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Special Needs

Terms in this set (165)

The first BP reading is high
Switch arms for 2nd reading
-Also beneficial to try a different cuff, may be too small
BP for the patient is overweight with thick arm tissue
Use extra large cuff (thigh cuff)
BP for the patient had a mastectomy with removal of lymph nodes
Switch to opposite arm
- If lymph nodes were removed from both, take BP on leg
BP for the patient has a dialysis shunt in the arm
Switch to opposite arm
Opening Crowded Contacts on Radiographs
To see the surface where there is overlap, you must take another film aimed specifically through those two teeth
-opening the closed contact will create overlap on other contacts
Beavertail
remove heavy, supragingival calculus
- broad, flat design
• Standard-diameter universal
remove moderate to heavy calculus
Standard-diameter triple bend
remove moderate to heavy calculus
- adapts to proximal surfaces, line angles
Slim-diameter
remove lighter calculus
Universal Curette
removal of small to medium-sized calculus
Area-specific Curette:
removal of small deposits, root plane
Plastic Scaler:
removal of deposits on implant surfaces
Sickle Scaler
removal of medium to large-sized supragingival calculus
Periodontal File
roughen burnished calculus, crush large calculus, smooth overhang
Chisel Scaler
removal of heavy interproximal calculus on anterior mandibular teeth; uses a push stroke
Hoe Scaler
removal of heavy subgingival calculus
Adverse Outcomes from Periodontal Debridement
-Exposed Root Surfaces (caries, sensitivity, appearance)
-hour glass roots (over instrument)
-gingival recession (edema resolves, over instrument)
-mobility (remove calc bridge)
Essential oils (Listerine)
Destroys bacteria associated with halitosis and biofilm
-Alcohol may burn with xerostomia
Chlorhexidine gluconate (Periogard, Paroex, Peridex)
-Not used long-term
-Increased calculus formation, staining of teeth and root surfaces
• Lactoperoxidase enzyme (Biotene)
Formulated for patients with serious illness or whose condition is compromised by medication use
Cetylpyridinium chloride (Pro-Health, Scope)
Destroys bacteria associated with halitosis and biofilm
Sodium fluoride (Act, Prevident)
Caries prevention
Tartar-control Dentifrice Active Ingredients
Pyrophosphate (inhibits mineralization) and Zinc (breaks down calc)
Powered brush
for everyone, lacking dexterity, ortho, perio
Single-tufted brush
areas not accessible with larger brush
Floss holder
lack dexterity
Floss threader
fixed bridge, ortho
Interdental brush
type II or III embrasure spaces
Toothpick
proximal surfaces and concavities, furcations
Interdental tip
proximal spaces, exposed furcations
• Water jet
ortho, gingivitis, implants, perio
Medication classes that Cause Xerostomia
• Antidepressants
• Antipsychotics
• Decongestants
• Antihistamines
• Muscle relaxants
• Bronchodilators
• Appetite suppressants
• Stimulants
• Antihypertensives
• Diuretics
• Urinary incontinence meds
Treatment of Xerostomia
Moisten Oral Tissues (water, saliva subsitutie, lubricants, humidifier), stimulate salivary flow (gum, lozenges, frozen grapes, pilocarpine)
- use fluoride at home, antimicrobial rinse daily, nutritional counseling, frequent recare
It is illegal to refuse care for a client based on client's
health condition, gender, race, ethnicity, sexual orientation
• discrimination
• the only exception is if you cannot prevent the spread of infection because disease is airborne or highly contagious
You can refuse to treat a client if the
-practitioner does not have the competence to provide the standard of care
-client refuses necessary radiographs or prophylactic antibiotic premedication
-the client's behavior is considered harassment to the practitioner
Clinical Manifestations of Anemia
- hypoxia
-tachycardia and palpitations
-increased rate and depth of respirations -dizziness, weakness, fatigue
- pale tissues (skin, nail beds, gingiva, mucosa, lips)
-glossitis and loss of papillae on dorsum of tongue
Kidneys perform three functions
1. excrete nitrogen waste products
2. regulate the volume, composition, and acid-base balance of plasma
3. synthesize hormones needed for erythrocyte production, bone metabolism, and maintenance of blood pressure
When kidneys fail, wastes and excess fluids accumulate
• gradual loss of waste removal, inability to concentrate urine, inability to conserve electrolytes
• systemic complications develop
Causes of Kidney Disease
diabetes and hypertension
