MANAGEMENT OF PATIENTS WITH SPECIAL NEED

Question 1

Risk factors for periodontitis

Answer 1

Elevated serum lipids high cholesterol levels Smoking
Diabetes
Age
Male gender
Stroke
Obesity and lack of fitness
Low socio-economic status

Question 2

Possible mechanism

Answer 2

Direct effect
Macrophages Il-1, Il-6, TNF- a

Indirect effect
Liver CRP (C-reactive protein) lipid abnormalities coagulation factors
Vascular lesion

Question 3

Prehypertension

Answer 3

Prehypertension: Systolic: 120–139 and Diastolic 80–89 No changes in dental treatment, Monitor BP

Question 4

Stage 1 htn

Answer 4

 Stage 1 hypertension 140–159 or 90–99
Routine medical consultation/referral, No changes in dental
minimize stress

Question 5

Stage 2 htn

Answer 5

 Stage 2 hypertension 160-179 or ≥100
treatment,
Medical consultation, Monitor BP at each appointment, Perform selective dental care nonsurgical periodontics, minimize stress

Question 6

 Systolic BP ≥ 180 or diastolic ≥100,

Answer 6

 Systolic BP ≥ 180 or diastolic ≥100, give immediate medical consultation. Emergency dental care only

Question 7

Angina pectoris

Answer 7

Angina pectoris occurs when myocardial oxygen demand exceeds supply, resulting in temporary myocardial ischemia

Question 8

Emergency medical treatment of a patient having an anginal episode in the dental chair

Answer 8

1. Discontinue the periodontal procedure. Administer 1 tablet (0.3 to 0.6 mg) of nitroglycerin sublingually
2. Reassure the patient and loosen garments
3. Administer O2 with the patient in a reclined position
4. If the signs and symptoms cease within 3 minutes, complete the procedure if possible, making sure that the patient is comfortable and terminated earlier
5. If the anginal signs and symptoms do not resolve with this treatment
   within 5 minutes, administer another dose of nitroglycerin, monitor the patient’s vital signs, call the patient’s physician and be ready to accompany the patient to the emergency department
6. A third nitroglycerin tablet can be given 5 minutes after the second
   Chest pain is not relieved by 3 tablets of nitroglycerin indicates likely MI. The patient should be transported to the nearest emergency medical facility immediately.
   MI patients deferred the treatment for 6 months period

Question 9

Prophylactic regimens for high-risk patients

Answer 9

1. Previous history of infective endocarditis
2. Prosthetic cardiac valves or prosthetic material for valve repair
3. Congenital heart disease (CHD)
4. Completely repaired congenital heart defect with prosthetic material or device during the first six months after the procedure.
5. Cardiac transplantation recipients who develop cardiac valvulopathy

Question 10

Guidelines for Diabetics

Answer 10

Level 70 mg/dl or low consume some carbohydrate or juice before starting treatment. If glycemic control has been poor over the preceding few months, the procedure may need to be postponed until control is established

Question 11

Signs and Symptoms of Hypoglycemia

Answer 11

■ Shakiness or tremors ■ Confusion
■ Agitation and anxiety ■ Sweating
■ Tachycardia
■ Dizziness
■ Feeling of “impending doom” ■ Unconsciousness
■ Seizures

Question 12

Management of hypoglycemia

Answer 12

Provide approximately 15 g of oral carbohydrate to the patient
• 4 to 6 ounces of juice or soda
• 3 or 4 teaspoons of table sugar • Hard candy with 15 g of sugar
2. If the patient is unable to take food or drink by mouth or sedated
• Give 25 to 30 mL of 50% dextrose intravenously, which provides 12.5 to 15.0 g of dextrose, or
• Give 1 mg of glucagon intravenously (i.e., 2350 glucagon results in rapid release of stored glucose from the liver), or
• Give 1 mg of glucagon intramuscularly or subcutaneously (if no intravenous access).

