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BOH2-ORHL2002-Lt8.LA Psychological Evaluation
BOH2-ORHL2002-Lt8.LA Psychological Evaluation
Are you allergic (itching, rash or swelling of hands, feet or eyes) or made sick by
penicillin, aspirin, codeine or any medications?
Evaluate carefully
If it is true allergy, G.A. may be an alternative
Handle as we talked about under general complications
Have you ever had excessive bleeding that required special treatment?
In the presence of bleeding disorders injection techniques with a greater incidence of positive
aspiration should be avoided
Must be investigated by G.P. before further treatment continues
Heart Pacemaker
These patients usually do not require antibiotic prophylaxis.
L.A. with vasoconstrictors may be administered safely
Implanted Cardioverter/defribrillator
This device is not located within the heart there is no need for antibiotic prophylaxis
However, given the nature of the cardiac condition consultation with the patients cardiologist is
suggested before treatment
Heart Operation
In most cases these patients with proper treatment modification may safely receive dental
care including vasoconstrictors
Physician consultation is required
Stroke
Patients with a history of cerebrovascular accident or transient ischemic attack require
treatment modification to decrease the risk
Monitor blood pressure
Use minimal L.A. with vasoconstrictors if indicated
Be extra careful with regards to intravascular administration
Kidney Trouble
A small percentage of L.A. is excreted unmetabolised in the urine
Patients with kidney failure could attain high levels of L.A. in their blood increasing the risk of
overdose
However usual doses of L.A. do not pose any increased risk
Thyroid Disease
Patients who are clinically hyperthyroid may demonstrate an exaggerated response to
vasopressors (sensitive to heat, sweat easily, increased body temperature, tachycardia, tremor
of the extremities etc.)
Such reactions can be prevented or minimised through the minimal use of adrenaline and
other vasopressors
Patients with surgical corrected or medication-controlled hyperthyroid respond in a
normal manner
Psychiatric Treatment
Can usually receive L.A. with no increased risk
Tricyclic antidepressants and Monoamine oxidase inhibitors pose a minimal risk to the
administration of vasopressors provided that the dose is kept minimal
Is not a relative contraindication to administration of vasopressors
Bruise easily
A potential bleeding disorder must be evaluated before administering L.A.
Dialogue History
If disorders are present you must next discuss these with the patient to obtain as much
information as possible concerning the severity of the problem and its impact on the planned
dental care