I’ve been working at a practice with one dentist for about a year now. Every time I have a patient with recent heart surgery or rods/pins that I’m concerned about either delaying treatment or needing a premed, he always says no. The only thing he thinks they should premed for are total joint replacements, and never is there a need to delay treatment. Should I mention I’m not allowed to take BP! I’m in situations where I’m uncomfortable with treatment regularly and today made me think hard about looking for something else. Is anyone else in these situations? What is the protocol in your office?
Sue, thanks! I have searched the ADA and the American heart association, but nothing conclusive about delaying tx, just about what to and what not to premed for. It looks like asking the patients physician is the most responsible way to go, but my dentist wouldn’t put up with that if it meant rescheduling and concerning the patient.
When in doubt always contact the patient’s physician and document that you did so. Don’t do anything you aren’t comfortable with! Here is a link to the ADA’s recommendations (you may want to print it for your doctor!): http://www.ada.org/en/member-center/oral-health-topics/antibiotic-prophylaxis
They have changed protocol for stemmed so many times. Your best resources would be the ADS and American Heart Association. Show him the literature if it is not in accordance with his protocols. Of course you can always check with the pts. MD too.
It is tough working with a boss that doesn’t treat you like a knowledgeable professional, if you are asked to do things you are not comfortable with, document, document, document!
We always ask for clearance from the patient’s physician. It’s just safer that way for everyone. Why aren’t you allowed to take BP?
When he’s at his office it’s either nap time or social hour, so the vast majority of the patients are his friends or family (he’s Greek, he has a lot of family). He wouldn’t want to “inconvenience” them with BP. In the same way, he doesn’t like me to tell people about their perio issues as it would inconvenience them and insult them. He usually tries to downplay or disregard perio issues entirely ( but I still tell them what they need to hear, and some people are in bad shape). What if we had to tell a pt their BP was too high! We would have to reschedule! gasp! Or they may be insulted!
He’s a dentist who doesn’t want any problems….he’s nearing retirement…..so the way he’s used to is the way it’ll stay.
Protocols are continuously changing. Current literature states full joint replacement, heart valve replacement, or hx of endocarditis. No longer are all heart murmurs or partial joints needing premed. Here, the cardiologists rec not procedure for 3-6 months after tx but no premed needed.
If he isn’t retiring tomorrow, you might need to move on. He is practicing managed neglect…
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