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INBDE High-Yield Medicine

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School
Dental Assistant Academy of Chicago**We aren't endorsed by this school
Course
DENTAL ASS 1182727
Subject
Medicine
Date
Dec 22, 2024
Pages
8
Uploaded by ProfTapirMaster1192
INBDE Bootcamp High-Yield Medicine | Bootcamp.comASA ClassificationClassDefinitionExamplesPatient considerationsASA IHealthyNon-smoker, no alcohol useNoneASA IIMild systemic diseaseCurrent smoker, pregnant, controlled hypertension, controlleddiabetes, controlled epilepsy, asthma, social drinker, obesityElective dental careMinor modificationsASA IIISevere systemic diseaseStable angina, history of heart attack or stroke (hx > 3months), poorly controlled hypertension (BP > 140/90),poorly controlled diabetes (HbA1c > 7%), poorly controlledepilepsy, dialysis for end-stage renal disease, alcoholdependenceElective dental careSerious modificationsASA IVSevere systemic disease that is a threat to lifeUnstable angina, recent heart attack or stroke (hx < 3months), hypertensive emergency, uncontrolled seizures, nodialysis for end-stage renal diseaseNo elective dental careUrgent care, non-invasive orinvasive, in a hospital settingASA VMoribund, < 24 hours to liveEnd-stage organ dysfunction, end-stage cancer, massivetrauma victimNecessary surgeryPalliative careASA VIBrain-deadOrgan donorNo dental carePathological ConditionsConditionBackground informationPatient considerationsOral manifestationsHypertension●Increased pressureof blood pushing against bloodvessel walls●Primary/essential hypertension: caused by outsidefactors such as smoking, exercise, diet, or age●Secondary hypertension:caused by conditions, suchas sleep apnea or chronic kidney diseaseClassSystolic(mm Hg)Diastolic(mm Hg)Normal BP< 120< 80Elevated BP120-129< 80Stage I hypertension130-13980-89Stage II hypertension> 140> 90Hypertensive crisis> 180> 120● Elevated but< 160/100○Short morning appointments○Stress management○Slow chair movement (avoid orthostatichypotension)○ Limit epinephrine(0.04 mg total, unsoakedretraction cords)●> 160/100○Repeat measurement○If still high, defer elective treatment○If dental pain/symptoms are contributing to BP →emergent treatment and monitor●> 180/110○ Repeat measurement○ If asymptomatic → refer to PCP ASAP○ If symptomatic → refer to ER● Dry mouth● Altered taste● Ulcerations● Gingival hyperplasia(calcium channel blockers)●Angioedema(ACE inhibitors, angiotensinreceptor blockers, renininhibitors)● Gingival bleeding(vasodilators)
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INBDE Bootcamp High-Yield Medicine | Bootcamp.comConditionBackground informationPatient considerationsOral manifestationsDiabetes● Metabolic disease thatincreases blood glucose,which contributes tooxidative damageto blood vessellining● Type I: lack of insulin production due to autoimmunereaction against pancreatic beta cells,juvenileonset● Type II: resistance to insulin due to target cells that areno longer sensitive,adultonset● Diabetes insipidus: kidneys cannot retain water due toinability to produce or react to ADH● Gestational: occurs during pregnancyDiagnosisHemoglobinA1c (%)Fastingbloodglucose(mg/dL)Glucosetolerancetest(mg/dL)Normal< 5.7< 99< 140Prediabetes5.7-6.4100-125140-199Diabetes>/= 6.5> 125> 200● Insulin administration can be rapid, short, intermediate,or long acting● Hypoglycemia○ Blood glucose < 70 mg/dL○ Tachycardia, irritable, restless, hungry, diaphoresis○ If conscious → administerglucosetab○ If unconscious → call EMS, IVdextroseor IMglucagon● Hyperglycemia○ Blood sugar >/= 126 mg/dL fasting, >/= 200 mg/dLafter meal○ Ketone breath, thirsty, nausea, vomiting, frequenturination, blurred