Board Alerts

Epi and Cocaine

EPI is contraindicated

Oral mucosa irritation

result of drug administration, not the drug itself

Adrenergic drugs should not be used when?

Patients with angina, uncontrolled hypertension, and uncontrolled hyperthyroidism

Atropine

used pre operatively to decrease salivary flow for dental procedures

Aspirin in children

Reye's syndrome

Pilocarpine

(Salagen)- treat xerostomia - (pillow// slobber on pillow)

Evoxac

"evacuate the slobber" ; treats xerostomia

NSAIDs and phenytoin

can increase phenytoin (seizure) levels

Acetaminophen contraindicated for

current and past alcoholics

Acetaminophen drug of choice for who?

patients on anticoagulants or with peptic ulcers

Ibuprofen can decrease the effects of:

ACE inhibitors

Beta Blockers

Loop diuretics

Corticosteroids

Cyclosporine

Lithium

Most common opioid in dentistry

codeine (Tylenol 3)

Sign of overdose/addiction to opioid

pinpoint pupils

Opioids lead to

constipation

What are opioids not used for

chronic pain

Antibiotics used to kill

bacteria NOT viruses

most likely antibiotic to cause allergic reaction and anaphylaxis

Penicillin

Which penicillin is preferred

VK over G because pen G is inactivated by gastric acids

Penicillin is not effective against

penicillinase (breaks down penicillin) producing bacteria.

Augmentin

IS effective against penicillinase producing bacteria- it prevents penicillinase from breaking down amoxicillin.

amoxicillin and clavulanic acid

erythromycins most common side effect

GI upset

Premed with penicillin allergy

Azithromycin and Clarithromycin

Tetracycline used for

used to treat NUP/NUG and aggressive perio due to their excretion into the gingival crevicular fluid where they have an anti-collagenase effect

What is not allowed while taking tetracycline?

Milk- causes photosensitivity

All tetracyclines do what?

cross the placental barrier and are excreted in breast milk (stain babies teeth)

Clindamycin can lead to

pseudomembranous colitis (C-diff: Clostridium difficile)

Severe persistent diarrhea

If alcohol is ingested with Nitroimidazoles

it will make you very sick- similar to disulfiram (antabuse) with alcoholic - avoid Listerine (high alcohol content)

If a pt indicates they are taking rifampin or isoniazid only

they are likely taking it as a preventive agent

Nystatin

is used topically to treat candidiasis (thrush)

Diflucan

(Fluconazole) used to treat systemic fungal infections.

Local anesthetic agents inhibit

the influx of sodium ions

Function loss in this order with ANS:

Autonomic - temperature- pain- touch/pressure- vibration and motor // REGAIN in the reverse order

Esters are metabolized in the

plasma (BLOOD)

Esters have a high potential for what?

allergic reactions

Benzocaine is an amide or ester?

is an ester and available as a topical

Amides are metabolized

in the liver

Prilocaine (Citanest) is associated with

methemoglobinemia (anemia that turns you blue)

Duration of action of anesthetics (shortest to longest)

Mepivacaine (shortest)

Lidocaine

Prilocaine

Articaine

Bupivacaine (longest)

pKa (dissociation constant)

related to ONSET of action

Lower pKa = better absorbed

Protein binding capacity

related to DURATION of action

Stronger binding= longer duration

Lipid solubility

related to POTENCY More lipid soluble = more potent

Vasodilating properties

affect POTENCY and DURATION of action Less vasodilation (vasoconstrictor added) = more potent and longer duration

Vasoconstrictors are added to anesthetics for:

Decreased systemic absorption

Decreased absorption

Increased duration of action

Decreased bleeding

Max recommended dose of epinephrine is based on the pts health status

HEALTHY: 0.2mg epi per dental appt

ASA I or II

"Cardiac dose": 0.04mg epi per dental appt ASA III or IV Pregnancy, diabetes hypertension, etc.

