Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Dental Management of a Complex Patient > Patient Evaluation and Risk Assessment > Flashcards

Patient Evaluation and Risk Assessment Flashcards

1
Q

Dentistry and medicine today are different
(3)

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Dentistry and medicine today are different
➢ 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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

increased number of conditions
increased complexity of conditions
increased number of medications
=

A

increased combinations and
permutations of dental
treatments

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

The dentist must now be more knowledgeable about a wider range of
medical conditions as patients receive dental treatment
➢ Many chronic disorders or their
treatments necessitate

A

modification
of dental treatment
➢ Hepatitis –1982 -gloves
➢ AIDS –1990 - PPE
➢ COVID-19 –2019 –PPE and vaccines

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Clincians must practice so that the benefit of dental treatment will

A

outweigh the risk(s) of a medical complication occurring either
during treatment or as a result of treatment.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Organized Risk Assessment
(Dental Care) (4)

A

Bleeding
Infection
Drug Effects
Ability to Tolerate Care(CV –Resp –Psych)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Organized Risk Assessment
Acquired Data can be applied to assess risk prior to any oral health care
delivery!
Use an — format.

A

A, B, C…..

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

SKIPPED
Adjunctive Tests
& Procedures

A
  • Refer
  • Imaging
  • Histopathology
  • Microbiology
  • Labs
  • Anesthesia
  • Molecular biology
  • Sequencing
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

P- patient evaluation
(7)

A

Medical History
Medications
Social and Family History
Review of Systems
Objective Findings
History of Present Illness
Chief Complaint

  1. Chief Complaint
  2. History of Present Illness
  3. Medical History
  4. Social and Family History
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

P- patient evaluation
* Identify ALL (2), taken or supposed to be taken
* Review —, discuss relevant issues with patient
* Examine patient for —
* Review or gather recent — or images
* Obtain a —

A

medications & drugs
medical history
signs and symptoms of disease
laboratory tests
medical consult

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Obtain a medical consult
(2)

A
  • If patient has a poorly controlled or undiagnosed problem
  • If you’re uncertain about the patient’s health
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

A (5)

A

Antibiotics
Analgesics
Anesthesia
Allergies
Anxiety

AL(llergies) was ANXIOUS to get ANTIBIOTICS,
ANALGESICS & ANESTHESIA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q
  • Allergies
A
  • Is the patient allergic to drugs or substances that may be used or
    prescribed?
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q
  • Anxiety
A
  • Will the patient need or benefit from a sedative or anxiolytic?
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q
  • Antibiotics
A
  • Will the patient need antibiotics?
  • Is the patient taking an antibiotic?
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q
  • Analgesics
A
  • Is the patient taking aspirin or NSAIDs that can increase bleeding?
  • Will analgesics be needed post-treatment?
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q
  • Anesthesia
A
  • Are there concerns using a local with or without epinephrine?
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

B
(3)

A

Breathing
Bleeding
BP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q
  • Bleeding
A
  • Is abnormal hemostasis possible?
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q
  • Breathing
A
  • Does the patient have difficulty breathing or is the patient’s
    breathing fast or slow?
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q
  • Blood pressure
A
  • Is the patient’s BP well controlled or is it possible it may
    increase/decrease during dental treatment
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

C
(1)

A
  • Chair position
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q
  • Chair position
A
  • Can the patient tolerate a supine or (horizontal) position?
  • Is the patient going to have a problem being raised quickly, after
    treatment?
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

D
(2)

A

Drugs
Devices

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q
  • Drugs
A
  • Any drug interactions, adverse effects, or allergies associated with
    drugs being currently being taken or drugs that the dentist may
    prescribe or use?
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q
  • Devices
A
  • Does the patient have prosthetic or therapeutic device that may
    require tailored management?
  • e.g., prosthetic heart valve, prosthetic joint, stent, pacemaker,
    defibrillator
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

E
(2)

