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258 Cards in this Set

  • Front
  • Back
What is question 17?
Have you ever received x-ray treatments for cancer?
Xerostomia
Lack of saliva. Dry mouth due to lack of function of the saliva glands. Normal gland function can be destroyed by radiation therapy.
Dysgeusia
Abnormal or impaired taste
Can be brought on by head and neck radiation?
Mucositis/ Stomatitis
Culture infections to identify fungal, bacterial, or viral origin.
Mouth pain- prescribe topical or systemic analgesics
Muscle trismus
Muscular contracture from radiation therapy
Radiation caries
Usually class V smooth surface caries which may encircle the cervical third of teeth.
Osteoradionecrosis
Results in reduction of vitality of bone through the decrease of vascularity. Bone necrosis secondary to radiation and a superimposed infection.
Where is there a greater potential for osteoradionecrosis?
In the Mandible rather than the maxilla
What is question 18?
Have you ever been treated for a growth, tumor, cancer, malignancy or any other similar condition?
What are the questions that should be asked if the patient put yes on their questionnaire for number 18?
Where was the tumor located?
Was the tumor benign or malignant?
How was the tumor treated?
When was the tumor treated?
What type of follow up care is needed following treatment? How often is the patient evaluated by a physician post treatment?
A positive response to question 18 should alert you to what?
-The pt may still have a primary lesion or condition.
-The lesion may have metastasized to other areas of the body including the mouth and jaws.
Thrombocytopenia is ...
An abnormal hematologic condition in which the number of platelets are reduced. Most common cause of bleeding disorder
Leukopenia
Prone to infection due to bone marrow suppression. Decrease in the WBC.
Decrease in hemoglobin concentration in RBC, the amount of RBCs,and volume of RBC per 100ml of blood are less than normal
Anemia
Where are some common sites of Primary lesions that can metastasize to the oral cavity?
Breast
Lung
Kidney
Thyroid
Prostate
Colon
What is question 19?
Are you HIV positive or do you have Acquired Immune Deficiency Syndrome (AIDS)?
In order to have AIDS a person must have had direct contact of body fluids with HIV or AIDS pt. through what?
Sexual contact.
IV drug use and sharing syringes.
Infected mother to infant.
Transfusion.
Health care workers with contaminated needle sticks.
What are some signs and symptoms of a patient that has HIV or AIDS?
- Malaise for a long period of time.
- Loss of appetite, loss of weight.
- Low grade fever for more than 1 month.
- Unexplained lymphadenopathy.
- Pneumonia
Oral manifestations of HIV and AIDS include what?
- Candidiasis
- Linear Marginal Erythema (LME)
- Necrotizing Ulcerative
- Periodontitis (NUP)
- Oral Hairy Leukoplakia
- Kaposi’s Sarcoma
What is HIV Gingivitis now called?
Linear Marginal Erythema (LME) or Linear Gingival Erythema.
What is HIV Periodontitis now commonly called?
Necrotizing Ulcerative Periodontitis (NUP).
What is question 20?
Have you ever had an artificial joint, pin, plate, or other device surgically implanted?
What must you ask when a patient answers yes to question 20?
Determine what type of appliance was placed and when it was placed.
Patients who answer yes to question 20 must be medicated in what way?
Patients with artificial joints will need to take antibiotic pre-medication for 2 years post surgery one hour prior to dental treatment
What is question 21?
Have you ever been treated for alcohol or drug dependency?
What questions must you ask if a patient answers yes to question 21?
(1) How long has sobriety lasted?
(2) How many times in treatment?
(3) Is patient still going to AA or NA?
(4) Ex: Pt. taking cocaine, Ecstasy, or methamphetamines in the last 24 hrs - give local anesthesia with epinephrine can cause stroke or death.
What must you be aware of with a patient that is still in their first year of sobriety?
- May require increased amount of local anesthesia and longer appointment times.
- Avoid use of nitrous oxide gas, narcotic medications and any meds with alcohol throughout recovery.
- Avoid alcohol containing mouthrinses ( Listerine, Scope, Peridex).
- Recovery is lifelong
What is question 22?
Do you have a pacemaker?
The current _____ guidelines do not recommend antibiotic prophylaxis to prevent Infective Endocarditis for a transvenous pacemaker or cardioverter defibrillator.
AHA - American Heart Association
What electromagnetic equipment should be avoided when your patient has a pacemaker?
Ultrasonic scaler
Pulp tester (electric
vitalometer)
Electrocautery unit
What is the first disease to be aware of in question 23?
Rheumatic Fever - acute inflammatory condition that follows a sore throat, caused by a group A streptococcal infection
When does RF commonly develop and in whom does it usually occur in?
- Develops 2-6 wks after initial pharyngitis.
- Most cases occur in children ages 5-15
What are typical characteristics of the Acute Phase of RF?
- Lasts 6-12 weeks.
- May take 6 months for the disease to resolve.
- 50% recurrence rate.
- RF and its sequelae account for 95% of heart disease in children.
- Cardiac damage to connective tissue and heart valves. Results in heart murmurs
What is the diagnosis and treatment of RF?
Diagnosis - Throat culture and blood test.
Treatment - Antibiotics, anti-inflammatory (NSAIDs), antipyretic meds, and bed rest
What % of RF patients develop RHD (Reumatic Heart disease)
30-80%
What is the second disease to be aware of in question 23?
Kidney Disease
When is Dental treatment best for a Patient suffering from Kidney Disease?
Dental treatment is best the day after dialysis.
What should you be aware of when taking the vitals of a patient with Kidney Disease?
Never take B/P in the same arm with shunt
What is Peritoneal dialysis?
- Hypertonic or dialysate solution instilled into the peritoneal cavity.
- Drains through catheter 4-6 hrs into a bag.
- Chronic ambulatory method.
What is a patient undergoing peritoneal dialysis at risk of?
Peritonitis
What is the third disease that you must be aware of from question 23?
Jaundice and/or Hepatitis
What are common causes of Hepatitis?
Viral - Hepatitis A, B,C
Chemically induced through alcohol or antibiotics
What must you be concerned with for viral hepatitis of a patient?
Protection of personnel and carrier state of patient
If liver function is impaired what is the tendency of the liver?
Bleeding tendency
What can impairment of liver function lead to?
Abnormalities in metabolism of amino acids, protein, carbohydrates, and lipids
If the liver loses its ability to detoxify what are some drugs that will be affected?
Barbiturates, Valium
Local anesthesia- Xylocaine,Carbocaine
Tylenol , Aspirin, Ibuprofen, Codeine
Ampicillin, Tetracycline
What is the fourth disease to be aware of from question 23?
Tuberculosis
A positive history of TB will require you to ask the patient what questions?
- How long was pt on medication?
- INH ( isoniazid) is used to treat and prevent TB. May be on drug 9mo-2yr.
