Medical questionnaire

Question Dental implication

Hospital, operation, - Any complications
GA - Relevant procedure
- Heart conditions
Serious problems after - LA, allergies (latex), delayed wound healing, bleeding
dental treatment
Diabetes - Risk factor for perio
- Reduced wound healing if not controlled
- Monitor glucose concentration: 3.5-12 mmol GOOD, >12 mmol BAD à
GP need to change dosage of meds, < 3.5 or hypoglycemic à
administer glucose and treat as ME
- Monitor HbA1C: <7.0% GOOD, >8.0% may have delayed soft tissue
healing
- Metformin: reduced production of glucose in liver
Kidney problem - Metabolism of drugs: Methotrexate, enoxaparin and metformin,
antibiotics, anti-virals, NSAIDs, diuretics, immunosuppressant,
chemotherapy drugs
Smoking - Masks perio, oral cancer, delayed healing
- Smoking cessation
Heart disease, high - HBP: check meds (anti-coags, anti-platelets), NSAIDs used with caution
blood pressure, heart - Heart mumur: Increased risk of endocarditis. If pathologicial or of
mumur, rheumatic unknown origin NEED AB prophy
fever - IHD and angia: Good medical history, Advise patient to bring
medication , Check INR, Judicious use of vasoconstrictors, Eliminate pain
and stress, Short session, morning
- Myocaridal infarction: No elective dental treatment first 6/12, Only
pain relief or emergency tx, Talk to GP, No stress, pain, Morning, short
session, After first 6/12, elective treatment permitted (precautions!)
Pacemaker - Do not use EMS (modern equipment does not interfere with pacemaker)
Bleed excessively - Medications
when you cut - Undiagnosed disease: haemophilia
yourself, bruising - Surgical procedures contraindicated if uncontrolled, ask pt to discuss
problems with GP to control
- Thrombocytopaenia
o Consult hematologist
o No surgery until problem corrected
o Conservative treatment of infection
o Avoid aspirin, NSAIDs
o May need additional steroids
o No treatment if platelets < 50,000/mm3
Stroke, fits, epilepsy - Medications
- Motor defect = poor OH, suggest electric toothbrush
- 7th cranial nerve = food accumulation, difficulty with dentures (design
thickened flange for denture)
- Anti-coag, anti-platelets should not be ceased of dentoalveolar
procedures
- Epilepsy: how often seizures, what triggers them, check pt has taken
meds for that day (no meds 48 hours = risk of seizure), avoid
stressful/long procedures, gingival hyperplasia due to anti-epilepsy
meds
Memory loss, - Meds à hyposalivation (some meds are sugar-based à caries)
Alzheimer, dimentia - sugar-based meds à caries
- Poor OH à caries
- Change in diet

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Tuberculosis, asthma, - TB (contagious) is latent = proceed as normal, standard inflection control
breathing problems precautions
- Any suggestions of symptoms of active TB = should be removed from
area, instructed to wear surgical/procedure mask, assess need for
dental care and then refer to GP
- Asthma: tell patients to bring inhaler, avoid drugs e.g. aspirin + NSAIDs
à can lead to bronchoconstriction (use paracetamol as analgesic +
antipyretic), increased risk of oral candidosis if using inhaling
corticosteroid, ask pts to wash mouth after use
-
Liver problems - HepA
o No treatment in acute stage except emergency
o Minimize drugs detoxified by liver
o Consult physician
o Symptoms last 8 weeks, can get recurrence in 6 months
o Increase risk of bleeding
o Liver metabolism, antibiotics contraindicated include
tetracycline, erythromycin and metronidazole. Use LA instead.
o Increase risk of caries and perio.
- Hep B = controlled drug therapy, Hep C = cure is possible
- HepC: increased dental caries, focus on preventive care
- Sedatives and NSAIDs should be avoided with viral hep, may be
hepatotoxic, use paracetamol carefully
- Metabolism disorders: LA à impaired drug clearance à systemic
toxicity à circumoral and tongue numbness, light-headedness, visual
auditory disturbances, muscular twitching, loss of consciousness, seizures,
coma, resp arrest, CV collapse
Joint problems, - Joint pain, may have limited mouth opening
arthritis, joint - Bleeding tendency secondary to aspirin, NSAIDs
replacement surgery - Bone marrow suppression due to drugs
- Immunosuppressed
- Difficulties with oral hygiene maintenance?
- Short appointment
- Position changes
- Coagulation screening tests preoperatively?
- May need additional corticosteroids
- Low threshold for antibiotic prescription
- Routine dental treatment
- No AB prophy for joint prostheses unless indicated by orthopedic
surgeons or GP
Behavioural or - Poor OH
psychological issues - Medications
- Check if diet is adequate
- LA not contraindicated with tricyclic anti-deps or selective serotonin
reuptake inhibitors (SSRI), but should be avoided taking mono-amine
oxidase inhibitors (MAOI)
- Be suspicious of pts asking for analgesic drugs – opioids, good level of
knowledge
Pregnant - Most dental procedures can be carried out safely, best treatment during
2nd trimester
- Dental procedures could harm fetus via radiation, drugs
- Supine hypotension (hypotension in preg woman when lying on back) in
late pregnancy
- Transmission of drugs to infant via breast milk (most drugs excreted
minimally via breast milk, only few defs contraindicated)
- Lead apron
- Avoid tx or prescribing drugs during first trimester if possible

