ONLINE CLASS

ORIENTATION
HOSPITAL DENTISTRY 1 LEC
2 N D SEMESTER 2020-2021
WELCOME TO THE SCHOOL OF
DENTISTRY
VIRTUAL CLASS HOUSE
RULES
GOAL?
 HOSPITAL DENTISTRY 1
Hospital Dentistry is an area of dentistry where we integrate medicine and dentistry.

Given such, we provide comprehensive dental care on patients with medical conditions,
psychiatric disorders, or physical limitations and necessitating dental care.
M1 – Introduction to
Hospital Dentistry
L E S S O N 1 - D E F I N I T I O N A N D C H A R A C T E R I S T I C S O F A H O S P I TA L
L E S S O N 1 . 2 - C H A R A C T E R I S T I C S O F A H O S P I TA L
L E S S O N 2 - M I S S I O N A N D F U N C T I O N S O F T H E H O S P I TA L
L E S S O N 3 - D E F I N I T I O N A N D O B J E C T I V E S O F H O S P I TA L D E N T I S T RY
 Lesson 1 - Definition and
Characteristics of a Hospital
DEFINITION OF HOSPITAL:       
The term Hospital was derived from the
word ‘hospes’ which means “host”,
“guest”, or “stranger”.
Hospital is defined as a charitable
institution for the needy, aged, infirm, or
young, also an institution where the sick
or injured are given medical or surgical
care.
 Lesson 1.2 - Characteristics of a
Hospital
CHARACTERISTICS OF A HOSPITAL

1. A charitable institution for the housing &

maintenance of the needy, infirm or aged;

2. A charitable institution for the maintenance &

education of the young

3. A place for rest, lodging & entertainment

4. A university hall, interchangeable w/ a hostel

5. An institution for the care of the sick & wounded

or those needing medical treatment.
 Lesson 2 - Mission and Functions of
the Hospital
BASIC FUNCTIONS OF A HOSPITAL 3. EDUCATIONAL – gives training to:
1. RESTORATIVE - most important; it is the reason for the
  a.  Medical undergraduates
existence of the hospital
a. For diagnosing as an in or out-patient   b.  Post-graduates
b. Tx of disease (curative, palliative)
c. Rehabilitation ( physical,mental,social)   c.  Nurses & midwives
d. Emergency care (accident & disease)
  d.  Medical social workers
2. PREVENTIVE -
a. Supervision of normal pregnancy & childbirth   e.  Other allied professionals
b. Supervision of growth & dev’t. of child & adolescent
4. RESEARCH
c. Control of communicable disease
d. Prevention of prolonged illnesses   a.  Physical, psychological & social aspects of health
e. Prevention of invalidism (mental & physical) disease
f. Health education
g. occupational health   b.  Hospital practices (technical & administrative)
 Lesson 3 - Definition and Objectives
of Hospital Dentistry
HOSPITAL DENTISTRY IS… The Hospital setting allows dental practice to
interrelate with other clinical and surgical
 It is part of the complete health care program of the specialties, and offers the support of central or
hospital; core services that can facilitate diagnosis and
 It should be preventive-oriented; treatment.

 It should function in close alliance with other health

specialty areas (Team Management Concept)
Such interrelation is particularly relevant with the
 It is part of the community practice of Dentistry Departments of Oral and Maxillofacial Surgery
and Stomatology; indeed, the Hospital Dental
Surgery Unit sometimes forms part of such
Departments.
M2 – Hospital
Familiarization
LESSON 1 – CLASSIFICATION OF PHILIPPINE HOSPITAL
LESSON 2 – HOSPITAL GOVERNANCE
LESSON 3 – HOSPITAL DEPARTMENTS
 M2 – Hospital Familiarization
The common type of hospital is the General hospital,
which typically has an emergency department to treat
urgent health problems ranging from fire and accident
victims to a sudden illness.

A District hospital typically is the major health care

facility in its region, with many beds for intensive care and
additional beds for patients who need long-term care.

Specialized hospitals include trauma centers, rehabilitation

hospitals, children’s hospital, geriatric hospitals, and
hospitals for dealing with specific medical needs such as
psychiatric treatment and certain disease categories.
 Lesson 1 – Classification of
Philippine Hospital
A. ACCORDING TO OWNERSHIP C.  ACCORDING TO FUNCTIONAL CAPACITY
1. Government - created by law.
1. General Hospital
2. Private - owned, established and operated with funds through
donation, principal, investment or other means by any individual,
corporation, association or organization.
a. Level l

b. Level 2
B. ACCORDING TO SCOPE OF SERVICES
c. Level 3
1. General - a hospital that provides services for all kinds of
illnesses, diseases, injuries or deformities.
2. Specialty Hospitals
2. Specialty - a hospital that specializes in a particular disease
or condition or in one type of patient. 3. Trauma Capability of Hospitals
 Lesson 2 – Hospital Governance
1. PUBLIC HOSPITALS 2. PRIVATE HOSPITALS - established and managed by private individuals or group of 
businessmen
1.1. Retained hospitals =under the governance of  Department  of ex. St. Luke’s Medical Center
Health  ex. Philippine General Hospital
GOVERNANCE OF PRIVATE HOSPITAL LIES WITH:
1.2 Devolved Hospitals – under the governance of the  local  or city 1.Governing Body -  ( Board of Trustees, Board of Directors, Board of Governors )
government ex. Ospital ng Maynila Medical Center,
– policy & decision-makers in the hospital

“Chairman of the Board” – head of the governing body.

