5. Oral Dental Considerations Flashcards by J L

Growth hormone deficiency – Oral Manifestations

Overall ____ stature
Body proportions normal
Smaller maxilla and mandible
____ tooth eruption
Delayed shedding of deciduous teeth
Delayed development of permanent teeth ____
General lack of ____ molar development
Reduced ____ of teeth (proportional)

short
delayed
roots
third
size

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Growth hormone excess – Oral Manifestations

Gigantism (childhood)
• Abnormally \_\_\_\_
• Enlargement of facial soft tissues
• Enlargement of \_\_\_\_ bones 
• \_\_\_\_

Acromegaly (Adult)
• Enlargement of \_\_\_\_ tissues • Coarsening of soft tissues
• Mandibular \_\_\_\_
• Increased dental spacing
• \_\_\_\_
• Macroglossia

tall
maxillofacial
macrodontia

bony
prognathism

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Hypothyroidism – Oral Manifestations

Cretinism (childhood); Myxedema (adult)
____ swelling
Lip thickening
Association with ____
Macroglossia
____
Tooth eruption delay / failure
Tooth ____ not impaired
Association with oral l____

facial
lingual thyroid
dysgeusia
development
lichen planus

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Hyperthyroidism – Oral Manifestations

Increased risk of ____
Rapid development of periodontal disease
Increased risk of ____
Accelerated development of jaws and teeth
Premature loss of ____

osteoporosis
dental caries
deciduous teeth

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Hyperparathyroidism – Oral Manifestations

Osseous changes
Loss of ____
____ pattern alterations
“____” appearance
Unilocular or multilocular radiolucencies of mandible
____ tumor
Alteration of maxillofacial bones
Associated with ____

dental lamina dura
trabecular
ground glass

brown
CRD/ESRD

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Thyroid disorders – Dental Management

Thorough baseline ____ history
Diagnosis / management of condition to date
Review of systems
____ of diagnosed disease
Recognition of undiagnosed disease
Need for medical consultation / referral

• Update ____ history at each visit

medical
stability
medical

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ypothyroidism – Dental Management

• No ____ to dental treatment in patients with stable disease

CNS depressants, sedatives or narcotic analgesics
Exaggerated ____ in hypothyroid patients
____ dose in mild disease
____ in patients with severe disease

contraindications
response
reduced
contraindicated

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Hyperthyroidism – Dental Management

• No ____ to dental treatment in patients with stable disease

Anti-thyroid medication may cause ____ suppression
Consider laboratory assessment
Poorly-controlled or undiagnosed disease
Defer ____ dental treatment until stable (preferred)
Dental treatment / oral infection can precipitate ____ crisis
Avoid use of ____
____-reduction protocols

contraindications
bone marrow
elective
thyrotoxic
epinephrine
stress

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Stress – Reduction Protocol

Recognition of ____ risk and anxiety
Medical ____
Consider ____
____ scheduling
Minimize ____ time
____ signs
____ of dental treatment
____ control

medical
consultation
premedication
appointment

waiting
vital
duration
pain

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Thyroid cancer – Dental Management

Management
Surgery
Ablative ____ iodine therapy (I131)
External radiation / chemotherapy – rare
Establish optimal oral ____ prior to treatment
Frequent recalls
Radioactive iodine therapy
____ gland complications
Oral pain
____

radioactive
hygiene
salivary
dysgeusia

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Diabetes mellitus – Oral Manifestations

____
Increased incidence / severity of caries
____
Oral burning / Glossodynia
____
Oral mucosal lesions
____ complications • Altered wound healing

xerostomia
candidiasis
lichen planus
salivary gland

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Periodontal Health and DM

• DM considered a risk factor for prevalence and severity of ____ disease

Degree of glycemic control
Increased levels of ____
Attachment loss
Progressive destructive ____
Alteration in wound healing
↑ risk of periodontal ____ formation

periodontal

gingivitis
periodontitis
abscess

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Periodontal Health and DM

Periodontal infection may adversely affect ____ control
Periodontitis may be associated with increased risk of developing ____ and macrovascular disease
Aggressive periodontal treatment may positively affects glycemic control

glycemic

nephropathy

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DM – Dental Management

Thorough baseline medical history
Diagnosis / management of condition to date
Review of systems
Stability of ____ disease
Recognition of ____ disease
Need for ____ consultation / referral

