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137 Cards in this Set
- Front
- Back
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In an emergency for an epilepsy patient, what protocol should be done?
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Remove any prosthetic appliances
Main objective is to remove objects around patient to prevent injury No need to move the patient to the floor Maintain airway- turn head to the side and use high evacuator for vomiting Oxygen can be used no restrains (passive) prolonged intravenous lorazapam administered |
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What is appropriate dental management of seizure patient?
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Schedule preferably within a few hours of taking anti-seizure meds
Try to be calm and prevent non irritating situations Have patient report aura as soon as it is sensed If questionable history or poorly controlled seizures, consult with physician Be alert to effect of medications Be prepared to handle a seizure Questions What type of seizures do you have? When was you last seizure? Do you know when a seizure is coming on? What usually happens during your seizure? Have you had a seizure during dental treatment? Are there any special things I should avoid during dental treatment to prevent a seizure? |
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Nonsurgical treatment= scaling and root planing/ scrupulous home care
Change in drug prescription; takes about 1 year to decrease gingival enlargement Surgical removal gingivectomy- not a permanent solution because often enlargement reoccurs These are examples of ______. |
Treatment of Phenytoin-induced gingival growth
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Contributing factors for phenytoin-induced gingival growth are?
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Bacterial plaque
Gingivitis THE BETTER THE ORAL HYGIENE, THE LESS LIKELY LESIONS ARE TO OCCUR OR LESS SEVERE |
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name the two types of seizures?
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1. Partial seizure
2. Generalized seizure |
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__________
simple partial seizures (consciousness*** is not lost) Tingling** sensation in arm, finger, foot Seeing flashing lights*** Speaking unintelligibly complex partial seizures (consciousness is impaired**) – may last a couple of minutes Patient sits motionless** or moves in inappropriate ways Blank stare** may evolve to Generalized Tonic-Clonic*** |
Partial
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_____________
Absence seizure (petit mal)** non-convulsive* seizures Blank stare _______of eyes Completely unaware they are having seizure Brief unconsciousness*** Tonic-clonic (grand mal)** Convulsive* seizures Both types have loss of ______ |
Generalized Seizures
Rhythmic blinking consciousness |
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Generalized ______-Clonic
_______= momentary sensory alteration involving ____ or smell preceding convulsion in 1/3 of patients. loss of consciousness** air forced out (________) Eyes- roll back and to the side; pupils dilate muscular rigidity Urination may occur |
Tonic
Aura sight epileptic cry |
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Generalized Tonic-_______
_______- beating movements Time lasts about ___ seconds Respiration breathing may stop postconvulsive coma becomes limp and comatose postconvulsive phase consciousness returns gradually with confusion and headache |
Clonic
Muscular spasms 90 |
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A _______ is a convulsive disorder that results from a transient, uncontrolled alteration of the brain function. It is a sudden electrical discharge of neurons in the brain.
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seizure
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What is usual treatment for a seizure patient?
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Medications
Usually taken for life Children take meds for 1-2 years until seizure free or until age of 16 Surgery Vagus nerve stimulation-used when meds are not working. Similar to a cardiac pacemaker in the brain. DO NOT NEED ANTIBIOTIC PREMEDICATION |
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Does a patient with Vagus nerve stimulation need a premedication?
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NOOOOOO
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Name the three anticonvulsant medications that seizure patients take.
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Phenytoin- Dilantin
Carbamazepine- Tegretol Valproic Acid – Depakote |
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________________
⇨ Gingival overgrowth |
Phenytoin- Dilantin
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. ____________
⇨ Xerostomia, delayed healing ⇨ Drug interaction with erythromycin *** |
Carbamazepine- Tegretol
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_________________-
⇨ Excessive bleeding (decreased platelet aggregation), delayed healing. ⇨ Also used for migraine headaches, mood stabilizers |
Valproic Acid – Depakote
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oral manifestations of epileptic patients...
