Intro Flashcards
Why is dentistry different today then it used to be?
➢ People live longer = more elderly patients
➢ People receive medical treatments for disorders that would be fatal a just a few years ago
➢ Pharmaceuticals continue to advance
The greater the number and the more complex the conditions and the more medications that are used to manage these conditions are all proportional the…
combinations and permutations of dental treatments for our patients
Many chronic disorders or their treatments necessitate
___________ of dental treatment
modification
What modification did Hepatitis cause in 1982?
use of gloves
What modification did AIDS cause in 1990?
use of PPE
What modification did Covid cause in 2019?
PPE and vaccines
Clincians must practice so that the benefit of dental treatment will outweigh the ______ of a medical complication occurring either during treatment or as a result of treatment
risks
A doctor who cannot take a good history and a patient who cannot give one are in danger of giving and receiving…
bad treatment
What is the organized risk assessment order?
P - Patient Evaluation
A - Allergies, Antibodies, Anesthesia, Analgesics, Anxiety
B - Bleeding, Breathing, BP
C - Chair Position
D - Drugs, Devices
E - Equipment, Emergencies
F - Follow Up
What does the P stand for in the organized risk assessment?
Patient Evaluation
What does the A stand for in the organized risk assessment?
Allergies, Antibodies, Anesthesia, Analgesics, Anxiety
What does the B stand for in the organized risk assessment?
Bleeding, Breathing, Blood Pressure
What does the C stand for in the organized risk assessment?
Chair Position
What does the D stand for in the organized risk assessment?
Drugs, Devices
What does the E stand for in the organized risk assessment?
Equipment, Emergencies
What does the F stand for in the organized risk assessment?
Follow Up
What are the parts of patient evaluation?
- chief complaint
- medical history
- medications
- social and family history
- review of systems
- history of present illness
- objective findings
What are the adjunctive tests and procedures for patient evaluation?
- Refer
- Imaging
- Histopathology
- Microbiology
- Labs
- Anesthesia
- Molecular biology
- Sequencing
What all should be done during a patient evaluation?
- Identify ALL medications & drugs, taken or supposed to be taken
- Review medical history, discuss relevant issues with patient
- Examine patient for signs and symptoms of disease
- Review or gather recent laboratory tests or images
- Obtain a medical consult
When do you need a medical consult?
- If patient has a poorly controlled or undiagnosed problem
- If you’re uncertain about the patient’s health findings
What question should you ask about allergies?
Is the patient allergic to drugs or substances that may be used or prescribed?
What question should you ask about anxiety?
Will the patient need or benefit from a sedative or anxiolytic?
What questions should you ask about antibiotics?
- Will the patient need antibiotics?
- Is the patient taking an antibiotic?
What questions should you ask about analgesics?
- Is the patient taking aspirin or NSAIDs that can increase bleeding?
- Will analgesics be needed post-treatment?
What question should you ask about anesthesia?
Are there concerns using a local with or without epinephrine?
What question should you ask about bleeding?
Is abnormal hemostasis possible?
What question should you ask about blood pressure?
Is the patient’s BP well controlled or is it possible it may increase/decrease during dental treatment
What question should you ask about breathing?
Does the patient have difficulty breathing or is the patient’s breathing fast or slow?
What questions should you ask about chair position?
- Can the patient tolerate a supine or (horizontal) position?
- Is the patient going to have a problem being raised quickly, after treatment?
What question should you ask about drugs?
Any drug interactions, adverse effects, or allergies associated with drugs being currently being taken or drugs that the dentist may prescribe or use?
What questions should you ask about devices?
- Does the patient have prosthetic or therapeutic device that may require tailored management?
- e.g., prosthetic heart valve, prosthetic joint, stent, pacemaker, defibrillator
What questions should you ask about equipment?
- Any potential issues with the use of dental equipment?
- e.g.: X-ray machine, electrocautery, oxygen supply, ultrasonic cleaner, apex locator.
What questions should you ask about emergencies?
- Are there medical emergencies that can be anticipated or prevented by modifying care?
- e.g: MI, stroke, asthma, uncontrollable bleeding
What do you need to know about follow up?
- Is any follow up care indicated?(post-op analgesics, antibiotics, anxiety)
- Post-op instructions for home care ALWAYS and prescriptions when necessary
- Should the patient be contacted at home to assess post-treatment response
If a local anesthetic(s) are used on a patient and there was _________ during the appointment, the patient should be contacted that evening or the following day
bleeding
What are the parts of the organized risk assessment? (listed out)
➢ Patient Evaluation
➢ Antibiotics
➢ Analgesics
➢ Anesthesia
➢ Allergies
➢ Anxiety
➢ Bleeding
➢ Breathing
➢ Blood Pressure
➢ Chair Positioning
➢ Drugs
➢ Devices
➢ Equipment
➢ Emergencies
➢ Follow up
What must be taken for every patient who is to receive dental treatment?
medical history
What are the two basic techniques used to obtain medical history?
