Dental Maintenance of the Medically Compromised Patient. More pathogenic biofilm means more oral inflammation, which, in turn, links directly with inflammatory disease: gum disease, bone loss, tooth loss and caries. Biofilm removal and control is an essential part of the oral health treatment plan.
Full Answer
How should the dentist evaluate the appropriate use of protective immobilization?
The dentist must communicate with the caregiver to evaluate the appropriateness of protective immobilization. The dentist should evaluate the patient’s emotional and cognitive levels and any past use of restraints. Another consideration is urgency of treatment (e.g., a dental emergency).
What is a mental illness and how does it affect the dentist?
Mental Illnesses can cause patients to be unmotivated or fearful of the dentist. Oftentimes, these patients have high rates of drug and alcohol use, leading to other systemic complications and noncompliance. 9
How do medical conditions and drugs affect oral health?
Some medical conditions and drugs can affect your oral health. Or they may affect the treatment you get and the materials your dental team use. So when you visit your dental team, they will ask you about your medical history – that is, any medical conditions or allergies you have, and any treatments you are having or have had.
What are the causes of poor oral hygiene?
Clinicians should identify the reasons for poor oral care. It could be a combination of a diet high in sugar or acidic substances, inability to brush or floss, or not knowing the importance of oral hygiene.
Medically Compromised Patients
Regular dental care is not always routine for some patients. Our specialized dental practitioners often provide oral health care to patients with:
What kind of dental care will I receive?
We provide patients with serious health care issues routine dental care; however, we work with your physician (s) to ensure our work aids your treatment and recovery. We will probably recommend you have cleanings and checkups more often to maintain the health of your mouth and teeth.
Are you a patient at The Johns Hopkins Hospital?
As a Johns Hopkins patient, we offer you the convenience to schedule your physician and dental appointments on the same day.
Can dental erosion cause asthma?
32. –Recently a study has been published linking dental erosion with asthma •Could be due to gastro- oesophageal reflux in asthmatics •Or acidic long term medication •Or to increased consumption of erosive beverages due to ‘drying’ of oral mucosa by inhalers •Paediatric Dentistry, 3rd Edition, by Richard Welbury and Monty Duggal, 2005 •Dental erosion in asthma: a case-control study from south east Queensland, Sivasithamparam K et al, Aust Dent J, 2002, Dec;47 (4):298-303 32
Can dental treatment cause emotional stress?
31. • Dental management of asthma –Dental treatment can cause emotional stress -> attack –Child may take puff of their inhaler before starting dental treatment –Use analgesics and sedatives with caution; opioids and sedatives decrease respiratory drive. 31 Paediatric Dentistry, 3rd Edition, by Richard Welbury and Monty Duggal, 2005
What antibiotics are used in endodontics?
Antibiotics: The most common antibiotics used in endodontics include penicillin, amoxicillin, clindamycin and amoxicillin/claveulenic acid (Augmentin). Occasionally, other classes of drugs are used including macrolides, fluroquninolones and tetracyclines. Recently, fluoroquinolones have been singled out for their side effects and thus are not recommended to be used except for advanced disease. In patients with chronic renal disease, it is best to avoid drugs that are eliminated and metabolized by the kidneys. Clindamycin should be considered in the management of endodontic infections in a patient with advanced renal disease.
What is the duty of an endodontist?
In conclusion, it is our duty as specialists to provide the pinnacle of endodontic care for our patients. As modern medicine continues to advance with an aging population, we must remain vigilant and well educated concerning the medical complexities or our patients. As with most things endodontic, the details make the difference!
Can a dentist measure blood pressure?
A proper clinical examination includes the measurement of vital signs. Often patients are surprised that a dentist is interested in measuring blood pressure, and this creates a timely opportunity for thorough medical history review. While there are no strict contraindications to endodontic treatment for patients with elevated blood pressure readings, it is advisable that elective treatment is deferred for values greater than 180/110 mmHg to minimize risk of an adverse cardiac event. However, any elevated reading warrants a referral to a primary care physician for evaluation and possible treatment.
Does dental anxiety cause syncope?