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Gingival overgrowth due to Dilantin
Effects of accidents during seizures scars of lips and tongue fractured teeth |
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Hyperplasia usually occurs 42 % of the time. (Gingival overgrowth)
Begins as painless enlargement of gingival margin Interproximal papilla become involved to cover the occlusal/incisal surface Located in anterior more often than posterior and buccal rather than lingual |
study
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________= overdose of insulin
⇨ sugar levels less than 50 mg/dL ________= ⇨ sugar levels greater than 126 mg/dL |
Diabetic shock/ hypoglycemia
Diabetic coma/ hyperglycemia |
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Diabetes mellitus may occur as a result of:
Genetic make-up- Type I or Type II (twin study) Destruction of islet cells due to inflammation, cancer, or surgery An endocrine disorder such as hyperthyroidism Disease caused by the use of steroids |
study
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Islets of Langerhans=hormone producing cells of _______
Beta cells= endocrine cells which produce _____ |
pancreas
insulin |
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__________( represents 10% of diabetics) Absolute insulin deficiency
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Type I
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_____ (represents 90-95% of diabetics= 10 X more common than Type I) Result of insulin resistance with an insulin secretory defect
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Type II
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IGT-impaired glucose intolerance /malnutrition related
GDM-gestational diabetes mellitus=abnormal glucose tolerance during pregnancy…. Baby becomes fat! |
study
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Lack of insulin or insulin action allows:
Build-up of glucose in the tissues ________ leads to increase in glucose excretion and increase in urinary volume leads to increase to _____ especially in elderly Also leads to metabolic acidosis which if severe, leads to coma and death=______ |
Hyperglycemia
dehydration KETOACIDOSIS |
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Life expectancy of diabetic- live on average ___ years less than general population OR median age of death is 49 years old
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22-24
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________
Beta cells are destroyed and no _______ is secreted Has a sudden onset of clinical symptoms Often found in individuals under 40 years of age In children it is preceded by sudden onset of growth spurt Has a weak genetic component _______ is leading cause of death Body build is usually normal or thin due to lack of glucose to cells/ cellular starvation |
type 1
NO INSULIN Renal failure |
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Cardinal symptoms of Type ____:
_______ (excessive thirst) _______(excessive urination) _______ (excessive eating) Weight loss=body shifts to metabolizing fat to “find” a source of glucose Loss of strength |
I
Polydipsia Polyuria Polyphagia |
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____________
Beta cells _____, but secrete low amounts of insulin and have insulin resistance Generally occurs after the age of 40 Has either increased insulin resistance or decreased insulin secretion Has a higher ________ component than Type I Obesity plays a major role in the development-60-70% are obese Most common cause of death in patients is ________/ by age 55, 1/3 of Type II diabetics die from coronary heart disease |
remain
genetic myocardial infarction |
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Cardinal symptoms of Type ____ diabetes is much less common and are more slowly developed
Usual symptoms: Body build is obese urination at night blurred and/or decreased vision Usual symptoms Paresthesia (abnormal sensation such as burning, pricking, tingling) Loss of sensation Impotence* Orthostatic hypotension* |
2
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Monitoring glucose
Glucometer- daily monitoring by patient who is diabetic Finger prick/ insulin dose determined by basis of the level of glucose HbA1c lab test- long term assessment of glycosylation of hemoglobin A Measures blood sugar control over the preceding 2-3 months 6%- 8% HbAlc good range/ 20% is out of control |
study
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Oral hypoglycemic agents- Type ___ diabetes= ______ (Glucophage)
Insulin therapy- injectable insulin- Type I diabetes Exubera® inhaled insulin Insulin pump- worn on a belt and sensors reflect the need for continuous insulin need Implantable insulin pump Pancreas transplantation |
II
metformin |
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Medications for _______
Injectable= insulin Injected because of it’s large molecular size Novolog* Humalog* Humulin* Lantus Novolin Oral preparations 4 groups according to their mechanism of action Metaformin* Glucagon* Acarbose Piogliatazone |
Diabetes
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_______________
__________ REACTION DUE TO EXCESS OF INSULIN/ BLOOD GLUCOSE LOW Rapid onset Patient has failed to eat , but has taken medication Patient has symptoms such as confusion, cold sweats, headache and shaking |
insulin shock
HYPOGLYCEMIC |
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Cardinal symptoms of Type ____ diabetes is much less common and are more slowly developed
Usual symptoms: Body build is obese urination at night blurred and/or decreased vision Usual symptoms Paresthesia (abnormal sensation such as burning, pricking, tingling) Loss of sensation Impotence* Orthostatic hypotension* |
2
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Monitoring glucose
