Cardiovascular, Lung, GI, Endocrine & Hematological Diseases in Dentistry PDF

CARDİOVASCULAR DISEASES & DENTISTRY Doç Dr Kader AYDIN ASA PHYSICAL CLASSIFICATION WITH DENTAL CONSIDERATIONS CARDIAC DISEASES THAT MAY PREDISPOSE TO ENDOCARDITIS CONGENITAL HEART DEFECTS ATRIAL / VENTRAL SEPTAL COMMUNICATION PATENT DUCTUS ARTERIOSUS...

CARDİOVASCULAR DISEASES & DENTISTRY Doç Dr Kader AYDIN ASA PHYSICAL CLASSIFICATION WITH DENTAL CONSIDERATIONS CARDIAC DISEASES THAT MAY PREDISPOSE TO ENDOCARDITIS CONGENITAL HEART DEFECTS ATRIAL / VENTRAL SEPTAL COMMUNICATION PATENT DUCTUS ARTERIOSUS AORTIC /MITRAL / PULMONIC/ TRICUSPID VALVE STENOSIS TETRALOGY OF FALLOT EISENMENGER COMPLEX MARPHAN SYDROME ACQUIRED HEART DEFECTS RHEUMATIC VALVE DISEASE VALVULOPATHY PROSTHETIC VALVES ENDOCARDITIS PROPHYLAXIS  ISCHEMIC HEART DISEASES ASYMPTOMATIC/ MINIMAL SYMPTOMS STABILIZED ANGINA PECTORIS NON STABILIZED ANGINA PECTORIS (PREINFACTUS ANGINA) VARIANT ANGINA PECTORIS SUDDEN DEATH MYOCARDIAL INFARCT CHRONIC CONGESTIVE HEART DISEASE ARRYTHMIA ANGINA PECTORIS  AVOID LONG- TRAUMATIC DENTAL PROCEDURES AVOID PATIENT EXCITATION AND FEAR PREOP NIDILATES MAY BE PREVENTIVE PREOP SEDATION PREOP CONSULTATION TO CESSATE ANTICOAGULANTS AVOID DENTAL PROCEDURES IN 3 MONTHS AFTER AP KEEP OXYGEN MASK NEARBY KEEP PATIENT IN UPRIGHT POSITION SUBLINGUAL NIDILATES WITH ANY CHEST PAIN MYOCARDIAL INFARCTION THROMBOTIC PLUG DUE TO RUPTURE OF THE PRESENT ATEROM PLAQUE PAIN OF THE CHEST AND LEFT ARM, SWEATING, PALENESS, AGITATION, FEAR OF DEATH NO ANSWER FOR NİTRATES  CLINICAL OBSERVATION, ACUTE EKG CHANGE, ENZYMATIC LOCOSITOSIS,ESR ,MYOGLOBULIN,CK-MB,TROPONIN, AST,LDH DIAGNOSED WITH 2 OF THE ABOVE CONDITIONS ARE PRESENT  PREOP CONSULTATION FOR ANTICOAGULANT CESSATION TO PREVENT CORONARY TROMBOSIS. AVOID DENTAL PROCEDURES IN 6 MONTHS TIME PROPHYLACTIC NIDILATE BLOOD PRESSURE AND PULSE MONITORING DURING PROCEDURE L.A. WITHOUT ADRENALINE OXYGENE MASK NEARBY  CONGESTIVE HEART FAILURE LIMITED BLOOD PUMPING TO THE PERIPHERAL ORGANS DUE TO ANATOMIC CARDIAC CHANGES. USUALLY CAUSED BY CORONARY ARTERY DISEASE, HYPERTENSION, VALVULAR DISEASES, ARRYTHMIAS AND CARDIOMYOPATHIES FINDINGS OF CONGESTIVE HEART FAILURE PULMONARY EDEMA LIVER FAILURE DYSPNEA, FATIGUE, PERIPHERAL CYANOSIS, SYNCOPE, OLIGUREA, CHEYNE- STOKES BREATHING, HAEMOPHTISIA, TACHYCARDIA, PULMONARY PRESSURE INCREASE, ACUTE PULMONARY EDEMA AVOID SUPINE POSITION, PRIMARY WORK WITH UPRIGHT POSITION TO AVOID DYSPNEA CORONARY ARTERY DISEASES ATEROSCLEROSIS: HARDENING AND NARROWING OF THE LARGE AND MEDIUM ARTERIES DUE TO INTIMAL LAYER. RISC FACTORS: HYPERTENSION, OBESITY, SMOKING, DM MALE