Test 3 Flashcards by Laura V

You are providing dental hygiene care for a 65-year-old client with a history of
hypothyroidism and hypertension. The client has moderate supra-gingival and sub-
gingival calculus, wears a partial denture, and has only 10 remaining teeth. Additionally,
they report temporomandibular joint (TMJ) pain. Their blood pressure is well-controlled
with medication.

What should be considered when scheduling this client for treatment?

Morning appointments may be preferable due to potential fatigue from
hypothyroidism

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Which precaution should be taken when administering local anaesthesia to this client?

Avoid using vasoconstrictors like epinephrine due to hypertension risk

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Why is it important to monitor blood pressure during dental hygiene treatment?

Hypertension increases the risk of complications like stroke during treatment

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Which of the following medications is most likely to be prescribed for this client’s hypothyroidism?

Levothyroxine

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Ms. Sarah Thompson, a 58-year-old female, comes in for a routine dental hygiene
appointment. She reports a medical history of hypertension (high blood pressure) and
hypothyroidism. Ms. Thompson takes medications to manage both conditions: a daily
dose of Lisinopril (an ACE inhibitor) for her hypertension and Levothyroxine (a synthetic
thyroid hormone) for her hypothyroidism. She mentions that she has recently felt more
tired than usual but has not noticed any other changes in her health. During the
appointment, you take her blood pressure and note a reading of 145/90 mmHg. Ms.
Thompson has been brushing her teeth twice a day but struggles with flossing regularly
due to difficulty with manual dexterity. She has no significant history of dental caries but
does experience occasional dry mouth.

What is the most likely oral side effect of Lisinopril (the medication prescribed for Ms. Thompson’s hyperstension)?

Xerostomia

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Given Ms. Thompson’s medical history and current medications, what is the most important dental hygiene advice to provide?

Advise drinking plenty of water and using saliva substitutes to manage dry mouth

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Given Ms. Thompson’s blood pressure reading of 145/90mmHg, which of the following is the most appropriate next step in her dental hygiene care?

Refer Ms. Thompson to her physician to reassess her blood pressure and ensure it is under control before proceeding with treatment.

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Dorris a 71-year-old female with osteoporosis arrives at your clinic for a regular dental hygiene appt.
Her chief complaint is that she is long in the tooth and has multiple ulcers in her mouth making brushing
difficult. She states her only flossing method is using toothpicks when food is stuck between her teeth.
Upon EO/IO exam you note multiple interproximal traumatic ulcers and severe generalized gingival
recession, with abundant generalized nicotine staining. The ct admits that they have been a pack a day
smoker for over 20 years.

What other IO finding would you expect to see in this patient?

Nicotine Stomatitis

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What is the primary risk factor for the severe generalized gingival recession and alveolar bone loss observed in this patient?

Chronic smoking and osteoporosis

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Which of the following oral hygiene modifications would be most beneficial for this patient?

Recommend a non-abraisive fluoride toothpaste, soft-bristled brush, and soft-bristled interdental aid

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Mrs. Dorris Day is a 71-year-old retired grade schoolteacher who comes in for a routine dental exam.
She has been a smoker for 20 years, smoking about one pack a day. Mrs. Day is currently taking
bisphosphonates and supplements to manage her condition. While her condition is manageable, she has
experienced a couple of fractures in the past. She reports experiencing general tooth sensitivity and
mentions that she brushes her teeth 3-4 times a day to maintain oral hygiene. During the exam, Mrs.
Day complains of discomfort in her jaw, which seems to be worse when chewing or when she opens or
closes her mouth.

What medical condition as evidienced by her medications is Mrs. Dorris Day experiencing?

Osteoporosis

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Given Mrs. Day’s medication history with osteoporosis and bisphosphonate use, what is an important consideration for her dental care?

Higher risk of osteonecrosis of the jaw

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What is a likely cause of the discomfort Ms. Day is experiencing in her jaw, especially when chewing or opening/closing her mouth?

TMD

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Your 23 year old client comes in for a routine dental cleaning. After an extraoral / intraoral
examination your client presents with moderate erosion of the maxillary lingual anteriors,
angular cheilitis, a red and bleeding throat, xerostomia, and green staining of the teeth.

