DENTAL MANAGEMENT OF THE MEDICALLY COMPROMISED PATIENT EBOOK
Dental Management of the Medically Compromised Patient - E-Book (Little, Dental Management of the Medically Compromised Patient) eBook: James W. Little. Dental Management of the Medically Compromised Patient - E-Book (9th ed.) Preview; Buy multiple copies; Give this ebook to a friend · Add to my wishlist. Dental management summary table summarizes important factors for consideration in the dental management of medically compromised.
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Dental Management Summary Table synthesizes important factors for consideration in the dental management of medically compromised patients. Center for. Furthermore, this is a Care of the medically compromised patient often is global . This ebook is uploaded by ecogenenergy.info DM1 Dental Management: A. Read "Dental Management of the Medically Compromised Patient" by James W. Little available from Rakuten Kobo. Sign up today and get $5.
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The purpose of the book remains the same—to give the dental provider an up-to-date, concise, factual refer- ence describing the dental management of patients with selected medical problems.
The more common medical disorders that may be encountered in a dental practice continue to be the focus. This book is not a comprehen- sive medical reference, but rather a book containing enough core information about each of the medical con- ditions covered to enable the reader to recognize the basis for various dental management recommendations.
In particular, the text is intended to give the dental provider an understanding of how to ascertain the severity and stability of common medical disorders and make dental management decisions that afford the patient the utmost health and safety. Continued emphasis has been placed on the medica- tions used to treat the medical conditions covered in this seventh edition.
Dosages, side effects, and drug interac- tions with agents used in dentistry—including those used during pregnancy—are discussed in greater detail. Emphasis also has been placed on having contemporary equipment and diagnostic information to assess and monitor patients with moderate to severe medical disease.
Our sincere thanks and appreciation are extended to those many individuals who have contributed their time and expertise to the writing and revision of this text. James W. Little Donald A. Falace Craig S. Miller Nelson L.
Rhodus ix 4. Dental Management: A Summary T his table presents the more important factors to be considered in the dental management of medically compromised patients. Each medical problem is outlined according to potential problems related to dental treatment, oral manifestations, preven- tion of these problems, and effects of complications on dental treatment planning.
This table has been designed for use by dentists, dental students, graduate students, dental hygienists, and dental assistants as a convenient reference work for the dental management of patients who have medical diseases dis- cussed in this book.
DM-1 5. Dental procedures that involve the manipulation of gingival tissues or the periapical region of teeth or perforation of the oral mucosa can produce a bacteremia. Although it is unlikely that a single dental procedure—induced bacteremia will result in infective endocarditis IE , it is remotely possible that it can occur. Patients with mechanical prosthetic heart valves may have excessive bleeding following invasive dental procedures as the result of anticoagulant therapy.
Routine delivery of dental care to a patient with severe uncontrolled hypertension could result in a serious outcome such as angina, myocardial infarction, or stroke.
Stress and anxiety related to the dental visit may cause an increase in blood pressure, leading to angina, myocardial infarction, or stroke. In patients taking nonselective beta blockers, excessive use of vasoconstrictors can potentially cause an acute elevation in blood pressure. Some antihypertensive drugs can cause oral lesions or oral dryness and can predispose patients to orthostatic hypotension. Cephalexin should not be used in individuals with a history of anaphylaxis, angioedema, or urticaria with penicillins.
If treatment becomes necessary before 9 days have passed, select one of the alternative antibiotics for prophylaxis. The stress and anxiety of a dental visit could precipitate an anginal attack, myocardial infarction, or sudden death. For patients who are taking a nonselective beta blocker, the use of excessive amounts of epinephrine could precipitate a dangerous elevation in blood pressure. Patients who are taking aspirin or other platelet aggregation inhibitor may experience excessive bleeding.
Questions may arise as to the necessity of antibiotic prophylaxis for patients with a history of coronary artery bypass graft, balloon angioplasty, or stent. Patients may have some degree of heart failure.
If the patient has a pacemaker, some dental equipment may potentially cause electromagnetic interference.
In patients who are taking a nonselective beta blocker, excessive amounts of epinephrine may cause a dangerous elevation in blood pressure. Patients who are taking aspirin or another platelet aggregation inhibitor or Coumadin may experience excessive postoperative bleeding. Questions may arise as to the necessity of antibiotic prophylaxis for patients with a history of CABG, balloon angioplasty, or stent.
