Download Dental management

Patient with special needs
and need oral care, may
have a profound influence
on the dental treatment
plane. The most important
medical problems include :
2. Patients with heart murmurs
may have orthopnea and need
to be placed in a upright
position during dental
treatment,
Mitral valve prolapsed
May be at risk of developing
tachycardia, syncope,
congestive heart failure and
endocarditis. Dental
management as with
pathologic murmur.
Rheumatic heart diseases
Patient how have history of Rh. Fever may
have a residual cardiac damage and Rh.
heart diseases, these patient need to be
given a prophylactic antibiotic cover during
dental treatment to prevent infective
endocarditis as in patient with pathologic
murmur.
Dental treatment:
medical consultation, antibiotic
prophylaxis (as surgeons
recommended), prothrombine time 1½
to 2½ times normal, need for steroids
supplemental for stressful dental
procedure ( as surgeon
recommendation).
 Antibiotic
prophylactic:
 Not allergy to penicillin: 2 gm
Ampicillin IM or IV followed by
gentamicin 1.5 mg/kg IM or IV
1h. before dental procedure
followed by 1 gm penicillin V
orally 6h. after loading dose.
Allergic
patient: 1g
Vancomycin IV infusion over
60 min prior to dental
procedure.
 patient
is not allergic to penicillin
 Amoxicillin, Adults, 2.0 g; children,
50 mg/kg orally one hour before
procedure.
 Cannot use oral medications:
 Ampicillin, Adults, 2.0 g IM or IV;
children, 50 mg/kg IM or IV within
30 minutes before procedure.
 Allergic
to Penicillin:
 Clindamycin, Adults, 600 mg;
children, 20 mg/kg orally one hour
before procedure.
 Cephalexin or cefadroxil, Adults,
2.0 g; children, 50 mg/kg orally one
hour before procedure.
 Azithromycin
or clarithromycin, Adults,
500 mg; children, 15 mg/kg orally one
hour before procedure.
 Cefazolin:
Adults, 1.0 g; children,
25 mg/kg IM or IV within 30
minutes before procedure
 Cephalexin: Adults, 2.0;
children, 50 mg/ kg IM or IV
within 30 minutes before
procedure
Dental
managements:
1. Identification & medical
consultation,
2.Short&
morning
appointment,
3. Semi supine chair position,
4. Patient own sublingual
tablet (Nitroglycerin) on hand.
8.
Avoid use of vasopressors
to control local bleeding and
in gingival cord.
 Dental
management of patient
with unstable angina or recent
M.I.
 1. Avoid elective dental care
(patients have increased
susceptibility to repeat
infarctions and other
cardiovascular complications).
 2.
Emergency dental care only
on hospital after physician
consultation, for pain control
(antibiotic for infection,
pulpotomy rather than
extraction).
 3. Pretreatment medication
with valium 5mg.
 Dental
management:
 1. Medical consultation for patient
with significant blood pressure
elevation.
 2. Reduce stress and anxiety, short
appointment.
 3. local anesthesia with epinephrine
1:100,000, aspirate &inject slowly on
more than 3 carp..
 4.
avoid use of vasopressors to
control local bleeding and in
gingival cord.
 5. Avoid orthostatic hypotension
by change the chair position
slowly.
 6.
Avoid gag reflex stimulation
(antihypertensive drugs nausea
and vomiting).
 7. avoid use of barbiturate (
antihypertensive ↑ sedative
effect).
5.
avoided use of
barbiturates, narcotic,
NSAIDs, aspirin, epinephrine
or levonordefrin ( containing
sulfites). as it may
precipitate an asthma attack
6.
upright position.
7. steroid supplemented as
physician recommended.
8. avoid rubber dam.
9. erythromycin avoided
theophylline (toxic blood
level of theophyllin).
Thyroid
Gland Disorder :
Hyperthyroidism
(Thyrotoxicosis)
Potential problem related to
dental care: infection, stress,
trauma → crisis. Heart
failure.
 Dental
management
 1. Detection the patient by
history & 2. Referral to medical
evaluation.
 3. Avoid any dental treatment
until good medical control of
thyrotoxicosis is achieved
(antibiotic for infection,
analgesic for pain).
 4.
For emergency treatment,
hospitalize the patient &
treated under physician
consultation.
 5. Avoid use of epinephrine and
other presser amine with
uncontrolled patient this may
lead to heart failure.
6.
Patient has significant
depression in immune
system thus risk for
developing infection
resulting from dental
procedure.
control
bleeding and
prothrombin times, avoid
drugs metabolized by
kidney, AB coverage, HB Ag
test.
2.
Dental instrument should
be away from the patient to
decrease patient's
stimulation.
 3. Maintain optimum oral
hygiene.
3.
Significant drug
interactions and side effects
are associated with tricyclic
antidepressants,
monoamine oxidase
inhibitors, and antianxiety
drugs,
 Haemophilia:
bleeding
 Dental management: 1.
Identification & medical
consultation, 2. Control bleeding
& prothrombin times, 3. AB
coverage, 4. Avoid Intra
muscular injections,
,
5. Maintaining healthy gums is
very important, 6. Avoid aspirin
&NSAIDs, 7. Carry out invasive
dental procedures in a hospital.
 NOTE: local measures for
control bleeding should be
always found in your clinic
(splints, thrombin, microfibrillar
collagen).
 AIDS:
transmission of disease,
infection, bleeding
(thrombocytopenia).
 Dental management: 1.All
precaution should be taken (
double masks, double gloves,
eye glass and disposable
instruments).
2.
Antibiotic prophylactic to
prevent infection in cases
where surgery must be
performed.
3. Bleeding time and platelet
count should be ordered.
 5.
Unstable diabetic patient
need AB coverage before
invasive dental care (
Amoxicillin 2 g. 1h.
preoperatively followed by
amoxicillin 500 mg. 3 times daily
for 4 days.
In
penicillin sensitive use
Clindamycin 600 mg. 1h.
preoperatively followed by
clindamycin 150 mg. 4 times
daily for 4 days).
 Arthritis
& joint prostheses:
 Rheumatoid arthritis: Joint pain,
bleeding tendency (Aspirin,
NSAIDs)
 Dental management: 1. Short
appoint., 2. Comfortable chair
position, 3. Control bleeding time,
4. Need for steroid supplement
discuss with physician.
Dental
management:
Before radiation: 1.extracted
all non restorable teeth, 2.
Restore all carious teeth, 3.
Establish good oral hygiene.
,
3. Treating dry mouth and
other complications by sucking
ice chips or sugar-free candy,
chewing sugar-free gum, night
guard, & fluoride treatment, 4.
Take precautions to protect
against trauma, 5. AB
coverage.