A

Equipment
Emergencies

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q
  • Equipment
A
  • Any potential issues with the use of dental equipment?
  • e.g.: X-ray machine, electrocautery, oxygen supply, ultrasonic cleaner,
    apex locator.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q
  • Emergencies
A
  • Are there medical emergencies that can be anticipated or prevented
    by modifying care?
  • e.g: MI, stroke, asthma, uncontrollable bleeding
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

F
(1)

A

Follow up

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q
  • Follow up
A
  • Is any follow up care indicated?
  • e.g.: 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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Simple Rule: If a local anesthetic(s) are used on a patient and
there was bleeding during the appointment, the patient should

A

be contacted that evening or the following day

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

Medical History
* Must be taken for

A

every patient who is to receive dental treatment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

Two basic techniques used to obtain a medical history
(2)

A

➢ Interview the patient
- Ask patient questions, record the patient’s verbal responses (axiUM at UMKC)
➢ A printed questionnaire the patient fills out

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

SKIPPED
Questions are designed to identify or hint to medical issues that may affect dental teatment:

A
  • Anxiety
  • Cardiovascular diseases
  • Neurologic disorders
  • Gastrointestinal diseases
  • Respiratory tract diseases
  • Musculoskeletal diseases
  • Endocrine diseases
  • STD’s
  • Cancer & radiation treatment
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

Medical History is different from

A

Review of Systems (ROS)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

MED history =

A

patient has already been diagnosed or,
patient presents with information needing a diagnosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

The point of a ROS is to

A

screen for potential new diseases

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

The point of a ROS is to screen for potential new diseases
(2)

A
  • Screening through signs and symptoms with a systems-based approach
  • Findings may be consistent with a particular systemic disease, but you will not diagnose
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

Findings may be consistent with a particular systemic disease, but you will not diagnose
(2)

A
  • Physician’s role →further examine, request labs, diagnose
  • Referral consultation letter →express findings, concerns and a basis for ROS
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

Functional Capacity
 It is important to ask some screening questions.

A

Does the pt have the
ability to engage in normal day-to-day physical activity?

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

It is important to ask some screening questions. 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
➢ Higher MET =

A

metabolic
equivalent levels (METs)
better physical condition

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

A MET is a unit of

A

oxygen consumption
➢ 1 MET equals 3.5 mL of oxygen per kg of body weight per minute at
rest

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

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.

A

T

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

SKIPPED
Caution

A

 Heart disease
 Diabetes
 Tuberculosis
 Anaphylactic allergies
 Asthma, COPD, emphysema
 Bleeding risk (disease-related and/or medication-related)
 Infective endocarditis
 Cancer and cancer treatment (past/present)
 Antiresorptive or antiangiogenic medications (past/present)
 Altered immune status (disease and/or medication-related)
 History of infectious disease (HIV, Hepatitis B,C, STDs etc.)
 Dialysis
 Pregnancy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

Not all ”allergies” are (true) allergies
➢ If a patient responds “yes” when asked if allergic to a particular substance the
mandatory follow-up question is

A

“ what happens?”

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

True allergy
(9)

A

➢ Anaphylaxis
➢ Itching
➢ Urticaria (hives)
➢ Rash
➢ Swelling
➢ Wheezing
➢ Angioedema
➢ Rhinorrhea
➢ Tearing eyes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

Intolerance or an adverse side effect
(5)

A

oNausea
oVomiting
oDiarrhea
oHeart palpitations
oFainting

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

Sexually Transmitted Diseases
 (3) can have manifestations in the oral
cavity

A

Syphilis, gonorrhea, HIV infection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

Syphilis, gonorrhea, HIV infection can have manifestations in the oral
cavity
➢ — may be the first to identify these conditions
➢ Some STD’s including (4), can
be transmitted to the dentist through direct contact with oral lesions
or infected blood
➢ — is the single
most common STD in the US.

