The document discusses various systemic medical conditions and considerations for dental treatment. It covers 17 different categories of conditions including cardiac diseases, blood disorders, diabetes, hepatitis, kidney disease, lung infections, pregnancy, menstruation, and more. For each condition, it outlines how the condition may impact dental treatment and provides recommendations such as using plain local anesthesia, consulting the physician, minimizing medications and stresses, and considering alternatives to extraction when possible.

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