Intro Flashcards
1
Q
Why is dentistry different today then it used to be?
A
➢ 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
2
Q
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…
A
combinations and permutations of dental treatments for our patients
3
Q
Many chronic disorders or their treatments necessitate
___________ of dental treatment
A
modification
4
Q
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
A
risks
5
Q
A doctor who cannot take a good history and a patient who cannot give one are in danger of giving and receiving…
A
bad treatment
6
Q
What is the organized risk assessment order?
A
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
7
Q
What does the P stand for in the organized risk assessment?
A
Patient Evaluation
8
Q
What does the A stand for in the organized risk assessment?
A
Allergies, Antibodies, Anesthesia, Analgesics, Anxiety
9
Q
What does the B stand for in the organized risk assessment?
A
Bleeding, Breathing, Blood Pressure
10
Q
What does the C stand for in the organized risk assessment?
A
Chair Position
11
Q
What does the D stand for in the organized risk assessment?
A
Drugs, Devices
12
Q
What does the E stand for in the organized risk assessment?
A
Equipment, Emergencies
13
Q
What does the F stand for in the organized risk assessment?
A
Follow Up
14
Q
What are the parts of patient evaluation?
A
- chief complaint
- medical history
- medications
- social and family history
- review of systems
- history of present illness
- objective findings
15
Q
What are the adjunctive tests and procedures for patient evaluation?
A
- Refer
- Imaging
- Histopathology
- Microbiology
- Labs
- Anesthesia
- Molecular biology
- Sequencing
16
Q
What all should be done during a patient evaluation?
A
- 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
17
Q
When do you need a medical consult?
A
- If patient has a poorly controlled or undiagnosed problem
- If you’re uncertain about the patient’s health findings
18
Q
What question should you ask about allergies?
A
Is the patient allergic to drugs or substances that may be used or prescribed?
19
Q
What question should you ask about anxiety?
A
Will the patient need or benefit from a sedative or anxiolytic?
20
Q
What questions should you ask about antibiotics?
A
- Will the patient need antibiotics?
- Is the patient taking an antibiotic?
21
Q
What questions should you ask about analgesics?
A
- Is the patient taking aspirin or NSAIDs that can increase bleeding?
- Will analgesics be needed post-treatment?
22
Q
What question should you ask about anesthesia?
A
Are there concerns using a local with or without epinephrine?
23
Q
What question should you ask about bleeding?
A
Is abnormal hemostasis possible?
24
Q
What question should you ask about blood pressure?
A
Is the patient’s BP well controlled or is it possible it may increase/decrease during dental treatment
25
What question should you ask about breathing?
Does the patient have difficulty breathing or is the patient’s breathing fast or slow?
26
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?
27
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?
28
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
29
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.
30
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
31
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
32
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
33
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
34
What must be taken for every patient who is to receive dental treatment?
medical history
35
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
36
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
37
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
38
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
39
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)
40
What is MET?
- metabolic equivalent levels
- unit of oxygen consumption
- Higher MET = better physical condition
41
1 MET equals ____ mL of oxygen per kg of body weight per minute at rest
3.5 mL
42
What are the characteristics of light functional capacity (<3.0 METs)?
- walking (slowly)
- sitting
- standing (light work)
- fishing
- playing most instruments
43
What are the characteristics of moderate functional capacity (3.0-6.0 METs)?
- walking (very brisk)
- cleaning (heavy)
- mowing lawn
- Bicycling
- badminton
44
What are the characteristics of vigorous functional capacity (>6.0 METs)?
- hiking
- jogging
- shoveling
- carryig heavy loads
- bicycling fast
- basketball
- soccer
- tennis
45
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
46
What are examples of true allergy symptoms?