GOVERNANCE OF PUBLIC HOSPITAL LIES WITH: 2. Chief of Staff - ( Medical director or the President of the Medical Staff )

                                  -  serves as a liaison between the medical staff, the Board & the CEO
 1.Chief of the Hospital  (Hospital Director) – physician who runs the
3.Hospital Administrator - ( President/ Executive Director / Chief Executive  Officer )
institution
                                 – he should be a “creative” executive, youthful, with originality &
 2. Chief of Clinics – Chief of the professional services
                                openness & sensitive  to the problems of the hospital community.
 3. Administrative Officer – runs the business aspect of the hospital Roles:  1. responsible for the overall operation of the hospital;

 4. Head of the Nursing Services          2. responsible & answerable to the board w/c delegates powers
 Lesson 3 – Hospital Departments
Two Main Divisions of Hospital Departments:
1. Those concerned with professional care of the patient:
a. The Medico-Administrative Group
b. The Medical Services
c. The Nursing Services
d. The Dietary Services

2. Those concerned with business management

a. Personnel Department
b. Public Relations
c. Accounting
d. Purchases and Supply
e. Mechanical Maintenance
f. General Maintenance
g. Housekeeping
h. Laundry
 Lesson 3 – Hospital Departments
DIVISION OF WORK IN THE HOSPITAL 3. DOMESTIC - provide overall support to the clinical & ancillary divisions in
terms of:
1. CLINICAL – carry out the diagnosis & treatment 3.1.Housekeeping
1.1.In-patient 3.2.Maintenance
1.2.Out-patient 3.3.Motor pool
1.3.Emergency 3.4.Engineering
1.4.domiciliary 3.5.Security

2. Ancillary – provide the technical support to the clinical services 4. ADMINISTRATIVE - provide overall support to the clinical, ancillary, &
division domestic in terms of:
Examples: x-ray, ECG, CSR, Pharmacy, Dietary, Ambulance, 4.1. Planning & administration
Medical Records
4.2. Accounting
4.3. Financing & disbursing
4.4. Supply
4.5. Public relations
M3 – Medical
Terminologies
LESSON 1 – MEDICAL TERMINOLOGIES, ABBREVIATIONS
AND SYMBOLS
 M3 – Medical Terminologies
The medical record allows the health care team to cogently communicate and document the patient’s
condition, progress, treatment plans, and orders for the planned therapy. Chart entries must be legible
and clear and can systematically communicate information.

To decrease the time required for writing notes and orders, every hospital has a standard set of
accepted terms and abbreviations that it accepts for use as part of the medical record.
 Lesson 1 – Medical terminologies,
Abbreviations and symbols
Medical Abbreviations Medical Abbreviations DON’Ts
• A standard set of accepted terms and abbreviations for •Cannot be used in Patient materials and documents
use in the medical records
•Abbreviations cannot have more than one meaning
• Medical notes, discharge summaries, medication within an organization-hospital
orders
• Improve communication and understanding between
health care practitioners
• To decrease time required for writing notes and orders

• Every organization would have their own set of

approved abbreviations
 Lesson 1 – Medical terminologies,
Abbreviations and symbols
Examples of Medical Abbreviations Examples of Medical Terminologies
 Lesson 1 – Medical terminologies,
Abbreviations and symbols
Examples of Medical Symbols Examples of Error-Prone Abbreviations
M4 – Data Privacy Act
LESSON 1 – REPUBLIC ACT 10173
LESSON 2 – HEALTH PRIVACY CODE OF THE PHILIPPINES
LESSON 3 – ACCESS OF HEALTH INFORMATION
Lesson 1 – Republic Act 10173
 Lesson 2 – Health Privacy Code of the
Philippines
SCOPE: 

        The Health Privacy Code applies to the Philippine Health

Information Exchange (PHIE) system, Health facilities, and health care
providers involved in the processing of health information.

Who is a health care provider?

         Any health care institution devoted primarily to the management,

treatment and care of patients, or a health care professional, who is any
doctor of medicine, nurse, midwife, dentist, or other health care
practitioner

What is a medical record or health record?

