BOARD REVIEW MEDICAL CONDITIONS

ASA 1

This ASA classification describes a normal healthy patient with little to no dental anxiety.

ASA 2

This ASA classification describes a patient with mild systemic diseases, allergies, well-controlled chronic conditions (e.g., controlled hypertension, diabetes without systemic effects, mild lung diseases), upper respiratory infections, current smoker, 30

ASA3

This ASA classification describes a patient with severe systemic diseases and some functional limitation.

-hepatitis

-poorly controlled hypertension, diabetes, COPD

-alcohol dependence

-chronic renal failure with regular dialysis

-history (over 3 months since episode) of myocardial infarction, stroke, stents, etc.

ASA 4

This ASA classification describes a patent with severe systemic disease that is a constant threat to life.

-recent (under 3 months since episode) of myocardial infarction, stroke, stents, etc.

-possible risk of death

-unstable angina

-symptomatic COPD

-symptomatic CHF

-hepatorenal failure

ASA 5

This ASA classification describes a moribund patient not expected to survive without surgery.

ASA 6

This ASA classification describes a brain-dead patient.

Arteriosclerosis (hardening of the arteries)

Blood vessels loose elasticity, become thick and stiff, sometimes restricting blood flow to the organs and tissues

Atherosclerosis

A type of arteriosclerosis in which arteries become hardened due to plaque (fats, cholesterol, and other substances) build up. This plaque can cause a blood clot in the arteries. If this happens in an artery supplying the heart muscle, it a cause a heart attack. If this happens in an artery supplying the brain, it can cause a stroke. Also called the silent killer. Hypertension is the most prevalent cause of stroke and kidney failure.

Normal

A blood pressure reading where the systolic is <120mmHg and the diastolic is <80mmHg

Elevated

A blood pressure reading where the systolic is 120-129 mmHg and the diastolic is <80mmHg

Doctors are likely to suggest lifestyle modifications to bring your blood pressure down to normal.

Hypertension stage 2

A blood pressure reading where the systolic is at or above 140mmHg and the diastolic is at or above 90mmHg

Physicians are likely to prescribe a combination of blood pressure medications along with lifestyle modifications.

Hypertension stage 1

A blood pressure reading where the systolic is 130-139 mmHg and the diastolic is 80-89mmHg

Physicians will likely prescribe lifestyle modifications and may consider adding blood pressure medication based on your risk of atherosclerotic cardiovascular disease.

Hypertensive crisis

A blood pressure reading where the systolic is at or above 180mmHg and the diastolic is >120mmHg

Need to get to a hospital right away.

Corinary artery disease

Narrowing of the arteries that supply blood to the heart.

heart attack (myocardial infarction)

Sudden blockage of blood flow to the heart

Heart failure

This condition involves the weakening of the heart's ability to pump blood effectively.

High blood pressure

This condition can contribute to the development of various heart conditions including:

Coronary artery disease, heart attack, heart failure, arrhythmias, stroke, kidney disease, eye problems, peripheral artery disease, aneurysm, metabolic syndrome, and cognitive decline and dementia

Retinopathy

damage to the blood vessels in the retina. Hypertension is a contributing factor

Aneurism

Weakened areas in the blood vessel walls that can potentially rupture and cause like-threatening bleeding.

Metabolic syndrome

A cluster of conditions that include high blood pressure, high blood sugar, abnormal cholesterol levels, and excess abdominal fat. Increases the risk of heart disease, stroke, and diabetes.

Avoid Levonordefrin reduce amount of epinephrine

When a patient has hypertension you should consider the use of vasoconstrictors. Avoid ————————- and reduce amount of ————————- in local anesthetics. The 2 chemicals are vasoconstrictors, and can make hypertension worse by increasing blood pressure.

Levonordefrin

What is the more potent vasoconstrictor out of Levonordefrin and epinephrine?

