First Clinical Session of Special Patients

1. Monitoring training
2. Assess A.S.A. status of a patient +
pharmacology
3. Distinguish among invasive and non-
invasive dental treatments
4. Clinical Cases: patient management
 First Clinical Session of Special Patients

1.Monitoring training

VITAL SIGNS: clinical

1.1. Blood pressure measurements, that indicate the
state of a patient's essential body
1.2. Glycemia functions

1.3. Oxygen saturation

1.4. Pulse
 1.1. Blood pressure

Digital automatic blood pressure monitor

MONITOR AUTOMÁTICO PARA MEDIR LA
PRESIÓN ARTERIAL

1.2. Glycemia

Glucose meter/ GLUCÓMETRO

1.3. Oxygen saturation

1.4. Pulse pulse oximeter/

PULSIOXÍMETRO
 First Clinical Session of Special Patients

1.Monitoring training

-What kind of patients

1.1. Blood pressure

1.2. Glycemia -How to use

the different devices.
1.3. Oxygen saturation
-Levels: safe and risk
1.4. Pulse
1.Monitoring training

What kind of patients/disease

-Elderly
1.1. Blood pressure -Medical history High BP

-Diabetics
1.2. Glycemia

1.3. Oxygen saturation -Cardiovascular and breathing diseases

-Anxiety
1.4. Pulse -Cardiovascular and breathing diseases
Devices used to check Blood pressure
and how to use
them.

Digital automatic blood

pressure monitor

stethoscope
sphygmomanometer
How to use a digital automatic
blood pressure monitor Blood pressure
1st. Ask patient to avoid alcohol, smoking or exercise for 30
minutes before measurement

2nd. Allow patient to sit at rest for as long as possible.

3rd. Place sphygmomanometer cuff on right

upper arm with about 3 cm of skin visible at
cubital fosse.

4th Inflate cuff: press the start button

5th. Wait and read the systolic/diastolic BP

6th Repeat the procedure in 5 minutes

Glucose meter
Blood glucose

Glucose meter
strips

Lancets

Lancet device
 Blood glucose
HOW TO USE A GLUCOSE METER

1. Wash your hands with warm soapy water and dry

thoroughly. Dirty or wet hands could affect results.

2. Turn on the meter and hold to see

the complete display.

3. Insert the test strip into the

meter in the direction of the
arrows. The meter turns on.
 Blood glucose

4. Make sure the code number on the

display matches the code number on the
test strip container

5. When the blood drop symbol

flashes, obtain a drop of blood
from your fingertip.
 Blood glucose
6. Gently squeeze your finger to assist the flow of blood.
Touch the drop to the tip of the yellow window of the test
strip. Do not put blood on top of the test strip.
 Blood glucose
7. When you see flash, you have enough blood in the test
strip. If you applied blood but do not see the flashing you
may reapply more blood within five seconds.

8. The result appears on the display

 Pulse and oxygen saturation

Oxygen saturation

Pulse, heart rate

PULSE OXIMETER
Levels: safe and risk Blood pressure

HYPOTENSION <90 <60

Class Systolic Diastolic
Normal I <130 <85
Normal high I 130-139 85-89
HYPERTENSION
GRADE
Mild I II 140-159 90-99
Moderate II III 160-179 100-109
Severe III IV 180-209 110-119
Much severe IV >210 >120
A.S.A. levels
 Blood glucose
Levels: safe and risk

Normal for NON-DIABETIC 70-100mg/dL

Normal for DIABETIC 90-130mg/dL

Risk glucose values > 140 mg/dl

Levels: safe and risk
Pulse and oxygen saturation

Normal level of OXYGEN SATURATION 98-99 SpO2%

Risk level of OXYGEN SATURATION <96 SpO2%

PULSE normal values, 65-75 bites/min at rest

Risk level PULSE values, <60 >120 bites/min

at rest
1.Monitoring training
En Tras Tras Niveles Niveles de
reposo ejercicio comer normales riesgo
At rest At After Normal Risk levels
exercise eating levels
/ stress
TENSION SYTOLIC
ARTERIAL/
BLOOD DYASTOLIC
PRESSURE

GLUCEMIA/
GLICEMIA

PULSE

SATURACION
OXIGENO/
OXYGEN
SATURATION
First Clinical Session of Special Patients

1. Monitoring training
2. Assess A.S.A. status of a patient +
pharmacology
3. Distinguish among invasive and non-
invasive dental treatments
4. Clinical Cases: patient management
 First Clinical Session of Special Patients

2. Assess A.S.A. status of a patient +

pharmacology

ASA
Medicines level
Place to
Signs and carry out
the dental Kind of
symptoms dental
treatment
treatment
Investigations (Elective/eme
rgencies) we
can
performance
2. Assess A.S.A. status of a patient

PHARMACOLOGY

-Active Ingredient
-Dose
2-0-1 -Dosage
-Used for
-Interactions
-Side-effects
MedicamentoActive Posología Indicaciones Interacciones Efectos
y cantidad
ingredient, Dosage Used for Interactions secundarios
Brand name
Principio Side-effects
and dose
activo,
Chronic Hep B Omeprazole ulcers, sores, or
Sovaldi Sofosbuvir 2-0-1
white spots in the
400mgr HB crónica mouth
Ulceras, dolor o
manchas blancas en
boca

