Professional Documents
Culture Documents
Done by:
Dr. Mohammad Salah Qrea
D.D.S
Al-Quds University Dental
Faculty
2009
• There is no doubt that the first dental
appointment is the most important
dental visit, because during this
visit we check the history of the
patient clinically, in addition to
several examinations that we
always do, so that we can build our
diagnosis and modify our dental
treatment upon this.
What should we do in the
first visit?
taking the patient personal data.
Asking the patient about his\her chief
complain.
Taking the medical history of the patient.
Taking the dental history of the patient.
Then “ THE EXAMINATION”.
Patients data
Name.
Age.
His\her address, and contact number.
Gender.
Occupation.
Marital status.
The chief complain
Very important because it will be our main goal of
treatment plan.
History of chief complain:-
1-) the first appearance.
2-) description of PAIN (( onset, intensity, duration,
location, and radiation.))
3-) precipitating and relieving factors of pain.
4-) other symptoms such as fever, chills, lethargy,
weakness,…etc that caused by this chief
complain.
Medical history
Review for previous hospitalization.
Review for serious illnesses and systemic
diseases.
Review for Blood transfusion.
Review for allergies.
Review for Medications.
Review for Pregnancy.
Review for Habits.
The examinations
• 1-) dental examination.
• 2-) physical examination.
• 3-) management of medically
compromised status.
DENTAL EXAMINATION
Teeth
• The number of teeth.
• Alignment of the teeth.
• Caries.
• Periodontal status of the teeth.
• Non carious lesions “ abrasion,
attrition, erosion,…etc”
• And X-rays “ OPT, periapicals,
bitewings, and occlusal.”
•
Bony tissues
• Checking the alignment of the
mandible margins, hard palate, and
buccal and lingual sulcus.
• Any bony exostosis or tori.
• Any swelling of tender areas within
bone.
Soft tissues
• Salivary glands “ swelling,
tenderness, amount of saliva,
consistency of saliva, and others.”
• Tongue “ movement, papillae, lateral
borders, and ventral surface.”
• Other cheek, soft palate, lips and
floor of the mouth lesions.
•
• Wait a PowerPoint presentation about “soft tissue lesions”
from dr.mohammad salah qrea always on esnips.
Physical examination
What do we examine?
• Vital signs.
• IPPA” inspection, palpation,
percussion, and auscultation.”
• Maxillofacial examination.” TMJ,
lymph nodes, skin, MOM, cranial
nerves,…etc”.
TMJ examination
Anatomy
• The Articulatory System is comprised
of three components: the
temporomandibular joints, the
muscles of mastication and the
occlusion (the nature contact
between the upper and lower
teeth).
We will examine...
• Tenderness to percussion.
• Movement of the jaw, and the range
of movement.
• And sounds from the joint.
Tenderness to percussion
• A tenderness to palpation implies
inflammation, generally as a result of
acute or chronic trauma.
• A finger should be placed in the
immediate pre-auricular area, gently
applying pressure on the lateral
pole/head of the condyle while the
jaw is closed. The level of pain and
discomfort on each side should be
assessed and compared.
• The little finger should also be placed in
the external auditory meatus, and
Palpation of the pre-
auricular area of the
temporomandibular joint.
Palpation of the intra-
auricular area of the
temporomandibular joint
Joint sounds
• Posterior guidance
• Anterior guidance
P o ste rio r
g u id a n ce
Anterior
guidance
LYMPH nodes EXAMINATION
Palpation
movements, or edema.
Palpate to identify any areas of
tenderness or deformity.
•
The ears
• Palpate the auricle and mastoid
process and ask the patient for
tenderness.
• Inspect the ear canal and middle ear
structures noting any redness,
drainage, or deformity.
The nose
• Tilt the patient's head back slightly.
Ask them to hold their breath for
the next few seconds.
• Inspect the visible nasal structures
and note any swelling, redness,
drainage, or deformity.
Throat
Using a wooden tongue blade and a good
light source, inspect the inside of the
patients mouth including the buccal
folds and under the tougue. Note any
ulcers, white patches (leucoplakia), or
other lesions.
If abnormalities are discovered, use a
your thumbs.
Excessive discomfort on one side or
nail
Cluster of slow-growing, shiny pink or
red lesions
Waxy-feeling scar
“MI”,
“Coronary”,
“Heart Attack”
Infarction - an
area of
necrosis in
tissue due to
ischemia
resulting from
obstruction of
Sequelae and
Complications of Acute MI
• Heart failure
• Angina/infarct extension
• Cardiogenic shock
(inadequate perfusion)
• Ventricular aneurysm and
rupture
• Arrhythmias
• Thromboembolism
Medical Management of
Acute MI
• Early hospital supportive care (EMS)
• CCU monitoring
• Early use of thrombolytics (Indicated only for
use in patients with ST-segment elevation MI).
• Coronary angioplasty (PTCA)
• Coronary artery by-pass graft (CABG)
• Adjunctive pharmacologic therapy (O2,
narcotics, anxiolytics, beta-blockers,
aspirin, heparin, warfarin, nitrates,
calcium-channel blockers, digitalis, ACE
inhibitors)
Clinical Predictors of
Risk
• Major Risk:
– Unstable coronary syndromes
• Recent myocardial infarction (< 1
month), with ischemic symptoms
• Unstable or severe angina
– CCS Class III: marked limitation
with ordinary physical activity;
climbing 1 flight of stairs at a
normal pace
– CCS Class IV: inability to carry on
any physical activity without
pain; may be present at rest
– Significant arrhythmias:
• A-V block
• Symptomatic ventricular arrhthmias
• Supraventricular arrhthmias with
uncontrolled ventricular rate
• Intermediate Risk:
– Mild angina pectoris
• CCS Class I: angina only with
strenuous or rapid or
prolonged exertion
• CCS Class II: pain with climbing
more than one flight of stairs
at a normal pace
– Previous myocardial infarction (> 1
month) with no ischemic symptoms
– Compensated (asymptomatic) heart
failure
– Insulin-dependent diabetes mellitus
– Renal insufficiency (creatinine > 2.0
mg/dl)
Dental Management
Correlate
• Elective dental care is ok if
it has been longer than 4-
6 weeks since the MI and
the patient does not
report any ischemic
symptoms.
