Dental management of medically compromised patients

Information about Dental management of medically compromised patients

Published on March 2, 2012

Author: drrachitwalia



PowerPoint Presentation: GOOD MORNING PowerPoint Presentation: Dental management of Medically compromised patients PowerPoint Presentation: Medically Compromised Conditions Cardiovascular Disorders Disorders of Blood Respiratory Disorders Metabolic & Endocrine Disorders Renal Disorders Neoplasms PowerPoint Presentation: Chromosomal Disorders Neurological Disorders Neuromuscular Disorders Musculoskeletal Disorders Dermatological Disorders Sensory Disturbances Infections Pregnancy Medically compromised conditions.. PowerPoint Presentation: Cardiovascular Disorders Conditions that affect the Heart and Blood vessels. Can be: Congenital Acquired Dental Care: Dental Care Anxiety & Pain increases load on the heart. Premedicate with 5mg Diazepam orally. Cardiovascular Disorders… PowerPoint Presentation: Prefer Local Anaesthesia. Methohexitone (Respiratory Depressant) Cardiovascular Disorders… Dental Care… PowerPoint Presentation: Avoid multiple extractions. Patients are on Anti Coagulant therapy. Application of Antiseptic before dental treatment. Cardiovascular Disorders… Dental Care… Infective Endocarditis: Infective Endocarditis Inflammation of Endothelial lining of the Heart. Predisposing Factors : Cardiac Lesion Bacteraemia Most Common : Streptococcus viridans Cardiovascular Disorders… PowerPoint Presentation: Micro-org in blood Bacteremia Infective Endocarditis… PowerPoint Presentation: Rate of incidence of Infective Endocarditis is found to be 16 cases per million per annum as per according to a community study. Infective Endocarditis… Cardiovascular Disorders… PowerPoint Presentation: Conditions not at risk of Infective Endocarditis Angioplasty Coronary By – Pass Rheumatic fever without Rheumatic Heart Disease. Mitral Valve Prolapse without Regurgitation. Cardiovascular Disorders… Infective Endocarditis Conditions at risk of Infective Endocarditis: Conditions at risk of Infective Endocarditis Cardiac Valvular defects Rheumatic Heart disease Prosthetic Cardiac valves Cardiovascular Disorders… Infective Endocarditis PowerPoint Presentation: H/o Endocarditis Hypertrophic Cardiac Myopathy Mitral Valve Prolapse with Regurgitation Cardiovascular Disorders… Conditions at risk…. Infective Endocarditis PowerPoint Presentation: Dental Care … Antibiotic prophylaxis is necessary for Invasive dental treatment Sub – gingival Scaling Periodontal surgeries Endodontic treatment Extractions Distal shoe Cardiovascular Disorders… Infective Endocarditis PowerPoint Presentation: Standard Oral Regimen : Amoxicillin : Adults : 2g single oral dose 1hr. before dental procedures. Children : 50mg/kg body wt. but not exceeding the Adult Dose. Cardiovascular Disorders… Antibiotic prophylaxis.. PowerPoint Presentation: Patients allergic to Penicillin / Amoxicillin Clindamycin Adults : 600mg single oral dose 1hr prior to dental procedure. Children : 6mg/kg body wt. Single oral dose 1hr before dental procedure . Cardiovascular Disorders… Antibiotic prophylaxis… PowerPoint Presentation: Azithromycin 500 mg 1 hr before procedure. Cephalexin 2g 1 hr before the procedure. Antibiotic prophylaxis… Cardiovascular Disorders… Unable to take oral medications : Unable to take oral medications Ampicillin 2g IM / IV 30 minutes before procedure. Clindamycin 600mg IV 30 minutes before procedure . Cefazolin 1g IM / IV 30 minutes before procedure. Cardiovascular Disorders… Antibiotic prophylaxis… Procedure prevalence of Bacteremia: Procedure prevalence of Bacteremia Extraction - single multiple PDL surgery Oral prophylaxis Endodontic surgery Toothbrushing Dental flossing Irrigation devices Chewing 51% 68-100% 36-88% 8-80% 83% 0-26% 20-58% 7-50% 17-51% Cardiovascular Disorders… Infective Endocarditis PowerPoint Presentation: HYPERTENSION Systolic blood pressure of 140mm