-Amoxicillin
-Clindamycin
-Acetaminophen (paracetamol)
-Ibuprofen
-Metamizole (nolotil)
-Codeine
-Antifungals azoles
-Adrenaline
-Lidocaine
-Mepivacaine
-Articaine
 2. Assess A.S.A. status of a patient
1. - male: 25 y.o.
- non medical history findings
- severe anxiety
- Dental treatment: 3.8 and 4.8 extractions with surgery

2. – Female: 72 y.o.
- Hypertension, type II diabetes
- Medicines: Valsartan 80 mg 1-0-0 Under control???
Glucophage 500mg 1-0-1 MONITOR
- on a diet (low carbohydrate diet)
- calmed patient
- Dental treatment: Emergency appointment, pain and severe
infection with swelling in quadrant 3.

3. – Male: 7 y.o.
- Allergic asthma well-controlled (<episode per month)
- Ventolin during acute asthma
- Fear of dental environment
- First dental checkup, needs 5.4 pulpotomy.
 2. Assess A.S.A. status of a patient
4. – Male:47 y.o.
- Myocardial Infarction 5 months ago
- AAS 100 mgr 1-0-1
- Relaxed patient
- Dental treatment: severe pain 2.7, 3.1 M filling

5. – Male: 67 y.o.
- Angina pectoris, 2 per week, on effort
- Takes Transiderm-Nitro 5 patches 1-0-0
- Stressed patient
- Dental treatment: upper removable prosthesis

6. – Female: 54 y.o
- History of hepatitis B. Currently hepatitis fetor, queilitis and
atrophic tongue.
- Relaxed patient.
- Dental treatment: 1.8 extraction and dental bleaching
 2. y.o.
7. – Female: 64 Assess A.S.A. status of a patient
- C.O.P.D.: oxygen saturation 98%, dyspnoea only on effort
- Theophylline 80 mgr 1-1-1
- Scared patient
- Dental treatment: 3.7 M filling, 2.5 implant

8. - Female: 43 y.o.
- Type 1 diabetic. Glycemic levels of 220
- Pharmacology: Novolin 70/30 7-0-5 units
- Calmed patient
- Dental treatment: fixed bridge prosthesis

9.– Male: 23 y.o.

- Idiopatic trombocytopenia Purpura
- Calmed patient
- Dental treatment: 1.6 D filling, scaling and root planning

10. – Male: 30 y.o.

- Von Willebrand disesase.
- Scared of dentist
- Dental treatment: 2.6 extraction, 2.7 extraction, 1.1 root canal
treatment
11. – Male: 71 y.o.
- Chronic obstructive pulmonary disease with needing of oxygen
support. Hard smoking
- Drugs: Formoterol Aldo-unión inhaler 12mcg 1-1-1
Theo-Dur Retard 300 mg tablets
- Relaxed patient
- Dental treatment: 4.6 root canal treatment, scaling and root
planning

12. – Male: 38 y.o.

- Hard alcoholic and smoker, overweigh.
- high levels of stress at work
- Dental treatment: 2.5 root canal treatment, ultrasonic scaling

13. – Male: 59 y.o.

- Angina, only at anaerobic exercise. CABG (bypass graft) surgery 3
years ago.
- Pharmacology: Aspirin 100mg
Glytrin 400mcg per metered dose sublingual spray
on chest pain.
- Relaxed patient
- Dental treatment: 3.6 implant, periodontal probing, scaling and
root planning
First Clinical Session of Special Patients

3. Distinguish among invasive and non-

invasive dental treatments

INVASIVE TREATMENT: tissues are disrupted

4. Clinical Cases: patient management

DENTAL MANAGEMENT:

1. Assess ASA patient´s status

Relevant medical history +
communication physician

2. Monitoring

3. Reduce stress
Clinical
4. Reduce pain: Local anesthetic cases
technique

5. Others
Remember to plan your clinical cases following these points:
•Look for the medicine information
•Invasive or non-invasive dental treatment
•Assess the ASA of your patient
•Should I speak with the patient´s Physician before to start the dental treatment?
Should I request for any investigation?
•Emergency appointment: Prescribe medicines before the dental treatment
infection, pain, fear.
•Monitoring (Don´t forget write the famous “risk levels”)
•How to reduce stress or fear
•Type of anesthesia
•Appointment time
•Position of the dental chair
•Medicines after the dental treatment
•Others (in relationship with the patients´ diseases: local measures of haemostasis…)
Cómo planear el tratamiento dental de un paciente:

-Medicación del paciente

-Tratamiento invasivo o no-invasivo
-ASA
-Consulta con el médico-especialista??
-Urgencias
-Monitorización
-Disminución del miedo-estrés
-Anestesia
-Hora de la cita
-Posición del sillón dental
-Medicinas tras el tratamiento dental
-Otras ( ejem. Medidas locales de hemostasia)
Homework PHARMACOLOGY
-Amoxicillin
-Clindamycin
-Acetaminophen (paracetamol)
-Ibuprofen
-Metamizole (nolotil)
-Codeine
-Adrenaline
-Lidocaine
-Mepivacaine
-Articaine
MedicamentoActive Posología Indicaciones Interacciones Efectos
y cantidad
ingredient, Dosage Used for Interactions secundarios
Brand name
Principio Side-effects
and dose
activo,