Diploma of the Faculty of Dental Surgery (MFDS) Medical and Pharmacological Foundations Syllabus

Medical and Pharmacological Foundations syllabus — full chapter and topic list

Expand any chapter to see its topics and sub-topics. This is the whole examinable outline for Medical and Pharmacological Foundations in Diploma of the Faculty of Dental Surgery (MFDS), not a summary of it.

1. 1

   Applied Clinical Medicine for Dentistry

   5 topics

   • Cardiovascular disease and dental implications
     • Hypertension, ischaemic heart disease and arrhythmias
     • Infective endocarditis prophylaxis (NICE/SDCEP)
   • Respiratory and endocrine disease
     • Asthma, COPD and diabetes mellitus
   • Bleeding disorders and anticoagulation
     • DOACs, warfarin and managing dental procedures
   • Renal, hepatic and immunosuppressed patients
   • Pregnancy and the elderly patient
2. 2

   Medical Emergencies in Dental Practice

   6 topics

   • Anaphylaxis recognition and management
     • Adrenaline dosing and the ABCDE approach
   • Cardiac arrest and basic life support
     • Adult and paediatric BLS, AED use
   • Hypoglycaemia and seizures
   • Vasovagal syncope and angina/MI
   • Emergency drugs and equipment requirements
   • Choking and airway obstruction
3. 3

   Pharmacology and Prescribing

   5 topics

   • Analgesics in dentistry
     • NSAIDs, paracetamol and opioids
   • Antimicrobial prescribing and stewardship
     • Indications, resistance and SDCEP guidance
   • Safe and legal prescribing
     • Dental Practitioners' Formulary and controlled drugs
   • Drug interactions relevant to dentistry
   • Adverse drug reactions and yellow card reporting
4. 4

   Pain and Anxiety Management

   4 topics

   • Local anaesthesia
     • Agents, techniques and maximum safe doses
     • Failure of anaesthesia and complications
   • Conscious sedation principles
     • Inhalation and intravenous sedation
     • Patient assessment and monitoring
   • Behavioural and non-pharmacological techniques
   • General anaesthesia indications and referral

Medical and Pharmacological Foundations flashcards for Diploma of the Faculty of Dental Surgery (MFDS)

22 of 60 cards from the Medical and Pharmacological Foundations deck — real questions with worked answers.

1. In a patient with a recent myocardial infarction, how long should elective dental treatment ideally be deferred?

   Defer elective treatment for at least 6 months (minimum 4 weeks) after an MI, due to the increased risk of re-infarction and arrhythmia in the early post-infarction period. Liaise with the cardiologist if treatment is urgent.

2. What dental precaution relates to adrenaline (epinephrine) use in patients with unstable cardiovascular disease?

   Limit the dose of adrenaline-containing local anaesthetic (avoid excess) and use careful aspiration to avoid intravascular injection, because exogenous adrenaline can precipitate arrhythmias, hypertension or angina in cardiovascularly unstable patients.

3. Which cardiac conditions does current NICE/SDCEP guidance consider 'at risk' such that antibiotic prophylaxis against infective endocarditis may be considered?

   High-risk groups include prosthetic heart valves, previous infective endocarditis, and certain congenital heart disease. Prophylaxis is not routine in the UK but should be considered on an individual basis in consultation with a cardiologist.

4. Why should an asthmatic patient be advised to bring their salbutamol inhaler to dental appointments?

   To allow immediate treatment of an acute asthma attack (bronchospasm), which can be triggered by anxiety, and because the inhaler is a key emergency drug for managing acute asthma in the dental setting.

5. Which two common dental drug groups should be used with caution in asthmatics, and why?

   NSAIDs (e.g. ibuprofen/aspirin) can precipitate bronchospasm in aspirin-sensitive asthmatics, and certain sulphite preservatives in local anaesthetics may trigger reactions. NSAIDs should be avoided where there is a history of aspirin-induced asthma.

6. How should dental treatment be timed for a diabetic patient on insulin to reduce hypoglycaemia risk?

   Schedule short, early-morning appointments after the patient has taken their normal medication and eaten their usual meal, so that treatment does not coincide with peak insulin action or a missed meal.

7. What clinical features distinguish hypoglycaemia from hyperglycaemia in a diabetic dental patient?

   Hypoglycaemia: rapid onset, sweating, tremor, confusion, aggression, tachycardia, drowsiness leading to unconsciousness. Hyperglycaemia: slow onset, dry skin, thirst, ketotic (acetone) breath, deep sighing (Kussmaul) breathing. When in doubt, treat as hypoglycaemia.