What condition may you suspect with these findings?

Bulimia

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Once you have suspected bulimia, how would youe approach the conversation with your client to confirm this?

Document the findings in your record, inform the client of the findings an suggest what these findings may indicate in an empathetic manner

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What OHI recommendations would you make?

At home fluoride trays/treatments

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Your client tells you they regularly use cannabis products. They
present with xerostomia, bloodshot eyes, and seem lethargic.

What should you do as their care provider?

As when they last smoked cannabis and postpone treatment if it was within a 12 hour period.

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You have a DD3 client coming in for quad scaling. They
requested LA to help with the sensitivity as it has been 10+
years since their last cleaning at your office. You administer
Lidocaine 2% 1:50,000. You then remember to look at their
medical history which states the client has anxiety, uses
cannabis, and is on a tricyclic antidepressant.

Which of the
following are contraindications to vasoconstrictor use?
a. Cannabis
b. Tricyclic antidepressants
C. Anxiety
D. A & B

A and B

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Which local anesthetic would you choose for a client who
regularly uses cannabis products and is on tricyclic
antidepressants?

Mepivacaine 2%

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After administering LA with a vasoconstrictor, you take your
client’s vital signs. Their blood pressure is twice as high as it was
at the beginning of the appointment. The BP reading is 210/110
mmHg. What should you do?

Call 911 as this is a medical emergency

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Mr. James Carter, a 45-year-old male, presents for a routine dental hygiene appointment. He
has a 10-year history of Crohn’s disease and is currently taking azathioprine and prednisone.
He reports experiencing occasional mouth ulcers and a persistent dry mouth. Mr. Carter also
mentions frequent fatigue and abdominal pain, which sometimes interfere with his daily oral
hygiene routine.

Which oral manifestation is most commonly associated with Crohn’s disease?

Aphthous ulcers

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Given Mr. Carter’s medical history, what is the most appropriate dental hygiene recommendation?

Encourage the use of soft-bristled toothbrushes and mild, non-irritating toothpaste

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What percautions should be taken when performing an invasive dental procedure on Mr. Carter?

Assess immune status and consult his physician regarding steroid management

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Ms. Emily Dawson, a 38-year-old female, arrives for her dental hygiene visit. She has been
living with Crohn’s disease for 12 years and is currently in remission. Ms. Dawson reports
experiencing occasional dry mouth and mild gum bleeding but denies any pain. Her medical
history includes long-term corticosteroid use. Clinical examination reveals mild gingival
inflammation and a few small oral ulcers.

What potential oral complication could arise from Ms. Dawson’s long-term corticosteroid use?

Increased risk of oral candidiasis

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Ms. Emily Dawson, a 38-year-old female, arrives for her dental hygiene visit. She has been living with Crohn’s disease for 12 years and is currently in remission. Ms. Dawson reports experiencing occasional dry mouth and mild gum bleeding but denies any pain. Her medical history includes long-term corticosteroid use. Clinical examination reveals mild gingival inflammation and a few small oral ulcers. given Ms. Dawson's condition, what is the most appropriate chair positioning for her during treatment?

Semi-supine position to prevent acid reflux symptoms

Ms. Emily Dawson, a 38-year-old female, arrives for her dental hygiene visit. She has been living with Crohn’s disease for 12 years and is currently in remission. Ms. Dawson reports experiencing occasional dry mouth and mild gum bleeding but denies any pain. Her medical history includes long-term corticosteroid use. Clinical examination reveals mild gingival inflammation and a few small oral ulcers. Ms. Dawson expresses concerns abut her occasional gum bleeding, what is the best recommendation?

Encourage gentle but consistent oral hygiene with a soft-bristled toothbrush and floss

Ms. Emily Dawson, a 38-year-old female, arrives for her dental hygiene visit. She has been living with Crohn’s disease for 12 years and is currently in remission. Ms. Dawson reports experiencing occasional dry mouth and mild gum bleeding but denies any pain. Her medical history includes long-term corticosteroid use. Clinical examination reveals mild gingival inflammation and a few small oral ulcers. If Ms. Dawson requires a scaling and root planing procedure, what is the best approach to minimize complications?

