Patient Care, Communication, and Oral Health Education
Assessment before care
Care begins with a thorough medical history updated at each visit, plus vital signs. Hypertension, diabetes, bleeding disorders, bisphosphonate use and cardiovascular disease change the plan: vasoconstrictors are used cautiously and aspiration is essential. Know ASA classes - I healthy, II mild systemic disease, III moderate, IV severe or life-threatening. Anxiety is managed with explanation, positioning and, when authorized, nitrous oxide-oxygen or premedication.
Communication that works
Health literacy is limited for many patients; use plain language, present only a few concepts at a time, and close the loop with teach-back ("show me how you'll clean around the implant"). Motivational interviewing outperforms lecturing: ask permission, explore ambivalence, reflect back what you hear. Tailor to the listener - a child needs short, concrete, nonthreatening words; an older adult may need larger print and hearing accommodation; use an interpreter rather than a family member for consent discussions when possible. Document what was discussed.
Education content
Name the technique: Bass or modified Bass for the gingival sulcus, modified Stillman where there is recession, floss or interdental brushes based on embrasure space. Nutrition counseling stresses the frequency of fermentable carbohydrate intake more than total amount. Caries prevention combines fluoride (toothpaste, varnish, water) with sealants. Tobacco cessation follows the 5 A's: Ask, Advise, Assess, Assist, Arrange.
Emergencies
Syncope: supine, legs raised, airway open. Conscious hypoglycemia: oral carbohydrate. Angina: sublingual nitroglycerin per protocol. Asthma: upright with their inhaler. Seizure: protect from injury, do not restrain or place objects in the mouth. Anaphylaxis: epinephrine.
Rule of thumb: a patient who is talking and following commands is not in cardiac arrest - position, oxygen and call for help.