Download dental managemnt of the medically compromised patient

DENTAL
MANAGEMENT
OF THE MEDICALLY
COMPROMISED
PATIENT
• 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
diseases
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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 HEART
DISEASES
• 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 )
ANGINA 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 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 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 DISEASES
• Hypertension is used to
describe patient with
blood pressure more than
140/90 mmHg
• Dental management:
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•
Same as angina except;
1. Local anesthesia.
2. General anesthesia.
3. treatment procedure.
RHEUMATIC 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
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 DISORDERS
• Common symptoms:
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1. cough.
2. wheezing.
3. cyanosis.
4. finger clubbing.
AVOID
1. General anesthesia: leads to hypoxia .
2. Analgesics & narcotics: leads to respiratory
depressants.
BRONCHIAL 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 management
1. Medical consultation.
2. stress & anxiety.
3. Local anesthesia.
4. General anesthesia.
5. Drugs used in treatment.
6. Drugs given to patient.
TUBERCULOSIS
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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 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 management
1. Medical consultation.
2. Avoid drugs metabolized in liver:
L.A------- Lidocaine, Mepicaine
Sedatives-------- Valium
antibiotics-------- Ampicillin
Analgesics------- Aspirin
3. Vit.k ----- 10 mg/day before surgery.
4. G.A ------ cause bleeding.
VIRAL HEPATITIS
• Dental management:
1. Patient with active hepatitis
2. Carriers:
a. low risk patient.
b. high risk patient.
DIABETUS MELLITUS
• It is characterized by
persistent increase of
blood glucose level.
• It is the result of
absolute or relative
deficiency of insulin.
•
• Oral manifestation:
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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 DISORDER
• Dental management:
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•
•
1. Uncontrolled or poorly controlled patient
2. patient with thyrotoxicosis.
Antithyroid drugs may couse leucopenic
aplastic anemia.
Management of thyroid crises
1. Ant thyroid drugs 2. Hydrocortisone
3. I.V. glucose
4. Oxygen administration
5. Cooling to decrease temp. of body.
NEUROGENIC DISORDER
(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.
Dentist is no longer
treating teeth in
patients, but rather
patients who have
teeth.
N.B:
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