• Update medical history at each visit

diagnosed
undiagnosed
medical

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Physician consultation / referral
• Patient presents with signs / symptoms of undiagnosed disease

Patient with known DM
Patient exhibits poor ____ control
BG values > ____ mg/dl
Extensive dental treatment and/or acute infection which may limit ____ intake necessitating altering ____ dose

diabetic
400
caloric
insulin

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Before Dental Treatment

• Determine ____ control (HbA1c)

Antibiotic prophylaxis?
Lack of evidence-based ____
____ AM appointments
1.5 - 3 hours after breakfast / insulin

• Avoid elective dental treatment with BG > ____ mg/dl • Have glucose source available

glycemic
recommendations

short
400

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During Dental Treatment

Limit ____ in poorly-controlled diabetics to minimize ↑ in blood glucose levels
Keep glucose ____ available
Recognize ____ and symptoms of hyper- and hypoglycemia

epinephrine
source
signs

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After Dental Treatment
• Adjust insulin dose according to ability to maintain ____ intake
• Avoid ____
• Post-____ antibiotics when appropriate

caloric
glucocorticosteroids
operative

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Adrenal disorders – Oral Manifestations

• ____ disease

Oral hypermelanosis
____ pigmentation
Diffuse / patchy
Hyperpigmentation of the skin
____
____ syndrome
____ tissue deposition in facial area

• Rounded facial appearance
“____”

> >

____ changes to bone

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addison
brown
bronzing

cushing
fatty
moon facies

osteoporotic

Adrenal disorders – Dental Management

Thorough baseline medical history
Diagnosis / management of condition to date
Review of systems
____ of diagnosed disease
Recognition of undiagnosed disease
Need for medical consultation / referral
Update medical history at each visit

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stability

Adrenal Disorders – Dental Management

____ insufficiency
____-reduction protocols
Avoid ____ / NSAIDs if GI ulcers present
Determine need for steroid supplementation
Risk of adrenal crisis
____

• ____ syndrome

• Adverse effects associated with secondary
diseases
• ____, HTN, CVD, ____, Psych
• Monitor VS

• Delayed wound healing

Increased risk of infection
Consider use of ____

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adrenal
stress
ASA
rare

cushing
DM
osteo

antibiotics

ASA

The physiology of pregnancy
• Endocrine changes are the most significant alterations during pregnancy
• ____ fold increase in estrogen levels
• ____ fold increase in progesterone levels
• Changes occur due to
• Increasing maternal and fetal requirements for growth • Preparation of mother for delivery

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Overall changes

1st Trimester (conception–13th week)
• ____
• Tendency for syncopal episodes
• Tendency for ____ and vomiting

2nd Trimester (14th – 27th week) • Relatively \_\_\_\_ symptoms
• General sense of well-being

3rd Trimester (28th week – childbirth) • Increasing ____
• Increasing discomfort
• Mild ____ may be evident

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fatigue
nausea
few
fatigue
medpression

Cardiovascular changes
• ____ in total blood volume (TBV)
• ____ in cardiac output (CO)
• ____ in stroke volume (SV)
• The combination of increased CO and SV can produce a functional ____ in 90% of females
• These murmurs typically disappear after delivery
• ____ in blood pressure during 2nd trimester with return to ____ in 3rd trimester

