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Dental management of the Medically Complex Patient > Lecture 1- Introduction > Flashcards

Lecture 1- Introduction Flashcards

1
Q

List how dentistry and medicine today are different (than previous years): (3)

A
  1. people liver longer= more elderly patients
  2. People receive medical treatments that would have been fatal just a few years ago
  3. pharmaceuticals continue to advance
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2
Q

What is proportional to an increase in combinations and permutations of dental treatment?

A
  1. increased number of conditions
  2. increased complexity of conditions
  3. increased number of medications
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3
Q

-increased number of conditions
-increased complexity of conditions
-increased number of medications

These are all proportional to an increase in:

A

combinations and permutations of dental treatment

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4
Q

With the current scope of dental practice, the dentist must be more knowledgable about a wider range of:

A

medical conditions as patients receive dental treatment

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5
Q

Many chronic disorders or their treatments necessitate:

A

modification of dental treatment

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6
Q

What sparked the use of gloves in dentistry?

A

Hepatitis (1982)

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7
Q

What sparked the use of PPE in dentistry?

A

AIDS (1990)

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8
Q

What sparked the use of updated PPE and required vaccines?

A

Covid-19 (2019)

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9
Q

Clinicians must practice so that the _____ of dental treatment will ______ of a medical complication occurring either during treatment or as a result of treatment

A

benefits; outweigh the risk(s)

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10
Q

When considering the benefits vs. risk, a clinician must take into account:

A
  1. pre-operative considerations
  2. intra-operative considerations
  3. post-operative considerations
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11
Q

What doctor stated “a doctor who cannot take a good history and a patient who cannot give one are in danger of giving and receiving bad treatment.”

A

Paul Dudley White MD (1876-1973)

(Ushered in the era of modern cardiology)

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12
Q

Organized risk assessment in dental care includes:

A
  1. bleeding
  2. infection
  3. drug effects
  4. availability to tolerate care (CV-Resp-Psych)
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13
Q

_____ can be applied to assess risk prior to any oral health care delivery

A

acquired data

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14
Q

Acquired data can be applied to assess risk prior to any oral health care delivery using a _____ format

A

P-A,B,C,

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15
Q

In the P-A,B,C format, the “P” stands for:

A

Patient evaluation

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16
Q

A chief complaint may be:

A

objective or subjective

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17
Q

List factors that contribute to “P” patient evaluation: (7)

A
  1. medical history
  2. medications
  3. social & family history
  4. review of systems
  5. history of present illness
  6. objective findings
  7. CC
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18
Q

What are some adjunctive tests & procedures: (8)

A
  1. Anesthesia
  2. Histopathology
  3. Imaging
  4. Labs
  5. Microbiology
  6. Molecular biology
  7. Refer
  8. Sequencing
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19
Q

Taking blood pressure is an example of:

A

organized risk assessment (P- Patient evaluation)

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20
Q

Patient Evaluation includes:

  1. identify ALL _______
  2. Review _____
  3. Examine ______
  4. Review or gather _____
  5. Obtain ______
A
  1. Identify ALL medications & drugs, taken or supposed to be taken
  2. Review medical history, discuss relevant issues with patient
  3. Examine patient for signs & symptoms of diease
  4. Review or gather recent laboratory tests or images
  5. Obtain a medical consult
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21
Q

When should you obtain a medical consult as part of the patient evaluation?

A
  1. if the patient has poorly controlled or undiagnosed problems
  2. if you’re uncertain about the patient’s health
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22
Q

You should request a medical consult to:

A

confirm & determine level of disease activity/status

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23
Q

A medical consult may be used to determine:

A

what precautions may be necessary for dental treatment

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24
Q

The precautions necessary for dental treatment are often determined by the: (2)

A
  1. degree of dental treatment
  2. level of disease activity/status
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25
Q

if you are uncertain about the patients health findings you should request a consult to determine if:

A

an undiagnosed disease exists

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26
Q

In the P-A,B,C format, what foes the “A” stand for?

A
  1. Antibiotics
  2. Analgesics
  3. Anesthesia
  4. Allergies
  5. Anxiety

“Al(lergies) was ANXIOUS to get ANTIBIOTICS, ANALGESICS & ANESTHESIA”

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27
Q

What should you question about the patients ALLERGIES?

A

Is the patient allergic to drugs or substances that may be used or prescribed?

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28
Q

What should you question about the patient ANXIETY?

A

Will the patient need or benefit from a sedative or anxiolytic?

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29
Q

What questions should be asked about ANTIBIOTICS?