- rifampin - Antituberculosis agent used for 6-9 months.
What is the fifth disease that you must be aware of from question 23?
Sexually Transmitted Disease
What questions do you have to ask a patient who answers yes to being involved with a sexually transmitted disease?
The nature of the patient’s disease.
The type of treatment given.
When was the disease treated?
The number and frequency of recurrences if any.
What is the sixth disease to be aware of from question 23?
Heart Disease
More than _____ of U.S. pop. Estimated to have some form of CVD
70 million (25%)
What is atherosclerosis?
Thickening of intimal layer of arterial wall caused by accumulation of lipid plaques.
Narrowed lumen – diminished blood flow and O2 .
What is the seventh disease that you must be aware of from question 23 of the health history?
Stroke
What are the questions that you must ask a patient who has had a stroke?
When did the stroke occur?
What degree of functional impairment resulted from the stroke?
Has the patient had other strokes?
How long should a stroke patient be deferred until it is safe for dental treatment?
Elective dental treatment should be deferred for 6 months.
Ischemic Stroke
- Occurs when artery that supplies brain is blocked.
- Most common type of stroke.
- Blood clots usually cause artery blockage.
- Stenosis of artery caused by atherosclerosis,
- Thickening, hardening, & loss of elasticity
Hemorrhagic stroke
Occurs when artery in brain bursts due to:
- Aneurysm,
- Arterial walls loose elasticity & become thin, brittle. Arteries crack & bleed.
Intracerebral hemorrhage
Occurs when a blood vessel leaks blood into the brain.
Subarachnoid hemorrhage
Bleeding under the outer membranes of the brain & thin fluid-filled space that surrounds the brain.
What is TIA (transient ischemic attacks)?
A “mini” stroke caused by a temporary disturbance in the blood supply to localized area of the brain. May experience numbness on one side of body, weakness, tingling or speech disturbances lasting a few minutes.
What are the risk factors for Stroke?
Hypertension, diabetes, coronary atherosclerosis, atrial fibrillation, high cholesterol, smoking, TIA or previous stroke, alcohol, genetics, and increasing age.
How should you manage a patient with a tendency for stroke?
- Short stress free, midmorning appointments.
- Monitor B/P.
- Use minimum amount of local anesthetic with vasoconstrictor.
What is question is the 9th disease discussed in question 23?
Bleeding Disorders
What are factors that have to be considered with patients that are suffering from bleeding disorders?
Need to question the patient about the specific diagnosis and treatment.
Need to consider lab tests if patient is unsure of diagnosis and believes they have a past history of abnormal bleeding.
Referral to physician for ordering lab tests prior to any dental surgery (PT, PTT, BT, or INR).
Prothrombin Time( PT)
Test the Extrinsic pathway ( Factor III, VII, calcium and phospholipids), and the Common pathway (Factor X, V, calcium and phospholipids). Normal value is 11-15 seconds.
Partial Prothromboplastin Time (PTT)
Tests the Intrinsic pathway (Factors XII, XI, IX, VII, calcium and phospholipids), and the Common pathway. Normal value is 25 -40 seconds.
Bleeding Time (BT)
Evaluates platelet function. Normal value is < 5 minutes.  with ASA,NSAIDS.
International Normalized
Ratio(INR)
Used to standardized a PT test. Normal value is 1.0-3.0.
What are the questions that you need to ask in order to determine true bleeding disorders?
(1) Have any of the following members of your family ever had a problem with prolonged or unusual bleeding, (parents,siblings, children, grandparents, or great-grandparents)?
(2)Have you ever had marked bleeding for up to 24 hrs after a surgical procedure, (tooth extraction or tonsillectomy)?
(3)Have you ever required a blood transfusion after surgery?
(4)Females: Do you feel that you have abnormal bleeding during menstruation?
(5)Do you get bruises larger than a quarter for which you cannot remember the injury?
(6)Do you experience numerous and severe nose bleeds for up to several hours?
(7)Do your gums often bleed not related to trauma or toothbrushing?
(8)Are you taking any blood thinners, (anticoagulants, aspirin)?
(9)Have you taken any medications, such as pills, powders, or liquids within the last week?
(10)Have you had or do you have liver disease?
What is the tenth disease coming from question 23?
Stomach Ulcers
What is a stomach ulcer?
A peptic ulcer is a well-defined break in the GI mucosa that results from chronic acid-pepsin secretions.
-->80% of ulcers are found in the duodenum.
-->20% of ulcers are found in the stomach.
What can cause a stomach ulcer?
Also caused by Helicobacter pylori bacteria.
-->Tetracycline or Amoxicillin is used to treat infection.
What should you do for a patient with stomach ulcers?
- Avoid giving patient aspirin, NSAIDs, or corticosteroids.
- Reduce stressful environment.
- Examine the mouth for signs of fungal overgrowth
- (Candidiasis),during or after systemic antibiotic use. Also examine for enamel dissolution of the teeth associated with persistent gastric reflux
Canidiasis (Candida albicans)
Overgrowth of yeast found in the normal oral flora. It can proliferate when the normal flora is changed from antibiotic use.
Tx: Antifungal drugs
Nystatin
What is the eleventh disease discussed in question 23?
Epilepsy
What questions do you have to ask the patient who has epilepsy?
(1)Type of seizure, frequency of seizure, and when was the last seizure?
(2)Age at time of onset?
(3)Cause of seizures?
(4)Current seizure medications?
(5)Regularity of physician visits?
(6)Degree of control?
-Well controlled - provide normal care
-Poorly controlled - consult with physician
(7)Precipitating factors?
(8)History of seizure related injuries?
What is the schools policy on treatment for patients with Epilepsy?
Patients with uncontrolled seizures are not accepted for treatment in the student clinic.
What is Dilantin hyperplasia?
- Gingival hyperplasia due to medication.
- Treatment is a gingivectomy or a change in the medication or both.
What is the 12 disease discussed in question 23?
Diabetes
What is Diabetes?
A clinical syndrome of disordered metabolism and hyperglycemia due to insulin deficiency or reduction of insulin effectiveness. A chronic disease complex with vascular components and clinical neuropathies.
The ability to oxidize carbohydrates is lost due to faulty pancreatic activity (Islets of Langerhans) or cells in the body can become less responsive to insulin.
How many people in the US are affected by Diabetes?
- There are approximately 23.6 million people or 7.8 % of the population in the United States who have diabetes.
- Estimated that 17.9 million have been diagnosed & 5.7 million people are undiagnosed.
-->The 23.6 million represents a 13.5% increase from the 20.8 million in 2005.
-->57 million people have pre-diabetes
What are the worldwide statistics of Diabetes?
- By 2010, estimated 250-300 million people worldwide with diabetes.
- Each day approximately 4,110 people are diagnosed with diabetes. In 2007, 1.6 million case diagnosed in people 20 yrs or older.
