PHASE 0-real deck

Question 1

Why a systemic phase of treatment?

Answer 1

• each pt has own unique health issues and dental needs
• dentist-establish and maintain the best possible stage of physical health before, during, and after tx.

Question 2

What is a core function of the systemic phase of treatment?

Answer 2

• evaluate the severity and complexity of health issues
• Assess how these issues might affect dental tx

Question 3

Pathophysiology: Decision making

Answer 3

• the disordered physiological processes associated w/disease or injury
  
  • must be aware for all the patients health problems
  • understand the implications that each health problem has independently and in combo on delivery of dental care
  • decide if it is safe to provide dental care
    
    • or alter, limiting or even postponing is necessary

Question 4

What would the systemic phase consist of for a patient with no to few health problems?

Answer 4

• evaluating vital sings
• updating health history

Question 5

What would the systemic phase consist of for a patient with multiple health issues, with polypharmacy?

Answer 5

• may require multi-faceted systemic phaser of care including
  
  • med consult w/physicians and pharmacist
  • lab testing
  • possible modification of dental tx.
  • careful monitoring of the patients health
    
    • before, during and afte

Question 6

Systemic Phase Goals

Answer 6

• Recognize symptoms and signs of undiagnosed systemic disease
  
  • refer pt to a physician for med eval
• Limit or modify dental tx based on systemic findings
• prevent
  
  • emergencies
  • serious post-op complications

Question 7

What are some examples of recognizing symptoms and signs of undiagnosed systemic disease and ultimately pt referral?

Answer 7

• BP readings consistently in the hypertensive range:
  
  • Hypertensive range:
    
    • Systolic >130
    • Diastolic >80
• Elevated blood glucose reading
  
  • Normal blood glucose:
    
    • Fasting>100
    • 2hr postprandial >140

Question 8

Examples of modifying/limiting dental treatment

Answer 8

• pt on dialysis
• extreme hypertension
• active oral herpetic lesion
• Active Herpes Zoster
• Pregnant

Question 9

ASA Classifications:

Answer 9

• estimate a patients risk status
• eval if systemic problems present a risk to providing dental care or will adversely affect the prognosis
• ASA 1
  
  • healthy patients
• ASA 2:
  
  • Mild→moderate systemic disease
    
    • caused by
      
      • surgical condition
      • pathological processes
    • medically well controlled
• ASA 3:
  
  • Severe disease
  • limits activity but is not incapacitating
• ASA 4
  
  • severe incapacitating disease
  • constant threat to life
• ASA 5
  
  • Moribund patient
  • not expected to survive 24 hrs with or without operation
• ASA 6
  
  • Declared Brain-Dead patient
  • organs are being removed for donor purposes

Question 10

Prevention of Post-op Complications

Answer 10

• some post-op sequelae is expected after most dental txs
• compromised patients-more severe problems
  
  • Immunocompromised, poorly controlled diabetes, kidney faillure
    
    • POST OP infection, pian, swelling
  • Anti-clotting, anticoagulant therapy, decreased liver function
    
    • higher risk for blood loss
• Dentist must recognize and anticipate management required
  
  • give patient detailed instructions
  • use stress reduction procedures
    
    • behavioral management
    • prescribing eds to alleviate anxiety