DTHY 1102

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27962
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DTHY 1102
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2010-07-25 21:56:30
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DtHy Theory Technique
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DtHy 1102 Lecture 1
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  1. Preventive antibiotics prior to a dental procedure are advised for patients with:
    • 1. artificial heart valves
    • 2. a history of infective endocarditis
    • 3. certain specific, serious congenital heart conditions
    • 4. a cardiac transplant that developes a problem in a heart valve
  2. serious congenital heart conditions that require preventive antibiotics prior to dental procedures
    • 1. unrepaired or incompletely repaired cyanotic congenital heart disease, including those with palliative shunts and conduits
    • 2. a completely repaired congenital heart defect with prosthetic material or device, whether placed by surgery or by catheter, during thr first 6 months after the procedure
    • 3. any repaired congenital heart defect with residual defect at the site or adjacent to the site of a prosthetic patch or a prosthetic device
  3. Patients with congenital heart disease can have complicated circumstances. They should:
    check with their cardiologist if there is any question at all as to the category that best fits there needs
  4. Endocarditis prophylaxis is NOT recommended for:
    • 1. mitral valve prolapse
    • 2. rheumatic heart disease
    • 3. bicuspid valve disease
    • 4. heart murmur
    • 5. prior use of the medicine phen-phen
    • 6. calcified aortic stenosis
    • 7. congenital heart conditions such as ventricular septal defect, atrial septal defect and hypertrophic cardiomyopathy
  5. Dental Procedures for which Endocarditis Prophylaxis is recommended:
    All dental procedures that involve manipulation of gingical tissue or the periapical region of teeth or perforation of the oral mucosa
  6. the following procedures or events do not need prophylaxis:
    • 1. routine anesthetic injections through noninfected tissues
    • 2. dental radiographs
    • 3. dental sealants
    • 4. dental impressions
    • 5. placement of removable prosthodontic or orthodontic appliances
    • 6. adjustment of orthodontic appliances
    • 7. placement of orthodontic brackets
    • 8. shedding of primary teeth
    • 9. bleeding from trauma to the lips of oral mucosa
  7. Prophylactic regimen for dental procedures American Heart Association
    single dose 30 - 60 minutes before procedure
  8. Oral - Amoxicillin
    adults - 2.0 g

    children - 50 mg/kg
  9. unable to take oral

    Ampicillin
    adults - 2.0g IM or IV

    children - 50 mg/kg IM or IV
  10. unable to take oral

    Cepazolin or ceftriaxone
    adults - 1.0g IM or IV

    children - 50 mg/kg IM or IV
  11. allergic to penicillins or ampicillin (oral)

    Clindamycin (most common)
    adults - 600mg

    children - 20 mg/kg
  12. allergic to cillins (oral)

    Cephalexin
    adults - 2.0g

    children - 50mg/kg
  13. allergic to cillins (oral)

    Azithromycin or Clarithromycin
    adults - 500mg

    children - 15mg/kg
  14. allergic to cillins and unable to take oral

    Cepazolin or ceftriaxone
    adults - 1.0g IM orIV

    children - 50mg/kg IM or IV
  15. allergic to cillins and unable to take oral

    Clindamycin
    adults - 600mg IM or IV

    children - 50mg/kg IM or IV
  16. antibiotic prophylaxis for patients w/ Total Joint Replacements


    Patients at increased risk of Hematogenous Total Joint Infection
    • 1. inflammatory arthropathies: rheumatoid arthritis, systemic lupus erythematosus
    • 2. disease, drug, or radiation-induced immunosuppression
    • 3. insulin dependent (type 1) diabetes
    • 4. first 2 years following joint replacement
    • 5. malnourishment
    • 6. hemophillia
  17. Dental Hygiene procedures requiring antibiotic premedication:
    1. peridontal procedures including surgery, subgingival placement of antibiotic fibers/strips, scaling and root planing, probing, recall maintenance

    2. prophylactic cleaning of teeth or implants where bleeding is anticipated
  18. Dental Hygiene Procedures not requiring antibiotic premedication:
    1. exposing oral radiographs

    2. flouride treatments

    3. oral impressions
  19. Personal, Medical, Dental History


    Assessment of Patient Includes:
    - gathering, organizing, and analyzing all data. It is a collection of all pertinent facts and materials to use as a guide during care planning and treatment.

