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Medically Compromised Patients Medicine

At a glance: what are the common medical conditions that predispose patients to dental problems?

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This post is based on the section on “Dental care for patients with systemic disorders” of the MERCK Manual website

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Hematological Disorders

Disorders that interfere with coagulation which require consultation with the patient’s general practitioner. 

Cardiovascular Disorders

Cardiovascular disease is a disease of the heart blood vessels which includes numerous problems. Many of these problems are related to a process called atherosclerosis, a condition that develops when a substance called plaque builds up in the walls of the arteries. 

Cancer

Extracting a tooth adjacent to a carcinoma of the gingiva, palate, or antrum facilitates invasion of the alveolus (tooth socket) by the tumor. Therefore, a tooth should be extracted only during the course of definitive treatment. In patients with leukemia or agranulocytosis, infection may follow an extraction despite the use of antibiotics.

Immunosuppression

People with impaired immunity are prone to severe mucosal and periodontal infections by fungi, herpes and other viruses, and, less commonly, bacteria.

Endocrine Disorders

Dental treatment may be complicated by some endocrine disorders, such as people with hyperthyroidism developing tachycardia, people with diabetes, hyperglycemia, and people with adrenocortical insufficiency.

Neurologic Disorders

Patients with seizures who require dental appliances should have non-removable appliances that cannot be swallowed or aspirated.

Obstructive Sleep Apnea

Patients with obstructive sleep apnea who are unable to tolerate treatment with a positive airway pressure (CPAP, biPAP) mask are sometimes treated with an intraoral device that expands the oropharynx.

Radiation Therapy

Extraction of teeth from irradiated tissues, particularly if the total dose was > 65 Gy, especially in the mandible is commonly followed by osteoradionecrosis of the jaw. This is a complication in which extraction sites break down, frequently sloughing bone and soft tissue.

 

Resources

  1. Merck manual: Systemic Disorders and the Mouth accessed on August 30, 2013.
  2. The American heart Association accessed on August 30, 2013.

 

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