DENTAL MANAGEMENT OF THE MEDICALLY COMPROMISED PATIENT
<ul><li>Systemic diseases include : </li></ul><ul><li>1. cardiovascular diseases </li></ul><ul><li>2. respiratory diseases...
Main signs & symptoms of C.V.S diseases   <ul><li>1. Chest pain </li></ul><ul><li>2. Dysnea </li></ul><ul><li>3. cyanosis ...
ISCHEMIC HEART DISEASES <ul><li>Mode of presentation of  ischemic heart disease: </li></ul><ul><li>1. Angina pectoris </li...
ANGINA PECTORIS <ul><li>It is a myocardial ischemia resulting from imbalance between coronary blood flow & oxygen demand <...
<ul><li>DENTAL MANAGENT OF ANGINA: </li></ul><ul><li>Medical consultation </li></ul><ul><li>Appointment </li></ul><ul><li>...
MYOCARDIAL INFARCTION <ul><li>It results from occlusion of coronary artery  </li></ul><ul><li>By a thrombus so deficient c...
CONGESTIVE HEART FAILURE <ul><li>It is the ability of heart to pump sufficient blood to meet the metabolic needs of the he...
HYPERTENSIVE DISEASES <ul><li>Hypertension is used to describe patient with blood pressure more than 140/90 mmHg </li></ul...
RHEUMATIC HEART DISEASE <ul><li>It is an acute inflammatory condition,  due to strep. Pharngitis infection following sore ...
PROPHYLACTIC ANTIBIOTIC REGIMEN FOR CARDIAC PT. <ul><li>1.  Under L.A </li></ul><ul><li>a)  Adults---- 2gm Amoxicillin or ...
IF PATIENT IS ALLERGIC: Adult  --------- Clindamycin 600 mg  OR Asathromycin 500 mg  OR Cephazolin  1 gm  (1 hour before t...
<ul><li>2. Under G.A </li></ul><ul><li>Adults----- 1gm Amoxicillin I.V at  induction. </li></ul><ul><li>OR  3gm Amoxicilli...
b) Children ------ (5–10 years)1/2 adult  (< 5 years) 1/4 adult
RESPIRATORY DISORDERS <ul><li>Common symptoms : </li></ul><ul><li>1. cough. </li></ul><ul><li>2. wheezing. </li></ul><ul><...
BRONCHIAL ASTHMA <ul><li>It is due to bronchospasm or hyperirritability of the tracheo_bronchial tree. </li></ul><ul><li>P...
<ul><li>Dental management </li></ul><ul><li>Medical consultation. </li></ul><ul><li>stress & anxiety. </li></ul><ul><li>Lo...
TUBERCULOSIS <ul><li>Can affect any organ. </li></ul><ul><li>Highly infectious. </li></ul><ul><li>Caused by Mycobacterium ...
Dental management: 1.  Patient with active T.B. 2. Patient with past history of T.B. 3. Patient with positive tuberculin t...
LIVER DISORDERS <ul><li>Advanced liver diseases include:  </li></ul><ul><li>Liver cirrhosis  -  Jaundice </li></ul><ul><li...
Dental management <ul><li>Medical consultation. </li></ul><ul><li>Avoid drugs metabolized in liver: </li></ul><ul><li>L.A-...
VIRAL HEPATITIS   <ul><li>Dental management: </li></ul><ul><li>Patient with active hepatitis  </li></ul><ul><li>Carriers: ...
DIABETUS MELLITUS   <ul><li>It is characterized by persistent increase of blood glucose level. </li></ul><ul><li>It is the...
<ul><li>Oral manifestation: </li></ul><ul><li>1. Gingivitis </li></ul><ul><li>2. Alveolar bone resorption </li></ul><ul><l...
Dental management : 1. Appointment. 2. Premeditation 3. Local anesthesia. 4. Treatment procedure . 5.  Patient assessment.
CHRONIC RENAL FAILURE <ul><li>Dental management : </li></ul><ul><li>Patient with conservative treatment. </li></ul><ul><li...