Glucometer- daily monitoring by patient who is diabetic Finger prick/ insulin dose determined by basis of the level of glucose HbA1c lab test- long term assessment of glycosylation of hemoglobin A Measures blood sugar control over the preceding 2-3 months 6%- 8% HbAlc good range/ 20% is out of control |
study
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Oral hypoglycemic agents- Type ___ diabetes= ______ (Glucophage)
Insulin therapy- injectable insulin- Type I diabetes Exubera® inhaled insulin Insulin pump- worn on a belt and sensors reflect the need for continuous insulin need Implantable insulin pump Pancreas transplantation |
II
metformin |
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Medications for _______
Injectable= insulin Injected because of it’s large molecular size Novolog* Humalog* Humulin* Lantus Novolin Oral preparations 4 groups according to their mechanism of action Metaformin* Glucagon* Acarbose Piogliatazone |
Diabetes
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_______________
__________ REACTION DUE TO EXCESS OF INSULIN/ BLOOD GLUCOSE LOW Rapid onset Patient has failed to eat , but has taken medication Patient has symptoms such as confusion, cold sweats, headache and shaking |
insulin shock
HYPOGLYCEMIC |
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Stages of ________
Mild * characterized by hunger, weakness, trembling, tachycardia, pallor and sweating * Occurs before meals, during exercise, when food has been omitted or delayed Moderate * Patient becomes incoherent, uncooperative, belligerent * Patient may injure him/herself or some one else Severe * Complete unconsciousness, with possible seizure * Takes place during sleep, or after exercise, or after ingestion of alcohol. * May need glucose IV |
insullin shock
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_____________
Hyperglycemia= build of glucose in blood Slower onset than diabetic shock, but is more life threatening Occurs from eating and neglecting to take medication Symptoms are ketoacidosis, increased thirst and urination, fruity breath Unable to manage infections and heal wounds Body fluids become acidic Decreased blood flow to area of injury Severe acidosis leads to coma and death |
diabetic coma
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Diabetic emergency
If you are unsure which scenario is happening and patient has passed out or incoherent, go ahead and dispense _____ source ASAP |
glucose
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Cardinal symptoms of _____ - refer to physician
Findings which may suggest diabetes: headache, dry mouth, blurred vision progressive periodontal disease, multiple periodontal abscesses |
diabetic
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What are some dental recommendations for brittle diabetics?
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Patient with brittle diabetes:
may need special dietary instruction after periodontal or surgical procedures and may need antibiotic prophylaxis if they develop an infection |
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Appointment Management of diabetic
Major goal is to prevent insulin shock during dental appointment Morning appointments-preferably right after breakfast Confirm patient has eaten and taken insulin Keep a source of sugar available Patient with brittle diabetes: may need special dietary instruction after periodontal or surgical procedures and may need antibiotic prophylaxis if they develop an infection Limit use of local anesthetic to the well-controlled diabetic |
study
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Diabetic patient who is controlled and under care can receive any indicated dental treatment
Delay treatment ***when fasting blood glucose is < 70mg/dL or > 200 mg/dL Recommend a liquid diet after extensive periodontal procedures and/or surgery (blend their normal diet in a blender) Have patient report any symptoms while you are working |
study
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Delay treatment of diabetic when fasting blood glucose is < ___mg/dL or > ____ mg/dL
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70
200 |
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oral manifestations of _______
Accelerated periodontal disease in poorly controlled diabetics Periodontal abscesses Increased caries- increase sucrose level in parotid gland in times of unbalanced glucose levels Xerostomia- due to increase of fluid depletion Poor healing Oral ulcerations Candidiasis Bacterial and fungal infections Numbness of oral tissues- diabetic neuropathy (nerves are damaged) Burning of oral tissues- diabetic neuropathy Lichen planus- altered immune system Children of diabetics have 28% more frequency of enamel hypoplasia |
diabetics
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Emergency management of diabetic patient
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place pat. in supine position
administer oxygen if conscious, give high sugar not conscious rub high sugar on buccal mucosa monitor and record vital signs Call 911 insulin shock improves immediately |
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________ is autoimmune disease of unknown etiology that is characterized by:
symmetric inflammation of _____ joints hands feet knees |
rheumatoid arthritis
large |
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Pathophysiology of ______
Changes in _______ (inner lining of the joint capsule) edema thickening folding Marked infiltration of cells into capsule lymphocytes plasma cells (B and T cells) Enzymatic activity of cells destroys cartilage Healing leads to granulation tissue _________“” |
RA
synovium squeaky wheels |
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Drug therapy for ____
1.aspirin= A LOT…. 5 tablets/ 4X day 2. NSAIDS ibuprofen=Motrin, Advil, 3.COX 2 inhibitors = Celebrex/ Vioxx (off the market now) 4. naproxen=Aleve 5. Injectable glucocorticoids- not long term 6. Gold compounds 7. Immunosuppressive= Methotrexate |
RA
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What are oral manifestations of RA?