GENDER, SEDANTARY LIFE, STRESS, GENETİC PREDISPOSITION HDL LDL AND TRİGLİSERİDE  TAKE CARE FOR ANTICOAGULANTS CONSULTATE FOR ANTICOAGULANT CESSATION PRESERVE DIGITALS, ANTIHYPERTENSION AND CARDIAC MEDICAMENT USAGE. PT, PTT, INR RATE BEFORE SURGICAL PROCEDURE ORAL HEAMORRAGIC LESIONS SPONTANEOUS MUCOSAL BLEEDING HEAMATOMA AFTER TRAUMA AND DENTAL PROCEDURES ACUTE INFECTIVE ENDOCARDITIS ACUTE FULLMINANT ROUTE OF HIGH BODY TEMPERATURE, LOCOSITOSIS AND HIGH ESR. SUBACUTE INFECTIVE ENDOCARDITIS PREVIOUS VALVULAR DISEASE, SUBFEVRILE BODY TEMPERATURE, NIGHT SWEATING, WEIGHT LOSS, HIGH ESR. ESR, HYPERGAMAGLOBULINEMIA, ANEMIA, CRP INCREASE, LOCOSITOSIS, RF (+)  DENTAL PROCEDURE INCLUDING TEETH AND GINGIVAL SURGERY PRODUCE HIGH RISC GROUP FOR INFECTIVE ENDOCARDITIS. PROPHYLAXIS; 2 G AMOXYCILLIN 1 H PREOP CONSULTATE FOR COUMADIN CESSATION, START HEPARINE; 3RD DAY INR < 2,5 GO ON WITH HEPARINE FOR 3 MORE DAYS 2 WEEK INTERWALS BETWEEN CESSATION OF COUMADIN  PACEMAKERS!!!!!!!!!!!! FOR ULTRASONICS (ULTRASONIC SCALERS, KEEP AWAY FROM HIGH ELECTROMAGNETIC FIELD: APEX LOCATORS, ELECTROCOATERISATION)  IE PROPHYLAXIS NON-NEEDS NEEDS PROSTHETIC VALVES ISOLATED ASD PREVIOUS IE PHYSIOLOGICAL MURMURS RHEUMATIC VALVULOPATHIES PACEMAKER AND IMPLANTED MVP WITH HEART FAILURE DEPHYBRILATORS HYPERTROPHIC CARDIOMYOPATHY CARDIAC CATHETERISATION CONGENITAL HEART DISEASES MARPHANS SYNDROME AV FISTULAS  DİŞHEKİMLİĞİNDE TIBBİ SORUNLAR ADNAN ÖZTÜRK, AHMET KESKİN https://docplayer.biz.tr/7184332-Amasya-agiz-ve-dis-sagligi-merkezi-akilci-antibiyotik- kullanimi-ve.html https://www.aapd.org/research/oral-health-policies-- recommendations/antibiotic-prophylaxis-for-dental-patients-at-risk-for- infection/ DENTAL PRECAUTIONS IN PULMONARY DISEASES  PULMONARY TBC MYCOBACTERİUM TUBERCULOSİS DROPLET INFECTION 4-8 HAFTA PRIMARY INFECTIOUS PERIOD MILD FEVER, COUGHING, SWEATING , WEAKNESS PRIMARY TBC OF ORAL CAVITY IS RARE POSTERİOR ORAL CAVITY IS EFFECTED TONGUE**, GINGIVA, MOUTH FLOOR, SOFT AND HARD PALATE  PAIN, INFLAMMATION, FİSSURES, GRANULOMAS CERVICAL LAP POSTOP HEALING DISORDERS POSTOP GRANULISATION PAIN AND SEKESTRATION IN TBC OSTEOMYELİTIS CYSTIC FIBROSIS DYSFUNCTION OF THE EXOCRINE GLANDS 1. BRONCHIECHTASIAS AND RECURRENT PULMONARY INF DUE TO MUCUS 2. GIS DISORDERS DUE TO PANCREATIC DYSFUNCTION 3. BLOOD CHLORIDE LEVEL 60 mEq/L DELAY IN TOOTH ERUPTION ENAMEL HYPOPLASIAS TERRACYCLIN COLORATIONS INCREASED TENDENCY FOR TOOTH DECAY ENLARGEMENT OF THE MAJOR S.G. COPD CHRONİC BRONCHITIS ANPHYSEMA DYSPNEA WITH EXCERSIZE THIN POSTURE, SHOULDERS DOWN+ FRONT, WHEEZİNG SOUND COUGHING DUE TO SECRETION GENERAL ANESTHESİA XXXXXXXXXXX RUBBER