NBDHE NBDHE Management of Special Needs Patients 3 — Questions and Answers
Question 1: A patient with epilepsy is taking phenytoin (Dilantin). Which oral manifestation is most commonly associated with long-term use of this medication?
- Angular cheilitis
- Gingival hyperplasia (Correct answer)
- Oral candidiasis
- Hairy tongue
Correct answer: Gingival hyperplasia
Phenytoin-induced gingival hyperplasia is a well-documented side effect, occurring in up to 50% of patients, especially with poor plaque control.
Question 2: During treatment, a patient with a known seizure disorder has a generalized tonic-clonic seizure. What is the dental hygienist's FIRST action?
- Insert a tongue blade to prevent tongue biting
- Clear the area, protect the patient from injury, and note the time (Correct answer)
- Administer oxygen via face mask immediately
- Call 911 before doing anything else
Correct answer: Clear the area, protect the patient from injury, and note the time
The immediate priority is patient safety: clear the area, cushion the head, never restrain the patient, and time the seizure.
Question 3: Which of the following is the most appropriate oral hygiene aid recommendation for a patient with severe rheumatoid arthritis affecting hand dexterity?
- Standard manual toothbrush with thin handle
- Electric toothbrush with a wide-grip handle (Correct answer)
- Floss picks only
- Wooden toothpicks
Correct answer: Electric toothbrush with a wide-grip handle
An electric toothbrush with a wide-grip handle compensates for reduced manual dexterity and requires less fine motor control.
Question 4: A patient with HIV/AIDS presents with a white, removable lesion on the lateral border of the tongue that wipes off easily. What is the most likely diagnosis?
- Oral hairy leukoplakia
- Pseudomembranous candidiasis (Correct answer)
- Lichen planus
- Leukoplakia
Correct answer: Pseudomembranous candidiasis
Pseudomembranous candidiasis (thrush) presents as a white, cottage cheese-like coating that wipes off easily, revealing an erythematous base.
Question 5: A 70-year-old patient on bisphosphonate therapy for osteoporosis requires a tooth extraction. What is the primary concern?
- Increased risk of dry socket only
- Medication-related osteonecrosis of the jaw (MRONJ) (Correct answer)
- Prolonged bleeding due to drug interaction
- Systemic infection risk
Correct answer: Medication-related osteonecrosis of the jaw (MRONJ)
Bisphosphonate therapy suppresses osteoclast activity, impairing bone healing and creating risk for MRONJ following invasive oral procedures.
Question 6: Which communication strategy is most effective when treating a patient with moderate hearing loss who does not use hearing aids?
- Speaking loudly and quickly to convey information
- Facing the patient directly, speaking clearly at a moderate pace, and using visual aids (Correct answer)
- Writing all communication on paper throughout the appointment
- Using only hand gestures for all instructions
Correct answer: Facing the patient directly, speaking clearly at a moderate pace, and using visual aids
Direct face-to-face communication with clear speech and supplemental visual aids maximizes comprehension for patients with hearing loss.
Question 7: A patient with Parkinson's disease presents with hyposalivation and difficulty swallowing. Which preventive measure is MOST critical?
- Recommending fluoride-free toothpaste
- Prescribing high-concentration fluoride and implementing a caries prevention protocol (Correct answer)
- Recommending alcohol-based mouthrinse
- Scheduling appointments every 12 months
Correct answer: Prescribing high-concentration fluoride and implementing a caries prevention protocol
Hyposalivation significantly increases caries risk, making prescription-strength fluoride and frequent recall appointments essential for this population.
NBDHE NBDHE Management of Special Needs Patients 3
A patient with epilepsy is taking phenytoin (Dilantin).
Which oral manifestation is most commonly associated with long-term use of this medication?