What is the mortality rate for diabetes?
- Diabetes is the fifth leading cause of death in the United States.
- Diabetes contributes to a total of 233,619 deaths per year in the U.S in 2005, based on death certificate data.
How does Diabetes affect blindness?
Diabetes is the leading cause of new cases of blindness in people ages 20-74. Each year, from 12,000 to 24,000 people lose their sight because of diabetes. Retinopathy occurs in all forms of diabetes. Development of retinopathy and blindness depends on the duration and control of the disease.
How does diabetes affect kidney disease?
Diabetes is the leading cause of end-stage renal disease, accounting for about 44% of new cases.
How does diabetes affect Heart disease and stroke?
People with diabetes are 2 -4 times more likely to have a MI or stroke. Heart disease & stroke accounts for 65 % of diabetes-related deaths (more than 77,000 deaths due to heart disease annually).
How does diabetes affect nerve damage leading to amputation?
About 60-70 % of people with diabetes have mild to severe forms of diabetic nerve damage, which, in severe forms, can lead to lower limb amputations.
Diabetes is the most frequent cause of non-traumatic lower limb amputations. The risk of a leg amputation is 10 times greater for a person with diabetes. In 2002, more than 82,000 amputations are performed among people with diabetes.
What is the physiology behind the nerve damage caused by diabetes?
Increased glucose uptake by Schwann cells leads to production of intracellular sorbitol, which attracts water into the cell. This causes cellular injury and nerve dysfunction
What are the risk factors for diabetes?
Blood relatives of people with diabetes.
Hypertension, high cholesterol or high triglyceride levels.
Obesity
Over 45 years of age.
Women with a PMH of gestational diabetes or who have had babies over 9 lbs at birth.
African Americans, Asian Americans, American Indians, Hispanic, Pacific Islanders.
People with Impaired Glucose Tolerance (IGT).
How does someone become diabetic?
Diabetes can occur as a result of either not enough insulin being present, or the cells fail to recognize insulin appropriately
What is the etiology of Diabetes?
- Genetic disorder (Type 1 or 2).
- Destruction of the Islet cell by inflammation, cancer, or surgery.
- An endocrine condition such as hyperpituitarism or hyperthyroidism.
- Iatrogenic disease from glucocorticoid steroid use.
What is Cortisol and what does it do?
- Primary glucocorticoid that regulates carbohydrate, fat, protein metabolism. Also maintains homeostasis during times of stress.
- Cortisol acts as an insulin antagonist. Then get increased blood glucose level and increase in liver glucose output.
What is the pathophysiology of Diabetes?
Glucose is stimulus for insulin secretion.
Insulin is needed for muscle, fat, and liver to utilize glucose from blood.
The CNS and renal cortex can utilize glucose from the blood without insulin.
After a meal is ingested, insulin is released and has 4 primary actions. Insulin remains in circulation for several minutes then interacts with target tissues and binds with cell surface insulin receptors. Lack of insulin allows glucose to accumulate in tissue fluids and blood.
What are the 4 primary actions of Insulin?
1. To transfer glucose from blood to insulin- dependent tissues, (muscle, fat, liver). Glucose is stored in liver as glycogen.
2. To stimulate transfer of amino acids from blood to cells. Otherwise, amino acids are converted into glucose and lose nitrogen in urine.
3. To stimulate triglyceride synthesis from fatty acids.
4. To inhibit breakdown of triglycerides for mobilization of fatty acids. If unable to use glucose, the body shifts to fat metabolism. The person with Type 1 diabetes can develop metabolic acidosis due to buildup of acetone and ketones in the body fluids. May lead to coma or death if not treated.
Number of diabetic cases increase because of ...?
- Increase in the population.
- Increase in the life expectancy.
- Increase in the number of people with obesity.
- Diabetic patients living longer because of better medical management.
What are the characteristics of Type 1 diabetes?
- AKA Insulin Dependent Diabetes Mellitus (IDDM), Juvenile diabetes.
- Due to insulin deficiency following beta cell destruction in the Islet of Langerhans.
- Viral, genetic vulnerability, and autoimmunity have all been linked.
- Generally occurs in people under age 40, thin body, require daily insulin dose.
- 5 - 10 % of diabetic population.
American Diabetes Association recommends a diabetic screening for people aged 45 and older and screening every 3 years. High risk pop. should be screened earlier.
What are the characteristics of Type 2 diabetes?
- AKA “non-insulin dependent diabetes mellitus”(NIDDM),
- Non-autoimmune, adult-onset diabetes.
- Pathogenesis is insulin resistance due to cell-receptor defect and glucose is unable to be absorbed into the cells for fuel and/or decreased insulin secretion by the pancreas in response to glucose levels.
- Insulin levels may be normal, increased, or decreased.
Insulin resistance of cells in the body appears to precede loss of insulin secretion by beta cells in pancreas .
- Patients tend to be obese (60-80%).
- Usually occurs in people over 40 years of age. Once called Adult-Onset diabetes, but is now occurring in children.
- Found in 90-95 % of diabetic population.
Comorbid conditions include ...?
Increased blood pressure, cholesterol, triglycerides.
High incidence of Type 2 diabetes found in ...?
African Americans, Asian, American Indian, Hispanic, & Pacific Islanders populations.
What are the usual characteristics of type 2 Diabetes?
- Frequently obese
- Blurred vision
- Tingling, numbness of hands and feet
- Recurring yeast infections
- Impotence
- Postural hypotension
- Strong family history
- Onset of symptoms may be slow
- Not prone to ketoacidosis until late in course of disease or with prolonged hyperglycemia.
What are the signs and symptoms of diabetes?
- Cardinal Signs - 3 P’s
-->Polydipsia (increased thirst)
-->Polyphagia ( increased hunger)
-->Polyuria (increased urination)
- Weight loss, loss of strength
- Blurred vision
- Loss of sensation (parathesias)
What is the treatment of Diabetes/
Type 1:
- Diet & exercise
- Insulin - injections, continuous infusion (insulin pump), pancreatic transplant
Type 2:
- Diet & exercise
- Oral hypoglycemic meds; Insul
What are the characteristics of Gestational Diabetes?
- A form of diabetes that appears during pregnancy and occurs most often in the 2nd and 3rd trimester. - These patients usually return to normal after birth.
- Occurs in approximately 4 % of pregnancies, 135,000 cases annually.
- Tested for GD between 24-28 weeks.
- Increased risk of loss of the fetus. Increased size of fetus that survives.
- Increased risk of congenital anomalies if glycemic control is poor.
- 20-50% chance of developing Type 2 diabetes within 5-10 years.
- 70% of women will develop Type 2 during lifetime.
Untreated or poorly controlled gestational diabetes can hurt developing fetus in what method?
