GMDC INNOCENZO SEPTEMBER 2023

Medical Consultation

• A medical consultation is a request for advice or opinion from a specialist or a physician with more expertise in a particular area.
• When requesting a consultation in a hospital, the opening sentence should include the patient's name, medical record number, and a brief description of the problem.

Timeframe for Consultation

• In a hospital setting, it typically takes around 30 minutes to answer a consultation request.

Post-Consultation Recommendations

• After providing recommendations in a consultation, the specialist should document the recommendations and communicate them to the requesting healthcare provider.

Dental Clearance

• In the context of a dental consultation, dental clearance is requested prior to aortic valve replacement to ensure the patient is healthy enough for the procedure.

Hyperthyroidism

• The most common cause of hyperthyroidism is Graves' disease.
• Hyperthyroidism is treated with antithyroid medications, radioactive iodine, or surgery.
• Oral findings associated with hyperthyroidism may include tooth loss, dental caries, and periodontal disease.

Hypothyroidism

• A possible oral manifestation associated with hypothyroidism is macroglossia.
• The recommended perioperative recommendation for a patient with hyperthyroidism undergoing a dental extraction is to obtain medical clearance.
• A possible symptom of poorly controlled hypothyroidism is lethargy.
• Thyroid storm is treated with antithyroid medications, beta blockers, and supportive care.
• A medical consultation should be obtained for a hypothyroid patient if they are symptomatic or have a history of thyroid surgery or radioactive iodine therapy.

Asthma

• A physical finding/clinical presentation of asthma is wheezing.
• The dental significance for a patient with asthma is that they may be prone to dental anxiety and require shorter appointments.
• Medications commonly used in the treatment of asthma include bronchodilators and corticosteroids.
• The dental management for a patient with poorly controlled asthma includes premedication with bronchodilators and corticosteroids.

Diabetes Mellitus

• Oral complications associated with diabetes mellitus include xerostomia, dental caries, and periodontal disease.
• Gestational diabetes develops in 1-3% of pregnancies in the 3rd trimester.
• Clinical manifestations of diabetes include polyuria, polydipsia, and weight loss.
• The lab test used for monitoring blood sugar control every 3 months is the HbA1c test.
• General considerations for dental management of diabetic patients include ensuring good blood sugar control and adjusting dental appointments according to the patient's blood sugar levels.

COPD

• A characteristic sign of a patient with COPD is a barrel chest.
• Dental efforts should be directed towards reducing stress and anxiety in patients with COPD.
• Nitrous oxide-oxygen sedation is not contraindicated in patients with severe COPD.
• Vasoconstrictors can be used in local anesthetics for patients with COPD.
• Questions to be asked regarding a patient's asthma include the type of medication used, frequency of use, and the severity of symptoms.

Syncope Episodes

• Interventions that can help prevent syncope episodes during dental visits include having the patient lie down, elevating their legs, and providing oxygen.

Test your knowledge on perioperative recommendations for a 60-year-old patient with a history of hypertension, chronic cough, and smoking. Learn about medication, dosage, recent lab work, and the patient's medical optimization for the procedure.