➢ Interview the patient
— Ask patient questions, record the patient’s verbal responses
➢ A printed questionnaire the patient fills out
What medical issues do you ask about during the med history that may affect dental treatment?
- Anxiety
- Cardiovascular diseases
- Neurologic disorders
- Gastrointestinal diseases
- Respiratory tract diseases
- Musculoskeletal diseases
- Endocrine diseases
- STD’s
- Cancer & radiation treatment
What is the difference between medical history and review of systems (ROS)?
Med history = patient has already been diagnosed or, patient presents with information needing a diagnosis
ROS = screen for potential new diseases
* Screening through signs and symptoms with a systems-based approach
* Findings may be consistent with a particular systemic disease, but you will not diagnose
What is a review of systems (ROS)?
- Screening through signs and symptoms with a systems-based approach
- Findings may be consistent with a particular systemic disease, but you will not diagnose
What is functional capacity?
Does the pt have the ability to engage in normal day-to-day physical activity?
➢ Ability to perform common daily tasks can be expressed in
metabolic equivalent levels (METs)
What is MET?
- metabolic equivalent levels
- unit of oxygen consumption
- Higher MET = better physical condition
1 MET equals ____ mL of oxygen per kg of body weight per minute at rest
3.5 mL
What are the characteristics of light functional capacity (<3.0 METs)?
- walking (slowly)
- sitting
- standing (light work)
- fishing
- playing most instruments
What are the characteristics of moderate functional capacity (3.0-6.0 METs)?
- walking (very brisk)
- cleaning (heavy)
- mowing lawn
- Bicycling
- badminton
What are the characteristics of vigorous functional capacity (>6.0 METs)?
- hiking
- jogging
- shoveling
- carryig heavy loads
- bicycling fast
- basketball
- soccer
- tennis
Asking a patient, “Can you walk up two flights of stairs without having to catch your breath” can indicate general cardiovascular and/or pulmonary health.
True
If patient replies yes to allergy, what do you ask next?
“What happens?”
What are examples of true allergy symptoms?
➢ Anaphylaxis
➢ Itching
➢ Urticaria (hives)
➢ Rash
➢ Swelling
➢ Wheezing
➢ Angioedema
➢ Rhinorrhea
➢ Tearing eyes
What are examples of symptoms of intolerance or adverse side effects?
o Nausea
o Vomiting
o Diarrhea
o Heart palpitations
o Fainting
Some STD’s including HIV infection, hepatitis B and C, and syphllis, can be transmitted to the dentist through direct contact with…
oral lesions or infected blood
What STD’s can be transmitted to dentist through direct contact?
- HIV
- HepB
- HepC
- Syhphillis
________________ is the single most common STD in the US.
Chlamydial genitalia infection
__________________________ are examples of steroids that are used to treat many diseases
Cortisone and prednisone
Why are steroids important for dental use?
important because their use can result in adrenal insufficiency and the patient is unable to mount a normal response to the stress of an infection or invasive dental procedure
Women who are or might be pregnant may need special consideration in dental management such as caution is warranted with:
- radiography
- drug administration
- timing of dental treatment
____ trimester is the safest to provide dental treatment
2nd
When can you take radiographs on pregnant pt?
urgent care only
Pt’s with a hx of IV drug use increased risk for infectious diseases like…
Hepatitis B, C, HIV/AIDS, and infective endocarditis
______________ should be avoided for cocaine and methamphetamine users
Vasoconstrictors
- These agents may precipitate
arrhythmias, severe hypertension, MI, and Stroke
What is the issue with alcohol consumption, misuse, and abuse?
- Risk factor for many cancers and other diseases
- May lead to liver cirrhosis, many complications
- Ask how many standard drinks/week
What is the issue with tobacco consumption, misuse, and abuse?
Risk factor for many cancers and other diseases (especially oral cancer)
Ask type of tobacco and frequency and establish cumulative risk, current and past (for how many years) such as…
➢ Cigarettes: packs/day ( 1 pack = 20 cigarettes)
➢ Smokeless tobacco: cans/week
➢ Hookah: hours/week
➢ E-cigarettes: cartridges/week
What parameters should you look for in social history?
- occupation
- marital status
- children
What signs and symptoms in the family history do you need to watch out for?
- Hypertension
- Diabetes
- Autoimmune disease
- Cancer
- Other hereditary diseases and syndromes
Checking ___________ first is a good way to initiate a the medical history
medications
All drugs, medicines, or ‘pills’ that a patient is taking or is supposed to be taking should be identified and investigated for…
actions, adverse side effects, and potential drug interactions
What are the objective findings to look for in a physical examination?