➢ Anaphylaxis
➢ Itching
➢ Urticaria (hives)
➢ Rash
➢ Swelling
➢ Wheezing
➢ Angioedema
➢ Rhinorrhea
➢ Tearing eyes
47
What are examples of symptoms of intolerance or adverse side effects?
o Nausea
o Vomiting
o Diarrhea
o Heart palpitations
o Fainting
48
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
49
________________ is the single most common STD in the US.
Chlamydial genitalia infection
50
__________________________ are examples of steroids that are used to treat many diseases
Cortisone and prednisone
51
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
52
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
53
____ trimester is the safest to provide dental treatment
2nd
54
Pt’s with a hx of IV drug use increased risk for infectious diseases like...
Hepatitis B, C, HIV/AIDS, and infective endocarditis
55
______________ should be avoided for cocaine and methamphetamine users
Vasoconstrictors
- These agents may precipitate
arrhythmias, severe hypertension, MI, and Stroke
56
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
57
What is the issue with tobacco consumption, misuse, and abuse?
Risk factor for many cancers and other diseases (especially oral cancer)
58
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
59
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
60
Checking ___________ first is a good way to initiate a the medical history
medications
61
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
62
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
63
What are the vital signs?
- Blood pressure
- pulse
- respiratory rate
- temperature
- height
- weight
64
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
65
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
66
How is blood pressure measured?
Determined by indirect measurement in the upper extremities with a BP cuff and stethoscope
67
How do you take a blood pressure?
➢ Cuff should encompass 80% of the circumference of the arm.
➢ Center of cuff over brachial artery
➢ Cuff too small → falsely elevated values
➢ Cuff too large → falsely low values
68
Where do you put the arm during a blood pressure?
Horizontal at heart level (mid-sternum)
69
Arm below heart level __________ systolic and diastolic pressures
Over-Estimates
70
Arm above heart level _____________ systolic and diastolic pressures
under-estimates
71
Cuff too small → falsely ________ values
elevated
72
Cuff too large → falsely ___ values
low
73
__________ method of BP measurement is universally accepted
Auscultation
74
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
75
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)
76
NO dental care at UMKSC SOD if BP ≥ __________ mmHg
180/110
77
How do you get a pulse?
➢ Palpate artery carotid at side of
trachea → MORE RELIABLE
➢ Palpate radial artery on the thumb side of wrist
78
Pulse may be influenced by
➢ Exercise/conditioning
➢ Anemia
➢ Anxiety
➢ Drugs
➢ Fever
79
Abnormal pulse rate may be a sign of ___ disorder
CV
80
What is a normal respiratory rate for adults?
12-16 breathes/min
81
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
82
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
83
Rapid weight loss may be a sign of...
malignancy, diabetes, tuberculosis, neoplasm
84
Rapid weight gain may be a sign of...
heart failure, edema, hypothyroidism, or neoplasm
85
What can cyanosis of the skin and nails mean?
cardiac or pulmonary insufficiency
86
What can yellow of the skin and nails mean?
jaundice may be due to liver disease
87
Alterations in fingernails usually seen in chronic disorder
➢ Clubbing (cardiopulmonary insufficiency)
➢ White discoloration (cirrhosis)
➢ Yellowing (malignancy)
➢ Splinter hemorrhages (infective endocarditis)
88
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
89
An earlobe crease ‘may’ be an indicator of...
coronary artery disease
90
What do you need to check on the neck?
➢ Normal, enlarged
* Soft, hard
* Mobile, fixed
* Non-tender, tender
➢ Infections, goiter, cysts, masses, vascular deformities
91
What does an intraoral exam require?
➢ Good lighting, constantly moving
➢ Dental mirror
➢ Gauze
➢ Periodontal probe
➢ Other circumstances: Endo Ice, explorer
92
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
93
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
94
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)
95
Common laboratory testing in dentistry:
- prothrombin time
- PTT (partial thromboplastin time)
96
What is an ASA I?
a normal healthy patient
97
What is an ASA II?
a patient with mild systemic disease
98
What is an ASA III?
a patient with severe systemic disease
99
What is an ASA IV?
a patient with severe systemic disease that is a constant threat to life
100
What is ASA V?
a moribund patient who is not expected to survive without the operation
101
What is ASA VI?
a patient declared brain-dead whose organs are being removed for donor purposes
102
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
103
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
104
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
105
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
