Periodontal Management for Diabetic Patients
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Questions and Answers

What should be done if hypoglycemia occurs during periodontal treatment?

  • Terminate treatment and have the patient consume juice or sugar. (correct)
  • Consult the patient's physician before acting.
  • Continue treatment as normal.
  • Administer insulin immediately.

What is advisable for well-controlled diabetic patients during routine periodontal treatment?

  • Take their usual insulin dosage if they eat normally. (correct)
  • Skip their normal meals.
  • Take double doses of insulin.
  • Avoid all medications.

Which condition requires avoiding periodontal treatment until good medical control is achieved?

  • Hypoglycemia.
  • Hypothyroidism.
  • Adrenal insufficiency.
  • Thyrotoxicosis. (correct)

In patients with untreated hypothyroidism, which of the following should be avoided?

<p>Stress and infection. (A)</p> Signup and view all the answers

What might occur in patients with adrenal insufficiency during dental treatment?

<p>Adrenal crisis characterized by severe hypotension. (D)</p> Signup and view all the answers

What should be avoided in an incompletely treated patient with hyperthyroidism?

<p>Use of epinephrine and pressor amines. (A)</p> Signup and view all the answers

Which of the following statements regarding corticosteroids is true?

<p>Corticosteroids can lead to adrenal gland suppression. (C)</p> Signup and view all the answers

How does the hypoglycemia management in periodontal treatment differ from that of adrenal insufficiency?

<p>Hypoglycemia needs juice or sugar intake. (B)</p> Signup and view all the answers

What is the recommended action for patients taking more than 20 mg of cortisol daily before extensive dental procedures?

<p>Double the normal daily dose one hour before the procedure (C)</p> Signup and view all the answers

How long should a patient wait after steroid therapy before resuming normal periodontal treatment?

<p>12 months (A)</p> Signup and view all the answers

What instruction is advised to pregnant patients experiencing nausea due to morning sickness regarding dental care?

<p>Wait to brush until at least 30 minutes after vomiting (D)</p> Signup and view all the answers

What positioning is recommended for a pregnant patient during dental treatment?

<p>On her left side for better blood flow (B)</p> Signup and view all the answers

Which dental product should a pregnant patient avoid due to strong smells during treatment?

<p>Strong flavored dentifrice (B)</p> Signup and view all the answers

What is the primary aim of periodontal therapy for pregnant women?

<p>Reduce inflammatory responses related to pregnancy (C)</p> Signup and view all the answers

What precautions should be taken with dental radiographs during pregnancy?

<p>Limit use and cover the patient with protective materials (C)</p> Signup and view all the answers

For patients currently on corticosteroid therapy, when is no supplementation necessary?

<p>If the patient is taking high doses for less than one month (B)</p> Signup and view all the answers

What is a common oral manifestation observed in patients with AIDS?

<p>Oral hairy leukoplakia (C)</p> Signup and view all the answers

What should be done for a patient with positive sputum cultures for mycobacterium tuberculosis?

<p>Limit treatment to emergency care only. (B)</p> Signup and view all the answers

What is the minimum duration required for adequate tuberculosis treatment?

<p>18 months (D)</p> Signup and view all the answers

Which sterilization method is recommended for dental tools when treating infectious disease?

<p>Autoclave at 120-130°C for 1-2 hours (B)</p> Signup and view all the answers

Which procedure is recommended to minimize aerosol generation during dental treatment?

<p>Manual scaling (A)</p> Signup and view all the answers

What should be done upon patient arrival at a dental practice during a pandemic?

<p>Complete a detailed medical history form. (C)</p> Signup and view all the answers

What is a recommended alternative for suspected COVID-19 cases with tooth pain?

<p>Provide pharmacological management. (C)</p> Signup and view all the answers

What practice is advisable to prevent contamination in a dental clinic during the COVID-19 pandemic?

<p>Promote terminal disinfection after care. (A)</p> Signup and view all the answers

What is the primary route of transmission for Hepatitis A and E?

