Quiz Flashcards
Most prevalent aerobic micro-organisms associated with odontogenic infections
Streptococci
An antibioma is:
A chronic inflammatory mass after prolonged antibiotic treatment alone
Organism typically associated with facial cellulitis
Group A Streptococci
What is fluctuance swelling?
Feeling of a fluid-filled balloon indicating an accumulation of pus in the underlying tissues
What is an indurated swelling?
Swelling that has the same firmness as a tightened muscle
Rate the most common to least common for odontogenic infections.
Aerobic, anaerobic, mixed
Mixed (60%) > Anaerobic (35%) > Aerobic (5%)
Osteoradionecrosis occurs most commonly at what dose and which arch?
Mandible at 65 Gy
The best restorations to restore teeth affected by caries after radiation are:
Amalgam and composites
What dose of radiation is safe to place implants after radiation therapy?
implants may be placed
> 45 Gy –> hyperbaric oxygen therapy before and after implant surgery
Should all impacted teeth be removed before irradiation?
No
What should be removed before irradiation?
- All hopeless & questionable teeth
- implants with questionable prognosis
- root fragments and other bone pathologies.
What is the optimal time between extraction of teeth and radiation?
3 weeks
Chemotherapy drug that may present with constant, deep pain that is often bilateral and frequently mimics toothache (odontalgia):
Vincristine
What are the pathological features of osteoradionecrosis?
- slow bone turnover rate
- non-vital bone within radiation beam
- resembles chronic suppurative osteomyelitis
Does risk of osteoradionecrosis diminish 10 years after radiotherapy?
No
After irradiation of the face and jaws, the underlying pathological event that leads to osteoradionecrosis is:
Endarteritis obliterans
Risk factors of osteoradionecrosis:
- exposure > 6000 cGy
- posterior mandible exposed
- poor dentition and oral hygiene
- poor nutrition
- smoking
- ill-fitting prosthesis causing
- chronic trauma
- post-RT extraction
What are the rationales for hyperbaric oxygen therapy?
- increase blood-tissue oxygen gradient
- stimulation of fibroblast proliferation, angiogenesis, collagen formation
- bactericidal & bacteriostatic
Symptoms of oral mucositis after radiation resolve typically after:
6 months
The Bosker transmandibular implant is indicated for:
A patient with a markedly resorbed mandibular ridge
When is surgery best taken if patient is on dialysis?
DAY AFTER dialysis tx (this allows the heparin to disappear, and then patient still has “fresh” blood
Which LAs in moderate amounts are least likely to harm fetus?
- Lidocaine
- Bupivacaine
Which analgesics are least likely to harm fetus?
- acetaminophen
- codeine
Which antibiotics are least likely to harm a fetus?
- penicillin
- cephalosporin
A patient with angina should be given no more than 0.04 mg of epinephrine in local anaesthetic solution over a period of:
30 minutes
List the components of antral regime.
- Broad spectrum antibiotics (amoxicillin)
- Nasal decongestant
- Antihistamine or nasal inhalations
A healthy adult has a platelet count in the range per microliter of blood):
150,000 to 400,000
Platelet function is assessed by which laboratory test?
Bleeding time
What is intermittent claudication?
Intermittent claudication arises due to vascular insufficiency, and manifests as severe pain in the calf muscles on exertion.It is typical of smokers.
What is the MOA of warfarin?
Warfarin inhibits the vitamin K-dependent synthesis of biologically active forms of the calcium-dependent clotting factors II, VII, IX and X.
Who are patients at risk of adrenal insufficiency?
Those that take > 20mg daily for at least 2 weeks in the past year prior to surgery
How do you handle adrenal insufficiency emergency situations?
- administer oxygen
- administer hydrocortisone 100 mg IV (or IM)
How to handle TIA (ie. temporary numbness of extremities, loss of vision)?
- Termination of dental treatment
- little can be done for patient other than reassurance
- referral to physician
Whereas cerebrovascular compromise from embolism develop slowly, ruptured vessel occurs quickly – ptn will have “the worst headache of their life”
- monitor vital signs
- call for medical assistance
- Oxygen is contraindicated unless respiratory difficulty occurs
- any narcotics the patient is on should be reversed
- begin cardiopulmonary resuscitation if loss of consciousness
What dose of epinephrine is given for severe anaphylaxis?
0.3 ml of 1:1,000
Late manifestations of acute adrenal insufficiency:
- vomiting
- pain in the abdomen
- mental confusion
What is the regime for patients currently taking corticosteroids?
Double the dose of steroid on the day before, the day of, and the day after surgery
What is the regime for patients who has received at least 20 mg of hydrocortisone for more than 2 weeks in the past year?
hydrocortisone 60 mg on the day before and morning of surgery, then 40 mg x 2 days, and finally 20 mg for 3 days thereafter
