OMFS 1 - OMFS Health Status Evaluation & Principles of Uncomplicated Exodontia (Dr. Stephens)

Medical History

Define the following:

A well-formulated structure that helps determine the patient's problems in a logical order and to establish any other relevant information

Engaging your patient

- First impressions matter

- Introduce yourself

- Communicate attentiveness

- Meet your patient where they are

- Try to be at eye level with your patient

- Make sure your patient is comfortable and do not rush them

- Give your patient the opportunity to speak

- Remember that your patient may not know what is important and what isn't

- Do not rush

- Ask open ended questions

- Create a setting where your patient is comfortable to volunteer person information to you

How can you set yourself up for success when taking a medical history?

- Demographic information

- Chief complaint

- History of Present Illness

- Past Medical History

- Past Surgical History

- Family History

- Social History

- Medications

- Allergies

- Review of Systems

What is the order of taking a structured medical history?

Chief complaint

What is a one sentence summary in the patients own words?

History of Present Illness (HPI)

Define the following:

Includes information gathered by your questioning of patient regarding their chief complaint

OLD CARTS

- Constitutional symptoms (fever, chills, lethargy, etc) should also be included

When recording a History of present illness, what nuemonic can help you gather all important information?

Onset

The O in OLD CARTS stands for:

Location/radiation

The L in OLD CARTS stands for:

Duration

The D in OLD CARTS stands for:

Character

The C in OLD CARTS stands for:

Aggravating factors

The A in OLD CARTS stands for:

Relieving factors

The R in OLD CARTS stands for:

Timing

The T in OLD CARTS stands for:

Severity

The S in OLD CARTS stands for:

True

T/F: From the med history, you will be asked what the patients medications are used to treat and what concerns they may pose to care

Review of systems

What has the following characteristics?

- Sequential, comprehensive method of eliciting patient symptoms on an organ system basis

- May reveal undiagnosed medical conditions unknown to the patient

- Should be guided by pertinent answers obtained from the history

- Cardiovascular

- Respiratory

- Nervous systems

If IV sedation or GA is planned, what systems should be reviewed?

- Head

- Ears

- Eyes

- Nose

- Mouth

- Throat

Dentists are expected to perform a quick review of what on every patient?

- Cardiovascular

- Respiratory (Pulmonary)

- Nervous

- Musculoskeletal

- GI

- Endocrine

- Urinary

- Reproductive

- Immune

- Lymphatic

- Integumentary

What are the organ systems that should be reviewed during review of systems?

- Physical exam

- Radiographs

What information is gathered after the patient history is complete?

ASA I

ID the ASA status:

- A Normal Healthy Patient

ASA II

ID the ASA status:

- A Patient with Mild Systemic Disease

- Mild Asthma, Controlled Hypertension, Anemia, Controlled Seizure, Early NIDDM

ASA III

ID the ASA status:

- A Patient with Severe Systemic Disease Which Limits Activity

- Angina Pectoris, Prior MI, COPD, IDDM, Advanced NIDDM

ASA IV

ID the ASA status:

- A Patient with Incapacitating Disease that is a Constant Threat to Life

- Congestive Heart Failure, End Stage Renal Disease, Advanced COPD, Hepatic Failure

Metabolic Equivalents (METS)

What has the following characteristics?

- Energy cost of physical activity

- Defined as the ratio of metabolic rate during activity to reference metabolic rate (3.5ml O2)/(kg x min)

- 1 MET = 1 kcal/(kg x h)

- Blood pressure

- Pulse

- Respiratory rate

- O2 saturation

- Temperature

What vitals information should be gathered during the physical exam?

Head and neck exam

What part of the physical exam...

- Notes any asymmetries, swellings, abnormal lesions such as moles or ulcers

- Palpates the face and neck to note any pain on palpation, swellings, etc.

- If maxillary sinus is involved, percussing the maxillary sinus area may be warranted

intraoral exam

What part of the physical exam...

