DENTAL MANAGEMENT OF THE MEDICALLY COMPROMISED PATIENT.

DENTALDENTALMANAGEMENTMANAGEMENT

OF THE MEDICALLYOF THE MEDICALLYCOMPROMISED COMPROMISED

PATIENTPATIENT

• Systemic diseases include:

• 1. cardiovascular diseases• 2. respiratory diseases• 3. liver diseases• 4. endocrine diseases• 5. renal diseases• 6. neurogenic diseases• 7. sexually transmitted

diseases• 8. blood diseases • 9. pregnancy & breast feeding

Main signs & symptoms of C.V.S Main signs & symptoms of C.V.S diseasesdiseases

• 1. Chest pain• 2. Dysnea• 3. cyanosis• 4. palpitation• 5. Syncope• 6. Edema of ankles• 7. Cold pale extremities• 8. Clubbing fingers• 9. Easy fatigue

ISCHEMIC HEARTISCHEMIC HEARTDISEASESDISEASES

• Mode of presentation of ischemic heart disease:

• 1. Angina pectoris

• 2. Myocardial infarction

• 3. Acute coronary insufficiency

• 4. Cardiac arrhythmia

• 5. Heart failure

• 6. Sudden death ( cardiac arrest, ventricular fibrillation )

• 7. Asymptomatic ( silent )

ANGINA PECTORISANGINA PECTORIS

• It is a myocardial ischemia resulting from imbalance between coronary blood flow & oxygen demand

DENTAL MANAGENT OF ANGINA:

1.Medical consultation

2. Appointment

3. Reduction of stress & anxiety

4. Local anesthesia

5. General anesthesia

6. Treatment procedures

7. Drugs used in treatment

8. If the attack developed

MYOCARDIAL INFARCTIONMYOCARDIAL INFARCTION

• It results from occlusion of coronary artery By a thrombus so deficient coronary arterial

blood supply to a region of myocardium that results in a cellular death & necrosis.

Dental management:As angina pectoris except;Drugs used in treatment.

CONGESTIVE HEART FAILURECONGESTIVE HEART FAILURE

It is the ability of heart to pump sufficient blood to meet the metabolic needs of the heart.

Dental management:Same as angina except;

1.preoperative antibiotic.2. Drugs used in treatment.3. Management of complications if

developed (attack)

HYPERTENSIVE DISEASESHYPERTENSIVE DISEASES

• Hypertension is used to describe patient with blood pressure more than 140/90 mmHg

• Dental management:• Same as angina except;• 1. Local anesthesia.• 2. General anesthesia.• 3. treatment procedure.

RHEUMATIC HEART DISEASERHEUMATIC HEART DISEASE

• It is an acute inflammatory condition, due to strep. Pharngitis infection following sore throat, result in scaring & calcification of valves followed by valvular stenosis.

• Dental management.• 1. Medical consultation.• 2. Prophylactic antibiotic.• 3. Mild tranquilizers (2-5 diazepam).• 4. Short dental appointment.

PROPHYLACTIC ANTIBIOTIC PROPHYLACTIC ANTIBIOTIC REGIMEN FOR CARDIAC PT.REGIMEN FOR CARDIAC PT.• 1. Under L.A• a) Adults---- 2gm Amoxicillin or 2gm

Ambicillin

(1 hour before treatment orally) OR

(1/2 hour ,,, ,,,,,,,,,,, injection)

• B) Children----- 50 mg per Kg Amoxicillin or

Ambicillin

IF PATIENT IS ALLERGIC:

Adult --------- Clindamycin 600 mg OR

Asathromycin 500 mg OR

Cephazolin 1 gm

(1 hour before ttt. Orally)

( ½ ,,, ,,,, ,,, injection)

Child --------- Clindamycin 20 mg per Kg.

Asathromycin 15 mg per Kg.

2. Under G.A

a)Adults----- 1gm Amoxicillin I.V at induction.

OR 3gm Amoxicillin orally 4 hours before induction followed by 3gm Amoxicillin immediately after recovery.

OR 300mg Clindamycin I.M ½ hour before induction.

OR 300mg Clindamycin I/V at induction

b) Children ------ (5–10 years)1/2 adult

(< 5 years) 1/4 adult

RESPIRATORY DISORDERSRESPIRATORY DISORDERS

• Common symptoms:• 1. cough.• 2. wheezing.• 3. cyanosis.• 4. finger clubbing.• AVOID • 1. General anesthesia: leads to hypoxia .• 2. Analgesics & narcotics: leads to respiratory

depressants.

BRONCHIAL ASTHMABRONCHIAL ASTHMA

• It is due to bronchospasm or hyperirritability of the tracheo_bronchial tree.

• Patient is treated by:

• 1. Corticosteroids inhalators.

• 2. Bronchodilator.

• 3. Beta adrenergic stimulator.

Dental management1. Medical consultation.

2. stress & anxiety.

3. Local anesthesia.

4. General anesthesia.

5. Drugs used in treatment.

6. Drugs given to patient.

TUBERCULOSISTUBERCULOSIS• Can affect any organ.

• Highly infectious.

• Caused by Mycobacterium T.B.

• Transmitted by air born droplets.

Dental management:

1. Patient with active T.B.

2. Patient with past history of T.B.

3. Patient with positive tuberculin test.

4. Patient with signs & symptoms of T.B.

5. Strict aseptic technique.

LIVER DISORDERSLIVER DISORDERS• Advanced liver diseases include: Liver cirrhosis - Jaundice

• Potential complications: 1. Impaired drug detoxication e.g.

sedative, analgesics, general anesthesia. 2. Bleeding disorders ( decrease clotting

factors, excess fibrinolysis, impaired vitamin K absorption).

3. Transmission of viral hepatitis.

Dental managementDental management

1. Medical consultation.2. Avoid drugs metabolized in liver: L.A------- Lidocaine, Mepicaine Sedatives-------- Valium antibiotics-------- Ampicillin Analgesics------- Aspirin3. Vit.k ----- 10 mg/day before surgery.4. G.A ------ cause bleeding.

VIRAL HEPATITISVIRAL HEPATITIS

• Dental management:1. Patient with active hepatitis

2. Carriers:

a. low risk patient.

b. high risk patient.

DIABETUS MELLITUSDIABETUS MELLITUS

• It is characterized by persistent increase of blood glucose level.

• It is the result of absolute or relative deficiency of insulin.

•

• Oral manifestation:• 1. Gingivitis

• 2. Alveolar bone resorption

• 3. Xerostomia

• 4. Delayed wound healing

• 5. Pulpitis in non carious tooth

• 6. Burning sensation in tongue

• 7. Acetone smell in breath

Dental management:

1. Appointment.

2. Premeditation

3. Local anesthesia.

4. Treatment procedure.

5. Patient assessment.

CHRONIC RENAL FAILURE

• Dental management:

1. Patient with conservative treatment.

2. Patient with hemodialysis.

3. Patient with kidney transplant.

4. Emergency treatment.

THYROID GLAND DISORDERTHYROID GLAND DISORDER

• Dental management:• 1. Uncontrolled or poorly controlled patient• 2. patient with thyrotoxicosis.• Antithyroid drugs may couse leucopenic

aplastic anemia.

Management of thyroid crises1. Ant thyroid drugs 2. Hydrocortisone3. I.V. glucose 4. Oxygen administration5. Cooling to decrease temp. of body.

NEUROGENIC DISORDER NEUROGENIC DISORDER (EPILEPSY)(EPILEPSY)

Neurogenic disorder: is disorder of the brain.

Epilepsy: is the most common neurogenic disorder the dentist may face in his clinic.

Potential problems:1. Precipitation of the attack.

2. Problems of drugs taken a) Dilantin------- gingival hyperplasia b) Depakene------- bleeding tendancy

Dental management:

1.Past medical history.

2.In case of controlled patient.

3.In case of uncontrolled patient.

4.Management of attack if developed.

N.B:N.B: Dentist is no longerDentist is no longer treating treating teeth teeth in in

patients, but rather patients, but rather patients who have patients who have

teethteeth..

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