Compromised patient

A-assessment

D-diagnosis

P-planning

I-implement

E-evaluate

D-document

What is the DH process?

120/80

Normal BP

12-20

Normal respiration

60-100

Heart rate normal

98.7

Normal temp

Less than <100 fasting

Blood glucose fasting normal ?

70-100

Post prandial after eating blood glucose range normal?

Determine patient needs and prepare the dental operatory, prepare wheelchair

Wheelchair transfer 2 person

2 person transfer is the best way to

Safest way transfer for wheelchair ?

A normal healthy patient

Asa 1

Patient with mild systemic disease

Asa 2

A patient with severe systemic disease

Asa 3

Patient with severe systemic disease

Asa 4

A moribund patient who is not expected to survive without the operation

Asa 5

Declared brain-dead patient whose organs are being removed for donor purposes

Asa 6

Feeding, dressing, grooming, bathing and toileting

What are basic activity's of daily living ? ADLs or BADL

Maintaining self-care regiments

Ability to make and keep dental appointments

Cooking

Shopping

Climbing stairs

Instrumental activities of daily living (IADL)

Ability to perform task without assistance

ADL Level 0

near normal functioning with some human assistance-may need a device but still independent

ADL Level 1

simulation of normal function with partial assistance

ADL Level II

Simulation of normal function with full assistance of third-party ( totally dependent)

Level III

C. To avoid orthostatic hypotension and prevent patient fall.

What is the primary reason a DH should raise the dental chair slowly for geriatric patients and allow the patient to sit upright for a few minutes before standing ?

A. To reduce the risk of syncope due to an anxiety.

B. To minimize nausea and following treatment.

C. To avoid orthostatic hypotension and prevent patient fall.

D. To help the patient rehydrate after long appointment.

B. Fear

Fear is a short term response to a specific identifiable threat in this case the needle .

A patient becomes visibly pants and begins sweating as the clinician prepares administer local anesthesia. The patient says I hate needles, but I'll be OK once it's done. What is the patient most likely experiencing?

A. Generalized anxiety.

B. Fear.

C. Panic disorder

D. Phobia.

C. Anxiety is vague, and anticipatory; fear is immediate and focused.

What which of the following best distinguishes anxiety from fear?

A. Anxiety is a short-term response. Fear is long-term.

B. Fear occurs without a known trigger anxiety always specific

C. Anxiety is vague, and anticipatory; fear is immediate and focused.

D. Anxiety triggered by real danger; fears imaginary.

Fear

Response to an immediate,identifiable treat. Short term and focus on specific danger. What is it ?

Anxiety

Response to vague, anticipated threat. Prolonged and can exist without a clear or present danger.

C. Bulimia Nervosa

Dental erosion from repeated vomiting is common and bulimia, cold intolerance, and lanugo are systemic signs due to nutritional deficiencies and altered metabolism

A 20-year-old female presents with smooth, shiny enamel loss on the palatal surfaces of her maxillary anterior teeth. She also reports cold intolerance and has visible fine body hair on her arms. What is the most likely underlying condition?

A. Anorexia Nervosa

B.gerd

C. Bulimia Nervosa

D. iron deficiency anemia.

Cold intolerance , growth of fine body hair.

Lanugo is ?

True

Deaf patients do not shout.

T or F

Pretend your are talking to them on the phone.

Service animal-do not pet or engage unnecessarily.

Blind patient 2 main concerns for proper care ?

2nd trimester

What trimester is SAFEST to treat pregnant patient ?

Daily fluoride because it's topical.

Not systemic because it can cross the placenta and end up with the baby.

Which fluoride would be best for pregnant woman : daily fluoride or systemic supplements ?

C. Turn her to the left side with a pillow under her right hip.

This positioning, relieves pressure on the inferior vena cava, improving blood flow and reducing the risk of supine hypotensive syndrome .

A pregnant patient in her second trimester begins to feel lightheaded while laying in the dental chairs. What is the most appropriate immediate response by the clinician?