Pancreas works overtime to produce insulin, but the insulin does not lower your blood glucose levels.
Insulin does not cross the placenta, glucose and other nutrients do. So extra blood glucose goes through the placenta, giving the baby high blood glucose levels. This causes the baby's pancreas to make extra insulin to get rid of the blood glucose.
The baby is getting more energy than it needs to grow and develop, the extra energy is stored as fat. This can lead to macrosomia, or a "fat" baby.
What are the problems and treatment of gestational diabetes?
Babies with macrosomia face health problems of their own, including damage to their shoulders during birth.
Because of the extra insulin made by the baby's pancreas, newborns may have very low blood glucose levels at birth and are also at higher risk for breathing problems.
Babies with excess insulin become children who are at risk for obesity and adults who are at risk for type 2 diabetes.
Treatment for gestational diabetes is key to keep blood glucose levels equal to those of pregnant women who don't have gestational diabetes.
Treatment for gestational diabetes always includes special meal plans and scheduled physical activity. It may also include daily blood glucose testing and insulin injections
What are some other types of diabetes?
Pancreatic disease - pancreatectomy, pancreatitis, carcinoma
Hormonal disease - Cushing’s disease (hyperadrenalism); Acromegaly (hyperfunction of the pituitary gland).
Drugs - Thiazide diuretics (used to treat hypertension, CHF); lithium salts (used to treat bipolar manic depressive psychosis).
What are the characteristics of pre-diabetes?
Pre-diabetes is impaired glucose tolerance (IGT) and impaired fasting glucose (IFG). It is a term used to distinguish people who are at risk of developing diabetes.
If a person has IFG and/or IGT then they are considered as having pre-diabetes.
IFG - condition in which the blood glucose level is elevated between 100-125 mg/dl after an overnight fast but not high enough to be classified as diabetes.
IGT - condition with blood glucose level is elevated between 140-199 mg/dl after a 2 - hour oral glucose tolerance test, but not high enough to be classified as diabetes.
What is the importance of blood glucose levels?
- Normal fasting blood glucose level is now defined as less than 100 mg/ dl. Below 70 mg/dl is too low and may experience hypogylcemia. (70 -100 mg/dl).
- Fasting blood glucose level > 126 mg/dl on two or more occasions indicates diabetes.
- Finger prick test not diagnostic for diabetes.
- If blood glucose level is > 200 mg/dl then do not treat the patient until they are seen by their physician and glucose level is the normal range.
- For acute dental infections, fasting blood glucose level 207-229 mg/dl increased risk of infection by 20 %.
- Above 230 mg/dl increased risk of infection by 80 %.
- Infections cause loss of control over diabetic condition and body’s defenses can’t handle infection as well as a non-diabetic patient.
What is a Fasting Venous Plasma Glucose Test?
The fasting blood glucose level is 126 mg/100ml (dl) or greater on 2 or more occasions. Levels of more than 126mg/dl on 2 or more tests indicates diabetes. Normal fasting blood glucose levels range between 70 -100 mg/100ml (dl) in venous blood
What is the Two Hour Postprandial Glucose Test?
Blood levels taken at 2 hr that are  200mg/100ml (dl) on 2 or more occasions after a 75-g glucose load after a night of fasting.
What is the Random Plasma Glucose Test?
Blood glucose levels ≥ 200 mg/dl in a patient with symptoms such as polyuria, polydipsia, and unexplained weight loss on 2 separate occasions. Reconfirm on a different day with a Fasting Plasma Glucose test.
_____ criteria are used for the diagnosis of diabetes mellitus and in the absence of unequivocal hyperglycemia. The diagnosis must be confirmed by _____ on a different day
Three different, repeat testing
What is Glycohemoglobin Measurement?
Glucose attaches to hemoglobin and forms HbA1c.
It can reflect glucose levels in the blood over a 6-12 week period preceding the test.
HbA1c less than 7% is good control and greater than 9% is poor control.
AKA: A1C, hemoglobin A1C, glycated hemoglobin.
What are the new A1c guidelines as of 12/29/10?
The American Diabetes Association revised clinical practice recommendations for A1c:
Diagnosis of diabetes using A1c as a faster, easier diagnostic test.
A1c level of 5% indicates absence of diabetes.
A1c level of 5.7 – 6.4 % indicates prediabetes.
A1c level of 6.5% or higher indicates diabetes. Optimal diabetic control target for diabetics is less than 7 % for A1c.
What are the characteristics to Ketone testing?
Ketones are a by-product of fat metabolism, and the presence of ketones indicates that the body is not metabolizing food properly because of a lack of carbohydrate or insulin.
May indicate ketoacidosis is impending or established in the body
Test urine with a dipstick (Ketostix, Chemstrip K)
When to test:
Blood glucose level is consistently > 300 mg/dl.
During periods of acute illness which can cause hyperglycemia.
With symptoms of hyperglycemia, N&V, abdominal pain
Type 1 - increased glucose readings do not tell you if a pt is ketotic. Ketosis is more serious.
Type 2 - if ketosis develops then pt is very ill. Needs immediate tx.
Ketoacidosis - (Type 1)
Caused by illness, omission of insulin
S&S: Elevated glucose level (> 250 mg/dl), dehydration, N & V, rapid breathing -acetone odor, warm dry skin, tachycardia.
Tx: requires hospitalization.
Hyperosmolar nonketotic coma - (Type 2)
Caused by therapeutic agents, chronic disease, acute infection
S&S: Prolonged hyperglycemia > 600 mg/dl, severe dehydration, absence of or slight ketosis, confusion, coma, may mimic a stroke, usually no N & V.
Tx: Requires hospitalization
Diabetic retinopathy
- leading cause of blindness Cataracts
Diabetic nephropathy
- renal failure, leading cause of death for Type 1
Accelerated atherosclerosis
MI is leading cause of death for Type 2
Coronary heart disease, hypertension, stroke
Ulceration and gangrene of feet
Diabetic neuropathy
- most common clinical complaint by patients and affects both Types 1
and 2.
Dysphagia, gastric distention, diarrhea, impotence, muscle weakness, cramps, oral pain, burning tongue, numbness, tingling, deep burning pain, gangrene.
Early death
Hyperglycemia-
Decreases phagocytic function of granulocytes in area of injury.
Facilitates growth of microorganisms.
Ketoacidosis -
Delays migration of granulocytes in area of injury
Decreases phagocytic activity.
Vascular wall changes
results in vascular insufficiency
Decreases blood flow, granulocytes, and oxygen tension in injury.
What are oral complications with patients with diabetes?
Infection
Poor healing
Periodontal disease
Caries
Periapical abscess
Candidiasis
Burning mouth
Xerostomia
Explain the diabetic oral complications
Oral complications in diabetic patients is due to poor metabolic control. Risk of caries due to xerostomia from medications. Candidiasis can occur due to systemic immunosuppression & poor glycemic control. Burning mouth is a symptom associated with Candidiasis. With xerostomia it is the most common complaint for oral complications and can increase the chance of developing candidiasis. Periodontal disease- microvascular problem that affects blood flow and leukocytes reaching an area of infection.