Hg or greater or a Diastolic blood pressure of 90mm Hg or greater. Cardiovascular Disorders… PowerPoint Presentation: Dental care Stress & anxiety related to dental visit may cause increase in blood pressure. Short appointments – Afternoon. HYPERTENSION.. Cardiovascular Disorders… PowerPoint Presentation: NSAID’s : Aspirin & Diclofenac Sodium are Contraindicated. Do not use Topical Vasopressors to control local bleeding. Cardiovascular Disorders… Dental Care… HYPERTENSION.. PowerPoint Presentation: Avoid orthostatic hypotension - change chair position slowly and support patient when getting out of chair. HYPERTENSION… Dental care.. Cardiovascular Disorders… PowerPoint Presentation: Cardiovascular Disorders… HYPERTENSION… Drug considerations Use L.A with minimal concentration of Vasopressor ( adrenaline1:200000) Aspirate & Inject slowly. PowerPoint Presentation: Dental care.. HYPERTENSION… Cardiovascular Disorders… G.A contraindicated : Malignant Hypertension Renal Insufficiency Coronary or Cerebral Artery Insufficiency PowerPoint Presentation: CORONARY ARTERY DISEASE Lumina of arteries is reduced resulting in deprivation of oxygen to myocardium. Angina Pectoris may be the first symptom. Cardiovascular Disorders… PowerPoint Presentation: Increased incidence in smokers and alcoholics. Greater the number of cigarettes smoked higher the risk. CORONARY ARTERY DISEASE… Cardiovascular Disorders… Dental Care: Dental Care Patients with Unstable Angina : Only emergency treatment. Patients with Stable Angina : Can undergo elective dental treatment. Cardiovascular Disorders… CORONARY ARTERY DISEASE… PowerPoint Presentation: Short appointments Reduce stress Conscious sedation Cardiovascular Disorders… CORONARY ARTERY DISEASE… Dental Care… PowerPoint Presentation: Supplemental O 2. L.A with Adrenaline Anti Coagulant Therapy Avoid Multiple Extractions Cardiovascular Disorders… Dental Care… CORONARY ARTERY DISEASE… Anginal episode in dental chair: Anginal episode in dental chair Discontinue procedure Administer 1 tab (0.3-0.6mg) Nitroglycerine Reassure patient Loosen restrictive garments Administer O 2 Cardiovascular Disorders… CORONARY ARTERY DISEASE… Dental Care… PowerPoint Presentation: Patient not relieved by 3 tablets of Nitroglycerine indicates Myocardial Infarction. Cardiovascular Disorders… CORONARY ARTERY DISEASE… Dental Care… PowerPoint Presentation: Dental Care… Patients with history of MI within previous 3-6 months should not receive routine dental treatment. CORONARY ARTERY DISEASE… Cardiovascular Disorders… PowerPoint Presentation: Pacemakers Used in management of abnormalities in conductive system of the heart. Cardiovascular Disorders… PowerPoint Presentation: DENTAL CARE Electromagnetic interference from non- cardiac electrical signals may interfere with those of Pacemaker. Certain Pulp testers, Cavitron scalers & Electrocautery may cause problems. Cardiovascular Disorders… Pacemakers PowerPoint Presentation: DISORDERS OF BLOOD PowerPoint Presentation: Coagulation Disorders : Hemophilia Hemophilia A Hemophilia B Hemophilia C Von willebrand’s disease DISORDERS OF BLOOD… PowerPoint Presentation: Pulp treatment of primary teeth, if indicated is to be done to avoid extractions. Primary teeth when shed in normal way cause little or no hemorrhage. However, if very mobile, extraction may be necessary. DISORDERS OF BLOOD… HAEMOPHILIA.. Dental Care PowerPoint Presentation: Never give Inferior dental nerve blocks as bleeding in Pterygomandibular region may result in Asphyxia. Haemostatic agents to be administered during periodontal procedures. DISORDERS OF BLOOD… HAEMOPHILIA Dental Care.. PowerPoint Presentation: Extraction -adequate replacement therapy and careful monitoring of factor VIII and factor IX levels. Acrylic Splint – To maintain Clot in place. DISORDERS OF BLOOD… HAEMOPHILIA Dental Care.. PowerPoint Presentation: Surgical procedures : Factor VIII : at least 30% Factor IX : at least 30-50% Factor