DENTAL

MANAGEMENT
OF THE MEDICALLY
COMPROMdgISED
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:

1. Medical consultation
2. Appointment
3. Reduction of stress & anxiety
4. Local anesthesia
5. General anesthesia
6. Treatment procedures
7. Drugs used in treatment
8. 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

IF PATIENT IS ALLERGIC:

Adult --------- Clindamycin 600 mg OR

Asathromycin 500 mg OR
Cephazolin 1 gm
(1 hour before ttt. Orally)
( ,,,

,,,,

,,, injection)

Child --------- Clindamycin 20 mg per Kg.

Asathromycin 15 mg per

2. Under G.A
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 hour
before induction.
OR

300mg Clindamycin I/V at induction

b) Children ------ (510 years)1/2 adult

(< 5 years) 1/4 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
1. Medical consultation.

2. stress & anxiety.

3. Local anesthesia.
4. General anesthesia.
5. Drugs used in treatment.
6. Drugs given to patient.

TUBERCULOSIS

Can affect any organ.

Highly infectious.
Caused by Mycobacterium T.B.
Transmitted by air born droplets.

Dental management:
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
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
1. Medical consultation.
2. 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:
1. Patient with active hepatitis
2. 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:
1. Patient with
conservative
treatment.
2. Patient with
hemodialysis.
3. Patient with kidney
transplant.
4. 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

1. Ant thyroid drugs 2. Hydrocortisone
3. I.V. glucose
4. Oxygen administration
5. Cooling to decrease temp. of body.

NEUROGEnkbjhnmnNIC
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:
1. Precipitation of the attack.
2. Problems of drugs taken
a) Dilantin------- gingival hyperplasia
b) Depakene------- bleeding tendancy

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

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

N.B: