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CMS > Week 4 - Pregnancy & MRONJ > Flashcards

Week 4 - Pregnancy & MRONJ Flashcards

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Introductory Sommelier Exam (CMS) flashcards
1
Q

pregnancy: what are they key concerns when it comes to dental treatment?

A
  • LA
  • radiography
  • amalgam
  • prescribing
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2
Q

pregnancy: which stages in the pregnancy should we avoid elective dental care?

A
  • first trimester

- final part of third trimester

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3
Q

pregnancy: when is the best stage of pregnancy to do treatment?

A

second trimester; 14-20 weeks best. low risk of pregnancy loss, more comfortable for pt

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4
Q

pregnancy: alternative materials to amalgam should be used for what type of patients?

A
  • children with primary teeth

- pregnant patients

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5
Q

pregnancy: antibiotics - which ones are not known to be harmful?

A 
amoxicillin
cefalexin
cefradine
clindamycin
co-amoxiclav
erythromycin
phenoxymetyl penicillin
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6
Q

pregnancy: treatment of bacterial infections:

antibiotics - which one should be avoided in high dose regimens?

A

metronidazole

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7
Q

pregnancy: treatment of viral infections: which medication is not known to be harmful? use only when?

A
  • aciclovir

- use only when potential benefits outweigh risks

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8
Q

pregnancy: treatment of fungal infections - prescribe what?

A

nystatin suspension can be given

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9
Q

pregnancy: treatment of pain: which painkiller is not known to be harmful?

A

paracetamol

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10
Q

pregnancy: local anaesthetic - which ones can be given?

A
  • lidocaine with epinephrine, prilocaine
  • mepivacaine: use with caution in early pregnancy
  • articaine: only if benefit outweighs risk, no info available
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11
Q

pregnancy: the oral manifestations in pregnancy are secondary to what factors?

A
  • increased vascular permeability
  • decreased immunocompetence
  • increased susceptibility to infection
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12
Q

pregnancy: changes in what lead to the occurrence of pregnancy gingivitis?

A
  • progesterone: it changes the composition of oral flora to be more pathogenic
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13
Q

pregnancy: what other oral manifestations are seen?

A
  • ptyalism: excess production of saliva that is linked to nausea (settles at 12-14 weeks)
  • erosion: secondary to vomiting and GORD
  • increased dental caries
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14
Q

pregnancy: pregnant women with gestational diabetes, more likely to have what oral disease?

A
  • perio disease
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15
Q

pregnancy: oral health - complications & adverse outcomes: association between periodontitis and what factors?

A
  • pre-term birth
  • low birth weight
  • pre-eclampsia
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16
Q

pregnancy: poor maternal oral health, increased risk of?

how to prevent? prevention measures result in?

A
  • early childhood caries in child
  • topical antibacterials e.g. xylitol, Chx in late pregnancy + post partum
  • reduced bacterial load, reduced transmission of oral bacteria from mother to child
17
Q

MRONJ: definition?

A

exposed bone or bone that can be probed through an intra-oral or extra-oral fistula in the maxillofacial region jaw that has persisted for more than 8 weeks
no history of radiation therapy to the jaws or metastatic disease to the jaws

18
Q

MRONJ: medications associated with MRONJ?

A
  • bisphosphonates
  • RANK ligand inhibitor: denosumab
  • anti-angiogenic medications:
    1) tyrosine kinase inhibitors,
    2) monoclonal antibodies against vascular endothelial growth factor
19
Q

MRONJ: action of bisphosphonates?

A
  • deposited in bone where they persist
  • inhibit the formation, recruitment and function of osteoclasts
  • increase apoptosis of osteoclast
  • anti-angiogenic
20
Q

MRONJ: indications for bisphosphonates?

A
  • osteoporosis
  • osteogenesis imperfecta
  • primary hyperparathyroidism
  • paget’s disease
  • fibrous dysplasia
  • cystic fibrosis
  • multiple myeloma
  • breast cancer
  • prostate cancer
  • bony metastatic lesions
  • hypercalcaemia of malignancy
21
Q

MRONJ: route of administration for bisphosphonates?

A
  • oral: osteoporosis, osteopenia etc

- intra venous: cancer related conditions, yearly for osteoporosis

22
Q

MRONJ: denosumab action?

A
  • antibody against RANK ligand
  • inhibits osteoclast function
  • inhibits bone resorption
  • *does not bind to bone
23
Q

MRONJ: denosumab indications?

A

osteoporosis

metastatic bone disease

24
Q

MRONJ: anti-angiogenics?

A

sunitinib (TKI)

bevacizumab (anti-VEGF)

25
Q

MRONJ: anti-angiogenics indications?

A

RANK

26
Q

MRONJ: pathogenesis?

A
  • reduced bone turnover
  • reduced vascularity
  • inflammation/infection
  • adverse effects on soft tissues
  • immune dysfunction
27
Q

MRONJ: risk factors?

A
  • potency
  • route of administration
  • cumulative dose
  • anti-angiogenic + bisphosphonate medication?
28
Q

MRONJ: when is a pt low risk?

A

oral or intravenous bisphosphonate/denosumab treatment for osteoporosis or Paget’s disease

29
Q

MRONJ: when is a pt high risk?

A

IV bisphosphonates,
denosumab,
anti-angiogenics for malignant conditions

  • previous MRONJ
  • systemic corticosteroids
  • immunosuppresants
  • coagulopathy
  • chemotherapy
  • radiotherapy
30
Q

MRONJ: risk factors for dental procedures?

A 
dento-alveolar 
periodontal 
deep root planing
periapical
complex restorations
implants

CMS (16 decks)

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