| { |
| "version": "2026-06-05", |
| "product": "Dental SOAP", |
| "principle": "Safety escalations are computed by deterministic rules from the user's story and structured answers. The model never authors, suppresses, or downgrades an escalation.", |
| "rules": [ |
| { |
| "id": "airway_or_deep_space_infection", |
| "domain": "dental_infection", |
| "tier": "emergency_now", |
| "title": "Airway or deep-space infection warning", |
| "patient_message": "Difficulty breathing, swallowing, rapidly spreading facial or neck swelling, or severe trouble opening the mouth can be dangerous. Seek emergency medical or urgent dental care now.", |
| "clinician_question": "Please assess for spreading odontogenic infection, trismus, airway risk, and need for urgent drainage or referral.", |
| "structured_triggers": [ |
| "difficulty_breathing", |
| "difficulty_swallowing", |
| "rapidly_spreading_swelling", |
| "severe_trismus_with_swelling_or_fever" |
| ], |
| "text_patterns": [ |
| "can't breathe", |
| "cannot breathe", |
| "hard to breathe", |
| "shortness of breath", |
| "can't swallow", |
| "cannot swallow", |
| "difficulty swallowing", |
| "neck swelling", |
| "under my jaw is swollen", |
| "floor of mouth", |
| "tongue lifting", |
| "can't open my mouth", |
| "cannot open my mouth", |
| "trismus", |
| "hard to swallow", |
| "harder to swallow", |
| "harder to breathe", |
| "trouble swallowing", |
| "trouble breathing", |
| "difficulty breathing", |
| "swallowing is getting harder", |
| "breathing is getting harder", |
| "throat is closing", |
| "can't open my jaw", |
| "cant breathe", |
| "cant breath", |
| "can't breath", |
| "i cant breathe", |
| "choking", |
| "throat feels like it is closing", |
| "closing up", |
| "difficulty in breathing", |
| "hard to swallow my spit", |
| "neck is huge", |
| "neck is swollen", |
| "مش عارف اتنفس", |
| "مش قادرة اتنفس", |
| "مش قادر اتنفس", |
| "مش عارفة اتنفس", |
| "صعوبة في التنفس", |
| "مش عارف ابلع", |
| "مش قادرة ابلع", |
| "مش قادر ابلع", |
| "مش عارفة ابلع", |
| "صعوبة في البلع", |
| "ورم في رقبتي", |
| "زورى بيقفل", |
| "زوري بيقفل", |
| "حلقي بيقفل", |
| "مش عارف افتح بوقي", |
| "مش قادر افتح بوقي", |
| "مش عارفة افتح بوقي", |
| "مش قادرة افتح بوقي", |
| "مش عارف افتح فمي", |
| "مش قادر افتح فمي", |
| "ختنق", |
| "خانقني", |
| "بيخنقني", |
| "نفسي بيتقطع", |
| "نفسي اتقطع", |
| "نفسي مقطوع", |
| "barely swallow", |
| "hardly swallow", |
| "barely breathe", |
| "hardly breathe", |
| "struggling to swallow", |
| "struggling to breathe", |
| "barely open my mouth", |
| "hardly open my mouth", |
| "ببلع بالعافية", |
| "بابلع بالعافية", |
| "ببلع بصعوبة", |
| "بابلع بصعوبة", |
| "بتنفس بالعافية", |
| "باتنفس بالعافية", |
| "بتنفس بصعوبة", |
| "باتنفس بصعوبة", |
| "رقبتي ورمت", |
| "ورم نازل على رقبتي", |
| "تحت لساني ورم", |
| "فتحت بوقي بالعافية", |
| "رقبتي بدات تورم", |
| "مش عارف افتح بوقي من الورم" |
| ], |
| "source_notes": [ |
| "Designing a Small-Model Dental Visit-Prep Assistant, section 3.1", |
| "Dental Handoff Clinical Content Frameworks, TMJ and endodontic red flags" |
| ] |
| }, |
| { |
| "id": "gca_jaw_claudication", |
| "domain": "tmj_or_orofacial_pain", |
| "tier": "urgent_medical", |
| "title": "Age over 50 with jaw claudication pattern", |
| "patient_message": "New jaw pain with chewing that improves with rest, especially with scalp tenderness, vision changes, or a new severe headache after age 50, needs urgent medical evaluation.", |
| "clinician_question": "Please consider non-dental causes of jaw pain, including giant cell arteritis, when age and symptom pattern fit.", |
| "structured_triggers": [ |
| "age_over_50", |
| "jaw_pain_with_chewing_relieved_by_rest", |
| "vision_changes_or_scalp_tenderness_or_new_severe_headache" |
| ], |
| "text_patterns": [ |
| "jaw pain when chewing", |
| "pain stops when I rest my jaw", |
| "scalp tenderness", |
| "scalp hurts to touch", |
