Medical Histories
Initial
Medical history is important for dental hygiene because it is a history of all of our patient’s medications, problems, and allergies. These shape how we treat our patients and give us explanations for dental problems. Medications can cause dry mouth and increase the risk for decay. Medical problems like orthostatic hypotension lets us know that the patient may not be able to be totally supine during their appointment. Allergies can let us know if there might be a medical emergency happening. This can be useful in case a patient was exposed before their appointment and are now having a reaction. Medical history can also be important because it can let us know when a patient needs a pre med due to a prior surgery. This helps us be able to avoid infections of joint and heart valves. Medical history helps us not be negligent.
Retrospective
The Importance of Medical History
Medical history is a crucial part of our appointment order because it keeps the patient safe and makes dental professionals aware of the medications, medical problems, allergies and implantable devices a patient may have. Certain medications may cause adverse dental effects like gingival enlargement, taste disorders, and oral candidiasis. Medical problems can change the treatment plan and affect how we treat patients. An example is COPD. If a patient has COPD, a dental professional may refrain from using the Cavitron because of the aerosols it produces. Allergies may affect the dental materials we use. A patient’s allergies can also explain a medical emergency they may be experiencing. This is why we must record a patient’s medical history in the beginning of the appointment and ask if there are any changes.
This semester, one of my patients stated that they were taking 2.5 mg of Amlodipine PO for hypertension. At first, I did not recognize this medication. I looked on Lexicomp and found that it can cause gingival hyperplasia. It can also cause orthostatic hypotension and erythema multiforme. This was noteworthy knowledge because gingival hyperplasia at first glance may look like gingivitis because of the swelling. Also it is important to tell my patient to get up from the dental chair slowly. Patients with orthostatic hypotension can get dizzy from standing up too quickly. This particular patient also took Aspirin (PO) for clotting control. I was not surprised by the adverse effects listed because of pharmacology class. A dental adverse effect may be excess bleeding, but in low doses this should not be a problem. If a patient is taking a high dose, bleeding on probing may be exaggerated. Another medication listed was Metropropal (25 mg) PO. I knew this drug was a beta1 selective blocker because we learned about it in pharmacology. My patient was taking this drug for angina and hypertension. An adverse dental effect I found was an infrequent occurrence of xerostomia and a rare occurrence of dysgeusia (metallic taste in mouth). Xerostomia could cause an increase in decay and halitosis. This is important to note especially if the patient is complaining of these effects. NSAIDS can reduce the hypotensive effect of beta blockers after three or more weeks of taking them. This is an important drug interaction that should be brought up to the patient to see if they are taking a long term or short term NSAID. The last medication was Pravastatin. I knew that this drug was used to lower LDL-C due to my knowledge of pharmacology. An adverse effect of this drug can be muscle weakness. This could make oral home care difficult. This was not a problem for my patient.
Medical problems my patient had were arthritis due to temperature change, Lyme disease and a past surgery for coronary heart disease in 2006 and 2014 (total of 5 stents put in). Arthritis can make dental home care difficult for patients. Electric toothbrushes and water pics can be recommended to make home care less painful. Flossing with arthritis is a huge challenge for the older population. There are some clinical manifestations of Lyme disease in the dental field. Some of these symptoms include facial pain, TMJ pain, facial nerve palsy, and masticatory pain. A RDH could refer a patient to see their doctor to test for Lyme if they have these symptoms. Past surgery could require a pre med in some instances to prevent bacteria from infecting the body, but stents do not require this.
References
Connecting to UNE library resources. UNE Library Services Login. (n.d.). https://online-lexi-com.une.idm.oclc.org/lco/action/home?siteid=1
Heir GM, Fein LA. Lyme disease: considerations for dentistry. J Orofac Pain. 1996
Winter;10(1):74-86. PMID: 8995919.
Reasons to Sharpen Instruments
As a dental hygienist, it is crucial to provide the best care for our patients. One aspect of providing the best care is making sure our instruments are safe, sharp, and effective. Sharpening instruments is a great way to achieve this. Scaling teeth with a dull instrument can cause a myriad of negative effects to the patient and the dental professional.
