Lisa Mayo, RDH, BSDH Concorde Career College Board Review DH227 Infection Control, Tooth Avulsion,...
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- Slide 1
- Lisa Mayo, RDH, BSDH Concorde Career College Board Review DH227
Infection Control, Tooth Avulsion, Dental Caries, Occlusion
- Slide 2
- DENTAL CARIES
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- Class II
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- DENTAL CARIES
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- Class III
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- DENTAL CARIES
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- Board Question Clinically, the dentist finds evidence of decay
on the cervical 1/3 of the facial of tooth #8. The G.V. Black
Classification of this decay is A.I B.V C.II D.IV E.VI F.III
- Slide 11
- Board Question Clinically, the dentist finds evidence of decay
on the cervical 1/3 of the facial of tooth #8. The G.V. Black
Classification of this decay is A.I B.V C.II D.IV E.VI F.III
- Slide 12
- Dental Caries Dental caries is a transmissible bacterial
infection that is preventable and sometimes reversible Dental
caries is the most common dental disease affecting children and
adults in the USA
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- DENTAL CARIES
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- Board Question Bacteria found in deep carious lesion are:
a.Spirochetes b.Lactobacilli species c.Streptococcus mutans
d.Actinomyces viscosus
- Slide 20
- Board Question Bacteria found in deep carious lesion are:
a.Spirochetes b.Lactobacilli species c.Streptococcus mutans
d.Actinomyces viscosus
- Slide 21
- DENTAL CARIES
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- Dental Caries Risk Assessment for Children 0 to 5 Years of Age
The protocol for a comprehensive CAMBRA 0 to 5 years oral care
visit includes the following components: Completion of the caries
risk assessment form Parent interview Examination of the child
Assignment of caries risk level
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- 25 Types of Dental Caries These terms communicate the urgency
with which restorative therapy should be delivered: Rampant caries
Early childhood caries Chronic caries Arrested caries Recurrent
caries
- Slide 26
- Rampant Caries Signifies advanced or severe decay on multiple
surfaces of many teeth Problems can also be caused by the self-
destruction of roots and whole tooth resorption when new teeth
erupt or later from unknown causes
- Slide 27
- Rampant Caries High risk groups Xerostomia Poor oral hygiene
Heavy alcohol intake = dry mouth Drug use: due to drug-induced dry
mouth and lifestyle Large sugar intake: sodas throughout the day If
rampant caries is a result of previous radiation to the head and
neck = may be described as radiation-induced caries
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- METH ADDICT
- Slide 29
- Early Childhood Caries "Baby bottle caries" Baby bottle tooth
decay" "Bottle Rot" Pattern of decay found in deciduous teeth The
teeth most likely affected are the maxillary anterior teeth, but
all teeth can be affected Causes Allowing children to fall asleep
with sweetened liquids in their bottles Feeding children sweetened
liquids multiple times during the day
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- Chronic Caries Form of caries that occurs over time and demands
regular dental intervention Difficult to control the caries Causes:
multiple and many unknown Genetics Salivary content Lack of early
preventive interventions
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- Arrested Caries State existing when the progress of the decay
process has halted It is noted by its dark staining without any
breakdown of tooth tissues
- Slide 33
- Recurrent Caries Extension of the carious process beyond the
margin of a restoration. Also called Secondary caries
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- 35 Copyright 2010 by Saunders, an imprint of Elsevier Inc.
