Reducing Risk for a Medical Emergency

What percentage of office emergencies are preventable?

About 90%.

What is the key to preventing medical emergencies?

Updating medical history, vital signs, identifying risks, and minimizing them.

Which patients require special attention in dental settings?

Patients with diabetes and cardiovascular disease.

What does 'Never Treat a Stranger' mean?

Thoroughly assess patients to identify unrecognized medical conditions.

According to the Surgeon General report, what is the mouth considered?

A mirror of health or disease.

What should be observed during patient assessment?

Physical appearance, body language, anxiety level, and emotional state.

Why is a thorough head and neck exam important?

It may reveal undiagnosed medical conditions.

What are the two major risk factors for medical emergencies in dentistry?

Health and stress.

Why is medical history important?

Provides legal documentation and identifies health risks.

What should be included in a medical history?

Medical conditions, allergies, medications, vital signs, consults, and premedication needs.

How often should vital signs be updated?

Baseline and at least yearly.

What type of questions should be asked during medical history review?

Open-ended questions.

Example of a good open-ended medical history question?

What health changes have you had since your last appointment?

What medication information should be updated?

Prescription meds, vitamins, herbs, supplements, and OTC medications.

Basic medical history question about bleeding?

Do you have a history of bleeding issues?

What should be done if a patient answers 'yes' to medical history questions?

Investigate further for treatment modifications.

Which cardiac patients require premedication?

Patients with prosthetic heart valves or valve repairs.

Patients with what heart infection history require premedication?

Infective endocarditis.

What congenital heart condition requires premedication?

Unrepaired cyanotic congenital heart disease.

What repaired congenital defects may require premedication?

Defects with residual shunts or valvular regurgitation.

Patients with what joint history may possibly need premedication?

Previous artificial joint infection.

What oral infection may require premedication?

Severe spreading infections like cellulitis.

Who is considered immunocompromised?

Patients with HIV/AIDS, uncontrolled diabetes, cancer therapy, transplant, etc.

When should premedication antibiotics be taken?

30-60 minutes before appointment.

Standard adult premedication regimen if not allergic to penicillin?

Amoxicillin 2 grams.

Are clindamycin and erythromycin recommended for penicillin allergy?

No.

Alternative antibiotics for penicillin-allergic patients?

Cephalexin, cefadroxil, azithromycin, or clarithromycin.

Normal fasting blood sugar range?

Approximately 70-99.

Recommended A1C for diabetic patients?

Less than 7%.

Why are morning appointments recommended for diabetics?

Helps maintain regular meals and glucose balance.

What should you ask diabetic patients before treatment?

If they ate and took medications today.

Should uncontrolled diabetic patients be treated?

No.

What should be done before extensive procedures for diabetics?

Test glucose levels.

Important asthma/COPD medical history questions?

Triggers, last attack, inhaler use, inhaler availability.

Prevention methods for breathing issues?

Keep inhaler accessible and patient slightly upright.

Risks associated with asthma/COPD medications?

Dry mouth and dental stress.

Prevention methods for airway obstruction?

Rubber dam, suction, gauze partition, floss ligatures.

Important seizure history question?

When was your last seizure?

Should uncontrolled seizure patients be treated?

No.

What should be avoided for seizure patients?

Known triggers.

What dental procedures account for most complications?

Extractions and pulp extirpations.

Most complications result from what?

Sudden unexpected pain.

What are signs of dental anxiety?

Sweaty palms, trembling, hyperventilation, nausea, increased vitals.

What is 'white-knuckle syndrome'?

Unnaturally stiff posture due to anxiety.

What are strategies for managing anxious patients?

Morning appointments, short appointments, minimize waiting.

Why should patients not stand too quickly after treatment?

Prevent dizziness or syncope.

What is normal blood pressure?

Less than 120/80.

What is the stage 1 hypertension range?

130-139 systolic or 80-89 diastolic.

What values indicate a hypertensive crisis?

Greater than 180/120.

What is the normal pulse range?

60-100 bpm.

What pulse values are considered distress?

Less than 50 or greater than 120.

What is the normal respiration rate?

12-20 breaths/minute.

What values indicate respiratory distress?

Less than 10 or greater than 20 respirations/minute.

What can gurgling respirations indicate?

Airway obstruction.

What can snoring sounds indicate?

Stroke.

How often does a coronary event occur in America?

Every 20 seconds.

What percentage of MI deaths occur in men age 35-50?

35%.

What are the types of stroke/CVA?

Thrombosis, embolism, hemorrhage.

What are the main causes of stroke?

Hypertension, arteriosclerosis, trauma, congenital issues.

How long after MI or stroke should elective dental care be avoided?

3-6 months.

What is the therapeutic INR range for patients on warfarin?

INR 2-3.

Why encourage tobacco cessation?

Improves cardiovascular and oral health.

When is medical consultation needed?

Recent MI, uncontrolled BP, unstable angina.

What time of day has the highest MI risk?

8-11 AM.

What is the preferred appointment time for cardiovascular patients?

Mid-afternoon.

What is the cardiac dose of epinephrine?

≤ 2 carpules of 1:100,000 epi.

Why can avoiding epinephrine increase stress?

Reduced anesthetic effectiveness may increase pain.

What emergency medications should be available for cardiovascular patients?

Nitroglycerin, aspirin, oxygen.

If a heart attack or stroke is suspected, what should you do?

Call 911.

What are prevention methods for drug overdose?

Record opioid history and identify drug-seeking behavior.

What are the gateway drugs mentioned in lecture?

Alcohol, marijuana, prescription pills.

Why is nonjudgmental communication important?

Encourages patients to seek help.

Why are herbal supplements important in dentistry?

They may affect bleeding, sedation, or vitals.

What supplement can cause tongue numbness and breathing difficulty?

Echinacea.

Which supplements interfere with sedatives?

Kava, valerian, St. John's Wort.

Which supplement increases vitals as a stimulant?

Ephedra.

What common medications affect blood clotting?

Aspirin, NSAIDs, warfarin, Eliquis, Pradaxa, Xarelto.

What supplements affect blood clotting?

Garlic, ginger, ginkgo, ginseng, turmeric, vitamin E.

Why should physicians be consulted before surgery with certain supplements?

Increased bleeding risk.

Why are anti-anxiety supplements concerning?

Many act as depressants.

Why should nitroglycerin not be given with ED drugs?

Blood pressure may drop dangerously low.

How long after Cialis should nitroglycerin be avoided?

Up to 36 hours.

What position may help if BP drops dangerously low?

Trendelenburg position.

What is ASA I classification?

Healthy patient.

What is ASA II classification?

Mild systemic disease, controlled.

What is ASA III classification?

Severe systemic disease requiring modifications.

What is ASA IV classification?

Severe systemic disease that is a constant threat to life.

Can ASA IV patients receive elective dental care without medical release?

No.

What are examples of ASA IV patients?

Recent MI/stroke, active TB, BP >180/120, unstable angina.

What diabetic condition qualifies as ASA IV?

Uncontrolled insulin-dependent diabetes.