CORRECTED Medically Com

8/2/2019 CORRECTED Medically Com

1/80

Adrenal Dis:

Pt. on steroids:

Any persons who was during the last 2 years on 20mg

preduisolone or more for 2 weeks or more is considered as

adrenal gland suppressed person.

Before Surgery: Give 100 mg of hydrocortisone.

during op: 100mg of Hydrocortisone in 1L of

RL /D5

Post op 100mg hydrocortison 16h.

dose reduced every day.

Pt need ext of tooth = double the dose before procedure.

Give prophylactic Ab before procedures.


2/80

For minor procedures:

Give 1. V hydrocortisone 100mg or 20mg prednisolone 2-hr of

procedures.

For long procedures: give 100 mg then 50mg / 6hrs

For major surgery: 100mg then 50mg/ 6hr for 72 hours.


3/80

Adrenocorticonal Dis:

1) Cushings dis: high Glugocorticoid central obesityhyperglycemia, hypertension, osteoporosis/ weakness

2) 2Adrenal insuffecancydue to ACTHsteroid therapy.

3) Conn ,s dis: high Aldosteron.

4) addisonns disease low glucocorticoid


4/80

Pt on Cortisone:

Peptic ulcers.

Susceptibility to infection (need Ab cover).

Succeptability to CA.

Hypertensive. Hyperglycemic.

Acne + fat redistribution.

Mood s + Psychosis.

Proximal myopathy.


5/80


6/80

Hyper thyroidisim: T3 T4

Graves dis.

Heat in tolerance.

wt. loss

Irritability ,,, tremor. Diahrrea.

Goiters/ enlarged thyroid glands.

Warm hands tachycardia.


7/80

Hypothyroidism:

Hashimottos dis

Cold intolerance.

Hoarsness of v.

wt gain dementia + constipation hair loss.

Macroglossia mexydema.

Anemia.

G. A. + Sedative mexydems coma


8/80


9/80

Management

HypothyrodismHypothyoideuthyroid.

If emergency ttt give 50mg 1.v thyroxine.

Pt. sensitive to narcotics respiratory depression.


10/80

Hyperthyrodism

Management: To reach euthyriod. If emergency ttt (Thyroid storm)

give antithyroid / thiouracil.

glucose I. v.

hydorocortsion.

propranolal B blocker 3mg 94

lodide 1.v 1-2 slowly. Cold mattress


11/80

Hyper lhyroidism common in Hypolhyruidism cretinismExpophlhalmous irriversable my mexydemaEye lid lag, jerky movement delayed toothemption

Thyroid swelling bradycardiaEarly tooth eruption hypotension

OsteoporosisAlv. Bone lossWarm moist hand

Tremor dry hands

Diahrrea constipationLoss of wt wt gainHeat intolerance cold intoleranceApettite apettileMetabolism metabolism

Nervous person alopecin


12/80

Carbimozole : Oral Ulcers b/ c agranlocytosis

Thiouracil Lymphopenia affect platletsso CBC

Bleeding profile.Delay TT until euthyroid

Give pilocarpine with felypression instead of adrenaline

Avoid

Povidine iodine b/c I is taken by lhyrold.


13/80

Hypothroidism

Avoid I Avoid G. A : should be eulhyroid. Avoid opoids + benzodia zipine.


14/80

PregnancyPregnancy

-Its an altered physiologic state and not a pathologic entity.- Consult her physician.- Do procedures on 2nd trimester.- Keep up right position.

- Avoid x-ray use sheild.- Avoid felypressin (contracture).

Pilocarpine (methymo globenemia) :

3rd trimester

supine hypotension syndrone. hypersensitive gag reflex.


15/80

Up right PositionUp right Position


16/80

Drugs In PregnancyDrugs In Pregnancy

SafeSafe

Antibiotic.

-Penicillin.-Cephalosporin.

-Climdamycin.

