Clinic Exam II

Introduction: Ms. Jones, a 62-year-old female, presents for a new patient examination. Ms. Jones explains that she has not seen a dentist in over 10 years due to not having any dental insurance. She states that she is having pain on the lower-right side of her mouth, and has trouble chewing on that side. Her pre-treatment vitals were as follows: BP: 130/82 / P: 64 / R: 12 / O2: 98% /Temp: 97.8*F Ms. Jones’ medical history document lists the following: Conditions Systemic Lupus Erythematosus (SLE) High Blood Pressure Anxiety Disorder Seasonal Allergies Medications Methotrexate (Rheumatrex) Immunosuppressant Warfarin (Coumadin) Anticoagulant Acetaminophen (Tylenol) Pain Reliever Hydrochlorothiazide (HCTZ) Thiazide Diuretic Lexapro (Escitalopram) Selective Serotonin Reuptake Inhibitors (SSRI) Zyrtec (Cetirizine) Antihistamine Medicinal marijuana (Cannabis) Allergy Penicillin QUESTION: Which of the following medications/medical conditions requires the provider to seek medical clearance?

Introduction: Ms. Jones, a 62-year-old female, presents for a new patient examination. Ms. Jones explains that she has not seen a dentist in over 10 years due to not having any dental insurance. She states that she is having pain on the lower-right side of her mouth, and has trouble chewing on that side. Her pre-treatment vitals were as follows: BP: 130/82 / P: 64 / R: 12 / O2: 98% /Temp: 97.8*F Ms. Jones’ medical history document lists the following: Conditions Systemic Lupus Erythematosus (SLE) High Blood Pressure Anxiety Disorder Seasonal Allergies Medications Methotrexate (Rheumatrex) Immunosuppressant Warfarin (Coumadin) Anticoagulant Acetaminophen (Tylenol) Pain Reliever Hydrochlorothiazide (HCTZ) Thiazide Diuretic Lexapro (Escitalopram) Selective Serotonin Reuptake Inhibitors (SSRI) Zyrtec (Cetirizine) Antihistamine Medicinal marijuana (Cannabis) Allergy Penicillin QUESTION: Select the appropriate blood pressure stage for Ms. Jones

Introduction: Ms. Jones, a 62-year-old female, presents for a new patient examination. Ms. Jones explains that she has not seen a dentist in over 10 years due to not having any dental insurance. She states that she is having pain on the lower-right side of her mouth, and has trouble chewing on that side. Her pre-treatment vitals were as follows: BP: 130/82 / P: 64 / R: 12 / O2: 98% /Temp: 97.8*F Ms. Jones’ medical history document lists the following: Conditions Systemic Lupus Erythematosus (SLE) High Blood Pressure Anxiety Disorder Seasonal Allergies Medications Methotrexate (Rheumatrex) Immunosuppressant Warfarin (Coumadin) Anticoagulant Acetaminophen (Tylenol) Pain Reliever Hydrochlorothiazide (HCTZ) Thiazide Diuretic Lexapro (Escitalopram) Selective Serotonin Reuptake Inhibitors (SSRI) Zyrtec (Cetirizine) Antihistamine Medicinal marijuana (Cannabis) Allergy Penicillin QUESTION: Select the appropriate ASA Classification for Ms. Jones

Introduction: Ms. Jones, a 62-year-old female, presents for a new patient examination. Ms. Jones explains that she has not seen a dentist in over 10 years due to not having any dental insurance. She states that she is having pain on the lower-right side of her mouth, and has trouble chewing on that side. Her pre-treatment vitals were as follows: BP: 130/82 / P: 64 / R: 12 / O2: 98% /Temp: 97.8*F Ms. Jones’ medical history document lists the following: Conditions Systemic Lupus Erythematosus (SLE) High Blood Pressure Anxiety Disorder Seasonal Allergies Medications Methotrexate (Rheumatrex) Immunosuppressant Warfarin (Coumadin) Anticoagulant Acetaminophen (Tylenol) Pain Reliever Hydrochlorothiazide (HCTZ) Thiazide Diuretic Lexapro (Escitalopram) Selective Serotonin Reuptake Inhibitors (SSRI) Zyrtec (Cetirizine) Antihistamine Medicinal marijuana (Cannabis) Allergy Penicillin QUESTION: Patients who have Systemic Lupus Erythematosus (SLE) require medical clearance due to the risk of:

Introduction: Ms. Jones, a 62-year-old female, presents for a new patient examination. Ms. Jones explains that she has not seen a dentist in over 10 years due to not having any dental insurance. She states that she is having pain on the lower-right side of her mouth, and has trouble chewing on that side. Her pre-treatment vitals were as follows: BP: 130/82 / P: 64 / R: 12 / O2: 98% /Temp: 97.8*F Ms. Jones’ medical history document lists the following: Conditions Systemic Lupus Erythematosus (SLE) High Blood Pressure Anxiety Disorder Seasonal Allergies Medications Methotrexate (Rheumatrex) Immunosuppressant Warfarin (Coumadin) Anticoagulant Acetaminophen (Tylenol) Pain Reliever Hydrochlorothiazide (HCTZ) Thiazide Diuretic Lexapro (Escitalopram) Selective Serotonin Reuptake Inhibitors (SSRI) Zyrtec (Cetirizine) Antihistamine Medicinal marijuana (Cannabis) Allergy Penicillin QUESTION: Ms. Jones’ medical team decided that she requires antibiotic prophylaxis prior to any dental treatment. Which of the following medications is the most appropriate to be prescribed:

Introduction: Ms. Jones, a 62-year-old female, presents for a new patient examination. Ms. Jones explains that she has not seen a dentist in over 10 years due to not having any dental insurance. She states that she is having pain on the lower-right side of her mouth, and has trouble chewing on that side. Her pre-treatment vitals were as follows: BP: 130/82 / P: 64 / R: 12 / O2: 98% /Temp: 97.8*F Ms. Jones’ medical history document lists the following: Conditions Systemic Lupus Erythematosus (SLE) High Blood Pressure Anxiety Disorder Seasonal Allergies Medications Methotrexate (Rheumatrex) Immunosuppressant Warfarin (Coumadin) Anticoagulant Acetaminophen (Tylenol) Pain Reliever Hydrochlorothiazide (HCTZ) Thiazide Diuretic Lexapro (Escitalopram) Selective Serotonin Reuptake Inhibitors (SSRI) Zyrtec (Cetirizine) Antihistamine Medicinal marijuana (Cannabis) Allergy Penicillin QUESTION: Warfarin (Coumadin) is an anticoagulant medication, which may affect Ms. Jones's ability to clot. Which of the following tests are routinely given to patients to test their clotting abilities?

Introduction: Ms. Jones, a 62-year-old female, presents for a new patient examination. Ms. Jones explains that she has not seen a dentist in over 10 years due to not having any dental insurance. She states that she is having pain on the lower-right side of her mouth, and has trouble chewing on that side. Her pre-treatment vitals were as follows: BP: 130/82 / P: 64 / R: 12 / O2: 98% /Temp: 97.8*F Ms. Jones’ medical history document lists the following: Conditions Systemic Lupus Erythematosus (SLE) High Blood Pressure Anxiety Disorder Seasonal Allergies Medications Methotrexate (Rheumatrex) Immunosuppressant Warfarin (Coumadin) Anticoagulant Acetaminophen (Tylenol) Pain Reliever Hydrochlorothiazide (HCTZ) Thiazide Diuretic Lexapro (Escitalopram) Selective Serotonin Reuptake Inhibitors (SSRI) Zyrtec (Cetirizine) Antihistamine Medicinal marijuana (Cannabis) Allergy Penicillin QUESTION: Which of the following is a nonmodifiable risk factor for Ms. Jones’ lupus?

Introduction: Ms. Jones, a 62-year-old female, presents for a new patient examination. Ms. Jones explains that she has not seen a dentist in over 10 years due to not having any dental insurance. She states that she is having pain on the lower-right side of her mouth, and has trouble chewing on that side. Her pre-treatment vitals were as follows: BP: 130/82 / P: 64 / R: 12 / O2: 98% /Temp: 97.8*F Ms. Jones’ medical history document lists the following: Conditions Systemic Lupus Erythematosus (SLE) High Blood Pressure Anxiety Disorder Seasonal Allergies Medications Methotrexate (Rheumatrex) Immunosuppressant Warfarin (Coumadin) Anticoagulant Acetaminophen (Tylenol) Pain Reliever Hydrochlorothiazide (HCTZ) Thiazide Diuretic Lexapro (Escitalopram) Selective Serotonin Reuptake Inhibitors (SSRI) Zyrtec (Cetirizine) Antihistamine Medicinal marijuana (Cannabis) Allergy Penicillin QUESTION: Most medications for the treatment of anxiety may cause xerostomia, increasing the individual’s risk for dental caries and periodontal disease. Immunosuppressants increase the risk of developing opportunistic infections.