A
  1. Will the patient need antibiotics?
  2. Is the patient taking an antibiotic?
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30
Q

What questions should be asked about ANALGESICS?

A
  1. Is the patient taking aspirin or NSAIDs that can increase bleeding?
  2. Will analgesics be needed post-treatment?
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31
Q

What question should be asked about ANESTHESIA?

A

Are there concerns using a local with or without epinephrine?

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32
Q

In the P-A,B,C format, what foes the “B” stand for?

A
  1. Breathing
  2. Bleeding
  3. BP
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33
Q

What question should be asked in regard to BLEEDING?

A

Is abnormal hemostasis possible?

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34
Q

What question should be asked in regard to BREATHING?

A

Does the patient have difficulty breathing or is the patient’s breathing fast or slow?

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35
Q

What question should be asked in regard to BLOOD PRESSURE?

A

Is the patient’s BP well controlled or is it possible that it may increase/decrease during dental treatment?

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36
Q

In the P-A,B,C format, what foes the “C” stand for?

A

Chair position

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37
Q

What questions should be asked regarding CHAIR POSITINO ?

A
  1. Can the patient tolerate a supine or horizontal position?
  2. Is the patient going to have a problem being raised quickly after treatment?
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38
Q

In the P-A,B,C format, what foes the “D” stand for?

A

Drugs & Devices

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39
Q

What questions should be asked regarding DRUGS?

A

Any drug interactions, adverse effects, or allergies associated with drugs currently being taken or drugs that the dentist may prescribe or use?

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40
Q

What question should be asked regarding DEVICES?

A

Does the patient have prosthetic or therapeutic device that may require tailored management?

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41
Q

List some examples of prosthetic or therapeutic devices that a patient may present with: (5)

A
  1. prosthetic heart valve
  2. prosthetic joint
  3. stent
  4. pacemaker
  5. defibrillator
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42
Q

In the P-A,B,C format, what foes the “E” stand for?

A

Equipment & Emergencies

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43
Q

What question should be asked regarding EQUIPMENT?

A

Any potential issues with the use of dental equipment?

(such as X-ray equipment, electrocautery, oxygen supply, ultrasonic cleaner, apex locator)

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44
Q

What question should be asked regarding EMERGENCY?

A

Are there medical emergencies that can be anticipated or prevented by modifying care?

(such as MI, stroke, asthma, uncontrolled bleeding)

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45
Q

In the P-A,B,C format, what foes the “F” stand for?

A

Follow-up

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46
Q

What question should be asked regarding FOLLOW-UP?

A

Is there any follow up care indicated?

(such as post-op analgesics, antibiotics, anxiety)

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47
Q

Post-op instructions for home care ______ and for_____ when necessary

A

ALWAYS; prescriptions

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48
Q

What is the simple rule that determines whether the patient should be contacted at home to assess post-treatment response?

A

If a local anesthetic(s) are used on a patient and there was bleeding during the appointment, the patient should be contacted that evening or the following day

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49
Q

The _____ MUST be taken for every patient who is to receive dental treatment

A

Medical history

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50
Q

T/F: It is okay to skip the medical history documentation if the patient is there for a follow-up

A

False

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51
Q

What are the two basic techniques used to obtain a medical history?

A
  1. interview the patient (ask patient questions, record patient’s verbal response - we do this at UMKC through Axium)
  2. a printed questionnaire the patient fills out
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52
Q

The questions asked when taking a medical history are designed to identify or hint to medical issues that:

A

may affect dental treatment

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53
Q

Medical history questions are designed to identify or hint to medical issues that may affect dental treatment such as:

A
  1. anxiety
  2. cardiovascular disease
  3. neurologic disorders
  4. gastrointestinal diseases
  5. respiratory tract diseases
  6. musculoskeletal disease
  7. endocrine disease
  8. STD’s
  9. cancer & radiation treatment
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54
Q

A medical history is different from ______

A

Review of systems (ROS)

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55
Q

T/F: Medical history is synonymous to ROS

A

False- different

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56
Q

If the patient has already been diagnosed, or patient presents with information needing diagnosis this would be charted under:

A

Medical history

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57
Q

What is the goal for ROS?

A

To screen for potential new diseases

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58
Q

What type of approach is used when screening through sign and symptoms during the ROS?

A

Systems-based approach

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59
Q

Even if the result of your ROS findings are consistent with a particular systemic disease, you will not:

A

Diagnose

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60
Q

What should you do if you get findings during the ROS that are consistent with a particular systemic disease?

