DH122
FALL 2009
MEDICAL EVALUATION OF DENTAL HYGIENE PATIENTS
Division:
Department:
Day/Time:
Instructor:
Office:
Phone:
Office Hours:
Health Sciences
Dental Hygiene
Wednesday 01:00 – 3:05 p.m.
Thomas P. Neiderer, RDH, MPH
R405B
(626) 585-7545
See posted hours on office door and by appointment
COURSE OUTLINE
Description:
Dental management of medically compromised patients. Emphasis placed on patient assessment,
treatment planning, patient management, patient motivation, and interpersonal communications for
medically compromised patients, special needs patients, and geriatric patients.
Corequisites: DH 101A, 109, 117, Anat 115
Lecture: 2 Hours Units: 2
Student Learning Outcomes (SLOs)
1.
Complete a comprehensive medical health history which will allow the student to assess the
patient’s ASA classification which will allow them to modify the treatment plan to meet the
patient’s needs and provide safe comprehensive care that meets the current standards of care
in dental hygiene.
2.
Given a particular medical condition the student will write a report that demonstrates
appropriate and competent writing that follows the format describe in the Medical Condition
Report assignment.
Behavioral Objectives:
Upon completion of this course the dental hygiene student will be able to:
1.
2.
3.
4.
5.
6.
7.
8.
Identify medically compromised patients and the oral changes that may be associated with the
medical condition.
Determine the need for medical consultation prior to dental hygiene treatment.
Determine the effects of medical complications on the dental hygiene treatment plan and
identify necessary treatment plan modifications.
Assess geriatric, special, and medically compromised patients’ dental and periodontal needs
and devise appropriate treatment plans and home care strategies.
Establish professional interpersonal communication strategies.
Define oral risk factors associated with the geriatric patient, and assess the geriatric patient’s
chronic medical conditions.
Describe compromised patients’ characteristics, and discuss motivation for oral hygiene
prevention and management.
Apply principles of ethics, professionalism, conduct, speech, and appearance as per the
Pasadena City College Dental Hygiene Program Manual, and Student Code of Ethics.
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Text:
Required:
Pickett, F. & Gurelian, J. (2005) The Medical History: Clinical implications and emergency
prevention in dental settings Philadelphia: Lippincott, Williams & Wilkins
Supplemental:
PCC Dental Hygiene Program Manual 2008 – 2009
Malamed, S. (2007). Medical emergencies in the dental office. (6th ed.). Mosby.
Wilkins, E. M. (2005) Clinical practice of the dental hygienist. (9th ed.).
Philadelphia: Lippincott, Williams & Wilkins
Darby M. L., Walsh M. M. (2003) Dental hygiene theory and practice. (2nd ed.)
Philadelphia: Saunders.
Course Content:
1.
2.
3.
4.
5.
Treatment Planning for the medically compromised patient
Patient assessment
- Medical history evaluation and analysis
- Medical complications analysis
- Medical consultation
Patient motivation
Professional communication
- Confidentiality
- With patient, faculty, medical consultant, and fellow student
Medical conditions:
Week 1
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Allergy
Anaphylaxis
Urticaria
Respiratory
Pulmonary Diseases
Emphysema
Asthma
Tuberculosis
Obstructive chronic bronchitis
Week 2
 Diabetic Patient
Type I & II
 Cardiovascular Disease
Congestive heart failure
Angina pectoris
Myocardial infarction
 Surgically corrected cardiac &
vascular disease
Week 3
 Congenital heart disease
 Hypertension/hypotension
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Arrhythmias
Pacemakers
Rheumatic heart disease
Heart Murmurs
Infective endocarditis
Antibiotic prophylaxis
Week 4
 Geriatric Patient
 Adrenal Disorders
Adrenal insufficiency
 Thyroid Disease
Hyperthyroidism
Hypothyroidism
Graves disease
Week 5
 Pituitary Diseases
 Gastrointestinal
Peptic ulcers
Regional enteritis
Pseudomembranous colitis
Crohn’s disease
2
Week 6
 Liver Disease
Etiology
Hepatitis A, B, C, D, E
Carrier status
Alcohol
 Inflammatory bowel disease
Transient cerebral ischemia
Cerebrovascular accident
Week 10
 Bleeding Disorders
 Blood dyscrasis
 Oral cancer
 Behavioral and Psychiatric disorders
Week 7
 Sexually transmitted disease (STDs)
Herpes
Gonorrhea
Syphilis
Infectious mononucleosis
Human papillomavirus
 HIV/AIDS & related conditions
Week 8
 Arthritis
Osteoarthritis
Rheumatoid arthritis
 Renal Disease
Chronic renal insufficiency
Hemodialysis
Week 9
 Autoimmune disorders
Systemic lupus erythematosus
Scleroderma
 Neurologic Disorders
Epilepsy
Seizures
Methods, Materials and Facilities:
1. Lecture, video, overhead & slide projector, screen & chalkboard
2. Reading assignments in Journals, newspapers, PDR, assigned text, and current
bulletins.
