CC OS - Basic SOPs

• Life expectancy in the Philippines: 71.66 years
• Male: 65.3 years
• Female: 72 years (2016 est.)
• Dental treatment files from 2002-2004 at the Faculty of Dentistry, Chulalongkor University were retrieved and reviewed for medically compromised conditions
• Results: 58,317 total number of patients, 7,167 (12.2%) were medically compromised
• Dentist's role


  Provide safe dental treatment in the presence of systemic disease
• Things dentists often neglect

  • Not taking medical history
  • Relying solely on medical questionnaire
  • Not updating medical history
  • Not familiar with medical drugs
  • Not aware of problems associated with disease
  • Not correlating dental treatment impact to medical condition
• Things we do during treatment

  • Instill fear in patients
  • Inflict pain
  • Inject local anaesthetics with vasoconstrictors
  • Cause bleeding
  • Dictate patient position
  • Expose to dental materials
  • Prescribe medications
  • Alter oral aesthetics and function
• Stress levels


  Increased when patient is afraid or in pain, can translate into undue increase in metabolic rate
• Dentists should be aware that many of our procedures cause bleeding
• Sudden changes in patient position may result in untoward incidents
• Dental materials, medications, and latex gloves can expose patients
• Prescribing medications can affect normal physiology, systemic disease, and have drug interactions
• Altering oral aesthetics and function can create physical and/or emotional impact on patients
• Risk assessment factors


  • Physical/emotional stability, control, tolerance, reserve
  • Dental procedure invasiveness, trauma, blood loss, duration
  • Functional capacity (METs)
• Medical questionnaire


  • Moral and legal necessity
  • Short form or long form
  • Provides information on physical and psychological state
  • Dependent on patient's knowledge and honesty
• Baseline vital signs


  • Provide information on patient's ability to tolerate stress
  • Reference values for before, during, and after procedures
  • Includes pulse rate, blood pressure, respiratory rate, temperature
• ASA physical status classification

  • ASA I: Normal healthy patient
  • ASA II: Mild systemic disease
  • ASA III: Severe systemic disease that limits activity
  • ASA IV: Incapacitating systemic disease that is constant threat to life
  • ASA V: Moribund patient not expected to survive 24 hours
• Risk classification of dental procedures (Sonis)

  • Type I: Nonsurgical, noninvasive, no wounds, no stress
  • Type II: Nonsurgical, noninvasive, no wounds, low stress
  • Type III: Nonsurgical, invasive, few superficial wounds, low stress
  • Type IV: Closed surgical, invasive, single deep wound, low stress
  • Type V: Open surgical, invasive, several deep wounds, moderate stress
  • Type VI: Open surgical, invasive, many deep wounds, high stress
• General observations


  • Body habitus
  • Gait
  • Respiration
  • Speech
• Body habitus


  Weight status vs height, body proportions, height/weight vs age, physical vs mental age, overt topographic changes
• Overweight and obesity


  • Abnormal or excessive fat accumulation that presents a risk to health
  • Measured by body mass index (BMI)
• BMI classifications


  • Normal weight: 18.5 to 24.9
  • Overweight: 25.0 to 29.9
  • Obese I: 30.0 to 34.9
  • Obese II: 35.0 to 39.9
  • Obese III: 40 and above
• Conditions associated with obesity


  • Hypertension
  • Coronary heart disease
  • Diabetes mellitus
  • Hypothyroidism
  • Steroid intake Cushing's disease
  • Dystrophia adiposogenitalis
• Conditions associated with abnormal weight loss

  • Diabetes mellitus
  • Chronic obstructive pulmonary disease
  • Hyperthyroidism
  • Malignant conditions
  • Substance abuse
  • Anorexia nervosa
• Anorexia nervosa


  Eating disorder characterized by deliberate self-starvation with weight loss, intense fear of gaining weight, distorted body perception, denial of hunger, constant exercising, sensitivity to cold, absent or irregular periods, wearing loose clothing to disguise weight loss
• Gigantism


  Rare condition causing abnormal growth in children due to excessive somatotropin production, generally well proportioned until epiphysis closure
• Dwarfism


  • Adult height of 4 feet 10 inches or less
  • Pituitary dwarf: lack of growth hormones, generally well proportioned except head
  • Thyroid dwarf: cretinism, insufficiency of thyroxine, mental retardation, enlarged head, short limbs, puffy eyes, tongue sticking out
• Pituitary gland cell types

  • Somatotrophs: produce growth hormones
  • Lactotrophs: produce prolactin essential to lactation
  • Corticotrophs: produce ACTH, POMC, MSH, endorphins, lipotropin
  • Thyrotrophs: produce thyroid secreting hormones
  • Gonadotrophs: produce LH and FSH
• Acromegaly


  Form of gigantism, persistence of excessive growth hormones after epiphysis closure, growth continues at distal parts like enlarged hands
• Dwarfism


  Lack of growth hormones
• Dwarfism


  • Generally well proportioned, except head
• Thyroid dwarfism


  Condition known as cretinism
• Thyroid dwarf


  • Infants suffer from insufficiency of thyroxine
  • Exhibits mental retardation
  • Enlarged head, short limbs, puffy eyes, tongue sticking out
• Somatotrophs


  Acidophilic cells that produce growth hormones (somatotropins)
• Lactotrophs


  Acidophilic cells that produce prolactin essential to lactation
• Corticotrophs


  • Basophilic cell that produce Adenocorticotrophic hormone (ACTH)
  • Pro-opiomelanocortin (POMC)
  • Melanocyte-stimulating hormone (MSH)
  • Endorphins
  • Lipotropin
• Thyrotrophs


  Basophilic cells that produce thyroid secreting hormones
• Gonadotrophs


  • Stimulate the testes and the ovaries
  • Luteinizing hormone
  • Follicle stimulating hormone
• Acromegaly


  • Form of gigantism
  • Persistence of excessive growth hormones after closure of epiphysis
  • Person no longer grows taller
  • Growth continues at distal parts