Using the ICF framework Taking a Medical History

Question 1

What are the types of barriers that can influence the patient’s treatment?

Answer 1

Individual (Anxiety, fear, financial, lack of access)

Dental

Societal (inadequate research)

Developmental

Question 2

What are the things we want to be able to do as dentists for patients with special needs

Answer 2

To be able to allow patients to maintain good oral hygiene +/- assistance

Keep patients away from pain

Maintain aesthetics

Do no harm to patients

Question 3

What are the 2 models of disability?

Answer 3

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

Question 4

What does the ICF tool allows healthcare workers to do?

Answer 4

To better understand the patients’ body structure and function, activities and participation rather than a central focus on medical criteria, specifically a medical diagnosis.

Question 5

What should be included in the medical summary?

Answer 5

Introduction

Presenting complaint

History of presenting complaint

Past medical/surgical history

Current meds

Past meds

Allergies and adverse effect

Question 6

What should be achieved from the medical history?

Answer 6

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?

Question 7

When should medical history be completed?

Answer 7

Ask about general health at the beginning of every appointment

Specific health issues relevant to patient

Use standardized medical questionnaire

Question 8

What psychological considerations should be made while treating a patient?

Answer 8

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.

Question 9

How can a dentally anxious/phobic patient be comforted in the chair?

Answer 9

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.

Question 10

What is anticoagulation?

Answer 10

Use of medication to directly or indirectly inhibit one or more coagulation factors thus inhibiting thrombus formation.

Question 11

What antiplatelets are commonly used and how do they work?

Answer 11

Aspirin blocks TXA2 receptor.

Clopidogrel blocks ADP

Question 12

What anticoagulants are commonly used?

Answer 12

Warfarin (vitK antagonist)

Rivaroxiban

Apixaban

Heparin

Question 13

What is the most important coagulation test to know for dentistry?

Answer 13

Prothrombin time INR ratio (how long it takes to stop bleeding generally)

Question 14

What challenging behaviours can be provided by patients with autism?

Answer 14

Non-compliance

Hyperactivity

Sensory hypersensitivity

Self-injurious behaviour

Question 15

What should be asked about with a patient that has had a stroke?

Answer 15

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

Question 16

What should be asked about with a patient that has neurological problems?

Answer 16

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?

Question 17

What should be asked about with dementia?

Answer 17

Form of dementia, manifestations

Management

Consent issues

Dependence on carers, level of care

Communication and compliance issues

Many barriers to access of care

Question 18

Can paid carers provide consent?

Answer 18

Paid carers do not provide consent

Question 19

How can recreational drugs affect oral health?

Answer 19

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

Question 20

Why is it important to ask about mental health for dental treatment?

Answer 20

Vulnerable lifestyle

Medications for mental health disorders

Fatigue and lack of motivation

Poor oral health outcomes and potential high costs

Question 21

What should be asked about respiratory conditions?

Answer 21

Want to see if patient can handle rubber dam, LA, etc

COPD

Asthma

TB

Influenza

Cystic fibrosis

Question 22

What should be asked to HIV patients?

Answer 22

CD4 count

White cell count

Specialist details

Question 23

Why ask about osteoporosis?

Answer 23

How is it being managed? Bisphosphonates (ONRJ) Prolea isn’t the first option

Question 24

How can behavioural modifications be implemented?

Answer 24

Tell-show-do

Rest breaks and signalling

Distraction

Positive reinforcement

Desensitization

Engage family and carers

Question 25

What pharmacological interventions can be used to modify behaviour?

Answer 25

Relative Analgesia (NO)

Sedation (IV or oral)

General anaesthesia

Question 26

How can diabetes affect treatment in special needs patients?

Answer 26

Hyperglycaemia, expelled glucose in urine, body has no glucose in cells so metabolizes fats for energy causing acidaemia leading to coma or death.

Question 27

What is type 1 diabetes?

Answer 27

20% of cases occurs early on and involves absolute deficiency of insulin, usually immune mediated, sudden onset

Question 28

What are the signs of type 2 diabetes?

Answer 28

Increasing obesity

Relative insulin deficiency (adequate insulin normally but resistant cells)

Question 29

How common is secondary diabetes?

Answer 29

<1% of cases

Question 30

What are the features of gestational diabetes?

Answer 30

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

Question 31

What levels of HbA1c indicate normal blood glucose control? what about fair and poor control?

Answer 31

5 - 8% good

8.1 - 11.9% fair

> 12% poor

Question 32

How should diabetic dental treatment be carried out?

Answer 32

Well-controlled = short, atraumatic, as stress free as possible

Question 33

What should diabetic patients be instructed to do?

Answer 33

Take meds as prescribed

Continue diet control

Continue self monitoring glucose levels

Eat normal breakfast before dental appointments

Organise early appointments

Question 34

What should be done with AB and LA on patients with diabetes?

Answer 34

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

Question 35

How should diabetic blood glucose be used to decide on whether to treat or not?

Answer 35

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

Question 36

How should poorly controlled diabetic patients be treated?

Answer 36

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.

Question 37

How does wound healing change in diabetic patients?

Answer 37

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.