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TMJ involvement- because of erosion of the condylar head; found in up to 75% of patients.
Anterior open-bite possible |
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What is specific dental management for RA?
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Short appointments
Allow patient to make frequent position changes for comfort Sitting or semi supine Physical supports such as rolled towels Pre medication needed for joint replacements |
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Drug related side effects(RA)
Prolonged bleeding due to _____ Immunosuppressives may cause ________ Gold salts may cause _____ |
NSAIDS
oral ulcerations stomatitis |
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________ is a Degenerative joint disease. It is the most common form of arthritis
etiology Unknown May be the end result of normal wear and tear on joints over a long period of time Genetic predisposition Obesity leading to overloading of joints |
osteoarthritis
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pathophysiology of _____
Articular cartilage becomes _____ Joint thins after a period leading to softening of the cartilage There is: progressive splitting and abrasion of cartilage down to the subchondral bone The exposed bone becomes “_____” and sclerotic New bone forms at: the margin of reticular cartilage in the non-weight-bearing part of the joint This creates “spurs”, often covered by cartilage This augments the degree of deformity |
OA
thicker polished |
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S&S of ___
Initial symptoms localized to one or two joints Dull painful swelling of the joints lasting 15 minutes typically in the morning or after inactivity Heberden’s nodes/Bouchard’s -painless bony growths TMJ symptoms: Crepitus Stiffness Pain during chewing |
OA
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Oral complications of ___
TMJ involvement= radiographic changes such as decreased joint space Occasional pain Crepitus Pain upon wide opening |
OA
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Medical management of __
Acetaminophen (Tylenol) considered first line of defense Aspirin or NSAIDS if Acetaminophen is not effective Narcotics for acute flare ups Joint replacement |
OA
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New guidelines
Given the potential adverse outcomes and cost of treating an infected joint replacement, the AAOS recommends that clinicians consider antibiotic prophylaxis for all total joint replacement patients prior to any invasive procedure that may cause bacteremia. However, patients with pins, plates and screws, or otherorthopaedic hardware that is not within a synovial joint are not at increased risk for hematogenous seeding by Microorganisms |
study
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Two thirds of PJI were the result of ____ infections
4.9% caused by STREP of possible oral origin most likely by physiological factors Evidence is weak |
STAPH
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Prosthetic implants placed to restore esthetics or function ARE NOT considered at risk for bacterial seeding from oral invasive procedures and DO NOT require antibiotic coverage.