        It is a primary repository of information concerning patient

healthcare, which consists of a compilation of pertinent facts regarding
a patient’s life history including past and present illnesses and
treatments entered by a health professional contributing to the patient’s
care.
 Lesson 2 – Health Privacy Code of the
Philippines
COLLECTION AND PROCESSING OF HEALTH Who shall obtain consent?
INFORMATION
Who can give consent?
CONSENT:
When consent shall be obtained?
Any freely-given, specific, informed indication of will, whereby Valid format of consent
an individual agrees to the collection and processing of personal
information relating to him or her.         -  Consent can either be in written, recorded, and/or in
electronic form.
Requirements of a valid informed consent
        -  It must be signed by the patient, guardian, or authorized
• Competence representative.
• Amount and Accuracy of Information         - If a patient is incapable of affixing his or her signature, a
• Patient understanding finger print, thumb mark, electronic signature, or other biometrics
may be considered, provided that a witness of legal age and sound
• Voluntariness mind is present
 Lesson 2 – Health Privacy Code of the
Philippines
Revocation and reinstating consent by the patient:

       If a previously given by an authorized representative on behalf of an unconscious or

otherwise incapacitated patient, such consent may be subsequently revoked by the latter
once he or she recovers consciousness or regains the capacity to give consent.

Exceptions for consent

       Consent shall not be required for the processing of personal data under the following
conditions:

• For purpose of medical treatment, carried out by a medical practitioner or a medical

treatment institution

• When necessary to protect the life and health of the patient or another person, and the
patient is not legally or physically able to express his or her consent prior to the processing;

• When processing is requires by existing law and regulation, such as, but not limited to:
• Act 3573: law of reporting of communicable diseases;
• Administrative Order No. 2008-0009: Adopting the 2008 revised list of notifiable
diseases, syndromes, health-related events and conditions.
 Lesson 2 – Health Privacy Code of the
Philippines
IDENTIFICATION OF HIGHLY COMMUNICABLE DISEASE AND Filing and Storage
SPECIAL CONDITIONS
       All information collected at different levels of care shall be
Amendment of data by health care personnel:
integrated into a common file. An electronic archiving system shall be
    Data collection and processing shall be done by an authorized employee of the developed for the storage of electronic data.
health facility and shall ensure that Clinical Practice Guidelines are observed
when changing data, specifically:        Health care providers shifting to electronic records shall ensure
that their paper records are stored properly. Paper records shall be
• Original entry must be visible digitized for the purpose of preservation and not destruction.
• Change must be dated and countersigned, or logged
       Providers of electronic medical records shall have a filing and
• Reason for the change must be entered or specified. storage protocol.
Sharing of information Data retention of health information
•         Health information shall be shared exclusively for continuity of medical       Subject to existing regulations, all medical records, whether in
services.
electronic and/or paper format, shall be stored for fifteen (15) years.
•         Health information shall be retained and shared only for purposes
prescribed upon its collection.
For medico-legal cases, records shall be stored for a lifetime.
 Lesson 3 – Access of Health Information
Access of Health Care Providers USER CONTROL ACCESS AND APPROVAL
Upon patient consent, only a health care provider and authorized entities  shall have PATIENT ACCESS RIGHTS
access to the patient’s health information.
ACCESS OF PATIENT DATA PERTAINING TO MINORS
Accessible information for Health Care Providers.
ACCESS OF PATIENT DATA PERTAINING TO
• History of past illness INCAPACITATED PERSONS
• Family history of illness THIRD PARTY USE, ACCESS AND DISCLOSURE:
• History of present illness • Any third party will be allowed access to health information of a patient in cases
required by law, or when such access is authorized under a valid contract to
• Clinical history, including immunization records, previous operations and
which the patient is a party
treatment;
• A third party shall not disclose health information unless provided in a contract or
• Allergies required by law. It shall use appropriate safeguards to prevent use and disclosure
• Medication history including adverse effects, if any of the health information other than as provided by contract or as required by law.

• Such third party shall report to the health care provider any unauthorized use or
• Results of laboratory and diagnostic procedures
disclosure of health information it becomes aware of, including personal data and
• Treatment outcome (Final diagnoses shall be included whether clinical or security incidents.
confirmed)
 Lesson 3 – Access of Health Information
USE AND DISCLOSURE OF HEALTH INFORMATION Disclosure of a Deceased individual’s health information

        Disclosure of health information of a deceased individual shall be made to the authorized

Use and disclosure of health information shall be limited to that covered by the
representative.
consent given by the patient, or his or her authorized representative, and shall
only be for the following purposes: Disclosure of health information in medico-legal cases

• Planning of quality services          In medico-legal cases, information may be disclosed to the authorized personnel in-charge upon
authorization from the patient or authorized representative (in case the patient is deceased).
• Reporting of communicable, infectious and other notifiable diseases, including Disclosure of health information to legal authorities  and/or Government agencies
those that pose a serious health and safety threat to the public
Privileged communication rule:
• Continuing care to patients
        Where information qualifies as privileged communication, the consent of both the patient and
• Reporting of physical injury physician must be secured prior to the use and/or disclosure of patient information for whatever
purpose.
• Reporting of interpersonal violence to proper authorities Disclosure of Professional, Educational or Academic purposes

• Reporting of diseases as registered in the Philippine Integrated Diseases       There shall be guidelines for the retrieval of information necessary for complying with the
Surveillance and Response requirements of the Professional Regulation Commission (PRC).

• Mandatory reporting required by licensing and accreditation bodies (e.g.,        A nondisclosure clause shall be included in the contract of a school affiliated with a PHCP.

