Patients at risk in pedodontics
Introduction
Following the medical questionnaire and the clinical examination, the practitioner is faced with one of the following 3 situations:
- Either the patient is healthy
- Either there is a pathology or ongoing medical treatment which may be the cause of infectious, hemorrhagic or medicinal risks, to be taken into consideration for treatment at the dental office
- Either a pathology is suspected during the clinical examination
- Either it is discovered accidentally during treatment
The practitioner must contact the treating physician for advice and must carry out certain investigations.
Risk depending on pathologies
Patients at risk in pedodontics
Patients at risk in pedodontics
Risk of bleeding in children
Definition
Hemostasis is the physiological process that allows bleeding to be stopped during a vascular breach. It takes place in 3 stages:
- Primary hemostasis
- Coagulation
- Fibrinolysis
Patients at risk in pedodontics
Assessment of bleeding risk
- First consultation
- Search for clinical signs during the anamnesis and clinical examination
- Known risk
- Unrecognized risk discovered during surgery
- Risk does not exist
- Exploration of hemorrhagic risk according to pathology
- First – line examinations
- Platelet count
- INR (exploration of the exogenous pathway )
- TCA (exploration of the endogenous pathway)
- Secondary examination
- They are prescribed by specialists
- Exploration of platelet function…
Patients at risk in pedodontics
- Planning and organization of interventions:
- Choice of the location of the intervention according to the risk of hemorrhage ; the procedure and the doctor’s opinion
- Preparing the intervention with precision
- Do not interrupt treatment in case of minor risk of bleeding.
- Plan for the injection of the missing factor and pre- and post-operative transfusions
Therapeutic attitude according to the act and the risk of hemorrhage
Therapeutic attitude during the surgical procedure
- Check surgical sites and stop bleeding postoperatively
- Use local means of hemostasis if bleeding persists
- Mechanical compression
- Sutures
- Surgicel and sponges
- Organic glues
- Compression gutter
- Tranexamic acid
Patients at risk in pedodontics
Infectious risk in children
Diagnosis of oral and dental infections of bacterial origin
- Patient’s vital prognosis related to general illness
- Risk associated with therapeutic abstention depending on the presumed virulence of the infectious focus
- Expected benefit of each therapeutic proposal for the patient’s comfort of life
- Children’s oral hygiene
Support based on the procedure to be performed and the level of risk
- Antibiotic prophylaxis
- Antibiotic cover therapy
Drug risk in children
- Drug risk concerns the adverse effects of drugs
- Pediatric pharmacology
Patients at risk in pedodontics
Drug risk management
- Define the real indication of the prescription and choice of molecule
- Compliance with the rules and recommendations of the prescription
- Check for allergy
Drug risk management
- Modification according to systemic pathologies
and/or their processing
In case of anaphylactic shock
Severe clinical reaction of rapid onset after contact with the allergen (15 min)
Clinical signs:
- Hives and itching
- Facial and laryngeal edema
- Nausea and vomiting; diarrhea and abdominal pain
- Dyspnea and runny nose
- Low blood pressure
Treatment:
- Antihistamines
- Corticosteroids
- Adrenaline
- Oxygen therapy
- Call the emergency services
Conclusion
- Clinical examination and questioning during the first consultation in order to detect patients at risk and take the necessary precautions during surgical procedures
- The dentist plays an important role in the detection of certain pathologies during our practice