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Hospi Dent 2 Lab
Hospi Dent 2 Lab
Hospi Dent 2 Lab
DENTISTRY 2 LAB
ORIENTATION 2ND SEMESTER 2020-
2021
M1 – MEDICAL
Lesson 1 – Review of Medical
Abbreviations
RESUSCITATION
M2 – CARDIO-PULMONARY
CEREBRAL RESUSCITATION
LESSON 1 – PRINCIPLES AND
STEPS OF CPR
LESSON 1 – PRINCIPLES AND
STEPS OF CPR
Steps of CPR
1. Check area safety
•Is the scene/environment safe?
•Is it safe to do CPR?
•What happened?
2. Check responsiveness
•Tap or gently shake victim
•Ask, “Hey, are you OK?”
•Check:
–Normal breathing?
Agonal breaths are NOT normal; sign of cardiac arrest
–Unresponsive?
LESSON 1 – PRINCIPLES AND
STEPS OF CPR
3. Call for HELP CHEST COMPRESSIONS
•Ambulance, Emergency services, Doctor
➛100 - 120 per minute or more
•Activates Emergency Medical Service (EMS)
➛30 counts, count aloud, complete chest recoil
•Get AED/Defibrillator
**pulse check
• for TRAINED Healthcare providers only COMPRESSION DEPTH:
• Carotid pulse
• Within 10s only ADULT: At least 2 -2.4 inches (5-6cm),
• Unsure? proceed to CHEST COMPRESSIONS CHILDREN: About 2-2.4 inches (5-6cm)
4. Compression (C-A-B) INFANTS: About 1.5 inches (4cm)
HOW?
•Kneel facing victim’s chest
HAND PLACEMENT:
•Heel of 1 hand at center of chest, other hand on top and fingers
interlaced ADULT: 2 hands, lower half of sternum
•Shoulders over hands, elbows locked, arm straight CHILDREN: 1 or 2 hands, lower half of sternum
•Compress down, release pressure gently INFANTS: 2 fingers, just below nipple line
LESSON 1 – PRINCIPLES AND
STEPS OF CPR
5. AIRWAY (C-A-B) 6. Breathing (C-A-B)
•Head-tilt, chin-lift maneuver •Maintain airway
• Press down on the forehead while pulling up on the
bony part of the chin with 2-3 fingers of the other •Pinch nose shut
hand
•Open your mouth wide, take a normal breath,
• Tilt the head past a neutral position top open the
airway while avoiding hyperextension of the neck make a tight seal around outside of victim’s
mouth
•Modified Jaw thrust (suspected cervical spine
injury) •Give 2 full breaths (1s breath)
• Put one hand on each side of the patient’s head •Observe chest rise and fall, listen and feel for
with thumbs near the corners of the mouth
escaping air
• Slide fingers into position under the angles of the
patient’s jawbone without moving the head or neck *rescue breath/ventilations
• Thrust the jaw upward without moving the • One-second breath
head/neck to lift the jaw
• 2 rescue breaths per 30 chest compressions
LESSON 1 – PRINCIPLES AND
STEPS OF CPR
Ventilations or Rescue Breathing 2. Pocket mask
3 Methods: •Creates a barrier between your mouth and the patient’s
1. Mouth-to-mouth mouth and nose
•Open airway past a neutral position using the head-tilt/chin-lift •Protects you from contact with a patient’s blood,
technique vomitus and saliva, and from breathing the air that the
•Pinch the nose shut and make a complete seal over the patient’s patient exhales
mouth your mouth
•steps:
•Give ventilations by blowing into the patient’s mouth • Assemble the mask and valve
• vTake a break between breaths by breaking the seal
• Open airway (head-tilt/chin-lift, from patient’s side)
Variation: Mouth-to-Nose • Place mask over the mouth and nose (bottom must not
•With the head tilted back, close mouth by pushing on the chin extend past the chin)
• Seal the mask
•Seal your mouth around the patient’s nose and breathe into the
• index finger and thumb on the top of the mask above the valve and
nose remaining fingers on the side of the patient’s face
•If possible, open the patient’s mouth between ventilations to • Hand closest to the chest, place thumb along base of the mask while
placing bent index finger under the patient’s chin, lifting the face into
allow air to escape the mask
LESSON 1 – PRINCIPLES AND
STEPS OF CPR
3.Bag-valve-mask (BVM) resuscitator
•A handheld device used to ventilate patients and administer
