VIVA

Question 1

What should you do if a patient experiences reflex syncope during a dental procedure?

Answer 1

You should immediately:
Stop the procedure.
Place the patient in a supine position with their feet slightly elevated.
Monitor them for rapid recovery, which usually occurs within 15–20 seconds.

Question 2

What is a simple mnemonic to remember the management of reflex syncope?

Answer 2

SSR (Stop, Supine, Recover).

Question 3

What are the primary dental considerations for a patient with SLE?

Answer 3

The key considerations are:
Bleeding & Infection Risk: The patient is often on immunosuppressants and may have anemia or thrombocytopenia.
Stress Reduction: It is important to manage the patient’s anxiety.
GP Consultation: Liaise with their doctor regarding their condition’s stability and current medications.

Question 4

What is a helpful mnemonic for managing a patient with SLE?

Answer 4

BIS (Bleeding/Infection, Involve GP, Stress reduction).

Question 5

What are the critical dental considerations for a patient with Graves’ Disease?

Answer 5

You must be aware of:
Thyrotoxic Crisis: High stress or infection can trigger this life-threatening event, so stress reduction is essential.
Hemorrhage Risk: Monitor their blood pressure. Be aware that anti-thyroid medication can have anti-vitamin K activity.
Avoid: Do not prescribe or recommend aspirin or NSAIDs.

Question 6

What is a useful mnemonic for these considerations?

Answer 6

THA (Thyrotoxic crisis, Hemorrhage risk, Avoid Aspirin/NSAIDs).

Question 7

How should you manage a dental patient with Hashimoto’s Disease?

Answer 7

The main considerations are:
Bleeding Risk: If bleeding occurs, apply local pressure for an extended time.
Infection Risk: Be aware that wound healing can be delayed.
Cardiovascular Risk: Consult their GP regarding their CVD status and any potential need for antibiotic prophylaxis.
Avoid Iodine: Do not use iodine-containing products.

Question 8

What mnemonic can help remember the dental management of Hashimoto’s?

Answer 8

BICA (Bleeding, Infection, Cardio-consult, Avoid Iodine).

Question 9

What modifications should be made when treating a patient with Rheumatoid Arthritis?

Answer 9

You should consider:
Appointments: Keep appointments short and frequent to minimize joint strain.
TMJ/Jaw Fatigue: Use a bite block and allow for frequent rest periods.
Dexterity Issues: Recommend home care aids like an electric toothbrush (ETB).
Dry Mouth: This is a common side effect of their medications (e.g., NSAIDs, corticosteroids).

Question 10

What is a good mnemonic for managing patients with RA?

Answer 10

JADD (Jaw rest, Appointment short, Dexterity aids, Dry mouth).

Question 11

What are the key dental management strategies for a patient with Multiple Sclerosis?

Answer 11

Key strategies include:
Appointments: Plan for short, stress-free, quiet, and comfortable appointments.
Communication: Provide slow, simple, and written instructions.
Muscle Spasticity: Recommend aids like an electric toothbrush, fluoride treatments, and floss alternatives (e.g., Piksters).
Dry Mouth: This is a common side effect of their medications.

Question 12

What is a mnemonic for the dental considerations for MS?

Answer 12

SCMD (Spasticity aids, Communication simple, Morning/short appts, Dry mouth).

Question 13

What are the essential precautions when treating a dental patient with Addison’s Disease?

Answer 13

The essential precautions are:
Adrenal Crisis: Be prepared for this medical emergency (characterised by low blood glucose, low sodium, and high potassium).
Stress Reduction: This is crucial to prevent triggering a crisis.
Steroid Cover: Consult their GP, as the patient may need their daily steroid dose increased to cope with procedural stress.

Question 14

What is the mnemonic for managing a patient with Addison’s Disease?

Answer 14

ASS (Adrenal crisis risk, Stress reduction, Steroid cover).

Question 15

How should you adapt dental treatment for a patient with Myasthenia Gravis?

Answer 15

You should adapt by:
Appointments: Schedule short, frequent appointments in the early morning when muscle strength is greatest.
Muscle Weakness: Use bite blocks, high-volume suction, and a semi-upright position to prevent aspiration.
Respiratory Emergency: Be aware of the risk of a sudden inability to swallow or maintain an airway.
Medication: Consult their GP about the optimal timing of their anticholinesterase drugs before the appointment.

Question 16

What mnemonic summarises these adaptations?

Answer 16

ARMS (Appointment AM, Respiratory risk, Muscle weakness aids, Semi-upright).

Question 17

What is the primary focus for the dental care of a patient with Scleroderma?

Answer 17

The focus should be on:
Prevention: Proactively manage the high risk of caries and dry mouth.
OHI & Diet: Provide rigorous oral hygiene instruction and anticariogenic dietary advice.
Screening: Conduct regular and thorough periodontal screenings and be mindful of potentially limited mouth opening.

Question 18

What is a helpful mnemonic for Scleroderma dental care?