Anesthetics WITHOUT a vasoconstrictor (plain solution)

Lidocaine: not available in dentistry in the US

Mepivacaine

Prilocaine

Local anesthetic pH

weak base and works poorly where there is infection due to the very acidic environment - increased dose may be needed in this area

Best way to reduce systemic toxicity from local anesthetic is:

Aspiration and inject slowly

Benzodiazepines and Barbiturates:

have no analgesic effect

Nitrous and oxygen tank colors

Nitrous: blue Oxygen: green

Nitrous oxide is excreted

exhalation

No biotransformation - inhaled and exhaled in same form

Preventing diffusion hypoxia

Place pt on 100% oxygen for 5 minutes following sedation

Diffusion hypoxia

rapid outward flow of C02 - decreasing ventilation - causing headache

Nitrous oxide / oxygen sedation maintains pt in what stage of anesthesia

Stage 1 anesthesia

Nitrous oxide / oxygen sedation can reduce the orofacial muscle tone in

cerebral palsy pts during dental treatment

Nitrous oxide abuse can lead to:

Neurologic symptoms similar to parkinson's disease and dementia

Numbness and tingling in the extremities

Supragingival nutrient source is

Saliva

Subgingival nutrient source is

GCF

class 3 and 4 furcations

Class IV furcation is the same as Class III, except the entrance to the furca is clinically visible because of advanced gingival recession

When can you start using fluoride mouthrinses for children

No fluoride mouthrinses under 6 yo

Where do you get cholesterol

Only animal products contain cholesterol not found in egg whites or plant foods- found highest in egg yolks, liver, organ meats

During tooth development, phosphorous deficiency results in:

Incomplete calcification of teeth

Failure of Dentin formation

Increased susceptibility to caries

What may well be recognized as the most important essential trace mineral for humans

Zinc

Amenorrhea:

missing at least 3 menstrual periods in a row

Lanugo:

Soft downy hairs all over body from anorexia

Phenylketonuria:

inability to metabolize amino acid phenylalanine- NO aspartame (Equal/Nutrasweet)

Marasmus:

waste away due to starvation; impairs brain development; in impoverished nations

Kwashiorkor:

when young children consume adequate calories and inadequate high-quality protein

Tertiary prevention

includes implants

Optimal fluoride level in drinking water

.7 ppm

Learning ladder

1:Unawareness

2: Awareness

3: Self-Interest

4: Involvement

5: Action

6: Habit

The goal for your program

is set FIRST ... then you develop measurable objectives

Summative evaluation:

evaluation of program AFTER implementation

Formative evaluation:

internal evaluation of program DURING planning

Eastman Interdental Bleeding Index:

Reversible

Uses wooden interdental cleaner

Assess papillary bleeding and indicates inflammation

DMFT/DMFS:

Decayed, missing, filled teeth/decayed, missing filled surfaces. --Irreversible

-Measures past and present caries experience in populations with adult dentitions

deft

primary teeth

Prevalence rate:

total number of cases at a given time

EXISTING

Null hypothesis:

NEGATIVE outcome; example: "There is no statistically significant differences between..."

Research hypothesis:

POSITIVE outcome; "There is a statistically significant difference between

Sample:

representative subset of the population

Random sampling:

best type of sampling; less bias

Convenience sampling:

creates bias; group is already together and convenient

Retrospective research:

investigates possible causes of disease; uses medical records

Experimental research:

investigates cause and effect and involves manipulation of variables

IRB (Institutional Review Board):

Reviews ethical implications of research study

Ensures safety

Standard Deviation

Square root of the variance

Most common and useful measure of dispersion

Correlation Coefficient Value (r-value)

Shows the strength of a relationship between two variables

Ranges from -1 to +1

Closer r is to 1: stronger the relationship

Closer r is to 0: weaker the relationship

Positive correlation

Direct relationship

r= +1: shows a perfect positive relationship

Negative correlation

Inverse relationship

INTRA-examiner Reliability

Consistent performance by the same investigator when using a data collection instrument

Example: your probing depths being consistent each time you collect data

INTER-examiner Reliability

Consistent performance by different investigators when using the same data collection instrument

Example: probe depths being consistent amongst a group of examiners

Endemic

Low but constant presence of disease in geographic region

Epidemic

Occurence of disease in excess of normal

Suddenly and spreading rapidly

Pandemic

An epidemic in which the disease may cross international borders to effect several countries

For Geriatric Pt:

Raise head of chair slowly and allow pt to sit for a few minutes before allowing to raise - avoid falling from hypotension

Deaf:

Do not shout

Remove mask when speaking

Pregnant:

2nd trimester is the safest

Daily fluoride rinses NOT systemic supplements

Client positioning may cause pressure on mothers vena cava creating hypotension: turn to LEFT side; pillow under right him

Tobacco Counseling to include

ASK: Do you smoke?

ADVISE: Importance of quitting

ASSESS: Level of readiness to quit

ASSIST: Let me know when you are ready

ARRANGE: set quit date

Medications used to help quit smoking

may have drug interaction with epinephrine

#1 cause of pancreatitis

Alcoholism