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199 Cards in this Set

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What establishes in pts mind that oral health is part of general health and that pts dental probs may be related to systemic complaints?
Do you think your teeth are affecting your health?
What is todays population concerned with?
esthetics
Important to determine if pts expectations are what?
realistic
Are you worried about receiving dental tx will determine what?
reason for apprehension
Discussion of fears and being sympathetic listener may do what?
alleviate fears
Most unusual reactions to dental anesthetic are due to what?
fear, anxiety, or syncope (fainting)
What occurs during an allergic reaction?
itching, hives, rash, swelling, inability to breath
What are not ture allergic reaction?
vomiting and fainting
do you have any difficulitiy chewing your food or opening your mouth wide gives cues to what?
ill fitting dentures/partial
TMJ prob
carious lesion
missing teeth
malocclusion
It is important to determine if difficulty chewing food or opening is what?
condition static or progressive
recent onset or a chronic prob
is mvt restricted due to pain, disease, occlusal interferences
sensitive teeth and gums can cause what?
pain
hot or cold sensitivity
percussion
mobility
What does cold sensitivity suggest?
hypermia of the pulp and possible reversible situation
What does hot sensitivity suggest?
irreversible process in dental pulp
What does percussion suggest?
involvement of PDL,
What does rebound tenderness suggest?
fractured tooth
What does mobility indicate?
periodontal disease, bruxism, periapical lesion or trauma
What do bleeding gums suggest?
perio disease, blood dyscrasias (Luekemia)
What are common causes of sensitive teeth?
gingival ression
periapical inflammation
excessive occlusal fun attrition and bruxism
perio disease
dental caries
referred pain from max sinus
What causes canker sores, sore mouth, or cold sores?
may be causes by trauma, physical or emotional stress, nutritional deficiencies, acidic foods, immunologic defect, or unknown
can canker sores, sore mouth, or cold sores be recurrent?
yes
What is another name for canker sores?
Aphthous Stomatitis
can dental tx causes mouth sores?
yes, in those with frequent occurances
What are characteristics of aphthous ulcers?
round, oval concave lesion with white, yellowish gray centers and a red erythematous border
Where do aphthous ulcers occur?
nonkeratinized mucosa, labial and buccal mucosa, ventral surface of tongue, soft palate, tonsillar fauces, floor of mouth
How are aphthous ulcers classified?
minor-less 0.5cm in diameter
major- larger than 0.5cm in diameter
How long do aphthous ulcers take to heal?
7-10 days
what topical soln can be applied to aphthous ulcers?
kenalog, orabase, lidex
What is common cause of herpes lesions, cold sores, fever blisters?
Herpes Simplex Virus Type 1
What are extra-oral location for herpes?
lip, nose
intra-oral location for herpes?
on attached gingival tissue over bone
What is the etiology to primary herpetic gigivostomatitis
acute inf with herpes simplex type 1 virus in a person with no previous exposure to the virus
in who can primary herpes occur?
infant, child, or young adult
What are the symptoms for primary herpes?
fever, malaise, dehydration, difficulty eating, irritability, painful cervical lymphadenopathy, pharyngitis
Multiple vesicles that rupture, coalesce (form blisters) with ulcer on the lip, buccal and labial mucosa, gingiva, palate, and tongue are characteristic for what?
primary herpes
What do primary herpes look like?
ulcers are painful, small, yellow with red inflammatory borders
How long does it take for onset of initial inf of primary herpies?
3-10 days
How long do herpe lesions last?
12-20 days
What are tx for primary herpes?
acyclovir
antipyretic agents-tylenol
oral anesthetic rinse
fluids
Do you give tylenol or aprin or NSAIDS to pt with hepes?
tylenol
What is the etiology for recurrent herpes?
reactivation of herpes simplex virus Type 1
From where does the herpes virus leave in recurrent cases? (nerve)
down the trigeminal ganglion to the nerve to produce lesions on the perioral skin or oral mucosa
what can trigger recurrent herpes?
aging, sunlight, local trauma, physical or emotional stress, emmunosuppression
What is the characteristics of recurrent herpes?
cluster of small vesicles which rupture to form small ulcers that can merge to form larger ulcer
What is most common site for recurrent herpes?
lower lip
Are intraoral or herpes labialis more common?
herpes labialis
On what type of tissue do recurrent herpes occur?
kertanized mucosa such as hard palate, and attached gingiva
Do recurrent herpes occur in the same location or at new sites?
same site/location
How long do recurrent herpes last?
7-14 days
What is the tx for recurrent herpes?
acyclovir- oral or ointment
valtrex
denavir
What is the incubation time for herpetic whitlow?