Department of Health, Philippine Health Insurance Corporation, Department of        Personnel and/or students of such a school that access data in the custody of the PHCP for
Interior and Local Government, Department of Social Welfare and Development, academic or clinical requirement purposes shall also sign a nondisclosure agreement.
etc.).
M5 – Case History
LESSON 1 – CASE HISTORY TAKING
 Lesson 1 – Case History Taking
STEPS IN CASE HISTORY TAKING  METHODS OF OBTAINING THE PATIENT
a. Assemble all the available facts gathered from HISTORY 
statistics, chief complaint, medical history, dental
There are 3 methods: 
history, and diagnostic tests.
a. Interview 
b. Analyze and interpret the assembled clues to reach
the provisional diagnosis.  b. Health questionnaire 
c. Make a differential diagnosis of all possible c. Combination of these 
complications. 

d. Select a closest possible choice-final diagnosis. 

f. Plan an effective treatment accordingly. 

 Lesson 1 – Case History Taking
COMPONENTS:  COMMON CHIEF COMPLAINTS 
•Statistics  •Extraoral examination  •Pain 
•Chief complaint  •Intraoral examination  •Swelling 
•History of present •Provisional diagnosis  •Ulcer 
illness 
•Investigations 
•Medical history 
•Final diagnosis 
•Past dental history 
•Treatment plan 
•Personal history 
•General examination 
 Lesson 1 – Case History Taking
EXTRAORAL EXAMINATION 
SKIN
FACIAL SYMMETRY
LIP COMPETENCY
EYE 
NOSE 
 JAWS 
TMJ 
 Lesson 1 – Case History Taking
INTRAORAL EXAMINATION
Soft Tissues

Labial and buccal mucosa, Lip, Floor of mouth,

Tongue, Gingiva, Salivary glands

Hard Tissues

Teeth present, teeth missing, carious teeth, wasting

disease, mobility, occlusion
 Lesson 1 – Case History Taking
INVESTIGATIONS: 
CHAIR SIDE INVESTIGATIONS: 
•PULP VITALITY TESTS 

•PERCUSSION TESTS  
 Lesson 1 – Case History Taking
 FINAL DIAGNOSIS: 
•The final diagnosis can usually be
reached following chronological organization and
critical evaluation of the information obtained from
the following: patient history,
physical examination and,  the result of radiological
and laboratory examination 
•The diagnosis usually identifies the diagnosis for
the patient primary complaint first, with subsidiary
diagnosis of concurrent problems. 
 Lesson 1 – Case History Taking
TREATMENT PLAN 
The formulation of treatment plan will depend
on both knowledge & experience of a competent
clinician and nature and extent of treatment
facilities available. 
Medical assessment is also needed to identify the
need of medical consultation and to recognize
significant deviation from normal health status that
may affect dental management. 
 Lesson 1 – Case History Taking
PRELIMINARY PHASE (Emergency phase)
Treatment phases: 
Preliminary phase 
Nonsurgical phase 
Surgical phase 
Restorative phase 
Maintenance phase 
 Lesson 1 – Case History Taking
NON-SURGICAL PHASE SURGICAL PHASE
 Lesson 1 – Case History Taking
RESTORATIVE PHASE MAINTENANCE PHASE
Lesson 1 – Case History Taking
M6 – Infection Control
LESSON 1 – INFECTION CONTROL TERMINOLOGIES
LESSON 2 – CHAIN OF INFECTION
 Lesson 1 – Infection Control
Terminologies
Infection - The invasion and multiplication of microorganisms

CDC - Centers for Disease Control.  It is one of the major operating components of the
DOH and Human services.

Disinfection - Refers to the process that eliminates many or all pathogenic microorganisms
on inanimate objects with the exception of bacterial spores.

DOH - Department of Health. The principal Health agency in the Philippines

HAI - Hospital Acquired Infection

HCAI  -  Health Care Associated Infection.  An infection occurring in a patient during the
process of care in a hospital.

Healthcare Facility -  Refers to the facility that employs health workers and cares for
patients or clients.

Healthcare Worker - Refers to any person working in a healthcare facility. e.g.  Medical
officer, nurse, physiotherapist, cleaners, psychologist

Hand Hygiene -  refers to the general term that applies to handwashing, antiseptic
handwash, antiseptic hand rub or surgical antisepsis.
 Lesson 1 – Infection Control
Terminologies
ICT - Infection Control Team - This is a group of people responsible for the day-to-day infection
control activities.  

Nosocomial - Infections that have been caught in a hospital or healthcare facility and are potentially
caused by organisms. 

Portal of Entry - The site through which microorganisms enter the susceptible host and cause
disease or infection.

PPE - Equipment that will protect the user against health or safety risks at work. Refers to a
protective barrier provided whenever necessary by reason of the hazardous nature of the process of
environment, chemical, radiological, or other mechanical irritants or hazards capable of causing
injury or impairment in the functions of any part of the body through absorption, inhalation, or
physical contact. (DOH)

Reservoir -  Place where organisms can thrive and reproduce. 