| "vision changes", |
| "blurred vision", |
| "new severe headache", |
| "temple headache", |
| "jaw claudication", |
| "jaw cramps when i chew", |
| "jaw cramps when chewing", |
| "temple is sore", |
| "temple is tender", |
| "vision blurs", |
| "blurry vision", |
| "وجع فكي مع المضغ", |
| "وجع في الفك", |
| "زغللة في العين", |
| "صداع شديد", |
| "صداع في جنبك", |
| "برتاح الوجع بيروح", |
| "لما برتاح الوجع بيروح", |
| "صداع جامد في الحته اللي جنب عيني", |
| "صداع جنب عيني", |
| "وجع الفك بيروح بالراحه" |
| ], |
| "source_notes": [ |
| "Dental Handoff Clinical Content Frameworks, TMJ red flags", |
| "Designing a Small-Model Dental Visit-Prep Assistant, section 3.4" |
| ] |
| }, |
| { |
| "id": "hypochlorite_accident", |
| "domain": "endodontic", |
| "tier": "emergency_now", |
| "title": "Possible endodontic irrigant accident", |
| "patient_message": "Sudden severe swelling, bruising, burning pain, or bleeding during or immediately after a root canal visit requires emergency evaluation. Seek emergency dental or medical care now — do not wait. Sodium hypochlorite extrusion can cause rapid tissue injury and airway risk.", |
| "clinician_question": "Please review timing relative to endodontic treatment and assess for chemical injury or post-procedural complication.", |
| "structured_triggers": [ |
| "sudden_swelling_after_root_canal", |
| "bruising_after_root_canal", |
| "severe_burning_pain_after_root_canal" |
| ], |
| "text_patterns": [ |
| "during root canal", |
| "after root canal my face swelled", |
| "sodium hypochlorite", |
| "bleach accident", |
| "burning pain after root canal", |
| "bruising after root canal", |
| "swelling immediately after root canal", |
| "swelling right after my root canal", |
| "swelling right after root canal", |
| "swelled right after root canal", |
| "swelled up right after root canal", |
| "وجع شديد في الحشو", |
| "ورم بعد حشو العصب", |
| "وجع شديد بعد حشو العصب", |
| "حرقان بعد حشو العصب", |
| "ورم فجأة بعد الحشو", |
| "ورم فجأة بعد حشو العصب", |
| "حشو عصب وفجاه وشي ورم", |
| "حرقان جامد في بقي", |
| "اثناء حشو العصب وورم", |
| "وانا بعمل حشو عصب ورمت", |
| "ورم مفاجي اثناء الحشو", |
| "حشو العصب وحسيت بحرقان جامد", |
| "حرقان رهيب بعد حشو", |
| "بحرقان رهيب بعد", |
| "حط مطهر وحسيت", |
| "نار في وشي", |
| "ورم في ثواني", |
| "حسيت بحرقان رهيب", |
| "ورم فجاه وبحرقان", |
| "حرقان نار", |
| "بحرقان ونار", |
| "مية نار نزلت", |
| "حسيت بحرقان ونار", |
| "مية نار", |
| "بيحرقني نار" |
| ], |
| "source_notes": [ |
| "Dental Handoff Clinical Content Frameworks, endodontic post-treatment complications" |
| ] |
| }, |
| { |
| "id": "loose_crown_aspiration", |
| "domain": "crown_or_bridge", |
| "tier": "same_day_urgent", |
| "title": "Loose crown or bridge aspiration risk", |
| "patient_message": "A very loose crown or bridge can detach while eating or sleeping. Avoid chewing on it and contact a dentist urgently; seek emergency care if it is swallowed, inhaled, or causes breathing trouble.", |
| "clinician_question": "Please assess restoration stability, aspiration/ingestion risk, exposed tooth structure, and need for temporary protection.", |
| "structured_triggers": [ |
| "very_loose_crown_or_bridge", |
| "crown_wobbling_or_nearly_detached" |
| ], |
| "text_patterns": [ |
| "loose crown", |
| "crown is loose", |
| "bridge is loose", |
| "crown wobbling", |
| "crown fell out", |
| "bridge fell out", |
| "nearly detached", |
| "about to fall off", |
| "cap came off", |
| "cap fell out", |
| "loose cap", |
| "wobbly crown", |
| "crown is wobbly", |
| "شرقت", |
| "بلعت الطربوش", |
| "بلعت الكوبري", |
| "طربوش فك", |
| "crown feels loose", |
| "cap feels loose", |
| "bridge feels loose", |
| "crown feels wobbly", |
| "cap feels wobbly", |
| "bridge feels wobbly", |
| "الطربوش مخلخل", |
| "الطربوش بيتحرك", |
| "الكوبري مخلخل", |
| "الكوبري بيتحرك", |
| "كوبري بيتلخلخ", |
| "طربوش بيتلخلخ", |