higher concentrations of oxygen than a pocket mask
•2 rescuers needed to effectively operate
•steps:
• Assemble the BVM as needed
• Open airway (head-tilt/chin-lift from the top of the patient’s
head)
• Use an E-C hand position
• Both hands around the mask, form an E with the last three fingers, and a
C with the thumb and index finger
• Second rescuer provide ventilations
• Depress bag halfway to deliver between 400-700 mL of volume to make
chest rise
• Give smooth and effortless ventilations (1 second)
• Do not completely deflate the bag
LESSON 1 – PRINCIPLES AND
STEPS OF CPR
When to STOP CPR HAINES (High Arm IN Endangered Spine)
• You see sign of return of spontaneous circulation •Used in situations in which the patient is suspected of
(movement or breathing) having a head, neck or spinal injury
• AED is ready to analyze the patient’s heart rhythm •Rescuer is alone and must leave the patient
• Other trained rescuers take over •Rescuer unable to maintain an open and clear airway
(vomit or fluid)
• Presented a valid do not resuscitate (DNR) order
How to: (H.A.IN.E.S)
• Too exhausted to continue • Kneel at side of the patient
• Roll patient toward the rescuer
• Scene becomes unsafe • Place top leg on the other with both knees in a bent position
Recovery Position (no cervical trauma) • Align the arm on top with the upper body
M3 – COPD
COPD
Anti-Inflammatory
Decreasing inflammation leads to less swelling and mucus production in the airways and
that makes it easier to breathe. These medicines are known as corticosteroids, which can
have serious side effects, such as weight gain, diabetes, osteoporosis, cataracts, and
increased risk of infection so they must be monitored carefully.
Antibiotics
People with COPD do experience flare-ups with more coughing, more mucus, and more
shortness of breath. This is often caused by bacterial or viral infections.
Anticholinergics
These relax the muscle bands that tighten around the airways. This action opens the
airways, letting more air in and out of the lungs to improve breathing. Anticholinergics
also help clear mucus from the lungs. As the airways open, the mucus moves more freely
and can, therefore, be coughed out more easily.
LESSON 3 – DENTAL
MANAGEMENT
LESSON 3 – DENTAL
MANAGEMENT
1.Assess the severity of the patient’s disease and its control. 1.Avoid nitrous oxide-oxygen inhalation sedation with
severe COPD because the gas may accumulate in the air
2.Review the history of evidence of concurrent coronary spaces of the diseased lung.
heart disease or hypertension and take appropriate
precautions. 2.General anesthesia is given when absolutely essential. I/V
barbiturates are absolutely contraindicated.
3.If the patient is on steroids, consider supplemental
steroids. 3.Consider low dose oral diazepam or other benzodiazepines
(these are respiratory depressants and also may cause oral
4.Avoid dental treatment if the upper respiratory infection is dryness).
present.
4.Avoid the use of barbiturates and narcotics since they are
5.Treat the patient in an upright chair position/semi-supine. respiratory depressants.
6.Use local anesthetic as usual. The use of bilateral 5.Antihistamines and anticholinergics are generally not used
mandibular blocks or bilateral palatal blocks can cause because of their drying properties and the resultant increase
unpleasant airway constriction sensation in some patients. of mucous tenacity.
7.Avoid the use of rubber dam in severe disease. 6.Avoid erythromycin, macrolide antibiotics (azithromycin)
and ciprofloxacin for patients taking theophylline, since
8.Use pulse oximetry to monitor oxygen saturation, consider these can retard the metabolism of theophylline, resulting
low flow (2 to 3L/min) supplemental oxygen when oxygen in theophylline toxicity.
saturation drops below 95percent.
7.Do not use outpatient general anesthesia.
