W10/11 Medically Compromised

Question 1

Name (4) Endocrine condition

Answer 1

1. Diabetes 2. Thyroid disorders 3. Adrenal disorders 4. Bisphosphonate treated and calcium disorders

Question 2

Define diabetes

Answer 2

A group of disorder characterized by elevated levels of glucose in the blood. Cause by bodies failure to either produce the hormone insulin, or use the insulin

Question 3

Define Type 1 diabetes

Answer 3

Starts in younger persons, children adolescent. Management: insulin

Question 4

Define Type 2 diabetes

Answer 4

Life style factor related. Management: insulin

Question 5

What is the normal contorl range blood glucose levels? Is it okay to proceed with tx?

Answer 5

Normal 3.5mmo/L - 80mmol/L Reasonable, yes.

Question 6

What is the fair control range blood glucose levels? Is it okay to proceed with tx?

Answer 6

8.1%-11.9% Reasonable, yes.

Question 7

What is the poor control range blood glucose levels? Is it okay to proceed with tx?

Answer 7

>12.0% Practitioner may wish to refer tx

Question 8

In what range should you administer glucose and treat as medical emergency?

Answer 8

3.5mmol/L hypoglycemia.

Question 9

If a pt presents with oral infection and is confused what medical condition may be presenting?

Answer 9

Diabetic Ketoacidosis

Question 10

What are the Oral manifestations of diabetes?

Answer 10

1. Periodontal disease 2. Dental caries 3. Increased susceptibility to oral infections - Candidiasis infections - Lichen planus & recurrent aphthous stomatitis

Question 11

What are (5) ways to manage a diabetic pt?

Answer 11

1. Adhere to management of monitoring blood glucose levels. 2. Short apps 3. Stress free 4. Earlier apps 5. After breakfast/lunch

Question 12

What is the LA management of a diabetic pt?

Answer 12

If poorly controlled: LA with vasoconstrictor for profound anaesthesia if required. (Dose reduction) Avoid excessive amounts of adrenaline. Importance of OHI behaviors, maintenance.

Question 13

What hormone does the thyroid produce?

Answer 13

Thyroxin which increases metabolic activity.

Question 14

What are the (2) main disorders of the thyroid?

Answer 14

Hyperthyroidisim Hypothyroidisim

Question 15

What are the Oral Manifestations of thyroid disorders?

Answer 15

Question 16

How do you manage a pt with unstable thyroid disorder?

Answer 16

1. Defer tx 2. Consult with GP 3. Avoid adrenaline in LA in unstable hyperthroidisim in emergency care.

Question 17

Define parathyroid disorder?

Answer 17

Linked with homeostatic regulation of calcium ion concerntration

Question 18

What are the oral manifestations of hypo/hyper parathyroidisim?

Answer 18

Question 19

What is a dental consideration of parathyroidisim?

Answer 19

They may also develop osteoporosis

Question 20

What are adrenal disorders treated with?

Answer 20

Corticosteroids; suppresses inflammatory responses.

Question 21

How do you manage a pt with adrenal disorder?

Answer 21

You determine medications and amounts. - Prednisone for 3 weeks. Always consult GP if alterations required. These pts could also be taking bisphosphonates for steroid induced osteoporosis

Question 22

When can a adrenal crisis present?

Answer 22

6-12hrs after surgical stress.

Question 23

What can initiate an adrenal crisis?

Answer 23

Dental treatment

Question 24

What are (3) considerations for patients who take corticosteroids?

Answer 24

1. Increased risk of oral infections 2. Delays wound healing 3. Risk of secondary infections

Question 25

What drug is used in bone and calcium disorders?

Answer 25

Bisphosphonates and corticosteroids.

Question 26

What condition is this picture?

Answer 26

BRONJ: Bisphoshonate-related osteonecrosis. Commonly follows exo; or ill fitting dentures.

Question 27

What is the dental management of BRONJ?

Answer 27

Must rule out other conditions; malignancy; head and neck radiotheraphy.

Question 28

Before commencing bisphonsphonates you the pt should?…..

Answer 28

• Pt must present for CC before going on medication. - Monitor OH, implants, dentures. - Bisphosphonates should not be cessed without consulting pt GP.

Question 29

What is the dental management of a pt with stroke?

Answer 29

Modification. Larger handle tp, powered tb. Education, F-!

Question 30

What are oral complications of a stroke?

Answer 30

1. Slurred speech 2. Weak palate 3. Difficulty swallowing 4. Tongue flaccid 5. RHS brain damage, requires assistance OHI.

Question 31

What other medication may a stroke pt be taking?

Answer 31

Anticoagulant; increased bleeding time

Question 32

Define epilepsy

Answer 32

A group of chronic neurological conditions. Well controlled, no dx issues. Poor control consult GP

Question 33

What (8) history points should you get from the pt that has epilepsy?

Answer 33

1. Type of seizure 2. Age of onset 3. Medications 4. Degree of control 5. Frequency 6. Date of last seizure 7. Triggers 8. History of related injuries

Question 34

How should you manage epilepsy clinically?

Answer 34

Short apps. Mouth prop to present injury if seizure presents

Question 35

What LA should be avoided in pts aking MAIOs?

Answer 35

Adrenaline (vasocontrictor). + Dose reduction for other types of antidepressant medications

Question 36

What is multiple sclerosis?

Answer 36

Myelin sheaths around nerves effected impacting nerve conduction.

Question 37

What is the dental management of pts with multiple sclerosis?

Answer 37

Medications can cause burning mouth problems, increased risk of infections. Short apps.

Question 38

What are dental considerations of the pt undergoing radiotheraphy?

Answer 38

Xerostomnia Prone to osteoradiocrosis Mucositis

Question 39

What are dental considerations of the pt undergoing chemotheraphy?

Answer 39

Modify tx to suit pts needs and circumstances - treat between chemo treatments.