Medical Risk Assessment in Patients Referred to Dental Clinics, Mashhad, Iran (2011-2012)

Prevalence and Variation of Medical Comorbidities in Oral Surgery Patients: A Retrospective Study at Jazan University

BACKGROUND An aged population is susceptible to chronic diseases, which impacts oral surgery treatment procedures. This retrospective study aimed to evaluate the incidence of medical comorbidities in 640 oral surgery patients treated at the College of Dentistry, Jazan University. MATERIAL AND METHODS This single-center observational study investigated medical records of outpatients who visited Jazan University Dental College Hospital in a 1-year period (2018-2019). Patients’ clinical and radiographic archives were screened to obtain relevant data. Categorical and continuous variables were expressed in terms of frequency and mean values, respectively. Differences in variables were statistically analyzed using the chi-square goodness of fit and proportional test, with a probability value P≤0.05 considered significant. RESULTS Analysis of 640 patient records included records of 300 men and 340 women who underwent oral surgery, of whom 176 patients (27.5%), including 97 men and 79 women, had medical comorbidities. The most common comorbidities were endocrine disease (7.03%), cardiovascular disease (6.71%), respiratory disease (4.53%), and hematological disorders (3.43%). Individual diseases that showed higher prevalence were diabetes mellitus (4.68%), hypertension (3.43%), bronchial asthma (2.65%), and anemia (1.4%). Differences by sex were observed in many individual disorders. CONCLUSIONS Outpatients in oral surgery clinics presented a significant variance in the incidence of medical comorbidities, among which diabetes and hypertension were most common. A proper case history is the best preventive measure that helps a surgeon avert medical emergencies and post-surgical complications.

[Construction of the Framework of a Prediagnostic Risk Assessment System for Outpatient Dental Care]

Objective

To establish the framework of a prediagnostic risk assessment system for outpatient dental care and to provide references for ensuring patient safety and improving the quality of medical services.

Methods

A total of 15 medical workers in a tertiary-care stomatology hospital in Sichuan Province were selected for qualitative interviews between October 2019 and December 2019. On the basis of the results of literature analysis and the interviews, an expert consultation form for prediagnostic risk assessment system for outpatient dental care was developed. Then, consultation of 10 experts in the field of oral health care and nursing was conducted between June 2020 and December 2020. Eventually, the framework of prediagnostic risk assessment system for outpatient dental care was formulated.

Results

Four themes emerged from the qualitative interviews. Firstly, prediagnostic risks of dental outpatients involved mainly syncope, cardiovascular emergencies, and other emergency medical risks. Secondly, medical risks came from three sources, patients, healthcare professionals, and the environment. Thirdly, medical professionals of outpatient dental care had limited awareness of the prediagnostic medical risks of patient. Fourthly, medical professionals of outpatient dental care showed inadequate response to and management of the prediagnostic medical risks of patient. The expert consultation helped finalize the Dental Outpatient Prediagnostic Risk Assessment Questionnaire, which included 3 primary indicators (namely, general information, medical history [including history of allergy], and medication assessment), 12 secondary indicators (including patient demographics, patients' status upon admission, oral hygiene habits and special lifestyle habits, sensory disorders, special periods for female patients [ie, menstruation, pregnancy, and breastfeeding], allergy history [history of oral treatment-related allergies], past/present medical history, types of medication, route of medication administration, duration of medication administration, accuracy of medication administration, and adverse drug reactions), and 39 tertiary indicators. The effective recall rate of the expert consultation form was 100%, expert positivity was 100%, and the authority coefficient was 0.83. Kendall's harmony coefficient ranged from 0.808 to 0.839, which was statistically significant (P<0.001).

Conclusion

The framework of prediagnosis risk assessment system for outpatient dental care is found to be scientific and specific, but its applicability still needs further validation in clinical practice.

Effect of the Ongoing Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Pandemic on Dental Service Utilization in Patients With Comorbidities

BACKGROUND

The keystone of safe and effective patient management is to approach a patient with up-to-date medical information. Assessment of patients for their medical conditions has changed during the coronavirus disease 2019 (COVID-19) pandemic and the need for appropriate research infrastructure has increased. Considering an updated list of high-risk underlying conditions in the post-COVID-19 era, this study aimed to evaluate the utilization of dental services by patients with comorbidities during the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic.