8. What is the dental relevance of patients taking long-term corticosteroids (steroid cover)?

   Long-term steroids cause adrenal suppression, risking an adrenal (Addisonian) crisis under stress. Current UK guidance generally does not require routine steroid cover for simple dental procedures, but stress, infection and major surgery may warrant liaison with the physician about supplementation.

9. State the components of the coagulation INR and the typical target range for a patient on warfarin undergoing dental extraction.

   INR (International Normalised Ratio) measures the extrinsic clotting pathway. For routine dental procedures including extractions, treat without interrupting warfarin if the INR is below 4.0 (ideally checked within 24-72 hours), using local haemostatic measures.

10. How should a patient on a single DOAC (e.g. apixaban, rivaroxaban) be managed for a dental extraction with higher bleeding risk?

    For higher-bleeding-risk procedures, consider miss/delay the morning dose (per SDCEP guidance) on the day of treatment, treat early in the day, use local haemostatic measures, and give post-operative analgesia advice avoiding NSAIDs. Do not routinely stop without advice.

11. Name three local haemostatic measures used after extractions in anticoagulated patients.

    Sockets packed with an oxidised cellulose or collagen sponge; suturing of the socket; and application of pressure with a damp gauze pad. Tranexamic acid mouthwash may also be used in selected cases.

12. Why should aspirin generally NOT be stopped before dental extractions?

    The risk of a thrombotic/cardiovascular event from stopping antiplatelet therapy outweighs the bleeding risk, which can be controlled with local measures. Low-dose aspirin should be continued for routine dental surgery.

13. What dental considerations apply to a patient with chronic kidney disease / on dialysis?

    Treat the day after dialysis (not on dialysis days) to avoid residual heparin and to optimise the patient's condition; avoid nephrotoxic drugs (NSAIDs); adjust doses of renally-excreted drugs; and consider the bleeding tendency and anaemia of uraemia.

14. Which analgesic should be avoided or used cautiously in patients with significant hepatic impairment, and why?

    Paracetamol must be used cautiously (reduced maximum dose) because it is metabolised by the liver and is hepatotoxic; NSAIDs are also avoided due to bleeding and renal risk. The liver also affects drug metabolism and clotting factor synthesis.

15. What are the key dental risks in an immunosuppressed patient (e.g. transplant, chemotherapy)?

    Increased risk of infection, delayed healing, oral ulceration/mucositis, candidal and viral (herpes) infections, and bleeding (if thrombocytopenic). Liaise with the medical team and consider antibiotic cover and timing around chemotherapy cycles.

16. Which trimester is generally considered safest for elective dental treatment in pregnancy, and why?

    The second trimester. The first trimester carries organogenesis/teratogenic risk and miscarriage concern, and the third trimester carries supine hypotension and patient discomfort; the second trimester balances safety and comfort.

17. What is supine hypotensive syndrome and how is it managed in a pregnant dental patient?

    In late pregnancy the gravid uterus compresses the inferior vena cava when supine, reducing venous return and causing hypotension, dizziness and faintness. Manage by positioning the patient on her left side (or tilt the right hip up) to relieve caval compression.

18. Name two analgesics to AVOID and one preferred analgesic in pregnancy for dental pain.

    Avoid NSAIDs (especially in the third trimester - risk of premature ductus arteriosus closure) and avoid aspirin. Paracetamol is the analgesic of choice in pregnancy.

19. List four typical features of anaphylaxis that distinguish it from a simple faint.

    Anaphylaxis: rapid onset of airway/breathing/circulation problems with urticaria, angio-oedema, wheeze/stridor, hypotension and tachycardia. A faint shows pallor, bradycardia and rapid recovery on lying flat, without rash or airway compromise.

20. State the first-line drug, dose, route and adult dose for anaphylaxis in the dental setting.

    Adrenaline (epinephrine) $500\ \mu g$ ($0.5\ \text{mL}$ of $1{:}1000$) given intramuscularly into the anterolateral thigh, repeated every 5 minutes if no improvement. Call 999 and give high-flow oxygen.

21. What is the immediate sequence of management for anaphylaxis (after recognition)?

    Call for help/999, remove the trigger, lay the patient flat with legs raised (sit up if breathing difficulty), give IM adrenaline, high-flow oxygen, and monitor airway, breathing and circulation. Repeat adrenaline after 5 minutes if needed.

22. State the adult chest compression rate, depth and compression:ventilation ratio in basic life support.

    Rate $100\text{-}120$ compressions per minute, depth $5\text{-}6\ \text{cm}$, with a compression-to-ventilation ratio of $30{:}2$.

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