DSE OSCE - 2021
1. What are the ADA recommendations for when pre-med is required: - pros- thetic cardiac valves, including
transcatheter-implanted prostheses and homografts
- prosthetic material used for cardiac valve repair, such as annuloplasty rings and chords
- a history of infective endocarditis
- a cardiac transplanta with valve regurgitation due to a structurally abnormal valve
- the following congenital (present from birth) heart disease
--unrepaired cyanotic congenital heart disease, including palliative shunts and con- duits
--any repaired congenital heart defect with residual shunts or valvular regurgitation at the site of or adjacent to the site of
a prosthetic patch or a prosthetic device
**ADA website**
https://www.ada.org/en/member-center/oral-health-topics/antibiotic-prophylaxis
2. 41-yo woman, pregnant; prev rheumatic fever with heart murmur (no valvu- lar abnormality); allergy to
penicillin. Positive history of infective endocarditis. Does she need to pre med?
- yes
- no: yes
- REVIEW HEALTH HISTORY - on my exam, this patient had a previous history of infective endocarditis. Pre-med
IS indicated
- many of the OSCE quizlets say no....
3. Pre-med options for pregnant woman w/hx of infective endocarditis and penicillin allergy
- amoxicillin
- cephalexin
- clarithromycin
- ciproflaxacin: *clarithromycin*
I may not be correct, the correct option may be cephalexin. however I chose clarithromycin due to penicillin allergy,
cross reaction with cephalosporins, and since clindamycin/erythromycin/azthromycin were not options. Ciproflaxacin is
con- traindicated in pregnancy. article for reference https://www.parents.com/pregnan- cy/my-body/is-it-safe/antibiotics-
and-pregnancy/
4. What procedure can a dentist perform without consulting MD if a patient is currently taking
bisphosphonates?
- endo therapy
- prophy and scaling
, DSE OSCE - 2021
- extraction
- occlusal restoration: *occlusal restoration*
although the main HELL NO is extraction, completing endo therapy increases risk if
, DSE OSCE - 2021
the apex is compromised/damaged during therapy. I teetered on prophy and scaling, but since it did not specify
supragingival, decided that the risk of scaling can nega- tively affect the periosteum of a bisphosphanate patient. ADA
recommendations: http://www.centreoms.com/admin/storage/news/ADA%20Recommenda- tions%20for%20Treatment
%20of%20Patients%20on%20Bisphosphon.pdf
5. Pregnant person afraid of needles - stress management by putting patient in what position when in your chair
(BEFORE they even get to the point of passing out)?
- supply oxygen
- place in Trendelenburg
- make patient sit up straight
- tell them to suck it up buttercup: place her in Trendelburg position.
- supine hypotension in 3rd trimester usually occurs (bc compression Inf vena cava)
=> must prevent this in dental chair bc it can cause patient to pass out.
- Best preventative treatment for supine hypotension is to turn the patient, preferably to the left side, to displace the uterus
away from the inferior vena cava. The patient can also be placed in a sitting position with the knees flexed.
6. 6 months pregnant had bleeding gums and mobile teeth, how should they be treated?
- immediate extractions
- do not treat until baby is born
- conservative debridement
- immediate endo: conservative debridement
.- pregnancy gingivitis: important to do ScRP (and stress good oral hygiene) to prevent plaque growth. The plaque can
enter blood stream and stimulate patient's immune system to produce prostaglandins, which can trigger uterine
contraction leading to early labor, premature birth, and a small baby.
7. Pregnant lady with a diastema in between #8 and #9 with deep probing depth and class 1 mobility on 8 and 9.
What is the reason for diastema?