    - a complete patient history is an essential part of the complete assessment.
  20. purposes of the history:
    • A. provides info pertinent to the diagnosis of oral conditions and the total treatment plan.
    • B. reveals conditions which necessitate precautions, modifications or adaptations during appointments to assure dental hygiene procedures will not harm the patient and emergency situations will be prevented.
    • C. aid in identifying unrecognized conditions for reference and for further diagnosis or treatment.
    • D. permits appraisal of general health and nutritional status.
    • E. give insight into emotional and psychological factors which may effect present and continuing care.
    • F. document records for reference and comparison over a series of appointments.
    • G. maintain legal documentation, furnish evidence in legal matters.
  21. The major rationale for taking the patient's health history is to identify:
    • A. diseases or medications that contraindicate dental or dental hygiene care.
    • B. diseases or conditions that require special precautionary measures for the patient prior to care.
    • C. reactions to drugs or patient allergies.
    • D. infectious diseases that endanger others
    • E. Special physiological states such as pregnancy
  22. History preparation
    • A. the general method for obtaining a Health History on a patient is by questionnaire and interview or review with follow up questions.
    • B. the patient should be given the form to complete when they arrive for appointment and they should be given a black ink pen and a seat in the reception area.
    • C. make sure patient understands the importance of answering everything truthfully. after the patient answers all questions, you may take them back to the dental chair, review questions and follow up on all "yes" answers.
    • *certain questions you will need to ask again - hospitalization/date, medication, heart conditions, allergies.
    • D. all three sections of the health history must be reviewed (personal, medical, dental)
  23. Personal History includes:
    • A. data essential for appointment planning and business aspects
    • - name, address, phone number, occupation, sex, marital status - update at each appointment

    • B. approval of care of minor
    • - birth date, name of parent or guardian

    C. patient's physician for consultation
  24. Dental History includes:
    A. *address first* Immediate problem or complaint; cause of pain or discomfort

    B. previous dental care as decribed by the patient, including extent of restorative and prosthetic replacement as well as any adverse effects or reactions to dental treatment

    C. attitude of patient toward oral hygiene habits

    D. personal daily care and dental habits performed by the patient
  25. Medical History includes:


    a list of questions to determine whether the patient has any condition in the following categories:
    • A. conditions that may complicate dental or dental hygiene treatment
    • B. diseases that require special precautions or premedication prior to treatment
    • C. Conditions under treatment by a physician that require medicating drugs that may influence or contraindicate treatment
    • D. allergic reactions
    • E. diseases and drugs with oral manifestations
    • F. communicable diseases that endanger dental personnel
    • G. physiologic state of the patient
  26. A. Conditions that may complicate dental or dental hygiene treatment
    1. Lowered resistance to infection - diabetic

    2. Hypertension - 159/94
  27. B. Diseases that require special precautions or premedication prior to treatment

    1. Antibiotic coverage to reduce the risk of Infective Endocarditis must be given for the following:
    • A. artificial heart valves
    • B. history of infective endocarditis
    • C. certain specific, serious congenital heart conditions
    • D. a cardiac transplant that develops a problem in a heart valve
    • E. reduced capacity to resist infection (anticancer chemotherapy, immunosuppressive medication, acute leukemia, renal transplant, kidney dialysis, glomerulonephritis)
    • F. prosthetic joint replacements (especially in the first 2 yrs)
  28. B. Diseases that require special precautions or premedication prior to treatment


    2. Prophylactic Antibiotic Premedication
    • A. Dental or dental hygiene procedures which may cause bleeding of tissues has the potential for creating a bacteremia (bacteria in the bloodstream)
    • B. Infective microorganisms (especially Alpha Hemolytic Streptococcus) in the blood stream may lodge on damaged or abnormal areas of heart valves, lining of the heart, or the underlying connective tissue.
    • C. When this occurs it causes: Infective Endocarditis, and can be life-threatening.
    • D. Antibiotic Premedication must be given to patients who are susceptible to infective endocarditis before any dental or dental hygiene care is provided.
  29. C. Conditions under treatment by a physician that require medicating drugs that may influence or contraindicate treatment

    1. Anticoagulant therapy
    Blood thinners - Coumadin, heparin, Warfarin

    physician must be consulted to see if reduction of medication is indicated (usually not adjusted)
  30. C. Conditions under treatment by physician that require medicating drugs that may influence or contraindicate treatment.