UnsafeUnsafe

Erythromycine

- Hepato toxicTetragcycline-Staining,Hypoplasia

Metronidazole-CleftAminoglycosides- Otonephrotoxicity


17/80

AnalgesicAnalgesic

Paracetamol :Paracetamol : Asprin:- ClettNSAID- Close

ductus .Pulmonary HTV

Local Anasthesia:Local Anasthesia: Pilocarpine:Lido caine

MethemoglobenemiaBupivacaine Felypressin

Contracture


18/80

Oral Contraceptive PillsOral Contraceptive Pills

Sex steroids. risk of MI +

Thromboemboli. risk of dry socket. Ab effect


19/80

LactationLactation

Not Pass withNot Pass with

MilkMilk

- Mefenaic acid.

-Paracetamol.- Penicilline.

- Erythromycine.- Cephalexin.

-Drug excreted inbreast milk is 1% ofmaternal dose- Avoid tetracyclin.

- Mother take drug +avoid breast feedingfor 4 hours.


20/80

Preganacy + X-rayPreganacy + X-ray

-Daily background radiation is 4rad.

1000

-Full Mouth X-ray 1 rad100. 000

- Genetic damage : 10 rad


21/80

Oral ComplicationOral Complication

Pregnancy Tumor:

- Its an exaggerated localized

inflammatory hyperplasic tissuesresponse.


22/80

Calcium in teeth + Pregnancy.

A tooth for every pregnancy

Ca is found in crystalline form in

teeth + its resorbed from bone notfrom teeth.


23/80

AsthmaAsthma

Syndrome : dyspneaCough

bronchospasm

WheezeIntrimsic - ve family hx

adult

Extrinsic - Allergenchildren

+ve family hx


24/80

BronchospasmBronchospasm

is due to: 1) thick basement memb of

bronchide.

2) Mucous.3) Edema4) Hypertrophy of Muscle.

Ocluded bronchiole.


25/80

How to manage dental asthmaticHow to manage dental asthmatic

ptpt

-Good hx. : identify Pt

- Avoid precipitaing factor pt bring hismedication.- Avoid anxeity diazepan given beforeprocedure.

- Avoid : AsprinNSAIDPenicillinSulfites (preservative in L. A)


26/80

- Give prophylactic B2 against salbutamol

- Morning visit.

Inemergency:Give salbutamol bronchodilator. Pt up; be calm. Give oxygen 10l/ min. Salbutamol / 2 mints.

Hydrocortisone 2oo mg 1.v

Be careful of status asmaticus = persistentattack not resolved by medication: fatacl


27/80

CandidaCandida

Due to cortisone in haler


28/80


29/80

HEMLICH

MANEUVER


30/80


31/80

Hysteric anexiety

Hyperventilation

Alkalosis

Loss of consciousAction:Pt should breath thru bag


32/80


33/80

diabeticdiabetic

Is a chronic metabolic disorder characterizedby relative or absolute lack of insulin.

B cells Pancreas Insulin


34/80

Dx of DMDx of DM

1)Fasting venous blood sugur 7mmol/ L 125 mg/d l2)2 hours oral glucose tolerance test

> 11.1 mmol/ L210 mg/ dl

3) Plasma glycosylated Hb Hb A1c > 7%


35/80

InsulinInsulin

+protein synlhesis.+ glycogenesis.

+ lipogenesis.-glygogeolysis.- proteolysis.

- gluconeogenesis.


36/80

Give early morning visits with pt. taking his meal dx IHD + Renal F

Postural hypotension due to autonomic heuwp .

Metformin (glucophage)

should be stopped in Diabetic pt. to prevent nepnrotoxicity.

Restant Metformin restantail 2-3 days.

Suscoptability to infection + delayed wound heafing.


37/80

-Leucocytes dysfunction DM is eqivocal

- Implant success rate 86% 96%

No contraindication to implant but give Ab.

Metformin stopped by i.v contrast

nephrotoxicity (Glugophage)

Give L. A e epinephrine no C. I

Asprin NSAID enhance OHD. Amoxycillin + Acetamenophen is best given.

