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Chapter 11

Preparation for Patient Care

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Information Gathering

• Personal

• Medical

• Dental

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Personal Information

• Name and address

• Social security number

• Insurance information

• Physician name

• Emergency contact

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Medical Information

• Past surgeries

• Systemic diseases

• Allergies

• Injuries

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Past Surgeries

• Heart valve replacement

• Joint replacement

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Antibiotic Prophylaxis

• American Heart Association guidelines– Amoxicillin/penicillin

• 2 grams 1 hour before procedure

– Clindamycin• For patients allergic to penicillin• 600 mg 1 hour before procedure

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Systemic Diseases

• Heart disease

• Epilepsy

• Diabetes

• Asthma/emphysema

• Parkinson’s disease

• Multiple sclerosis

• Cancer

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Health Alerts for Antibiotic Prophylactics

• Mitral valve prolapse (MVP)

• Heart murmurs– Valvular regurgitation

• Prosthetic heart valve

• Systemic pulmonary shunts

• Past surgeries

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Allergies of Concern

• Anesthetic

• Latex

• Medication

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Injuries

• Back

• Jaw

• Neck

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Dental Information

• Patient concerns/reason for appointment

• Patient attitude toward dentistry

• Quality of previous dental care

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Clinical Observation

• Gait

• Speech

• Behavioral problems

• Hands and fingernails

• Eyes– Dilated

• Facial symmetry– Droopy eyelids

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Extraoral Evaluation

• Mouth and lips– Cracking or ulceration

• External floor of mouth

• Lymph nodes

• Temporomandibular joint (TMJ)

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Intraoral Evaluation

• Lesions

• Abscessed teeth

• Color changes

• Tissue irregularities

• Soft tissue: oral mucosa

• Hard tissue: teeth

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Charting Existing Conditions

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Examining the Lips

Smile line

Vermilion border

Commissures of the lip

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Examining the External Tissue of the Mandible and the Floor of the Mouth

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Examining the Cervical Lymph Nodes

• Swelling

• Abnormalities

• Tenderness

• Infection

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Examining the Temporomandibular Joint

• Noises

• Tenderness

• Pain

• Limited function

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Examining the Floor of the Mouth

• Tenderness

• Abnormalities

• Lesions

• Bony tori

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Examining the Oral Mucosa and Frenum

• Frenum attachment: a narrow band of tissue that connects two structures– Labial– Buccal– Lingual

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Examining the Tongue and Palate

• Palatal tori

• Geographical tongue

• Precancerous lesions

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Examining the Tongue

• Color

• Papillae

• Coating

• Abnormalities

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Vital Signs

• Body temperature

• Pulse

• Blood pressure

• Respiration rate

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Antipyretic: Method of Reducing Fever

• Cold pack

• Alcohol rub

• Aspirin

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Hypothermic

• Body temperature is below normal.

• Possible causes:– Too much aspirin– Prolonged exposure to cold

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Radial Pulse

• Adults:

– 60 to 90 beats per minute

• Children:

– 90 to 120 beats per minute

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Pulse Rates

• Tachycardia

– Rapid resting pulse rate

• Bradycardia

– Abnormally slow pulse

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Respiration

• The process of inhaling and exhaling (breathing)

• Normal respiration– Adults

• 10 to 20 breaths per minute– Children

• 20 to 26 breaths per minute

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Blood Pressure

• The amount of labor the heart has to exert to pump blood throughout the body

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Normal Readings

• Adults: 120/80

– Systolic: below 140

– Diastolic: below 90

• Children: 100/66

• Adolescents: 118/76

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Systolic

• The first sound heard when taking blood pressure

• The highest number in the reading

• Caused by the heart contracting and forcing blood through the arteries

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Diastolic

• Reflects the heart muscle at rest

• Heart takes blood to be oxygenated before the next contraction

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Taking Blood Pressure

• Extend the patient’s arm to the level of the heart.• Make sure arm is supported and relaxed.• Place the cuff 1 to 2 inches above the antecubital

space.• Wrap and secure cuff around arm.• Expel all air from cuff before taking BP.• Inflate cuff to 160 to 180.• Slowly release 2 to 4 mm mercury per second.

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Locating the Brachial Artery