History and Physical for the Pediatric Dental Patient : Establishing a Systematic Approach for Procedural Sedation

This book serves as a quick reference for all dentists who perform physical exam before the sedation and treatment of pediatric patients. In the dental care setting, pediatric patients present unique challenges to proper sedation and management of dental pathology. A prior history and physical exam is often absent. Learning how to properly conduct a history and physical exam on Pediatric patients is an essential skill for dentists, and has significant implications for parents, patients, and our healthcare system. This book aims for a comprehensive coverage of the review of systems, improve patient care and identify possible complications in pediatric sedation. Each chapter will focus on a single system, discussing its important features and difficulties, and highlighting implications for the dental management. The book includes checklists for practitioners as they go through the physical exam of a pediatric patient, and helps to adequately prepare for comprehensive dental treatment. It includes contributions by leading experts in the field and is structured for quick reference making it a necessary tool in every dental office. This book will bridge the gap between the dental and medical professionals when it comes to the history and physical of the pediatric patient. Prologue: Conducting, Interpreting and Understanding the History and Physical: A Dentists Perspective Contents 1: Conducting a History and Physical: “Succinct yet Exhaustive” References 2: Assessment of the Vital Signs 2.1 Development of the Lung 2.2 Sleep Disordered Breathing 2.3 Mechanism of Gas Exchange 2.4 Abnormal Vital Sign Readings References 3: Assessment of the Head and Neck 3.1 Extraoral Examination 3.2 Differential Considerations for Deviations: Child Abuse 3.3 Examination of the Neck 3.4 Obesity 3.5 Intraoral Examination 3.6 Tonsils 3.7 The Tongue Reference 4: The Eye Examination During a Dental Procedure 4.1 The Examination 4.1.1 Vision 4.1.2 Pupils 4.1.3 Lids, Lashes, and Orbit 4.1.4 Motility 4.2 Sclera and Conjunctiva 4.2.1 Cornea 4.2.2 Anterior Chamber 4.2.3 Red Reflex 4.2.4 Eye Reflexes 4.3 Ophthalmic and Systemic Considerations Prior to Dental Procedures 4.4 Dental Local Anesthesia and Potential Ophthalmic Complications 4.5 General Anesthetic Agents and Intraocular Pressure Changes 4.6 Potential Ophthalmic Complications from Dental Procedures References 5: Ear Exam for the Non-ENT 5.1 External Ear 5.1.1 Anatomy 5.1.2 Exam 5.1.3 Pathology 5.1.3.1 Otitis Externa 5.1.3.2 Cerumen Impaction 5.1.3.3 TMJ Dysfunction 5.1.3.4 Odontogenic Referred Pain 5.1.3.5 Microtia/Anotia/Ear Canal Stenosis/Atresia 5.1.3.6 Preauricular Anomalies 5.2 Tympanic Membrane/Middle Ear 5.2.1 Anatomy 5.2.2 Exam 5.2.3 Pathology 5.2.3.1 Otitis Media 5.2.3.2 Tympanic Membrane Perforation 5.2.3.3 Cholesteatoma 5.3 Inner Ear 5.3.1 Anatomy 5.3.2 Exam 5.3.3 Pathology 5.3.3.1 Vertigo 5.3.3.2 Sensorineural Hearing Loss 6: Assessment of the Lungs 6.1 Introduction 6.2 Differences Between the Pediatric and Adult Airway 6.3 Assessment of the Airway 6.4 Oral Cavity 6.5 Nasal Cavity 6.6 Epiglottis and Larynx 6.7 Vocal Cords and Trachea 6.8 Ribs and Lungs 6.9 Preoperative Airway Assessment 6.10 Airway Examination 6.11 Oropharyngeal and Nasopharyngeal Examination 6.12 Assessment of the Atlanto-Occipital Joint Mobility 6.13 Examination of the Chest and Lungs 6.13.1 Respiratory Rate 6.14 Chest and Lungs 6.15 Possible Complications 6.15.1 Cough 6.15.1.1 Congenital Syndromes 6.16 Conclusion References 7: Assessment of the Heart 7.1 Cardiac Anatomy 7.2 Cardiac Circulation 7.3 The Cardiac Cycle 7.4 The Cardiovascular Exam 7.4.1 General Appearance 7.4.2 Baseline Vital Signs and Palpation of Pulses 7.4.2.1 Blood Pressure 7.4.2.2 Heart Rate and Rhythm 7.4.2.3 Pulse Oximetry 7.4.3 Auscultation of Heart Sounds and Palpation of the Precordium 7.4.3.1 First Heart Sound (S1) 7.4.3.2 Second Heart Sound (S2) 7.4.3.3 Third and Fourth Heart Sounds (S3 and S4) 7.4.4 Classification of Heart Murmurs [16] 7.4.4.1 Murmur Areas [5, 7] 7.4.4.2 Systolic Murmurs 7.4.4.3 Diastolic Murmurs 7.4.4.4 Continuous Murmurs 7.4.4.5 Pericardial Friction Rub 7.4.4.6 Still’s Murmur 7.4.4.7 Pulmonary Flow Murmur 7.4.4.8 Venous Hum 7.4.5 Atrial Septal Defects 7.5 Integrating Examination Findings 7.5.1 Murmur Evaluation in the Pediatric Patient References 8: Assessment of the Gut 8.1 Introduction 8.2 Medical History 8.2.1 Family History and Past Medical History 8.2.2 History of Autoimmune Conditions 8.2.3 History of Malabsorption 8.2.4 History of Gastroesophageal Reflux Disease (GERD), Chest Pain and Eating Disorders 8.2.5 History of Liver Disease and GI Bleeding 8.2.6 History of Immunosuppression 8.3 Physical Examination 8.4 Gastrointestinal Tract Conditions that Manifest in the Oral Cavity References 9: Assessment of the Musculoskeletal System 9.1 Introduction 9.2 Family History or Previous Medical History 9.3 Examination 9.3.1 Skin 9.3.2 Neck 9.3.3 Shoulders and Elbows 9.3.4 Hands and Forearms 9.3.5 Knees and Legs 9.3.6 Feet 9.3.7 Spine 9.3.8 Gait 9.4 Orthopedic Findings/Diagnoses and How to Proceed Reference 10: Assessment of the Brain 10.1 Overview of Neurologic History and Physical 10.2 Mental Status 10.3 Cranial Nerves 10.4 Motor Evaluation 10.5 Sensory Examination 10.5.1 Reflexes 10.5.2 Common Neurological Conditions of Interest to the Dentist Further Reading 11: Assessment of the Teenager References 12: COVID-19 and Procedural Sedation References