Case selection part 2 ( systemic factors )
-
Upload
mohammad-omar -
Category
Travel
-
view
40 -
download
5
Transcript of Case selection part 2 ( systemic factors )
Second: Systemic considerations:
Prophylactic antibiotics should be given in the following cases to avoid subacute bacterial endocarditis :
•Congenital heart disease•Rheumatic heart disease•Valvular disease.
1- cardiac diseases
In Patients using pacemakers avoid using equipments that emit electromagnetic waves as
In patients with Coronary insufficiency use plain anesthesia (adrenaline free)
•Pulp testers
•Sonics and ultrasonics
•Apex locators
•Electrosurgery and cautery
1- cardiac diseases
To avoid Cardiac arrhythmia
In patients taking Anticoagulants or vasodilators avoid surgery or consult physician
In patients with Uncontrolled hypertension avoid stresses and consult physician.
In patients with Severe hypertension use plain anesthesia (adrenaline free)
2- cardiovascular diseases
In Hemophilia patients there may be bleeding with injection , pulp extirpation and rubber dam application.
However RCT is more safe than extraction after consulting physician.
In patients with Blood disorders such as
Leukemia.Aplastic anemia.ThrombocytopeniaPolycythemia.scurvy
require a written consent from the physician Specially when prescribing analgesics and antibiotics.
3- blood disorders
4. Diabetes mellitus:
Appointments after the meal and medication.
Avoid Adrenalin because it breakdown glycogen to glucose causing diabetic coma.
So Use different LA. As carbocain with Neocobefrin.
Avoid Aspirin because it decreases blood sugar causin shock (similar to insulin shock)
So Analgesics other than aspirin should be used.
4- Diabetes mellitus
- Discard used instruments or sterilize by autoclaving .
- The patient is suufering from liver damage So avoid medications detoxified in liver.
- consult physician before using the following drugs
•Aspirin.•Acetaminophen.•Barbiturates.•Valium.•Librum.•Penicillins.•Ampicillins.•Cephalosporins•Tetracyclines.
5- Hepatitis
the patient is suffering from Renal damage So avoid medications metabolized and excreted by the kidneys
Such as
•Narcotics.•Vasoconstrictors.•Aspirin.•Acetaminophen.•Penicillins.•Tetracyclines.
6- Kidney diseases
RCT is preferable than extraction.
Prophylactic antibiotic course is recommended.
7- Radiation therapy
Patient has to take the epileptic medication prior to treatment.
Handle the patient gently and reassuringly.
If you Inject L.A. into blood vessels CNS stimulation may happen epileptic fit
8- Epilepsy
Clinical manifestations
Persistent cough.Hemoptysis.Chest pain.Fatigability.Weakness.Loss of weight.Anorexia.
- low Oxygenation and nutrition poor resistance and delayed repair.- Lung disease is highly contagious.- Palliative care only until the case is brought under control.
9- lung infections & Tuberculosis (TB )
Addison’s disease : decrease blood corticosteroids.
Poor ability to cope with stressful situations (infection and surgery)
Case should be medically controlled first.
Cushing’s disease :
increase blood corticosteroids. Cushing’s disease or prolonged corticosteroid therapy suffers from
Prior to treatment medical adjustment and prophylactic antibiotics.
Hypertension.Osteoporosis.Susceptibility to bruises.Low body resistance.Impaired healing.
10- Adrenal cortex diseases
Hypothyroidism LOW Resistance to infection.LOW Resistance to prolonged stresses.Patients are subject to adrenocortical
insufficiency.Therefore dental appointments should be as
brief and as atraumatic as possible.
11- Thyroid diseases & Goiter
Hyperthyroidism (Goiter) :Suffers from Heat intolerance. Sweating. Weight loss. Weakness
Hyperthyroid patient if given L.A. with epinephrin thyroid crises.
Because Epinephrine potentiates the action of thyroid gland.
Use L.A. without epinephrine as (Carbocaine, Citanest).
Sedative premedications are recommended.
Barbiturates are dangerous it causes paradoxical stimulatory reaction.
So Non barbiture sedatives are recommended.
Syncope transient cerebral anoxia.Extremely nervous patients cerebral
anoxia syncope.Push the head between patients knees or
lower it than the rest of the body.Nitrous oxide – oxygen analgesia
concentration of O2.Frequent spells of syncope cerebral
disease.
12- Fainting ( Syncope )
Ideal time for treatment 2nd
trimester Recommendations a-minimum medications. b-Protective lead shield with
radiographs. c-Consult the
gynaecologist.
13- Pregnancy
Menstruation hormonal changes. - Vasodilatation.- LOW Tissue resistance.
Toothache.
Post extirpation bleeding.
Post surgical hemorrhage.
Flare-ups.
14- Menestruation
Menopause depletion of estrogen. Osteoporotic jaw lesions.Atypical facial neuralgia (simulate pulpalgia).Impaired healing of periapical rarefaction
after RCT. No clinical signs and symptoms no
further treatment.Visible enlargement of periapical rarefactions
apical surgery.Medical consultation estrogen
replacement therapy
15- Menopause
Aspirin:
o In Patients taking anticoagulants aspirin will increase bleeding.
o In Diabetic patients aspirin will increase the insulin effect hypoglycemia (insulin shock).
o Aspirin should be avoided in case of peptic ulcers
17- Drugs & medications