Plzzz Help me !!!

[Pal4ever]

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Hey Every one ..
How u doen ??
Im a second year dental student .. and they ( the doctors)

distributed cases on us .. and we have to intrepet this cases in 5 pages ..

so plz could u help me ... by either giving me any ideas or providing me with any site or any type of help .....
here is the case ..​

Mr. Brown is planned to have a tooth extraction under local anaesthesia. He gave a history of rheumatic fever when young. How does this disease affect his dental management?

I need to know if local anesthesia could interface with the medication that Mr.brown takes ..


Is there any hope that any one could help me ...


Thaaaaaaaanx all 4 ur support ..

 

[pts218]

I think this question is more concerned about the issue of whether or not you will require antibiotic prophylaxis due to his previous history of rheumatic fever and not necessarily about possible side effects/interactions with the anesthetic.

The AHA revised their guidelines this year on what requires prophylaxis prior to dental procedures w/ potential access to systemic blood circulation where you'd be at risk for infective endocarditis (i.e. extractions, perio, etc.). Previous history of rheumatic fever alone, no longer requires prophylaxis any more. I would maybe ask if there was any history of severe valvular dysfunction due to the rheumatic fever, then send for a med consult with patient's physician.

If the physician wants them to be prophylaxed then they could prescribe the antibiotics, but realistically if they don't fall into the AHA's high risk category then no antibiotics are required. Sometimes physicians just don't know the latest recommendations, I had a pateint's doctor who kept insisting that prophylaxis was required for a murmur the patient had as a child; finally I sent over the AHA guidelines with a note saying that if they wanted them to be prophylaxed they would need to write the prescription for it.

If they already had a previous history of endocarditis then you definitely need to prophylax.

Here's the link to the new AHA guidelines.
http://circ.ahajournals.org/cgi/content/full/116/15/1736#SEC6

Hope that helps

 

[rarm1]

Hey Every one ..
How u doen ??
Im a second year dental student .. and they ( the doctors)

distributed cases on us .. and we have to intrepet this cases in 5 pages ..

so plz could u help me ... by either giving me any ideas or providing me with any site or any type of help .....
here is the case ..​

Mr. Brown is planned to have a tooth extraction under local anaesthesia. He gave a history of rheumatic fever when young. How does this disease affect his dental management?

I need to know if local anesthesia could interface with the medication that Mr.brown takes ..


Is there any hope that any one could help me ...


Thaaaaaaaanx all 4 ur support ..

first, that is not a complete history.... you need total history... all medical problems (with completed questionaire), all meds, allergies, etc....
ALso total dental exam, x-rays, and a TP... what anesthesia? other problems?

If this is a problem orientated teaching experience... you need to get all the facts.

 

[Elipar]

It might just be me, but I think there are a couple of things you need to change. First, when speaking to colleagues you should use proper spelling and grammar. If you're speaking to a friend or exchanging cordial email, use all the "thx", "4", and "u" all you want. But when speaking to a medical professional about patient treatment, use proper grammar and spelling. Second, you're asking us to provide answers to you that you ought to seek yourself. When you graduate, people will come to you looking for treatment. If you don't know what you're doing, what right have you to offer your services? Now I'm not saying that you have to know everything. Everyone will at one point in time or another seek consultation with others. But what you're supposed to be doing on this project is to analyze a situation and make treatment recommendations based on scientific fact. By asking others to give you answers, you're missing the point of the project.

 

[Sam1980DDS]

hahaha this is very funny..are you for real
go read people's PARQ notes, SOAP notes, I think you missing alot
everything we use in dentistry is abbr.

 

[Columbia07]

You're a second year dental student and you have no ideas or recommendations about how you would treat this patient?

I'm 8 weeks into my first year of dental school and could tell you the exact prophylactic treatment (that is of course, if the patient suffered from any valvular disease like someone else mentioned) and the varied treatments based on the patient's allergies. And my knowledge is based solely on what I've learned in dental school (case-based).

Also, like others have mentioned, there is a lot of info. missing about your patient. PMH and HPI (among other things) are extremely important in a situation in which the patient suffered from rheumatic fever.

Finally, I think you're missing the point. This is clearly a prophylactic tx case. I would advise that you sit down and figure this out on your own instead of asking the SDN dental community to do your dirty work. Especially because you WILL see this patient in your 40+ years of practicing dentistry.

 

[Elipar]

hahaha this is very funny..are you for real
go read people's PARQ notes, SOAP notes, I think you missing alot
everything we use in dentistry is abbr.

You need to talk to your malpractice carrier. Ask him/her if it's appropriate to substitute "u" for "you". Yes, there are plenty of abbreviations, but the great majority are misused. In order to use an abbreviation, you must fist establish what that abbreviation is, or it must be commonly established. For example, everyone would know what "lido" means, yet it's not a legal abbreviation until you establish that lido=lidocaine. Proper use of grammar and punctuation are also nice...

 

[armorshell]

You're a second year dental student and you have no ideas or recommendations about how you would treat this patient?

I'm 8 weeks into my first year of dental school and could tell you the exact prophylactic treatment (that is of course, if the patient suffered from any valvular disease like someone else mentioned) and the varied treatments based on the patient's allergies. And my knowledge is based solely on what I've learned in dental school (case-based).

Also, like others have mentioned, there is a lot of info. missing about your patient. PMH and HPI (among other things) are extremely important in a situation in which the patient suffered from rheumatic fever.

Finally, I think you're missing the point. This is clearly a prophylactic tx case. I would advise that you sit down and figure this out on your own instead of asking the SDN dental community to do your dirty work. Especially because you WILL see this patient in your 40+ years of practicing dentistry.

Nail on the head. Don't tell me you can't at least google rheumatic fever and figure out from the wikipedia page that rheumatic fever is a heart valve crushing juggernaut.

At that point, if you even know a guy who's heard of the AHA guidelines you should be able to figure out that it's time to find out a little more about Mr. Brown's disease and determine whether he'll require prophylaxis before the extraction.

(More advice from a first year 😉 )

 

[NileBDS]

Case dismissed.

im a dental student at the university of sharjah in UAE


im really happy to meet u guys

 

[SunnyState]

Pal4ever,

If UAE also follows the AHA guidelines then Mr. Brown won't have to take antibiotics prior to the extraction according to recent changes. You can check the link below for more details. Good luck!

http://www.ada.org/public/topics/antibiotics.asp

Case dismissed.

Quote:
Originally Posted by Pal4ever View Post
im a dental student at the university of sharjah in UAE


im really happy to meet u guys

 

[UKdent]

I need to know if local anesthesia could interface with the medication that Mr.brown takes ..


Is there any hope that any one could help me ...


Thaaaaaaaanx all 4 ur support ..

And just what medication is he on??
- once you figure that out grab a PDR..
Rheumatic carditis alone is no longer requires prophylactic treatment. So if that is all preform the extraction.