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25 Cards in this Set
- Front
- Back
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Our Goals
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Evaluate any source of infection that may
compromise successful periodontal therapy and restore optimal oral health and function: • Thorough medical and dental history, including medications • Complete periodontal /dental charting • Physician consultation to corroborate medical history and coordinate dental and medical care • Arrange treatment… • Initiate preventive therapy… • Arrange follow up… |
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list the medically comprised patients
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• Cardiovascular diseases
• Endocrine Disorders • Renal Diseases • Liver Diseases • Pulmonary Diseases • Immunosuppression and Chemotherapy • Prosthetic Joint Replacement • Hemorrhagic Disorders • Infectious Diseases |
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Cardiovascular diseases
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• Hypertension
• Cerebrovascular Accident • Ischemic heart diseases • Infective Endocarditis |
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Hypertension
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• Primary (no underlying pathology, 95% )
• Secondary: underlying etiology can be found and often treated. (renal disease, endocrinologic changes, and neurogenic disorders) • In early hypertension, the patient may be asymptomatic • If not identified, diagnosed, and treated.. hypertension may persist and increase in severity, leading eventually to coronary artery disease, angina, myocardial infarction, congestive heart failure, cerebrovascular accident, or kidney failure. |
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List the three classifications of hypertension
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Systolic , Diastolic , dental treatment modification
1) Normal --> <120 and <80 ---- no changes in treatment 2) Prehypertension --> 120-139 or 80-89 -- : - no changes in dental treatment -see blood pressure at each appointment 3)stage 1 hypertesntion --> 140-159 or 90-99 -- : -no changes in dental treatment -inform patient of finding -routine medical consultaion / referral -monitor blood pressure each appointment - minimize stress 4)Stage 2 hypertenstion >= 160 or >= 100 ---- : -inforim patient - if systloic BP is < 180 and distaloic is <110 , peforme selective dental care ( routine exam prohphlyaxis , resotrative nonsurgical peridontics ) -if systoliac BP >= 180 or diastolaic >= 100 give immedate medical consultaion/referral and peform emergancy dental care ONLY to alevaite pain or miminze inflmmation --> to minimize stress ! |
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• Dental treatment for hypertensive
patients is generally safe as long as stress is minimized , true or false ? |
TRUE
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Local Anasethesia for hypersentive patients
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Local anesthesia: (epinephrine,
intravascular injection, stress..) • The smallest possible dose of epinephrine should be used • Local anesthesia without epinephrine may be used for short procedures (less than 30 minutes).. It is important to minimize pain.. (to avoid an increase in endogenous epinephrine) Aspiration before injection of local anesthetics is critical.. |
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List the anti-hypersenesitve drugs
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Antihypertensive drugs:
1. Postural hypotension 2. Depression 3. Nausea 4. Oral dryness 5. Lichenoid drug reactions 6. Gingival overgrowth |
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Infective Endocarditis
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Microorganisms colonize the damaged
endocardium or heart valves.. • The term infective endocarditis is preferred to the previous term bacterial endocarditis |
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Talk about the etiology of the inective endocarditis
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a-hemolytic streptococci (e.g., Streptococcus
viridans). However, nonstreptococcal organisms often found in the periodontal pocket have been increasingly implicated, including Eikenella corrodens, Actinobacillus actinomycetemcomitans, Capnocytophaga, and Lactobacillus species. |
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Periodontics treatment and IE
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1)Transient bacteremia,
2_American Heart Association (AHA) recommends antibiotic prophylaxis before procedures "associated with significant bleeding from hard or soft tissues, periodontal surgery, scaling and professional teeth cleaning. 3)• bacteremia may occur even in the absence of dental procedures 4)AHA states that patients who are at risk for IE should "establish and maintain the best possible oral health to reduce potential sources of bacterial seeding." 5)According to AHA new guidelines 2007, All dental procedures that involve manipulation of gingival tissue or the periapical region of teeth or perforation of the oral mucosa need prophylactic antibiotic coverage. |
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Procedures that don't need prophylaxis with IE
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• Routine anesthetic injections through noninfected tissue,
• Taking dental radiographs, • Placement of removable prosthodontic or orthodontic appliances, • Adjustment of orthodontic appliances, • Placement of orthodontic brackets, • Shedding of deciduous teeth, • Beeding from trauma to the lips or oral mucosa. |
