contraindications, emergencies Flashcards
If someone on bisphopshantes, what to do if have to have it extracted. Do you need prophylaxis?
-ideally avoid extraction, do RCT
-discuss risks and benefits
-if need extraction, no need for antiobitc prophylaxis unless required for another reason. follow-up after 8 weeks then refer to secondary care if it was not healing
What is the platelet count below where you avoid extraction
<100 x 10^9 per litre
-if so, refer to secondary care
<50 delay elective procedures
What is first line for fungal angular chelitis
miconazole ointment, but avoid in hepatitis or if on warfarin
How osteoradionecrosis is caused and why extraction needs to be avoided. What to do if need extraction
-caused by radiotherapy of head and neck region. It obliterates arteries, impairing blood supply. So if have extraction, then poor healing so avoided.
-if need extraction, send to secondary care where they will need to make it as atraumatic as possible and not use vasoconstrictor in LA. Pre and post op co-amoxicillin is advised
How to treat dry socket (first line)
Irrigate with saline and pack with alveogyl
What to do if someone has swelling around the ear and parotid, likely due to mumps
recommend paracetamol, tell them to isolate, go see GP to confirm it is mumps
If someone has prothetic heart valves and has had previous IE, that needs RSD, what do you do before hand
they are high risk so consult the cardiologist regarding prophylaxis
which antifungals to avoid or reduce with warfarin & hepatitis. which one can you use
-lower dose of fluconazole
-avoid miconazole
-can use nystatin
Which antibiotics to avoid with warfarin. and therefore which is used for abscess
-avoid penicillins, metranizadole, erythromycin, rifampicin
-clindamycin is used
If someone comes in with vesicles on mouth due to herpes that has been there for a day, what to do
=gingivostomatitits and risk of herpetic whitlow
-send them away, advise to take fluids and paracetamol rest
Recommend getting topical acyclovir, only systemic acyclovir if immunocompromised
Which LA to avoid in liver disease.
Avoid amides (lidocaine, prilocaine, articaine.) as they are broken down in liver
So ideally give esters (Benzocaine, procaine)
-but if ester allergy, give prilocaine or articaine reduced to 2 cartridges as less broken down in liver
What to do if 1-2 sprays of GTN sublingual spray doesn’t work
-repeat every 3-5 mins. Max 3 times
-100% oxygen 15l/min
-If no working could be MI so 300mg aspirin, call 999
-could be MI
Which antibiotics to avoid if pregnant, breastfeeding or risk of preterm
-Breastfeeding: clindamycin caution
-Pre-term: co-amoxiclav and metranidazole avoid
-Pregnacy: metronidazole, tetracycline
Which antibiotics to avoid if liver disease. which is safest
penicillins safest
-avoid tetracyclines, clindamycin, erythromycin
-reduce metronidazole or avoid
Which antibiotics to avoid or reduce dose if kidney disease
-Avoid=tetracyclines
-Reduce= erythromycin, amoxicillin
When must INR be checked before treatment, if stable and unstable with warfarin. What values it needs to be.
-take INR within 72hrs if stable, within 24hr if unstable
-INR <4 can be treated
What to do if warfarin patient has INR >4 and need extraction
-Inform GP, delay treatment until it is below 4. May need vitamin K and prothrombin
-Once <4, use local measures to achieve haemostasis
When someone would need to stop their DOAC before a dental procedure
-don’t need to stop treatment for 3-4 simple extractions and other low risk procedures
- if high risk procedure (surgical etc.) advise to miss morning dose dabigatran/apixaban, and delay rivaroxiban. And take >4 hours after haemostasis
-But never interrupt it if DVT or PE in last 3 months, or on med for cardioversion, stent, prosthetic heart valve
What to give a hypoglycaemic patient. what if uncooperative. What to do if unconscious in dental setting
-give oral glucose tablet or drink
-buccal hypostop for uncooperative
-inconscious = IM glucagon 1mg
Steroid cover for adrenal insufficiency (Addison’s) for minor and major procedures
-Minor surgery under LA – no change to steroid dose
-Major surgery LA, or GA -double dose hydrocortisone 24hrs before & after.
OR 100-200mg hydrocortisone IM 30 mins before, or IV instantly
What to give if bacterial angular chelitis
2% fusidic acid
What angular chelitis looks like and causes
-soreness, erythema, fissuring in corners of mouth
-assoicated with iron deficiency, dentures, reduced OVD, HIV, crohn’s
-either bacterial or fungal
What to do in acute adrenal crisis
-hypotensive, hypoglycaemia, hyponatraemic
lay flat, ABCDE, IV electrolytes and glucose. 200mg hydrocortisone
Management and medication for cardiac arrest with 1) no heart beat and 2) chaotic rhythm
with no heart beat= not shockable. 1mg IV adrenaline
With chaotic rhythm: DC shock. If fails, Adrenaline + amiodarone. Lidocaine. Atropine