DSE OSCE - 2024
What are the ADA recommendations for when pre-med is required - ANS- 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 transplanta with valve regurgitation due to a structurally abnormal valve
- the following congenital (present from birth) heart disease
--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
**ADA website**
https://www.ada.org/en/member-center/oral-health-topics/antibiotic-prophylaxis
41-yo woman, pregnant; prev rheumatic fever with heart murmur (no valvular abnormality);
allergy to penicillin. Positive history of infective endocarditis. Does she need to pre med?
- yes
- no - ANSyes
- REVIEW HEALTH HISTORY - on my exam, this patient had a previous history of infective
endocarditis. Pre-med IS indicated
- many of the OSCE quizlets say no....
Pre-med options for pregnant woman w/hx of infective endocarditis and penicillin allergy
- amoxicillin
- cephalexin
- clarithromycin
- ciproflaxacin - ANS*clarithromycin*
I may not be correct, the correct option may be cephalexin. however I chose clarithromycin due
to penicillin allergy, cross reaction with cephalosporins, and since
clindamycin/erythromycin/azthromycin were not options. Ciproflaxacin is contraindicated in
pregnancy. article for reference
https://www.parents.com/pregnancy/my-body/is-it-safe/antibiotics-and-pregnancy/
What procedure can a dentist perform without consulting MD if a patient is currently taking
bisphosphonates?
- endo therapy
- prophy and scaling
- extraction
- occlusal restoration - ANS*occlusal restoration*
although the main HELL NO is extraction, completing endo therapy increases risk if the apex is
compromised/damaged during therapy. I teetered on prophy and scaling, but since it did not
,specify supragingival, decided that the risk of scaling can negatively affect the periosteum of a
bisphosphanate patient. ADA recommendations:
http://www.centreoms.com/admin/storage/news/ADA%20Recommendations%20for%20Treatme
nt%20of%20Patients%20on%20Bisphosphon.pdf
Pregnant person afraid of needles - stress management by putting patient in what position when
in your chair (BEFORE they even get to the point of passing out)?
- supply oxygen
- place in Trendelenburg
- make patient sit up straight
- tell them to suck it up buttercup - ANSplace her in Trendelburg position.
- supine hypotension in 3rd trimester usually occurs (bc compression Inf vena cava) => must
prevent this in dental chair bc it can cause patient to pass out.
- Best preventative treatment for supine hypotension is to turn the patient, preferably to the left
side, to displace the uterus away from the inferior vena cava. The patient can also be placed in
a sitting position with the knees flexed.
6 months pregnant had bleeding gums and mobile teeth, how should they be treated?
- immediate extractions
- do not treat until baby is born
- conservative debridement
- immediate endo - ANSconservative debridement
.- pregnancy gingivitis: important to do ScRP (and stress good oral hygiene) to prevent plaque
growth. The plaque can enter blood stream and stimulate patient's immune system to produce
prostaglandins, which can trigger uterine contraction leading to early labor, premature birth, and
a small baby.
Pregnant lady with a diastema in between #8 and #9 with deep probing depth and class 1
mobility on 8 and 9. What is the reason for diastema?
- chronic periodontitis
- distal drift
- normal during pregnancy - ANSchronic perio
- increased incidence of periodontal disease during pregnancy => must emphasize good oral
hygiene, and remove all their plaque so it doesn't lead to premature birth / low birth weight
Permanent staining as a result of tetracyline; did this happen?
- During development (as fetus)
- 0-5yrs
- 5-10 yrs
- 10-15 yrs - ANSage 0-5 years
- remember that PERMANENT dentition does not begin calcification until birth
Pentobarbital (Nembutal) and Secobarbital (Seconal) are what type of drugs?
- benzodiazepines
, - NSAIDS
- barbituates
- atypical antipsychotic - ANSbarbituates
- used primarily evening BEFORE appointment
A patient has an allergic reaction to a barbiturate, how do you treat?
- epinephrine
- diphenhydramine
- send to ER - ANSbenadryl (diphenhydramine)
- And discontinuation of the drug. Obviously if there are concerns with airway, treatment may
differ... but this was not indicated in the question stem. However, I did not have answer choices
that reflected this scenario nor was it addressed in the question stem
A patient is on a steroidal medication. What information do you need to obtain before treating
them?
- dose and pharmacy that filled the RX
- duration of prescription
- both dose and duration - ANS*dose and duration*
- "The rule of twos": Ask whether the patient is currently on steroids or has been on
corticosteroids for 2 weeks or longer within the past 2 years. You must go back 2 years in the
history because it can take 2 weeks to 2 years for the adrenal glands to bounce back to normal
function.
What is the most important factor when calculation medication dosage for a child
- age
- weight
- gender
- height - ANSweight
A patient is confirmed to have trisomy 21. What are you initially concerned about?
- congenital heart defect
- Cushings
- cerebrovascular accident - ANScongenital heart defects; however, early onset periodontal
disease is a significant oral health issue, but this was not an answer for those who have had this
question. Consider cardiac status and posibility of pre-medication
- atrioventricular septal defect, patent ductus arteriosus, Tetralogy of Fallot
A patient has recently had a stroke. What is your first concern?