Scaling with a dull instrument can cause fatigue for the patient and for the dental professional. A dull instrument can cause a hygienist to have to use multiple strokes to remove calculus. This can contribute to excess strain on the wrist and forearms (Gupta et. al., 2014). Dull instruments cause an increase in force, pressure, and a tight pinch grip. Strain on the body can cause early onset of musculoskeletal disorders. This will shorten a dental professional’s career considerably. A sharp instrument can lessen the amount of strokes used and promote better ergonomics. Dull ineffective instruments can make a dental hygienist frustrated and increase their stress levels. A patient could also lose faith in their hygienist if they are unable to remove their calculus. This will increase stress levels in the patient. Dull instruments are not beneficial for the patient or the hygienist.
Dull instruments can contribute to missed calculus. A hygienist may lose sensitivity in the working ends of the instruments which can leave burnished calculus on the tooth surface (Destephano, 2018). The hygienist is forced to tighten their grip on the instrument and loses their tactile sensitivity (Destephano, 2018). This negatively affects the patient’s oral health. Leftover calculus can cause periodontal disease and gingivitis. This is because calculus is a contributing factor to periodontal disease. Burnished calculus can also cause inflammation and bleeding. Sharp instruments also allow the hygienist to have better control and be more exact. Altogether, using dull instruments to remove calculus is less effective and can negatively affect the patient.
Sharpening instruments can contribute to quicker appointment times. It is known that additional strokes are needed to remove calculus with dull instruments which can increase the length of appointment times. This is an important factor to keep in mind because some patients may struggle with long appointments. Examples of these patients may be the elderly, children, and special needs patients. A dental hygienist may also have to see fewer patients because of the increase in appointment times due to dull instruments. Taking a few minutes out of the day to sharpen instruments will be worth it in the long run.
There are a lot of pros to sharpening instruments. It is important for a dental hygienist to understand how to properly sharpen their instruments and why it is crucial to do so. Sharpening instruments gives the patient the best care possible. Dull instruments cause pain for the patient and the dental hygienist.
References
The dangers of dull instruments | registered dental hygienists. (n.d.). https://www.rdhmag.com/home/article/16408091/the-dangers-of-dull-instruments
Gupta, G., Gupta, A., Mohammed, T., & Bansal, N. (2014). Ergonomics in Dentistry. International Journal of Clinical Pediatric Dentistry, 7(1), 30–34. https://doi.org/10.5005/jp-journals-10005-1229
SANDERS, M. (2004). Preventing work-related MSDS in Dental hygienists. Ergonomics and the Management of Musculoskeletal Disorders, 448–473. https://doi.org/10.1016/b978-0-7506-7409-6.50027-0
Periodontal Staging and Grading
Initial
Staging and grading periodontal disease is helpful because it lets us know how to treat and educate our patients. It also helps us plan treatment for future appointments.i know that staging has changed since past years. There is health or gingivitis if you do not have periodontal disease. Then there are 4 other stages. Stage one is the least severe. Stage 4 is the most severe. Factors determine what stage of periodontal disease a patient has like bone loss, probe depths, if the patient is a smoker, tooth loss and if the patient has diabetes.
Retrospective
Staging and Grading Comparison
At the beginning of the semester, I was asked to explain why staging and grading periodontal disease was a helpful tool. I was also asked to write everything I know about staging and grading. This past month, my knowledge about staging and grading periodontal disease has grown exponentially. I still agree with most of what I had said in my previous assignment, but I definitely have a better depth of knowledge on this subject.
Gingivitis is a type of periodontal disease. In the previous assignment, I said that the three conditions of the mouth were health, gingivitis, and periodontal disease. This is not exactly right because gingivitis is a form of periodontal disease. The three broad categories are health, gingivitis, and periodontitis. If a patient has gingivitis, they do not have periodontitis. Gingivitis rarely transitions to periodontitis. It is now known that “patients with gingivitis can revert to a state of health, but a periodontitis patient remains a periodontitis patient for life, even following successful therapy, and requires life‐long supportive care to prevent recurrence of disease” (Caton et. al., 2018). As dental professionals, language and terminology are important. Dental professionals must be aware of this terminology when communicating to a patient in order to provide the best care.