Lesson 1 – Oral Manifestations of
M4 – DM DM
M5 – HEPATITIS
Diagnostic markers for Hepatitis
M6 – HYPERTENSION Hypertension
•Local anesthetics are recommended for patients with hypertension because they can decrease pain and increase comfort.
•The selection of a local anesthetic : duration of the procedure the need for hemostasis the required degree of pain control
•Vasoconstrictors added to local anesthetics to aid in hemostatic control and to increase the duration
•Risk of epinephrine: sympathomimetic effect on cardiac β1-receptors.
•Avoid Norepinephrine or levonordefrin, unopposed activation of α1-receptors in HT increasethe duration of the drug’s
effect (activation lead to uncontrolled increases in BP)
•2% lidocaine with 1:100,000 epinephrine most commonly used to achieve the necessarydegree of anesthesia for most
dental situations.
•Maximum recommended dose of local anesthetic solution for hypertension (poorly controlled): two 1.8- ml cartridges
(total dose of 3.6 ml) with 1:100,000 (0.036 mg) epinephrine per appointment.
CONTRAINDICATIONS: LOCAL ANESTHETICS WITH VASOCONSTRICTORS
DRUG CONSIDERATIONS
• Minimal concentration (epinephrine 0.036 mg), aspirate before injection and injection slowly.
•Caution when using vasoconstrictors in patient taking a nonselective beta-blocker.
• Do not use gingival packing material that contains epinephrine.
• Reduce dosage of barbiturates and other sedative (action may enhance by antihypertensive
agent).
• Epinephrine used judiciously with MAO inhibitor.
Lesson 1 – Fetal Circulation
•Procedures
• Surgical repair - not corrected till 1 year to wait for
spontaneous closure
• Catheter procedure
• Hybrid procedure
LESSON 3 –
CLASSIFICATION OF CHD
2.ATRIAL SEPTAL DEFECT
An atrial septal defect is an abnormal opening between the heart's upper chambers.
Small defects might be found by chance and never cause a problem. Some small atrial
septal defects close during infancy or early childhood. It usually presents late in life at
about 30 years as a late cyanotic heart disease. The hole increases the amount of blood
that flows through the lungs.
There are several types of atrial septal defects, including:
•This is the most common type of ASD and occurs in the middle of the wall between
the atria (atrial septum).
•This defect occurs in the lower part of the atrial septum and might occur with other
congenital heart problems.
•Sinus venosus. This rare defect usually occurs in the upper part of the atrial septum
and is often associated with other congenital heart problems.
•Coronary sinus. In this rare defect, part of the wall between the coronary sinus —
which is part of the vein system of the heart — and the left atrium is missing.
TREATMENT
•Medical monitoring - many atrial septal defects close on their own during childhood.
For those that don't close, some small atrial septal defects might not require treatment.
•Surgery - Many persistent atrial septal defects eventually require surgery mostly with
medium to large atrial septal defect.
• Cardiac catheterization
• Open-heart surgery
LESSON 3 – CLASSIFICATION OF
CHD
3.PATENT DUCTUS ARTERIOSUS
Patent ductus arteriosus (PDA) is a persistent opening between the
two major blood vessels leading from the heart, the aorta and the
pulmonary artery. The opening, called the ductus arteriosus, is a
normal part of a baby's circulatory system before birth that usually
closes at the 1st or 2nd day of life.
TREATMENT
Treatment options for a patent ductus arteriosus include
•Monitoring – for premature babies, it may close on its own and for
full-term babies, children and adults who have small PDAs that
aren't causing other health problems, monitoring might be all that's
needed.
•Medications – NSAIDs or PGE2 inhibitor might help to close PDA
in a premature baby.
•Closure by surgery - If medications aren't effective and the
condition is severe or causing complications, surgery might be
recommended.
•Closure by cardiac catheterization – can be used for full-term
babies, children, and adults.
LESSON 3 –
Cyanotic Group
CLASSIFICATION OF CHD TREATMENT
Surgery is the only effective treatment.