<p>Fecal-oral route (A)</p> Signup and view all the answers

Which hepatitis virus requires the presence of Hepatitis B for its survival?

<p>Hepatitis D (B)</p> Signup and view all the answers

What percentage of patients infected with Hepatitis C recover completely?

<p>15% (B)</p> Signup and view all the answers

What is the recommended precaution when treating patients with active hepatitis?

<p>Using full barrier techniques (C)</p> Signup and view all the answers

Which of the following hepatitis infections is associated with a high chronic infection rate?

<p>Hepatitis B (B)</p> Signup and view all the answers

What procedure should be taken after treating a patient with active hepatitis?

<p>Dispose of all used items properly (B)</p> Signup and view all the answers

Which of the following is FALSE about Hepatitis C?

<p>A vaccine is available for it (B)</p> Signup and view all the answers

What is a characteristic of AIDS?

<p>It is characterized by impairment of the immune system (D)</p> Signup and view all the answers

What is the definition of thrombocytopenia?

<p>A condition where platelet count is less than 100,000/mm³ (B)</p> Signup and view all the answers

Which drug should be discontinued prior to periodontal therapy, and for how long?

<p>Aspirin; 7 to 10 days (C)</p> Signup and view all the answers

What is the appropriate action if a patient with thrombocytopenic purpura requires more invasive periodontal treatment?

<p>Consult a physician beforehand (B)</p> Signup and view all the answers

Which of the following is a recommendation for leukemic patients prior to periodontal treatment?

<p>Administer antibiotic coverage (A)</p> Signup and view all the answers

What is the primary concern for patients undergoing periodontal treatment with bleeding disorders?

<p>Prolonged bleeding during and after procedures (C)</p> Signup and view all the answers

Which local measures can be implemented to prevent excessive bleeding during periodontal treatment?

<p>Applying pressure and ensuring wound closure (D)</p> Signup and view all the answers

In what scenario is periodontal surgery considered contraindicated in the dental office?

<p>In patients with uncontrolled bleeding (A)</p> Signup and view all the answers

What must be measured before proceeding with a dental procedure in patients at risk of bleeding?

<p>Platelet count and bleeding time (D)</p> Signup and view all the answers

What is the primary test used to assess glycemic control in diabetic patients before periodontal treatment?

<p>Glycosylated hemoglobin test (HbA1c) (C)</p> Signup and view all the answers

What is the normal range for HbA1c in healthy individuals?

<p>Below 5.7% (C)</p> Signup and view all the answers

What is the recommended HbA1c level for well-controlled diabetic patients?

<p>Below 7.0% (B)</p> Signup and view all the answers

Which symptom is NOT commonly associated with hypoglycemia?

<p>Frequent urination (D)</p> Signup and view all the answers

Which of the following statements is true regarding insulin management before dental appointments?

<p>Patients should take their usual insulin dosage and eat normal meals. (C)</p> Signup and view all the answers

What is the potential HbA1c level in some uncontrolled diabetic patients?

<p>20% (D)</p> Signup and view all the answers

Why is it important to know how many times per day a patient takes insulin?

<p>To avoid scheduling treatment during peak insulin activity (D)</p> Signup and view all the answers

What is a common dental complication associated with poorly controlled diabetes?

<p>Hypoglycemia (A)</p> Signup and view all the answers

Flashcards

Diabetes Mellitus

Metabolic disorder with high blood glucose levels and insulin dysfunction.

Type 1 Diabetes

Insulin-dependent diabetes; body doesn't produce insulin.

Type 2 Diabetes

Non-insulin-dependent diabetes; body doesn't use insulin properly.

Gestational Diabetes

Abnormal glucose tolerance during pregnancy.

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Fasting Blood Glucose

Blood glucose level after an 8-hour fast.

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HbA1c

Glycosylated hemoglobin; indicator of average blood glucose over 2-3 months.

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Hypoglycemia

Low blood sugar.

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Hyperthyroidism

Thyroid gland overly active.

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Adrenal Insufficiency

Adrenal gland under-functioning, may need steroid supplement.

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Corticosteroid

Medication affecting adrenal function.