DAM XXXXXXXXXXX KEEP BRONCHODİLATOR, O2 ASTHMA ALLERGIC/ NON-ALLERGIC GRUNTING DYSPNEA, RECURRENT DYSPNEA ATTACKS CHRONIC, PERSİSTANT AIRWAR DISEASE CHRISIS ELONGATES IN NON- ALLERGIC TYPE VENTOLİN, BRİCANYL SPREY İNHALER PREDNİSOLON BRONKODİLATOR- DRY MOUTH, PREDISPOSITION FOR ANTERIOR CARIES PREOP ANTİHİSTAMİNİCS, PREDNİSOLON INTRAOP O2, BRONKODİLATORS PENİSİLİN, ASPİRİN ALLERGY !!!!!!!! ERİTROMYCINE IS TOXİC !!!!!!!! SARCOİDOSİS GRANÜLAMATOUS DISEASE OF THE LUNGS AND LYMPH NODES SUBFEVRILE FEVER, WEIGHT LOSS, WEAKNESS, COUGHING, DYSPNEA WITH EXERCISE, CHEST PAIN,LAP FEVER+ BILATERAL PAROTITIS, UVEITIS , PARALYSIS OF N. FASIALIS = UVEOPAROTİDE FEVER STEROİDS, CHLOROKİNİN, İNz ORAL SARKOİDOZİS, ENLARGEMENT OF THE MAJOR S.G. DRY MOUTH, GİNGİVAL FİBROSİS GIS DISEASES IN DENTISTRY  GASTROOSOFAGEAL REFLUX- EROSION PEPTIC ACID DISEASES- CARIES COELIAC DISEASE- OSTEOPOROSIS/ OSTEOMALACY, PETECHIAE, ECCHIMOSIS, ROA, GLOSSITIS, DELAY OF TEETH ERUPTION, ENAMEL HYPOPLASIA  INFLAMMATORY BOWEL DISEASES: 1. ULCERATIVE CHOLITIS- ROA, HEMORRAGIC ULCERS, BUMPS OF THE CHEEK AND LIPS, HYPERPLASTIC GINGIVITIS, PYOSTOMATITIS VEGETANS 2. CROHN DISEASE- ROA, FIBROUS HYPERPLASIA, GRANULAMATOUS ULCERS GIS POLYPS: 1. GARDNER SYNDROME- OSTEOMAS OF THE SKULL, MAXILLA, MANDIBULA , PNS; DENTIGEROUS CYSTS, IMPACTED TEETH, SUPERNUMERARY TEETH, BONE EXOSTOSES, HYPERSEMENTOSIS, MALIGNANCY. 2. PEUTZ- JEGHERS DISEASE- MELANIN PIGMENTATIONS OF THE OROFACIAL, PERIORAL AREA 3. FAMILIAL ADENAMATOUS POLYPOSIS  DISEASES OF THE LIVER CARE FOR DRUG TOXICITY AND HEMORRAGIC DIATESES !!!NSAII, ASA, MACROLIDES, TETRACYCLIN, METRANIDAZOLE AND AMID GROUP LA: Lidocain, Mepivacain (Carbocaine), Prilocain (Citanest), Bupivacain (Marcaine), Etidocain (duranest), Dibucain (Nupercaine) GINGIVAL BLEEDING, JAUNDICE, PETECCIAE, HEMATOMAS, GLOSSITIS, LICHEN PLANUS HEPATITIS A Anti HAV, Anti HAV IgM HEPATITIS B HBsAg, HBeAg, Anti HBc IgM, Anti HBc , Anti Hbe, Anti HBs, HBV DNA HEPATITIS C Anti HCV, HCV RNA HEPATITIS D Anti Delta , Anti Delta RNA, HDV RNA HEPATITIS E Anti HEV, Anti HEV IgM  Anti HBc HBsAg Anti-HBs HBsAb HBcAb-IgM HBcAb-IgG Bulaşıcılık HBcAb Kuluçka dönemi veya asemptomatik taşıyıcı + - - - - + Akut Enfeksiyon + - + + + +++ İyileşme Dönemi - - + + + +/- Aşı ile Bağışık - + - - + - Geçirilmiş enfeksiyondan bağışık - + - + + - Kronik enfeksiyon Aktif Taşıyıcı + - - + + +++ Yüksek Bulaşıcı Kronik Enfeksiyon İnaktif Taşıyıcı + - - + + + Düşük Bulaşıcı  CIRRHOSIS Halitosis Enlargement of the parotis, Erithema of the palms Longitudinally striated white fingernails, Ecchimosis, petechiae of the oral mucosa, Foeter hepaticus