• perio disease (most important)
• poor OH
• # of unrestored/extracted teeth
• malocclusion
• caries (same as other populations)

- lack of coordination

- lack of understanding

1. heart disease
2. stroke
3. premature birth

• finding a dentist (that will treat them)
• architectural (e.g., lack of wheelchair ramp)
• transportational
• financial
• attitudinal
• psychological (fear)

• medicaid (ends at 21)
• Dinar Grottos
• private funds (church, family, foundations)

- non-progressive neuromuscular disorder caused by brain damage due to anoxia at or near birth

• spastic - most common; e.g., hands compressed against chest
• athetoid - involuntary movement
• hypotonic - lack of muscle tone
• ataxic - walking dysfunction
• rigid
• mixed (usually see mixed)

- spastic tongue thrusting

- speech problems

- mouth breathing

• poor OH
• perio disease
• anterior open bite

- xerostomia

- biotene

- phenytoin (brand name dilantin)

- gingival hyperplasia

- if pt can tell they're about to have seizure, call 911

- don't put anything in the mouth that isn't ligated

- use a bite block

- discontinue Tx

- don't let them go home alone

- notify doctor

- document details in chart

- prolonged seizure

- life-threatening

- thrombocytopenia (increased bleeding)

*consult with physician before surgery

- seizure control

- anxiety control

- give muscle relaxants like benzodiazepine (e.g., valium)

- nitrous

- restraints (e.g., hand-holding, papoose boards)

- complex developmental disorder that affects communication and social interaction

- symptom onset usually before age 3

- dysfunctional social interaction

- clumsiness (delayed motor milestones)

- behavior repetition

- focused area of unusual intelligence

- overly sensitive to physical stimuli

- distress from change in routine

- repeated body movements

- unusual attachment to objects

- expectation of unpredictable behavior

- discuss behavior with caregiver

- anxiolytic meds

- restraints

- general anesthesia

- not as many trisomy 21 cells

- higher functioning

• low-set ears
• flat nasal bridge
• orbital hypertelorism
• mid-facial hypoplasia (makes jaw look big, like class III)
• short stature
• overweight
• exaggerated epicampal folds
• extra skin on back of neck

• low caries
• high perio disease - early tooth loss
• congenital absence of teeth (max laterals most common)
• delayed eruption of 1˚ teeth
• bruxism
• taurodont molars

- immune cell dysfunction

- increased risk of leukemia

- leukemia

- congenital heart defects

- intestinal problems

- URT infections with high fevers

- those with congenital heart defects

- they are susceptible to subacute bacterial endocarditis (SBE)

- bedsores

- have cushions available to minimize shearing forces

- hydrocephaly

- stenosis of aqueduct of sylvius (cannot maintain fluid equilibrium b/t lateral ventricles in brain, leading to expansion of one ventricle)

- yes, for procedures that cause bleeding

- no (b/c shunt does not go to heart)

• nitrile gloves, dam
• cover contact areas
• silk tape
• elastomeric thread
• molt mouth prop
• metal based prohpy brush
• JP drains

• rash
• hives
• itching
• tearing
• sneezing, coughing
• wheezing, difficulty breathing
• chest pains/tightness
• throat tightness
• hypotension

Step 1: 1 mg/kg diphenhydramine every 4-6 hrs (max dose 300mg/24hrs) OR .01mL/kg 1:1000 SC epinephrine (max dose 0.5mL)

Step 2: 1 mg/kg diphenhydramine every 4-6 hrs for minimum of 48 hrs AND consult physician

- chest pain

- pain in left shoulder/arm

- pain in lower jaw/neck

- pain in upper back

- nausea, dizziness, vomiting

- if pt has been to cardiologist and is managing disease, OK to treat

- if severe, may refer to oral surgeon

- make sure pt has nitroglycerin

- if angina occurs during Tx, stop and let pt take nitroglycerin, then wait for symptoms to resolve

- nitrous OK

- congestive heart failure

- enlarged heart from having to pump harder

- shortness of breath

- swelling in extremities (clubbing of fingers = sign of hypoxia)

- tortuous neck veins

- don't use anything over 1:100,000 epi

- don't give more than 3 carpules (1.5 for kids)

- aspirate

• ventricular septal defect
• atrial septal defect
• patent ductus arteriosus
• aortic stenosis
• coarctation of orta
• tetralogy of fallot

• prosthetic valve or part of valve
• previous infective endocarditis
• unrepaired cyanotic CHD, including shunts
• repaired CHD (with prosthetic material) w/in 6 months of repair (until endothelialization)
• repaired CHD with residual effects (that prevent endothelialization)
• cardiac transplant pts with valvulopathy

• all that involve manipulation of gingiva or periapical region
• all that involve perforation of oral mucosa
• E.g., S/RP, oral surgery, prophy (for pts with inflamed gingiva)

• routine LA (even thru infection)
• x-rays
• placement of removable/ortho appliances (including brackets)
• adjustment of ortho appliances
• shedding of deciduous teeth
• bleeding from trauma to oral mucosa

Amoxicillin - 2g for adults, 50mg/kg for kids

Clindamycin - 600mg for adults, 20mg/kg for kids

coverage - ventriculoatrial and ventriculovenous

no coverage - ventriculoperitoneal

normal = < 100mg/dL

pre-diabetic = 100-125mg/dL

diabetic = > 125 mg/dL

• increased thirst
• increased hunger w/o weight gain
• frequent urination
• weight loss
• blurred vision

