Emergencies & Records - Week 5 PP

Question 1

Endocrine Disorders Include..

Answer 1

1. Hyperthyroidism
2. Hypothyroidism
3. Diabetes mellitus

Question 2

Hyperthyroidism and Oral Effects - How does hyperthyroidism affect oral health and dental treatment?

Answer 2

• A patient with an overactive
  thyroid gland may be diagnosed
  with Graves’ disease, the most
  common form of hyperthyroidism. This disorder affects women four to seven times more often than men.
• Hyperthyroid patients who are
  not being treated are highly sensitive to epinephrine and other amine anesthetics.
• Accelerated tooth development potential for malocclusion

Question 3

Hypothyroidism and Oral Effects

Answer 3

These patients are not in any danger associated with
receiving dental care however:

• Untreated inadequately controlled hypothyroidism may cause an increased susceptibility to infections.
• Hypothyroidism, the most common thyroid disorder, occurs when the thyroid does not produce enough thyroid hormone
• the most common cause is an autoimmune disorder called Hashimoto’s disease

Dental concerns - periodontitis, easily bleeding gingiva, oral candidiasis, poor wound healing

Question 4

Diabetes Mellitus

Answer 4

A disease characterized by a sustained high blood glucose level resulting from no or a lack of insulin.

Question 5

Type 1 Insulin dependent diabetes

Answer 5

A disease characterized by a sustained high blood glucose
level resulting from no or a lack of insulin.

Question 6

Type 2 Diabetes

Answer 6

Occurs when the pancreatic insulin
secretion may be low, normal,
higher than normal. Onset
typically after age 30 90% to 95%
of all those with diabetes

Question 7

Diabetes - Appointment & Oral Considerations

Answer 7

APPOINTMENTS
Minimize Stress
Keep appointments short
Book midmorning
Consider using Sedation
(Diazepam or Nitrous)

ORAL CONSIDERATIONS
Acetone Breath
Xerostomia
Red Swollen and painful
gingiva
Bone loss and tooth ache
Slow healing.

Question 8

Gastrointestinal and Urinary Conditions

Answer 8

1. Celiac Disease (CD)
2. Inflammatory bowel diseases
   (IBDs) CROHNs
3. Renal Disease

Question 9

Celiac Disease (CD)

Answer 9

Prevalence - more frequent in women. occurs in more northern areas possibly due to a lack of vitamin D and an immune response

clinical symptoms - Oral Aphthous Ulcers
Discolored teeth
Developmental enamel
abnormalities
Angular cheilosis
Glossitis

Dental Considerations -
Use gluten‐free products
Mouth rinses containing
lidocaine
Topical Steroids

Question 10

Inflammatory bowel disease (IBDs) and Crohns Disease

Answer 10

Prevalence - slightly higher in women than in men, smoking doubles the risk of Crohn’s disease, antibiotic use triples the odds of developing Chron’s disease

Clinical Symptoms - Xerostomia, Higher Caries Risk, Angular Cheilosis, Glossitis

Dental Considerations - Avoid the use of NSAIDs (Advil), encourage quitting smoking, mouth rinses containing lidocain, topical steroids

Question 11

Renal (Kidney) Disorders

Answer 11

Prevalence - 10% of the general public suffers from kidney disorders. Diabetes is the most common causes.

Clinical Symptoms - Ulcers, Xerostomia, Mineralization during tooth development, Periodontist

Dental Considerations - monitor blood pressure, bleeding tendencies, poor healing, susceptible to infection, *pre-medication (check with their specialist)

Question 12

Neurologic Disorders examples

Answer 12

1. Alzheimer’s Disease
2. Seizures
3. Multiple Sclerosis
4. Stroke

Question 13

Alzheimer’s Disease

Answer 13

Prevalence - A progressive disease that deteriorates the mental
capacity of adults 65 plus. The
patient will show symptoms of
memory loss, confusion, impairment of judgment and depression

Clinical Symptoms - Xerostomia
Periodontal Disease
Poor Oral Hygiene

Dental Considerations - Try to complete treatment in the early stages of the disease
Regular Visits
Saliva substitutes
Have family members in the
treatment room

Question 14

Seizures

Answer 14

Prevalence - Seizures cause abrupt suspension of motor, sensory, behavioral, or bodily function at any time. Grand mal seizures are associated with spasms, and twitching of muscles, followed by loss of consciousness.

Clinical Symptoms - drug-induced gingival overgrowth (Dilantin)
Increased bleeding, xerostomia

Dental considerations - Be aware of trigger factors such as anxiety or tiredness.
Be prepared to handle an
emergency.
Severe cases may require dental
treatment to be completed under
general anesthesia or sedation
Maintain oral hygiene and regular
visits

Question 15

Multiple Sclerosis (MS)

Answer 15

Prevalence - MS is one of the most common neurological disorders affecting adults between the ages of 30-50. Causes weakness, unsteadiness, and paralysis.