What is the dental management of Type 1 Diabetes (Insulin-Controlled)
Usually all dental procedures can be performed.
AM appointments are best.
Advise patient to take insulin and eat prior to dental appointment.
Tell patient to inform you if symptoms of insulin reaction occur.
Always have a source of glucose available (OJ, cake icing, Glucola,soda(Coca
What must you consider with a patient with Type 1 Diabetes (Insulin-Controlled)?
Consider dietary needs following surgical post-op. May need to consult with physician.
Consider antibiotics for patient with brittle diabetes or taking high doses of
insulin to prevent post-op infection
What is the dental management with Type 1 diabetes (Uncontrolled):
Refer to physician before any treatment.
May give antibiotics and pain meds if needed for infection if present.
What is the dental management with Type 2 Diabetes?
For the non-insulin dependent patient:
All dental procedures can be performed.
No special precautions needed unless complications of diabetes are present.
For Type 2 insulin dependent patient treat as an Insulin -controlled patient
Ask patient of they took their diabetes medication(s) and ate a meal prior to treatment. Record this information in the patient’s chart.
What are some questions to ask a known diabetic?
History on type of diabetes and onset of disease, meds patient is taking, and who is the physician that is managing their diabetes .
How often does the patient see their physician to evaluate their diabetes status? (Recall visits vary with level of control). Usually seen every 1-3 months by their physician.
Known diabetic patient :
What is the usual blood glucose measurement?
When was the last time blood glucose was tested?
How often does patient have insulin reactions?
Medications taken and dosage.
Does patient test urine for glucose?
Any symptoms present?

Establish severity of disease and degree of control.
What do you do to determine undiagnosed diabetes?
History of signs & symptoms of diabetes or its complications.
High risk for developing diabetes.
Family history (diabetic parents).
Given birth to 1 or more large babies, spontaneous abortions, stillbirths
What are some signs for an undiagnosed diabetic?
Obese
Over 40 years of age
Referral for screening test for diabetes
Hypoglycemic reaction can occur when ...?
Patient fails to eat in normal routine but continues to take their regular insulin injection and may have a reaction due to excess of insulin.
A hypoglycemic reaction also can be caused by and overdosage of insulin or an oral hypoglycemic agent.
Three stages to an insulin shock reaction:
Mild stage- hunger, weakness, tachycardia, pallor,sweating, paraesthesias. Occurs before meals, during exercise, skipping or delaying meals.Give patient fruit juice or anything with sugar.
What is a Moderate stage of Insulin Shock?
incoherence, uncooperativeness, belligerence, lack of judgment, poor orientation. Patient may injure themselves or someone else if driving. Give patient fruit juice or anything with sugar.
What is a severe stage of insulin Shock?
unconsciousness, tonic or clonic movements, hypotension, hypothermia, rapid thready pulse. May occur while sleeping, after exercise, or alcohol ingestion. Patient will need IV glucose solution, glucagon, or epinephrine. Call 911 or activate EMS.
What are some key points to diabetes?
Generally, diabetics are more susceptible to infection. Infection may alter the patient’s insulin requirement.
Prolonged healing.
Appointments should be scheduled soon after mealtime (9:00 A.M. or 1:00 P.M.). Always ask pt. if eaten & taken meds before starting dental procedure. Record in chart.
Consider altering the insulin dosage if dental procedure prevents patient from maintaining a normal diet. Request the physician to alter dosage. EX : Extractions or Perio surgery
Always give sugar for a diabetic emergency. Never give insulin! Pt could die!
You won’t find insulin in the emergency kits for dental offices. Glucose paste or glucose tablets is quick method to treat hypoglycemia in a conscious patient.
What is the thirteenth disease associated with question 23?
High Blood Pressure
What is Hypertension?
sustained abnormal elevation of arterial pressure usually asymptomatic. If severe then get headaches & dizziness.
Normal B/P is < 120/80. For hypertension the control target is < 140/90.
The target is < 130/80 for pts with diabetes or renal disease.
Causes long term damage to heart, brain, eyes, kidneys & blood vessels
What is the dental professionals role with high blood pressure?
- detection of hypertension, and monitoring of effective control. Always check the pt. B/P before dental appointment. Always ask if pt took their medication that day. Record in chart for medicolegal purposes.
How many people are affected by Hypertension?
Estimated more than 65 million in U.S. have hypertension or are taking antihypertensive meds. Hypertension increases with age, sex, and is more prevalent in African Americans, Hispanics, and American Indians.
Many of the meds have significant side effects, some interact with vasoconstrictors, or have oral manifestations.
What are the oral manifestations of High blood Pressure?
All calcium channel blockers, especially Nifedipine can cause gingival hyperplasia.
Xerostomia
Calcium channel blockers is...?
a class of antihypertensive medications. Used to treat hypertension, arrythmias, CHF, and angina. MOA: These drugs decrease the peripheral vascular tone (vasodilation occurs) by decreasing the calcium influx in vascular smooth muscle. Also depresses the force and rate of cardiac contractions to various degrees. Gingival hyperplasia occcurs in 1-10% of patients taking these meds. Can alter collagen activity and local immune response. Treatment: Tissue can regress if medication is stopped and physician will need to switch the patient to a different class of antihypertensive medications.
Dental Management of the Hypertensive Patient :
Reduction of Stress & Anxiety
Establish honest, supportive relationship with the patient. Discuss questions, fears, concerns.
Avoid long or stressful appointments.
Use pre-medication as needed - Valium
Use nitrous oxide gas
Provide gradual changes of position to avoid postural hypotension. Avoid stimulating the gag reflex.
Baseline B/P measurement needed for ER management.
Dismiss pt if appears to be overstressed.
What is the 14th disease associated with question 23?
Infectious Mononucleosis
What are the characteristics of Infectious Mononucleosis?
Etiology: Epstein-Barr Virus (herpes virus family). Transmitted by oropharyngeal route (intimate kissing or close personal contact).
Signs & Symptoms: fever, sore throat, malaise, anterior and posterior cervical lymph node enlargement. Usually in adolescents or young adults.
Treatment: symptomatic, bed rest, analgesics, antipyretics, Acyclovir (antiviral drug), gargling with warm salty water.
Virus may be present for up to 6 months in the oral cavity. Relapses are common
After acute episode of _____, the virus remains latent in the _____.
Infectious Mononucleosis
B-lymphocytes
What are the oral manifestations of Infectious Mononucleosis?
Multiple red petechiae located on the palate are earliest signs.