Example: breast and penile |
study
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S&S of ___
Joint inflammation and damage Joint stiffness Muscle and soft-tissue weakness TMJ more frequently involved High fever and/or rash High level of white cells in the blood Enlarged: lymph nodes liver spleen |
juvenille arthritis
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S&S of ____
Arthritis: the most common manifestation (76%) Butterfly rash of: nose and cheeks on areas of sun exposure Recurrent pharyngitis Oral ulcerations Renal abnormalities Neuropsychiatric symptoms Pulmonary manifestations |
SLE
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Oral manifestations of ____
Oral lesions of lips and mucous membranes 5-25% of the time Resemble lichen planus or leukoplakia Xerostomia Hyposalivation Dysgeusia and glossodynia (burning or painful tongue) |
SLE
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Autoimmune disease classified with the rheumatic diseases which affects the salivary and lacrimal glands. (Dry mouth and dry eyes)
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SJOGREN’S SYNDROME
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oral manifestations of ______
Hyposalivation-less than 5% or normal quantity of saliva Glossitis Burning tongue-tongue become depapillated and fissured Candidias of the tongue Mucositis Parotid gland hypertrophy Angular cheilosis Dysgeusia- taste dysfunction |
SJOGREN’S SYNDROME
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Glucocorticoids = (cortisol)
Cortisol regulates Carbohydrate, fat, and protein ______ Inhibits _____ Maintains homeostasis during physical/emotional stress |
metabolism
inflammation |
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_______= (aldosterone)
Aldosterone regulates: sodium and potassium balance in the kidney maintenance of extra cellular fluid |
Mineralocorticoids
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Primary adrenocortical insufficiency:
hypoadrenalism * _____ disease Secondary adrenocortical insufficiency: 5 times more common than primary hypoadrenalism * Pituitary disease or steroid therapy Excess production of adrenal products: hyperadrenalism *______ disease |
Addison’s
Cushing’s |
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_______=deficiency of aldosterone and cortisol
Primary symptoms weakness fatigue abnormal pigmentation*** |
Addison’s disease
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Rare but life threatening in spite of steroid supplementation
⇨ If patient is challenged by stress, they may not have enough steriods to handle the stress ⇨ Considered a medical emergency that can result in death: * profuse sweating * sunken eyes * severe hypotension * nausea, vomiting * circulatory collapse ⇨ Requires IV injection of glucocorticoid |
adrenal crisis
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Hypoadrenalism:
⇨ Patients undergoing stressful surgical procedures may need additional supplemental glucocorticoids |
study
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Prevention of Complications
Routine dental care can be provided for patients with adrenal insufficiency Only those going under stressful situations such as surgery might need supplemental glucocorticoids If additional glucoccorticoids are taken, they are taken within 2 hours before the procedure |
study
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____________
A patient who has been receiving high dose corticosteroid therapy Also considered hyperandrenalism * hypertension, heart failure, depression * increased risk for osteoporosis * weight gain * round or moon shaped face * “buffalo hump” on back * acne |
HYPERADREALISM CUSHING’S SYNDROME
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Hyperadrenalism: (Cushing’s syndrome)
⇨Monitor blood pressure*** (increased likelihood of hypertension) ⇨ Address the risk of increased risk of periodontal involvement ***(osteoporosis) |
study
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Hyperthyroidism = _________
Hypothyroidism = ______ or cretinism) |
Thyrotoxicosis
(Myxedema |
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______________
SYMPTOMS Restlessness, fever, tachycardia, sweating, onto coma and or death. * BEGIN EMERGENCY TREATMENT: - cool patient with cold towels because of elevation of body temperature - injection of hydrocortisone - call 911 |
thyrotoxic crisis
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oral manifestations of ______
Osteoporosis More aggressive perio Extensive caries Premature loss of deciduous teeth Early eruption of permanent teeth Early jaw development Tumors found in midline of posterior dorsum of the tongue |
thyrotoxicosis
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S&S of ______
Signs and symptoms - eyes retraction of upper lid bright-eyed stare lower lid lag jerky motions of lid Found in 50% of Grave’s patients and causes the most disability of the symptoms |
graves disease
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Patients with untreated or poorly managed thyrotoxicosis are highly sensitive to:
____________- or other amines Do not use local anesthetic with EPINEPHRINE or impregnated epinephrine cord if patient is not being managed with physician |
epinephrine
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____________________
Five to six more times common than hyperthyroidism 10% of women over the age of 40 have a thyroid hormone deficiency Treated with: thyroid extract of synthetic thyroid*** |
Hypothyroidism/Acquired or Congenital
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Oral manifestations of ______
Increased tongue size delayed eruption of teeth malocclusion gingival edema |
cretinism
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Examine gland- enlarged thyroid will feel ____ than the normal gland
Normal gland- will feel _____ Posterior dorsal region of tongue-examine for nodule that could be lingual thyroid disease. Carcinoma- will feel ___ and are usually isolated swellings (estimated number of cases in the U.S. 18,400 with 75% being women) |
softer
rubbery firm |
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Recognition of ____ (coma):occurs in untreated severe hypothyroidism.