- when was their last cleaning
- are they on anticoagulants
- current blood pressure - ANSAre they on anticoagulants
- Stroke patients could be on blood thinners, such as aspirin, dipyradamole (Persan- tine),
clopidogrol (Plavix), or Coumadin, postrecovery. Prior to major surgery, always consult with the
patient's physician to determine whether and when the blood thinners can be stopped and
What are the ADA recommendations for when pre-med is required - ANS- 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 transplanta with valve regurgitation due to a structurally abnormal valve
- the following congenital (present from birth) heart disease
--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
**ADA website**
https://www.ada.org/en/member-center/oral-health-topics/antibiotic-prophylaxis
41-yo woman, pregnant; prev rheumatic fever with heart murmur (no valvular abnormality);
allergy to penicillin. Positive history of infective endocarditis. Does she need to pre med?
- yes
- no - ANSyes
- REVIEW HEALTH HISTORY - on my exam, this patient had a previous history of infective
endocarditis. Pre-med IS indicated
- many of the OSCE quizlets say no....
Pre-med options for pregnant woman w/hx of infective endocarditis and penicillin allergy
- amoxicillin
- cephalexin
- clarithromycin
- ciproflaxacin - ANS*clarithromycin*
I may not be correct, the correct option may be cephalexin. however I chose clarithromycin due
to penicillin allergy, cross reaction with cephalosporins, and since
clindamycin/erythromycin/azthromycin were not options. Ciproflaxacin is contraindicated in
pregnancy. article for reference
https://www.parents.com/pregnancy/my-body/is-it-safe/antibiotics-and-pregnancy/
What procedure can a dentist perform without consulting MD if a patient is currently taking
bisphosphonates?
- endo therapy
- prophy and scaling
- extraction
- occlusal restoration - ANS*occlusal restoration*
although the main HELL NO is extraction, completing endo therapy increases risk if the apex is
compromised/damaged during therapy. I teetered on prophy and scaling, but since it did not
,specify supragingival, decided that the risk of scaling can negatively affect the periosteum of a
bisphosphanate patient. ADA recommendations:
http://www.centreoms.com/admin/storage/news/ADA%20Recommendations%20for%20Treatme
nt%20of%20Patients%20on%20Bisphosphon.pdf
Pregnant person afraid of needles - stress management by putting patient in what position when
in your chair (BEFORE they even get to the point of passing out)?
- supply oxygen
- place in Trendelenburg
- make patient sit up straight
- tell them to suck it up buttercup - ANSplace her in Trendelburg position.
- supine hypotension in 3rd trimester usually occurs (bc compression Inf vena cava) => must
prevent this in dental chair bc it can cause patient to pass out.
- Best preventative treatment for supine hypotension is to turn the patient, preferably to the left
side, to displace the uterus away from the inferior vena cava. The patient can also be placed in
a sitting position with the knees flexed.
6 months pregnant had bleeding gums and mobile teeth, how should they be treated?
- immediate extractions
- do not treat until baby is born
- conservative debridement
- immediate endo - ANSconservative debridement
.- pregnancy gingivitis: important to do ScRP (and stress good oral hygiene) to prevent plaque
growth. The plaque can enter blood stream and stimulate patient's immune system to produce
prostaglandins, which can trigger uterine contraction leading to early labor, premature birth, and
a small baby.
Pregnant lady with a diastema in between #8 and #9 with deep probing depth and class 1
mobility on 8 and 9. What is the reason for diastema?
- chronic periodontitis
- distal drift
- normal during pregnancy - ANSchronic perio
- increased incidence of periodontal disease during pregnancy => must emphasize good oral
hygiene, and remove all their plaque so it doesn't lead to premature birth / low birth weight
Permanent staining as a result of tetracyline; did this happen?
- During development (as fetus)
- 0-5yrs
- 5-10 yrs
- 10-15 yrs - ANSage 0-5 years
- remember that PERMANENT dentition does not begin calcification until birth
Pentobarbital (Nembutal) and Secobarbital (Seconal) are what type of drugs?
- benzodiazepines
, - NSAIDS
- barbituates
- atypical antipsychotic - ANSbarbituates
- used primarily evening BEFORE appointment
A patient has an allergic reaction to a barbiturate, how do you treat?
- epinephrine
- diphenhydramine
- send to ER - ANSbenadryl (diphenhydramine)
- And discontinuation of the drug. Obviously if there are concerns with airway, treatment may
differ... but this was not indicated in the question stem. However, I did not have answer choices
that reflected this scenario nor was it addressed in the question stem
A patient is on a steroidal medication. What information do you need to obtain before treating
them?
- dose and pharmacy that filled the RX
- duration of prescription
- both dose and duration - ANS*dose and duration*
- "The rule of twos": Ask whether the patient is currently on steroids or has been on
corticosteroids for 2 weeks or longer within the past 2 years. You must go back 2 years in the
history because it can take 2 weeks to 2 years for the adrenal glands to bounce back to normal
function.
What is the most important factor when calculation medication dosage for a child
- age
- weight
- gender
- height - ANSweight
A patient is confirmed to have trisomy 21. What are you initially concerned about?
- congenital heart defect
- Cushings
- cerebrovascular accident - ANScongenital heart defects; however, early onset periodontal
disease is a significant oral health issue, but this was not an answer for those who have had this
question. Consider cardiac status and posibility of pre-medication
- atrioventricular septal defect, patent ductus arteriosus, Tetralogy of Fallot
A patient has recently had a stroke. What is your first concern?
- when was their last cleaning
- are they on anticoagulants
- current blood pressure - ANSAre they on anticoagulants
- Stroke patients could be on blood thinners, such as aspirin, dipyradamole (Persan- tine),
clopidogrol (Plavix), or Coumadin, postrecovery. Prior to major surgery, always consult with the
patient's physician to determine whether and when the blood thinners can be stopped and
