Periodontal Treatment Of Medically Compromised Pt Flashcards
Classification Of BP
normal (less than 120/80)
prehypertensive (120-139 and 80-89)
stage 1 (140-159 and 90-99)
stage 2 ( greater than 160 and greater than 100)
Whats the management of stage 2 HTN
Inform pt, Referrel, Monitor Bp at each appointment , If Bp is less than 180-110 than perform selective dental care (examination and non surgical endodontics and periodontics)
If Bp is greater than 180-110 Immediate medical consultaion and refferal, and perform emergency dental treatment to stop pain,infection,bleeding only
Hypertensive crises?
When BP is higher than 180-110
Treatment of HTN is much safer if——–is minimized ?
Stress
———Time of the day is preffered for the appointment of hypertensive pt?
Afternoon because Bp is higher in early morning and peak in mid morning
Consultation w physician is necessary if pt is ———
recieving HTN medication
Epinephrine containing LA rises BP so in HTN pt its ratio should not exceed
1:100000
If procedure is short (less than30 minutes ) than LA without———is given
Epinephrine, as its function is to increase the duration of action of anesthesia which is not mandatory in short procedures
Name 2 ischemic heart diseases
Angina and MI
2 Types Of Angina
1.Unstable
2.Stable
Type of angina occurs irregularly ,multiple occassion without any predisposing factor is ?
Unstable angina
Pt come with unstable angina his treatment will be?
Emergency dental treatment along with consultation with his physician
Explain Stable Angina
Associated with stress and can be managed by medication and rest
Protocols for the pt of angina
- Stress reduction by profound LA and concious sedation
2.Supplemental O2 - Ask pt to bring Nitroglycerrin
4.limit the use of Epinephrine
5.If pt become fatigue or uncomfortable or there is sudden change in heart rythm then stop the treatment
If during treatment pt has anginal attack then what protocols must be applied?
1.1 tab of 0.3-0.6 nitroglycerin
2. tighten clothes should be loosen
3. If symptoms subside then continue treatment ASAP
4. If signs and symptoms dont subsides till 5 minutes then another nitroglycerin dose is given and vital signs of pt are monitored and being ready to transport the pt to emergency department
5.Give 3rd dose of nitroglycerin after 5 minutes of 2nd dose if pain dont reduce from 3rd dose it indicates MI and pt should be transported to emergency
Dont treat pt of MI for——–months because of peak mortality rate during this time
6 months
Why CHF pts are treated in upright position rather than supine position
because of ORTHOPENIA(Inability to breath)
Whats infective endocarditis
Condition in which microbes damages endocardium or heart valves
Types of endocarditis?
1.Acute Endocarditis
2.Subacute Endocarditits
A pt is at risk of infective endocarditis what prophylactic antibiotic is given to the pt?
2g Amoxicilin 30-60 minutes before the procedure.
If Pt is allergic then Clindamycin 600mg 30-60 min before the procedure.
Defer treatment of Cardiovascular Accident (CVA) pts for ——- months and only emergency dental treatment is given because of risk of reoccurence ?
6 mts
Normal Ranges of fasting, 2hr post prandial, random, HbA1C glucose levels?
Fasting: 70-100mg
2 Hr Post prandial: 140mg
Random: 120-180mg
HbA1c 4%-6%
Periodontal therapy response is very well if HbA1c is
less than 8%
if HbA1C is >8% periodontal therapy has
poor prognosis
A undiagnosed diabetic pt with severe dental infection comes then provide ………..
Emergency dental care treatment
OHI and nonsurgical debridement of plaque and calculus until diagnosis is established.
Treatment protocol if known diabetic pt
Monitor glucose
If blood glucose is <70mg than advice 4 ounce of juice preoperatively
If pretreatment gluocose is higher and it determines the diabetic control is poor than only provide emergency treatment.
if diabetic control is very good then proceed elective periodontal surgery
After surgery check any fluctuations in sugar
Treatment of Hypoglycemic shock
1.If pt feels symptoms of hypoglycemia then blood glucose level is checked and if falls below< 60mg then provide immediately 15 gm oral carbohydrate like 4,6 ounce of juice or 3,4 teaspoon sugar , hard candy with 15gm sugar
2.If pt is unable to take orally/pt is sedated then IV 25-30ml dextrose is given which provides 12.5 to 15gm dextrose
or
1mg IV,IM,SUBCUTANEOUS glucose is given
Which pts have inadequate coagulation mention 4
1.Haemhoragic disease
2.Vitamin K deficiency
3.Long term Alcohol consumption
4.Prolonged antibiotics(as they kill flora which produce vitamin K)
5.Chronic hepatitis
Protocols for the treatment of a patient with liver disease?
Consult physician
Lab tests : PT,BT,Platelet count, and PTT, INR should be done
conservative nonsurgical periodontal therapy
For simple surgery INR should be less than 2.5
Platelet count should be more than 80%
complex surgery require INR LESS than 1.5-2
———– drug interefere with normal platelet aggregation and should be stoped during periodontal surgery for 4-7 days
ASPRIN
but pts taking low dose 325mg/day than no need to stop the drug
for how many days ASPIRIN is discontinued while planing for the periodontal surgery
4-7 days
Drugs that are metabolized by kidney or nephrotoxic drug should not be given to the pt of
renal disease
Lidocaine is not safe for the pt of renal disease T/F
F
What should be minimized in patients with pulmonary disease?
A: Stress.
When should a patient with emphysema be treated?
A: In the afternoon, several hours after sleep, to allow airway clearance.
Q: What type of medications should be avoided in pulmonary disease patients?
A: Medications that cause respiratory depression
Q: Why should bilateral mandibular block anesthesia be avoided in patients WITH PULMONARY DISEASE?
A: It can cause increased airway obstruction
Q: What should an asthma patient bring to their dental appointment?
A: Their medication and inhaler
Q: Should a patient with an active fungal or bacterial respiratory infection be treated?
A: No, unless it is an emergency periodontal procedure
Is periodontal treatment safe during pregnancy?
.
A: Yes, non-surgical periodontal therapy, such as scaling and root planing, is safe and can have positive effects on fetal health
Q: Which trimester is the safest for periodontal treatment?
A: The second trimester (14-28 weeks) is the safest because the first trimester involves fetal development, and the third trimester may cause discomfort when lying down
Q: How should a dentist position a pregnant patient during treatment?
A: The patient should be in a semi-reclined position with a slight tilt to the left to avoid supine hypotensive syndrome
Q: Are local anesthetics safe during pregnancy?
.
A: Yes, lidocaine with epinephrine is considered safe, but the lowest effective dose should be used
Q: What medications should be avoided in pregnant patients?
r.
A: Avoid tetracyclines, NSAIDs (like ibuprofen), and metronidazole in the first trimeste
