Asa physical Status Classification system* asa I



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ASA Physical Status Classification SYSTEM*

ASA I

Normal and healthy. Little or no anxiety. Little or no risk.


ASA II

Mild to moderate systemic disease or are healthy ASA I patients who demonstrate a more extreme anxiety and fear toward dentistry. Patients are able to walk up one flight of stairs or two level city blocks, but will have to stop after completion of the exercise because of distress.



Examples: well-controlled NIDDM, epilepsy, asthma, and/or thyroid conditions; ASA I with a respiratory condition, pregnancy, and/or active allergies.
ASA III

Severe systemic disease that limits activity, but is not incapacitating. Patients are able to walk up one flight of stairs or two level city blocks, but will have to stop enroute because of distress



Examples: angina, MI or CVA history, IDDM, CHF, COPD
ASA IV

Patients have severe systemic disease that limits activity and is a constant threat to life. Distress is present even at rest.



Examples: unstable angina, MI or CVA within the last six months, HTN, severe CHF or COPD, uncontrolled epilepsy, diabetes, or thyroid condition.

STAGES OF HTN




Systolic

Diastolic

Treatment Modifications

Normal

< 130 mm Hg

< 85 mm Hg

None

Stage 1

140 - 159

90-99

Inform pt, med referral

Stage 2

160 - 179

100-109

Med referral, selective tx

Stage 3

180 - 209

110-119

ER tx only, med referral

Stage 4

> 210

> 120

Immediate med referral



LOCAL ANESTHESIA





Injection

Injection Site

Affected Ares

Depth

ASA

C / 1P eminence

CI, LI, C (P)

16mm

MSA

MB fold of 2P

1/2P + MB root of #3

A few mm

PSA

45/45/45 to 2M

Molars except MB #3

16 mm

Nasoplatine

Side of incisive papilla

1P-1P

A few mm

Greater palatine

Ant to foramen

Post hard palate

< 10 mm

IAN

Opp. P, Occ. plane

Mn teeth ant to M

10-25 mm

Long Buccal

Post to 3M, Occ. plane

Buccal of M

1-2 mm

Lingual

Opp. P, Occ. Plane

Ant 2/3 tongue, FOM, Li soft tissues

10-12 mm


RADIOGRAPHIC TECHNIQUE
MxM PA – 2 exposures, HA=80, Mesial of 1M lines up with anterior edge of film

MxP PA – CR  to facial surfaces of 1M & P, record distal Ca1M

MxCa PA – CR  MxCa, tip biteblock  for the side recorded, no contact from LI/Ca

MxI PA - VA -5 (move PID )

MnM PA – HA=80, VA +5 (move PID ), record distal of 1M3M, edge of film at mesial of 1M

MnP PA – record distal of Ca1M, CR to PM/1M

MnCa PA – decrease the –VA 5 (move PID ), no tip of film

MnI PA – decrease the –VA 5

M BW – CR to IP b/t 1M & 2M, anterior edge of film lines up with mesial of 1M, VA~+15-20

PM BW – CR to IP b/t 1M & 2P, VA~+10-15

Common HTN Meds
Diuretics:

  • Acetazolamide (Diamox®)

  • Indapamide (Lozol®)

  • Metolazone (Zaroxolyn®)

  • Spirnolactone (Aldactone®)

  • Torsemide (Demadex®)

  • Triamterene (Dyrenium®)


Beta Blockers:

  • Atenolol (Tenormin®)

  • Bisoprolol (Zebeta®)

  • Carvedilol (Coreg®)

  • Metoprolol (iLopressor®)

  • Timolol (Blockadren®)


Calcium Channel Blockers:

  • Amlodipine (Norvasc®)

  • Felodipine (Plendil®)

  • Idradipine (DynaCirc®)

  • Nicardipine (Cardene®)

  • Nisoldipine (Sular®)


ACE Inhibitors:

  • Benazepril (Lotensin®)

  • Captopril (Capoten®)

  • Enalapril (Vasotec®)

  • Fosinopril (Monopril®)

  • Lisinopril (Prinivil®)

  • Quinapril (Accupril®)

  • Ramipril (Altace®)

  • Trandolapril (Mavik®)



AAP PERIO CLASSIFICATION
I – Gingival Disease (no attachment loss)

  1. Plaque-associated gingivitis

    1. Chronic gingivitis

    2. Acute necrotizing ulcerative gingivitis

    3. Gingivitis assoc with systemic conditions or medications

      1. Hormone induced

      2. Drug induced

      3. HIV

  2. Gingival manifestations of systemic disease and mucocutaneous lesions

    1. Bacterial, fungal, viral

      1. Acute herpetic gingivostomatitis

    2. Blood dyscrasias

      1. Acute monocytic leukemia

    3. Mucocutaneous diseases

      1. Lichen planus

  3. Other gingival changes

II – Early Periodontitis (1-2 mm attachment loss)

III- Moderate Periodontitis (3-5 mm attachment loss)



  • Increased mobility?

  • Furcation involvement?

IV- Advanced Periodontitis (6 mm and more attachment loss)

  • Mobility

  • Furcations likely

V- Refractory Periodontitis

  • Post therapy loss of attachment


ICC TRIAGE (30-45 minutes)

Have patient in Endo or Oral Surgery by 10 am or 2:30 pm


  1. Determine CC

  2. Radiograph ASAP

  3. Obtain short medical history

  4. If tooth is unable to be restored, or patient does not want to save the tooth refer to oral surgery.

    1. Report to ICC secretary before referral!

  5. If tooth is savable:

    1. Pulp test

    2. Periodontal condition

    3. Is saving the tooth the best choice?

    4. If tooth need endo and patient agrees: Do 1 tooth treatment plan, report to ICC secretary, have patient go to accounting before endo clinic.


PULP DIAGNOSIS
Normal- short response to thermal and electrical stim, does not exibit caries, attrition, abrasion, etc.
Reversible Pulpitis- Pain must be provoked, short response to thermal stim, sensitivity to sweets and exhibits caries, attrition, abrasion, etc without exposing the pulp.
Irreversible Pulpitis- Pain may be spontaneous, radiating, wake the patient. Not relieved by Tylenol or aspirin. Thermal stim produces prolonged pain. Usually assymptomatic, caries excavation can serve as a diagnostic test. Pulpal expusure.
Necrotic- Non responsive to thermal or electrical stim


Painful to percussion=Acute Apical Periodontitis

Necrotic = RA of periapical exibit RL areas




Tooth #

3

4

5

13

Cold

+

++ lingering

+

+

Percussion

-

+++

-

-

EPT

+

+ sharp

+

+

Palpation

-

++

-

-

PERIRADICULAR DIAGNOSTIC CATEGORIES

Normal

Acute Apical Periodontitis- Tissues associated with the tooth are normal, painful to percussion

Chronic Apical Periodontitis- Tissues exhibit RL areas, patient is assymptomatic. There may be a sinus tract.

Chronic Periradicular Abscess- Tissues exhibit Rl areas, patient is assymptomatic. Has a sinus tract.

Acute Periradicular Abscess- Tissues appear normal, may have RL area. Patient with exhibit pain and/or swelling.

Condensing Osteitis- tissues exhibit a proliferation of bone, patient id asymptomatic

Phoenix Abscess- exacerbation of a previously symptom free periradicular pathosis of pulpal origin.


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