Staging and grading periodontal disease is an important factor in treatment planning and patient education. This is a point that was made in the previous assignment that still rings true. Identifying the cause of the periodontal disease helps dental professionals create the best form of treatment. Patient education is an important role in arresting periodontal disease. It may be caused by improper homecare, medications, systemic diseases, or by a compromised immune system. A patient needs to be aware of the cause and extent of the disease.
In 2015, a new look was taken at the staging and grading of periodontal disease. The 1999 staging and grading criteria was too broad and did not look at many factors that played a significant role in the disease/inflammation process. This upgraded system was mentioned in the previous assignment. Some of the new factors involving gingivitis were cases that were not induced by plaque, bleeding on probing after treatment, and sulcus depth. For periodontitis, the new system looked at systemic conditions, like diabetes, and loss of supporting structures. These factors play a big role in the disease process. Now, dental professionals have a more comprehensive system for staging and grading.
References
Caton J., A. G. (2018). A new classification scheme for periodontal and peri-implant diseases and conditions-introduction and key changes from the 1999 classification. Journal of Clinical Periodontology, DOI: 10.1111/jcpe.12935.
J.Gehrig, D.Shin, & D.Willman. (2019). Foundations of Periodontics for the Dental Hygienist 5th edition. Philadelphia: Wolters Kluwer.
DHDX
DHDX: Patient presents with periodontal health. Patient had adequate plaque control due to brushing twice a day with an electric toothbrush. The patient is aware of the importance of adequate home care. The treatment for this patient is a prophylaxis with F2.
Final Reflection
Over this semester we have learned many topics in the field of dental hygiene. The information we have learned has been helpful and useful during clinic. The two topics I would like to reflect on are medical history and periodontal staging and grading. In my entry, I discuss the importance of medical history. Prior to this semester I was aware that recording medical history was important, but after this semester I know it is crucial for the safety of the patient. Different types of medications can cause adverse dental effects. One of these adverse effects is gingival hyperplasia. This is also known as gingival overgrowth. The drugs that cause this are calcium channel blockers, anticonvulsants, and immunosuppressants. This knowledge is beneficial because patients may be unaware of this side effect and may think they have gingivitis. We can use this information to educate patients about this adverse effect. Throughout this semester, I have had a couple of patients who are on these drugs and have not known this side effect. It felt good to let them know about this side effect. This semester, I also had a patient who was an alcohol abuser and needed an SRP. Through medical history, I was able to decide that articaine would be the best LA to use. This is because articaine is metabolized in the blood. Using lidocaine would not be beneficial because it is biotransformed in the liver and my patient had decreased liver function. This could cause the LA to be metabolized at a decreased rate. Medical history is an important tool to help us treat patients safely and correctly. I still believe this and will always take the time to look into medications, medical conditions, and allergies.
This semester, periodontal staging and grading has become more concreted in my mind. I am now more knowledgeable and accurate when it comes to staging and grading. I have markers in my head which can differentiate a patient from one stage to another. An example would be tooth loss and if a patient has less than 10 pairs of opposing teeth. Some other indicators can be the amount of horizontal or vertical bone loss, if the bone loss is more than 30%, and attachment loss. These factors help us determine what stage and grade our patients are. Staging and grading can also help us differentiate periodontal disease from gingivitis. Gingivitis does not include bone loss. Gingivitis is also reversible. Periodontal disease is not reversible. Periodontology class has also helped me be more comfortable and knowledgeable in the signs of periodontal disease. I am no longer worried in clinic when staging and grading due to practice.
Throughout the semester, these two topics have become more ingrained in me and my routine during appointments. I think I can still improve and I will continue to learn new things about both of these topics. Next semester, I am excited to improve these skills and continue them. I am so happy with myself that I see improvement in my clinic skills involving these topics.
References
J.Gehrig, D.Shin, & D.Willman. (2019). Foundations of Periodontics for the Dental Hygienist 5th edition. Philadelphia: Wolters Kluwer.
