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The Effects of Physical Problems on Dental Treatment 1.

Diabetes Uncontrolled diabetes is frequently accompanied by multiple small oral abscesses andd poor tissue tone. The disease should be brought under controll before prosthodontic treatment is innitiated. The decreased resistance to infection exhibited by diabetic patients necessitates special care during treatment and follow-up. Diabetic patient often display reduced salivary output. This significantly reduces patients ability to wear a prosthesis and increases the likelihood of dental caries. 2. Arthritis Arthritic changes in temporomandibular joint of a patient may produce changes in occlusion. Arthritic changes also may create difficulties in the determination and recording of jaw relations. 3. Paget Disease Patients with paget disease may show enlargement of the maxillary tuberosities. This can cause changes in the fit and occlusion of prosthesis. A frequent recall program should be instituted for patients with Paget disease. 4. Acromegaly A patient with acromegaly may have enlargement of the mandible. Consequently, patients with acromegaly should be examined frequently to evaluate the fit and function of removable prosthesis. 5. Parkinson Disease Parkinson disease is characterized by rythmic contractions of the musculature, including the muscles of mastication. The symptoms are sometimes so severe that it is impossible for a patient to insert and remove a removable partial denture, let alone practice the oral hygiene procedures necessary for the maintenance of oral health. Impression procedures also may be compromised by the presence of excessive quantities of saliva. 6. Pemphigus Vulgaris Pemphigus vulgaris is a disease that usually begins with formation of bullae in the oral cavity with gradual extension to the skin. In acute phase, oral discomfort and dryness of the mouth are common symptom. These symptoms

may be erroneously linked to the presence of removable prosthesis. Consequently, patients have been known to go from dentist to dentist for the relief of pain, or the fabrication of new prosthesis. When the disease is brought under controlled with appropriate medication, patients can wear prosthesis successfully. However, care must be taken to establish smooth, polished borders in the finished prosthesis. 7. Epilepsy The construction of removable partial dentures is usually contraindicated if the patient has frequent, severe seizures that occur with little or no warning. However, of the seizure are well controlled or if the patient has adequate premonition to permit removal of prosthesis, a removable partial dentures may be indicated. All material used in the construction of removable partial dentures should be radiopaque so that any parts of the prosthesis that is swallowed or aspirated during a seizure can be located radiographically. If the patients medication includes phenytoin, one must take particular care to ensure that the removable partial denture does not irritate the gingival tissue, otherwise, gingival hyperthrophy may result. 8. Cardiovascular Patients with the following cardiovascular condition require medical consultation before the initiation of the dental procedures : a. Acute or recent myocardial infarction b. Unstable or recent onsent of angina pectoris c. Congestive heart failure d. Uncontrolled arrhytimia e. Uncontrolled hypertension Prophylactic antibiotic therapy is always recommended if surgical procedures are to be accomplished for patients with a congenital or rheumatic valvular heart disease, cardiac murmurs, or repaired coarctation of the aorta. There is conflicting evidence regarding the need for prophylactic medication when lesser degree of tissue trauma are anticipated, such as the placement of restorations and the making of impressions.

9. Cancer Oral complications caused by ionizing radiotion and chemotherapy such as mucosal irritations, xerostomia, bacterial infections, and fungal infections may complicate the construction and wear of removable partial dentures. 10. Transmissible Disease HIV, hepatitis, influenza, tbc, and other transmissible disease pose a particular hazard for patients, dental auxiliaries, and dentists. It is imperative that dental personel take precautions to prevent contamination and disease transmission, such as properly disinfected impression, and tools. Evaluating the Effects of Drugs on Treatment 1. Anticoagulants Postsurgical bleeding may be a problem for patients receiving anticoagulants. Care must be taken to stop the ingestion of this medication before dental treatment initiated. 2. Antihypertensive Agents The most significant side effect of antihypertensive drugs is orthostatic hypotension, which may result in syncope when a patient suddenly assumes an upright position. Treatment for hypertension may also include the prescription of antidiuretic agent which may contribute to a decrease of salive and associated dry mouth. 3. Endocrine Therapy A patient undergoing endocrine therapy may experience severe oral discomfort related to dry mouth. If the patient is wearing a prosthesis, it could be mistakenly blamed for causing discomfort. 4. Saliva-Inhibiting Drugs Methanteline, atropine, and their derivatives are sometimes used to controll excessive salivary secretion. These drugs are particularly useful when a practitioner is making impression. Saliva-inhibiting drugs are contraindicated in patients with cardiac disease because of their vagolytic effects. These drugs should be avoided in patients with prostatic hyperthrophy and glaucoma.