A

Dentist
HIV infection, hepatitis B and C, and syphllis
Chlamydial genitalia infection (Chlamydia trachomatis)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

Steroids
 (2) are examples of steroids that are used to treat
many diseases

A

Cortisone and prednisone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

Cortisone and prednisone are examples of steroids that are used to treat
many diseases
➢ They are important because their use can result in

A

adrenal
insufficiency and the patient is unable to mount a normal response to
the stress of an infection or invasive dental procedure, e.g., extractions
or periodontal surgery.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

Operations & Hospitalizations
 History of hospitalizations can provide clues to past illnesses that
may have current significance
➢ An — aspect of your evaluation but an effective way to
identify a current condition

A

INDIRECT

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

History of hospitalizations include (3)

➢ Operations; —; any
emergencies; post-op bleeding; infection; drug allergy should
be ascertained

A

diagnosis, tx, and complications
reason for procedures must always be asked

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

Women who are or might be pregnant may need special consideration in
dental management
➢ Caution is warranted with:
(3)

A

*radiography
*drug administration
*timing of dental treatment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

 Good — is important during pregnancy
 — trimester is the safest to provide dental treatment
 — for urgent care only

A

oral hygiene
2nd
Radiography

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

 Pt’s with a hx of IV drug use increased risk for infectious diseases like:
(4)

A

Hepatitis B, C, HIV/AIDS, and infective endocarditis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
58
Q

 — and sedative meds should be Rx’dwith great caution or not at all
➢ Risk of triggering a relapse

A

Narcotic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
59
Q

 Vasoconstrictors should be avoided for cocaine and methamphetamine
users
➢ These agents may precipitate

A

arrhythmias, severe hypertension, MI,
and Stroke

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
60
Q

Substance Use, Misuse and Abuse
 This portion of the patient interview →

A

PROFESSIONAL TRUST

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
61
Q

Substance Use, Misuse and Abuse
Alcohol consumption
* Risk factor for many cancers and other diseases
* May lead to —, many complications
* Ask how many standard drinks /week

A

liver cirrhosis

62
Q

Substance Use, Misuse and Abuse
Tobacco
* 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)

➢ Cigarettes:
➢ Smokeless tobacco:
➢ Hookah:
➢ E-cigarettes:

A

packs/day ( 1 pack = 20 cigarettes)
cans/week
hours/week
cartridges/week

63
Q

Social Parameters
(3)

A
  • Occupation –looking for environmental/occupation risk
  • Marital status - social support
  • Children
64
Q

Family History
Gives insight to potential diseases with heritability
Watch out for signs and symptoms
(5)

A
  • Hypertension
  • Diabetes
  • Autoimmune disease
  • Cancer
  • Other hereditary diseases and syndromes
65
Q

Family History
Questions?
(3)

A
  • Do any diseases run in your family?
  • Are your parents and siblings alive and well?
  • What did your (mother/father/sibling pass of?)
66
Q

Checking — first is a good way to initiate a the medical history

A

medications

67
Q

➢ Compare with their reported past medical history
➢ Speeds up the intake process, more focused on what to look for as well as on ROS
(3)

A
  • Should match up with medical history
  • Signs and symptoms of disease progression
  • Signs and symptoms of drug-related adverse effects (bleeding, immunosuppression, BP,
    MRONJ, etc.)
68
Q

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.
(2)

A

➢ Patients usually do not list OTC drugs or herbal medicines
➢ Complete list of medications may need to be sought from the patient’s
physician

69
Q

Physical Examination –Objective Findings
(5)

A

 Vital signs
 General appearance
 Skin
 Fingers
 Nails

70
Q

Head and neck examination
(6)

A

Skin
Eyes & Nose
Ears
Cranial nerves
Neck examination
Intra-oral examination

71
Q

Vital Signs
(6)

A

Blood pressure, pulse, respiratory rate, temperature, height,
weight

72
Q

➢ In the dental setting, typically only (2) are measured
directly

A

BP and pulse

73
Q

➢ Respiratory rate is by observation (— r/m)

A

12-16

74
Q

➢ Temperature is measured when

A

infection or systemic
involvement is suspected
- due to COVID pandemic, currently a part of every patient
encounter

75
Q

Height and weight determined by

A

asking the patient

76
Q

Establishing baseline
(2)

A

➢ Can compare if medical emergency occurs during treatment
➢ Screening for problems: poor control, progression,
undiagnosed

77
Q

Purpose is for detection of abnormality and not diagnosis
(2)

