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Oral surgery > Medically compromised patints > Flashcards

Medically compromised patints Flashcards

1
Q

What does the ASA classification predict?

A

The risk of general anesthesia and its application to dental care.

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2
Q

How are ASA PS III patients described?

A

Severe systemic disease, limited physical activity, and need for treatment modifications.

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3
Q

What is an example of ASA PS III condition?

A

History of myocardial infarction or heart failure over 30 days ago.

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4
Q

Which ASA classification represents a healthy patient?

A

ASA PS I.

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5
Q

How should patients classified as ASA PS IV be treated?

A

Hospital-based care due to life-threatening systemic conditions.

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6
Q

What is infective endocarditis (IE)?

A

Microbial infection and inflammation of the endocardium, including heart valves.

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7
Q

What dental procedures can lead to bacteremia in patients at risk of IE?

A

Procedures involving gingival manipulation, periapical region, or oral mucosa perforation.

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8
Q

When is antibiotic prophylaxis not required for IE prevention?

A

Routine anesthetic injections, radiographs, or orthodontic adjustments.

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9
Q

What is the interval required between appointments for antibiotic prophylaxis?

A

At least 10 days to prevent penicillin-resistant organisms.

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10
Q

Which antibiotics are alternatives to penicillin for IE prophylaxis?

A

Clindamycin, azithromycin, or clarithromycin.

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11
Q

Why are cephalosporins not recommended as alternatives for IE prophylaxis?

A

They are not effective and may increase resistance risk.

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12
Q

What is the clinical definition of hypertension?

A

Systolic BP > 140 mmHg and/or diastolic BP > 90 mmHg.

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13
Q

What is the primary concern for hypertensive patients during dental treatment?

A

Sudden acute elevation in BP, leading to stroke, MI, or severe bleeding.

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14
Q

How much epinephrine is safe for hypertensive patients during dental treatment?

A

One to two cartridges of 2% lidocaine with 1:100,000 epinephrine.

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15
Q

How should a hypertensive patient with BP 165/105 and severe pain be managed?

A

Provide analgesics and antibiotics until hypertension is controlled; consult a physician.

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16
Q

What is ischemic heart disease?

A

Lack of oxygen to heart muscles due to coronary artery blockage, spasm, or embolism.

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17
Q

What are the three types of angina?

A

Stable angina, unstable angina, and Prinzmetal angina.

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18
Q

How should patients with stable angina be managed in dental care?

A

Routine care with nitroglycerin available; monitor BP and limit epinephrine use.

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19
Q

What is the recommendation for patients with Class 3 angina?

A

Elective dental care with modifications and limited anesthetic use.

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20
Q

How should unstable angina patients be treated?

A

Avoid elective care; consult a physician and treat in a hospital setting if necessary.

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21
Q

What precautions should be taken for dental care after myocardial infarction (30+ days)?

A

Limit epinephrine to 2 carpules, monitor BP, and follow stress reduction protocols.

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22
Q

What is the cause of myocardial infarction (MI)?

A

Persistent ischemia leading to irreversible necrosis of myocardial fibers.

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23
Q

What are the guidelines for dental care within 30 days of MI?

A

Avoid elective care; consult a cardiologist and provide hospital-based care if urgent.

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24
Q

What precautions are necessary for MI patients more than 30 days post-event?

A

Elective care can be performed with limited vasoconstrictors and stress reduction.

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25
Q

Why is continuous monitoring necessary for MI patients undergoing urgent dental care?

A

To prevent cardiac arrest and manage complications effectively.

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26
Q

What drug interactions should be considered in MI patients on antiplatelet therapy?

A

Aspirin or other antiplatelet medications may increase bleeding risk.

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27
Q

What are the symptoms of heart failure (HF)?

A

Shortness of breath, orthopnea, fatigue, and inability to cope with physical activity.

28
Q

How should patients with Stage A or B heart failure be managed?

A

Routine dental care with stress reduction and limited epinephrine use.

29
Q

What should be avoided in patients with advanced stages of HF during dental care?

A

Supine position and general anesthesia due to pulmonary congestion.

30
Q

What is the maximum amount of epinephrine allowed for HF patients?

A

2 carpules of 1:100,000 epinephrine.

31
Q

What causes dysrhythmias or arrhythmias?

A

Disruption of electrical impulse generation or conduction in the heart.

32
Q

When is medical consultation needed for a patient with arrhythmia?

A

If the condition is poorly controlled, undiagnosed, or uncertain in nature.

