Dental Management of Medically Complex Patients

Abstract

Managing dental patients with medical illnesses such as hypertension, diabetes mellitus, epilepsy or heart diseases is not a straightforward road, as every case needs to be addressed according to its severity. Some may end up in emergency situations on the dental chair. This article presents a novel concept designed by the author called the ‘traffic signal concept’ and a simple, easy-to-understand guide for dentists for managing medically compromised patients in the dental clinic safely and quickly. The article introduces a rapid triage framework that should be used alongside current condition-specific guidance, local protocols and formal emergency training.

Introduction

Noncommunicable diseases commonly include cardiovascular disease, chronic respiratory illnesses, diabetes, various cancers etc and are estimated to account for around 60% of all deaths. Cardiovascular diseases such as ischemic heart disease and cerebrovascular diseases such as stroke, account for 17.7 million deaths globally and are the leading cause of death.1

In accordance with the World Health Organization, India accounts for one-fifth of these deaths worldwide especially in younger population. Indians are known to have the highest coronary artery disease rates, and the conventional risk factors fail to explain this increased risk.

The most common medical emergency which may occur during dental treatment as per global data is syncope. After syncope, various common medical emergencies in dental practice include

• seizures
• asthma
• hypoglycemia
• myocardial infarction and
• hypotension.

According to the Indian Council of Medical Research (2019), India has almost 20 crore adults with hypertension (one in every four individuals). The same report stated that the number of people suffering from diabetes mellitus in India are 77 million. One of the most common neurological disorders is epilepsy with more than 10 million (registered) cases in India .

Looking at the figures above, a dentist must be well versed with such common medical illnesses which may create life threatening situations in dental clinic, and know how to handle such situations. All medically compromised patients must be screened well before performing any dental procedure. To help the dentist in taking quick, structured and safer initial decisions, I have developed this new concept which will be able to guide the dentist on do’s and dont’s in managing medically compromised patients at the dental clinic.

The traffic-light signal concept

The traffic-light signal concept is a new, simple and pictorial concept. This concept is based upon the fact that image-based guide is easier to follow. Secondly if the image is very popular and can be understood by almost all the individuals, then it becomes very easy to put into practice. This concept utilizes the traffic signal light images which we all are very familiar with. In traffic signals

• the red light means stop,
• yellow light means proceed with caution or wait, and
• green light means go ahead.

Similarly, in medical emergencies, the same concept can be applied to heavily simplify this loaded topic.

Besides the main dentist, the consultant specialists and associate doctors, this super-simplified concept can be followed by the auxiliary staff like dental assistants and clinic receptionists too. So, all the common medical illnesses which we come across routinely in dental practice have been written as per the traffic signal concept below and all you need is to just read and print the images to train your clinic staff.

Conditions as per the traffic signal concept

In the video below, I have included following most common and relevant medical conditions which may affect our dental practice:

1. Vasovagal syncope
2. Hypertension and stroke
3. Ischemic heart disease
4. Diabetes mellitus
5. Epilepsy

Video link of the traffic signal concept: https://youtu.be/HpCgdn03Bs4 Tips:

• Use this 16-minute overview as a training aid; it does not replace accredited medical-emergency training or local protocols.
• The video has been divided into mini-chapters along with corresponding time stamp - simply click on the condition you are interested in and watch.
• When the traffic signal concept of the particular condition comes up----