L11. Dental Risk Assessment

"Who is the lecturer for this PowerPoint?

Laurie MacPhail PhD DMD"

"What textbook is referenced in this lecture?

Little and Falace’s Dental Management of the Medically Compromised Patient 10th edition"

"Which courses use this textbook?

D204 Nervous System and Pain D299 Human Systems I D300 Human Systems II"

"When else is this textbook useful?

After graduation in dental practice"

"Why is risk assessment necessary?

Due to advances in medical science and increasing complexity of patients"

"What is one goal of risk assessment?

Obtain reliable information"

"Another goal of risk assessment?

Eliminate unpleasant surprises"

"Another goal of risk assessment?

Increase awareness of risks"

"Another goal of risk assessment?

Establish rapport"

"Another goal of risk assessment?

Communicate with physician"

"What is NOT a goal of risk assessment?

Diagnosing or treating medical conditions"

"Why has need for risk assessment increased?

Advances in medical science"

"What type of diseases increase need for risk assessment?

Chronic medical problems"

"What aspects of systemic disease matter?

Clinical features management and impact on dental care"

"First component of risk assessment

Diagnosis nature of disease"

"Second component of risk assessment

Severity of disease"

"Third component of risk assessment

Control of disease"

"Fourth component of risk assessment

Stability of disease"

"Define functional capacity in risk assessment

Ability of patient to respond to physical or emotional demand"

"What emotional factor must be assessed?

Emotional status of patient"

"What procedure factor must be assessed?

Type and magnitude of planned procedure"

"Example of invasive procedure consideration

Multiple extractions vs dentures"

"What does the A-F checklist include: Analgesics?

Part of risk assessment checklist"

"What does the A-F checklist include: Antibiotics?

Part of risk assessment checklist"

"What does the A-F checklist include: Anesthesia?

Part of risk assessment checklist"

"What does the A-F checklist include: Allergies?

Part of risk assessment checklist"

"What does the A-F checklist include: Anxiety?

Part of risk assessment checklist"

"What does the A-F checklist include: Bleeding?

Part of risk assessment checklist"

"What does the A-F checklist include: Breathing?

Part of risk assessment checklist"

"What does the A-F checklist include: Blood pressure?

Part of risk assessment checklist"

"What does the A-F checklist include: Capacity to tolerate care?

Part of risk assessment checklist"

"What does the A-F checklist include: Drugs?

Part of risk assessment checklist"

"What does the A-F checklist include: Devices?

Part of risk assessment checklist"

"What does the A-F checklist include: Equipment?

Part of risk assessment checklist"

"What does the A-F checklist include: Emergencies?

Part of risk assessment checklist"

"What does the A-F checklist include: Follow-up?

Part of risk assessment checklist"

"Analgesic concern question

Is patient taking aspirin or NSAIDs?"

"Why is aspirin important?

Increases bleeding time"

"Analgesic planning question

Will analgesics be needed post procedure?"

"Antibiotic question 1

Does patient need prophylactic antibiotics?"

"Antibiotic question 2

Is patient currently taking antibiotics?"

"Anesthesia concern

Problems with local anesthetic or vasoconstrictor"

"Allergy question

Does patient have drug allergies?"

"Allergy follow up

What was reaction?"

"Anxiety question

Does patient need anxiolytic or sedative?"

"Stress reduction step 1

Open communication"

"Stress reduction step 2

Short morning appointments"

"Stress reduction step 3

Preoperative sedation"

"Example benzo

Triazolam Halcion"

"Triazolam dose

0.125-0.25 mg"

"When give triazolam

1 hour before appointment"

"Additional dosing option

Night before"

"Intraoperative sedation option

Nitrous oxide oxygen"

"Injection technique

Use topical before injection"

"Post-op management

Adequate pain control"

"Follow up anxiety

Call patient evening of procedure"

"Bleeding concern

Abnormal hemostasis from disease or meds"

"Breathing concern

Difficulty breathing or abnormal rate"

"Blood pressure concern

Is BP controlled during dental treatment"

"Chair position question

Can patient tolerate supine?"

"Position change concern

Rapid position change tolerance"

"Functional capacity example 1

Walk 4 mph"

"Functional capacity example 2

Climb stairs without SOB fatigue chest pain"

"Drug question

Any interactions adverse effects allergies?"

"Documentation requirement drug

List name class indication"

"Where to check meds

axiUm eRx"

"Pharmacy records info

Drug allergies included"

"Step 1 axiUm meds

Select Medications"

"Step 2 axiUm meds

Select +"

"Step 3 axiUm meds

Select eRx"

"To view history

Show medication history"

"Why use Google in meds

Correct spelling"

"Example drug spelling

Hydrochlorothiazide"

"Accurate drug source 1

Epocrates"

"Accurate drug source 2

Lexicomp for Dentistry"

"How access Epocrates

Through axiUm or free signup"

"How access Lexicomp

Through axiUm Temple subscription"

"Example device needing consideration

{d}"

"Example device needing consideration

{d}"

"Example device needing consideration

{d}"

"Example device needing consideration

{d}"

"Example device needing consideration

{d}"

"Example device needing consideration

{d}"

"Equipment concern example

X-ray machine"

"Equipment concern example

Electrocautery"

"Equipment concern example

Oxygen supply"

"Monitoring device example

Pulse oximeter"

"Monitoring device example

Blood pressure monitor"

"Emergency question

Any anticipated emergencies?"

"Follow up question

Need post-op follow up?"

"Follow up method

Call patient at home"

"Medical history definition

Planned professional conversation"

"Purpose medical history

Allow patient to communicate symptoms feelings fears"

"Medical history determines

Illnesses and mental attitudes"

"Medical history type

Two way interaction"

"First step ease patient

Greet and introduce"

"Question type

Open ended"

"Clarification importance

Clarify responses"

"Encourage talk

Build rapport"

"History technique 1

Questionnaire"