- Vital signs
- General appearance
- Skin
- Fingers
- Nails
- Head and neck examination
—Skin
—Eyes & Nose
—Ears
—Cranial nerves
—Neck examination
—Intra-oral examination
What are the vital signs?
- Blood pressure
- pulse
- respiratory rate
- temperature
- height
- weight
What is the purpose of obtaining vital signs?
Purpose is for detection of abnormality and not diagnosis
➢ Diagnosis is responsibility of the physician
➢ Refer if finding is significantly abnormal
Why is it important to check blood pressure?
- Screening: you may be the first to detect
- Monitoring: compliance/control/progression
- Risk assessment: potential serious complications
- Treatment modifications
How many readings of BP should you take?
multiple b/c BP is variable
How is blood pressure measured?
Determined by indirect measurement in the upper extremities with a BP cuff and stethoscope
How do you take a blood pressure?
➢ Cuff should encompass 80% of the circumference of the arm.
➢ Center of cuff over brachial artery
BP Cuff too small →
falsely elevated values
BP Cuff too large →
falsely low values
“White Coat HTN” elevates BP by how much?
30 mmHg
Pregnant patients with _____ increase in sysytolic BP from baseline puts them at risk for ________
greater than 10 mmHG
risk of eclampsia –> immediate referral
Where do you put the arm during a blood pressure?
Horizontal at heart level (mid-sternum)
Arm below heart level __________ systolic and diastolic pressures
Over-Estimates
Arm above heart level _____________ systolic and diastolic pressures
under-estimates
__________ method of BP measurement is universally accepted
Auscultation
What is the Auscultation method of blood pressure?
➢ BP cuff should be inflated until radial pulse disappears; then add additional 20-30 mm Hg
➢ Release valve slowly turned. Fall rate of needle ~2-3 mm Hg per second
➢ First audible ‘Beating sound’ (Korotkoff sounds)
➢ As needle continues to fall, beat will become louder and then diminish until marked diminution in intensity occurs
How do you make sure you have an accurate blood pressure reading?
- Pt avoid caffeine, exercise, nicotine
- Pt empty bladder prior to BP
- Sit quietly for at least 5 minutes
- Support limb to measure BP
- Don’t take BP over clothes
- Take 2-3 readings (on 2-3 occasions)
What is normal BP?
less than 120/80 mmHg
What is elevated BP?
120-129/ less than 80 mmHg
What is Stage 1 HTN?
130-139/80-89 mmHg
What is Stage 2 HTN?
greater than 140/ greater than 90 mmHg
What BP is hypertensive crisis?
greater than 180/ greater than 120 mmHg
NO dental care at UMKSC SOD if BP ≥ __________ mmHg
180/110
How do you get a pulse?
➢ Palpate artery carotid at side of trachea → MORE RELIABLE
➢ Palpate radial artery on the thumb side of wrist
What is normal pulse?
60-100 bpm
What is tachycardia?
greater than 100 bpm
What is bradycardia?
less tham 60 bpm
Pulse may be influenced by
➢ Exercise/conditioning
➢ Anemia
➢ Anxiety
➢ Drugs
➢ Fever
Abnormal pulse rate may be a sign of ___ disorder
CV
How long should you palpate the pulse if an arrythmia is suspected?
for a full minute
What is a normal respiratory rate for adults?
12-16 breathes/min
What are abnormal breathing patterns?
- Labored breathing
- Rapid breathing
- Irregular breathing patterns
- May be signs of systemic problems, especially cardiopulmonary disease
- A common finding in apprehensive patients is hyperventilation
When do you take a temp?
when a patient has febrile signs or symptoms that may be due to an abscessed tooth or a mucosal or gingival lesion
What is the normal temp?
98.6
Rapid weight loss may be a sign of…
malignancy, diabetes, tuberculosis, neoplasm
Rapid weight gain may be a sign of…
heart failure, edema, hypothyroidism, or neoplasm
What can cyanosis of the skin and nails mean?
cardiac or pulmonary insufficiency
What can yellow of the skin and nails mean?
jaundice may be due to liver disease
Petechiae or ecchymoses can be sign of –>
blood dyscrasia or bleeding disorder
Alterations in fingernails usually seen in chronic disorder
➢ Clubbing (cardiopulmonary insufficiency)
➢ White discoloration (cirrhosis)
➢ Yellowing (malignancy)
➢ Splinter hemorrhages (infective endocarditis)
What are examples of systemic disease you can see in the eyes/nose?
➢ Hyperthyroidism
* Lid retraction
➢ Hypercholesterolemia
* Xanthomas of the eyelids
➢ Liver Disease (**Problem metabolizing drugs)
* Yellowing of sclera
* Hepatitis, Alcoholics
➢ Allergy or Sicca syndrome
* Conjunctiva reddening
An earlobe crease ‘may’ be an indicator of…
coronary artery disease
What do you need to check on the neck?