1.TETRALOGY OF FALLOT
• Intracardiac repair
Tetralogy of Fallot is a rare condition caused by a combination of four heart defects that
are present at birth (congenital). • Usually done during the first year after birth and involves several
repairs.
a. Pulmonary valve stenosis - Pulmonary valve stenosis is a narrowing of the pulmonary • In this procedure, the surgeon places a patch over the ventricular septal
valve — the valve that separates the lower right chamber of the heart (right ventricle) defect to close the hole between the lower chambers of the heart
from the main blood vessel leading to the lungs (pulmonary artery).
• Temporary surgery
b. Ventricular septal defect - A ventricular septal defect is a hole (defect) in the wall
(septum) that separates the two lower chambers of the heart • This procedure may be done if your baby was born prematurely or has
pulmonary arteries that are undeveloped.
c. Overriding aorta - In tetralogy of Fallot, the aorta is shifted slightly to the right and lies • In this procedure, the surgeon creates a bypass (shunt) between a large
directly above the ventricular septal defect. In this position the aorta receives blood artery that branches off from the aorta and the pulmonary artery.
from both the right and left ventricles, mixing the oxygen-poor blood from the right
ventricle with the oxygen-rich blood from the left ventricle.
•Surgery
• Resection with end-to-end anastomosis. This method involves removing
the narrowed segment of the aorta (resection) followed by connecting the
two healthy sections of the aorta together (anastomosis).
• Subclavian flap aortoplasty. Left subclavian artery might be used to
expand the narrowed area of the aorta.
• Bypass graft repair.This technique involves bypassing the narrowed area
by inserting a tube called a graft between the portions of the aorta.
• Patch aortoplasty. Treatment of coarctation by cutting across the
narrowed area of the aorta and then attaching a patch of synthetic material
to widen the blood vessel.
LESSON 3 –
CLASSIFICATION OF CHD
2.AORTIC STENOSIS AND ATRESIA TREATMENT
Aortic valve stenosis or aortic stenosis occurs when the heart's Treatment for aortic valve stenosis depends on the
aortic valve narrows. This narrowing prevents the valve from severity of your condition, whether you're experiencing
opening fully, which reduces or blocks blood flow from your heart
into the main artery to your body (aorta) and onward to the rest of signs and symptoms, and if your condition is getting
your body. When the blood flow through the aortic valve is worse.
reduced or blocked, your heart needs to work harder to pump •Monitoring for mild symptoms
blood to your body. Eventually, this extra work limits the amount
of blood it can pump, and this can cause symptoms as well as •Surgery for moderate to severe
possibly weaken your heart muscle. It is the most common • Aortic valve repair - Surgeons rarely repair an aortic valve
anomaly of aorta is congenital bicuspid valve. Not much of to treat aortic valve stenosis, and generally aortic valve
functional significance except predisposes it to calcification. stenosis requires aortic valve replacement. To repair an
3 types of congenital aortic stenosis: aortic valve, surgeons may separate valve flaps (cusps)
that have fused.
1.Valvular: cusps thickened and malformed
• Balloon valvuloplasty - A procedure using a long, thin
2.Subvalvular: thick fibrous ring under the aortic valve tube (catheter) to repair a valve with a narrowed opening
(aortic valve stenosis).
3.Supravalvular: uncommon
• Aortic valve replacement - Surgeons removes the
Congenital aortic atresia are rare and is incompatible with life. It damaged valve and replaces it with a mechanical valve or
is the congenital absence of the normal valvular opening from the a valve made from cow, pig or human heart tissue
left ventricle of the heart into the aorta. (biological tissue valve).
LESSON 3 – CLASSIFICATION OF
CHD
3.PULMONARY STENOSIS AND ATRESIA TREATMENT
• Stenosis •Medication
• IV Prostaglandin.
