Dentistry: Medically Compromised Patients and Referral Criteria Quiz

A medically compromised patient is a patient with a condition or treatment that may impact the delivery of safe and optimal dental care.
4 factors to determine whether a patient should be referred to a hospital: • Thorough medical history • Identifying the condition • Understanding the significance of the disease and its impact on dental care • Determining which cases can be safely treated in practice and which ones require a hospital setting

5 types of histories taken for patients: • Medical history • Dental history • Family history • Social history • Past dental treatment history

3 potential complications for patients with a compromised CVS: • Becoming breathless when laid flat (heart failure) • Bleeding tendency due to anticoagulants (atrial fibrillation) • Acute ischemic event (angina/MI)
Preferred anesthetic for compromised CVS: Citanest (no adrenaline)
General anesthesia (GA) is a risk for patients with a compromised CVS

Definition: Infection of the lining of the heart, particularly affecting the heart valves
Causes: Bacteria, occasionally other infectious agents
Risk factors: • Congenital heart disease • Rh heart disease • Aortic valve disease • Prosthetic valves • Previous endocarditis • Hypertrophic cardiomyopathy • IVDU
Antibiotic prophylaxis is no longer routinely recommended for patients with infective endocarditis
Advice for patients with infective endocarditis: Maintain good oral health

Treatment: Antihypertensive drugs
3 side-effects of antihypertensive drugs: • Xerostomia (diuretics) • Lichenoid reactions (ACE inhibitors) • Gingival hyperplasia (Ca channel blockers)

Patients with postural hypotension should be sat up slowly after long supine periods

3 things to have at hand for patients with respiratory disease: • Salbutamol • LA instead of GA • Steroid cover if they have adrenocorticocotical suppression
3 dental risks for patients with respiratory disease: • Inhaled steroid and oral candida can occur, so rinsing of the mouth is recommended • They may be sensitive to NSAIDs • Anxiety may cause exacerbation of respiratory disease

2 considerations for appointments with diabetic patients: • Timing of appointments to avoid hypoglycaemia, schedule close to meal times • Orofacial infections and surgery cause stress response, raising glucose
3 potential dental complications for diabetic patients: • Periodontal disease • Xerostomia • Risk of ischemic heart disease
If GA is used, IV insulin may be necessary for diabetic patients

Ideal timing for dental treatment: When there is good seizure control
4 potential dental problems for patients with epilepsy: • Convulsions (buccal midazolam used to control) • Drug reactions (enzyme inducers) • Bleeding tendency due to sodium valporate (CBZ) • Gingival hyperplasia due to phenytoin

7 functions of the liver: • Immunity against infections • Factory for proteins and cholesterol • Excretes wastes via bile • Excretes bile for fat digestion • Regulates blood clotting • Clears blood of drugs, chemicals, and alcohol • Converts excess glucose to starch for storage
6 dental considerations for liver disease patients: • Bleeding tendency • Altered drug metabolism • Delayed healing due to protein and Ig deficiency • LA is safe, but avoid IV sedation and GA • Risk of viral hepatitis • Weakened immune response after liver transplant

11 consequences of alcohol dependence: • Liver disease • Cirrhosis • Bleeding • Drug metabolism • CVS HTN • Cardiomyopathy • CNS perip neuropathy • Wernicke encephalopathy • Korsakoff psychosis • Impotence testicular atrophy • Gynaecomastia
2 dental considerations to avoid with alcohol-dependent patients: • NSAIDs and metronidazole (risk of GTI, gastritis, and oesophagitis) • Avoid aspirin
2 effects of alcohol dependence on the endocrine system: • Increased oestrogen • Decreased testosterone

3 functions of a healthy kidney: • Sodium and water removal • Waste removal • Hormone production
3 problems with an unhealthy kidney: • Fluid overload • Elevated wastes (urea, creatinine, potassium) • Changes in hormone levels (blood pressure, red blood cell production, calcium uptake)

Used to reduce inflammation and suppress the immune system
Replace hormones in the adrenal gland
2 commonly used corticosteroids: • Prednisolone • Hydrocortisone
Groups of people who take corticosteroids: • Addison's disease • Acne • Asthma • Lupus • Eczema • COPD • Giant cell arteritis
10 side effects of corticosteroids: • Cataracts • Diabetes • Hypertension • Increased weight gain • Mood swings • Insomnia • Cushing's syndrome • Increased risk of infections • Poor wound healing • Osteoporosis
When a patient should not be advised to come off corticosteroids: • If they have been taken for over 3 weeks and more than 30mg a day • This can lead to adrenal insufficiency and an adrenal crisis
Dose of corticosteroid for surgery in patients taking corticosteroids: • Double the normal dose
2 dental side effects of corticosteroids: • Oral candidiasis (weakened immune system) • Impaired wound healing (extractions need to be more carefully managed)
Corticosteroid use can cause the need for steroid cover in a dental setting
People taking corticosteroids are liable to infections such as candidiasis
Avoid NSAIDs with corticosteroid use, as they increase the risk of peptic ulceration