Schedule short, frequent visits to reduce strain on her immune system

A 35-year-old female patient with a recent diagnosis of systemic lupus erythematosus (SLE) comes into your dental office for a routine cleaning. She is currently on a medication regimen that includes corticosteroids and immunosuppressive drugs. She reports having occasional dry mouth and oral ulcers. The patient is experiencing some fatigue and joint pain but feels comfortable for her appointment. She has requested a morning appointment due to her energy levels. You plan to perform gentle scaling and polishing, fluoride treatment, and provide some oral care recommendations. What is the most appropriate chair positioning for this patient during the appointment?

Supine position with frequent breaks

A 35-year-old female patient with a recent diagnosis of systemic lupus erythematosus (SLE) comes into your dental office for a routine cleaning. She is currently on a medication regimen that includes corticosteroids and immunosuppressive drugs. She reports having occasional dry mouth and oral ulcers. The patient is experiencing some fatigue and joint pain but feels comfortable for her appointment. She has requested a morning appointment due to her energy levels. You plan to perform gentle scaling and polishing, fluoride treatment, and provide some oral care recommendations. What treatment modification would be most appropriate for this patient, considering her dry mouth and lupus diagnosis?

Provide a non-alcohol mouth rinse like Biotene and fluoride treatment

A 35-year-old female patient with a recent diagnosis of systemic lupus erythematosus (SLE) comes into your dental office for a routine cleaning. She is currently on a medication regimen that includes corticosteroids and immunosuppressive drugs. She reports having occasional dry mouth and oral ulcers. The patient is experiencing some fatigue and joint pain but feels comfortable for her appointment. She has requested a morning appointment due to her energy levels. You plan to perform gentle scaling and polishing, fluoride treatment, and provide some oral care recommendations. Given this patient's medical history and current medications, what is the most appropriate local anaesthetic choice for this dental procedure?

Lidocaine with minimal epi

A 42-year-old male patient with a diagnosis of systemic lupus erythematosus (SLE) presents to your dental office for a routine dental cleaning. The patient is currently on the following medications: ● Prednisone (for inflammation management) ● Methotrexate (an immunosuppressant) ● Hydroxychloroquine (for controlling lupus symptoms) ● Ibuprofen (for pain management) He is experiencing mild oral lesions, but his condition is generally stable, and he reports no recent flare-ups. However, the patient also mentions that he is feeling slightly fatigued. He is due for a dental cleaning and seeks advice on proceeding with his treatment. Given the patient's current medication regimen, is medical clearance from his physician required before proceeding with the dental treatment?

Yes, medical clearance is required due to the use of immunosuppressive therapy and corticosteroids

A 42-year-old male patient with a diagnosis of systemic lupus erythematosus (SLE) presents to your dental office for a routine dental cleaning. The patient is currently on the following medications: ● Prednisone (for inflammation management) ● Methotrexate (an immunosuppressant) ● Hydroxychloroquine (for controlling lupus symptoms) ● Ibuprofen (for pain management) He is experiencing mild oral lesions, but his condition is generally stable, and he reports no recent flare-ups. However, the patient also mentions that he is feeling slightly fatigued. He is due for a dental cleaning and seeks advice on proceeding with his treatment. Should the dental treatment be postponed based on the patient's current medical condition and medication regimen?

Yes, treatment should be postponed due to the presence of oral lesion and the potential for disease flare-ups

A 42-year-old male patient with a diagnosis of systemic lupus erythematosus (SLE) presents to your dental office for a routine dental cleaning. The patient is currently on the following medications: ● Prednisone (for inflammation management) ● Methotrexate (an immunosuppressant) ● Hydroxychloroquine (for controlling lupus symptoms) ● Ibuprofen (for pain management) He is experiencing mild oral lesions, but his condition is generally stable, and he reports no recent flare-ups. However, the patient also mentions that he is feeling slightly fatigued. He is due for a dental cleaning and seeks advice on proceeding with his treatment. Which of the following medications is commonly used by lupus patients to control disease symptoms, including joint pain and inflammation?

