OMFS Midterm Exam With
Complete Solution
Cigarette smoking stimulates: - Answer *destructive enzymes* (MMPs, elastase,
collagenase)
*oxidative stress* (superoxide, hydrogen peroxide) - interferes with molecular and
cellular mechanisms of wound healing
1 pack-per-day smoking = - Answer tissue hypoxia for 15-20 hrs/day
CO in cigarette smoking will - Answer competitively inhibit the binding of oxygen
carrying capacity of hemoglobin (carboxyhemoglobin)
Nicotine in cigarettes results in - Answer NE and E release resulting in vasoconstriction
and decreased tissue perfusion (hypoxia)
What are some risks factors for delayed healing? - Answer - smoking
- corticosteroids
- poorly controlled diabetes (defective immune response, prolonged chronic
inflammation, impaired angiogenesis and microvascular dysfunction)
Pts with COPD risks? - Answer If you give them too much *oxygen, they'll stop
breathing!*
They're acclimated to high CO2 levels and depend on high CO2 so too much oxygen
means they CANT breath!!!
*AVOID SUPINE POSITION*
Pts with eating disorders consider risks of: - Answer *anxiolysis* (great dental fear and
anxiety than other patients)
dental procedures like *3rd molar extractions can exacerbate relapse*!!
Pts with AV fistulas risks: - Answer call nephrologist and say pt requires oral surgery
what are your recommendations for preoperative *Abx*?
*AVOID NSAIDs*
Pts with asthma risks: - Answer *AVOID NSAIDs* can precipitate asthma attacks in
severe asthmatic pts
*N2O is ok!* as long as they're not having an attack
Pregnant pt risks/considerations: - Answer *use acetaminophen*
,NSAIDs cause prolongation of pregnancy and premature closure of ductus arteriosus
*position* put rolled blanket under right hip (left lateral decubitus position)
Always review and update: - Answer medical history in their consult that day
Pt presents for post op follow up. Pt complained of slight tenderness of ext socket #5.
Also experiences some pain on mastication. Since last visit, pt has developed another
site of exposed bone on the gingiva lateral to the ext socket of #5. Pt still is presenting
with a bony sequestration that needs eval/possible removal.
What should you do? - Answer Radiation tattoo seen on pts face
TAKE HX: pt had nasopharyngeal carcinoma, radiation therapy, smokes, HIV+
Perioperative management for anticoagulation: - Answer continue patients on their
medications DO NOT STOP, tell pt you are not going to stop the med
for Coumadin, check INR
TREAT IN THE AM!
NSAIDs/aspirin can interfere so think about pain management!
What is "bridging"? - Answer For pts taking Coumadin who need major surgeries or
many extractions
stop Coumadin for 3 days, then take LMW heparin, do surgery, then they start Coumadin
again
Pt presents to clinic at 7:45pm with pain and swelling around tooth #17. What will you
do? - Answer Start Abx (if its simple/localized)
if its complex/diffuse large swelling extra orally then OR
For physical exam if WNL you should write: - Answer unremarkable
If pt has a bridge that requires ext: - Answer must section before!
How do you manage a pt with HTN, what causes elevated BP? - Answer Ask if they took
their meds
Pain increases BP
Was the cuff used too small or large
Anxiety
White coat HTN
If elective procedure might want a consult
, White Coat Hypertensions (WCH) Syndrome prevalence: - Answer 20%
(but prevalence during dental visits has not been established)
Unclear if WCH is associated with increase cardiovascular risk
65 yo make presents c/o pain tooth #30 x 2 weeks. Pt is taking OTC ibuprofen for pain.
PMH: DM II, HTN, MI 2 years ago
Meds: Metformin (noncompliant), amlodipine
No clinical signs of infection (trismus/swelling)
VS: BP 145/90 HR 75
HbA1c 11.4 (10 days ago)
9.7 (4 months ago)
What is your plan?
Are you concerned about their BP?
What information do you want for medical consult? - Answer Premed, give Abx, take the
tooth out!
yes A1c is high and you're worried about healing but think about pain and risk of
infection
(note NSAIDs with diabetes there is greater risk of renal disease esp olde pts, note
NSAIDs with HTN greater risk of stroke and MI)
BP: *Greater risk of complications and end organ damage + HTN*
In consult, pt requires oral surgery, please provide perioperative management
If a pt has long term CVD should not be given - Answer long term NSAIDs
(1 week is ok but 28 days TOO long!)
this can increase risk of MI and stroke
so in this kind of pt consider alternative pain management
Do you premeditate Abx for cardiac stents? - Answer NO!
Do you stop aspirin before oral surgery? - Answer NO
Pt allergic to epinephrine, what do you do? - Answer **NOT possible to be allergic to
epinephrine!
If they come in and bring X-rays on their phone, it must be: - Answer placed into axium!
