Preventive Procedures - Week 4 PP Flashcards
Role of the Dental Assistant
- Aiding the dentist in providing treatment
- Serving as a source of information to the patient and family
- Making the patient more comfortable and
reducing anxiety
Patient’s Medical History
A thorough medical history is taken from every patient before dental treatment can
proceed. NO blank spaces on medical history form - must complete every question.
The responsibility of the dental team is to review the medical history, initiate conversation, and ask questions to gain greater insight into the patient’s well-being.
Importance of Medical History
The medical history section includes questions regarding the patient’s medical history, present physical conditions, chronic conditions, allergies, and current medications.
This information:
1. Alerts the dentist to possible medical conditions and medications that could complicate or interfere with dental treatment
2. Aids the dentist in anticipating any potential medical emergencies based on the patient’s medical background
3. Identifies special treatment needs that a patient may require.
If specific medical conditions are a matter of concern to the dentist, the dentist will consult with the patient’s physician regarding treatment.
The patient would be required to sign a release-of-information form to give consent before a consultation can take place.
Medical & Dental History
- Systemic diseases such as acquired immunodeficiency syndrome, human immunodeficiency virus infection, and diabetes can decrease resistance of the tissue to infection
- Dental history is used to gather information about conditions that could indicate periodontal disease
- For example, patients with periodontal disease often complain of bleeding gums, loose teeth, or a bad taste in the mouth
Bacteremia
When bacteria or other microorganisms enter the bloodstream, they are killed before they can do serious damage.
When the heart is already damaged because of disease (for example congenital heart disease or valve disease) or surgery (such as implantation of an artificial heart valve or
a pacemaker), the tissue becomes rough and bacteria can attach more easily to heart valves or the heart lining.
This can have serious consequences - can happen with any simple dental procedure - even probing/exploring.
How Bacteremia is produced:
Bacteremia is the presence of bacteria in the blood. Those who are immunocompromised have a hirer risk.
Evidence suggests daily oral activities can produce transient bacteremia some
examples are:
1. Chewing
2. Tooth brushing
3. Flossing
-Bacteremia is significantly higher in patients who have more dental biofilm accumulation and gingival inflammation following tooth brushing.
-Power toothbrushes cause more bacteremia than manual toothbrushes.
-Despite these findings, there is no clear association between transient bacteremia and infective endocarditis (heart conditions).
-Research suggests that patients, especially those who are medically compromised, should maintain meticulous removal of dental biofilm on a daily basis to reduce the chances of bacteremia
Antibiotic Prophylaxis
Antibiotic prophylaxis (AP) is prescribing an antibiotic to a patient to prevent bacterial colonization (infection) while undergoing dental treatment.
Indications for antibiotic prophylaxis are prescribed for patients who are at the greatest risk of post-treatment bacterial related complications for infective endocarditis, which includes:
1. Prosthetic cardiac valves/material
2. Congenital heart disease (CHD)
3. Previous, relapse, or recurrent infective endocarditis
4. Cardiac transplant recipients who develop cardiac valvopathy
Must wait 6 months after heart attack for dental treatment.
There are other diseases/conditions that will warrant the use of antibiotics - would come from consult with doctor/dentist.
Who is at risk?
The Canadian Dental Association (CDA) supports the American Heart Association (AHA) recommendations that only patients who are at the greatest risk adverse outcome from infective endocarditis, an infection of the heart’s lining of heart valves require prophylaxis prior to dental procedures that:
“Involve manipulation of gingival tissue or the periapical regions of teeth that perforate the oral mucosa, for example dental probing”
Benefits must outweigh the risks
When is antibiotic prophylaxis is NOT required for high-risk patients
The following procedures and events do not need prophylaxis for high-risk patients:
1. Routine anesthetic injection through no infected soft tissue
2. Dental radiographs
3. Placement of removable prosthodontic or orthodontic appliances
4. Adjustment of orthodontic appliances
5. Placement of orthodontic brackets
6. Shedding of deciduous (primary) teeth
7. Bleeding from trauma to the lips or mucosa
Who is at risk?
- People with underlying heart problems such as congenital heart disease, valvular heart disease, hypertrophic cardiomyopathy, rheumatic heart disease, or previous experiences with endocarditis.
- Individuals who have undergone heart valve repair or replacement, or have had a pacemaker inserted into their chest.
- Intravenous drug users
- People who are immunocompromised by such things as an organ transplant or HIV.
The periodontal examination includes:
-Assessment of the amounts of plaque and calculus
-Changes in gingiva health and bleeding
-Assessment of the level of bone (when you have periodontal disease.. there is bone loss)
-Detection of periodontal pockets
(a) Normal probing depth
(b) inflamed periodontal pocket deeper probing depth
Normal Sulcus vs. Periodontal Pocket
Healthy Sulcus - 1-3mm
- the probing depth should be between 1-3mm
- gingiva is tightly connected to the cementum on the root the connective tissue cover of the alveolar bone
Diseased Sulcus - 4mm and up!!!
- a probing depth deeper than 3mm indicates a periodontal pocket
-changes in the gingiva (colour, size, shape, texure)
-gingival inflammation
- evidence of exudates (pus)
Periodontal Pockets vs Gingival Pocket
Periodontal Pocket “diseased”
A pocket is formed as a result of disease or degeneration that causes junctional epithelium to migrate apically along the cementum.
- The connective tissue attachment at the base of a periodontal pocket is destroyed
-indicates disease and bone loss
Gingival pockets - not diseased
a pocket formed by gingival enlargement without apical migration of the junctional epithelium.
Can also be referred to as a “pseudo pocket” (fake)
Calibrated Periodontal Probes
Used to locate and measure the depth of periodontal pockets
On some types of probes, the tip is color-coded to make the measurements easier to read
Periodontal probe is tapered to fit into the gingival sulcus and has a blunt or rounded tip.
Six measurements are taken and record for each tooth. (Buccal, Disto-Buccal, Mesio-Buccal, Lingual, Disto-Lingual, Mesio-Lingual)
Computer Assisted Probe
Computer-assisted probes allow auto-mated and guided measurements that are integrated into the software o the clinic.
The results are transferred directly to management software, allowing the results to be displayed quickly on the periodontal graph and do not have to be recorded manually.