Sanitation - refers to the maintenance of hygienic conditions through services such as garbage
collection and wastewater disposal (WHO)

Sterilization -  Reduction in microorganisms of more than 99.9% or a decrease in microbial load

achieved by physical, chemical or mechanical methods or by irradiation. (DOH)

Virulence - the severity or harmfulness of a disease

WHO - World Health Organization

 Lesson 2 – Chain of Infection
Infection control prevents or stops the spread of
infection in healthcare settings.

It encompasses all policies and procedures to prevent the

spread of infection.

-prevent the transmission of disease producing agents

such as bacteria, viruses and fungi from one patient to
another, from dental practitioner and dental staff to
patients, and from patients to dental practitioner or other
dental staff.

-it is necessary that endogenous spread of infection is

also prevented by limiting the spread of infectious agents
 Lesson 2 – Chain of Infection
How Infection is Spread?
Infection occurs when germs Enter the
body, Increase in number and Cause a
reaction of the body
Three things necessary for infection
Source
Susceptible person
Transmission
 Lesson 2 – Chain of Infection
BEFORE TREATMENT:
1. Remove unnecessary items from the dental procedure area

2. Pre-plan the materials needed during treatment. Set out all instruments,
medications, impression materials, and other items that are needed for a
procedure.

3. Utilize disposable items whenever possible

4. Use pre-arranged tray set-ups for routine or frequently performed procedures.

5. Use individualized, sterilized bur blocks for each procedure

6. If indicated, have the rubber dam setup on the tray.

7. Identify those items that will become contaminated during treatment.

8. Review patient records before initiating treatment and place radiographs on the
view box.

9. Prepare personnel involved in patient care. An essential pretreatment

procedure is the preparation of all personnel involved in patient care.
 Lesson 2 – Chain of Infection
DURING Treatment: (Chairside) POST Treatment:
1) Use care when receiving, handling, or passing sharp 1. Continue to wear personal protective equipment
instruments. during clean-up.
2) Take special precautions with syringes and needles. 2. Remove all disposable barriers.
3) Use a rubber dam whenever possible. 3. Clean and disinfect all items not protected by
4) Avoid touching unprotected switches, handles and barriers.
other equipment once gloves have been contaminated.

5) Avoid entering cabinets once gloves have been

contaminated
 Lesson 2 – Chain of Infection
Disinfection – the process of 5 METHODS OF STERILIZATION:
eliminating or reducing harmful
HEAT
microorganism from inanimate objects
and surfaces. CHEMICALS
IRRADIATION

Sterilization is the process of killing HIGH PRESSURE

All microorganisms FILTRATION
 Lesson 2 – Chain of Infection
PERSONNEL HEALTH ELEMENTS OF AN
INFECITON CONTROL PROGRAM:
1. EDUCATION AND TRAINING -­Personnel are more
3. EXPOSURE PREVENTION and
likely to comply with an infection control program and POST
exposure control plan if they understand its rationale
EXPOSUREMANAGEMENT
2.IMMUNIZATION PROGRAMS for HCW
Handwashing
MMR vaccine

Tdap vaccine PPE

Flu vaccine

Meningococcal

BCG vaccine
M7 – Hospital Diagnostics
LESSON 1 – HOSPITAL DIAGNOSTIC PROCEDURE
AND EQUIPMENT'S
Lesson 1 – Hospital Diagnostic Procedure
and equipment's
Lesson 1 – Hospital Diagnostic Procedure
and equipment's
Lesson 1 – Hospital Diagnostic Procedure
and equipment's
 Lesson 1 – Hospital Diagnostic Procedure
and equipment's
CT SCAN
A computer tomography (CT or CAT) scan allows doctors
to see inside you body. It uses a combination of x-rays and
a computer to create pictures of your organs, bones, and
other tissues.

CT scanner uses a motorized x-ray source that rotates

around the circular opening of a donut-shaped structure
called a gantry. During a CT scan, the patient lies on a bed
that slowly moves through the gantry while the x-ray tube
rotates around the patient, shooting narrow beams of x-
rays through the body. Instead of film, CT scanners use
special digital x-ray detectors, which are located directly
opposite the x-ray source.
 Lesson 1 – Hospital Diagnostic Procedure
and equipment's
USES: CT SCAN WITH CONTRAST
CT scans can detect bone and joint problems, like complex bone Contrast materials are usually made of iodine or barium
fractures and tumors.
sulfate. You might receive these drugs in one or more of
Conditions like cancer, heart disease, emphysema, or liver masses, CT three ways:
scans can spot it or help doctors see any changes.
Injection: The drugs are injected directly into a vein. This is
They show internal injuries and bleeding, such as those caused by a car
done to help your blood vessels, urinary tract, liver, or
accident.
gallbladder stand out in the image.
They can help locate a tumor, blood clot, excess fluid, or infection.
Orally: Drinking a liquid with the contrast material can
Doctors use them to guide treatment plans and procedures, such as
enhance scans of your digestive tract, the pathway of food
biopsies, surgeries, and radiation therapy.
through your body.
Doctors can compare CT scans to find out if certain treatments are
working. For example, scans of a tumor over time can show whether it's Enema: If your intestines are being scanned, the contrast
responding to chemotherapy or radiation. material can be inserted in your rectum.
 Lesson 1 – Hospital Diagnostic Procedure
and equipment's
Cone Beam CT
Dental cone beam computed tomography (CT) is a
special type of x ray machine used in situations where
regular dental or facial x-rays are not sufficient. It is not
used routinely because the radiation exposure from this
scanner is significantly more than regular dental x rays.
It does not provide the full diagnostic information
available with conventional CT, particularly in
evaluation of soft tissue structures such as muscles,
lymph nodes, glands and nerves. However, cone beam
CT has the advantage of lower radiation exposure
compared to conventional CT.
 Lesson 1 – Hospital Diagnostic Procedure
and equipment's
USES: BENEFITS:
 Surgical planning for impacted teeth. The focused x-ray beam reduces scatter radiation, resulting in
better image quality.
 Diagnosing temporomandibular joint disorder
A single scan produces a wide variety of views and angles that
 Accurate placement of dental implants. can be manipulated to provide a more complete evaluation.