    2. Corticosteroid therapy
    physician may need to be consulted to increase therapeutic dose

    daily/longer than 2 wks/more than 20mg
  31. C. Conditions under treatment by a physician that require medicating drugs that may influence or contraindicate treatment

    3. Diabetes
    (some diabetic patients may require antibiotic premedication due to lower immunity - ussually the uncontrolled diabetic)

    recognize the symptoms of undiagnosed diabetic: dry mouth, excessive thirst, frequent urination.

    make sure patient took medication and has eaten breakfast, lunch...

    diabetics tend to be slow healers; minimize tissue trauma.
  32. C. conditions under treatment by a physician that require medicating drugs that may influence or contraindicate treatment

    4. Patient taking Nitroglycerin for Angina Pectoris
    must have patients Nitroglycerin at hand, dental stress may cause an attack.

    pill is placed under tongue to relieve chest pains
  33. C. Conditions under treatment by a physician that require medicating drugs that may influence or contraindicate treatment

    5. Hemophilia
    physician must be consulted about the level of clotting factor and history of bleeding problems.

    normal BT(bleeding time) 1 - 6 min

    * dental treatment can be performed when 2x normal or <20 min
  34. C. conditions under treatment by a physician that require medicating drugs that may influence or contraindicate treatment

    6. Recent Heart Attack Patient
    *no treatment recommended within 6 months, need to check with patient's physician concerning medications prescribed and need for precautions or premedications.
  35. D. Allergic Reactions
    1. ALL allergies to drugs must be noted in RED in upper right corner of history form.

    2. Asthmatic patients must be asked: what triggers attack? when was last attack? what medication is used? if prescribed an inhaler, patient must have it with him or treatment will not be given and patient will need to reschedule and bring inhaler with them.

    3. Latex hypersensitivity; must be noted in red in upper right corner and must wear vinyl gloves or non-latex during treatment.
  36. E. Diseases and drugs with oral manifestations
    1. Epilepsy; patient taking Dilantin (phenytoin) may have gingival overgrowth(gingival hyperplasia) as a drug side effect. Ask patient when was last seizure, how often do they occur, is there anything which triggers seizure? make sure they took medication that day; keep instruments on counter rather than tray.

    2. Sexually transmitted infections (syphilis, gonnorrhea, AIDS) may have oral lesions.

    3. Herpes lesions can be transmitted readily; they look like small blisters which erupt to form ulcers.
  37. F. Communicable diseases that endanger dental personnel
    • 1. Tuberculosis; no treatment if disease recently diagnosed. Patient usually taking: isoniazid
    • 2. Viral Hepatitis (type B); hygienist must have Hep B vaccine
    • 3. AIDS
    • 4. STDs
    • 5. Herpes virus
    • 6. Childhood infections such as Measles, chickenpox, Mumps
    • 7. Must treat ALL patients as infective - practice Standard Precautions (glasses, mask, gloves, strict infection control policies)
  38. G. Physiologic state of patient (the following may have an effect on the gingival tissues)
    • 1. pregnancy
    • 2. puberty
    • 3. menopause
    • 4. birth control pills
  39. Indications for medical consultation

    documentation is essential
    • A. patient has a condition which may require prophylactic antibiotic premedication
    • B. patient is taking medication which may efect dental care (anticoagulant, steroids)
    • C. suspicion of undiagnosed condition (diabetes, hypertension)
    • D. Abnormal vital sighns
    • E. patient is receiving radiation therapy or chemotherapy
  40. ASA Classification System for Patient Health Status:


    Class 1
    a normal, healthy patient

    ex. healthy w/ good exercise tolerance
  41. ASA Classification System for Patient Health Status:


    Class 2
    A patient w/ mild systemic disease; controlled medical conditions

    ex. controlled hypertension, diabetes w/o system effects, any tobacco use w/o evidence of COPD, anemia, mild obesity, age less than 1 or greater than 70, pregnancy
  42. ASA Classification System for Patient Health Status:

    Class 3
    patient having medical conditions w/ significant systemic effects

    ex. controlled CHF, stable angina, old MI(heart attack), poorly controlled hypertension, morbid obesity, bronchospastic disease w/ intermittent symptoms, chronic renal failure
  43. ASA Classification System for Patient Health Status:

    Class 4
    patient w/ a medical condition that is poorly controlled, associated w/ significant dysfunction and is a potential threat to life

    ex. unstable angina, symptomatic COPD, symptomatic CHF, hepatorenal failure

    NO DENTAL HYGIENE TREATMENT PERMITTED
  44. ASA Classification System for Patient Health Status:

    Class 5
    patient w/ critical medical condition that is associated w/ little chance of survival with or without the surgical procedure.

    ex. Multiorgan failure, sepsis syndrome w/ hemodynamic instability, hypothermia, poorly controlled coagulopathy

    NO DENTAL HYGIENE TREATMENT PERMITTED

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