| "خايفه ابلعه و انا نايمه", |
| "خايف ابلعه وانا نايم", |
| "خايف ابلعه", |
| "التلبيسه مخلخله", |
| "بخاف ابلعه", |
| "خايفه ابلعه" |
| ], |
| "source_notes": [ |
| "Dental Handoff Clinical Content Frameworks, crown/bridge red flags" |
| ] |
| }, |
| { |
| "id": "swallowed_or_aspirated_object", |
| "domain": "ingestion_or_aspiration", |
| "tier": "same_day_urgent", |
| "title": "Swallowed or inhaled tooth, filling, or dental piece", |
| "patient_message": "A swallowed tooth, filling, or dental fragment usually passes on its own, but it still needs same-day medical or dental advice — especially for a child. If there is any coughing, choking, wheezing, or trouble breathing after it went down, it may have entered the airway: seek emergency care now.", |
| "clinician_question": "Please assess ingestion versus aspiration risk and whether imaging or urgent referral is needed, especially in a child.", |
| "structured_triggers": [], |
| "text_patterns": [ |
| "swallowed a tooth", |
| "swallowed my tooth", |
| "swallowed the tooth", |
| "swallowed his tooth", |
| "swallowed her tooth", |
| "swallowed a baby tooth", |
| "swallowed the baby tooth", |
| "swallowed a filling", |
| "swallowed my filling", |
| "swallowed the filling", |
| "swallowed a piece", |
| "swallowed a crown", |
| "swallowed my crown", |
| "swallowed the crown", |
| "swallowed a cap", |
| "swallowed the cap", |
| "swallowed a coin", |
| "inhaled a tooth", |
| "inhaled the tooth", |
| "inhaled a piece", |
| "breathed it in", |
| "breathed in a", |
| "went down my throat", |
| "went down his throat", |
| "went down her throat", |
| "بلع سنة", |
| "بلعت سنة", |
| "بلع السنة", |
| "بلعت السنة", |
| "بلع الحشوة", |
| "بلعت الحشوة", |
| "بلع حتة", |
| "بلعت حتة", |
| "ابني بلع", |
| "بنتي بلعت", |
| "بلعت التلبيسه", |
| "بكح بعد ما بلعت", |
| "حاسس اني بكح ومش قادر", |
| "شرقت وبكح", |
| "نزلت في زوري", |
| "بكح ومش بتطلع", |
| "بلعت حته من الضرس", |
| "حاجه نزلت في زوري", |
| "بلعت الطربوش", |
| "دخل ف القصبه الهوائيه", |
| "القصبه الهوائيه", |
| "شرقت في حته", |
| "بكح ومش بتروح" |
| ], |
| "source_notes": [ |
| "Designing a Small-Model Dental Visit-Prep Assistant, section 3.1 — ingestion/aspiration of dental objects", |
| "Dental Handoff Clinical Content Frameworks, crown/bridge red flags" |
| ] |
| }, |
| { |
| "id": "facial_swelling_fever_abscess", |
| "domain": "endodontic_or_infection", |
| "tier": "same_day_urgent", |
| "title": "Swelling or systemic infection signs", |
| "patient_message": "Facial or gum swelling, fever, feeling very unwell, or a gum pimple/drainage with dental pain should be evaluated urgently by a dental or medical professional.", |
| "clinician_question": "Please assess for acute apical abscess, spreading infection, and systemic involvement.", |
| "structured_triggers": [ |
| "facial_or_gum_swelling", |
| "fever", |
| "malaise", |
| "gum_pimple_or_drainage" |
| ], |
| "text_patterns": [ |
| "face swollen", |
| "facial swelling", |
| "gum swelling", |
| "swollen gum", |
| "fever", |
| "chills", |
| "feel sick", |
| "feeling very unwell", |
| "pimple on my gum", |
| "gum pimple", |
| "pus", |
| "draining", |
| "puffed up", |
| "cheek is huge", |
| "cheek is swollen", |
| "face is swollen", |
| "high temperature", |
| "feel hot and my face", |
| "gum boil", |
| "boil on my gum", |
| "bump on my gum", |
| "ورم فجأة", |
| "خدي ورم", |
| "وشي ورم", |
| "خدي وارم", |
| "وشي وارم", |
| "ورم في خدي", |
| "ورم في وشي", |
| "عندي حرارة", |
| "حرارة عالية", |
| "تعبان اوي", |
| "تعبان أوي", |
| "تعبانة اوي", |
| "تعبانة أوي", |
| "حاسس اني هموت", |
| "حاسس إني هموت", |
| "حاسة اني هموت", |
| "يطلع صديد", |
| "بيطلع صديد", |
| "خدي كله وارم", |
| "وشي كله وارم", |
| "خراج في اللثه", |
| "سخن جدا", |
| "صديد بيطلع من اللثه", |
| "وشي كله منفوخ", |
| "وشي منفوخ", |
| "وجهي منفوخ", |
| "ورم ف خدي", |
| "بينزل قيح", |
| "قيح ف بوقي" |
| ], |