VIII : Parenteral 1-deamino 8-D arginine vasopressin Factor IX : Purified prothrombin complex concentrates. DISORDERS OF BLOOD… HAEMOPHILIA Dental Care.. PowerPoint Presentation: Routine therapy with Anti-fibrinolytic agents: Tranexamic acid Epsilon Aminocaproic acid Prior to and for a few days following the procedure. DISORDERS OF BLOOD… HAEMOPHILIA Dental Care… PowerPoint Presentation: Dental Care.. DISORDERS OF BLOOD… HAEMOPHILIA Medications containing aspirin (salicylates) must not be prescribed. Paracetamol compounds – safe. Non-steroidal anti-inflammatory drugs are contraindicated. Avoid Saliva Ejectors. PowerPoint Presentation: Preventive treatment is important. Topical / Systemic fluorides at regular intervals. DISORDERS OF BLOOD… HAEMOPHILIA Dental Care.. PowerPoint Presentation: Bite wing radiographs should be taken at regular intervals . Careful application of matrix bands and retainer. DISORDERS OF BLOOD… HAEMOPHILIA.. Dental Care.. PowerPoint Presentation: THROMBOCYTOPENIA Reduction in number of platelets (Normal range : 1.5 - 4.0 lac/mm 3 ) DISORDERS OF BLOOD… PowerPoint Presentation: Characterized by : Petectial Hemorrhages Haematemesis Hematuria Malena Sub mucosal hemorrhage in palate DISORDERS OF BLOOD… THROMBOCYTOPENIA PowerPoint Presentation: THROMBOCYTOPENIA DISORDERS OF BLOOD… Dental Care Platelet count should be estimated. Scaling & Root planing – 60,000/mm 3 Surgical Procedures – 80,000/mm 3 Corticosteroids (Prednisolone) – Increase platelet count. PowerPoint Presentation: Infiltration anesthesia, Scaling, Root planing : INR < 3.0 Block anesthesia, Minor surgery, Extractions : INR < 2.0 Major surgery : INR < 1.5 DISORDERS OF BLOOD… THROMBOCYTOPENIA Dental Care… PowerPoint Presentation: Surgical treatment should be as Atraumatic as possible. Local Hemostatic measures should be applied. Platelet transfusion may be required before surgery. DISORDERS OF BLOOD… THROMBOCYTOPENIA Dental Care… PowerPoint Presentation: SICKLE CELL ANAEMIA Clumped together, blocking small blood vessels, reduction in blood supply and thereby necrosis of tissue supplied. DISORDERS OF BLOOD… PowerPoint Presentation: Dental Care Level of Haemoglobin should be investigated before extraction or surgery. Level of Haemoglobin – S should be less than 30%. DISORDERS OF BLOOD… SICKLE CELL ANAEMIA PowerPoint Presentation: Poor healing may ensure after surgical dental procedures. L.A should be used in preference to G.A . Prophylactic Antibiotics. SICKLE CELL ANAEMIA DISORDERS OF BLOOD… Dental Care… PowerPoint Presentation: THALASSAEMIA Disorder of Haemoglobin synthesis. Expansion of medullary cavities of facial bones, which gives rise to expansion of maxilla, creating protrusion of middle third of face. DISORDERS OF BLOOD… PowerPoint Presentation: Dental Care Gradual expansion of maxilla obviously has repercussions as far as orthodontic management is concerned. HIV screening is must. DISORDERS OF BLOOD.. THALASSAEMIA PowerPoint Presentation: LEUKEMIA Malignant disease in which there is widespread proliferation of WBC’ s . Spontaneous haemorrhage from gingiva . DISORDERS OF BLOOD… PowerPoint Presentation: Dental Care No treatment should be carried out until the patient is in remission unless there is an emergency. DISORDERS OF BLOOD… LEUKEMIA PowerPoint Presentation: Swabbing the mouth with an antibacterial solution may help to prevent ulcers. Mouth washes with local anaesthetic properties may be beneficial. DISORDERS OF BLOOD… LEUKEMIA Dental Care… PowerPoint Presentation: Inferior dental blocks are contra indicated as there is possibility of deep hemorrhage. Bleeding time and platelet count should be checked before extractions or extensive scaling. Dental Care.. DISORDERS OF BLOOD… LEUKEMIA PowerPoint Presentation: Susceptible to infections - maintained on prophylactic antibiotics. If viral infections such as Herpetic gingival – stomatitis develop, then IV or Oral Acyclovir. If Candidial infections