THYROID GLAND DISORDER <ul><li>Dental management : </li></ul><ul><li>1. Uncontrolled or poorly controlled patient </li></u...
NEUROGENIC DISORDER (EPILEPSY)   <ul><li>Neurogenic disorder: is disorder of the brain. </li></ul><ul><li>Epilepsy: is the...
<ul><li>Dental management: </li></ul><ul><li>Past medical history. </li></ul><ul><li>In case of controlled patient. </li><...
N.B:   Dentist is no longer  treating   teeth  in patients, but rather  patients who have teeth .
THANK YOU
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DENTAL MANAGEMENT OF THE MEDICALLY COMPROMISED PATIENT DENTAL MANAGEMENT OF THE MEDICALLY COMPROMISED PATIENT

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DENTAL MANAGEMENT OF THE MEDICALLY COMPROMISED PATIENT DENTAL MANAGEMENT OF THE MEDICALLY COMPROMISED PATIENT

  1. 1. DENTAL MANAGEMENT OF THE MEDICALLY COMPROMISED PATIENT
  2. 2. <ul><li>Systemic diseases include : </li></ul><ul><li>1. cardiovascular diseases </li></ul><ul><li>2. respiratory diseases </li></ul><ul><li>3. liver diseases </li></ul><ul><li>4. endocrine diseases </li></ul><ul><li>5. renal diseases </li></ul><ul><li>6. neurogenic diseases </li></ul><ul><li>7. sexually transmitted diseases </li></ul><ul><li>8. blood diseases </li></ul><ul><li>9. pregnancy & breast feeding </li></ul>
  3. 3. Main signs & symptoms of C.V.S diseases <ul><li>1. Chest pain </li></ul><ul><li>2. Dysnea </li></ul><ul><li>3. cyanosis </li></ul><ul><li>4. palpitation </li></ul><ul><li>5. Syncope </li></ul><ul><li>6. Edema of ankles </li></ul><ul><li>7. Cold pale extremities </li></ul><ul><li>8. Clubbing fingers </li></ul><ul><li>9. Easy fatigue </li></ul>
  4. 4. ISCHEMIC HEART DISEASES <ul><li>Mode of presentation of ischemic heart disease: </li></ul><ul><li>1. Angina pectoris </li></ul><ul><li>2. Myocardial infarction </li></ul><ul><li>3. Acute coronary insufficiency </li></ul><ul><li>4. Cardiac arrhythmia </li></ul><ul><li>5. Heart failure </li></ul><ul><li>6. Sudden death ( cardiac arrest, ventricular fibrillation ) </li></ul><ul><li>7. Asymptomatic ( silent ) </li></ul>
  5. 5. ANGINA PECTORIS <ul><li>It is a myocardial ischemia resulting from imbalance between coronary blood flow & oxygen demand </li></ul>
  6. 6. <ul><li>DENTAL MANAGENT OF ANGINA: </li></ul><ul><li>Medical consultation </li></ul><ul><li>Appointment </li></ul><ul><li>Reduction of stress & anxiety </li></ul><ul><li>Local anesthesia </li></ul><ul><li>General anesthesia </li></ul><ul><li>Treatment procedures </li></ul><ul><li>Drugs used in treatment </li></ul><ul><li>If the attack developed </li></ul>
  7. 7. MYOCARDIAL INFARCTION <ul><li>It results from occlusion of coronary artery </li></ul><ul><li>By a thrombus so deficient coronary arterial blood supply to a region of myocardium that results in a cellular death & necrosis. </li></ul><ul><li>Dental management: </li></ul><ul><li>As angina pectoris except; </li></ul><ul><li>Drugs used in treatment. </li></ul>
  8. 8. CONGESTIVE HEART FAILURE <ul><li>It is the ability of heart to pump sufficient blood to meet the metabolic needs of the heart. </li></ul><ul><li>Dental management: </li></ul><ul><li>Same as angina except; 1.preoperative antibiotic. </li></ul><ul><li>2. Drugs used in treatment. </li></ul><ul><li>3. Management of complications if developed (attack) </li></ul>
