Advanced Education in General Dentistry

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Guidelines for Completing a Medical Consultation Form

A. Reasons For Requesting a Medical Consultation

  1. Clarification of a specific condition or a specific drug therapy
  2. Clarification of a condition that may require pre-operative antibiotic coverage
  3. Requesting specific
    1. Laboratory test results, or
    2. Complete findings from a recent complete physical examination

B. Providing Information to the Consulting Healthcare Practitioner

  1. Oral diagnoses
  2. Use language suitable to the knowledge of the other healthcare provider
  3. Include all oral diagnoses
  4. Include some indication of the severity of each diagnosis
    1. i.e. “moderate to severe” periodontitis
    2. “1.5 cm.” squamous cell carcinoma with “associated lymphadenopathy”

C. Advising HCWs About Recommended Dental Treatment

  1. Include all foreseeable forms of treatment that may be employed
    1. All procedures that will cause significant bacteremia (e.g. deep scaling, C&B cord, etc.)
    2. All procedures that involve mucogingival surgery
      1. Biopsies, exodontia, implant placement
    3. All modes of anesthesia
      1. Local anesthetic; regional block anesthesia
      2. N2O, IVSD, general anesthesia
    4. Drug therapies: antibiotic pre-meds, antibiotic management of perio dx, alteration of Coumadin, Amicar
  2. This is the most important part of any medical consultation request
    1. It establishes, for the physician or other HCW, that you have been careful in:
      1. Taking a thorough patient history

        Assessing the patient’s simple or complex medical status, AND MOST IMPORTANTLY

  3. That you have appropriately analyzed the significant medical factors in the patient’s history and FORMULATED A SPECFIC SET OF RELEVANT QUESTIONS.
  4. All medical consultations should be narrowly tailored to ask specific medical management questions that call for specific objective answers.
  5. Only if the objective data is particularly open to a fairly wide range of clinical judgment, should an opinion on that objective data be expressly requested by the dentist and given by the consulting physician or other HCW.
  6. Better medical consultations identify the dental management problem for the physician to consider, in the first line of this section, and then suggest a specific management approach to be used to ameliorate the problem.
  7. Example: 72 y.o. AA female è h/o MI x 3, CABG, and A-fib, on Coumadin.
    1. Must have patient’s INR 2.0-2.5 to proceed. If pt.’s INR is higher, we would normally D/C Coumadin 2 days prior to tx, do stat PT/INR the AM of tx, and resume Coumadin at the next scheduled dose. OK?

      Please report the pt.’s most recent INR and advise.

  8. It is extremely important that a medical consultation reflects the patient’s comprehensive needs so that repeated consults are not required because the dental practitioner failed to think through potential medical complications which may arise with different modalities of treatment.
  9. Telephone consults are strongly discouraged!
    1. They should be limited to clarification of the physician’s recommendation, if it is illegible or contrary to regular regimens employed throughout Dentistry or Medicine.
    2. For example, chronic renal failure patients on hemodialysis may require a different antibiotic for SBE prophylaxis, and/or a different dosing regimen than other patients.
    3. A contemporaneous note in the chart should summarize this clarification of the initial consult.

D. The following patients may be unable to reliably relate their medical histories:

  1. Elderly
  2. Those suffering dementia or Parkinson’s disease
  3. Developmentally Challenged; Special Needs Patients
  4. Mentally Disable (psychosis patients)
  5. In these cases, the only reliable method for determining relative safety to treat is the Complete Physical Examination findings.
  6. The Complete Physical Examination
  7. Interpreting the Findings for Relative Safety to Treat the Dental Patient
  8. Who Cannot Reliably Relate a Medical History.