Diagnosis Lec 3, 4, & 5 PDF

 Past dental history The following details should be investigated routinely in the past dental history: Frequency of visits to a dentist: to know the interest of the patient in his dental health. Frequency of dental prophylaxis: which may be a valuable guide in evaluating periodontal cond...

 Past dental history The following details should be investigated routinely in the past dental history: Frequency of visits to a dentist: to know the interest of the patient in his dental health. Frequency of dental prophylaxis: which may be a valuable guide in evaluating periodontal conditions that are present and provides the dentist with prognostic information. Past experience during and after local anesthesia: this may alert the dentist to the possible allergic or unwanted reaction to the anaesthetic agent. Past experience during and following extraction: history of excessive hemorrhage or infection and delayed wound healing may need further systemic evaluation before proceeding with additional extractions. Past periodontal therapy and the type of treatment he received (complete scaling, occlusal adjustment or surgery). Past orthodontic treatment and the nature of the appliances used. Dental appliance history: length of time of worn, whether or not modified such as rebase or addition of teeth, personal care of appliance. Fixed bridges: length of service, comfort, modifications. Root canal fillings: length of time present, apisectomy. Surgical procedures in and about the mouth other than extractions, nature of the tissue removed manner in which it was removed, recurrences.  Past medical history - Childhood disease: (mumps, measles, chickenpox, scarlet fever and rheumatic fever) Fever→ enamel defects Tetracycline→ staining of the dentine Rh. fever→ damage to the heart valves →bacterial endocarditis??? - Hospitalization→ past diseases Neoplasm?? - Radiation therapy→ osteoradionecrosis - Facial injury→ devitalized or fractured teeth TMJ→ injury or due to fractured jaw - Allergies→ to certain materials or L.A. - Medications?? High-Risk Conditions: Prosthetic valves, previous bacterial endocarditis, single ventricle states, transposition of the great arteries, tetralogy of Fallot Potential Problems Related to Dental Care 1. Patients with these conditions are at high risk for bacterial endocarditis secondary to dental treatment resulting in significant bleeding, even if they have had surgical repair 2. Patients with mechanical prosthetic valves may be at risk for excessive bleeding because of long-term anticoagulant therapy 3. Patients with cyanosis (right to left shunt) may have excessive bleeding and be prone to infection.  Oral Manifestations Usually none with prosthetic valves or history of previous bacterial endocarditis; possible cyanotic appearance of oral mucous membranes with complex cyanotic congenital heart disease and petechiae or ecchymosis because of hematologic abnormalities. Moderate-Risk Conditions: Other uncorrected congenital cardiac malformations, acquired valvular dysfunction, hypertrophic cardiomyopathy, mitral valve prolapse with regurgitation Potential Problems Related to Dental Care 1. Patients with these conditions are at moderate risk for bacterial endocarditis, secondary to dental treatment resulting in significant bleeding. 2. Patients with surgically repaired congenital defects without residual dysfunction do not require antibiotic prophylaxis 3. Patients with a history of rheumatic fever but without evidence of rheumatic heart disease do not require antibiotic prophylaxis. 4. Patients with mitral valve prolapse without regurgitation do not require antibiotic prophylaxis. Hypertension  Potential Problems Related to Dental Care 1. Stress and anxiety related to dental visit may cause increase in blood pressure, angina, myocardial infarction, or cerebrovascular accident 2. Patients being treated with antihypertensive agents may become nauseated or hypotensive, or may develop postural hypotension. 3. Excessive use of vasopressors may cause significant elevation of blood pressure. 4. Sedative medication used in patients taking certain antihypertensive agents may bring about hypotensive episodes.  Oral Manifestations 1. Xerostomia secondary to diuretics and other antihypertensive medications. 2. Ulceration or stomatitis caused by mercurial diuretics. 3. Lichenoid reactions seen with thiazides, methyldopa, propranolol, and labetalol. 4. Lupus-like reaction rarely seen with hydralazine. Angina Pectoris Potential Problems Related to Dental Care 1. Stress and anxiety related to dental visit could precipitate an anginal attack, myocardial infarction, or sudden death in the office. 2. For patient taking a non-selective beta blocker, the use of excessive amount of epinephrine could precipitate a dangerous elevation of blood pressure. 3. Patient taking aspirin or other platelet aggregation inhibitor could experience excessive bleeding. 4. Potential to cause endarteritis of coronary artery stent in the immediate post-placement period exists as a result of dentally induced bacteremia.  Oral Manifestations Usually none as a direct result of angina; however, may see drug- related changes such as dry mouth, taste changes, or stomatitis; also may have excessive postsurgical bleeding due to platelet aggregation inhibition. Myocardial Infarction  Potential Problems Related to Dental Care 1. Stress and anxiety related to dental visit could precipitate an anginal attack, myocardial infarction, or sudden death in the office. 2. Patient may have some degree of congestive heart failure. 3. Electrical interference could occur with the use of certain dental equipment if pacemaker in place. 