Glossitis, anguler cheliosis, Delay in healing. PT, PTT, plt #, BT Max 4 ml LA, AVOİD AMİDES, sedatives, tranquilisans, If PT is elongated 10 mg Kvit/day 1-2 days earlier  ENDOCRINOLOGICAL DISEASES & DENTISTRY Doç Dr Kader AYDIN  POSTERİOR PİTUİTARY HYPOFUNCTION Diabetes İnsipidus(Dİ) Diabetes inisipidus is due to vasopressin (ADH) deficiency / surrenal gland deficiency. Anterior Pituiter Hypofunction Due to hypotalamus / hypophyseal lesions. Tumors in children / postpartum uteral bleeding are general causes.  ANTERİOR PİTUİTARY HYPERFUNCTION GİGANTİSM AND ACROMEGALY When growth hormone (GH) release continues after epyphyseal plate development is completed ACROMEGALY. Before epyphyseal plate development is closed GIGANTISM In Gigantism internal organs, extremities and mandible and skull is mostly effected. In Acromegaly skin is thickened. Seborrea is observed. Hyperhydrosis, guatr, diabetes mellitus, hypertensiyon, Cardiyomyopathy can be observed. Typically enlargement of the lips, nose, tongue and square shaped mandibular angulus formation is seen.  Diastemas between upper incisors. Mandibular prognatism. enlargement in sinuses. Hoarseness. Sinovial thickening and enlargement of bones and cartilage lead to arthritis TMJ and several joints display dismobility. Costochondral ment leads to thoracal change. Osteoporosis may develop. Bromocriptine (20-60 mg/day) can be involved in acromegaly treatment. 2.51 M. https://tr.wikipedia.org/wiki/Sultan_K%C3%B6sen CHRONIC ADRENOCORTİCAL DEFICIENCY (Addison’s Disease) Glukocortikoid ve mineralocortikoid insufficiency is the main reason %90 degeneration of the cortex needs to be damaged for the formation of adrenal deficiency. Hyperpigmentation is the main clinical finding IN THE ORAL MUCOSA AND GINGIVA Fasting hypoglicemia due to cortisol deficiency, and fasting syncopes may occur.  During febrile diseases and exercising Daily medicament dosage must be doubled. When nausea / vomitting starts, glucocorticoid must be started parenterally. (Dexamethasone 4 mg.i.m) SYSTEMIC CORTİCOSTEROİD TREATMENT Adrenocortical function compression starts if the patient is using corticosteroids or has used for at least One month during the last year. Delay in wound healing. Tendency for infection. Tendency for oral candida. Antibiotic prophylaxis and atrumatic/ aseptic surgery.  