Dear patient
We understand the frustration caused by completing our medical questionnaire. We know that these forms do not need to be completed at visits to your medical GP, however they are the ones who diagnose conditions and prescribe the medication, so they automatically have access to the information needed. Unfortunately, this is not routinely shared between medical and dental healthcare providers, and we do not have access to your medical information.
We have compiled this document (quite comprehensive) to explain the need for keeping this information up to date. Each dental practice is to do a risk assessment to determine at which intervals written updates are required, and after careful consideration we have established that 6 monthly written updates, and verbal updates in between, will keep our patients as safe as possible, demonstrate compliance with Dental Council Standards (relevant extract of document on last page of this document), and cause the least frustration possible.
Unfortunately, any individual’s health conditions can and does change overnight, and some of the conditions and medicines used to treat these conditions, can have a significant impact on possible treatment options and risks associated to treatment provided therefor if you refuse to complete the form and we do not have the updated details, we will be able to consult, but not be able to perform some procedures needed. If medical information has been withheld at time of initial consult, and a treatment plan identified that has increased risk for certain medications and procedures (e.g. extractions and implants), then a second consult will be required to discuss the treatment plan once relevant health information has been disclosed. To avoid additional cost of a follow up consultation to you, and minimise time loss, we kindly request the information be provided when requested, in advance of appointments.
We do experience strong opposition from patients to complete the details at regular intervals, but we have also had patients attend with life threatening complications due to treatment provided by previous dental treatment providers, where these details were not checked. In order to keep both you, and our dental professionals safe form allegations of negligence, we will greatly appreciate your compliance. Unfortunately, the only way we can proof that we adhere to the council standards, is to have your signature at least 6 monthly as it is impossible to proof that some relevant information was withheld from us (either intentionally or unintentionally, if only confirmed verbally. If other dental practices you attended in the past, have not asked you to confirm medical status/changes, then they have put you at risk of complications.
Below are some (but not all) possible medications of importance
It is essential for patients to inform their dentist of all medications, including over-the-counter medications and dietary supplements. This information enables the dentist to modify the treatment plan to the patient’s specific needs and minimize any potential complications or interactions.
Medication history is an important consideration when discussing treatments.
Anticoagulants
Anticoagulants like Warfarin, Eliquis, and Xarelto as well as Antiplatelet medications such as Aspirin, Plavix, and Brilinta can increase the risk of bleeding during and after treatment. It is important for clinicians to be up to date on the protocols for these medications and seek consultation with their doctors before extracting teeth. Some of these medications need to be out of the system before surgery. Others just require extra care in managing increased bleeding.
When discussing extractions and dental implants with patients, it is extremely important to determine if the patient is on bisphosphonate drugs and which drug they are taking. Some examples of bisphosphonate drugs are Fosamax, Actonel, and Zometa. Bisphosphonates increase the risk of MRONJ or Medication-Related Osteonecrosis of the Jaw.
Bisphosphonates
As the field of medicine is advancing, increasing the average lifespan and the aging baby boomer generation, we are seeing a large increase in elderly patients. Most of them require medication to maintain their health. It is also common for these patients to need dental extractions, and many are electing to replace teeth with dental implants. These medications, which are frequently prescribed for osteoporosis and certain cancer treatments, can occasionally cause osteonecrosis of the mandible. Patients taking bisphosphonates must inform their dentist or orthodontist of their medication history, as dental procedures may require special precautions
In lay terms, the bone dies when exposed to air. It can be devastating to the patient’s jawbone and life threatening. Some of the more potent ones are given intravenously while others are oral. There is less of a risk when taking oral bisphosphonates. There have been times when a patient didn’t know they were taking one of these drugs, however by looking at your medical history, our dentists are able to identify patients possibly on these medications and ask for confirmation from GP’s. Since it is not in a pill form in front of them daily, it is common for them to forget.
Immunosuppressants.
Medications that suppress the immune system (for example adalimumab and Methotrexate), such as those prescribed for organ transplants or autoimmunity, can increase the risk of oral infections. Effective management of oral health while taking these medications requires close communication between the patient, his or her physician, and the dentist.
