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Dental care & Medicine

ASA PHYSICAL STATUS CLASSIFICATION SYSTEM*


      

ASA I ASA II ASA III ASA IV ASA V ASA VI ASAASA-E

ASA I


Patients are considered to be normal and healthy. Patients are able to walk up one flight of stairs or two level city blocks without distress. Little or no anxiety. Little or no risk. This classification represents a "green flag" flag" for treatment.

ASA II


Patients have mild to moderate systemic disease or are healthy ASA I patients who demonstrate a more extreme anxiety and fear toward dentistry. Patients are able to walk up one flight of stairs or two level city blocks, but will have to stop after completion of the exercise because of distress. Minimal risk during treatment. This classification represents a "yellow flag" for flag" treatment.

Examples: Examples: History of well-controlled disease states wellincluding nonnon-insulin dependent diabetes, prehypertension, epilepsy, asthma, or thyroid conditions; ASA I with a respiratory condition, pregnancy, and/or active allergies. May need medical consultation. Note: Patients who demonstrate a more extreme anxiety and fear toward dentistry have a baseline of ASA II even before their medical history is considered; that situation raises the classification system.

ASA III


Patients have severe systemic disease that limits activity, but is not incapacitating. Patients are able to walk up one flight of stairs or two level city blocks, but will have to stop enroute because of distress. If dental care is indicated, stress reduction protocol and other treatment modifications are indicated. This classification represents a "yellow flag" for treatment. flag"

Examples: History of angina pectoris, myocardial infarction, or cerebrovascular accident, congestive heart failure over six months ago, slight chronic obstructive pulmonary disease, and controlled insulin dependent diabetes or hypertension. Will need medical consultation.

ASA IV


Patients have severe systemic disease that limits activity and is a constant threat to life. Patients are unable to walk up one flight of stairs or two level city blocks. Distress is present even at rest. Patients pose significant risk since patients in this category have a severe medical problem of greater importance to the patient than the planned dental treatment. Whenever possible, elective dental care should be postponed until such time as the patient's medical condition has improved to at least an ASA III classification. This classification represents a "red flag" - a warning flag flag" indicating that the risk involved in treating the patient is too great to allow elective care to proceed.

Examples: Examples: History of unstable angina pectoris, myocardial infarction or cerebrovascular accident within the last six months, severe congestive heart failure, moderate to severe chronic obstructive pulmonary disease, and uncontrolled diabetes, hypertension, epilepsy, or thyroid condition. If emergency treatment is needed, medical consultation is indicated.

ASA V


Patients are moribund and are not expected to survive more than 24 hours with or without an operation. These patients are almost always hospitalized, terminally ill patients. Elective dental treatment is definitely contraindicated; however, emergency care, in the realm of palliative treatment may be necessary. This classification represents a red flag" for dental flag" care and any care is done in a hospital situation.

ASA VI


Clinically dead patients being maintained for harvesting of organs.

ASAASA-E


Emergency operation of any variety (used to modify one of the above classifications, i.e., ASA III-E). III-

 1. 2.  1. 2. 3.

Types of dental care is divided into either: Primary care Secondary care Or either into: Routine Elective emergency

ORAL MEDICINE IN THE HOSPITAL




The hospital is frequently the setting for the most complex cases in oral medicine. Hospitalized patients are most likely to have oral or dental complications of bone marrow transplantation, hematologic malignancies, poorly controlled diabetes, major bleeding disorders, and advanced heart disease.

The hospital that wishes to provide the highest level of care for its patients must have a dental department. The hospital dental department should serve as a community referral center by providing the highest level of dental treatment for patients with severe systemic disease and management of the most medically complex patients

Because of the availability of sophisticated diagnostic and life-sustaining equipment and the lifeproximity of expert consultants in all areas of health care.

Hospital patient in dentistry




The patient may be admitted as an inpatient to the dental service. The patient may be seen as a hospital outpatient. The patient may be seen by consultation at the request of another department of the hospital.

Dental considerations
       

Pregnancy Hypertension Diabetes Adrenal insuffieciency Ischemic heart Pregnancy Renal disease Bleeding tendancy

PAIN CONTROL TECHNIQUES


     

STRESS REDUCTION PROTOCOL PREPRE-EMPTIVE ANALGESIA LOCAL ANAESTHESIA CONSCIOUS SEDATION GENERAL ANAESTHESIA PATIENT CONTROLLED ANALGESIA

OBJECTIVES OF PAIN CONTROL




  

Relive patient anxiety to help establishing a communication. communication. Allow better patient assessment Associate patient in the treatment plan. plan. Improve quality of life postoperatively (pain is related to sickness)

1. Recognize medical risk/ anxiety 2. Consult patients physician(s) 3. Pharmacological sedation, as indicated 4. Short appointments 5. Morning appointments 6. Minimize waiting room time 7. Excellent intraoperative pain control 8. Excellent post-operative pain control post-

StressStress-Reduction Protocol (Medically Compromised Patients)

PREPRE-EMPTIVE ANALGESIA


Prevention of pain rather than treating pain is important and could reduce the analgesic requirements after surgery. surgery. Systemic analgesics before the local anaesthetic (LA) has worn off or an LA during general anaesthesia (GA) to prevent pain in the early postoperative phase

PATIENT CONTROLLED ANALGESIA




Usually intravenous (i.v.) morphine is (i. used via an infusion pump, after major head & neck surgery, with a lock to limit the dose for safety. safety. Patients given this control over their own pain relief usually use smaller doses than would have been prescribed. prescribed.

CONSCIOUS SEDATION


A technique in which drug/drugs are used to produce a state of depression of the CNS enabling the treatment to be carried out , during which verbal contact with the patient is maintained . The drug and technique should posses a safety margin , render consciousness, retain reflexes, throughout the treatment.

     

DrugDrug-induced, altered state of consciousness May be oral, inhalational, or intravenous Local anaesthesia is still required Required a trained dentist & nurse to perform it Morbidity & mortality is less than G.A Needs patient selection

GENERAL ANAESTHESIA
 

A controlled state of unconsciousness Partial or complete loss of protective reflexes. reflexes. Inability to maintain an airway and respond purposefully to verbal commands Usually performed at hospitals

It prevents anxiety during treatment because of loss of consciousness Risk of morbidity & mortality, require patient selection Anesthetist must administer the anaesthetic agent. Can be as an out-patient or in-patient outinservice.

Anaesthesia is the loss of consciousness and all form of sensation. sensation. Local Anaesthesia is the local loss of pain, temperature, touch, pressure and all other sensation. sensation. In dentistry, Only loss of pain sensation is desirable. Local Analgesia. Analgesia.

Local anaesthetic agents




Are drugs that block nerve conduction when applied locally to nerve tissues in appropriate concentrations. concentrations.


Acts on:
any part of the nervous system, peripheral or central  all types of nerve fibres, sensory or motor.


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