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Oral Med Quiz 3
| Question | Answer |
|---|---|
| What is infective endocarditis? | A microbial infection of the endocardium (heart's inner lining) |
| What 3 structures can infective endocarditis affect? | One or more of the heart valves The mural endocardium Septal wall |
| What is the etiology of infective endocarditis? | Bacteria enter bloodstream and infect damaged endocardium or endothelial tissues that are located near high-flow shunts between arterial and venous channels |
| Infective endocarditis most often infects what valve? | Tricuspid valve |
| What are the other two valves that are often infected? | Mitral and aortic valves |
| Multiple _____ involvement is common. | Valve |
| What can infection of the tissues with bacteria lead to? | formation of vegetations (bacterial growths) |
| How does blood move through the heart? | Vena cava to right atrium Right atrium to right ventricle Right ventricle to lungs Lungs to left atrium Left atrium to left ventricle Left ventricle to body |
| Function of the valves? | Let blood move forward through the heart. |
| What 5 things make a pt. at higher risk of bacterial endocarditis? | Damaged native or prosthetic heart valves Congenital heart defects IV drug users History of previous heart/valve infections Oral diseases |
| What bacteria causes carries? | Strep. veridans group |
| What bacteria type is associated with hospital settings? | Staphlococcus aureus |
| If endocarditis is so rare why do dental pros worry about it so much? | High correlation between bacteremia from oral cavity causing bacterial endocarditis. |
| Why is primary prevention of infective endocarditis so important? | Substantial morbidity and mortality from the infection. |
| Who does bacterial endocarditis usually develop in? | Those with underlying structural heart defects that develop bacteremia with organisms that are likely to cause endocarditis |
| What can surgical and dental procedures and instrumentation involving mucosal surfaces or contaminated tissue cause? | Transient bacteremia that can result in IE. |
| Diagnosis of bacterial endocarditis is easily missed, so ______ diagnosis is needed. | Differential |
| What deadly event can be caused due to bacterial endocarditis? | Systemic cerebral emboli, where bacterial dislodge and go to brain causing ischemic stroke. |
| What are symptoms of undiagnosed IE? (12) | Fever, Heart murmur, shortness of breath, cough that won’t go away, paleness, Small red/purplish painful bumps on fingers or toes(Osler’s nodes), Small dark red/brown/purple flat spots on palms of hands and soles of feet~painless (Janeway lesions), Tiny s |
| 60% to 80% of IE patients have what? | Some type of predisposing heart or arterial disease. |
| What percentage of the general population are considered susceptible to IE? | 5-10 (1 in 10 patients) |
| Why do we use antibiotic prophylaxis to prevent IE? (3) | 1.) Endocardial lesions attract bacterial colonization/vegetations . 2.) Transient bacteremias are associated with certain dental procedures. 3.) Bacteria implicated in resultant endocarditis are oral inhabitants |
| What guidelines should we follow for antibiotic prophylaxis of pt. with IE risk? | AHA guidelines |
| What does AHA recommend in terms of spacing out appointments and why? | 10-day interval between procedures in order to reduce occurrence of Antibiotic-resistant microorganisms |
| True or False: A pre-treatment antimicrobial rinse has been successfully proven to decrease bacteremias before dental tx? | False |
| What is a treatment modification used when pt. is on antibiotic prophylaxis for IE? | Complete as much dental treatment as possible at each pre-medicated appointment. |
| What increases chance of bacteremias even in the absence of dental procedures? | Poor dental hygiene, Periodontal or periodical infections |
| How should pt. at risk for IE be educated? | Told of the importance of maintaining great oral health to reduce resources of bacterial seeding |
| What are the 2 most common types of bacteria to cause IE after dental tx? | Staphlococcus aureus (hospital acquired) & Streptococcus viridans |
| What is the preferred antibiotic prophylaxis routine for pt at risk of IE? | single dose of oral amoxicillin, 2 grams, 1 hour prior to procedure |
