National Dental Examining Board Remembered

This topic contains 80 replies, has 1 voice, and was last updated by  mrmsekar 2 years, 3 months ago. This post has been viewed 432 times

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  • #17920
     mrmsekar 
    Participant

    How long do you take patient off of Coumadin before surgery? 2-3 days The INR is used to gauge the anticoagulant action of warfarin. Most physicians will allow the INR to drop to about 2.0 during the perioperative period, which usually allows sufficient coagulation for safe surgery. Patients should stop taking warfarin 2 or 3 days before the planned surgery. On the morning of surgery, the INR value should be checked; if it is between 2 and 3 INR, routine oral surgery can be performed. If the PT is still greater than 3 INR, surgery should be delayed until the PT approaches 3 INR. Surgical wounds should be dressed with thrombogenic substances, and the patient should be given instruction in promoting clot retention. Warfarin therapy can be resumed the day of surgery (Hupp, James R.. Contemporary Oral and Maxillofacial Surgery, 5th Edition. Mosby, 032008. 1.3.6.2). Warfarin and Coumadin are oral anticoagulants that inhibit the biosynthesis of the vitamin K–dependent coagulation proteins (factors VII, IX, and X and prothrombin). These drugs are bound to albumin, metabolized by hydroxylation by the liver, and excreted in the urine. The PT is used to monitor warfarin therapy because it measures three of the vitamin K– dependent coagulation proteins: factors VII and X, and prothrombin. The PT is particularly sensitive to factor VII deficiency. Therapeutic anticoagulation with warfarin takes 4 to 5 days.1 Level of anticoagulation and need for altering dosage to avoid excessive bleeding PTR (1.5 to 2.0) or INR (2.0 to 3.0): Dosage does not need to be altered PTR (2.0 to 2.5) or INR (2.5 to 3.5): Dosage may be altered PTR (2.5 or >) or INR (3.5 or >): Delay invasive procedure until dosage decreased Decision is made to alter dosage of anticoagulation medication Physician will reduce patient’s dosage Affect of reduced dosage takes 3 to 5 days Dental appointment needs to be scheduled within 2 days once desired reduction in PTR or INR has been confirmed For patients taking more than 325 mg of aspirin per day, aspirin may need to be discontinued 7 to 10 days before surgical therapy

    (Newman, Michael G.. Carranza’s Clinical Periodontology, 10th Edition. Saunders Book Company, 072006. 44.10.1).

    (Little, James W.. Dental Management of the Medically Compromised Patient, 6th Edition. Mosby, 042002. 21.6.5.5.1).

    #17921
     mrmsekar 
    Participant

    Benzodiazepine affects gaba (Note: Benzo are minor tranquilizers that are used to relieve anxiety and induce sleep, skeletal mm. relaxant. It depresses the limbic system and inhibits the neurons GABA0(gamma amnio butyric acid) on the chloride channels. )

    #17922
     mrmsekar 
    Participant

    Albuterol –asthma ( is an expiratory wheezing- is treated by inhaler albuterol which is a b2 adrenergic agonist other examples are metaproterenolo and salmeterol. It is also tx by theophylline or the leukotriene called montelukast. In an office if inhaler is not available one gcan use epinephrine to treat anaphylactic shock.) mosby pg 300301

    #17923
     mrmsekar 
    Participant

    If patient wants to last for 8 hours which is long acting drug? Aspirin, ibuprofen, acetominaphine, n-something

    Diflunisal is 3 to 4 fold more potent than aspirin as an analgesic and an antiinflammatory agent, but has no anti-pyretic properties.(p.504 lippincott pharmacology) Diflunisal ( DOLOBID ) is a difluorophenyl derivative of salicylic acid; it is not converted to salicylic acid in vivo. Diflunisal is more potent than aspirin in antiinflammatory tests in animals and appears to be a competitive inhibitor of cyclooxygenase. However, it is largely devoid of antipyretic effects, perhaps because of poor penetration into the CNS. The drug has been used primarily as an analgesic in the treatment of osteoarthritis and musculoskeletal strains or sprains; in these circumstances it is about three to four times more potent than aspirin. The usual initial dose is 500 to 1000 mg, followed by 250 to 500 mg every 8 to 12 hours. For rheumatoid arthritis or osteoarthritis, 250 to 500 mg is administered twice daily; maintenance dosage should not exceed 1.5 g per day. Diflunisal does not produce auditory side effects and appears to cause fewer and less intense gastrointestinal and antiplatelet effects than does aspirin. (Hardman, Joel G.. Goodman & Gilman’s the Pharmacological Basis of Therapeutics, 10th Edition. McGraw-Hill Professional Publishing, 082001. 29.2.4.4).

