theone

2. Considerations
in case selection
Local “ tooth “
considerations
Systemic
considerations

3. Second: Systemic considerations:
1- cardiac diseases
 Prophylactic antibiotics should be given in the following
cases to avoid subacute bacterial endocarditis :
•Congenital heart disease
•Rheumatic heart disease
•Valvular disease.

4. 1- cardiac diseases
 In Patients using pacemakers  avoid using
equipments that emit electromagnetic waves as
•Pulp testers
•Sonics and ultrasonics
•Apex locators
•Electrosurgery and cautery
To avoid Cardiac
arrhythmia
 In patients with Coronary insufficiency  use plain
anesthesia (adrenaline free)

5. 2- cardiovascular diseases
 In patients taking Anticoagulants or vasodilators 
avoid surgery or consult physician
 In patients with Uncontrolled hypertension 
avoid stresses and consult physician.
 In patients with Severe hypertension  use plain
anesthesia (adrenaline free)

6. 3- blood disorders
 In Hemophilia patients  there may be bleeding with
injection , pulp extirpation and rubber dam application.
However RCT is more safe than extraction after consulting
physician.
 In patients with Blood disorders
such as  L e u k e m i a .
Aplastic anemia.
Thrombocytopenia
Polycythemia.
scurvy
require a written consent from
the physician Specially when
prescribing analgesics and
antibiotics.

7. 4- Diabetes mellitus
4. Diabetes mellitus:
 Appointments  after the meal and medication.
 Avoid Adrenalin  because it breakdown glycogen to
glucose  causing diabetic coma.
So Use different LA.  As carbocain with
Neocobefrin.
 Avoid Aspirin  because it decreases blood
sugar causin shock (similar to insulin shock)
So Analgesics other than aspirin should be used.

8. - Discard used instruments or sterilize by autoclaving .
- The patient is suufering from liver damage  So
avoid medications detoxified in liver.
- consult physician
before using the following drugs
•Aspirin.
•Acetaminophen.
•Barbiturates.
•Valium.
•Librum.
•Penicillins.
•Ampicillins.
•Cephalosporins
•Tetracyclines.
5- Hepatitis

9. 6- Kidney diseases
the patient is suffering from Renal damage  So
avoid medications metabolized and excreted by the
kidneys
Such as • N a rcotics.
•Vasoconstrictors.
•Aspirin.
•Acetaminophen.
•Penicillins.
•Tetracyclines.

10. 7- Radiation therapy
 RCT is preferable than extraction.
 Prophylactic antibiotic course is recommended.

11. 8- Epilepsy
 Patient has to take the epileptic medication prior to
treatment.
 Handle the patient gently and reassuringly.
 If you Inject L.A. into blood vessels  CNS
stimulation may happen  epileptic fit

12. 9- lung infections & Tuberculosis (TB )
Clinical
manifestations
Persistent cough.
Hemoptysis.
Chest pain.
Fatigability.
Weakness.
Loss of weight.
Anorexia.
- low Oxygenation and nutrition  poor resistance and delayed repair.
- Lung disease is highly contagious.
- Palliative care only until the case is brought under control.

13. 10- Adrenal cortex diseases
 Addison’s disease :
 decrease blood corticosteroids.
 Poor ability to cope with stressful situations (infection and surgery)
 Case should be medically controlled first.
 Cushing’s disease :
 increase blood corticosteroids.
 Cushing’s disease or prolonged corticosteroid therapy suffers from
Hypertension.
Osteoporosis.
Susceptibility to
bruises.
Low body resistance.
Impaired healing.
 Prior to treatment  medical adjustment and prophylactic antibiotics.

14. 11- Thyroid diseases & Goiter
 Hypothyroidism
 LOW Resistance to infection.
 LOW Resistance to prolonged stresses.
 Patients are subject to adrenocortical insufficiency.
 Therefore dental appointments should be as brief
and as atraumatic as possible.

15.  Hyperthyroidism (Goiter) :
Suffers from
 Heat intolerance.
Sweating.
Weight loss.
Weakness
 Hyperthyroid patient  if given L.A. with epinephrin
 thyroid crises.
Because Epinephrine potentiates the action of thyroid gland.
 Use L.A. without epinephrine as (Carbocaine, Citanest).
 Sedative premedications are recommended.
 Barbiturates are dangerous  it causes paradoxical
stimulatory reaction.
So Non barbiture sedatives are recommended.

16. 12- Fainting ( Syncope )
Syncope transient cerebral anoxia.
 Extremely nervous patients cerebral anoxia
syncope.
 Push the head between patients knees or lower it than
the rest of the body.
 Nitrous oxide – oxygen analgesia concentration of
O2.
 Frequent spells of syncope cerebral disease.

17. 13- Pregnancy
 Ideal time for treatment 2nd trimester
 Recommendations
a-minimum medications.
b-Protective lead shield with radiographs.
c-Consult the gynaecologist.

18. 14- Menestruation
 Menstruation hormonal changes.
- Vasodilatation.
- LOW Tissue resistance.
 Toothache.
 Post extirpation bleeding.
 Post surgical hemorrhage.
 Flare-ups.

19. 15- Menopause
Menopause depletion of estrogen.
 Osteoporotic jaw lesions.
 Atypical facial neuralgia (simulate pulpalgia).
 Impaired healing of periapical rarefaction after RCT.
No clinical signs and symptoms no further
treatment.
Visible enlargement of periapical rarefactions
apical surgery.
Medical consultation estrogen replacement therapy

20. 16- Allergy
 Good medical history.
 Use antihistaminics.
 Keep “Emergency Kit” ready for use.

21. 17- Drugs & medications
 Aspirin:
o In Patients taking anticoagulants  aspirin will
increase bleeding.
o In Diabetic patients  aspirin will increase the
insulin effect  hypoglycemia (insulin shock).
o Aspirin should be avoided in case of peptic ulcers

22.  Corticosteroids:
 Antibiotic coverage and decrease of the number of visits
to avoid complications.

23. THANK YOU
GOOD LUCK