Hydroxychloroquine

You are providing dental hygiene care for a 49-year-old woman who weighs 50 kg with a history of infective endocarditis (IE) because of prosthetic material used for cardiac valve repair. The condition with appropriate antibiotic therapy is under control. She is allergic to amoxicillin. The client has gum bleeding, oral mucosa soreness, and discomfort while brushing. She has mild gingivitis and moderate plaque buildup under and above the gumline. What kind of antibiotic prophylaxis will be used for the client?

500mg azithromycin

You are providing dental hygiene care for a 49-year-old woman who weighs 50 kg with a history of infective endocarditis (IE) because of prosthetic material used for cardiac valve repair. The condition with appropriate antibiotic therapy is under control. She is allergic to amoxicillin. The client has gum bleeding, oral mucosa soreness, and discomfort while brushing. She has mild gingivitis and moderate plaque buildup under and above the gumline. What is the recomended timing for administrating antibiotic prophylaxis before a dental procedure for this client?

30-60 minutes before the procedure

Emphasizing meticulous self-oral hygiene including toothbrushing and interdental aids

John Miller, a 70-year-old male, presents for a routine dental cleaning at the dental hygiene clinic. He has a medical history of atrial fibrillation (AFib) and is currently taking warfarin to manage his condition. John mentions that he has noticed some gum bleeding, particularly after brushing, and that his gums feel tender. He is concerned about how his heart condition and medication might affect his dental health. During the dental exam, generalized gingival bleeding is observed, along with some gingival inflammation. John also has dry mouth and occasional altered taste. Given his history of AFib and anticoagulant use, the dental hygienist needs to approach his treatment with caution, particularly regarding bleeding control. What is the most important consideration before performing any invasive dental procedure on John, given his use of warfarin?

Confirming that his INR levels are within a safe range to minimize bleeding risks

John Miller, a 70-year-old male, presents for a routine dental cleaning at the dental hygiene clinic. He has a medical history of atrial fibrillation (AFib) and is currently taking warfarin to manage his condition. John mentions that he has noticed some gum bleeding, particularly after brushing, and that his gums feel tender. He is concerned about how his heart condition and medication might affect his dental health. During the dental exam, generalized gingival bleeding is observed, along with some gingival inflammation. John also has dry mouth and occasional altered taste. Given his history of AFib and anticoagulant use, the dental hygienist needs to approach his treatment with caution, particularly regarding bleeding control. Why is John at an increased risk of bleeding during dental procedures due to his anticoagulant medication?

Warfarin inhibit's the blood's ability to clot, which can lead to prolonged bleeding after procedures

Sally Thompson, a 65-year-old woman, presents for her routine dental check-up and scaling at the clinic. She has been diagnosed with atrial fibrillation (AFib) and is currently on anticoagulant therapy with dabigatran (Pradaxa). Sally has been noticing increased gum sensitivity and bleeding, especially when brushing or flossing, and is worried about her oral health. She also reports that she has had difficulty with dry mouth and occasional gum swelling. During the exam, it is noted that Sally has generalized gingival inflammation and a moderate amount of plaque buildup. Given her medication and heart condition, careful attention must be paid to her bleeding tendency and overall oral health management What dental approach should be taking when treating Sally, given her anticoagulant use?

Start with non-invasive procedures and assess bleeding response before proceeding to more

Sally Thompson, a 65-year-old woman, presents for her routine dental check-up and scaling at the clinic. She has been diagnosed with atrial fibrillation (AFib) and is currently on anticoagulant therapy with dabigatran (Pradaxa). Sally has been noticing increased gum sensitivity and bleeding, especially when brushing or flossing, and is worried about her oral health. She also reports that she has had difficulty with dry mouth and occasional gum swelling. During the exam, it is noted that Sally has generalized gingival inflammation and a moderate amount of plaque buildup. Given her medication and heart condition, careful attention must be paid to her bleeding tendency and overall oral health management. What is the reason that antibiotic prophylaxis is not required for Sally before dental procedures depsite her AFib?

