The document provides guidelines for dentists treating medically compromised patients to avoid complications. For all patients, dentists should consult physicians, use stress reduction protocols, proper pain control and sedation if needed. Specific guidelines are given for treating patients with diabetes, heart failure, and COPD. For diabetes patients, appointments should avoid peak insulin periods and blood sugar should be checked. For heart failure and COPD patients, medical conditions must be well-controlled before dental treatment and risks of stress and drug interactions considered.

1. How to avoid and prevent the
complications of medically
compromised patient

2. In general for any medically compromised patients the
dentist should consult the Physician and follow the
stress reduction protocol :
• Morning, short dental visits
• Shortens waiting time
• Proper communication skills with patients
• Proper pain control before, during, and after procedures
• Avoid sudden maneuver during procedures
• Sedations, if not contraindicated, are used with sever anxiety

3. Diabetes mellitus : is a group of metabolic
diseases that lead to high levels of blood glucose
Diabetes mellitus :

4. How to avoid the complications ?
As with any patient, the dentist should:
• Review the patient’s medical history
• Take vital signs
• Evaluate for oral signs and symptoms of inadequately controlled diabetes, which
may be common.
• Oral manifestations of uncontrolled diabetes can include xerostomia, burning
sensation in the mouth (which may possibly be related to neuropathy), impaired/
delayed wound healing, increased incidence and severity of infections, secondary
infection with candidiasis; parotid salivary gland enlargement; gingivitis and/or
periodontitis.
Diabetes mellitus :

5. For the vital signs:
Diabetes mellitus :

6. How to prevent the complications?
Diabetes mellitus :
1. In general, morning appointments are advisable in patients with diabetes since endogenous cortisol
levels are typically higher at this time; because cortisol increases blood sugar levels, the risk of
hypoglycemia is less.
2. For patients using short- and/or long-acting insulin therapy, appointments should be scheduled so
they do not coincide with peak insulin activity, which increases the risk of hypoglycemia.
3. It is important to confirm that the patient has eaten normally prior to the appointment and has
taken all scheduled medications.
4. Measure thier blood suger prior the treatment
5. Having sugar available in some form in case of insulin reaction.
7. Regular Oral Hygiene visits (1 per 6 months).
8. If a procedure is planned with the expectation that the patient will alter normal eating habits ahead
of time (e.g., conscious sedation), diabetes medication dose may need to be modified in consultation
with the patient’s physician.

7. How to prevent the complications?
Diabetes mellitus :
1. Patients with well-controlled diabetes can usually be managed conventionally for most
surgical procedures.
2. If the patient’s food consumption will be affected after oral or dental surgery, a plan to
balance the patient’s diabetes medications and food intake should be established in advance.
3. Dentists should be careful on the side of caution when treating patients with marginally or
poorly controlled diabetes.
4. Coordination with the patient’s physician may be necessary to determine the patient’s health
status and whether planned dental treatment can be safely and effectively accomplished.
5. Physicians should make laboratory test results available to the dentist upon request, and
inform the dentist of any diabetic complications prior to dental procedures.
6. The physician may need to adjust the patient’s diabetes medication to help ensure sustained
metabolic control, before, during, and after surgical procedures.

8. Heart failure
is a chronic progressive condition that affects the pumping power of your heart muscles.

9. How to prevent the complications:
Heart failure
1. Detection of classification of patient for heart failure for quick assessment and possible referral to
physician and no routine dental care until patient under good medical management
2. Patients need to be under good medical management and the cause of heart failure and any other
complications must be controlled prior routine dental care including:
(Hypertension, Valvular disease (rheumatic heart disease) with premedication, Congenital heart
disease ,Myocardial infarction, Renal failure)
3. Assessment of oral manifestations of disease.
4. Assess for adverse events from medication

10. How to avoid the complications:
Heart failure
As with any patient, the dentist should:
• Review the patient’s medical history
• Avoidance of outpatient general anesthesia

11. COPD
COPD is a lung disease characterized by chronic obstruction of lung airflow that
interferes with normal breathing

12. How to prevent the complications:
COPD
1. Assessment of oral manifestations of COPD.
3. Detection of classification of patient for COPD for quick assessment and possible
referral to physician
4. No routine dental care until patient under good medical management

13. How to avoid the complications:
COPD
The dentist should bear in mind:
• Stresses increase:
• Drug interaction with bronchodilator
• The need for oxygen and adrenalin secretion
• Severe cough which interferes with performing the procedures
• Patients my not tolerate supine position
• Hypertension and/or cardiac comorbidity may develop
• Some patients take systemic corticosteroid (adrenal insufficiency)
• Review the patient’s medical history
• Evaluate for signs and symptoms

14. REFERENCES:
1. National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) Diabetes Statistics. June
2016. Accessed February 28, 2019.
2. Centers for Disease Control and Prevention (CDC) National Diabetes Statistics Report, 2017.
Atlanta, GA: U.S. Department of Health and Human Services 2017. Accessed February 28, 2019.
3. Kidambi S, Patel SB. Diabetes mellitus: considerations for dentistry. J Am Dent Assoc 2008;139
Suppl:8s-18s.
4. Kane SF. The effects of oral health on systemic health. Gen Dent 2017;65(6):30-34.