What is a systemic condition that may require special considerations in the dental office?

Dental professionals can be the first to identify these oral manifestations and make early referrals to appropriate health professionals. Evidence suggesting systemic disease can be found in the mouth and adjacent structures (see Introduction to the Dental Patient Approach Introduction to the Dental Patient Approach). The doctor should always examine the mouth and be able to recognize major oral disorders, in particular possible oral cancers. However, consultation with a dentist is necessary to evaluate patients.

Read more and table Oral findings in systemic disorders (oral findings in systemic disorders). The dentist should consult a doctor when a systemic disorder is suspected, when the patient is taking certain drugs (p. e.g., warfarin, bisphosphonates) and when the patient's ability to withstand general anesthesia or extensive oral surgery should be evaluated. Certain medical conditions (and their treatment) predispose patients to dental problems or affect dental care.

People who have disorders that interfere with clotting (p. (e.g., hemophilia) Hemophilia are common hereditary bleeding disorders caused by coagulation factor VIII or IX deficiencies. The degree of factor deficiency determines the likelihood and severity of bleeding. Read more, acute leukemia Acute leukemia Leukemia Leukemia is a malignant condition that involves the excessive production of immature or abnormal leukocytes, which eventually suppresses the production of normal blood cells and causes symptoms.

Read more, thrombocytopenia Overview of platelet disorders Platelets are fragments of circulating cells that function in the coagulation system. Thrombopoietin helps control the number of circulating platelets by stimulating the bone marrow to produce megakaryocytes. (Read more) require medical consultation before undergoing dental procedures that may cause bleeding (p. e.g., extraction, mandibular blockage, dental cleaning).

Patients with hemophilia should be given coagulation factors before, during, and after an extraction and restorative dentistry that requires local anesthesia (p. e.g. fillings). Most hematologists prefer that patients with hemophilia, especially those who have developed factor inhibitors, receive local, infiltrative anesthetics rather than blockages for restorative dentistry.

Restorative dentistry can be performed in a dental office after consultation with a hematologist; however, if the patient has factor VIII and factor IX anticoagulant inhibitors, the circulating anticoagulants are usually autoantibodies that neutralize specific coagulation factors in vivo (for example, an autoantibody against factor VIII or factor V) or inhibit proteins bound to phospholipids. Read more, dentistry should be performed in a hospital under general anesthesia. Oral surgery should be performed in the hospital, in consultation with a hematologist. All patients with bleeding disorders should maintain a routine of regular, lifelong dental visits, including cleanings, fillings, topical fluoride, and preventive sealants, to avoid the need for extractions.

Congenital heart defect completely repaired with a prosthetic material or device (for 6 months after the procedure) The heart is better protected against low-grade bacteremia, which occurs in chronic dental conditions, when receiving dental treatment (with prophylaxis) than when it is not. Patients who are going to undergo heart valve surgery or repair congenital heart defects should undergo any necessary dental treatment before surgery. Although it is likely to have a marginal benefit, antibiotic prophylaxis is sometimes recommended in patients with hemodialysis referrals and within 2 years of receiving a major prosthesis (hip, knee, shoulder, elbow). The organisms that cause infections at these sites are almost always of dermal rather than oral origin.

The extraction of a tooth adjacent to a carcinoma of the gum, palate, or antrum facilitates the invasion of the socket (dental cavity) by the tumor. Therefore, a tooth should be extracted only during the course of definitive treatment. In patients with leukemia or agranulocytosis, infection can occur after an extraction, despite the use of antibiotics. People with immunity problems are prone to serious mucosal and periodontal infections caused by fungi, herpes and other viruses and, less commonly, by bacteria.

Infections can cause bleeding, delayed healing, or sepsis. Dysplastic or neoplastic oral lesions may develop after a few years of immunosuppression. People with AIDS can develop Kaposi's sarcoma, non-Hodgkin's lymphoma, hairy leukoplakia, candidiasis Candidiasis (mucocutaneous) Candidiasis. Candidiasis is an infection of the skin and mucous membranes by Candida species, most commonly Candida albicans.