Calcium channel blockers

Gingival hyperplasia is related to the use of this medication that is used to treat hypertension.

Diuretics and beta-blockers

These 2 types of medications are used to treat hypertension. They can both (2) cause xerostomia.

5 minutes or less

Usually an angina attack lasts for a short time. Approximately:

Stage I

An adult patient's blood pressure reading was 130/76 mmHg. What category are they in?

Normal, elevated, stage I, stage II, or hypertensive crisis

Stage I

An adult patient's blood pressure reading was 118/86 mmHg. What category are they in?

Polishing paste

You should check the sodium content in this of the patient has hypertension, as it can make the condition worse.

COPD chronic obstructive pulmonary disease

Group of lung diseases that block airflow in the lungs. Chronic bronchitis (blue bloater): inflammation of the brinchial tree which scretes excessice mucous. Emphysema (pink puffer): air sacs (alveoli) at the end of the smaller air passages (bronchioles) in the lungs are gradually destroyed, barrel chest. Etiology is closely related to smoking. Most common in adults and conditions are chronic. Symptoms include shortness of breath, cough, sputum, and wheezing (asthma like symtoms). Oral conditions: candidiasis and xerostomia from inhaler use.advise pts to rinse w water after. Avoid U/S scaler and air polishing. Patients may not be able to breathe easily in supine position, may need supplimental oxygen. Avoid nitrous oxide.

Cystic fibrosis

Lungs produce abnormally thick and sticky mucous that blocks alveoli and can become infected. Symptoms include persistent coughing or wheezing, and weight loss.

Diabetes

Metabolic disease related to insulin that is produced in the pancreas.

Insulin

Hormone needed to convert sugar, starches, and other food into energy for daily life.

Type 1 diabetes (IDDM) insulin dependant.

The body cannot produce insulin. Autoimmune destruction of the pancreatic Beta cells. Affects 5% of the population, usually peaks at the age of 20. Patient can experience the 3 Ps: polydipsia (excessive thirst), polyuria (excessive urination), and polyphagia (excessive appetite).

Ketoacidosis

When the body cells do not get the glucose they need for energy, the body burns fat, which produces ketones. Ketones are acids that circulate in the blood. This lowers the pH of the blood, and lead to coma or death. (Normal blood pH is around 7.4 but can lower with this). Can be obvious by the smell of a person’s breath, referred to as fruity breath. Tx: insulin injections or pulp therapy, proper diet, exercise.

Type II diabetes (NIDDM) non insulin dependent

The body cannot produce enough insulin or cannot use insulin properly. Over 90% of the diabetic cases. Obesity is a common finding. Tx: insulin therapy, proper diet, exercise. T

Alpha cells

The pancreas is composed of the alpha and beta cells. These cells produce glucagon that stores glycogen in the liver if the blood glucose levels are too low.

Beta cells

The pancreas is composed of the alpha and beta cells. These cells produce insulin to allow glucose to enter into cells.

diabetes mellitus

Cardiovascular problems including atherosclerosis, high BP, and stroke. Retinopathy: vision problems, cataracts, blindness. Nephropathy: renal failure. Neuropathy: loss of sensation in the extremities. Gangrene of the feet: death of the body tissue from lack of blood flow or bacterial infection, slow healing. Hyperglycemia, hypoglycemia. Oral conditions: pts are susceptible to infection (PD and oral candidiasis) and show poor wound dealing. Xerostomia, parotid gland enlargement, loss of taste, burning mouth syndrom.

Above 240mg/dL

Hyperglycemia (diabetic coma) occurs when there is too much sugar in the blood. Above how much mg/dL. Too little insulin. Symptoms include drowsiness, thirst, and fruity breath.

Below 70mg/dL

Hypoglycemia (insulin shock) occurs when there is not enough sugar in the blood, below how much mg/dL, too much insulin. Symptoms: increased heart rate, fast breathing, dizziness, shakiness, numbness. Most common adverse reaction of diabetes medication.