A. Set the patient up quickly and give water.

B. Turn her to the right side with a pill under her left hip.

C. Turn her to the left side with a pillow under her right hip.

D. Place her in tredelenburg position.

D. Acetaminophen.

Tylenol is generally safe avoid ibuprofen .

Which of the following pain meds is generally considered safest during pregnancy?

A. Aspirin.

B. Ibuprofen.

C. Naproxen.

D. Acetaminophen.

C. Halitosis and Xerostomia

Alcohol leads to dry mouth and bad breath , increasing the risk for caries and periodontal disease.

Which of the following oral findings is most commonly associated with chronic alcohol use?

A.mottled enamel

B. Enlarged tonsils

C. Halitosis and Xerostomia

D. Blue-gray gingiva

C. Consult with patient physicians about the need for premed

Some IV drug users may be at risk for infective endocarditis ; medical consultation is needed before treatment.

Which of the following is the best initial step when treating a known IV drug user who may need invasive dental procedures ?

A. Administer prophylaxis antibiotic immediately

B. Delay tx for 6 months

C. Consult with patient physicians about the need for premed

D. Refer the patient to a specialist.

Ensure thorough oral cancer screening for everyone.

What is the most important thing about clients who use Nicotene products?

Ask- do you smoke or use nicotine

Advise- importance of quitting

Asses level of readiness to quit

Assist-let me know when you're ready

Arrange a quit date a week from now, arrange from follow up.

Tobacco counseling should include :

C. Let me know when you're ready.

This aligns with the assist phase when a patient is not yet ready to quit. Pushing them to set a quit date before they're ready would be premature .

During the dental hygiene appointment, the clinician ask the patient if they smoke explains the risks and offers resources to help quit. The patient says they're not ready to stop yet according to the five model of tobacco counseling which of the following is most appropriate next step?

A. Set a quit date one week from today.

B. Referred the patient to a smoking cessation program.

C. Let me know when you're ready.

D. Remind the patient they're harming their oral health.

B. Advice.

The hygienist is clearly advising the patient on the benefits of quitting, which is the second a in the five days model .

Hygienist learned that the patient smokes one pack of cigarettes per day. She tells the patient that quitting would greatly reduce the risk of perio disease and oral cancer which step of the five is this?

A. Ask.

B. Advice.

C.assist

D. Arrange.

C. Set a Quit day and provide follow-up support.

This falls under the arrange step once the patient is ready. The clinician should help them set a quit. They usually within one week and arrange follow up.

A patient says they're ready to quit smoking and would like support. according to the five days model, which is the most appropriate action?

A. Let me know when you're ready.

B. Tell them to try quitting cold turkey.

C. Set a Quit day and provide follow-up support.

D. Recommend they reduce to half a pack per day for now.

B. Bupropion (zyban)

Bupropion is an antidepressant used for smoking cessation . It can cause their stoma and interact with epinephrine so cautions advised in dental settings.

Which of the following smoking cessation medication's is classified as an anti-depressant in is known to cause Xerostomia and possible interactions with epinephrine?

A. Nicotine patch.

B. Bupropion (zyban)

C.Varenicline (Chantix)

D. Nicotine gum

B. Nicotine receptor agonist,Xerostomia

Chantix mimics nicotine to reduce withdrawal symptoms and their stoma is a common side effect

What is the mechanism of action for Chantix (varenicline) and what is the common oral side effect?

A. Antidepressant., mucositis

B. Nicotine receptor agonist,Xerostomia

C. Burning mouth, SSRI

D., Dopamine block, tooth sensitivity

May have drug interactions with epinephrine

Medication used to help quit smoking be cautious with what?

B. Increase risk of petechia and prolonged bleeding.

Liver damage from chronic alcohol use affects clotting factors, increasing bleeding, and the likelihood of petechia

A patient with a history of heavy alcohol use presents for dental treatment which of the following is a key concern during treatment planning?