We know that dental anxiety alone can result in increased blood pressure, syncope, irritability and diaphoresis. However, underlying medical conditions such as hypertension, diabetes and thyroid abnormalities, to list a few, may also be associated with the same manifestations.
Can endodontics cause hypoglycemic episodes?
Endodontic treatment can certainly disrupt a patient’s normal routine, and even well-controlled diabetic patients are subject to adverse events. One may simply fail to eat prior to the appointment, and even a minimal amount of stress can result in a hypoglycemic episode. Obviously, having a form of sugar available during treatment is recommended. Furthermore, inquiring about the patient’s current HbA1C levels guides the practitioner in potential treatment modifications, especially when considering surgical options or evaluating the outcome of prior treatment.
Medically Compromised Children
Medically compromised children can be challenging to treat and can affect the provision of dental care. To treat medically compromised patients safely it is important to:
Bleeding Disorders
This is an X-linked recessive disorder which leads to a decrease in levels of clotting factor VIII. It is passed from mothers to sons and affects 1:10,000 live births. Daughters of a father with Haemophilia A are obligate carriers. The disease may be classified as mild, moderate or severe depending on circulating factor VIII levels
Other Common Disorders
Leukaemia is a type of cancer of the blood or bone marrow characterised by an abnormal increase of immature white blood cells known as lymphoblasts. Acute lymphoblastic leukaemia ( ALL) is the most common form of childhood cancer accounting for 75% of childhood leukaemia.
Why do people need dental care?
Caregivers often bring in noncommunicative patients after they have stopped eating and are losing weight due to lack of nutrition. Another reason individuals with complex health needs pursue oral care is due to a physician’s request for dental clearance prior to cardiac or transplant surgery, chemotherapy and/or radiation treatment.
Why is it important to prepare dental teams for special care?
Preparing dental teams and clinics for the provision of special care dentistry can help improve the oral and systemic health of this patient population.
How can a dentist help with special needs?
Dentists can fill the void in dental care for these individuals by making sure the office can accommodate patients with complex needs, understanding the patient’s medical and dental histories, and making modifications to dental treatment. Caring for these patients often requires collaborating with other health care professionals and using specialized resources (such as the Special Care Dental Association and American Dental Association) to ensure optimal oral health outcomes.
What is special needs dentistry?
S pecial care dentistry is the branch of oral health care that treats people with special needs, including those with physical, medical, developmental or cognitive conditions that limit their ability to receive routine dental care. 1 The 2010 U.S. census reports that about 56.7 million Americans — or one out of every five — live with a disability. 2 The Americans with Disabilities Act defines a person with a disability as someone with physical or mental impairment that substantially limits one or more major life activities. 3 Additionally, as patients continue to live longer, their health histories become more complex. Unfortunately, people with special needs often report difficulties finding dentists who are willing to treat them, leading to increased rates of periodontal disease, caries and other oral problems. 4,5 This article will explore treating adult patients with special needs and complex medical conditions. It will also review the process of evaluating special needs, accessing a patient’s level of cooperation, treatment planning, management techniques and sedation.
How to use behavioral management in pediatric dentistry?
Behavioral management techniques used in pediatric dentistry can often be applied to people with special needs , particularly on patients with intellectual disabilities. Throughout the procedure, the team should provide positive reinforcement. 18 Depending on the patient’s cognitive level, the dentist might have to repeat instructions several times. Direct observation can help patients who have not received significant dental care in the past; this involves allowing patients to watch a video or a patient directly being treated. 18 Having the patient’s caretaker pose as a patient in the dental chair, and permitting the patient to touch the chair, air-water syringes and lights can make a hesitant patient more relaxed. Patients who can communicate should be encouraged to ask questions.
What should a receptionist do when a patient with special needs contacts the clinic?
When a patient with special needs contacts the clinic, the receptionist should ascertain as much information as possible. Typically, a patient or caregiver can describe the patient’s major medical concerns, any requested accommodations, and preferred appointment timing. The patient should be instructed to bring contact information for his or her physician (s) to the first appointment in case a medical consultation is necessary.
Why should a recall interval be established for routine cleanings and periodic exams?
Establish a Maintenance Schedule: In an effort to prevent additional dental problems, a recall interval should be established for routine cleanings and periodic exams.
