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BDS3 - Special Care Dentistry > PBL 1 - cardiology > Flashcards

PBL 1 - cardiology Flashcards

1
Q

what is Marfan’s syndrome

A
  • disorder of the body’s connective tissue, a group of tissues that support the structure of the body and support internal organs and other tissues
  • gene defect which leads to abnormal production of a protein called fibrillar
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2
Q

what are some typical characteristics of Marfan’s syndrome

A
  • being tall
  • abnormally ling and slender limbs, fingers and toes
  • heart defects
  • lens dislocation = vision impaired
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3
Q

what can happen to the heart in Marfan’s syndrome

A
  • walls of the aorta are weakened
  • can cause aorta to enlarge and possibly rupture
  • can cause mitral or tricuspid valves to not close properly causing blood to leak back through the valve
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4
Q

what medication are those with Marfan’s syndrome given

A
  • beta blockers
  • used to treat hypertension
  • but most people with this condition have hypotension
  • in this case, beta blockers help slow down the heart rate and decrease the strength of heartbeat, which in turn helps slow down enlargement of the aorta
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5
Q

what medication does those with Marfan’s syndomre take

A
  • bisoprolol
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6
Q

what are the dental considerations for patients with Marfan’s syndrome

A
  • risk of infective endocarditis = antibiotic prophylaxis ?

- interactions of bisoprolol

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7
Q

what are some of the interactions of bisoprolol

A
  • with adrenaline = increase risk of hypertension and bradycardia
  • with alcohol = increase risk of hypotension
  • with lidocaine = predicted to increase risk of CV adverse effects
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8
Q

what are contra-indications for bisoprolol

A
  • asthma
  • bronchospasm
  • COPD
  • heart failure
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9
Q

what are some side effects of bisoprolol

A
  • constipation, bradycardia, depression, confusion, HF, fatigue, vomiting
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10
Q

what is infective endocarditis

A

an infection of the inner lining of the heart (endocardium)

- can occur in those with a congenital heart disease, or a prosthetic valve

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11
Q

what pathogen is commonly seen causing IE

A
  • streptococci viridans

- or staph aureus

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12
Q

what might you have to do for patients with a risk of IE

A
  • antibiotic prophylaxis
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13
Q

when is AB prophylaxis recommended

A
  • it is not routinely recommended for people undergoing dental procedures
  • only a sub-group of those at increased risk
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14
Q

which patients will receive AB prophylaxis

A
  • prosthetic valve
  • previous IE
  • congenital heart disease
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15
Q

what procedures would AB prophylaxis be needed

A
  • only invasive procedures
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16
Q

what are some invasive procedures

A
  • matrix bands, subgingival dam and clamps
  • sub gingival restorations
  • endo before apical stop has been established
  • PMC
  • full perio exam
  • RSD/subgingival scaling
  • incision/drainage of an abscess
  • extractions
17
Q

how is AB prophylaxis given

A
  • give patient AB at appointment prior to procedure

- AB needs to be taken 60 mins before procedure = patient comes into surgery and you monitor them

18
Q

what are the two drugs given for AB prophylaxis

A
  • amoxicillin

- clindamycin = only used if allergic to penicillin

19
Q

how much amoxicillin is given for AB prophylaxis

A
  • 3g 60 mins prior to procedure

- 1 sachet

20
Q

how much clindamycin is given for AB prophylaxis

A
  • 600mg 60 minutes prior to procedure

- 2 tablets

21
Q

what are the risks of AB prophylaxis

A
  • hypersensitivity
  • associated with rise in clostridium difficile associated diseases
  • AB associated colitis can be fatal
  • AB resistance is increasing
22
Q

what must you do if a patient who needs AB prophylaxis has had a course of AB’s in the past 6 weeks

A
  • give a drug from a different AB class for prophylaxis
23
Q

what are the 2 types of congenital heart disease

A
  • cyanotic and acyanotic
24
Q

what is aortic valve disease

A
  • valve between left ventricle and aorta is not working

- can be congenital or acquired

25
Q

what does the term dental fit mean

A
  • no active disease = caries, endo, perio

- want to reduce the bacteraemia

26
Q

what are the patients at increased risk of IE who would not routinely get AB prophylaxis

A
  • acquired valvular heart disease with stenosis or regurgitation
  • hypertrophic cardiomyopathy
  • previous IE
  • structural congenital heart disease, including surgically corrected or palliated structural conditions
  • valve replacement
27
Q

what does a BPE of 2 indicate

A
  • pockets <3.5mm
  • supra/sub gingival plaque or calculus
  • black band entirely visible
28
Q

what is the treatment for BPE 2

A
  • OHI

- removal of plaque retentive factors including all sub and supra gingival calculus

29
Q

what does BPE 3 indicate

A
  • probing depth 3.5-5.5mm

- black band partially visible

30
Q

what is the treatment fir BPE 3

A
  • initial therapy including self-care advice (OHI)
  • 6PPC in sextants that scored a 3
  • radiographs should be taken for those sextants to look at bone levels
  • OHI, removal of plaque retentive factors and RSD if required
31
Q

what is dental anxiety

A
  • a sense of apprehension that something dreadful is going to happen in relation to dental treatment, coupled with a sense of losing control
32
Q

what can you do to help patient with dental anxiety

A
  • ask what specifically they are scared of
  • agree on a signal for them to use if they want to stop during treatment
  • assess anxiety with MDAS scale
  • liaise with GP about giving sedation
33
Q

what are the 3 most common types of sedation

A
  • inhalation sedation = nitrous oxide
  • intravenous
  • oral sedation

BDS3 - Special Care Dentistry (19 decks)

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