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Clinical Theory Final Exam
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NOT DONE WITH ALL EXAM 2 INFO. Partially Quiz 2 info
Terms in this set (85)
describe the changes that occur in the enamel prior to appearance of white spots
Mineral is lost and becomes more porous
What is the purpose of obtaining a complete medical and dental hx?
· Safe treatment can be provided to the patient
· Ensures that the dental care treatment plan is consistent with the patient's health status
· To avoid potential medical emergencies in the office
· To identify patient who might require premedication
What are the medical Hx update questions for subsequent appts?
1. Have there been any changes in your medical history since your last appointment with me?
2. Are you taking any new medications? Have you discontinued any medications?
3. Have you seen your MD since your last appointment? For what reason?
4. Have you been hospitalized since your last appointment with me?
Where should you document the patient's vital signs?
physical examination area of axiUm and SOAP note
What are the 4 vital signs that we take in clinic?
Temperature, Pulse, BP, Respiration
Temperature: no hot or cold liquids for ___ mins and no smoking for ___ mins prior
15 mins; 10 mins
What is a normal temperature?
36-38 C (96.8-100.4 F)
What is a hypothermia temperature
below 96 (medical emergency)
what is Pyrexia Temperature?
37.5 C (alert DDS)
What is a Hyperthermia temperature?
above 41 C (medical emergency)
What is the normal pulse rate of an adult?
60-100 beats/min
what is a normal pulse rate for a child?
70-150 beats/min
PULSE vital sign: resting HEART rate GREATER than 100 beats/min
Tachycardia
PULSE vital sign: resting HEART rate LESS than 60 beats/min
Bradycardia
PULSE vital sign: irregular pulse/heart beat
Arrhythmia
How do you take pulse vital sign?
- Pt arm supported at side
- Place the first two or three fingers on the patient's radial artery (do NOT use your thumb) for 30 seconds. Multiply by 2 and record in chart
What are pulse points?
- radial
- ulnar
- brachial
- carotid
- temporal
What is a normal respiration rate for a normal adult?
12-20 cycles/min
What is a normal respiration rate for a normal child?
18-30 cycles/min
RESPIRATION vital sign: less than 12 res/min
Bradypnea
RESPIRATION vital signs: greater than 20 res/min
Tachypnea
How do you check a patient's respiration?
Leave fingers on radial artery while observing the patient's respiration (rise and fall of chest) for 30 seconds. Multiply by 2 and record in chart.
What is a normal systolic (BP) reading?
120 mmHg
What is a normal diastolic (BP) reading?
80 mmHg (less than 80)
BP: what is a hypertension reading
140/90 or greater
How do you check a pt's blood pressure?
- Pt's arm supported at side
- Blood pressure cuff is placed over the brachial artery
- Place 2 fingers on the radial pulse
- Inflate the cuff until the radial pulse stops. Then pump 20 mmHg beyond the point at which the radial pulse stopped
- Use the stethoscope to listen for the 1st sound or tap as the air lock is slowly and gradually released - systolic reading
- As the air is continuously released from the cuff, the sound becomes louder, then muffled, and disappears - diastolic reading
When a BP reading is (140-159/90-99) what stage is it
High blood pressure stage 1 (confirm within 2 months)
When a BP reading is (160-179/100-109) what stage is it?
High blood pressure stage 2 (see healthcare provider within a month)
When a BP reading is (>180/>110) what stage is it?
High blood pressure stage 3 (See healthcare provider IMMEDIATELY)
Why is performing the EO/IO exam important?
A dental healthcare provider is often the 1st line of defense against oral cancer. A thorough exam of the oral cavity and head/neck area helps the clinician assess patient health
Which EO/IO exam palpation technique: use of one finger?
digital
Which EO/IO exam palpation technique: use of thumb and another finger of the same hand
bidigital
Which EO/IO exam palpation technique: using both hands simultaneously to examine the SAME structure
bimanual
Which EO/IO exam palpation technique: using both hands simultaneously to examine structures on OPPOSITE sides of the body
Bilateral
what is the most common medical emergency?
syncope (fainting)
How can syncope be caused?
- in a dental setting, can be caused by fright and pain.
- can be caused by dehydration
what is a SOAP note?
A standardized summary of pt treatment given by health care provider, a legal document
describes the patient's current condition in narrative form. This section usually includes the patient's chief complaint, or reason they came to the dental appointment
subjective
Documents objective, repeatable, and traceable facts about the patient's medical and dental status - vital signs
objective
The medical/dental measurements for the dental visit on the given date of the note—Extra/Intraoral inspection, radiographs, periodontal assessment, O'Leary's plaque index
assessment
This describes what the dental health care provider will do to treat the patient - prophylaxis, therapeutic scaling by quad, referrals by consulting DDS, all procedures planned and performed for pt
Plan
What are some examples of assessment procedures (SOAP notes)
· Radiographs
· EO/IO exam
· Charting dental restorations
· Periodontal assessment
- O'Leary's plaque score
What are some examples of treatment procedures?
· PreRinse with antimicrobial (Listerine)
· Disclosing agent
· OHI
· Ultrasonic scaling/hand instrumentation
· Selective polishing
· Fluoride treatment
Name the types of carious lesions
pits and fissures
smooth surface
root surface
recurrent decay
Which type of carious lesion can you find by: o Tracing the length of the occlusal groove with explorer tip
- Directing tip into groove and applying light pressure
- Carious surface will catch or feel "sticky"
pit and fissure
Which type of carious lesion can you find by:
o Moving explorer tip over surface noting any changes in shape or hardness
o Visual cues are discoloration of the enamel surface
o Radiographs
smooth surface
Which type of carious lesion can you find by:
o Gently assess the root surface with the explorer tip
o Root caries will be indicated by a depressed area that feels rough or leathery
Root surface
Which type of carious lesion can you find by:
o Tracing the margin of the restoration using the explorer tip
o Areas that the tip can penetrate or catch in should be further evaluated
recurrent decay
no progression, hard surface, dark color
arrested caries
virgin surface, early lesion- incipient
primary caries
widespread, severity may increase over a relatively short time
rampant caries
Who requires prophylactic antibiotic premed? Patients with....