hypothermia bradycardia hypotension epileptic seizure seek immediate medical aid hydrocortisone (100-300mg) CPR |
myxedema
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_____________
Hypotension to normal, BP, bradycardia Intolerance to cold Intolerance to CNS depressant drugs Unintentional weight gain Edema of face, tongue, neck, goiter Lethargic, fatigued, dry skin Medical emergency=myxedema coma |
HYPOTHYROIDISM
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____________________
Hypertension, tachycardia Elevated body temperature Intolerance to epinephrine Weight loss Bulging eyes, goiter Nervous, trembling, sweating Medical emergency= thyroid storm |
HYPERTHYOIDISM
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____________ is a condition in which fluid accumulates in the brain
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Hydrocephalus
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CSF shunts do not appear to increase the risk of bacterial infection after dental procedures
American Heart Association issue a statement that pre medication is not needed before dental procedures (2003) |
study
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With the ___________ shunt in place, cerebrospinal fluid flows into the ventricular (collection) catheter and down the exit catheter, which shunts the fluid into the peritoneal cavity.
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Ventriculoperitoneal
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_______
Patients may complain of initial symptoms to dental hygienist of abnormal facial pain, visual disturbances Dental care should be given during remission According to impairment; i.e. wheelchair transfer Short _______ appointments due to the fatigue factor in the afternoon |
Management for multiple sclerosis
morning |
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oral manifestations of MS
Occur only 2-3% of the time ____ of the orofacial structures Produces slow, irregular speech |
Numbness
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A progressive irreversible disease characterized
by degeneration of the brain cells and leading to severe dementia |
Alzheimer’s Disease
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The Alzheimer’s patient should be placed in an aggressive preventive dentistry program ( in the early stages of the disease) which should include:
__ month recall Oral examination Prophylaxis Fluoride gel application OH education- may be given to primary caregiver Adjustment of prosthesis Patients with advanced dementia may require sedation and short appointments |
3
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Management of ______ patients
Repeat instructions and explanations Nonverbal communication can be helpful Facial expression and body posture should demonstrate support and care Positive nonverbal communication includes: direct eye contact, smiling, touching the patient at the shoulders or arms |
Alzheimer’s
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Drug consideration for Stroke pat.- for oral surgery
aspirin-obtain pretreatment bleeding time(<__ minutes) Warfarin (Coumadin)-obtain prothrombin time <2.5 seconds PT or < 3.5 INR |
20
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Oral complications of ______
Might have difficulty in swallowing Slurred speech Right side damage leaves left side possibly neglected Food and debri might accumulate in impaired area Might see ______ of the carotid arteries on panoramic films. (Near C 3 or 4) This indicates a risk of stroke and patient may need referred |
stroke patients
calcified plaques |
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emergency management of stroke patient
Patient can be given oxygen EMS should be activated ASAP Signs of a patient having a stroke: Can not smile Can not raise both arms Can not speak a simple sentence coherently |
study
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Medical management of stroke
First is prevention Fruits, vegetables, exercise have significant protective effects Reduce or eliminate high BP, smoking diabetes Aspirin 81- 325 mg daily reduces stroke by 25% in the at risk population After stroke Anticoagulant therapy for thrombosis or embolism Possibly corticosteroids (reduce cerebral edema) Surgery Stent Rehabilitation |
study
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_____ is a neurologic deficit caused by sudden interruption of oxygenated blood to the brain
Focal necrosis of the brain tissue is the end result This interruption is usually caused by thrombosis of a cerebral vessel- 60-80% of strokes embolism (blood clot) or intracranial hemorrhage/aneurysm- 15% of strokes |
Cerebrovascular Accident (CVA
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Most commonly, a major stroke is preceded by one or two Transient Ischemic Attack (TIA) within a day to a week. There are some warning signs.
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study
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Described as a “mini-stroke”
Numbness of face, legs, arms, tingling or speech disturbances lasting less than 10 minutes Ischemia= temporary deficiency of blood flow to an organ or tissue. |
TIA
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modes of transmission for ___
Transmission by inhalation: A typical infection: inhalation of infected droplets are then carried to the alveoli bacteria settle begin to multiply Infection progresses locally may involve regional lymph nodes Infection is dependent on the number of organisms inhaled and the susceptibility of the individual Most commonly by: Cough or sneezing or talking Smaller droplets evaporate readily Bacteria float in the air are easily inhaled Transmission by ingestion: rarely occurs since pasteurization of milk |
TB
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_______=The interval from infection to development varies:
from a few weeks to decades most cases are due to reactivation of tubercle-could even be 20 years later about 10% result from initial infection |
transmission
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oral manifestations of ____
Oral ulceration (uncommon)- deep irregular ulcer on the back side of the tongue Tuberculosis involvement of: cervical lymph nodes submandibular lymph nodes involvement called scrofula- large and painful nodes that abscess and need drained |
TB
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What are dental modifications for TB?