No relation with bleeding


38/80

Features of DMFeatures of DM

-Polyuria-Polydypsia-Polyphagia

-Thirst-Wt loss-Weakness-confusion


39/80

Problem of DMProblem of DM

Glucose intolerance

Fat breakdown F. acids

Acetone (bad breath) Metabolic Acidosis Ketonebodies


40/80

Management of DMManagement of DM

Poor Controlled DM > 250 mg/ dlDefer until controlled in emergency : do surgery but giveprophylactic

Ab

-DM + on Diet + controlled No precausion

-DM on oral hypoglycemic controlled no precausia- If uncontrolled stop oral hypog. start insulin

check glucose / 2h(stabilize lucose by insulin)


41/80

EmergencyEmergency

Always give glucose if pt. is conscious + dont giveInsulin b/ c hypoglycemic.Hypoglycemic Diabetic

Hyporglycemic comicSweaty dehudrared

Bounding pulse weak pulseRapid anset slow onsetLoss of conscious acetone breathConvulsions vomiting

Give glucose give insulin+ K+

Or glucagon (.mg

Hypoglycemia is more fatal chan hyperglycemia.


42/80

HypoglycemiaHypoglycemia

Give oral glucose if pt. can. If Pt. drowsy sublingual glucogel Put i.v line if you can. If put Unconscious gluagon 1mg 1.m

+ repeat / 2-3 min+ call for amulance

start CPR.


43/80

HypertensionHypertension

Persistent raised B. p > 140/90Bp controlled by out put + vascular

resistanceBp e age + in morning + night

Bp measured in relaxed situation.


44/80

Antihypertensive drugsAntihypertensive drugs

Xerostomia

Gingival swelling.


45/80

Categories of HT N HTNCategories of HT N HTN

Hypertensive emergency 210/ 120 end organfailure.Hypertensive urgency no end organ failure.Mild uncomplicated.

Transient Hypertensive episode.


46/80

HTN EtiologyHTN Etiology

Essential 2 nd HTN90% casesObesity pregnancy

SmokingcontracetivepillsGenetics endocrineFamilial


47/80

Pain perception in hypertensive pt. is less than

normal pt. why?!Not known


48/80

Features of HypertensiveFeatures of Hypertensive

Headache Dizziness. Tinnitus Angina

vision disturbance protein hematuria


49/80

ClassificationClassification

ASAI < 140/190 II 140-160/ 90-100 III 160-180/ 95-110

IV > 180 / > 110

Routine workcheck Bprestrict epinephrinecontrol Bp


50/80

ManagementManagement

Consult physician Temazepan 10 mgprop. check Bp If elvated 40 mg furisomtle captopril 2Img

Give L.A with adrenaline expect in 200/120 Late morning visits why? postural hypo tensive, why?


51/80

Inadequate O2

for myocardium

causes:- Altheroma + narrawing of coronary Vs

- DM HTN LDL

- Lack of exercise smoking.Signs:- breathlessness 50B- Chest Pain : need morphine.

ttt

-B blocker. - Subblingual nitrate.- Ca channel blocker.- stenting, Angioplasty- GABG

IHDIHD


52/80

Not all angina painful. Silent Angina diabetic pt.


53/80

1) Avoid stressful events.2) Be brief with short visits.3) Give all the Rx medication even the

Anticoagulant.4) Avoid painful events with good L. A. +

Long acting agents.

How to manageHow to manage?!?!


54/80

Best local anasthetic is mepivacaiene?

Give preop temazepam


55/80

Give preop temazepam. diazepam 10 mg.

G. A is contraindication for MI pt until 9 month.

- Diuretics so short session.- Antihypertensive Postural hypotensia.

raise him slowly. Dry mouth

-Bleeding tendency due to Auticaoagulant.

- Ca channel blocker giwgiual swelling.- 2 puffs of subbing Nitroglycirne before ttforstable Angina pt.

