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DSE OSCE Guaranteed Success ADA Recommendations for Pre-Medication - **Pre-med is required for patients with:** - Prosthetic cardiac valves, including transcatheter-implanted prostheses and homografts - Prosthetic material used for cardiac valve repair, such as annuloplasty rings and chords - A h...

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  • 30 augustus 2024
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ADA Recommendations for Pre-Medication

- **Pre-med is required for patients with:**

- Prosthetic cardiac valves, including transcatheter-implanted prostheses and homografts

- Prosthetic material used for cardiac valve repair, such as annuloplasty rings and chords

- A history of infective endocarditis

- A cardiac transplant with valve regurgitation due to a structurally abnormal valve

- The following congenital heart diseases:

- Unrepaired cyanotic congenital heart disease, including palliative shunts and conduits

- Any repaired congenital heart defect with residual shunts or valvular regurgitation at the site of or
adjacent to the site of a prosthetic patch or a prosthetic device



Case Study: 41-year-old Pregnant Woman

- **Does she need to pre-med?** ✔️ Yes

- (REVIEW HEALTH HISTORY - Patient has previous history of infective endocarditis. Pre-med IS
indicated).



- **Pre-med options for pregnant woman with history of infective endocarditis and penicillin allergy:**

- Options:

- Amoxicillin

- Cephalexin

- Clarithromycin

- Ciprofloxacin

- **Recommended answer**: ✔️ Clarithromycin

- (However, the correct option may be cephalexin due to concerns about cross-reactivity with
cephalosporins).



Procedures and Bisphosphonates

,- **What procedure can a dentist perform without consulting MD if a patient is currently taking
bisphosphonates?** ✔️ Occlusal restoration

- (Extraction is not advised; endo therapy can increase risk if apex is compromised).



Pregnant Patient Management

- **Stress management position for pregnant person afraid of needles:** ✔️ Place her in
Trendelenburg position

- (This helps prevent supine hypotension, which can occur in the third trimester).



- **Treatment for 6-month pregnant patient with bleeding gums and mobile teeth:** ✔️ Conservative
debridement

- (It is important to perform scaling and root planing to prevent plaque growth).



- **Reason for diastema in pregnant lady with deep probing depth and class 1 mobility on 8 and 9:**
✔️ Chronic periodontitis.



Tetracycline Staining

- **Permanent staining as a result of tetracycline; did this happen?** ✔️ Age 0-5 years

- (Permanent dentition starts calcification at birth).



Medications

- **Pentobarbital (Nembutal) and Secobarbital (Seconal) are what type of drugs?** ✔️ Barbiturates.



- **How to treat a patient with an allergic reaction to a barbiturate?** ✔️ Benadryl (diphenhydramine)

- (Discontinue the drug as well).



Steroidal Medication Information

- **What information do you need to obtain before treating a patient taking steroids?** ✔️ Dose and
duration

- (Rule of twos applies here).

,Pediatric Medication Dosage

- **What is the most important factor when calculating medication dosage for a child?** ✔️ Weight.



Concerns for Trisomy 21 Patient

- **What are you initially concerned about?** ✔️ Congenital heart defect

- (Must consider cardiac status and the possibility of pre-medication).



Recent Stroke Patient Concerns

- **What is your first concern for a patient who has recently had a stroke?** ✔️ Are they on
anticoagulants?

- (Consider bleeding risk when planning treatment).



Anaphylaxis vs. Syncope

- **Main symptom that differentiates anaphylaxis from syncope:** ✔️ Bronchoconstriction

- (Anaphylaxis is accompanied by wheezing, while syncope involves anxiety and light-headedness).



ELISA Test Interpretation

- **What does a negative ELISA test result mean for a person who had a needle stick?** ✔️ The patient
has no antibodies to HIV-1 present.

- (Not definitive for infection as false negatives can occur).



Diagnosis for Teen with Inflamed Gingiva

- **Diagnosis for a 14-year-old with inflamed gingiva and abnormal bloodwork:** ✔️ Leukemia

- (High WBC, lymphadenopathy, and painful gingiva are indicators).



Stem indicates patient has recently taken medications, which one likely caused the rash present on their
arm?
- Acetamiophen
- Barbituates

, - Penicillin
- diphenhydramine
(on 2024 exam)

Penicillin allergy
- hives is a common response to penicillin allergies

Name the drugs that induce hyperplasia
(on 2024 exam)

calcium channel blockers, cyclosporines, anticonvulsants, immunosuppressants
- nifedipine, amlodipine, phenytoin, sodium valproate, phenobarbitone, ethosuximide

Drugs that may have increased chance of periodontal destruction
- "-statin"
- "-olol"
- "-ipril"
- Amlodipine
(on 2024 exam)

I put Amlodipine (gingival hyperplasia,
- statins have actually been shown to improve periodontal treatment outcomes due to the osteoblastic
activity induced

https://www.intechopen.com/books/oral-diseases/adverse-effects-of-medications-on-periodontal-
tissues

Pt presents with white lesion, lateral anterior tongue. History of trauma (continuously biting it, ect).
Resembled a papillary lesion.
- papilloma
- fibroma
- squamous cell carcinoma
(on 2024 exam)

Use your best judgement. History of trauma leads to fibroma diagnosis; but medical history may lead to
papilloma. If described as "cauliflower" assume papilloma!

Pt has a history of multiple odontomas. What syndrome is suspected?
- Addison's disease
- ectodermal dysplasia
- Gardner's syndrome
- Cushing's syndrome

Gardner's Syndrome
- colorectal polyposis

What is the treatment for a mucocele?
- corticosteroids
- excision with local glands

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