Presentation on theme: "Medical Risk Assessment for Dental Patients"— Presentation transcript:
1Medical Risk Assessment for Dental Patients Does the benefit of having dental treatment outweigh any increased medical risk to the patient?
2ObjectivesHelp you identify patients with various types of medical problems who might be at risk for having problems as a result of dental treatmentHelp 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.
3What do we do in the course of providing dental care that can affect the health and well being of a patient?Control body positionExpose to radiationExpose to dental materialsPrescribe medicationsAlter oral functionAlter appearanceInstill fearInflict painInject local anesthetic solutionsInject potent vasoconstrictorsCause bleeding
4Determining the Risk for the Occurrence of an Adverse Event Must take into consideration 4 factors:The medical condition of the patient (diagnosis, severity, stability, control)The functional (cardiopulmonary) reserve of the patient that enables them to perform physical tasksThe emotional stability of the patient (fear, anxiety)The nature of the dental procedure (invasiveness, length of procedure, blood loss, type of anesthesia, use of vasoconstrictor)
8Most Common Medical Emergencies in Dental Practice SyncopeMild Allergic ReactionAngina PectorisPostural HypotensionSeizuresAsthmatic AttackHyperventilationEpinephrine ReactionInsulin ShockCardiac ArrestAnaphylaxisMyocardial InfarctionMany of these events are preventable, or at least the chances of them occurring can be lessened
9Risk AssessmentCan 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)
10Medical Risk Assessment Begins with the Identification of Medical Problems Medical HistoryPhysical Examination (vital signs, general survey, face, eyes, skin)Laboratory testsMedical consultation (physician, previous dentist, pharmacist)
11The Medical History – Now What?? Review the Medical History and note positive responsesInterview the patient to gain more information about those positive responsesInnocuous or insignificant problems can be disregardedPotentially significant disorders OR unfamiliar disorders require further thought and/or investigationYOUR RESONSIBILITY!!
12Drug Information Drug Name (brand and generic) Drug type or action Why prescribedInteractionsEpinephrineAntibioticsAnalgesicsSedative/hypnoticsOral manifestationsSide effects
13Medical Problem Worksheet ID of medical problemID of drugs taken for the problemRecognition of signs, symptoms or abnormal lab value related to problemAssessment of control or stability of the problemRecognition of possible issues or concerns related to dental careTreatment alterations
14Clinical Examination General appearance Behavior Vital signs Head and neckOral tissuesRadiographsLaboratory tests
15Laboratory 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)
16Medical Consultation Purpose: Verify or clarify information Determine risk for doing dental treatment on the patientDetermine if any changes are required in the delivery of dental treatmentBe brief and to the pointResponse should attached to or recorded in the patient’s chartFax, mail, or give to patient
17Phone ConsultationA phone call is not the best way to obtain information but does provide information quicklyOften the physician will not be available to talk to you directlyIt is mandatory to document this conversation, to include to whom you spoke and what was saidDirect, written confirmation of this consult is advisable for medico-legal reasonsSuggestion: Write a brief summary of the conversation
18Medical Consult: Example Pt History: 24 year old female with a past history of heart murmur but is unsure of current statusReason for consult: Determine if the patient has a heart murmur and if so, determine if the patient requires antibiotic prophylaxis for invasive dental treatment?
19Medical 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 painReason for Consult: Can this patient tolerate routine dental treatment including fillings, and gingival surgery using local anesthetic with 1:100,000 epinephrine?
20ABC’s of Problem Identification AntibioticsAnesthesiaAnxietyAllergyBleedingChair positionDrugsDevicesEquipmentEmergencies
21You 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 mannerIf 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?
22Examples of Treatment Modifications Pre-op:prophylactic antibioticssedativefood intakeIntra-op:upright chair positionminimize or avoid epinephrinenitrous oxidehemostasis measuresPost-op:analgesicsanti-fibrinolytic agentantibiotics
23Examples of Treatment Modifications Limit treatment to specific times (e.g. hemodialysis; pregnancy)Preoperative anticoagulation level; blood pressurePreoperative 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)
24Finally, answer this question…. Are there any oral manifestations or abnormalities present that may be related to the disease or it’s treatment?
25Oral Manifestations Dry mouth (xerostomia) or burning mouth or tongue Oral ulcerations/lesionsBleedingGingival hyperplasiaFungal/bacterial infections