Types of Caries by Location This descriptive mechanism may be best
suited for describing the dental problem to the client Pit and
fissure caries Approximal caries Smooth surface caries Root
caries
- Slide 36
- 36 Copyright 2010 by Saunders, an imprint of Elsevier Inc. Pit
and Fissure Caries Smooth Surface Caries
- Slide 37
- Interproximal/Approximal Caries
- Slide 38
- DENTAL CARIES
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- Remineralization Fluoride mechanisms of action Inhibits
demineralization When fluoride is present in the fluid of the
biofilm around the enamel crystals (or dentin of the root) Pass
through the diffusion channels with the acid Increase the fluoride
of the subsurface lesion Prevent the continued dissolution of the
minerals
- Slide 41
- Remineralization Fluoride mechanisms of action Enhances
remineralization As the saliva flows over the biofilm, its
buffering properties neutralize the acid produced by the bacteria
The pH rises toward neutral and prevents further dissolution of the
minerals Minerals in the saliva can go back into the tooth for
remineralization
- Slide 42
- Remineralization Fluoride mechanisms of action Inhibits
bacteria in the biofilm Fluoride can change to HF (hydrogen
fluoride) when it is contacted by the acid produced by the bacteria
from the carbohydrates in the patients diet In the HF form it can
then diffuse over the cell membrane of the acidogenic bacteria
Inside it dissociates again and the fluoride ions interfere with
essential enzyme activity within the bacterial cell
- Slide 43
- Occlusion A: Class I B: Class II, D.I C: Class II, D.II D:
Class III
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- Class I: normal neutrocclusion MB cusp of max 1 st molar
occludes with the MB groove of mand 1 st molar Class II:
retrognathic or distocclusion Pt has small chin MB cusp max 1 st
molar is M to MB groove mand 1 st molar Max canine M to mand canine
by at least the width of itself Division I: molars are in Class II
relationship but incisors normally slightly protruded Division II:
molars Class II relationship with max central incisors retruded and
inclined L Class III: prognathic or mesiocclusal. Bulldog MB cusp
of max 1 st molar is D to MB groove mand 1 st molar by at least
width of a pm Max canine D to mand canine
- Slide 45
- Board Question In Angles classification for occlusion for the
permanent dentition, a Class II Division II denotes a a.Prognathic
profile b.Mesognathic profile c.Retrognathic profile, with one or
more teeth protruded facially d.Retrognathic profile, with one or
more anterior teeth inclined lingually
- Slide 46
- Board Question In Angles classification for occlusion for the
permanent dentition, a Class II Division II denotes a a.Prognathic
profile b.Mesognathic profile c.Retrognathic profile, with one or
more teeth protruded facially d.Retrognathic profile, with one or
more anterior teeth inclined lingually
- Slide 47
- Occlusion
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- Interarch Relationships Curve of Spee: anterior to post curve
Curve of Wilson: medial to lateral curve Centric Occlusion Where
max. intercuspation occurs Characteristics: 1. Overjet: max teeth
to overlap mand by 1-2mm 2. Overbite: characteristic of max ant
teeth in a vert. direction by a third of the lower crown
height
- Slide 51
- Interarch Relationships Contd 3. Crossbite: maxillary teeth are
positioned lingual to mand teeth 4. Openbite: teeth not in
occlusion between max and mand arch 5. Midline Shift (Deviation):
midline of max central incisors do NOT align with midline of mand
central incisors 6. Edge-To-Edge: incisal edge to incisal edge of
max ant to mand ant teeth 7. End-To-End: cusp-to-cusp relationship
of post teeth
- Slide 52
- Occlusal Relationships Intercuspation: post teeth to intermesh
in a faciolingual direction Mand F and Max L cusps are centric
cusps that contact interocclusally in the opposing arch
Interdigitation: each tooth to articulate with 2 opposing teeth
Mand tooth occludes with the same tooth in the upper arch and the
ones mesial to it Maxillary tooth occludes with the same tooth in
the mand arch and the one distal to it.
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- Overjet or Overbite?
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- Overbite: lower teeth not visible
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- Tooth Avulsion
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- Treatment of Avulsed Tooth Tooth will need to heal following
re- implantation healing more likely if tooth handled by crown only
and if tooth remains moist and not debrided in any way The sooner
the tooth is re-implanted the better the prognosis for retention
without root resorption 1-13
- Slide 61
- Treatment of Avulsed Tooth If the apical end incompletely
formed good chance of pulp vitality returning after re-
implantation If apical end completely developed endodontic
treatment necessary Best method is to replace tooth in alveolus and
hold gently until patient transported to oral healthcare setting
aids in nutrition of PDL cells 1-13
- Slide 62
- Sealants 80-90% total caries in kids occur on occ. surface of
molars Fluoride better at preventing smooth surface caries
Mechanical retention Mechanism of Action 1.Occludes pit and fissure
surfaces to prevent plaque and bacterial penetrating the areas
2.Bacteria already in fissure and incipient lesion has formed:
sealant blocks substrate to the bacteria that may already lie below
the sealant. Bacteria cannot produce sufficient acid to cause min.
loss abd further destruction 3.Sealant layer forms a smooth
non-porous surface which improves the pts self care
- Slide 63
- Sealants: Types Almost all are composed of BIS_GMA (bisphenol
A-glycidyl methacrylate) 1. Chemical Cured-Autopolymerized
Polymerization: mix equal drops of activator (5% organic
amine+BIS-GMA) + initiator(Benzoly peroxide +BIS-GMA) Hardens
1.5-2min Low cost, ample working time Cannot control set time once
mixed, mixing can create air bubbles, polymerization takes longer
and can get contaminated easier, lower cost
- Slide 64
- Sealants: Types 2.Visible Light Cured: Photoploymerization
Polymerization: camphoraquinonne+BIS-GMA Not activated until
illuminated by a blue-light source, visible or halogen light
Eliminates mixing, min. air bubbles, longer work time, cures 40sec,
surfaces slightly harder, high cost, eye safety Resin is a
dimethacrylate monomer, activator is a diketone in presence of
organic amine
- Slide 65
- Sealants Selecting Teeth 1. Newly erupted with pits and
fissures: deep occlusal fissures/pits/fossa, buccal pits molars,
lingual pits max. incisors, cusp carabelli max 1 st molars 2.