occur, Treat with Amphotericin B, Nystatin or Fluconazole. Dental Care.. DISORDERS OF BLOOD… LEUKEMIA PowerPoint Presentation: RESPIRATORY DISORDERS PowerPoint Presentation: ASTHMA Characterized by Expiratory Wheezing Breathlessness RESPIRATORY DISORDERS.. PowerPoint Presentation: Dental Care Stress free environment. Pre medicate anxious patient. RESPIRATORY DISORDERS.. ASTHMA PowerPoint Presentation: Numerous dental products : Tooth paste, Fissure sealants, Methyl methacrylates have been associated with exacerbation of Asthma. RESPIRATORY DISORDERS.. ASTHMA Dental Care… PowerPoint Presentation: Careful positioning of suction tips as they may elicit cough reflex. If on Oral Steroids & surgery is required –double the dose to avoid Adrenal Insufficiency. Bronchodilators – half life is 2-4 hrs so treatment should be done after taking medication. RESPIRATORY DISORDERS.. ASTHMA Dental Care… PowerPoint Presentation: Avoid respiratory depressant drugs – NSAID Narcotics and Barbiturates Erythromycin RESPIRATORY DISORDERS.. ASTHMA Dental Care… PowerPoint Presentation: Antifungal medication for patients taking Corticosteroids. No Contraindication for L.A with Adrenaline, Sulphites present as preservatives may exacerbate Asthma. RESPIRATORY DISORDERS.. ASTHMA Dental Care… PowerPoint Presentation: Seat patient upright and administer Oxygen. Hydrocortisone (200mg) should be injected IV and Bronchodilator inhaler given. RESPIRATORY DISORDERS.. ASTHMA Dental Care… If asthmatic attack occurs: TUBERCULOSIS: TUBERCULOSIS Lower Respiratory Tract Infection RESPIRATORY DISORDERS.. Dental care: Dental care Treatment is deferred to prevent Respiratory Tract against Cross – Infection. Reduction of Splatter & Aerosols. Avoid Ultrasonic Instruments. RESPIRATORY DISORDERS.. TUBERCULOSIS PowerPoint Presentation: Use Rubber dam. G.A Contraindicated. Clearance of Diazepam & Hepatotoxicity of Paracetamol are enhanced by Rifampicin & Isoniazid. TUBERCULOSIS RESPIRATORY DISORDERS.. Dental care… PowerPoint Presentation: Cystic fibrosis Cystic changes in pancreas and fibrous scarring. RESPIRATORY DISORDERS.. Discolouration of teeth due to administration of tetracycline PowerPoint Presentation: Dental Care Cirrhosis of liver may result in defect in clotting mechanism and subsequent bleeding following extractions or surgery. RESPIRATORY DISORDERS.. Cystic fibrosis PowerPoint Presentation: METABOLIC AND ENDOCRINE DISORDERS PowerPoint Presentation: DIABETES MELLITUS Endocrine disorder resulting in Persistent Hyperglycemia . METABOLIC & ENDOCRINE DISORDERS.. PowerPoint Presentation: Dental Care Prevention of oral infection and maintenance of healthy periodontal tissues is important. Accelerated periodontal breakdown in poorly controlled diabetic patients. METABOLIC & ENDOCRINE DISORDERS.. DIABETES MELLITUS PowerPoint Presentation: Controlled diabetics - more gingival inflammation and significant loss of gingival attachment compared with non-diabetics. Due to altered and impaired Neutrophil function. DIABETES MELLITUS METABOLIC & ENDOCRINE DISORDERS.. Dental Care… PowerPoint Presentation: Prescribe sugar free Medicines. Appointments should be arranged in the morning, following their insulin injection/ oral hypoglycemic drugs and a routine breakfast. METABOLIC & ENDOCRINE DISORDERS.. DIABETES MELLITUS Dental Care… PowerPoint Presentation: General anaesthesia should never be administered to an outpatient because careful monitoring of diabetes is necessary to prevent undetected hypoglycemia during anaesthesia. Glucose should be available in clinic to manage hypoglycemic shock. METABOLIC & ENDOCRINE DISORDERS.. DIABETES MELLITUS Dental Care… PowerPoint Presentation: HYPOPARATHYROIDISM Results from Congenital absence of the glands. Damage to the Glands during surgery. Radiograph shows alteration of Trabecular pattern. Loss of lamina dura around the teeth. METABOLIC & ENDOCRINE DISORDERS.. PowerPoint Presentation: Dental Care Candidiasis may