Medically Comprimised Children Flashcards
T/F medically compromised children are high caries risk?
T
What are medically compromised children?
Medical conditions affect dental care
Consequences of dental disease could be life threatening
What are the two common cardiovascular diseases?
CHD and Aquired heart disease
What are more common CHD or Aquired in children?
CHD
80% of cases
What are the three types of CHD? And name the diseases for each category.
Cyanotic: occurs due to deoxygenated blood bypassing the lungs and entering the systemic circulation eg tetralogy of fallot, transposition of great vessels and eisenmengers syndrome
Acyanotic:shunting (flowing) of blood occurs from the left side of the heart to the right side of the heart due to a structural defect (hole) in the
interventricular septum eg. ASD, VSD, aortic and pulmonary stenosis, coarctation of aorta
Cardiomyopathies: IE, RHD
What are the acquired heart diseases?
Rheumatic fever and diseases of myocardium
What are the oral features for those suffering from cardiovascular disease?
- Increased risk of caries for primary and permanent
- delayed tooth eruption
- intrinsic tooth staining due to medication, diet or compliance
What are the aims of management for people with cardiovascular diseases ?
Eliminate the cause and risk of infection
Reduce the risk of bacterial endocarditis
Maintain good OH
What two medical treatment should you not offer to people upwith cardio disease?
CHX
AB prophylaxis Nice 2008
How should you manage pulpyally involved teeth in people with cardiovascular disease?
- extract pulpally involved primary teeth since vital, non vital and Pulpectomy are contra indicated
- permanent teeth Endo is indicated
What are the haematological disorders?
Vascular disorders: puroura, haemangiomas, Vit C def
Platelet disorder: thrombocytopenia, platelet function disorders
Coagulation defect: liver disease, haemophilia a, b and VWD
What are the oral features of those suffering from haematological diseases?
- Bruising of skin and mucosa eg petechiae, purpura and heamatoma
- excessive or prolonged bleeding following xla or trauma
- Spontaneous gingival bleeding
What are the medical implications of those that have haematological disorders?
Prolonged bleeding which may be excessive
Increased risk of infection
Anticoagulant consideration
May have other medical problems
How do you manage children with haematological problems?
Aggressive prevention
And liase with haematologist
Avoid extractions in general practice and multiple extractions done in hospital
Monitor blood values: should be more than 50000/l but prefer above 80000/l
Avoid extractions and do endo where possible and can be done without factor cover but do not over instrument
Avoid mandibular blocks and use infiltration
Avoid drugs that exacerbate bleeding eg NSAIDS
Use rubber dam
How do you manage an oral haemorrhage?
Identify site Compress alveolus Suture and pack Apply pressure Written post op instructions Prescription of non aspirin medications
What is an immuniodef?1
Quantitive and qualitative defect in neutrophils, primary and secondary immunodef or acquired disorders
What are the medical implications for immunodef?1
Risk of sepsis
Opportunistic infections
Delayed wounds healing
Transmission of infection
What are the dental implications of immunodef?
Opportunistic infections: thrush, severe gingivitis, prepubertal perio , Recurrent herpes
Premature exfoliation of primary teeth
How do you mange immunodef dentally?
Regular reviews and prevention
Extractions or maintenance of carious teeth should be done on a worst case scenario during periods of immunodef
All mobile primary teeth removed at least two weeks prior to BMT
What types of malignancies account for 50% of childhood malignancies?
Acute leukaemias and tumours of CNS
What are the three management options for oncology patients and what effect have they had on survival?
Chemo
Radio
Surgery
Increased rates
What are the oral,features of potential maligancy?
Pain Gingival swelling Spon bleeding Abnormal tooth mobility Altered taste
What are the principles to the dental management of oncology patients?
Pre cancer treatment screen to eliminate all sources of infection
Emergency treatment should only be done in the acute phase
Ensure platelet levels are greater than 80,000 prior to surgery for haemostasis
Prophylactic antibiotics anti fungals and antivirals
If xla is required and neutrophil count is less than 1.8 * 10^9 then needs anti microbials
Delay any elective dental treatment until child is in remission or on maintenance chemo
Pulp therapy is contra indicated in the induction and consolation phase of chemo
CBA of endo in permanent teeth
What type of renal problems may we face as dentists?
Renal disorders : acute and chronic renal failure
REnal transplant
What are the oral features of people within renal disease?
Chronological enamel Hypoplasia
Intrinsic discolouration
Low caries rate
Gingival hyperplasia
What are the medical implications for people with renal Disease?
Often on steroids and immunosuppressants Bleeding tendency Poor wound control Secondary infection Hypertension Osteodystrophy (hypocalcaemia )
How do we mange renal patients dentally?
Consult nephrologist
Postpone elective treatment until renal function restored
AB prophylaxis prior to surgeryb
Consider steroid cover
Extract pulpally involved teeth to reduce risk of bacteraemia
Which endocrine diseases can cause problems for dentist?
Diabetes
Pituitartu and adrenal disorders
Thyroid
Parathyroid
What are the problems for those suffering from diabetes ?
Poor wound healing
Pre GA fasting needs monitoring
Poor wound healing
GA required hospital admission
Which neurological diseases are problems for dentist?
Epilepsy
Epileptics suffer from recurrent seizures
T/F
T
What are the problems with epilepsy ?
Gingival enlargement and risk of seizure whilst in dental chair
Try to ensure usage free medicine
What is the consequences of gingival hypertrophy? Which drug does not cause it?
Needs good OH and gingivectomy can be performed in in permanent dentitions and used CHX gel to reduce inflammation
Sodium valproate
How can you prevent seizures ?
Avoid stress and direct over head lighting
GA preferred in children with poor seizure control
Removable appliances contraindicated
Which two respiratory diseases are common?
Asthma
Cystic fibrosis
What are the medical implications of respiratory diseases?
Dyspnoea
Risk of acute resp arrest
Chronic hypoxamia
What are the oral features for those suffering from asthma?
Developmental enamel defects
Dental erosion
Some steroid and bronchodilators may cause extrinsic staining and drying of mouth
Candidas
Adrenal suppression if on high dose steroids
What are the dental implications in asthmatic?
Avoid long appt Rubber dam Steroid prophylaxis consider Good preventative regimen Use of RA and GA must be discussed Asthma attach in sugery: make sure have drugs Staining to teeth: due to drugs Dry mucosa Candida Immunosuppression for those on high dose steroids Be careful with duraphat
What is cystic fibrosis?
AR multisystem disease affecting mainly exocrine glands
Thick mucous is produced and blocks airways and leads to malabsorption
T/F
There is chronic airway obstruction in people with CF?
T
What are the oral features of someone with CF?
Delayed dental development Enamel opacitie More prone to calculus due to ca in saliva Decreased caries incidence Oral ulceration
What are the GI diseases that can lead to dental problems?
Reflux
Liver disease and transplant
IBD eg crohns
Coeliac disease
What are the oral features for people suffering from GI diseases?
Developmental defects of enamel eg Hypoplasia
Delayed tooth eruption
Gingival hyperplasia
Enamel erosion, halitosis and high restoration due to relux
Periodontal disease
How do GI diseases affect our management as a dentist ?
Consult Gasteroenterologist
Use steroid and AB prophylaxis is necessary
Fluoride and good prevention
