Diverse Needs Test 1: Medical Terms & Definitions Study Set

2 Basic techniques for medical history

Interview and Questionnaire (most common)

Heart Failure

Not a disease but a syndrome complex. Semi Supine chair position. Untreated or symptomatic heart failure results in higher risk of heart attack, arrhythmias, acute heart failure, sudden death, people who are physically unstable (NOT candidates for dental procedures)

Heart Attack

Myocardial Infarction. Postpone elective dental care for 6 months. During the immediate post-infarction period patients are at an increased risk for re-infarctions, arrhythmias and heart failure. Change in medications (anti-anginals, anticoagulants, adrenergic blocking agents, calcium channel blockers, anti-arrhythmic agents or digitalis) Dental care causes more stress which can cause increased risk for MI

Angina Pectoris

Chest pain, which may radiate to the left arm and jaw, that occurs when there is an insufficient supply of blood to the heart muscle. Brought on by physical activity or emotional stress. Common symptom of coronary heart disease. Unstable patients at risk for arrhythmias, MI and sudden death.

High Blood Pressure

Greater than >140/90 mmHg (book). "Silent Killer". Vasoconstrictors - B - adrenergic blocking agents. Macrolide Antibiotics - calcium channel blockers. **Defer treatment if greater than or equal to >180/110 mmHg.

Heart Murmur

Turbulence of blood flow that produces vibratory sounds during the beating of the heart. Normal or abnormalities. Underlying condition. NO Pre-Med - unless the murmur is caused by previous endocarditis, prosthetic heart valve, congenital cyanotic heart disease (the murmur is not the concern the primary cause is.)

Mitral Valve Prolapse

Leaflets of the mitral valve "prolapse" or balloon back into the left atrium during systole. Concern leakage and back flow. Regurgitation. NO Pre Med

Rheumatic Fever

Autoimmune condition follows Strep (bacterial). Can lead to damage of heart valves. NO Pre-Med.

Congenital Heart Disease

Increased risk for infective endocarditis. NO Pre-Med - most types of congenital heart disease. Pre Med needed for complex cyanotic heart disease (tetralogy of Fallot), incomplete surgical repairs of congenital heart disease that still leak, heart valve replaced.

Artificial Heart Valves

Higher risk for infective endocarditis. PRE MED REQUIRED. Medication - anti-coagulants. Stents can be placed also to keep valve open (adds structural support), Stents do not need pre med.

Arrhythmias

Related to heart failure or ischemic heart disease. Vasoconstrictors used cautiously. A Fib - anticoagulant or antiplatelets, not beating the way it needed too, high stroke risk. Pacemakers/Defibrillators

Coronary Artery Bypass Graft, Angioplasty or Stent

Preformed to restore patency to blocked coronary arteries. NO Pre-Med.

Cyanosis

Skin- systemic concerns. Turning blue, cardiac, lack of oxygenated blood.

Petechiae or ecchymoses

Skin - systemic concerns. Bleeding disorder

Yellowing

Skin - systemic concerns. Liver

Clubbing

Nails - Cardiopulmonary insufficiency

Nails - white

Cirrhosis

Nails - yellowing

Malignancy

Nails - Splinter hemorrhages

Infective Endocarditis.

Ears

Crease in earlobe may be an indicator of coronary artery disease. Common spot for skin cancer

Normal Pregnancy

40 weeks, Premature refers to birth before 37 weeks.

Early development of the embryo is greatly influenced by

Heredity and general health of mother

First Trimester

Embryo highly susceptible to injuries, malformations and mortality. Teratogenic effect- maternal poor nutrition, infections, drugs. Organ Systems are formed (organogenesis). Tooth buds develop between 5-6 week. Lips form 4th-7th week, Cleft lip apparent 8th week. Palate 8th-12th week. Cleft palate 12th week. 12 Weeks fetus moves and swallows. Mineralization occurs 4th-5th month.

Second Trimester

Organs completed, growth and maturation continues. Ideal time for dental treatment. Rapid fetal growth and weight changes occur during 2nd and 3rd trimester.

Third Trimester

Infections - infection can cause mother to go into pre term labor (low birth weight).

Pharmacokinetics - nearly all drugs pass across the placenta to enter circulation of fetus. May have teratogenic effects based on gestational age, route of administration, dose, absorption and maternal serum levels. Tetracycline - intrinsic tooth staining. ART - HIV - safe and effective tx

Drugs of Abuse and Dependence- Tobacco, alcohol, substance. Birth weight , perinatal death, SIDS, 2nd hand smoke

Herbal Dietary Supplements - Not regulated by FDA. Echinacea - used for upper respiratory infections (allergic reactions or immunosuppressant) Valerian - used for insomnia and stress - has a sedative effect.

Oral Findings During Pregnancy

Increased Gingival Inflammation - increased circulating estrogen and progesterone, immunologic alterations, exaggerated response of the tissues to dental biofilm and irritants, trauma, poor self care. Appears 1st trimester = max level 8th month. Symptoms abate after birth (a completely healthy condition may not result).