- measures amt of glycated hemoglobin (amt of sugar sticking to RBCs)

- tells how well diabetic pt is doing over time (2-3 months)

- viral or toxic damage to pancreatic islet cells in kids who are genetically predisposed

- autoimmune damage to ß cells

- kidney failure

- MI

- blindness

- incoherence

- bizarre behavior

- dizziness

- seizure

- make sure they've eaten

- have source of glucose on hand

- stress OH (b/c increased risk of perio disease)

- morning appts (when blood sugar best controlled)

- consult physician before invasive treatment

- perio disease

- xerostomia

- delayed healing

- HIV

- chemo

- bone marrow transplants

- fever

- sore throat

- muscle/joint pain

- swollen glands

- candidiasis

- atypical (fiery red) gingivitis

- parotid swelling

- Karposi's sarcoma

- herpes

- hairy leukoplakia

- magic mouthwash (careful w/ kids b/c of lidocaine - toxic)

- tylenol

- chlorhexidine

- lasers

severe - less than 1%

moderate - 2-5%

- factor VIII

- 85%

• if pt has had replacement therapy, OK to treat
• do as much as possible in 1 visit to limit need for replacement therapy
• normal replacement therapy contraindicated for hemophiliacs w/ inhibitors
• tell hemotologist before procedure (especially if giving an IAN)
• use 27 gauge to facilitate aspiration
• if aspirate positive, then move needle and continue injection, but keep pt for a few hrs after procudure
• protect soft tissue (careful with film)
• never prescribe aspirin-containing meds

- partial thromboplastin time (PTT)

- prothrombin time, bleeding time, platelet function and count are w/in normal limits, but PTT is prolonged in mod-severe cases (may be normal in mild cases)

- normal

- reduced

- XI

- autosomal

- joint and muscle bleeding (most common)

- post-op bleeding

- easy bruising

- social, psychological, vocational problems

- lack of excessive hemorrhage from cuts b/c platelets are normal

- mucosal bleeding infrequent

• fresh frozen plasma
• cryoprecipitate
• recombitant DNA
• amicar (slows clot breakdown)
• concentrates (most common) - take blood from donors and concentrate into powder, pts administer themselves

- give such a high dose of factor VIII that body can't make enough antibodies

- give factor IX, hoping that body will make antibodies to it instead

- adrenaline

- topical thrombin

- absorbable collagen

- pressure

- factor VIII (deficiency)

- platelets (adhesion disorder)

- severe, frequent nosebleeds

- bruising easily

- prolonged menstruation

- bleeding (decreased platelets)

- infection (decreased lymphocytes)

- bradycardia

- hypotension

- if not sure what to do, call 911

- trendelenburg

- ammonium carpules

- rag on face or back of neck

- refer pt to physician to make sure not due to underlying condition

- when ANS pathways disrupted (e.g., by spinal cord injury)

- afferents sense that bladder is full, but cannot relay message to relax sphincter and empty bladder

- BP increases until bladder empty, so will increase indefinitely unless catheterized

- make sure bladder bag not full before Tx

- get consult from physician for sedation (especially w/ respiratory depressors like hydrocodone)

- get chest x-ray to determine lung capacity

- ask pt how they can best be seated

- x-linked recessive defect in dystrophin gene (for muscular protein)

- causes progressive muscular degeneration

- poor prognosis

- inability to breathe (due to muscle degeneration)

- CHF (heart tries to pump hard to compensate for respiratory difficulties)

- delayed muscle development

- drooling

- ptosis

- ataxia / frequent falls

- difficulty breathing

- dantrolene Na

- manages fulminant hypermetabolism of skeletal muscle

- hypodontia

- hypotrichosis

- hypohydrosis (can lead to malignant hypothermia)

- angular chelitis

- cone-shaped incisors

- saddle-shaped nose

- face like inverted triangle

- autosomal dominant simplex (no scarring)

- autosomal dominant dystrophic (scarring)

- autosomal recessive dystrophic (scarring)

- autosomal recessive lethalis (early death)

- very good

- dentures when young (adjusted as they grow)

- implants when older

- enamel hypoplasia (increased decay)

- taurodont molars

- autoimmune reaction to antibiotics (e.g., sulfur, penicillin)

- can have erythema multiforme (target lesions)

- can have permanent systemic sequelae

- can have uneruption of permanent teeth

- fragile bones (fractures)

- blue sclera

- dentinogenesis imperfecta

- deafness

- joint laxility

- skin fragility

- hernias

- cardiac valvular insufficiency

• 6+ cafe au lait spots
• 2+ neurofibromas of any kind OR 1 plexiform neurofibroma
• freckling of axilla or groin
• 2+ lisch nodules (benign iris hamartomas)
• hearing loss

- forms in deep tissue

- has fingerlike projections that cannot be removed

- Down's syndrome

- epidermolysis bullosa

- cleidocranial dysplasia

- gardner syndrome

- cleft lip/palate

• ectodermal dysplasias
• epidermolysis bullosa
• mucopolysaccharidosis
• tuberous sclerosis
• cleft lip/palate