4. Use of excessive amount of epinephrine could precipitate a dangerous elevation of blood pressure if patient taking a nonselective beta-blocker. 5. Patient taking aspirin, other platelet aggregation inhibitor, or Coumadin could experience excessive bleeding with invasive dental procedures. 6. Potential exists for endarteritis of coronary artery stent in the immediate post-placement period as a result of dentally induced bacteremia.  Oral Manifestations Usually none as a direct result of myocardial infarction; however, may see drug-related changes such as dry mouth, taste changes, or stomatitis; also may have excessive postsurgical bleeding due to platelet aggregation inhibition or anticoagulation.  Viral Hepatitis, Types B, C, D, E Potential Problems Related to Dental Care 1. Hepatitis may be contracted by dentist from infectious patient 2. Patients or staff can be infected by dentist with active hepatitis or who is a carrier. 3. With chronic active hepatitis patient may have bleeding tendency or altered drug metabolism. Oral Manifestations Bleeding. Lichenoid eruptions. Diabetes Mellitus  Potential Problems Related to Dental Care 1. In uncontrolled diabetic patients: a. Infection. b. Poor wound healing. 2. Insulin reaction in patients treated with insulin. 3. In diabetic patients, early onset of complications relating to cardiovascular system, eyes, kidneys, and nervous system (angina, myocardial infarction. Cerebrovascular accident, renal failure, peripheral neuropathy blindness, hypertension, congestive heart failure).  Oral Manifestations 1. Accelerated periodontal disease. 2. Gingival proliferations. 3. Periodontal abscesses. 4. Xerostomia. 5. Poor healing. 6. Infection. 7. Oral ulcerations. 8. Candidiasis. 9. Mucormycosis. 10. Numbness, burning, or pain in oral tissues. Pregnancy and Lactation  Potential Problems Related to Dental Care 1. Dental procedures could harm developing fetus via: a. Radiation. b. Drugs. c. Stress. 2. Supine hypotension in late pregnancy. 3. Poor nutrition and diet can affect oral health. 4. Transmission of drugs to infant via breast milk. Oral Manifestations 1. Exaggeration of periodontal disease, "pregnancy gingivitis". 2. "Pregnancy tumor". 3. Tooth mobility.  Thrombocytopenia (primary or secondary) Caused by Chemicals, Radiation, or Leukemia  Potential Problems Related to Dental Care 1. Prolonged bleeding 2. Infection in patients with bone marrow replacement or destruction. 3. In patients being treated with steroids, serious medical emergency resulting from stress. Oral Manifestations 1. Spontaneous bleeding. 2. Prolonged bleeding following certain dental procedures. 3. Petechiae. 4. Ecchymoses. 5. Hematomas.  Radiation-Treated Patients (radiation to head and neck) Potential Problems Related to Dental Care 1. Patients treated by radiation tend to develop the following problems during and just after completion of therapy: a. Mucositis. b. Xerostomia. c. Loss of taste. d. Constricture of muscles (trismus). e. Secondary infections—viral, bacterial, fungal (candidiasis). f. Tooth sensitivity. 2. Chronic problems caused by radiation therapy include: a. Xerostomia. b. Cervical caries. c. Osteonecrosis. d. Muscle trismus. e. Tooth sensitivity. f. Loss of taste  Oral Manifestations 1- Mucositis. 2- Candidiasis. 3- Xerostomia. 4- Loss of taste. 5- Trismus. 6- Sensitivity of teeth. 7- Cervical caries. 8- Osteonecrosis. Seizure Disorder (epilepsy) Potential Problems Related to Dental Care 1. Occurrence of generalized tonic-ctonic seizure in dental office. 2. Drug-induced leukopenia and thrombo- cytopenia (phenytoin. carbamazepine, valproic acid). Oral Manifestations 1. Gingival overgrowth secondary to phenytoin (Dilantin). 2. Traumatic oral injuries. 3. Drug-induced erythema multiform. Systemic Lupus Erythematosus Potential Problems Related to Dental Care 1. Systemic manifestations. 2. Possible bleeding tendency. 3. Infection susceptibility. 4. Adrenal suppression (taking corticosteroids). 5. Infective endocarditis (rare). Oral Manifestations Drug-induced stomatitis and oral ulceration. Discoid lupus erythematosus, erythematous Radiating white patches and scaling lesions on vermilion. with erythema in the buccal sulcus, which is characteristic of the oral lesions of lupus erythematosus. Facial “butterfly rash” of systemic lupus erythematosus. Leukemia  Potential Problems Related to Dental Care 1. Prolonged bleeding 2. Infection 3. Delayed healing Oral Manifestations 1. Infection. 2. Ulceration 3. Gingival bleeding 4. Ecchymoses 5. Petechiae 6. Gingival hyperplasia 7. Soft tissue and osseous lesions 8. Paresthesias—numbness, burning, tingling 9. Candidiasis 10. Lymphadenopathy Diseases which contra-indicate any kind of dental treatment Leukemia: because of altered defense mechanism against infection, excessive hemorrhage after extraction, delayed wound healing Hemophilia: decrease factor 8 lead to severe and fatal bleeding. Addison's disease: should be controlled by exogenous steroids before surgery to avoid adrenal crisis which may be fatal. Hyperthyroidism "Toxic type" should be controlled at first to avoid fatal attack of thyroid crisis. Congestive heart failure "advanced type".  Diseases which endanger dentist There are few diseases which the dentist may feel require special precautions on his part because of close contact with patients at the chair. Active tuberculosis is obviously a disease requiring special precautions during dental operations. (Face mask, use conventional speed not high speed, adequate sterilization). Recent history of infection of viral hepatitis should alert the dentist to be cautions in contacting the patient's blood and saliva directly, and to take special care to autoclave all instruments to prevent transmission of the disease to another patient.