Dent4060 2024 Medical History & Risk Assessment PDF

Dent4060 (2024) - Medical History and Risk Assessment Dr David Fu BDSc, DClinDent(SND) Acknowledgements to Prof Laurence J Walsh Dr Claudia Lopez-Silva Learning Objectives Examples of medical history Risk assessment methods Antibiotic prophylaxis Lifestyle factors Relevant Medical Condit...

Dent4060 (2024) - Medical History and Risk Assessment Dr David Fu BDSc, DClinDent(SND) Acknowledgements to Prof Laurence J Walsh Dr Claudia Lopez-Silva Learning Objectives Examples of medical history Risk assessment methods Antibiotic prophylaxis Lifestyle factors Relevant Medical Conditions 2 ISOH Med Hx versus Paper 3 Private Clinic Example 1 4 Private Clinic Example 2 5 Private Clinic Example 3 6 Private Clinic Example 4 7 8 Medical History and Capacity The presence of neurological disorders (e.g. dementia) and other disorders related to cognitive impairment (e.g. acquired brain injury) puts extra onus on the dentist to ensure that the person can provide useful information, and understands the intended treatment, examination or procedure. Does the person have capacity? Is that capacity to understand sufficient for simple versus complex dental treatment? 9 10  Medical History Condition History of Condition Medications Related to Condition Dosage of Medication Impact on Dentistry Multiple Myeloma 2017 detected in the spine IV Zoledronic Acid Monthly for a year (MM) Currently in remission Prednisone Daily High Medications are no longer taken Chemotherapy Daily Type 2 Diabetes Episodes of hypoglycaemia Insulin Aspart Protamine Suspension 16 units BD June 2019 - HbA1C: 8.2% Gliclazide ( Diamicron) 120mg MANE High Mellitus (NIDDM) Chronic Kidney Stage IIIA Dutasteride – Tamsulosin ( Duodart) 500mcg-400mcg NOCTE Secondary to MM treatment Ceased oxybutynin Medium Disease eGFR – 51 ml/min Hypertension Diagnosed prior to 2000 Perindopril (Coversyl) 2mg NOCTE Coronary artery bypass graft Metoprolol (Minax) 50mg BD Medium 2013 Lercanidipine ( Lercadip) 20mg MANE Ceased aspirin Atorvastatin (Lipitor) 40mg NOCTE Osteoporosis Vitamin D deficiency Vitamin D + Calcium (Ostevit-D) 1000 IU MANE Sarcoidosis 1971 Low Laminectomy 2013 Knee replacement surgery 2016 Gastric Oesophageal Secondary effect to MM Ceased pantoprazole, sodium Low Reflux Disease (GORD) treatment bicarbonate capsules (Sodibic ) Prostamegaly Secondary effect to MM Baclofen (Gablofen) 10mg MANE Low Page 11 12 13 14  78 yr old female OHC version 2017 Nature of heart valve disorder? ABT cover needed or not? (for Up to 10% of women may have high risk Pts having high risk procedures) some degree of thyroid Zanadip = lercanidipine HCl = Ca channel blocker deficiency. antihypertensive Hypothyroidism. Low energy, Noten = atenolol = selective type 1 beta blocker depression, fatigue. antihypertensive Elevated TSH = goitre. Coversyl = perindopril arginine = ACE inhibitor antihypertensive Lipitor = atorvastatin = statin. Oroxine = thyroid suppl. Low dose aspirin for blood thinning. Caltrate Ca supplement. 15 Antibiotic Prophylaxis 16 National Institute for Health and Clinical Excellence (NICE) 2008: Cessation of ANY antibiotic prophylaxis for patients at risk of IE for ANY invasive dental procedure Argument: Growing issues of antibiotic resistance of microorganisms and lack of evidence for antibiotic use far outweighed benefit of potential reduction in IE incidence from dental procedures Page 17 CRICOS code 00025B Risks of adverse events Versus Risk of IE Page 18 CRICOS code 00025B Therapeutic Guidelines (2019) Page 19 CRICOS code 00025B Therapeutic Guidelines – Dental Procedures Indicated Page 20 CRICOS code 00025B Australian Therapeutic Guidelines 2008 Page 21 CRICOS code 00025B  Page 22 CRICOS code 00025B  Page 23 CRICOS code 00025B  Page 24 CRICOS code 00025B Lifestyle choices and Risk Factors Page 25 CRICOS code 00025B  Page 26 CRICOS code 00025B  Page 27 CRICOS code 00025B  Page 28 CRICOS code 00025B Common Conditions – Cardiovascular Disease Antibiotic prophylaxis? Medical emergency? Duration of treatment? Anti-thrombotic medication (ie. Blood thinners) Liaise with medical specialist? (eg. Medical GP, cardiologist) Page 29 CRICOS code 00025B