POC - WK 7 - Ch 54, 55, 56

pretreatment program including biofilm control, daily fluoride & dietary instruction

A dental hygiene intervention you will most likely provide for your patient before the medical treatment for cancer may include a .

Osteoradionecrosis

A destructive blood vessel compromise and necrosis of bone that can occur after high dose radiation treatment in the head and neck area.

Fluoride

A measure that can help prevent dental caries in a patient with xerostomia related to cancer treatment.

controlled Diabetes type 2

A patient with ____________________ _______________ _______________ affects 90-95% percent of diabetics, is an ASA class 2, may be controlled by diet & exercise, and may or may not take insulin.

type I

A patient with diabetes type ___ will require insulin shots due to a malfunctioning pancreas; and is more prone to candidiasis showing up in the mouth.

Convalescence (kanve 'lesns)

A period of time when you get well again after an illness or a medical operation; the process of getting well.

A LeFort classification II

A pyramid-shaped fracture of the maxilla in which the lines of fracture meet at an apex near the bridge of the nose.

Arch bar

A ready-made contoured appliance that provides hooks from which to position elastic bands that secure the maxillary and mandibular jaws together.

Gram-positive bacterial infections

All are types of oral infections common during and after treatment for cancer EXCEPT..

- swishing - rinsing - smoking - drinking from a straw - eating solid food for 24 hours - spitting

All of the following are important habits the patient should avoid after oral surgery.

- Suture removal - Irrigation of socket - Patient instruction

All of the following are important habits the patient should avoid after oral surgery. Select the exception

Down syndrome

All of the genetic syndromes are sometimes associated with diabetes except one, select the exception?

6 weeks

An uncomplicated mandibular fracture will heal in approximately

Neurotoxicity

Can cause a bilateral feeling of toothache related to chemotherapy treatments for cancer

providing positive reinforcement, demonstrate acceptance & empathy, and practice active listening skills

Cancer patient suggestions for their dental care plan include

metastasis has occurred

Cancer stage is based on tumor size, lymph node involvement, & if

type of cells from which they arise.

Cancers are classified based on the origin of the tissue involved or

tumor size, presence/absence of lymph node involvement, & presence/absence of metastasis

Cancers are described by "staging" which is a standardized description of tumor based on

oral mucositis, oral infection, xerostomia dental caries, and poor oral hygiene.

Chronic oral complications include

Pain displaced, fractured, mobile teeth or jaws & malocclusion

Clinical signs that can aid in recognition of a fractured jaw

A hematopoietic cell transplantation

Described as a patient receives high-dose chemotherapy to depress immune system and kill all malignant cells.

exodontics

Describes the branch of dentistry dealing with the surgical removal of teeth

infections, cardiovascular disease, & kidney dysfunction.

Diabetic patients are at risk for increased susceptibility to

Remission

Diminishment or abatement of the symptoms of a disease

Dysgeusia

Distortion of the sense of taste

protein, vitamin A, & vitamin C.

Essential micro/ macro nutrients needed in the diet to promote healing include

soft eggs, cooked cereal, soft eggs, soft cooked vegetables, and fruits are

Examples of a soft diet for a patient that has had single-jaw fixation appliances.

polyphagia

Excessive ingestion of food

polydipsia

Excessive thirst

Polyuria

Excessive urination

ketoacidosis

Fruity acetonic smelling breath is a classic symptom of

Candida albicans

Fungus that commonly causes oral infection related to treatment for cancer

promote healing & prevent new carious lesions.

Goals for a patient recovering from a fractured jaw would include maintaining adequate nutritional state to

Diabetes type 1

Has a rapid onset, usually diagnosed during childhood, and affects 5-10% of the diabetics, and is ASA 3 classification.

Graft-verses-host disease

Has acute and chronic symptoms that occur when the recipient reacts to the donor marrow and rejects it.