- Examine the dentition

- Note any swellings, pain on palpation, firmness of the floor of the mouth, deviation of the uvula, etc.

- Note any pathologies including ulcers, pigmentations, or raised lesions

False! Both pertinent positive and pertinent negatives must be documented. Within normal limits (or any of the myriad synonyms will not be accepted)

T/F: Only fill in the medical history for pertinent positives

PA radiograph

What type of radiograph should be taken for single teeth (except 3rd molars)?

Panoramic radiograph

What type of radiograph should be taken for...

- Overview of the maxilla and the mandible

- Good for boney pathologies, 3rd molars, dentoalveolar or trauma to the mandible and maxilla

CT scan

What type of radiograph should be taken for...

- Detailed 3 dimensional view of the facial skeleton and soft tissue

- Good for maxillofacial trauma, severe infection, maxillofacial pathology, implant planning, etc.

Assessment in SOAP note

What has the following characteristics?

- A summary of your findings

- Differential diagnosis can be included in this section

- E.g. 30 y/o M who presented with pain associated with #3. The patient is being treated for asthma, but is controlled with albuterol

Plan in SOAP note

What has the following characteristics?

- Stepwise treatment for the patient

- Include type of anesthesia

- E.g. the plan is to extract #3 under local anesthesia

NO! It is a consult, NOT clearance

Do we get clearance from medical doctors to go forward with a treatment?

True

T/F: If it isn't document, it didn't happen

Clinical documentation

What has the following characteristics?

- Critical for delivering high-quality, safe, and efficient healthcare It

- Supports patient care, communication, legal compliance, reimbursement, and risk management

- Ensures continuity of care, informed decision- making, and prevention of medical errors

- Facilitates communication among providers

Clinical documentation

What has the following characteristics?

- Patients have access: Respectful, accurate, and objective documentation is expected

- Legal evidence of care provided and helps defend against malpractice claims

- Justifies billed services and supports claims approval by payers

- Provides a clear trail of clinical decisions and actions, safeguarding against audits and legal scrutiny

New Patient History and Physical Note

What type of note?

- To be completed at initial visit (150 exam completion in UG clinics) to TUSDM clinics including consultation visits to specialty departments.

Emergency Procedure Note

What type of note?

- To be completed for patients who are new to TUSDM (do not have established providers) and are having a procedure performed. Details of the procedure may be recorded under the section "Record of Procedure". This template includes components of both the New Patient note and the Procedure Note.

Procedure Note

What type of note?

- To be completed when a procedure is performed on an established patient who has already had a New Patient note completed. Details of the procedure may be recorded under the section "Record of Procedure".

Follow Up Note

What type of note?

- To be completed during follow up visits after a procedure or other situations outside of those outlined in the above templates. This template is in the SOAP format.

"Record of Procedure"

A ________ is found in either Procedure Note or Emergency Procedure Note. This is where you document what you did during a particular procedure

- Disclosure of information

- Patient competency

- Voluntary decision-making

- Reasonable alternatives with risks

- Assessment of understanding

- Consent involves a discussion of the risks, benefits, and alternatives of a procedure

What are the five elements of informed consent?

Time Out

What has the following characteristics?

- To be completed before all irreversible procedures

- The individual signing the time out must see you identify the tooth with an instrument and obtain the patients agreement

Periapical curette

ID the tool (yellow arrow):

No. 9 Molt periosteal elevator

ID the tool (orange arrow):

No. 9 Molt Periosteal Elevator

What is typically one of the first instruments used when starting an extraction?

Periapical curette

What is typically one of the last instruments used after an extraction?

Minnesota retractor

ID the tool:

Bone file

ID the tool (orange arrow):

Root picks

ID the tool (yellow arrow):

Seldin Retractor

ID the tool (blue arrow):

Syringe

ID the tool (blue arrow):

Scalpel Handle

ID the tool (pink arrow):

#15

What number scalpel blades is most commonly used in dentistry?

Hemostat

What tool should you use to connect a #15 blade to a scalpel handle?