be a problem. Teeth may be Hypoplastic - treatment may be done depending on extent of hypoplasia present. METABOLIC & ENDOCRINE DISORDERS.. HYPOPARATHYROIDISM PowerPoint Presentation: RENAL DISORDERS PowerPoint Presentation: NEPHROTIC SYNDROME Damage of Glomeruli leading to protein urea. RENAL DISORDERS… PowerPoint Presentation: Dental Care Increased susceptibility to infection. Prophylactic Antibiotics. RENAL DISORDERS… NEPHROTIC SYNDROME PowerPoint Presentation: Nephrotoxic Drugs should not be given: Phenacetin Tetracycline Aminoglycoside antibiotics Acetaminophen may be used for analgesia. Diazepam for sedation. RENAL DISORDERS… NEPHROTIC SYNDROME Dental Care… PowerPoint Presentation: CHRONIC RENAL FAILURE Gradual loss of Nephrons leading to loss of Renal function. RENAL DISORDERS… PowerPoint Presentation: Dental Care If GA is required, hospitalize patient and administer IV fluid pre-operatively to prevent dehydration and salt depletion. Abnormalities of clotting mechanism. Risk of mandible fracture during extractions as a result of renal bone disease (Renal osteodystrophy) RENAL DISORDERS.. CHRONIC RENAL FAILURE PowerPoint Presentation: DIALYSIS Employed for patients with end – stage Renal failure RENAL DISORDERS… PowerPoint Presentation: Dental Care Reduced immune response . Administration of Antibiotics . Administration of Heparin to prevent clotting during Hemodialysis, there may be complications with Extractions and Oral surgery. RENAL DISORDERS… DIALYSIS PowerPoint Presentation: Dental treatment should be carried out the day after dialysis when Anticoagulation is minimal and benefits of Dialysis are maximal. GA may be hazardous to the patient because of associated Hypertension, Arteriosclerosis and Anaemia. RENAL DISORDERS… DIALYSIS Dental Care … PowerPoint Presentation: TRANSPLANTATION Kidney transplant Increased susceptibility to infection and poor wound healing. RENAL DISORDERS… PowerPoint Presentation: Dental Care Antibiotics - prevent transient bacteraemia. - post operative infection . If patient is on steroids, additional steroids will be necessary to prevent Adrenal insufficiency. TRANSPLANTATION RENAL DISORDERS… PowerPoint Presentation: Nystatin mouth washes should be prescribed the day before transplant operation and also post – operatively to avoid Candidiasis which occurs in Immuno – suppressed patient. TRANSPLANTATION RENAL DISORDERS… Dental Care… PowerPoint Presentation: Gingival hyperplasia may occur in patients on Cyclosporin A and Nifedipine. Treatment is by removal of calculus and meticulous oral hygiene and if necessary, gingivectomy. RENAL DISORDERS… TRANSPLANTATION Dental Care… PowerPoint Presentation: Neoplasms PowerPoint Presentation: Effects of Radiotherapy and Chemotherapy Used alone or in conjunction with Surgical resection for treatment of Head & Neck Tumors. Xerostomia. Neoplasms… PowerPoint Presentation: Salivary flow may be stimulated by saliva substitutes. Prosthetic appliances may be difficult to wear due to lack of lubrication. Aggressive form of caries may develop which affects all surfaces of the teeth. Neoplasm's… Effects of Radiotherapy PowerPoint Presentation: Non –restorable or severely periodontally diseased teeth should be extracted before radiotherapy. Extractions following radiotherapy are extremely hazardous and are likely to result in Osteoradionecrosis . Neoplasm's… Effects of Radiotherapy PowerPoint Presentation: Candidial infection of the oral mucosa- treated with Nystatin, Amphotericin B lozenges or Miconazole gel. Neoplasms… Effects of Radiotherapy PowerPoint Presentation: CHROMOSOMAL DISORDERS PowerPoint Presentation: DOWN’S SYNDROME Result of chromosomal non dysjunction resulting in total of 47 chromosomes instead of 46. CHROMOSOMAL DISORDERS PowerPoint Presentation: DOWN’S SYNDROME… CHROMOSOMAL DISORDERS… Delayed tooth eruption. Teeth are usually smaller than normal and there may be congenital absence of teeth. Higher incidence of