2-20 days
What is caused by auto-inoculaiton from a herpes lesion, from lip or genital area, can be HSV type 1 or type 2
herpetic whitlow
what is characteristic of herpetic whitlow?
pain, erythema, vessicles, crusting, desquamation
How long does it take for herpetic whitlow to heal and wat tx is used?
2-3 wks
acyclovir
What does herpes simplex belepharitis infect?
eyelid
What is accumulation of small vesicles or pustules along the lid margin and or periocular skin?
Herpes Simplex Blepharitis
What can trigger herpes simplex Blepharitis?
fever, trauma, emotional stress, menstration, exogenous, immunosupressive agents, overexposure to UV radioation
What is tx for herpes simplex blepharitis?
use warm saline compresses with a topical drying agent
It is important to determine what if a person had a previous toothache?
nature of toothache
treated or not
type of tx
what is the present status of the tooth
When one has had a face or jaw injury you must be aware of what possible findings?
devitalization of teeth
malocclusion
TMJ pain
facial deformity
retained foreign object
What is a possible cause of max molar toothache?
sinus trouble
If someone is having sinus trouble one would look at a radiograph for what?
see if roots are adjacent to infected sinus
If a pt answers yes to currently being treated by a physician what must you determine?
nature of the condition and type of tx that the pt is receiving
Does a dentist ever need to meet with a pts physician before dental tx?
yes, if they have a chronic or acute disease
What will the pts current state of health influence?
dental diagnosis, therapy, prescribed drugs
What should be listed along with the type of med a pt is taking?
the purpose for taking the drug
Medications can help indicate what?
specific disease and severity of disease
What are common side effects of medications?
Xerostomia
increased bleeding
susceptibility to infection
intolerance to stress
What drugs can cause xerstomia?
antianxiety, antihypertensive
What drugs and increase bleeding?
blood thinners (Coumadin), Asprin, NSAIDS, Herbal OTC (GINGKO)
What drug increase susceptibility to infection and intolerance to stress?
corticosteroids
What are drugs that many pt may not consider to report?
asprin, birthcontrol, vitamins, herbal supplements
knowing the pt dosage of med in relation to the usual and customary does will help you what?
understand the severity of the disease
What is included in a positive response to someone being examined by a physician in the last 5 yrs?
Date of exam
reasons for exam
conditions discovered and tx
Is a negative response to have you been examined by a physician in the last 5 yrs good or bad?
bad
What does seriously ill indicate?
impaired health
If a person has been hospitalized what are other complications we are worried about?
excessive hemorrhage
wound infection
delayed healing
drug allergies
difficult convalescence
Tranfusions and GA usually indicate what
major surgery
Repeated tranfusions may indicate whay type of blood dyscrasia?
hemophilia
Aplastic anemia
What is aplastic anemia?
decrease in bone marrow elements such as RBS, platelets, granulocytes, WBC
One should be aware of the possibility of a pt having what if they have had multiple transfusions?
Hep B (most common(
Hep C
HIV
Any details and complications of general anesthesia should be recored on what?
health history form
what is donated blood screened for?
Blood typing, Rh factor, blood grouping
Hep B surface antigens
Hep B core
Hep C antibodies
What does Hep B surface antigen detect?
present infection or carrier state
What does Hep B core detect?
past or present infection
Which types of Hep have no carrier state?
A and E
Waht is he risk of becoming a carrier of Hep B
5-10%
What is the risk of becoming a carrier of Hep C
80-90%
What is the risk of becoming a carrier of hep D
20-70%
What else is donated blood screened for?
alanine amionotransferase enzyme
HIV
Syphilis
CMV
Sickel cell trait
Cholesterol level
West Nile Virus
What is alanine aminotransferase enzyme?
a liver enzyme to detect undetectable hep
What is CMV?
cytomeglovirus (member of herpetovirus group) May be seen in HIV pt, can also affect newborns and elderly pt
What does this question pertain to..have you ever been treated by x-ray, radium, cobalt tx as tx for cancer?
reguarding radiation tx for some form of cancer
What should a previous history of tx for malignancies alert you for?
possible recurrence
What prob can result form radiation in the head and neck region?
serstomia
dysgeuia
mucositis/stomatitis
muscle trismus
radiation caries
osteoradionectosis
What is xerstomia?
lack of saliva, dry mouth due to lack of function of saliva glands
Whay is dysgeuia?
abnormal or impaired taste
What is mucositis/stomaitis?
culture infections to identify fungal, bacterial, or viral orgion
Mouth pain prescribe topical or systemic analgesics
What is muscle trimus
muscular contracture from radiation therapy
What is radiation caries?
usually class V smooth surface caries which may encircle the cervicle third of teeth
What class are radiation caries?
