DHS Special Patient Population

What is the role of the dental hygienist?

Recognize physical, medical, mental, social, and dental needs; communicate with patient, caregiver, and health professionals; record medical conditions, medications, and vital signs; adapt the treatment plan.

When should a dental hygienist NOT treat a patient?

When the medical condition is uncontrolled.

When should the dental hygienist consult a physician?

When the condition is complex, unstable, unclear, or involves medication interactions.

What is the purpose of the stress reduction protocol?

To reduce anxiety and decrease risk of medical emergencies.

How should appointments be scheduled when using stress reduction protocol?

Short, morning appointments.

How should communication be handled during stress reduction protocol?

Communicate clearly and encourage questions.

What teaching method is recommended for special needs patients?

Tell-Show-Do.

What is the goal for pain management in medically compromised patients?

Make procedures as pain-free as possible.

What can patients do to manage xerostomia?

Increase hydration and use room humidification.

What products are recommended for xerostomia management?

Saliva substitutes.

What medications stimulate saliva production?

Cholinergics such as pilocarpine.

How can caries risk be reduced in xerostomia patients?

Recommend home fluoride rinses.

How often should xerostomia patients be seen?

Frequent maintenance appointments.

Which patients require chair position modification?

CVA, CHF, COPD, and pregnancy patients.

How should home care instructions be delivered?

Simple written and verbal instructions.

Why should caregivers be involved in oral care?

Patients may have limited functional ability.

What behavioral technique should be used during treatment?

Positive reinforcement.

What should be reviewed for cardiovascular patients?

Medical history, disease severity, functional limitations.

What should be reviewed if a cardiovascular patient had surgery?

Type of surgery and date.

Which medications are common in cardiovascular patients?

Aspirin and warfarin (Coumadin).

What protocol should always be used for cardiovascular patients?

Stress reduction protocol.

Why might cardiovascular patients not tolerate supine positioning?

It can impair breathing or circulation.

What is the maximum epinephrine dose for cardiac patients?

0.04 mg (2 carpules of 1:100,000).

Why should epinephrine retraction cord be avoided?

It can increase cardiovascular risk.

What should be done if a patient has undiagnosed chest pain?

Refer to physician immediately.

Why is hypertension called the silent killer?

It often has no symptoms.

What is normal blood pressure?

Less than 120/80.

What is elevated blood pressure?

120-129 systolic and less than 80 diastolic.

What defines Stage 1 hypertension?

130-139 systolic OR 80-89 diastolic.

What defines Stage 2 hypertension?

140 or higher systolic OR 90 or higher diastolic.

What defines a hypertensive crisis?

Greater than 180 systolic and/or greater than 120 diastolic.

What complications can hypertension cause?

CVA, MI, renal failure.

What is primary hypertension?

Hypertension with no identifiable cause.

What is secondary hypertension?

Hypertension caused by another condition or drugs.

What side effects are associated with ACE inhibitors?

Dry cough and angioedema.

What is a dental concern with beta blockers?

Caution with vasoconstrictors if non-cardioselective.

What oral side effects do calcium channel blockers cause?

Gingival hyperplasia and xerostomia.

What side effects do diuretics cause?

Postural hypotension and xerostomia.

How should vitals be handled for hypertensive patients?

Monitor closely.

What sedation is recommended for hypertensive patients?

Nitrous oxide and oxygen.

Why should the chair be raised slowly?

To prevent orthostatic hypotension.

Why should sodium-based air polishers be avoided?

Risk of sodium load.

At what BP should treatment be deferred per ADA guidelines?

Over 160/100.

At what BP is emergency care deferred?

Over 180/120.

What causes a myocardial infarction?

Necrosis of heart muscle due to prolonged ischemia.

What are common symptoms of MI?

Pain, nausea, sweating, shortness of breath, weakness.

How long should elective dental treatment be delayed after MI?

6 months.

What modifications are required for MI patients?

Stress reduction, nitrous oxide/O₂, monitor vitals, limit epinephrine.

