indications and contraindications key points

Question 1

broad indication categories

Answer 1

medical
psychosocial
dental

Question 2

medical indications

Answer 2

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 (Cerebal Palsy) - midazolam muscle relaxant
• Parkinsons (reduce movements)

Question 3

psychosocial indications

Answer 3

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

Question 4

dental indications

Answer 4

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

Question 5

phobia

Answer 5

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

Question 6

broad contraindication categories

Answer 6

medical
dental
social

Question 7

medical contraindications

Answer 7

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

Question 8

medical contraindications for IV

Answer 8

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

Question 9

medical contraindications for IHS

Answer 9

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

Question 10

dental contraindications

Answer 10

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

Question 11

social contraindications

Answer 11

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

Question 12

advantages

Answer 12

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

Question 13

disadvantages

Answer 13

training and equipment required

recovery time and aftercare