Copyright 2003, Elsevier Science (USA). All rights reserved. Chapter 29 The Medically and Physically Compromised Patient Copyright 2003, Elsevier Science.

Copyright 2003, Elsevier Science (USA). All rights reserved.

Chapter 29The Medically and Physically

Compromised Patient

Chapter 29The Medically and Physically

Compromised Patient

Copyright 2003, Elsevier Science (USA).

All rights reserved. No part of this product may be reproduced or transmitted in any form or by any means, electronic or mechanical, including input into or storage in any information system, without permission in writing from the publisher.

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ISBN 0-7216-9770-4


IntroductionIntroductionMore individuals are living with some type of medical or physical disorder.More individuals are living with some type of medical or physical disorder.


Americans with Disabilities Act American Dental Association

• Title I: Employment Discrimination• Title II: Access for Disabled• Title III: Public Accommodations• Title IV: Telecommunication Services

Americans with Disabilities Act American Dental Association

• Title I: Employment Discrimination• Title II: Access for Disabled• Title III: Public Accommodations• Title IV: Telecommunication Services

The Rights of a PatientThe Rights of a Patient


Aid in providing treatment. Provide information to patient and

family. Make patient comfortable. Help in reducing anxiety.

Aid in providing treatment. Provide information to patient and

family. Make patient comfortable. Help in reducing anxiety.

Role of the Dental AssistantRole of the Dental Assistant


Aging is the irreversible and inevitable changes that occur with time.

Stages of the older population• Young/Old: People age 65 to 74 years

old.• Old: People age 75 to 84 years old.• Old/Old: People age 85 years old or

older.

Aging is the irreversible and inevitable changes that occur with time.

Stages of the older population• Young/Old: People age 65 to 74 years

old.• Old: People age 75 to 84 years old.• Old/Old: People age 85 years old or

older.

The Aging PopulationThe Aging Population


Xerostomia: Condition from certain disorders and medications that cause a decreased flow of saliva.

Periodontal disease: An increasing problem in the older population. Tissues of older patients may be slower to heal.

Dental decay: Increase in the form of coronal and root caries and recurrent decay around defective restorations

Dark and brittle teeth: As a result of deposits of secondary dentin that have gradually reduced the size of the pulp chamber.

Bone resorption: Loss of the alveolar ridge.

Xerostomia: Condition from certain disorders and medications that cause a decreased flow of saliva.

Periodontal disease: An increasing problem in the older population. Tissues of older patients may be slower to heal.

Dental decay: Increase in the form of coronal and root caries and recurrent decay around defective restorations

Dark and brittle teeth: As a result of deposits of secondary dentin that have gradually reduced the size of the pulp chamber.

Bone resorption: Loss of the alveolar ridge.

Dentally Related Aging ChangesDentally Related Aging Changes


Patient Assessment• Category I: Healthy patient• Category II: Medical conditions

requiring schedule changes• Category III: Medical conditions

requiring significant modifications in dental treatment

• Category IV: Medical conditions requiring major modifications in dental treatment

• Category V: Serious medical conditions

Patient Assessment• Category I: Healthy patient• Category II: Medical conditions

requiring schedule changes• Category III: Medical conditions

requiring significant modifications in dental treatment

• Category IV: Medical conditions requiring major modifications in dental treatment

• Category V: Serious medical conditions

The Medically Compromised PatientThe Medically Compromised Patient


Alzheimer’s disease: Brain disorder that is marked by deterioration of mental capacity.

Disease progresses in three stages:• The early disease, or forgetfulness phase.• The intermediate disease, or confused

phase.• The late disease, or dementia phase.

Dental care management

Alzheimer’s disease: Brain disorder that is marked by deterioration of mental capacity.

Disease progresses in three stages:• The early disease, or forgetfulness phase.• The intermediate disease, or confused

phase.• The late disease, or dementia phase.


Neurologic DisordersNeurologic Disorders


Seizure: An abrupt suspension of motor, sensory, and/or body function.

Epilepsy • Petit mal: Type of seizure lasting no

longer than 30 seconds. • Grand mal: These seizures have many

causes and arise in all age groups. Dental care management

Seizure: An abrupt suspension of motor, sensory, and/or body function.

Epilepsy • Petit mal: Type of seizure lasting no

longer than 30 seconds. • Grand mal: These seizures have many

causes and arise in all age groups. Dental care management

Neurologic Disorders cont’dNeurologic Disorders cont’d


Multiple Sclerosis: A debilitating and degenerative disorder of the central nervous system with a progressive weakening of the lower extremities, causing muscle weakness, unsteady gait, and paralysis.


Multiple Sclerosis: A debilitating and degenerative disorder of the central nervous system with a progressive weakening of the lower extremities, causing muscle weakness, unsteady gait, and paralysis.




Parkinson’s disease: A progressive disorder causing degeneration of the nerves in the brain. This degeneration will lead to tremors, weakness of muscles, and slowness of movement.


Parkinson’s disease: A progressive disorder causing degeneration of the nerves in the brain. This degeneration will lead to tremors, weakness of muscles, and slowness of movement.




Cerebrovascular accident: A cerebrovascular accident or stroke is a minor to severe loss of the central nervous system function caused by a sudden vascular lesion of the brain, such as hemorrhage, embolism, thrombosis, or ruptured aneurysm.


Cerebrovascular accident: A cerebrovascular accident or stroke is a minor to severe loss of the central nervous system function caused by a sudden vascular lesion of the brain, such as hemorrhage, embolism, thrombosis, or ruptured aneurysm.




Heart disease is the leading cause of death in the United States.

Manifestations of heart disease• Angina: Severe pain in the chest

associated with an insufficient supply of blood to the heart

• Myocardial Infarction: Heart attack

Heart disease is the leading cause of death in the United States.

Manifestations of heart disease• Angina: Severe pain in the chest

associated with an insufficient supply of blood to the heart

• Myocardial Infarction: Heart attack

Cardiovascular DisordersCardiovascular Disorders


Hypertension: Referred to as high blood pressure, is the result of the heart having to work harder as it pumps against resistance such as a blocked artery.

Major factors associated with hypertension:• Stress• Age• Heredity• Smoking• Obesity

Hypertension: Referred to as high blood pressure, is the result of the heart having to work harder as it pumps against resistance such as a blocked artery.

Major factors associated with hypertension:• Stress• Age• Heredity• Smoking• Obesity

Cardiovascular Disorders cont’dCardiovascular Disorders cont’d


Cardiac and Prosthetic Considerations: A patient with cardiac disease or a prosthetic replacement carries an increased risk of becoming infected from bacteria carried in the blood system.

Endocarditis: Severe infection of the cardiac valves and supporting structures caused by blood-borne pathogens that gain entry to the bloodstream from such places as the mouth and gastrointestinal tract.

Cardiac and Prosthetic Considerations: A patient with cardiac disease or a prosthetic replacement carries an increased risk of becoming infected from bacteria carried in the blood system.

Endocarditis: Severe infection of the cardiac valves and supporting structures caused by blood-borne pathogens that gain entry to the bloodstream from such places as the mouth and gastrointestinal tract.

Cardiovascular Disorders cont’dCardiovascular Disorders cont’d


Disorders that affect the lungs and are characterized by airway obstruction.

• Bronchial asthma: Often arising from allergies characterized by an increased hypersensitivity to various stimuli, which results in bronchial edema and widespread narrowing of the bronchial airways.


Disorders that affect the lungs and are characterized by airway obstruction.

• Bronchial asthma: Often arising from allergies characterized by an increased hypersensitivity to various stimuli, which results in bronchial edema and widespread narrowing of the bronchial airways.


Pulmonary DisordersPulmonary Disorders


Chronic obstructive pulmonary disease: General term for pulmonary diseases characterized by blocked airflow during respiration.

Bronchitis: Irreversible narrowing of the bronchial airways as a result of chronic inflammation.

Emphysema: Irreversible enlargement of the size of the air spaces, resulting in labored breathing and an increased susceptibility to infection.

Chronic obstructive pulmonary disease: General term for pulmonary diseases characterized by blocked airflow during respiration.

Bronchitis: Irreversible narrowing of the bronchial airways as a result of chronic inflammation.

Emphysema: Irreversible enlargement of the size of the air spaces, resulting in labored breathing and an increased susceptibility to infection.

Pulmonary Disorders cont’dPulmonary Disorders cont’d


Disorders that involve the cellular elements of the body. • Leukemia: An excessive increase in

white blood cells.• Hemophilia: Excessive bleeding

caused by a congenital lack of a protein substance necessary for blood clotting to occur.

Disorders that involve the cellular elements of the body. • Leukemia: An excessive increase in

white blood cells.• Hemophilia: Excessive bleeding

caused by a congenital lack of a protein substance necessary for blood clotting to occur.

Blood DisordersBlood Disorders


Musculoskeletal system includes the bones, muscles, and joints. • Arthritis: Older patients are more

likely to have chronic progressive arthritis with stiffening of joints.

• Muscular Dystrophy: Involves the striated muscles in the body, causing progressive atrophy and weakness.

Musculoskeletal system includes the bones, muscles, and joints. • Arthritis: Older patients are more

likely to have chronic progressive arthritis with stiffening of joints.

• Muscular Dystrophy: Involves the striated muscles in the body, causing progressive atrophy and weakness.

Muscular DisordersMuscular Disorders


Glands located in many different regions of the body, all of which release hormones into the bloodstream which help regulate the metabolism in body cells.• Hyperthyroid: An overactive thyroid

gland. • Hypothyroid: An underactive thyroid

gland that produces fewer hormones.

Glands located in many different regions of the body, all of which release hormones into the bloodstream which help regulate the metabolism in body cells.• Hyperthyroid: An overactive thyroid

gland. • Hypothyroid: An underactive thyroid

gland that produces fewer hormones.

Endocrine DisordersEndocrine Disorders


Diabetes Mellitus: Disease characterized by a sustained high blood glucose level resulting from an absolute or a relative lack of insulin.

• Type I: Patient is insulin dependent.• Type II: Disease is controlled through

diet and oral medications. Dental care management

Diabetes Mellitus: Disease characterized by a sustained high blood glucose level resulting from an absolute or a relative lack of insulin.

• Type I: Patient is insulin dependent.• Type II: Disease is controlled through

diet and oral medications. Dental care management

Endocrine Disorders cont’dEndocrine Disorders cont’d


Types of disorders• Anxiety: Feeling of impending

disaster. • Depression: Condition of general

emotional rejection and withdrawal. • Schizophrenia: A disturbance in

thinking and perception with delusions, hallucinations, and impaired reality testing.

Types of disorders• Anxiety: Feeling of impending

disaster. • Depression: Condition of general

emotional rejection and withdrawal. • Schizophrenia: A disturbance in

thinking and perception with delusions, hallucinations, and impaired reality testing.

Psychiatric DisordersPsychiatric Disorders


Eating disorders• Anorexia nervosa: Condition is indicated

when a person has an obsessive fasting (starving) condition.

• Bulimia: Disorder in which a person eats an abnormal amount of calories at one time and then induces vomiting or uses laxatives.

Substance related disorders• Drugs• Alcohol• Nicotine

Eating disorders• Anorexia nervosa: Condition is indicated

when a person has an obsessive fasting (starving) condition.

• Bulimia: Disorder in which a person eats an abnormal amount of calories at one time and then induces vomiting or uses laxatives.

Substance related disorders• Drugs• Alcohol• Nicotine

Behavioral DisordersBehavioral Disorders


The wheelchair-bound patient• Transferring the patient

Seeing-impaired patient Hearing-impaired patient

The wheelchair-bound patient• Transferring the patient

Seeing-impaired patient Hearing-impaired patient

The Physically Compromised PatientThe Physically Compromised Patient

Copyright 2003, Elsevier Science (USA). All rights reserved. Chapter 29 The Medically and Physically Compromised Patient Copyright 2003, Elsevier Science.

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