Medical Considerations in Periodontal Therapy Flashcards
what are cardiac conditions that have a antibiotic prophylaxis indication?
-prosthetic cardiac valve
-previous/relapse/recurrent infective endocarditis
-congential heart disease
-cardiac transplant (with cardiac valvulopathy
pt is already taking a short course of oral antibiotic. does the pt still need to take loading dose of antibiotic prophylaxis prior to dental tx?
YES
the antibiotic blood levels must be high to protect the pt from infective endocarditis or wait 10 days after finishing the antibiotic regimen to schedule dental tx. use normal AP regimen
what goes into a medical consultation letter?
1) Define patient’s dental problem, tx plan
2) Supply medical condition of concern
3) List of questions to be answered by physician
what changes will you see in regards to the periodontium and puberty
-Increased prevalence gingivitis
-Increased Prevotella intermedia
-Periodontal tissues have exaggerated response to local factors
what is the occurrence rate of pyogenic granulomas?
0.2-9.6%
when would you excise a pyogenic granuloma?
2nd trimester
T/F perio in a pregnant mother plays into having a baby with pre term low birth weight
True
are radiographs ok during pregnancy?
when indicated for diagnosis, yes
what should you avoid with positioning during tx of pregnant mothers?
avoid supine hypotensive syndrome
sit them in a semi-supine position
what is the amount of drugs excreted into the breast milk?
usually 1-2% of dose
what is the recommendation for breastfeeding mothers and medications?
mother should take prescribed drugs after breastfeeding and avoid nursing for ≥4 hours
T/F osteopenia/osteoporosis is assoc. with menopause
true
Estrogen Deficiency and Osteopenia/Osteoporosis associated with Increased:
-Attachment loss
-Crestal bone density loss
-Enhanced attachment loss and bone loss when combined with smoking
what will bisphophonate therapy do for the oral cavity?
-Diminished osteoclast activity
-Bisphosphonate-related osteonecrosis of the jaws
where is Medication-related Osteonecrosis of the Jaws more likely to happen?
the mandible (75%)
what bisphonates are taken for osteoporosis/osteopenia
Fosamax ® (Alendronate)
Actonel ® (Risedronate)
Boniva ® (Ibandronate)
Reclast ® (Zoledronate)
what iv bisphophonates are taken for bone cancer?
-Zometa ® (Zoledronate)
-Aredia ® (Pamidronate injection)
what are other drugs related to osteonecrosis of the jaws
-prolia (denosumab)
-xgeva (denosumab)
what is the mechanism of action for denosumab
-binds to inhibits RANKL
-inhibits maturation of osteoclasts
-mimics action of osteoprotegerin
what is the ARONJ risk for oral bisphosphonates?
0.02-0.04%
ARONJ risk for IV bisphosphonates for cancer?
<5%
ARONJ risk with Denosumab?
0.3%
ARONJ (Antiresorptive Agent-Related Osteonecrosis of the Jaw) risk after tooth ext for oral bisphosphonates?
0-0.15%
ARONJ risk after tooth ext for IV bisphosphonates?
1.6-14.8%
ARONJ risk after tooth ext for denosumab
1%
T/F for pt treated with IV bisphosphonates you can perform invasive tx with caution
false. avoid invase tx
what is the tx recommendation for denosumab pt’s?
-physician’s consultation
-planned dentoalveolar surgery 3-4 months following last dose of DMB
-Next dose 6-8 weeks post-surgery
with hypertension what precautions should you take?
-Consult physician
-Short appointments
-Adequate anesthesia (≤1:100,000 epi)
-Limit 2 cartridges
-Carbocaine without epi
with a pt with an unstable angina pectoris what kind of care can we offer them?
emergency care only
with a stable angina pectoris pt what consideration do we take with the anesthesia?
limit epinephrine
with myocardial infarction OR cerebrovascular accident when can you perform dental tx?
delay elective dental tx 6 months
with myocardial infarction what should you do first?
consult cardiologist
what should the pt do the day of procedure if they have a history of mycardial infarction OR cerebrovascular accident?
The international normalized ratio (INR)
what considerations with positioning should be taken regarding a pt with congestive heart failure?
don’t fully recline
T/F you should limit IV fluids during parenteral sedation when working on a pt with congestive heart failure
True
what should the blood glucose level be below to initiate tx?
<200 mg/dl
what should the HbA1c be at for perio and implant surgeries?
<7%
what time of day should diabetes pt’s be scheduled at?
short, morning appt’s
what are the most common medical emergency in diabetic pt’s?
-hypoglycemia
-monitor blood glucose during long procedures
what are some the signs to look for in someone who is hypoglycemic
Shakiness or tremors
Confusion
Agitation or anxiety
Sweating
Tachycardia
Dizziness
Feeling of impending doom
Unconsciousness
Seizures
with hyperthyroidism what should you limitin the pt?
stress
with hypothyroidism what should you limit?
limit sedation
what is the primary adrenal insufficiency?
addison’s disease
what is the secondary adrenal insufficiency?
exogenous glucocorticosteroids
when is the demand for cortisol seen in adrenal insufficient pt’s?
1-5 hours after oral surgery (related to post-op pain)
how can you diminish the need to extra cortisol in adrenal insufficient pt’s?
-adequate post-op pain control
-Supplemental steroid prior to oral surgery may not be needed if pain is managed adequately
-Usual dose taken within 2 hours of procedure
what is the rule of 2’s for medical consult?
-20 mg Hydrocortisone for ≥2 weeks within past 2 years.
-Note: 5 mg Prednisone = 20 mg Hydrocortisone
what are some things to watch out for when dealing with perio tx on a pt before a kidney transfer?
-monitor blood pressure
-monitor laboratory values
-don’t give drugs metabolized by the kidney (e.g. tetracycline, ibuprofen)
what are the safe items to use on a perio pt who will get a transplant?
acetaminophen and lidocaine
what should you do to a pt prior to kidney transplant?
remove questionable teeth, Post-transplant immunosuppressive drugs reduce resistance to infection
when should you do perio tx on a pt who’s going through hemodialysis?
the day after hemodialysis (minimize effects of heparin)
when is an antibiotic prophylaxis recommended in regards to pt’s doing hemodialysis?
when they have arteriovenous fistula or shunt
what lab tests do you need with liver disease?
international normalized ratio (INR), bleeding time, platelet count
T/F you can perform surgeries on pt’s with liver disease
false. conservative therapy, non-surgical
if surgery is needed what INR readings should be seen
INR < 2.0
simple surgery: INR < 2.5
platelet count: > 80,000/mm^3