| Amoxicillin, ampicillin, and penicillin-V are all equally effective against the bacteria, so why is amoxicillin preferred? | Tt is better absorbed from the gastrointestinal tract and provides higher and more sustained serum levels |
| What does AHA recommend now in terms of antibiotic prophylaxis? | most patients no longer need short-term antibiotics as a preventive measure before their dental treatment |
| What is this recommendation based on? | Studies showing that the risks of taking preventive antibiotics outweighs the benefits for most patients |
| What are the 4 main reasons that AHA recommends most pts don't need antibiotic prophylaxis anymore? | 1.) Adverse reactions to antibiotics 2.) No compelling evidence that prophylaxis prevents IE 3.) Their hearts are already exposed to bacteria from the mouth, which can enter bloodstream during daily activities |
| What is more important than antibiotic prophylaxis for pt at risk for IE? | Good oral health, it reduces incidence more. |
| IE is more likely to occur as a result of what, rather than dental tx? | Everyday activities. |
| These guidelines are aimed at who? | Pts with highest risk of IE |
| What 3 things indicate pt needs prophylaxis to prevent IE? | Artificial heart valves, History of previous infective endocarditis, cardiac transplant with valve regurgitation due to a structurally abnormal valve (vulvulopathy) |
| What certain specific, serious congenital heart disease conditions indicate need for prophylaxis? | Unrepaired or incompletely repaired congenital malformations, Completely repaired congenital heart defects during the first six months after surgery, any repaired congenital heart defect with residual defect |
| What tx do not need prophylaxis? | Anesthetic injections through noninflected tissue, taking x-rays, placing removable appliances, shedding of primary teeth, bleeding from trauma |
| If pt. is allergic to amoxicillin what can they take for prophylaxis? | cephalexin (2 g) or Azithromycin (500 mg) or clarithromycin (500 mg) |
| If pt. can't take meds orally what can they take? | ampicillin (2 g) |
| Do I need to confer with the patient’s physician before treating according to the guidelines? | Yes |
| What if a patient insists he/she wants the premedication even though they no longer need it? | Dentists are not obligated to give treatment that they deem not to be in the patient’s best interest, simply because the patient requests it. |
| Do patients with stents require prophylaxis? | Not for dental tx |
| My patient forgot to premedicate. What do I do? | recommendation is to give the antibiotics 30-60 minutes before treatment, but if the antibiotic inadvertently is not administered, the dosage may be given up to 2 hours after the procedure |
| What is to do if pt forgets premed at Clark College? | student must confer with their instructor as to the best plan of action, dentist has final say. May be able to use clinic pre- meds and then proceed with treatment after 60 minutes. |
| I have a patient who is already taking antibiotics. How does that affect the prophylactic regimen? | REQUIRED to select an antibiotic from another class rather than to increase the dose of the currently administered antibiotic. |
| What antibiotics can be used instead of amoxicillin? | clarithromycin, clindamycin, or azithromycin |
| The patient presents with a condition requiring pre-medication according to the current AHA guidelines but has never taken it or been told to take it by their physician before. | Using the Physician Consult form, obtain written documentation from their physician stating whether or not pre-medication is needed. Always confirm the consult has been received back and is in the EHR of the patient prior to treatment. |
| The patient has previously been pre-medicated for a condition no longer on the current 2017 AHA guidelines but has not consulted with their physician as to whether it is still needed. | Follow same procedure as in scenario #1 |
| he patient presents with a condition that was listed on past AHA guidelines but is no longer on the current 2017 AHA guidelines. They also have never been pre-medicated for that condition. | No action is needed. Pre-medication is not required |
| Who makes final decision as to whether premed is needed? | always made by the CCDDHP supervising dentist |
| Who is more likely to die from pregnancy? | Minority women are 2-3 times more likely to die than white women. |
| Pregnancy related death increases with______. | age |