vision○ CallEMS● Well-controlled○ Short morning appointments, ensure medicationstaken and meals eaten○ Have glucose source available○ Be aware of drug interactions● Poorly-controlled○ Defer elective treatment○ If urgent treatment and asymptomatic → manageinfections and refer to physician○ If urgent treatment and symptomatic → call EMS● Dry mouth● Delayed wound healing (vasculardamage)● Increasedinfectionrisk● Caries● Oral candidiasis● Enlargement of parotid glands● Periodontal diseaseChronic obstructivepulmonary disease(COPD)●Restriction of airflow,primarily due to cigarettesmoking● Chronic bronchitis○ Chronic inflammation of the airway that narrowsairways and increases mucus production○ Difficulty breathing in and out○ “Blue bloater”● Emphysema○ Inflammatory mediators destroy lung epitheliumand enlarge air spaces○ Difficulty breathing out○ “Pink puffer”● Well-controlled○ Avoid irritants such as rubber dam○ Chair position semi-supine or upright○ Avoid bilateral nerve blocks○ Avoid respiratory depressants (narcotics,barbiturates)○ Use pulse oximeter to monitor and administerO2 ifO2 saturation < 95%○ Avoid nitrous oxide● Poorly-controlled○ Shortness of breath, cough, upper respiratoryinfection,O2 saturation < 91%○ Refer to doctor or hospital● Poor oral hygiene →aspirationpneumonia(bacteria fromplaque enters airways)●Dry mouth(due toanticholinergics)● See oral manifestations ofsmokingAsthma● Chronic respiratory disease with reversibleepisodes ofairway inflammation○ Inflammation of bronchioles, hyperplasia of gobletcells, spasm of smooth muscle● Symptoms○ Shortness of breath, difficulty breathing, coughing● Stimuli○ Allergens, upper respiratory infection, exercise,cold, NSAIDs, smoke● Well-controlled○ Avoid stress and causes for attack○ Patient should haveinhalerand EpiPen with them○ Isolation during treatment○ Avoid some medications (NSAIDs, narcotics,barbiturates)○ Monitor with pulse oximeter, administer O2 if O2saturation < 95%● Poorly-controlled○ Refer to doctor●Dry mouth(due to inhaler)●Caries● GERD● Oral candidiasis● Enamel defects● Periodontal disease●Malocclusion
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INBDE Bootcamp High-Yield Medicine | Bootcamp.comConditionBackground informationPatient considerationsOral manifestationsCushing’s syndrome● Hypothalamus (CRH) → anterior pituitary (ACTH) →adrenal gland (cortisol)●Increasedproduction ofcortisol● Endogenous○ Can be due to tumor○ Can be primary, secondary, or tertiary● Exogenous○ Due to glucocorticoid usage○20 mgof exogenouscortisol,2+ weeks, in thelast2 years● Signs and symptoms○ Moon face, buffalo hump, central obesity,hypertension, mood changes, tired● Well-controlled○ Avoid stress○ Cautious use of general anesthesia○ Monitor vitals○ Drug interactions● Poorly-controlled○ Refer to doctor●Periodontal disease(due toreduced bone density)● Delayed growth and tootheruption in children● Loss of lamina duraAddison’s disease● Hypothalamus (CRH) → anterior pituitary (ACTH) →adrenal gland (cortisol)● Decreased production of cortisol● Endogenous○ Can be due to immune destruction of glands○ Can be primary, secondary, tertiary● Signs and symptoms○ Hyperpigmentation, immune compromise, fatigue,weakness, weight loss● Addisonian crisis○ Critically low corticosteroids causing an acuteadrenal insufficiency and atrophy of adrenal cortex○ Stress can cause a crisis with hypotension,vomiting, hypovolemic shock○ Tx: call EMS, IV saline, IV hydrocortisone● Well-controlled○ Avoid stress○ Cautious use of general anesthesia○ Monitor vitals○Hypotension→ place in supine position toincrease BP○ Drug interactions○Steroid supplementationfor intense surgery● Poorly-controlled○ Refer to doctor●Pigmentationof oral mucosaMedication-relatedosteonecrosis of thejaw (MRONJ)● Use ofbisphosphonatesand bone exposure → loss ofblood supply to the bone →death of the bone● Occurence in mandible > maxilla● Posterior jaw > anterior jaw● Risk factors: estrogen or glucocorticoid use, > 65 yearsold, bisphosphonates with nitrogen● Diagnosis requirements○ Use of bisphosphonates○ Exposed bone > 8 weeks○ No radiation to the jaws● Bisphosphonates○ Go to hydroxyapatite binding sites of bone that arebeing turned over○Reduces osteoclasts(in function and number)○ Can also decrease osteoblasts and bone healing● If patient is at risk for MRONJ:○ Treat infections first○Non-surgical treatmentpreferred○ If surgical treatment required, be conservative○ Antibiotic coverage○ Drug holiday is debated● If patient has active MRONJ:○ Chlorhexidine rinse○ Debridement, curettage○ Systemicantibiotics○ Irrigate with local antibiotics○ Hyperbaric O2 is debated●Necrotic bone→ pain,purulence, swelling
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INBDE Bootcamp High-Yield Medicine | Bootcamp.comConditionBackground informationPatient considerationsOral manifestationsPlatelet disorders● Von Willebrand disease○ Deficiency of vWF (activates platelets) → affectsability of platelets to adhere to blood vessels○ Congenital disorder● Thrombocytopenia○ Low platelet count, < 150,000/uL○ Usually due to another disease or etiology● Testing○ Platelet count, bleeding test, peripheral bloodsmear, platelet aggregation test, platelet functionanalysis● Consult with hematologist● Dentistry should be conservative, minimally invasive● Local hemostasis● No NSAIDs● Spontaneous gingival bleeding●Petechiae, ecchymoses●Hemarthrosisof TMJClotting disorders● Von Willebrand disease: vWF, factor 8 deficiency● Hemophilia A: factor 8 deficiency, x-linked recessive● Hemophilia B: factor 9 deficiency● Hemophilia C: factor 11 deficiency● Vitamin K deficiency: affects factors 2, 7, 9, 10● Liver disease: deficient in vitamin K factors● Anticoagulants○ Warfarin, heparin, apixaban, dabigatran● Testing○ Activated partial thromboplastin time (PTT)○ Prothrombin time (PT/INR)● Consult with hematologist● Dentistry should be conservative, minimally invasive● Local hemostasis● Warfarin○ No NSAIDs, barbiturates, steroids, metronidazole,erythromycin○Hemostatic measures(packing, sutures, topicalthrombin, tranexamic acid, primary closure)○ Based onINR● INR 2-3○ Acceptable for treatment● INR 3-3.5○ Simple surgery○ Complex surgery → refer to doctor to reducewarfarin● INR > 3.5○ Defer any treatment → refer to doctor● Spontaneous gingival bleeding●Petechiae, ecchymoses●Hemarthrosisof TMJHyperthyroidism● Hypothalamus (TRH) → anterior pituitary (TSH) →thyroid gland (T3, T4)●Excess thyroid hormonein bloodstream● Endogenous○ Can be caused by a tumor○ Can be primary, secondary, or tertiary● Grave’s disease: autoimmune, antibodies target TSHreceptors● Symptoms○ Fatigue, anxious, heat intolerance, weight loss,tachycardia, exophthalmos, goiter● Thyrotoxic crisis○ Thyroid storm, untreated hyperthyroid○ Stress can cause crisis, with symptoms oftachycardia, atrial fibrillation, fever, sweating, lossof consciousness○ Call EMS, vitals, ice packs, IV hydrocortisone ororal dexamethasone, IV glucose, propylthiouracil● Evaluate thyroid in every patient● Avoidepinephrine(2 carpules maximum, unsoakedretraction cord)● Limit NSAIDs● Early tooth eruption● Lingual thyroid● Osteoporosis● Caries● Periodontal disease● Propylthiouracil → ulcers,sialoliths, necrosis of gingiva
