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 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 ) 7. Asymptomatic ( silent )

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

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

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: 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

Adult --------- Clindamycin 600 mg OR Asathromycin 500 mg OR 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 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

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.

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 stress & anxiety. Local anesthesia. Medical consultation. stress & anxiety. Local anesthesia. General anesthesia. Drugs used in treatment. Drugs given to patient.

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

Dental management: 2. Patient with past history of T.B. 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 Potential complications: 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 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.

VIRAL HEPATITIS Dental management: Patient with active hepatitis 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: 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: Patient with conservative treatment. Patient with hemodialysis. Patient with kidney transplant. Emergency treatment.

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.

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

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

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

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