Acute ulcerative gingivitis
Pharyngeal ulcerations
Exudative tonsillitis
Petechiae
develop the first week of infection. Exudate refers to pus and you can see the pus on the tonsils. Incubation is 30-50 days. A prodromal period of 3-5 days precedes the clinical phase, which can last 7-20 days. During the prodomal phase, the virus infects the oropharyngeal epithelial cells and spreads to the B-lympohocytes in the tonsillar crypts. Peak age is 15-19 yrs in the US. Annual incidence is 3.4-6.7 cases per 1000 persons.
What is the 15th disease that is associated with question 23?
Depression/Anxiety
What are the questions that you have to ask the patient if they answered yes to Depression / Anxiety?
When were they diagnosed?
How was it treated?
What are the current medications used for treatment? Did they take meds today?
Most drugs are for “mood disorders” with oral side effects- xerostomia, stomatitis, bad taste. Many of these drugs interact with epinephrine in local anesthesia. Ex. Elavil(amitriptyline
Elavil
is an antidepressant medication and can increase the effect of epinephrine
What is the 16th disease associated with question 23?
Eating Disorder
What questions do you have to ask someone with an eating disorder?
Type of disorder?
Type of treatment?
Is patient still in a recovering state?
If not getting treatment for eating disorder then find a referral source for the patient.
What are the signs and symptoms of Bulimia?
Chronic sore throat
Burning tongue
Thermal sensitivity
Parotid swelling
Enamel erosion
Frequent caries
Raised amalgams
Eroded occlusal surfaces and lingual surfaces.
What is the Dental Management for eating disorders?
Delay non-urgent restorative care except for pain or temporary cosmetic procedures.
Rinse with baking soda, bicarbonate, antacid to neutralize stomach acid.
Don’t brush immediately after purging.
Use a neutral sodium fluoride.
Custom fluoride trays.
What is the 17th disease associated with question 23?
Intestinal Disorder
What questions do you have to ask a patient who has an intestinal disorder?
For a specific diagnosis.
The type of treatment.
Is the patient taking any medications for the condition?
What are some characteristics of Intestinal Disorders?
Common types of intestinal disorders are ulcerative colitis and Crohn’s disease (Inflammatory bowel disease - IBD), gastritis,and GERD (gastric esophageal reflux disease).
IBD patients may be on long term steroid therapy. May be at risk for an acute adrenal insufficiency because of suppressed adrenal function and reduced ability to withstand stress. May need a physician’s consult.
Avoid drugs that irritate the GI tract such as aspirin, NSAIDs, some antibiotics.
What are the oral manifestations of Gastric Esophageal Reflux Disease (GERD)?
Severe erosion due to reflux of stomach acid
Sensitivity of teeth
Burning tongue
May see more erosion on one side of mouth if patient sleeps on one side most of the night due to reflux of stomach acid.
What are some other conditions that the patients can discuss when you pose the question at the end of question 23?
Thyroid disease
Unusual diseases
Mental health problems - Schizophrenia, bipolar disorder
Hypothryodism is common medical condition not specifically questioned on the health history forms
What is question 24?
Have you had a heart attack?
What questions must you ask a patient who admits to having a heart attack?
When did the heart attack occur?
How severe was it?
Whether the patient has had other heart attacks?
What limitations are on any physical activity?
Which drugs is the patient currently taking? Does patient carry meds with him/her?
Cardiac meds - digitalis
Anticoagulants - Coumadin, Aspirin
6. Does pt. experience anginal attacks?
Frequency, duration, severity
Nitroglycerin
What constitutes a major cardiac risk?
History of MI in previous month with residual ischemic symptoms such as:
Chest pain, SOB, easy fatigue.
What constitutes an intermediate cardiac risk?
If clinically stable are at minimal risk for routine dental treatment.
Risks of cardiac instability, arrhythmias, & reinfarction may be _____.
increased
What is the Dental Management for Patients with Unstable Angina or Recent MI?
MI within the past 30 days:
Avoid elective care.
Consult with physician if emergency care is needed.
Limit treatment to pain relief, treatment of acute infection, control bleeding.
Cautious use of epinephrine in local anesthesia.
Frequent B/P monitoring.
Prophylactic nitroglycerin, sedation, oxygen.
Pulse oximeter.
What is the Dental management with Stable Angina or MI after 4-6 weeks?
- AM/Short appointments.
- Pretreatment vital signs.
- Comfortable chair position.
- Nitroglycerin readily available.
- Stress & anxiety reduction
- Nitrous oxide gas, oral sedation, good communication.
- Use local anesthetic with vasoconstrictor to insure good pain control. Maximum 0.036 mg of epi.
- Avoid epinephrine –impregnated retraction cord.
- Adequate post op pain control.
What is question 25 of the health history form?
Have you ever been told by a physician that you have a heart murmur?
A “Yes” answer to question 25 would require you to ask what questions?
- What is the specific diagnosis?
- Is the problem congenital or acquired?
- Is there any history of surgery?
- Are there any current medications?
Sound caused by turbulence of blood circulating through the valves and chambers of the heart. Turbulence is due to an increased flow rate of blood, change in viscosity,narrowed valves or vessels, dilated valves or vessels, or a vibration of the valve leaflets. May be acquired or congenital disease.
Heart Murmur
How are Murmurs are described?
- Basis of occurrence in the cardiac cycle (systolic, diastolic, or continuous)
- Loudness or intensity (on a scale of I to VI)
- The location on the chest where best heard
- Whether the sounds radiate or are localized
How is a heart murmur detected?
Auscultation with a stethoscope.
What is required for the diagnosis of Heart Murmur?
Presence of a heart murmur requires testing to determine the cause of the turbulent blood flow.
Interpretation of murmurs is not always easy.
What are the Medical tests to check for a heart murmur?
- Complete medical history and physical exam
- AP(anterior-posterior) chest radiographs
- ECG (electrocardiogram),
- Echocardiogram
- Blood laboratory tests.
What are Functional (Innocent)?
When can they be detected?
- Sounds caused by turbulence in the absence of a cardiac abnormality.
- May be detected during childhood (increased blood flow rate through the heart), pregnancy (increased blood volume), periods of high fever, anemia, and sepsis.
- No antibiotic premed needed prior to dental treatment.
What are the other characteristics of functional (innocent)?
- Heard during systole.
- Common description would be a grade II/VI
- Systolic ejection murmur best heard at the pulmonic area that does not radiate.
- Usually disappears after puberty or childbirth
- Also referred to as non-organic, physiologic, or benign murmurs.
What are Organic (Pathologic) Murmurs?
Sounds caused by a pathologic abnormality ( valvular disorder) in the heart. Most often heard during diastole and do not disappear with time.
How are organic murmurs caused?
- Stenotic valve - reduced orifice between heart chambers.
- Regurgitation of blood from endocardial fibrosis - results in a floppy, incompetent valve.