| "source_notes": [ |
| "Designing a Small-Model Dental Visit-Prep Assistant, sections 3.1 and 3.3" |
| ] |
| }, |
| { |
| "id": "trauma_bite_change_fracture", |
| "domain": "occlusion_or_trauma", |
| "tier": "emergency_or_same_day", |
| "title": "Trauma with sudden bite change", |
| "patient_message": "A sudden bite change after a fall, hit, or accident can signal jaw or tooth-support injury. Seek urgent dental, oral surgery, or emergency assessment.", |
| "clinician_question": "Please assess occlusion after trauma and consider jaw, condyle, alveolar, or tooth fracture evaluation.", |
| "structured_triggers": [ |
| "recent_facial_trauma", |
| "sudden_bite_change_after_trauma", |
| "cannot_close_bite_after_trauma" |
| ], |
| "text_patterns": [ |
| "fell on my jaw", |
| "hit my face", |
| "after accident", |
| "after trauma", |
| "my bite suddenly changed", |
| "teeth don't meet", |
| "cannot close my teeth", |
| "only one side touches", |
| "punched", |
| "car accident", |
| "hit my chin", |
| "hit my head", |
| "got hit", |
| "اتخبطت في فكي", |
| "القفله اتغيرت", |
| "سناني مش بتقفل", |
| "فكي اتخبط", |
| "مش عارف اقفل سناني", |
| "سناني مش مطابقه", |
| "عضتي اتغيرت", |
| "سناني اللي فوق مش بتركب", |
| "اتخبطت في خناقه", |
| "مش راكبه على بعضها", |
| "العضه اتغيرت", |
| "مش راكبه على بعض", |
| "عضه بوقي اتغيرت", |
| "عضتي مش مظبوطه" |
| ], |
| "source_notes": [ |
| "Dental Handoff Clinical Content Frameworks, occlusal red flags" |
| ] |
| }, |
| { |
| "id": "dental_trauma_avulsion", |
| "domain": "occlusion_or_trauma", |
| "tier": "emergency_or_same_day", |
| "title": "Tooth knocked out (avulsion)", |
| "patient_message": "A permanent tooth knocked completely out is time-critical: hold it by the crown (not the root), do not scrub it, keep it moist in milk or saliva, and see a dentist or emergency service immediately — ideally within 30–60 minutes. Baby teeth should not be pushed back in, but the child should still be checked the same day.", |
| "clinician_question": "Please assess the avulsion site, replantation or space-management options, adjacent-tooth and alveolar injury, and tetanus status if the tooth contacted soil.", |
| "structured_triggers": [], |
| "text_patterns": [ |
| "knocked my tooth out", |
| "knocked his tooth out", |
| "knocked her tooth out", |
| "knocked out my tooth", |
| "knocked out his tooth", |
| "knocked out her tooth", |
| "knocked out a tooth", |
| "tooth got knocked", |
| "teeth got knocked", |
| "tooth knocked out", |
| "tooth was knocked", |
| "avulsed", |
| "avulsion", |
| "tooth flew out", |
| "whole tooth came out", |
| "entire tooth came out", |
| "tooth came out root and all", |
| "including the root", |
| "including root", |
| "tooth out of its socket", |
| "tooth completely out", |
| "came out when i fell", |
| "came out after a fall", |
| "fell and my tooth came out", |
| "سنتي اتخلعت", |
| "اتخلعت سنتي", |
| "ضرسي اتخلع", |
| "سنتي طارت", |
| "سنتي طلعت من مكانها", |
| "اتخبطت وسنتي وقعت", |
| "وقعت سنتي من الخبطة", |
| "طلعت من مكانها", |
| "كوبايه لبن", |
| "محتفظ بيها في", |
| "وقعت علي وشي والسنه", |
| "السنه الاماميه كلها طلعت", |
| "ضرسي وقع من مكانه", |
| "سنتي خرجت من مكانها", |
| "سنتي وقعت في ايدي", |
| "طلع من مكانه بالكامل", |
| "وقعت كلها", |
| "كلها في ايدي", |
| "بجدورها", |
| "بجذورها", |
| "طالعه من جدرها", |
| "طالعه من جذرها", |
| "طارت من مكانها", |
| "كلها طلعت", |
| "طلعت برا" |
| ], |
| "source_notes": [ |
| "International Association of Dental Traumatology guidance on avulsed permanent teeth — replantation is minutes-critical", |
| "Designing a Small-Model Dental Visit-Prep Assistant, trauma red flags" |
| ] |
| }, |
| { |
| "id": "neurologic_or_cardiac_mimic", |
| "domain": "tmj_or_systemic", |
| "tier": "emergency_now", |
| "title": "Neurologic or cardiac warning signs", |
| "patient_message": "Facial droop, new numbness, confusion, weakness, chest pain, or jaw pain with exertion can be medical emergencies. Seek emergency care now.", |
