Dentist Mohanad

Dental management of medical compromised patients

,WBC,PML, ( no less than 50000 platelets , WBC 2000. ,20% poly morphonuclear leukocytes) . And use local hemostatic measures e.g gel foam, surgecal. 2️⃣oral hygiene measures . 3️⃣avoid GA in sever anemia. 3️⃣prophylacti antibiotic , anti-fungal(fluconazole), anti viral(acyclovir )to reduce infections. 4️⃣avoid aspirin because interaction with methotrexate . 5️⃣topical or systemic folinic acid to reduce stomatitis. 6️⃣recall every 3-6 months . 7️⃣low blood contents patients are advised to avoid flossing, use soft brush and remove any removable appliance. . ➖➖➖➖➖➖➖➖➖➖ 💉Dental management of radiotherapy: 1️⃣remove all sources of infections by endodontic treatment, extraction of teeth done at least 3 wks before radiotherapy. 2️⃣treat chronic inflammatory lesions. 3️⃣All sharp bone and margins trimmed. 4️⃣management of xerostomia, mucositis . 5️⃣ soft diet, avoid irritating food , tobacco,alcohol. 6️⃣instruct the patient to do 10 times a day saline wash+ twice aday chlorhexidine. 7️⃣prevention of trismus by maintain mouth opening . 8️⃣maintain nutrition and follow up. 9️⃣Antifungal . ➖➖➖➖➖➖➖➖➖➖ 🎁Cardiovascular diseases. 📌Cardiac arrhythmia &pacemaker 💉Dental management: 1️⃣consultation 2️⃣stress reduction protocol 3️⃣local anesthesia without adrenaline 4️⃣avoid diathermy and ultrasonic scalar in case of pacemaker. 5️⃣in case of decreased heart rate: ➡️direct vigorous thumbing on the pericardium. 6️⃣in case of rapid heart beats: ➡️vagal stimulation through carotid sinus massage. ➖➖➖➖➖➖➖➖➖➖➖ 💉Dental management of angina pectoris: 1️⃣consultation. 2️⃣advice the patient to eat lightly before appointment. 3️⃣premedication with short acting barbiturates. 4️⃣stress reduction protocol. 5️⃣nitroglycerin tab sublingually : 5 min before appointment & keep it handy. 6️⃣monitor vital signs. 7️⃣avoid prolonged procedure. 8️⃣avoid painful stimuli. 9️⃣injection of LA containing vasoconstrictor: safe suggestion 2 carpules containing maximum 1,100,000 adrenalin , injection slowly with Aspiration. 🔟if unstable angina , postpone surgery, Only emergency cases are done. ➖➖➖➖➖➖➖➖➖➖➖ 💉Dental management of coronary angioplasty : 🎁 introduction of catheter containing ballon in narrowed coronary arteries. 🕹 the same precautions for Angina pectoris. 🕹 Anticoagulant drug management : 🔆 never withdrawal the anticoagulant because lead to rebound thrombosis. 🔆reduce the dose of oral anticoagulant to allow prothrombin time 1.5-2 . ➖➖➖➖➖➖➖➖➖➖➖ ‏💉Dental management of myocardial infarction: 1️⃣ consultation and advice hospitalization. 2️⃣postpone surgery till 6 months after attack. 3️⃣prophylactic coronary dilator. 4️⃣anti coagulant drug management : 🕹never withdrawal anti coagulant ( fear of rebound thrombosis) 🕹reduce dose of oral anti coagulant to maintain prothrombin time 1.5-2 . 5️⃣ stress reduction protocol. 6️⃣monitor vital signs. 7️⃣decrease amount adrenaline. 8️⃣local hemostatic measures : 🕹 constant pressure. 🕹gel foam in socket After extraction. 🕹multiple suture under tension. 🕹heavy bite pressure at least 1 hr. 🕹apply ice pack externally . 9️⃣ avoid rinsing and hot liquids for 72 hrs. ➖➖➖➖➖➖➖➖➖➖➖ 💉Dental management of coronary artery bypass grafing ✳️same considerations as myocardial infarction with pre operative prophylactic anti biotics against infective endocarditis, for the first 6 months. ➖➖➖➖➖➖➖➖➖➖➖ ‏💉Dental management of Rheumatic heart disease: 1️⃣physician consultation. 