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Adc New Scenario Based Question 2

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524 views4 pages

Adc New Scenario Based Question 2

Uploaded by

Peter Habeeb
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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lOMoA

ADC New scenario based question-2

BDS (Kerala University of Health Sciences)

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lOMoA

ADC New scenario based question-2


ENDODONTICS+ANTICOAGULANT THERAPY
Q. A 48 year old patient on warfarin present with a tender root canal filled upper molar. Pain
is severe and intermittent and is more pronounced on biting. He had received prosthetic heart
valve replacement 5 months ago. The tooth is tender on percussion. The radiographic
examination showed that canal is over filled but there is no periapical radiolucency.

Based upon the radiograph and symptoms, the most likely diagnosis for the condition
of first molar?

a. Fractured root
b. Periapical periodontitis
c. Apical scar
d. Apical cyst

No radiolucency in the periapical area- Can exclude periapical cyst and


periapical granuloma.
For the diagnosis of root fracture requires other investigations to diagnosis
other than radiographs and clinical findings.
Tenderness on biting and percussion
Indicates inflammation of PDL and the overfilled canal provide a likely
cause. Although no radiolucency shown on radiograph, but it is not to
require to diagnose in the presence of typical symptoms.

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lOMoA

The patient records showed that he is not a regular attendee due to living in a regional
area, the recommended treatment in this case is:

a. Restoration of upper molar


b. Extraction
c. Root canal treatment
d. Root canal treatment and restore with post and core

The patient is at the risk of infective endocarditis. He has


prosthetic valve which is associated with increased risk of
infective endocarditis and requires IE prophylaxis.
We have to remove any source of infection and it can be done by
extraction or another RCT.

RCT can be finish in single visit, but it require crown placement so needs multiple
visit and not the answer.
RC retreatment and restore with post and core is the best treatment option but the
patient is not a regular attendee.
If the patient is residing at main city like Sydney, the option is (d).

3. The patient had a prosthetic valve replacement 5 months ago, is he at a risk of


infective endocarditis?
a. No
b. May be
c. Yes, prophylactic AB is needed preoperatively
d. Yes, AB is needed postoperatively
e. C and D

Post operatively not required


Refer therapeutic guideline, 2019 (box 24 new)

1. The primary consideration during treatment of this patient is:


a. Remove any source of infection
b. Stop the pain
c. Restore aesthetic
d. All
The patient is at the risk of IE and the potential source of infection should be
removed.

2. Post-operative (extraction) are necessary regarding the risk of endocarditis. Which statement
is wrong?
a. Patient should be alert for signs and symptoms of endocarditis

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lOMoA

b. The symptom may be of acute onset and progress rapidly or persists for weeks or
months before cardiac sign develops.
c. Endocarditis is caused by streptococci is usually acute type.
d. Patient with endocarditis of prosthetic valve progress to heart failure more rapidly.

Endocarditis caused by streptococci is usually of sub-acute type.

Cardiac conditions for which endocarditis prophylaxis is recommended for


patients undergoing a procedure listed in Box 25
Endocarditis prophylaxis is recommended only for patients with the following cardiac conditions (that
are associated with an increased risk of developing infective endocarditis and the highest risk of
adverse outcomes from endocarditis) who are undergoing a procedure listed in Box 25 (p.195) )
[NB1] [NB2]:

• Prosthetic cardiac valve, including trans catheter-implanted prosthesis or homograft


• Prosthetic material used for cardiac valve repair, such as annuloplasty rings and chords
• Previous infective endocarditis
• Congenital heart disease but only if it involves:
— unrepaired cyanotic defects, including palliative shunts and conduits
— repaired defects with residual defects at or adjacent to the site of a Prosthetic patch or
device (which inhibit endothelialisation)
• Rheumatic heart disease in high-risk patients INIB3]

NB1: Endocardi 琀椀 s prophylaxis is not recommended for pa 琀椀 ents with forms of valvular
or structural heart disease not listed in this box, including pa 琀椀 ents with mitral valve
prolapse, septal defects or cardiac implantable electronic devices.

NB2: Pa 琀椀 ents with a heart transplant who have developed cardiac valvulopathy may
also be at high risk of adverse outcomes from endocardi 琀椀 s; consult the pa 琀椀 ent's
cardiologist for speci 昀椀 c recommenda 琀椀 ons.

NB3: See p.195 for discussion of pa 琀椀 ents with rheuma 琀椀 c heart disease.

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