| "clinician_question": "Please consider non-dental urgent causes when neurologic or exertional/cardiac symptoms are present.", |
| "structured_triggers": [ |
| "facial_droop", |
| "new_numbness_or_weakness", |
| "confusion", |
| "chest_pain", |
| "jaw_pain_with_exertion" |
| ], |
| "text_patterns": [ |
| "facial droop", |
| "face drooping", |
| "numbness", |
| "weakness", |
| "confusion", |
| "slurred speech", |
| "chest pain", |
| "pain with exertion", |
| "jaw pain when walking", |
| "is drooping", |
| "face droop", |
| "lip is numb", |
| "face is numb", |
| "feels numb", |
| "chest pressure", |
| "pressure in my chest", |
| "tight chest", |
| "chest feels tight", |
| "chest hurts", |
| "وشي من الجنب مرخي", |
| "بوقي معوج", |
| "كلامي متلغبط", |
| "مش عارف اضحك", |
| "ضغط جامد في صدري", |
| "تقل في صدري", |
| "فكي الشمال بيسمع في دراعي", |
| "ضغط علي صدري لما بعمل مجهود", |
| "نص وشي نمل", |
| "بوقي اتعوج", |
| "شفتي منمله", |
| "شفتي نمل", |
| "كلامي تقيل", |
| "ضغط على صدري", |
| "تقل على صدري", |
| "كبشه ف صدري", |
| "كبشه في صدري", |
| "كبس على صدري", |
| "كبس عليه", |
| "على صدري", |
| "في صدري", |
| "وشي معوج", |
| "تنميل في شفتي", |
| "تنميل ف شفتي" |
| ], |
| "source_notes": [ |
| "Dental Handoff Clinical Content Frameworks, TMJ red flags", |
| "Designing a Small-Model Dental Visit-Prep Assistant, section 3.4" |
| ] |
| }, |
| { |
| "id": "severe_uncontrolled_pain", |
| "domain": "pain", |
| "tier": "urgent_dental", |
| "title": "Severe uncontrolled pain", |
| "patient_message": "Severe dental pain that is worsening, prevents sleep, or is not controlled with usual over-the-counter measures should be assessed urgently by a dentist or urgent dental service.", |
| "clinician_question": "Please assess severe pain pattern, thermal sensitivity, percussion/biting pain, and need for urgent dental intervention.", |
| "structured_triggers": [ |
| "pain_score_8_or_more", |
| "pain_prevents_sleep", |
| "severe_pain_not_relieved" |
| ], |
| "text_patterns": [ |
| "unbearable pain", |
| "worst pain", |
| "can't sleep", |
| "cannot sleep", |
| "wakes me up", |
| "pain is 10", |
| "severe throbbing", |
| "not relieved", |
| "excruciating", |
| "keeps me up", |
| "keeps me awake", |
| "pain is a 9", |
| "pain is a 10", |
| "9 out of 10", |
| "10 out of 10", |
| "8 out of 10", |
| "وجع مموتني", |
| "مش قادر انام من الوجع", |
| "مش عارف انام من الوجع", |
| "المسكنات مش بتعمل", |
| "مسكن مش جايب نتيجه", |
| "مفيش مسكن جايب نتيجه", |
| "مفيش فايده من المسكنات", |
| "وجع 10 من 10", |
| "10 على 10", |
| "9 من 10", |
| "مفيش اي تاثير", |
| "مش عارف انام بقالي", |
| "هيموتني", |
| "هتموتني" |
| ], |
| "source_notes": [ |
| "Designing a Small-Model Dental Visit-Prep Assistant, sections 3.1 and 3.3" |
| ] |
| }, |
| { |
| "id": "post_extraction_bleeding", |
| "domain": "oral_surgery", |
| "tier": "same_day_urgent", |
| "title": "Prolonged bleeding after tooth extraction", |
| "patient_message": "Bleeding that will not stop after a tooth extraction needs same-day attention. Bite firmly on clean gauze for 20–30 minutes without peeking or spitting. If bleeding continues beyond an hour of firm pressure, or if you are soaking through gauze rapidly, contact your dentist or an urgent dental service today.", |
| "clinician_question": "Please assess post-extraction socket for clot stability, active bleeding, and need for haemostatic measures. Review anticoagulant or bleeding-disorder history.", |
| "structured_triggers": [], |
| "text_patterns": [ |
| "cannot stop bleeding", |
| "can't stop bleeding", |
| "won't stop bleeding", |
| "bleeding after extraction", |
| "bleeding after tooth extraction", |
| "socket bleeding", |
| "bleeding from socket", |
| "tooth extraction bleeding", |
| "extraction site bleeding", |
| "still bleeding after tooth", |
| "bleeding hours after", |
