Dentistry related

Question 1

Cardiac patient at dental office?

Answer 1

• Complete anamnesis in the initial assessment of the patient.
• Measure the patient’s vital signs before starting treatment.
• In case of valvular damage, prescribe antimicrobial prophylaxis to avoid bacterial endocarditis.
• Check the INR in case the patient receives treatment with oral anticoagulants.
• Monitor the appearance of orthostatic hypotension.
• Apply anxiety control protocols if necessary.
• Avoid vasoconstrictor use in anesthesia

Question 2

Rekommendation to anticoagulant patient after intervention?

Answer 2

• Perform rinses with tranexamic acid every 6 hours the days after surgery.
• Apply ice packs.
• Avoid eating hard or warm foods.
• Avoid Aspirin and NSAIDs as analgesics (of choice: paracetamol + codeine)

Question 3

Complicated extractions, the protocol includes:

Anticoagulant patient

Answer 3

1) INR should be controlled from 4 days before surgery, oral anticoagulation should
replaced by LMWH.

2) Check the day of surgery that INR <1.5 and the doctor has authorized the surgery.
3) To reduce the risk of bleeding, apply local hemostasis before, during and after the intervention.
4) LMWH therapy should be maintained after intervention.
5) The patient must return to the specialist who controls their anticoagulation.

Question 4

Simple extraction INR <3

Answer 4

Usually dont need to stop AC treatment

Inform general practitioner

Apply local hemostatic during procedure

Question 5

Simple extraction INR >3

Answer 5

Stop AC 4 days before and change to LMWH

Make sure INR is <1.5 day of extraction

Apply local hemostatic

Question 6

How to act in a bleeding?

Answer 6

Absorbable materials → Gelatin and fibrin foam

Fresh plasma thrombin (↑clot formation) → Extemporaneous solution

Cotton or gauze soaked with VC → Adrenaline and astringent agents

Anti-fibrinolytics → TRANEXAMIC ACID

Question 7

Management of hypertensive patient in Dental office?

Answer 7

• Monitoring BP in patients with risk factors.
• The patient with uncontrolled hypertension should not be treated.
• Reduce the stress and anxiety associated with the dental visit.
• Preferably use anesthesia without vasoconstrictor.
• Caution when changing the position of the patient in
  the dental chair, due to risk of orthostatic hypotension.
• Monitor if the patient takes other active drugs at the cardiovascular level (antiplatelet agents, anticoagulants, etc. that may require discontinuation or local hemostasis).

Question 8

Glucocorticoids in dentistry!

Answer 8

They are only used in the following situations:

➢Mouth ulcers/affections

➢Pemphigus, lichen planus

➢Treatment of dental pulp pain

➢Treatment of pain in the TMJ

➢Post extraction of third molars

Question 9

Patient with myocardial ischemia in dental office?

Answer 9

• Good clinical history (anamnesis).
• Do not perform any dental intervention until the patient is stabilized.
• Reduce stress.
• Avoid adrenaline as an adjunct to local anesthesia.
• Control vital functions.
• Avoid hypotension when the patient is incorporated.
• In case of precordial pain or fatigue, discontinue treatment. If the patient takes nitroglycerin, it should be taken.

Question 10

Management of immunosuppressed patient in dental office?

Answer 10

✓ Do an adequate clinical history.

✓ Recommend: Strict oral hygiene.

✓ The presence of oral infections by Candida, herpes, some bacteria, etc. is frequent in immunosuppressed patients.

✓ Periodic controls.

✓ Apply antimicrobial prophylaxis before a dental intervention.

Question 11

Clindamycin in dentistry?

Answer 11

Clindamycin is reserved for infections caused by anaerobes in patients who can not receive penicillins or macrolides.

Very good bone penetrability:

o Bone infections
o Perialveolar abscesses

Question 12

Spiramycin uses in dentistry?

Answer 12

Associated with metronidazole for the treatment and prevention of acute, chronic or recurrent oral infections

Question 13

TIGECYCLINE uses in dentistry?

