam suppresses CNS)
severe mental/physical disability
severe psychiatric problems
narcolepsy
poorly-controlled hypothyroidism
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8
Q

medical contraindications for IV

A
intracranial pathology
COPD (resp depressant)
myaesthenia gravis (muscle relaxant so may stop breathing)
hepatic insufficiency (long recovery)
pregnancy and lactation
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9
Q

medical contraindications for IHS

A
blocked nasal airway
COPD
pregnancy
 - single exposure fine
 - staff can't do it while pregnant - repeated exposure is the issue
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10
Q

dental contraindications

A

procedure too difficult for LA alone
procedure too long
spreading infection - airway threatening, limits LA
procedure too traumatic

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11
Q

social contraindications

A
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
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12
Q

advantages

A
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
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13
Q

disadvantages

A

training and equipment required

recovery time and aftercare

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