Pulmonary valve stenosis is a condition in which a deformity on or
near your pulmonary valve narrows the pulmonary valve opening •Procedures for pulmonary stenosis
and slows the blood flow. It is the most common form of • Balloon valvuloplasty - Using the small tube that was threaded through a vein in
your leg to your heart for a cardiac catheterization, your doctor places an
obstructive CHD and it occurs as component of Tetralogy of Fallot uninflated balloon through the opening of the narrowed pulmonary valve.
or it may be an isolated defect. The pulmonary valve is located • Open-heart surgery - When a balloon valvuloplasty isn't an option, you may
between the lower right heart chamber (right ventricle) and the require open-heart surgery. During surgery, doctors either repairs the pulmonary
pulmonary arteries. Adults occasionally have pulmonary valve artery or valve or replaces the valve with an artificial valve.
stenosis as a complication of another illness, but mostly, pulmonary •Procedures for pulmonary atresia
valve stenosis develops before birth as a congenital heart defect. • Balloon atrial septostomy - A balloon can also be used to enlarge the natural
hole (foramen ovale) in the wall between the upper two chambers of the heart.
•Atresia
• Stent placement – Placing of a rigid tube in the natural connection between the
In pulmonary atresia, the valve that lets blood out of the heart to go aorta and pulmonary artery.
to your or your baby's lungs (pulmonary valve) doesn't form • Shunting - Creating a bypass (shunt) from the aorta to the pulmonary arteries
allows for adequate blood flow to the lungs.
correctly. Instead of opening and closing to allow blood to travel
• Glenn procedure - In this surgery, one of the large veins that normally returns
from the heart to the lungs, a solid sheet of tissue forms. So blood blood to the heart is connected directly to the pulmonary artery instead.
can't travel by its normal route to pick up oxygen from the lungs. • Fontan procedure - If the right ventricle remains too small to be useful, surgeons
Instead, some blood travels to the lungs through other natural may use a Fontan procedure to create a pathway that allows most, if not all, of
passages within the heart and its arteries. Without treatment, the blood coming to the heart to flow directly into the pulmonary artery.
pulmonary atresia is nearly always fatal. • Heart transplanst - In some cases, the heart is too damaged to repair and a heart
transplant may be necessary.
LESSON 3 –
CLASSIFICATION OF CHD
Dental Care for Patients with CHD
1.First step to providing appropriate care is to obtain and document a comprehensive medical and social history of the patient.
2.Where clinically indicated, radiographs should be exposed to augment the clinical examination.
3.Liaison with the family medical practitioner or the cardiology team responsible may be required, prior to providing active treatment.
4.Preventive dentistry in the form of dietary advice, home and office fluoride therapy, and oral hygiene advice can and should be provided for all
patients.
5.This group should receive every appropriate measure in the preventive armamentarium in order to minimize their risk of developing dental caries.
6.Fissure sealant placement may or may not be appropriate, depending on age and cooperation, but should be considered as soon as it is feasible.
7.Placement of resin-modified or conventional glass ionomer sealants may be considered as an interim measure for teeth especially at risk of caries
that are not yet fully erupted, or for children who are unable to tolerate the placement of a conventional resin sealant
8.Should disease occur, identification of potential foci of infection in the mouth is the cornerstone of treatment planning
9.Treatment of dental caries, whether surgical or restorative, must be provided in the context of the risk of IE.
10.Definitive treatment is preferable to temporary or short-to-medium- term solutions.
11.Extraction is generally favored over pulp therapy, especially for the primary dentition. Extractions and other surgical treatment should be carefully
planned and consideration given to potential coagulation problems.
12.Restorative treatment should be definitive, and the placement of stainless steel crowns (SSCs) is often preferable to direct intra- coronal
restorations, especially for carious primary teeth.
13.Appropriate consultation with the cardiac and anesthetic teams at the planning stage forms the basis for minimizing the risks during sedation and
general anesthesia.
Lesson 1 – Physiologic changes of
pregnancy
Respiratory changes
Renal changes
•The diaphragm is pushed up by 4cm
•Renal blood flow increases: the renal arteries are also affected by the fall in
•Tidal volume increases by ~ 30-50% SVRI, and this is mediated by relaxin (which influences endothelial nitric oxide
production).
•Respiratory rate increases to 15-17 •GFR increases by as much as 85%
•Urea and creatinine decrease because of this
•Minute volume increases by 20-50%.