Genetic Diseases of pancreas Hormone pathologies Drug-induced diabetes Infections Immune-mediated diabetes

Identify the health related factors besides pregnancy that can result in diabetes

Do not keep them waiting. Provide appointment times that help maintain regular mealtime schedule. Avoid long appointments. Recognize emergency symptoms and have glucose supplements at hand.

Identify ways that the dental hygienist can reduce stress and prevent an emergency situation during an appt with the pt with diabetes

130

If your pt tells you that the result of his fasting palm glucose test this morning was less than _________ mg/dl, you know that his diabetes is well controlled and it is safe to provide dental treatment

Mucositis

Inflammation of the oral mucosa

Immunosuppression

Inhibition of antibody responses resulting from leukopenia related to chemotherapy treatments

Internal radiation therapy

Involves placing radioactive implants (seeds) in the body and delivers less radiation to surrounding tissues compared to external radiation therapy.

compound comminuted fracture

Involves shattering a bone into many pieces & open communication with the outside (open wound).

Chemotherapy

Is recommended when the cancer has metastasized to other parts of the body.

Trismus

Limited jaw opening because of spasm or fibrosis of muscles or joint; may occur 3-6 months after radiation treatment to head and neck

Alopecia

Loss of hair

The first statement is false the second statement is true

Maxillary fractures are NOT easier to manage than mandibular fractures. This is because the number or bones, associated anatomy, complications of basal skull fractures, and esthetics.

LeFort classification

Maxillary fractures are classified using the:

Autologous (aw-TAH-luh-gus)

Means derived or transplanted from the same individual's body.

Type 2 diabetes characteristics

Most prevalent type of diabetes symptoms result from defective cell receptors that prevent glucose transfer into the cell Blood glucose levels lead first to increased production and later to decreased production of insulin Patients tend to be over weight typical onset is after age 30 often identified after screening after risk factors are identified formerly named ketosis-resistant diabetes Insulin resistance use oral hypoglycemic agents slow onset; frequently goes undiagnosed acute complications are rare prevention/delay with life style changes more often diagnosed with ethnic populations

10-20, 3-12, 1-3

New bone marrow is infused, which functions to increase immune system within ___-___ days, immune recovery in ___-___months, and long-term recovery in ___-___ years.

Intermaxillary fixation (IMF)

Non-surgical (non-invasive), relatively simple method (beneficial in developing countries) of applying wires and or elastic bands between the maxillary & mandibular arches.

- Dysgeusia - Sore mouth - Diminished saliva - Trismus

Oral changes that can influence nutritional intake and further compromise the health status of a patient who is undergoing cancer therapy.

pre-med for deep scaling procedures

Patients with uncontrolled glucose levels are more prone to perio disease but do not require a

- Basic oral care with soft toothbrush - Care with flossing - Bland mouthrinse - Ice chips

Personal care recommendations you can make to help the patient who is undergoing treatment for cancer to reduce the risk for mucositis or to increases ability to maintain daily oral hygiene measures when mucositis is already a problem.

- Fear/apprehension - Impatience - Resignation to loss of teeth - Discouragement - Resentment

Personal factors that can affect communication with your patient when you are providing oral hygiene instruction to him or her before oral surgery.

SRP completed, questionable teeth extracted, & any restorations completed

Prior to head & neck radiation it's recommended that the patient have

- Reduce bacterial count for asepsis - Interpretation of dentists instructions - Reduce infection potential - Ensure subsequent gingival health - Dietary instruction

Reasons why it is important to provide dental hygiene care for a patient before oral and maxillofacial surgery, even when all of the patient's teeth will be removed during the surgical procedure.

Relapse

Recurrence of a disease after its apparent cessation

the oral bacterial count & gingival inflammation.

Removing calculus deposits is recommended before oral and maxillofacial surgery and will reduce

cervical caries.

Salivary gland hypofunction (xerostomia) is a concern for a patient with

2-3

Short acting insulin will peak between ____-____ hours after the injection.

mucositis, xerostomia, & trismus.

