Most important, if the patient has a medical diagnosis or is currently on any medications, it is highly recommended for the dental hygienist or even the treating dentist to contact the patient’s primary physician or cardiologists to discuss drug regimens and plan optimal patient management before altering any medications. Also, it is suggested that updating medical records should include requesting latest copies of clinical test reports such as INR and patient’s current and compete medical diagnoses list, along with other medications.57 This requires active communication, building trust and frequent engagement with other healthcare professionals such as physicians, nurses, aides, pharmacists and anyone involved in providing care for the elderly patient. Even a minor fluctuation in the dosage of a patient’s current medication can hamper the outcome of the dental procedure. In order to have a better understanding of a patient’s dental outcome, a direct conversation with the previous dentist can be beneficial in understanding the behavioral patterns and any modifications in the treatment approach. Of utmost importance is the maintenance of comprehensive and accurate medical and treatment records, as all practitioners are required by law to maintain these records in order to provide evidence of continuity of care as well these records may be subpoenaed in medico-legal or insurance fraud cases.43
For wheelchair bound patients, the wheelchair should be moved as close as possible to the dental chair44 for the dental staff to have full access to their dental equipment. In some cases where the patient cannot be transferred to the dental chair, special head and neck support systems (Figure 4) can be employed that will provide support for the patient’s neck and head to minimize patient discomfort.
The staff should also be trained in understanding the basic concepts of Safe Patient Handling (SPH) and be aware and accountable for providing appropriate assistance during the movement of patients.45,46 For patients having difficulty standing up or have reduced weight bearing capacities, they should be assisted when moving from their wheelchair to the dental chair and then back to their wheelchair using patient transfer devices or other mechanical, devices. The determination to have either a one-person or two-person transfer should be made considering the staff training and the disability of the patient. Transfer Boards, Pivot Discs, Transfer belts (Figure 5), EZ lift (Figure 6) or Hoyer lifts (Figure 7) can be used by the staff in transferring the patient to or from the wheelchair.