| "still bleeding after tooth", |
| "bleeding wont stop", |
| "bleeding won't stop", |
| "cannot stop the bleeding", |
| "bleeding will not stop", |
| "gushing", |
| "pouring blood", |
| "pulled my tooth", |
| "tooth was pulled", |
| "tooth came out", |
| "wont stop bleeding", |
| "still bleeding", |
| "الدم مش عايز يقف", |
| "الدم مش راضي يقف", |
| "النزيف مستمر", |
| "القطنه بتتملي دم", |
| "غرقت دم", |
| "الدم مالي بوقي", |
| "النزيف شديد", |
| "غيرت القطنه", |
| "مش عارف اوقفه", |
| "غرقان دم", |
| "شاش يتبل", |
| "الشاش بيغرق", |
| "بقي مليان دم", |
| "بينزف دم كتير", |
| "لسه بينزف", |
| "بينزف ومش بيقف" |
| ], |
| "source_notes": [ |
| "Designing a Small-Model Dental Visit-Prep Assistant, section 3.1 — uncontrolled bleeding listed as red flag" |
| ] |
| }, |
| { |
| "id": "mronj_medication_prompt", |
| "domain": "medical_history", |
| "tier": "dentist_discussion", |
| "title": "Bone-modifying medication to mention before invasive dental care", |
| "patient_message": "If you take or previously took bisphosphonates, denosumab, or antiangiogenic cancer medications, tell your dentist before extractions, implants, or surgery and ask about jaw-bone healing risk.", |
| "clinician_question": "Please review antiresorptive or antiangiogenic medication history before invasive dental treatment.", |
| "structured_triggers": [ |
| "bisphosphonate_or_denosumab_or_antiangiogenic" |
| ], |
| "text_patterns": [ |
| "fosamax", |
| "alendronate", |
| "reclast", |
| "zoledronic", |
| "prolia", |
| "denosumab", |
| "xgeva", |
| "bisphosphonate", |
| "antiangiogenic", |
| "avastin" |
| ], |
| "source_notes": [ |
| "Dental Handoff Clinical Content Frameworks, medical history and MRONJ" |
| ] |
| }, |
| { |
| "id": "bleeding_or_allergy_medication_prompt", |
| "domain": "medical_history", |
| "tier": "dentist_discussion", |
| "title": "Medication or allergy detail to bring to the visit", |
| "patient_message": "Blood thinners, steroid/immunosuppressive medicines, and drug allergies can change dental care. Bring exact medication names, doses, and allergy reactions to the dentist.", |
| "clinician_question": "Please review anticoagulants, immunosuppression, steroid use, and drug allergy reaction type before treatment.", |
| "structured_triggers": [ |
| "blood_thinner", |
| "immunosuppression", |
| "steroid_use", |
| "drug_allergy" |
| ], |
| "text_patterns": [ |
| "warfarin", |
| "eliquis", |
| "apixaban", |
| "xarelto", |
| "rivaroxaban", |
| "plavix", |
| "clopidogrel", |
| "aspirin daily", |
| "prednisone", |
| "steroid", |
| "immunosuppressed", |
| "penicillin allergy", |
| "amoxicillin allergy", |
| "latex allergy" |
| ], |
| "source_notes": [ |
| "Dental Handoff Clinical Content Frameworks, comprehensive medication profile and allergies" |
| ] |
| }, |
| { |
| "id": "immunocompromised_context", |
| "domain": "medical_history", |
| "tier": "dentist_discussion", |
| "title": "Weakened immune system to mention before dental care", |
| "patient_message": "Cancer treatment, transplant medicines, or a weakened immune system can make dental infections spread faster and change treatment planning. Tell your dentist about this — and seek care the same day if you also have swelling, fever, or feel unwell.", |
| "clinician_question": "Please factor immunocompromise (chemotherapy, transplant, immunosuppressive therapy, neutropenia) into infection-risk assessment and urgency of treatment.", |
| "structured_triggers": [ |
| "immunosuppression" |
| ], |
| "text_patterns": [ |
| "chemo", |
| "transplant", |
| "immunocompromised", |
| "immunosuppressed", |
| "immunosuppressive", |
| "immune system is weak", |
| "weak immune system", |
| "weakened immune system", |
| "neutropenia", |
| "neutropenic", |
| "low white blood", |
| "كيماوي", |
| "علاج كيماوي", |
| "مناعتي ضعيفة", |
| "زرع كلى", |
| "زرع كبد", |
| "زرع نخاع", |
| "ادويه مثبطه للمناعه", |