Thyroid

This gland plays an important role in regulating the body’s metabolism and calcium balance. Iodine and tyrosine are used to produce thyroxine (T4) and triiodothytonine (T3) in this gland.

Pituitary gland

The thyroid gland is stimulated by thyroid stimulating hormone (TSH) from the what gland? Located in the brain stem.

Hyperthyroidism

Excessive production of thyroid hormone from the thyroid gland. The body's metabolism increases.patient can experience exophthalmos (bulging of the eyes), heat intolerance, fatigue, insomnia, dyspnea (shortness of breath), tachycardia, weight loss, muscle weakness, etc.

Grave's disease

Autoimmune disease caused by antibodies that attach to specific sites of the thyroid gland and cause an overproduction of hormones. A thyroid storm (thyrotoxic crisis) may occur if the hyperthyroidism is left untreated. Call 911.

Oral conditions: early loss of deciduous teeth, early eruption of permanent teeth, large mandible, osteoporosis of alveolar bone causing more progressive periodontal disease.

Hyperpituitarism

Both giantism and acromegaly are caused by this condition:

Giantism

Overproduction of growth hormone is children produces this condition:

Acromegaly

Caused by an increase in growth hormone during adulthood. Oral conditions: enlargement of the maxilla and mandible causing separation of the teeth and malocclusion, thickened lips, and macroglossia.

Adrenal glands

Small triangular glands located on top of both kidneys and produce hormones important to all parts of the body. Outer organ= ——————— cortex secretes corticosteroid and aldosterone that regulate the level of sodium and potassium, maintain blood volume and blood pressure.

Inner organ= ——————— medulla produces epinephrine (also called adrenaline) and norepinephrine to help the body respond to a stressful situation by increasing the heart rate and the force of heart contractions.

Addison's disease (hypocortisolism)

Hyposecretion of cortisol and aldosterone by the adrenal glands. Caused by the destruction of the adrenal cortex (outer layer). Symptoms: skin pigmentations, weakness and fatigue, low tolerance for stress, low blood pressure, and susceptibility to infections, rapid heart, and respiratory rates.

Oral conditions: pigmentation on oral tissues.

Adrenal crisis: sudden appearance of symptoms triggered by excessive stress.

Cushing's syndrome (hypercortisolism)

This is basically the opposite of Addisons disease. Hypersecretion of cortisol by the adrenal glands. Symptoms: weight gain, fatty tissue deposits in the face and body creating a "moon face" and "buffalo hump".

Blood sugar too high, insulin level low

Diabetic ketoacidosis (DKA) happens when blood sugar is too: (high or low?)

Type II

This type of diabetes is considered non-insulin dependent. No medications can cure but some may increase the production of insulin while others may imporove insulin resistance. Some meds include: biguanides, sulphonylureas, alpha glucosidase inhibitors, thiazolidinediones, DPP-4 inhibitors, SGLT2 inhibitors, and insulin injections. Healthy diet and exercise are the first steps in controlling blood sugar levels.

Hepatitis

Inflammation of the liver caused by the ——————— viruses, toxic substances (e.g., alcohol, certain drugs), and autoimmune diseases. The condition can be self-limiting or can progress to fibrosis (scarring), cirrhosis or liver cancer. There are 5 main ——————— viruses, referred to as types A, B, C, D, and E. dental health care workers should be vaccinated against ——————— B. No vaccines for type C at this time. ——————— virus can live outside the body for at least 7 days. Symptoms include fatigue, dark urine, and jaundice.

Hepatitis B and C

These 2 type of hepatitis are transmitted through blood or other body fluids.

Hepatitis A and E

These 2 types of hepatitis are transmitted indirectly through contaminated food and water.

Hepatitis D

This type of hepatitis is a piggyback virus that is linked to hepatitis B.