    #17924
     mrmsekar 
    Participant

    Glass ionomer placed on rampant caries

    #17925
     mrmsekar 
    Participant

    Epulis fissuratum-inflamed tissue in ridge area to put denture back in it is due to ill fitting denture in the buccal flange area. It is flappy(hyperplastic) tissue on the ridge area. Tx. Will be to adjust the denture border and use tissue conditioner. Mosby pg 322

    #17926
     mrmsekar 
    Participant

    Why do you take denture out at night Patients should be told that dentures must be left out of the mouth at night to provide needed rest from the stresses they create on the residual ridges. Failure to allow the tissues of the basal seat to rest may be a contributing factor in the development of serious oral lesions, such as inflammatory papillary hyperplasia, or may increase the opportunity for microbial infections, such as candidiasis. When dentures are left out of the mouth, they should be placed in a container filled with water to prevent drying and possible dimensional changes of the denture base material. (Zarb, George. Prosthodontic Treatment for Edentulous Patients: Complete Dentures and Implant-Supported Prostheses, 12th Edition. Mosby, 092003. 4.2.1.7).

    #17927
     mrmsekar 
    Participant

    Ectodermal dysplasia Hereditary ectodermal dysplasia 1. An X-linked recessive condition that results in partial or complete anodontia. 2. Patients also have hypoplasia of other ectodermal structures, including hair, sweat glands, and nails. (Mosby. Mosby’s Review for the NBDE, Part II. Mosby, 042007. 4.1.19).

    #17928
     mrmsekar 
    Participant

    Ameloblastoma-dentigerous cysts Ameloblastoma most likely develop in the wall of a dentigerous cyst( Mosby pg 118119. IT is a benign but aggressive odontogenic tumor with high recurrence.Cystic variant is less aggressive and less likely to occur. The solid type occurs in adults 40 years old. Common location-mandibular molar ramus. It is unilocular or multiocular radioluceny. 3 variants of solid type1. Follicular 2. Plexiform 3.desmoplastic- favor anterior maxilla TX. Enucleation with curettage

    #17929
     mrmsekar 
    Participant

    Process of PCN-not wide range

    #17930
     mrmsekar 
    Participant

    Periostat n doxycycline inhibits what? collagenase Subantimicrobial tetracycline (Periostat) is useful in treating moderate to severe chronic periodontitis. The active ingredient in Periostat is doxycycline hyclate. In concert with scaling and root planing, Mohammad et al.38 have shown this treatment to be effective in institutionalized older adults. Periostat is contraindicated for those patients with an allergy to tetracycline. The semisynthetic compounds (e.g., doxycycline) were more effective than tetracycline in reducing excessive collagenase activity in the gingival crevicular fluid (GCF) of chronic periodontitis patients.

    #17931
     mrmsekar 
    Participant

    How do you clean furcation after perio surgery? Floss, toothbrush, water Subgingival irrigation performed with an oral irrigator using chlorhexidine diluted to one-third strength, performed regularly at home and after scaling, root planing, and inoffice irrigation therapy, has produced significant gingival improvement compared with controls. Subgingival irrigation with specialized tips for deep pockets and furcation areas is effective when used daily as part of the home care routine. Use chorahexadine. The best view of bone defect is with a flap reflection. (Newman, Michael G.. Carranza’s Clinical Periodontology, 10th Edition. Saunders Book Company, 072006. 50.8.2).

    #17932
     mrmsekar 
    Participant

    What type of reinforcement is smiling and praising a child Positive reinforcement (i.e. ‘behaviour shaping’) at every stage of the treatment process is recommended, to indicate to the child that he is making successful steps in the process of receiving treatment. The frequent use of praise during a child’s appointment — when the child performs an appropriate behaviour — is essential. (Humphris, Gerry. Behavioural Sciences for Dentistry. Churchill Livingstone, 022000. 9.10).

    #17933
     mrmsekar 
    Participant

    ANUG comes with spirochetes Acute necrotizing ulcerative gingivitis (ANUG) 1. Characteristics a. Painful, bleeding gingival tissues. b. Blunting of interproximal papillae. c. Pseudomembrane on the marginal gingiva. Sloughing off d. Fetid breath. e. High fever. 2. Caused by fusiform bacilli (spirochetes), Prevotella intermedia and other anaerobes. 3. Most common in teenagers and young adults. 4. Responds well to debridement, oxidizing mouth rinses, and antibiotics. ANUG(gingiva only, low grade fever ) must be distinguish form acute herpes infection ( ulcer on mucosa and gingival , high fever ) (Mosby. Mosby’s Review for the NBDE, Part II. Mosby, 042007. 5.2.7). also Prevotella intermedia are seen in high levels in necrotizing disease pg. 243 Mosby

    #17934
     mrmsekar 
    Participant

    White sponge nevus: of buccal mucosa. The lesions of white sponge nevus usually appear at birth or in early childhood, but sometimes the condition develops during adolescence. Symmetrical, thickened, white, corrugated or velvety, diffuse plaques affect the buccal mucosa bilaterally in most instances. Other common intraoral sites of involvement include the ventral tongue, labial mucosa, soft palate, alveolar mucosa, and floor of the mouth, although the extent of involvement can vary from patient to patient. Extraoral mucosal sites, such as the nasal, esophageal, laryngeal, and anogenital mucosa, appear to be less commonly affected. Patients are usually asymptomatic. TREATMENT AND PROGNOSIS Because this is a benign condition, no treatment is necessary. The prognosis is good

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