periodontal disease with progressive loss of supporting bone. PowerPoint Presentation: Malocclusions occur as a result of the underdevelopment of maxilla . Class III incisor relationship occurs and the enlarged tongue often results in an anterior open bite and a posterior cross bite. DOWN’S SYNDROME… CHROMOSOMAL DISORDERS… PowerPoint Presentation: Dental Care Endodontic treatment may be considered if an adequate apical seal can be obtained. Antiseptic mouthwashes may help in controlling periodontal disease. DOWN’S SYNDROME… CHROMOSOMAL DISORDERS… PowerPoint Presentation: Orthodontic treatment may not be possible due to skeletal discrepancy and co-operation problems. Dentures should be considered if there are missing teeth. DOWN’S SYNDROME… CHROMOSOMAL DISORDERS… Dental Care… PowerPoint Presentation: CHROMOSOMAL DISORDERS… DOWN’S SYNDROME… Dental Care… Degree of co-operation is related largely to the level of intelligence. Severe learning difficulties, General Anaesthesia may be necessary to carry out dental treatment. PowerPoint Presentation: NEUROLOGICAL DISORDERS PowerPoint Presentation: CEREBRAL PALSY Non-progressive lesion of the Brain resulting in Impairment and In-coordination of the muscles. NEUROLOGICAL DISORDERS.. PowerPoint Presentation: NEUROLOGICAL DISORDERS.. CEREBRAL PALSY… Bruxism resulting in marked attrition. High incidence of traumatized anterior teeth, due to frequent falls. Anterior open bite, high arched palate and malocclusion. PowerPoint Presentation: Dental Care Irregular movements of the head and body making treatment difficult. Restrict treatment to short visits in view of short attention span. CEREBRAL PALSY… NEUROLOGICAL DISORDERS.. PowerPoint Presentation: Tooth brushing may be difficult and adaptations to the tooth brush can be made to improve the grip. CEREBRAL PALSY… NEUROLOGICAL DISORDERS.. Dental Care… PowerPoint Presentation: Restorations on posterior teeth can be difficult due to bite reflex. Although orthodontic treatment is possible, it may result in unstable position of teeth, necessitating permanent retention. CEREBRAL PALSY… NEUROLOGICAL DISORDERS.. Dental Care… PowerPoint Presentation: EPILEPSY System complex, consisting of recurrent paroxysmal attacks of unconciousness usually with a succession of tonic/ clonic muscular spasm. NEUROLOGICAL DISORDERS.. PowerPoint Presentation: Dental Care Fracture of teeth are common. EPILEPSY NEUROLOGICAL DISORDERS.. PowerPoint Presentation: Replacement of missing teeth -With dentures adequately retained with clasps. Phenytoin effective in controlling seizures, results in gingival hyperplasia. EPILEPSY NEUROLOGICAL DISORDERS.. Dental Care… PowerPoint Presentation: Severe hyperplasia may prevent the eruption of teeth. EPILEPSY NEUROLOGICAL DISORDERS.. Dental Care… PowerPoint Presentation: Gingivectomy may be necessary to improve the appearance but if the drug is not changed and if oral hygiene is not maintained to a very high standard then hyperplasia will recur. EPILEPSY NEUROLOGICAL DISORDERS.. Dental Care… PowerPoint Presentation: Be prepared to manage seizures, if it occurs in dental clinic. Place patient on floor. Maintain airway. Administer oxygen. Prevent tongue bite. Administer 5-10 mg Diazepam IV. EPILEPSY NEUROLOGICAL DISORDERS.. Dental Care… PowerPoint Presentation: AUTISM Profound inability to relate to people and apparent disconnection from the world around. NEUROLOGICAL DISORDERS.. PowerPoint Presentation: Dental Care Should not be kept waiting and sessions should be brief. Constant repetition of procedures is necessary so that the patient accepts a routine. Lack of co-operation – Treatment under G.A NEUROLOGICAL DISORDERS.. AUTISM PowerPoint Presentation: Neuromuscular Disorders PowerPoint Presentation: MUSCULAR DYSTROPHY Inherited condition affecting Skeletal muscles and is Progressive and Degenerative. Neuromuscular Disorders… PowerPoint Presentation: Dental Care Regular visits - to maintain oral health, as