Tuberculosis (TB)

Bacterial infection of the lungs caused by the bacterium Mycobacterium tuberculosis. Spread through airborne particles, when an infectious pt coughs, sneezes, talks, etc. PPD (purified protein derivative), aka the Mantoux skin test is an antigen used to test for this bacterial infection. The swelling is read after 48-72 hours after the antigen is injected. Postpone pts who have active —— or who are suspected to have it.

AIDS/HIV

human immunodeficiency viruses invade T lymphocyte cells (CD4 helper cells), inject their RNA, and take over the replication stage to produce new viruses. Eventually the CD4 cell count falls below 200 cells/mm3 of blood. Body becomes weak, the original infection leads to the more advanced version. People diagnosed with ———— typically survive for 3 years or mote. Death is usually due to an opportunistic infection. The body cannot get rid of this infection. Symptoms: flu-like symptoms and chronic infection. only transmitted through blood, semen, rectal fluids, vaginal fluids, and breast milk.

500-1600 cells/mm3

Normal CD4 count (T lymphocyte) is:

Candidiasis

The most common intraoral manifestation for HIV

Linear gingival erythema

Intraoral condition associated with HIV. Darker colour band along the gingiva margin.

Hairy leukoplakia

Intraoral condition associated with HIV. White lesion on the lateral boarder of the tongue.

Kaposi's sarcoma

Intraoral condition associated with HIV. Red/purple, flat/raised lesion on the hard palate, tongue, and/or gingiva.

NUG/NUP

Intraoral condition associated with HIV. Ulceration and necrosis of the gingiva with or without periodontist attachment loss.

CD4 count lower than 200/mm3, neutrophil count lower than 500/mm3

Prophylactic antibiotics are recommended for invasive procedures if the CD4 count is lower than what and if the neutrophil count is lower than what. Because the patient is susceptible to opportunistic infection.

Syphilis

Disease caused by the spirochete bacterium Treponema pallidum. Usually transmitted via direct sexual contact. Develops in stages. Stage 1 (primary): highly infectious lesions appear about 3 weeks after exposure. Lesions are called chancres, and heal in about 6 weeks w/o tx.

Stage 2 (secondary): occurs about 6 weeks after primary lesion. Lesions called mucous patches, multiple, painless w/ gray/white plaques covering ulcerated mucosa. Latent: period of no symptoms, can last years, if no tx, symptoms reappeat or develop into tertiary.

Tertiary: if condition not treated, disease may damage brain, nerves, heart, etc. these lesions are called “gumma” and are non-infectious.

infectious mononucleosis

“Kissing disease”. Caused by the Epstein-Barr virus. Symptoms including sore throat, fever, extreme fatigue, lymphadenopathy, etc. can appear 4-6 weeks after the infection. Common among teenagers and young adults. Spread through bodily fluids, especially saliva. Maintain good hydration.

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Alcohol dependency

Patients usually suffer from malnutrition, especially thiamine (B-1) and folate (B-9) deficiency. Oral conditions: ——————— and tobacco used in combination significantly increases the risk of oral cancer. Teach patients to perform self-oral cancer exams. Avoid alcohol containing mouthwashes and nitrous oxide.

pernicious anemia

Type of anemia caused by vitamin B-12 (cobalamin) deficiency. This is triggered by a lack of intrinsic factor. Intrinsic factor is secreted by the parietal cells of the stomach and helps the absorption of vitamin B-12 in the small intestine. Without instrinsic factor, vitamin B-12 leaves the body as waste.

Anemia

Drop in oxygen-carrying hemoglobin in red blood cells.

Folate deficiency anemia

Type of anemia caused by B-9 (folic acid) deficiency

Sickle cell anemia

Type of anemia caused by abnormal (sickle-shaped) red blood cells. These abnormal cells can get stuck in small blood vessels and slow/block blood flow and oxygen to the body. More commonly affects African-Americans. Bone loses trabeculae and appears to have irregular and large bone marrow spaces on rads. The changes in the skull is described as hair-on-end pattern because the trabeculae radiate outward.