A

Referral consultation letter that expresses findings, concerns and basis for ROS

(Its the physicians role to further examine, request labs and diagnose)

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61
Q

What category would the following signs and symptoms fall under in the ROS?

  • recent weight change
  • fatigue
  • malaise
  • fever
  • chills
  • night sweats
A

General

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62
Q

What category would the following signs and symptoms fall under in the ROS?

  • rashes
  • lumps
  • ulcers
  • dryness
  • pruritus (itching)
  • finger clubbing
  • nail changes
A

Dermatologic

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63
Q

What category would the following signs and symptoms fall under in the ROS?

  • headaches
  • dizziness
  • head trauma
A

Head

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64
Q

What category would the following signs and symptoms fall under in the ROS?

  • changes in vision & visual fields
  • spots
  • floaters
  • diplopia
  • blurriness
  • dryness
  • tearing
  • itching
A

Eyes

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65
Q

What category would the following signs and symptoms fall under in the ROS?

  • hearing loss
  • pain
  • discharge
  • tinnitus
  • vertigo
A

Ears

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66
Q

What category would the following signs and symptoms fall under in the ROS?

  • stuffiness
  • sneezing
  • rhinorrhea
  • itching
  • epistaxis (nose bleeds)
  • change in sense of smell
A

Nose/Sinuses

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67
Q

What category would the following signs and symptoms fall under in the ROS?

  • bleeding or painful gums
  • lesions
  • dental pain
  • halitosis
  • altered taste
  • hoarseness
  • sore throat
  • dysphagia
  • neck swelling
A

Mouth/Throat/Neck

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68
Q

What category would the following signs and symptoms fall under in the ROS?

  • dyspnea
  • chest pain
  • wheezing
  • cough
  • sputum
  • hemoptysis
A

Respiratory

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69
Q

What category would the following signs and symptoms fall under in the ROS?

  • chest pain
  • palpitations
  • orthopnea
  • dyspnea on exertion
  • paroxysmal nocturnal dyspnea
  • peripheral edema
A

Cardiovascular

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70
Q

What category would the following signs and symptoms fall under in the ROS?

  • appetite changes
  • abdominal pain
  • nausea
  • vomiting
  • diarrhea
  • constipation
  • heart burn
  • belching
  • bloating
  • flatulence
  • dysphagia
  • bleeding (hematemesis, hemorrhoids, melena, hematochezia)
  • jaundice
  • ascites
A

Gastrointestinal

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71
Q

What category would the following signs and symptoms fall under in the ROS?

  • Frequent urination
  • Hesitant urination
  • urgent urination
  • incontinence
  • nocturia
  • dysuria
  • hematuria
  • abnormal genital discharge
  • genital lesions
  • changes in libido
A

Genitourinary

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72
Q

What category would the following signs and symptoms fall under in the ROS?

  • polydispsia
  • polyuria
  • polyphagia
  • heat & cold intolerance
  • weight gain or loss
  • excessive sweating
  • thyroid enlargement or pain
A

Endocrine

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73
Q

What category would the following signs and symptoms fall under in the ROS?

  • anemia
  • easy bruising or bleeding
  • lymphadenopathy
A

Hematologic

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74
Q

What category would the following signs and symptoms fall under in the ROS?

  • arthritis
  • arthralgia
  • pain
  • swelling
  • redness
  • limitations in ROM
  • muscle weakness
  • trauma
A

Musculoskeletal

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75
Q

What category would the following signs and symptoms fall under in the ROS?

  • seizures
  • memory loss
  • loss of consciousness
  • paresthesia
  • anesthesia
  • muscles weakness
  • paralysis
A

Neurologic

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76
Q

What category would the following signs and symptoms fall under in the ROS?

  • menopause
  • menstrual changes
  • dysmenorrhea
A

Gynecologic

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77
Q

What category would the following signs and symptoms fall under in the ROS?

  • mood
  • anxiety
  • depression
  • changes in sleep pattern
  • decreased ability to concentration
A

Psychiatric/emotional

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78
Q

Asking this question can help you determine the patients ______

“Do you have the ability to engage in normal day-to-day activity?”

