DH 206: Comprehensive Module 5 Case Study on Pharmacological Interventions in Dentistry

Marianne K. is a 54-year-old woman who is finishing her last round of radiation for squamous cell carcinoma of the tongue. She also had a partial glossectomy and is taking speech therapy to help her to accommodate to her oral changes. The radiation oncologist has referred her to your clinic for prevention of radiation caries and for treatment of her severe xerostomia. When she comes to your clinic, she tells you that she has been sucking on lemon drops to help with her "dry mouth," and you see many decalcified areas on the cervical areas of all her teeth. She is also experiencing "terrible mouth sores."

1. Which medications could be prescribed to increase Marianne's salivary flow?

* A and C only

a. Pilocarpine (Salagen) and c. Cevimeline hydrochloride (Evoxac)

Which medications or treatments would help with the mouth sores Marianne is experiencing?

a. Diphenhydramine (Benadryl)

b. Systemic analgesics

c. Immaculate oral hygiene

d. Sodium carboxymethylcellulose paste (Orabase)

e. Topical steroids, such as fluocinonide or betamethasone

g. All of the above medications and treatments

The dental hygienist can provide all measures to prevent further decalcification and cervical caries caused by the xerostomia and damage to the salivary glands except which of the following?

Custom fluoride tray with acidulated phosphate fluoride

Marianne is suffering from depression as a result of the pain and disfigurement she has suffered with her cancer and its treatment. What special considerations should her physician make when prescribing antidepressants?

The antidepressant could cause additional xerostomia.

The immunosuppression caused by the radiation therapy triggered a severe attack of recurrent herpes simplex 1, and Marianne is in so much pain that she is unable to eat. Which medications could shorten the duration of her outbreak?

Penciclovir (Denavir)

Noreen F. is expecting her third child and is at the clinic for prenatal counseling. When she meets with the nurse, she asks what she can do to prevent the new baby from having "rotten teeth like my older kids." The nurse determines that Noreen's 4-year-old and 2-year-old suffer from early childhood caries, and both have had full mouth restorations with stainless steel crowns. The nurse refers Noreen to a pediatric specialist. At the dental office, the dental hygienist meets with Noreen to discuss preventive measures for her new baby and for the older children.

6. Which fluoride application would be most appropriate when the new baby's teeth erupt?

Sodium fluoride (NaF) varnish

Because of the older children's caries history, Noreen's pediatrician prescribes fluoride drops for the newborn in the amount of 1 mg a day. She and her family live in a city with water fluoridated at 1.2 ppm. Based on the current American Dental Association (ADA) recommendations, which of the following is the prescribed dose?

Excessive dose based on high caries risk and age of child

If Noreen follows the recommendations of her pediatrician and administers the fluoride drops to her new baby, what is the most likely outcome?

The infant's permanent teeth may develop moderate fluorosis.

The 4-year-old finds the bottle of fluoride drops and feeds the entire bottle to the newborn infant. What action should be taken?

Noreen should call 9-1-1, induce vomiting, give milk, and provide supportive care until the paramedics arrive.

In addition to fluoride, the dental hygienist makes several other recommendations to reduce the caries risk to Noreen's new baby and to the older children. All strategies would be helpful except which of the following?

Use of essential oil mouth rinses

Kathryn R. is a well-nourished 57-year-old Caucasian woman. She is 5 feet 5 inches tall and weighs 190 pounds. She reports a history of mitral valve prolapse with regurgitation. She is allergic to penicillin and tetanus toxoid. Her medications include Inderal, Lasix, lisinopril, nifedipine, potassium, and an aspirin a day. Her blood pressure is 150/96 mm Hg, and her pulse rate is 100 bpm. She comes to your dental hygiene clinic wanting her teeth "cleaned" because she reports that she is afraid of dentists and has not seen one in 10 years. Because of her fear, your instructor suggests that periodontal debridement be performed under local anesthesia. On seating Kathryn in your chair, you notice that her ankles are quite swollen. Her gingival tissue is enlarged and bleeds readily on probing. She has moderate horizontal bone loss and generalized pocketing of 6 to 8 mm. Her oral hygiene is fair, but she says she cannot get the floss "all the way back."

11. Which of Kathryn's medications could account for her gingival enlargement?

Nifedipine/Procardia

Which classification of medication is lisinopril?

Angiotensin-converting enzyme inhibitor

Which medication is most likely to relieve the swelling in Kathryn's ankles?

Furosemide/Lasix

Does Kathryn need to be prophylactically premedicated because of her mitral valve prolapse?

No, mitral valve prolapse is a condition for which prophylactic premedication is not indicated.

Kathryn has been diagnosed with moderate periodontitis. Which is the relationship between periodontal disease and cardiovascular (CV) disease?

There is a possible relationship between periodontal disease and CV disease.