Junior Promotion Objective Structured Clinical Examination (OSCE) Study Materials

Treatments that cause ___________, due to penetration to the gingival pockets require ____________

Bacteremia

Antibiotic Premed

List 6 procedures requiring premed

1. Probing

2. Any scaling

3. Coronal polishing

4. PDL or intraosseous injections

5. Orthodontic BAND placements

6. Endo/periodontal surgery.

Premed is NOT required for 4 procedures

1. Supragingival procedures

2. Oral hygiene procedures which pt will perform at home

3. Dental bracket placement

4. Anesthetic blocks.

AHA premed guidelines for which compromised patients?

1. Prosthetic cardiac valves

2. Prosthetic material used in cardiac valve repair

3. Previous IE

4. Unrepaired cyanotic congenital heart defect or repaired CHD with residual effects

5. Cardiac transplant with valve regurgitation (due to structurally abnormal valve)

(ALL other CHD does not need premed)

Total Joint Replacement: MED CONSULT ONLY for high risk pts with 8 comorbidities including

1. Same joint replaced more than once OR hx of previous joint infection

2. Rheumatoid arthritis/Systemic lupus

3. Hemophilia

4. Insulin-dependent diabetics

5. Drug-induced immunosuppression

6. Malnourishment

7. HIV

8. Malignancy/Chemo.

Drug, dosages for cardiac premed, NO allergy to penicillin:

Amoxicillin or Cephalexin 2000 mg

Drug, dosages for cardiac premed, pt ALLERGIC to penicillin:

Doxycycline 100 mg

Timing of premed:___ to ___ minutes before procedure, ____ is IDEAL

Up to ___ hours after procedure—in emergency only

30-60 minutes

60

2 hrs

INR is used to monitor all patients on __________ Treatable range = ______

Coumadin (Warfarin)

2 to 3 (<3.5)

What does the A1c measure?

Whats the normal and treatable range?

measures the average blood glucose levels over the past 3 months.

Normal: 6 Treatable Range: <8.5

What does the blood glucose measure?

Treatable range/Controlled range?

the level of glucose (sugar) in your blood at a single point in time.

Treatable Range for FBG: 70 - 130

Postprandial (2 hrs after a meal): 180

3 consecutive readings of >200 = med consult required

rapid onset of severe emergency

Hypoglycemia

gradual deterioration, eventually emergent

Hyperglycemia

Treatment for Hypoglycemia: Conscious

oral glucose: juice, frosting, soda

Treatment for Hypoglycemia: Unconscious

injectable glucose or glucagon

Syncope is the most common adverse reaction in dental office, associated with administration of

local anesthetic

Symptoms of Syncope

Pallor, sweating, loss of consciousness. Tx: Supine position, 02 administration

Hyperventilation

Signs/Symptoms

Tx?

anxiety increases

pulse/respiration increases

palpitation

tightness in chest/suffocating

dizziness

lightheadedness

paresthesia (numbness or cold) perioral and extremities

Upright position, reassure pt, paced breathing (4-6/minute)

AAP: Health

CAL, ppds, BOP?

no CAL or radiographic bone loss

ppds: <3mm

may have slight localized (<10% of teeth) BOP

AAP: Healthy but Reduced Periodontium

CAL, BOP, PPDs?

CAL present

NO BOP

PPDs: <4 mm

AAP: Stage I Perio (early/slight perio)

Bone loss, CAL, PPDs, BOP?

<15% Rad bone loss

1-2 mm CAL

4 mm PPDs

BOP present

AAP: Stage II Perio (mod perio)

Bone loss, CAL, PPDs, BOP?

15-33% rad bone loss

3-4 mm CAL

5 mm PPDs

BOP present

AAP: Stage III Perio (advanced-severe perio)

Bone loss (horizontal + verticle), CAL, PPDs, BOP

>33% horizontal bone loss

>3 mm verticle bone loss

>5 mm CAL

6 mm PPDs

BOP present

AAP: Stage IV Perio (severe-complex perio)

Furcation, Mobility, Defects, Remaining teeth?

Class 2-3 furcations

Class 2-3 mobility

Severe ridge defects

<20 remaining teeth

Complex rehabilitation needed

_________ presents in pts with normal clinical attachment level

Height of alveolar crest lies ______-______ mm apical to level of CEJ

Biologic space

1-1.5 mm

Post crest level should parallel line btwn distal CEJ of one tooth and mesial CEJ of adjacent tooth

Well-mineralized alveolar crest

Classifications of periodontitis in regard to bone loss

Slight, Moderate, Severe

Slight: <15% bone loss

Mod: 15-33% bone loss

Severe: >33% bone loss

What is this?