A

Functional capacity

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79
Q

According to functional capacity, the ability to perform common daily tasks can be expressed in:

A

Metabolic equivalent levels (METs)

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80
Q

METs:

A

Metabolic equivalent levels

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81
Q

An MET is a:

A

unit of oxygen consumption

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82
Q

Tells you the patients ability to tolerate exercise which is linked to patients overall health:

A

METs

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83
Q

A higher MET corresponds with:

A

better physical condition

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84
Q

1 MET =

A

3.5 mL of oxygen per kg of body weight per minute at rest

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85
Q

List some activities that are considered “light” in regards to MET:

A

(Less than 3.0 METs)

  1. walking- slowly
  2. sitting- using computer
  3. standing- light work (cooking or washing dishes)
  4. fishing- sitting
  5. playing most instruments
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86
Q

List some activities that are considered “moderate” in regards to MET:

A

(3.0-6.0 METs)

  1. walking- very brisk (4 mph)
  2. cleaning- heavy (washing windows, vacuuming or mopping)
  3. mowing lawn (walking power mower)
  4. bicycling- light effort (10-12 mph)
  5. badminton- recreational
  6. tennis- doubles
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87
Q

List some activities that are considered “vigorous” in regards to MET:

A

(>6.0 METs)

  1. walking/hiking
  2. jogging (6 mph)
  3. shoveling
  4. carrying heavy loads
  5. bicycling fast (14-16 mph)
  6. basketball game
  7. soccer game
  8. tennis- singles
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88
Q

T/F: Asking a patient “can you walk up two flights of stairs without having to catch you breath” can indicate general cardiovascular and/or pulmonary health.

A

True

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89
Q

T/F: Not all “allergies” are true allergies

A

True

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90
Q

If a patient response “yes” when asked to a particular substance, the mandatory follow-up question should be:

A

“What happens?”

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91
Q

List some examples of reactions that indicate TRUE allergies: (9)

A
  1. anaphylaxis
  2. itching
  3. urticaria (hives)
  4. rash
  5. swelling
  6. wheezing
  7. angioedema
  8. rhinorrhea
  9. tearing eyes
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92
Q

List some examples of reactions that indicate an INTOLERANCE or ADVERSE SIDE EFFECT: (5)

A
  1. nausea
  2. vomiting
  3. diarrhea
  4. heart palpations
  5. fainting
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93
Q

Treating every patient as if they’re infectious:

A

standar precaution

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94
Q

What STDs can have manifestations in the oral cavity:

A
  1. Syphilis
  2. Ghonorrhea
  3. HIV
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95
Q

Some STDs including ________, can be transmitted to the dentist through direct contact with oral lesions or infected blood

A
  1. HIV
  2. Hep B
  3. Hep C
  4. Syphilis
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96
Q

T/F: Some STDs including HIV, Hep B, Hep C and Syphilis can be transmitted to the dentist through indirect contact with oral lesions of infected blood

A

False- only through DIRECT contact

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97
Q

The single most common STD in the US:

A

Chlamydia genitalia infection

(Chlamydia trachnomatis)

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98
Q

_____ & ____ are examples of steroids that are used to treat many diseases

A

Cortisone & Prednisone

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99
Q

Steroids are important because their use can result in ______ and the patient is unable to mount a normal response to the stress of infection or invasive dental procedure such as extraction or periodontal surgery

A

adrenal insufficiency

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100
Q

When patients are using steroids, and this results in adrenal insufficiency why might this be a concern as a dentist?

A

The patient may be unable to mount normal response to stress of infection or invasive dental procedures

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101
Q

Steroids can make a patient _____ to some degrees and can also make ____ less likely to work

A

immunosuppressive; antibiotics

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102
Q

The long term use of steroids cause a patient to:

A

stop making steroids

103
Q

The long term use of steroids cause a patient to stop making steroids, when does this become a concern?

A

Cardiac crisis

104
Q

T/F: Not every hospitalization has long term reprocussions but it may so its good to know

105
Q

History of hospitalizations can provide:

A

Clues to past illnesses that may have current significance

106
Q

An INDIRECT aspect of your evaluation but an effective way to identify a current condition:

A

History of operations & hospitalizations

107
Q

Obtaining a history of operations and hospitalizations is considered:

A

An INDIRECT aspect of your evaluation

108
Q

What questions should you ask the patient in regards to operations?

A
  1. REASON for procedure
  2. Any emergencies
  3. Post-op bleeding
  4. Post-op infection
  5. Drug allergy
109
Q

Caution with pregnant patients is warranted with:

A
  1. radiography
  2. drug administration
  3. timing of dental treatment
110
Q

What trimester is the safest to provide dental treatment?

111
Q

When should radiography be used for dental treatment during pregnancy?

