Evidence-based Periodontics Flashcards
T/F - No routine perio treatment should be given to a patient who is hypertensive and not under medical management
True
What is the systolic limit for routine perio procedures?
> 180 mmHg
160 mmHg in OSU clinic
What is the diastolic limit for routine perio procedures?
> 110 mmHg
What are the two major types of diabetes
Type 1 = Insulin-dependent
Type 2 - Insulin-independent
T/F - now-a-days, patients are more loosely managing their glycemic indexes
False - they’re more tightly managing
What should you do if you suspect a patient of having undiagnosed diabetes?
Consult their physician
Analyze lab tests
Rule out acute orofacial infection or severe dental infection, and provide emergency care only until a diagnosis is established
If a patient is a diabetic, what is critical to know prior to perio treatment?
Their level of glycemic control
T/F - Fasting Glucose and Casual Glucose levels are key in determining long-term glycemic control
False - they reveal nothing about long-term. They only provide “snap-shots” of the blood glucose concentration
What test is used to assess long-term glycemic control
Glycosylated or Glycated Hemoglobin Assay
What does a Glycosylated Hemoglobin Assay reflect?
The blood glucose concentrations over the preceeding 6-8 weeks and may provide an indication of the potential response to perio therapy
What level is considered well-controlled diabetes? And how do these people respond to perio treatment?
HbA1c
What level is considered poorly-controlled diabetes? How do these people respond to perio treatment?
HbA1c >10%
Often have a poor response to treatment, and with more post-op complications and less favorable long-term results
Even though they’re different from pervious cards and self-contradictory, what are the different levels of a Glycated Hemoglobin Assay?
HbA1c 4-6% = Good diabetic control
HbA1c 7-8% = Moderate diabetic control
HbA1c >8% = Poor diabetic control
T/F - Perio infection may worsen glycemic control
True - and it should be treated aggressively
When possible, an HbA1c of
T/F - a diabetic pt should bring their glucometer to the dental office each apt
True
What happens if a patient has a glucose index on the lower end of normal (70 mg/dl) immediately before treatment?
They may become hypoglycemic intraoperatively
They should consume carbs prior to starting treatment
What should you do if a diabetic pt’s pretreatment glucose level is excessively high?
Potentially postpone treatment until better control is established
T/F - A diabetic pt doesn’t need to check their glucose levels following treatment
False - it should be checked it check for fluctuations
During treatment, if a patient starts to feel hypoglycemic, what should you do?
Check glucose immediately, it may prevent the onset of severe hypoglycemia, which is a medical emergency
What are some signs or symptoms of hypoglycemia
Shakiness or tremors Confusion, agitation, or anxiety Sweating Tachycardia Dizziness Feeling of "impending doom" Unconsciousness, seizures
At what levels does hypoglycemia usually occur?
Once blood-glucose levels fall below 60 mg/dl
But sometimes a pts with poor glycemic control who have prolonged hyperglycemia can be hypoglycemic well above 60 mg/dl
A person has AIDS if he or she has one of the following:
CD4+ T-cell count below 200 cells/ul (or less than 15% of total lymphocytes)
Diagnosed Hodgkin’s, non-Hodkin’s lymphoma, lymphocytic leukemia, multiple myeloma, or any cancer of lymphoreticular or histocytic tissue, or angioimmunoblastic lymphoadenopathy
A genetic immunodeficiency syndrome atypical of HIV infection, such as one involving hypogamma globulinemia
T/F - Antiretrovirals can help cure AIDS
False - there is no cure, but antiretroviral treatment can slow the course of the disease and may lead to a near-normals like expectancy
But they’re expensive and may be associated with side effects
What are the specific factors influencing operative morbidity?
An absolute CD4 count of less than 200 cells/ml
or
Viral load greater than 10,000 copies/ml
What is an anticoagulant used for?
It prevents coagulation of the blood
What are the different types of anticoagulants we went over?
Coumarins
Heparin and derivative substances
Direct factor Xa inhibitors
Direct thrombin inhibitors
Coumarins
Anticoagulant derived form plant
example is Warfarin
Requires 48-72 hours for the effect to develop
Patients older than 80 have pronounced effects
What are Coumarins used to treat
Deep vein thrombosis
Pulmonary embolism
Atrial fibrilation
Mechanical heart valve
What are PT/PR/INR used to determine?
They measure the extrinsic pathway of coagulation
They’re sued to determine clotting tendency of blood, in the measure of warfarin dosage, liver damage, and vitamin K status
What should be the goal of treating pregnant women
Minimize an inflammatory response
Short appointments
Carefully consider meds that are prescribed
What should perio treatment of a pregnant woman include?
Meticulous oral hygiene instruciton
SRP
Deplaquing
Who is most effected by Osteoporosis?
Post-menopausal women
Osteonecrosis of the Jaw
Characterized by bone death as a consequence of a wide variety of systemic and local factors that compromise bone blood flow (environmental pollutants, systemic disease, meds, radiotherapy)
What are some working diagnosis features of Osteonecrosis of the Jaw?
Patients using bisphosphonates
No evidence of healing after 8 weeks of appropriate evaluation and dental care
No evidence of metastatic disease of the jaw or osteoradionecrosis
T/F - the etiology and pathogenesis of osteonecrosis of the jaw are poorly characterized
True
What are some risk factors for ONJ?
Cancer Chemo Radiotherapy Corticosteroids Poor oral hygiene Perio disease Local infections Dental procedures
