Treatment Modifications

Question 1

How would you modify the treatment plan or pt education if they present with sleep apnea?

Answer 1

Possibility for xerostomia. Might be cautious using airway sedation depending on throat closure.
Educate about CPAP causing dry mouth, risk of drowsiness in daily tasks, and that it increases likelihood for high bp, heart disease, etc.

Question 2

How would you modify the treatment plan or pt education if they present with asthma?

Answer 2

Possibility for xerostomia, higher caries risk, candidal infection with increased inhaler use. Tell pt to bring inhaler to appointments.

Question 3

How would you modify the treatment plan or pt education if they present with acid reflux or GERD?

Answer 3

Possibility for acid erosion of teeth and gingival irritation. Instruct pt to keep high water intake to prevent stomach acid erosion.

Question 4

How would you modify the treatment plan or pt education if they present with increased clotting time?

Answer 4

Consult with physician, hematologist, or cardiologist if invasive procedures are required. Obtain INR if on warfarin.

Question 5

How would you modify the treatment plan or pt education if they present with type 2 diabetes? (or type 1?)

Answer 5

• Avoid periodontal or oral surgery if poor glycemic control
• Be aware of comorbidities that can complicate diabetes: Hypertension, CHF, MI, Angina, Renal Failure
• Measure blood glucose levels prior to invasive treatment
• Monitor HbA1C
• Keep candies or glucose packet in office in case of a hypoglycemic incident
• Schedule morning appointments

Question 6

How would you modify the treatment plan or pt education if they present with a history of Deep Vein Thrombosis or Pulmonary Embolus?

Answer 6

• careful physical review for swelling of extremities or trouble breathing or chest pain
• review blood thinning medications and get med consult prn if invasive procedure planned

Question 7

How would you modify the treatment plan or pt education if they present with Hypertension or consistently high BP?

Answer 7

• If above HTN threshold (130/80) then instruct them to see a physician.
• If above 180/110 mmHg then do not treat and refer them to their physician unless it is an emergency procedure handled in a dental office

Question 8

How would you modify the treatment plan or pt education if they present with liver disease such as hepatitis or cirrhosis?

Answer 8

• possible med consult for INR, CBC, hepatic functions
• benzodiazepines have longer half-life so dose lower
• tylenol should be limited to 2g/day and avoided in alcoholic hepatitis or acute liver injury
• be conscious about dosing amide LAs like lido, septo, prilo, etc.

Question 9

How would you modify the treatment plan or pt education if they are pregnant?

Answer 9

• limit radiographs to 2nd & 3rd trimesters prn
• bupivacaine can have adverse cardiovascular effects
• avoid nitrous oxide
• 2nd trimester includes weeks 13-26
• 3rd trimester includes weeks 27-birth

Question 10

What are contraindications for using Nitrous oxide?

Answer 10

• pulmonary obstructions
• having a cavity of air inside the body, such as pneumothorax, pulmonary bleb, air embolism, bowel obstruction, surgery on middle ear
• pregnancy
• mouth breather or nasal obstruction
• caution with stroke, hypotension, cardiac concerns

Question 11

Your patient has COPD. How would you modify their treatment plan?

Answer 11

• no nitrous
• no narcotics
• no smoking
• bring inhaler to all appts
• don’t use rubber dam
• reduce stress as much as possible