2️⃣antibiotic cover. 3️⃣patient may also anti coagulated. ➖➖➖➖➖➖➖➖➖➖➖➖ 🎁dental management of hypertension: 1️⃣patient best treated in late morning with BP less than 180/110. 2️⃣ stress reduction protocol with short appointments. 3️⃣5 mg diezepam could be given. 4️⃣NSAID reduce effect anti hypertensive drug. 5️⃣ adequate analgesia must be provided . 6️⃣anesthesia without adrenaline . 7️⃣gingival cord containing epinephrine should be avoided. ➖➖➖➖➖➖➖➖➖➖ 🎁dental management of congestive heart failure: 1️⃣postpone treatment until patient is well controlled. 2️⃣avoid supine position. 3️⃣follow stress reduction protocol 4️⃣administer oxy

ively to increase Hb synthesis. 6️⃣local hemostatic measures and prophylactic antibiotics to prevent post operative infection. ➖➖➖➖➖➖➖➖➖➖ 💉Dental management of Renal dialysis . 1️⃣consultation. 2️⃣stress reduction protocol. 3️⃣Avoid drugs that excreted through kidney. 4️⃣Avoid nephrotoxic drugs. 5️⃣ postpone the surgery to the day following dialysis. 6️⃣prophylactic anti-biotic 7️⃣least traumatic surgery. 8️⃣least amount of L.A. 9️⃣High infection control measures. ➖➖➖➖➖➖➖➖ 💉Dental management of Renal Transplant: 1️⃣consultation. 2️⃣stress reduction protocol. 3️⃣Regulation of corticosteroid: 🕹minimal stress ➡️no change 🕹moderate stress➡️double the dose. 🕹severe stress➡️100 mg hydrocortisone IV . 4️⃣avoid nephrotoxic drugs. 5️⃣prophylactic antibiotic. 6️⃣high infection control measures. ➖➖➖➖➖➖➖➖➖➖ 💉Dental management of Liver diseases: 1️⃣medical consultation . 2️⃣liver function tests e.g ALT&AST 3️⃣coagulation screening profile. 4️⃣Regulation of bleeding tendency: 🕹blood transfusion prior to surgery if needed. 🕹vitamin K 10 mg one hour before surgery and after surgery. 5️⃣stress reduction protocol. 7️⃣prophylactic antibiotic (uracin : ampicillin/ sulbactam) 8️⃣high infection control measures. 9️⃣avoid hepatotoxic drugs. 🔟avoid use drugs metabolized in liver. 1️⃣1️⃣LA is safe with small amount & concentration. 1️⃣2️⃣least amount of surgical intervention. 1️⃣3️⃣local hemostatic measures. ➖➖➖➖➖➖➖➖➖➖➖ ‏Dental management of liver 💉transplant: 🔆pre transplant : 1️⃣extraction of infected, non restorable, hopeless tooth. 2️⃣Oral hygiene instructions. 🔆post transplant: 1️⃣no elective dental treatment for 3 months after surgery. 2️⃣routine prophylaxis Anti biotic is not recommended. 3️⃣prophylactic care. 4️⃣recall check after 3 months. ➖➖➖➖➖➖➖➖➖➖ 💉Dental Management of Epilepsy: 1️⃣consultation 2️⃣postpone surgery until condition is well controlled. 3️⃣anticonvulsant premedication. 4️⃣stress reduction protocol. 5️⃣Avoid hypoglycemia. 6️⃣Avoid lengthy procedures. 👨🏻‍⚕️ in case of seizure: 1️⃣stop procedure. 2️⃣ put the patient on the floor on his side. 3️⃣remove all hard objects around. 4️⃣Dont try to put your hands inside his mouth. 5️⃣4 mg IV lorazepam . 6️⃣if hypoglycemia is occured , Give sugar orally . ➖➖➖➖➖➖➖➖➖➖➖ 💉Dental management of AIDS 🎁characterized by : 🔆generalized lymphadenopathy. 🔆opportunistic infection. 🔆malignancies. 🔆progressives periodontal disease. 🔆hairy leukoplakia. 🔆xerostomia. 💉Dental Management : 1️⃣Medical consultation. 