Managing Patients with Medical Conditions

Molarcubs
Apr 1, 2023
1 min read

Updated: Nov 13, 2023

Dental patients may have pre-exisiting medical conditions. To ensure quality dental care, dental health professionals need to take extra precaution. Here are some of the most common medical conditions listed in alphabetical order. Learn about them and the current management strategies!

Nervous System Disorders

Alzheimer's Disease

About

Alzheimer's Disease is a progressive neurodegenerative disorder. The onset for Alzheimer's Disease is typically in a patient's 70s and 80s. Alzheimer's disease affects more women than men. This bias is usually due to women living to longer ages than men.

Oral Manifestations

As many patients with Alzheimer's disease are elderly and may be on other medications, this predisposes them to xerostomia.

Patient Management

Plan appointments early in the morning. Due to the Sundown Effect, patients may become more irritable and restless in the afternoon. Appointments should be kept as short as possible, particularly during the late stages of Alzheimer's Disease
Oral hygiene instructions should be tailored to the cognitive state of the patient. The caregiver team needs to be well-informed as well.
Consider equipment such as water flosser, Collis Curve toothbrush or electric toothbrush.
Consider salivary substitutes.

Parkinson's Disease

Oral Manifestations

Tremor is one of the early signs and typically affect the hands but also lips and tongue. Bradykinesia is another symptom which affects the facial muscles. Orofacial pain can also lead to discomfort in the temporomandibular joint (TMJ), dental fractures, trauma of soft tissue, restoration detachment and lack of lack of salivary control. This makes prosthetic restorations quite difficult. Parkinson’s medications can induce xerostomia, thus worsening oral conditions.

Patient Management

Due to a decrease in motor function, consider educating the patient on the use of an electric toothbrush with easy grip to maintain oral hygiene.

Stroke

Signs of stroke

Face – mouth droops

Arms – cannot life one arm

Speech – patient cant understand you

Time – call 000 immediately (most damage occurs in the next 48 hours)

Types

Haemorrhagic – vessel rupture

Ischaemia- blood clot

Patient Management

Reconsider the use of dentures. Facial nerve weakness can cause food debris on affected side so thickened flange is necessary.

Pharmaceutical Considerations

Do not give aspirin if the stroke is hemorrhagic.

Avoid blood pressure lowering drugs.

Manage well as risk of reoccurrence is higher in those with a history of stroke

Syncope

Types

Orthostatic hypotension: can occur when standing up after sitting down for an extended period in the dental chair. Indicates damage to sympathetic system

Vasovagal syncope: either as a reaction to pain, anxiety and fear before or during a dental procedure.

Management

If the patient feels faint:

Stop dental treatment

Raise patient legs

Place head below heart

Lay in supine position

Monitor heart rate (blood pressure if patient also unconscious)

If patient doesn’t gain consciousness

Call 000

Perform basic life support

Asthma

Asthma is a common lung condition whereby there is inflammation of the muscles of the airways causing constriction and difficulty breathing.

Medical Management

- Asthma patients usually take corticosteroid medications in the form of puffers.

- Puffers may be categories as

o Relivers (short-acting bronchodilators) such as Ventolin

o Preventers (longer-acting bronchodilators) such as fluticasone

o Dual Purpose Relievers help asthma – Combine budesonide/formoterol in a dual purpose reliver.

Dental Management

- Take an asthma history (past attack, medications, what triggers their asthma)

- Oral candidiasis may be more common for people using corticosteroid

- Avoid objects that may trigger their asthma

- Avoid drugs such as NSAIDS, aspirin

Management of Asthma attack.

Cease Dental treatment
Sit patient upright. Give patient reassurance and stay calm
Give 4 puffs of Ventolin through a spacer to the patient. One puff followed by 4 breaths.
Wait 4 minutes. If patient still cannot breathe call ambulance immediately and keep giving reliever till ambulance arrives

Cancer

Epilepsy

In case of epileptic attack, leave the patient to seize. This prevents unwanted damage to the patient.

Hypertension

Be aware that patient may be taking anticoagulants

Normal blood pressure levels are 120mmHg/ 80 mmHg. However, during dental appointments, there is additional stress, which contributes to blood pressure levels above 130mmHg/ 85mmHg.

When taking blood pressure levels, it is important to maintain a quiet environment.

Bleeding Disorders

Plan appointments early in the morning. This ensures sufficient time to manage medical emergencies should it arise. Haemophiliac patients have an 80% risk of developing a haematoma following a inferior alveolar nerve block. To prevent this, one must administer a Factor VIII infusion. For patients with bleeding disorders, it is necessary to consult with their physician and haematologist before proceeding. Bleeding disorders means that Septicel and haemostatic measures must be in place

Angina

About

Angina is a serious chest pain caused by reduced blood flow to the heart. It usually accompanies those who have coronary artery disease which is caused by plaque buildup around major blood vessels.

Patient Management

Early morning appointments
Ensure stress free environment
Sufficient anaesthesia
Have GTN available in case of an attack.
Treatment should be deferred for those who are unstable
Individuals may take blood thinner so bleeding risk should be assessed.

Managing an Angina Attack

STOP
CHECK PULSE AND CONSCIOUSNESS
GTN spray under tongue and repeat after 5 mins if pain persists. Maximum of two metered doses.
Call ambulance immediately (as precaution)
Begin CPR if pulse stops or breathing stops
If the patient recovers, do not continue dental treatment. Patient should be assessed medically and ensure that they travel home with a responsible adult.

Heart Conditions

Patient Management

Antibiotic prophylaxis is required 1h before the appointment for patients with previous infective carditis, rheumatic heart disease or prosthetic heart valves.

Warfarin is an anticoagulant medication mainly indicated for atrial fibrillation (AF), the presence of artificial heart valves, deep venous thrombosis (DVT), and pulmonary embolism (PE) Patients on warfarin must have their INR checked 24 hours before invasive procedures such as extractions and subgingival scaling. Their INR must be below 4.0 according to the Australian Oral and Dental Therapeutic Guidelines for the procedure to proceed. However, many clinicians cite 2.50 - 3.50 or below as the ideal. This is provided only if consultation with the GP and haematologist took place. If the INR is less than 2.0, it means that the medication is not working and this should conveyed to their doctor.

Cardiovascular Disorders

Gastrointestinal Disorders

Renal Disease

Renal Disease: The kidney is the filtration system of the human body and deteriorates with age and certain renal diseases. Medical Management: People with chronic renal disease will need regular dialysis while waiting for a kidney transplant. Oral consequences Greater bleeding tendency Hypertension Anaemia Drug intolerance Increased susceptibility to infections Presence of oral manifestation associated with the disease and its treatment Dental management - Consultation with the nephrologist - Platelet dysfunction and anaemia resulting in a bleeding tendency - Heparin anticoagulation is giving to patients having haemodialysis mean life of 4hrs. perform dental work on another day. - Some drugs must not be prescribed and need dose adjustment - A late of sign of CRD is renal osteodystrophy. Bone is weakened and more susceptible to fractures due to secondary hyperparathyroidism. Care is needed during dental extractures. - Immunosuppression may be required antibiotic prophylaxis prior to invasive dental treatment - DIGO of immunosuppressive drugs such as cyclosporin