Class V
What is osteoradionecrosis?
results in reduction of vitality of bone through the decrease of vascularity
What is bone necrosis secondary to?
radioation and superimpsoed infection
Where has a greater potential for osteoradionecrosis?
mandible
When can osteoradionecrosis occur?
any time in life following radiation tx to jaw
What is tx for osteoradionecrosis?
hyperbaric oxygen and antibotics
What questions should be asked if someone has been treated for a tumor?
where was the tumor located?
Was the tumor benign or malignant
how was the tumor treated
when was the tumor treated
What type of follow up care
How often evaluated
How are most cancer treated?
surgery or chemotherapy
A positive response to being or had been treated for tumor should alert one to what possibilities?
pt may still have a primary lesion or condition
the lesion may have metastasized to other areas of the body including the mouth and jaws
What is an example of an oral manifestation from a primary disease?
bleeding with leukemia
What changes can tx for a tumor cause?
thrombocytopenia
leukopenia
anemia
What is thrombocytopenia?
an abnormal hematologic condition in which the number of platelets are reduced
What is the most common cause of bleeding disorder/
thrombocytopenia
What is leukopenia?
prone to infection due to bone marrow suppression. Decrease in the WBC
What is anemia?
decrease in hemoglobin concentration in RBC, the amount of RBC, and volume of RBC per 100ml of blood are less than normal
What are the common sites of primary lesion that can metastasize to the oral cavity?
(in order of most to least likely)
breast
lung
kidney
thyroid
prostrate
colon
What is the #1 killing cancer for both men and women?
lung cancer
In order for someone to have a reason to believe they have been exposed to AIDS what must have happened/
person must have had direct contact of body fluids with HIV or AIDS pt
What ways can a person become infected with HIV or AIDS?
sexual contact
IV drug use and sharing syringes
infected mother to infant
transfusion
health care workers with contaminated needle sticks
What are the signs and symptoms of AIDS?
malaise for long period of time
loss of appetite, loss of wt
low grade fever for more than 1 month
unexplained lymphadenopathy
pneumonia
What oral manifestations are included in AIDS?
candidiasis
linear marginal erythema (LME)
Necrotizing Ulcerative Periodontitis (NUP)
oral hairy leukoplakia
Kaposi's Sarcoma
How is candidiasis treated?
antifungal drugs
What is the old term for linger marginal erythema?
HIV gingivitis
What is the old term for necrotizing ulcerative periodontitis?
HIV periodontitis
What if the tx for oral hair leukoplakia?
antifungal antibiotic
who is Kaposi's sarcoma most seen in?
65+ males of medirtianian descent
It is important to determine what if the pt has had an artificial joint, pin, plate or other device surgically implanted?
what type of appliance was placed and when it was placed
Do pins, plates, screws need antibiotic premed?
No
For how long post surgery do pt with artificial valve need to take antibiotic pre-med prior to dental tx?
2 yrs
What do you need to ask if someone had a drug or alcohol dependency?
how long have you been sober
how many time in tx
are you still going to AA or NA
What can happen if you give local anesthesia to a pt taking cocaine, ecstasy or meth in the last 24 hrs>
the epinephrine can cause a stroke or death
What yr of sobriety is the hardest?
first yr
Do drug addicts require more or less anesthesia and apt times?
longer and longer
How long is recovery form a dependency?
livelong
The current AHA guidleines DO OR DO NOT recommend antibiotic prophylaxis to prevent infective endocarditis for a transvenous pacemaker or cardioveter defibrillator?
DO NOT
What equipment should be avoid with a pacemaker pt?
ultrasonic scaler
pulp tester (electric vitalometer)
electrocautery unity
What is rheumatic fever?
acute inflammatory conditon that follows a sore throat, caused by a group A streptococcal infection
How long after initial pharyngitis does rheumatic fever develop?
2-6 wks
most cases of rheumatic fever are in what age group/
5-15
How many cases of rheumatic fever occur per yr in US?
100,000
Describe the acute phase of rheumatic fever?
lasts 6-12 wks
How long does it take for acute phase of rheumatic fever to resolve?
6 mo
What is the recurrence rate of the acute phase of rheumatic fever?
50%
Rheumatic fever and its sequelae account for how much of child heart disease?
95%
What type of cardiac damage can occur in rheumatic fever and what results?
damage to connective tissue and heart valves, results in heart murmurs
How is Rheumatic fever diagnosised
throat culture and blood test
What is the tx for rheumatic fever/
antibiotics, anti-inflammatory (NSAIDS), antipyretic meds, and bed rest
Do pt with history of RF and residual cardiac damage with rheumatic heart disease (RHD) require antibiotic pre-med?