Incipient caries lesions 3. Kids at high risk: Low-SES 4. Those
with limited access dental care 5. Special needs 6. Medically
compromised
- Slide 66
- Sealants Contraindications 1. Operculum remaining on newly
erupted tooth 2. Occ decay with caries completely through enamel 3.
Tooth with proximal decay 4. Restoration already present 5. Pt
behavior does not permit use of adequate dry field 6. Life
expectancy of tooth is short
- Slide 67
- Sealants Modes of Failure 1.Contamination = decreased bond
strength a.Saliva during placement b.Microscopic calcium phosphate
reaction as a result of phosphoric acid etch interacting with
enamel over etching not thorough rinsing c.Presence of Fluoride:
block micro pores in enamel which need to be opened to increase the
bond 2.Wear that uncovers terminal ends of fissures 3.Direct loss
of sealant 4.Absence of bonding within otherwise intact
sealant
- Slide 68
- Sealant IndicatedPossibly Indicated (Clinical Judgment)
Contraindicated Deep, narrow pits and fissures OCC, L, B The fossa
selected is well isolated from another fossa with a restoration
There is an open occlusal lesion Deep sticky occlusal fissure is
present Are selected is confined to a fully erupted fossa, even
through the D pit not fully erupted Caries exist on other surfaces
of tooth Sound occ surfaces are present where the contralateral
surfaces R carious or restored Incipient lesion in a pit or fissure
confined to enamel Pt behavior does not permit use of adequate dry
field Sound teeth in a mouth that already has many occ lesions or
restorations Restoration already present Broad, well-coalesced pit
and fissures
- Slide 69
- INFECTION CONTROL
- Slide 70
- Infection Control PPE Mask, Gloves, Eyewear, Gown Min. exposure
to Aerosols Spatter Direct transmission (directly touching
infectious agents) Indirect transmission (through contaminated
instruments) MSDS Info regarding hazards of chemicals & how to
protect themselves
- Slide 71
- Sterilization
- Slide 72
- INDICATOR TAPE Just because turned brown, does not mean
sterilized only means reached a certain temperature Does NOT
guarantee sterility BIOLOGICAL INDICATORS Should be conducted
weekly Determine is the sterilization cycle is reaching proper temp
and pressure to kill ALL microorg.
- Slide 73
- Moist HeatDry HeatChemical Vapor Ethylene OxideGlutaral- dehyde
AdvantageGood Penetration Short cycle time No dull No rust No dull
No rust Short cycle time Good penetration No residue Use if cannot
do use moisture/heat sen. Instrum. DisadvantageCorrosion Dull
instrum. Not dry well Destroy heat sensitive items Poor pentration
Long cycle Destroy heat-sen. items Instrum need to be dry Destroy
heat-sen items odor Slow Tissue irritation Explosive Long time
Toxic to skin Toxic to mucous membrane 121 degrees 15lbs 15min
160/2HRS 170/1HR 127-132 20-40lbs 20min 2-12HRS7-10HRS
- Slide 74
- Disinfection
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- Board Question Which of the following is an example of a high-
level disinfectant? a.Iodophor b.Simple phenol c.Glutaraldehyde
d.Complex phenol
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- Board Question Which of the following is an example of a high-
level disinfectant? a.Iodophor b.Simple phenol c.Glutaraldehyde
d.Complex phenol
- Slide 79
- Agent, usually a chemical, that destroys microorganisms but may
not kill bacterial spores Used on inanimate surfaces Kills
Tuberculosis in 10min (NBQ) TB kill time is how disinfectants are
ranked low, intermediate or high (only low does NOT kill TB) High:
Glutaraldehyde (can be used as a sterilant if equipment immersed
for certain length of time) Disinfection
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- From Mosbys Board Book
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- High-level disinfectants inactivate spores and all forms of
bacteria, fungi and viruses. Intermediate- level disinfectants
inactivate all forms of microorganisms but do not destroy spores.
a.Both statements are TRUE b.Both statements are FALSE c.The first
statement is FALSE, the second is TRUE d.The first statement is
TRUE, the second is FALSE NBQ
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- High-level disinfectants inactivate spores and all forms of
bacteria, fungi and viruses. Intermediate- level disinfectants
inactivate all forms of microorganisms but do not destroy spores.