METHODS

 Data of patients with comorbidities seeking dental care at a dental school during the COVID-19 pandemic were retrospectively evaluated. Demographic variables (age, gender) and medical history of the participants were recorded. The patients were classified according to their diagnosis. Data were analyzed using descriptive statistics and Chi-square analysis. The significance level was determined at α=0.05.

RESULTS

 The study included data from 1067 patient visits between September 1, 2020 and November 1, 2021. Among these patients, 406 (38.1%) were males and 661 (61.9%) were females, with a mean age of 38.28 ± 14.36 years. Comorbidities were identified in 38.3% of the patients with predominance in females (74.1% n=303). Single comorbidity was observed in 28.1% while multi-morbidity was detected in 10.2% of the cohort. The most prevalent comorbidity was hypertension (9.7%), followed by diabetes (6.5%), thyroid disorders (5%), various psychological diseases (4.5%), COVID-19 infection (4.5%), and different allergies (4%). The presence of one or more co-morbidities was observed mostly in the 50-59 years age group.

CONCLUSIONS

 The seeking of dental care among the adult population with comorbidities was high during the SARS-CoV-2 pandemic. It would be beneficial to develop a template for obtaining a medical history from patients by taking full account of the consequences of the pandemic. The dental profession needs to respond accordingly.

Preparedness of Dentists and Dental Clinics for Medical Emergencies in Jordan

BACKGROUND

Dentistry, as most clinical specialties, has a wide range of invasive procedures in which patients are at risk of having a medical emergency (ME). The stress induced at clinic during treatment, the medically compromised elderly patients whom are increasing in number due to the new advancements in medicine and the invasive techniques such as injections, surgical flaps, devitalization or extractions are risk factors for medical emergencies' occurrence.

OBJECTIVE

The aim of this study was to assess the knowledge and the training of dentists and the availability of the emergency drugs and equipment in a sample of dental clinics in Jordan.

METHODS

A questionnaire was designed and distributed using an online service to dentists all over Jordan. It included different question categories; Demographic, Medical emergencies, emergency equipment and medications and dentists' self confidence and training to manage medical emergencies.

RESULTS

Number of 180 completed questionnaires were accepted for the study, 102 were females and 92 were specialists. 158 (87.8%) responders faced a medical emergency at their work place. Most common medical emergency faced in the clinic was the vasovagal attack 81(45%). Major emergencies were witnessed by 79(43.9%) of the dentists. 110 (61.1%) of the responding dentists had their training in medical emergency management after graduation from dental school while 49(27.7%) had their training during dental school. 156(86.7%) found themselves still in need for further training. Blood pressure meter was the most available device at clinics 33(18.3%) and was the most used. Defibrillators were only used by 13(11.3%) of the responders. Epinephrine, steroids and nitro-glycerine were the available drugs for medical emergencies management in the practices (27.8%, 26.7% and 18.9%) respectively. Most dentists were not confident enough to handle medical emergencies.

CONCLUSION

Preparedness of dentists and dental clinics to handle and manage medical emergencies needs further attention and focus to assure prevention and management of such incidents.

Medical Conditions, Oral Health Practices, and Barriers to Treatment among Patients Visiting a Teaching Dental Hospital in Eastern Saudi Arabia

Objective

To assess the prevalence of medical conditions, oral hygiene practices, and dental visits among patients who attended a teaching dental hospital in Dammam, Saudi Arabia. Materials & Methods. This retrospective cross-sectional study used patient records from 2009 to 2015 from the dental hospital of the College of Dentistry Imam Abdulrahman Bin Faisal University, Dammam. Patients' demographics, medical history, oral hygiene practices, reasons for attending the facility, attendance patterns, and smoking habits were studied.

Results

The study included 1502 records of patients with 65.1% of males and 34.9% of females. The prevalence of medical conditions was 25.7% in the study. The most common medical conditions included diabetes mellitus (7.2%), hypertension (6.5%), and anemia (4.7%). Only 21.8% reported visiting the dental hospital in the past one year. The prevalence of smoking was 16.7%, and this did not differ significantly between healthy and medically compromised patients (P=0.165). Fillings were the most common (21.6%) reason for visiting a dental hospital, followed by treatment for periodontal problems (12.9%) and oral lesions (12.6%), whereas treatment for braces (orthodontics) was the least common (5%) reason for visiting the hospital. The reasons for visiting the hospital did not differ significantly between healthy and medically compromised patients (P > 0.05). The three most common barriers to dental visits included long waiting time (18.1%), fear of dental treatment (14.4%), and difficulty in getting an appointment (11.3%).

