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?

Stress and infection. Signup and view all the answers

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

Adrenal crisis characterized by severe hypotension. Signup and view all the answers

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

Use of epinephrine and pressor amines. Signup and view all the answers

Which of the following statements regarding corticosteroids is true?

Corticosteroids can lead to adrenal gland suppression. Signup and view all the answers

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

Hypoglycemia needs juice or sugar intake. 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?

Double the normal daily dose one hour before the procedure Signup and view all the answers

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

12 months Signup and view all the answers

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

Wait to brush until at least 30 minutes after vomiting Signup and view all the answers

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

On her left side for better blood flow Signup and view all the answers

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

Strong flavored dentifrice Signup and view all the answers

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

Reduce inflammatory responses related to pregnancy Signup and view all the answers

What precautions should be taken with dental radiographs during pregnancy?

Limit use and cover the patient with protective materials Signup and view all the answers

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

If the patient is taking high doses for less than one month Signup and view all the answers

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

Oral hairy leukoplakia Signup and view all the answers

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

Limit treatment to emergency care only. Signup and view all the answers

What is the minimum duration required for adequate tuberculosis treatment?

18 months Signup and view all the answers

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

Autoclave at 120-130°C for 1-2 hours Signup and view all the answers

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

Manual scaling Signup and view all the answers

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

Complete a detailed medical history form. Signup and view all the answers

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

Provide pharmacological management. Signup and view all the answers

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

Promote terminal disinfection after care. Signup and view all the answers

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

Fecal-oral route Signup and view all the answers

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

Hepatitis D Signup and view all the answers

What percentage of patients infected with Hepatitis C recover completely?

15% Signup and view all the answers

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

Using full barrier techniques Signup and view all the answers

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

Hepatitis B Signup and view all the answers

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

Dispose of all used items properly Signup and view all the answers

Which of the following is FALSE about Hepatitis C?

A vaccine is available for it Signup and view all the answers

What is a characteristic of AIDS?

It is characterized by impairment of the immune system Signup and view all the answers

What is the definition of thrombocytopenia?

A condition where platelet count is less than 100,000/mm³ Signup and view all the answers

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

Aspirin; 7 to 10 days Signup and view all the answers

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

Consult a physician beforehand Signup and view all the answers

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

Administer antibiotic coverage Signup and view all the answers

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

Prolonged bleeding during and after procedures Signup and view all the answers

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

Applying pressure and ensuring wound closure Signup and view all the answers

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

In patients with uncontrolled bleeding Signup and view all the answers

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

Platelet count and bleeding time Signup and view all the answers

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

Glycosylated hemoglobin test (HbA1c) Signup and view all the answers

What is the normal range for HbA1c in healthy individuals?

Below 5.7% Signup and view all the answers

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

Below 7.0% Signup and view all the answers

Which symptom is NOT commonly associated with hypoglycemia?

Frequent urination Signup and view all the answers

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

Patients should take their usual insulin dosage and eat normal meals. Signup and view all the answers

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

20% Signup and view all the answers

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

To avoid scheduling treatment during peak insulin activity Signup and view all the answers

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

Hypoglycemia Signup and view all the answers

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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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.