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Pregnancy Precautions

Special considerations during periodontal treatment for pregnant women.

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Supine Hypotension Syndrome

Low blood pressure due to extended lying-down position.

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Hemophilia A

Bleeding disorder due to coagulation factor VIII deficiency.

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Hemophilia B

Bleeding disorder due to coagulation factor IX deficiency.

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Bleeding Disorders

Conditions affecting blood clotting.

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Blood Dyscrasias

Disorders of blood cell function.

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Liver Diseases

Conditions affecting liver function.

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Epilepsy

Chronic neurological disorder with recurrent seizures.

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Hepatitis

Inflammation of the liver.

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AIDS

Immune deficiency disorder caused by HIV.

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Tuberculosis

Bacterial infection affecting lungs.

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COVID-19

Infectious disease caused by SARS-CoV-2 virus.

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Normal HbA1c Range

For healthy individuals, a normal HbA1c level is below 5.7%. 5.7% to 6.4% indicates prediabetes, and 6.5% or higher indicates diabetes.

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HbA1c Goal for Diabetics

The goal for diabetic patients is often to keep their HbA1c below 7%, minimizing long-term complications.

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Well-Controlled Diabetic HbA1c

In well-controlled diabetic patients, the HbA1c level should be below or equal to 6.5%. These patients usually respond to treatment similar to non-diabetics.

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Uncontrolled Diabetic HbA1c

Uncontrolled diabetic patients often have a poor response to treatment and higher HbA1c levels, sometimes reaching 20%.

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Insulin Shock

A dangerous condition where the blood sugar level drops dangerously low, often caused by insulin overdosing.

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Preventing Insulin Shock

To prevent insulin shock in diabetic patients, ensure they take their usual insulin dosage and eat normally before dental appointments. Schedule appointments in the morning.

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Symptoms of Hypoglycemia

Common symptoms of hypoglycemia include tremors, confusion, anxiety, sweating, tachycardia, and unconsciousness.

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Dental Treatment Modifications for Diabetes

Well-controlled diabetic patients can have routine periodontal treatment with normal insulin doses if they eat their normal meals. If the procedures are long, the insulin dose may need to be reduced. Consult the patient's physician for adjustments.

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Thyrotoxicosis and Periodontal Treatment

Patients with thyrotoxicosis (hyperthyroidism) should avoid periodontal treatment until they have good medical control. Avoid epinephrine and other pressor amines in partially treated patients. Prevent stress and control periodontal infection to prevent a thyrotoxic crisis.

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Hypothyroidism and Periodontal Treatment

Patients with hypothyroidism should avoid stress and infection to prevent hypothyroid coma. Avoid narcotics and tranquilizers in untreated patients. Once under good medical management, they can receive dental treatment.

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Adrenal Insufficiency and Stress

Adrenal insufficiency, often caused by steroid therapy, makes patients vulnerable to stress. Dental anxiety, surgery, or infection can trigger an adrenal crisis characterized by severe hypotension.

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Corticosteroid Equivalents

Different corticosteroids have varied potency. 25 mg cortisone equals 20 mg hydrocortisone equals 5 mg prednisolone.

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Adrenal Crisis Symptoms

An adrenal crisis, triggered by stress in patients with adrenal insufficiency, causes severe hypotension.

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Dental Treatment for Adrenal Insufficiency

Patients with adrenal insufficiency should avoid dental procedures that can cause stress. Consultation with their physician is crucial to manage their condition and ensure safe treatment.

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Managing Steroid Use in Dental Patients

Patients on systemic corticosteroids may have suppressed adrenal glands, making them susceptible to dental stress. The extent of suppression depends on the medication, dose, duration, and route of administration. Topical corticosteroids have less impact than systemic ones.

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Steroid Therapy & Dentistry

Patients on steroid therapy require special considerations for dental procedures to prevent adrenal insufficiency.

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Steroid Supplementation: Short-Term

Patients taking low-dose steroids (less than 20mg) for less than a month or topical steroids don't typically need supplementation.