-Instable Angina best to avoid. risk of MI

- MI delay > 6 mo.Pacemakers:

-Avoid: - Ultrasanic Scaler - MRI - Lithotripsy - U/

E i h i ?!


56/80

Epinephrine?!Max does of epinephrine for O Pt. according to AHAis 0.04 mg.

Endogenous epinephrine released by body is higherthan the amount in L. A + is more dangerous.So, Give L. A e long acting agent i.e. bupivacaine +epinephrine.

[ ] < 1 : 100.000I g : 100.000 ml .01 X 1.41000 mg 100.000 mlI mg : 100 ml0.0 lmg : ml

? : 1.8 ml (Cartidges).? = 1.8 ml X 0.0 lmg

ml0.018 mg

0.04mg / 0.018 mh = 2 cartridges in each session


57/80

-Infection of Endocardium by bacteria whereturbulence is found.

-Infection vegetation + emboli.- Turbulence = Cardiac Lesion.

- dental ext = I. E in 1/3000 pt.- Bacteria : Strepto. Viridins.

whymultiple attachment Ability to multiply rapidly.

- Indrug addict: staph (skin)-

Infective Endocardits IEInfective Endocardits IE


58/80


59/80


60/80


61/80


62/80


63/80

- Occur 3-4 weeks after surgical procedure.-Low fewer malaise.- Anemia , joint pain- infarct due to emboli micro emboli.

- Kidney heat emboli hematuria.- Stroke.- If not tt 30% fatal.- Murmurs.- Echo ECG- Osters nodules.- Tender skin vasculitis.

Clinical Features of I. EClinical Features of I. E


64/80

Factors of I. EFactors of I. E

-No3 of Bacteria.

- Host factors.

- congental O dis.- Ab.- Adherence to endocardium


65/80

Mainly I. EMainly I. EOld Age > 60

Mitral valve 40%Rare in child.


66/80

Chance of I. EChance of I. E

dentaldental

Extraction : 1/3000Extraction : 1/3000


67/80

- Admission- ECG.- Echo Cardio gram.- 3 Blood culture if hr interval.- 2-3 week of Ab Amoxycillin + gentamycin.- Replace infected valve.

Management of IEManagement of IE


68/80

Dont give Ab. For low riskDont give Ab. For low risk

people or low risk procedurespeople or low risk proceduresProcedure

s

NeedEndo beyond apexSialographyRubberSubgingprocedures

CordsScaling

ExtIntroligamentalinjMatrix bandtwedge

No NeedStich removedXrayExfoliation ofdecide

Endo not beyond

apex impressiaI + D


69/80

Risks GroupsRisks Groups

High Intermediate Low

Prosthetic Ov. I ASD GABB

Previous I. E VSD 6m Mitral valve

Mitral v.

prolopsse

Downs sy. Pulm. Stenisis

MI

Bl di Di d


70/80

Bleeding Disorders:

Hemophilia A

X-linked spontaneous bleeding. bleeding after stops procedure but clot dissociated+ pressure. Will not resume clotting.

Interenal bleeding, hemarthrosis, joint deformity. petectes.


71/80


72/80


73/80


74/80


75/80


76/80

Classification:


77/80

Classification:

Depends on level of 8 in blood

One unit/ One ml.


78/80

< One Unit : / one ml severerspontaneaus.1-5 unit/ one ml bleeding from moderate traume.> 5 unit/ one ml major traumer

cause bleeding


79/80

Bleeding Time: NormalProlhrombin T : normal

Partial lhromboplastic Time: prolonged.


80/80

Management- Give replacement therapy factor 8 TT iv +

Hcn- Decompression : intransal spray.

1.5 mg/ ml 0.1 ml0.3 0.5 mg/ kg

Deamino 8 D arginine vasopressin (D8DAVP)

-Tranexamic acid (lysine) Not approved by FDA lg/ orally x 4

10mg/ kg 1.v30mg/ kg oral

Antifrbrynolytic thrombosis episodes. topical 5% m/w.

Documents

CORRECTED Medically Com