2️⃣strict infection control measures. ➖➖➖➖➖➖➖➖➖➖➖ 💉Dental management of pregnancy and lactation : 1️⃣consultation . 2️⃣second trimester of gestation is safe time for dental procedure. 3️⃣emergency treatment could be done any time. 4️⃣short appointment. 5️⃣avoid painful stimuli. 6️⃣avoid supine position . 7️⃣avoid radiograph. 8️⃣GA is not recommended . 9️⃣avoid teratogenic drugs. 🔟LA without adrenaline is preferred. ➖➖➖➖➖➖➖➖➖➖ 🎁 permissible drugs during lactation : 🔆kefflex 🔆Erythromycin 🔆xylocine . ➖➖➖➖➖➖➖➖➖➖➖ 💉Dental management of Anti coagulant receiving patient: 📌 patient recovering aspirin: 1️⃣consult for safety of stopping drug for several days. 2️⃣stop drug for 5 days. 3️⃣ local hemostatic measures. 4️⃣ restart drug on the day following surgery if no bleeding is present. ➖➖➖➖➖➖➖➖➖➖➖ 📌patient receiving heparin : 1️⃣ consultation for safety of stopping drug for pre operative peroid. 2️⃣ defer surgery until at least 6 hrs after heparin is stopped. 3️⃣restart heparin once clot has formed. ➖➖➖➖➖➖➖➖➖➖➖ 📌patient receiving warfarin ( coumarin) 1️⃣ consultation for safety of allowing PT to fall to 1.5 INR for few days. 2️⃣if PT is 1-1.5 INR, proceed with surgery and take hemostatic measures during and after surgery. 3️⃣ if PT is more than 1.5 INR , stop warfarin 2 days before surgery. 4️⃣ check PT daily until it is 1.5 . 5️⃣ restart warfarin on the day of surgery. ➖➖➖➖➖➖➖➖➖➖➖ 💉Dental Management of chemotherapy: 1️⃣Before chemotherapy : remove all sources of infections by exo or endo of infected teeth after check number of platelets

#الامراض_في_عيادة_الاسنان📚📚 ((Dental Management of Medically compromised patient). Salim Khalaf Sallaum Tikrit University College of Dentistry ./5 Grade.(سابقا😆) كتبتها من جنت بالخامس بلكي تفيد احد ./ #انسخها_يمك ➖➖➖➖➖➖➖➖➖➖➖ ‏💉Dental management of Asthma ‏Asthma is reversible spasmodic contraction of smooth muscles of bronchioles. ‏🎁characterized by ‏wheezing ,dyspnea,cough. ‏📚Dental management: ‏1️⃣consultation ‏2️⃣stress reduction protocol ‏3️⃣ pre operative broncho dilator ( theophylline) ‏4️⃣ oxygen. ‏5️⃣ patient on theophylline, avoid prescription of : ‏📌NSAID, erythromycin, narcotic, barbiturates, sulfite containing anesthesia. ‏6️⃣in sever attack: ‏💉 aminophyline 250 mg IV slowly ‏💉hydrocortisone 100 mg IV slowly ‏👨🏻‍⚕️Oxygen. ➖➖➖➖➖➖➖➖➖ 💉Dental management of COPD 🎁COPD is bronchitis associated with excessive mucous secretion, cough and expectoration . 🎁Etiology : smoking and environmental pollutants. 🚑 Dental management: 1️⃣consultation. 2️⃣schedule afternoon to allow respiratory clearance. 3️⃣stress reduction protocol. 4️⃣Avoid narcotic and barbiturates because they are respiratory depressants. 5️⃣keep bronchodilator inhaler accessible. 6️⃣Upright position in dental chair. 7️⃣Avoid bilateral palatal or mandibular nerve block to avoid sensation of respiratory obstruction. 8️⃣Use of rubber dam is not advisable. 9️⃣Patient on oxygen, should be continued during surgery. 🔟prophylaxis for Adrenal insufficiency if patient under steroid. 1️⃣1️⃣ Avoid Anti Histamin and atropine because it lead to dry mouth and encourage mucous production. ➖➖➖➖➖➖➖➖➖➖➖ 💉Dental management of Hyperthyroidism. 🎁 increased secretion of thyroid hormones T3&T4 in the circulation that may lead to thyroid crisis. 🕹Signs of Hyperthyroidism: ✳️tachycardia ✳️exophthalmos ✳️tremor. 