MJDF Human Disease 2

Question 1

A patient with haemophilia A requires extraction of a lower molar. What is haemophilia A and how should the extraction be managed?

Accepted Answer

Haemophilia A is an X-linked recessive deficiency of clotting Factor VIII; extraction requires pre-operative factor replacement to achieve adequate factor levels (ideally >50%), liaison with the haematology team, use of local haemostatic measures (tranexamic acid, suturing, oxidised cellulose), and post-operative monitoring

Answer

Haemophilia A is a platelet disorder treated with platelet transfusion

Answer

Haemophilia A only affects females and requires no special dental management

Answer

A standard extraction with no modifications is appropriate

Question 2

What is the pathophysiology of Type 1 diabetes mellitus and how does it differ from Type 2?

Accepted Answer

Type 1 is autoimmune destruction of pancreatic beta cells causing absolute insulin deficiency (requires insulin replacement); Type 2 involves insulin resistance and relative insulin deficiency (managed initially with lifestyle, then oral hypoglycaemics, and eventually insulin if needed)

Answer

Type 1 and Type 2 diabetes are the same disease with different names

Answer

Type 1 only affects adults over 60; Type 2 only affects children

Answer

Type 1 is caused by excessive sugar intake; Type 2 is caused by exercise

Question 3

A patient taking warfarin presents with a supratherapeutic INR of 6.0 and spontaneous gingival bleeding. What is the appropriate immediate management?

Accepted Answer

Withhold warfarin, administer oral vitamin K (1-5 mg phytomenadione), apply local pressure to bleeding sites, and refer to the patient's anticoagulant clinic urgently; if bleeding is severe, refer to A&E for possible IV vitamin K and/or prothrombin complex concentrate

Answer

Continue warfarin and observe

Answer

Perform a full mouth debridement to stop the bleeding

Answer

Prescribe aspirin to counteract the warfarin

Question 4

What are the key features of an acute myocardial infarction and what should a dental team do if a patient develops symptoms during treatment?

Accepted Answer

Crushing central chest pain radiating to the left arm, jaw, or back, with sweating, nausea, and breathlessness; the dental team should stop treatment, call 999, administer aspirin 300 mg (chewed), GTN spray if available and not contraindicated, high-flow oxygen if SpO2 <94%, and be prepared to commence CPR if cardiac arrest occurs

Answer

Myocardial infarction presents as mild headache and can be treated with paracetamol

Answer

MI only causes tooth pain and is not a medical emergency

Answer

Administer adrenaline intramuscularly and continue dental treatment

Question 5

What is the dental significance of a patient being HIV-positive and what oral manifestations may be seen?

Accepted Answer

HIV-positive patients may present with oral candidiasis, oral hairy leukoplakia, Kaposi's sarcoma, necrotising ulcerative gingivitis/periodontitis, linear gingival erythema, recurrent aphthous ulceration, and HPV-related lesions; these may be the first signs of HIV infection or indicate disease progression and falling CD4 count

Answer

HIV has no oral manifestations

Answer

HIV only affects the lungs and has no relevance to dentistry

Answer

HIV-positive patients cannot receive any dental treatment

Question 6

A patient with epilepsy taking phenytoin presents for dental review. What are the dental implications of this medication?

Accepted Answer

Phenytoin causes drug-induced gingival overgrowth (enlargement) in approximately 50% of patients, particularly in the presence of plaque; additionally, the dental team must be prepared to manage a seizure during treatment, and phenytoin interacts with some dental prescriptions (azole antifungals, metronidazole)

Answer

Phenytoin has no dental side effects

Answer

Phenytoin only affects tooth colour

Answer

Patients on phenytoin cannot have dental treatment