NBDHE NBDHE Management of Special Needs Patients 5 — Questions and Answers
Question 1: A patient with congestive heart failure is taking furosemide (Lasix). Which oral manifestation may result from this diuretic therapy?
- Gingival hyperplasia
- Xerostomia due to reduced fluid intake and diuretic effect (Correct answer)
- Increased calculus formation
- Oral ulcerations
Correct answer: Xerostomia due to reduced fluid intake and diuretic effect
Diuretics like furosemide reduce overall body fluid, which can contribute to decreased salivary flow and xerostomia.
Question 2: A patient with a latex allergy is scheduled for a dental appointment. What is the most critical preparation step?
- Scheduling the patient last in the day to allow latex particles to settle
- Scheduling the patient as the first appointment and ensuring a latex-free environment (Correct answer)
- Using only nitrile gloves while keeping other latex items in the operatory
- Asking the patient to bring their own gloves
Correct answer: Scheduling the patient as the first appointment and ensuring a latex-free environment
A latex-free environment must be established before the patient arrives; scheduling first minimizes airborne latex antigen accumulation.
Question 3: A patient with chronic kidney disease (CKD) presents for a routine dental hygiene visit. Which oral manifestation is characteristically associated with uremia?
- Gingival hyperplasia
- Uremic stomatitis with ammonia breath (fetor uremicus) (Correct answer)
- Hairy leukoplakia
- Necrotizing ulcerative gingivitis
Correct answer: Uremic stomatitis with ammonia breath (fetor uremicus)
Uremia causes accumulation of nitrogenous waste products that can manifest as uremic stomatitis and characteristic ammonia-like breath.
Question 4: When treating an elderly patient with dementia, which legal and ethical principle is most important before beginning treatment?
- Proceeding with all planned treatment regardless of patient behavior
- Verifying that informed consent is obtained from the legal guardian or healthcare proxy (Correct answer)
- Limiting communication to written instructions only
- Avoiding treatment until the patient can verbally consent
Correct answer: Verifying that informed consent is obtained from the legal guardian or healthcare proxy
Patients with dementia who lack decision-making capacity require consent from their legally authorized representative before treatment proceeds.
Question 5: A patient with Sjögren's syndrome presents for care. Which combination of findings is most characteristic of this autoimmune condition?
- Hypersalivation and parotid gland atrophy
- Xerostomia, dry eyes (xerophthalmia), and rampant cervical caries (Correct answer)
- Gingival hyperplasia and lichenoid reactions
- Candidiasis and hairy tongue only
Correct answer: Xerostomia, dry eyes (xerophthalmia), and rampant cervical caries
Sjögren's syndrome causes lymphocytic destruction of exocrine glands, resulting in dry mouth, dry eyes, and secondary rampant dental caries.
Question 6: Which radiographic finding is most commonly associated with patients who have undergone head and neck radiation therapy?
- Increased bone density in the mandible
- Osteoradionecrosis presenting as radiolucent areas with irregular borders (Correct answer)
- Hypercementosis on posterior teeth
- Pulp calcifications throughout dentition
Correct answer: Osteoradionecrosis presenting as radiolucent areas with irregular borders
Radiation therapy damages the vascularity of bone, leading to osteoradionecrosis, which appears radiographically as irregular radiolucent areas.
Question 7: A patient with a history of substance use disorder is in recovery and taking methadone maintenance therapy. Which dental concern is most significant?
- Increased susceptibility to periodontal disease only
- Methadone's high sugar content and xerogenic effects causing rampant caries (Correct answer)
- Increased calculus formation from salivary pH changes
- Gingival overgrowth from methadone metabolism
Correct answer: Methadone's high sugar content and xerogenic effects causing rampant caries
Methadone syrup has high sugar content and causes xerostomia, creating conditions for rapidly progressing 'meth mouth' type carious lesions.
NBDHE NBDHE Management of Special Needs Patients 5
A patient with congestive heart failure is taking furosemide (Lasix).
Which oral manifestation may result from this diuretic therapy?