Documenting safe treatment of the medical-risk patient

Article Abstract:

A new system that insures a greater degree of safety for high-risk dental patients has been developed. The system was first formulated at the University of Southern California School of Dentistry in 1975 and continues to be examined and modified. The treatment involves a physical evaluation and specific treatment modification for patients as needed. The process also relies upon the classification system of the American Society of Anesthesiologists, which highlights the following conditions as potential areas of concern: difficulty in breathing, chest pain, and fatigue. The dentist should be concerned if patients experience one or more of these symptoms in conjunction with normal physical activity. Medical histories are more frequently being taken as a routine part of dental practice. Conditions such as coronary artery disease may need particular consideration prior to dental treatment. More emphasis is being placed on the relief of stress, pain, and anxiety, especially in the high-risk patient, where one or more of these problems may trigger serious or even life-threatening situations. A recommended list of things to be done to relieve or minimize stress in the patient is included. A number of general considerations in the administration of oxygen, sedation, and outpatient general anesthesia are also discussed. Three specific conditions, and guidelines for each, are briefly summarized, namely advanced pulmonary emphysema, angina pectoris, and congestive heart failure. In conclusion, this two-part system, which emphasizes treatment modification and medical history, will help provide more comprehensive and safe dental treatment. (Consumer Summary produced by Reliance Medical Information, Inc.)

Anesthesia in dentistry, Dental anesthesia, Chronically ill

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The impact of a quality assessment program on the practice behavior of general practitioners: a follow-up study

Article Abstract:

Although there is almost universal agreement on the need to maintain or improve the quality of health care delivery, there is little agreement on how this may be accomplished. A survey of 300 dentists indicates that evaluation and ranking alone may be sufficient to stimulate positive change. The 300 practices were subjected to an evaluation which typically took over six hours. The practitioners were told that they would receive an evaluation report, and might also receive a follow-up visit after two years. The evaluation indicated not only a score for the individual practice, but also a rank showing how the score compared with the other practices surveyed. After two years, 70 practices were again visited. Thirty of these were control offices which had, in fact, not been sent the results of their evaluation. This served to control for general changes which might have occurred in practices over the two years but were independent of reaction to the results of the evaluation. The remaining 40 practices had received evaluations and rankings. The second visit confirmed that those dentists who had received evaluations had instituted significantly more changes in their practices than those who had not. Although the results were statistically significant, the changes were generally modest and any actual clinical significance may be minimal. The study demonstrates that a combination of assessment and proactive quality assurance can influence general dental practitioners to improve the quality of patient care. (Consumer Summary produced by Reliance Medical Information, Inc.)

Practice, Quality control, Dentistry

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Ohio dental care providers' treatment of young children, 2002

Article Abstract:

A study examining the factors influencing dental care providers to provide services to young children, from low-income families, is presented.

Science & research, Services information, Ohio, Research, Services, Dental care services, Poor children

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