A

Urgent care ONLY

112
Q

During pregnancy ____ have changed and the patient is more susceptible to _____

A

endocrine systems; periodontal issues

113
Q

Patients with a history of IV drug use are at an increased risk for diseases like:

A
  1. Hep B
  2. Hep C
  3. HIV/AIDs
  4. Infective endocarditis
114
Q

For what population of patients should sedatives & narcotics be prescribed with a great deal of caution or not at all?

A

Patients with history of drug abuse

115
Q

For patients with a history of drug abuse, sedatives & narcotics be prescribed with a great deal of caution or not at all, this is because:

A

Risk of triggering relapse

116
Q

_____ should be avoided for cocaine & methamphetamine users

A

Vasoconstrictors

117
Q

Why should vasoconstrictors be avoided for cocaine & methamphetamine users?

A

These agents may cause
-arrhythmias
-severe HTN
-MI
-stroke

118
Q

When talking to about substance use, misuse and abuse, this requires a level of:

A

professional trust

119
Q

What are we trying to avoid in patients with history of drug abuse/misuse?

A

Respiratory depression

120
Q

Alcohol consumption is a risk factor for:

A

many cancers & other diseases

121
Q

Alcohol consumption may lead to ____ which can cause many complications

A

liver cirrhosis

122
Q

What should you ask the patient in regard to alcohol use?

A

How many standard drinks per week

123
Q

The national institute of alcohol abuse and alcoholism came up with minimally acceptable amount of alcohol =

A

4 drink units per day or 8 per week (men)
3 drink units per day or 7 per week (women)

124
Q

T/F: Men & women should not regularly exceed 12 units per week of alcohol

A

False- 14 units

125
Q

Wine drinking can lead to:

A
  1. liver toxicity
  2. delayed healing
  3. dementia
  4. bleeding issues
126
Q

Tobacco use poses a risk for:

A

many cancers and other diseases (especially oral cancer)

127
Q

What should you ask a tobacco user?

A
  1. type of tobacco
  2. frequency of use
  3. years of usage

(to establish cumulative risk, current & past)

128
Q

T/F: Smoking tobacco is much more detrimental than chewing tobacco

129
Q

Describe the parameters of the following when discussing amounts:

  1. cigarettes
  2. smokeless tobacco
  3. hookah
  4. e-cigarettes
A
  1. packs/day
  2. cans/week
  3. hours/week
  4. cartridges/week
130
Q

Asking your patient about occupation, marital status, and children are examples of:

A

Social parameters

131
Q

Why might we ask the patient about their occupation?

A

To determine environmental/occupational risk

132
Q

Why might we ask the patient about their marital status?

A

To determine social support

133
Q

Social parameters can be very personal but can effect:

A

patient compliance with treatment

134
Q

Gives insight to potential disease with heritability:

A

Family history

135
Q

In regards to family history, we should watch out for signs and symptoms of:

A
  1. HTN
  2. DM
  3. autoimmune disease
  4. cancer
  5. other hereditary disease & syndromes
136
Q

What questions may we ask the patient to get info on their family history?

A
  1. do any disease run in your family?
  2. are your parents & siblings alive and well?
  3. what did your (mother/father/sibling pass of?)
137
Q

T/F: What we do may affect the patients medications. What medications the patient takes may affect our dental treatment.

A

Both statements true

138
Q

_____ is a good way to initiate the medical history

A

Checking the medications first

139
Q

Give some examples of signs and symptoms of drug-related adverse effects:

A
  1. bleeding
  2. immunosuppression
  3. BP
  4. MRONJ
140
Q

T/F: Patients typically list all medications including OTC drugs & herbal medicines

141
Q

During the physical examination, objective findings include:

A
  1. vital signs
  2. general appearance
  3. skin
  4. fingers
  5. nails
142
Q

What are we checking on the head & neck examination?

A
  1. skin
  2. eyes & nose
  3. ears
  4. cranial nerves
  5. neck examination
  6. intra-oral examination
143
Q

Vital signs include:

A
  1. BP
  2. Pulse
  3. Respiratory rate
  4. temperature
  5. height
  6. weight
144
Q

In a dental setting, what vital signs are typically taken?

A

Only BP & pulse

(these are the only measured DIRECTLY)

145
Q

Respiratory rate is taken by:

A

observation

146
Q

A normal respiratory rate:

147
Q

____ is measured when infection or systemic involvement is suspected

A

temperature

148
Q

Height and weight are determined by:

A

asking the patient (in dental setting)

149
Q

Vital signs are used to establish:

A

a baseline

150
Q

What is the purpose of taking vital signs?

A

Detection of abnormality NOT diagnosis

151
Q

The purpose of taking vital signs is for detection of an abnormality, NOT diagnosis. Diagnosis is the responsibility of:

A

the physician

152
Q

Why is it important to check BP?

A
  1. screening (you may be the first to detect)
  2. monitoring (compliance/control/progression)
  3. risk assessment (potential serious complications)
  4. treatment modifications
153
Q

T/F: Blood pressure is variable so multiple readings are really the most appropriate

154
Q

Is blood pressure a direct or indirect measurement?

155
Q

The blood pressure cuff should encompass ____% of the circumference of the arm. The cuff should center over the _____

A

80%

brachial artery

156
Q

What happens if the blood pressure cuff is:

-too small
-too big

A

too small –> falsely elevated values
too big –> falsely low values

157
Q

White coat HTN can elevate the BP by:

158
Q

If pregnant patient has a greater than or equal to increase of ____ from baseline increase in systolic BP this poses a risk for _____ and you should _____

A

10 mmHg; eclampsia; immediately refer

159
Q

Blood pressure helps to identify patients at risk of:

A

cardiovascular disease

160
Q

Arm position matters when taking BP. The arm should be:

A

Horizontal at heart level (mid-sternum)

161
Q

When the arm position is _____ heart level, this OVER-ESTIMATES systolic and diastolic pressures

A

Below

(similar to cuff being too small)

162
Q

When the arm position is _____ heart level, this UNDER-ESTIMATES systolic and diastolic pressures

A

Above (similar to cuff being too big)

163
Q

_____ method of BP measurement is universally accepted

A

auscultation

164
Q

Describe how to take a blood pressure:

A
  1. BP cuff should be inflated until radial pulse disappears; then add additional 20-30 mmHg
  2. Slowly turn release valve. Fall rate of needle should be around 2-3mmHg per second
  3. Listen for sounds - these sounds are the systolic pressure
  4. As needle continues to fall, the beat will become louder and then diminish
  5. listen for weekend beats & when sounds disappear completely this = diastolic pressure
164
Q

When taking a blood pressure, the first audible sound:

A

Korotkoff sounds (beating sounds)

165
Q

The pressure point of the first audible sound (Korotkoff sounds) =

A

systolic pressure

166
Q

What is the reliable index of diastolic pressure?

A

Point when sound disappears completely

167
Q

How can you ensure an accurate measurement of BP?

A
  1. Pt avoids caffeine exercise & nicotine
  2. Pt empty bladder prior to measurement
  3. Have patient relax for 5 min prior to measurement
  4. support limb when taking BP
  5. don’t take BP over clothes
  6. take 2-3 readings on 2-3 occasions
168
Q

What BP range falls under the classification:

-normal:
-elevated:
-stage 1:
-stage 2:
-hypertensive crisis:

A

-normal: LESS THAN 120/80
-elevated: (120-129) / LESS THAN 80
-stage 1: (130-139) / (80-89)
-stage 2: GREATER THAN OR EQUAL TO 140 / 90
-hypertensive crisis: GREATER THAN OR EQUAL TO 180 / 120

169
Q

Categorize the following BP measurement:

180/120

A

Hypertensive crisis

170
Q

Categorize the following BP measurement:

120/81

171
Q

Categorize the following BP measurement:

118/76

172
Q

Categorize the following BP measurement:

132/80

173
Q

Categorize the following BP measurement:

140/ 90

174
Q

When classifying a patients BP, you need:

A

at least 2 readings on at least 2 separate visits

175
Q

At UMKC, we will not perform any dental care on a patient if their BP is:

A

Greater than or equal to 180/110 mmHg

176
Q

180/120 is classified as a _____ by the _____ based on the 2017 guidelines

A

Hypertensive urgency; AHA

177
Q

If your patient presents with 180/120 BP and is asymptomatic this requires:

A

urgent referral to doctor

178
Q

If your patient presents with 180/120 BP and is symptomatic this requires:

A

emergency room!

179
Q

What is the standard for assessing pulse?