in the later stages there may be limited opening of the mouth, making any form of dental treatment difficult. General Anaesthetics must be avoided as there is an added risk of Cardiac Arrest. Neuromuscular Disorders… MUSCULAR DYSTROPHY PowerPoint Presentation: MYASTHENIA GRAVIS Neuromuscular Disorders… PowerPoint Presentation: Dental Care Avoid General anesthesia - weak respiratory muscles. Excessive salivation -side effect of the Anti – Cholinesterase drugs. MYASTHENIA GRAVIS.. Neuromuscular Disorders… PowerPoint Presentation: Infection or stress may cause a Myasthenic crisis during which patient may have difficulty in clearing secretions from the throat and develop respiratory distress which may be life threatening. Neuromuscular Disorders… MYASTHENIA GRAVIS.. Dental Care… PowerPoint Presentation: MUSCULOSKELETAL DISORDERS PowerPoint Presentation: RHEUMATOID ARTHRITIS Chronic inflammatory disease of joints. MUSCULOSKELETAL DISORDERS PowerPoint Presentation: Bleeding tendencies secondary to NSAIDs Good oral hygiene can be difficult to maintain Dental Care RHEUMATOID ARTHRITIS MUSCULOSKELETAL DISORDERS PowerPoint Presentation: Handles of toothbrushes may require modification. MUSCULOSKELETAL DISORDERS RHEUMATOID ARTHRITIS Dental Care… PowerPoint Presentation: Temporomandibular joint surgery - severe involvement of the joint. Stiffness is worse in the morning, so dental appointments may be better in the afternoon. Dental Care… RHEUMATOID ARTHRITIS MUSCULOSKELETAL DISORDERS PowerPoint Presentation: Osteogenesis Imperfecta Disorder of Mesenchyme and its derivatives resulting in the abnormal synthesis of collagen. Bones are fragile, leading to frequent fractures with minimal trauma. MUSCULOSKELETAL DISORDERS PowerPoint Presentation: Dental Care Care during extractions -to avoid fracturing the mandible. Dislocation of TMJ may occur during dental treatment as a result of the lax ligaments. MUSCULOSKELETAL DISORDERS Osteogenesis Imperfecta PowerPoint Presentation: Dermatological Disorders PowerPoint Presentation: SCLERODERMA Affects tissues of mesenchymal origin – causes degenerative changes and hypertrophy of the collagenous component of skin and subcutaneous tissues. Dermatological Disorders.. PowerPoint Presentation: Alveolar growth affected. Teeth in affected area are firm in spite of a widening of periodontal membrane. Gingival recession & loss of alveolar bone Dermatological Disorders.. SCLERODERMA PowerPoint Presentation: Dental Care Preventive treatment - to avoid extractions. Access to the oral cavity difficult - because of fibrosis of skin. Dermatological Disorders.. SCLERODERMA PowerPoint Presentation: Dermatological Disorders.. SCLERODERMA Dental Care… Oesophagitis may cause Erosion of teeth. PowerPoint Presentation: EPIDERMOLYSIS BULLOSA Genetically determined skin condition in which the skin and mucous membrane blister as result of mechanical trauma. Dermatological Disorders.. PowerPoint Presentation: Dental Care Advice soft toothbrush and Antiseptic mouthwashes to maintain oral hygiene. Cleaning with sponges or cotton wool buds may be beneficial . Dermatological Disorders.. EPIDERMOLYSIS BULLOSA PowerPoint Presentation: Great care must be taken to avoid cotton rolls becoming stuck to the mucosa and saliva ejectors damaging or traumatizing the mucosa. Dermatological Disorders EPIDERMOLYSIS BULLOSA Dental Care… PowerPoint Presentation: Retention of teeth is of utmost importance as patients will be unable to tolerate dentures. General anaesthesia -- care during Intubation. Dermatological Disorders.. Dental Care… EPIDERMOLYSIS BULLOSA PowerPoint Presentation: ECTODERMAL DYSPLASIA Affects tissues derived from the Ectoderm. Reduction in Salivary flow and Lacrimal flow. Hypodontia. Dermatological Disorders.. PowerPoint Presentation: Teeth present are conical in form. Dermatological Disorders.. ECTODERMAL DYSPLASIA PowerPoint Presentation: Dental Care Prevention of Dental Disease - to maintain