A

➢ Diagnosis is responsibility of the physician
➢ Refer if finding is significantly abnormal

78
Q

Blood Pressure
Why is it important to check?
 Screening:
 Monitoring –
 Risk assessment –
 Treatment modifications
 Blood pressure (BP) is variable so — readings are
really the most appropriate

A

you may be the first to detect
compliance/control/progression
potential serious complications
multiple

79
Q

Blood Pressure
 Determined by
➢ Cuff should encompass —% of the circumference of the arm.
➢ Center of cuff over — artery
➢ Cuff too small →
➢ Cuff too large →

A

indirect measurement in the upper extremities with a BP
cuff and stethoscope
80
brachial
falsely elevated values*
falsely low values*

80
Q

White Coat HTN’ elevate BP by — mm Hg*

A

30

81
Q

Pregnant pts w/ ≥ 10 mm Hg increase in systolic BP from baseline
➢ Risk of

A

eclampsia →immediate referral

82
Q

lood Pressure
 Arm position matters

A

➢ Horizontal at heart level (mid-sternum)

83
Q

Arm below heart level

A

Over-Estimates systolic and diastolic pressures
Similar to Cuff too small →falsely elevated values*

84
Q

Arm above heart level

A

under-estimates systolic and diastolic pressures
Similar to Cuff too large →falsely low values

85
Q

Auscultation method of BP measurement is universally accepted
➢ BP cuff should be inflated until radial pulse disappears; then add
additional
➢ Release valve slowly turned. Fall rate of needle ~— mm Hg per second
➢ First audible ‘Beating sound’ (Korotkoff sounds)
*This pressure point =

A

20-30 mm Hg
2-3
Systolic pressure

86
Q

As needle continues to fall, beat will become louder and then diminish
until marked diminution in intensity occurs
(2)

A

➢ Weakened beats heard for a few moments
➢ Reliable index of diastolic pressure = point when sound disappears,
completely

87
Q

Blood Pressure & Dentistry
Focus on accurate measurements:
 Pt avoid (3)
 Pt empty — prior to BP
 Sit quietly for at least – minutes
 Support — to measure BP
 Don’t take BP over —
 Take – readings (on – occasions)

A

caffeine, exercise, (nicotine*)
bladder
5
limb
clothes
2-3 , 2-3

88
Q

cuff too small →
arm too low →

A

falsely elevated values*
falsely elevated values*

89
Q

cuff too large →
arm too high →

A

falsely low values
falsely low values

90
Q

Classification Range
Normal
Elevated
Stage 1
Stage 2
Hypertensive Crisis

A

< 120/80 mm Hg
120 - 129/< 80 mm Hg
130-139 or 80-89 mm Hg
≥ 140 or 90mm Hg
≥ 180 and/or >120

91
Q

— Readings on — Separate Visits

A

≥ 2
≥ 2

92
Q

NO dental care at UMKSC SOD if BP

A

≥ 180/110 mmHg

93
Q

NO dental care at UMKSC SOD if BP ≥ 180/110 mmHg
➢ — is classified as a Hypertensive Urgency by the AHA based on
2017 guidelines
➢ Urgent referral →
➢ If patient is symptomatic →

A

180/120
see doctor ASAP
Emergency Room

94
Q

Pulse
 Standard for
assessing pulse rate
(2)

A

➢ Palpate carotid
artery at side of
trachea →MORE
RELIABLE
OR
➢ Palpate radial artery
on the thumb side
of wrist

95
Q

Do not use the — for
pulse detection

A

thumb
thumb has a pulse

96
Q

Classification Range
Normal
Tachycardia (too fast)
Bradycardia (too slow

A

60-100 bpm
>100 bpm
<60 bpm

97
Q

Abnormal pulse rate may be a sign of — disorder

A

CV

98
Q

Pulse may be influenced by
(5)

A

➢ Exercise/conditioning
➢ Anemia
➢ Anxiety
➢ Drugs
➢ Fever

99
Q

Rhythm The normal pulse is a series of rhythmic beats at regular intervals
➢ Irregular beats are described as:
➢ Palpate the pulse for a full (—) min for accuracy if an arrhythmia is
suspected