  9. 9. HYPERTENSIVE DISEASES <ul><li>Hypertension is used to describe patient with blood pressure more than 140/90 mmHg </li></ul><ul><li>Dental management: </li></ul><ul><li>Same as angina except; </li></ul><ul><li>1. Local anesthesia. </li></ul><ul><li>2. General anesthesia. </li></ul><ul><li>3. treatment procedure. </li></ul>
  10. 10. RHEUMATIC HEART DISEASE <ul><li>It is an acute inflammatory condition, due to strep. Pharngitis infection following sore throat, result in scaring & calcification of valves followed by valvular stenosis. </li></ul><ul><li>Dental management . </li></ul><ul><li>1. Medical consultation. </li></ul><ul><li>2. Prophylactic antibiotic. </li></ul><ul><li>3. Mild tranquilizers (2-5 diazepam). </li></ul><ul><li>4. Short dental appointment. </li></ul>
  11. 11. PROPHYLACTIC ANTIBIOTIC REGIMEN FOR CARDIAC PT. <ul><li>1. Under L.A </li></ul><ul><li>a) Adults---- 2gm Amoxicillin or 2gm Ambicillin </li></ul><ul><li>(1 hour before treatment orally) OR </li></ul><ul><li>(1/2 hour ,,, ,,,,,,,,,,, injection) </li></ul><ul><li>B) Children----- 50 mg per Kg Amoxicillin or </li></ul><ul><li>Ambicillin </li></ul>
  12. 12. IF PATIENT IS ALLERGIC: Adult --------- Clindamycin 600 mg OR Asathromycin 500 mg OR Cephazolin 1 gm (1 hour before ttt. Orally) ( ½ ,,, ,,,, ,,, injection) Child --------- Clindamycin 20 mg per Kg. Asathromycin 15 mg per Kg.
  13. 13. <ul><li>2. Under G.A </li></ul><ul><li>Adults----- 1gm Amoxicillin I.V at induction. </li></ul><ul><li>OR 3gm Amoxicillin orally 4 hours before induction followed by 3gm Amoxicillin immediately after recovery. </li></ul><ul><li>OR 300mg Clindamycin I.M ½ hour before induction. </li></ul><ul><li>OR 300mg Clindamycin I/V at induction </li></ul>
  14. 14. b) Children ------ (5–10 years)1/2 adult (< 5 years) 1/4 adult
  15. 15. RESPIRATORY DISORDERS <ul><li>Common symptoms : </li></ul><ul><li>1. cough. </li></ul><ul><li>2. wheezing. </li></ul><ul><li>3. cyanosis. </li></ul><ul><li>4. finger clubbing. </li></ul><ul><li>AVOID </li></ul><ul><li>1. General anesthesia: leads to hypoxia . </li></ul><ul><li>2. Analgesics & narcotics: leads to respiratory depressants. </li></ul>
  16. 16. BRONCHIAL ASTHMA <ul><li>It is due to bronchospasm or hyperirritability of the tracheo_bronchial tree. </li></ul><ul><li>Patient is treated by: </li></ul><ul><li>1. Corticosteroids inhalators. </li></ul><ul><li>2. Bronchodilator. </li></ul><ul><li>3. Beta adrenergic stimulator. </li></ul>
  17. 17. <ul><li>Dental management </li></ul><ul><li>Medical consultation. </li></ul><ul><li>stress & anxiety. </li></ul><ul><li>Local anesthesia. </li></ul><ul><li>General anesthesia. </li></ul><ul><li>Drugs used in treatment. </li></ul><ul><li>Drugs given to patient. </li></ul>
  18. 18. TUBERCULOSIS <ul><li>Can affect any organ. </li></ul><ul><li>Highly infectious. </li></ul><ul><li>Caused by Mycobacterium T.B. </li></ul><ul><li>Transmitted by air born droplets. </li></ul>
  19. 19. Dental management: 1. Patient with active T.B. 2. Patient with past history of T.B. 3. Patient with positive tuberculin test. 4. Patient with signs & symptoms of T.B. 5. Strict aseptic technique.