| "دواء مثبط للمناعه", |
| "زرعت كلي", |
| "زرعت كبد", |
| "زرعت نخاع", |
| "باخد مثبطات المناعه", |
| "علاج مثبط للمناعه" |
| ], |
| "source_notes": [ |
| "Dental Handoff Clinical Content Frameworks, medical history — immunocompromise lowers the threshold for urgent dental-infection care" |
| ] |
| }, |
| { |
| "id": "facial_swelling_with_fever", |
| "domain": "endodontic_or_infection", |
| "tier": "emergency_or_same_day", |
| "title": "Facial swelling together with fever", |
| "patient_message": "Facial or cheek swelling together with fever or feeling unwell can mean a dental infection is spreading through the body. Seek urgent same-day dental or medical care — go to emergency care if the swelling spreads quickly, reaches the eye or neck, or breathing or swallowing becomes difficult.", |
| "clinician_question": "Please assess for spreading odontogenic infection with systemic involvement and the need for urgent drainage, antibiotics, or referral.", |
| "structured_triggers": [], |
| "text_patterns": [], |
| "source_notes": [ |
| "Compound escalation: swelling plus systemic signs is tiered above isolated swelling — Designing a Small-Model Dental Visit-Prep Assistant, sections 3.1 and 3.3" |
| ] |
| }, |
| { |
| "id": "oroantral_communication", |
| "domain": "oral_surgery_or_sinus", |
| "tier": "same_day_urgent", |
| "title": "Possible mouth–sinus opening after extraction or sinus repair", |
| "patient_message": "Fluid or air passing between your mouth and nose after an upper tooth extraction or sinus repair can mean the opening has not sealed. Contact your dentist or oral surgeon the same day. Until seen, avoid blowing your nose, using straws, or sneezing with your mouth closed.", |
| "clinician_question": "Please assess for an oroantral communication or fistula at the extraction or sinus-repair site and evaluate maxillary sinus involvement.", |
| "structured_triggers": [], |
| "text_patterns": [ |
| "out of my nose when i drink", |
| "out of my nose when drinking", |
| "out of my nose when i rinse", |
| "into my nose when i drink", |
| "up my nose when i drink", |
| "drink goes up my nose", |
| "drinks go up my nose", |
| "water comes out of my nose", |
| "fluid comes out of my nose", |
| "liquid comes out of my nose", |
| "air passes between my mouth and nose", |
| "air passing between my mouth and nose", |
| "air moves between my mouth and nose", |
| "air goes from my mouth into my nose", |
| "air leaking into my nose", |
| "air leaks into my nose", |
| "bubbling from the socket", |
| "air bubbles from the socket", |
| "oroantral", |
| "oro-antral", |
| "sinus communication", |
| "hole into my sinus", |
| "hole in my sinus", |
| "opening into my sinus", |
| "opening into the sinus", |
| "فقافيق بتطلع", |
| "بين بوقي ومناخيري", |
| "الميه بتخرج من مناخيري", |
| "الميه بتطلع من مناخيري", |
| "ميه بتنزل من مناخيري", |
| "الهوا بيطلع من مكان الخلع", |
| "بحس الهوا بيطلع", |
| "من مناخيري" |
| ], |
| "source_notes": [ |
| "Builder's own case: #16 extraction with immediate oroantral-communication repair (March 2026), later confirmed odontogenic sinusitis", |
| "Dental Handoff Clinical Content Frameworks, endodontic and oral-surgery complications" |
| ] |
| }, |
| { |
| "id": "repeated_adjustments_without_relief", |
| "domain": "occlusion_or_tmj", |
| "tier": "dentist_discussion", |
| "title": "Repeated bite adjustments without lasting relief", |
| "patient_message": "When the same tooth needs repeated bite adjustments and still does not feel right, ask your dentist whether the bite itself could be shifting — for example from jaw-muscle or TMJ involvement — rather than one spot being high.", |
| "clinician_question": "Please consider occlusal re-evaluation for a shifting bite, including jaw-muscle or TMJ compensation and whether stabilization should precede further irreversible adjustment.", |
| "structured_triggers": [], |