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INBDE Bootcamp High-Yield Medicine | Bootcamp.comConditionBackground informationPatient considerationsOral manifestationsHypothyroidism● Hypothalamus (TRH) → anterior pituitary (TSH) →thyroid gland (T3, T4)● Low thyroid hormone● Commonly due to iodine deficiency● Hashimoto’s: antibodies attack the thyroid gland● Cretinism: in children, stunted growth● Can be primary, secondary, or tertiary● Symptoms○ Weight gain, cold intolerance, bradycardia, goiter,Wormian bones● Myxedematous coma○ Critically low thyroid hormones○ Stress can cause symptoms of bradycardia,hypotension, hypothermia○ Call EMS, vitals, blankets, IV levothyroxine, IVhydrocortisone, IV glucose● Evaluate thyroid in every patient● Avoid CNS depressants (narcotics barbiturates, sedatives)● Delayed tooth eruption● Macroglossia● Xerostomia● PainSubstance abuse●Recurrent substance useover past12 monthswithconsequences● Marijuana○ Psychoactive ingredient is delta-9-THC○ Can alleviate pain and seizures, alter perception○ Causes tachycardia, hallucinations, bronchitis● Opioids○ Can reduce pain, sedate, cause euphoria○ Causes respiratory depression, nausea, vomiting,constipation○ Reverse overdose with Naloxone (Narcan)○ Prescription monitoring program to track, DEA #required to prescribe● Cocaine○ CNS stimulant that blocks reuptake of NT○ Causes tachycardia, arrhythmias, hypertension,pupil dilation, heart attack● Amphetamines○ Psychostimulant that releases dopamine○ Causes tachycardia, hyperactivity, headache,confusion● Sedatives○ CNS depressants○ Can treat seizures and anxiety● Alcohol○ CNS depressant with temporary stimulant○ Causes cognitive impairment, liver cirrhosis, GIbleed, cardiac problems● If intoxicated → do not treat, defer●Marijuana○ Orthostatic hypotension → slow chair movement○ Oral cancer screening● Opioids○ Benzodiazepines, nitrous oxide to reduce anxiety○ HaveNaloxoneavailable● Cocaine○ Do not treat within 6-8 hrs of last dose○Avoid epinephrinefor 24 hours○ Monitor vitals● Amphetamines○ Do not treat within 6-8 hrs of last dose○Avoid epinephrinefor 24 hours○ Monitor vitals● Alcohol○ Risk ofbleeding○ Oral cancer screening○ Avoid acetaminophen●Oral hygiene neglect→ plaque,calculus, caries, periodontaldisease● Dental phobia● Increased risk forbloodborneinfections(hep B, hep C, HIV)● Marijuana○ Xerostomia○ Oral cancer,leukoplakia○ Leukoedema○ Candidiasis● Opioids○ Candidiasis○ Bruxism● Cocaine○ Gingival recession○ Facial erosion● Amphetamines○ “Meth mouth”○ Xerostomia, high sugardiet, bruxism○ Rampant caries, wear,periodontal disease● Alcohol○ Oral cancer○ Glossitis○ Candidiasis○ Gingival bleeding○ Sialadenitis
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INBDE Bootcamp High-Yield Medicine | Bootcamp.comConditionBackground informationPatient considerationsOral manifestationsHyperparathyroidism● Parathyroid hormone (PTH) is released from chief cellsandregulates calciumin bodies● Excess PTH● Primary: parathyroid gland tumor● Secondary: low vitamin D, renal failure● Tertiary: chronic secondary● Symptoms○ Kidney stones, osteoporosis, constipation,nausea, vomiting, fatigue, depression, psychosis● Increased alkaline phosphatase● Surgical treatment may increase risk of bone fracture● Giant cell lesions● Loss of lamina dura●Decreased trabecular pattern(salt and pepper)Hypoparathyroidism● Lack of PTH● Often during thyroidectomy, parathyroid gland isdamaged or removed● Causes hypocalcemia● Focus on caries prevention● Muscle spasms● Radiopacity in skull● Enamel hypoplasia● Delayed eruption of teeth● Dilacerated roots● Radiopacity of jawsPregnancy● 1st trimester: worst symptoms, organ systems of fetusare being formed● 2nd trimester:safest for dental treatment● 3rd trimester: risk of tooth discoloration in fetus● Physiological changes in the mother○ Low iron, low