  20. 20. LIVER DISORDERS <ul><li>Advanced liver diseases include: </li></ul><ul><li>Liver cirrhosis - Jaundice </li></ul><ul><li>Potential complications: </li></ul><ul><li>1 . Impaired drug detoxication e.g. sedative, analgesics, general anesthesia. </li></ul><ul><li>2. Bleeding disorders ( decrease clotting factors, excess fibrinolysis, impaired vitamin K absorption). </li></ul><ul><li>3. Transmission of viral hepatitis. </li></ul>
  21. 21. Dental management <ul><li>Medical consultation. </li></ul><ul><li>Avoid drugs metabolized in liver: </li></ul><ul><li>L.A------- Lidocaine, Mepicaine </li></ul><ul><li>Sedatives-------- Valium </li></ul><ul><li>antibiotics-------- Ampicillin </li></ul><ul><li>Analgesics------- Aspirin </li></ul><ul><li>3. Vit.k ----- 10 mg/day before surgery. </li></ul><ul><li>4. G.A ------ cause bleeding. </li></ul>
  22. 22. VIRAL HEPATITIS <ul><li>Dental management: </li></ul><ul><li>Patient with active hepatitis </li></ul><ul><li>Carriers: </li></ul><ul><li>a. low risk patient. </li></ul><ul><li>b. high risk patient. </li></ul>
  23. 23. DIABETUS MELLITUS <ul><li>It is characterized by persistent increase of blood glucose level. </li></ul><ul><li>It is the result of absolute or relative deficiency of insulin. </li></ul>
  24. 24. <ul><li>Oral manifestation: </li></ul><ul><li>1. Gingivitis </li></ul><ul><li>2. Alveolar bone resorption </li></ul><ul><li>3. Xerostomia </li></ul><ul><li>4. Delayed wound healing </li></ul><ul><li>5. Pulpitis in non carious tooth </li></ul><ul><li>6. Burning sensation in tongue </li></ul><ul><li>7. Acetone smell in breath </li></ul>
  25. 25. Dental management : 1. Appointment. 2. Premeditation 3. Local anesthesia. 4. Treatment procedure . 5. Patient assessment.
  26. 26. CHRONIC RENAL FAILURE <ul><li>Dental management : </li></ul><ul><li>Patient with conservative treatment. </li></ul><ul><li>Patient with hemodialysis. </li></ul><ul><li>Patient with kidney transplant. </li></ul><ul><li>Emergency treatment. </li></ul>
  27. 27. THYROID GLAND DISORDER <ul><li>Dental management : </li></ul><ul><li>1. Uncontrolled or poorly controlled patient </li></ul><ul><li>2. patient with thyrotoxicosis. </li></ul><ul><li>Antithyroid drugs may couse leucopenic aplastic anemia. </li></ul><ul><li>Management of thyroid crises </li></ul><ul><li>Ant thyroid drugs 2. Hydrocortisone </li></ul><ul><li>3. I.V. glucose 4. Oxygen administration </li></ul><ul><li>5. Cooling to decrease temp. of body. </li></ul>
  28. 28. NEUROGENIC DISORDER (EPILEPSY) <ul><li>Neurogenic disorder: is disorder of the brain. </li></ul><ul><li>Epilepsy: is the most common neurogenic disorder the dentist may face in his clinic. </li></ul><ul><li>Potential problems: </li></ul><ul><li>Precipitation of the attack. </li></ul><ul><li>Problems of drugs taken a) Dilantin------- gingival hyperplasia b) Depakene------- bleeding tendancy </li></ul>
  29. 29. <ul><li>Dental management: </li></ul><ul><li>Past medical history. </li></ul><ul><li>In case of controlled patient. </li></ul><ul><li>In case of uncontrolled patient. </li></ul><ul><li>Management of attack if developed. </li></ul>
  30. 30. N.B: Dentist is no longer treating teeth in patients, but rather patients who have teeth .
  31. 31. THANK YOU

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