Need help

[foreigndentist]

You see a 55yr old female patient with osteoprosis in the clinic. She is taking hormone replacement therapy drugs & drugs for her osteoprosis.

You have to give her L.A. to extract a tooth. You shd be concerned about

1 HRT drugs
2 Osteoprosis drugs
3 Both of them
4 None of the above.

Can someone please explain this.

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[drkooks]

i am not sure but i think HRT drugs as some hormones can affect heart rate
but osteoporosis drug i do not find any relation ...

 

[skabbaraju]

i am not sure but i think HRT drugs as some hormones can affect heart rate
but osteoporosis drug i do not find any relation ...

I would say, both.

 

[dr.ymp]

You see a 55yr old female patient with osteoprosis in the clinic. She is taking hormone replacement therapy drugs & drugs for her osteoprosis.

You have to give her L.A. to extract a tooth. You shd be concerned about

1 HRT drugs
2 Osteoprosis drugs
3 Both of them
4 None of the above.

Can someone please explain this.

I will say osteoporosis drug... AS osteoporosis, in old female is caused by deficiency of estrogen, which doesnt affect LA but calcium can be displaced by Local anesthetic which is used to prevent osteoporosis.... So ..2nd choice is good

 

[foreigndentist]

I will say osteoporosis drug... AS osteoporosis, in old female is caused by deficiency of estrogen, which doesnt affect LA but calcium can be displaced by Local anesthetic which is used to prevent osteoporosis.... So ..2nd choice is good

But HRT contains estrogen which also helps to improve osteoprosis & 2nd that patient is already having the treatment for the osteoprosis.

Skabbaraju, can you please explain your ans.

 

[skabbaraju]

But HRT contains estrogen which also helps to improve osteoprosis & 2nd that patient is already having the treatment for the osteoprosis.

Skabbaraju, can you please explain your ans.

You guys just gave the answers. In osteoporosis, some form of Ca +2 and estrogens are administered, similarly, the hormone therapy might include something that could be sympathomimetic or cholinergic which could have an effect on the LA duration, effect etc.

 

[drkooks]

can u clarify exactly how estrogen affect Local anesthesia

 

[impaction]

can you plz tell why not both of these is an option

 

[impaction]

I will say osteoporosis drug... AS osteoporosis, in old female is caused by deficiency of estrogen, which doesnt affect LA but calcium can be displaced by Local anesthetic which is used to prevent osteoporosis.... So ..2nd choice is good

can you plz explain it

 

[32pearls]

I've heard that some drugs used for osteoporosis can cause jaw bone necrosis or "osteonecrosis of jaw" because of less blood flow.This usually gets aggravated by dental treatment esp an extraction.So definitely the osteoporosis drugs must be taken into consideration.
Not sure abt HRT though.If anybody can explain,that'll be great !

 

[dr.ymp]

But HRT contains estrogen which also helps to improve osteoprosis & 2nd that patient is already having the treatment for the osteoprosis.

Skabbaraju, can you please explain your ans.

Osteoporosis treatment
Hormone replacement therapy contain estrogen which doesn't have any interection with LA... So its not right choice

Diphosphonate used in treatment of osteoporosis is causing osteonecrosis, so if LA with epinephrine is admistered it aggrevate there action,

So osteoporosis drug is good choice!!

IF you are saying HRT is right choice, can you explaine there interection with LA?????

 

[li1p0ptart]

Fosamax anyone? BISPHOSPHONATES. Extraction of the tooth would be more worrisome than the L.A.

 

[foreigndentist]

here is some more.

A patient has pain in tooth no 14. Dr. is about to talk to patient abt the root-canal Rx. Patient is not ready to listen & just wants extraction.
What shd Dr do?

1. Refuse the treatement.
2. Do the extraction
3. Still he shd. explain to the patient abt the root canal.


Mandinular 1st premolar will drain initially to

1.Submental nodes
2.Sub- mandibular nodes.

I think I read somewhere that all lower ant. & 1st pm drain to submental nodes not SURE???, So I just want to confirm.

 

[skabbaraju]

Fosamax anyone? BISPHOSPHONATES. Extraction of the tooth would be more worrisome than the L.A.

Actually, I was wrong. The answer should be None of the above as neither options causes issues with LA but if its extraction, then Osteoporosis drugs might cause an issue (bisphosphonates might cause osteonecrosis). Sorry.

