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