MJDF Human Disease

Question 1

A patient with rheumatic heart disease and a prosthetic mitral valve presents for dental treatment. What is the primary cardiac concern during dental procedures?

Accepted Answer

Risk of infective endocarditis from transient bacteraemia caused by invasive dental procedures, though NICE guidelines no longer recommend routine antibiotic prophylaxis in the UK

Answer

Risk of myocardial infarction during treatment

Answer

Risk of cardiac arrest from the local anaesthetic

Answer

There are no cardiac concerns for patients with prosthetic heart valves

Question 2

What is the significance of a patient's ASA (American Society of Anesthesiologists) classification in dental practice?

Accepted Answer

It classifies patients by their physical health status to assess fitness for treatment under sedation or general anaesthesia, ranging from ASA I (healthy) to ASA V (moribund); it guides the level of monitoring, setting, and modifications needed for safe dental care

Answer

It determines the cost of dental treatment

Answer

It is only relevant for hospital-based treatment

Answer

It classifies the type of dental restoration needed

Question 3

A patient presents with a history of adrenal insufficiency (Addison's disease) and takes daily prednisolone 10mg. What is the risk during a stressful dental procedure and how should it be managed?

Accepted Answer

The patient may develop an adrenal crisis (acute adrenal insufficiency) if the hypothalamic-pituitary-adrenal axis cannot mount an adequate cortisol response to stress; management depends on the procedure complexity — for minor procedures under LA, the usual dose is adequate; for more stressful procedures, supplementary corticosteroid cover may be needed

Answer

There is no additional risk for patients on corticosteroids

Answer

All dental treatment must be performed under general anaesthesia

Answer

The prednisolone must be stopped 48 hours before dental treatment

Question 4

What are the dental implications of a patient undergoing head and neck radiotherapy?

Accepted Answer

Complications include mucositis, xerostomia (permanent if salivary glands are in the radiation field), radiation caries, osteoradionecrosis of the jaws, trismus from fibrosis of muscles of mastication, altered taste, and candidiasis; pre-radiotherapy dental assessment and extractions of poor-prognosis teeth are essential

Answer

Radiotherapy to the head and neck has no effect on the oral cavity

Answer

Only mucositis occurs and it resolves immediately after treatment

Answer

Dental treatment is permanently contraindicated after radiotherapy

Question 5

A patient with liver cirrhosis presents for dental treatment. What are the key medical considerations?

Accepted Answer

Impaired coagulation (reduced clotting factor synthesis), altered drug metabolism (prolonged action of hepatically-metabolised drugs), increased infection risk, and potential for excessive bleeding requiring pre-treatment coagulation screen (INR, platelet count) and possible liaison with hepatologist

Answer

Liver disease has no relevance to dental treatment

Answer

Only the choice of local anaesthetic is affected

Answer

The patient cannot receive any dental treatment

Question 6

What is the dental significance of a patient having a history of organ transplantation and taking immunosuppressive medication?

Accepted Answer

Immunosuppressive drugs (ciclosporin, tacrolimus, mycophenolate, corticosteroids) increase susceptibility to oral infections (candidiasis, herpes reactivation), impair healing, and ciclosporin causes gingival overgrowth; dental treatment should be coordinated with the transplant team, and prophylactic antibiotics may be needed for invasive procedures

Answer

Transplant patients require no special consideration for dental treatment

Answer

Only dental X-rays should be avoided

Answer

Immunosuppressive medication protects against dental disease