Medically Compromised Patient

Medically Compromised Patient

Rajan Dental Laboratory was set up with German collaboration to create the finest dental implant prosthetic / aesthetic solutions.

Dental Health for People with Kidney Disease

A clinical study reported that people with kidney disease and those on dialysis are more likely to have periodontal disease and other oral health problems than the general population. A Buildup of bacteria in the mouth can cause infection. Because people with kidney disease have weakened immune systems, they are more susceptible to infections.

Bone loss in the jaw can occur in those with kidney disease. Calcium imbalance contributes to loss of calcium from the bones resulting in weak bones. Weak bones can cause teeth to become loose and potentially fall out. The best way to help prevent bone loss is to make sure calcium and phosphorus levels stay within the goal range.

Ideally, dental procedures, such as tooth extraction or any invasive dental procedure, should occur on a non-dialysis day for those on hemodialysis. Heparin, administered during hemodialysis, may cause some people to have extra bleeding.

As for dental considerations and management strategies for these patients, we should take into account that the drug dose adjustment must be done using creatinine clearance; before invasive dental procedures, a blood test must be requested.

In dental practice, the function of the kidneys can be assessed indirectly through plasmatic creatinine (Cr). Normal values of serum Cr are 0.5- 1.4 mg/dl; in patients with renal insufficiency, Cr will be of 1.5 mg/dl or more.

In transplant patients, the need of supplemental corticosteroid has to be considered. Hemodialysis and peritoneal dialysis do not indicate the need for an antibiotic prophylaxis.

Dental Health for People with CABG

Patients with certain heart conditions have a higher risk of endocarditis. This is an infection of the heart. It can be life threatening. It happens when bacteria in the bloodstream attach to damaged heart valves or other damaged heart tissue.

People with certain heart conditions may need antibiotics before they have certain types of dental procedures. Make sure to inform your dentist of any heart issues.

In 2007, the American Heart Association updated its guidelines on the use of antibiotics before dental treatments. The new policy advises antibiotics for fewer conditions than the old policy did.

The American Heart Association guidelines recommend pre-treatment antibiotics for dental procedures that involve an incision or manipulation of the gums or the tissues around a tooth root.

Antibiotics are not required for the following:

  • Routine anesthetic injections through noninfected tissue
  • X-rays
  • Placement of dentures
  • Placement or adjustment of removable orthodontic appliances
  • Placement of the bracket part of braces (not bands)

Based on the review of literature, it can be concluded that current recommendations and consensus are in favor of not stopping antiplatelet dose of aspirin prior to tooth extraction. It must be emphasized that appropriate use of local hemostatic measures should always be considered whenever indicated. There is no justification to predispose the patient to the risk of thromboembolism at the expense of minor bleeding which can be easily controlled.

Dental Health for People with Diabetic

Whether you have type 1 diabetes or type 2 diabetes, managing your blood sugar level is key.

The healing period of the wound after tooth remoal (about one week) for a person with diabetes is comparable to a non-diabetic. However, the blood glucose level and/or haemoglobin A1c (HbA1c) target of a person with diabetes should be optimal before a tooth extraction, to prevent post-surgical complications.

In fact, people with diabetes are at a higher risk for gum problems because of poor blood sugar control. As with all infections, serious gum disease may cause blood sugar to rise.

Regular dental visits are important. Research suggests that treating gum disease can help improve blood sugar control in patients living with diabetes, decreasing the progression of the disease. Practicing good oral hygiene and having professional deep cleanings done by your dentist can help to lower your HbA1c.

Monitoring Glucose Levels. Blood-glucose levels can be checked chairside using a drop of blood. Glucometers designed for use in a variety of settings, such as dental clinics.

Exercising good clinical judgment is essential because, in some situations, elective dental treatment may need to be delayed until the patient’s diabetes is considered stable or better controlled.Dental implants can be placed in patients with well-controlled diabetes, and possibly in those with moderately controlled disease. However, implant placement in patients with poorly controlled disease has an unpredictable prognosis and, if possible, should be avoided.

Dental Health for People with Osteoporosis

Osteoporosis refers to a disease characterized by extremely fragile and less dense bones. The main causes of the problem are aging, menopause, and lack of Vitamin D and calcium. Osteoporosis also has a direct relationship on oral and dental health. One should realize that the disease can hamper or damage jaw bones. It also triggers dental and oral health issues, including gum or periodontal diseases and loss of teeth.

Some antiresorptive agents, are taken orally to help prevent or treat osteoporosis (thinning of bone) and. Others antiresorptive agents, are administered by injection. However, there are some concerns regarding potent intravenous bisphosphonates with respect to tolerability and to safety, mainly a theoretical risk of over suppression of bone turnover, renal toxicity and osteonecrosis of the jaw.

While osteonecrosis of the jaw can occur spontaneously, it more commonly occurs after dental procedures that affect the bone or associated tissues (for example, pulling a tooth). Be sure to tell your dentist if you are taking antiresorptive agents so he or she can take that into account when developing your treatment plan.

It’s not possible to say who will develop osteonecrosis and who will not. Most people (more than 90 percent) diagnosed with ONJ associated with these medications are patients with cancer who are receiving or have received repeated high doses of antiresorptive agents through an infusion. The other 10 percent (of people with ONJ) were receiving much lower doses of these medications for treatment of osteoporosis.

Ideally, these patients should have a dental examination before beginning therapy with antiresorptive agents so that any oral disease can be treated.

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