Medically compromised patints Flashcards
What does the ASA classification predict?
The risk of general anesthesia and its application to dental care.
How are ASA PS III patients described?
Severe systemic disease, limited physical activity, and need for treatment modifications.
What is an example of ASA PS III condition?
History of myocardial infarction or heart failure over 30 days ago.
Which ASA classification represents a healthy patient?
ASA PS I.
How should patients classified as ASA PS IV be treated?
Hospital-based care due to life-threatening systemic conditions.
What is infective endocarditis (IE)?
Microbial infection and inflammation of the endocardium, including heart valves.
What dental procedures can lead to bacteremia in patients at risk of IE?
Procedures involving gingival manipulation, periapical region, or oral mucosa perforation.
When is antibiotic prophylaxis not required for IE prevention?
Routine anesthetic injections, radiographs, or orthodontic adjustments.
What is the interval required between appointments for antibiotic prophylaxis?
At least 10 days to prevent penicillin-resistant organisms.
Which antibiotics are alternatives to penicillin for IE prophylaxis?
Clindamycin, azithromycin, or clarithromycin.
Why are cephalosporins not recommended as alternatives for IE prophylaxis?
They are not effective and may increase resistance risk.
What is the clinical definition of hypertension?
Systolic BP > 140 mmHg and/or diastolic BP > 90 mmHg.
What is the primary concern for hypertensive patients during dental treatment?
Sudden acute elevation in BP, leading to stroke, MI, or severe bleeding.
How much epinephrine is safe for hypertensive patients during dental treatment?
One to two cartridges of 2% lidocaine with 1:100,000 epinephrine.
How should a hypertensive patient with BP 165/105 and severe pain be managed?
Provide analgesics and antibiotics until hypertension is controlled; consult a physician.
What is ischemic heart disease?
Lack of oxygen to heart muscles due to coronary artery blockage, spasm, or embolism.
What are the three types of angina?
Stable angina, unstable angina, and Prinzmetal angina.
How should patients with stable angina be managed in dental care?
Routine care with nitroglycerin available; monitor BP and limit epinephrine use.
What is the recommendation for patients with Class 3 angina?
Elective dental care with modifications and limited anesthetic use.
How should unstable angina patients be treated?
Avoid elective care; consult a physician and treat in a hospital setting if necessary.
What precautions should be taken for dental care after myocardial infarction (30+ days)?
Limit epinephrine to 2 carpules, monitor BP, and follow stress reduction protocols.
What is the cause of myocardial infarction (MI)?
Persistent ischemia leading to irreversible necrosis of myocardial fibers.
What are the guidelines for dental care within 30 days of MI?
Avoid elective care; consult a cardiologist and provide hospital-based care if urgent.
What precautions are necessary for MI patients more than 30 days post-event?
Elective care can be performed with limited vasoconstrictors and stress reduction.
Why is continuous monitoring necessary for MI patients undergoing urgent dental care?
To prevent cardiac arrest and manage complications effectively.
What drug interactions should be considered in MI patients on antiplatelet therapy?
Aspirin or other antiplatelet medications may increase bleeding risk.
What are the symptoms of heart failure (HF)?
Shortness of breath, orthopnea, fatigue, and inability to cope with physical activity.
How should patients with Stage A or B heart failure be managed?
Routine dental care with stress reduction and limited epinephrine use.
What should be avoided in patients with advanced stages of HF during dental care?
Supine position and general anesthesia due to pulmonary congestion.
What is the maximum amount of epinephrine allowed for HF patients?
2 carpules of 1:100,000 epinephrine.
What causes dysrhythmias or arrhythmias?
Disruption of electrical impulse generation or conduction in the heart.
When is medical consultation needed for a patient with arrhythmia?
If the condition is poorly controlled, undiagnosed, or uncertain in nature.
What precautions are necessary for patients with pacemakers during dental treatment?
Avoid electromagnetic interference from devices like electrosurgery units.
What is the safe dose of epinephrine for arrhythmia patients?
0.036 mg (two cartridges of 1:100,000 epinephrine).
Why are diabetic patients more prone to infection?
High blood sugar levels impair immune response and wound healing.
When should diabetic patients be scheduled for routine dental care?
Early morning appointments after a normal meal and usual medication.
How should infections in brittle diabetics be managed?
Aggressive treatment with incision, drainage, and antibiotics.
What blood glucose level should delay elective dental care?
Fasting plasma glucose >200 mg/dL or <70 mg/dL.
What precautions are needed for poorly controlled diabetics during emergency care?
Provide appropriate emergency care and consult with a physician.
Are dental implants recommended for poorly controlled diabetics?
No, as their prognosis is unpredictable.
What should insulin-using patients monitor before dental procedures?
Preoperative plasma glucose levels.
What drug interaction risks exist for diabetic patients?
Corticosteroids can increase blood sugar, and NSAIDs may enhance hypoglycemic effects.
What causes primary adrenal insufficiency (Addison’s disease)?
Autoimmune antibodies, granulomatous diseases, or adrenal hemorrhage.
When should dental treatment be avoided for patients with adrenal insufficiency?
Without prior medical consultation to confirm stability.
When is supplemental steroid cover needed for dental procedures?
For patients recently tapered off systemic corticosteroids undergoing stressful procedures.
Why is blood pressure monitoring essential during invasive procedures in adrenal insufficiency?
To detect adrenal crisis and manage hypotension.
What anesthetic considerations are needed for adrenal insufficiency?
Use long-acting local anesthetics for better postoperative pain control.
What is the postoperative monitoring time for moderate to major surgeries?
At least 8 hours to detect complications.
What are the risks of untreated severe hypothyroidism during dental procedures?
Risk of myxedema coma under stress or infection.
What precautions are needed for patients with hyperthyroidism?
Avoid vasoconstrictors in uncontrolled cases; monitor vital signs closely.
What dental care is appropriate for patients with well-controlled thyroid disorders?
Routine care without special precautions.
What drugs should be avoided in hypothyroid patients?
Narcotics, barbiturates, and tranquilizers due to sensitivity.
What is the risk of thyrotoxic crisis in hyperthyroid patients?
It can be triggered by stress, trauma, or infection.
What is the best time for dental treatment for dialysis patients?
The day after hemodialysis to minimize bleeding risks.
What precautions are needed for patients with a hemodialysis shunt?
Avoid BP cuffs or venipuncture on the shunt arm.
What local hemostatic measures can be used for dialysis patients?
Absorbable gelatin sponge, thrombin, and oxidized cellulose.
When should dental procedures be delayed for ESRD patients?
Until dialysis is initiated and the patient is medically stable.
What antibiotics may be needed for ESRD patients with infections?
Broad-spectrum antibiotics for severe leukocyte suppression.
What is the risk of NSAIDs in ESRD patients?
They can impair kidney function further and exacerbate acid-base imbalance.
What should the dentist do if a patient is heparinized during dialysis?
Delay treatment until the heparin effects wear off (3–6 hours).
What dental procedures should be completed before radiation therapy?
Extraction of hopeless teeth and management of bone pathology.
How should fluoride therapy be provided during radiation?
Daily fluoride gel trays or toothpaste to prevent demineralization.
What is the Marx protocol for osteoradionecrosis prevention?
20 hyperbaric oxygen sessions before and 10 after surgery in irradiated fields.
How often should post-radiation therapy patients be recalled?
Every 3–6 months for caries prevention and monitoring.
Why should prosthetics be avoided during radiation therapy?
To prevent irritation and mucosal ulceration in radiated tissues.