33
Q

What precautions are necessary for patients with pacemakers during dental treatment?

A

Avoid electromagnetic interference from devices like electrosurgery units.

34
Q

What is the safe dose of epinephrine for arrhythmia patients?

A

0.036 mg (two cartridges of 1:100,000 epinephrine).

35
Q

Why are diabetic patients more prone to infection?

A

High blood sugar levels impair immune response and wound healing.

36
Q

When should diabetic patients be scheduled for routine dental care?

A

Early morning appointments after a normal meal and usual medication.

37
Q

How should infections in brittle diabetics be managed?

A

Aggressive treatment with incision, drainage, and antibiotics.

38
Q

What blood glucose level should delay elective dental care?

A

Fasting plasma glucose >200 mg/dL or <70 mg/dL.

39
Q

What precautions are needed for poorly controlled diabetics during emergency care?

A

Provide appropriate emergency care and consult with a physician.

40
Q

Are dental implants recommended for poorly controlled diabetics?

A

No, as their prognosis is unpredictable.

41
Q

What should insulin-using patients monitor before dental procedures?

A

Preoperative plasma glucose levels.

42
Q

What drug interaction risks exist for diabetic patients?

A

Corticosteroids can increase blood sugar, and NSAIDs may enhance hypoglycemic effects.

43
Q

What causes primary adrenal insufficiency (Addison’s disease)?

A

Autoimmune antibodies, granulomatous diseases, or adrenal hemorrhage.

44
Q

When should dental treatment be avoided for patients with adrenal insufficiency?

A

Without prior medical consultation to confirm stability.

45
Q

When is supplemental steroid cover needed for dental procedures?

A

For patients recently tapered off systemic corticosteroids undergoing stressful procedures.

46
Q

Why is blood pressure monitoring essential during invasive procedures in adrenal insufficiency?

A

To detect adrenal crisis and manage hypotension.

47
Q

What anesthetic considerations are needed for adrenal insufficiency?

A

Use long-acting local anesthetics for better postoperative pain control.

48
Q

What is the postoperative monitoring time for moderate to major surgeries?

A

At least 8 hours to detect complications.

49
Q

What are the risks of untreated severe hypothyroidism during dental procedures?

A

Risk of myxedema coma under stress or infection.

50
Q

What precautions are needed for patients with hyperthyroidism?

A

Avoid vasoconstrictors in uncontrolled cases; monitor vital signs closely.

51
Q

What dental care is appropriate for patients with well-controlled thyroid disorders?

A

Routine care without special precautions.

52
Q

What drugs should be avoided in hypothyroid patients?

A

Narcotics, barbiturates, and tranquilizers due to sensitivity.

53
Q

What is the risk of thyrotoxic crisis in hyperthyroid patients?

A

It can be triggered by stress, trauma, or infection.

54
Q

What is the best time for dental treatment for dialysis patients?

A

The day after hemodialysis to minimize bleeding risks.

55
Q

What precautions are needed for patients with a hemodialysis shunt?

A

Avoid BP cuffs or venipuncture on the shunt arm.

56
Q

What local hemostatic measures can be used for dialysis patients?

A

Absorbable gelatin sponge, thrombin, and oxidized cellulose.

57
Q

When should dental procedures be delayed for ESRD patients?

A

Until dialysis is initiated and the patient is medically stable.

58
Q

What antibiotics may be needed for ESRD patients with infections?

A

Broad-spectrum antibiotics for severe leukocyte suppression.

59
Q

What is the risk of NSAIDs in ESRD patients?

A

They can impair kidney function further and exacerbate acid-base imbalance.

60
Q

What should the dentist do if a patient is heparinized during dialysis?

A

Delay treatment until the heparin effects wear off (3–6 hours).

61
Q

What dental procedures should be completed before radiation therapy?

A

Extraction of hopeless teeth and management of bone pathology.

62
Q

How should fluoride therapy be provided during radiation?

A

Daily fluoride gel trays or toothpaste to prevent demineralization.

63
Q

What is the Marx protocol for osteoradionecrosis prevention?

A

20 hyperbaric oxygen sessions before and 10 after surgery in irradiated fields.

64
Q

How often should post-radiation therapy patients be recalled?

A

Every 3–6 months for caries prevention and monitoring.

65
Q

Why should prosthetics be avoided during radiation therapy?

A

To prevent irritation and mucosal ulceration in radiated tissues.

Oral surgery (5 decks)

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