the teeth that are present for as long as possible, particularly where there are no permanent successors. Dermatological Disorders.. ECTODERMAL DYSPLASIA PowerPoint Presentation: Hypodontia - Prosthetic treatment. Failure of development of many permanent teeth- restoration of facial height with over dentures. Dermatological Disorders.. ECTODERMAL DYSPLASIA Dental Care… PowerPoint Presentation: Dermatological Disorders.. Dental Care… ECTODERMAL DYSPLASIA PowerPoint Presentation: Sensory Disturbances PowerPoint Presentation: Hearing Impairment Principal sensory pathway through which Speech and Verbal communication develop. Sensory Disturbances PowerPoint Presentation: Dental Care Main difficulty – Communication. Have normal intelligence. Sign language may be necessary. Sensory Disturbances Hearing Impairment PowerPoint Presentation: Wearing of a mask makes it difficult for the patient to understand. Talk in a clear voice, slightly slower than usual but with a normal rhythm. If hearing aid is worn - switch it off before using high-speed turbine or scaler. Sensory Disturbances Hearing Impairment Dental Care… PowerPoint Presentation: Visual Impairment Wide range of visual loss, from those who are able to define shapes and light and darkness to those unable to perceive light at all. Sensory Disturbances PowerPoint Presentation: Dental Care Patient should be encouraged to feel the chair and equipment and full explanations should be given. Touch – Tell -- Do Sudden unexplained movements should be avoided. Sensory Disturbances Visual Impairment PowerPoint Presentation: INFECTIONS PowerPoint Presentation: Meningitis Inflammation of the Meninges of the Brain and Spinal cord. INFECTIONS.. PowerPoint Presentation: Dental Care Treatment should not present any problems following recovery unless there has been permanent brain damage when mental impairment may prevent co–operation. INFECTIONS.. Meningitis. PowerPoint Presentation: HIV infected person with CD4 count below 200/ μ l as well as any HIV infected individual with Pulmonary TB ,recurrent episodes of Pneumonia or Invasive Cervical Carcinoma. INFECTIONS.. Acquired Immune Deficiency Syndrome (AIDS) PowerPoint Presentation: Dental Care Treatment should not be denied to those with HIV infection. Likelihood of generating aerosols by low and high speed drills, ultrasonic scalers and irrigation emphasizes the need to wear protective eye wear, rubber gloves and a mask when working with known HIV positive patient. INFECTIONS.. HIV.. PowerPoint Presentation: CD4 count ,T4 lymphocyte level, should be evaluated. Acetaminophen contraindicated- Patients taking Zidovudine. Dextran sulphate causes prolonged bleeding. INFECTIONS.. HIV.. Dental Care … PowerPoint Presentation: Hepatitis Group of inflammatory diseases which affect the liver. INFECTIONS.. PowerPoint Presentation: Dental Care As it is not possible or practical to screen all patients, it is therefore necessary to use a strict aseptic technique. Treatment of patients with acute hepatitis should be avoided until the patient has recovered. INFECTIONS.. Hepatitis PowerPoint Presentation: Coagulation time should always be checked before any surgical procedures are undertaken. Liver is responsible for production of clotting factors, which may consequently be impaired. INFECTIONS.. Hepatitis Dental Care… Pregnancy: Pregnancy Dental care Avoid Radiographs. Best period – 2 nd Trimester 3 rd Trimester – Supine Hypotensive Syndrome. PowerPoint Presentation: Avoid Drugs Safe Antimicrobials Penicillin Cephalosporins Erythromycin Safe Analgesics : Paracetamol Codiene NSAID’s - Contraindicated Pregnancy… PowerPoint Presentation: Dentist must be aware of potential complications while undertaking routine dental care. Comprehensive medical history is a must so that we can assess the general health of the patient. CONCLUSION PowerPoint Presentation: Thank You Thank you

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