STEROİD NEED İS İNCREASED WHİLE İNFECTİON, TRAUMA, OPERATİONS AND ANESTHESİA. IN MINOR OPERATIONS PREOP / POSTOP ORAL DOSE OF 100 MG HİDROKORTİZON / 20 MG PREDNİZOLON, 4 MG DEKSAMETAZON CAN BE SUSTAINED. HYDROCORTISONE MUST BE ADMINISTERED IF THE PATINT IS IN HYPOTENSION OR COLLAPS. ASPIRIN AND OTHER NSAID DRUGS CAUSE GIS ULCERS /SURELY AVOID. TENDENCY FOR OSTEOPOROSIS/ BONY FRACTURE. CUSHING Too much of the hormone cortisol over time. This can result from taking oral corticosteroid medication. Or your body might produce SYNDROME too much cortisol. SLOW ONSET CLINICAL FINDINGS MAY REVEAL MONTHS LATER. WEIGHT GAIN OBESITY IS OBSERVABLE MOSTLY AT THE FACE AND TRUNK MOON FACE APPEARANCE  FEOCHROMOSİTOMA FEOCHROMOSİTOMA(FEO) İS THE TUMOUR OF ADRENAL MEDULLA /EXRAADRENAL KROMOFİN SYSTEMİN R. hypertensıon/ glucose ıntolerance FOR DENTİSTRY; DENTAL TREATMENT MUST BE POSTPONED UNTİL SURGİCAL TREATMENT. AVOİD GENERAL ANESTHESİA BEFORE SURGİCAL TREATMENT STEROİD İS NEEDED İN POSTOP PATİENTS BECAUSE HYPOADRENOCORTİCOSİSM MAY OCCUR. OTOIMMUNE THYRIODOTIS ANTI- TPO IS PRODUCED AGAINST THYROID TISSUE. (Basedow-Graves , Hashimoto thyroiditis, mixedema.) THYROID GLAND IS INFLAMMATORY AND DİSTRUCTED IN HASHIMOTO, ALAS GLAND IS HYPERFUNCTIONING IN BASEDOW – GRAWES.  HYPERTHYROIDITIS TOO MUCH ANXIETY, FEAR SEDATION PREFERRED FEAR, ANXIETY, TREMORS AND DYSPNEA MAY LEAD TO VENTRICULAR FIBRYLATION POTASYUM İODİDE, PROPİL THİOURACİL, PROPRANOLOL OR KLORPROMAZİN IS USED HYPOTİROİDİSM MAY DEVELOP LATER ON. CARBİMAZOL BAZAN CAUSES AGRANULOSİTOSIS WHICH LEADS TO ORAL ULCERATIONS.  PTH CONTROLS Ca ABSORBANCE AND P ELIMINATION STIMULATES (1.25 kolekalsiferol) PARATHYROIDITIS ACTIVATES Ca TRANSFUSION FROM THE SKELETON TO PLASMA. PTH/ CALCITONIN HAS ANTAGONIST EFFECTS ON ORGANISING Ca METABOLISM.  HYPOPARATHYROIDITIS INCREASE IN ORAL CANDIDA TETANI, ANXIETY, PERSONALITY DISORDERS AND FATIGUE CAN BE SEEN. CATARACTS, MUSCLE CRAMPS, LARYNGEAL STRIDOR DURING INHALANCE, DIPLOPY AND CONVULSIONS MAY BE SEEN. DELAY IN TOOTH ERUPTION, ENAMEL HYPOPLASIAS, SHORT ROOTS (RHIZOMICRY), AND OSTEODENTIN MAY BE OBSERVED. FACIAL PARALYSIS MAY BE SEEN  HYPERPARATHYROIDITIS MOST SPARSE INVOLVEMENT OF THE BONES IS OSTEOPOROSIS. SKULL REFLECTS MARBLE GLASS APPEARANCE INTERBONY CYTSTS OF THE LONG BONES, EXTREMITY BONES, PELVIS AND RIBS. PATHOLOGICAL FRACTURES, INTERBONY AND JOINT PAINS ARE OBSERVED.  UNI AND MULTILOCULARY CYSTIC FORMATIONS AND OSTEOPOROSIS OF THE MANDIBLE TEETH DONT LOOSE Ca ALAS JAW BONES LOOSE A LOT. LOSS OF LAMINA DURA DECREASE IN CORTICAL BONE, SPARSE DENSITY DECREASES AND RAREFACTIONS, LOSS OF LAMINA DURA, GIANT CELL LESIONS HEMATOLOGICAL DISEASES IN DENTISTRY  Hemostasıs Etıology of bleedıng dısorder Evaluatıon of bleedıng dısorders Dental management HEMOSTASIS 1. VASCULAR PHASE; VASOCONSTRICTION; IMMEDIATELY 2. PLATELET PHASE; ADHESION & AGGREGATION; 1-2 SECONDS LATER (PRIMARY) 3. COAGULATION PHASE; EXTRINSIC & INTRINSIC PATHWAYS (SECONDARY) 4. FIBRINOLYTIC PHASE; RELEASE ANTITHROMBOCYTIC AGENT  * INTRINSIC PATHWAY: ACTIVATION OF FACTOR XII * EXTRINSIC PATHWAY: INITIATED BY THROMBOPLASTIN THAT ACTIVATES FACTOR VII  ANTITHROMBOCYTIC AGENT PROSTOGLANDIN; SECRETED BY ENDOTHELIUM PRIMARY AT III PROTEIN C; INACTIVATE FACTOR V AND VIII IN COMPANY WITH PROTEIN S PLASMIN ; ACTIVATED FROM PLASMINOGEN BY UROKINASE AND STREPTOKINASE SECONDARY Etiology of bleeding disorders 1. Nonthrombocytopenia 1. vascular wall alteration: infection,chemical,allergy 2.disorder of platelet function: Genetic defects (Bernard-Soulier disease: glycoprotein,GP-ıb dysfunction with VWF Aspirin,NSAIDs,broad-spectrum antibiotics, (Ampicillin, Penicillin, Gentamycin, Vancomycin) Autoimmue disease 2. Thrombotic Thrombocytopenia purpuras(TTP) 1.primary 2.secondary:Chemicals, ex:mitomycin C Pysical agent(radiation) Systemic disease(leukemia)  Character: 1.Thrombocytopenia 2.Micro-angiopathic hemolytic anemia(MAHA) 3.Fever 4.Hyporenal function 5.Neural systemic disturbance due to ischemia Considered to be an emergency Tx: plasma exchange and glucocorticosteroid 3. Dısorders of coagulation 1. Inherited : Hemophilia A Christmas disease von Willebrands disease 2. Acquired : Liver disease K avitaminosis Anticoagulation drugs (heparin, coumarin) Anemia ORAL SIGNS Jaundice Petechiae Purpura Ecchymoses Spider angioma Oral ulcer Gingival hyperplasia Hemarthrosis Screening lab tests 1. Platelet count 2. BT(Bleeding Time) Primary 3. PT(prothrombin time) 4. aPTT 5. TT Secondary  Normal platelet count:140000-400000 Thrombocytopenia < 140000 Clinical bleeding problem < 50000 Life threatening spontaneous bleeding < 20000 Normal BT 1-6 min  PT (PHROTOMBIN TIME) Activated by tissue thromboplastin Displays extrinsic and common factors (VII, I,II,V,X) NORMAL 11-15 SEC PT at 1.5 to 2.5 time at coumarin therapy INR < 2.5 SURGERY CAN BE DONE = 3.0- 3.5 CONSULTATİON NEEDED > 3.5 DELAY SURGERY aPTT ACTİVATED BY KAOLİN TESTS İNTRİNSİC AND COMMON PATHWAYS NORMAL 25-35 SEC PTT 55-60 SEC BY HEPARIN THERAPY TT TESTS ABILITY TO FORM INITIAL CLOT FROM FIBRINOGEN NORMAL 9-13 SEC  PATIENT AT MODERATE RISK PATIENT ON ANTICOAGULANT THERAPY (COUMADIN, ASPIRIN) PATIENT AT HIGH RISK PATIENTS WITH KNOWN BLEEDING DISORDERS: THROMBOCYTOPENIA, THROMBOCYTOPATHY, CLOTTING FACTOR DEFECTS PATIENTS WITHOUT ANY KNOWN BLEEDING DISORDERS WITH ABNORMAL PLT COUNT, BT, PT , PTT, SIGNS AND SYMPTOMS OF ANEMIA Screenıng lab tests ORAL MANIFESTATION  Splenomegaly, cardiac enlargement, cardiac failure, osteomyelitis, aseptic bone necrosis, liver and kidney failure. Susceptible for