 Evaluation of the jaw, sinuses, nerve canals and nasal Cone beam CT scans provide more information that conventional
cavity. Detecting, measuring and treating jaw tumors. dental x-ray, allowing for more precise treatment planning.
CT scanning is painless, noninvasive and accurate.
 Determining bone structure and tooth orientation.
A major advantage of CT is its ability to image bone and soft
 Locating the origin of pain or pathology.
tissue at the same time.
 Cephalometric analysis. No radiation remains in a patient's body after a CT examination.
 Reconstructive surgery. X-rays used in CT scans should have no immediate side effects.
Lesson 1 – Hospital Diagnostic Procedure
and equipment's
 Lesson 1 – Hospital Diagnostic Procedure
and equipment's
MRI
An MRI or magnetic resonance imaging is a
radiology technique scan that uses magnetism, radio
waves, and a computer to produce images of body
structures.

The MRI scanner is a tube surrounded by a giant

circular magnet.
 Lesson 1 – Hospital Diagnostic Procedure
and equipment's
USES: RISKS
An MRI scan can be used as an extremely accurate method of Patients who have any metallic materials within the body must
notify their physician prior to the examination or inform the MRI
disease detection throughout the body
staff. * Metallic chips, materials, surgical clips, or foreign material
It is most often used after the other testing fails to provide sufficient (artificial joints, metallic bone plates, or prosthetic devices, etc.) can
significantly distort the images obtained by the MRI scanner.
information to confirm a patient's diagnosis.
Patients who have heart pacemakers, metal implants, or metal chips
In the head, trauma to the brain can be seen as bleeding or swelling. or clips in or around the eyeballs cannot be scanned with an MRI
Other abnormalities often found include brain aneurysms, stroke, because of the risk that the magnet may move the metal in these
tumors of the brain, as well as tumors or inflammation of the spine areas.

It provides valuable information on glands and organs within the Similarly, patients with artificial heart valves, metallic ear implants,
abdomen, and accurate information about the structure of the joints, bullet fragments, and chemotherapy or insulin pumps should not
have MRI scanning.
soft tissues, and bones of the body.
During the MRI scan, patient lies in a closed area inside the
Often, surgery can be deferred or more accurately directed after magnetic tube. Some patients can experience a claustrophobic
knowing the results of an MRI scan. sensation during the procedure.
Lesson 1 – Hospital Diagnostic Procedure
and equipment's
Lesson 1 – Hospital Diagnostic Procedure
and equipment's
Lesson 1 – Hospital Diagnostic Procedure
and equipment's
Lesson 1 – Hospital Diagnostic Procedure
and equipment's
Lesson 1 – Hospital Diagnostic Procedure
and equipment's
 Lesson 1 – Hospital Diagnostic Procedure
and equipment's
LABORATORY TEST
ADRENAL CORTEX
ADRENAL TESTS
Secretes mineralocorticoids, glucocorticoids and
Adrenal medulla androgens
◦ Secretes catecholamines
◦ 24-hour urinary excretion of epinephrine, Tests to assess function of adrenal cortex:
◦ Plasma and urine aldosterone
norepinephrine and vanillymandelic acid (VMA) is
◦ Plasma renin activity
used to assess its function
◦ Serum testosterone
◦ Serum estradiol
◦ Plasma cortisol (morning and evening)
◦ Plasma adrenocorticotropic hormone (ACTH) (morning)
◦ Urinary excretion rates of 17-hydroxycorticosteroids, 17-
ketogenic steroids and 17-ketosteroids
 Lesson 1 – Hospital Diagnostic Procedure
and equipment's
PANCREATIC TESTS
Amylase Glycosylated hemoglobin
◦ Secreted by pancreas, bowe, parotids and gynecologic system
◦ Assesses long-term control of insulin therapy
◦ Common screening and monitoring parameter for acute
pancreatitis ◦ Differentiates factitious hyperglycemia from diabetes

