Download CLINICAL CONSIDERATION BEFORE MINOR ORAL PROCEDURE

CLINICAL CONSIDERATION
BEFORE MINOR ORAL
PROCEDURE
BY DR.MUTANGILI
ORAL&MAXIOFACIAL SURGERY
K.N.H
MINOR ORAL PROCEDURE
A minor surgical procedure
either clean or sterile
performed under local
anaethesia and lasting for
not more than 1 hour.
RE: Australian Dental Council
MEDICAL CONSIDERATION
Taking into account medical
conditions pre-existing prior to a
surgical procedure that may impart
negatively (intra-operative;
immediate post operative, or long
term post operative) on the safety
and well being of the patient.
COMMON MEDICAL CONDITIONS ENCOUNTERED BEFORE
MINOR ORAL PROCEDURE
INCLUDES:
 High blood pressure
 Diabetes mellitus
 Pregnant dental patient
 Haemophilia
 Patient on long term anti coagulant
therapy(Cardiovascular Diseases)
Including (RHD,CHD,CAD,M.I)
 Asthmatic patient
 Patient with PTB
 HIV patient
 Patient allergic to latex
 The special patient
 The psychiatric dental patient
HYPERTENTION
 Clinically comes in two forms:
 A know hypertensive
 The unknown hypertensive
The Known:
Already under medication
Knows the drugs
Normal 120 Systolic
80 Diastolic
and below
Mild 121-130/80-90
Moderate 131-139/91-95
Normal proceed with treatment under local anaethesia without
adrenaline
Mild/Moderate ;
Monitor
Alleviate fear , stress & anxiety
Review medication
Refer for consultation before surgery
Severe
readings above 139 systolic and 95 diastolic
Defer treatment
Refer for physician review
 The unknown hypertensive patient
 Patient not aware of existing high blood pressure,
Common complaints;
Hx of frequent headaches
Hx of bleeding nose
Hx of dizziness
Hx of syncope
Maybe suffering from high blood pressure
Take blood pressure ,best practice to take two reading from left
and right the do the average.
depending on the results proceed as above
Possible complications excess bleeding
Excess loss may lead to Hypovolumic shock
Longer stay in hospital
Unexpected expenses
DIABETES MALITUS(TYPE 1,TYPE 2)
 Persistent high sugar levels in blood presents as
-A Known Diabetic
-The Known
The Known - already diagnosed
- On medication
Normal –Radom sugar 3-6g/dl
Fasting sugar 3-4g/dl
 Hypoglycemic <3 (both fasting, random)
 Diabetic
>9 fasting
>10 random
Possible Completion
-Compromised immunity
-Risk of infection post operative
-Delayed or failed healing
-Possibility of excessive bleeding
-Risk of spread of infection to potential
spaces(including necrotising fasicitis)
The UNKNOWN
 May present:
-Polyuria-frequent passing of urine
-Polydipsia-increased water intake
-Polyphagia-increased appetite
- Recent marked loss of weight
 Carry out –RBS
-FBS next morning depending on results
Results of sugar>9g/dl, defer treatment and refer to
physician for start, control of blood sugar.
THE PREGNANT PATIENT
 1ST Trimester concern- the inter-uterine life:
Precautions on medications that may put the unborn
child includes -the use of nitroimmidazole drugs.
-X-ray exposure
-If X-ray must be taken.
-Risk of developing gestational diabetes
may be precipitates by dental treatment stress
 3rd Trimester
-Risk of developing hypertension due to
hormonal changes and postural changes
-Discomfort for longer procedures in supine
position
-Diminished blood to the foetus
-Procedures like MMF may compromise the
health of the developing fetus.
PATIENT ON LONG TERM ANTICOAGULAT THERAPY
 Warfarin:
-Risk of excessive bleeding
-Decreased volume worsening an existing
cardiovascular diseases
 If surgical procedure has to be done
-Best managed as in patient
-Stop the warfarin 3days to day of surgery
-Start patient of short acting anticoagulat
drugs
-Clexane S.C. BD
-Stop the clexane in the morning of surgery
-Do INR-if <1.2 proceed with surgery
-Restart warfarin soon after
HEAMOPHILIA
 Usually a young boy
 Manage as inpatient with consultation with hematologist
 Prepare the factor 8 concentrate before surgery
ASHMATIC
-The antiasthmatic must be readily available in
the clinic before surgery can start. Particularly
aerosols or nebulizer
 Infective Stages
-Schedule as last patient of the day
-Use high volume suction to reduce aerosols
-Handler must use special face
masks(hepa,niosh,NG5)
 HIV
-Need not be isolated
-Must be done under sterile environment
-Surgical sites must be cleared with and septic
(chlorohexidine/iodine solutions)
To avoid introducing new infections
PATIENT ALLERGIC TO LATEX
 Increasing
 Major challenge , many clinic set ups mainly use latex
gloves
 Incidences of severe anaphylaxis and even death have
been reported
Careful History
-Patients who report allergy to
bananas,kiwis,avocados,watermelon should be
suspected to be allergic to latex
These fruits contain chemical similar to NRL which is the
allergen in latex.
Keep epinephrine ready
-Use latex free gloves, tubing and suction tips
-Patient should be scheduled as first patient in the
morning, cases of reaction from services contaminated
with latex have been reported.
-May be managed in isolation not near rooms with
latex containing material
Q &A
FIN
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