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29 Cards in this Set

  • Front
  • Back
Infective Endocarditis Lesion
-Vegetation (bacterial) that develops on a heart valve because of generally turbulent backflow of blood through the heart due to defect
-Congenital or acquired defect of endothelial tissues near high-flow shunts
-males > 60 years of age (about 25 % of all cases)
Common microbial agents involved in IE
-most common individual organism is staph aureus (accounts for 33%)
-most common group is viridians strep (accounts for 55%)
cardiac conditions that Must use Antibiotic premedication

High Risk

-Prosthetic heart valves
-Previous history of IE
-Complex cyanotic congenital heart dx (Tetrology of Fallot)
-Surgically constructed -systemic pulmonary shunts
cardiac conditions that Must use Antibiotic premedication

Most other congenital cardiac malformations
-Acquired valvular dysfunction
-Idiopathic hypertrophic cardiomyopathy (murmurs)
-Mitral valve prolapse with valvular regurgitation
procedures requiring antibiotics before for cardiac condition patients
Prophy, Scaling, probing
Restorations below the gum line
standard meds for cardiac patients before dental procedure
-Amoxicillin: 2.0 gm 1 hr prior to dental appointment
-Allergic to Penicillins:
Clindamycin 600 mg 1 hr prior to procedure
-if unable to take oral meds than inject 30 min. prior
standard meds for children that have heart problems before dental procedure
-based on body mass
-Amoxicillin 50 mg/kg orally 1 hr prior to procedure
-Allergic to Pencillins
Clindamycin 10 mg/kg 1 hr before procedure, then half dose 6 hours after initial dose
-Cephalexin or Cefadroxil 50 mg/kg orally 1 hr before procedure
-30 mins before if must be injected
if patient taking long term penicillian what percautions should be taken
-Avoid cephalosporins if allergic (anaphylaxis) reaction to penecillin
-this is because About 1/3 of cephalosporins are cross-reactive with pencillins
Rheumatic Heart Disease (RHD)
-Sequellae of acute rheumatic fever

-Associated with valvular stenosis and regurgitation that predisposes pt. to IE
-Caused by: Group A beta-hemolytic streptococcal pharyngitis
results in damage to the heart valves, primarily the mitral valve
40-50 % of patients w Acute Rheumatic Fever have carditis
Prosthetic Heart Valves
Requires monitoring of coagulation status prior to any surgical procedure
Atherosclerotic Heart Disease (ASHD)
-Thickening of the intimal layer of the arterial wall caused by the accumulation of lipid plaques
-Results in narrowed lumens, diminished blood flow & O2 supply
-Atherosclerosis is the most common cause of angina & MI, of strokes (CVA) & peripheral arterial disease
Signs & Symptoms of High Lipids
-Arcus senilus: a yellow ring of lipid around the iris of the eye
-Xanthomas: skin deposit of lipid and cholesterol look like bags under eyes
-High blood pressure
Pulmonary Disease
Most common problems
Chronic Obstructive Pulmonary Disease (COPD)
-Two most common forms:
Chronic bronchitis
COPD Dental Mgt
-Avoid nitrous oxide inhalation sedation
-Avoid use of barbiturates, narcotic, antihistamines, anticholinergics
-Treat in upright chair position
-Avoid erythromycin, macrolide antibiotics, and ciprofloxacin for patient taking theophylline
Retards theophylline metabolism risking toxicity
GI System: Dental Management

acid blocking drugs
(cimetidine) decrease the metabolism of certain dental drugs:
Diazepam (valium)
Tricyclic antidepressants
Dental Implications IBD
(Inflammatory Bowel Disease)
-Ulcerative Colitis pts
Small oral ulcers with white center and red ring on mucosa
-Crohn’s disease,
may be atypical mucosal ulcerations & diffuse swelling of the lips & cheeks
Dental Drugs Metabolized in Liver
Metronidazole ^

^ avoid if severe liver disease present, these are not completely metabolized
Hepatitis B
Transmission is primarily by percutaneous and permucosal exposures
-small cuts in the skin
-through mucosal surfaces (mouth, eye)
-transfer from surfaces
epilepsy Long-term drug management
Phenytoin (dilantin)
Carbamzepine (tegretol)
Valproic acid
-Drugs may cause an oral side-effect: gingival hyperplasia (42 %)
Lupus info
-Patients may have oral lesions, ulcerations resemble lichen planus or leukoplakia
Xerostomia, hyposalivation, dysgeusia, glossodynia
-may have infection potential, especially if patient is on corticosteroids or cytotoxic medications
-butterfly mark on face
Diabetes glucose levels
(FBS-fasting blood sugar)-serum
Normal: 70 -100 mg/dl
DM: > 125 mg/dl
Hypo is below 50
diabetes hemoglobin levels
Normal: 4 – 8
Good diabetic control: < 7.5
Poor diabetic control: 9 - 20

Elevated in hyperglycemia
diabetes medications
Type II

Type I
(Hyperthyroidism)Dental Management
Untreated, incompletely treated patients are sensitive to actions of epinephrine or other pressor amines, & should not be given these agents; If the patient is well managed, agents may be used
Do not use LA with epinephrine in untreated hyperthyroid patients!
Hypothyroidism (Myxedema)Dental Management
Patients may have enlarged tongue
Palpate thyroid gland on soft tissue exam
In untreated or poorly treated patients avoid:
Surgical procedures
Oral infection
CNS depressants
nephrotoxic drugs

drugs kidneys have hard time processing
Acetaminophen in high doses
Patients Receiving Dialysis
-Follow conservative management protocols
-Physician consultation advised
-Avoid taking BP or placing IV in the arm with the arterio-venous shunt (A-V Shunt)
-Best time for care: day after dialysis

Care: increased risk for carrier state of hepatitis B,C viruses & HIV
Anemia: Signs
Patients may complain of sore or painful tongue, smooth tongue, redness of tongue, loss of taste sensation. Dental papillae is lost
-Oral mucosa will appear pale