C-Peptide Insulin
◦ Sometimes used to assess pancreatic function Released from beta ◦ Obtained during assessment of pancreatic function
cells in equimolar amounts with insulin

Glucose Lipase
◦ Used to assess pancreatic function and the response to insulin ◦ Specific marker for acute pancreatic disease
replacement therapy al Fasting serum glucose-10-14 hours of
fasting (before breakfast)
◦ b) Glucose tolerance test - 10-16 hours of fasting
◦ c) Random serum glucose any time without fasting
 Lesson 1 – Hospital Diagnostic Procedure
and equipment's
THYROID TESTS GASTROINTESTINAL SYSTEM
Free thyroxine index (FT41)
◦ Product of measured free hormones thyroxine (T4) and triiodothyronine Biliary System - BILIRUBIN (>2mg/dL)
uptake (T3U)
◦ Decreased in hypothyroidism and increased in hyperthyroidism
◦ Alkaline Phosphatase - Biliary Cirrhosis,
cirrhosis, and intrahepatic bile duct disease.
Thyroid-stimulating hormone (Thyrotropin)
◦ Elevated in thyroidal hypothyroidism and decreased in pituitary ◦ Direct Bilirubin - water soluble conjugated
hypothyroidism post-hepatic bilirubin: Biliary and liver disease
Thyroid uptake of radiolodine ◦ Delta Bilirubin - albumin bound conjugated
◦ Administered orally
◦ Normal radioactive iodine uptake is about 10-35%
bilirubin: Biliary and liver disease
◦ Indirect Bilirubin - unconjugated bilirubin;
Thyrotropin-releasing hormone
◦ Stimulates the pituitary to release TSH hemolytic anemia and liver diseases
Triiodothyronine uptake ◦ Total Bilirubin - hepatic and hemolytic disease.
◦ Indirectly estimates the amount of thyroid-binding globulin in the serum
 Lesson 1 – Hospital Diagnostic Procedure
and equipment's
HEPATOCELLULAR ENZYMES ALANINE AMINOTRANSFERASE (ALT)
◦ Serum glutamic pyruvic transaminase (SGPT)
Very High elevation - viral or toxic hepatitis ◦ HEPATOCELLULAR DAMAGES

Moderately high elevations - infectious ASPARTATE AMINOTRANSFERASE (AST)

mononucleosis, chronic active hepatitis, ◦ serum glutamic oxaloacetic transaminase (SGOT)
extrahepatic bile duct obstruction, intrahepatic ◦ Non specific marker of hepatocellular damage
cholestasis
GAMMA GLUTAMYL TRANSPEPTIDASE (GGT)
Modest elevations - pancreatitis, alcoholic fatty ◦ Alcoholic liver disease
liver, biliary cirrhosis, neoplastic infiltration
Lactic Dehydrogenase (LDH)
◦ Shock syndrome
◦ Hepatocellular damage
 Lesson 1 – Hospital Diagnostic Procedure
and equipment's
RENAL SYSTEM CARDIOVASCULAR SYSTEM
◦ Urinalysis - screen renal and nonrenal disease
◦ Dipstick screening - urinary pH and specific gravity Cardiac Enzymes
1. Bilirubin - severe liver disease
◦ The pattern and time course of the appearance of
enzymes in the blood after cardiac muscle cell damage
2. Blood- UTI, renal stones, sickle cell disease, glomerulonephritis
are used to diagnose myocardial infarction (MI)
3. Glucose - diabetes mellitus
Creatinine Kinase (CK; creatinine phosphokinase)
4. Ketones - diabetes ketoacidosis
◦ Isoenzyme fractions identify the type of tissue damaged.
5. Leukocyte esterase - UTI and vaginal infection ◦ CK-BB (CK1) is found in the brain, bladder, stomach
6.Nitrites - E. coli in urinary tract and if urine is retained in the bladder for 4 hours and colon; CK-MB (CK2) is found in cardiac tissue; and
7.pH - kidney stone CK-MM (CK3) is found in skeletal muscle
◦ CK-MB is detected in the blood within 3 to 5 hours after
8.Protein - variety of renal disease
a myocardial infarction; levels peak in about 10-20
9.Specific Gravity - greater concentration of urine, the higher the gravity is hours and normalize within about 3 days.
10.Urobilinogen - severe liver disease or obstructive biliary disease
 Lesson 1 – Hospital Diagnostic Procedure
and equipment's
Lactic Dehydrogenase (LDH) Cholesterol
◦ It is found in a variety of body tissues. Isoenzyme fractions ◦ Cholesterol is separated into lipoproteins by protein
are used to identify the type of tissue damage electrophoresis:
◦ LDH1 and LDH2: found in the heart, brain, and ◦ Low-density lipoprotein (LDL) is strongly correlated with
coronary artery disease.
erythrocytes. LDH2 normally accounts for the highest
◦ High density lipoprotein (HDL) is inversely correlated with
percentage of total serum LDH. After a myocardial
infarction (MI) the rise in LDH1 concentration exceeds the coronary artery disease
rise in LDH2 concentration (the LDH1-to-LDH2 ratio is C-Reactive Protein
>1; a "flipped" ratio).
◦ C-reactive protein is a biologic marker of systemic inflammation.
◦ LDH3 is found in the brain and kidneys
◦ ↑C-reactive protein concentration, ↑risk of myocardial infarction,
◦ LDH4 is found in the liver, skeletal muscle, and kidneys. ↑stroke, ↑peripheral arterial disease
LDHS is found in the liver, skeletal muscle, and ileum.
Myoglobin
LDH increases within about 12 hours after a myocardial ◦ Myoglobin is a small protein found in cardiac and skeletal
infarction, peaks between 24 and 48 hours, and muscle. The presence of myoglobin in the urine or plasma is a
relatively sensitive indicator of cellular damage.
normalizes by about day 10
 Lesson 1 – Hospital Diagnostic Procedure
and equipment's
Electrocardiogram (ECG)
An electrocardiogram (ECG) is a test which
measures the electrical activity of your heart to
show whether or not it is working normally.
An ECG records the heart's rhythm and activity
on a moving strip of paper or a line on a screen.
Your doctor can read and interpret the peaks and
dips on paper or screen to see if there is any
abnormal or unusual activity.
 Lesson 1 – Hospital Diagnostic Procedure
and equipment's
Angiogram
A coronary angiogram is a procedure that uses X-
ray imaging to see your heart's blood vessels. The
test is generally done to see if there's a restriction in
blood flow going to the heart.
During a coronary angiogram, a type of dye that's
visible by an X ray machine is injected into the
blood vessels of your heart. The X-ray machine
rapidly takes a series of images (angiograms),
offering a look at your blood vessels.
 Lesson 1 – Hospital Diagnostic Procedure
and equipment's
Echocardiogram
An echocardiogram uses sound waves to produce
images of your heart. This common test allows your
doctor to see your heart beating and pumping blood.

