Introduction:

If the dental hygienist is to be a true provider of primary preventive dental care, medically compromised patients must be included in his/her practice. The dental hygiene profession recognizes the existence of a gap between medicine and dentistry in terms of one profession's methods not being fully understood by the other. Dental hygiene has taken the initiative to close the gap by increasing their knowledge of medicine. The need is not for dental hygienists to become medical diagnosticians, but rather to be responsible and competent in interpreting and applying medical information about their dental hygiene patients. Better dental hygiene care for all patients will result, which is the continuing goal of every dental hygienist.

1. Completing Forms
   • Complete forms following performance criteria.
   • Check that histories of mentally handicapped and patients under 18 years of age have been signed by a parent or legal guardian.
   • PARENTAL CONSENT FOR MINORS OR THE MENTALLY HANDICAPPED WHO ARE RECALLED AND REAPPOINTED.  If the parent or legal guardian has not accompanied a recall patient under 18 years of age, the medical history can be updated via telephone.  (Only when the medical history has already been completed and signed on a previous appointment).  Record in the Treatment Record page that the medical history was updated via telephone, and witnessed by two individuals. 
   • A new medical history should be completed if the form is outdated or the existing form is filled to capacity.
     
2. Contraindications for Treatment
   • Active Hepatitis A (transmissible only when the infection is active)
   • Active Mononucleosis
   • Active Venereal Disease.  Patient may be treated after two blood tests are negative
   • Active Tuberculosis
   • Uncontrolled Diabetes
   • Patients requiring prophylactic antibiotics who are not premedicated
   • Hypertension - Untreated patient (not taking medication) with a diastolic pressure over 110 mm Hg and /or systolic pressure over 180 mm Hg physician consult is required prior to treatment.
     
3. Conditions Requiring Physician's Consultation/Approval
   • Patients with congenital heart disease (example:  heart murmur), or valvular heart disease, either congenital or acquired (example:  rheumatic fever).  Each new patient presenting with a history of rheumatic fever, heart murmur, vascular reconstruction or prosthetic joint replacement will be premedicated according to the current IE prophylaxis regimen established by the American Heart Association or the patient must supply a letter from a CARDIOLOGIST indicating the IE prophylaxis is not necessary for their specific heart murmur or rheumatic fever history.
   • Patients with a foreign body implanted within their hearts such as a patch to repair a congenital heart defect.
   • Patients with mitral or tricuspid valve prolapse with regurgitation.
   • Patients with previously documented infective endocarditis - even in the absence of clinically detectable heart disease.
   • Patients with cardiovascular disease who have been hospitalized within the past 6 months.  (Examples:  heart attack, coronary occlusion, angina pectoris, myocardial infarction, congestive heart failure).
   • Patients who are taking an anticoagulant.
   • Patients with a cardiac pacemaker.
   • Patients who are uncontrolled diabetics. 
   • Patients who have hepatitis, have had hepatitis within the past six months, or are unsure of the type of hepatitis with which they were infected.
   • Patients who display jaundice.
   • Patients who have glomerulonephritis, a kidney transplant, or are undergoing dialysis.
   • New patients who are under treatment for epilepsy.
   • Patients who have had an organ transplant.
   • Patients who have had orthopedic reconstruction.
   • Patients who are hyperthyroid.
   • Patients who are or have been on prolonged corticosteroid therapy.
   • Patients who are taking phenothiazine derivatives. (Examples:  thorazizne, compazine and sparine.)
   • Patients who have recently had radiation therapy, or are undergoing radiation therapy. 
   • Patients who have recently had chemotherapy or are undergoing chemotherapy.
   • Patients whose diastolic blood pressure exceeds 110.
   • Patients who display agranulocytosis hemophilia, leukemia or other blood dyscrasias.
   • Patients diagnosed as having Acquired Immune Deficiency Syndrome.
     
4. Consultation Procedures for Medical Problems or Premedication
   1. Telephone
      • The patient must contact teh physician's receptionist.
      • The student involved and a witness must be present when approval for treatment is granted via telephone.
      • Identify yourself.
      • Identify patient.
      • State pertinent findings in patient's medical history.
      • State summary of patient's dental needs.
      • State specific questions you have about patient's health.
      • Discuss your plans for dental management of the patient.
      • Note that approval has been granted via telephone, in the Treatment Record, and signed by both student and witness.
   2. Physician's Consultation Form
      • Explain the procedures involved in the oral prophylaxis and the rationale for the consultation.
      • Confirm the need for a medical consult with the supervising instructor.
      • Complete form in duplicate.
      • Staple one copy inside patient folder. 
      • Request patient to schedule appointment following receipt of physician's approval.  
      • Record in Treatment Record that a Physician's consult was request
5. Barrier Technique
   • Students will employ full barrier technique for all procedures.
     
6. Procedure for Additional Medical Concern
   1. Angina Pectoris
      • Place nitroglycerin tablets on bracket table.
      • Apprehension worry and long fatiguing procedures should be avoided.
   2. Cardiovascular Diseas
      • Be sure patient has taken medication.
      • Consider drug interactions.
      • Apprehension worry and long appointments should be avoided.
   3. Epilepsy
      • Be sure that the patient has taken medication and note type of seizure that usually occurs.
      • Dismiss patient if medication has not been taken
   4. Chronic Respiratory
      • Chair in semi-supine position
   5. Diabetes
      • Appoint patient in morning.
      • Be sure patient has taken prescribed medicine and not missed any meals.
      • Dismiss patient if medication has not been taken or meals have been missed.
   6. Hypothyroidism
      • Undue excitement may precipitate a thyroid crisis.
      • Low tolerance to narcotics.
   7. Patients with Pacemakers
      • Do not use: ultrasonic scaler, pulp tester, or electro-desensitizing equipment
   8. Patients taking anticoagulants
      • Anticipate hemorrhage
      • Consider drug interactions with Aspirin, Barbiturates and Vitamin K.
   9. Conditions possibly requiring prophylactic antibiotic therapy
      • Long term adrenocorticosteroid therapy
      • Rheumatic and congenital heart disease
      • Prosthetic valve and joint replacements
      • Mitral valve prola

Note: The listing provided has only identified frequently occurring situations requiring additional medical concern. For conditions not listed, treatment protocol must be researched.