A

irregular, dysrhythmic or arrhythmic
1

100
Q

Respiration
 Rate and depth of breathing noted by careful observation of movement of
the chest and abdomen in the quietly breathing patient
➢ Normal respiratory rate adults:
➢ Note: Respiratory rate in small children is — than adults

A

12-16 breaths/min
higher

101
Q

Respiration
Abnormal Breathing Patterns
(4)

A

 Labored breathing
 Rapid breathing
 Irregular breathing patterns
 May be signs of systemic problems, especially cardiopulmonary disease

102
Q

A common finding in apprehensive patients is hyperventilation (rapid,
prolonged, deep breathing or sighing), which may result in

A

lowered carbon
dioxide levels and cause disturbing symptoms and signs

103
Q

Pre-COVID-19 pandemic - — is not usually recorded during
routine dental examinations

A

Temperature

104
Q

Pre-COVID-19 pandemic - Temperature is not usually recorded during
routine dental examinations
➢ Determined when a patient has febrile signs or symptoms that may be
due to

A

an abscessed tooth or a mucosal or gingival lesion

105
Q

A Normal oral temp. is —°F (37°C) but may vary by as much as plus or
minus 1°F over 24 hours

A

98.6

106
Q

Weight
 Patient’s should be questioned about recent unintentional loss or gain of
weight
➢ Rapid weight loss may be a sign of:

A

*malignancy, diabetes, tuberculosis, neoplasm or other wasting
disease

107
Q

➢ Rapid weight gain can be a sign of:

A

*heart failure, edema, hypothyroidism, or neoplasm

108
Q

SKIPPED
General Appearance

A

 A lot can be learned about a patient’s health from a purposeful but tactful
visual inspection
➢ Lead to awareness of abnormal/unusual features or medical conditions
that may exist and could influence your dental care
 This survey is an assessment of the general appearance and inspection of
exposed body areas
➢ Each visually accessible area may demonstrate peculiarities that can
signal underlying disease

109
Q

Changes in the skin and nails can be associated with systemic disease.
Examples:
➢ Cyanosis can indicate
➢ Yellowing or jaundice may be due to
➢ Pigmentation may be due to
➢ Petechiae or ecchymoses can be sign of

A

cardiac or pulmonary insufficiency
liver disease
hormonal abnormalities
blood dyscrasia or bleeding disorder

110
Q

Alterations in fingernails usually seen in chronic disorder
➢ Clubbing
➢ White discoloration
➢ Yellowing
➢ Splinter hemorrhages

A

(cardiopulmonary insufficiency)
(cirrhosis)
(malignancy)
(infective endocarditis)

111
Q

Dorsal hand surfaces are common for

A

actinic keratosis & basal cell carcinomas

112
Q

A raised, darkly pigmented lesion w/ irregular borders could be a —

A

melanoma

113
Q

Shape and symmetry of face are abnormal in many syndromes and
conditions
 Well-regarded examples:
➢ acromegaly
➢ Cushing’s syndrome
➢ Bell’s palsy

A

Coarse and enlarged features
Moon face
Unilateral paralysis

114
Q

bells palsy
May be indicative of a

A

permanent or temporary paralysis
May limit intraoral access

115
Q

Eyes can be indicators of — and should be
inspected closely
 Patients wearing glasses should be asked to remove them during
examination of head and neck

A

systemic disease

116
Q

➢ Hyperthyroidism

A
  • Lid retraction
117
Q

➢ Hypercholesterolemia

A
  • Xanthomas of the eyelids
118
Q

➢ Liver Disease (**Problem metabolizing drugs)

A
  • Yellowing of sclera
  • Hepatitis, Alcoholics
119
Q

➢ Allergy or Sicca syndrome

A
  • Conjunctiva reddening
120
Q

Ears
 An earlobe crease ‘may’ be an indicator of
 Malignant or premalignant lesions may be found in or around the ears