Conclusion

The study showed that dental patients had a high prevalence of medical conditions. Diabetes mellitus was the most prevalent problem. Most patients visited the dental hospital to receive restorative treatment, and a long waiting time was the most common barrier to dental visits. Public health measures should be taken to improve the general health and oral care of patients.

The Evaluation of Medical Conditions in Patients Admitted to the Oral Diagnosis Clinic

Background/Aim: The aim of this study is to set forth the current systemic diseases of the patients admitted to the oral diagnosis clinic of the Faculty of Dentistry Sütçü İmam University, and the prevalence of these diseases.

Material and Methods: This study will be conducted by retrospective evaluation of anamneses in the tooth information management system of patients admitted to the oral diagnosis clinic of the Faculty of Dentistry, Sütçü İmam University for dental treatment. The anamneses taken from the patients before their treatments will be obtained from digital medium.

Results: Out of 4077 patients included in the study, 2554 were female, and 1523 were male. Of them, 25.6% had systemic diseases. The mean age of the patients was 35.24%+12.3. It was found that cardiovascular diseases were more common than the other systemic diseases. The most common cardiovascular disease was found to be hypertension (7.5%), while the most common endocrine system disease was diabetes mellitus (7.5%).

Conclusions: Dental practitioners must keep themselves up-to-date as they encounter patients with systemic diseases. They must pay attention while taking anamneses from patients. Therefore, they may apply medical consultation to prevent probable complications when necessary.

Psychometric Analysis of the European Medical Risk-Related History Questionnaire within Indonesian-Speaking Population

OBJECTIVES

Medical complications during dental treatment are increasingly anticipated because advances in medical treatment have prolonged life expectancy. Therefore, a thorough analysis of medical history data to assess the medical risks that may occur before, during, and after dental procedures is required. The European Medical Risk-Related History (EMRRH) questionnaire has been used in 10 European countries to detect medical problems and determine the risks of complications. However, no similar questionnaire has been developed for Indonesian patients. This study aimed to develop an Indonesian version of the EMRRH questionnaire and analyze its psychometric properties.

MATERIALS AND METHODS

The EMRRH questionnaire was utilized and processed for cross-cultural adaptation according to the Beaton guidelines. The final version was used after completing all of the steps of cross-cultural adaptation. The psychometric property analysis was performed by measuring the validity, reliability, sensitivity, and specificity of the questionnaire in 172 dental patients using cross-sectional survey at the National Drug Rehabilitation Center.

RESULTS

The content validity was first measured by an internist and anesthesiologist, and the coefficient was 0.91. The construct validity assessment revealed significant associations for five of six global questions (P < 0.05). Cronbach's alpha coefficient for internal consistency was 0.790. The test-retest reliability results were excellent based on reevaluation in 17 patients (intraclass correlation coefficient = 0.846), including sensitivity and specificity values of 69.31% and 92.2%, respectively.

CONCLUSION

The Indonesian version of the EMRRH questionnaire is valid, reliable, sensitive, and specific for this population. Further study to explore its use in larger Indonesian populations is needed.

Preparedness of dental clinics for medical emergencies in Riyadh, Saudi Arabia

Aim

To assess knowledge, training of dental staff and the availability of emergency drugs and equipment in dental clinics, Riyadh, Saudi Arabia.

Methods

Cross-sectional survey was conducted in a random sample (N: 325) of governmental and private clinics in Riyadh, Saudi Arabia, between June-December 2016. Questions included Dentist’s specialty, age, years of experience, knowledge and preparedness to handle ME (level of training, types of emergency drugs and equipment available).

Results

One dentist from each clinic filled the questionnaire (100% of the sample), 19% of whom were general dentists. Medical history is taken orally by 86% of respondents before dental treatment and 12% take vital signs every visit.

Of the surveyed clinics, 30% didn’t have emergency contact numbers available, 78% didn’t have an emergency protocol and only 54% have a medical emergency plan with 11% performing periodic office emergency drills.

The most available emergency drug and equipment were Aspirin (53%) and Sphygmomanometer (86%). Oxygen delivery device was not available in 90% of the surveyed clinics.

Conclusion

There is an alarming inadequacy of clinic/staff preparation to deal with ME. Efforts should be made to increase the awareness of dentists to take needed precautions and prepare their clinics.