| What are drugs that cause birth defects called? | Taratogenic |
| X-ray treatment modifications for pregnant women? (2) | Avoid in first trimester Defer unless considered necessary for tx. |
| Morning sickness that induces vomiting increases risk for what? | Enamel erosion and decay. |
| How should pregnant women take care of teeth after vomiting? | DO NOT brush. Instead rinse with a soda water or baking soda to make mouth more basic. |
| When is the optimal/safest time to complete necessary dental treatment for pregnant woman? | 2nd trimester |
| What trimesters pose greatest risk to mom and baby? | 1 and 3 |
| What is the old way of drug safety classification for pregnant women? | FDA Pregnancy Categories |
| Categories A & B | Considered safe for pregnancy |
| Category C: | Should be used only when benefit exceeds the potential risk |
| Categories D & X | NOT recommended for use during pregnancy: definite risk to absolute fetal anomalies occurring |
| What is the current way to determine drug safety for pregnant women? | Pregnancy and Lactation Labeling Rule (PLLR) AKA drug package insert. |
| Why do we use this new method instead of the old one? | Provides better patient-specific counseling and informed decision making for pregnant women seeking medication therapies because it is more informational. |
| What information does the PLLR contain? | Pregnancy (includes Labor and Delivery), lactation, Females and Males of Reproductive Potential |
| What information does the pregnancy section of the PLLR contain? | dosing and potential risks to pregnant women about the drug being prescribed: Pregnancy Exposure Registry Risk Summary Clinical Considerations Data |
| What information does the lactation section of the PLLR contain? | describes the drug metabolites excreted in breast milk, drugs that should not be used during breastfeeding and potential side effects on both mothers and babies as described from known studies in both human and animal research. |
| What information does the Females and Males of Reproductive Potential section of the PLLR contain? | drug effects on fertility in both men and women before conception, information on birth control, pregnancy testing, or pregnancy loss. |
| What treatment modifications should be used for epinephrine for pregnant woman? | The cardiac dose, which is 2 cartridges 1:100,000 OR 4 cartridges of 1:200,000 |
| What are acceptable antibiotics for pregnant women? (6) | Penicillins, Cephalosporins (cephalexin), Clindamycin, Erythromycin ethylsuccinate (NOT E. estolate form), Acetaminophen |
| What kind of antibiotics can a pregnant woman not have and why? | Tetracyclines, they cause permanent tooth discoloration and hypoplasia. |
| What is the analgesic and antipyretic of choice during pregnancy? | Acetaminophen |
| Considerations for NSAIDS and Aspirin (ASA) during pregnancy? | Avoid, especially in 3rd trimester |
| Why must NSAIDS and Aspirin (ASA) be avoided? | Causes delayed delivery, premature patent ductus arterious in utero, Complicates delivery, causes Maternal or fetal hemorrhage |
| Considerations for Codeine and Opioid Pain Meds during pregnancy? | Avoid, causes teratogenicity and Neonatal respiratory depression |
| Considerations for Benzodiazepines and Barbiturate during pregnancy? | Avoid, causes cleft lip and cleft palate |
| Considerations for nitrous oxide during pregnancy? | Avoid chronic, multiple exposures because it can cause fetal abnormalities, miscarriages, & low birth weight |
| What is Supine Hypotension Pregnancy Syndrome? | A condition in late pregnancy where the weight of the uterus compresses the inferior vena cava, causing reduced blood flow back to the heart and leading to a drop in blood pressure |
| Give steps to how Supine Hypotension Pregnancy Syndrome works? | Less blood to the heart slows the heart down & dilates the vessels, causing less O2 to the brain. The lowered blood pressure may cause syncope when sitting up from supine. |
| What else can Supine Hypotension Pregnancy Syndrome cause? | Fetal hypoxia due to ;lessened cardiac output. |
| What should you do if Supine Hypotension Pregnancy Syndrome occurs? | head below heart, belly rolled to the left side, apply O2, & monitor vitals til patient recovers or 911 if BP stays < 60 bpm |
| How should pregnant patient be placed in chair during 3rd trimester? | Place in semi supine position and put a pillow under their right hip to help them tilt towards their left side. |