•Kidneys become enlarged; the renal pelvis dilates and there is a "physiological
•Chest wall compliance decreases hydronephrosis" - more so on the right because the right ureter crosses iliac and
ovarian vessels at an angle. This predisposes to pyelonephritis
•Lung compliance remains the same •Tubular resorption of urate and glucose decreases
LESSON 1 – PHYSIOLOGIC
CHANGES OF PREGNANCY
Gastrointestinal and nutritional changes Haematological changes in the oral cavity
•Nausea and vomiting: in 50-90%.
•The overall trend is towards hyper coagulability. In
•esophageal sphincter tone is decreased (aspiration is more likely) the third trimester, coagulation activity is about
• There is increased intra gastric pressure due to upward displacement
double that of normal.
• Gastric emptying is delayed, and is virtually non-existent during labor •Platelet count decreases, particularly in late
pregnancy
•Thiamine supplementation is important, because prolonged hyper
emesis can result in vitamin deficiency. • Normal pregnancy is associated with a degree
of enhanced platelet destruction which is
•Abdominal compartment pressure measurements are going to be compensated for by increased production
wildly inaccurate.
• The destruction takes place in the utero
• There is insulin resistance, particularly later in pregnancy placental circulation
• Metabolic fuel use favors lipolysis, preserving the glucose and amino
acids for use by the fetus. •Factors V, VII, VIII, IX, X, XII and von Wille brand
factor increase significantly
• Protein catabolism is decreased
• Factor VII may increase as much as tenfold.
•There is a peak of calcium demand in the third trimester
LESSON 1 – PHYSIOLOGIC
CHANGES OF PREGNANCY
Changes in the oral cavity
Cavities. These are small, damaged areas in the surface of Periodontal disease. If gingivitis is untreated, it can lead to
your teeth. Being pregnant makes you more likely to have periodontal disease. This causes serious infection in the gums and
cavities. You can pass the bacteria that causes cavities to your problems with the bones that support the teeth. Your teeth may get
baby during pregnancy and after birth. This can cause loose, and they may have to be extracted (pulled). Periodontitis
problems for your baby’s teeth later in life. can lead to bacteremia (bacteria in the bloodstream).
Pregnancy tumors (also called pyogenic granuloma). These
Gingivitis. Gingivitis is inflammation (redness and swelling)
tumors are not cancer. They’re lumps that form on the gums,
of the gums. If untreated, it can lead to more serious gum usually between teeth. Pregnancy tumors look red and raw, and
disease. they bleed easily. They can be caused by having too much plaque
Signs and symptoms include: (a sticky film containing bacteria that forms on teeth). These
Redness and swelling tumors usually go away on their own after giving birth. In rare
Tenderness in the gums
cases they may need to be removed by your health care provider.
Bleeding of the gums, even when you brush your teeth gently Tooth erosion. If you have vomiting from morning sickness, your
Shiny gums teeth may be exposed to too much stomach acid. This acid can
harm the enamel (the hard surface) of your teeth. Morning
Loose teeth. High levels of the hormones progesterone and sickness (also called nausea and vomiting of pregnancy or NVP)
estrogen during pregnancy can temporarily loosen the tissues is nausea and vomiting that happens during pregnancy, usually in
and bones that keep your teeth in place. This can make your the first few months.
teeth loose.
LESSON 2 – DENTAL
MANAGEMENT OF PREGNANT
PATIENT
LESSON 2 – DENTAL MANAGEMENT
OF PREGNANT PATIENT
Signs and symptoms of dental problems include: If you have a dental problem that needs treatment,
•Bad breath make sure your dentist knows that you’re pregnant.
•Loose teeth Depending on your condition, you may be able to
wait for treatment after your baby’s birth.
•Mouth sores or lumps on the gums
Treatments that are safe during pregnancy include:
•New spaces between your teeth
•Receding gums (when your gums pull away from your teeth so you can •Local anesthesia. Anesthesia is medicine that lessens or
see roots of your teeth) or pus along your gumline (where your gums prevents pain. Local anesthesia is used in a specific part
meet your teeth) of the body, like to numb your mouth for a dental
•Gums that are red, swollen, tender or shiny; gums that bleed easily filling or to have a tooth pulled. This medicine is safe
•Toothache or other pain to use during pregnancy.