📌To prevent thyroid crisis : 1️⃣consultation. 2️⃣postpone surgery until thyroid dysfunction is well controlled ( 1-2 months after controlling the case) 3️⃣stress reduction protocol. 4️⃣Avoid Anesthesia with Adrenaline. 5️⃣Avoid Atropine that lead to thyroid crisis. 💊💊💊💊💊💊💊💊💊💊💊💊 🚑Management of thyroid crisis: 1️⃣emergency call. 2️⃣ice pack to reduce temperature. 3️⃣oxygen. 4️⃣CPR. 5️⃣100-300 mg hydrocortisone IV. 6️⃣anti thyroid medication : potassium iodide or 200 mg propranolol. 7️⃣IV fluids as supportive measures . ➖➖➖➖➖➖➖➖➖➖ ‏💉Dental management of hypothyroidism: 🎁Oral manifestation: 1️⃣Teeth abnormalities ( enamel hypoplasia) 2️⃣micrognathia 3️⃣enlarged tounge & lips. 4️⃣face is wide. 5️⃣retraction of nose bridge with flaring. 💉Dental management: ✅Diagnosed patient:- 📌avoid acute infection 📌Avoid CNS depressant, sedatives, diezepam, narcotic , barbiturates, opoid analegesic, and general anesthesia. 📌prepare yourself for hypothyroidism coma. 💉Management of hypothyroidism coma: 1️⃣seek medical aid. 2️⃣hydrocortisone 100-300 mg 3️⃣artificial respiration 4️⃣CPR ➖➖➖➖➖➖➖➖➖➖ 💉Dental management of Diabetic patient . ✳️characterized by polyphagia, polyuria, polydipsia, blurred vision, glycosuria , vascular diseases. 1️⃣consultation. 2️⃣ any uncontrolled patient should be referred to physician. 3️⃣ stress reduction protocol. 4️⃣ best appointment in the morning , 90-180 mins after breakfast and usual dose insulin taking . 5️⃣in non insulin controlled patient ,all dental procedure could be done. 6️⃣prophylactic antibiotic the day &2-3 days after surgery ( im massive surgery) 7️⃣use small amount of epinephrine in LA ( not more than 1/100000) because it raise blood sugar. 8️⃣if there's doubt of insulin shock/ diabetic coma ➡️IV dextrose. 9️⃣sugar should always available for hypoglycemia. ➖➖➖➖➖➖➖➖➖➖ 💉 Dental management of Anemia ✳️characterized by fatigue, shortness of breath, headach , pallor mucosa. 1️⃣medical consultation. 2️⃣complete blood picture. 3️⃣postpone surgery if Hb concentration is less than 10 g/100ml. 4️⃣search for signs and symptoms of anemia : 📌sore tounge 📌necrotizing ulceration of gingiva 📌bleeding during examination 5️⃣consider irons and multi vitamins therapy preoperat

حالة صعبة وتحدي كبير 😍😌 اعادة تأهيل كامل للفكين بعد فقدان الاسنان الخلفية وتكسر بالاسنان الامامية وخلل بالاطباق خطة العلاج استمرت تقريبا ٨ اشهر تم خلالها تعويض الاسنان الخلفية بطخم اسنان متحرك واستعماله برفع الاطباق وتصحيحه ثم معالجة الاسنان الامامية بحشوات جذر واعادة بناء وتغليف بمادة الزاركون 😍😌 لتكون الابتسامة بهذا المنظر 😌 Treatment plan :- • removable dentures for upper and lower arch • Vertical dimension correction by adding composite to the occlusal surface of 1st & 2nd molar of the removable denture ( 1mm added every 3 weeks ) • Give the pt any muscle relaxant and pain killer • Repeat the adding of composite every three weeks till you getting agood space betwwen upper and lower arch ( in this case about 8 months just to get a good occlusion • Endodontic treatment for anterior teeth and fiber post • Zerconum bridge from canine to canine • The dental implant is much preferred in this case but the bone quality & quantity is not good

اليوم راح انشر الكم حاله عن Molar incisor hypominerlization وبالتفصيل وكذلك راح نقارن بينها وبين الكيسات المشابهه الها وشلون نميز بينهم