Medical Emergencies - Patient History

patient history is:

- gathered ____ to patient treatment

- guides _______ through appointment

- necessary prior to treatment involving _________ _______ manipulation

prior, clinician, soft tissue

What are the three components of patient history

dental history, medical history, psychosocial history

What are examples of psychosocial aspects that can influence health

smoking/drug use, diet, stress, living situation, education, attitudes toward health, cultural practices

What are the reasons for obtaining patient history

- provide info important for diagnosing/identifying etiology of oral conditions

- provide info about pre-existing conditions

- help identify possible undiagnosed conditions

- general appraisal of patients overall health

- insight into emotional and psychological state

- reference and comparison for multiple appointments

- written record for legal purposes

- identify cultural/ethical/racial influences on oral disease risk factors

What are some reasons for inaccurate or incomplete answers on medical history form

- patient misunderstands importance

- embarrassing situation for the patient

- patient fears refusal of treatment

- location of conversation- confidentiality issue

- language barrier

pre-appointment information is

basic information that is obtained prior to the actual appointment

pre-appointment information helps to

- identify medical problems/ if pre-medication is needed before patient arrives

- alert staff of modifications that may be needed

- provide basic information for patient record

- alert staff to other considerations

What is some information that should be gathered and informed to the patient prior (pre-appointment information)

- pre-medication

- heart problems/surgeries

- pregnancy

- patient contact information

- blood thinning meds

- inform patient to bring list of meds

- inform patient of appointment length

Day of appointment, complete detailed ___ ____ with patient

medical history

after completing medical history, determine what should occur

- render treatment

- treatment contraindicated

- physicians referral or medical clearance required

- consult supervising faculty or dentist who may request physicians referral

- special precautions or alternatives in treatment plan, routine or techniques

What are conditions that contraindicate treatment in the hygiene clinic

- hemophilia

- heart attack or stroke within last 6 months

- blood pressure >180/110

- active herpetic lesion (vesicular)

- active tuberculosis (TB)

- INR (international normalized ratio) > 3.5

- Pregnancy

during the first trimester of pregnancy, limit treatment to

periodontal prophylaxis and emergency treatment only

during the second half of the third trimester of pregnancy

no routine dental treatment

what is the medical alert

document used to call attention to potential emergency situations

What info should be included in the medical alert

- serious allergies

- hypertension

- heart conditions

- infectious disease

- need for antibiotic pre-med

- diabetes

- immunocompromised

- bisphosphonate use

- psychiatric

- thyroid conditions

- anticoagulants

- seizures

- dental anxiety (9 or 10)

what is prophylactic

measure designed to preserve health/ prevent disease

what is infective endocarditis

infection of inner lining of heart or valves caused by masses of bacteria and blood clots

what is transient bacteremia

occurs when bacteria is introduced into the patients blood stream through procedures such as scaling, probing, and exploring

what is prophylactic antibiotic pre-medication

provision of an effective antibiotic before invasive clinical procedures that can create a transient bacteremia which can cause infective endocarditis or other serious infection

What is the standard amoxicillin dosage recommended by the AHA for prevention of bacterial endocarditis

2 g orally (usually 4 tabs, 500 mg each) 30-60 minutes prior to dental appointment

If patient is allergic to penicillin or if patient is already taking an antibiotic but requires a pre-med, an ______ premed from a _____ _____ of ____ must be given before treatment

additional, different class, antibiotic

What conditions require/potentially need premedication

1. prosthetic cardiac valves/material

2. previous subacute bacterial endocarditis

3. congenital heart defect

4. cardiac transplant recipients with cardiac valvulopathy

5. certain total joint replacement recipients

6. coronary artery bypass graft (CABG) and coronary artery stents placed

7. certain immunosuppressed patients

What conditions absolutely need premedication

1. prosthetic cardiac valves/ materials

2. previous subacute bacterial endocarditis (SBE)

3. congenital heart defect (CHD)

4. cardiac transplant recipients with cardiac valvulopathy

What conditions require special consideration/consultation concerning pre medication

1. certain total joint replacement recipients

2. coronary artery bypass graft (CABG) surgery and coronary artery stents placed

What should you include when educating the patient about why pre-medication may needed

1. relationship between bacteria in blood stream and risk of infections due to specific conditions

2. stress importance of good home care practices

when is a medical consult used

when patients medical history indicates consultation with physician is necessary prior to treatment

What is the procedure for a medical consult

1. appropriate form is filled out by student

2. form given to COD staff and a formal letter faxed to physician

3. student and faculty notified of consult return and patient may then be rescheduled

What are the three appropriate medical consult forms

1. health care provider consultation form (for complex medical consultations)

2. hypertension consultation form

3. brief health care provider consultation form (simple questions such as A1C, INR, etc)

What conditions require a physicians referral or medical clearance prior to treatment

1. elevated blood pressure

2. patients at highest risk of infectious endocarditis and/or joint replacement with overlying health issues

3. history of steroid use

4. pregnant patients requiring the administration of drugs

5. anti-coagulation therapy (Coumadin)

6. history of significant medical problems or unclear medical history

7. diabetic patient to determine HbA1c

If blood pressure is

routine treatment

if blood pressure is elevated (120-129/

routine treatment

if blood pressure is in hypertension stage I (130-139/80-89) what is recommended treatment

routine treatment if asymptomatic and no target organ disease

if blood pressure is in hypertension stage II (≥140 or ≥90) what is recommended treatment

consult with faculty and/or staff DDS

If patient is in hypertension stage II and patient is well managed, what is the recommended treatment for prophy/perio maintenance and SRP/using local anesthetic

prophy/perio maintenance: may send consult after treatment for physician follow up

SRP/using local anesthetic: consult with DDS prior to treatment

If patient is in hypertension stage II and patient is not well managed, what is the recommended treatment for prophy/perio maintenance and SRP/using local anesthetic

prophy/perio maintenance: consult with DDS prior to treatment and send consult after treatment for physician follow up

SRP/using local anesthetic: consult with DDS and physician prior to treatment

if blood pressure is in hypertension stage III (>180/110) what is recommended treatment

No elective treatment can be performed on a patient

What are examples of significant medical problems that may require physicians referral or medical clearance

-immunocompromised (AIDS, chemotherapy patients)

-hemodialysis (end stage renal disease)

-history of or currently taking bisphosphonates

a HbA1c of ≥8 may require

consultation with DDS or medical clearance