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INI-CET MDS study materials
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INI-CET MDS: General Medicine: Medical Risk in Dental Practice

INI-CET MDS · Work through your exam, one topic at a time.

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General Medicine: Medical Risk in Dental Practice

General Medicine

This domain tests how systemic disease modifies dental treatment planning: glycaemic control, hypertension, cardiac risk and endocarditis prophylaxis, anticoagulation, and endocrine emergencies.

Core rules

  • Diabetes: HbA1c below 7% indicates good control; poorly controlled diabetes impairs healing and worsens periodontitis. Avoid elective surgery when glucose is very high with ketosis, and schedule morning appointments with food intake confirmed.
  • Hypertension: elective treatment is deferred above 180/110 mmHg; adrenaline should be limited (about two cartridges of 1:100,000) in severe cardiovascular disease.
  • Infective endocarditis prophylaxis is now limited to highest-risk cardiac conditions - prosthetic valve, previous endocarditis, unrepaired cyanotic congenital heart disease, and repaired defects with prosthetic material. Amoxicillin 2 g orally 30–60 minutes before the procedure; clindamycin is no longer the standard alternative.
  • Anticoagulation: with warfarin and an INR within therapeutic range (commonly up to 3.5), simple extractions can proceed with local haemostatic measures; do not stop the drug without medical input.
  • Adrenal insufficiency requires steroid cover for significant surgery; pregnancy is best managed in the second trimester with left lateral positioning.

Worked example

A patient with a mechanical mitral valve needs an extraction. The valve is a highest-risk condition, so prophylaxis is indicated: amoxicillin 2 g orally 30–60 minutes preoperatively, or a cephalosporin, azithromycin or doxycycline if penicillin-allergic. He is also on warfarin with an INR of 3.0. Because the INR is within the accepted range, the extraction proceeds with local measures rather than stopping warfarin - stopping it risks valve thrombosis, which is a far greater hazard than bleeding from a dental socket.

Traps

  • Giving prophylaxis for prosthetic joints or mitral valve prolapse - no longer recommended.
  • Choosing clindamycin as the default penicillin alternative.
  • Advising patients to stop anticoagulants unilaterally.
  • Performing elective treatment on severely uncontrolled hypertension or diabetes.