Complete Solution
Cigarette smoking stimulates: - Answer *destructive enzymes* (MMPs, elastase,
collagenase)
*oxidative stress* (superoxide, hydrogen peroxide) - interferes with molecular and
cellular mechanisms of wound healing
1 pack-per-day smoking = - Answer tissue hypoxia for 15-20 hrs/day
CO in cigarette smoking will - Answer competitively inhibit the binding of oxygen
carrying capacity of hemoglobin (carboxyhemoglobin)
Nicotine in cigarettes results in - Answer NE and E release resulting in vasoconstriction
and decreased tissue perfusion (hypoxia)
What are some risks factors for delayed healing? - Answer - smoking
- corticosteroids
- poorly controlled diabetes (defective immune response, prolonged chronic
inflammation, impaired angiogenesis and microvascular dysfunction)
Pts with COPD risks? - Answer If you give them too much *oxygen, they'll stop
breathing!*
They're acclimated to high CO2 levels and depend on high CO2 so too much oxygen
means they CANT breath!!!
*AVOID SUPINE POSITION*
Pts with eating disorders consider risks of: - Answer *anxiolysis* (great dental fear and
anxiety than other patients)
dental procedures like *3rd molar extractions can exacerbate relapse*!!
Pts with AV fistulas risks: - Answer call nephrologist and say pt requires oral surgery
what are your recommendations for preoperative *Abx*?
*AVOID NSAIDs*
Pts with asthma risks: - Answer *AVOID NSAIDs* can precipitate asthma attacks in
severe asthmatic pts
*N2O is ok!* as long as they're not having an attack
Pregnant pt risks/considerations: - Answer *use acetaminophen*
,NSAIDs cause prolongation of pregnancy and premature closure of ductus arteriosus
*position* put rolled blanket under right hip (left lateral decubitus position)
Always review and update: - Answer medical history in their consult that day
Pt presents for post op follow up. Pt complained of slight tenderness of ext socket #5.
Also experiences some pain on mastication. Since last visit, pt has developed another
site of exposed bone on the gingiva lateral to the ext socket of #5. Pt still is presenting
with a bony sequestration that needs eval/possible removal.
What should you do? - Answer Radiation tattoo seen on pts face
TAKE HX: pt had nasopharyngeal carcinoma, radiation therapy, smokes, HIV+
Perioperative management for anticoagulation: - Answer continue patients on their
medications DO NOT STOP, tell pt you are not going to stop the med
for Coumadin, check INR
TREAT IN THE AM!
NSAIDs/aspirin can interfere so think about pain management!
What is "bridging"? - Answer For pts taking Coumadin who need major surgeries or
many extractions
stop Coumadin for 3 days, then take LMW heparin, do surgery, then they start Coumadin
again
Pt presents to clinic at 7:45pm with pain and swelling around tooth #17. What will you
do? - Answer Start Abx (if its simple/localized)
if its complex/diffuse large swelling extra orally then OR
For physical exam if WNL you should write: - Answer unremarkable
If pt has a bridge that requires ext: - Answer must section before!
How do you manage a pt with HTN, what causes elevated BP? - Answer Ask if they took
their meds
Pain increases BP
Was the cuff used too small or large
Anxiety
White coat HTN
If elective procedure might want a consult
, White Coat Hypertensions (WCH) Syndrome prevalence: - Answer 20%
(but prevalence during dental visits has not been established)
Unclear if WCH is associated with increase cardiovascular risk
65 yo make presents c/o pain tooth #30 x 2 weeks. Pt is taking OTC ibuprofen for pain.
PMH: DM II, HTN, MI 2 years ago
Meds: Metformin (noncompliant), amlodipine
No clinical signs of infection (trismus/swelling)
VS: BP 145/90 HR 75
HbA1c 11.4 (10 days ago)
9.7 (4 months ago)
What is your plan?
Are you concerned about their BP?
What information do you want for medical consult? - Answer Premed, give Abx, take the
tooth out!
yes A1c is high and you're worried about healing but think about pain and risk of
infection
(note NSAIDs with diabetes there is greater risk of renal disease esp olde pts, note
NSAIDs with HTN greater risk of stroke and MI)
BP: *Greater risk of complications and end organ damage + HTN*
In consult, pt requires oral surgery, please provide perioperative management
If a pt has long term CVD should not be given - Answer long term NSAIDs
(1 week is ok but 28 days TOO long!)
this can increase risk of MI and stroke
so in this kind of pt consider alternative pain management
Do you premeditate Abx for cardiac stents? - Answer NO!
Do you stop aspirin before oral surgery? - Answer NO
Pt allergic to epinephrine, what do you do? - Answer **NOT possible to be allergic to
epinephrine!
If they come in and bring X-rays on their phone, it must be: - Answer placed into axium!
