1. DENTAL MANAGEMENT OF THE MEDICALLY COMPROMISED PATIENT

2. Systemic diseases include:
1. cardiovascular diseases
2. respiratory diseases
3. liver diseases
4. endocrine diseases
5. renal diseases
6. neurogenic diseases
7. sexually transmitted diseases
8. blood diseases
9. pregnancy & breast feeding

3. Main signs & symptoms of C.V.S diseases
1. Chest pain
2. Dysnea
3. cyanosis
4. palpitation
5. Syncope
6. Edema of ankles
7. Cold pale extremities
8. Clubbing fingers
9. Easy fatigue

4. ISCHEMIC HEART DISEASES
Mode of presentation of ischemic heart disease:
1. Angina pectoris
2. Myocardial infarction
3. Acute coronary insufficiency
4. Cardiac arrhythmia
5. Heart failure
6. Sudden death ( cardiac arrest, ventricular fibrillation )
7. Asymptomatic ( silent )

5. ANGINA PECTORIS
It is a myocardial ischemia resulting from imbalance between coronary blood flow & oxygen demand

6. DENTAL MANAGENT OF ANGINA:
Medical consultation
Appointment
Reduction of stress & anxiety
Local anesthesia
General anesthesia
Treatment procedures
Drugs used in treatment
If the attack developed

7. MYOCARDIAL INFARCTION
It results from occlusion of coronary artery
By a thrombus so deficient coronary arterial blood supply to a region of myocardium that results in a cellular death & necrosis.
Dental management:
As angina pectoris except;
Drugs used in treatment.

8. CONGESTIVE HEART FAILURE
It is the ability of heart to pump sufficient blood to meet the metabolic needs of the heart.
Dental management:
Same as angina except; preoperative antibiotic.
2. Drugs used in treatment.
3. Management of complications if developed (attack)

9. HYPERTENSIVE DISEASES
Hypertension is used to describe patient with blood pressure more than 140/90 mmHg
Dental management:
Same as angina except;
1. Local anesthesia.
2. General anesthesia.
3. treatment procedure.

10. RHEUMATIC HEART DISEASE
It is an acute inflammatory condition, due to strep. Pharngitis infection following sore throat, result in scaring & calcification of valves followed by valvular stenosis.
Dental management.
1. Medical consultation.
2. Prophylactic antibiotic.
3. Mild tranquilizers (2-5 diazepam).
4. Short dental appointment.

11. PROPHYLACTIC ANTIBIOTIC REGIMEN FOR CARDIAC PT.
1. Under L.A
a) Adults---- 2gm Amoxicillin or 2gm Ambicillin
(1 hour before treatment orally) OR
(1/2 hour ,,, ,,,,,,,,,,, injection)
B) Children mg per Kg Amoxicillin or
Ambicillin

12. Adult --------- Clindamycin 600 mg OR Asathromycin 500 mg OR
IF PATIENT IS ALLERGIC:
Adult Clindamycin 600 mg OR
Asathromycin 500 mg OR
Cephazolin 1 gm
(1 hour before ttt. Orally)
( ½ ,,, ,,,, ,,, injection)
Child Clindamycin 20 mg per Kg.
Asathromycin 15 mg per Kg.

13. 2. Under G.A Adults----- 1gm Amoxicillin I.V at induction.
OR gm Amoxicillin orally 4 hours before induction followed by 3gm Amoxicillin immediately after recovery.
OR mg Clindamycin I.M ½ hour before induction.
OR mg Clindamycin I/V at induction

14. b) Children ------ (5–10 years)1/2 adult

15. RESPIRATORY DISORDERS
Common symptoms:
1. cough.
2. wheezing.
3. cyanosis.
4. finger clubbing.
AVOID
1. General anesthesia: leads to hypoxia .
2. Analgesics & narcotics: leads to respiratory depressants.

16. BRONCHIAL ASTHMA
It is due to bronchospasm or hyperirritability of the tracheo_bronchial tree.
Patient is treated by:
1. Corticosteroids inhalators.
2. Bronchodilator.
3. Beta adrenergic stimulator.

17. Dental management stress & anxiety. Local anesthesia.
Medical consultation.
stress & anxiety.
Local anesthesia.
General anesthesia.
Drugs used in treatment.
Drugs given to patient.

18. TUBERCULOSIS Can affect any organ. Highly infectious.
Caused by Mycobacterium T.B.
Transmitted by air born droplets.

19. Dental management: 2. Patient with past history of T.B.
1. Patient with active T.B.
2. Patient with past history of T.B.
3. Patient with positive tuberculin test.
4. Patient with signs & symptoms of T.B.
5. Strict aseptic technique.

20. LIVER DISORDERS Potential complications:
Advanced liver diseases include:
Liver cirrhosis - Jaundice
Potential complications:
1. Impaired drug detoxication e.g. sedative, analgesics, general anesthesia.
2. Bleeding disorders ( decrease clotting factors, excess fibrinolysis, impaired vitamin K absorption).
3. Transmission of viral hepatitis.

21. Dental management Medical consultation.
Avoid drugs metabolized in liver:
L.A Lidocaine, Mepicaine
Sedatives Valium
antibiotics Ampicillin
Analgesics Aspirin
3. Vit.k mg/day before surgery.
4. G.A cause bleeding.

22. VIRAL HEPATITIS Dental management: Patient with active hepatitis
Carriers:
a. low risk patient.
b. high risk patient.

23. DIABETUS MELLITUS
It is characterized by persistent increase of blood glucose level.
It is the result of absolute or relative deficiency of insulin.

24. Oral manifestation: 1. Gingivitis 2. Alveolar bone resorption
3. Xerostomia
4. Delayed wound healing
5. Pulpitis in non carious tooth
6. Burning sensation in tongue
7. Acetone smell in breath

25. Dental management: 1. Appointment. 2. Premeditation
3. Local anesthesia.
4. Treatment procedure.
5. Patient assessment.

26. CHRONIC RENAL FAILURE Dental management:
Patient with conservative treatment.
Patient with hemodialysis.
Patient with kidney transplant.
Emergency treatment.

27. THYROID GLAND DISORDER
Dental management:
1. Uncontrolled or poorly controlled patient
2. patient with thyrotoxicosis.
Antithyroid drugs may couse leucopenic aplastic anemia.
Management of thyroid crises
Ant thyroid drugs Hydrocortisone
3. I.V. glucose Oxygen administration
5. Cooling to decrease temp. of body.

28. NEUROGENIC DISORDER (EPILEPSY)
Neurogenic disorder: is disorder of the brain.
Epilepsy: is the most common neurogenic disorder the dentist may face in his clinic.
Potential problems:
Precipitation of the attack.
Problems of drugs taken a) Dilantin gingival hyperplasia b) Depakene bleeding tendancy

29. Dental management: Past medical history.
In case of controlled patient.
In case of uncontrolled patient.
Management of attack if developed.

30. N.B: Dentist is no longer treating teeth in patients, but rather patients who have teeth.

31. THANK
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