MOH DHA HAAD Dental Study Material Part 2
MOH DHA HAAD Dental Study Material Part 2
MOH DHA HAAD Dental Study Material Part 2
TOPICS
1. 2. 3. 4. 5. 6.
Bleeding problems Infective Endocarditis Hypertension and epinephrine use Diabetes Adrenal insufficiency and Steroid use Total joint replacement
BLEEDING PROBLEMS
Warfarin or Coumadin therapy, INR, PT and PTT Aspirin and Plavix therapy
QUESTION 1
Your 60 year old female patient who is on Warfarin needs extraction of #30. Her INR on the day of the surgery is 4.0. What should you do? A. Postpone surgery and decrease Warfarin dose until INR becomes 3.0 B. Perform the surgery C. Perform the surgery with local hemostatic measures D. Avoid local anesthetics and perform surgery under general anesthesia.
QUESTION 2
Your 68 year old patient is on clopidogrel to prevent blood clot formation. You need to extract #14, 15 and 16. Would you: A. Discontinue the clopidogrel B. Obtain the bleeding time C. NOT discontinue clopidogrel D. Obtain platelet function tests
INFECTIVE ENDOCARDITIS
Source: ADA
QUESTION 3
Ms. Sanchez is a 6 year old girl with a history of mitral valve prolapse. Does she need premedication prior to invasive dental procedures? A. Yes B. No Conditions that no longer need prophylaxis: mitral valve prolapse rheumatic heart disease bicuspid valve disease calcified aortic stenosis congenital (present from birth) heart conditions such as ventricular septal defect, atrial septal defect and hypertrophic cardiomyopathy
Source: ADA
QUESTION 4
Maria has a previous history of infective endocarditis and requires an intraligamentary injection for #15. Should you premedicate? A. Yes B. No
Source: JADA
ANTIBIOTIC REGIMEN
Cephalosporins should NOT be used in a person with a history of anaphylaxis, angioedema or urticaria with penicillins or ampicillin Source: JADA
QUESTION 5
Mr. Kato needs antibiotic prophylaxis but forgot to take his medication today. Your new associate failed to check with the patient and started the subgingival placement of antibiotic fibers and strips. What should you do?
A. Yell and swear at your associate! B. Stop all procedures and reschedule the patient C. Say a prayer and cross your fingers! D. Premedicate immediately
"If the dosage of antibiotic is inadvertently not administered before the procedure, the dosage may be administered up to two hours after the procedure."
OTHER SITUATIONS:
Coronary artery stents? Antibiotic prophylaxis for dental procedures is not recommended for patients with coronary artery stents Patient is already on Penicillin? Select an antibitoic from another class rather than to increase the dose of the currently administered antibiotic. For example, if a patient is already taking amoxicillin, the dentist should select clindamycin, azithromycin, or clarithromycin for IE prophylaxis.
Source: JADA
QUESTION 6
Your patient is on Propranolol for hypertension. His blood pressure today is 140/80. Can you administer lidocaine with 1:100,000 epinephrine? A. Yes B. No C. 1 to 2 cartridges of lido with 1:100,000 epi can be administered safely (try a test dose of 1 mL first!) D. Refer patient to his physician to change the Propranolol to Atenolol
DIABETES
QUESTION 7
Mr. Khan has a long standing history of Diabetes. Mr. Khans Hemoglobin A1c (HgA1c) level is 7.5% and his post prandial blood glucose on the day of the test is 140 mg/dL. Is he: A. Controlled diabetic B. Uncontrolled diabetic C. Not a diabetic anymore
QUESTION 8
Mr. Khan needs extraction of #3 and 4 (grade III mobility with periodontal abscesses) and his HgA1c is 8%. Should you:
A. Extract using atraumatic procedure B. Get a physician consult and then pre medicate the patient prior to extraction C. Administer insulin shot 2 hours prior to procedure, check glucose levels and then extract D. Do not extract, postpone procedure until diabetes is controlled
QUESTION 9
Mr. Padilla is on Prednisone 5mg every other day for his asthma. He needs extraction of #1 and 16 due to severe periodontal disease. What should you do? A. Inform Mr. Padilla to bring the prednisone and take it only if he has an asthma attack during surgery B. Mr. Padilla MUST take 5mg of Prednisone 2 hours before procedure C. Mr. Padilla MUST take 25 mg of Hydrocortisone equivalent on day of surgery D. Mr. Padilla must have a ACTH or HPA axis stimulation test
QUESTION 10
Mrs. Smith is a 45 year old female with a long standing history of Rheumatoid Arthritis. She had a car accident and suffered multiple fractures which were plated using metal pins and screws. She is now seeing you for an extraction of fractured #12 and 13. Should you premedicate Mrs. Smith prior to the extraction? A. Yes, for the first 2 years B. Yes, any time before a invasive dental procedure C. No premedication D. Only Clindamycin premedication
ALWAYS CONSIDER PREMEDICATION FOR ALL TOTAL JOINT REPLACEMENT PATIENTS PRIOR TO ANY INVASIVE DENTAL PROCEDURES! Guidelines may change in 2011.