Dental implications
Dealing w/ patients | Opioid addiction | Contraindications | Assignment
Dealing
with patients
In order to provide your patients with quality dental hygiene care and ensure their safety, you must be able to sufficiently review and assess your patient’s health history.
From a healthy history questionnaire and follow-up questioning, you should determine if you need to...
- Take a thorough medical history & determine if the patient is allergic or needs a lower dose (elderly, patients with liver or kidney disease).
- Remind patient these drugs are sedating & they should not drive or perform anything that requires coordination or concentration.
- Remind patients not to drink alcohol when taking opiod drugs, the combination can lead to severe side effects that may be life threatening.
- Advise patient to drink adequate amounts of water & eat plenty of fruits & vegetables to counteract the xerostomia & constipation side effects.
Opioid addiction & dentistry
Prolonged use of opiods can lead to tolerance, habituation and dependence or addiction. The dental professional should remind patients that short-term use of these drugs for pain control will not lead to addiction. Occasionally patients who are dependent on opiods will seek new medical & dental providers to hide their addiction and obtain additional drugs.
Below are some warning signs that should trigger further questioning before prescribing an opiod:
- The patient asks for a specific drug by name & says it is the only drug that works for them.
- The patient claims allergies
to non-opiod drugs.
- The patient insists that
non-opiod drugs (NSAIDS, acetaminophen, aspirin) don’t work for
them.
- The patient calls in for
a prescription of an opiod, but does not want to come in for an appointment.
- Patients who frequently
change dentists because they “don’t understand their pain
threshold”.
- The patient complains of pain for several days after a minor dental or dental hygiene procedure.
Contraindications & concerns
Most patients with cardiovascular disease can be treated in the dental office, but circumstances do occur in which it is prudent to delay treatment until you are able to consult with the patient’s physician.
The list below shows absolute contraindications to treatment until you've been able to consult with the physician:
| Drug | Contraindications | Concerns |
|---|---|---|
| Salicylates |
Patients with
renal & liver disease are at high risk for adverse reactions
to aspirin. Patients with
hypersensitivity to NSAIDs often have cross-sensitivity to aspirin. Use with caution
in patients with asthma, CV disease, coagulation disorders, ulcers,
and fluid retention problems. Do not give
aspirin to children or teens because of Reye’s Syndrome. Avoid aspirin
use in patients with: |
Check for medications
that would interact with aspirin. Give instructions
for proper use including: |
| NSAIDs |
Patients with
renal & liver disease are at high risk for adverse reactions
to NSAIDs. Patients with
hypersensitivity to aspirin often have cross-sensitivity to NSAIDs. Use with caution in patients with asthma, CV disease, coagulation disorders, ulcers, and fluid retention problems. |
Check for medications
that would interact with NSAIDs. Give instructions
for proper use including: |
| Acetaminophen | Should not be given to patients with alcoholism because of hepatoxicity or nephrotoxicity. |
Determine if
patient has renal or liver disease, or alcoholism. Give instructions
for proper use including: |
| Opiods | Head injury patients. |
 |
Reye’s Syndrome Your patient, Mrs. Jones, is in today for her 6 month check-up. During the course of the appointment, she tells you that her 5 year old son has been sick with the flu and a fever for a few days. She heard that giving aspirin to a child to manage a fever was not recommended and she asks if you know the reason. 1. What is Reye's Syndrome? 2. What role does aspirin play in the development of this disease? 3. Why is it important as a dental professional to be knowledgeable about this medical disease? To learn more about Reye's Syndrome, visit these sites: National
Reye’s Syndrome Foundation, Inc. National Institute of Neurological Disorders and Stroke Post your answers in the Forums. |
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