1. Copyright 2003, Elsevier Science (USA). All rights reserved. Chapter 29 The Medically and Physically Compromised Patient Copyright 2003, Elsevier Science (USA). All rights reserved. No part of this product may be reproduced or transmitted in any form or by any means, electronic or mechanical, including input into or storage in any information system, without permission in writing from the publisher. PowerPoint ® presentation slides may be displayed and may be reproduced in print form for instructional purposes only, provided a proper copyright notice appears on the last page of each print-out. Produced in the United States of America ISBN 0-7216-9770-4

2. Copyright 2003, Elsevier Science (USA). All rights reserved. Introduction More individuals are living with some type of medical or physical disorder.

3. Copyright 2003, Elsevier Science (USA). All rights reserved.  Americans with Disabilities Act  American Dental Association Title I: Employment Discrimination Title II: Access for Disabled Title III: Public Accommodations Title IV: Telecommunication Services  Americans with Disabilities Act  American Dental Association Title I: Employment Discrimination Title II: Access for Disabled Title III: Public Accommodations Title IV: Telecommunication Services The Rights of a Patient

4. Copyright 2003, Elsevier Science (USA). All rights reserved.  Aid in providing treatment.  Provide information to patient and family.  Make patient comfortable.  Help in reducing anxiety.  Aid in providing treatment.  Provide information to patient and family.  Make patient comfortable.  Help in reducing anxiety. Role of the Dental Assistant

5. Copyright 2003, Elsevier Science (USA). All rights reserved.  Aging is the irreversible and inevitable changes that occur with time.  Stages of the older population Young/Old: People age 65 to 74 years old. Old: People age 75 to 84 years old. Old/Old: People age 85 years old or older.  Aging is the irreversible and inevitable changes that occur with time.  Stages of the older population Young/Old: People age 65 to 74 years old. Old: People age 75 to 84 years old. Old/Old: People age 85 years old or older. The Aging Population

6. Copyright 2003, Elsevier Science (USA). All rights reserved.  Xerostomia: Condition from certain disorders and medications that cause a decreased flow of saliva.  Periodontal disease: An increasing problem in the older population. Tissues of older patients may be slower to heal.  Dental decay: Increase in the form of coronal and root caries and recurrent decay around defective restorations  Dark and brittle teeth: As a result of deposits of secondary dentin that have gradually reduced the size of the pulp chamber.  Bone resorption: Loss of the alveolar ridge.  Xerostomia: Condition from certain disorders and medications that cause a decreased flow of saliva.  Periodontal disease: An increasing problem in the older population. Tissues of older patients may be slower to heal.  Dental decay: Increase in the form of coronal and root caries and recurrent decay around defective restorations  Dark and brittle teeth: As a result of deposits of secondary dentin that have gradually reduced the size of the pulp chamber.  Bone resorption: Loss of the alveolar ridge. Dentally Related Aging Changes

7. Copyright 2003, Elsevier Science (USA). All rights reserved.  Patient Assessment Category I: Healthy patient Category II: Medical conditions requiring schedule changes Category III: Medical conditions requiring significant modifications in dental treatment Category IV: Medical conditions requiring major modifications in dental treatment Category V: Serious medical conditions  Patient Assessment Category I: Healthy patient Category II: Medical conditions requiring schedule changes Category III: Medical conditions requiring significant modifications in dental treatment Category IV: Medical conditions requiring major modifications in dental treatment Category V: Serious medical conditions The Medically Compromised Patient

8. Copyright 2003, Elsevier Science (USA). All rights reserved.  Alzheimer’s disease: Brain disorder that is marked by deterioration of mental capacity.  Disease progresses in three stages: The early disease, or forgetfulness phase. The intermediate disease, or confused phase. The late disease, or dementia phase.  Dental care management  Alzheimer’s disease: Brain disorder that is marked by deterioration of mental capacity.  Disease progresses in three stages: The early disease, or forgetfulness phase. The intermediate disease, or confused phase. The late disease, or dementia phase.  Dental care management Neurologic Disorders

9. Copyright 2003, Elsevier Science (USA). All rights reserved.  Seizure: An abrupt suspension of motor, sensory, and/or body function.  Epilepsy Petit mal: Type of seizure lasting no longer than 30 seconds. Grand mal: These seizures have many causes and arise in all age groups.  Dental care management  Seizure: An abrupt suspension of motor, sensory, and/or body function.  Epilepsy Petit mal: Type of seizure lasting no longer than 30 seconds. Grand mal: These seizures have many causes and arise in all age groups.  Dental care management Neurologic Disorders  cont’d

10. Copyright 2003, Elsevier Science (USA). All rights reserved.  Multiple Sclerosis: A debilitating and degenerative disorder of the central nervous system with a progressive weakening of the lower extremities, causing muscle weakness, unsteady gait, and paralysis.  Dental care management  Multiple Sclerosis: A debilitating and degenerative disorder of the central nervous system with a progressive weakening of the lower extremities, causing muscle weakness, unsteady gait, and paralysis.  Dental care management Neurologic Disorders  cont’d

11. Copyright 2003, Elsevier Science (USA). All rights reserved.  Parkinson’s disease: A progressive disorder causing degeneration of the nerves in the brain. This degeneration will lead to tremors, weakness of muscles, and slowness of movement.  Dental care management  Parkinson’s disease: A progressive disorder causing degeneration of the nerves in the brain. This degeneration will lead to tremors, weakness of muscles, and slowness of movement.  Dental care management Neurologic Disorders  cont’d

12. Copyright 2003, Elsevier Science (USA). All rights reserved.  Cerebrovascular accident: A cerebrovascular accident or stroke is a minor to severe loss of the central nervous system function caused by a sudden vascular lesion of the brain, such as hemorrhage, embolism, thrombosis, or ruptured aneurysm.  Dental care management  Cerebrovascular accident: A cerebrovascular accident or stroke is a minor to severe loss of the central nervous system function caused by a sudden vascular lesion of the brain, such as hemorrhage, embolism, thrombosis, or ruptured aneurysm.  Dental care management Neurologic Disorders  cont’d

13. Copyright 2003, Elsevier Science (USA). All rights reserved.  Heart disease is the leading cause of death in the United States.  Manifestations of heart disease Angina: Severe pain in the chest associated with an insufficient supply of blood to the heart Myocardial Infarction: Heart attack  Heart disease is the leading cause of death in the United States.  Manifestations of heart disease Angina: Severe pain in the chest associated with an insufficient supply of blood to the heart Myocardial Infarction: Heart attack Cardiovascular Disorders

14. Copyright 2003, Elsevier Science (USA). All rights reserved.  Hypertension: Referred to as high blood pressure, is the result of the heart having to work harder as it pumps against resistance such as a blocked artery.  Major factors associated with hypertension: Stress Age Heredity Smoking Obesity  Hypertension: Referred to as high blood pressure, is the result of the heart having to work harder as it pumps against resistance such as a blocked artery.  Major factors associated with hypertension: Stress Age Heredity Smoking Obesity Cardiovascular Disorders  cont’d

15. Copyright 2003, Elsevier Science (USA). All rights reserved.  Cardiac and Prosthetic Considerations: A patient with cardiac disease or a prosthetic replacement carries an increased risk of becoming infected from bacteria carried in the blood system.  Endocarditis: Severe infection of the cardiac valves and supporting structures caused by blood-borne pathogens that gain entry to the bloodstream from such places as the mouth and gastrointestinal tract.  Cardiac and Prosthetic Considerations: A patient with cardiac disease or a prosthetic replacement carries an increased risk of becoming infected from bacteria carried in the blood system.  Endocarditis: Severe infection of the cardiac valves and supporting structures caused by blood-borne pathogens that gain entry to the bloodstream from such places as the mouth and gastrointestinal tract. Cardiovascular Disorders  cont’d

16. Copyright 2003, Elsevier Science (USA). All rights reserved.  Disorders that affect the lungs and are characterized by airway obstruction. Bronchial asthma: Often arising from allergies characterized by an increased hypersensitivity to various stimuli, which results in bronchial edema and widespread narrowing of the bronchial airways.  Dental care management  Disorders that affect the lungs and are characterized by airway obstruction. Bronchial asthma: Often arising from allergies characterized by an increased hypersensitivity to various stimuli, which results in bronchial edema and widespread narrowing of the bronchial airways.  Dental care management Pulmonary Disorders

17. Copyright 2003, Elsevier Science (USA). All rights reserved.  Chronic obstructive pulmonary disease: General term for pulmonary diseases characterized by blocked airflow during respiration.  Bronchitis: Irreversible narrowing of the bronchial airways as a result of chronic inflammation.  Emphysema: Irreversible enlargement of the size of the air spaces, resulting in labored breathing and an increased susceptibility to infection.  Chronic obstructive pulmonary disease: General term for pulmonary diseases characterized by blocked airflow during respiration.  Bronchitis: Irreversible narrowing of the bronchial airways as a result of chronic inflammation.  Emphysema: Irreversible enlargement of the size of the air spaces, resulting in labored breathing and an increased susceptibility to infection. Pulmonary Disorders  cont’d

18. Copyright 2003, Elsevier Science (USA). All rights reserved.  Disorders that involve the cellular elements of the body. Leukemia: An excessive increase in white blood cells. Hemophilia: Excessive bleeding caused by a congenital lack of a protein substance necessary for blood clotting to occur.  Disorders that involve the cellular elements of the body. Leukemia: An excessive increase in white blood cells. Hemophilia: Excessive bleeding caused by a congenital lack of a protein substance necessary for blood clotting to occur. Blood Disorders

19. Copyright 2003, Elsevier Science (USA). All rights reserved.  Musculoskeletal system includes the bones, muscles, and joints. Arthritis: Older patients are more likely to have chronic progressive arthritis with stiffening of joints. Muscular Dystrophy: Involves the striated muscles in the body, causing progressive atrophy and weakness.  Musculoskeletal system includes the bones, muscles, and joints. Arthritis: Older patients are more likely to have chronic progressive arthritis with stiffening of joints. Muscular Dystrophy: Involves the striated muscles in the body, causing progressive atrophy and weakness. Muscular Disorders

20. Copyright 2003, Elsevier Science (USA). All rights reserved.  Glands located in many different regions of the body, all of which release hormones into the bloodstream which help regulate the metabolism in body cells. Hyperthyroid: An overactive thyroid gland. Hypothyroid: An underactive thyroid gland that produces fewer hormones.  Glands located in many different regions of the body, all of which release hormones into the bloodstream which help regulate the metabolism in body cells. Hyperthyroid: An overactive thyroid gland. Hypothyroid: An underactive thyroid gland that produces fewer hormones. Endocrine Disorders

21. Copyright 2003, Elsevier Science (USA). All rights reserved.  Diabetes Mellitus: Disease characterized by a sustained high blood glucose level resulting from an absolute or a relative lack of insulin. Type I: Patient is insulin dependent. Type II: Disease is controlled through diet and oral medications.  Dental care management  Diabetes Mellitus: Disease characterized by a sustained high blood glucose level resulting from an absolute or a relative lack of insulin. Type I: Patient is insulin dependent. Type II: Disease is controlled through diet and oral medications.  Dental care management Endocrine Disorders  cont’d

22. Copyright 2003, Elsevier Science (USA). All rights reserved.  Types of disorders Anxiety: Feeling of impending disaster. Depression: Condition of general emotional rejection and withdrawal. Schizophrenia: A disturbance in thinking and perception with delusions, hallucinations, and impaired reality testing.  Types of disorders Anxiety: Feeling of impending disaster. Depression: Condition of general emotional rejection and withdrawal. Schizophrenia: A disturbance in thinking and perception with delusions, hallucinations, and impaired reality testing. Psychiatric Disorders

23. Copyright 2003, Elsevier Science (USA). All rights reserved.  Eating disorders Anorexia nervosa: Condition is indicated when a person has an obsessive fasting (starving) condition. Bulimia: Disorder in which a person eats an abnormal amount of calories at one time and then induces vomiting or uses laxatives.  Substance related disorders Drugs Alcohol Nicotine  Eating disorders Anorexia nervosa: Condition is indicated when a person has an obsessive fasting (starving) condition. Bulimia: Disorder in which a person eats an abnormal amount of calories at one time and then induces vomiting or uses laxatives.  Substance related disorders Drugs Alcohol Nicotine Behavioral Disorders

24. Copyright 2003, Elsevier Science (USA). All rights reserved.  The wheelchair-bound patient Transferring the patient  Seeing-impaired patient  Hearing-impaired patient  The wheelchair-bound patient Transferring the patient  Seeing-impaired patient  Hearing-impaired patient The Physically Compromised Patient