Question 13

 Bleeding disorders are classified as

Answer 13

coagulation disorders, thrombocytopenic purpuras, or nonthrombocytopenic purpuras

Question 14

 Laboratory tests include hemorrhagic

Answer 14

 Laboratory tests include bleeding time, tourniquet test, complete blood cell count, prothrombin time, partial thromboplastin time and coagulation time.

Question 15

Inr liver disease

Answer 15

INR of less than 2.5 in liver disease

Question 16

Inr coagulation disorder

Answer 16

& less than 3.0 with coagulation disorder

Question 17

Block anesthesia, minor periodontal surgery usually require an INR of
less than

Answer 17

2

Question 18

Periodontal surgery may require hospitalization and INR of less than

Answer 18

Periodontal surgery may require hospitalization and INR of less than 1.5 to 2.0 only after consultation with a physician

Question 19

Monitor laboratory values daily: leukemia

Answer 19

Monitor laboratory values daily: bleeding time, coagulation time, PT and platelet count
 Only emergency PD care during the acute phases

Question 20

The Treatment Plan for Leukemia Patients

Answer 20

 Twice-daily rinsing with 0.12% chlorhexidine gluconate is recommended after OH procedures
 Extract all hopeless, non maintainable or potentially infectious teeth at least 10 days before chemotherapy if systemic conditions allow
 Use pressure/topical hemostatic agents as indicated
 Oral ulcerations and mucositis are treated palliatively with agents
such as viscous lidocaine
 Oral candidiasis is common in leukemic patients and can be treated with nystatin suspension (400,000–600,000 U/mL four times daily) or clotrimazole vaginal suppositories (10 mg four or five times/day

Question 21

The most prominent sign and symptom in patients with leukemia appears on the gingiva among the following are:

Answer 21

Bluish red and necrotizing ulcerative

Friable, ulcerative with necrosis of the gingiva

Question 22

Treatment for Renal Failure Patients

Answer 22

Monitor BP, Check PTT, PT, bleeding time & platelet count; hematocrit; blood urea nitrogen (do not treat if <60 mg/dL) & serum creatinine (do not treat if <1.5 mg/dL)
 Eliminate areas of oral infection
 Good oral hygiene with frequent recall appointments
 Periodontal treatment should aim at eliminating inflammation or infection & easy maintenance
 Questionable teeth should be extracted if medical parameters permit

Question 23

Safe for renal patients

Answer 23

Acetaminophen, diazepam and lidocaine as LA are usually safe medication

Question 24

Treatment in Pulmonary Disease

Answer 24

 Avoid elicitation of respiratory depression or distress: Minimize the stress of a periodontal appointment
 The patient with emphysema should be treated in the afternoon to allow for airway clearance
 Avoid narcotics, sedatives, GA, bilateral mandibular block anesthesia (can increase airway obstruction)
 Position the patient to allow maximal ventilator efficiency, be careful to prevent physical airway obstruction, keep the patient’s throat clear
 For a person with a history of asthma, make sure the patient’s inhaler is available or accessible in the dental treatment room
 Patients with active fungal or bacterial respiratory diseases should not be treated unless the periodontal procedure is an emergency

Question 25

Complications of hiv

Answer 25

Delayed wound healing & increased risk of post operative infection are possible complicating factors

Question 26

Control of HIV-associated mucosal diseases;

Answer 26

chronic candidiasis, recurrent oral ulcerations, acute infections

Question 27

Maintenance therapy for hiv

Answer 27

Maintenance Therapy for HIV
Maintain meticulous personal oral hygiene & recall visits at short intervals (2 to 3 months)
Medical confidentiality; upheld patients concern
Elicit depression, anxiety, and anger toward the dentist and the staff - coping with a life-threatening disease - need concern and understanding for the patient’s situation
Provide treatment in a calm, relaxed atmosphere, with minimum stress to the patient
Advise & counsel patients on their oral health
Assist the patient in obtaining testing with oral lesions suggestive of HIV infectio