Antibiotic prophylaxsis is only recommended for patients with a history of endocarditits, not for AFib patients

Your 55-year-old client presents for a routine dental check-up. They have a medical history that includes chronic kidney disease (Stage 2) and are on immunosuppressive therapy following a kidney transplant. Upon examination, you notice gingival overgrowth, xerostomia, and an increased risk of bleeding. What is the most appropriate course of action to begin?

Request medical clearance due to the immunosuppressive therapy

Your 60-year-old client, who has a history of chronic kidney disease and uses a CPAP machine for sleep apnea, complains of bad taste in their mouth and swelling in the gum area. Upon examination, you notice signs of gingival overgrowth. What should you do to ensure the best treatment for this client?

Schedule the next appointment in the morning after the client's CPAP use

A 60-year-old client with chronic kidney disease (Stage 2) and a kidney transplant complains of dry mouth, difficulty swallowing, and an increased risk of oral infections. What is the most appropriate management plan for this client?

Recommend a daily oral hygiene regimen with fluoride toothpaste and saliva substitutes

: A 60-year-old female client with a known allergy to sulfites is scheduled for a routine dental cleaning. You are planning to use a local anesthetic containing epinephrine. What is the most important consideration when preparing for this treatment?

Ensure the local anaesthetic is free from sulfites to prevent an allergic reaction

John Doe, a 55-year-old male, arrives at the dental clinic for his routine check-up. He has a pacemaker and a history of COPD. He is taking Amlodipine (CCB) and Flovent (inhaled corticosteroids), besides other medications. John has been experiencing generalized sensitivity in his teeth, dry mouth, and swollen, bleeding gums. He usually does not floss and brushes 3-4 times a week. He prefers to eat sweet foods and drinks as he is experiencing a burning sensation in his mouth. Do we need medical clearance for COPD?

Not if controlled, yes if uncontrolled

Amlodipine (CCB)

Artificial saliva or supplements

Timmy France, a 58-year-old male, visits a new dental office; his medical history states that he has COPD and has a pacemaker. His medical history also indicates he is on inhaled corticosteroids and bronchodilators for his COPD. Upon his dental history, he states he experiences dry mouth; gums bleed when he brushes, and sensitivities to cold. Which oral side effect is most commonly associated with corticosteroid use?

Oral candidiasis

Timmy France, a 58-year-old male, visits a new dental office; his medical history states that he has COPD and has a pacemaker. His medical history also indicates he is on inhaled corticosteroids and bronchodilators for his COPD. Upon his dental history, he states he experiences dry mouth; gums bleed when he brushes, and sensitivities to cold. Timmy mentions that his pacemaker was placed about 3 weeks ago. What consideration should the RDH take before proceeding with treatment?

Get medical clearance to ensure the pacemaker is stable and operating as intended

Timmy France, a 58-year-old male, visits a new dental office; his medical history states that he has COPD and has a pacemaker. His medical history also indicates he is on inhaled corticosteroids and bronchodilators for his COPD. Upon his dental history, he states he experiences dry mouth; gums bleed when he brushes, and sensitivities to cold. What considerations should the RDH prioritize throughout Timmy's dental treatment?

Short appointments and semi-supine position

You have a new patient exam with Emily (44) and are reviewing med hx. Emily states she had a stroke a year and a half ago but had regained almost all function, aside from occasional R arm weakness.When reviewing her medications, Emily states she takes ramipril and a direct oral anti-coagulant called Dabigatran. Emily tells you she is happy she is not onWarfarin because she does not need to have regular blood tests monitored for an INR like her family member who also had a stroke. Is medical clearance required?

Yes

You have a re-care patient exam with Louise (70) who stated no changes to their medical hx. During conversation, Louise reveals she had a TIA a few weeks prior. She did not think the TIA was relevant to her med hx for dental tx because the symptoms barely lasted 10 minutes. Is medical clearance required?

