temas parciales 1

What is a gastric ulcer?

An ulcer caused by impairment of the gastric mucosal defense mechanisms.

What is a duodenal ulcer?

An ulcer associated with increased acid production.

What microorganism is strongly associated with chronic active gastritis and peptic ulcers?

Helicobacter pylori (H. pylori).

What medications are important risk factors for peptic ulcers?

NSAIDs and steroids.

What is the main clinical symptom of peptic ulcer disease?

Epigastric pain that may radiate to the chest, back, or abdomen.

What are signs of a complicated peptic ulcer?

Melena, hematemesis, anemia, weight loss, or obstruction.

How is H. pylori-associated peptic ulcer disease treated?

Antibiotics combined with gastric acid suppressants for approximately 4–8 weeks.

What antibiotics are listed for H. pylori treatment?

Clarithromycin, amoxicillin, metronidazole, levofloxacin, and tetracycline.

How should patients with esophageal reflux be positioned during dental treatment?

Avoid prolonged supine positioning.

Which analgesics should be avoided in patients with peptic ulcer disease?

NSAIDs and steroids.

What analgesic is recommended instead for short-term pain control?

Acetaminophen.

What oral problem can result from hyposalivation?

An increased risk of caries and periodontal disease.

What can be recommended for patients with hyposalivation who wear removable or complete dentures?

Artificial saliva and prosthetic adhesives.

What dental treatment is recommended for tooth sensitivity caused by erosion?

Topical fluoride.

What oral manifestation can occur with esophageal reflux?

Dysgeusia.

What mouthwash is recommended for dysgeusia?

A sodium bicarbonate mouthwash.

Why is strict plaque control important in patients with current or previous H. pylori peptic ulcer disease?

To maintain good oral health and reduce the risk of caries and periodontal disease.

When should a CBC be considered in a patient with peptic ulcer disease?

When signs of anemia are present.

What oral findings can result from dental erosion?

Tooth sensitivity to temperature changes and dysgeusia.

What mucosal changes can occur with esophageal reflux?

Erythematous areas on the palatal or buccal mucosa.

What oral pigmentation can occur with frequent use of bismuth-containing antacids?

Black pigmentation of the lingual papillae and dorsum of the tongue.

What is an important interaction between histamine receptor antagonists and amide local anesthetics?

They can increase systemic toxicity of local anesthetics by reducing hepatic clearance.

What is the interaction between cimetidine and oral antifungals?

Cimetidine can impair their absorption by increasing gastric pH.

What happens when calcium, aluminum, or magnesium salts are taken with tetracycline or erythromycin?

Chelation can occur, reducing drug absorption.

What is the important interaction between prednisone and NSAIDs or aspirin?

They can have synergistic gastrointestinal irritation, increasing the risk of peptic ulcer and severe GI bleeding.

What are the main liver functions relevant to dental management?

Metabolism and clearance of harmful substances, synthesis of coagulation factors, and storage of glycogen, cholesterol, triglycerides, and vitamin B12.

What is cirrhosis?

Replacement of injured or destroyed hepatocytes with non-functional fibrous scar tissue due to chronic inflammatory injury.

What are major causes of cirrhosis?

Chronic alcohol abuse, hepatotoxic medications, obesity/non-alcoholic steatohepatitis, and viral hepatitis, especially hepatitis C.

What is portal hypertension?

Increased vascular resistance in the portal circulation caused by hepatocyte loss and fibrosis.

What causes jaundice in cirrhosis?

Accumulation of bilirubin resulting in hyperbilirubinemia.

How can biliary obstruction affect vitamin absorption?

It can reduce absorption of fat-soluble vitamins, especially vitamins D and K.

Why are patients with cirrhosis at increased risk of bleeding?

They may have coagulation factor deficiencies and thrombocytopenia.

Why must medications be carefully selected in patients with hepatic impairment?

Impaired hepatic clearance can cause drug accumulation and toxicity, requiring dosage adjustments.

What local hemostatic agents can be used during dental procedures in cirrhotic patients?

Gelfoam, Hemostal Gel, Urgosorb, and BioGlue.

