Top Rated Hyderabad Call Girls Erragadda ⟟ 6297143586 ⟟ Call Me For Genuine ...
gen med intro.pptx
1. GENERAL MEDICINE AND DENTISTRY:
AN INTRODUCTION
DR. ATUL SHARMA
CONSULTANT, CRITICAL CARE
M.B.B.S., MMED(ANAESTHESIOLOGY),
DNB(ANAESTHESIOLOGY), D.C.C.M., F.I.C.M.,
F.C.CS.(CRITICAL CARE)
2. Objectives
► Help you identify patients with various types of
medical problems who might be at risk for having
problems as a result of dental treatment
► Help you to plan and deliver dental treatment in
such a way as to decrease the risk of an adverse
event or outcome occurring, thus protecting your
patients from injury, disease or adversity.
► Help you to avoid litigation, anxiety, and sleepless
nights.
3. What do we do in the course of providing dental care
that can affect the health and well being of a patient?
► Instill fear
► Inflict pain
► Inject local anesthetic
solutions
► Inject potent
vasoconstrictors
► Cause bleeding
► Control body position
► Expose to radiation
► Expose to dental
materials
► Prescribe medications
► Alter oral function
► Alter appearance
4. Determining the Risk for the
Occurrence of an Adverse Event
Must take into consideration 4 factors:
I. The medical condition of the patient (diagnosis,
severity, stability, control)
II. The functional (cardiopulmonary) reserve of the
patient that enables them to perform physical
tasks
III. The emotional stability of the patient (fear,
anxiety)
IV. The nature of the dental procedure
(invasiveness, length of procedure, blood loss,
type of anesthesia, use of vasoconstrictor)
8. Most Common Medical
Emergencies in Dental Practice
► Syncope
► Mild Allergic Reaction
► Angina Pectoris
► Postural Hypotension
► Seizures
► Asthmatic Attack
► Hyperventilation
► Epinephrine Reaction
► Insulin Shock
► Cardiac Arrest
► Anaphylaxis
► Myocardial Infarction
Many of these events are preventable, or at least
the chances of them occurring can be lessened
9. Risk Assessment
Can we provide routine dental treatment to this patient
without endangering their (or our) health and well
being?
Yes. Most patients. No problems are anticipated, and
treatment can be delivered in the usual manner. Risk is
very low. (Benefit > Risk)
Yes, BUT potential problems may be anticipated, and
modifications in the delivery of treatment are necessary.
Risk is moderately increased (Benefit > Risk)
No. Potential problems exist that are serious enough to
make it inadvisable to provide elective dental treatment.
Risk is significantly increased (Risk > Benefit)
10. Medical Risk Assessment Begins with the
Identification of Medical Problems
► Medical History
► Physical Examination (vital signs, general survey,
face, eyes, skin)
► Laboratory tests
► Medical consultation (physician, previous dentist,
pharmacist)
11. The Medical History – Now What??
► Review the Medical History and note positive
responses
► Interview the patient to gain more information about
those positive responses
► Potentially significant disorders OR unfamiliar
disorders require further thought and/or
investigation
► YOUR RESPONSIBILITY!!
12. Drug Information
► Drug Name (brand and generic)
► Drug type or action
► Why prescribed
► Interactions
► Epinephrine
► Antibiotics
► Analgesics
► Sedative/hypnotics
► Oral manifestations
► Side effects
13. Medical Problem Worksheet
► Name of medical problem
► Drugs taken for the problem
► Recognition of signs, symptoms or abnormal lab value related to
problem
► Assessment of control or stability of the problem
► Recognition of possible issues or concerns related to dental care
► Treatment alterations
14. Clinical Examination
► General appearance
► Behavior
► Vital signs
► Head and neck
► Oral tissues
► Radiographs
► Laboratory tests
15. Laboratory Tests
► Determine coagulation/hemostasis status
► Screening for blood glucose (severe periodontal disease, burning
mouth)
► Screen for rheumatologic disease (Sjögren’s syndrome, SLE,
rheumatoid arthritis)
► Screening for liver function (hepatitis C, cirrhosis)
► Screening for kidney function (renal failure)
► Complete blood count with differential (burning mouth, unexplained
oral lesions)
16. Medical Consultation
► Purpose:
► Verify or clarify information
► Determine risk for doing dental treatment on the patient
► Determine if any changes are required in the delivery of
dental treatment
► Be brief and to the point
► Response should attached to or recorded in the patient’s
chart
► Fax, mail, or give to patient
17. Phone Consultation
► A phone call is not the best way to obtain information
but does provide information quickly
► Often the physician will not be available to talk to you
directly
► It is mandatory to document this conversation, to
include to whom you spoke and what was said
► Direct, written confirmation of this consult is advisable
for medico-legal reasons
► Suggestion: Write a brief summary of the conversation
18. Medical Consult: Example
► Pt History: 24 year old female with a past history of
heart murmur but is unsure of current status
► Reason for consult: Determine if the patient has a
heart murmur and if so, determine if the patient
requires antibiotic prophylaxis for invasive dental
treatment?
19. Medical Consult: Example
► Pt History: 62 year old male with
history of symptomatic heart failure; an
inability to climb a flight of stairs
without getting short of breath or
having chest pain
► Reason for Consult: Can this patient
tolerate routine dental treatment
including fillings, and gingival surgery
using local anesthetic with 1:100,000
epinephrine?
20. ABC’s of Problem
Identification
► Antibiotics
► Anesthesia
► Anxiety
► Allergy
► Bleeding
► Chair position
► Drugs
► Devices
► Equipment
► Emergencies
21. You have obtained the history, performed a clinical
exam, obtained appropriate lab results and consulted
with the physician if necessary. Now, answer this
question….
► Are there any potential problems related to the provision
of dental care?
► If not, proceed with treatment in the usual manner
► If yes, then…
► Are there any potential problems related to the provision
of dental care? If yes, then…
► How do I need to modify treatment to avoid those
problems?
23. Examples of Treatment Modifications
▪ Limit treatment to specific times (e.g. hemodialysis; pregnancy)
▪ Preoperative anticoagulation level; blood pressure
▪ Preoperative antibiotics (e.g. prosthetic heart valve)
▪ Provide pre-operative or intra-operative sedation (e.g. unstable
cardiac patient; fearful patient)
▪ Minimize the intraoperative use of epinephrine in local anesthesia,
(e.g. unstable cardiac patient)
▪ Avoid the administration or prescription of certain drugs (e.g.
erythromycin for patients taking certain lipid-lowering drugs)
▪ Make position changes slowly (e.g. BP medications)
▪ Ensure a comfortable chair position (e.g. heart failure, emphysema,
pregnancy, arthritis)
▪ Provide postoperative antibiotics (poorly controlled diabetic with
dental abscess)
24. Finally, answer this question….
►Are there any oral
manifestations or abnormalities
present that may be related to
the disease or it’s treatment?
