Membership of the Joint Dental Faculties (MJDF) Human Disease, Pharmacology and Medical Emergencies Syllabus

Human Disease, Pharmacology and Medical Emergencies syllabus — full chapter and topic list

Expand any chapter to see its topics and sub-topics. This is the whole examinable outline for Human Disease, Pharmacology and Medical Emergencies in Membership of the Joint Dental Faculties (MJDF), not a summary of it.

1. 1

   Relevant Human Disease

   5 topics

   • Cardiovascular disease and the dental patient
     • Hypertension and ischaemic heart disease
     • Infective endocarditis prophylaxis (NICE)
   • Diabetes and endocrine disorders
   • Respiratory, hepatic and renal disease
   • Bleeding disorders and anticoagulant management
   • Immunosuppression and the dental patient
2. 2

   Therapeutics and Prescribing

   4 topics

   • Safe and effective prescribing
     • Dental Practitioners' Formulary and BNF use
     • Drug interactions relevant to dentistry
   • Analgesics and management of dental pain
   • Antimicrobials and antifungals in dentistry
   • Adverse drug reactions and allergy
3. 3

   Pain and Anxiety Control

   3 topics

   • Local anaesthesia
     • Agents, techniques and maximum doses
     • Complications and failure of anaesthesia
   • Conscious sedation principles and patient selection
   • General anaesthesia indications and referral
4. 4

   Medical Emergencies in Dental Practice

   4 topics

   • Recognition and immediate management of emergencies
     • Anaphylaxis and adrenaline use
     • Cardiac arrest, MI and choking
     • Hypoglycaemia, seizures and syncope
     • Asthma attack and adrenal crisis
   • Emergency drugs and equipment requirements
   • Basic life support and resuscitation (UK Resus Council)
   • Documentation and post-event review

Human Disease, Pharmacology and Medical Emergencies flashcards for Membership of the Joint Dental Faculties (MJDF)

18 of 50 cards from the Human Disease, Pharmacology and Medical Emergencies deck — real questions with worked answers.

1. Which two cardiac conditions, per current UK guidance, do NOT routinely require dental treatment to be deferred, and what blood pressure threshold should prompt deferral of elective treatment?

   A patient with stable angina or a myocardial infarction more than ~4-6 weeks ago can usually receive routine care. Defer elective treatment if blood pressure is uncontrolled, generally a systolic $\geq 180$ mmHg or diastolic $\geq 110$ mmHg.

2. For a dental patient on long-term aspirin (antiplatelet) needing a simple extraction, what is the standard SDCEP recommendation regarding the drug?

   Do NOT stop aspirin. Treat without interrupting antiplatelet therapy, use local haemostatic measures (pressure, sutures, oxidised cellulose), and stage extensive surgery if needed.

3. What is the maximum recommended amount of adrenaline (epinephrine)-containing local anaesthetic in a patient with significant cardiovascular disease, expressed as cartridges of 2% lidocaine with 1:80,000 adrenaline?

   Limit to about 2 cartridges (containing roughly $0.04$ mg adrenaline total) and aspirate before injecting to avoid intravascular adrenaline.

4. A diabetic dental patient becomes confused, sweaty and tremulous mid-appointment. What is the diagnosis and the immediate management if the patient is conscious and able to swallow?

   Hypoglycaemia. Give 15-20 g fast-acting oral carbohydrate (e.g. glucose tablets, $150{-}200$ mL fruit juice or sugary drink), repeat after 10-15 min if needed, then give longer-acting carbohydrate.

5. What is the immediate emergency drug treatment for a hypoglycaemic dental patient who is unconscious or unable to swallow safely?

   Intramuscular glucagon $1$ mg (adult), or IV glucose ($75{-}80$ mL of 20% or $150{-}160$ mL of 10%) if IV access available. Call for help and monitor airway.

6. Define HbA1c and state the value (in mmol/mol) that broadly indicates good glycaemic control for a diabetic dental patient.

   HbA1c (glycated haemoglobin) reflects average glycaemia over ~2-3 months. Good control is generally an HbA1c $< 53$ mmol/mol (approximately $< 7\%$ in old DCCT units).

7. Which adrenal/endocrine condition raises concern for an adrenal (Addisonian) crisis under dental stress, and what is the classic feature of such a crisis?

   Adrenal insufficiency (Addison's disease, or long-term/recently stopped corticosteroid therapy). Crisis presents with profound hypotension, collapse and shock; treat with IM/IV hydrocortisone $100$ mg, fluids and call for help.

8. For an asthmatic dental patient, which two common analgesic/drug classes can precipitate bronchospasm and should be used cautiously?

   NSAIDs (including aspirin) and, less commonly, opioids. NSAID-sensitive asthma occurs in a subset of patients; check history before prescribing.

9. What is the immediate dental-surgery management of an acute asthma attack not relieved by the patient's own inhaler?

   Sit upright, give salbutamol (2 puffs via spacer, repeat up to 10 puffs), give oxygen $15$ L/min if available, and if no improvement call 999 for a severe/life-threatening attack.

10. Why must drug doses (e.g. lidocaine, paracetamol, NSAIDs, certain antibiotics) be reduced or avoided in significant hepatic impairment?

    The liver metabolises most of these drugs; impaired metabolism causes accumulation and toxicity, and reduced clotting-factor synthesis and thrombocytopenia increase bleeding risk.

11. In a patient with chronic kidney disease, which common dental analgesic should generally be AVOIDED, and which is preferred?

    Avoid NSAIDs (nephrotoxic, reduce renal perfusion). Paracetamol is the preferred first-line analgesic, with dose adjustment for severe impairment.

12. For a dental patient on warfarin, what INR value is the upper limit at which minor oral surgery can usually proceed safely, and when should it be checked?

    Proceed if INR is $< 4.0$ (ideally checked within 24 hours, or up to 72 hours if stable). Do NOT interrupt warfarin; use local haemostatic measures.

13. List the four direct oral anticoagulants (DOACs) and the SDCEP advice for a higher-bleeding-risk dental procedure.

    Apixaban, rivaroxaban, dabigatran, edoxaban. For higher-bleeding-risk procedures, miss (apixaban/dabigatran twice-daily morning dose) or delay (rivaroxaban/once-daily) the morning dose, treat early in the day, and use local measures.

14. Classify haemophilia A and B by the deficient clotting factor.

    Haemophilia A = deficiency of factor VIII ($\text{F VIII}$). Haemophilia B (Christmas disease) = deficiency of factor IX ($\text{F IX}$). Both are X-linked recessive.

15. Which clotting screen test assesses the extrinsic pathway and is used to monitor warfarin, and which assesses the intrinsic pathway and monitors heparin?

    Prothrombin time / INR assesses the extrinsic pathway (warfarin). Activated partial thromboplastin time (APTT) assesses the intrinsic pathway (unfractionated heparin).

16. Name three local haemostatic measures used after extractions in patients with a bleeding tendency.

    Sutures, oxidised regenerated cellulose or collagen sponge packed in the socket, and pressure with a gauze pad; tranexamic acid mouthwash and socket packing are additional adjuncts.

17. Why are immunosuppressed dental patients (e.g. transplant recipients, those on chemotherapy) at increased oral risk, and what infection is classically opportunistic?

    Impaired immune defence increases risk of infection, delayed healing and malignancy. Oral candidiasis (Candida albicans) is the classic opportunistic infection; also herpes and atypical bacterial infections.

18. A neutropenic patient is at risk of severe sepsis. Below what absolute neutrophil count is the risk of serious infection markedly increased, and what is the implication for invasive dental treatment?

    Neutrophils $< 1.0 \times 10^{9}/\text{L}$ (severe if $< 0.5 \times 10^{9}/\text{L}$). Defer elective invasive treatment and liaise with the medical team; antibiotic cover may be required.

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