1. Previous infective endocarditis
2. Congenital heart disease
3. Prosthetic cardiac valve
4. total joint replacement
What are symptoms of infective endocarditis?
- Weakness
- Fatigue
- Weight loss (unexplained)
- Fever
- Chills
- Night sweats
- Swelling in feet or abdomen
What is prophylactic antibiotic premedication?
Antibiotic coverage for patients with certain conditions (endocarditis and joint replacement) given prior to an operation or treatment
Prescribe to prevent infections in those patients who might be at risk for infection from bacteremia (bacteria in blood)
What are high risk dental procedures that may cause bacteremia?
- Extractions
- Class V or subgingival restorations
- Crowns
- Dental Implant placement
- Root Canal Tx outside the root tip (apicoectomy)
- Periodontal procedures
What is the sequence of bacteremia?
- Discharge of bacteria into bloodstream
- Adherence of microbes to damaged area
- Multiplication of organisms
- Development of local/systemic infection
- Damage to endocardial surface
Patients at risk for complications resulting from a bacteremia or IE:
§ Immunocompromised (HIV) / Immunosuppressed (transplant)
§ Insulin dependent diabetics
§ Hemodialysis shunts
§ Following total joint replacement
§ Previous prosthetic joint infection
§ Acute infections at a distant site
§ Hemophilia
§ Malnourishment
What microorganisms may cause infective endocarditis?
- Streptococcus (strep)
- Staphylococcus aureus (staph)
- Streptococcus viridans most common in DH Tx
inflammation of the endocardium, inner linings of the heart
bacterial endocarditis
the serous membrane that lines the cavities of the heart
endocardium
encompasses yeast, viral or fungal infections to the lining inside the heart valves
Infective Endocarditis (IE)
what are predisposing factors for IE
- Hx of heart valve disease
- Hx of rheumatic fever
- Heart valve replacements
- Previous Hx of IE
What prophylactic antibiotic should be given to patient for prevention of bacterial/infective endocarditis... (adult/child)
Amoxicillin
Adult: 2.0g
Child (less than 88Ibs): 50mg
1 hour prior
what other premeds are equally effective to Amoxicillin in preventing IE
ampicillin & penicilin
what premed is better for absorption from GI tract
Amoxicillin
what premeds are an alternative from patients allergic to amoxicillin/penicillin
Clindamycin
Adult: 600mg
Child (less than 66Ibs): 20mg
1 hour prior
What ASA classification:
healthy individual with no systemic disease
· normal and healthy patient, able to walk up one flight of stairs or two city blocks without distress
ASA 1
What ASA classification:
individual with a mild systemic disease which is well controlled
· pts who have mild systemic disease, able to walk up stairs and two city blocks but may be short of breath, mild anxiety and some related fear toward dental treatment
ASA 2
What ASA classification:
individual with moderate/severe systemic disease - limits activity
· pts with severe systemic disease that limits activity but not incapacitating, able to walk up a flight of stairs and two city blocks but distress en route that causes them to stop
ASA 3
What ASA classification:
individual with severe systemic disease - life threatening
· pts with incapacitating systemic disease that is a constant threat to their lives, unable to walk up one flight of stairs or one city block distress at rest, anxiety is noted, elective dental care should be postponed until medical condition is improved
ASA 4
What ASA classification:
A moribund (point of death) patient who is not expected to survive without the operation
ASA 5
What ASA classification:
clinically dead, maintained for harvesting of organs
ASA 6
What are areas considered high risk sites for oral cancer?
· Floor of mouth
· Lateral borders of the tongue
· Soft palate including uvula
· Anterior tonsillar pillars (palatoglossal fold)
- Buccal mucosa
name the extraoral anatomical landmarks
· Facial form, skin, hair
· Eyes & ears
· Occipital lymph nodes
· Post- & pre-auricular lymph nodes
· TMJ (open/close, lateral excursion, & range of motion [3 fingers])
· Temporalis muscle
· Masseter muscle
· Parotid glands
· Submental lymph nodes
· Submandibular glands
· Submandibular lymph nodes
· Sternomastoid muscle
· Cervical lymph nodes (lie anteriorly & posteriorly to sternomastoid muscle)
· Supraclavicular lymph nodes
· Neck & larynx
name the intraoral anatomical landmarks
· Superficial inspection of oral cavity
· Lips & labial mucosa
· Buccal mucosa & buccal fold
· Parotid gland function
· Submandibular & sublingual gland function
· Floor of the mouth
· Tongue
· Hard & soft palate
· Oropharynx and nasopharynx
gray, white film on buccal mucosa; common in dark skinned individuals
leukoedema
Increased keratin
white hairy tongue
Due to chromogenic bacteria; tobacco
black hairy tongue
Benign tumor; cauliflower-like
papilloma
Caused by sialolith
ranula
Pregnancy tumor
pyogenic granuloma
White plaque like lesion; tobacco pouch keratosis
leukoplakia
malignant skin tumor associated with excessive sun exposure
basal cell carcinoma
Initially, lesions appear as a slight thickening over a red or white base which may lead to nodularity or ulceration, causing pain and discomfort
squamous cell carcinoma
HHV-8
kaposi's sarcoma
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