Clinical Symptoms - TMJ Disorder, Muscle weakness, tremors, and painful spasms of the facial muscles triggered by touch or movement.
Difficulty swallowing, higher risk for periodontal disease, oral thrush

Dental Considerations - Schedule short appointments.
Patient may be in a wheelchair.
Dental dams may be useful
only if the patient is able to
breathe through their nose.
Sedation may be required

Question 16

Stroke

Answer 16

Prevalence - People who have had a Cerebrovascular accident (CVA), or stroke, can experience minor to
severe loss of central nervous
system (CNS) function caused by a
sudden vascular lesion in the brain.
Due to a hemorrhage, embolism,
thrombosis, or a ruptured
aneurysm

Clinical Presentation - Depending on the area and extent of injury to the brain. The patient may have weakness or paralysis of the eyes and facial muscles, as well as slurring or loss of speech. Numbness, vertigo, visual disturbances, sweating, headache, and nausea present.

Dental Considerations - Schedule patients for mid‐morning appointments and add at least 10
minutes to the appointment for
additional communication and
explanation of instructions.
Tooth brushing and flossing
modifications may need to be introduced for home care. The caregiver may need to become
involved with home care routines.

Question 17

Arthritis

Answer 17

1. Older persons are likely to have chronic progressive arthritis with stiffening of joints
2. This disorder causes the joints to become inflamed and painful
3. Physicians prescribe aspirin and corticosteroids to reduce the symptoms of arthritis
4. Two most common types
   a) Rheumatoid arthritis
   b) Osteoarthritis

Question 18

Clinical Considerations for Arthritis

Answer 18

1. Schedule patients with arthritis in the morning and keep appointments short
2. The disease can limit the patient’s ability to hold and use
   a toothbrush
3. Arthritis of the jaw joints limits the patient’s ability to open the mouth or chew comfortably

Question 19

Cancer

Answer 19

Cancer occurs when normal cells are transformed into malignant ones.

As cancel cells increase the mass of abnormal tissue forms until it takes over a host site.

Cancers are classified based on:
a) the origin of the tissue involved
b) type of cell from which they arise

Question 20

Clinical considerations for Cancer

Answer 20

Include:
1. Xerostomia, Oral mucosistis/stomatitis
2. Infections (bacterial, viral, fungal), Bleeding
3. Trismus (inability to open the mouth completely)
4. Radiation caries - more susceptible to caries when undergoing radiation, Loss of taste

Question 21

Allergies

Answer 21

A condition in which the body reacts to an antigen
1. Most reactions can be managed by having the patient take an over‐the‐counter medication or a prescribed medication that reduces the symptoms of the allergy
2. If the reaction goes beyond this type of management, the allergy becomes a life‐threatening emergency

Question 22

Clinical Considerations for Allergies

Answer 22

1. Complete a thorough medical history to determine specific allergens
2. Pay special attention to latex and dental material use
3. Have an EpiPen available for possible emergencies

Question 23

Antibiotic Prophylaxis Indications

Answer 23

Indications for antibiotic prophylaxis are prescribed for patients who are at the greatest risk of post‐treatment bacterial related complications for infective endocarditis, which includes:
1. Prosthetic cardiac valves/material
2. Congenital heart disease (CHD)
3. Previous, relapse, or recurrent infective endocarditis
4. Cardiac transplant recipients who develop cardiac valvopathy

Question 24

Who is at risk? (requiring antibiotic prophylaxis)

Answer 24

The Canadian Dental Association (CDA) supports the American Heart Association (AHA) recommendations that only patients who are at the greatest risk adverse outcome from infective endocarditis, an infection of the heart’s lining of heart valves require prophylaxis prior to dental procedures that:
Involve manipulation of gingival tissue or the periapical
regions of teeth that perforate the oral mucosa, for example
dental probing

Question 25

When Antibiotic Prophylaxis is NOT required

Answer 25

The following procedures and events do not need prophylaxis for high risk patients:
1. Routine anesthetic injection through no infected soft tissue
2. Dental radiographs
3. Placement of removable prosthodontic or orthodontic appliances
4. Adjustment of orthodontic appliances
5. Placement of orthodontic brackets
6. Shedding of deciduous teeth
7. Bleeding from trauma to the lips or mucosa

Question 26

Prosthetic Join Infections

Answer 26

Patients with prosthetic joint implants, prophylactic antibiotics are not routinely recommended prior to dental procedures to prevent prosthetic joint infection

Most transient bacteremia of oral origin occurs outside of dental procedures.
* The significant majority of prosthetic joint infections are not due to organisms found in the
mouth.
* Few prosthetic joint infections have an observable and clearly defined relationship with dental
procedures.
* There is no reliable evidence that antibiotic prophylaxis prior to dental procedures prevents prosthetic joint infections

