Additional Tidbits for the National Board

Transcription

1 Additional Tidbits for the National Board The following represents additional material that will likely make an appearance on the National Board. Enjoy! Tetracycline has anti collagenase properties Festooning refers to the distinct rounding and enlargement of the gingival margins associated with an acute inflammatory response; described as looking like a lifesaver There is much confusion regarding what an infra or intrabony defect is. Intra means within intrabony defects occur within bone. Supra denotes above suprabony defects occur above the alveolar bone crest. When periodontal infection results in the development of an intrabony defect, the base of the pocket is apical to a wall of bone. By contrast, when a suprabony pocket develops, the base of the defect is coronal to the crest and is located above the bone Adapted from: Hempton, TJ, DDS; Wilkins, E, DMD, and Lancaster, D; RDH, BS: A review of the biologic principles of restoring bone resorbed as a result of periodontal infection (part 1 of a two part series). RDH Magazine; accessed on 7/13/13 at: 17/issue 10/feature/periodontal regeneration.html You may need to know additional information about the arachidonic acid pathway such as: o Arachidonic acid is both a product of the body s natural linoleic acid (omega 6) conversion and a component of animal based foods like egg yolk and meat o Arachidonic acid is commonly converted to pro inflammatory eicosanoids upon injury and then metabolized to produce inflammatory mediators (such as prostaglandins and leukotrienes) It is likely that you will encounter questions regarding different types of studies involved in research methodology. To expand upon the information contained in your review book, please be familiar with the following: o Descriptive ( case control ) study: In a descriptive or case study, all subjects receive the treatment and there is no formal control group A cross sectional study is a type of descriptive study in which disease and exposure status are measured simultaneously in a given population; cross sectional studies can be thought of as providing a snapshot of the frequency and characteristics of a disease in a population at a particular point in time; can be used to assess the prevalence of acute or chronic conditions (Ex. Gingivitis) in a population; however, since exposure and disease status are measured at the same point in time, it may not be possible to distinguish whether the exposure preceded or followed the disease, and thus cause and effect relationships are not certain o Experimental study: A null hypothesis is preferred because it is easier to disprove an hypothesis than eliminate all potential contributing factors

2 o Analytical studies Retrospective ( case control ) study: Case control studies observe two groups of subjects one which has developed a disease (case) and another which has not (control); these studies are designed to look back in time to identify factors that might have caused the condition being observed (neither the case nor the control groups are aware of exposure or non exposure to the factors being investigated); if the researcher believes the risk factor exists at the same time the condition does, the study is considered to be a cross sectional case control study (Ex. Comparing children s cognitive development when living in homes with lead based paints versus non lead paint) Prospective study ( cohort study ): follows large groups of people over a long period of time in order to evaluate the effects of a wide variety of variables on health; as a group, these types of studies have provided valuable information about the link between lifestyle factors and disease; once a specified amount of time has elapsed, the characteristics of people in the group are compared to test specific hypotheses (Ex. Effect of dietary supplementation with vitamin D3 on cognitive function); KEYS: o Though time consuming and expensive, cohort studies generally provide more reliable information than casecontrol studies because they do not rely on information from the past o Cohort study subjects determine whether they are to receive the intervention or not (the researcher is not involved with the subject s decision to use the intervention) o If the two study groups are observed simultaneously, it is called a concurrent cohort study; concurrent cohort studies are also known as prospective cohort studies because participants are followed forward in time A convenience sample may or may not increase bias Measures of Central Tendency can be defined as the average value of any distribution of data that bests represents the middle; represents the graphed point of data in which distribution is balanced The Health Belief Model (HBM) BOARD ALERT!!! o Developed in the early 1950s by social scientists at the U.S. Public Health Service in order to understand the failure of people to adopt disease prevention strategies or screening tests for the early detection of disease o Later uses of HBM were for patients' responses to symptoms and compliance with medical treatments o The HBM suggests that a person's belief in a personal threat of an illness or disease together with a person's belief in the effectiveness of the recommended

3 health behavior or action will predict the likelihood the person will adopt the behavior. o The HBM derives from psychological and behavioral theory with the foundation that the two components of health related behavior are: the desire to avoid illness, or conversely get well if already ill the belief that a specific health action will prevent, or cure, illness o Ultimately, an individual's course of action often depends on the person's perceptions of the benefits and barriers related to health behavior o There are six constructs of the HBM: Perceived susceptibility: This refers to a person's subjective perception of the risk of acquiring an illness or disease. There is wide variation in a person's feelings of personal vulnerability to an illness or disease Perceived severity: This refers to a person's feelings on the seriousness of contracting an illness or disease (or leaving the illness or disease untreated). There is wide variation in a person's feelings of severity, and often a person considers the medical consequences (e.g., death, disability) and social consequences (e.g., family life, social relationships) when evaluating the severity. Perceived benefits: This refers to a person's perception of the effectiveness of various actions available to reduce the threat of illness or disease (or to cure illness or disease). The course of action a person takes in preventing (or curing) illness or disease relies on consideration and evaluation of both perceived susceptibility and perceived benefit, such that the person would accept the recommended health action if it was perceived as beneficial. Perceived barriers: This refers to a person's feelings on the obstacles to performing a recommended health action. There is wide variation in a person's feelings of barriers, or impediments, which lead to a cost/benefit analysis. The person weighs the effectiveness of the actions against the perceptions that it may be expensive, dangerous (e.g., side effects), unpleasant (e.g., painful), time consuming, or inconvenient. Cue to action: This is the stimulus needed to trigger the decision making process to accept a recommended health action. These cues can be internal (e.g., chest pains, wheezing, etc.) or external (e.g., advice from others, illness of family member, newspaper article, etc.). Self efficacy: This refers to the level of a person's confidence in his or her ability to successfully perform a behavior. This construct was added to the model most recently in mid Self efficacy is a construct in many behavioral theories as it directly relates to whether a person performs the desired behavior.

4 o Limitations of Health Belief Model Limitations of the model include the following: It does not account for a person's attitudes, beliefs, or other individual determinants that dictate a person's acceptance of a health behavior. It does not take into account behaviors that are habitual and thus may inform the decision making process to accept a recommended action (e.g., smoking). It does not take into account behaviors that are performed for non health related reasons such as social acceptability. It does not account for environmental or economic factors that may prohibit or promote the recommended action. It assumes that everyone has access to equal amounts of information on the illness or disease. It assumes that cues to action are widely prevalent in encouraging people to act and that health actions are the main goal in the decision making process. o The HBM is more descriptive than explanatory, and does not suggest a strategy for changing health related actions. The individual constructs are useful, depending on the health outcome of interest, but for the most effective use of the model it should be integrated with other models that account for the environmental context and suggest strategies for change. o The Learning Ladder represents an example of the HBM Plasma albumin is an abundant plasma protein that binds to a remarkably wide range of drugs; this interaction may interfere with active drug concentrations in the blood Clark s Rule employs weight when determining drug dosing Ritain and Adderall are psychostimulant drugs prescribed to treat attention deficit hyperactivity disorder (ADHD) and narcolepsy; they have abuse potential Examples of commercially available ibuprofen medications include Advil, Motrin, and Nuprin Naproxen (Aleve ) is considered an NSAID and works by reversibly inhibiting cyclooxygenase 1 and 2 ( COX 1 and COX 2 ) enzymes which results in decreased formation of prostaglandin precursors o Side effects: Possible increased risk of serious cardiovascular (CV) thrombotic events, myocardial infarction, and stroke Prolongs bleeding time Helpful Hint: As drug schedule number increase, abuse potential decreases

5 The Board wants you to know the maximum recommended dose ( MRD ) for each local anesthetic agent: o Lidocaine (Xylocaine) MRD: 300 mg o Mepivacaine (Carbocaine) MRD: 300 mg o Prilocaine (Citanest / Citanest Forte) MRD: 400 mg o Bupivacaine (Marcaine) MRD: 90 mg o Articaine (Septocaine) MRD: 500mg Necessary information for calculating recommended and/or determining the dose of local anesthetic drugs administered include these factors: o concentration of selected anesthetic drug o dilution percentages for vasoconstrictors o standard cartridge volumes (for Board purposes: 1.8 ml per cartridge) o defined maximum recommended dose ( MRD ) for EACH drug administered MRD refers to the maximum quantity of a drug that can be safely administered during an appointment o relevant patient factors (weight/health status) To determine the maximum safe dose for specific a patient, multiply maximum safe dose ( MRD ) of drug by patients weight Plavix (clopidogrel) is an anti coagulant medication often used to prevent blood clots after a recent heart attack or stroke, and in people with certain disorders of the heart or blood vessels Methicillin resistant staphylococcus aureus (MRSA) infections are often treated with vancomycin and bactrim Viral replication takes place in the host cell cytoplasm