- Hold blade handle in gloved hand

- Grasp dull side of blade with needle driver

- Align beveled end of blade with beveled edge of handle

- Slide blade onto handle end until it engages with a "click"

How do you attach a surgical blade?

"Sweetheart" tongue retractor

- Common for procedures under anesthesia

ID the tool:

Bishop retractor (cheek and tongue retractor)

ID the tool:

Side cutting rongeur (can cut bone)

ID the tool:

End cutting rongeur (can cut bone/smooth it down)

ID the tool:

Suture Scissors

ID the tool (blue arrow):

Needle holder

ID the tool (pink arrow):

Tissue forceps

ID the tool:

Small curved hemostat

ID the tool:

Small straight elevator (used 1st and helps make teeth mobile)

ID the tool (blue arrow):

Large straight elevator (helps make teeth mobile)

ID the tool (pink arrow):

- Blade

- Shank

- Handle

What are the parts of a straight elevator:

- As type 1 LEVER and WEDGE

- Wedge first, then lever

What type of simple machine is the straight elevator?

Apical

What direction of pressure do you apply with the straight elevator?

Cryer Elevators OR East / West Elevators

*Uses a wheel and axel mechanics

ID the tools:

Miller elevators

ID the tools:

Crane pick

ID the tool:

Universal Maxillary Extraction Forceps (#150)

ID the tool:

Universal Mandibular Extraction Forceps (#151)

ID the tool:

- Beak

- Hinge

- Handle

What are the components of a forceps? (3)

Root Tip Forceps (286) /Bayonet forceps

ID the tool:

Straight Maxillary Anterior Forceps (#1)

ID the tool:

Cowhorn Forceps #23

*used for furcation (esp. mandibular molars)

ID the tool:

Ash Forceps (English Style)

*used for bicuspids/anterior teeth

ID the tool:

Proximators

*used to make space for elevator use & retractora

ID the tool:

Proximators

*used to make space for elevator use & retractora

ID the tools:

Hall Drill

*lots of torque, thick bone

ID the tool:

Lower risk of air emphysema

What is the benefit of using a Hall drill vs. a traditional handpiece?

- Plain Gut

- Chromic Gut

- Vicryl

What are 3 types of absorbable suture material?

E - this is absorbable

All of the following are types of non-absorbable suture material EXCEPT:

A. Silk

B. Polypropylene

C. Polyester

D. Nylon

E. Gut

Chromic gut

What suture material do we use at TUFTS?

Thinner

The numbers of a suture material denote the thickness of the

material. A higher numbers mean _________ material

Chromic gut

What type of suture material?

- Absorbable suture material

- Derived from bovine intestine with chromic salts to slow absorption (vs plain gut)

- 6-10 days of tensile strength

- Most commonly used intraoral suture

Vicryl

What type of suture material?

- Absorbable braided synthetic material

- Holds tensile strength for ~14 -21 days

Plain Gut

Which absorbable suture absorbs the quickest?

- Plain Gut

- Chromic Gut

- Vicryl

Vicryl

Which absorbable suture absorbs the slowest?

- Plain Gut

- Chromic Gut

- Vicryl

Maxillary

In terms of chair position, you should put the seat higher and a more reclined position when extracting ______ teeth

Mandibular

In terms of chair position, you should put the seat lower and a more upright position when extracting ______ teeth

Left

When doing an extraction, if you are right handed, you should stand to the front and to the _____ side of the patient

Right

When doing an extraction, if you are left handed, you should stand to the front and to the _____ side of the patient

Simple extraction: D7140

ID the procedure:

- Extraction, erupted tooth or exposed root (elevation, and/or forcep removal)... routine removal of tooth structure, minor smoothing of socket bone and closure as necessary

Surgical extraction: D7210

ID the procedure:

- Requiring removal of bone and/or sectioning of tooth, and including elevation of mucoperiosteal flap if indicated

Circumferentially

For a simple extraction, detach soft tissue off of the tooth ___________