platelets, low lung capacity,increased coagulation factors, increased WBCs● Possible conditions for mother○ Acid reflux○ Urinary frequency○ Gestational diabetes○ Preeclampsia● Supine hypotensive syndrome● Monitor vitals● Radiographs only if necessary● No elective treatment in 1st trimester and late 3rd trimester● No nitrous oxide in 1st trimester● No tetracyclines, fluoride in 2nd/3rd trimesters● No NSAIDs, benzodiazepines● Maintain oral hygiene● Pregnancy gingivitis● Caries● Pyogenic granuloma● Dental erosion● Sinusitis● Gag reflexHypercholesterolemia● Lipids in the blood● Build up in arteries and constrict diameter, blockvasodilation● HDL: should be > 50 mg/dL● LDL: should be < 130 mg/dL● Treated with statins (HMG-CoA reductase inhibitors)● Drug interactions● Commonly occurs with diabetes, hypertension● Poorly controlled → refer to doctor● Pulp calcification(statin use)● Muscle pain, weakness● Periodontal diseaseCancer● Males: prostate cancer is the most common● Females: breast cancer is the most common●Oral cancer screeningat all exams● Signs: fixed or matted lymph nodes● Oral cancer○ Risk factors: tobacco, alcohol, HPV○ Often located on tongue, lower lip, floor of mouth● Before chemotherapy or radiation○ Treat sources of infection or irritation○Extractnon-restorable, hopeless teeth○ Periodontal care○ Maintain oral hygiene● During chemotherapy or radiation○ Avoid removable appliances causing irritation○ Manage salivation (pilocarpine)● After chemotherapy or radiation○ Recalls to look for cancer recurrence○ Avoid extractions→ osteoradionecrosis● Xerostomia● Mucositis● Taste changes●Secondary infections(candida)● Bleeding● Radiation caries● Hypersensitivity● Trismus● Osteoradionecrosis
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INBDE Bootcamp High-Yield Medicine | Bootcamp.comConditionBackground informationPatient considerationsOral manifestationsHumanimmunodeficiencyvirus (HIV) &Acquiredimmunodeficiencysyndrome (AIDS)●Enveloped RNA retrovirusthat infectsCD4 T cells● Can be transmitted sexually, by sharing needles, motherto child○ Low risk of occupational exposure (0.3%)● Stage 1: HIV, asymptomatic, CD4 > 500 cells/uL● Stage 2: HIV, symptomatic, CD4 200-499 cells/uL○ Lymphadenopathy, weight loss, thrush● Stage 3: AIDS, symptomatic,CD4 < 200 cells/uL○ Malignancy, wasting, opportunistic infection● Diagnose with ELISA, Western blot, PCR● Treated with highly active antiretroviral therapy● HIV○ Standard precautions(do not double glove ordouble barrier)○ Post exposure prophylaxis○ Drug interactions with antiretrovirals● AIDS○ Standard precautions○ Post exposure prophylaxis○ Invasive treatment requires consult with doctor,antibiotic prophylaxis, platelets○ No NSAIDs● Oral lesions can be first sign● Xerostomia● Caries● Periodontal disease● Candidiasis● Herpes simplex, zoster● HPV● Oral hairy leukoplakia● Cytomegalovirus● Kaposi sarcoma● Non-Hodgkin lymphomaGastroesophagealreflux disease(GERD)●Reflux of stomach acidand contents of stomach intoesophagus● Risk factors: diet, age, weight, smoking● Acidic diet can worsen GERD● Test salivary function● Candida● Taste changes● Erythema multiforme● Erosion● XerostomiaPeptic ulcer disease● Break in stomach, esophagus, or duodenum lining● Often due to infection withH. pylori, NSAIDs● Risk factors: age, smoking, alcohol, stress● No NSAIDs● Oral hygiene maintenance● Drug interactions● Antibiotic regimen should not overlap with dentalantibiotics● Candida● Taste changes● Erythema multiforme● Erosion● XerostomiaHepatitis●Inflammation of the liver, commonly due to hepatitisvirus or alcohol use● Most are single stranded RNA virus● Can cause liver cirrhosis, carcinoma● Hepatitis A: fecal-oral○ Acute onset, no chronic disease, vaccine○ Jaundice, fever, malaise● Hepatitis B: percutaneous contact with blood○ DNA virus,high risk of transmission (30%)○ Jaundice, fever, malaise○ Vaccine, post exposure prophylaxis● Hepatitis C: percutaneous contact with blood○ Asymptomatic,harder to transmit (1.8%)○ No vaccine, but can be treated● Hepatitis D: direct contact, coinfection with Hep B● Hepatitis E: fecal-oral● Active hepatitis○ Only necessary treatment○ Elective care → defer, refer to doctor○ Urgent care can be done in isolated operatory,standard precautions, minimal aerosols○ Avoid drugs metabolized in liver● Recovered from hepatitis○ No modifications● Jaundice● Petechiae● Atrophic glossitis● Xerostomia● Lichen planus● Hepatocellular carcinomaMultiple myeloma●Malignant plasma cellscausing bone resorption, bonemarrow replacement○ Results in anemia, leukopenia, thrombocytopenia● Diagnose:Bence-Jones proteinin urine● Medications○ Thalidomide, bortezomib, bisphosphonates● Death typically occurs due to infection or renal failure● WBC < 2000○ Antibiotic prophylaxis may be required● Platelets < 50,000○ Invasive procedures → platelet transfusion● Follow bisphosphonate modifications● Follow chemo/radiation modifications● “Punched-out” radiolucencies● Tongue amyloidosis
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INBDE Bootcamp High-Yield Medicine | Bootcamp.comConditionBackground informationPatient considerationsOral manifestationsSleep apnea● Central sleep apnea○ Lack of inspiration stops airflow (CNS blockage)○ Due to poliomyelitis, spinal cord injury, encephalitis● Obstructive sleep apnea○ Physical obstruction stops airflow (physicalblockage)○ Can be naso-, oro-, or hypopharyngeal● Measured by apnea-hypopnea index● Signs/symptoms○ Snoring, sleepiness, light sleep, sweating,nocturia, bad memory, morning headaches,GERD, nocturnal bruxism, cardiovascularsymptoms● Risk factors○ Obesity, age, males, alcohol, smoking, asthma,Down syndrome, cleft palate, anatomic (largetongue, high palate)● Diagnose withpolysomnogram● Treat with behavior modification, positive airwaypressure, oral appliances, ortho, surgery, hypoglossalnerve stimulation● Screen for sleep apnea● Sleep acid triad○ GERD, obstructive sleep apnea, nocturnal bruxism● STOP BANG questionnaire○ Snoring, tired, observed apnea, pressure of blood,BMI, age > 50, neck increased circumference,gender male● Oral appliances● HigherMallampati score● Scalloped tongueSmoking● Associations○ Cataracts, pneumonia, lung cancer, COPD,asthma, cardiovascular disease, oral cancer, acutemyeloid leukemia● Nicotineactivates endogenous reward systemthroughdopaminecircuits and release ofepinephrine● E-cigarettes and vapes should not be recommended toprevent cigarette smoking● Cessation○ Behavioral counseling○ Pharmacologic: nicotine replacement therapy,bupropion, varenicline● Opportunity for cessation● 5 A’s: ask, advise, assess, assist, arrange● Leukoplakia● Squamous cell carcinoma● Nicotine stomatitis● Smoker’s melanosis● Hairy tongue● Halitosis● Smokeless tobacco keratosis●Periodontal diseaseTuberculosis●Mycobacterium tuberculosis infection, transmittedthrough droplet nuclei (airborne)● Latent infection○ No symptoms, cannot spread○ At risk of advancing to active disease●Active infection○ Symptoms include cough, night sweats, chestpain, fever, fatigue○ Can spread to others, can cause death● Diagnose with tuberculin skin test or Mantoux test● Active infection○ Elective care → defer, refer to doctor○ Urgent care → isolated operatory, standardprecautions, N95 mask, minimize aerosols● Latent infection○ No modifications● Ulcers● Tuberculous osteomyelitis
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