- Combination - of stenotic and regurgitant valves.
What are the most common valves to be affected in a heart murmur?
- Valves on the left side of the heart are more commonly affected than the valves on the right side.
- Mitral valve - most frequently affected valve; left atrium
What are the causes of organic heart murmur?
- Congenital heart defects (mitral valve prolapse, MVP).
- Rheumatic heart disease; connective tissue disease (Osteogenesis imperfecta).
- Autoimmune disease (Systemic lupus erythematosus).
- Common description of a murmur is III/VI diastolic murmur heard best over the fourth rib radiating to the axilla.
What is the relation of heart murmurs to dentistry?
- Organic heart murmur indicates that a valve is damaged and a potential hazard that pathogenic microbes released into the circulation during invasive dental treatment may colonize the diseased valve (Infective endocarditis). Microbial proliferation can result in infection spreading throughout the body. Significant morbidity and mortality are associated with IE.
- Antibiotic premed is not always necessary prior to dental treatment. Guidelines were modified in June 2007
What is question 26 on the health history?
Do you have an artificial heart valve?
Patients with artificial heart valves are considered to be highly susceptible to _____ from bacterial seeding from bleeding during dental treatment.
Bacterial endocarditis
What is required for a patient with an artificial heart valve before they receive dental treatment?
Antibiotic prophylaxis.
What are the two types of artificial valves?
- Mechanical and porcine.
- Patients with prosthetic valves are on Coumadin to prevent blood clots from forming around the valve.
What is Infective endocarditis (IE)?
What causes the disease?
- Caused by infection of the heart valves, endocardium, in proximity to congenital or acquired defects.
Infection may be caused by
- Streptococcus viridans, Staphylococcus aureus, or Candida albicans, and gram negative bacteria.
What is question 27 of the health history form?
Have you had endocarditis?
What is question 28 of the health history form?
Have you ever experienced an unusual reaction to any of the following?
What is a general rule for allergic reactions?
They tend to get worse with subsequent exposures.
What is the most severe allergic reaction a patient can have?
- Anaphylaxis.
- A person with more than one drug allergy is at a higher risk of anaphylaxis than a person without allergies.
What are the allergic reactions to Aspirin (ASA)?
- May produce rash (urticaria) or swelling (edema).
- Asthmatic patients may have a severe asthma reaction. May be precipitated by 5 grains (325mg) of ASA.
- Rule of thumb: Do not give asthma patients aspirin or NSAIDs
What are the allergic reactions to Penicillin?
- Reactions range from mild skin rash to anaphylaxis.
- Any previous history of allergic reaction to any drug in the penicillin family would be a reason to avoid any future use of the drug no matter how mild the drug reaction.
What are the allergic reactions to Latex?
- Can cause skin rash on operator or on patient.
-->Mild - Anapylaxic reactions
Use vinyl or nitrile gloves, rubber dam for patients with latex allergy.
Why do we ask question 28?
- These questions are asked to find out about multiple drug allergies which should make us aware of the possibility of anaphylaxis with a drug that we might use or prescribe.
- Iodine sensitivity usually produces a skin rash. Several dental products contain an iodine base. At OUCOD a betadine scrub is used in the OS clinic.
What is question 29 of the patient health history form?
Do you use tobacco in any form (cigarettes, smokeless tobacco, pipe)?
What are the details that you need to get regarding question 29?
- Does pt. use tobacco?
- Determine if pt is current, former, or never tobacco user.
- What is the form, frequency, & duration of tobacco use?
- Document tobacco use status in health history information.
What diseases are associated with smoking?
Oral cancer, oropharyngeal cancer
COPD (chronic obstructive pulmonary disease).
Atherosclerosis
Ischemic heart disease, stroke, MI, peripheral vascular disease, sudden death
What are the negative statistics for smoking?
- Estimated 44.5 million (20.9% ) population in U.S. are current smokers.
- 440,000 deaths in U.S. per year.
- 8.6 million people are disabled due to smoking related diseases.
What are the effects of tobacco on oral cavity?
- Vasoconstriction decreases blood flow to oral tissues.
- Impairs healing for oral tissues (nutrients)
- Diminishes host immune response (leukocytes).
What are oral diseases related to smoking?
- Leukoplakia
- Non-healing ulcerations
- Oral cancer
- Gingival recession
- Hairy tongue
- Nicotine stomatitis
- Smoking can impair periodontal health & therapy
- Extrinsic stain
- Halitosis
What is question 30 on the patient health history?
Has there been any change to your general health recently?
Why is question 30 included?
Cross check of previous questions that the patient may have not answered honestly, intentionally, or from forgetfulness.
Why are Questions 30 - 44 included in the health history?
They relate to symptoms the patient may have
Section is referred to as the systems review and is necessary to recognize any undiagnosed disease and refer to the physician.
What is question 31 on the patient health history?
Are you frequently ill or often exhausted or fatigued?
What are some extra questions to include when asking about a patients fatigue?
- What is the patient’s lifestyle?
- Is their lifestyle difficult or stressful?
-->Work schedules?
-->New baby in the house?
-->Family problems?
-->New job, location?
- First year dental or dental hygiene student?
- If unknown cause, suspect undiagnosed systemic illness and refer to a physician
What is question 32 of the patient health history?
Do you ever have asthma, hay fever, hives, skin rash, or respiratory allergies?
What is the purpose of question 32?
Target patients that may have multiple allergies who are at a higher risk of allergy to local anesthesia or other drugs.
Periodontal health may be affected by what?
- Mouth breathing.
- Patients with chronic nasal congestion tend to breath through their mouth which dries out the tissue, leaving them red and inflamed.
What can result from steroid asthma inhalers?
Acute Atrophic Candidiasis
What is question 33 on the patient health history form?
Do you bleed for a long time when cut?
What else do you have to know when a patient is susceptible to bleeding?
Identify a patient with a history of abnormal bleeding.
Bleeding tendencies are congenital (hemophilia A - Factor VIII deficiency) or acquired (leukemia, various medications).
Further questioning and laboratory tests may be necessary before dental treatment.
What is question 34 on the patient health history form?
Do you have headaches, eye trouble or ear trouble?
What are the types of headaches?
Tension headaches - frontal bone, occipital area, muscles of the neck.
Hypertension - can produce headaches in the occipital area, visual disturbances, muscle aches in lower extremities. Does not go away with rest.
Temporal - may be related to TMJ problems, myofascial pain (muscle spasms).
Migraine, Cluster headaches
What constitutes ear trouble?
- Ear trouble - may be associated with TMJ problems, myofasical pain.
- Tinnitus - noises in the ear such as buzzing,roaring or ringing (hypertension).
- Meinere’s disease - a chronic disease of the inner ear characterized by recurrent episodes of vertigo.
- Inner ear infection
- Hard of hearing may present a communication problem.