A. Increase risk of syncope due to anxiety.

B. Increase risk of petechia and prolonged bleeding.

C. Reduce the risk of periodontal disease.

D. Improved wound healing.

C. It may lead to dangerously low blood pressure.

Alcohol and nitroglycerin are both vasodilators and can cause hypotension when combined .

What is the significance of combining alcohol use with nitroglycerin therapy?

A. It reduces the effectiveness of nitroglycerin.

B. It can cause dangerously high blood pressure.

C. It may lead to dangerously low blood pressure.

D. It enhances blood clotting.

C. Alcohol and tobacco.

When used together alcohol in tobacco center just to increase the risk of oral and orAl pharyngeal cancers.

Which of the following combinations significantly increases the risk for oral cancer?

A. Alcohol and caffeine.

B. Alcohol and sugar.

C. Alcohol and tobacco.

D. Alcohol and spicy foods.

Provide thorough, oral cancer screening.

Remember higher risk alcohol plus tobacco increases risk

What is the most important step for dental hygienist to treat clients with alcohol alcoholism?

Clients with alcoholism

What is the number one cause of pancreatitis?

B. Acetaminophen.

Tylenol is metabolized by the liver . Chronic alcohol used in parents, liver function, increasing the hep toxicity, even at normal doses. It should be used when extreme caution or avoided in these patients.

A patient reports consuming several alcoholic beverages daily. Which of the following medication should be avoided due to increase the risk of liver toxicity.

A. Ibuprofen.

B. Acetaminophen.

C. Amoxicillin.

D. Aspirin.

Metronidazole

Which antibiotic is not recommended alcohol can cause a reaction (disulfiram like reaction) in some people. Symptoms may include flushing, headache , nausea and vomiting, stomachs cramps and rarely death.

U-shaped or Cleft Palate, gingivitis, abnormal tooth eruption, tooth malformation

Fetal alcohol syndrome clients oral findings ?

Along with behavioral issues

Hyperactivity is a symptom ?

fetal alcohol syndrome clients

Indistinct philtrum is a common facial feature of what type of patients?

B.pinpoint pupils

A patient presents with a history of heroin use which of the following signs is most commonly associated with opioid use?

A.dilated pupils

B.pinpoint pupils

C. Increased respiratory rate

D. Elevated heart rate

Metahdone

Which medication treats, withdrawal and dependence and will also cause constricted pupils?

C. Narcan

Which of the following is used to reverse the effects of an opioid overdose and should develop in a dental office emergency kit?

A. Methodone

B.diazepam

C. Narcan

D. Atropine

True

Higher risk of infective endocarditis , hepatitis B , HIV (in injection drug user )

T or F

Do use epi and dilated pupils

Cocaine contraindications?

Do not use EPI, dilated pupils

Methamphetamine

ALBUTEROL inhaler

What is the medication used for asthma?

Xerostomia,candida infections ,increased caries

Albuterol inhaler may cause?

Air polisher and ultrasonic scaler

Aspirin and NSAID

Avoid epinephrine in local anesthesia or levo my pivot has sulfides epinephrine with anesthesia =dyspena

What are some contraindications for asthma?

Asthma

Wheezing, coughing, shortness of breath , holding chest, Dyson a , aspiration are all risks for ?

Administer oxygen or epinephrine

What happens if there's an emergency in the office with asthmatic?

Life-threatening persistent exacerbation of asthma, despite drug therapy

Status asthmaticus

C, use of nitrous oxide, oxygen sedation

Natures oxide is contraindicated in patients with COPD due to the risk of suppressed respiratory drive. elevating the head using high vac and rubber. Dems are helpful if tolerated.

A patient with a history of COPD arrives for dental treatment which of the following is contraindicated for this patient

A. Use of high evacuation suction system.

B. Use a rubber dam.

C, use of nitrous oxide, oxygen sedation

D. Elevating the head of the dental chair.

B. Xerostomia and oral candidiasis

Which of the following is a common side effect of medication's used to treat respiratory conditions such as asthma or COPD?