Question 27

Medical Alert Instructions

Answer 27

1. Only the supervising dentist/dental hygienist can designate a patient
   record/chart as a medical alert.
2. If a student suspects a possible medical alert (MA), he/she is to red star the
   condition on the Medical History note page.
3. The supervising dentist/dental hygienist will note the medical alert by, placing a
   red star next to the medical alert on the medical and dental history form and by
   writing medical alert on the upper right corner of the patient chart in red pen.
4. A red tab will also be placed on the chart, three slots from the tag color coded
   to indicate the patient’s first letter of their last name.
5. Medical Alert designation must reflect a potential medical emergency during
   the procedure or must have an impact on dental treatment.
6. The medical alert will also be recorded in the patient’s electronic file

Question 28

Allergy Medical Alerts

Answer 28

• All anaphylactic allergies will be considered a MA.
• Any allergy to prescription medications or over the counter medications will be considered a MA.
• Allergies to latex will be considered a MA.
• Allergies to components of dental products will be a MA

Milk or seasonal allergies are NOT MA

Question 29

Asthma - Medical Alert

Answer 29

1. Due to frequent fluctuations and changes in the disease, it will be designated as an MA.
2. If the patient has their inhaler, it will be placed on the operatory counter for accessibility.
3. If requested by the supervising dentist/dental hygienist, the student will retrieve a Bronchodilator inhaler from the medical kit

Question 30

Blood Pressure (High blood pressure is MA)

Answer 30

1. A baseline blood pressure will be taken on all adult new patients (18 years of age or older).
2. Blood pressure readings will be taken on all adult patients at their initial appointment and updated every 6 months or sooner as required by clinic blood pressure protocols or for evaluation purposes.
3. The supervising dentist/dental hygienist will determine treatment protocols for any abnormally high readings as based on the Guidelines for Blood Pressure for Adults in the SAIT Dental Clinic.
4. Patients with a history of high blood pressure and/or a blood pressure over 140/90 will be designated as a MA

Question 31

Heart Disease - Medical Alert

Answer 31

1. Heart attack and congestive heart disease will be deemed a MA due to the risk of a medical emergency,
2. Other heart conditions will be considered a MA based on patient responses and will be determined by the supervising dentist or dental hygienist

Question 32

Diabetes, Stroke, Emphysema and Epilepsy
- Medical Alert

Answer 32

Due to an increased risk of a medical emergency and special needs of patients with a history of the above conditions they will be considered a MA

Question 33

Bleeding Disorders - Medical Altert

Answer 33

Due to the special needs of patients with bleeding disorders and the complications that may arise from treatment, patients with a bleeding disorder will be considered a MA

Question 34

Antibiotic Prophylaxis - Medical Alert

Answer 34

Any patient who requires antibiotic prophylaxis prior to dental care will be considered a MA

Question 35

Pregnancy

Answer 35

Consultation with a pre-natal health care professional is usually not required prior to routine preventive dental care. Consultation, however, should be sought before treating pregnant patients who have been deemed at being high risk for pregnancy complication such as: Diabetes, hypertension, pulmonary or cardiac disease, bleeding disorders (threat of spontaneous abortion) or a
history of premature labour

Question 36

Pregnant women are to be positioned appropriately during preventive care - for comfortability

Answer 36

-Keep the woman’s head at a higher level than her feet.
* Place woman in a semi-reclining position, as tolerated, and allow frequent position changes.
* Place a small pillow under the right hip, or have the woman turn slightly to the left as needed to avoid dizziness or nausea resulting from hypotension
 Short appointments should be considered during the second
and third trimester

Question 37

Fluoride treatment on pregos

Answer 37

Fluoride treatment may be needed for pregnant patients with severe gastric reflux caused by nausea and vomiting during early pregnancy, which can cause erosion of tooth enamel. Topical fluoride gel may cause nausea, so application of a fluoride varnish may be better tolerated. The application of topical fluoride should follow evidence-based guideline

Question 38

Xrays on pregos

Answer 38

a no-no

The routine use of radiographs should be avoided in all trimesters of pregnancy

Question 39

Patients with Cardiac Devices

Answer 39

The use of ultrasonic scalers can produce electromagnetic interference with some cardiac pacemakers or implantable cardioverter-defibrillators (ICDs) and should be used with caution
Most new pacemakers and ICDs are designed with preventive measures that include electronic filters or insulators to ensure proper operation and reduce electromagnetic interference and will be considered a MA

Question 40

Ultrasonic Scalers & Pacemakers

Answer 40

DENTSPLY, the manufacturer of the SAIT Dental Clinic ultrasonic scalers
recommends that the handpiece and cables be kept at least 15-23 cm away from any pacemaker and pacemaker leads during use and that consultation with the patient’s physician is recommended prior to use
Therefore, patients who present to the SAIT Dental Clinic with a cardiac pacemaker or ICDs must be hand scaled as the use of an ultrasonic scalers may be contraindicated. Consultation with patient’s physician is required