MIDTERMS

• Rheumatic Fever

  Inflammatory disease that can develop when strep throat or scarlet fever isn't properly treated
• Rheumatic Fever

  • Damage located at the mitral valve makes it possible for the physician to hear a murmur when auscultating
  • Aortic valve is also affected
  • Permanent damage of mitral and aortic valve
  • Occurs in young children (5 to 15 years old) and adults
  • Caused by Group A Streptococcus, specifically, Streptococcus Pyogenes
• Aschoff Lesion or aschoff bodies

  Characteristic lesion of rheumatic fever in the interstitial tissue of the myocardium
• Aschoff Lesion or aschoff bodies


  • Multiple tiny granulomatous lesions of the heart
• Clinical Features of Rheumatic Fever

  • Migratory Arthritis
  • Erythema Marginatum
  • Sydenham's Chorea
  • Subcutaneous Nodules
  • Carditis
• Dental Procedures that need IE Prophylaxis

  • Periodontal procedures – surgery, scaling and root planning, probing and maintenance recall
  • Dental Extraction
  • Dental implant placement & reimplantation of avulsed teeth
  • Endodontic instrumentation or surgery beyond the apex
  • Initial placement of orthodontic band but not brackets
  • Intraligamentary local anesthetic injections
• Bacteremia


  Bacteria will enter the bloodstream
• • 18 – 85% - bacteremia in dental extractions
  • 26% - bacteremia in brushing
  • 17 – 51% - bacteremia in chewing of gums
• Amoxycillin 40 mg/kg


  Therapeutic dose for children for prophylaxis
• Standard Regimen for Prophylactic Antibiotic - Adult Dosage

  • Amoxicillin – 2g 1hr before procedure
  • Azithromycin – 500mg 1hr before procedure
  • Clarithromycin – 500mg 1hr before procedure
  • Cephalexin – 2g 1hr before procedure
  • Cefadroxil – 2g 1hr before procedure
• Cephalosporin should not be used in individuals with immediate hypersensitivity reaction (urticaria, angioedema, or anaphylaxis) to penicillin
• Standard Regimen for Patients Allergic to Amoxicillin/Penicillin - Adult Dosage

  • Clindamycin – 600mg 1hr before procedure
• Standard Regimen for Prophylactic Antibiotic - Children's Dosage

  • Amoxicillin – 50mg/kg
  • Clindamycin – 20mg/kg
  • Cephalexin – 50mg/kg
  • Cefadroxil – 50mg/kg
  • Azithromycin – 15mg/kg
  • Clarithromycin – 15mg/kg
• Patients Unable to take Oral Medication

  • Ampicillin - Adult: 2g IV or IM within 30 minutes before procedure, Children: 50mg/kg IV or IM 30 minutes before procedure
  • Cefazolin - Adult: 1g IV or IM within 30 minutes before procedure, Children: 25mg/kg IV or IM within 30 minutes before procedure
  • Clindamycin - Adult: 600 mg IV within 30 minutes before procedure, Children: 20mg/kg IV within 30 minutes before procedure
• Dental Procedure that does not need IE Prophylaxis

  • Restorative Dentistry (operative & prosthodontic) with or without the use of retraction cord
  • Non intraligamentary injections
  • Post placement & buildup
  • Placement of rubber dam
  • Postoperative suture removal
  • Placement of removable prosthodontic & orthodontic appliance
• Tuberculosis


  A chronic bacterial infection of the lungs & other organs caused by tubercle bacilli. Mycobacterium Tuberculosis
• Phthisis


  Tuberculosis of the lungs
• Clinical Manifestation of Tuberculosis

  • Recent initial infection, no symptoms
  • Symptoms present: fever, cough, & malaise
• Mode of Transmission of Tuberculosis

  • Inhalation
  • Ingestion
  • Through the skin & mucous membrane
• Tests Used to Detect TB bacteria

  • Tuberculin Skin Test
  • Mantoux Test/Purified Protein Derivative (48-72 hours to take effect; can also take 1 week to determine)
  • Chest PA (Posterior-Anterior Projection)
  • Sputum Smear (presence of acid-fast bacilli)
• Scrofula


  Tuberculosis involving the cervical lymph nodes as well as hilar nodes
• Scrofula


  • Unilateral, painless enlargement without signs of acute inflammation
• Cardiovascular diseases

  Diseases that affect the blood vessels and heart
• Treatment for Tuberculosis

  • Anti TB drugs – Rifampin, Isoniazid, Ethambutol, Pyrazinamide
  • Macrolides – Azithromycin
• Arteriosclerosis


  Thickening of the walls of arteries resulting in reduced blood supply to the heart
• Lupus Vulgaris


  Also known as Tuberculosis luposa. Painful cutaneous tuberculosis skin lesions with nodular appearance, most often on the face around the nose, eyelids, lips, cheeks, ears, and neck
• Use of vasoconstrictors

  Can affect patients with arteriosclerosis which could lead to heart attack/stroke
• Arteriosclerosis


  • High blood pressure is the vital sign used to detect it
• Tuberculosis in other organs

  • Kidney
  • Female & Male Genitalia
  • Bones & Joints
  • Brain
• Types of arteriosclerosis

  • Atherosclerosis (involves large arteries)
  • Medial Calcific Sclerosis (calcium deposits on arterial walls)
  • Arteriolar Sclerosis (affects small arteries and arterioles)
• Factors contributing to arteriosclerosis

  • High cholesterol
  • High blood pressure
  • High triglycerides
  • Insulin resistance/diabetes
  • Obesity
  • Smoking
• Diagnostic tests for arteriosclerosis

  • Blood test - Lipid Profile
  • Angiography
  • Angiogram
  • Electrocardiogram
  • Stress test
• Statins


  Medications that help lower the level of low-density lipoprotein (LDL) cholesterol in the blood
• Angina pectoris


  Chest pain that is one of the most frequent complaints of patients in ambulatory practice
• Angina pectoris


  • Described as squeezing, crushing, burning, or smothering whereas others describe it as a shortness of breath or simply a feeling of heaviness
• Nitroglycerin


  Medication for angina pectoris, can be administered orally or sublingually
• Anxiety


  Provoking factor for angina pectoris
• Dental management for angina pectoris


  • Consultation to patient's physician
  • Caries susceptible in the mandibular incisor region
  • Nitroglycerin prophylaxis
  • Monitor vital signs
  • When attack occurs during dental procedure, discontinue
  • Maintain verbal contact with patient
• Myocardial infarction


  Also known as heart attack, most common form of ischemic disease resulting from irreversible death of heart muscle due to lack of oxygen supply
• Dental management for myocardial infarction

  • Consult patient's physician
  • No routine dental treatment until at least 8 months after infarction
  • Morning & short appointment
  • No more than 3 cartridge of anesthetic with 1:100,000 epinephrine
  • 3% Mepivacaine/4% Prilocaine can be used
  • Patient taking antihypertensives and digitalis may be prone to nausea and vomiting
  • Consider patient taking anticoagulant