Steroids
Steroids are medications that are often used to treat inflammation and pain. They can be effective for managing certain conditions, though, they can also increase the risk of infection and slow down the healing process. Inform your dentist if you are taking any steroids, as they may need to adjust your treatment plan to minimize these risks.
Anticoagulants
Anticoagulants, also known as blood thinners, are medications that are commonly used to prevent blood clots. While these medications are necessary for many people with certain medical conditions, they can increase the risk of bleeding during dental procedures. Blood-thinning medications such as warfarin, heparin, and aspirin can increase the risk of haemorrhaging during dental procedures. It is essential for dental professionals to be aware of a patient’s medication history in order to take the necessary precautions and modify treatment plans as needed.
Antidepressants.
Some antidepressants, particularly tricyclic antidepressants and selective serotonin reuptake inhibitors (SSRIs) can produce dry mouth as a side effect. This can increase the likelihood of dental caries and oral discomfort. Dentists may recommend additional preventive measures, such as increased hydration, saliva substitutes, or modified oral hygiene practices, to patients with dry mouth.
Heartburn Medications
Patients with chronic heartburn are frequently prescribed proton pump inhibitors (PPIs) like Pantoloc and omeprazole when getting dental implants. By inhibiting the enzyme responsible for producing acid in the stomach wall, these drugs lower acid production. PPIs may lower the amount of calcium that our bodies can absorb, which could lower bone density and increase the risk of fractures overall. According to studies, those who use PPIs have a 4.30 times higher chance of dental implant failure; they may influence how bones recover and fuse together.
Diabetes
People with unmanaged diabetes do not heal quickly after oral surgery or other dental procedures because blood flow to the treatment site can be damaged. People with diabetes who smoke are at an even higher risk — up to 20 times more likely than non-smokers to develop thrush and periodontal disease. Smoking also seems to impair blood flow to the gums, which might affect wound healing in this tissue area.
It is therefore important to ensure that diabetes is well controlled before doing surgical dental procedures like extractions and implants.
Further complications of unmanaged diabetes is a decrease saliva (spit) flow, resulting in dry mouth. Dry mouth can further lead to soreness, ulcers, infections and tooth decay. Another complication of diabetes is that it causes blood vessels to thicken. This slows the flow of nutrients to and waste products from body tissues, including the mouth. When this combination of events, the body loses its ability to fight infections. Since periodontal disease is a bacterial infection, people with unmanaged diabetes might experience more frequent and more severe gum disease.
NZ Dental Association Code of Practice: Medical emergencies in dental practice -18 August 2015
Preparation for emergencies
Medical risk assessment
A key tool in preventing a medical emergency or reducing the adverse effects of such an occurrence, is determining which patients are at risk of a medical problem occurring by conducting a medical risk assessment. This involves an active review of the medical and drug status of all patients prior to undertaking any form of treatment. This review should identify patients who are at a heightened risk of a medical problem occurring and once identified, dental practitioners can take additional precautions or may refer the patient to a more suitably qualified practitioner for care.
Health Practitioners must review and confirm patient-completed written medical histories verbally with the patient. A patient’s medical status and/or medication can change regularly so medical and drug histories must be updated (and recorded) at least annually, and prior to treatment sessions. These responsibilities must not be delegated.
New Zealand Dental Council Medical Emergencies Practice Standards with guidance – August 2021
You must ensure a concise and relevant medical history is included in the patient record of every patient and updated regularly
Guidance
➢ Understand that a clear and comprehensive medical history is fundamental in the prevention and management of a medical emergency.
➢ Include in the medical history: past medical history, current medical conditions, current medications (prescribed and non-prescribed), and allergies.
➢ Identify patients who have a severe medical condition/s or an increased risk of a medical problem arising during dental treatment.
➢ Consider whether additional precautions might be needed for you to provide safe care; or whether referral is required to a more suitably qualified practitioner or a more appropriate medical environment, such as a hospital-based dental practice.
➢ Update the medical history at each appointment and document any changes in the patient record.