| What considerations should be made when scheduling pregnant pt.? | Schedule short appointments, afternoons to lessen morning sickness |
| Treat infections but delay _______ procedures until after delivery | elective |
| What is Preeclampsia or Eclampsia | disorders of high blood pressure in pregnancy |
| What are two symptoms of preeclampsia? | Pregnancy Hypertension with proteinuria (> 300 mg/dL over a 24 hr. period) |
| What is a normal proteinuria level? | at or below 150mg/d |
| When does it most often occur? | Late pregnancy |
| Symptoms of preeclampsia? | Excessive swelling (edema) in face, hands, Headaches, dizziness, Decrease in urination, nausea, vomiting, Vision changes (sensitivity to light) |
| What is preeclampsia dangerous for? | Mom's liver and kidneys. Risk of hemorrhagic stroke in brain of mother/death. |
| Risks with eclampsia Decrease once baby is born in most cases, however, 30% of eclampsia seizures/strokes happen ___-___ hrs. postpartum | 24-72 |
| How does eclampsia differ from preeclampsia? | Eclampsia is more severe and can involve seizures and coma due to elevated BP and proteinuria. (Past the preeclampsia phase) |
| Risk factors for baby due to eclampsia? (5) | Inefficient nutrient delivery to the baby Low birth weight Impaired blood and O2 flow resulting in brain/growth damage and possible stillbirth. Early delivery increases possibilities for cerebral palsy, deafness, blindness, other complications |
| What to do if BP is elevated or the patient shows signs of other preeclampsia signs/symptoms? | Refer to obstetrician. |
| 2 types of pregnancy related gingival inflammation? | pregnancy gingivitis pyogenic granulomaAKA ‘pregnancy tumor’ |
| Pregnancy hormones can cause what? | Increased biofilm/deposits |
| What 4 things should you educate pregnant pt. on? | Diet, safe drugs/herbal supplements, caries prevention and control, severe effects of tobacco. |
| Active periodontal disease while pregnant can contribute to what? | preterm and low–birth-weight babies |
| Why is treating a pregnant woman with Periodontal disease important? | Pregnant women with periodontal disease who are treated with scaling, root planing, and oral hygiene instruction have no greater risk for preterm or low–birth-weight babies than do pregnant women without periodontal disease. |
| Why is it important to let breast feeding mother schedule her apptmnts and for you to show up on time? | They have time constraints. |
| Don’t administer any drugs without doing what? | checking drug references for implications for lactating mothers. |
| Can radiographs be taken on a breastfeeding mother? | Yes |
| What may still be present after mom gives birth? | Some residual pregnancy gingivitis |
| What should you encourage mother to do? | Take care of herself and her oral care needs!!! |
| Women on BCPs are at higher risk for what? (3) | Blood clots hypertension weight gain |
| Gingival Effects of BCPs? | Similar to those of pregnancy- Increased response to biofilms and accretions and Increased bleeding |
| There is a decrease in effectiveness in BCPs when used in combination with certain other drugs like... | Antibiotics, anticonvulsants & rifampin (TB drug) |
| What should you advise a pt. who is on BCPs and needs to take an antibiotic? | to use additional non-hormonal birth control during & 1 full week after completion of the antibiotic |
| Hormone replacement for menopausal women helps what kinds of symptoms? (6) | Hot flashes, night sweats, sleep problems, depression, anxiety, and weight gain |
| True or False: BCP & HRT meds have side effects that relate to dental procedures. | True |
| What are they? | Increased Blood pressure Nausea Increased bleeding Higher incidence of dry socket after extraction |
| What are BCP and HRT meds used for? | Menopause |
| What oral side effects are menopausal women at risk for? (6) | Xerostomia, osteoporosis, gum disease, gum bleeding, burning tongue/gums/mouth, changes in taste. |
| What two things should you advise/do if woman has xerostomia? | Suggest salivary substitutes Give Fluoride for prevention of root caries |
| What general things should you advise for women in menopause? (2) | Advise on dietary supplements (calcium, vit. D) Emphasize relationship between general health, oral health and immunity with age. |
| Almost ALL female risk considerations can be PREVENTED with what? | INFORMATION |
Created by:
Saylorlee5