quiz 14,15,16 DHCP

Patient evaluation and risk assessment for your patient indicate he is a well-controlled Type II Diabetic. Currently, his drug history states he is taking a diabetic oral medication and his A1c result from 2 weeks ago was 6.3%. He is scheduled for his 3 month periodontal maintenance appointment. What are the appropriate dental management considerations?

Ask the appropriate questions and proceed with treatment being aware of possible problems.

Case A: Ms. Hettie Before the treatment the patient's blood glucose level were:

With the normal range

Complications of long term diabetes mellitus are multifactorial and include the following:

all the complications listed

Your patient reports he has Type 2 diabetes. In order to determine his level of glycemic control, you ask him the result of his last

hemoglobin A1C if within the past 3 month period.

If a patient presents with good medical management of hyperthyroidism (thyrotoxicosis), there is no contraindication for dental treatment except

if an acute infection occurs

Thyroid storm may be a potential medical concern related to dental treatment in patients with untreated or poorly controlled thyroid conditions. What may be a precipitating factor causing the thyroid storm to occur?

infection and stress

Type II Diabetes is characterized by:

insulin resistance and relative insulin deficiency

Hyperthyroidism is associated with all of the following except:

mental and physical slowness

Hypothyroid emergency is associated with

myxedema coma

Insulin is normally produced in the

pancreas

Type I diabetes is the result of:

pancreas beta cell destruction resulting in no insulin production

When providing oral health care for a diabetic patient receiving insulin therapy, what method would not be indicated to prevent an insulin reaction?

Decrease insulin dosage

A power scaling instrument would be contraindicated for patients with:

HIV infection

Which ASA classification would you place a patient with well controlled diabetes?

II

Your patient reports she is being treated for hypothyroidism. She seems extremely nervous today and is scheduled to have implants placed for congenitally missing laterals #7 and #10. After you give the local anesthetic for the dentist, she complains of feeling cold, racing heartbeat, blood pressure drops and convulsions begin. What is occuring?

Myxedema/ hypothyroid coma

Your patient presents with long term use of long term use of glucocorticoids for arthritis. The patient is in good health and is well controlled in her osteoarthritis. She is scheduled for Phase I periodontal therapy. The physician has recommended you follow the conservative protocol outlined in Little DMS. This would include:

No modification in current drug regimen. Follow appropriate anxiety and pain management.

Case B: Susan Fones The peak action of Susan's insulin is reached in 2-3 hours. This range indicates she is taking what classification of insulin?

Rapid acting such as lispro or aspart

Case A:Ms. Hettie Prevention of a diabetic emergency would include all of the following steps, except one. Which one is the exception?

Schedule the appointment before meals

Case A:Ms. Hettie Before the emergency, the blood pressure reading obtained would be classified as:

Stage 1 hypertension

A new patient presents with history of Type II diabetes. His medications include Metformin, HCTZ and Lopressor. His blood pressure is 155/100 with rapid pulse rate. His last A1c (1 month ago) was 9.5%. He took his medication this morning and states he is feeling light headed. What is your course of action?

Take his blood glucose with office glucometer, treat with sucrose if low. Defer all treatment and encourage him to see his physician before rescheduling.

Case B: Susan Fones Susan's dental appointment should be scheduled during the early morning to ensure she is treated shortly after a meal. The ideal time for appointment when considering her insulin intake is during the peak time of her insulin dosage.

The first statement is true. The second statement is false.

Case B Susan Fones: What type of diabetes does Susan have?

Type 1

Which of the following is not a complication of uncontrolled diabetes?

Arthritis

The most common type of primary adrenal hyperadrenalism is related to the overproduction of glucocorticoids. This pathophysiologic disease is referred to as:

Cushing's Disease

Generalized enlargement of the thyroid gland may be diffuse or nodular. This condition is referred to as a:

goiter

Which ASA classification would you place a patient with Type 1 diabetes?

ASA 3

Case A: Ms. Hettie Use to answer the next 5 test items. At the end of a periodontal debridement appointment, a 63 year old female patient becomes shaky, pale and weak. She is under the care of a physician for Type 2 diabetes, which she states is controlled by oral medication. Her vital signs today included B/P 138/88, pulse rate of 76, regular respiration of 16. She ate breakfast about 2 hours before her appointment and her blood glucose this morning was 100mh/dL. The hygienist notifies the dentist and they reassure the client while managing the emergency. Which of the following actions would be the most important in managing this potential emergency safely?

