Periodontal Treatment Of Medically Compromised Pt

Question 1

Classification Of BP

Answer 1

normal (less than 120/80)

prehypertensive (120-139 and 80-89)

stage 1 (140-159 and 90-99)

stage 2 ( greater than 160 and greater than 100)

Question 2

Whats the management of stage 2 HTN

Answer 2

Inform pt, Referrel, Monitor Bp at each appointment , If Bp is less than 180-110 than perform selective dental care (examination and non surgical endodontics and periodontics)

If Bp is greater than 180-110 Immediate medical consultaion and refferal, and perform emergency dental treatment to stop pain,infection,bleeding only

Question 3

Hypertensive crises?

Answer 3

When BP is higher than 180-110

Question 4

Treatment of HTN is much safer if——–is minimized ?

Answer 4

Stress

Question 5

———Time of the day is preffered for the appointment of hypertensive pt?

Answer 5

Afternoon because Bp is higher in early morning and peak in mid morning

Question 6

Consultation w physician is necessary if pt is ———

Answer 6

recieving HTN medication

Question 7

Epinephrine containing LA rises BP so in HTN pt its ratio should not exceed

Answer 7

1:100000

Question 8

If procedure is short (less than30 minutes ) than LA without———is given

Answer 8

Epinephrine, as its function is to increase the duration of action of anesthesia which is not mandatory in short procedures

Question 9

Name 2 ischemic heart diseases

Answer 9

Angina and MI

Question 10

2 Types Of Angina

Answer 10

1.Unstable
2.Stable

Question 11

Type of angina occurs irregularly ,multiple occassion without any predisposing factor is ?

Answer 11

Unstable angina

Question 12

Pt come with unstable angina his treatment will be?

Answer 12

Emergency dental treatment along with consultation with his physician

Question 13

Explain Stable Angina

Answer 13

Associated with stress and can be managed by medication and rest

Question 14

Protocols for the pt of angina

Answer 14

1. Stress reduction by profound LA and concious sedation
   2.Supplemental O2
2. Ask pt to bring Nitroglycerrin
   4.limit the use of Epinephrine
   5.If pt become fatigue or uncomfortable or there is sudden change in heart rythm then stop the treatment

Question 15

If during treatment pt has anginal attack then what protocols must be applied?

Answer 15

1.1 tab of 0.3-0.6 nitroglycerin
2. tighten clothes should be loosen
3. If symptoms subside then continue treatment ASAP
4. If signs and symptoms dont subsides till 5 minutes then another nitroglycerin dose is given and vital signs of pt are monitored and being ready to transport the pt to emergency department
5.Give 3rd dose of nitroglycerin after 5 minutes of 2nd dose if pain dont reduce from 3rd dose it indicates MI and pt should be transported to emergency

Question 15

Dont treat pt of MI for——–months because of peak mortality rate during this time

Answer 15

6 months

Question 16

Why CHF pts are treated in upright position rather than supine position

Answer 16

because of ORTHOPENIA(Inability to breath)

Question 17

Whats infective endocarditis

Answer 17

Condition in which microbes damages endocardium or heart valves

Question 18

Types of endocarditis?

Answer 18

1.Acute Endocarditis
2.Subacute Endocarditits

Question 19

A pt is at risk of infective endocarditis what prophylactic antibiotic is given to the pt?

Answer 19

2g Amoxicilin 30-60 minutes before the procedure.

If Pt is allergic then Clindamycin 600mg 30-60 min before the procedure.

Question 20

Defer treatment of Cardiovascular Accident (CVA) pts for ——- months and only emergency dental treatment is given because of risk of reoccurence ?

Answer 20

6 mts

Question 21

Normal Ranges of fasting, 2hr post prandial, random, HbA1C glucose levels?

Answer 21

Fasting: 70-100mg
2 Hr Post prandial: 140mg
Random: 120-180mg
HbA1c 4%-6%

Question 22

Periodontal therapy response is very well if HbA1c is

Answer 22

less than 8%

Question 23

if HbA1C is >8% periodontal therapy has

Answer 23

poor prognosis

Question 24

A undiagnosed diabetic pt with severe dental infection comes then provide ...........