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No treatment planning modifications are required for these patients if disease is not active or patient has received proper medication for proper length of time
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Dental patients are placed in 4 categories for management purposes.
Patient with recently diagnosed clinically active and sputum-positive TB Patients with past history of TB 3. Patients with recent conversion to “+” TB skin test 4. Patients with signs and symptoms of TB |
study
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What are the three drugs used for TB?
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RIFAMPIN (can cause leukopenia and thrombocytopenia=increase in gingival bleeding)
ISONIAZID PYRAZIMAMIDE These three drugs are given: for 8 weeks if susceptible organisms are present Followed by isoniazid and rifampin (without pyrazimamide) for the next 4 months To complete a 6 month treatment ADVERSE EFFECTS OF THESE DRUGS: WITH THE LIVER , GI, AND XEROSTOMIA |
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These are oral manifestations of ________ substance abuser
Poor hygiene and neglect (caries) Nutritional deficiencies resulting in glossitis/ loss of papilla/ angular cheilitis Sweet musty odor*** associated with liver failure Enlarged parotid glands** soft and non tender Increased risks factor for development of squamous cell carcinoma in lateral boarder of tongue and floor of the mouth |
alcohol
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Modifications to Dental Treatment for ______________
Postpone treatment for intoxicated patients Pain control a problem: aspirin may cause GI problems of bleeding; acetaminophen, up to ___day (limited dose) _______can be used A thorough head and neck exam for squamous cell carcinoma Any non painful oral ulceration present for more than two weeks should be referred for biopsy Recommend _________ mouth rinses |
Alcoholics
4g/ Lidocaine non alcohol |
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GUM® brand Chlorhexidine Gluconate Mouth Rinse -
Crest Pro-Health Peroxyl Biotene Plax Tom’s Natural mouthwash Are all examples of _______ mouthrinses? |
non alcoholic
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Peridex™ Chlorhexidine Gluconate 0.12% Oral Rinse prescribing information
Recommended use is twice daily rinsing for 30 seconds, morning and evening after tooth brushing. Usual dosage is 15ml of undiluted Peridex Oral Rinse. Patients should be instructed to not rinse with water, or other mouthwashes, brush teeth, or eat immediately after using Peridex Oral Rinse. Peridex Oral Rinse is not intended for ingestion and should be expectorated after rinsing. |
study
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Dental Management of ______ User
Should not receive any treatment for at least ___hours after last use Danger of myocardial ischemia and cardiac arrhythmia ** Don’t use local anesthetic with ___ if treatment occurs within 24 hours after use Patient should not be prescribed addictive substances** |
Cocaine
24 epi |
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Oral Manifestations of _________
_______ is characterized by broken, discolored and rotting teeth The drug causes the salivary glands to ______, which allows the mouth's acids to eat away at the tooth enamel, causing cavities Teeth are further damaged when users obsessively grind their teeth, binge on sugary food and drinks, and neglect to brush or floss for long periods of time Increased incidence of perio disease because of ______ to tissues causing permanent damage |
Methamphetamine
Meth mouth" dry out vasoconstriction |
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Dental Treatment Modifications of _______
No treatment for at least ___ hours after drug administration ⇨ peak blood levels may last 24 hours Caution with local anesthetics, nitrous, and prescription narcotics-wait 8 hours ⇨ could cause severe hypertension Speak slowly , using low voice Use slow movements and hands visible No bright lights** ⇨ may cause them to react violently Keep patient talking to avert paranoid thoughts Often full mouth extraction indicated*** |
methamphetamine
8 |
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Dental Treatment Modifications for _______ users
Heavy users should refrain from use at least ______ before dental treatment with local anesthetic |
Marijuana
one week |
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Acute effects of ______
Mental/ euphoria, relaxation, increased visual and auditory awareness Ocular/visual- dry, bloodshot eyes, impairs tracking ability Hormonal/ disrupts testosterone secretion, reduced sperm count Increased appetite, ______ increased heart rate Difficulty concentrating, disrupts short term memory |
marijuana
dry mouth |
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Morphine
Heroin Hydrocodone= Loratab®,Vicodene hydrocodone + acetaminophen Codeine=Plain codeine (injection) Tylenol#2,3,4® codeine + acetaminophen Oxycodone= Percocet® acetaminophen +oxycodone Percodan® aspirin +oxycodone |
study
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_____ is a Fat soluble form of morphine
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heroin
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Which two forms of Hep is contracted through feces, route of transmission is through feces-oral, and are not chronic infections?