Yes
What percentage of pt develop rheumatic heard disease after rheumatic fever?
30-80%
What is the earlies sign of damage of rheumatic heard disease?
organic heart murmer
Do you pre-med for pt with history of RF and no evidence of rheumatic heart disease?
NO
When is dental tx best with a pt with kidney diease/
day after dialysis
Why would you not treat a pt on day of dialysis?
heparin use (anticoagulant0
Do you take BP in arm with Av shunt used for dialysis?
no, use other arm
do pt with AV shunt require pre-med?
yes
What is peritoneal dialysis?
hypertonic or dialysate soln instilled into peritoneal cavity
how does peritoneal dialysis drain?
catheter 4-6 hrs into bag
peritoneal dialysis pt are at risk for what?
peritonitis
hemodialysis can remove certain drugs from the blood which does what?
shorten the effect of prescription med
How do you adjust for the affect of hemodialysis?
increase does
What type of drug may a pt with kidney transplant be taking?
immunosuppressive drugs
What drugs are toxic to pt/
Aspirin, NSAIDS, tylenol, acyclovir
Do you need to consult a physician prior to treating a pt with kidney disease/
Yes
Jaundice or hep can be chemically induced through what?
alcohol, antibiotics
What must you be concerned with when you have a pt with viral hep?
protection of personnel and carrier stat of pt
Pt with impaired live have tendency of what?
bleeding
Liver plays what vital role in metabolic functions?
bile secretion
conversion of glucose to glycogen
excretion of bilirubin
synthesis of coagulation factors
metabolism of drugs
Bile secreation is need for what?
need for fat absorption
Excretion of bilirubin is needed for what?
waste product of hemoglobin metabolism
Impairment of liver function can lead what abnormalities in metabolism?
amino acids, protein, carbs, and lipids
What is the most common liver disease in US?
cirrhosis
people with liver disease tend to have bleeding tendency?
reduction of prothrombin production
A person with liver disease may have prob detoxify what drugs?
Barbiturates, Valium
Local anesthesia, Xylocaine, Carbocaine
Tylenol, Asprin, Ibuprofen, Codeine
Ampicillin, Tetracycline
A positive TB skin test means what?
that the pt was exposed to Tb and does not mean they have the active disease
If you suspect active TB you should do what?
refer to physician
A positive history of TB will require you to find out when diagnosed and treated through what question?
how long on med
What meds are used to treat TB and for how long
INH (isoniazid) used tp treat and prevent TB, may be on 9mo-2yr
Rifampin- antiTB agent used for 6-9mo
If pt answers yes to venereal disease need to ask what?
nature of disease
type of tx
when disease treated
the # and frequency of recurrences
What are common drugs for heart attack pt?
cardiac med- digitalis
anticoagulant- coumadin, Asprin
if pt experience angina need to know what?
frequency, duration, severity,
and if on nitroglycerin
What is the general rule for heart attack pt?
elective tx should be postponed at least 6mo past date of heart attack
What special measures need to be taken with a pt with previous heart attack?
short apts,
pretreatment vital signs
semisupine chair position
pt shoudl bring own nitroglycerine
A heart attack should have what options to reduce stress and anxiety?
nitrous or valium
what should be used with local anesthetic to ensure good pain control?
vasoconstrictor
Stroke is a what?
cerebrovascular accident, CVA
What questions should be asked to a stroke pt?
when occur
degree of functional impairment
had any other strokes
are you currently taking meds due to stroke
How long should elective tx be postponed due to stroke?
6mo
What are the most common drugs given to stroke pt?
anticoagulants and antihypertensives
What is the number one cause of stroke?
hypertension
What is transient ischemic attack? TIA
mini stroke, caused by temporary disturbance in the blood supply to localize area of brain
What is common sign of transient ischemic attack?
numbness on one side of body, weakness, tingling or speech disturbances lasting few min
Of people with transient ischemic attacks, what percentage will have a stroke within a yr?
50%
A stroke victim should have what before dental treatment?
medical consult
Describe ideal apt for stroke pt?
short stress free, midmoring apt
What should you monitor during tx for a stroke pt?
BP
What risk factors do you need to be aware of for a stroke pt?
hypertension
diabetes
coronary atherosclerosis
high cholesterol
smoking
transient ischemic attacks
previous stroke
increasing age
For a stroke pt you need to use more or less local anesthetic with vasoconstricor?
less
If a pt is unsure of bleeding disorder, one needs to consider what?
lab tests
A person with a bleeding disorder need to do what prior to dental surgery?
be referred to a physician for ordering lab
What are the 4 things tested for with lab test in pt with bleeding disorder
PT, PTT, BT, INR