A

coronary artery disease

121
Q

earlobe crease –non-specific for

A

heart disease

122
Q

Head & Neck Examination
 Examination of the head and neck may vary in its comprehensiveness but
should include

A

inspection and palpation of the soft tissues of the oral
cavity, maxillofacial region, and neck, as well as evaluation of cranial nerve
function

123
Q

Neck Inspected for enlargement or asymmetry
➢ Normal, enlarged
(3)

A

*Soft, hard
*Mobile, fixed
*Non-tender, tender

124
Q

inspected for enlargement or asymmetry
(5)

A

Infections, goiter, cysts,
Masses, vascular deformities

125
Q

intraoral Examination
 Should be performed in an organized way:
➢ Don’t go straight for the patient’s —
➢ Following a logical identical sequence every time
(remember protocol on reading an FMS)
➢ Only evaluate — structure at a time; if you multitask you are likely to –
➢ – is extremely important

A

chief complaint
one, miss details
Palpation

126
Q

Intraoral Examination
Requires
(5)

A

➢ Good lighting, constantly moving
➢ Dental mirror
➢ Gauze
➢ Periodontal probe
➢ Other circumstances: Endo Ice, explorer

127
Q

Physical Examination
Must be routine
(2)

A

➢ do it the same way every time
➢ aka - like reviewing an FMS

128
Q

Physical Examination
A recommended sequence (courtesy of Dr. Tiffany Tavares)

A

➢ 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
* Ask patient to take a deep breath through their mouth and say ”ah”

129
Q

Stress & Anxiety Reduction
 Open communication about —
 — appointments (usually in the —)
 Pre-dental treatment sedation—
 During dental treatment sedation (i.e., —)
 Profound —
 Good post-dental treatment — control
 Patient contacted the — of the procedure

A

fears/concerns (rapport)
Short, morning
1hr prior appt., Benzodiazepines (e.g., triazolam .25mg)
Nitrous Oxide
local anesthesia
pain
evening

130
Q

Risk Assessment
 Completion of patient evaluation
(3)

A

➢ Medical history
➢ Meds/drugs
➢ Clinical examination

131
Q

SKIPPED
Do I have all the information I need?
(4)

A

➢ Do I need adjunctive tests and procedures?
➢ Is a medical consultation/referral warranted?
➢ Can the patient safely undergo the planned treatment?
➢ Are treatment modifications necessary?

132
Q

Clinical Laboratory Tests
 An important part of the evaluation of a patient’s —
 When laboratory test results are reported, they are accompanied by —-
 If you’re ordering labs or reviewing labs with a patient, than more than
likely the patient has —

A

health status
normal values for that particular laboratory
medical complexities

133
Q

Clinical Laboratory Tests
 Indications for laboratory testing in dentistry:
(4)

A

➢ 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)

134
Q

Clinical Laboratory Tests Common laboratory testing in dentistry:
➢ CBC: Complete blood count with platelets & WBC differential
* RBC:
* WBC:
* Platelet Count:

A

4.2-5.9 million/mm3
4,000-10,000/mm3 h
150,000-400,000/mm3

135
Q

Common laboratory testing in dentistry:
➢ Prothrombin time –International Normalized Ratio (PT-INR):
* Helps determine
* Measures (2)
* Normal =
* Higher INR means

A

bleeding risk
extrinsic and normal coagulation cascade pathways
1 (INR= 2-3 if on Coumadin)
higher bleeding risk

136
Q

Common laboratory testing in dentistry:
➢ P.T.T.: Partial Thromboplastin Time (I.V. Heparin)
* — Pathway
* Normal range is
* aPTT is used for
**Balance the risk of bleeding vs risk of —

A

Intrinsic
25-38 seconds
Pradaxa (activatedPTT)
thrombosis

137
Q

Current Physician(s)
 Identify the patient’s physician
 Why is the patient receiving medical care, diagnoses, and treatment
received
➢ Even for routine physical examinations, the patient should be asked

➢ The name, address, and phone number of the physician should be
recorded

A

whether any problems were discovered and the last date of the exam

138
Q

Current Physician(s)
 Patient without a physician, no recent routine check-up history? CAUTION
 The response may provide insight into the priorities that a patient assigns
to health care
➢ The patient may be unaware of an underlying condition
➢ — is very important in these patients
➢ Refer patient to have a check-up and general labs drawn prior to any
invasive dental treatment

A

ROS

139
Q

Medical Consultation/Referral
 On the basis of medical history, physical examination, and laboratory
screening, contact with the patient’s physician for consultation or referral
purposes may be warranted
 Requests for information should be made in writing by letter or fax, if
possible; however, a phone call may be more expedient
 Document — in the patient’s chart!
 A — record is a legal record!

