The Increase in Medically Complex Patients: Dental EHR Needs

Lauren Patton (DDS) overviews a variety of reasons why medically complex patients are on the rise, and why dentists need to not only be aware, but start actively searching for, integrating and using complex health data. This change in the US population is a vital part of the need for dental EHRs that collect, utilize and inform dentists for appropriate and relevant dental care.

Dr. Patton points to the aging, obese, medicated US population where viral diseases, cancer and tobacco are all chronic and a diabetes epidemic is on the rise. In particular, she highlights the need to prevent infective endocarditis and other remote infections from dental implants and surgeries. Frequent dental procedures are linked to infective endocarditis, particularly if the patient has existing heart implants, damaged valves or other conditions. But in the past few years, the recommendations have changed about preventative antibiotic treatment for patients with existing heart conditions. For instance, patients with mitral valve prolapse are no longer recommended for preventative antibiotic treatment to reduce remote infections after dental procedures. The recommendations about patients with artificial joints of any kind and avoiding remote infections have changed over the course of several years. Worry about antibiotic resistant strains, in particular, has changed the risk factors for those patients.

Patients on blood thinning or clotting drugs also have specific dental needs. Patients on medications of any kind may have interactions with antibiotics, anesthetics or other dental medications. For instance, lithium toxicity can increase due to antimicrobial medications. Common supplements also affect dental procedures–for instance, green tea and gingko can increase bleeding. Psychological disorders also change a patients’ ability to withstand the stress of dental procedures.

This discussion brings stark attention to the need for clinical guidelines and evidence-based decision support in dental EHRs. When selecting and implementing EHRs, being able to track and share this kind of information should be a top consideration. Clearly, complex patients demand up-to-date and evidence-based treatment to prevent dangerous complications. Dental EHRs not only should contain the key health information that affects treatment, but should also support evidence-based decisions. This can also help in pointing patients at the most recent evidence, so that they understand their care. Coordination of care across physician and dental health professionals is becoming not just important, but crucial, as the population of medically complex patients continues to increase.

Lessons Learned:

  • Medically complex patients are on the rise due to an aging, medicated, obese US population where viruses, arthritis and diabetes are on the rise.
  • Many supplements, medications, implants and conditions affect dental care, particularly risk of infection and bleeding risks. The clinical recommendations about these change regularly and are not yet supported by dental EHRs.
  • Coordination of care across complex patients demands EHRs that contain and disseminate dental, medication, existing conditions and ongoing risks.

 Patton, Lauren (2011) Yellow Brick Road to Managing Medically Complex Patients.   www.mahec.net/handouts/823ManagementofMedicallyComPPT.pdf (Note: Downloads as a PDF)