Yes

A 28-year-old female presents for a routine dental hygiene visit. She reports that she noticed “something” on her lips, it appears finger-like, pointed and 1cm in length. What is an important consideration before performing dental treatment on this client?

Reschedule treatment due to active infectious disease being present

A 28-year-old female presents for a routine dental hygiene visit. She reports that she noticed “something” on her lips, it appears finger-like, pointed and 1cm in length. What does the client present with on her lips?

Filiform warts

A 28-year-old female presents for a routine dental hygiene visit. She reports that she noticed “something” on her lips, it appears finger-like, pointed and 1cm in length. What is an effective OHI that can be provided to the client given her condition?

Oral cancer screening

A 25-year-old female presents for a dental hygiene examination. She reports a white, wart-like lesion on the buccal mucosa. She has a history of HPV infection and takes Imiquimod for treatment. Clinical examination reveals multiple small, cauliflower-like growths on the oral mucosa. What should be considered when treating this client?

Maintain strict infection control and educate the patient on HPV transmission, obtain medical clearance if lesion is active and not treated

Verruca vulgaris

Imiquimod

A 30-year-old male presents for a dental hygiene visit with a history of HPV. He reports a painless growth on his tongue that has been slowly enlarging over the past few months. Clinical examination reveals he has a squamous papilloma on the palate. His medical history is unremarkable aside from a prior diagnosis of HPV-related genital warts. What should be considered when planning this client's dental treatment?

Educate on the importance of oral hygiene and regular oral cancer screenings

A 30-year-old male presents for a dental hygiene visit with a history of HPV. He reports a painless growth on his tongue that has been slowly enlarging over the past few months. Clinical examination reveals he has a squamous papilloma on the palate. His medical history is unremarkable aside from a prior diagnosis of HPV-related genital warts. Which of the following best describes the appearance of an HPV-related oral lesion?

A solitary or multiple exophytic, cauliflower-like growth

A 30-year-old male presents for a dental hygiene visit with a history of HPV. He reports a painless growth on his tongue that has been slowly enlarging over the past few months. Clinical examination reveals he has a squamous papilloma on the palate. His medical history is unremarkable aside from a prior diagnosis of HPV-related genital warts. Following the CDHO guidelines, can the dental hygienist proceed with care?

No. The presence of an HPB-related lesion automaticaly contraindicates dental treatment

Eleanor Mills is a 65-year-old retired librarian who arrives at the dental hygiene clinic for her routine care. She reports bleeding gums, dry mouth, and difficulty keeping her mouth open during long appointments. Eleanor was diagnosed with rheumatoid arthritis 12 years ago and takes Methotrexate weekly. She lives independently but admits that morning stiffness in her hands often interferes with her ability to brush and floss effectively. Upon assessment, you find Eleanor to have Stage II, Grade B Periodontitis. Whic factor most likely contributes to Eleanor's periodontal condition? A. Poor nutrition B. Methotrexate use alone C. Infrequent dental visits D. Systemic inflammation and limited dexterity from RA

Systemic inflammation and limited dexterity from RA

Eleanor Mills is a 65-year-old retired librarian who arrives at the dental hygiene clinic for her routine care. She reports bleeding gums, dry mouth, and difficulty keeping her mouth open during long appointments. Eleanor was diagnosed with rheumatoid arthritis 12 years ago and takes Methotrexate weekly. She lives independently but admits that morning stiffness in her hands often interferes with her ability to brush and floss effectively. Upon assessment, you find Eleanor to have Stage II, Grade B Periodontitis. What appointment modification does Eleanor require for comfort?

Short, quadrant-based appointments in a semi-supine position

Eleanor Mills is a 65-year-old retired librarian who arrives at the dental hygiene clinic for her routine care. She reports bleeding gums, dry mouth, and difficulty keeping her mouth open during long appointments. Eleanor was diagnosed with rheumatoid arthritis 12 years ago and takes Methotrexate weekly. She lives independently but admits that morning stiffness in her hands often interferes with her ability to brush and floss effectively. Upon assessment, you find Eleanor to have Stage II, Grade B Periodontitis. To help with Eleanor's dry mouth, what would you recommend?

Increase water intake