Infections can occur anywhere and are most common in skin folds, digital. Read more, aphthous ulcers Recurrent aphthous stomatitis Recurrent aphthous stomatitis (RAS) is a common condition in which painful round or ovoid ulcers reappear on the oral mucosa. Read more, or a rapidly progressing form of periodontal disease, HIV-associated periodontitis Necrotitis is a chronic inflammatory oral disease that progressively destroys the supporting apparatus of the teeth. It usually occurs as a worsening of gingivitis and then, if left untreated, with.

Dental treatment can be complicated by some endocrine disorders. For example, people with hyperthyroidism. Hyperthyroidism Hyperthyroidism is characterized by hypermetabolism and high serum levels of free thyroid hormones. Symptoms include palpitations, fatigue, weight loss, heat intolerance, anxiety, and tremors.

Read more: You can develop tachycardia and excessive anxiety, as well as a thyroid storm if epinephrine is administered. Insulin needs may be reduced by eliminating oral infection in diabetics; it may be necessary to reduce the dose of insulin when food intake is limited due to pain after oral surgery. In people with diabetes, hyperglycemia, with subsequent polyuria, can cause dehydration, resulting in decreased salivary flow (xerostomia). Xerostomia is dry mouth caused by reduced or no saliva flow.

This condition can cause discomfort, interfere with speech and swallowing, make it difficult to wear dentures, and cause halitosis. Read more), which, together with high salivary glucose levels, contributes to tooth decay. Patients receiving corticosteroids and those with adrenal insufficiency Overview of adrenal function The adrenal glands, located in the cephalaceous part of each kidney (see figure Adrenal glands), consist of a cortical medulla. The adrenal cortex and adrenal medulla have a separate endocrine system.

Read more: You may require supplemental corticosteroids during major dental procedures. Patients with Cushing syndrome Cushing syndrome Cushing syndrome Cushing syndrome is a constellation of clinical abnormalities caused by chronically high levels of cortisol in the blood or related corticosteroids. Cushing's disease is Cushing's syndrome that results from. Read more or those taking corticosteroids may have alveolar bone loss, delayed wound healing and increased capillary fragility.

Patients with obstructive sleep apnea Obstructive sleep apnea (OSA) Obstructive sleep apnea (OSA) consists of multiple episodes of partial or total closure of the upper respiratory tract that occur during sleep and cause the interruption of breathing (defined as a period of. Read more People who cannot tolerate treatment with a continuous positive airway pressure (CPAP) or two-level (BiPAP) mask are sometimes treated with an intraoral device that expands the oropharynx. This treatment isn't as effective as CPAP, but more patients tolerate its use. Many medications cause dry mouth (xerostomia).

(Read more), which is a major health problem, especially in geriatric patients. The causative drugs usually have anticholinergic effects and include certain antidepressants, antipsychotics, diuretics, antihypertensives, anxiolytics and sedatives, nonsteroidal anti-inflammatory drugs (NSAIDs), antihistamines, and opioid pain relievers. Some anticancer drugs (p. (e.g., doxorubicin, 5-fluorouracil, bleomycin, dactinomycin, cytosine, arabinoside, methotrexate) cause stomatitis.

Oral inflammation and ulcers, known as stomatitis, can be mild and localized or severe and generalized. See also: Dental Patient Assessment and Gingivitis. Read more, which is worse in patients with pre-existing periodontal disease Periodontitis is a chronic inflammatory oral disease that progressively destroys the supporting apparatus of the teeth. Before prescribing such medications, oral prophylaxis should be completed and patients should be taught how to properly brush and floss their teeth.