Health or gingivitis

whats this

Stage 1 perio

Whats this

Stage IV Perio

Whats this

Stage II/III Perio

4 Steps in formulating a TX plan

1. Assessment

2. Diagnosis + Plan for hygiene procedure

3. Implement Hygiene tx

4. Post-treatment evaluation

What evaluation is rare? But will occur 1-2 weeks following SRP?

Tissue Check (evaluates tissue healing in acute conditions

When is does the perio re-eval occur after SRP?

4-6 wks re-eval of active Tx (full data and perio consult)

Either recall (every ____ mo) or Referral if_____ or Additional_____

3 months (perio maintenance)

Perio, restorative, oral surgery, endo (dentist can't provide this tx)

Active tx (re-RP)

A patient has 6mm PPD, but 3mm coronal (gingival margin) to the CEJ, how many mm is CAL?

3 mm CAL

A patient has 6 mm from CEJ to the base of the pocket, how many mm is CAL?

6 mm CAL

A patient has 6mm PPD and 3 mm recession, how many mm is CAL?

9 mm CAL

MOst common referrals?

Grad perio

Dental student for POE

Restorative TX

Root planing by quad or sextant

quad: when 4 or more teeth in a quad need RP

sextant: 1-3 teeth in sextant need root planing

Pateints with current perio disease have recalls ___ mos to start. WHY? What 3 goals?

3 months

12 weeks allows for the recolonization of perio pockets

1. Maintain health/prevent disease

2. Maintain control of disease

3. NO BLEEDING

Perio consult is needed for?

Perio disease diagnosis

Tx plan approval for RP

Diagnosis for additional perio tx (surgery) at re-eval

Grade A

bone loss/CAL

Biofilm?

Smoking/Diabetes?

No bone loss/CAL over 5 yrs

Heavy Biofilm, low destruction

Non-smoker

No diabetes

Grade B

Bone loss/CAL

Biofilm?

How many cigarettes/A1c?

<2 mm bone loss/CAL over 5 yrs

Destructive biofilm

<10 cigarettes/day

A1c <7% in diabetics

Grade C

Bone loss/CAL

Biofilm?

How many cigarettes/A1c?

> 2mm bone loss/CAL over 5 yrs

Excessive destructive biofilm

Rapid progression

>10 cigarettes/day

A1c >7% in diabetics

ASA 1

<120/80 - 139/89

ASA II

140/90 - 150/99

Stress reduction

ASA III

160/100 - 170/109

Stress reduction med consult advised

(MI/CVA > 6 mo ago)

ASA IV

>180/110

MED CONSULT NEEDED

(MI/CVA < 6 mo ago)

10 Absolute contraindications to VASO

1. BP > 180/110

2. Severe hypertension

3. Uncontrolled CHF

4. Unstable angina

5. Uncontrolled hyperthyroidism

6. Uncontrolled diabetes

7. Recent heart attack/stroke/coronary bypass surgeru <60 mo

8. Sulfite allergy

9. Drug abuse

10. Glaucoma

Whats the cardiac dose of epinephrine?

2 carts (0.04 mg)

14 VASO with caution using cardiac dose

1. Hypertension

2. Stable angina

3. Heart attack/stroke >6 mo

4. Heart transplant patients

5. Arrhythmias (especially if taking beta blockers 'olol' or digoxin)

6. CHF

8. Hyperthyroid

9. Chronic Hep C

10. Pt taking antidiabetics

11. Pregnant (best during 2nd tri)

12. Sickle cell anemia

13. Tricyclic antidepressants

5 Absolute contraindications to nitrous

1. Communication difficulties

2. Inability to use nasal mask

3. Middle ear infection, sinusitis, recent inner ear surgery (due to gas expansion)

4. Latex allergy

5. Cocaine/meth within 24 hrs

Relative contraindications to nitrous

1. Drug or alcohol abuse

2. Previous negative experience

3. Pregnancy

4. COPD/emphysema (avoid with severe)

5. Psychiatric disorders

6. Asthma (okay unless attack occurs)

7. Sickle cell disease

A blood platelet count below_____ requires med consult

50,000

If your patient has HIV what two tests do you ask for?

CD4 (<200 is low) or ANC (<1500 is low)