• If there is any doubt or
Drug Therapy:
Warfarin (Coumadin)
Action: inhibits vitamin K
which is a precursor for
clotting factors II, VII, IX and
X
Dental treatment, including
S Y S T O LIC D IA S T O LIC
C a te g o ry P re ssu re ( m m H G ) P re ssu re ( m m H g )
H ig h N o rm a lB P 1 3 0 -1 3 9 8 5 -8 9
H yp e rte n sio n
S ta g e I 1 4 0 -1 5 9 9 0 -9 9
S ta g e II 1 6 0 -1 7 9 1 0 0 -1 0 9
S ta g e III 1 8 0 -2 0 9 1 1 0 -1 1 9
Erythema multiforme.
And paresthesia.
•
Anesthesia
( local anesthesia )
• The local anesthesia should be
perfect to reduce anxiety and pain
during the procedure.
• No epinephrine should be used with
local anesthesia.
• If we want to use very small doses of
epinephrine we should inject it
properly by using aspirating
syringe, avoiding intrabony, or
intralegamentary injections to
General anesthesia
• All antihypertensive drugs are
potentiated by general anesthetic
agents, especially barbiturates.
• G.A. agents (such as ,halothane and
isoflurane) tend to reduce the blood
pressure significantly and this may
be fatal to the patients organs that
become adapted to raised blood
pressure.
• Hypokalemia as a result of diuretics
may be associated with
arrhythmias.
Anxiety control
• Anxiety reduction protocol.
• Using of sedative agents pre and
post operatively.
• Relative analgesia technique using
N2O, can reduce the blood pressure
10-15 mmHg.
•
OTHER DENTAL CONCERNS
• Afternoon appointments are
recommended over mornings.
• Avoiding sudden postural changes,
such as return to sitting position
from the supine operating position.
• Aspirin is now commonly taken by
patients with hypertension.
• Many patients with hypertension
develop systolic heart murmurs, in
which case prophylaxis for
endocarditis
Endocrine diseases
Endocrine diseases
• Diabetes mellitus.
• Adrenal insufficiency.
• Hyperthyroidism.
• Hypothyroidism.
•
Diabetes mellitus
• Diabetes mellitus is a disorder
characterized by impairment or
destruction of the pancreas' ability
to produce insulin and the resultant
inability of the body to metabolize
carbohydrates, fats, and proteins.
Clinical presentation
• There are two types of DM:
• Type I Insulin Dependent Diabetes
Mellitus, that occurs under age of
40 years. It is a severe, acute
condition with a sudden onset of
symptoms including: polydipsia,
polyuria, nocturia, polyphagia, loss
of weight, loss of strength, marked
irritability, recurrence of bed
wetting, drowsiness, and malaise.
Type II
• Non-Insulin Dependent Diabetes
Mellitus, that occurs over the age of
40 years.
• The primary manifestations are
hyperglycemia, ketoacidosis, and
vascular wall disease contribute to
the inability of uncontrolled diabetic
patients to manage infections and
heal wounds.
• Other signs and symptoms relating
to the complications of diabetes are
skin lesions, cataracts, blindness,
DENTAL MANAGEMENT
• Medical history:
• Take a thorough medical history
concerning the type of diabetes,
and referral of any patient with
cardinal diabetes symptoms to the
physician.
• Well controlled patients with no
serious complications such as renal
failure, hypertension,
atherosclerosis,..etc, can receive
any indicated dental treatment.
Avoiding sugar shock
hypoglycemia
• The most dangerous thing in
diabetetic patients during dental
procedure is hypoglycemic shock, to
prevent it do:
• Verify the patient has taken his
medication as usual, and adequate
food intake.
• Schedule appointments in the
morning.
• A source of sugar, such as orange
juice, must be available in the
dental office should the symptoms
Oral surgery concerns.
IDDM diabetics under periodontal or
oral surgery procedures may be
placed on prophylactic antibiotic
therapy during the postoperative
period to avoid infection.
Consultation with a patient's physician
Poor healing,
Precipitating agents
or afternoon.
• Assess severity of asthmatic condition.
• Consider antibiotic prophylaxis for
immunosuppressed patients
• Consider corticosteroid replacement for
adrenally suppressed patients
• Avoid using dental materials that may
elicit an asthmatic attack
• Have supplemental oxygen and
bronchodilators available in case of
acute asthmatic exacerbation
•
During treatment
• Use vasoconstrictors judiciously
• Avoid using local anesthetics
containing sodium metabisulfite
• Use rubber dams cautiously
• Avoid eliciting a coughing reflex
• Use techniques to reduce the
patient’s stress:
üAvoid using barbiturates
üAvoid using nitrous oxide in people
with severe asthma.
After treatment
Be aware that some patients may
trimester
• Can use Chlorhexidine throughout
pregnancy
CATEGORIES OF RISK FOR DRUGS DURING
PREGNANCY
Category Description
A These drugs are the safest. Well-designed
studies in people show no risks to the fetus