Your doctor can use the images from an

echocardiogram to identify heart disease.
M8 – Medical Emergencies
in Dental Clinic
LE SS O N 1 – E ME RG EN CY D RU G S A N D EQ U I P M EN T'S
 Lesson 1 – Emergency Drugs and
Equipment's
Dentists, through their academic, clinical and continuing education, should be
familiar with the prevention, diagnosis, and management of common emergencies. In
addition, they should provide appropriate training to their staff so that each person
knows what to do and can act promptly.

Since these skills are not used every day, regular review is necessary: at least
annually but preferably more often. Conducting mock emergencies may help office
staff to be more confident with their roles when a real emergency occurs. As a result,
dentists and their staff should be prepared to recognize, respond and effectively
manage a medical emergency.

The components of a sound medical emergency plan for the dental office should
include:

• Medical emergency prevention

• Development of an action plan

• Recognizing a patient’s distress and management of medical emergencies

• Emergency drugs and equipment

 Lesson 1 – Emergency Drugs and
Equipment's
EMERGENCY DRUGS AND EQUIPMENT
RECOMMENDED
DRUG   INDICATION   AVAILABILITY  
FOR KIT  
1:2000(0.15 
1 pre-loaded syringe +
Epinephrine  Anaphylaxis  mg\dose) 
3x1mL ampules of 1:1000 
 

Diphenhydramine 2-3 ampules x 1mL ampules

Mild allergy  50 mg\ml 
HCl  of 50 mg/mL 

“E” cylinder 
Minimum 1; preferably 2 
Oxygen  All emergencies  +delivery devices 
 
 

Albuterol  Bronchospasm  Metered aerosol inhaler  1 aerosol inhaler 

Orange juice;  12-ounce bottles of orange

Sugar  Hypoglycemia  instant glucose  juice or 1 tube
  of instaglucose 
Suspected myocardial
Aspirin  325 mg tablets  1-2 sealed tablets 
infarction 
Nitroglycerin  Angina pectoris  Metered spray  1 nitro lingual spray 
 Lesson 1 – Emergency Drugs and
Equipment's
ANTIDOTAL DRUGS 
Recommended 
Drug  Indication  Availability 
for kit 
     
 

1x10 mL
Benzodiazepine 
Flumazenil  0.1mg/mL  multidose 
antagonist 
    vial 
 
 

Naloxone  Opioid antagonist  0.4 mg/mL  2x1 ml ampule of 

      0.4 mg/mL 
 Lesson 1 – Emergency Drugs and
Equipment's
EMERGENCY EQUIPMENT
•Automated external defibrillator​

•Face masks​

•Disposable syringes  and needles​

•Spacer for  bronchodilator inhaler
 Lesson 1 – Emergency Drugs and
Equipment's
Urgencies vs Emergencies
Urgency: a problem that requires prompt response; it is not Emergency: a problem that is immediately life
immediately life threatening but could become so if not resolved
threatening and requires immediate action​
promptly​

Syncope​ Cardiac arrest​

Hypoglycemia​ Anaphylaxis​
Seizure​
Obstructed airway
Asthmatic attack​

Hyperventilation​

Angina​

Mild allergic reaction​