Symptoms include weakness, pallor, impaired memory, paresthesia of the hands and feet, and fatigue.

Oral conditions: pallor of oral tissues, ulcerations, glossitis, loss of papillae on dorsal surface of tongue (filiform papillae).

Hemophilia

Disorder in blood coagulation that results in prolonged bleeding. Plasma proteins involved in the coagulation cascade necessary for the conversion of fibrinogen to fibrin are insufficient. Type A and B. Oral conditions: spontaneous gingival bleeding, hematoma, and ecchymosis. Pts should maintain healthy soft tissues to prevent gingival bleeding. Prolonged cleaning and hemorrhage after dental procedures may happen.

Type A hemophilia: Plasma thromboplastinogen ( or factor VIII ) deficiency.

This is the most common type of hemophilia

Type B

This type of hemophilia is due to Plasma thromboplastin ( or factor IX) deficiency, AKA Christmas disease.

Von Willebrand Disease

Genetic condition causes extended or excessive bleeding. Von Willebrand factor is a protein for clotting blood. Symptoms include red/blue discoloration of the skin or mucosa, excessive bleeding, frequent nosebleed, easy bruising, etc. patients may have prolonged bleeding and hemorrhage after dental procedures. When patients present with bruise-like marks, before suspecting abuse, review medical history for this.

Leukemia

Cancer of the body's blood forming tissues. Including bone marrow and the lymphatic system. Results in an excessive number of abnormal white blood cells. Acute ——————— primarily affects children and young adults. Has a good prognosis. Chronic ——————— primarily affects middle-aged adults, progression is slow. Symptoms include fatigue, unexplained bruising, infections, paleness, weight loss.

Oral conditions: gingiva enlargement, NUG, bleeding gums, pallor of the lips and gingiva, petechiae and ecchymosis of the palate.

500/mm3

If the neutrophil count is less than what, preprocedural prophylactic antibiotics should be administered.

50 000/mm3

If platelet count is less than what, postpone treatment.

Agranulocytosis

Significant reduction in circulating granulocytes (neutrophils, eosinophils, and basophils) which plat an important role in the immune system. Normally there are at least 1500 per microliter of blood. Granulocytopenia: the level is between 100-1500 per microliter of blood. Agranulocytosis: the level drops below 100 per microliter of blood. Leads to chronic infections and can be life-threatening. Oral conditions: necrotizing ulcerations, bleeding gingiva, and rapid destruction of the periodontium.

Cyclic neutropenia

Inherited disorder with repeated decrease in the number of neutrophils for a short period (2-3 days). Neutrophils make up 60-70% of circulating WBCs and serve as the primary defence against infections. The normal neutrophil count is 1500-8000 per microliter of blood. Symptoms: fever, malaise, sore throat, occasional cutaneous infections. Periodontal disease is initiated and worsened during these periods. When neutrophils return to normal, oral lesions tend to improve. Over time, episodes will lead to severe periodontal disease. Tx should be initiated when circulating neutrophil count is normal.

Prothrombin (PT)

This is a blood test used to evaluate clotting function and monitor anticoagulant therapy with warfarin (Coumadin). Normal range is 11-13.5 seconds.

Partial prothrombin (PTT)

This test also evaluates blood clotting ability of the body. The normal range for this test is 25-35 seconds.

INR (international normalized ratio)

Most physicians use this when measuring blood clotting time. This is the ratio of a patients PT in comparison to a normal (control sample). The value of this is 0.8-1.1 in healthy patients. Patients on warfarin are often treated with a therapeutic ——— goal of 2.0-3.5. Patients with an ——— value of 3.5 and higher are at a particularly high risk for prolonged bleeding.

