Evidence-based Periodontics

Question 1

T/F - No routine perio treatment should be given to a patient who is hypertensive and not under medical management

Answer 1

True

Question 2

What is the systolic limit for routine perio procedures?

Answer 2

> 180 mmHg

160 mmHg in OSU clinic

Question 3

What is the diastolic limit for routine perio procedures?

Answer 3

> 110 mmHg

Question 4

What are the two major types of diabetes

Answer 4

Type 1 = Insulin-dependent

Type 2 - Insulin-independent

Question 5

T/F - now-a-days, patients are more loosely managing their glycemic indexes

Answer 5

False - they’re more tightly managing

Question 6

What should you do if you suspect a patient of having undiagnosed diabetes?

Answer 6

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

Question 7

If a patient is a diabetic, what is critical to know prior to perio treatment?

Answer 7

Their level of glycemic control

Question 8

T/F - Fasting Glucose and Casual Glucose levels are key in determining long-term glycemic control

Answer 8

False - they reveal nothing about long-term. They only provide “snap-shots” of the blood glucose concentration

Question 9

What test is used to assess long-term glycemic control

Answer 9

Glycosylated or Glycated Hemoglobin Assay

Question 10

What does a Glycosylated Hemoglobin Assay reflect?

Answer 10

The blood glucose concentrations over the preceeding 6-8 weeks and may provide an indication of the potential response to perio therapy

Question 11

What level is considered well-controlled diabetes? And how do these people respond to perio treatment?

Answer 11

HbA1c

Question 12

What level is considered poorly-controlled diabetes? How do these people respond to perio treatment?

Answer 12

HbA1c >10%

Often have a poor response to treatment, and with more post-op complications and less favorable long-term results

Question 13

Even though they’re different from pervious cards and self-contradictory, what are the different levels of a Glycated Hemoglobin Assay?

Answer 13

HbA1c 4-6% = Good diabetic control
HbA1c 7-8% = Moderate diabetic control
HbA1c >8% = Poor diabetic control

Question 14

T/F - Perio infection may worsen glycemic control

Answer 14

True - and it should be treated aggressively

When possible, an HbA1c of

Question 15

T/F - a diabetic pt should bring their glucometer to the dental office each apt

Answer 15

True

Question 16

What happens if a patient has a glucose index on the lower end of normal (70 mg/dl) immediately before treatment?

Answer 16

They may become hypoglycemic intraoperatively

They should consume carbs prior to starting treatment

Question 17

What should you do if a diabetic pt’s pretreatment glucose level is excessively high?

Answer 17

Potentially postpone treatment until better control is established

Question 18

T/F - A diabetic pt doesn’t need to check their glucose levels following treatment

Answer 18

False - it should be checked it check for fluctuations

Question 19

During treatment, if a patient starts to feel hypoglycemic, what should you do?

Answer 19

Check glucose immediately, it may prevent the onset of severe hypoglycemia, which is a medical emergency

Question 20

What are some signs or symptoms of hypoglycemia

Answer 20

Shakiness or tremors
Confusion, agitation, or anxiety
Sweating
Tachycardia
Dizziness
Feeling of "impending doom"
Unconsciousness, seizures

Question 21

At what levels does hypoglycemia usually occur?

Answer 21

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

Question 22

A person has AIDS if he or she has one of the following:

Answer 22

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

Question 23

T/F - Antiretrovirals can help cure AIDS

Answer 23

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

Question 24

What are the specific factors influencing operative morbidity?

Answer 24

An absolute CD4 count of less than 200 cells/ml
or
Viral load greater than 10,000 copies/ml

Question 25

What is an anticoagulant used for?

Answer 25

It prevents coagulation of the blood

Question 26

What are the different types of anticoagulants we went over?

Answer 26

Coumarins
Heparin and derivative substances
Direct factor Xa inhibitors
Direct thrombin inhibitors

Question 27

Coumarins

Answer 27

Anticoagulant derived form plant
example is Warfarin
Requires 48-72 hours for the effect to develop
Patients older than 80 have pronounced effects

Question 28

What are Coumarins used to treat

Answer 28

Deep vein thrombosis
Pulmonary embolism
Atrial fibrilation
Mechanical heart valve

Question 29

What are PT/PR/INR used to determine?

Answer 29

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

Question 30

What should be the goal of treating pregnant women

Answer 30

Minimize an inflammatory response
Short appointments
Carefully consider meds that are prescribed

Question 31

What should perio treatment of a pregnant woman include?

Answer 31

Meticulous oral hygiene instruciton
SRP
Deplaquing

Question 32

Who is most effected by Osteoporosis?

Answer 32

Post-menopausal women

Question 33

Osteonecrosis of the Jaw

Answer 33

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)

Question 34

What are some working diagnosis features of Osteonecrosis of the Jaw?

Answer 34

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

Question 35

T/F - the etiology and pathogenesis of osteonecrosis of the jaw are poorly characterized

Answer 35

True

Question 36

What are some risk factors for ONJ?

Answer 36

Cancer
Chemo
Radiotherapy
Corticosteroids
Poor oral hygiene
Perio disease
Local infections
Dental procedures