Dental Review lecture

Question 1

Hypertension

- What systolic bp (in mmHg) is considered hypertensive?

Answer 1

140 mmHg (diastolic is 90 mmHg)

Question 2

Hypertension

- What diastolic bp (in mmHg) is considered hypertensive?

Answer 2

90 mmHg (systolic is 140 mmHg)

Question 3

Hypertension

- What systolic and diastolic bp is considered pre-hypertensive?

Answer 3

120-139 / 80-90 mm Hg

Question 4

4. At late stages of hypertension, target organ damage to occur. What are four organ examples?

Answer 4

Kidney, brain, heart, and eye

Question 5

4. Hypertension

- what eye damage can occur?

Answer 5

Retinal vessel hemorrhage, exudate, papilledema -> Advanced malignant hypertension

Question 6

4. Hypertension

- What brain damage can occur?

Answer 6

Hypertensive encephalopathy: headache, irritability, alterations in consciousness, CNS dysfunction

Question 7

4. Hypertension

- What heart damage can occur?

Answer 7

Left ventricle enlargement, congestive heart failure

Question 8

4. Hypertension

- What kidney damage can occur?

Answer 8

Hematuria, proteinura, renal failure

Question 9

7. At patient BP of >140/90, but

Answer 9

1. Yes, you provide any required dental treatment

2. No, but you do encourage patient to see physician

Question 10

7. At patient BP of >160/100, but

Answer 10

1. You provide any required, but consider intraoperative monitoring of BP for upper level stage 2
2. Prompt referral to physician (w/in one month)

Question 11

7. At patient BP of >180/110
   - Do you provide required dental treatment?
   - Do you refer to physician?

Answer 11

1. You defer elective treatment

2. Refer to physician ASAP; if patient is symptomatic, refer immediately

Question 12

8. What are some examples of oral manifestations of antihypertensive drugs?

Answer 12

Dry mouth, orthostatic hypotension, angioedema, dysguesia, lichenoid reactions, gingival hypertension

Question 13

Many studies and meta-analyses have shown that NSAIDS (increase/decrease) BP, most significantly in those who have ___

Answer 13

1. Increase

2. Hypertension

Question 14

Why should you avoid norepinephrine and levonordefrin in HTN patients?

Answer 14

They have an increased alpha-1 stimulation

Question 15

24. Can you treat someone immediately after MI?

Answer 15

No, you have to wait thirty days

Greatest risk: Lowest left ventricular ejection fraction

Question 16

27. What are short term consequences of hyperglycemia (diabetes)?

Answer 16

1. Polydipsia, polyuria, polyphagia

2. Diabetic coma (ketoacidosis or hyperosmotic)

Question 17

27. What are three long term consequences of hyperglycemia?

Answer 17

1. Microangiopathy

2. Deposition of by-products in tissue

Question 18

28. What are three relevant diagnostic labs for diabetes and the associated values?

Answer 18

1. Fasting blood glucose (>126/100mL)
2. 2hr Post-prandial Glucose (>200mg/100ml)
3. HbA1c
   (>7% in well-controlled diabetes)

Question 19

Do patients with diabetes have problems with:

• Saliva
• Infections
• Healing
• Pathology

Answer 19

1. Yes, xerostomia
2. Yes, bacterial, viral, and fungal
3. Yes, poor wound healing, candidiasis
4. Yes, caries, gingivitis, perio, abscesses, burning mouth, and leukoplakia

Question 20

35. What are consequences of kidney disease?
    - Increased susceptibility to __
    - Decreased amount of RBC
    - Abnormal b__
    - Electrolyte and fluid __
    - High blood pressure
    - __ intolerance
    - __ abnormalities

Answer 20

1. Infection
2. Anemia
3. Bleeding
4. Imbalance
5. Hypertension
6. Drug
7. Skeletal

Question 21

38. What are important lab values for Kidney disease?

Answer 21

1. Kidney function tests (GFR, BUN, Creatinine clearance)
2. Platelet count
3. Neutrophil count
4. Hemoglobin

Question 22

39. Kidney - At what level of GFR should dosage modification be considered?

What kind of meds should be avoided?

Question 23

47. What kind of tests for liver disease?

Answer 23

INR

Platelet

ALT/AST etc

They are susceptible to infection

Question 24

49. What drugs to avoid if liver disease?

Is acetaminophen (tylenol) okay?

Answer 24

1. Avoid NSAIDs and Aspirin

2. Yes, but only if limited to

Question 25

51. What antibiotics can you use safety? Which should be used with caution and increased dose intervals? (Aminoglycosides, beta-lactam antibiotics, clindamycin, macrolines, metronidazole, minocycline, tetracycline)

Answer 25

1. Beta-lactam ab 2. Metronidazole (use with caution) 3. Tetracycline, minocycline, and doxycycline should be used at reduced dosages and increased dose intervals

Question 26

53. Antibiotic prophylaxis for prosthetic cardiac valve, previous infective endocarditis, cardiac transplantation recipient who develop cardiac valvulophy, patient with congenital heart disease

Answer 26

test

Question 27

59. Anti-platelet - what is normal INR? - what's normal range for PT? - What is normal platelet?

Answer 27

1. INR 50k

Question 28

66. New Oral Anticoagulants - Dabigatran - direct and specific __ inhibitor - Irreversible binding? - Which factor of the extrinsic pathway does Dabigatran block?

Answer 28

Thrombin Reversible binding Factor 2

Question 29

Oral Antiresorptive Medications - if systemic conditions permit, Discontinue use how many months prior and how many months post?

Answer 29

1. 2 months prior | 2. 3 months post