Answer 13

IN DENTISTRY, IT MAY BE USED IN SERIOUS INFLAMMATIONS OF SOFT PARTS IN WHICH ORAL ANAEROBES ARE INVOLVED

Question 14

Metronidazole

Answer 14

It is the drug of choice in oral infections caused by anaerobes (for example, acute ulcerative necrotizing gingivitis)

DEN MÅSTE DU ADMINISTRERA MED AMOXICILLIN, CEPHALOSPORIN OCH MACROLIDE

Question 15

Eythromycin uses in dentistry?

Answer 15

Potent enzymatic inhibitor (risk of interactions)

Different types of infections, ulcers, abscess

Question 16

Azithromycin

Answer 16

Alternative to prophylaxis in dental surgery

Question 17

Chlorhexidine use in dentistry?

Answer 17

• It is one of the most effective agents against dental plaque and gingivitis (including acute necrotizing ulcerative gingivitis)
• It prevents infection after oral surgery even in immunosuppressed patients
• Chlorhexidine is the most used antiseptic in dentistry

Names:
Chlorhexidine (0.12-1.2%) Cetrimide
Cetylpyridonium chloride

Question 18

Sodium Hypoclorite 2%

Answer 18

It is used as a root canal treatment: irrigation with 2% sodium hypochlorite solution dissolves the necrotic dental pulp and generates rapid antisepsis.

Question 19

Antivirals?

Answer 19

In dentistry, the application of antiretroviral treatments is limited to the treatment of oropharyngeal herpes simplex and cold sores, which mainly affect immunocompromised patients.

Question 20

Recommendations for patient with chemotherapy treatment in dental office?

Answer 20

Many of the oral complications of chemotherapy can be relieved by good dental control before starting chemotherapy. Such control should include

✓ Proper treatment of caries, periodontal lesions and other potential sources of infection.

✓ Smoothening of cusps or cutting prosthesis to avoid injury.

✓ Maintenance of a good oral hygiene throughout the treatment.

Question 21

Stomatitis ulcer

Answer 21

CHLORHEXIDINE MOUTHWASH

Question 22

Candida infection

Answer 22

NYSTATIN MOUTHWASH

Question 23

Pain caused by mucositis

Answer 23

PILLS/ORAL GEL WITH BENZOCAINE, LIDOCAINE (IF P A IN IS INTEN SE → OPIOIDS)

Question 24

Buccal infection

Answer 24

SYSTEMIC ANTIBIOTICS EFFECTIVE AGAINST GRAM (+), (-) AND ANAEROBIC

METRONIDAZOLE
TIGECYCILINE

Question 25

Patient with asthma and COPD in dental office

Answer 25

The dental process can cause an acute exacerbation (crisis). In this case, treatment should be discontinued and short-acting bronchodilators should be administered. It has been suggested that prophylactic administration of bronchodilators prior to dental treatment may prevent the decrease in lung function. In patients with asthma who do not respond adequately to treatment, the intervention should be postponed. Take the necessary precautions in case the patient receives oral steroids. Note: Precaution with CVD patient as high doses o prescribing Sympathomimetic such as salbutamol could activate B-1 cells and the heart!

Question 26

Reccomendations in treatment of peptic ulcer patient in dental office?

Answer 26

- Avoid the prescription of non-selective NSAIDs (ibuprofen, aspirin, dexketoprofen, etc.). The analgesic of choice in these cases will be paracetamol. - Assess the need for gastroprotection if necessary, if NSAIDs are prescribed. - Insist on compliance with adequate hygienic-dietary measures. - Stress management. - Apply measures of local hemostasis (ulcerous patients with tendency to hemorrhage).

Question 27

Recommendations for treatment of diabetic patients in dental office?

Answer 27

- Diabetes mellitus is generally associated with a higher incidence of caries, periodontal diseases and oral infections. - The glycaemia of the dental patient must be well controlled. - If a diabetic patient treated with insulin or ADs agents is going to skip meals after a dental procedure, care should be taken that there is no hypoglycemia. (ibland så får vi ju inte äta efter vi gjort en operation, alltså viktigt att se till så dom inte får hypoglycemia om de fortsätter med insulinet trots ingen mat) - If diabetes is poorly controlled, they should receive antimicrobial prophylaxis.