Medications that interfere with clotting may need to be reduced or stopped before oral surgery. Patients taking aspirin, NSAIDs, or clopidogrel should stop taking them 4 days before undergoing dental surgery and can resume taking them once the bleeding stops. Most patients who take an oral anticoagulant and have a stable international standard quotient (INR) %26 lt 4 do not need to discontinue the drug before ambulatory dental surgery (including extraction) because the risk of significant bleeding is very small and the risk of thrombosis may increase if oral anticoagulants are temporarily discontinued. For people receiving hemodialysis Hemodialysis In hemodialysis, a patient's blood is pumped into a dialyzer that contains 2 compartments of liquid configured as bundles of hollow fiber capillary tubes or as parallel, interspersed sheets of semipermeables.

Read more, dental procedures should be performed the day after dialysis, when heparinization has decreased. Presented by Merck %26 Co, Inc. Learn more about the Merck handbooks and our commitment to global medical knowledge. While the idea that oral bacteria may contribute to disease in other parts of the body has been discussed at least since the late 19th century.1 Over the past few decades, several systemic diseases have been associated with oral health, in particular cardiovascular diseases and diabetes, 2-5 There are two mechanisms that have been hypothesized to explain the associations observed.

First, chronic inflammation in the oral cavity can increase levels of inflammatory markers in the bloodstream, affect the immune response, or increase the body's overall disease burden. Secondly, the oral cavity can act as a reservoir for pathogenic bacteria that can enter the bloodstream and affect systemic or distant pathologies (systemic endotoxemia or bacteremia). In 2000, the Surgeon General published a report on the state of oral health in the United States. Department of State, in which it recognized the association between periodontal disease and cardiovascular health, strokes, diabetes and adverse pregnancy outcomes, and in which more research was called for to determine if causality could be established.

4, 5 Despite the lack of evidence of a causal relationship between periodontal disease and other system health problems, the report highlighted that “oral health is an integral part of overall health.”. You can't be healthy without oral health. Systemic problems vary widely in terms of their relevance and impact on the dental treatment plan. Some conditions, such as mitral valve prolapse with regurgitation, trigger certain automatic modifications (antibiotic prophylaxis) to prevent bacterial endocarditis in the way dental care is provided.

Conditions such as arthritis or asthma, on the other hand, may or may not have a significant impact on dental treatment, depending on the nature and severity of the disease or condition. Until relatively recently, people with systemic diseases as serious as liver, kidney, or heart failure did not seek dental services unless they had an acute dental problem. A comprehensive study of the relationship with dental treatment planning for all major systemic disorders is beyond the scope of this book. Modifiable lifestyle-associated risk factors for periodontitis (and ACVD) should be addressed in the dental office and in the context of comprehensive periodontal therapy, i.

To ensure the safe administration of dental treatment and minimize postoperative problems, the dentist must be able to recognize when a patient needs or will benefit from systemic phase treatment.


were also increasingly paying attention to other factors that influenced the cause of certain oral conditions, such as genetics, chemotherapy and medications. Referring a child with generalized periodontitis to a doctor can help determine if periodontitis is a manifestation of a systemic disease. When treating patients with systemic conditions, dentists consult on the cause of less common dental diseases, possibly related to medical conditions, and in half of the cases they request clinical guidelines and evidence-based interventions to treat dental diseases with an established association with systemic conditions.

Performing this service is important for the patient's well-being and for the general management of risks in the dental office. Not only did they talk about these topics, but they also posted questions or asked their colleagues about a specific dental issue related to systemic conditions. Several items in the general medical history may indicate problems that may affect the provision of dental care. These preventive or treatment-oriented services may help prevent certain dental conditions after treatment, such as infection of exposed roots, dental abscesses and large carious lesions, or to manage persistent problems, such as radiation-induced xerostomia (dry mouth syndrome).

Other types of medical emergencies seen in dentistry include allergic reactions to medications and dental materials, chest pain, seizures, and difficulty breathing. Carefully asking all new patients about their level of dental anxiety and any previous history of syncope may indicate that the doctor should monitor the patient's anxiety or pay close attention to the position in the dental chair. .

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