➢ Normal, enlarged
* Soft, hard
* Mobile, fixed
* Non-tender, tender
➢ Infections, goiter, cysts, masses, vascular deformities
What does an intraoral exam require?
➢ Good lighting, constantly moving
➢ Dental mirror
➢ Gauze
➢ Periodontal probe
➢ Other circumstances: Endo Ice, explorer
What is the recommended sequence for a physical head/neck exam?
➢ Lower lip, upper lip
➢ R buccal mucosa and vestibule – “milk” parotid gland (extraoral)
➢ R retromolar trigone
➢ R mandibular arch (buccal and lingual – push the tongue away)
➢ L mandibular arch (buccal and lingual – push the tongue away)
➢ L retromolar trigone
➢ L buccal mucosa and vestibule - “milk” parotid gland (extraoral)
➢ L maxillary arch, vestibule, and tuberosity
➢ L hard palatal mucosa
➢ R hard palatal mucosa
➢ R maxillary arch, vestibule, and tuberosity
➢ Tongue dorsum – stick out, wipe off, lasso with a gauze
➢ R ventral tongue – pull to left with gauze and ALWAYS palpate; should be
able to see lingual tonsils
➢ R floor of mouth
➢ L ventral tongue - pull to right with gauze and ALWAYS palpate; should
be able to see lingual tonsils
➢ Remove gauze and look at anterior ventral tongue and caruncle
➢ Bimanual palpation of salivary glands and ”milk” sublingual glands
➢ Soft palate
➢ Oropharynx – depress tongue dorsum with mirror or tongue depressor
How do you reduce stress and anxiety?
- Open communication about fears/concerns (rapport)
- Short appointments (usually in the morning)
- Pre-dental treatment sedation—1hr prior appt.*
- During dental treatment sedation (i.e., Nitrous Oxide)
- Profound local anesthesia
- Good post-dental treatment pain control
- Patient contacted the evening of the procedure
What are the indications for laboratory testing in dentistry?
➢ Aid in detecting suspected disease (e.g., diabetes, infection, bleeding disorders, malignancy)
➢ Screen high-risk patients for undetected disease (e.g., diabetes, AIDS, chronic kidney disease)
➢ Establish normal baseline values before treatment (e.g.,anticoagulant
status, white blood cells, platelets)
➢ Address medical-legal considerations (e.g., possible bleeding disorders, hepatitis B infection)
Common laboratory testing in dentistry:
- CBC
- prothrombin time
- PTT (partial thromboplastin time)
What is normal prothrombin time?
Normal = 1
2-3 if on Coumadin
higher INR = higher bleeding risk
What is an ASA I?
a normal healthy patient
What is an ASA II?
a patient with mild systemic disease
What is an ASA III?
a patient with severe systemic disease
What is an ASA IV?
a patient with severe systemic disease that is a constant threat to life
What is ASA V?
a moribund patient who is not expected to survive without the operation
What is ASA VI?
a patient declared brain-dead whose organs are being removed for donor purposes
What are the characteristics of ASA 1?
▪ Pt is able to walk up one flight of stairs or 2 level city blocks without distress
▪ Little or no anxiety
▪ Little or no risk during treatment
What are the characteristics of ASA 2?
▪ Pt has mild systemic disease
▪ ASA PS1 with extreme anxiety/fear
▪ Pt walk one flight of stairs or 2 level city blocks, but has to stop after exercise because of distress
▪ ASA 1 w/ respiratory condition, allergies, phobic, pregnant
▪ Diet or hypoglycemic agent-controlled diabetic
▪ Well-controlled asthmatic
▪ Well-controlled epileptic
▪ Well-controlled hypertensive, not on medication
▪ Minimal risk during treatment
What are the characteristics of ASA 3?
▪ Severe systemic dz, limits activity but not incapacitated
▪ Can walk up 1 flight of stairs or 2 level city blocks but has to stop on the way b/c of distress
▪ Well-controlled hypertensive on medication
▪ Well-controlled diabetic on insulin
▪ Slight COPD
▪ 30 days or more ago hx of: myocardial infarction, cerebrovascular accident, congestive heart failure
▪ If dental care is needed,
stress reduction protocol and other
tx modifications are indicated
What are the characteristics of ASA 4?
▪ Severe systemic dz, limits activity and constant threat to life
▪ Unable to walk up 1 flight of stairs or 2 level city blocks. Distress is present at rest
▪ Hx unstable angina, MI, CVA in last 30-days
▪ Severe congestive heart failure
▪ Mod to severe COPD
▪ Uncontrolled hypertension
▪ Uncontrolled diabetes
▪ Uncontrolled epilepsy or seizure disorder
▪ Pt poses significant risk during treatment
▪ Elective dental care postponed until ASA 3 class
▪ Emergency dental care may be best in a hospital with a consultation with the Pt’s physician team