LESSON 3 – MEDICATIONS OF
PREGNANT PATIENT IN
RELATION TO DENTISTRY
LESSON 3 – MEDICATIONS OF
PREGNANT PATIENT IN RELATION TO
DENTISTRY
Safe medications
The most common drugs used by dentists to be safe for use in pregnancy with a few exceptions:
Lidocaine with epinephrine is safe, but as with any patient, proper aspiration to avoid intravascular injection is necessary
for effective anesthesia and to avoid the cardiovascular side effects of epinephrine.
Too rapid heartbeat and systemic vasoconstriction can lead to fetal hypoxia.
Penicillin, clindamycin, and cephalosporins are safe antibiotics and should be prescribed when indicated. Tetracyclines of
any type should be avoided during pregnancy and breastfeeding to avoid any discoloration of the teeth.
Analgesia presents a more difficult decision, but acetaminophen is OK for most patients.
Aspirin and other nonsteroidal, anti-inflammatory drugs (e.g., ibuprofen) should not be prescribed.
For severe pain, oxycodone is considered safe. Codeine, hydrocodone, or propoxyphene are probably safe for a short time.
Nitrous oxide is probably safe as long as there is oxygen administered as well.
Tooth whitening carbamide bleaching solutions continues to be cautious and it is not recommended during pregnancy.
Primary prophylaxis is with Amoxicillin 2.0g given orally one hour before the procedure. Penicillin-allergic women can
be treated with Clindamycin 600mg orally.
Lesson 1 – Oral Manifestations of HIV
M9 – HIV Infection
6.Chlorhexidine gel is applied with applicators. 3.Antifungals are used if a candida infection is diagnosed.
4.Appliance wear is discontinued if the mouth becomes painful.
7.In the event of trismus, jaw exercises are
implemented. 5.Obturators are reviewed regularly. They may require frequent attention
with adjustment or remake.
LESSON 3 – MEDICATIONS OF
CANCER PATIENTS IN
RELATION TO DENTISTRY
LESSON 3 – MEDICATIONS OF CANCER
PATIENTS IN RELATION TO DENTISTRY
Post-irradiation
Pre- irradiation phase Irradiation phase (6-7 wks)
phase(life long) •For patients at higher risk of osteonecrosis of the jaw in whom an
Pre-treatment assessment 1. Mucositis prevention extraction is indicated, explore all possible alternatives where
1. Wound
A. Oral rinses/spraying teeth could potentially be retained, e.g. retaining roots in the
A. Extraction healing-
B. Selective elimination of oral flora C.
Discourage denture wearing
absence of infection. Consider seeking advice from secondary
B. Removal of foci 3 wks
D. Pain relief dental care.
2. Relief of oral dryness
•If an extraction or any procedure that impacts on bone is required,
A. Oral rinses
B. Saliva substitute discuss the risks and benefits of treatment with the patient to
C. Sialogogues
D. Mucin
ensure valid consent before proceeding.
lozenges
•Do not prescribe antibiotics or antiseptic prophylaxis unless
3. Prevention of caries and periodontal disease required for other clinical reasons.
A. Oral hygiene B. Topical fluoride
A. Oral hygiene B.
Topical fluoride
•Refer to secondary dental care if the socket has not healed at eight
2. Oral prophylaxis weeks.
3. Restorative procedures 4. Trismus prevention
4. Initiation of preventive programme
A. Monitoring •After treatment:
A. Monitoring mouth opening B.
mouth opening B. • Manage simple denture problems after surgery
Exercises
Exercises
C. Physiotherapy • Alleviate the effects of post-irradiation dry mouth, e.g. preventing caries
C. Physiotherapy
5. Nutritional counseling • Monitor for recurrence, new premalignant lesions and second primary tumors
A. Return to regular • Monitor for cervical metastasis
A. Advices diet • Maintain morale of and provide additional support to patients and their
B. Monitoring body weight C. Artificial B. Adjustment to
feeding individual needs C. relatives
Non-cariogenic diet