Medical Problems in Dentistry
Medical Problems in Dentistry
MEDICAL PROBLEMs in
DENTISTRY
الأمراض العامة في طب الأسنان
Dr.Husein Jabi
Maxillofacial Surgeon (M.O.M.S)
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Clinical examination: الفحص السريري
-Physical examination:(Cardiovascular system,Respiratory system,Neurological system).
-Examination of patient’s appearance
-Anxity.
-Facial examination(bone deformity,facial movement and sensation)
-Mouth opening.
-Salivary glands.
Analgesia المسكنات
Acetaminophen (paracetamol):Maximum daily dose : less than 4 gr/day.
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Non- steroidal anti- infammatory drugs (NSAIDs)
1. Cox-1 inhibitors:(Ibuprofen ,Diclofenac sodium), containdication for: Bronchial
Asthma_Renal disease_Pregnancy_Peplic ulcer_Bleeding
tendency_Allergy_cardiac failiar_Patient on corticosteroid.
2- COX-2 inhibitors:(celecoxib,Meloxicam) prolong (PT,INR),Preferred for Pt with
Peplic ulcer, containdication for cardiac disease.
Contraindications of epinephrine(Adrenaline)
مضادات استطباب الأدرينالين
Untreated hyperthyroidism (Absolute contraindication).
Cardiac Pt on Digoxine.
– فرط نشاط الغدة الدرقية الغير منضبط2ارتفاع الضغط الغير منضبط أو الغير معالج-1 : مضادات اإلستطباب القطعية
مرضى القلب المعالجون,ارتفاع الضغط المعالج بحاصرات بيتا:) مضادات استطباب نسبية (تتبع رأي الطبيب المعالج
مريض الربو المتحسس من السولفات, بعد عالج شعاعي للعظم المجاور, بالديجوكسين
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Effective painless LA is essential, and an aspirating syringe should be used
Epinephrine-containing LA should not be given in excessive doses to Pt on beta blockers.
Citanest(Prilocain&octapresine) is not recommended to be used for cardiac or
hypertensive Pt.
Assure the patient, Stress free short, late- morning appointments are recommended.
Antibiotic prophylaxis may be recommended for cardiac patients to prevent infective
endocarditis.
Pre – op : Nitroglycerin.
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During the procedure :Menimal anxity , monitor (BP,Pulse,SPO2) , effictive(LA) , medical
help (O2,Nitroglycerin)should be ready.
If Pt has chest pain Stop treatment+ Nitroglycerin(S.L)+O2+Sitting upright+check
vital signs pain relief Go home .
pain not relief ask medical help + give Nitroglycerin every 5 min
for 3 doses pain more + syncope + vomiting Myocardial infarction
chew Aspirine 300mg + O2 + Nitrous oxide or Morphin.
Defer dental procedure 3 monthes after angina attack, and 6 monthes after (M.I).
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Dental aspects: Adrenocortical function may be suppresed if Pt on systemic Pednisolone <7.5
mg Now or more than one month at the last year :
&& Double oral steroid dose in morning, before any dental procedure (conservative dentistry
,extraction, scaling ..) , or Hydrocortisone/50mg ( IV ) preopertive.
&& Avoid : NSAIs or Aspirine peptic ulcer.
&& Antibiotc prophylactic may be indicated , because of impaired wound healing.
&& Management of adrenal crises: Give Hydrocortisone ( IV) 100mg تدبير الصدمة الكظرية
1-Tetany ()التكزز.
2-Seizurs )(اختالجات ال إرادية.
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3- DM ( )مرض السكر.
4- Dysrhythmias ( )اضطراب نظم القلب.
5-Facial paraesthesia, twitching(Chvostik,s sign)
)خدر ورعشة في عضالت الوجه عند لمسها (عالمة تشفوستك
Heparin
For surgery Need medical consultation.
Lymphoma
Problems: Anaemia , infection , Corticosteroid therapy,bleeding tendency,
Radiotherapy, cardiac disease , acute Leukaemia , xerostomia.
Management:
- Avoid regional LA .
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Elective dental care should be deferred in severe asthmatics until they are in a better
phase.
Allergy to penicillin may be more frequent.
Epinephrine, erythromycin, clindamycin and azithromycin are contraindicated for
patients on theophylline
some asthmatic patients may react to sulphites present as preservatives in it.
Aspirin and NSAIDs should be avoided as they are considered asthma precipitating
drugs.
تجنب وصف مضادات اإللتهاب غير الستيروئيدية أو األسبرين, تأكد أن البخاخ معه, التجهد المريض
Hepatitis B
Pt should be the last one in the list.
To avoid bleeding : check (PT , Platelet).
Prescripe the minimal amount of drugs.
Avoid scattered drops from the oral cavity (transmision of HBV by saliva is low risk).
After needle stick injury:allow spontenous bleeding, wash by water, disinfect by Povidon
, the person should receive Hepatitis B immunoglobulin (HBIG) withen 24 hr + the first
dose of the Hepatitis Vaccine .
& Note : 0.0000001 ml from blood plasma serum Virus transmition.
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Pregnancy الحمل
Gynae consultation.
Avoid giving any drugs if not important,specially if Pt has a history of abortion or her
pregnancy was after a year of failur.
Dental treatment is best carried out in the second trimester,( short vesits ).
If the Pt has a syncope avoid supine position , put Pt on the left side.
LA is safe.
Avoid :ASA , NSAIDs,Corticosteroids,Codeine.
If radiologe is issential Pt must wear a lead apron.
High risk antibiotics: Doxicycline,Tetracycline,Clarythromycine.
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