GDA Action October 2021

34 • October 2021 few root fractures. In that participation workshop, we emphasize two things. One is body positioning to prevent lower back pain. The other is how to rotate the tooth around your wrist and not the other way around. Use proper body mechanics and best principles of hand physics to prevent physical ailments from cutting your career and the joy of practicing short. Your hand is your tool. Preserve your tool.  Additional Tips to Make the OR Case Successful Safe and Proper Prescribing In the OR, I generally order triple AAA. That includes Antibiotics to prevent an infection, Anti-inflammatory Decadron to reduce post-operative swelling, and Analgesics for pain management. Postoperatively, based on my assessment of their pain level and tolerance over the following few days, I will prescribe some pain relieving medicine. It may be pills or liquid. If I did not order it before the case, then I may call it in right after, or just hand a script over to the patient’s responsible party. Post-Op Follow-Up We always call the patient later that day, or the following day. We want to assure that they are healing and recovering well, and answer any questions they may have. It keeps the lines of communication open, keeps the patient’s team satisfied, and prevents late night wake-up calls. Preventing Post-Op Self-Injurious Behavior Some people in this population may exhibit self-injurious behavior. If they are in pain or frustrated and cannot express it well, they may attempt to injure themselves or even someone else. If they have a helmet, we place it on after the facility’s pillows have done their part (Photos 10, 11). If hand holding alone does not prevent injurious thrashing, then gentle mesh and Velcro ties for a short while may be in order. Usually, once the family or other loved ones are in the recovery room the patient quiets down and becomes manageable. We are here to treat injuries, not facilitate them. By being preventive and proactive, we help keep everyone safe. Two-Day to Two-Week Follow-Up In a previous paragraph, we talked about the follow up visit after discharge from the ANXIETY OR SPECIAL NEEDS Continued from page 33 By taking two images but charging for one, we obtain useful information on each one, then draw preliminary treatment plan from that. Intraoral photos and/or video helps with treatment planning and documentation. In the OR, we always obtain excellent high-quality images. Most facilities have available both wheeled in X-ray units with a long swing arm (Photo 8), as well as a hand-held unit. We have several NOMAD-Pro and NOMAD-Pro 2 units in our facilities and our office. The staff prefers the swing arm because they don’t have to hold it. The hand-held is a great back up and also allows us the angle from positions the swing arm cannot reach. The end result are excellent intraoral images. When the film sensors or the computers are unavailable for any reason, we use the ever-ready Ergonom-X Self developing film described in the previous articles (Photo 9). We never proceed without radiographs. We don’t work blindfolded and do everything to avoid surprises. Anesthesia in the OR The type of anesthesia selected is the domain of the anesthesia team. Other than knowing that we strongly prefer nasal over oral intubation, they need to know our estimate for the case duration. I provide running updates of my estimated completion time so they will know how much more anesthesia to use. This facilitates wake up and recovery. In certain instances, general anesthesia is not an option. That is when they discuss IV, which has its own advantages and disadvantages, benefits and risks. They may start with oral Versed then give some IM Ketamine in order to safely start an IV. Other times, they use a mask inhalation and then start the IV. It generally depends on the patient’s level of cooperation, with or without the oral sedative and the IM injection. For people who have abandonment anxieties, a family member is generally allowed in the OR for the first few minutes until the patient is comfortably sedated. Preserving Your Body I teach a 2.5 hour course on using special body mechanics to extract teeth with no wrist fatigue, no shoulder or arm fatigue, and very the patient’s desire, and indicates so in writing to relieve me of any responsibility if and when the treatment fails. It is their health, their mouth, their money, and their choice. We are here to serve, but cannot take responsibility for their clinical choices. Maintain and Retain Detailed Records There are varying and conflicting rules regarding how long to keep medical records. You need to consult your state’s rules and regulations because requirements change over the years. Later, it may be necessary to prove if a minor was involved, if there was an infectious disease, or if fraud was involved. The safest thing is to scan and shred everything, and have a backup of it all. Dentists who dispose of records that they thought were too old to ever be recalled are being cited for not being able to produce them when new rules and requirements are enacted. Be safe. Be smart. Scan, save, and shred it all with backup. It is only disc space, not shelving or basement storage. Preventing Lawsuits It is not a secret that the best prevention against a lawsuit is good rapport and great communications. Don’t overpromise, and never guarantee specific performance. You should promise to do your best, and cannot be sued if your best just was not good enough to save that tooth or appliance. Preparing for the Worst No one can prepare for everything. So prepare for the most common and most likely. Keep communication open and get it all in writing.  Tricks and Tips for Your Best OR Dentistry Getting Good Radiographs in the OR We can’t always get good intraoral X-rays in the office. For some patients, we can’t get any X-rays at all. In the office, we often sedate the patient with a benzodiazepine as described in previous articles in this series. We allow and even encourage non- pregnant family members or caregivers to assist in obtaining office intra-oral radiographs. If that fails then we take two panoramic images (Photo 7). The patient may remain in the wheelchair, with all helpers draped with Velcro lead aprons.