#6 – Reviews health history on every client

Review the health history of clients at their recall appointments. This is always done immediately after the blood pressure.  If the patient has had hepatitis, rheumatic fever, drug allergic, or if there is a need for premedication, make sure there is a red sticker on the outside of the folder indicating so.  If not, put the sticker on right now!  Don’t wait!  You might forget!  Ask the patient if there has been any changes in their health or medications they are taking since their last visit.  If so record the changes, initial and date them on the health history form at the bottom.  If the health history is more than 5 years old ask them to fill out a new one.  If you notice when you are going through your charts at the beginning of the day that a certain patient has an outdated health history (5 years or older) note on computer – change color of appt. so the receptionist can ask the patient to fill out when they first come in!  This will save you time and help you be on time!  If a client has had a significant change in his/her health history (such as a heart attack, diabetes), ask them to fill out a new history.

Here is a list of clients who should be prophylactically covered with an antibiotic before any significant treatment.

  1. Previous infective endocarditis
  2. Mitral Valve Prolapse with regurgitation
  3. Prosthetic Heart Valve
  4. Coronary Bypass less than 6 months ago
  5. Congenital Heart Disease (CHD)
  6. Heart Transplant
  7. Bone marrow transplant
  8. First 2 years after joint replacement
  9. Clients on these medical therapies

a.  Cytotoxics

b.  Corticosteroids

c.  Radiation therapy

In reviewing clients health history, if one of the above conditions exists and patient is unaware of pre‑medication needs, our office policy is:

‑ Explain to patient how their condition related to potential bacterial infection and why pre‑medication is necessary

‑ Fill out and send physician consult form

‑ Give initial premed dose and continue appointment.

Recommended coverage

For most clients ‑ oral amoxicillin

a. Adult ‑ 2.0 gm amox  30-60 minutes before procedure

b. Child (less than 60 pounds) ‑ 1/2 adult dose (50 mg/kg)

Allergic to penicillin

a. Adult ‑ Clindomycin ‑ 150 mg tabs ‑ 4 tabs 30-60 minutes before treatment

b. Child (less than 70 lbs.) 125 mg chewable ‑ 2 tabs 1 hr before treatment (50 mg/kg)

High risk clients

a. Adults 1‑2 gm Ampicilin + 1.5 mg/kg entamicin IM 30 min before procedure

b. Children ‑ ampicilin 50 mg/kg + gentamicin 2 mg/kg

High risk clients allergic to penicillin

a.      Adults ‑ Bancomycin 1 gm I.V. over 60 minutes beginning 60 min. before procedure

b.     Children ‑ Vanomycin 20 mg/kg IV

                        Bacterial Endocarditis

BE is heart damage caused by bacteria lodging on the valve or endocardium.  Protecting the client that has some damage is very important to prevent further heart damage.  There are many misconceptions concerning BE.  Here are the facts as of 1995.

1.  Only 27% of physicians and 37% of dentists follow American Heart Association BE guidelines.

2.  Most BE of dental origin is caused by poor oral hygiene, not dental procedures performed on clients not covered with an antibiotic.  It   is the cumulative exposure that causes the BE.

3.  The AHA antibiotic regimens don’t provide 100% safety from BE. Many people have antibiotic resistant strains of bacteria.

4.  Premedication is not necessary for injections.  However, premedication is necessary for procedures that cause significant bleeding.

5.  Oral premedication is preferred over antibiotic injections.

6.  Miral Valve Prolapse clients should only be pre-medicated if there is evidence of valvular regurgitation.

7.  Problems of antibiotic over-use make it important to prescribe only when necessary.  To avoid:

a.  Anaphylaxis

b.  Pregnancy caused by blockage of action of birth control pills

c.  Development of resistant strains

d.  Gastro‑intestinal tract upset

e.  Added cost

8.  If client is already on penicillin, s/he should also be pre-medicated with Clindamycin since they will have developed some penicillin resistant bacteria.

Ideas on Medical Questionnaire

  1. Exposure to Hepatitis
    1. 500,000 new cases are discovered annually
    2. Many carriers are not aware they have hepatitis
  2. Sexually transmitted diseases (gonorrhea, syphilis, herpes, AIDS)
    1. If not treated, stop appointment and refer to physician
    2. Oral lesions are very contagious
  3. Heat murmur, artificial heart valve
    1. At risk of bacterial endocarditis
    2. Probably requires antibiotic premedication
    3. Get physician consult
  4. Artificial joints
    1. Contact physician for possible antibiotic premedication
    2. In 1997 there is no consensus whether premedication is necessary
  5. Regularly taking any medication
    1. Write down he name and function of each drug, how long it has been taken and the dosage
    2. Will any of these drugs cause dental side effects?
  6. Allergies
    1. Use sticker on folder
  7. Cancer
    1. Chemotherapy – reduces resistance to infection
    2. Radiation therapy – to head/neck can cause xerostomia and reduced healing
    3. If in current treatment, contact oncologist
    4. Give client a copy of cancer handouts kept in Dr. Smith’s files
  8. Diabetes, heart failure, kidney disease
    1. At increased risk of picking up infectious diseases
    2. May need antibiotics to help control infections

I.   Abnormal bleeding –  Aspirin, warfarin, heparin “thin the blood” and Get okay before deep scale in presence of inflammation

J.   Alteration in taste (lack of taste or bitter taste) – Medications – cardiovascular agents, central nervous system stimulants, non-steroidal anti-inflammatories, respiratory inhalers, nicotine patches

K.  Mouth Sores – BP medications, immunosuppressive agents, oral contraceptives

L.  Enlarged gums – Anti-seizure medications, immunosuppressive drugs, calcium channel blockers

M. Dry mouth – Antihistamines, decongestants, pain killers, BP meds, muscle relaxants, urinary incontinence meds, Parkinson’s meds, antidepressants

N.  Fungal infection – Asthma inhalers

O. Pulse – Normal: 60-80 beats/minute and  Men: 40-50 if healthy and in good condition