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Steroid Supplementation: Long-Term

Patients taking high-dose steroids (over 20mg) for prolonged periods require supplementation for dental procedures.

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Steroid Supplementation: Extensive Dental Work

For extensive procedures, patients on high-dose steroids should double their normal dose 1 hour before the appointment.

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Steroid Therapy: Past Use Considerations

Patients with a history of steroid therapy need a minimum of 12 months to recover adrenal function before standard dental procedures.

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Pregnancy & Periodontitis

Pregnant women may experience exaggerated inflammatory response in gums due to hormonal changes.

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Pregnant Patient: Dental Treatment Precautions

Dental appointments should be shorter, frequent, and involve specific considerations during pregnancy.

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Dental Radiographs During Pregnancy

Use of dental X-rays during pregnancy should be minimized and involve proper shielding for the mother and fetus.

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Vitamin K Antagonists

Drugs that block the action of vitamin K, which is essential for blood clotting.

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Aspirin and Periodontal Therapy

High doses of aspirin (over 325 mg a day) should be stopped for at least 7-10 days before periodontal treatment to reduce bleeding risk.

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Thrombocytopenia

A condition characterized by a low platelet count (<100,000/mm³), which is crucial for blood clotting.

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Purpuras

Red patches or bruises caused by bleeding under the skin or mucous membranes. Often caused by low platelets.

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Periodontal Treatment with Bleeding Disorders

Periodontal procedures can be performed in patients with clotting disorders, but require careful precautions and may need physician consultation.

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Leukemia and Periodontal Treatment

Patients with leukemia may have bleeding tendency and increased infection risk, requiring medical evaluation and possibly hospital-based procedures.

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Pre-Periodontal Treatment Precautions

Measure platelet count and bleeding time before procedures. If either is low, postpone treatment and refer the patient to a physician.

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Hepatitis A & E

Viral infections causing inflammation of the liver, transmitted through the fecal-oral route. They are self-limiting, meaning they eventually resolve on their own without causing chronic liver disease.

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Dental Care for Hepatitis Patients

Avoid periodontal treatment if active Hepatitis is present. For recovered Hepatitis A & E patients, proceed with routine care. For recovered Hepatitis B & D, screen for HBsAg to determine infectivity.

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Full Barrier Techniques

Use masks, gloves, eye protection, and disposable gowns when treating patients with active Hepatitis to prevent cross-infection.

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HIV/AIDS

Human Immunodeficiency Virus (HIV) causes Acquired Immunodeficiency Syndrome (AIDS). HIV weakens the immune system, leading to a compromised ability to fight infections.

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AIDS Periodontal Management

Managing periodontal issues in AIDS patients involves using full barrier techniques, careful instrument handling, proper sterilization, and avoiding ultrasonic instruments.

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Tuberculosis Dental Treatment

Patients with tuberculosis should receive emergency dental care only. Consult their physician about sputum culture results. Periodontal treatment is limited to emergencies until tuberculosis is adequately treated for at least 18 months.

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Coronavirus (COVID-19) Dental Care

Patients with suspected or confirmed COVID-19 should complete a detailed medical history form. Avoid overcrowding. For urgent care, consider leaving patients for the end of the shift and terminal disinfection. Preoperative chlorhexidine rinse is recommended. Avoid aerosol-generating procedures.

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Double Gloving and Masking

In cases of infectious diseases, double gloves and double masks are recommended to minimize risk of contamination.

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Sterilization for Infectious Diseases

Sterilization using an autoclave at 120-130°C for 1-2 hours is crucial for infectious diseases.

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Oral Manifestations of AIDS

AIDS patients may exhibit oral hairy leukoplakia, oral candidiasis, and necrotizing ulcerative gingivitis or periodontitis (NUG or NUP).

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COVID-19 Urgent Dental Care

For urgent dental care in suspected or confirmed COVID-19 cases, prioritize drainage procedures. Consider delaying treatment to the end of the shift and promote terminal disinfection to minimize contamination risk.