 

[skabbaraju]

here is some more.

A patient has pain in tooth no 14. Dr. is about to talk to patient abt the root-canal Rx. Patient is not ready to listen & just wants extraction.
What shd Dr do?

1. Refuse the treatement.
2. Do the extraction
3. Still he shd. explain to the patient abt the root canal.


Mandinular 1st premolar will drain initially to

1.Submental nodes
2.Sub- mandibular nodes.

I think I read somewhere that all lower ant. & 1st pm drain to submental nodes not SURE???, So I just want to confirm.

1. Do the extraction (the patient is not willing to listen, that's why)
2. Submandibular nodes.

 

[dr.ymp]

Fosamax anyone? BISPHOSPHONATES. Extraction of the tooth would be more worrisome than the L.A.

Agree so, here question regarding extraction... and its affected by Osteoporotic drugs...

 

[dr.ymp]

1. Do the extraction (the patient is not willing to listen, that's why)
2. Submandibular nodes.

I agree with you in first question

For second question Mandibular premolar drain into Buccal vestibule only.. Even If we consider Lingually placed root then infection will be in sublingual as the root of premolar will be above the mylohyoid in most instance... So none of above choice is good

For
Incisors and canine -
Root above mentalis - Vestibule
Below mentalis - Submental space

First and second mandibular premolar drain.... Vestibule

 

[foreigndentist]

I agree with you in first question

For second question Mandibular premolar drain into Buccal vestibule only.. Even If we consider Lingually placed root then infection will be in sublingual as the root of premolar will be above the mylohyoid in most instance... So none of above choice is good

For
Incisors and canine -
Root above mentalis - Vestibule
Below mentalis - Submental space

First and second mandibular premolar drain.... Vestibule

Thanks

The explanation you gave in relation to the mylohyoid for 2nd Q. is what I was thinking.I am not sure abt the vestibule? But I was thinking that if the root tip is above mylohyoid it is sublingual LN. All the mand. posterior teeth roots except 1st pre-molar is below mylohyoid so they shd drain into sub-mandibular LN. May be I am CONFUSED. And mand 3 molar sure is deep cervical.

 

[drkooks]

but the q is about lymph nodes and note spaces ....
ant teeth ...submental LN
post teeth submand LN
mand third molar...deep cervical LN

please correct my info or idea
thanks

 

[32pearls]

I'm a little confused,how can a premolar drain straightly into the vestibule?Shouldn't the ans be submandibular nodes?

The all lower anteriors,lower lip,tip of the tongue drain into submental & subsequently into submandibular.

All mandibular posteriors into submandibular.
So how cud it be vestibule or sublingual??

 

[dr.ymp]

but the q is about lymph nodes and note spaces ....
ant teeth ...submental LN
post teeth submand LN
mand third molar...deep cervical LN

please correct my info or idea
thanks

IF they are asking about lymphnode then I am fully agree with you. But if question is related to space infection then answer would be vestibule

Lymphnode involvement (Mandi Ant)
Ant Mandi - Submental LN
Post Mandi - submandibular LN

Space involvement
Incisors and canine
Root above mentalis - Vestibule
Below mentalis - Submental space

First and second mandibular premolar drain.... Vestibule

 

[Cold Front]

You see a 55yr old female patient with osteoprosis in the clinic. She is taking hormone replacement therapy drugs & drugs for her osteoprosis.

You have to give her L.A. to extract a tooth. You shd be concerned about

1 HRT drugs
2 Osteoprosis drugs
3 Both of them
4 None of the above.

Can someone please explain this.

This exact same question was on my test, the correct answer is #2.

Reason: bisphosphonates are class of drugs used to treat osteoporosis, so they will cause jaw necrosis if you do invasive procedure on your patient while they are on that drug. This is a pharmacology type question, so need to know that for the testlets.

If anyone is interested in old exams, I still have 1978-1998, 2000 and 2004 with answer keys, let me know (for ~$35).

Good luck with your test!

 

[drkooks]

Lymphnode involvement (Mandi Ant)
Ant Mandi - Submental LN
Post Mandi - submandibular LN

Space involvement
Incisors and canine
Root above mentalis - Vestibule
Below mentalis - Submental space

First and second mandibular premolar drain.... Vestibule


thanks for reply...what about space involvement in max teeth and mand molars...

please reply