DH-II ORIENTATIONORAL DIAGNOSIS & RADIOLOGY CLINIC

DR. SUSAN L. SETTLEFALL 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 MoreClinical 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 ExamLook 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 RadiographsUsually Panoramic and Two

BitewingsFaculty Will Sign For RadiographsPatient 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 FacultyAccept/Reject The Patient

“HOW TO SCREEN”If Patient Is Accepted:

They Will Receive/Review/Sign the Following Forms:o Patient Bill of Rightso Payment Policyo Yellow Copy of the Encounter Slipo Conditions of Treatment (Yellow Copies)

o Consent to Treatment (Yellow Copy)

“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 RejectedIf They Inquire, We Can Make Copies Of

The Screening Films To Either Be Sent To Another Dentist Or Take With ThemThis 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 FORMPATIENT BILL OF RIGHTS FORM

SCREENING PROCESSTypes Of Patients To Reject

Patients With Unrealistic ExpectationsPatients Who Do Not Have The Time To

Commit To OUCODPatients With Rampant CariesPatients With Severe Periodontal

DiseaseMany 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 RotationAlways Get Faculty PermissionTo Leave Clinic Before 12:00 p.m. Or 4:00 p.m.

Miscellaneous

Dress CodeGood Infection Control Techniques!

Times Have Changed!

DS IV ROTATIONDENTAL HYGIENE CLINIC

Part Of The DS IV O.D. RotationGoals:

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 ROTATIONDENTAL HYGIENE CLINIC

Goals (Continued):To Foster An Attitude Of

TeamworkTo Facilitate The Dental

Student’s Ability To Work With A Dental Hygienist As A Member Of The Dental Team

PATIENTS TAKING ANTICOAGULANTSWarfarin (Coumadin):

International Normalized Ratio (INR) is the test referenced to measure warfarin effect

Patients at greatest risk for intraoperative bleeding:Presence of Prosthetic Cardiac ValvePrevious 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 pressurePrimary closure (sutures)Synthetic collagenGelfoamTranexamic acid rinse

PATIENTS TAKING ANTICOAGULANTSWarfarin dose of 2.5 mg/day:

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 7.0-10 mg/day: Need INR/medical consultation

PATIENTS TAKING ANTICOAGULANTSAspirin:

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 quadrantsApply local measures as needed

PATIENTS TAKING ANTICOAGULANTSWhen in doubt, seek medical

consultationMost bleeding concerns will

involve periodontal surgery, oral surgery

High-risk patients:Prosthetic heart valvesPrevious blood clots

INFECTIVE ENDOCARDITIS PREVENTION GUIDELINES

PROPHYLAXIS IS RECOMMENDED FOR FOUR GROUPS OF PATIENTS:

Patients with:Prosthetic heart valvesPrevious history of infective

endocarditsCardiac transplant with resulting

valve damageCertain 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 immunosuppressionRadiation-induced

immunosuppression

PROPHYLAXIS TO PREVENT INFECTION TO PROSTHETIC MAJOR JOINTS, PROPHYLAXIS INDICATED:

Patients with co-morbidities, e.g.:Previous prosthetic joint infectionsMalnourishmentHemophiliaHIV infectionType 1 diabetesMalignancy

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?