Medically Comprised Patients
Our surgeons are highly trained and skilled in the treatment of a medically compromised patient. Their first step in managing the patient with medical problems is acquiring a thorough health history; the second step is for our surgeons to fully understand the significance of the disease that may be endorsed by the patient. Each identified condition can affect dental care in a unique manner. For example, medication prescribed for a medical condition might produce a problem during the administration of a General, IV sedation, oral sedation, local anesthetic or it could interact with pain medication prescribed post surgery. Our surgeons need to understand the potential complications that can occur as a consequence of dental surgery treatment of a medically compromised patient and when pre-treatment or post-treatment medication or emergency care is indicated.
Certain medically compromised patients should only be treated in a hospital setting where emergency issues, should they arise, can be immediately addressed and promptly attended to in a controlled manner. For example, the patient with a significant bleeding problem or thrombocytopenia arising as a primary condition or secondary to medication, radiation, or leukemia is best managed in an in-patient environment where replacement of platelets can be provided before the procedure or afterwards if spontaneous bleeding occurs (eg, following a tooth extraction)
Surgical dental management of the medically compromised patient requires acquisition of a complete health history of the patient. This should include documentation as well as a verbal history. A comprehensive health history questionnaire should include questions about the patients cardiovascular, hematologic, neural and sensory, gastrointestinal, respiratory, dermal, mucocutaneous, and musculoskeletal, endocrine, and urinary systems as well as questions related to sexually transmitted diseases, drug use (eg, alcohol, tobacco), allergies, x-ray exposure or treatment, medications, and hospitalizations.
The dental history should also include questions related to current oral conditions such as periodontal disease or oral ulceration and past dental treatment and potential complications from prior intervention including treatment failure and the delivery of anesthesia or post-treatment medication.
Technical considerations
Examination of the patient with a history of medical problems should be more extensive than that associated with the healthy patient. Physical assessment should include evaluation of the patient’s general appearance (eg, weight, posture, skin, and nails), blood pressure and temperature, pulse rate, respiratory rate, a thorough head and neck inspection (including assessment of lymph nodes, salivary glands, otologic assessment, assessment of breath smell), and cranial nerve examination.
In patients that present with problems identified at examination that have not previously been reported to a health care practitioner the dentist can be instrumental in defining potential pathology and making the appropriate referral for additional medical evaluation. Such patients should be referred for medical assessment prior to any dental or Surgical treatment.
In the patient with pre-existing disease, preparation for dental treatment should include determination of disease status. For example, treatment of the patient with diabetes needing extensive oral surgery (eg, multiple extractions or periodontal surgery) necessitates knowing the level of brittleness of the disease.
In the patient with uncontrolled diabetes needing emergency oral surgery for acute infection, dental procedures need to be modified. Other laboratory tests that may be necessary prior to any dental surgical treatment which may include a complete blood count with differential and tests for hemostasis, Hepatitis or HIV.
Planning for dental treatment in the medically compromised patient primarily involves having an understanding of the nature of the patient’s disease and how it can impact their physiology and his/her response to dental management and post dental treatment healing.
Our surgeons will consult with each individual patient prior to surgery and thoroughly review your medical history with you. It is very important that full disclosure of your health history be discussed with our surgeons to prevent any unforeseen contraindications that may put you at risk.