MANAGEMENT OF PATIENTS WITH SPECIAL NEED Flashcards
Risk factors for periodontitis
Elevated serum lipids high cholesterol levels Smoking
Diabetes
Age
Male gender
Stroke
Obesity and lack of fitness
Low socio-economic status
Possible mechanism
Direct effect
Macrophages Il-1, Il-6, TNF- a
Indirect effect
Liver CRP (C-reactive protein) lipid abnormalities coagulation factors
Vascular lesion
Prehypertension
Prehypertension: Systolic: 120–139 and Diastolic 80–89 No changes in dental treatment, Monitor BP
Stage 1 htn
Stage 1 hypertension 140–159 or 90–99
Routine medical consultation/referral, No changes in dental
minimize stress
Stage 2 htn
Stage 2 hypertension 160-179 or ≥100
treatment,
Medical consultation, Monitor BP at each appointment, Perform selective dental care nonsurgical periodontics, minimize stress
Systolic BP ≥ 180 or diastolic ≥100,
Systolic BP ≥ 180 or diastolic ≥100, give immediate medical consultation. Emergency dental care only
Angina pectoris
Angina pectoris occurs when myocardial oxygen demand exceeds supply, resulting in temporary myocardial ischemia
Emergency medical treatment of a patient having an anginal episode in the dental chair
- Discontinue the periodontal procedure. Administer 1 tablet (0.3 to 0.6 mg) of nitroglycerin sublingually
- Reassure the patient and loosen garments
- Administer O2 with the patient in a reclined position
- If the signs and symptoms cease within 3 minutes, complete the procedure if possible, making sure that the patient is comfortable and terminated earlier
- If the anginal signs and symptoms do not resolve with this treatment
within 5 minutes, administer another dose of nitroglycerin, monitor the patient’s vital signs, call the patient’s physician and be ready to accompany the patient to the emergency department - A third nitroglycerin tablet can be given 5 minutes after the second
Chest pain is not relieved by 3 tablets of nitroglycerin indicates likely MI. The patient should be transported to the nearest emergency medical facility immediately.
MI patients deferred the treatment for 6 months period
Prophylactic regimens for high-risk patients
- Previous history of infective endocarditis
- Prosthetic cardiac valves or prosthetic material for valve repair
- Congenital heart disease (CHD)
- Completely repaired congenital heart defect with prosthetic material or device during the first six months after the procedure.
- Cardiac transplantation recipients who develop cardiac valvulopathy
Guidelines for Diabetics
Level 70 mg/dl or low consume some carbohydrate or juice before starting treatment. If glycemic control has been poor over the preceding few months, the procedure may need to be postponed until control is established
Signs and Symptoms of Hypoglycemia
■ Shakiness or tremors ■ Confusion
■ Agitation and anxiety ■ Sweating
■ Tachycardia
■ Dizziness
■ Feeling of “impending doom” ■ Unconsciousness
■ Seizures
Management of hypoglycemia
Provide approximately 15 g of oral carbohydrate to the patient
• 4 to 6 ounces of juice or soda
• 3 or 4 teaspoons of table sugar • Hard candy with 15 g of sugar
2. If the patient is unable to take food or drink by mouth or sedated
• Give 25 to 30 mL of 50% dextrose intravenously, which provides 12.5 to 15.0 g of dextrose, or
• Give 1 mg of glucagon intravenously (i.e., 2350 glucagon results in rapid release of stored glucose from the liver), or
• Give 1 mg of glucagon intramuscularly or subcutaneously (if no intravenous access).
Bleeding disorders are classified as
coagulation disorders, thrombocytopenic purpuras, or nonthrombocytopenic purpuras
Laboratory tests include hemorrhagic
Laboratory tests include bleeding time, tourniquet test, complete blood cell count, prothrombin time, partial thromboplastin time and coagulation time.
Inr liver disease
INR of less than 2.5 in liver disease
Inr coagulation disorder
& less than 3.0 with coagulation disorder
Block anesthesia, minor periodontal surgery usually require an INR of
less than
2
Periodontal surgery may require hospitalization and INR of less than
Periodontal surgery may require hospitalization and INR of less than 1.5 to 2.0 only after consultation with a physician
Monitor laboratory values daily: leukemia
Monitor laboratory values daily: bleeding time, coagulation time, PT and platelet count
Only emergency PD care during the acute phases
The Treatment Plan for Leukemia Patients
Twice-daily rinsing with 0.12% chlorhexidine gluconate is recommended after OH procedures
Extract all hopeless, non maintainable or potentially infectious teeth at least 10 days before chemotherapy if systemic conditions allow
Use pressure/topical hemostatic agents as indicated
Oral ulcerations and mucositis are treated palliatively with agents
such as viscous lidocaine
Oral candidiasis is common in leukemic patients and can be treated with nystatin suspension (400,000–600,000 U/mL four times daily) or clotrimazole vaginal suppositories (10 mg four or five times/day
The most prominent sign and symptom in patients with leukemia appears on the gingiva among the following are:
Bluish red and necrotizing ulcerative
Friable, ulcerative with necrosis of the gingiva
Treatment for Renal Failure Patients
Monitor BP, Check PTT, PT, bleeding time & platelet count; hematocrit; blood urea nitrogen (do not treat if <60 mg/dL) & serum creatinine (do not treat if <1.5 mg/dL)
Eliminate areas of oral infection
Good oral hygiene with frequent recall appointments
Periodontal treatment should aim at eliminating inflammation or infection & easy maintenance
Questionable teeth should be extracted if medical parameters permit
Safe for renal patients
Acetaminophen, diazepam and lidocaine as LA are usually safe medication
Treatment in Pulmonary Disease
Avoid elicitation of respiratory depression or distress: Minimize the stress of a periodontal appointment
The patient with emphysema should be treated in the afternoon to allow for airway clearance
Avoid narcotics, sedatives, GA, bilateral mandibular block anesthesia (can increase airway obstruction)
Position the patient to allow maximal ventilator efficiency, be careful to prevent physical airway obstruction, keep the patient’s throat clear
For a person with a history of asthma, make sure the patient’s inhaler is available or accessible in the dental treatment room
Patients with active fungal or bacterial respiratory diseases should not be treated unless the periodontal procedure is an emergency