Also, bleeding may be excessive because of the use of aspirin, other platelet aggregation inhibitors, or Coumadin. Management may include establishment of an IV line; sedation; monitoring of electrocardiogram, pulse oximeter, and blood pressure; oxygen; cautious use of vasoconstrictors; and prophylactic nitroglycerin.
Excess bleeding is usually manageable through local measures only; discontinuation of medication is not recommended. The stress and anxiety of dental treatment or excessive amounts of epinephrine may induce life-threatening arrhythmias in susceptible patients.
Patients with existing arrhythmia are at increased risk for serious complications such as angina, myocardial infarction, stroke, heart failure, or cardiac arrest. Patients with a pacemaker or a defbrillator are at risk for possible malfunction caused by electromagnetic interference from some dental equipment; some question about the need for prophylactic antibiotics may arise.
Patients who are taking digoxin are at risk for arrhythmia if epinephrine is used; digoxin toxicity is also a potential problem. Providing dental treatment to a patient with symptomatic or uncontrolled heart failure may result in worsening of symptoms, acute failure, arrhythmia, myocardial infarction, or stroke. Elective dental care should be deferred; if care becomes necessary, it should be provided in consultation with the physician. Management may include establishment of an IV line; sedation; monitoring of electrocardiogram, pulse oximeter, and blood pressure; oxygen; and cautious use of vasoconstrictors.
For patients who are taking Coumadin, the INR should be 3. For patients who are taking digoxin, avoid the use of epinephrine because of the increased risk of inducing arrhythmia; be observant for signs of digoxin toxicity e.
Heart failure is due to an underlying condition such as coronary artery disease or hypertension that may require management considerations. The use of epinephrine in patients who are taking digoxin may cause arrhythmia. Tuberculosis may be contracted by the dental health care worker from an actively infectious patient. Patients and staff may be infected by a dentist who is actively infectious. Have the patient bring medication inhaler to each appointment, and prophylax with an inhaler prior to each appointment for persons with moderate to severe persistent asthma.
Questionable history of adequate treatment 2. Lack of appropriate medical supervision since recovery 3. Patients with untreated obstructive sleep apnea are at increased risk for hypertension, stroke, arrhythmia, myocardial infarction, and diabetes. Hepatitis may be contracted by the dentist from an infectious patient. Patients or staff may be infected by the dentist with active hepatitis or who is a carrier.
With chronic active hepatitis, the patient may have chronic liver dysfunction, which may be associated with a bleeding tendency or altered drug metabolism. Because most carriers are undetectable by history, all patients should be treated with the use of standard precautions see Appendix B ; risk may be decreased by the use of hepatitis B vaccine. Age at time of infection type B uncommon at younger than 15 years of age 2. Source of infection if food or water, usually type A or E 3.
If blood transfusion related, probably type C 4. If type is indeterminate, assay for hepatitis B surface antigen HBsAg may be considered.
Dental Management of the Medically Compromised Patient
In patients who are being treated with steroids, stress may lead to serious medical problems. Bleeding tendency 2. Hypertension 3. Anemia 4. Intolerance to nephrotoxic drugs metabolized by the kidney 5.
Hepatitis active or carrier 7. Bacterial endocarditis 8. Syphilis may be contracted by the dentist from an actively infectious patient. Patients or staff may be infected by the dentist who has syphilis. Consultation with physician. Delay dental treatment for at least 4 hours following dialysis to avoid heparin effects potential for excessive bleeding ; best to perform dental treatment on the day following dialysis.
Avoid drugs metabolized by kidney or nephrotoxic drugs. AHA does not recommend antibiotic prophylaxis for invasive dental procedures. Avoid placing blood pressure cuff on the arm containing the shunt used for dialysis. In uncontrolled diabetic patients: Infection b.
Poor wound healing 2. Insulin reaction in patients treated with insulin 3. Appropriate treatment and follow-up care should be provided. Inability to tolerate stress 2. Delayed healing 3. Susceptibility to infection 4. Thyrotoxic crisis thyroid storm may be precipitated in untreated or incompletely treated patients with thyrotoxicosis by: Trauma c.
Surgical procedures d. Stress 2. Patients with untreated or incompletely treated thyrotoxicosis may be very sensitive to actions of epinephrine and other pressor amines; thus, these agents must not be used; once the patient is well managed from a medical standpoint, these agents may be administered. Thyrotoxicosis increases the risk for hypertension, angina, MI, congestive heart failure, and severe arrhythmias. Give 25 mg hydrocortisone every 8 hours for 24 to 48 hours postoperatively.
