Medically compromised patient

Question 1

What do we need to be aware of with medically compromised patients?

Answer 1

1. The medical condition they have
2. Treatment the patient needs
3. Drug interactions
4. Oral manifestations

Question 2

What are some cardiovascular things we need to be aware of?

Answer 2

1. Anti-coagulation (risk of bleeding)
2. MI in last 3 months (dont do treatment under 3 months is up)
3. Angina - need GTN spray sublingually
4. Hypertension (over 160/100 we dont treat them, patients may be on diuretics causing dry mouth, ACE inhibitor causing lichenoid reactions, calcium channel blockers causing gingival overgrowth)

Question 3

What is the dental implication of respiratory disease?

Answer 3

• Salbutamol may be needed if patient is having an asthma attack
• Steroid cover may be needed if patient is on long term corticosteroids
• Inhalers may cause oral-candida rinse mouth
• Dental anxiety may exacerbate asthma

Question 4

How is diabetes relevant to dentistry?

Answer 4

• Timing for late morning appointments so patient can have breakfast and lunch
• Use LA without adrenaline so it wears off quicker so patient can continue to eat
• Patient is more prone to infection and worse wound healing
• Risk of PDD
• Insulin sliding scale may be needed for GA
• Be aware of what to do for a hyper or hypo (never give insulin)

Question 5

What are the dental implications of epilepsy?

Answer 5

• Know patient triggers and when they last had a trigger
• Buccal midazolam injection
• Patients on phenytoin may have gingival hyperplasia
• Management of epileptic fits

Question 6

What are the dental implications of liver disease?

Answer 6

1. Bleeding tendency
2. Altered drug metabolism
3. Delayed healing
4. Avoid IV and GA
5. Liver transplant: immunosupressants

Question 7

What are the dental implications of alcohol dependance?

Answer 7

1. Cardiovascular problems such as hypertension or angina
2. Neurological problems such as peripheral neuropathy, encephalopathy
3. GI complications such as gastritis due to high acid alcohol content
4. Avoid metronidazole: reacts badly with alcohol

Question 8

What is the dental relevance of kidney disease?

Answer 8

1. Drug metabolism
2. More prone to infection, can be immunosuppressed
3. Too much renin (hypertension)
4. Patient on dialysis - heparin increases chance of bleeding

Question 9

What is the dental relevance of anaemia?

Answer 9

1. Oral manifestations (angular cheilitis, burning mouth syndrome, glossitis)
2. Dont do extractions on these patients unless in secondary care

Question 10

What is the dental relevance of transplants?

Answer 10

1. Immunosuppressant (cyclosporin - gingival overgrowth)
2. Antibiotic prophylaxis
3. Steroid cover

Question 11

What are the dental implications of pregnancy?

Answer 11

1. Avoid drugs and radiation exposure
2. If antibiotics needed: give penicillin or erythromycin
3. If treatment needs to be done - do it in second trimester

Question 12

What are the side effects of radio and chemo therapy?

Answer 12

• Mucositis
• Xerostomia
• Osteoradionecrosis

Question 13

What is the dental relevance of taking bisphosphonates?

Answer 13

• Risk of medication related osteonecrosis of the jaw