Medically Compromised
Patient Dental Care
Neurologic Disorders
1. Alzheimers Disease
Is a brain disorder, marked by deterioration of mental
capacity.
Treatment plan modifications:
Pay special attention to daily care of the mouth.
Patients may show signs of xerostomia caused by a
prescribed psychoactive drug.
Regular oral hygiene and the use of fluoride
supplements and salivary substitutes are important in
preserving dental health.
2. Seizures
Abrupt suspension of motor, sensory, behavioral, or bodily function
at any time.
Cardiovascular Disorders
3. Angina
Is a coronary disease in which a decrease in blood supply to the heart
muscle causes a sharp pain in the chest.
Angina is a sign that a patient is at risk for a heart attack.
Treatment plan modifications for a patient with heart disease:
Avoid stressful, lengthy appointments
Assess vital signs before and throughout the procedure.
The dentist may use premedication and nitrous oxide to help relieve
stress.
The use of supplemental oxygen throughout the procedure
The use of prophylactic sublingual nitroglycerin immediately before
treatment.
Seat the patient in a semisupine position.
Pulmonary Disorders
Affect the lungs and are characterized by airway
obstruction. Such as allergies and bronchial Asthma.
Treatment plan modification for a patient with Asthma:
Every effort should be made to minimize stress.
Schedule short appointments.
Use sedation techniques.
The use of epinephrine and aspirin should be
minimized.
Blood Disorders
Such as anemia, leukemia and hemophilia
Treatment plan modifications
These patients are susceptible to bacterial
infection
Antibiotic prophylaxis may need to be
prescribed for high-risk procedures.
Musculoskeletal Disorders
Such as Arthritis (the joints becomes inflamed and
painful)
Treatment modifications for a patient with Arthritis:
Schedule these patients in the morning and keep
appointments short.
The disease can limit the patients ability to hold and
use a toothbrush.
Arthritis of the jaw joints limits the patients ability to
open the mouth or chew comfortably.
Endocrine Disorders
1. Hyperthyroidism
Is an overactive thyroid gland. Infection, physical or
emotional stress, trauma, pain or surgery may precipitate a
hyperthyroid crisis, which can be fatal.
Treatment plan modification:
An accurate and current history and medical consultation
are essential.
Hyperthyroid patients who are not being treated are highly
sensitive to epinephrine and other amine anesthetics.
2. Diabetes Mellitus
Specific problems related to dental care for a patient with diabetes include:
Acetone breath.
Dehydration of oral soft tissues due to xerostomia.
Red, swollen and painful gingiva due to medication therapy
Alveolar bone loss, toothache and delayed healing.
Treatment plan modifications:
Minimize stress by keeping appointments short and scheduling them in the
midmorning.
Use sedation techniques such as administration of nitrous oxide or oral
diazepam.
Instruct patient to maintain normal dietary intake before dental
appointments; the most common cause of hypoglycemia is failure to eat.
Minimize the risk for infection.
Psychiatric disorder
Treatment plan modification:
Xerostomia may result from the psychoactive
drug.
Regular hygiene and the use of fluoride
supplements and salivary substitutes are
important for preserving dental health.
Patient cooperation may cause problems.
Hearing-impaired patients
Treatment modifications:
Stand in front of patients so that they can see
your face and follow your lip movements.
Do not shout. Speak slowly and distinctly.
Keep directions simple and provide visual
demonstrations.
Keep a written copy of all instructions.
THANK YOU
DR.EMAN ABED