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 - Significant surgery, major reconstructive procedures, crowns, bridges,
best delayed until after delivery
- GA and or IV sedation: should be done after baby is born, pref after
breast feeding has stopped
Cancer meds, - Make sure dentally fit, review by dentist before radiotherapy
radiotherapy, (hyposalivatation) + chemotherapy (warm of mucositis, oral pain)
chemotherapy, - Bisphosphonates à BRONJ à painful, reduce bone healing
calcium or bone o BRONJ = adverse drug Rx; progressive destruction and death
disorders, of bone that affects the mandible or maxilla of patients
osteoporosis exposed to the treatment with nitrogen-containing
bisphosphonates, in the absence of a previous radiation
treatment
- C-terminal telopeptide (CTX) is a breakdown product of bone
resorption and there its serum concentration provides an estimate of
bone turnover.
- Before commencing long term bisphosphonates in any patient, GP
should refer the patient to a dentist for check up on oral health.
- Normal is between 400 and 500 pg/mL
o If CTX is above 150 pg/mL, can proceed treatment
o If less than 150 pg/mL, patients are at risk of developing
BRONJ
o So need to cease bisphosphonates temporarily by consulting GP
-
Allergies, latex - Penicillin allergy: Adult: Clindamycin 600 mg orally 1 hour prior to
procedure, Child: 15 mg/kg up to 600 mg orally, 1/24 pre-procedure
- Latex: nitrile gloves instead, stop procedure, monitor swelling, oral anti-
histamines
Pressure bed sore, risk - Shorter appointment
of developing them - Position might change away from pressure sore
Fall in last 28 days - Impaired motor skills
- Consider if patient has had surgery, anti-coags (low-dose warfarin, low-
molecular-weight heparins and aspirins) generally used post-op à
clotting complications
- Incomplete restoration of physical function
o 33 ~ 40% of hip fracture patients recover the ability to
perform everyday activities within the first 6 months
o Possible deterioration of dental health due to physical and
functional impairment
o Dental appointment should be tolerable in length
o Pt’s physical capacity to endure prolonged dental procedure
may also be compromised
o Pain or discomfort resulting from sitting on dental chair for long
period of time
- Prosthetic joint infection
o AB prophy not recommended
o No evidence of increased risk of infection in surgery site
following dental treatment
o No statistically significant association between prophylactic
antibiotics prior to dental procedure and reduction of the risk
for prosthetic hip infection.
- Pts w/ previous and current bisphosphonates therapy have risk of
developing BRONJ following bone-invasive dental treatments

- Patients under good medical management:

o Any indicated dental treatment
o If acute infection develops – talk to patient’s GP
- Thyrotoxic patient:

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 o Conservative tx, antibiotic for infection, analgesics (adrenaline
contraindicated à thyroid storm), etc.
Hypothyroidism - Untreated hypothyroid patients
o Conservative treatment of infection
o Avoid surgical procedures
o Pain control with non-narcotic analgesics
- Pt. under good medical management:
o Any indicated dental treatment
Leukaemia - During acute stage avoid dental treatment if possible
o Antibiotic + analgesic for infection
o Drainage through pulp chamber rather than extraction
- During remission treat all active dental disease
o No complex treatment plan if poor prognosis
Adrenal - Adrenal glands produce steroid hormones from the cortex and
insufficiency/disorders catecholamines from the medulla.
- Adrenal glands are destroyed or removed à replacement of steroid
hormones particularly the glucocorticoids is essential
- Therapeutic use of corticosteroids is the most common cause of adrenal
suppression
- If Pt can’t produce sufficient glucocorticoids following such stress à
Addisonian (adrenal) crisis
o Presents as a progressive hypotension occurring 6-12 hours
after dental treatment with the patient feeling faint, confused
and collapse.
- Stressful dental treatment should be done in the morning so if an
Addisonian crisis occurs, symptoms can present when awake. If done in
the afternoon, symptoms may present when asleep à death.