Systemic Complications from CKD
fluid retention, anemia, dry skin, hypertension, heart disases, excessive thirst/halitosis, Secondary hyperparathyroidism
Systemic Complications from CKD fluid retention
• decreased frequency of urination
• edema in legs, ankles, or feet
• hypertension
• shortness of breath
Systemic Complications from CKD anemia
• kidneys are not producing enough erythropoietin
• decreased stimulation of red blood cell production from the bone marrow
• fatigue, drowsiness, pale tissues
Systemic Complications from CKD dry skin
reduced perspiration and oil production
Systemic Complications from CKD hypertension
• early manifestation of CKD
• multifactorial etiology
• early identification and treatment of HTN is proven to slow progression of CKD
Systemic Complications from CKD heart disease
left ventricular hypertrophy and ischemic heart disease can lead to heart failure
Systemic Complications from CKD excessive thirst
presence of nitrogen
Systemic Complications from CKD Secondary hyperparathyroidism
• mineral and bone disorder
• kidneys lose the ability to excrete phosphorus and activate vitamin D
• calcium levels in the blood decrease
• body triggers the release of excessive levels of parathyroid hormone
Excessive parathyroid hormone causes
hypercalcemia
• abnormal leaching of calcium from bone
osteodystrophy
causes a decrease in trabeculation, loss of lamina dura, narrowing of pulp chambers
End-stage renal disease (ESRD)
• severe decline in kidney function resulting in minimal removal of waste
• dialysis and/or a kidney transplant is required to survive
Malnutrition from ESRD
• restricted protein intake to control uremia OR increased intake of protein when on dialysis due to albuminuria
Oral Manifestations of CKD Xerostomia
-Candidiasis may occur due to reduced salivary flow
-swish with water and SPIT OUT
-suck on ice, frozen grapes, button on floss
-humidifier
-oral irrigator and power brush
Oral Manifestations of CKD
1. pallor in mucosa (anemia)
2. uremia
• breath that smells like ammonia
• accelerated rate of calculus formation
• powered brush to remove more biofilm • stomatitis: topical anesthetic applied before eating
3. radiographic abnormalities (hyperparathyroidism)
4. delayed healing if receiving dialysis
• protein is filtered out during dialy
Dialysis
Dialysis is a method of cleaning and filtering wastes and toxins from the blood when the kidneys cannot
• give the patient time to find a kidney match
• three treatments/week
Hemodialysis
blood is filtered out through a shunt in the arm, cleaned by a machine, and returned to the patient
• uses heparin to thin blood
Peritoneal dialysis
blood is filtered through their own peritoneal lining
• solution is administered through an abdominal catheter
• eliminates needle sticks
• waste products combine with this fluid and are drained out the catheter
Treatment Modifications for Patients Undergoing Hemodialysis
• Consult with and obtain clearance from the patient's nephrologist to confirm that the patient is medically stable enough to receive dental treatment =if premedication is needed
• access site =Do not take blood pressure readings in the dialysis access site arm (stent)
• Avoid dental treatment if dialysis treatment has already been performed that same day =heparin
Treatment Modifications for Patients Undergoing Peritoneal Dialysis
Consult with and obtaining medical clearance from the patient's nephrologist to confirm that the patient is medically stable enough to receive dental treatment •
-determine if prophylactic antibiotic premedication is required
- cardiovascular complications (infective endocarditis)
Caries prevention ESRD
• meticulous oral self-care with fluoridated toothpaste
• use antimicrobial mouth rinses twice daily
• use xylitol-containing products
Prevention of oral infection ESRD
adjust dentures and oral appliances
• meticulous daily oral self-care to minimize random bacteremias
• frequent professional debridement
• calculus
• oral hygiene counseling
• avoid products with sodium and NSAIDS
• powered toothbrush for effective removal of thick plaque and food debris
Immediately after transplantation, only ____ dental care is recommended.
emergency
Most transplant recipients are treated with a trio of
immunosuppressive medications: cyclosporine, prednisone, and mycophenolate mofetil. Nifedipine can also be used.
transplant dental care
1. Gingival enlargement may be the result of poor oral hygiene, increased sensitivity to cyclosporine/nifedipine or both.
2. Physicians are reluctant to alter the immunosuppressive therapy when the patient's medical condition is medically stable; therefore, the prevention of gingival enlargement is best.
3. Meticulous daily oral self-care should be emphasized. Gingivectomy may be required.
During the stable post-transplant phase:
• consult with and obtain clearance from the nephrologist
• confirm that the patient is medically stable enough to receive dental treatment
• determine the need for prophylactic antibiotic premedication
• determine if the patient is susceptible to adrenal crisis
cerebral palsy
lack of O2 during birth. NOT a disease and NOT contagious
cerebral palsy
lack of muscle control with involuntary movements and muscle spasms. inability to swallow (drooling), tongue thrusting, mouth breathing, bruxism
can help control involuntary movements
nitrous with cerebral palsy patients does what
muscular dystrophy
progressive, chronic disease causing muscle atrophy, onset usually age 20-40, mouth breathing, oral motor dysfunction - drooling
atrohpy
to waste away
scoliosis
idiomatic, congenital, genetic, or neuromuscular related. may have accentuated spinal shadow on panoramic image
needs ventilator
C4 injury
minimal funcitoning, partial shoulder/biceps
C5
sit, eat with devices, shoulder/biceps/partial wrist
C6
personal self care with devices, shoulder/biceps/wrist/partial hand
C7
personal self-care, wheel chair transfer
C8-T1
cardiovasular conditions
what condition might not tolerate supine position
undiagnosed chest pains
refer to MD if what
primary hypertension
no identifiable cause, develops over years
secondary hypertension
caused by an underlying condition (pregnancy, kidney failure, medications, illegal drugs)
CVA (stroke), MI, renal failure, cardiac hypertrophy (enlarged heart)
high blood pressure can cause what
CVA, CHF, COPD, pregnancy
modify the chair position for what patients
stroke
CVA means what
congestive heart failure
CHF means what
CVA, MI, renal failure cardiac hypertrophy (enlarged heart)
what happens if you have high blood pressure
Angiotensin-converting enzyme
(ACE) inhibitors stand for
xerostomia and gingival hyperplasia
side effects of calcium channel blockers
postural hypotensions, dry cough
side effects of angiotensin converting enzymes
Xerostomia and postural hypotension
side effects of diuretics
stress reduction for hypertension
nitrous oxide is recommended for who
raise chair slowly
risk of patients with hypertension
Pain, Nausea, diaphoresis (sweating), dyspnea (shortness of breath), weakness
symptoms of acute MI
necrosis of heart muscles form prolonged ischemia
what is a heart attack
pain radiate to arm, shoulder, neck, or mandible
angina pectoris symptoms
5-15 mins
how long does angina last
one tablet every five minutes, max of 3 tablets in 15 minutes.