Answer 18

PODS (Prevention, OHI, Diet, Screening).

Question 19

What are the main dental issues to address in a patient with Celiac Disease?

Answer 19

The main issues are:
Caries/Dry Mouth: Focus on prevention strategies.
Ulcers: Provide relief for aphthous-like ulcers.
Enamel Defects: Discuss cosmetic treatment options for any developmental enamel defects.

Question 20

What is a simple mnemonic for these dental issues?

Answer 20

CUE (Caries prevention, Ulcer relief, Enamel defects).

Question 21

What are the key dental considerations for a patient with IBD?

Answer 21

The key points are:
Avoid NSAIDs: These can trigger flare-ups; recommend paracetamol instead.
Stress (HPA function): Evaluate if the patient can tolerate the stress of extensive procedures.
Oral Lesions: Be prepared to diagnose and manage oral inflammation and granulomatous lesions.

Question 22

What mnemonic can be used for managing IBD patients?

Answer 22

NAO (NSAIDs avoided, Assess stress, Oral lesions).

Question 23

What oral conditions should you look for and manage in a patient with Psoriasis?

Answer 23

You should focus on:
Periodontitis: Actively manage periodontal disease, which can be associated with psoriasis.
Painful Lesions: Address pain from oral manifestations like sores, peeling gingiva, pustules, and geographic or fissured tongue.

Question 24

What is a mnemonic for the oral management of Psoriasis?

Answer 24

POP (Perio management, Oral lesions, Pain relief).

Question 25

How should dental treatment be planned for a patient with Kidney Disease?

Answer 25

Treatment planning involves: Consult: Always consult with the renal physician before treatment. Extraction > Endo: Extractions are often preferred over endodontics to eliminate infection sources. LA/Drugs: Be cautious with local anesthetics and other drugs due to impaired renal elimination. Setting: Treat severe cases in a hospital setting.

Question 26

What is a good mnemonic for these planning steps?

Answer 26

REAL (Refer to specialist, Extraction > endo, Anesthetic care, Location: hospital).

Question 27

What are common oral health changes to be aware of during pregnancy?

Answer 27

Common changes include: Gingivitis: An exaggerated inflammatory response to plaque is common. Granuloma: 'Pregnancy tumors' (pyogenic granulomas) can occur. Gag Reflex: An increased gag reflex is common, especially with morning sickness. Tooth Sensitivity: May be heightened.

Question 28

What is a simple way to remember these changes?

Answer 28

The 3 G's (Gingivitis, Granuloma, Gag reflex).

Question 29

What are the fundamental principles for providing dental care to a patient with HIV/AIDS?

Answer 29

The fundamental principles are: Consult GP: Liaise regarding the patient's immune status (neutropenia, thrombocytopenia) to manage infection and bleeding risks. Lesions: Evaluate any oral lesions (e.g., Candidiasis, Kaposi sarcoma). Precautions: Use standard precautions for all patients. Needlestick: Maintain strict protocols to avoid injury.

Question 30

What is a helpful mnemonic for these principles?

Answer 30

CLIP (Consult GP, Lesions, Infection control, Precautions).

Question 31

What are the critical dental considerations for a patient who has had or will have an organ transplant?

Answer 31

The critical points are: Timing: Extract non-restorable teeth >10 days BEFORE the transplant. Delay elective care for up to 1 year AFTER. Consult: Liaise with the specialist/oncologist. Prophylactic antibiotics may be needed. Monitor: Check blood counts (platelets, INR, neutrophils) and for oral signs of graft rejection. Avoid NSAIDs: These can be toxic to the liver and kidneys.

Question 32

What mnemonic can help remember transplant patient management?

Answer 32

TEAM (Timing, Emergency only post-op, Avoid NSAIDs, Monitor bloods).

Question 33

How should you manage a patient with a known or suspected bleeding disorder?

Answer 33

You should: History: Obtain a careful medical and family history. Avoid: Do not prescribe Aspirin or NSAIDs. Avoid traumatic procedures like IAN blocks if possible. INR: For patients on warfarin, ensure their INR is within a safe range (usually < 3.0) before procedures. Local Measures: Use prolonged pressure, hemostatic agents, and sutures to control bleeding.

Question 34

What is a good mnemonic for managing bleeding risk?

Answer 34

HAIL (History, Avoid NSAIDs, INR check, Local measures).

Question 35

What are the key principles for treating a dental patient with an immunodeficiency?

Answer 35

The key principles are: Consult: Liaise with the pediatrician/immunologist regarding treatment timing and the need for prophylaxis. Prophylaxis: Antibiotic, antifungal, or antiviral cover may be required. Prevention: Emphasize meticulous OHI and fluoride use. Treatment: Extractions are often preferred over endodontics to definitively remove sources of infection.

Question 36

What mnemonic can summarise these principles?

Answer 36

CEPT (Consult, Extraction > endo, Prophylaxis, Prevention).