Professional Documents
Culture Documents
A Summary
This table presents several important factors to be considered in the dental man-
agement of medically compromised patients. Each medical condition is outlined
according to potential problems related to dental treatment, oral manifestations,
prevention 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 discussed in
this book.
DM1
Dental Management: A Summary
DM2
Potential Medical Problem
Related to Dental Care Oral Manifestations Prevention of Problems Treatment Planning Modification(s)
Infective Endocarditis (IE)
Chapter 2
DM3
DM4
DENTAL MANAGEMENT: A SUMMARY
Dental Management: A Summary—cont’d
DM5
Dental Management: A Summary—cont’d
DM6
Potential Medical Problem
Related to Dental Care Oral Manifestations Prevention of Problems Treatment Planning Modification(s)
Arrhythmias
Chapter 5
DM7
DM8
DENTAL MANAGEMENT: A SUMMARY
Dental Management: A Summary—cont’d
Potential Medical Problem
Related to Dental Care Oral Manifestations Prevention of Problems Treatment Planning Modification(s)
Chronic Obstructive Pulmonary Disease
Chapter 7
1. Aggravation or worsening of • Leukoplakia, • Avoid treating if upper respiratory infection is present. • None
compromised respiratory erythroplakia, or • Use an upright chair position.
function squamous cell carcinoma • Use of local anesthesia is appropriate; minimize the
may develop in chronic use of bilateral mandibular or palatal blocks.
smokers of tobacco. • Do not use a rubber dam in patients with severe
disease.
• Use pulse oximetry to monitor oxygen saturation.
• Use of low-flow oxygen is helpful.
• Do not use nitrous oxide–oxygen sedation in patients
with severe emphysema.
• Low-dose oral diazepam is acceptable.
• Avoid barbiturates, narcotics, antihistamines, and
anticholinergics.
• Usual daily steroid dose may be needed in patients
who are taking systemic steroids for surgical
procedures.
• Avoid macrolide antibiotics (erythromycin,
clarithromycin) and ciprofloxacin for patients who are
taking theophylline.
• Outpatient general anesthesia is contraindicated.
Potential Medical Problem
Related to Dental Care Oral Manifestations Prevention of Problems Treatment Planning Modification(s)
Asthma
Chapter 7
1. Precipitation of an acute • Oral candidiasis is • Identify asthmatic patient by history. • None required.
asthma attack reported with the use of • Determine character of asthma:
a corticosteroid inhaler • Type (allergic or nonallergic)
inhaler without a • Precipitating factors
“spacer,” but it occurs • Age at onset
rarely. • Level of control (frequency, severity of attacks
• Maxillofacial growth can [mild, moderate, severe])
be altered when asthma • How usually managed
is severe during • Medications being taken
childhood. • Necessity for past emergency care
• Baseline forced expiratory volume at 1 second
(FEV1) stable (not decreasing)
• Avoid known precipitating factors.
• Consult with physician for severe persistent asthma.
• Reduce the risk of an attack: Have the patient bring
medication inhaler to each appointment, and
recommend prophylaxis with an inhaler before each
appointment for persons with moderate to severe
persistent asthma.
• Drugs to avoid:
DM9
DM10
Dental Management: A Summary—cont’d
DM11
DM12
Dental Management: A Summary—cont’d
Potential Medical Problem
Related to Dental Care Oral Manifestations Prevention of Problems Treatment Planning Modification(s)
Viral Hepatitis Types B, C, D, and E
DM13
• If antibiotics are used, monitor for signs or symptoms
(diarrhea, GI distress) of pseudomembranous colitis.
Continued
DM14
Dental Management: A Summary—cont’d
DM15
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DENTAL MANAGEMENT: A SUMMARY
Dental Management: A Summary—cont’d
Potential Medical Problem
Related to Dental Care Oral Manifestations Prevention of Problems Treatment Planning Modification(s)
Genital Herpes
Chapter 13
1. Inoculation of oral cavity and • Autoinoculation of type CAVEAT: Many patients with sexually transmitted disease • None usually required; patients prone
potential transmission to dentist 2 herpes to oral cavity cannot be identified by history or examination; to recurrence after dental treatment
(fingers, eyes) therefore, all patients must be approached with the use should be prescribed a systemic
of standard precautions (see Appendix B). antiviral drug for prophylactic use
• Localized genital infection poses no problem; for a few days.
however, be aware of possibility of autoinoculation
to dermal sites and the oral cavity by the patient.