Gingivitis - most common pregnancy oral condition. Predisposing factors - maternal immunologic factors, local irritation and infection from poor oral care, hormonal changes, increased proportions or oral microbiota (AA. P Gingivalis C. Rectus)

Oral Pyrogenic Granuloma

"Pregnancy Tumor" Not a tumor - is hyperplasia. Can occur in men. Benign inflammatory lesion, rapid growing. Isolated, discrete, soft, round enlargement near gingival margin, mushroom shape, color depends on age (Newer = Darker) Bleeds easily, painless. Concern for bacteria growth, chewing discomfort, esthetics, ruled out.

Enamel Erosion

From morning sickness - leads to demineralization and erosion primarily on max. palatal surfaces. Treat with sodium bicarbonate rinse (neutralize acid on teeth), chewing gum (with xylitol), No brushing (use a soft tb and low abrasive toothpaste to prevent damage to demineralization areas)

ALARA

As Low As Reasonably Achievable

Treatment Considerations for pregnant women

Silver diamine fluoride not contraindicated- potassium iodide to reduce staining from silver diamine - dont use it just to be safe.

Elective tx postponed

Short appointments

Patient position - supported on left side and supine position - weight of fetus bears down on aorta and inferior vena cava.

Not on left side can cause hypotension and syncope

Diet for pregnant women

Minerals - Calcium and phosphorus for bones and teeth, iron for RBC's, Vitamin D for calcium metabolism, Folate to prevent neural tube defects and low birth weight

RDA of calcium for pregnant women

1,300 mg for ages 14-18; 1,000 mg for ages 19-50

Over the counter teething products

Those containing Benzocaine NOT recommended for children under 2 y.o. Benzocaine can cause methemaglobinemia

Infant Daily Care

Grain of rice sized fluoride toothpaste for infants- 3 y.o.

Non-nutritive Sucking

Decrease incidence of SIDS with use of pacifier. Recommends pacifier for 1st year. Orthodontic nipple causes less severity of malocclusion. Ventilated shield larger than child's mouth - 1-1/2 inches wide, or 3.8 cm

Pediatric Dentistry

Requires 2 years of additional residency training.

AAPD

American Academy of Pediatric Dentistry

Toddler (1-3 years)

2-3 years for first visit more likely to require restorative care. Crying is normal at this age. Exam for abuse and frenum (tongue tied)

Childhood Caries

Bottle/sippy cup in bed. At will feedings. Maxillary anterior teeth and primary molars are first to be effected - nipple covers mandibular anterior teeth

OSA

Obstructive Sleep Apnea. Daytime sleepiness, snoring, abrupt awakening, dry mouth, morning headache.

Tooth loss ____ with age but NOT because of the ____ ____

Increases; Aging Process

Biological Age

Anatomic or physiologic age of a person as determined by changes in organismic structure and function; takes into account features such as posture, skin texture, strength, speed and sensory acuity

Chronologic age

Actual measure of time elapsed since a persons birth

Functional age

How well an older person performs

Primary aging

Age related changes, skin wrinkling

Secondary age

Age related changes due to disease that leads to impairment. Related to trauma or chronic disease (heart disease)

Optimal aging

Aging is slowed or altered due to preventative measures (diet and exercise)

Musculoskeletal System

Decreases after 40. Diminished in strength and speed or response. Curvature of vertebrae, decrease in bone density and atrophic changes in cartilage and muscle. Joints stiffen, loss of elasticity in ligaments.

Cardiovascular System

Decline in cardiac output - minimal increase in size of left ventricular wall. Blood vessels become elastic and flexible (lumen decreases output to liber and kidneys decrease). Atherosclerosis. Changes do not affect function under normal non stressful conditions.

Respiratory Systems

Capacity diminished = decreased efficiency of oxygen carbon dioxide exchange. Skeletal changes weaken respiratory muscles. Less effective cough reflux.

Sensory System

Vision changes - presbyopia, decrease visual acuity (more light needed), peripheral vision, color clarity, decreased pupal reaction.

Hearing - thicker, dryer wax, decreased ability to hear high frequency, ringing

Oral Changes Associated with Aging

Lips, Oral mucosa, Tongue, Xerostomia, Oral Candidiasis, Xerostomia, Teeth, Denta Pulp, Attrition, Abrasion, Root Caries, The periodontium.

Pre-Med Needed

Complex cyanotic heart disease, Artificial heart valve, previous endocarditis, incomplete surgical repairs of congenital heart disease that still leak

Osteoarthritis

Loss of articular cartilage

Osteoporosis

a bone disease involving loss of mineral content and bone mass

Sexually transmitted diseases

On the rise in older adults. Thinning of epithelium of vaginal area. Diminished immune response.

CVD

Most common cause of death for the older adult population over age 65

Alzheimer's disease

Non reversible type of dementia and most common type of all dementia's

Causes of xerostomia

Conditions. Medications. Autoimmune. Decreased salivary flow.

Oral Candidiasis

Denture stomatitis and angular cheilitis most common forms. Antibiotics, head/neck radiation, chemo, steroids, immunosuppressive drugs. Xerostomia.