A

Palpate carotid artery at side of trachea (the most reliable)

or

Palpate radial artery on thumb side of wrist

180
Q

Do NOT use the _____ for pulse detection

181
Q

Classify the following pulse ranges:

-normal:
-tachy:
-brady:

A

-normal: 60-100
-tachy: >100
-brady: <60

182
Q

Abnormal pulse rate may be a sign of:

A

cardiovascular disorder

183
Q

Pulse may be influenced by:

A
  1. exorcise/conditioning
  2. anemia
  3. anxiety
  4. drugs
  5. fever
184
Q

The normal pulse is:

A

a series of rhythmic beats at regular intervals

185
Q

Irregular beats are described as:

A
  1. irregular
  2. dysrhythmic
  3. arrhythmic
186
Q

Palpate the pulse for a _____ for accuracy if a _____ is suspected

A

full minute; arrythmia

187
Q

Rate and depth of breathing noted by careful observation of movement of the chest and abdomen in the quietly breathing patient:

A

respiration

188
Q

Normal respiration rate in adults:

A

12-16 breaths/min

189
Q

Respiratory rate in small children is ____ compared to adults

190
Q

Abnormal breathing patterns (respiration) include:

A
  1. labored breathing
  2. rapid breathing
  3. irregular breathing patterns
191
Q

Abnormal breathing patterns may be signs of:

A

systemic problems, especially cardiopulmonary disease

192
Q

A common respiration finding in apprehensive patients is _____

A

Hyperventilation (rapid, prolonged, deep breathing or sighing)

193
Q

A common respiration finding in apprehensive patients is hyperventilation (rapid, prolonged, deep breathing or sighing). This may result in:

A

lowered carbon dioxide levels

194
Q

Rapid weight loss may be a sign of:

A
  1. malignancy
  2. diabetes
  3. tuberculosis
  4. neoplasm
  5. other wasting disease
195
Q

Rapid weight gain may be a sign of:

A
  1. heart failure
  2. edema
  3. hypothyroidism
  4. neoplasm
196
Q

A lot can be determined by the patients health from a purposeful but:

A

tactful visual inspection

197
Q

Changes in the skin & nails can be associated with systemic disease, what are some examples?

A
  1. cyanosis
  2. jaundice
  3. pigmentation
  4. petechia or ecchymoses
198
Q

What can the following changes indicate in a patients skin & nails?

  1. cyanosis
  2. jaundice
  3. pigmentation
  4. petechia or ecchymoses
A
  1. cardiac or pulmonary insufficiency
  2. liver disease
  3. hormonal abnormalities
  4. blood dyscrasia or bleeding disorder
199
Q

Alterations in finger nails are usually seen in:

A

chronic disorder

200
Q

Alterations in finger nails is usually seen in chronic disorders such as:

A
  1. clubbing
  2. white discoloration
  3. yellowing
  4. splinter hemorrhages
201
Q

The following signs on the fingernails are associated with what chronic diseases?

  1. clubbing
  2. white discoloration
  3. yellowing
  4. splinter hemorrhages
A
  1. cardiopulmonary insufficiency
  2. cirrhosis
  3. malignancy
  4. infective endocarditis
202
Q

______ hand surfaces are common for actinic keratosis & basal cell carcinomas

203
Q

A raised, darkly pigmented lesion with irregular borders could be:

204
Q

List some characteristics of melanoma:

A
  1. darkly pigmented
  2. irregular borders
  3. raised
205
Q

_____ & ____ of the face are abnormal in many syndromes & conditions

A

shape & symmetry

206
Q

List some well-regarded examples of syndromes and conditions that may result in face & symmetry changes in the face:

A
  1. Acromegaly- coarse & enlarged features
  2. Cushing syndrome- moon face
  3. Bell’s palsey- unilateral paralysis
207
Q

T/F: Eyes can be indicators of systemic disease and should be inspected closely. Patients wearing glasses should be asked to remove them during examination of head & neck

A

Both statements true

208
Q

Involving the eyes & nose, give an example of an indicator of hyperthyroidism:

A

lid retraction

209
Q

Involving the eyes & nose, give an example of an indicator of hypercholesteremia:

A

xanthomas of the eyelids

210
Q

Involving the eyes & nose, give an example of an indicator of liver disease (problem metabolizing drugs):

A

yellowing of sclera

211
Q

Involving the eyes & nose, give an example of an indicator of allergy or sicca syndrome:

A

conjunctiva reddening

212
Q

An earlobe crease may be an indicator of:

213
Q

Examination of the head & neck may vary in its comprehensiveness bu should include:

A

inspection & palpation of:

  1. soft tissues of oral cavity
  2. maxillofacial region
  3. neck

(as well as evaluation of the cranial nerve function)

214
Q

What do we look for when physically examining the neck?

A
  1. normal or enlarged?
  2. soft or hard?
  3. mobile or fixed?
  4. tender or non-tender?
215
Q

What may be some causes of abnormal findings in the neck?

