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DS4102 > W3 - Medically Compromised Children - Mani > Flashcards

W3 - Medically Compromised Children - Mani Flashcards

1
Q

Cardiac medical implications to consider in compromised children (6)

A
  • Risk of bacterial endocarditis (valve defects, birth defects)
  • Bleeding tendency - anticoagulants?
  • Possibility of oxygenation issues
  • Blood pressure issues
  • Other medical conditions
  • Medications
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2
Q

Clinical features / presentations of cardiac patients (5)

A

Dyspnoea - shortness of breath

Cyanosis

Clubbing of fingers

Heart sounds (murmurs)

Altered heart rate

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3
Q

Oral features of cardiac patients (2)

A

No direct effects, HOWEVER indirect effects due to meds, routine, etc

  • Developmental defects of enamel
    • Hypoplasia in primary teeth
  • Increased risk of caries
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4
Q

Dental management of cardiac patients (5)

A
  • Liase with cardiologist
  • AB cover indicated?
  • Reduce risk of bacterial endocarditis
  • Prevention - good OH and frequent check ups
  • Careful with LA w/ vasoconstrictor (not contraindicated)

DO NOT LEAVE ANY SOURCE OF INFECTION IN MOUTH IN CARDIAC PT

Exo rather than pulp therapy

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5
Q

Why is pulp therapy (pulpectomy, pulpotomy) contraindicated in primary teeth in cardiac patients

A

Do not leave any source of infection in mouth of child with congenital cardiac disorders

  • They will have increased risk of bacterial endocarditis

Extract instead

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6
Q

Primary vs secondary haemostasis

A

Primary: platelet adhesion (thrombocytes)

Secondary: coagulation cascade (clotting factors)

Ultimate goal is for fibrinogen to form fibrin clot

Additional info:

Thrombocytopoenia / platelet disorder is associated with PRIMARY haemostasis

Von Willebrands and Hemophilia is associated with SECONDARY haemostasis

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7
Q

How are platelet disorders classified (2) examples?

A

Quantitative - reduced # (thrombocytopoenia)

  • can be inherited (many; rare) or acquired (infections like HIV)

Qualitative - altered function

  • can be inherited (von willebrand) or acquired (aspirin or NSAID)
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8
Q

How does Aspirin and NSAID affect haemostasis?

A

Inhibits COX which blocks production of thromboxane A2

  • Leads to reduced platelet aggregation
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9
Q

What are 4 dental implications that can occur if you treat a pt with a platelet disorder or coagulation mechanism disorders?

A

Failure to clot

Excessive bleeding

Spontaneous gingival bleeding

Purpura / petechiae

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10
Q

Dental management of pts with platelet disorders (4)

A

Management platelet levels (only tx once safe)

Avoid block injections

Avoid exo

Good surgical technique + local measures to control bleeding

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11
Q

Why should you avoid block injections (IAN) in pts with platelet disorders?

A

Accidental injury to vessel could cause inadvertant/excessive bleeding

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12
Q

Examples of inherited (2) and acquired (5) coagulation mechanism disorders

A

Inherited

  • Hemophilia A (factor 8 def) and B (factor 9 def)
  • Von Willebrands

Acquired

  • Anti-coagulation therapy (warfarin)
  • Vit K deficiency
  • Liver disease
  • Renal failure
  • Bone marrow suppresion
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13
Q

What clotting factors are associated with Haemophilia A, B, and Von Willebrands

A

Hemophilia A (factor 8 def)

Hemophilia B (factor 9 def)

Von willebrands (factor 8 def)

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14
Q

Why may delayed bleeding occur in pts with hemophilia or von willibrands

A

They still have primary haemostasis to stop bleeding (formation of platelet plug)

Fibrin clot will not develop however and thus they will bleed later

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15
Q

How to manage patients with coagulation disorders (hemophilia/ von willibrands) (5)

A
  • Liase with haematologist
  • Avoid oral surgery / invasive procedure in general dentist setting (consider hospital setting)
    • Avoid prescribing NSAID / Aspirin
    • Local measures to control bleeding
    • Nerve block (IAN) requires haematologic prophylaxis
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16
Q

Oral manifestations of Deficiency anemia (Fe, B12, folate) (4)

A

Angular cheilitis

Atrophic glossitis

Soreness of tongue

Recurrent ulcerations

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17
Q

Cause of hemolytic anemia (2) and consideration

A
  • Extrinsic factors (malaria
  • Defects with hemoglobin (thalassemia, sickle cell)

REQUIRE AB PROPHYLAXIS

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18
Q

Oral features of immunocompromised pts (5)

A

Candidosis (could be angular cheilitis)

gingivitis / perio

Recurrent aphthous ulceration

Recurrent herpetic infections

Premature tooth exfoliation

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19
Q

Dental management of immunodeficient patients (3)

A
  • Preventive care
  • Antibacterial / antifungal / antivirals
  • Extraction of pulpally involved teeth
20
Q

Treatment of candidiasis in children (2 ways) younger than 2 years

A

Nystatin liquid 100 000 units/mL 1 mL topically (then swallowed), 4xday after feeding for 7-14 days (or 2-3 days after symptoms resolve)

OR

Miconazole 2% gel 1.25mL topically (then swallowed), 4xday after feeding for 7-14 days (continue tx for 7 days after symptoms resolve)