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COVID-19 Alternative Management

For non-urgent conditions like tooth pain or swelling, pharmacological management with antibiotics and analgesics can offer symptomatic relief until the patient recovers from COVID-19.

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Study Notes

Periodontal Management of Medically Compromised Patients (Part II)

  • Diabetes Mellitus: A group of metabolic diseases characterized by high blood glucose levels (hyperglycemia). Two major types are type 1 (insulin-dependent) and type 2 (non-insulin dependent), and gestational diabetes.
  • Pre-Treatment Precautions: Diabetic patients require special precautions before periodontal therapy.
  • Managing Blood Glucose: Patients manage blood glucose by diet, oral agents, or insulin.
  • Classic Signs: Polydipsia (excessive thirst), polyuria (excessive urination), and polyphagia (excessive hunger with weight loss).
  • Diagnosis and Monitoring: If these signs appear, consulting a physician is crucial. Fasting blood glucose ≥126 mg/dL (normal 70-100 mg/dL) or symptoms of diabetes plus non-fasting plasma glucose of ≥200 mg/dL indicate possible diabetes. Two-hour postprandial glucose tolerance test (75g of glucose dissolved in water, measured immediately before and two hours after consumption), normal is >140mg/dL.
  • Emergency Treatment: Only provide emergency periodontal treatment for patients with suspected diabetes, like acute periodontal abscess, until diagnosis.
  • Glycemic Control: HbA1c (glycated hemoglobin) is a primary test for diabetes control. Normal range: Below 5.7%; 5.7% to 6.4%: Prediabetes (increased risk of developing diabetes); 6.5% or higher: Diagnostic for diabetes. Goal is often to keep HbA1c below 7% for those with diabetes, in well-controlled patients the level of HbA1c should stay below or equal to 6.5%.
  • Thyroid Disorders: Hyperthyroidism (thyrotoxicosis) may increase risk of hypertension, angina, and congestive heart failure. Avoid periodontal treatment until good medical control. Avoid epinephrine and other pressor amines in incompletely treated patients.
  • Hypothyroidism: This can cause stress, potentially impacting treatment. Avoid stress and infection to prevent hypothyroid coma.
  • Adrenal Insufficiency: Can lead to severe hypotension. Patients who have received steroid therapy need careful monitoring.

Pregnancy

  • Periodontal Therapy: Treatment should minimize risk of inflammation due to hormonal changes. Short appointments, side-lying positions and avoiding excessive nausea-inducing activities during treatment is recommended.
  • Specific Precautions: Avoid using strong-flavored mouthwashes. Recommendations regarding radiographic procedures to prevent excessive radiation and nausea avoidance are provided.

Hemorrhagic Disorders

  • Bleeding Concerns: Management focuses on minimizing bleeding risk from past illness and family history. Evaluate bleeding time and platelets before any procedure.

Neurological Disorders

  • Epilepsy: Dental care for patients with epilepsy should involve patient identification, seizure history and medication compliance. Care should be taken to prevent injury and potentially avoid stress during treatment (medications should be checked with the treatment plan) that can induce a seizure. Emergency preparations for patients having seizures during treatment should be in place.

Infectious Diseases

  • Hepatitis: Six identified viruses (A, B, C, D, E, G). Transmission, management, and preventive measures are a crucial part of this category. Dental care should involve standard precautions for each patient.
  • Tuberculosis: Involving emergency care until the results of sputum cultures for mycobacterium tuberculosis are negative.
  • AIDS: Patients with AIDS require specific full barrier techniques when providing treatment (including proper sterilization of equipment).

Other Relevant Notes

  • General: Periodontal treatment for medically compromised patients should generally be managed by a physician, should not contain antibiotics, and any complications should be referred to the physician.

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Periodontal Management of Medically Compromised Patients (Part II) PDF

Description

This quiz focuses on the periodontal management of patients with diabetes mellitus, emphasizing the unique considerations required for medically compromised individuals. It covers important pre-treatment precautions, ways to manage blood glucose, and the classic signs of diabetes. Test your knowledge on how to effectively care for diabetic patients undergoing periodontal therapy.

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