a.Both statements are TRUE b.Both statements are FALSE c.The first
statement is FALSE, the second is TRUE d.The first statement is
TRUE, the second is FALSE NBQ
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- Board Question All the following are properties of a good
disinfectant EXCEPT one. a.Has a residual effect b.Kills ALL
microorganisms c.Environmentally compatible d.Broad-spectrum
antimicrobial
- Slide 85
- Board Question All the following are properties of a good
disinfectant EXCEPT one. a.Has a residual effect b.Kills ALL
microorganisms c.Environmentally compatible d.Broad-spectrum
antimicrobial
- Slide 86
- Sanitization
- Slide 87
- Asepsis
- Slide 88
- Communicable Diseases Proper sterilization, disinfection, hand
washing, PPE helps controls spread C.D. Goal = break cycle of
transmission PPE: mandated by OSHA. Purpose is to protect clinician
not patient from splash or splatter
- Slide 89
- PATIENT APPOINTMENT
- Slide 90
- Patient Assessment Review med/dent hx ASA Classification Record
Vitals Temp Resp Pulse BP Important areas: under card MD,
hospitalized in last 5 years, meds, smokes, tobacco use, pregnant,
med/social history, CC Social Hx/CC: helps determine appropriate
care
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- OBJECTIVE #8: Premed
- Slide 94
- 94 Prophylactic Antibiotic Premedication Antibiotic
premedication is also known as antibiotic prophylaxis Infective
endocarditis is a life-threatening infection of the tissue lining
the heart and the underlying connective tissue, sometimes also
called bacterial endocarditis
- Slide 95
- Prophylactic Antibiotic Premedication The regimen intended to
prevent Infective endocarditis has been developed by the American
Heart Association Infection in a total joint replacement has been
developed by the American Dental Association and American
Association of Orthopedic Surgeons
- Slide 96
- Prophylactic Premedication Risk for infectious
endocarditis/bacteremia Risk factors with invasive procedures
Routine use of antibiotics not indicated Timing of ingestion of
oral antibiotics 1hour prior
- Slide 97
- AHA Guidelines Rationale for 2007 revision Exposure to
bacteremias more likely to occur in daily activities than in dental
procedures Antibiotic prophylaxis prevents only small # of cases of
IE Risks of antibiotic-associated adverse events outweigh benefits
of prophylaxis Maintenance of oral health with daily biofilm
removal reduces risk for IE No evidence-based method to decide
which procedures require prophylaxis Low incidence of IE, wide
variety of types of cardiac diseases and invasive dental procedures
Antibiotic premedication does not always prevent IE Most current
guidelines: www.americanheart.org
- Slide 98
- Medical Conditions Requiring Antibiotic Premedication
Prosthetic cardiac valve Previous endocarditis Congenital heart
disease Cardiac transplantation recipients with cardiac valvular
disease
- Slide 99
- Procedures Requiring IE Prophylaxis for At-Risk Patients Dental
& dental hygiene procedures involving Manipulation of gingival
tissue The periapical region of teeth Perforation of the oral
mucosa
- Slide 100
- Procedures NOT Requiring IE Prophylaxis for At-Risk Patients
Routine anesthetic injections Taking dental radiographs Placement
of removable appliances Adjustment of orthodontic appliances
Placement of orthodontic brackets Shedding of primary teeth
Bleeding from trauma to lips or oral mucosa
- Slide 101
- Clinical Procedures Medical Hx Pre-Med Needs Assessment Cardiac
conditions: artificial heart valves, previous hx endocarditis,
serious congenital heart defects, repair heart defect w/in 6mo,
cardiac transplant with valve issues Other: immunocompromised,
organ transplants, joint replacement (2yrs), uncontrolled diabetes,
hx IV drug use Review Regimens in handout Dental Hx
- Slide 102
- 7. Prevention of Infective Endocarditis SITUATIONDRUGDOSE
ADULTSDOSE KIDS OralAMOX2.0g50mg Unable to take oral meds
Ampicillin Cephalosporins (cefazolin, ceftriaxone) 2.0g parental 1g
parental 50mg Allergic to pen/ampicillin Cephalexin(Keflex)
Clindamycin Azithromycin or clarithromycin 2g 600mg 500mg 50mg 20mg
15mg Allergic to pen/ampicillin & unable to take oral meds
Cephalosporins (cefazolin, ceftriaxone) Clindamycin 1g 600mg 50mg
2-mg HAVE TO KNOW EVERYTHING ON THIS GRAPH!!