3. Discussion, guest speakers
4. Written assignments & projects
5. Written quizzes & examinations
Evaluation:
The final grade will be based on the percentage of the total possible points the student receives for
this course.
Grading Scale: 100 - 90% = A
89 - 80% = B
79 - 75% = C
74 - 65% = D
65% = F
Five points will be deducted from the total points for each day an assignment is late.
The Course must be passed with at least a grade of 75% in order to continue into the next semester.
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Evaluation continued
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2.
3.
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6.
7.
Absences and tardies will be handled according to the PCC Catalog. Be sure to read and understand
the Class Drops Upon Faculty Recommendation section.
Plagiarism, cheating, and citizenship will be handled as per the college handbook and
clinic manual under standards of conduct. When it is indicated that citizenship is
unsatisfactory, the student will be subject to reprimand, disciplinary probation,
suspension, and/or expulsion.
Plagiarism and cheating will result in an “F” for the test/project and referral as per the
college handbook.
There will be a teamwork grade on all cooperative learning projects. A grade 25%
lower than the total points earned by the group/individual will result from nonparticipation and/or non-cooperation.
Any disputes regarding test questions or grades will be handled following the class or
during conference hours.
Make up tests and quizzes will result in a grade no higher than 75%.
Professionalism
a) Failure to complete all of the course work will result in a grade of “D”.
b) Professional behavior as described in the Clinic Handbook and the PCC College Bulletin
includes but is not limited to the following:
-Absences or tardiness to class and/or lab/clinic sessions.
-Communication through speech, demeanor, and appearance.
-Teamwork and cooperation with peers and faculty.
-Application of knowledge gained from previous and current classes.
-Demonstration of consistent progress in didactic and attitudinal
skills.
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Medical Condition Report
The written report is due one week after the mid-term examination
For this project each student will select a medical condition and complete a written report
following the guidelines below.
Format for written report:
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Name of topic/condition.
Detailed description of the condition.
Medication(s) commonly prescribed/used for the condition. (If applicable)
Oral manifestations as a result of the condition and/or medication(s).
Identify any recommended treatment/behavioral modifications.
- Use Physician’s Desk Reference (PDR) to look up drugs for dental treatment
modifications
References will be listed using the MLA citation method.
A minimum of three references must be used.
Your required course textbook and lecture material cannot be one of your referenced
sources.
All reports must be typed & double-spaced.
The written report is to be no longer than 5 pages.
Medical Condition Report Evaluation Criteria
Points
10
10
Medical name of topic/condition & Detailed description of the condition
Medication(s) commonly prescribed/used for the condition
Side effects and/or Oral manifestations as a result of the condition
and/or medication(s)
Identify any recommended treatment/behavioral modifications
Grammar, Spelling, etc. (Typed DOUBLE SPACED)
References will be listed using the MLA citation method
A minimum of three references must be used.
10
10
10
05
Total
55
Weekly Home Work Assignment (10 points per assignment)
Each week you will be assigned up to 10 medical conditions listed in the syllabus. For each
condition you will:
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Define/Describe the condition
Provide a brief description of how a client with the condition will be treated in
the DH clinic
o Medical consults
o Treatment modifications
o Medications (2) commonly used to treat condition
Refer to Program Handbook for most conditions
ALL ASSIGNMENTS MUST BE TYPED
Note: Lecture Topics are to be read in Program Handbook Chapters 2 & 4 prior to each
days lecture.