Introduction: Ms. Jones, a 62-year-old female, presents for a new patient examination. Ms. Jones explains that she has not seen a dentist in over 10 years due to not having any dental insurance. She states that she is having pain on the lower-right side of her mouth, and has trouble chewing on that side. Her pre-treatment vitals were as follows: BP: 130/82 / P: 64 / R: 12 / O2: 98% /Temp: 97.8*F Ms. Jones’ medical history document lists the following: Conditions Systemic Lupus Erythematosus (SLE) High Blood Pressure Anxiety Disorder Seasonal Allergies Medications Methotrexate (Rheumatrex) Immunosuppressant Warfarin (Coumadin) Anticoagulant Acetaminophen (Tylenol) Pain Reliever Hydrochlorothiazide (HCTZ) Thiazide Diuretic Lexapro (Escitalopram) Selective Serotonin Reuptake Inhibitors (SSRI) Zyrtec (Cetirizine) Antihistamine Medicinal marijuana (Cannabis) Allergy Penicillin QUESTION: Medical marijuana is legal in the state of Connecticut. All of the following actions are appropriate for the clinician to take, EXCEPT

Introduction: Ms. Jones, a 62-year-old female, presents for a new patient examination. Ms. Jones explains that she has not seen a dentist in over 10 years due to not having any dental insurance. She states that she is having pain on the lower-right side of her mouth, and has trouble chewing on that side. Her pre-treatment vitals were as follows: BP: 130/82 / P: 64 / R: 12 / O2: 98% /Temp: 97.8*F Ms. Jones’ medical history document lists the following: Conditions Systemic Lupus Erythematosus (SLE) High Blood Pressure Anxiety Disorder Seasonal Allergies Medications Methotrexate (Rheumatrex) Immunosuppressant Warfarin (Coumadin) Anticoagulant Acetaminophen (Tylenol) Pain Reliever Hydrochlorothiazide (HCTZ) Thiazide Diuretic Lexapro (Escitalopram) Selective Serotonin Reuptake Inhibitors (SSRI) Zyrtec (Cetirizine) Antihistamine Medicinal marijuana (Cannabis) Allergy Penicillin QUESTION: Due to Ms. Jones requiring antibiotic prophylaxis, the clinician must re-appoint the patient prior to completing further treatment. The dental hygienist may complete the following during the initial appointment EXCEPT

A 44-year-old man presents as a new client for dental hygiene care. His medical history reveals type 2 diabetes, high blood pressure (BP) controlled with medication, and a hip replacement. He reports no blood glucose monitoring and controls diabetes with diet and exercise. He had a physical examination last year but is not sure of the examination results. He assumes “everything is fine.” You record his BP reading at 150/102 mm Hg. Which of the following should be considered before implementing dental hygiene care for this client?

A 44-year-old man presents as a new client for dental hygiene care. His medical history reveals type 2 diabetes, high blood pressure (BP) controlled with medication, and a hip replacement. He reports no blood glucose monitoring and controls diabetes with diet and exercise. He had a physical examination last year but is not sure of the examination results. He assumes “everything is fine.” You record his BP reading at 150/102 mm Hg. What is this client’s ASA physical status (PS) classification?

A 44-year-old man presents as a new client for dental hygiene care. His medical history reveals type 2 diabetes, high blood pressure (BP) controlled with medication, and a hip replacement. He reports no blood glucose monitoring and controls diabetes with diet and exercise. He had a physical examination last year but is not sure of the examination results. He assumes “everything is fine.” You record his BP reading at 150/102 mm Hg. What is the BEST course of action for the dental hygienist related to the BP reading?

A 44-year-old man presents as a new client for dental hygiene care. His medical history reveals type 2 diabetes, high blood pressure (BP) controlled with medication, and a hip replacement. He reports no blood glucose monitoring and controls diabetes with diet and exercise. He had a physical examination last year but is not sure of the examination results. He assumes “everything is fine.” You record his BP reading at 150/102 mm Hg. Which human need should be considered during the dental hygiene process of care?

A 25-year-old female presents for dental hygiene care. Her records indicated that 10 months have lapsed since receiving dental hygiene care, and she scheduled the appointment because her teeth are sensitive when she eats candy and her “gums” hurt when she brushes her teeth. She reports an arrhythmia but is not sure of the type or cause and irregularly takes the prescribed medication for its treatment. Her vital signs are within normal limits. During the dental and periodontal assessment, you record generalized marginal gingival inflammation, generalized moderate interproximal subgingival calculus deposits, generalized bleeding on probing, with 2-mm to 4-mm probing depths. Existing restorations include teeth #14-MO, #4-MOD, #13-MO, #18-MO, and #19-B. Radiographs reveal no evidence of bone loss, proximal carious lesions on #29 D, #30 M, and #19 M and restoration overhangs on #14 M and #4 D. She brushes once a day and does not use an interproximal cleaning aid. Which of the following conditions represents the MOST accurate periodontal disease classification?