A

communications
written

140
Q

Good practices
* Provide clinical context

A
  • Patient-reported medical history
  • Patient-reported medications
  • Positive findings on review of systems where applicable
  • Vital readings
  • Dental treatment to be performed (stress, bleeding, drugs to be used pre, peri, and/or
    post-operatively )
  • Any other relevant intraoral or extraoral findings
  • Avoid dental jargon
  • Concisely express your concerns, but be specific about the input you need
  • You MUST KNOW WHY you are asking that question
  • Take ownership (even if partial) of the risk assessment
    Remember that you are asking for a favor
    When there is complex medical history or if patient seems to be a poor
    historian
  • Ask for last clinical note (helps provide more context on the patient’s
    health status)
141
Q

Take ownership (even if partial) of the risk assessment
* Sample questions:
(2)

A

➢What is the patient’s BP goal (range)?
➢ Do you have any concerns regarding the proposed dental treatment based on his current
cardiac status?

142
Q

When there is complex medical history or if patient seems to be a poor
historian
* Ask for last clinical note (helps provide more context on the patient’s
health status)
➢ Please provide us with

A

a copy of the patient’s most recent clinical note

143
Q
  • Check for missing medical information and updated medication list
    (2)
A

➢ Are there any other medical problems not listed here that we should be aware of?
➢ Please provide an updated medication list. OR Is the patient taking any other
medications not listed here?

144
Q

Treatment Modifications
(2)

A

 Systematic assessment of risk and identifying potential problems
 Simple modifications in dental tx delivery can reduce risk to the patient

145
Q

 Simple modifications in dental tx delivery can reduce risk to the patient
➢ Risk is always increased when treating a
➢ Try to anticipate

A

medically complex patient
possible urgencies or emergencies and be prepared to
manage

146
Q

 Don’t start something you cannot finish
 Don’t start a procedure if you cannot deal with the potential complications
(3)

A

➢ Know potential complications
➢ Apply to patient’s clinical context
➢ Plan around likelihood of most severe complication

147
Q

ASA PS 1
(5)

A

▪ Healthy 20
year old
▪ 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
A normal healthy
patient

148
Q

ASA PS 2
▪ — systemic disease

▪ Blocks/fight of stairs
▪ — risk during treatment

▪ Who? (6)

A

Mild
▪ Pt has mild systemic disease
Pt walk one flight of stairs
or 2 level city blocks, but
has to stop after exercise
because of distress

Minimal

▪ ASA PS1 with extreme anxiety/fear
▪ 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

149
Q

ASA PS 3
▪ — Systemic disease
▪ Blocks/flight of stairs
▪ If dental care is needed,

▪ Who? (3)

▪ 30 days or more ago hx of:
(3)

A

Severe
▪ 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
stress reduction protocol and other tx modifications are indicated

▪ Well-controlled hypertensive on medication
▪ Well-controlled diabetic on insulin
▪ Slight COPD

➢ Myocardial infarction
➢ Cerebrovascular accident
➢ Congestive heart failure

150
Q

asa 3
Patient’s disease has significant impact on

A

daily activity

151
Q

ASA PS 4
▪ — Systemic disease that is a —

▪ Block/flight of stairs?
▪ Pt poses
▪ Elective dental care postponed until
▪ Emergency dental care may be
best in

Who? (6)

A

Severe, constant threat to life
▪ 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

significant risk during treatment
ASA 3 class
a hospital with a consultation with the Pt’s physician team

▪ 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

Dental Management of a Complex Patient (13 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions