DENTAL MANAGEMENT OF THE MEDICALLY COMPROMISED PATIENT

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DENTALMANAGEMENTOF THE MEDICALLYCOMPROMISED
PATIENT
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• 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

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Main signs symptoms of C.V.S diseases

• 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

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ISCHEMIC HEARTDISEASES

• 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 )

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ANGINA PECTORIS

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

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• DENTAL MANAGENT OF ANGINA
• Medical consultation
• Appointment
• Reduction of stress anxiety
• Local anesthesia
• General anesthesia
• Treatment procedures
• Drugs used in treatment
• If the attack developed

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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.

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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)

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HYPERTENSIVE 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.

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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.

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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

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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.

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• 2. Under G.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
  

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b) Children ------ (510 years)1/2 adult
(lt 5 years) 1/4 adult
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RESPIRATORY 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.

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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.

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• Dental management
• Medical consultation.
• stress anxiety.
• Local anesthesia.
• General anesthesia.
• Drugs used in treatment.
• Drugs given to patient.

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TUBERCULOSIS

• Can affect any organ.
• Highly infectious.
• Caused by Mycobacterium T.B.
• Transmitted by air born droplets.

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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.
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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.

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Dental management

• Medical consultation.
• 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.

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VIRAL HEPATITIS

• Dental management
• Patient with active hepatitis
• Carriers
• a. low risk patient.
• b. high risk patient.

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DIABETUS MELLITUS

• It is characterized by persistent increase of
  blood glucose level.
• It is the result of absolute or relative
  deficiency of insulin.

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• 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

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• Dental management
• 1. Appointment.
• 2. Premeditation
• 3. Local anesthesia.
• 4. Treatment procedure.
• 5. Patient assessment.

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CHRONIC RENAL FAILURE

• Dental management
• Patient with conservative treatment.
• Patient with hemodialysis.
• Patient with kidney transplant.
• Emergency treatment.

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THYROID GLAND DISORDER

• Dental management
• 1. Uncontrolled or poorly controlled patient
• 2. patient with thyrotoxicosis.
• Antithyroid drugs may couse leucopenic aplastic
  anemia.
• Management of thyroid crises
• Ant thyroid drugs 2. Hydrocortisone
• 3. I.V. glucose 4. Oxygen
  administration
• 5. Cooling to decrease temp. of body.

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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
• Precipitation of the attack.
• Problems of drugs taken
  a) Dilantin------- gingival
  hyperplasia b) Depakene-------
  bleeding tendancy

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• Dental management
• Past medical history.
• In case of controlled patient.
• In case of uncontrolled patient.
• Management of attack if developed.

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N.B Dentist is no longer treating teeth in
patients, but rather patients who have teeth.
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THANK YOU