Side effects of radiation therapy include

polyuria, polydipsia, polyphagia.

Signs & symptoms of a hyperglycemic patient include

- Bleeding control - Dental biofilm control - Rest, diet, pain - Complications and what to do

Specific components to include in instruction which you will provide your patient immediately after a surgical procedure.

Headache, dizziness, hunger, & sweaty skin.

Symptoms of hypoglycemia include

alopecia, nausea, & anemia.

Systemic side effects of chemotherapy include

False

T/F: Fear and anxiety don't usually influence patient's ability to attend to and comply with the counseling and oral hygiene instructions that you provide before, during, and after treatment for cancer.

Tobacco

The greatest single risk factor for oral & pharyngeal cancer.

incomplete or greenstick fracture.

The type of fractured jaw that is more likely to occur in a small child is

Palliative

Treatment that provides relief of symptoms but is not intended to cure

trauma & pathologic conditions.

Two possible causes of a fractured jaw are

- Fungal infection (candidiasis) - Gram-negative bacterial infections - Viral infections (herpes simplex)

Types of oral infections common during & after treatment for cancer

candidiasis

Uncontrolled glucose levels place your pt at risk for __________, an opportunistic oral infection

Herpes simplex

Virus that can cause oral infection during or after radiation therapy

- Mucositis - Xerostomia - Oral infections - Bleeding - Neurotoxicity

What are oral complications commonly noted with various types of treatment for cancer?

V8 Campbells soup Jello, Macaronia & cheese

What are some foods you can recommend post-operative

- Tobacco and alcohol - Sunlight for lip cancer - Environmental exposure to carcinogens - Socioeconomic status

What are the risk factors for developing cancer?

- Food and liquid intake prior to surgery - Alcohol & medication restrictions - Transport - Regarding rest the night before surgery - Personal items-clothing, care of contact lenses, and prostheses

What are types of printed instructions you would provide as part of your pre-surgical patient education.

Different for each patient; food intake, illness, stress, variations in exercise, presence of infections

What factors determine the dose of insulin administer for each patient

Insulin from a source outside the patient

What is exogenous insulin

Education Referral for screening or treatment Monitoring oral manifestations associated with diabetes

What is the role of the deal hygienist in planning care for pt who are at risk for diabetes or who are exhibiting signs and and symptoms of diabetes

- Plastic straw - Spoon-feeding - Tube feeding

What options are examples of feeding methods used for patients after surgical fixation procedure.

Placing a gauze pad or cold wet teabag over the surgical area

Whats recommended to control the bleeding when bleeding persists is

Comminuted fracture

When the bone is cracked in atleast 2 places

sore throat

Which of the following is not a contraindication for using an IMF

Vitamin A & Vitamin C

Which two vitamins are essential in the diet of a patient who is healing after an oral/maxillofacial surgical procedure.

Gestational diabetes mellitus (GDM)

Which type of diabetes is related to genetics, obesity and hormones during pregnancy

Slow healing response; increased possibility of complications

Why should you be very careful to avoid undue tissue trauma when providing dental care for your pt with diabetes

Intermaxillary fixation

Wiring the upper and lower jaws together (in occlusion) after fracture for stability during healing.

soreness, erythema

World Health Organization scale for oral mucositis level 1 symptoms

oral ulcers, solid foods tolerated

World Health Organization scale for oral mucositis level 2 symptoms

oral ulcers, liquid diet only (due to mucositis)

World Health Organization scale for oral mucositis level 3 symptoms

oral ulcers, alimentation impossible (due to mucositis)

World Health Organization scale for oral mucositis level 4 symptoms

no oral mucositis

World Health Organization scale for oral mucositis level zero symptoms

Documentation

________________________ for a diabetic patient includes type (1 or 2), date of last A1C, if pt has fruity breath, best time of day for dental appointment, name of Rx(s) & if pt took Rx, what time pt ate last & what s/he ate, last glucose reading, pt's homecare routine, & a DHDx statement.

Increase risk for infections Peripheral neuropathy Autonomic neuropathy Nephropathy Retinopathy Cardiovascular disease Increased risk for amputation and pregnancy problems

common physical complications associated with uncontrolled diabetes

- airway problems - Frequent vomiting - dietary problems - risk for increased caries and periodontal infection due to hygiene limitations - mental illness

contraindication for using an IMF

Uncontrolled diabetes contributes to the severity of periodontal infection, and periodontal infection complicates the control of blood glucose levels in diabetes.

describe the relationship between poorly controlled diabetes and periodontal disease

Early diagnosis Patient education Regular exercise Healthy diet Elimination of tobacco and alcohol

diabetes can be controlled but to date, there is no known cure. List five factors important for maintaining the overall good health and well being of an individual with diabetes at risk for diabetes

Injection in abdomen, thigh, or upper arm, through insulin pump attached to abdomen, or inhalable insulin taken following a meal

how is exogenous insulin administered

Rapid acting 30-90 minutes Short acting 2-3 hours Intermediate 4-12 hours Long acting 12-16 hours Inhalable 30-90 minutes

identify the duration of peak action for each of the classes of insulin

diabetic coma; ketoacidosis

if too little insulin is administered to control hyperglycemia, _____________ __________ or __________ can occur

hypoglycemia; insulin shock

if too much insulin is circulating in the blood because of inadequate nutritional intake, __________, sometimes refereed to as __________ __________ can occur

not well controlled

if your pat tells you that her postprandial glucose level this morning was >200mg/dl, you know that her diabetes is what

Hypoglycemia (can cause syncope)

if your pt is taking sulfonylureas or meglitinides to control type 2 diabetes, what side effect is important for you to watch for during dental hygiene treatment

Hyperglycemia is defined by blood glucose levels ≥200 mg/dL (11.1 mmol/L) at any time of the day or glucose levels ≥126 mg/dL (7.0 mmol/L) after fasting for 8 hours. Normal is below those levels.

normal glucose blood leveal hyperglycemia

These drugs increase tissue sensitivity to insulin that is already in the bloodstream.

oral hypolgycemic agents act differently from insulin to control blood glucose levels. What is the mechanism of action of biguanides and thiazolidinediones

Orthognathics

relates to the relationship, positions, and integrity of the bones of the jaws.

Type 1 diabetes Characteristics

symptoms result from a lack of insulin circulating in the blood Pancreas does not produce insulin Patient tends to be underweight usually arises in childhood usually identified by acute symptoms formally named IDDM as well as brittle diabetes Insulin deficiency Dependent on exogenous insulin is less frequently hereditary Rapid onset of symptoms enhances diagnosis Acute complications are possible Prevention methods are unclear Most common in caucasians

Fasting Plasma Glucose level of 126 mg/dl or Oral Glucose Tolerance Test (OGTT) grater than 200mg/dl

what criteria is used to diagnose diabetes

to facilitate glucose uptake into cells.

what is the role of insulin in the human body

Postprandial assessment after consuming a meal Causal plasma glucose measurement done at any time

what self administered test are used for monitoring blood glucose levels during treatment of diabetes

Produced in beta cells of the islets of Langerhans in the pancreas

where is insulin produced in the human body

- Assessment of oral problems - Management of mucositis - Elimination of infection - Motivate for prevention of oral effects of treatment - Improve conditions for healing

why is it important to plan comprehensive and coordinated dental hygiene care for your patient before, during, and after treatment?

Stress increases hyperglycemia.

why is stress prevention an important component of a dental hygienist care plan for a pt whit diabetes

Nervous system (neuropathy) Kidneys (nephropathy) Circulatory system (cardiovascular problems) Reproductive system (pregnancy complications)

your pt with uncontrolled diabetes is at risk for many long term health complications. Identify the body systems or organs that can be affected