Dental Considerations For Medically Compromised Patients

Front 1

copd

Back 1

asthma/emphazema/bronchitis
sit patient upright
no rubber dam
no n2o
avoid barbiturates, narcotics, anti histamines
avoid erythromycin, clarithromycin if patient takes theophyline

Front 2

asthma

Back 2

make sure pt has inhaler
avoid aspirin,
avoid sulfite containing local
can use n2o or diazepam
use pulse oxometer if necessery

Front 3

tuberculosis

Back 3

active- consult with physician before treatment, only emergencies
inactive-treat as normal patient
may be taking isoniazid for 6 months to a year prophylactically

Front 4

viral hepatitis (bcde)

Back 4

active- consult with physician, emergency only
inactive- treat as normal

Front 5

hyperthyroidism

Back 5

avoid eli and other vasoconstrictors in untreated patients

Front 6

hemodialysis

Back 6

wait at least 4 hours after dialysis, should wait till next day
pre-treatment screen for bleeding disorders
avoid drugs metabolized by kidneys
avoid bp cuff on arm containing shunt
no routine dental care contraindications

Front 7

end stage renal disease

Back 7

consult with dr for hematologic disorders
check bp before and during and treatment
avoid drugs excreted by kidney or nephrotoxic drugs
extensive reconstructive crown and bridge not recommended

Front 8

seizure

Back 8

get bleeding time for patines on valproic acid
no aspirin or nsaids
no propoxyphene and erythromycin for paints taking carbamazepine
use bite block
use metal instead of porcelain

Front 9

what to expect with radiation patients

Back 9

mucositis, zerostomia, taste loss, trismus, candidiasis, secondary infections, cervical caries, osteoradionecrosis

Front 10

head and neck radiation

Back 10

have patient come every 3-4 months, use flu ride, and chi for plaque and candidiasis control

Front 11

chemotherapy patients

Back 11

eliminate all oral infections and treat advanced caries
use topical fluoride and chi
rx rinses for mucositis and xerostomia

Front 12

blood pressure numbers

Back 12

normal <120 and <80
pre-hypertensive 120-139 or 80-89
stage 1 140-159 or 90-99
stage 2 >160 or >100

Front 13

hypertension

Back 13

send for medical eval if 180/110 before treatment
avoid orthostatic hypotension (change chair position slowly)
use minimal epi, no cord with eli
caution using eli with patients taking non selective beta blockers
reduce dosage of barbiturates/sedatives whose action can be enhanced by anti-hypertensive agents

Front 14

stroke history

Back 14

no elective care for current transiend ischemic attacks-delay treatment for 6 months
consider panorex periodically to assess carotid artery patency
short morning appts
no epi in retraction cord

Front 15

hemophilia

Back 15

prolonged bleeding
no dental procedures until cleared with physician

Front 16

von willebrands disease

Back 16

avoid aspirin nsaids
can use tylenol with codeine or cox 2 inhibitors )celecoxib, rofecoxib)
screen prolonged bleeding time pfa=100
or prolonged partial thromboplastin time

Front 17

anti coagulation

Back 17

no dental procedures until medical consult done
check pt time
may have to delay procedure 2-3 days if anti coagulation meds have to be reduced

Front 18

acceptable prothrombin time

Back 18

pt 2.5 or less, or int is 3.5 or less