A
  1. infections
  2. goiter
  3. cysts
  4. massess
  5. vascular deformities
216
Q

List the groups of lymph nodes that should be palpated in a head & neck examination:

A
  1. pre-auricular
  2. post-auricular
  3. tonsillar
  4. submandibular
  5. anterior cervical
  6. posterior cervical
  7. supraclavicular
217
Q

Describe how you may want to organize the appointment for a patient with known dental anxiety:

A
  1. short appointments
  2. usually in morning
  3. pre-dental treatment sedation (1hr prior to appt)
  4. sedation during treatment (nitrous oxide)
  5. profound local anesthesia
  6. post-dental pain control
  7. patient contacted the evening of the procedure
218
Q

What type of drugs may be prescribed for to be taken 1 hour prior to treatment for an anxious patient? Give an example:

A

Benzodiazepines; Triazolam .25mg

219
Q

Indications for laboratory testing in dentistry include:

A
  1. aid in detecting suspected disease
  2. screen high-risk patients for undetected disease
  3. establish normal baseline values before treatment
  4. address medical-legal considerations
220
Q

Common labs a dentist may order include:

A
  1. CBC (complete blood count with platelets & WBC differential)
  2. prothrombin time
  3. partial thromboplastin time
221
Q

What measurements may be found on a CBC? Include normal values:

A
  1. RBC: 4.2-5.9 million/mm3
  2. WBC: 4-10 thousand/mm3h
  3. PLT count: 150k-400l/mm3
222
Q

The prothrombin time test is:

A

International normalized ratio (PT-INR)

223
Q

What is the purpose of a prothrombin time test (PT-INR)?

A

Helps to determine bleeding risk & measures extrinsic & normal coagulation cascade pathways

224
Q

What is considered a normal INR (from a PT-INR test)?

A

normal = 1

For patient on Coumadin = 2-3

225
Q

What does a higher INR indicate?

A

Higher bleeding risk

226
Q

P.T.T:

A

Partial thromboplastin time

227
Q

PT-INR:

A

Prothrombin time- international normalized ratio

228
Q

The P.T.T measures the ____ pathway

229
Q

Normal range for a P.T.T=

A

25-38 seconds

230
Q

aPTT is ______ and is used for _____

A

activated PTT; Pradaxa

231
Q

A _____ record is a legal record

232
Q

T/F: Risk is sometimes increased when treating a medically complex patient

A

False- ALWAYS

233
Q

When dealing with a complex patient, plan around:

A

likelihood of most severe complication

234
Q

ASA:

A

American Society of Anesthesiologist

235
Q

Assign an ASA classification for the following situation:

A normal healthy patient

236
Q

Assign an ASA classification for the following situation:

A patient with mild systemic disease

237
Q

Assign an ASA classification for the following situation:

A patient with severe systemic disease

238
Q

Assign an ASA classification for the following situation:

A patient with severe systemic disease that is a constant threat to life

239
Q

Assign an ASA classification for the following situation:

A moribund patient who is not expected to survive without operation

240
Q

Assign an ASA classification for the following situation:

A patient declared brain-dead whose organs are being removed for donor purposes

241
Q

Higher ASA status (2-6) increases with:

A

increasing age

242
Q

ASA classification that poses little or no risk during treatment:

243
Q

ASA classification that poses minimal risk during treatment:

244
Q

ASA classification of a patient that can walk up one flight of stairs or two level city blocks but has to stop on the way because of distress:

245
Q

For ASA 3 patients, if dental care is needed, ____ & other ____ are indicated

A

stress reduction protocols; other treatment modifications

246
Q

T/F: 30 days or more ago history of Myocardial infarction, cerebrovascular accident & CHF place a patient in the classification of ASA 4

A

False- ASA 3

247
Q

What is the ASA classification for patient that has severe systemic disease that is a constant threat to life?

248
Q

What is the ASA classification for a patient unable to walk up 1 flight of stairs or two level city blocks. Distress is present at rest.

249
Q

Elective dental care should be postponed until the patient is an:

250
Q

Emergency dental care for an ASA class 4 patient:

A

may be best in a hospital with a consultation of the patients physician team

251
Q

What is the ASA classification, for a paten with unstable angina, MI or CVA in the last 30 days?

252
Q

What is the ASA classification for:

-severe CHF
-moderate to severe COPD
-uncontrolled HTN
-uncontrolled DM
-uncontrolled epilepsy or seizure disorder

Dental management of the Medically Complex Patient (5 decks)

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