dental infection. Hypersementosis, bone marrow hyperplasia, osteoporosis of the jaws, hypomineralisation of SICKLE CELL permanent dentition, tower head formation, thickening of the skull, osteomyelitis of the jaws, ANEMIA large radioopaque lesions of the skull and jaws, labial anesthesia due to cranial neuropathies,jaundice and paleness at the oral mucosa due to hemolytic anemia. Radiological aspect; osteoporosis, radioopaque jaw lesions, osteomyelitis, thickening of the skull, enlargement of lamina dura, hypersementosis.  Routine dental treatment can be done Surgery under ab prophylaxis, Hb above 10g/dl Avoid general aenesthesia to prevent further sickle cell anemia formation. Avoid drugs that make depression of the pulmonary system Keep 30% O2 level, provide red blood cell transfusion under 50% Hb Bony infacts and osteomyelitis can mimic dental pain Acute sickle cell anemia crisis has severe bone pain, sometimes localized at the jaws. Analgesic addiction may be seen.  1/3 of acute leukemia patients display oral findings Mucosal bleeding, petechiae, paleness of the mucosa, hypertrophy and edema of the gingival borders sometime to full overlapping of the teeth, red- purple color change at the gingiva, necrotic- ulcerative gingiva and mucosa. ACUTE Cervical LAP, enlargement of the tonsilla, paresthesia at the lower lip, extrusion of the teeth, swallowing of the Parotid LEUKEMIAS gland (Mikulich Syndrome), painful swallowings of mandibula, fungal and herpetic infections of the mouth anf paranasal sinuses. Radiological aspect; narrowing of the lamina dura, alveolar bone loss, periapical bone destruction of the mandibular posterior teeth.  İnfections of the oral mucosa due to KT and immunosupressive drugs. Antibiogram must be obtained Oral hygiene care with oral mouthwashes and antifungal agents. Plt transfusion may be needed for excessive gingival bleeding. Consultate doctor Consevative care, avoid surgery till remission is obtained Atraumatic and aseptic treatment Avois aspirin and nitrous oxide If needed provide resorbeable suture material  Fatigue, paleness, apetite loss, night sweating, weight loss, fever, LAP, hepatosplenomegaly. Red and purple skin nodules, plaque, purpura, maculopapullary lesions, vesiculobullary lesions CHRONIC and herpes zoster. Gingival hypertrophy is less than acute LEUKEMIAS conditions. Swallowing of the palatinal mucosa, gingival bleeding, petechiae, oral ulcerations, viral and candidal oral infections, Mikulich Syndrome. Better prognosis than acute conditions LEUKOPENIA < 4000/ MM3 LEUCOCYTES Leukemia, aplastic anemia, drugs (analgesics: fenilbutazon, khloramphenicol, co