Study These Flashcards

increase
increase
increase
murmur
decrease
baseline

Supine Hypotensive Syndrome * Affects up to 8% of ____ * Mainly after ____ trimester * When in supine position, there is compression of the ____ by the fetus * Results in impaired venous return to the heart * Symptoms * ____ * Bradycardia * ____ * Nausea * Dizziness * ____ * Roll the patient on to her ____ side • Lifts uterus off the ____ • Rapid return to normal

females second IVC hypotension sweating left IVC

Hematologic changes * Increased ____ count * Increase in ____ volume * Plasma volume is increased disproportionately to erythrocyte volume and creates a ____ anemia * 20% of females develop ____ anemia * Decreased levels of ____ seen * Additional iron and folate required * Clotting factors ____ are increased • Anti-clotting factors ____ are decreased • Pregnant female is considered “____” • Increased risk for ____

WBC erythrocyte physiologic iron-deficiency hemoglobin VII-X XI and XIII hypercoagulable thromboembolism

Gastrointestinal changes * ____ and vomiting * 66% of females * Starts ____ weeks after last menstrual cycle * Peaks between ____weeks * Symptoms gradually decline for most females * May continue throughout pregnancy * Likely due to ____ alterations * Increased risk of dental erosion * Pyrosis * ____ * Up to 50% of females * Due to * enlarging ____ * slow rate of ____ * decreased resting pressure of ____ sphincter * Increased ____ * Cravings for unusual foods

nausea 5 8-12 hormonal heartburn fetus lower gastroesophageal appetite

Gestational Diabetes * Occurs in 5% of pregnancies * Increased risk with maternal ____ / advancing age * Progressive maternal ____ to insulin * Maternal hyperglycemia→fetal ____ * Normoglycemic state returns s/p ____ * Increased risk of developing: * ____ (maternal / fetal) * ____ (maternal / fetal) * ____ disease (maternal) * ____ (fetal)

obesity insensitivity hyperinsulinemia parturition type 2 DM metabolic syndrome cardiovascular obesity

Oral and facial changes • ____ • Results from an enhanced inflammatory response to local irritants due to elevated hormone levels * Usually affects the ____ and interdental gingiva * Usually begins during ____ month of pregnancy * Most common oral complication of ____ * Pregnancy does not cause ____ disease but may cause an existing condition to worsen * Possible association between periodontal disease and risk of ____ birth and ____ birth weight

pregnancy gingivitis ``` marginal second pregnancy periodontal preterm low ```

* Pregnancy ____ (epulis gravidarum) * AKA “pregnancy tumor” * Etiology * Increased ____ coupled with local factors (i.e. plaque) * Primarily on ____ aspect of interdental papilla * Most common in first ____ and during ____ trimesters

``` granuloma angiogenesis labial pregnancies first and second ```

* Melasma * “Mask of Pregnancy” * Increase in facial ____ appearing as bilateral brown patches on the face * Usually appears during ____ trimester * Observed in approx. 75% of pregnant females • Usually ____ after giving birth

paigmentation first resolves

When to Consult with Prenatal Health Care Professional? * If ____ conditions are present that could affect management of the patient (i.e. diabetes, hypertension, pulmonary or cardiac disease and bleeding disorders) * If considering use of ____ sedation or general anesthesia * If considering the use of ____ as an adjunct to local anesthesia Otherwise, consensus guidelines state that dental care can be ____ delivered during all trimesters of pregnancy

comorbid intravenous sedation nitrous oxide

Radiographs * Dental radiographs may be ____ during pregnancy because radiation exposure to the fetus in utero is negligible * Fetal dose of radiation when completing a full mouth series using D speed film is equivalent to less than ____ hours of average daily background radiation in the U.S.

prescribed | 2.5

* Minimize radiation exposure to mother and fetus via: * Using ____ x-rays instead of panoramic radiographs when appropriate (to minimize total radiation dose) * Using____ films (____ speed) or ____ radiography * Use of ____ collimation * Use of a properly ____ beam * Use of a ____ collar and lead apron over the abdomen

bitewing high-speed E digital rectangular collimated thyroid

Drug Administration * Easy transfer of free (unbound) drug across the placenta exposing the fetus to the drug * Due to changes in drug metabolism and bioavailability in pregnant females * Caution must be used when prescribing drugs to pregnant females * Use only if expected ____ to mother > potential risks to fetus * Most drugs are excreted in ____ • Exposes newborn to the drug

benefits | breast milk

U.S. FDA Guidelines • Categorization of prescription drugs for pregnancy based on their potential risk of fetal injury • Drugs in category____ are preferable for prescribing • Drugs in category ____ typically present the most difficulty for the health care providers in terms of therapeutic and medicolegal decisions

A or B | C

* Category A—Controlled human studies indicate no apparent ____ to the fetus. The possibility of risk to the fetus is remote. * Category B—Animal studies do not indicate fetal ____. Well- controlled human studies have failed to demonstrate a risk. * Category C—Animal studies show an ____ effect on the fetus but there are no controlled studies in ____. The benefits from use of such drugs may be acceptable. * Category D—Evidence of ____ risk, but in certain circumstances the use of such a drug may be ____ in pregnant women despite its potential risk. * Category X—Risk of use in pregnant women clearly ____ possible benefits.

``` risk risk adverse humans human acceptable outweighs ```

Analgesics * Acetaminophen * Category ____ * Most commonly used ____ to be used during pregnancy * ____ secretion in breast milk * Aspirin * Category ____ * Prostaglandin inhibitor * Known to cause constriction of ____ * ____ in breast milk * Ibuprofen * Category ____ in 1st and 2nd Trimester, Category ____ in 3rd Trimester * Similar to aspirin effects * ____ secretion in breast milk (less than aspirin)

B analgesic limited D ductus arteriosus secreted B D limited

Local Anesthetics • Lidocaine • Category ____ • Safe to use for pregnant patients * Mepivicaine, bupivicaine, and articaine * Category ____ • Epinephrine use is considered to be ____ during pregnancy

B C safe

Antibiotics / Antifungals * Penicillins and cephalosporins * Category ____ * First choice for ____ infections * Safe when used in pregnancy * Clindamycin * Category ____ * Recommended for pregnant patients with ____ allergy * Nystatin (antifungal) * Category ____

B oro-facial B penicillin B

Oral Hygiene * Educate patient regarding importance of oral ____ during pregnancy * Maintain ____ / flossing regimen as per dental team recommendations * Rinse daily with over-the-counter ____, alcohol-free mouthrinse * After eating, chew ____-containing gum (↓ bacteria that can cause tooth decay) * After vomiting, rinse mouth with ____ (and 1 tsp of baking soda, if available) * (↓ acid that can affect tooth structure)

``` hygiene brushing fluoridated xylitol water ```

1st Trimester – Clinical Management • Emphasize importance of ____ • Dental treatment may be provided on an as-needed basis • Radiographs may be prescribed ____ • Patient may be ____ due to nausea and vomiting during 1st trimester

oral hygiene selectively uncomfortable

2nd Trimester – Clinical Management * Emphasize importance of oral hygiene * Dental treatment may be provided on an as-needed basis * Radiographs may be prescribed selectively * Patients typically have ____ overall discomfort during the 2nd trimester

less

3rd Trimester – Clinical Management • Emphasize importance of oral hygiene • Dental treatment may be provided on an as-needed basis • Radiographs may be prescribed selectively • ____ dental appointments should be considered with appropriate positioning while in the chair • Promote patient comfort • Minimize risk of supine hypotensive syndrome

short

Postpartum – Clinical Management * Return to routine oral hygiene regiment * Return to routine dental care recommendations * Monitor for resolution of any oral changes that may have occurred during pregnancy * Appropriate use of ____ in patients who are nursing

medications

5. Oral Dental Considerations Flashcards

(45 cards)