how do u treat angina
if systolic BP is >100
give angina patient medicine when
once opened expire in 6 months. degenerates with air exposure
describe angina medication
transient ischemia attack (TIA)
mini stroke is called what
face drooping, arm weakness, speech difficulty, time to call 911
FAST stands for what
stroke
FAST is for what
pace maker
SA node
AV node
pace setter
ventricular fibrillation
emergency treated with AED
cardiac arrhythmia or CHF
do not treat if what is uncontrolled
coronary bypass surgery
do not need a premed for what
6 weeks
how long should you wait for a patient to have elective treatment with coronary bypass surgery
Cardiac Glycosides (Digoxin/lanoxin)
patient with CHF may be taking what
nitrous (except asthma)
do not use what with respiratory problems
Albuterol (Ventolin), salmeterol (servant), fluticasone (Flovent), advair
common medications for asthma
increase risk for caries and candida (rinse with water after inhaler use)
what can steroid inhalers cause
rinse with water
asthmatics should do what after using inhaler
aspirin, epinephrine (bisulfides)
what should you avoid with asthmatics
negates any bisulfide reaction
epinephrine 1:1,00 does what
Athsma
only respiratory condition to use nitrous oxide
local anesthesia with epi in it
bisulfides are found in what
emphysema (pink puffer), chronic bronchitis (blue bloater)
what are the COPDs
emphysema
pink puffer
chronic bronchitis
blue bloater
blue bloater
emphysema
dry cough
chronic bronchitis
wet cough
COPD patients
do not use rubber dam with who
cystic fibrosis
inherited disorder of exocrine glands (glands that go to surfaces - tears, sweat, saliva, digestive juices). accumulation of music blocks O2 exchange in the lungs.
mycobacteria
what bacteria causes TB
drug-resistant strains spread through airborne transmission (cough, sneeze, spit)
describe TB
skin test is a test that determines if you have tuberculosis (TB)
what is a purified protein derivative
type IV
TB test is what kind of hypersensitivity
does not mean active infection but exposure to TB.
positive TB test means what
may lead to hepatotoxicity - avoid drugs metabolized in liver (acetaminophen)
TB drugs may cause what
CD4 helper T-cell lymphocytes
what reduced during HIV/AIDS
opportunistic infections
what can HIV people get
angular cheilitis, aphthous-like ulcers, candidiasis, increased caries, capos sarcoma, linear gingival erythema, lymphoma, NUG, NUP, oral hairy leukoplakia, papilloma lesions, persistent lymphadenopathy, recurrent herpetic infections, xerostomia
oral manifestations of HIV
leukemia
may cause aplastic anemia
leukemia
possible gingival enlargement
bleeding problems, poor healing, and or immune suppression
describe leukemia
>50,000 for surgical producers
MD consult for leukemia patients with platelet count of what
are undergoing chemotherapy
premed for patient who
caries, emphasize plaque control. antimicrobial mouthwash (alcohol-free)
leukemia patients are more likely for what
mucosal pallor, delayed tooth eruption, atrophy of tongue papillae (smooth tongue)
oral findings of sickle cell anemia
sickle cell anemia
possible premed for who
people with chronic renal failure (can cause electrolyte imbalance)
do not use air polisher on who
day after dialysis
best time for appointments for patients with chronic renal failure
apthout-like ulcers
oral manifestations of Crohn's disease
hepatitis
abnormal bleeding
C, D, E
which hepatitis do not have a vaccine
if you have hepatitis B
you can only get hepatitis D when
HBsAg
what indicated hepatitis
adrenal comical insufficiency
too little steroid production
TB
what can destroy adrenal glands
weight loss, muscle weakness, fatigue, dehydration, hypoglycemia, bronzing of skin
describe Addison's disease
Addison's disease
give steroids for who, stressful situations (dental appointments)
Cushing syndrome (hypercorisolism)
caused from excess pituitary gland (Acth production
weight gain, stretch marks, bone fractures, poor healing
describe Cushing syndrome
periodontal disease, caries, candidiasis, poor healing, oral burning
oral findings of diabetes
>6.5%
diabetes indicates long term blood sugar of what
Meformin (Glucophage), glyburide (DiaBeta)
what types of medicines are used for diabetes
insulin shock
hypoglycemia is also called what
hyperglycemia
diabetic coma
grave's disease or lack of iodine
goiter is caused by what
hyperthyroidism
graves disease is what
Hyperthyroidism
who does not get epi
hypotension, bradycarida, dry skin, cold intolerant, obesity, delayed tooth eruptio
signs of hypothyroidism
cretinsim
early onset; mental/physical retardation, macroglossia, delayed tooth eruption (hypothyroidism)
myxedema
adult onset, long-term undiagnosed hypothyroidism
synthroid (levothryoxine)
synthetic thread hormone replacement therapy
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