Using the ICF framework Taking a Medical History Flashcards
What are the types of barriers that can influence the patient’s treatment?
Individual (Anxiety, fear, financial, lack of access)
Dental
Societal (inadequate research)
Developmental
What are the things we want to be able to do as dentists for patients with special needs
To be able to allow patients to maintain good oral hygiene +/- assistance
Keep patients away from pain
Maintain aesthetics
Do no harm to patients
What are the 2 models of disability?
The medical model of disability: Impairments or problems that pose real difficulties to the patient. Focus is on the individual with the disability.
The social model of disability: People are disabled by barriers in society. All medical and dental functions should remove the barriers for the individual to have access to adequate care
What does the ICF tool allows healthcare workers to do?
To better understand the patients’ body structure and function, activities and participation rather than a central focus on medical criteria, specifically a medical diagnosis.
What should be included in the medical summary?
Introduction
Presenting complaint
History of presenting complaint
Past medical/surgical history
Current meds
Past meds
Allergies and adverse effect
What should be achieved from the medical history?
Taking a medical history means you should be able to interpret its significance
How does disease progression affect treatment plans?
What is normal organ function?
When should medical history be completed?
Ask about general health at the beginning of every appointment
Specific health issues relevant to patient
Use standardized medical questionnaire
What psychological considerations should be made while treating a patient?
Anxiety/phobia or negative experiences at the dentist.
Risk of other complications
Patients who have had adverse experience are more likely to have similar experience in the future.
How can a dentally anxious/phobic patient be comforted in the chair?
Establish a good relationship with the patient and avoid mistakes of the past.
Acknowledge the patient and try to address them
Sedation can be considered.
What is anticoagulation?
Use of medication to directly or indirectly inhibit one or more coagulation factors thus inhibiting thrombus formation.
What antiplatelets are commonly used and how do they work?
Aspirin blocks TXA2 receptor.
Clopidogrel blocks ADP
What anticoagulants are commonly used?
Warfarin (vitK antagonist)
Rivaroxiban
Apixaban
Heparin
What is the most important coagulation test to know for dentistry?
Prothrombin time INR ratio (how long it takes to stop bleeding generally)
What challenging behaviours can be provided by patients with autism?
Non-compliance
Hyperactivity
Sensory hypersensitivity
Self-injurious behaviour
What should be asked about with a patient that has had a stroke?
Date of the stroke, persistent neurological deficits and their impact on activities of daily living
Current medical managemetn and rehabilitation
Subsequent visits: Information regarding further stroke incidents
What should be asked about with a patient that has neurological problems?
History of fits or faints
Type, frequency, precipitating factors, medications, stroke history
Are you suffering from memory loss or have you been diagnosed with dementia/alzheimer’s?
What should be asked about with dementia?
Form of dementia, manifestations
Management
Consent issues
Dependence on carers, level of care
Communication and compliance issues
Many barriers to access of care
Can paid carers provide consent?
Paid carers do not provide consent
How can recreational drugs affect oral health?
Cannabis: Xerostomia, caries, perio, increased risk of oral cancer
Amphetamines: Poor oral hygiene, rampant caries, bruxism, noncarious tooth wear, xerostomia
Cocaine: Bruxism, non-carious tooth wear, gingival erosions, ulcerative lesions
Opioids: Rampant caries and periodontitis
Why is it important to ask about mental health for dental treatment?
Vulnerable lifestyle
Medications for mental health disorders
Fatigue and lack of motivation
Poor oral health outcomes and potential high costs
What should be asked about respiratory conditions?
Want to see if patient can handle rubber dam, LA, etc
COPD
Asthma
TB
Influenza
Cystic fibrosis
What should be asked to HIV patients?
CD4 count
White cell count
Specialist details
Why ask about osteoporosis?
How is it being managed? Bisphosphonates (ONRJ) Prolea isn’t the first option
How can behavioural modifications be implemented?
Tell-show-do
Rest breaks and signalling
Distraction
Positive reinforcement
Desensitization
Engage family and carers
What pharmacological interventions can be used to modify behaviour?
Relative Analgesia (NO)
Sedation (IV or oral)
General anaesthesia
How can diabetes affect treatment in special needs patients?
Hyperglycaemia, expelled glucose in urine, body has no glucose in cells so metabolizes fats for energy causing acidaemia leading to coma or death.
What is type 1 diabetes?
20% of cases occurs early on and involves absolute deficiency of insulin, usually immune mediated, sudden onset
What are the signs of type 2 diabetes?
Increasing obesity
Relative insulin deficiency (adequate insulin normally but resistant cells)
How common is secondary diabetes?
<1% of cases
What are the features of gestational diabetes?
2 - 4% of all pregnancies
Often returns to normal after delivery.
In untreated cases infant mortality of 7%.
Diet modification may control the disease but insulin required in some cases
What levels of HbA1c indicate normal blood glucose control? what about fair and poor control?
5 - 8% good
8.1 - 11.9% fair
> 12% poor
How should diabetic dental treatment be carried out?
Well-controlled = short, atraumatic, as stress free as possible
What should diabetic patients be instructed to do?
Take meds as prescribed
Continue diet control
Continue self monitoring glucose levels
Eat normal breakfast before dental appointments
Organise early appointments
What should be done with AB and LA on patients with diabetes?
Vasoconstrictor drugs should be included
AB cover not necessary in routine dental care. May be required if there is poor control.
AB administered for oral infections
How should diabetic blood glucose be used to decide on whether to treat or not?
Unstable = proceed if 6 - 11mmol/L glucose. If >12mmol refer patient to medical practitioner to have meds adjusted. If <3mmol hypoglycaemia, patient requires glucose and should be referred to medical practiitioner to be treated as an emergency
How should poorly controlled diabetic patients be treated?
Prophylactic antibiotics indicated for surgical or periodontal treatment. This is to minimise the potential for post op infection and delayed wound healing.
Consult with patient’s physician and treat with caution.
How does wound healing change in diabetic patients?
Wound healing is a problem in patients with long standing hyperglycaemia due to lack of factors from saliva to help with healing. Many poorly controlled diabetics will have poor dental health and oral hygiene and may avoid relevant health professionals.
