Knowing Your Patient

Front 1

Infective Endocarditis Lesion

Back 1

-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)

Front 2

Common microbial agents involved in IE

Back 2

-most common individual organism is staph aureus (accounts for 33%)
-most common group is viridians strep (accounts for 55%)

Front 3

cardiac conditions that Must use Antibiotic premedication

HIGH RISK OF BACTEREMIA

Back 3

High Risk

-Prosthetic heart valves
-Previous history of IE
-Complex cyanotic congenital heart dx (Tetrology of Fallot)
-Surgically constructed -systemic pulmonary shunts

Front 4

cardiac conditions that Must use Antibiotic premedication

MODERATE RISK OF BACTEREMIA

Back 4

Most other congenital cardiac malformations
-Acquired valvular dysfunction
-Idiopathic hypertrophic cardiomyopathy (murmurs)
-Mitral valve prolapse with valvular regurgitation

Front 5

procedures requiring antibiotics before for cardiac condition patients

Back 5

Prophy, Scaling, probing
Extraction
Surgery
Restorations below the gum line

Front 6

standard meds for cardiac patients before dental procedure

Back 6

-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

Front 7

standard meds for children that have heart problems before dental procedure

Back 7

-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

Front 8

if patient taking long term penicillian what percautions should be taken

Back 8

-Avoid cephalosporins if allergic (anaphylaxis) reaction to penecillin
-this is because About 1/3 of cephalosporins are cross-reactive with pencillins

Front 9

Rheumatic Heart Disease (RHD)

Back 9

-Sequellae of acute rheumatic fever

-Associated with valvular stenosis and regurgitation that predisposes pt. to IE
-Caused by: Group A beta-hemolytic streptococcal pharyngitis

Front 10

Carditis

Back 10

results in damage to the heart valves, primarily the mitral valve
40-50 % of patients w Acute Rheumatic Fever have carditis

Front 11

Prosthetic Heart Valves

Back 11

Requires monitoring of coagulation status prior to any surgical procedure

Front 12

Atherosclerotic Heart Disease (ASHD)

Back 12

-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

Front 13

Signs & Symptoms of High Lipids

Back 13

-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

Front 14

Pulmonary Disease
Most common problems

Back 14

Chronic Obstructive Pulmonary Disease (COPD)
-Two most common forms:
Chronic bronchitis
Emphysema
Asthma
Tuberculosis

Front 15

COPD Dental Mgt

Back 15

-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

Front 16

GI System: Dental Management

acid blocking drugs

Back 16

(cimetidine) decrease the metabolism of certain dental drugs:
Diazepam (valium)
Lidocaine
Tricyclic antidepressants

Front 17

Dental Implications IBD
(Inflammatory Bowel Disease)

Back 17

-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

Front 18

Dental Drugs Metabolized in Liver

Back 18

-Antibiotics
Ampicillin
Tetracycline
Metronidazole ^
Vancomycin^

^ avoid if severe liver disease present, these are not completely metabolized

Front 19

Hepatitis B

Back 19

Transmission is primarily by percutaneous and permucosal exposures
-small cuts in the skin
-through mucosal surfaces (mouth, eye)
-transfer from surfaces

Front 20

epilepsy Long-term drug management

Back 20

Phenytoin (dilantin)
Carbamzepine (tegretol)
Valproic acid
-Drugs may cause an oral side-effect: gingival hyperplasia (42 %)

Front 21

Lupus info

Back 21

-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

Front 22

Diabetes glucose levels

Back 22

(FBS-fasting blood sugar)-serum
Normal: 70 -100 mg/dl
DM: > 125 mg/dl
Hypo is below 50

Front 23

diabetes hemoglobin levels

Back 23

Normal: 4 – 8
Good diabetic control: < 7.5
Poor diabetic control: 9 - 20

Elevated in hyperglycemia

Front 24

diabetes medications

Back 24

Type II
Diabeta
Glyburide
Glipizide

Type I
Insulin

Front 25

(Hyperthyroidism)Dental Management

Back 25

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!
Hypertension
Tachycardia
Dysrhythmia

Front 26

Hypothyroidism (Myxedema)Dental Management

Back 26

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

Front 27

nephrotoxic drugs

drugs kidneys have hard time processing

Back 27

Acetaminophen in high doses
Acyclovir
Aspirin
NSAIDs

Front 28

Patients Receiving Dialysis

Back 28

-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

Front 29

Anemia: Signs

Back 29

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