Introduction to Physical Evaluation. Part 2

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Introduction to Physical

Evaluation

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Medical History

• Patient must check off each box. No lines to be drawn down a column.

• Obtain additional info from patient on any “yes” answer.

• Make sure that you and the patient have

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the English translation following the

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RED

For all yes answers in the health history

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Always answer

YES

Adjacent to the correct medical alert type

Medical Alert type is present in the UR ALERTS BOX

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Review Medical History Form

• Review the form with the patient --- any “YES” answer needs follow up info.

• You can write comments on the paper form and then transfer them into to the “comment” section in AxiUm.

• The Herman Ostrow School of Dentistry of USC has a system by system medical history form

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At times, you may need to Update the “Medical Alert” box

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Medical Alerts:

to add or delete info, right click in the box – most “yes” answers are automatically placed in the alert box for you – some conditions will require you to

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Right click on computer mouse

when in the medical alerts box, click on “Update Medical Alerts”

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Find the medical alert you want to add,

highlight it and click “OK”.

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The medical

history is a

system by

system

review starts

off with

“Cardiovascular”

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American Heart Association Guidelines for Prophylactic Premedication

• In 2007, the AHA updated their guidelines for patients who require antibiotic premedication prior to invasive dental procedures

• Amoxicillin 2.0 grams one hour prior to the

invasive procedure is the recommended drug of choice for adults

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AHA Guidelines

• What if the person has an allergy to Penicillin?

• Clindamycin 600 mg one hour prior to the dental procedure

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CV

• High B/P: limit of 2 carps of Lidocaine with epinephrine • Heart attack: NO elective dental treatment for 6 months • Stroke: NO elective dental treatment for 6 months, discover

what side was affected

• Angina: exercise or stressed induced

• Cholesterol: current lab level

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CVA/Stroke

• If the right side of the brain is damaged, there will be paralysis on the left side of the body

---thought, memory and spatial relations may be impaired.

• If the left side of the brain is damaged, the right side of the body will be affected –

problems with speech, language and memory.

• This will affect how you communicate with and educate your patient.

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If patient is on anticoagulant meds:1 minute test – if bleeding is excessive – stop, manage and advise patient that a medical consult may

be needed – meds like Plavix, Aspirin, Coumadin. Lab results for INR, plts, PT/PTT, etc…..

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Bleeding/Clotting Labs

• PTT Ref range = 24.0 – 36.0 seconds

• PT Ref. range = 9.7- 12.9 seconds

• INR Ref range 1-2 mg/dL is normal

1-3.5 is acceptable for dental treatment Over 3.5 delay treatment

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Implant cases

• If bleeding is a

concern during an implant case – lab values to know are:

• INR

• Platelet count

• PT/PTT

• **picture is not an Ostrow implant case!

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Anticoag meds and dentistry

• Evidence suggests that stopping oral anticoag meds is not necessary in patients requiring

low-risk dental procedures and may actually increase thrombosis risk.

• Local measures can be effective at controlling bleeding.

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Pacemakers

• There may be a risk to patients with

pacemakers from ultrasonic devices and battery operated curing lights.*

• Find out the brand of the pacemaker, date placed and research to see if there are any contraindications to the above.

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Endocrine

• Freq hunger/thirst: ask about diabetes

• Diabetic: type? Remind them to eat prior to all apts. Current HgbA1C?

• Cancer: type?

• HIV: when dx? Current CD4 count and viral load, on meds?

• Organ transplant: what kind? When?

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Chemo?

If a patient is on chemotherapy, a physical evaluation update is needed with phys eval faculty.

A medical consult needs to be sent to the physician/oncologist.

Treatment may need to be completed in the Special Patient Clinic.

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HIV/Immunocompromised Patients

• Recent lab tests must be within 3-6 months

depending on viral load.

• Viral Load must be less than 50.

• Absolute Neutrophil Count greater than 500.

• Platelet count greater than 60,000

• CD4 greater than 200

• If the lab test is not current or the values fall outside the recommendations, call phys eval faculty.

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Diabetic Patients

• Well Controlled?

• Medicines and doses?

• Monitor glucose levels at home?

• Often see MD?

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HGB A1 C RESULTS

The Hemoglobin A1C blood test shows the blood glucose level over a 2 – 3 month period. Diabetics ideally should try to be a 7% or below. A result of 7 means the person’s glucose level averages around a reading of 154 daily for the past 2 -3 months.

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Hemoglobin A1C

• The Hgb A1C test is based on the lifefspan of

red blood cells – approximately 120 days.

• Note: The A1C may not be accurate in several settings, including pediatric and geriatric

populations, anemia or other blood disorders resulting in rapid turnover of red blood cells, chronic liver and renal disease, recent

transfusions, or in certain hospital settings.

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Implants and Diabetics

• If the diabetes is well controlled, ok for

implant placement but final say lies with Oral Surgery and/or Perio

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