What are important oral manifestations of liver disease?

Angular cheilitis, a smooth glossy tongue from atrophic glossitis, hepatic halitosis, bleeding tendency, petechiae, ecchymosis, and hematomas.

How can impaired vitamin D absorption affect dental treatment?

It can alter bone metabolism and compromise bone healing after dental extractions.

What is hypertension?

A persistent blood pressure greater than 140/90 mmHg, based on 3 or more readings.

What are the four stages of hypertension?

Stage 1: 140–159/90–99; Stage 2: 160–179/100–109; Stage 3: 180–209/110–119; Stage 4: >210/>120 mmHg.

What is the formula for blood pressure?

Blood pressure = Cardiac Output × Peripheral Vascular Resistance.

What is primary hypertension?

Hypertension without an identifiable specific cause.

What is secondary hypertension?

Hypertension caused by an identifiable underlying condition or factor.

What system plays an important role in regulating blood pressure through sodium and water retention?

The renin-angiotensin-aldosterone system (RAAS).

When can dental treatment generally proceed in a patient with Stage 1 hypertension?

When the patient is asymptomatic, has no target-organ damage, and is receiving treatment.

What is the maximum epinephrine dose listed for a patient with Stage 1 hypertension?

0.2 mg.

What is the maximum epinephrine dose listed for a patient with Stage 2 hypertension?

0.054 mg, or a maximum of 3 cartridges.

Why should epinephrine retraction cord be avoided in patients with cardiovascular risk?

It can produce significant systemic absorption of epinephrine and cardiovascular stimulation.

What is coronary heart disease (CHD)?

A condition in which coronary blood flow is obstructed, causing myocardial ischemia.

What is the most common cause of coronary artery obstruction?

Atherosclerosis caused by lipid deposition in the arterial walls.

What is angina pectoris?

Chest pain caused by temporary myocardial ischemia without permanent myocardial necrosis.

What does typical angina pain feel like?

An oppressive or squeezing pain that may radiate to the left shoulder or arm.

How long does a typical angina episode usually last?

Usually less than 20 minutes.

What commonly triggers stable angina?

Physical exertion, emotional stress, extreme temperatures, or heavy meals.

What is the difference between stable and unstable angina?

Stable angina is predictable and usually triggered by exertion; unstable angina is unpredictable and may occur at rest.

What is Prinzmetal angina?

Angina caused by coronary artery vasospasm.

What is Syndrome X in the context of angina?

Chest pain associated with myocardial ischemia despite normal or non-obstructed coronary arteries.

What medications are commonly used to treat acute angina?

Nitrates, especially nitroglycerin.

What is a myocardial infarction (MI)?

Irreversible necrosis of cardiac muscle caused by acute myocardial ischemia.

How does MI pain differ from typical stable angina?

MI pain generally lasts more than 20 minutes and is associated with prolonged acute ischemia.

What should be done if a patient develops angina during dental treatment?

Stop treatment, place the patient comfortably, administer prescribed nitroglycerin, and monitor the patient.

When should elective dental treatment generally be provided after a myocardial infarction according to the presentation?

After a 6-month period.

What should be evaluated before dental treatment in a patient with a history of MI?

Blood pressure and cardiac rhythm, with medical referral when indicated.

What type of anesthetic approach is suggested for patients with significant cardiovascular disease when vasoconstrictors are a concern?

Use an appropriate anesthetic without adrenergic vasoconstrictors; the presentation specifically lists felypressin for emergency situations.

Which injections should be avoided in patients at cardiovascular risk?

Intraligamentary and intraosseous injections when they could cause rapid systemic absorption of vasoconstrictor.

What is tachyarrhythmia?

An abnormally fast heart rate, generally greater than 100 beats per minute.

What is bradyarrhythmia?

An abnormally slow heart rate, generally less than 60 beats per minute.

What should be done with dental treatment in a patient with refractory arrhythmia according to the presentation?

Dental treatment should not be provided.

What is an important dental consideration when changing the patient's chair position?

Avoid sudden changes in position because they can cause cardiovascular symptoms such as dizziness or hypotension.