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Hep A and E
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HAV=
infectious hepatitis 2-3 week period before onset of jaundice communicability decreases after jaundice appears |
Hep A
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______:
before jaundice appears (1-2 weeks) ______: while jaundice is present(GI symptoms for 2-8 weeks) ________: without jaundice Jaundice may appear in adults, rarely in children |
Preicteric:
before jaundice appears (1-2 weeks) Icteric: while jaundice is present(GI symptoms for 2-8 weeks) Anicteric: without jaundice Jaundice may appear in adults, rarely in children |
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(HBV); ________ virus:
DNA type virus (HBsAg); Hepatitis B surface antigen found on surface layer of virus serum marker in ____ disease carrier state*** |
Hepatitis B
acute |
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(Anti - HBs); ______- YOU
indicates immunity or passive antibody from HBIG (vaccination) (HBcAg); ________ found in center/core of virus marker for ____ disease when found < 6 months persistent infection when found > 6 months |
antibody to HBsAg
Hepatitis B core antigen active |
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(HBeAg) ; ________
indicates high infectivity*** persists into carrier state |
Hepatitis B “e” antigen:
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Direct percutaneous inoculation-needle sharing, tattooing, body piercing
FIVE TYPES OF TRANSMISSION OF ____ |
HBV
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OCCUPATIONAL TRANSMISSION
Usually through a sharps injury with contaminated blood HBV and HCV are the only hep virus with occupational risk. HCV is at _____ risk Risk of contracting HBV or HCV after an injury is 6-30% |
less
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Absorption of infective secretions; the most frequent route of transmission in the U.S. is by sexual activity is the most frequent mode of transmission for _____
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HBV
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____________
Patient undiagnosed for hepatitis but: develops antibodies permanent immunity transient because: the individual has a rapid immune response strong immune response to the HBV HBV is cleared before it can become established May persist for decades causing liver damage and/or heptatocellular carcinoma |
Transient Subclinical Infection
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Postexposure Prophylaxis
Immediately “bleed “ the wound cleanse with soap and water Draw patient blood for: serology (HBsAg) and Draw blood from inoculated individual for: serology (Anti-HBs) Test results..... HBsAg- patient: no treatment HBsAg+ patient: no treatment if vaccinated and have adequate level of Anti-HBs+ level |
study
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Post exposure Prophylaxis
Patient HBsAg+: Practitioner unvaccinated give HBIG within 48 hours: (Hepatitis B immune globulin. Passively delivered antibody that provides “instant” protection against HBV) and begin HBV vaccination series Patient HBsAg+: practitioner vaccinated with inadequate levels of Anti-HBs+ HBIG and vaccine booster |
study
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HCV - Hepatitis C Virus
Most common _______ blood borne infection in the United States Illicit drug users (60% of HCV are in this group and HCV is four time more common than HIV) |
chronic
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HDV - ______:
cause of delta hepatitis causes infection only in the presence of HBV (co-infection) HD Ag: ___________ detectable in early acute delta infection |
Delta virus
Delta antigen |
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HEV :
Cause of hepatitis E Hepatitis E virus name for: enterically transmitted (through small intestine) nA-nB hepatitis similar to HAV-fecal/oral Anti – HEV: Hepatitis E antibody indicates past or present infection to HEV |
study
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No dental treatment other than urgent care for patients with active hepatitis unless patient is clinically recovered
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***study
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No treatment modifications are required for patients who have recovered from hepatitis/ STANDARD PRECAUTIONS
Patients with chronic active hepatitis or who are carriers: ⇨ liver becomes unable to metabolize drugs ⇨ lidocaine becomes a factor and ___ carps of 2% lidocaine is the limited dose |
3
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