Oral Medicine Flashcards
When is antibiotic prophylaxis recommended?
- Previous hx of infective endocarditis
- Prosthetic heart valve or heart valve repair w/prosthetic material
- Heart transplant w/valvular regurgitation
- Reapired congenital heart defect w/residual shunts or valvular regurgitation
- Unrepaired cyanotic heart diseases
Peds:
* completely repaired congenital heart defect w/prosthetic material–>Antibiotics for 1st 6 months after sx.
When scenarios should antibiotic prophylaxis be used?
Dental Procedures:
* Manipulation of gingival tissue or periapical region or perforation of oral mucosa
* ext, cleaning, SRP, biopsy, sutures, probing
Severely immunocompromised states:
* HIV w/CDR < 200
* AIDs related opportunistic infection
* Bone marrow or organ transplant
* Neutropenia
* Cancer chemotherapy
* Hx of H&N radiation
* RA w/prednisone>10mg/day
* SCID
* Autoimmune disease (SLE, juvenile arthritis)
Hyperglycemic states (Uncontrolled diabetes)
* Hba1c> 8%
* Random blood glucose > 200 mg/dL
HTN Categories
Stage 1: 1 medication
Stage 2: 2 meds from different drug classes
Hypertensive crisis: Hospitalization if signs of organ damage
Oral Manifestations of HTN
Dry mouth, taste changes and ulcerations related to HTN meds
Gingival Hyperplasia
ANgioedema
Gingival Bleeding
Diabetes Mellitus
Leads to High blood glucose
* body cannot produce or react to insulin
* Polydipsia (thirsty), Polyphagia (hungry), and polyuria (urinate a lot)
Diabetes Insipidus
Kidneys can’t retain water
* can’t produce or react to ADH
* Polydipsia, polyuria
Type 1 Diabetes
- Juvenile onset
- insulin dependent (Autoimmune- Kills b cells that make insulin)
- Insulin Deficiency
- Ketone Breath
- No way to prevent
- All cases require insulin injections
Type 2 Diabetes
- Adult onset
- non-insulin dependent
- Insulin Resistance
- Most cases can be prevented
- Late stage cases require insulin injections
Blood Glucose Measurement
Measures glucose conc. in a blood sample
Varies throughout the day
HbA1c measurement
Measures glycosylated hemoglobin
Stable for 3 months
* life cycle of blood cell
want under 7%
Diabetic vs Prediabetic vs Normal:
* A1c Test
* Fasting Blood sugar test
* Glucose Tolerance Test
Medications used for Type 1 diabetes
Insulin
* rapid Acting: Lispro, Aspart, Glulisine
* Short acting: Human insulin
* Intermediate acting: NPH
* Long-acting: Determir, glargine
Medications used for Type 2 Diabetes
Sulfonylurea: 30 mins b4 meals
Biguanide: Taken w/ meals
DP4 inhibitor: -liptan
Thiazolidinedione: -litazone
SGLT3 inhibitor: Liflozin
Hypoglycemia
COLD AND CLAMMY NEED SOME CANDY
TIRED:
* Tachycardia
* Irritability
* Restlessness
* Excessive Hunger
* Diaphoresis (Sweating)
Blood sugar < 70 mg/dL
Hyperglycemia
HOT AND DRY SUGAR HIGH
SINFUL:
* Sweet breath (ketone breath)
* Increased Thirst
* Nausea & Vomitting
* Frequent
* Urination (Polyuria)
* Loss of clear vision
Fasting Blood sugar >/= 126 or
Post-prandial >/= 200
Can lead to life threatening complications:
* Diabetic ketoacidosis
* Hyperosmolar hyperglycemic state
Patient with diabetes is undergoing general anesthesia. what do you do?