| "text_patterns": [ |
| "multiple bite adjustments", |
| "several bite adjustments", |
| "many bite adjustments", |
| "repeated adjustments", |
| "repeated bite adjustments", |
| "adjusted twice", |
| "adjusted it twice", |
| "adjusted three times", |
| "adjusted 3 times", |
| "adjusted four times", |
| "adjusted 4 times", |
| "adjusted five times", |
| "adjusted 5 times", |
| "adjusted several times", |
| "adjusted many times", |
| "adjusted multiple times", |
| "adjusted it three times", |
| "adjusted it 3 times", |
| "adjusted it four times", |
| "adjusted it 4 times", |
| "adjusted it five times", |
| "adjusted it 5 times", |
| "adjusted it several times", |
| "adjusted it many times", |
| "adjusted it multiple times", |
| "ground down several times", |
| "ground it down again", |
| "filed down several times", |
| "filed down multiple times", |
| "shaved down again", |
| "still feels high after", |
| "still high after the adjustment", |
| "still hits first after", |
| "keeps hitting first", |
| "adjustments but i still", |
| "adjustments, but i still", |
| "adjustments and i still", |
| "بردولي الحشو مرتين", |
| "بردولي الحشو تلات", |
| "بردولي الحشو كذا", |
| "بردلي الطربوش كذا", |
| "عشان يبرد الضرس تلات", |
| "لسه عالي وبيخبط", |
| "برضه عالي وبيخبط", |
| "بيخبط قبل السنان", |
| "بيخبط قبل سناني" |
| ], |
| "source_notes": [ |
| "Builder's own case: tooth #37 adjusted five times without relief — shifting bite from TMJ compensation, not a high spot", |
| "Dental Handoff Clinical Content Frameworks, occlusal disharmony interview fields" |
| ] |
| }, |
| { |
| "id": "medication_bruxism_link", |
| "domain": "medical_history", |
| "tier": "dentist_discussion", |
| "title": "Medication that can contribute to clenching or grinding", |
| "patient_message": "Some antidepressants (SSRIs/SNRIs) and stimulant medicines can contribute to night-time clenching or grinding. Mention these medicines to your dentist and ask whether your jaw symptoms could be medication-associated bruxism.", |
| "clinician_question": "Please review SSRI/SNRI or stimulant use as a possible contributor to bruxism when jaw, temple, or morning-tightness symptoms are present.", |
| "structured_triggers": [ |
| "ssri_snri_or_stimulant_with_jaw_symptoms" |
| ], |
| "text_patterns": [], |
| "source_notes": [ |
| "Dental Handoff Clinical Content Frameworks, medication list — SSRIs/SNRIs and CNS stimulants can induce bruxism" |
| ] |
| }, |
| { |
| "id": "progressive_tooth_mobility", |
| "domain": "periodontal", |
| "tier": "urgent_dental", |
| "min_age": 14, |
| "title": "Tooth becoming progressively loose", |
| "patient_message": "An adult tooth that is becoming noticeably loose, or new widening gaps around it, can signal rapid loss of bone or tooth support and should be assessed urgently by a dentist.", |
| "clinician_question": "Please assess periodontal support, mobility grading, occlusal trauma, and the need for radiographs.", |
| "structured_triggers": [], |
| "text_patterns": [ |
| "tooth is getting loose", |
| "tooth is getting looser", |
| "teeth are getting loose", |
| "tooth feels loose", |
| "teeth feel loose", |
| "tooth is loose", |
| "teeth are loose", |
| "loose tooth", |
| "loose teeth", |
| "tooth is wobbly", |
| "wobbly tooth", |
| "teeth are loosening", |
| "tooth is loosening", |
| "gap is widening", |
| "gaps are widening", |
| "widening gap", |
| "space between my teeth is getting bigger", |
| "spaces between my teeth are getting bigger", |
| "teeth are spreading apart", |
| "سنتي بتتحرك", |
| "سنه بتتحرك", |
| "بتتلخلخ جامد", |
| "الحركه بتزيد", |
| "المسافه بين سناني بتوسع", |
| "الفرغات بتوسع", |
| "هتوقع من مكانها", |
| "سنه متلخلخه", |
| "بتلق جامد بقالها" |
| ], |
| "source_notes": [ |
| "Dental Handoff Clinical Content Frameworks, occlusal red flags — progressive tooth mobility with widening spaces" |
| ] |
| } |
| ] |
| } |
|
|