- Deafness
What constitutes eye trouble?
- Eye trouble - What is the reason for poor vision? May be related to diabetes or hypertension.
- Antisialogogue - Drug that prevents the flow of saliva. In a patient with glaucoma, the use of antisialogogues are contraindicated because the drug causes an increase in the intraocular pressure. Ex: atropine, scopolamine
What is question 35 on the patients health history form?
Do you have frequent colds, sore throats or nosebleeds?
How do you define frequent colds?
- 3 or 4 per year
- Decreased resistance and susceptible to illness.
- Continuous cold suggests an allergy.
What are sore throats a result of?
Allergies
Mouth breathing
Smoking.
- If unknown etiology refer to physician.
What do nosebleeds result from?
Drying of nasal tissues, a nasal pharyngeal tumor, hypertension, breathing disorder, trauma
What is question 36 on the patient health history form?
Do you ever have chest pain, shortness of breath or swelling of the ankles?
What does Chest pain (angina pectoris) suggests?
Insufficiency of the blood supply to the heart. Prior to a stressful dental procedure may use Nitroglycerin sublingual to prevent angina pain during treatment.
What does shortness of breath suggest?
Congestive heart failure (CHF), which is the inability of the of blood being supplied (backup of blood) causing systemic congestion.
When can ankle swelling occur?
Heart failure and chronic nephritis.
If the patient complains of ankle swelling and shortness of breath, refer to a physician.
May see pitting edema
What is question 37 on the patient health history form?
Do you have a chronic cough or do you ever cough up blood?
What is the First question to ask the patient if they are coughing up blood?
“Do you smoke?”
- A persistent cough may be due to smoking, asthma, allergies, chronic obstructive pulmonary disease (COPD) which includes chronic bronchitis or emphysema, TB, AIDS, carcinoma of the lung.
What is the second question to ask the patient if they are coughing up blood?
- Is the cough productive or non-productive?
- Production of sputum may be from an inflammatory process.
- A non-productive cough suggests bronchogenic neoplasm or AIDS.
- Hemoptysis (coughing up blood) may be from TB, bronchial inflammation, lung cancer.
What is question 38 on the patient health history form?
Has your appetite changed or have you just lost weight?
What does a sharp increase in appetite suggest?
Hyperthyroidism or diabetes.
Patient does not gain any weight.
What does a sharp increase in appetite suggest?
Hyperthyroidism or diabetes.
Patient does not gain any weight.
What does a decrease in appetite suggest?
- Hepatitis
- Infectious mononucleosis
- Anorexia
- Depression
- GI cancer
- AIDS.
- Patient may be dieting to lose weight.
What is question 39 on the patient health history form?
Do you have any difficulty with swallowing or eating some foods or indigestion or vomiting?
What is difficulty in swallowing related to?
Anxiety, pharyngeal carcinoma.
What are the most common causes of indigestion?
GERD
Peptic ulcer
Gall bladder disease.
- May have an anxious patient.
What can frequent vomiting be due to?
Hiatal hernia
Bulimia
Alcoholism
Pregnancy
Ulcers.
- Check for signs of erosion on teeth from stomach acid.
What is question 40 on the patient health history form?
Do you urinate frequently or drink large amounts of liquids?
Frequent urination is more than _____ times a day.
Six
- This may be variable depending upon the pt’s normal fluid intake daily.
- Patient may need to be screened for diabetes, renal disease, bladder disease, or prostate disease.
What is question 41 on the patient health history form?
Have you ever had painful, swollen joints, numb or prickling skin?
A single joint may be from ...
Trauma or over-exertion (tennis elbow).
Multiple joint pain or swollen joints may be indicative of ...
Rheumatoid arthritis or osteoarthritis. May have TMJ pain.
Numb or prickly skin may be result of ...
Injury to a nerve or invasion of a tumor.
What is question 42 on the patient health history form?
Do you ever have seizures or tendency to faint?
What must be done after you identify a patient with epilepsy or seizure disorder?
- A physician’s consult may be needed prior to treatment to see if medications need to be increased. - There are many types of seizure disorders.
What does a tendency to faint identify?
Patients with a tendency for syncope. Talk with patient about it.
What is question 43 on the patient health history form?
Females - Are you pregnant?
What kind of treatment should a woman in her first trimester have?
Avoid elective dental treatment.
ER treatment only.
May perform prophy with visual exam, provide OHI.
- Most critical time for teratogenicity.
- Development of major organs in fetus
What kind of treatment should a woman in her second trimester have?
- More ideal time for dentistry.
- Routine prophy and minor restorative care.
- Fetus is past critical stage of development and mother is not to large to be uncomfortable in dental chair.
What kind of treatment should a woman in her third trimester have?
- Avoid elective dental care mainly due to mother’s size and discomfort while reclining in chair. - Pt should sit or lie with right hip elevated to avoid pressure on the vena cava and sciatic nerve.
- ER treatment only.
- Possibility of premature labor.
- Avoid drugs - aspirin, NSAIDs, opioids, tetracyclines, valium, nitrous oxide gas
What are the drugs that can be used by women who are pregnant?
Penicillin
Clindamycin
Acetaminophen
Lidocaine
Codeine used in combination with acetaminophen (low doses for short duration.)
What is question 44 on the patient health history form?
Do you have any other medical or dental condition or symptoms not previously mentioned?
What is the purpose of question 44 on the patient health history form?
This is a catch all type of question. If answered as “Yes,” then follow up with patient about history of disease
What does ASA stand for?
American Society of Anesthesiologists
What are the ASA (American Society of Anesthesiologists) Classifications?
This is a system of classifying a patient according to their physical status and guiding dental management decisions.
What is the ASA I classification?
Normal healthy patient
No dental management alterations. No problems climbing stairs or running for at least 2 minutes.
What is the ASA II classification?
Mild systemic disease that does not interfere with day-to day activity or that has a significant health risk factor, (smoking, alcohol abuse, obesity).
May or may not need dental management alterations.
EX.: mild hypertension, Type 2 diabetes, heart murmur,allergy, well controlled epilepsy, well controlled asthma.
Should be able to climb 2 flights of stairs with no problems.
What is the ASA III classification?
Moderate to severe systemic disease that is not incapacitating but may alter day - to-day activity.
May have significant drug concerns
May require special patient care, require altered dental management.
EX: Type 1 diabetes, COPD, moderate hypertension,stable angina, MI within past 6 months,CHF, AIDS, hemophilia
Climbing 2 flights of stairs would cause SOB or discomfort.
What is the ASA IV classification?
Severe systemic disease that is a constant threat to life.
Patient will be unable to do light activity for a short period of time and may experience discomfort at rest.
Requires altered dental management.
Severe hypertension, ESRD, liver failure, advanced AIDS, acute MI or stroke within past 6 months, unstable angina