Avoiding Suggestive Questions

Question Types to Avoid

• Suggestive Questions: Lead the respondent towards a specific answer.
• Example of Suggestive: “Do you feel the pain in your left arm when you get it in your chest?”
• Better Alternative: “When you get the pain in your chest, do you notice it anywhere else?”
• Leading Questions: Imply the answer the interviewer is seeking.
• Example of Leading: “You haven’t used any recreational drugs, have you?”
• Better Alternative: “Do you use recreational drugs?”

Medical History Sections

• Source and Reliability: Includes identifying information (age, gender) and reliability assessment of the source.
• Biographic Information: Captures date/place of birth, sex, race, ethnic background, and gender identity.
• Chief Complaint: Patient's own words summarizing the reason for seeking care.
• History of Present Illness: Details recent health changes relating to the chief complaint (what, when, how, etc.).
• Pain Assessment: Evaluates pain condition, including location, intensity, duration, and aggravating/alleviating factors.
• General State of Health: Patient’s perception of health and recent physical exams.
• Past Medical History: Summary of childhood/adult illnesses, significant conditions, and treatments.
• Current Medications: List of medications currently being taken by the patient.
• Allergies: Documented patient allergies.
• Psychosocial History: Patient's social history impacting health.
• Health Maintenance: Records preventive care received.
• Occupational and Environmental History: Job history and relevant exposures.
• Diet, Sleep Patterns, and Family History: Assessment of dietary habits, sleep quality, and medical history of relatives.

INR and Coagulation Tests

• INR (International Normalized Ratio): Measures blood clotting speed; ranges indicate slow (high INR) or fast (low INR) clotting.
• PT (Prothrombin Time): Commonly used to gauge the effectiveness of anticoagulant therapy like warfarin.
• CoaguChek Device: Allows patients to self-monitor INR with minimal blood sample, providing quick results.
• Prosthetic Patients: AB prophylaxis not routinely needed for patients with certain medical devices like cardiac pacemakers.

Antibiotic Prophylaxis Considerations

• No Evidence of Benefit: AB prophylaxis is not recommended for most dental procedures in patients with specific cardiac devices.
• Dentists and Prophylaxis Requests: Can decline unnecessary requests for AB if no medical rationale exists.

Hemophilia Management

• rFVIIa (NovoSeven RT): Used primarily for patients with inhibitors; recommended dosage is 70-90 mcg/kg.
• Desmopressin (DDAVP): Stimulates release of F-VIII, useful for mild Hemophilia A; available in IV and nasal spray form.
• EACA/Tranexamic Acid: Can be used alongside DDAVP for stabilizing clots in mild Hemophilia A patients.
• Management for Severe Deficiency: Requires F-VIII replacement or rFVIIa administration prior to dental procedures.

Bleeding Risk Assessment

• NSAIDs and Dental Procedures: Generally safe for invasive work; dual antiplatelet therapy may increase bleeding risk.
• Vorapaxar and Other Antiplatelet Drugs: Important considerations when assessing cardiovascular health.

Dental Treatment Guidelines

• Hypertension: Understanding ASA classification is crucial for managing treatment risks relative to blood pressure.

Thromboembolic Event Risks

• High-risk Factors: Identify recent DVT/PE, mechanical heart valves, high CHA₂DS₂VASc scores, and other specific conditions.

Cerebral Vascular Aneurysms

• Clinical Presentation: Often asymptomatic; rupture leads to severe headache, neck stiffness, and altered consciousness.
• Management Approaches: Surgical intervention or endovascular coiling for ruptured cases; medical management for unruptured cases aims to reduce rupture risk.
• Dental Considerations: Evaluate bleeding risk in patients on anticoagulants and avoid excessive strain during treatment.

Stroke and TIA Management

• Transient Ischemic Attack (TIA): Symptoms resolve within 24 hours; present with visual disturbances and motor/sensory dysfunction.
• First-line Pharmacologic Treatment: Aspirin or clopidogrel for secondary prevention.
• Surgical Intervention: Consideration for patients with carotid artery-related TIA.