Case selection part 2 ( systemic factors )

Case Selection for

Endodontic Treatment

BY PROF.MAGED NEGM

Considerations in case selection

Local “ tooth “

considerations

Systemic consideratio

ns

Second: Systemic considerations:

Prophylactic antibiotics should be given in the following cases to avoid subacute bacterial endocarditis :

 •Congenital heart disease•Rheumatic heart disease•Valvular disease.

1- cardiac diseases

In Patients using pacemakers avoid using equipments that emit electromagnetic waves as

In patients with Coronary insufficiency use plain anesthesia (adrenaline free)

•Pulp testers

•Sonics and ultrasonics

•Apex locators

•Electrosurgery and cautery

1- cardiac diseases

To avoid Cardiac arrhythmia

In patients taking Anticoagulants or vasodilators avoid surgery or consult physician

In patients with Uncontrolled hypertension avoid stresses and consult physician.

In patients with Severe hypertension use plain anesthesia (adrenaline free)

2- cardiovascular diseases

In Hemophilia patients there may be bleeding with injection , pulp extirpation and rubber dam application.

However RCT is more safe than extraction after consulting physician.

In patients with Blood disorders such as

Leukemia.Aplastic anemia.ThrombocytopeniaPolycythemia.scurvy

require a written consent from the physician Specially when prescribing analgesics and antibiotics.

3- blood disorders

4. Diabetes mellitus:

Appointments after the meal and medication.

Avoid Adrenalin because it breakdown glycogen to glucose causing diabetic coma.

So Use different LA. As carbocain with Neocobefrin.

Avoid Aspirin because it decreases blood sugar causin shock (similar to insulin shock)

So Analgesics other than aspirin should be used.

4- Diabetes mellitus

- Discard used instruments or sterilize by autoclaving .

- The patient is suufering from liver damage So avoid medications detoxified in liver.

- consult physician before using the following drugs

•Aspirin.•Acetaminophen.•Barbiturates.•Valium.•Librum.•Penicillins.•Ampicillins.•Cephalosporins•Tetracyclines.

5- Hepatitis

the patient is suffering from Renal damage So avoid medications metabolized and excreted by the kidneys

 Such as

•Narcotics.•Vasoconstrictors.•Aspirin.•Acetaminophen.•Penicillins.•Tetracyclines.

6- Kidney diseases

 RCT is preferable than extraction.

Prophylactic antibiotic course is recommended.

7- Radiation therapy

Patient has to take the epileptic medication prior to treatment.

Handle the patient gently and reassuringly.

If you Inject L.A. into blood vessels CNS stimulation may happen epileptic fit

8- Epilepsy

Clinical manifestations

Persistent cough.Hemoptysis.Chest pain.Fatigability.Weakness.Loss of weight.Anorexia.

- low Oxygenation and nutrition poor resistance and delayed repair.- Lung disease is highly contagious.- Palliative care only until the case is brought under control.

9- lung infections & Tuberculosis (TB )

Addison’s disease : decrease blood corticosteroids.

Poor ability to cope with stressful situations (infection and surgery)

Case should be medically controlled first.

Cushing’s disease :

increase blood corticosteroids. Cushing’s disease or prolonged corticosteroid therapy suffers from

Prior to treatment medical adjustment and prophylactic antibiotics.

Hypertension.Osteoporosis.Susceptibility to bruises.Low body resistance.Impaired healing.

10- Adrenal cortex diseases

Hypothyroidism LOW Resistance to infection.LOW Resistance to prolonged stresses.Patients are subject to adrenocortical

insufficiency.Therefore dental appointments should be as

brief and as atraumatic as possible.

11- Thyroid diseases & Goiter

Hyperthyroidism (Goiter) :Suffers from Heat intolerance. Sweating. Weight loss. Weakness

Hyperthyroid patient if given L.A. with epinephrin thyroid crises.

Because Epinephrine potentiates the action of thyroid gland.

Use L.A. without epinephrine as (Carbocaine, Citanest).

Sedative premedications are recommended.

Barbiturates are dangerous it causes paradoxical stimulatory reaction.

So Non barbiture sedatives are recommended.

Syncope transient cerebral anoxia.Extremely nervous patients cerebral

anoxia syncope.Push the head between patients knees or

lower it than the rest of the body.Nitrous oxide – oxygen analgesia

concentration of O2.Frequent spells of syncope cerebral

disease.

12- Fainting ( Syncope )

 Ideal time for treatment 2nd

trimester Recommendations a-minimum medications. b-Protective lead shield with

radiographs. c-Consult the

gynaecologist.

13- Pregnancy

  Menstruation hormonal changes. - Vasodilatation.- LOW Tissue resistance.

Toothache.

Post extirpation bleeding.

Post surgical hemorrhage.

Flare-ups.

14- Menestruation

Menopause depletion of estrogen. Osteoporotic jaw lesions.Atypical facial neuralgia (simulate pulpalgia).Impaired healing of periapical rarefaction

after RCT. No clinical signs and symptoms no

further treatment.Visible enlargement of periapical rarefactions

apical surgery.Medical consultation estrogen

replacement therapy

15- Menopause

 Good medical history.

Use antihistaminics.

Keep “Emergency Kit” ready for use.

16- Allergy

Aspirin:

o In Patients taking anticoagulants aspirin will increase bleeding.

o In Diabetic patients aspirin will increase the insulin effect hypoglycemia (insulin shock).

o Aspirin should be avoided in case of peptic ulcers

17- Drugs & medications

Corticosteroids:

Antibiotic coverage and decrease of the number of visits to avoid complications.

THANK YOU

GOOD LUCK