Cerebral palsy

Caused by an abnormality or disruption in brain development, usually before the child is born. Symptoms: lack of controlled muscle movements and involuntary muscle movements. Intellectual disability only affects less than half of the pts and learning disability is usually caused by sensory impairment. Oral conditions: grooming, gag reflex, difficulty opening mouth. Gingival hyperplasia from seizure meds, trauma on oral cavity from repeated falling, bruxism, attrition, etc. mouth breathing, tongue thrusting, high caries risk and high PD risk.

C-2, C-3

A spinal injury at this level means the patient will have limited head and neck movement, patient depends on ventilator.

C-4

A spinal injury at this level means the pt will have arm and leg paralysis with possible respiratory problems.

C-5

A spinal injury at this level involves limited shoulder control, patient can perform daily tasks of eating.

C-7

Spinal injury at this level means the pt has hand, wrist, elbow , shoulder movement. Can perform self care.

T-1 to T-2

A spinal injury at this levels means the patient has normal motor function of the upper body (head, neck, shoulders, arms, hands, and fingers with increased used of rib, abdominal., and trunk). Patient may independently use wheelchairs, crutches, or other aids to walk.

Spina bifida

Neural tube defect caused by failure of the spine to develop and close properly during the first month pf pregnancy. Results in the incomplete development of the brain and spinal cord. Different degrees of permanent paralysis exist. Meningocele: protrusion of the meninges and cerebrospinal fluid from an open body defect of the spinal column. Hydrocephalus: buildup of fluid in the brain that puts pressure on it. Etiology of the condition includes folic acid (B-9) deficiency. Latex allergy occurs frequently in patient with this.

Bell's palsy

Unilateral facial muscle paralysis affecting the 7th (VII) cranial nerve. Most patients recover in 3 weeks or up to 6 months. Symptoms: unilateral facial paralysis, drooling, inability to close the eye on the affected side.

Lupus erythematous

Autoimmune disease causing damage to the joints, skin, kidneys, heart, lungs, blood vessels, and brain. The condition can be triggered by UV rays, medications, viruses, stress, etc. a butterfly-shaped rash on the nose unfolding across both cheeks occurs in many, but not all cases.

Multiple sclerosis (MS)

Immune system attacks the myelin sheath covering of the nerves, disrupting the communication between the brain and the body. Affects mostly young adults. Experience moments of symptoms followed by periods of remission. Treat patient during remission. Wide range of symptoms including fatigue, slurred speech, muscles spasms, short term memory loss. Pt can experience heat sensitivity.

Muscular dystrophy

Group of genetic diseases in which muscle fibres are unusually susceptible to damage. Duchenne syndrome: affects infants and young children (ages 3-5) especially male. Weakness starts with the lower body, then spreads through the whole body. Children are unable to walk by the age of 12, and life expectancy is around 25.

OsteoArthritis

Damage to the cartilage of the joints (the hard, slick coating on the ends of the bones). Enough damage can result in bone grinding directly on bone. Most common type of arthritis in the united states.

Rheumatoid arthritis

Damage to the lining of the joint capsule (a tough membrane that encloses all the joint parts). Can eventually destroy cartilage and bone within the joint. More common in women. Symptoms include joint tenderness, swelling and stiffness that worsten with age. Pts mau have TMJ problems. The use of aspirin for inflammation can cause prolonged bleeding. Medications such as corticosteroids can suppress the immune system.

Marian syndrome

Genetic disorder that affects the body's connective tissue. Patients are usually very thin, tall, and often have heart problems. Oral conditions: high palate, narrow jaw, crowding of teeth, and malocclusion.

Amyotrophic lateral sclerosis (ALS)

Also called Lou Gehrig's disease, it is a progressive neurodegenerative disease that affects motor neurons from the brain to the spinal cord. Eventually leads to death. Most commonly occur in ages 40-60. Symptoms: muscle weakness, twitching, shortness of breath, etc. mental ability remains mostly the same as before the onset.