3rd BDS Clinical Medical Science

Tutorial 1 Cases

Medical Issues
Mr Jones, a 67 year old retired publican, attends your dental practice for a routine
check-up. He was last seen for treatment 2 years before when it was noted that he had
leg claudication and mild COPD. He has since has a stent placed in his right femoral
artery to reduce his claudication. Mr Jones gives you a form from the cardiac surgery
department requesting that you sign him as “dentally fit” for his upcoming heart
valve replacement operation.

Medication
Atorvastatin, Enalapril, Combivent, Bendroflumethiazide, Aspirin, digoxin

Dental Issues
Mr Jones wears a full upper denture which requires replacement. He also needs either
endodontic treatment for 45 or the tooth extracted and restoration of 36 (extensive
MODL), 42 (MI) and he has pockets greater that 5mm around 45, 32, 31, 41 and 42.

Questions
1. For each of his medications, indicate to which drug classes they belong and
state the purpose of each?
2. What is the ‘stent’ placed in his femoral artery?
3. What oral problem may result from his COPD treatment?
4. What do you understand by the term ‘dentally fit’ for cardiac valve surgery?
5. What treatment is needed to allow you to declare Mr Jones ‘dentally fit’?
6. Does he need antibiotic prophylaxis for dental treatment:
a. For this course of treatment?
b. After his valve replacement?

Case 2

Medical Problem
Mrs Claus, a 72 year old lady with significant heart failure, attends for her routine
dental treatment. She has been a patient of your practice for many years but this is the
first time that you have treated her. She is due to have a scale and polish as she has
extensive calculus deposits around her teeth. You note from her medical records that
she had rheumatic fever aged 13 and she has always been given antibiotic cover for
dental care in your practice.

Medication
Bendroflumethiazide, isosorbide mononitrate, perindopril, omeprazole, simvastatin,

Questions

1. For each of his medications, indicate to which drug classes they belong and
state the purpose of each?
2. What should happen about antibiotic cover for this patient?