Question 28

Osteonecrosis of the jaw?

Answer 28

- BNPs = risk factor Sometime a dental procedure is the onset of ONJ or a dental pathology such as periodontitis due to inflammation

Question 29

Consideration of Bisphosponates?

Answer 29

IV administration = much higher risk of ONJ Oral administration= high risk after 3 years ( take it standing upp and with empty stomach and plain water)

Question 30

Recommendation to patients with IV BNP at the dental office?

Answer 30

- Information to the patient about the oral risks and their duration. - Clinical and radiological odontological evaluation before starting treatment. - Before starting treatment: elimination of infectious foci, teeth without possibility of treatment, treatment of periodontal disorders, etc. - Raise awareness about the importance of proper oral hygiene. During treatment, perform conservative treatments and avoid oral surgeries. - Periodic dental examinations. - Avoid oral surgery for at least 10 years after the end of treatment.

Question 31

Recommendations to patients with oral BPN <3 years without other risk factors?

Answer 31

The risk of ONJs from invasive treatments is minimal. - All necessary exodoncies or surgeries should be performed in the same setting as dental or medical emergencies. - In case of invasive treatments, indicate chlorhexidine rinses previously. - Dental examinations.

Question 32

Recommendations to patients with oral BPN >3 years without other risk factors?

Answer 32

- Apply conservative treatments whenever possible. - If it is necessary to perform a treatment that entails bone exposure, ideally, if the conditions of the patient allow it, discontinue treatment with BPN 3 months earlier - In this case, antibacterial prophylaxis and chlorhexidine rinses should be instituted, causing the least possible trauma. - Also, regular dental check ups. - Measures to prevent tooth decay and periodontal disease.

Question 33

Recommendations anti-platelet patient in dentistry?

Answer 33

Most anti-platelet medications require discontinuation in case of major surgery!!! Aspirin treatment should be discontinued one week before any dental surgery (although in most cases, the patient's CDV risk does not allow to do so). In any case, adequate control of hemostasis with (coagulant agents) When doses below 300 mg of aspirin are used, the risk of bleeding in simple extractions is usually reduced In patients with double antiplatelet therapy (ASA + clopidogrel), the risk of bleeding increases. If patient conditions allow (low CDV risk), it is recommended to discontinue clopidogrel, at least 5 days before the intervention

Question 34

Drugs that decrease anticoagulants

Answer 34

Rifampicin Oral contraceptives Hypnotics Griseofulvin

Question 35

Drugs that iecrease anticoagulants

Answer 35

Broad spectrum antibiotics NSAIDS Metronidazole Amiodarone

Question 36

When only risk person need prophylaxis?

Answer 36

- Use of clamps and isolation with rubber dam (only prophylaxis in risk patient) - Periodontal and implant prophylaxis (only prophylaxis in risk patient) - Periodontal probing (only prophylaxis in risk patient) - Periodontal maintenance (only prophylaxis in risk patient) - Endodontics (only prophylaxis in risk patient) - Impression taking (only prophylaxis in risk patient) - Application and withdrawal of surgical sutures (only prophylaxis in risk patient) - Impression taking - Incision for drainage

Question 37

When no patient need prophylaxis?

Answer 37

- PLACEMENT OF REMOVABLE ORTHODONTIC DEVICES

Question 38

CEPHALOSPORINS

Answer 38

Substitute for penicillin G and Amoxicillin Good against resistant bacteria in acute and oral recurrent infections NEPHROTOXICITY (1st gene)

Question 39

PENICILLIN G

Answer 39

INTRAMUSCULAR BECUASE DONT TOLERATE STOMACH ACID HIGH RISK OF HYPERSENSITIVITY USED IN PROPHYLAXIS

Question 40

Anti-arrhythmic patient in dental office?

Answer 40

- Make a careful medical history. - Avoid addition of vasoconstrictor to the local anesthetic. - Measures to control the stress. - Monitor orthostatic hypotension. - Check the INR* in case the patient receives treatment with oral anticoagulants. * [International National Ratio (INR) is a experimental parameter that measures the coagulation capacity of a patient].