A. Gingival hyperplasia.

B. Xerostomia and oral candidiasis

C. Tooth erosion.

D. Black hair tongue.

Elevate, head of dental chair

Short stress-free appointments

Tobacco counseling

High evacuation system,

patient may have own oxygen tank

For dental treatment for COPD patient?

CPR, administer oxygen

Emergency situation with a COPD patient what should you do?

chronic bronchitis , thick heavy mucus and phlegm.

What is a blue bloater ?

Pink puffer , hard time breathing

What is emphysema ?

Cystic fibrosis

Exocrine gland disorder -genetic is ?

B. Use of nitrous oxide.

Patient with cystic fibrosis have compromised lung function and gas exchange issues . nitrous oxide is contraindicated due to the risk of further respiratory depression elevating the assisted breeding and his encouraged

A patient with cystic fibrosis presents for dental care. Which of the following is his contraindicated during treatment?

A. Use a fluoride varnish.

B. Use of nitrous oxide.

C. Manual scaling with limited aerosol.

D. Elevating the head of the dental chair.

C. Thick, Sticky secretions in exocrine glands

Cystic fibrosis is a genetic disorder of exocrine glands that causes overproduction of thick secretions. Affecting lungs, sweat, saliva and digestive enzymes leading to impaired breeding and digestion

Cystic fibrosis is characterized by which of the following?

A. Hypo secretion of exocrine glands.

B. Auto immune destruction of alveoli.

C. Thick, Sticky secretions in exocrine glands

D. Inflammation of lymphatic tissue.

Fever

Weight loss

Nodules on lung tissue

Night sweats \ persistent cough

What are symptoms of TB?

droplets, ingestion, coughing, sneezing, contaminated dust

How is tuberculosis transmitted?

30 days to six months

Incubation of TB is

Do not treat

If a patient has active tuberculosis, what should you do?

TRUE

Positive positive PPD does not mean active TB.

T OR f

Hepatotoxic

TB drugs are

Tb

Mycobacterium tuberculosis is the causative organism for

mycolic acid

M. Tuberculosis has an unusual waxy coating on the cell surface which makes cells impervious to gram staining.

Tb

Acid fast stain is used for

Epi

With cardiac conditions , limit

0.04

What is the cardiac dose

D. Tylenol.

All of the following could trigger an asthma attack except ;

A. Exercise.

B. Allergies.

C. Aspirin.

D. Tylenol.

Prosthetic cardiac valve, prosthetic material for heart valve repair, unrepaired cyanotic congenital heart defect , cardiac transplant with valve regurgitation due to a structurally abnormal valve.

Premed for prevention of infective endocarditis?

Irregular heartbeat leading to inadequate blood flow

Cardiac arrhythmias

Irregular or rapid heartbeat, treated with medication ablation, cardioversion, or implanted device

Atrial fibrillation (Afib)

T

No epi for Cardaic ararythmias

T or F

This happens when there's anomaly of the hear during development

Ex: Down syndrome.

Need to consult w/cardiologist , pre-med might not be needed

Congenital heart disease

Consult with a cardiologist for further evaluation

For congenital heart disease, what do you need to do ?

Premed needed for unprepared congenital defects

Decreased resistance to infections

Angina pectoris and myocardial infarction are prevalent

Coronary heart disease (Ischemic heart disease )

Not enough oxygen in the heart vessels , chest starts to crush/burn mistaken for gerd

Angina pectoris

Viagra and Cialis (tadalafil) within 24 hrs

Nitroglycerin counteracts with ?

Relaxation med of vascular smooth muscles. Should be available on tray.

Nitroglycerin is

6 mo

Nitroglycerin should be no older than ?

It's a sudden reduction or arrest of blood flow to the heart

Myocardial infarction is what ?

Nausea, vomiting, palpitations and decreased blood pressure

What are some symptoms of MI?