Severe diabetes should not if possible
Well controlled can but recommend:
* Fasting at midnight
* use only 1/2 insulin dose
ASA Classification
CPR Checklist
5 A’s
1. Appraise scene safety
2. Assess responsiveness
3. Alert for Help
4. Assess Breathing & Pulse
5. Activate EMS
CPR Compressions
30
* lower half of sternum b/w nipples
* 2 inches
* 100-120 compression per min
CPR Airway
Head tilt-chin lift
* if trauma=jaw thrust
CPR: Breathing
2 breaths
AED
Automated External Defibrillator
* Stop an abnorally beating heart
* attach pads to UR & LL of chest
* over 8 y.o=adult pads
Witnessed Cardiac arrest: Use AED ON ARRIVAL
Unwitnessed Cardiac arrest: Use AED after 5 cycles/2 mins of CPR
* Cardiac arrest=no pulse + Abnormal breathing
Cardiac Arrest + Respiratory Arrest
Respiratory arrest:
* pulse
* Abnormal breathing
Cardiac Arrest:
* no pulse
* Abnormal breathing
Child/Infant CPR:
Pulse:
* Child/Adult=Carotid
* Baby=Brachial
Start CPR immediately if unwitnessed collapse
Small children: 1 hand
Infant: 2 fingers
compress: 1/3 depth of chest
15 compressions for every 2 breaths if 2 rescuers
Rescue Breating
Do if–>Pulse + Abnormal breathing (Respiratory arrest)
K I D: 1 breath every 3 seconds
A D U L T: 1 breath every 5 seconds
Choking/Foreign Body Obstruction
IF CONSCIOUS:
Encourage coughing
* Can’t cough, but conscious=abdominal thrusts- b/w xiphoid process & navel
* Infants: 5 back slaps then 5 chest thrusts
IF UNCONSCOUS:
* Check mouth before breaths
* CPR
How long can the brain survive w/o oxygen?
6 mins
Nitrous Oxide: Indications vs Contraindications
Indications:
* Dental ANxiety
* Gag Reflex
* Asthma
Contraindications:
* COPD
* Nasal Obstruction
* Multiple Sclerosis
* Pregnant (1st trimester especially)
* Otitis Media
* Sickle Cell Disease
Supplemental Oxygen: Indications vs Contraindications
Indications:
* COPD
* Asthma
Contraindications:
* Bleomycin
* Paraquat poisoning (toxic herbicide)
Steroids:
- Derived from Cholesterol
- Glucocorticoids=cortisol
Cushing Syndrome
HIGH CORTISOL levels
Endogenous: Due to benign tumor
* Primary: Increased cortisol at adrenal cortex
* Secondary: Increased ACTH at anterior pituitary
* Tertiary: Increased CRH at hypothalamus
Exogenous: Due to taking too many glucocorticoids
* Rule of 2s: 20 mgs of exogenous cortisol + for 2 weeks + within last 2 years==>Suspect: suprresion of adrenal cortex & Possible Crisis
* 20 mg hyrocoritsone=5 mg prednisone=0.75 dexamethasone
Symptoms:
* Moon facies: round, red, and fulll f ace
* Bufallo hump: fat b/w shoulders
Addison’s Disease
Low CORTISOL Levels
Endogenous: due to immune-mediated tissue destruction
* Primary: Decrease cortisol at adrenal cortex
* Secondary: Decreased ACTH at anterior pituitary
* Tertiary: Decreased CRG at hypothalamus
SYmptoms:
* Hyperpigmentation: Bronzing, brown macules on lips/mucosa
Addisonian Crisis
Aka Acute Adrenal Insufficiency/Adreanl Crisis
Corticosteroids are critcally Low
stress leads to Hypovolemic shock (Severe fluid loss=heart unable to pump blood)
Activate EMS
* Apply ice packs
* monitor vital signs
* * Start IV Saline (to help w/hypovoemia)
* GIVE IV HYDROCORTISONE
Bisphosphonates
Prevent bone resorption by Osteoclasts apoptosis
* increase bone density
* slows tooth movement
* impairs bone healing
* may lead to osteonecrosis
Bisphosphonates are used in what conditions?
- Osteoporosis
- Pagets disease
- Multiple myeloma
- Metastatic bone lesions of various cancers
Bisphosphonate Medications
-Dronate
Medication-Related Osteonecrosis of the Jaws (MRONJ)
Medication: Bisphosphonate, denosumab
Osteonecrosis: Dead bone
Posterior Mandible
What gives you a higher risk and severity for MRONJ?
Higher Dose
more frequent administration
Longer duration
IV administartion
Diagnosis criteria for MRONJ
Current or previous tx w/a medication
Exposed bone>8 weeks
No hx of radiation therapy to the jaws (ORNJ)
What are the phases of Hemostasis
- Vascular
- Platelet=primary hemostasis
- Coagulation=Secondary Hemostasis
- Fibrinolytic (plasmin cuts fibrin mesh and dissolves clot)
Platelet Disorders
Von Willebrand Diseases
Thrombocytopenia
COPD: Patient Considerations
COPD Medications
Asthma: Patient Considerations
Asthma Medications
MRONJ: Patient Considerations
* Risk of MRONJ
* Active infection
d
Antiplatelet Medications
Aspirin
Clopidorel
Abciximab
Anticoagulants
Substance Abuse
Recurrent use of a substance over the past 12 months w/subsequent adverse consequences
*Disrupts dopamine circuits in the brain
Dependence
uncontrollable need for a substance despite adverse consequences
Tolerance
Need for increased amount of a substance to get desired effect