• For oral infection with HSV-1 or HSV-2 postpone
elective dental care until lesion is healing (in scab
phase or when it disappears).
Human Papillomavirus (HPV) Infection
Chapter 13
1. Inoculation of oral cavity and • Benign manifestations: CAVEAT: Many patients with sexually transmitted disease • Discuss risks of transmission and the
potential transmission to fingers papilloma, verruca cannot be identified by history or examination; potential for development of
vulgaris, condyloma therefore, all patients must be approached with the use carcinoma with high-risk types (HPV
acuminatum of standard precautions (see Appendix B). 16, 18, 31, 33, 35). Appropriate
• Specific genotypes • Localized genital infection poses no problem; treatment and follow-up care should
associated with risk for however, be aware of the possibility of be provided.
development of autoinoculation to the oral cavity by the patient.
carcinoma • Oral lesions should be excised and submitted for
histologic examination. HPV typing should be
considered.
Potential Medical Problem
Related to Dental Care Oral Manifestations Prevention of Problems Treatment Planning Modification(s)
Diabetes Mellitus
Chapter 14
1. In patients with uncontrolled • Accelerated periodontal • Detection by the following methods: • In patients with well-controlled
diabetes: disease • History diabetes, no alteration of treatment
a. Infection • Gingival proliferations • Clinical findings plan is indicated unless complications
b. Poor wound healing • Periodontal abscesses • Screening for blood glucose of diabetes are present, such as:
c. Risk for systemic problems • Xerostomia • Referral for diagnosis and treatment • Hypertension
2. Insulin reaction in patients • Poor healing • Monitoring and control of hyperglycemia by • Congestive heart failure
treated with insulin • Infection assessment of blood glucose • Myocardial infarction
3. In diabetic patients, early onset • Oral ulcerations • Monitoring of hemoglobin A1c (A1C) status • Angina
of complications relating to • Candidiasis • For patients receiving insulin (or sulfonylurea • Renal failure
cardiovascular system, eyes, • Mucormycosis drugs), insulin reaction is prevented by the following • Defer orthodontic and prosthodontic
kidneys, and nervous system • Numbness, burning, or methods: care until periodontal disease is well
(angina, myocardial infarction, pain in oral tissues • Eating normal meals before appointments controlled.
cerebrovascular accident, renal • Scheduling appointments in morning or mid- • Avoid periodontal or oral surgery if
failure, peripheral neuropathy morning poor glycemic control.
blindness, hypertension, • Informing the dentist of any symptoms of insulin
congestive heart failure) reaction when they first occur
• Having sugar available in some form in cases of
insulin reaction
• Diabetic patients who develop oral infection may
require increased insulin dosage and consultation with
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Dental Management: A Summary—cont’d
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Dental Management: A Summary—cont’d
Thyroiditis
Chapter 16
1. Acute suppurative—patient has • Usually none • None • Postpone elective dental care until
acute infection, antibiotics are infection has been treated.
required.
2. Subacute painful—period of • Pain may be referred to • Include in differential diagnosis for jaw pain; see • Avoid elective dental care if possible
hyperthyroidism mandible. earlier under Hyperthyroidism. until symptoms of hyperthyroidism
have cleared.
3. Subacute painless—up to • None • See earlier under Hyperthyroidism. • Avoid elective dental care if possible
6-month period of until symptoms of hyperthyroidism
hyperthyroidism have cleared.
4. Hashimoto’s—leads to severe • Tongue may enlarge. • See earlier under Hypothyroidism. • In hypothyroid patients under good
hypothyroidism medical management, any indicated
dental treatment can be performed.
See above for uncontrolled disease.
