Dental Management of Patients with Urinary Disorders PDF

DENTAL MANAGEMENT OF PATIENTS WITH URINARY DISORDERS RENAL DISORDERS Disease of hydrogen ion concentration and electrolytes Glomerular diseases Acute renal failure Chronic renal failure End stage renal failure or uremic syndrome Renal transplants ORAL MANIFESTATIONS OF IMPAIRED...

DENTAL MANAGEMENT OF PATIENTS WITH URINARY DISORDERS RENAL DISORDERS Disease of hydrogen ion concentration and electrolytes Glomerular diseases Acute renal failure Chronic renal failure End stage renal failure or uremic syndrome Renal transplants ORAL MANIFESTATIONS OF IMPAIRED RENAL FUNCTION Ammonia like taste and smell Uremic stomatitis Gingivitis ORAL MANIFESTATIONS OF IMPAIRED RENAL FUNCTION XEROSTOMIA PAROTITIS GLOMERULAR DISEASES An inflammation of the glomerular capillaries Acute nephritic syndrome Chronic glomerulonephritis Nephrotic syndrome ACUTE RENAL FAILURE Acute and reversible deterioration of renal function which develops over a period of days, or rarely weeks and results in uremia. CHRONIC RENAL FAILURE Chronic renal failure is the irreversible deterioration in renal function which results from a diminished mass of the excretory, metabolic and endocrine functions of the kidney which leads to the development of the clinical syndrome of uremia (buildup of toxins in your blood) DENTAL MANAGEMENT Consultation with patient’s physician Avoid dental treatment if disease is unstable Monitor blood pressure closely Pay meticulous attention to good surgical technique Avoid nephrotoxic drugs Adjust doses of drugs metabolized by the kidney DENTAL MANAGEMENT Ensure good infection control Keep only the easily maintainable teeth Encourage good oral hygiene If patient is in advance stages, dental care may best be provided after physician’s consultation and in a hospital like setting DENTAL MANAGEMENT Because of the potential for bleeding problems: 1. Pretreatment screening for bleeding time and platelet count 2. A hematocrit(volume percentage of red blood cells in blood) level and hemoglobin count should be obtained to assess the status of anemia NEPHROTOXIC DRUGS Tetracyclines Streptomycin Vancomycin Gentamycin Acyclovir Acetaminophen Phenacetine NSAIDs Asprin Antihistamines, Phenobarbitones DECREASE DOSAGE Cephalosporins Penicillins Ampicillin Metronidazole Acyclovir Paracetamol Benzodiazpine NORMAL DOSE Cloxacillin Erythromycin Minocycline Codiene Diazepam Lidocaine PATIENT RECEIVING DIALYSIS Beware of concerns of arteriovenous shunt Consult with the physician about risk for infective endocarditis Avoid blood pressure cuff and IV medications in arm with shunt Avoid dental care on day of treatment; best to treat on day after Consider antimicrobial prophylaxis RENAL TRANSPLANT PATIENT Infection in such patients is life –threatening Before transplantation easily only maintained teeth should be determined by dental team approach Teeth with furcation involvement, periodontal abscesses, or extensive surgical requirements should be extracted DENTAL MANAGEMENT 1- Emergency treatment only for 1st 6 month 2-Prophylactic antibiotics according to AHA recommendations 3- Erythromycin is contraindicated in patients on cyclosporins 4-Cyclosporin causes gingival overgrowth 5-Immunosuppressed patient requires supplemental corticosteroids