- Slide 103
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- BODY TEMPERATURE
- Slide 105
- Body Temperature No single temperature is normal for all people
Table 11-2 in DARBY lists the factors that may affect body
temperature, including: Hormonal imbalances Time of day or
environment Age Smoking Exercise Stress Ovulation and
menopause
- Slide 106
- Maintenance of Body Temperature Normal values Need to know
ranges for adults, children Temperature variations Pyrexia: Fever,
over 37.5 0 C or 99.5 0 F Hyperthermia: over 41.0 0 C or 105.8 0 F
Hypothermia: below 35.5 0 C or 96.0 0 F
- Slide 107
- Body Temperature Factors that alter body temperature Time of
day: highest afternoon/early PM. Lowest sleeping/early AM Exercise
Beverages/food Smoking Temperature outside Pathologic States:
Infection, Dehydration, Hyperthyroidism, Myocardial infarction,
Starvation, Hemorrhage, Physiologic shock
- Slide 108
- RESPIRATIONS
- Slide 109
- Respiration Function: To supply oxygen to the tissues and to
eliminate carbon dioxide Variations in normal respirations may be
shown by such characteristics as the rate, rhythm, depth, and
quality and may be symptomatic of disease or emergency states.
Normal respirations: a respiration is one breath taken in and let
out
- Slide 110
- Respiration Normal respiratory rate: DARBY Table 11-5 Adults =
14 to 20 per minute, slightly higher for women Children = The rate
decreases steadily during childhood 1 st year: 30 per minute 2 nd
year: 25 per minute 8 th year: 20 per minute 15 th year: 18 per
minute
- Slide 111
- Respiration Factors that influence respirations Many of the
same factors that influence pulse rate 12 per minute subnormal for
an adult 28 is accelerated 60 are extremely rapid and dangerous
Increased respiration: Caused by work and exercise, excitement,
nervousness, strong emotions, pain, hemorrhage, shock Decreased
respiration: Caused by sleep, certain drugs, pulmonary
insufficiency Emergency situations: Listed in Tables 69-4 and 69-5
WILKINS
- Slide 112
- Procedures for Observing Respirations Factors to observe
1.Depth: shallow, normal, deep 2.Rhythm: regular (evenly spaced) or
irregular (with pauses of irregular lengths between) 3.Quality:
strong, easy, weak, or labored (noisy) 4.Sounds: deviant sounds
made during inspiration, expiration, or both Record: record all
findings in the patients record
- Slide 113
- PULSE
- Slide 114
- Increased pulse ExerciseStrong emotions StimulantsExtremes in
heat/cold EatingHeart Disease Decreased pulse SleepDepressants
FastingQuieting emotions Low vitality from prolonged illness
Emergency situations Listed in Tables 69-4 and 69-5 in WILKINS
Pulse
- Slide 115
- Pulse: Have to know Ranges for Assessment Normal pulse rates
Adults. There is no absolute normal. 60-100bpm. Slightly higher for
women than for men Children. The pulse or heart rate falls steadily
during childhood In utero: 150 bpm Birth: 130 bpm 2 nd year: 105
bpm 4 th year: 90 bpm 10 th year: 70 bpm
- Slide 116
- Procedures for Determining Pulse Rate Sites 1.Radial pulse: at
the wrist (see figure on next slide). 2.Temporal artery: on the
side of the head in front of the ear, or 3.Facial artery: at the
border of the mandible 4.Carotid pulse: used during cardiopulmonary
resuscitation. 5.Brachial pulse: used for an infant.
- Slide 117
- Slide 118
- BLOOD PRESSURE
- Slide 119
- Blood Pressure Components of blood pressure: When the left
ventricle of the heart contracts Blood is forced out into the aorta
Travels through the large arteries Smaller arteries, arterioles,
& capillaries The pulsations extend from the heart arteries and
disappear in the arterioles. During the course of the cardiac
cycle, the blood pressure is changing constantly
- Slide 120
- Blood Pressure Systolic pressure: peak or the highest pressure.
It is caused by ventricular contraction. The normal systolic
pressure is less than 120 mmHg Diastolic pressure: lowest pressure.
It is the effect of ventricular relaxation. The normal diastolic
pressure is less than 80 mmHg Pulse pressure: difference between
the systolic and diastolic pressures. The normal or safe difference
is less than 40 mmHg.
- Slide 121
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- Slide 123
- Blood Pressure Follow-Up Criteria Advise & refer for
further evaluation 180/110mmHg Cannot proceed with DH or Dental Tx
until pt sees MD Never diagnose or treat based on 1 reading