5. Chronic fibrosing (Riedel’s)— • None • None • None
usually euthyroid
Potential Medical Problem
Related to Dental Care Oral Manifestations Prevention of Problems Treatment Planning Modification(s)
Thyroid Cancer
Chapter 16
1. Usually none • Usually none; metastasis • Examine for signs and symptoms of thyroid cancer: • For most patients, the dental
to the oral cavity is rare. • Hard, painless lump in thyroid treatment plan is not affected unless
• Post-radiation induced • Dominant nodule in multinodular goiter the cancer treatment includes external
chronic sialodenitis, • Hoarseness, dysphagia, dyspnea irradiation or chemotherapy. See
xerostomia, risk for root • Cervical lymphadenopathy summaries for Chapter 26. Patients
caries. • Nodule that is affixed to underlying tissues with anaplastic carcinoma have a
• Patient usually euthyroid poor prognosis, and complex dental
• Patients found to have thyroid nodule(s) should be procedures usually are not indicated.
referred for fine needle aspiration biopsy.
2. Levothyroxine suppression after • Usually none • Consult with patient’s physician regarding permissible • Care with the use of epinephrine is
surgery and radioiodine degree of hyperthyroidism in patients treated with indicated in patients treated with
ablation is usual treatment for thyroid hormone. thyroid hormone.
DM21
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Dental Management: A Summary—cont’d
DM23
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DENTAL MANAGEMENT: A SUMMARY
Dental Management: A Summary—cont’d
DM25
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Dental Management: A Summary—cont’d
DM27
sensitization.
• Do not use in topical form.
Continued
DM28
Dental Management: A Summary—cont’d
DM29
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Dental Management: A Summary—cont’d
DM31
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Dental Management: A Summary—cont’d
DM33
Continued
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Dental Management: A Summary—cont’d
DM35
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DENTAL MANAGEMENT: A SUMMARY
Dental Management: A Summary—cont’d
Related to Dental Care Oral Manifestations Prevention of Problems Treatment Planning Modification(s)
Leukemia
Chapter 23
1. Infection • Gingival swelling/ • Referral for medical diagnosis, treatment, and • Inspect head, neck, and radiographs
2. Bleeding enlargement consultation for undiagnosed or latent disease
3. Delayed healing • Mucosal or gingival • Complete blood count to determine risk for anemia, (e.g., retained root tips, impacted
4. Mucositis bleeding bleeding, and infection teeth) and infections that require
• Oral infection • Antibiotics, antivirals, and antifungals provided during managment before chemotherapy.
chemotherapy to prevent opportunistic oral infection • Eliminate infections before
• Chlorhexidine rinse/bland rinses to manage mucositis chemotherapy.
• Extractions should be performed at
least 10 days before initiation of
chemotherapy.
• Implement plaque control measures
and chlorhexidine during
chemotherapy.
• Use prophylactic antibiotics if WBC
count is less than 2000/µL, or
neutrophil count is less than 500/µL
(or 1000 at some institutions).
• Platelet replacement may be required
(if platelet count is <50,000/µL)
when invasive dental procedures are
performed.
DM37
chemotherapy and radiation therapy
for treatment plan modifications.)
Continued
DM38
Dental Management: A Summary—cont’d
DM39
Dental Management: A Summary—cont’d
DM40
Potential Medical Problem
Related to Dental Care Oral Manifestations Prevention of Problems Treatment Planning Modification(s)
Acquired Disorders of Coagulation (liver disease, broad-spectrum antibiotics, malabsorption syndrome, biliary tract
obstruction, heparin, other agents/factors)
Chapter 24
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Dental Management: A Summary—cont’d
DM43
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Dental Management: A Summary—cont’d
DM45
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DENTAL MANAGEMENT: A SUMMARY
Dental Management: A Summary—cont’d
Continued
DM47
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Dental Management: A Summary—cont’d
DM49
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Dental Management: A Summary—cont’d
DM51
• Adjunctive medications—antidepressants, muscle
relaxants, steroids, anticonvulsants, antibiotics
Continued
DM52
DENTAL MANAGEMENT: A SUMMARY
Dental Management: A Summary—cont’d
DM53
Continued
DM54
Dental Management: A Summary—cont’d
DM55
DM56
Dental Management: A Summary—cont’d
Potential Medical Problem
Related to Dental Care Oral Manifestations Prevention of Problems Treatment Planning Modification(s)
Antimanic (Mood-Stabilizing) Drugs
Chapter 29
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DENTAL MANAGEMENT: A SUMMARY
Dental Management: A Summary—cont’d
DM59