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Talk about the managment of IE (part 1 )
the dr focused in these three : • Define the susceptible patient. • Provide oral hygiene instruction. • Prophylactic Antibiotics |
• Define the susceptible patient. (careful
medical history) Cardiac Conditions Associated for Which Prophylaxis Is Reasonable • Prosthetic cardiac valve • Previous IE • Congenital heart disease (CHD) -- Unrepaired cyanotic CHD, including palliative shunts -- Completely repaired congenital heart defect with prosthetic material or device, whether placed by surgery or by catheter intervention, during the first 6 months after the procedure -- Repaired CHD with residual defects at the site or adjacent to the site of a prosthetic patch or prosthetic device (which inhibit endothelialization) |
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Talk about the managment of IE ( DRUGS ) ( part 2 )
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Orally --> Amoxicillin 2g
can't take orally --> Ampicllin ( 2g IM or IV ) or Cafezolin or Creftitaxone (1g IM or IV ) . allergic to pencillines or ampicallin - orally taken --> Cephalexin ( 2g ) , Clindamycin ( 600mg ) or Azithromycin and Clarithormycin ( 500mg) allergic to pencillines or ampicallen and can't take orally ---> Cafezolin ( 1g IM or IV ) , Ceftrixone ( 1G IM or IV ) or Clindmycin ( 600 mg IM or IV ) |
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talk about the mangment of IE (part 3 )
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• Eliminate the infection associated with
periodontal disease. • Teeth with severe periodontitis and a poor prognosis may require extraction • All periodontal treatment procedures (including probing) require antibiotic prophylaxis • Pretreatment chlorohexidine mouth washes • Numerous procedures may be accomplished at each appointment • Post-operative antibiotics.. |
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List the endocrine disorders
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• Diabetes
• Hypoglycemia • Thyroid and Parathyroid Disorders • Adrenal Insufficiency |
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Diabetes
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• Increased blood glucose level..
• Absolute or relative deficiency of insulin.. • Insulin Dependent • Non-Insulin Dependent |
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Undiagnosed patient:
Intraoral signs of undiagnosed or poorly controlled diabetes include the following : |
• Gingivitis
• Alveolar bone resorption • Xerostomia • Delayed wound healing • Pulpitis in non carious teeth • Burning sensation • Acetone smell in breath.. |
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What should you do for an undiagonised DM patient with marked signs as in the previous question ?
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Thorough history is indicated and the following procedures
should be performed: • Consult the patient's physician.. • Analyze laboratory tests: … • Rule out acute orofacial infection or severe dental infection |
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Talk about the mangment of DM
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• Oral hygiene instructions,
• Mechanical debridement to remove local factors, • Regular maintenance.. • Periodontal infection may worsen glycemic control, and should be managed aggressively.. • HbA1c of <10% should be estabished before surgical treatment is performed.. • Systemic antibiotics are not needed routinely, • Tetracycline antibiotics in combination with scaling and root planing may positively influence glycemic control… • Prophylactic antibiotics (poor glycemic control ) • Frequent reevaluation after active therapy |
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talk about DM during the peridontal treatment
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• Check blood glucose before any long procedure to get a
baseline level. • Patients with blood glucose levels at or below the lower end of normal (70 mg/dl) before the procedure may become hypoglycemic intraoperatively. • Breakfast.. |
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what are the signs of hypo-glycemia
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• Shakiness or tremors
• Confusion • Anxiety • Sweeting • Tachycardia • Dizziness • Unconsciousness • seizures |
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What to do if hypoglycemia occurs during dental office ?
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1. Provide approximately:
• 15 g of oral carbohydrate to the patient: • 4 to 6 oz of juice or soda • 3 or 4 tsp of table sugar • Hard candy with 15 g of sugar 2. If the patient is unable to take food or drink by mouth, or if the patient is sedated: • Give 25 ml to 30 ml of 50% dextrose IV • Give 1 mg of glucagon IV • Give 1 mg of glucagon IM |
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Again .. our goals ...
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Evaluate any source of infection that may
compromise successful periodontal therapy and restore optimal oral health and function: • Thorough medical and dental history, including medications • Complete periodontal /dental charting.. • Physician consultation to corroborate medical history and coordinate dental and medical care… • Arrange treatment… • Initiate preventive therapy… • Arrange follow up… |
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medically compromised
patients |
medically compromised
patients • Cardiovascular diseases • Endocrine Disorders • Renal Diseases • Liver Diseases • Pulmonary Diseases • Immunosuppression and Chemotherapy • Prosthetic Joint Replacement • Hemorrhagic Disorders • Infectious Diseases |
