W10/11 Medically Compromised Flashcards
To understand the management of a variety of patient whom may be medically compromised.
Name (4) Endocrine condition
- Diabetes 2. Thyroid disorders 3. Adrenal disorders 4. Bisphosphonate treated and calcium disorders
Define diabetes
A group of disorder characterized by elevated levels of glucose in the blood. Cause by bodies failure to either produce the hormone insulin, or use the insulin
Define Type 1 diabetes
Starts in younger persons, children adolescent. Management: insulin
Define Type 2 diabetes
Life style factor related. Management: insulin
What is the normal contorl range blood glucose levels? Is it okay to proceed with tx?
Normal 3.5mmo/L - 80mmol/L Reasonable, yes.
What is the fair control range blood glucose levels? Is it okay to proceed with tx?
8.1%-11.9% Reasonable, yes.
What is the poor control range blood glucose levels? Is it okay to proceed with tx?
>12.0% Practitioner may wish to refer tx
In what range should you administer glucose and treat as medical emergency?
3.5mmol/L hypoglycemia.
If a pt presents with oral infection and is confused what medical condition may be presenting?
Diabetic Ketoacidosis
What are the Oral manifestations of diabetes?
- Periodontal disease 2. Dental caries 3. Increased susceptibility to oral infections - Candidiasis infections - Lichen planus & recurrent aphthous stomatitis
What are (5) ways to manage a diabetic pt?
- Adhere to management of monitoring blood glucose levels. 2. Short apps 3. Stress free 4. Earlier apps 5. After breakfast/lunch
What is the LA management of a diabetic pt?
If poorly controlled: LA with vasoconstrictor for profound anaesthesia if required. (Dose reduction) Avoid excessive amounts of adrenaline. Importance of OHI behaviors, maintenance.
What hormone does the thyroid produce?
Thyroxin which increases metabolic activity.
What are the (2) main disorders of the thyroid?
Hyperthyroidisim Hypothyroidisim
What are the Oral Manifestations of thyroid disorders?
How do you manage a pt with unstable thyroid disorder?
- Defer tx 2. Consult with GP 3. Avoid adrenaline in LA in unstable hyperthroidisim in emergency care.
Define parathyroid disorder?
Linked with homeostatic regulation of calcium ion concerntration
What are the oral manifestations of hypo/hyper parathyroidisim?
What is a dental consideration of parathyroidisim?
They may also develop osteoporosis
What are adrenal disorders treated with?
Corticosteroids; suppresses inflammatory responses.
How do you manage a pt with adrenal disorder?
You determine medications and amounts. - Prednisone for 3 weeks. Always consult GP if alterations required. These pts could also be taking bisphosphonates for steroid induced osteoporosis
When can a adrenal crisis present?
6-12hrs after surgical stress.
What can initiate an adrenal crisis?
Dental treatment
What are (3) considerations for patients who take corticosteroids?
- Increased risk of oral infections 2. Delays wound healing 3. Risk of secondary infections
What drug is used in bone and calcium disorders?
Bisphosphonates and corticosteroids.
What condition is this picture?
BRONJ: Bisphoshonate-related osteonecrosis. Commonly follows exo; or ill fitting dentures.
What is the dental management of BRONJ?
Must rule out other conditions; malignancy; head and neck radiotheraphy.
Before commencing bisphonsphonates you the pt should?…..
- Pt must present for CC before going on medication. - Monitor OH, implants, dentures. - Bisphosphonates should not be cessed without consulting pt GP.
What is the dental management of a pt with stroke?
Modification. Larger handle tp, powered tb. Education, F-!
What are oral complications of a stroke?
- Slurred speech 2. Weak palate 3. Difficulty swallowing 4. Tongue flaccid 5. RHS brain damage, requires assistance OHI.
What other medication may a stroke pt be taking?
Anticoagulant; increased bleeding time
Define epilepsy
A group of chronic neurological conditions. Well controlled, no dx issues. Poor control consult GP
What (8) history points should you get from the pt that has epilepsy?
- Type of seizure 2. Age of onset 3. Medications 4. Degree of control 5. Frequency 6. Date of last seizure 7. Triggers 8. History of related injuries
How should you manage epilepsy clinically?
Short apps. Mouth prop to present injury if seizure presents
What LA should be avoided in pts aking MAIOs?
Adrenaline (vasocontrictor). + Dose reduction for other types of antidepressant medications
What is multiple sclerosis?
Myelin sheaths around nerves effected impacting nerve conduction.
What is the dental management of pts with multiple sclerosis?
Medications can cause burning mouth problems, increased risk of infections. Short apps.
What are dental considerations of the pt undergoing radiotheraphy?
Xerostomnia Prone to osteoradiocrosis Mucositis
What are dental considerations of the pt undergoing chemotheraphy?
Modify tx to suit pts needs and circumstances - treat between chemo treatments.