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Date
Topics
Reading
Time
Week 1 Syllabus and Class assignments
Health Histories
Pickett
Malamed
Chap.1
Chap. 2
1 hrs
1 ¼ hrs
Week 2 Hyperventilation, Syncope, TMJ
Pickett
Malamed
Chap. 2
Chap. 6 & 12
2 ¼ hrs
Week 3 Tuberculosis
Pickett
Malamed
Chap. 3
pp. 25-26
2 ¼ hrs
Pickett
Malamed
Chap. 4
Chap. 7, 22
pp. 85-86
2 ¼ hrs
Week 6 Endocarditis, Murmurs, & Antibiotic Prophylaxis
Pickett
Malamed
Chap. 5
Chap. 2
2 ¼ hrs.
Week 7 Tobacco & Alcohol use
Pickett
Malamed
Pickett
Malamed
Chap. 5
pp. 30 & 174
Chap. 7
pp. 29, 149
½ hrs
Pickett
Malamed
Chap. 6
Chap.24
1 ¾ hrs
Quiz #1
Week 4 Drug therapy, Hypertension, &
Postural Hypotension
Week 5 Employee Flex Day (No Classes)
Joint replacement, Pregnancy, & Osteoporosis
Week 8 Allergies
Quiz #2
1 ¼ hrs
½
Week 9 Midterm
2 ¼ hrs
Week 10Blood related abnormalities
Thrombocytopenia, Hemophilia, Hepatitis, HIV,
STDs, & anemia
Pickett
Malamed
Chap. 8
pp. 21, 27-28
2 ¼ hrs
Week 11Cancer, Diabetes, Lupus, Arthritis
Pickett
Malamed
Chap. 9
Chap. 17
pp. 24 & 27
2 ¼ hrs
Week 12Cardiovascular System: Angina, Anticoagulant
Therapy, MI, CHF, CVA
Pickett
Malamed
Chap. 10
2 ¼ hrs
Chap. 2, 19, 26-30
Week 13Seizures, GI, & Respiratory
Quiz #3
Pickett
Malamed
Chap. 11-12
2 ¼ hrs
Chap. 10, 11, 13, 15, 21
Week 14Glaucoma, Kidney, & Thyroid
Pickett
Malamed
Chap. 13
2 ¼ hrs
Chap. 18, pp. 27, 28
Week 15Clinical application & HIPPA
Medicolegal Considerations
PCC Clinic Chart
Pickett
Malamed
Chap. 14
Chap. 4
2 ¼ hrs
Week 16Final Exam
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The Medical History… Chapter Objectives
Ch. 1
 Describe stategies for gaining complete health history information
 Use health history information to identify risks for medical emergencies during
oral health treatment.
 Identify normal limits of vital sign measurements and their relevance in assessing
potential medical risks of dental treatment.
 Apply the American Dental Association’s policy on screening for hypertention in
the dental office to planning oral healthcare.
Ch. 2
 Identify appropriate follow-up information needed from the client as it relates to
the Dental Information section of the American Dental Assoc. Health History.
 Apply didactic information to determine treatment modifications based on
responses provided by the client during the health history interview or oral
conditions found during oral exam.
 Describe stress related emergencies that can occur in treatment and management
procedures to resolve emergency situations.
Ch. 3
 Describe the dental management for a client who reports a history of tuberculosis
disease or who demonstrates signs of tuberculosis disease.
 Differentiate between tuberculosis disease and tuberculosis infection.
 Describe the criteria used for determining a noninfectious status in clients with a
history of active tuberculosis.
 Identify the types of information needed to determine the client’s physical health
status.
 Discuss the importance of obtaining significant recent health information
Ch. 4
 Discuss the reasons for investigating drug therapy as part of the health history
review.
 Identify the clinical relevance of effects of pharmacologic products to the oral
healthcare treatment plan.
 Identify the side effects of medications that pose risks for medical emergencies.
 Identify the five elements that must be considered when evaluating the types of
prescription and nonprescription medications or supplements that patients are
taking.
 Describe prevention and management procedures for side effects that are likely to
result in a medical emergency during oral healthcare.
Ch. 5
 Identify circumstances in which antibiotic prophylaxis is indicated before
providing oral healthcare.
 Discuss management of a client who requires antibiotic prophylaxis for the
multiple dental and dental hygiene appointments.
 Describe the clinical relevance associated with clients who abuse alcohol and
other substances.
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Explain the rationale for requiring clients to wear safety glasses during
treatment.
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Identify precautions during treatment when the client reports a history of
allergy.
List signs of mild and severe allergic reactions.
Identify appropriate follow- up historical questions to gain appropriate
information and apply critical thinking related to preventing emergency
situations caused by allergy.
Describe management procedures for clients who have symptoms of local skin
or mucosal allergic reactions.
Ch. 6
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Ch. 7
 Identify clients recommended for antibiotic prophylaxis to prevent infection after
having total joint replacement.
 Identify appropriate antibiotics to use for antibiotic prophylaxis in the total joint
replacement client.
 Describe the rationale for antibiotic prophylaxis in selected clients who have had
a total joint replacement.
 Describe the treatment plan considerations for the pregnant client and for the
lactating client.
 Describe the treatment plan considerations for the client taking birth control pills
or hormone replacement therapy.
Ch. 8
 Identify medical considerations associated with increased bleeding and determine
when bleeding is likely to occur during oral healthcare.
 Describe prevention and management strategies for the various conditions that
may result in increased bleeding.
 Describe treatment modifications associated with a medical history of AIDS or
HIV infection and sexually transmitted diseases.
 Identify postexposure prophylaxis recommendations for bloodborne infections.
 Identify oral healthcare treatment modifications for bleeding disorders and
anemia.
 Determine the risks of treating the client reporting a history of blood transfusion.
Ch. 9
 Identify treatment modifications for providing oral healthcare to clients
undergoing cancer, chemotherapy, or radiation treatments.
 Specify disease conditions on drug therapies that predispose the client to
immunosuppression and list treatment modifications for this situation.
 Describe the signs of uncontrolled diabetes and the treatment plan modifications
for the diabetic dental client.
 Describe the treatment modifications for the client with systematic lupus
erythematosus.
 Identify disease conditions that involve persistent swollen glands, unexpected
weight loss, and oral ulcerative disease and describe treatment modifications for
these situations.
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Ch. 10
 Identify examples of cardiovascular disease and explain the pathophysiology of
each condition.
 Identify the clinical applications of information related to the client with
cardiovascular diseases.
 Describe potential cardiovascular emergency situations, measures to prevent the
occurrence of the emergency, and the management of the emergency should it
occur.
 Identify oral healthcare procedures that may precipitate a migraine attack and
information that helps to prevent precipitation of migraine headache.
Ch. 11
 Identify the types of seizure disorders and determine the risks for the medical
emergency situations in each type of seizure.
 Describe the management of seizures during oral headache.
 Describe the clinical implications of treating the client who reports a history of
fainting or blackouts.
 Determine clinical implications for clients who suffer from sleep disorder and
chronic pain.
 Identify treatment implications, drug effects, and follow-up questioning for a
client with a mental health disorder.
Ch. 12
 Describe the pathophysiology of various conditions involving the gastrointestinal
system and determine the potential emergency situations that can occur in these
individuals.
 Describe the management of the client with a gastrointestinal condition.
 Identify respiratory disorders that can result in a modification of the oral
healthcare treatment plan and describe those modifications.
 Describe the management of the client with an airway obstruction.
Ch. 13
 Identify the client at risk for an attack of acute glaucoma and describe measures to
prevent this during the oral healthcare appointment.
 List kidney conditions that cause a change in the oral healthcare plan, and
describe the medical management of the client and the prevention of infection
after oral healthcare.
 Describe the dental management of the client on hemodialysis.
 Describe how to prevent thyroid storm in the uncontrolled hyperthyroid client.
Ch. 14
 Identify appropriate clinical recording information and describe the rationale for
analyzing clinical data.
 Describe the advantages of documenting the analysis of the healthy history.
 Identify regulations to assure client information is kept private.
 Describe reasons for establishing emergency management protocols and staff
practice sessions for those protocols.
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DH122 Medical Evaluation of Dental Hygiene Patients
Fall Syllabus
Please sign and date this form to verify that you have received, printed, and read the course syllabus.
This form must be handed in on the first day of class. Any questions regarding the course will be
discussed on the first day the class meets. Be sure to bring the course syllabus with you on the first
day the class meets.
Student Name (Print) _________________________________________________
Student Signature ____________________________________________________
Date _______________________________________________________________
Faculty Name ________________________________________________________
Faculty Signature ____________________________________________________
Date Received _______________________________________________________
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