Administration of sugar source

Your dental team is interested in the total health of all of your patients. Identification of patients with undiagnosed diabetes and prediabetes is one of your goals as healthcare providers. What is your evaluation method in detecting problems related to diabetes?

All described

The American Diabetes Association suggests which of the following targets for patients with diabetes for glycemic management? This indicated the patient is well-controlled.

All of those listed are correct. However, the target goals may be slightly different for each patient based upon individual considerations.

Case B: Susan Fones is a 34 year old teacher who is a 6 month recare patient. She was diagnosed with diabetes as a child and gives herself insulin shots daily. She is concerned about her bleeding gums and noticed tooth mobility in mandibular anterior region. She reports dry mouth and a burning tongue. At the exam you notice an increase her periodontal probing depths, bleeding and Class 1 mobility in maxillary and mandibular anterior teeth.. She has 3 new carious lesions and white chalky calculus on the mandibular anteriors and maxillary molars. Also, she presents with a white lesion which could be wiped off on the buccal mucosa. She reports she missed her last appointment with her endocrinologistand has not been taking care of herself as she has in the past due to her hectic work schedule. What following etiological factors are most probable for the development of this type of diabetes?

Autoimmune destruction of the beta cells

Case B Susan Fones: What is your best diagnosis of the white lesion on the buccal mucosa with the information given?

Candidiasis infection

Which of the following is a dental management consideration in a patient treated for hypothyroid disease?

avoidance of CNS depressants like narcotics and barbiturates

Clients with diabetes are contraindicated for implant placement because implants are foreign objects which are commonly rejected by persons with diabetes.

both are false

Addison's Disease is a primary adrenocorticoid insufficiency where the adrenal cortex is destroyed resulting in a deficiency of all the adrenocortical hormones which may be caused by autoimmune disease, infection or tumor. The more common form of adrenal insufficiency known as secondary adrenocortical insufficiency results in a deficiency of only cortisol which may be caused by the overuse of exogenous corticosteroids.

both are true

For routine dental treatment, patients who are currently taking corticosteroids do not require additional additional steroid supplementation. Some patients with adrenal insufficiency may experience a crisis during the extreme stress of dental treatment.

both statements true

The potential medical short term concerns relating to the dental care of an uncontrolled diabetic who may be taking insulin include all of the following except:

diabetic coma

Case A: Ms Hettie If this patient becomes unconscious, which of the following actions is contraindicated

dministration of orange juice

Which of the following is not a symptom of hypoglycemia?

dry hot skin

During the patient assessment, you notice signs and symptoms of possible thyroid cancer. These include all of the following except:

dysgeusia

Oral manifestations of poorly controlled diabetics may include all of the following except:

enamel hypoplasia

Cardinal signs of diabetes mellitus are:

polydipsia, polyuria, polyphagia

Possible medical problems relating to dental care are more likely to occur in patients with

primary hypoadrenal disease

Patients with untreated hyperthyroidism are deferred for dental treatment until they are stabilized by their medical provider because a thyroid crisis may be precipitated by all of the following except:

radiation from dental imaging

When treating a patient with diabetes, one may do all of the following except:

reduce the number of appointments by scheduling extended appointment time

Thyroid hormones secreted by the thyroid gland influences all of the following except:

regulates salt and water balance

Case B: Susan Fones The presence of xerostomia is likely caused by:

renal function

Recognition of the early stages of thyroid storm is essential. What are the early signs?

severe tachycardia or palpitations, hypertension, fever

Adrenal crisis is a rare and potentially life-threatening emergency requiring immediate bolus of hydrocortisone intravenously. What are the signs and symptoms of an adrenal crisis?

sudden drop in blood pressure (<100/60)

Signs of a mild insulin reaction or low blood sugar include all of the following except:

unconsciousness, seizures, hypotension

A patient with diabetes presents with an HbA1c of 9%. This indicates the patient is

uncontrolled