Common Conditions – Hypertension/Hypotension Page 30 CRICOS code 00025B Common Conditions – Diabetes Mellitus Random blood glucose test/BGL (mmol/L) Haemoglobin A1c/HbA1c (%) Consider that patients can have multiple oral conditions manifest Candida infections Oral med lesions Higher risk of caries and periodontal disease Hyposalivation/xerostomia Consider medical emergencies (ie. hyperglycaemia, hypoglycaemia) Consider other morbidities that occur with these patients 31 Common Conditions – Asthma 32 Other Relevant Conditions - Stroke 33 Other Relevant Conditions - Epilepsy 34 Prescribed medicines Obtain an accurate medical history including medication regimen. Patients with mental illness are often reluctant to admit the reasons for their use of medications Ask patients for medication updates at each appointment. Medication changes can affect the appropriate care of the patient from a medical and/or appointment management standpoint. Be supportive and non-judgmental. Discuss dental treatment with their treating medical provider if needed. 35 Medication history Australian medicines handbook : www.amh.net.au Australian Drug Information (Aus DI) : ausdi.hcn.com.au Medicine Dose Duration of use Purpose Adverse What happened? When it happened reactions (nausea, rash swelling) type 1 within 1 day Ab IgE Agent response skin test reaction; type IV after 2-3 days T cell response 36 Example of Information from Medications Venlafaxine, sold under the brand name Effexor among others, is an antidepressant of the selective serotonin-norepinephrine reuptake inhibitor class. Lithicarb (lithium carbonate 250 mg) –Treatment and prophylaxis of mania, manic depressive (bipolar) illness and recurrent endogenous (unipolar) depressive illness. Spironolactone, sold under the brand name Aldactone among others, is a medication that is primarily used to treat fluid build- up due to heart failure, liver scarring, or kidney disease. Atenolol (Tenormin) is a beta-blocker that affects the heart and circulation, and is used to treat angina and hypertension. Lipex used to treat hypercholesterolemia and hyperlipidaemia as an adjunct to diet and prevent coronary heart disease. It contains simvastatin. Alendronic acid or alendronate sodium, solder under the trade name Fosamax among others, is a bisphosphonate drug used for osteoporosis, osteogenesis imperfecta, and several other bone diseases 37 38 Prevention of MRONJ Dental clinicians to screen patients prior to the use of anti-resorptive and anti-angiogenic medications Clinicians understanding different risk factors for IV versus oral bisphosphonates and medical reasons for taking bisphosphonates Up to 3-fold decrease in incidence of MRONJ with patients undergoing preventive dentistry over those with no preventive measures Risks of MRONJ can be discussed prior to drug therapies, ensuring patients understand the reason for good oral hygiene Reduction in MRONJ incidence for cancer patients with IV bisphosphonates in 1,243 patients Ruggiero, S. L., Dodson, T. B., Fantasia, J., Goodday, R., Aghaloo, T., Mehrotra, B., & O'Ryan, F. (2014). American Association of Oral and Maxillofacial Surgeons position paper on medication-related osteonecrosis of the jaw—2014 update. Journal of oral and maxillofacial surgery, 72(10), 1938-1956. Sim, I. W., Sanders, K. M., Borromeo, G. L., Seymour, J. F., & Ebeling, P. R. (2015). Declining incidence of medication-related osteonecrosis of the jaw in patients with cancer. The Journal of Clinical Endocrinology & Metabolism, 100(10), 3887-3893. Page 39 CRICOS code 00025B Information related to risk assessment for MRONJ Page 40 CRICOS code 00025B Treatment Planning Systemic Phase Acute Phase Disease control Phase Definitive Phase Maintenance Phase Page 41 CRICOS code 00025B  Page 42 CRICOS code 00025B  Conclusion Understand the importance of medical history Reflect how that will change your treatment planning Helps you tailor your treatment towards the patient’s needs and goals More information = less unpredictability Understanding medical history and performing risk assessments is what makes you a better Dental Clinician and not just a “technician who drills teeth’ Page 43 CRICOS code 00025B