Cardiac risk factors for dental procedures: knowledge among dental practitioners in Wales

[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.

Managing Cardiac Patients: Dentists' Knowledge, Perceptions, and Practices

OBJECTIVES

Dental patients may require invasive treatment, and awareness of their medical conditions is essential for optimal care. We assessed the knowledge, perceptions, and attitudes of dentists practicing in Saudi Arabia (SA) and their associations with managing patients with common cardiac conditions.

METHODS

A national survey of knowledge and attitudes of practicing dentists towards patients with common cardiac conditions was conducted from May 2019 to July 2020 in SA. The survey comprised a newly developed, validated, electronic, self-administered English questionnaire.

RESULTS

Overall, 282 dentists completed the survey, of whom 45.5% perceived cardiac patients as difficult to manage, while 64.5% stated that they refer these patients to cardiologists before dental intervention. Regarding knowledge about cardiac conditions, 72% achieved an overall knowledge score <55%; however, their infective endocarditis scores were better. Consultants and specialists (P < .001), those with a PhD/board certification (P = .013), dentists with prior education on cardiac patient management (P = .002), and those working with a cardiologist (P = .016) scored higher on knowledge. Conversely, private dentists (P = .003) and those referring patients to cardiologists before treatment (P = .003) scored lower. Dentists' knowledge of cardiovascular diseases in women was low; only those who believed women experience a greater risk of cardiac complications achieved a higher score. Approximately 90.1% wished to receive education regarding cardiac patient management.

CONCLUSIONS

Knowledge of cardiac patient management was suboptimal in this study. Dentists perceived cardiac patients as difficult to manage, but wished to learn more regarding optimal management. Thus, postgraduate education programmes that promote optimal dental management strategies for cardiac patients are necessary.

Dentists' practice and compliance with current guidelines of infective endocarditis prophylaxis- National survey study

Background

The objective of this study was to assess the attitude, practice, and knowledge of Croatian dentists regarding infective endocarditis (IE) prophylaxis.

Material and Methods

A cross-sectional, self-reporting questionnaire survey was conducted with the participation of 348 Croatian dentists. The questionnaire was designed to collect information on participants’ work experience, place of work, their attitudes related to the treatment of IE-risk patients, knowledge and adherence to IE antibiotic prophylaxis guidelines.

Results

Knowledge and adherence to the current guidelines decreased with the higher years of experience. Compliance with the current guidelines varied, mostly because of respondents’ insecurity regarding which guidelines to follow. AHA guidelines have been most frequently the first choice (25% participants). Surprisingly, 23% of dentists didn’t follow any of the official guidelines. The majority of participants (68%) have declared a lack of preparedness or willingness to treat the patients at risk of IE. Dentists with specialty or working at university/hospital have shown a higher level of knowledge and preparedness to treat IE-risk patients.

Conclusions

The lack of knowledge of guidelines and consequent inconsistencies in IE antibiotic prophylaxis in Croatian dental practice indicates the need for urgent improvement.

Key words:Antibiotic prophylaxis, dentistry, infective endocarditis.

The influence of systemic diseases on the diagnosis of oral diseases: a problem-based approach

Although all dentists are taught about the importance of oral health to general health and that systemic disease can manifest in the oral cavity, the 4-year dental school curriculum does not allow time to gain competency in these relationships. Nevertheless, all dentists must have skills in taking a medical history and an appreciation of oral findings that might have a systemic origin. This article focuses on the identification of abnormal signs and symptoms in the oral cavity and the determination of those that have a systemic origin. It is imperative that clinicians are mindful of the possible oral-systemic associations, because these could potentially have a huge impact on patient care.