Untreated patients with severe hypothyroidism exposed to stressful situations such as trauma, surgical procedures, or infection may develop hypothyroid myxedema coma. Untreated hypothyroid patients may be highly sensitive to actions of narcotics, barbiturates, and tranquilizers. Acute suppurative—Patient has acute infection, antibiotics 2. Subacute painful—Period of hyperthyroidism 3. Subacute painless—Up to 6-month period of hyperthyroidism 4.
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Usually none 2. Levothyroxine suppression following surgery and radioiodine ablation is usual treatment for follicular carcinomas.
Patient may have mild hyperthyroidism. May be sensitive to actions of pressor amines. See above for uncontrolled disease. Hard, painless lump in thyroid b. Dominant nodule in multinodular goiter c. Hoarseness, dysphagia, dyspnea d. Cervical lymphadenopathy e. See summary of Chapter Patients with anaplastic carcinoma have a poor prognosis and complex dental procedures are usually not indicated. Dental procedures could harm the developing fetus via: Radiation b.
Drugs c. Supine hypotension in late pregnancy 3. Poor nutrition and diet can affect oral health. Transmission of drugs to infant via breast milk 5.
Transmission of infectious agents to dental personnel and patients includes: Hepatitis B virus HBV c. Hepatitis C virus HCV d. Epstein-Barr virus EBV e. Cytomegalovirus CMV 2. To date, no dental health care workers have been infected with HIV through occupational exposure; six patients may have been infected by an HIV-infected dentist; thus, risk of HIV transmission in the dental setting is very low, but the potential exists.
The second trimester and most of the third trimester are the best times for elective treatment. Transmission of infectious agents to dental personnel and patients includes the following: HIV b.
Hepatitis B virus c. Hepatitis C virus d. Epstein-Barr virus e. Cytomegalovirus 2. To date, with the exception of possible transmission by a Florida dentist: HIV has not been found to be transmitted to patients in the dental setting.
No dental health care workers have been HIV infected through occupational exposure. Patients with decreasing CD4 lymphocytes may be thrombocytopenic and hence potential bleeders.
Transmission of infectious agents to dental personnel and patients: To date, HIV has not been found to be transmitted to patients in the dental setting possible exception of six patients who may have been infected by a Florida dentist ; no dental health care workers have been HIV infected through occupational exposure; however, HBV and HCV have been transmitted to patients or dental health care workers on a number of occasions in the dental setting.
Patients may be bleeders because of thrombocytopenia. Severe reaction following administration of agent to patient who is allergic to agents such as: Drugs b. Local anesthetic c. Nonemergency; edematous swelling of lips, cheek, etc. Most patients who say they are allergic will describe a fainting episode or a toxic reaction.
If an allergic reaction has occurred, identify the type of anesthetic used, and select one from various chemical groups. Refer to allergist for provocative dose testing, or b. Use diphenhydramine Benadryl with epinephrine 1: High rate of infection, but the role of transient dental bacteremias that cause these infections has not been established.
Infection from suppression of immune response by the following: Cyclosporine b. Azathioprine c. Prednisone d. Antithymocyte globulin e. Antilymphocyte globulin f. Orthoclone monoclonal antibody 2. Acute rejection, reversible 3. Chronic rejection, nonreversible, includes the following: Graft failure—End-stage organ failure b. Bleeding—Liver, kidney c. Drug overdosage—Liver, kidney d. Death or need for transplantation of heart, liver e.
Osteoporosis f. Psychoses g. Anemia h. Leukopenia i. Thrombocytopenia j.
Gingival hyperplasia k. Adrenocortical suppression l. Tumors listed above m. Poor healing n. Bleeding o. Degree of failure 2. Current status of patient 3. Need for antibiotic prophylaxis 4. Need to modify drug selection or dosage 5. Need to take special precautions to avoid bleeding 6. If surgery is indicated, access to recent prothrombin time, partial thromboplastin time, bleeding time, and white cell count or differential may be needed.
Provide emergency dental care only. Continue oral hygiene procedures. Maintain oral hygiene. Recall every 3 months.Levothyroxine suppression following surgery and radioiodine ablation is usual treatment for follicular carcinomas.
The second trimester and most of the third trimester are the best times for elective treatment. Use prophylactic antibiotics for major surgical procedures.
Bleeding o. Neurological Disorders Anthony S. Dental Implants: Surgical procedures d. Avoid placing blood pressure cuff on the arm containing the shunt used for dialysis.
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