- chronic periodontitis
- distal drift
- normal during pregnancy: chronic perio
- increased incidence of periodontal disease during pregnancy => must emphasize good oral hygiene, and remove all
their plaque so it doesn't lead to premature birth
/ low birth weight
8. Permanent staining as a result of tetracyline; did this happen?
, DSE OSCE - 2021
- During development (as fetus)
- 0-5yrs
- 5-10 yrs
1. What are the ADA recommendations for when pre-med is required: - pros- thetic cardiac valves, including
transcatheter-implanted prostheses and homografts
- prosthetic material used for cardiac valve repair, such as annuloplasty rings and chords
- a history of infective endocarditis
- a cardiac transplanta with valve regurgitation due to a structurally abnormal valve
- the following congenital (present from birth) heart disease
--unrepaired cyanotic congenital heart disease, including palliative shunts and con- duits
--any repaired congenital heart defect with residual shunts or valvular regurgitation at the site of or adjacent to the site of
a prosthetic patch or a prosthetic device
**ADA website**
https://www.ada.org/en/member-center/oral-health-topics/antibiotic-prophylaxis
2. 41-yo woman, pregnant; prev rheumatic fever with heart murmur (no valvu- lar abnormality); allergy to
penicillin. Positive history of infective endocarditis. Does she need to pre med?
- yes
- no: yes
- REVIEW HEALTH HISTORY - on my exam, this patient had a previous history of infective endocarditis. Pre-med
IS indicated
- many of the OSCE quizlets say no....
3. Pre-med options for pregnant woman w/hx of infective endocarditis and penicillin allergy
- amoxicillin
- cephalexin
- clarithromycin
- ciproflaxacin: *clarithromycin*
I may not be correct, the correct option may be cephalexin. however I chose clarithromycin due to penicillin allergy,
cross reaction with cephalosporins, and since clindamycin/erythromycin/azthromycin were not options. Ciproflaxacin is
con- traindicated in pregnancy. article for reference https://www.parents.com/pregnan- cy/my-body/is-it-safe/antibiotics-
and-pregnancy/
4. What procedure can a dentist perform without consulting MD if a patient is currently taking
bisphosphonates?
- endo therapy
- prophy and scaling
, DSE OSCE - 2021
- extraction
- occlusal restoration: *occlusal restoration*
although the main HELL NO is extraction, completing endo therapy increases risk if
, DSE OSCE - 2021
the apex is compromised/damaged during therapy. I teetered on prophy and scaling, but since it did not specify
supragingival, decided that the risk of scaling can nega- tively affect the periosteum of a bisphosphanate patient. ADA
recommendations: http://www.centreoms.com/admin/storage/news/ADA%20Recommenda- tions%20for%20Treatment
%20of%20Patients%20on%20Bisphosphon.pdf
5. Pregnant person afraid of needles - stress management by putting patient in what position when in your chair
(BEFORE they even get to the point of passing out)?
- supply oxygen
- place in Trendelenburg
- make patient sit up straight
- tell them to suck it up buttercup: place her in Trendelburg position.
- supine hypotension in 3rd trimester usually occurs (bc compression Inf vena cava)
=> must prevent this in dental chair bc it can cause patient to pass out.
- Best preventative treatment for supine hypotension is to turn the patient, preferably to the left side, to displace the uterus
away from the inferior vena cava. The patient can also be placed in a sitting position with the knees flexed.
6. 6 months pregnant had bleeding gums and mobile teeth, how should they be treated?
- immediate extractions
- do not treat until baby is born
- conservative debridement
- immediate endo: conservative debridement
.- pregnancy gingivitis: important to do ScRP (and stress good oral hygiene) to prevent plaque growth. The plaque can
enter blood stream and stimulate patient's immune system to produce prostaglandins, which can trigger uterine
contraction leading to early labor, premature birth, and a small baby.
7. Pregnant lady with a diastema in between #8 and #9 with deep probing depth and class 1 mobility on 8 and 9.
What is the reason for diastema?
- chronic periodontitis
- distal drift
- normal during pregnancy: chronic perio
- increased incidence of periodontal disease during pregnancy => must emphasize good oral hygiene, and remove all
their plaque so it doesn't lead to premature birth
/ low birth weight
8. Permanent staining as a result of tetracyline; did this happen?
, DSE OSCE - 2021
- During development (as fetus)
- 0-5yrs
- 5-10 yrs