Why may diazepam be used in patients with cardiovascular disease?

To reduce anxiety and stress associated with dental treatment.

What is the recommended diazepam dose listed for cardiovascular dental management?

2–5 mg.

Why should NSAIDs be used cautiously in patients taking antihypertensive medications?

NSAIDs can reduce the effectiveness of antihypertensive drugs.

What oral adverse effects can antihypertensive medications cause?

Xerostomia, gingival hyperplasia, lichenoid reactions or black tongue, and taste alterations.

What are the main functions of the kidneys?

They filter blood, eliminate nitrogenous waste and organic solutes, regulate body fluids and blood pressure, control erythropoiesis, regulate electrolytes and pH, metabolize calcium/vitamin D, and contribute to glucose regulation.

What hormone produced by the kidneys stimulates red blood cell production?

Erythropoietin.

What happens to red blood cell production when renal function is impaired?

It becomes altered and can cause anemia.

How do the kidneys regulate electrolyte and pH balance?

Through reabsorption of water, glucose, and amino acids and excretion of sodium, potassium, and hydrogen.

What role do the kidneys play in calcium metabolism?

They perform tubular calcium filtration and activate vitamin D.

What is acute kidney disease?

Kidney disease occurring after injury to the renal tubules.

Are patients with acute kidney disease candidates for elective dental care?

No. They may require dialysis and are frequently hospitalized.

What is chronic kidney disease (CKD)?

An incremental, irreversible loss of kidney function developing over months or years, with sustained uremia.

What are the two major causes of CKD?

Diabetes mellitus and arterial hypertension, accounting for 70%.

What is the GFR for Stage 1 CKD?

Greater than 90 mL/min.

What is the GFR for Stage 2 CKD?

60–90 mL/min.

What is the GFR for Stage 3 CKD?

30–60 mL/min.

What is the GFR for Stage 4 CKD?

15–30 mL/min.

What is the GFR for Stage 5 CKD?

Less than 15 mL/min.

What gastrointestinal manifestations can uremia cause?

Gastrointestinal irritation, esophagitis, gastritis, and possible bleeding.

What skin and mucosal changes can occur in CKD?

Pale/whitish, dry, and pruritic skin.

What neurological and muscular problems can occur in CKD?

Neuromuscular irritability, conduction defects ranging from hypermobility to paralysis, and impaired brain function.

Why can CKD cause hypertension?

An altered renin-angiotensin system promotes increased blood pressure.

What are the main medical treatments for CKD?

Dietary counseling, management of secondary hypertension, peritoneal dialysis or hemodialysis, and renal transplantation.

What should the dentist determine before treating a patient with CKD?

The disease stage and whether the patient is managed pharmacologically/dietarily, dialysis-dependent, preparing for transplantation, or post-transplant.

What precautions are needed for periodontal, endodontic, or oral surgical procedures in CKD patients?

Close collaboration with the attending physician and careful attention to hemostatic and hematologic parameters.

Why are hepatitis B and C tests considered in CKD patients?

Because of the high risk of cross-contamination.

What dental drugs are listed as potentially nephrotoxic?

Penicillins, cephalosporins, conventional NSAIDs, COX-2 inhibitors, amphotericin B, caspofungin, acyclovir, ganciclovir, and antiretrovirals.

What is uremic bleeding and how can it present orally?

Bleeding associated with uremia that can present as ecchymosis, purpura, or epistaxis.

What dental developmental defect can occur after severe renal damage during tooth development?

Enamel hypoplasia secondary to abnormal calcium metabolism.

What is Chronic Obstructive Pulmonary Disease (COPD)?

A chronic pulmonary disorder characterized by airflow limitation from the lungs that is not fully reversible.

What is chronic bronchitis?

Chronic inflammation of the bronchi with excessive tracheobronchial mucus production and persistent cough with sputum for at least 3 months in at least 2 consecutive years.

What is emphysema?

Permanent enlargement of lung air spaces accompanied by destruction of their walls without obvious fibrosis.

What is the major risk factor for COPD?

Smoking; risk increases with the number of cigarettes smoked per day and duration of smoking.