2. Interrelationships Of
Medicine And Dentistry
Physical Evaluation & Risk Assessment
Practice Goals
Deliver The Best Care Possible For
The Patient
Be Aware What Impact The Systemic
Status And Medications May Have On
Delivery Of Treatment
To Feel Comfortable Treating A
Variety Of Patients
3. Value Of The Health History Questionnaire &
Medical History
It Is The Cornerstone Of Patient
Evaluation & Risk Assessment
Identifies Systemic Disease
Identifies Medications
Establishes Rapport
Medicolegal Protection For The
Practitioner
4. Risk Assessment Involves
Identification Of:
Nature, Severity, & Stability Of The
Patient’s Medical Condition
Functional Capacity Of The Patient
Emotional State Of The Patient
Type & Magnitude Of The Dental
Procedure
6. ASA Classification Groups
ASA I
Normal, Healthy Patient
ASA II
Mild Disease
Does Not Interfere With Daily Activities
May Need Some Alteration Of Dental
Treatment
Examples: Mild HTN Or COPD,Type II
Diabetes, Allergy, Well-Controlled
Epilepsy Or Asthma
7. ASA Classification Groups
ASA III
Moderate To Severe Systemic Disease
May Alter Daily Activities
Generally Requires Alteration Of Dental
Treatment
Medications
Type I Diabetes, Moderate To Severe HTN,
Angina, CHF, AIDS, COPD, Hemophilia, MI In
Last 6 Months
8. ASA Classification Groups
ASA IV
Severe Systemic Disease
Life-Threatening Conditions
Requires Alteration Of Dental
Management
ESRD, Liver Failure, Advanced
AIDS
9. ASA Physical Status
P1 A normal healthy patient
P2 A patient with mild systemic disease
P3 A patient with severe systemic disease
P4 A patient with severe systemic disease that
is a constant threat to life
P5 A moribund patient who is not expected to
survive without the operation
P6 A declared brain-dead patient whose organs
are being removed for donor purposes
10. Patients Requiring Further Evaluation By
The Anesthesiologist For General Surgery
Morbid Obesity (BMI>38)
MI Within 6 Months
Angioplasty Within 3 Months
History Of Heart Transplant
History Of Unstable Angina
11. Patients Requiring Further Evaluation By
The Anesthesiologist For General Surgery
History Of Carotid Surgery Within 6
Months
History Of Steroid-Dependent
Asthma Or COPD Particularly With
URI In Last 4 Weeks
(Upper Respiratory Infection)
Seizure Within 3 Months While
Taking Anticonvulsants
12. Patients Requiring Further Evaluation By
The Anesthesiologist For General Surgery
History Of Allergy To Local Anesthetics
History Of Dialysis Or Renal Transplant
History Of CVA/TIA Within 6 Months
(Cerebrovascular Accident/Transient Ischemic Attack)
Systolic BP>200 And/Or Diastolic BP>100
History Of Cirrhosis (Need Recent CBC, INR,
LFT)
13. Risk Assessment
ABCs Of Risk Assessment Are More
Helpful Than The ASA Physical
Classification System
ASA System Does Not Provide
Information About Modification Of
Treatment
15. Medical History Overview
Cardiovascular Diseases
Heart Failure (CHF)
A Clinical Syndrome Complex
No Routine Treatment If Not Controlled
Consider Chair Position
Cardiac Glycosides (Digoxin, Lanoxin)
+ Vasoconstrictors Arrhythmias
(Avoid Vasoconstrictors If Possible)
16. Medical History Overview
Cardiovascular Diseases (Cont.)
Myocardial Infarction
No Routine Treatment If
In Last 1-6 Months (Refer To Your Text!)
Increased Risk Of Reinfarction, CHF &
Arrhythmias
17. Medical History Overview
Angina Pectoris
Stable
Unstable: Chest Pain At Rest
Increased Incidence Of
Arrhythmias, MI’s, Sudden
Death
Elective Treatment
Contraindicated
Cardiovascular Diseases (Cont.)
20. Medical History Overview
Rheumatic Heart Disease
From Rheumatic Fever Following A
Beta-Hemolytic Streptococcal Infection
Valve Damage?
No Recommendation For
Endocarditis Prophylaxis
Cardiovascular Diseases (Cont.)
21. Medical History Overview
Congenital Heart Disease
Prosthetic Heart Valves
Arrhythmias: Frequently Related To
Heart Failure Or Ischemic
Disease
Cardiovascular Diseases (Cont.)
22. Medical History Overview
Cardiac Surgery
CABG (Coronary Artery
Bypass Graft)
Transplant:
Immunosuppression
Considerations
Cardiovascular Diseases (Cont.)
23. Medical History Overview
Stroke Or CVA: Anticoagulation
Possibilities
Aneurysm: If Repaired, No
Prophylaxis Required After
6 Months
Cardiovascular Diseases (Cont.)
24. Medical History Overview
Hematologic Disorders
Transfusion: Why Was It Done? Risks
Anemia
Leukemia
“Bleeds Longer Than Normal”
Genetic (Hemophilias)
Acquired (Pharmacotherapy)
25. Medical History Overview
Neural/Sensory Disorders
Headache, Dizziness, Syncope
Glaucoma: Avoid Anticholinergic Drugs
If Patient Has Closed-Angle Glaucoma
(Banthine, Pro-Banthine)
Given To “Dry Up” Saliva
Epilepsy, Seizures, Convulsions
Psychiatric Treatment
36. Medical History Overview
Medications
Use Appropriate References When
Looking Up Something
Steroids, Anticoagulants,
Immunosuppressives
Allergies, Adverse Reactions
Stress Importance Of OTC (Over The
Counter) Drugs
37.
38. Medical History Overview
Dental History
Vital Signs: Initial Exam, Recalls,
Whenever Indicated
Pulse
Rate & Rhythm (60-100
bpm)
BP: S <120; D <80
Respiration (12-16 bpm)
40. Medical History Overview
Laboratory Tests
(Indicated?)
Hematocrit, Hemoglobin
Platelet Count, PT (INR)
Fasting Blood Glucose
Biopsy
Culture & Sensitivity
Who Orders The Tests?
41. Communication With Physician
HIPAA Forms Must Be Filled
Out By Patient At Physician’s
Office
HIPAA Forms Must Be Filled
Out By Patient At Dentist’s
Office
43. And Now For Some Relatively New
Stuff:
2007 AHA Guidelines for Endocarditis
Prophylaxis
History Of Bisphosphonate Use
2009 American Association of Orthopaedic
Surgeons Information Statement
Regarding Prosthetic Joint Prophylaxis
44. Risk Is Always Increased When
You Treat A Medically
Compromised Patient
Your Goal Is To Reduce The Risk
As Much As Possible