What causes angina pectoris?

Myocardial ischemia.

How is angina pain described?

Crushing, pressure, squeezing.

Where can angina pain radiate?

Arm, shoulder, neck, mandible.

How long does angina pain usually last?

5-15 minutes.

What is the purpose of nitroglycerin?

Vasodilation to increase blood flow.

How is nitroglycerin administered during an angina attack?

1 tablet every 5 minutes.

What is the maximum nitroglycerin dose?

3 tablets in 15 minutes.

How should nitroglycerin be stored?

Dark, tightly sealed glass container.

When should nitroglycerin NOT be given?

Systolic BP under 100 or use of erectile dysfunction drugs.

What should be done if pain continues after nitroglycerin?

Activate EMS.

What causes a cerebrovascular accident?

Disruption of oxygen supply to the brain.

What is a TIA?

A transient ischemic attack or mini-stroke.

What conditions increase stroke risk?

Hypertension, cardiovascular disease, diabetes.

What does FAST stand for in stroke recognition?

Face droop, Arm weakness, Speech difficulty, Time to call 911.

How long should elective care be deferred after CVA?

6 months.

What appointment changes are needed for CVA patients?

Modify chair position and assist transfers.

What causes cardiac arrhythmias?

Disrupted electrical impulses.

What is the SA node?

The pacemaker.

What is the AV node?

The pacesetter.

What is ventricular fibrillation?

Erratic ventricular impulses requiring AED.

Can ultrasonic scalers be used with pacemakers?

Yes, generally safe.

What is congestive heart failure?

Inability of heart to pump sufficient blood.

What are signs of CHF?

Pulmonary congestion and peripheral edema.

How should CHF patients be positioned?

Upright or semi-reclined.

What devices are contraindicated in CHF?

Air polisher and ultrasonic scaler.

What medication increases gag reflex in CHF patients?

Digoxin.

Why should epinephrine be avoided with digoxin?

Risk of cardiac complications.

What is a coronary artery bypass graft?

Grafting a vessel to bypass blocked coronary arteries.

How long should elective care be delayed after CABG?

6 months.

Is antibiotic premedication required for CABG?

No.

What patients require antibiotic premedication for heart conditions?

Prosthetic valves, infective endocarditis history, congenital defects, transplant with valve pathology.

Why do mechanical valve patients take warfarin?

To prevent clot formation.

What is asthma?

A chronic inflammatory disease causing airway narrowing and mucus production.

What questions should be asked when assessing asthma?

Time of last attack, severity, frequency, and triggers.

What are signs of an asthma attack?

Dyspnea, wheezing, anxiety, coughing, hyperventilation.

What is Albuterol (Ventolin)?

A short-acting bronchodilator rescue inhaler.

What is Salmeterol (Serevent)?

A long-acting bronchodilator.

What is Fluticasone (Flovent)?

A corticosteroid for long-term asthma control.

What is Advair?

A combination bronchodilator and corticosteroid.

Why do inhaled steroids increase caries risk?

They increase Candida and reduce saliva.

What should patients do after using steroid inhalers?

Rinse with water.

What must asthma patients bring to appointments?

Rescue inhaler.

Is nitrous oxide allowed for asthma patients?

Yes, asthma is the only respiratory condition that allows it.

When is epinephrine acceptable in asthma emergencies?

1:1,000 concentration.

What should NOT be used in asthma patients?

(Entry incomplete, omitted).

What is COPD?

A group of lung diseases causing airflow obstruction

What is emphysema?

Overinflation of alveoli causing impaired airflow

Why are emphysema patients called pink puffers?

They breathe rapidly but maintain oxygenation

What cough is associated with emphysema?

Dry cough

What is chronic bronchitis?

Inflammation of bronchial tubes with mucus production

Why are chronic bronchitis patients called blue bloaters?

Cyanosis, mucus buildup, and overweight appearance

What chair position is best for COPD patients?

Upright