21
Q

How to treat oral candidiasis in adults and children >2 years

3 ways

“favourite exam question .. oral manifestation and treatment of fungal disorders”

A

Miconazole 2% gel 2.5mL topically (then swallowed), 4xday after food for 7-14 days (continue tx for 7 days after symptoms resolve)

OR

Nystatin liquid 100 000 units/mL 1mL topically (then swallowed) 4xday after food, for 7-14 days (or 2-3 days after symptoms resolve)

OR

Amphotericin B 10mg lozenge, 4xday after food, for 7-14 days (continue tx for 2-3 days after symptoms resolve)

22
Q

Oral complications of chemotherapy (5)

A

Mucositis

Infection (due to neutropenia)

Haemostasis problems

Hyposalivation

Affect development of teeth

23
Q

Oral complications of radiotherapy (5)

A

Salivary gland atrophy

Demin / Caries

Altered tooth development

Microdontia

Osteoradionecrosis

24
Q

Oral complications of Bone Marrow Transplant (for cancer pts)

A

Mucositis

Mucosal sloughing

Xerostomia

Loss of taste

Acidic saliva (low pH)

25
Q

How to manage pts who are about to go for cancer therapy (5)

A
  • Pre tx exam
  • Liase with oncologist
  • Radical dental care to eliminate / stabilise oral infection
  • Avoid active dental tx during acute stage - emergency tx only
  • Focus on preventive therapy
26
Q

Oral features of renal conditions in kids (3)

A

Developmental defects of enamel

Intrinsic discolouration of enamel

Gingival hyperplasia

27
Q

What drugs should be avoided in pts with renal conditions (kidney)

A

Nephrotoxic drugs

  • Paracetamol
  • Penicillin
  • Tetracycline
28
Q

How to dentally manage kids with renal conditions (5)

A

Haemostatic prophylaxis

AB prophylaxis

Aggressive mgmt of infection

Exo pulpally involved teeth

Don’t prescribe drugs without contacting GP (esp nephrotoxic drugs)

29
Q

What is the main consideration with pts with liver disorders when providing dental tx

A

Bleeding issues

  • problems with coagulation
30
Q

Dental implications of bleeding disorders (systemic, how does it affect oral tissues) (5)

A

Problems with coagulation

Immunosuppression

Enamel development defects

Enamel staining

Gingival hyperplasia

31
Q

Dental managment of paeds pts with liver disorders (3)

A

Liase with gastroenterologist / haematologist

Radical mgmt of teeth (remove infection)

AB prophylaxis

32
Q

Dental management of organ transplant pts (4)

A

These pts likely have reduced immune function

  • Eliminate sources of infection (Caries)
  • Preventive regime
  • Gingivectomy (bc cyclosporin)
  • AB prophylaxis
33
Q

oral features of graft vs host disease

A

Erythema

Desquamative gingivitis

Angular cheilitis

Loss of lingual papillae

Xerostomia

34
Q

In oral conditions that present with desquamative manifestations, what is the likely cause?

A

issues with host immune response /

Immunomodulatory issues /

autoimmune disorders

35
Q

Dental management of gastroenterology pts (4)

A

liase with gastroenterologist

Definitive tx

Preventive regimen to remin

active monitoring

36
Q

Common examples of endocrine disorders (4)

A

Diabetes

Pituitary

Thyroid

Parathyroid disorders

37
Q

Medical implications of paeds pts with diabetes/endocrine disorders (6)

A

Altered growth/development

Hyperglycemia (diabetes)

Hypertension

Poor wound healing

Inability to tolerate stress

Skeletal anomalies

38
Q

Dental mangement of endocrinology/diabetic patients (5)

A

Liase with endocrinologist

Steroid prophylaxis as required

Definitive resto and perio care

Preventive regimen

Emergency care only during acute phase

39
Q

Oral features of diabetes / endocrinology disorder pts (5)

A
  • Developmental enamel & dentine defects
  • Altered tooth development
  • Perio
  • Xerostomia
  • “Spontaneous abscess”
40
Q

Features of hyperthyroidism (3)

A

Precocious eruption of teeth

  • Early loss of deciduous
  • Early eruption of primary

Accelerated growth

Osteoporosis

41
Q

Features of Hypothyroidism (3)

A

Delayed eruption

  • Primary teeth overretained
  • Delayed permanent eruption

Mentally retarded

Generalised body edema

42
Q

Dental management of pts with resp conditions / asthma (5)

A

Advise to bring puffer

Avoid rubber dam when possible

Avoid NSAIDs (give COX2 inhib nsaids or para instead)

Steroid prophylaxis as indicated

Avoid long appts

43
Q

What drug should be avoided in asthma / resp patients? Alternative?

A

NSAIDs - cause bronchospasm / restriction (Ibuprofen, aspirin, naproxen)

Use selective COX2 inhibitor nsaids (celecoxib) or paracetamol instead

44
Q

Oral features of pt having allergies (6)

A

Pallor / cyanosis

Blushing

Oedema of lips

Paraesthesia

Metallic taste

Contact stomatitis

45
Q

Dose of adrenaline in epipens (adults and kids)

A

300 microgram - kids

500 microgram - adults

46
Q

AB prophylaxis MUST KNOWS (4)

A

Prosthetic heart valves
Previous history of infective endocardidits
Congenital Heart Disease
Cardiac transplant recipients with valve issues

DS4102 (37 decks)

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