Managing Patients With Complex Medical Cnditions

Question 0

What should be reviewed in the dental history?

Answer 0

Reason for referral
CC
Prevenitive practices
Caries and perio assessment

Question 1

What should be included in the medical history with these kids?

Answer 1

What conditiions, who are they seeing for this?
History of hosppitalisation (esp CLP)
Medications
Allgies/ sensitivities (spina bifida can mean latex allergy)
Eyes, ears, nose, throat, seizures, respiratory system, endocrine, bruising
NEEDS TO BE REVIEWED EVERY SESSION

Question 2

What should be looked at during the exam?

Answer 2

E/o
- cardiac disorders might have cyanotic lips

Oral structures
Occlusion
Dntition
Radiographs

Question 3

What medical conditioins would almost always require MD consultatn?

Answer 3

Cardiac disorders
Bleeding disorders
Systemic illness - need to know BGL - if not, speak to the endocrinologist
Childhood cancer or bone marrow transplant
Previous radiotherapy (always get clearance as there is risk for ORNJ)
Sickle cell disease

Question 4

When should Ab prophylaxis be considerd?

Answer 4

Manipulation of tissues (if causing bleeding)

Question 5

Which kids are at risk an should have ab cover considered?

Answer 5

Immunosupression
Head and neck radiology
Autoimmune dss
Chronic steroid usage
Sickle cell
No spleen
Controled diabetes (if uncontrolled type I)
Bisphosphanate therapy

Question 6

How should treatment of these children be carried out?

Answer 6

Rubber dam essential along with good suction
Pulp therapy with poor prognosis not recommended for kids with congenital heart disease or immunosupression
(abcess in cardiac kid NOT GOOD)
Good LA is essential
Oral surgery - need to be reffered to a specialist DO NOT ATTEMPT IN CLINIC

Question 7

What ara some local measures of haemostasis?

Answer 7

Pressure, gelform, sutures

Vasoconstrictors should be used with caution

Question 8

What are some considerations for these kids?

Answer 8

All dental treatment must be carried out prior to major surgery or procedures. 2-3 weeks of healing before.
Cancer kids - need to look at blood counts all the time

Question 9

What measures should be considerd hematologically?

Answer 9

Platelet count
- Above 75 is fine
Absolute neutrophil count
- aboe 1 is fine