Answer 24

Emergency dental care treatment OHI and nonsurgical debridement of plaque and calculus until diagnosis is established.

Question 25

Treatment protocol if known diabetic pt

Answer 25

Monitor glucose If blood glucose is <70mg than advice 4 ounce of juice preoperatively If pretreatment gluocose is higher and it determines the diabetic control is poor than only provide emergency treatment. if diabetic control is very good then proceed elective periodontal surgery After surgery check any fluctuations in sugar

Question 26

Treatment of Hypoglycemic shock

Answer 26

1.If pt feels symptoms of hypoglycemia then blood glucose level is checked and if falls below< 60mg then provide immediately 15 gm oral carbohydrate like 4,6 ounce of juice or 3,4 teaspoon sugar , hard candy with 15gm sugar 2.If pt is unable to take orally/pt is sedated then IV 25-30ml dextrose is given which provides 12.5 to 15gm dextrose or 1mg IV,IM,SUBCUTANEOUS glucose is given

Question 27

Which pts have inadequate coagulation mention 4

Answer 27

1.Haemhoragic disease 2.Vitamin K deficiency 3.Long term Alcohol consumption 4.Prolonged antibiotics(as they kill flora which produce vitamin K) 5.Chronic hepatitis

Question 28

Protocols for the treatment of a patient with liver disease?

Answer 28

Consult physician Lab tests : PT,BT,Platelet count, and PTT, INR should be done conservative nonsurgical periodontal therapy For simple surgery INR should be less than 2.5 Platelet count should be more than 80% complex surgery require INR LESS than 1.5-2

Question 29

----------- drug interefere with normal platelet aggregation and should be stoped during periodontal surgery for 4-7 days

Answer 29

ASPRIN but pts taking low dose 325mg/day than no need to stop the drug

Question 30

for how many days ASPIRIN is discontinued while planing for the periodontal surgery

Answer 30

4-7 days

Question 31

Drugs that are metabolized by kidney or nephrotoxic drug should not be given to the pt of

Answer 31

renal disease

Question 32

Lidocaine is not safe for the pt of renal disease T/F

Answer 32

F

Question 33

What should be minimized in patients with pulmonary disease?

Answer 33

A: Stress.

Question 34

When should a patient with emphysema be treated?

Answer 34

A: In the afternoon, several hours after sleep, to allow airway clearance.

Question 35

Q: What type of medications should be avoided in pulmonary disease patients?

Answer 35

A: Medications that cause respiratory depression

Question 36

Q: Why should bilateral mandibular block anesthesia be avoided in patients WITH PULMONARY DISEASE?

Answer 36

A: It can cause increased airway obstruction

Question 37

Q: What should an asthma patient bring to their dental appointment?

Answer 37

A: Their medication and inhaler

Question 38

Q: Should a patient with an active fungal or bacterial respiratory infection be treated?

Answer 38

A: No, unless it is an emergency periodontal procedure

Question 39

Is periodontal treatment safe during pregnancy? .

Answer 39

A: Yes, non-surgical periodontal therapy, such as scaling and root planing, is safe and can have positive effects on fetal health

Question 40

Q: Which trimester is the safest for periodontal treatment?

Answer 40

A: The second trimester (14-28 weeks) is the safest because the first trimester involves fetal development, and the third trimester may cause discomfort when lying down

Question 41

Q: How should a dentist position a pregnant patient during treatment?

Answer 41

A: The patient should be in a semi-reclined position with a slight tilt to the left to avoid supine hypotensive syndrome

Question 42

Q: Are local anesthetics safe during pregnancy? .

Answer 42

A: Yes, lidocaine with epinephrine is considered safe, but the lowest effective dose should be used

Question 43

Q: What medications should be avoided in pregnant patients? r.

Answer 43

A: Avoid tetracyclines, NSAIDs (like ibuprofen), and metronidazole in the first trimeste