P. 1
medically_compromised_3

medically_compromised_3

|Views: 90|Likes:
Published by zeklawy

More info:

Published by: zeklawy on Sep 30, 2010
Copyright:Attribution Non-commercial

Availability:

Read on Scribd mobile: iPhone, iPad and Android.
download as PPT, PDF, TXT or read online from Scribd
See more
See less

02/01/2013

pdf

text

original

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

Asymptomatic ( silent ) . Acute coronary insufficiency ‡ 4. ventricular fibrillation ) ‡ 7. Heart failure ‡ 6. Cardiac arrhythmia ‡ 5.ISCHEMIC HEART DISEASES ‡ Mode of presentation of ischemic heart disease: ‡ 1. Angina pectoris ‡ 2. Sudden death ( cardiac arrest. Myocardial infarction ‡ 3.

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

Appointment 3. Reduction of stress & anxiety 4. Drugs used in treatment 8. General anesthesia 6. Local anesthesia 5. If the attack developed . Treatment procedures 7.DENTAL MANAGENT OF ANGINA: 1. Medical consultation 2.

Drugs used in treatment.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.

2. Management of complications if developed (attack) . Dental management: Same as angina except. 1. 3.preoperative antibiotic. 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.

HYPERTENSIVE DISEASES ‡ Hypertension is used to describe patient with blood pressure more than 140/90 mmHg ‡ Dental management: ‡ ‡ ‡ ‡ Same as angina except. 2. 1. . Local anesthesia. 3. treatment procedure. General anesthesia.

‡ 4. ‡ 1. Short dental appointment. ‡ 3.RHEUMATIC HEART DISEASE ‡ It is an acute inflammatory condition. . result in scaring & calcification of valves followed by valvular stenosis. due to strep. Pharngitis infection following sore throat. Medical consultation. ‡ 2. ‡ Dental management. Mild tranquilizers (2-5 diazepam). Prophylactic antibiotic.

‡ 1.50 mg per Kg Amoxicillin or Ambicillin . Under L..2gm Amoxicillin or 2gm Ambicillin (1 hour before treatment orally) OR (1/2 hour . .........A ‡ a) Adults---.PROPHYLACTIC ANTIBIOTIC REGIMEN FOR CARDIAC PT... injection) ‡ B) Children----..

Clindamycin 20 mg per Kg. . ...IF PATIENT IS ALLERGIC: Adult --------.. Orally) ( ½ .. ...Clindamycin 600 mg OR Asathromycin 500 mg OR Cephazolin 1 gm (1 hour before ttt.. Asathromycin 15 mg per Kg. injection) Child --------.

1gm Amoxicillin I. OR 300mg Clindamycin I.2.A a)Adults----.V at induction.M ½ hour before induction. OR 3gm Amoxicillin orally 4 hours before induction followed by 3gm Amoxicillin immediately after recovery. OR 300mg Clindamycin I/V at induction . Under G.

b) Children -----.(5±10 years)1/2 adult (< 5 years) 1/4 adult .

3. wheezing. cyanosis. finger clubbing. General anesthesia: leads to hypoxia . . 2. AVOID 1.RESPIRATORY DISORDERS ‡ Common symptoms: ‡ ‡ ‡ ‡ ‡ ‡ ‡ 1. 2. cough. 4. Analgesics & narcotics: leads to respiratory depressants.

Corticosteroids inhalators. Bronchodilator. ‡ Patient is treated by: ‡ 1. ‡ 3. ‡ 2. Beta adrenergic stimulator. .BRONCHIAL ASTHMA ‡ It is due to bronchospasm or hyperirritability of the tracheo_bronchial tree.

.Dental management 1. Drugs given to patient. stress & anxiety. Drugs used in treatment. 5. General anesthesia. 6. Medical consultation. Local anesthesia. 2. 4. 3.

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

5. 4.Dental management: 1. 2.B.B. Patient with signs & symptoms of T. Patient with positive tuberculin test. Patient with active T. Strict aseptic technique.B. Patient with past history of T. . 3.

2.g. Bleeding disorders ( decrease clotting factors. Transmission of viral hepatitis. general anesthesia.LIVER DISORDERS ‡ Advanced liver diseases include: Liver cirrhosis . Impaired drug detoxication e.Jaundice ‡ Potential complications: 1. analgesics. impaired vitamin K absorption). excess fibrinolysis. 3. . sedative.

2.10 mg/day before surgery. Avoid drugs metabolized in liver: L. . 4.Lidocaine. G.Valium antibiotics-------.A -----. Vit. Mepicaine Sedatives-------.A------.k ----.Dental management 1.Aspirin 3.Ampicillin Analgesics------. Medical consultation.cause bleeding.

VIRAL HEPATITIS ‡ Dental management: 1. Carriers: a. b. high risk patient. Patient with active hepatitis 2. low risk patient. .

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

Gingivitis 2. Acetone smell in breath . Pulpitis in non carious tooth 6. Delayed wound healing 5. Burning sensation in tongue 7.‡ Oral manifestation: ‡ ‡ ‡ ‡ ‡ ‡ ‡ 1. Xerostomia 4. Alveolar bone resorption 3.

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

Patient with kidney transplant.CHRONIC RENAL FAILURE ‡ Dental management: 1. 2. Emergency treatment. Patient with hemodialysis. . 3. 4. Patient with conservative treatment.

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

2. Problems of drugs taken a) Dilantin------. Potential problems: 1. Precipitation of the attack. Epilepsy: is the most common neurogenic disorder the dentist may face in his clinic.bleeding tendancy .NEUROGENIC DISORDER (EPILEPSY) Neurogenic disorder: is disorder of the brain.gingival hyperplasia b) Depakene------.

Past medical history. .Dental management: 1. 3. 4.In case of controlled patient.Management of attack if developed.In case of uncontrolled patient. 2.

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

THANK YOU .

You're Reading a Free Preview

Download
scribd
/*********** DO NOT ALTER ANYTHING BELOW THIS LINE ! ************/ var s_code=s.t();if(s_code)document.write(s_code)//-->