Transcript DS-III Orientation Oral Diagnosis

DH-II ORIENTATION
ORAL DIAGNOSIS &
RADIOLOGY CLINIC
DR. SUSAN L. SETTLE
FALL 2010
ORAL DIAGNOSIS
ROTATION
Screening
Examinations for
Prospective Patients:
9:00 a.m., 1:00 p.m.
PURPOSE OF SCREENING
 To
Provide Suitable Patients For
Dental Hygiene And Dental Students
 To Provide Students With More
Clinical Experiences
 To Increase Awareness Of Oral
Conditions Beyond Patients Assigned
To You
“HOW TO SCREEN”

Your Patient’s Screening Folder Will Contain:
A Consent Form
 Conditions of Treatment form
 Abbreviated CDI
 Preliminary Screening Form
 Patient Bill Of Rights
 Encounter Slip
 Radiology Log
 Radiology Index Card

SCREENING PROCESS
 Take
Patient From Reception Area To
Chair And Review Health History With
The Patient
 If There Are Questions Regarding
Medical History, Etc., Ask O.D. Faculty
SCREENING PROCESS
 Perform
A Head And Neck Exam
 Look In The Patient’s Mouth And
Attempt To Chart Restorations Which
Are Obviously Deficient
SCREENING PROCESS
 Probing
Depths: Deepest In Each
Sextant Is Recorded
 Head And Neck Exam Findings Are
Written Under Comments
 CDI: Abbreviated Case Difficulty
Index
SCREENING PROCESS
 Request
Appropriate Radiographs
 Usually Panoramic and Two Bitewings
 Faculty Will Sign For Radiographs
 Patient Goes Back To Reception Area &
Will Be Called To Radiology
“HOW TO SCREEN”
 Place
The Patient Folder In The Chart
Holder In Radiology
 A Radiology Technician Will Call The
Patient Into Radiology
 The Radiology Tech Will Return The
Folder To The Clinic When Films Are
Developed
“HOW TO SCREEN”
 Review
Films & Findings With
Faculty
 Return The Patient To The Chair
And Review Findings With Faculty
 Accept/Reject The Patient
“HOW TO SCREEN”
 If
Patient Is Accepted:
 They Will
Receive/Review/Sign the
Following Forms:
Patient Bill of Rights
o Payment Policy
o Yellow Copy of the Encounter Slip
o Conditions of Treatment (Yellow
Copies)
o Consent to Treatment (Yellow
Copy)
o
“HOW TO SCREEN”
 If

Patient Is Accepted:
Tell The Patient They Will Be Called By
A Student - But There Is No Set Time
They Will Be Called!
“HOW TO SCREEN”
 If

Patient Is Rejected
If They Inquire, We Can Make Copies Of
The Screening Films To Either Be Sent To
Another Dentist Or Take With Them

This Must Be Done Through Patient
Management (Clinic Operations)
There Is A $5.00 Charge For Duplications
 If You Have Trouble Saying “No-” Ask For
Faculty Assistance

PATIENT CONDITIONS OF
TREATMENT FORM
PATIENT BILL OF RIGHTS FORM
SCREENING PROCESS
 Types





Of Patients To Reject
Patients With Unrealistic
Expectations
Patients Who Do Not Have The
Time To Commit To OUCOD
Patients With Rampant Caries
Patients With Severe Periodontal
Disease
Many Other Complex Dental
Conditions
SCREENING PROCESS
 You
must take the encounter
form (both copies of it) and
accompany the patient to the
CBO unless instructed
otherwise.
Miscellaneous
DS IV’s May Be Seeing Emergency Or
Screening Patients During Your
Rotation
Always Get Faculty Permission
To Leave Clinic Before 12:00 p.m. Or
4:00 p.m.
Miscellaneous
Dress Code
Good Infection Control Techniques!
Times Have
Changed!
DS IV ROTATION
DENTAL HYGIENE CLINIC
 Part
Of The DS IV O.D. Rotation
 Goals:
To Increase The Dental Student’s
Awareness Of The Dental Hygiene
Program And Its Role In Patient
Care At OUCOD
 To Facilitate Communication
Between Dental Hygiene And
Dental Students

DS IV ROTATION
DENTAL HYGIENE CLINIC
 Goals
(Continued):
To Foster An Attitude Of
Teamwork
 To Facilitate The Dental
Student’s Ability To Work With A
Dental Hygienist As A Member Of
The Dental Team

PATIENTS TAKING
ANTICOAGULANTS
 Warfarin
(Coumadin):
International Normalized Ratio (INR) is
the test referenced to measure warfarin
effect
 Patients at greatest risk for
intraoperative bleeding:

Presence of Prosthetic Cardiac Valve
 Previous Thromboembolic Events (Like A
Stroke)
 History Of Peripheral Vascular Disease
(PVD)

PATIENTS TAKING
ANTICOAGULANTS
 An
INR of 3.0 to 4.0 or lower is
usually safe for performance of
dental procedures likely to induce
bleeding
 Use local measures if needed:





Direct pressure
Primary closure (sutures)
Synthetic collagen
Gelfoam
Tranexamic acid rinse
PATIENTS TAKING
ANTICOAGULANTS
 Warfarin

Very slight risk of increased bleeding; use local
measures
 Warfarin

dose of 5.0 mg/day:
Greater risk of bleeding; start instrumentation
in one quadrant and assess bleeding; use local
measures as needed
 Warfarin

dose of 2.5 mg/day:
dose of 7.0-10 mg/day:
Need INR/medical consultation
PATIENTS TAKING
ANTICOAGULANTS
 Aspirin:
Doses of 81(low-dose ASA) to 325
(regular dose ASA) mg daily will not
significantly alter bleeding times
 For higher doses, slightly higher risk for
postoperative bleeding following
periodontal therapy

PATIENTS TAKING
ANTICOAGULANTS
 Other
anticoagulants
(Plavix, Pletal, Persantine, Ticlid)
 Therapeutic doses usually will not
interfere with non-surgical
periodontal therapy
 Assess bleeding by quadrants
 Apply local measures as needed

PATIENTS TAKING
ANTICOAGULANTS
 When
in doubt, seek medical
consultation
 Most bleeding concerns will involve
periodontal surgery, oral surgery
 High-risk patients:
Prosthetic heart valves
 Previous blood clots

INFECTIVE ENDOCARDITIS
PREVENTION GUIDELINES
 PROPHYLAXIS
IS RECOMMENDED
FOR FOUR GROUPS OF PATIENTS:
 Patients with:
Prosthetic heart valves
 Previous history of infective endocardits
 Cardiac transplant with resulting valve
damage
 Certain types of congenital heart
disease

COMPLEX CONGENITAL HEART
DISEASE FOR WHICH
PREMEDICATION WILL STILL BE
INDICATED:
 Unrepaired
cyanotic congenital heart
disease (CHD), including palliative
shunts & conduits
 Completely repaired CHD with
prosthetic material or device, during
the first 6 months after the procedure
 Repaired CHD with residual defects
DENTAL PROCEDURES FOR
WHICH ENDOCARDITIS
PROPHYLAXIS IS RECOMMENDED
 All
dental procedures that involve
manipulation of gingival tissue or the
periapical region of teeth or perforation of
the oral mucosa
DENTAL PROCEDURES THAT DO
NOT NEED PROPHYLAXIS
Routine anesthetic injections through
noninfected tissues
 Radiographs
 Placement of removable prosthodontic or
orthodontic appliances
 Adjustment of orthodontic appliances
 Placement of orthodontic brackets
 Bleeding from trauma to the lips and oral mucosa
 Loss of deciduous teeth

PROPHYLAXIS TO PREVENT
INFECTION TO PROSTHETIC
MAJOR JOINTS
 Major

joints include:
Hips, shoulders, knees
 Prophylaxis
for all patients within
the first two year of joint placement
PROPHYLAXIS TO PREVENT
INFECTION TO PROSTHETIC MAJOR
JOINTS, PROPHYLAXIS INDICATED:
 Immunocompromised/immunosup-
pressed patients･Inflammatory
arthropathies e.g.:




rheumatoid arthritis (RA)
systemic lupus erythematosus (SLE)
Drug -induced immunosuppression
Radiation-induced immunosuppression
PROPHYLAXIS TO PREVENT
INFECTION TO PROSTHETIC MAJOR
JOINTS, PROPHYLAXIS INDICATED:
 Patients
with co-morbidities, e.g.:
Previous prosthetic joint infections
 Malnourishment
 Hemophilia
 HIV infection
 Type 1 diabetes
 Malignancy

PROPHYLAXIS TO PREVENT
INFECTION TO PROSTHETIC
MAJOR JOINTS

American Academy of Orthopedic Surgeons
reviewed &changed recommendations for dental
treatment in 2009
Recommend prophylaxis for all patients with
prosthetic joints for all invasive dental procedures for
the life of the patient
 ADA, AAOS, Infectious Disease Experts May Meet To
Discuss The Above

QUESTIONS?