trimaksazol; antipsychotics, cytotoxic drugs), autoimmune diseases POLISITEMIA VERA Continious increase of the erithrocytes Flebotomy; taking blood Thrombosis and hemorragic diatesis  MULTIPL MYELOMA WALDENSTROM MACROGLOBLUNEMIA PRIMARY AMILOIDOSIS IMMUNOPROLIFERATIVE DISEASES KLL, NON HODGKIN LYMPHOMAS BICLONAL GAMMAPATHIES BENIGN MONOCLONAL GAMMAPATHIES  OSTEOLYTIC LESIONS TISSUE PLASMOCYTOMAS PATHOLOGICAL BONE FRACTURES PUNCH HOLE BONE LESIONS (70% AT SKULL, MAND> MAX) HYPERCALCEMIA KYDNEY DYSFUNCTION TENDENCY FOR INFECTIONS MM BONE PAIN DURING MOVEMENT TENDENCY FOR ANEMIA, THROMBOCYTOPENIA, LEUKOPENIA. RAYNAUD FHEUNOMENON, AMILOIDOSIS, THROMBOSIS. ANGULUS MAND MOST EFFECTED, ROOT RESORBTION, MOBILITY OF TEETH, MENTAL PARESTHESIA, PATHOLOGICAL FRACTURES, RARELY GINGIVAL BLEEDING, PETECHIAE, HSV, HERPES ZOSTER, AMILOIDOSIS OF THE MOUTH  AMYLOID (HYALIN) ACCUMULATION AT THE TONGUE, TMJ AND RARELY SALIVARY GLANDS TISSUE BIOPSY INDICATED AMILOIDOSIS GINGIVAL HYPERTROPHY, MACROGLOSSIA, MUCOSAL PETECHIAE  CERVICAL LAP WALDEYER RING EFFECTED AT NHL RARE ORAL FINDINGS: ULCERATIVE ERYTHEMATOUS LYMPHOMAS BUMPS OF THE LIPS, GINGIVA, PALATE, TONGUE AND PHARYNX, SOMETIMES JAWS. ANEMIA, FUNGAL AND VIRAL INFECTIOS DUE TO KT  ATROPHY OF THE ORAL MUSOCA DUE TO DECREASED TURN- OVER RATE OF THE EPITHELIAL CELLS. PAINFUL, ULCERATIVE, ERITHEMATOUS MUCOSA ORAL WITHIN 7-10 DAYS AFTER CYTOTOXIC TREATMENT; RELIEVES 2-3 WEEKS AFTER FINDINGS OF TREATMENT CESSATION. KT MARGINAL GINGIVITIS AND BLEEDING BLOOD SCREEN, KT DATE, CONSULTATION BEFORE DENTAL CURE. KEEP ORAL HYGIENE BEFORE AND DURING KT. FOCAL INFECTION DETECTION AND TREATMENTS BEFORE KT  MOSTLY SQUAMOUS TYPE ERITHROPLAKIA AND LEUKOPLAKIA CONSIDERED PREMALIGN SINUS CA WITH NICKEL CONTACT TUMORS OF ANTERIOR PART OF THE SKULL/ FACE AND CERVICAL REGION ( LIPS, ANTERIOR TONGUE) ARE LESS CERVICOFACIAL AGRESSIVE THAN POSTERIOR PART (NASOPHARYNX, LARYNX) TUMORS METASTATIC FOR NEIGHBOURING TISSUES AND LUNGS, AND BONES EARLY TREATMENT: RESECTIVE OPERATION. TUMOR CONTROL WITH RT (TUMOR TYPE, EXTENSION AND LAP) KT WITH EXTENSIVE TUMORS.  RT CELLULAR TURNOVER decreases , SENSITIVITY ERYTHEMA OF THE MUCOSA ,MUCOSITIS , ULCERATIONS PAIN, DYSPHAGIA,TASTE DISORDERS EPITHELIAL ATROPHY SUBMUCOSAL ARTERIOGENESIS DISORDERS: PALE MUCOSA: SALIVARY GLAND ATROPHY AND XEROSTOMIA SALIVARY VISCOSITY, PH : ATYPICAL CARIES, JAW INFECTIONS, PERIODONTAL LOSS CARIES ONSET WITHIN 2-10 MONTHS SALIVARY REPLACEMENT: XIALINE, OXYFRESH SUBMUCOSAL FIBROSIS: DECREASES MUCOSAL MOBILITY; TRISMUS OF THE MUSCLES OF MASTICATION OSTEORADIONECROSIS (MAND > MAX) HYPERBARIC O2 TOPICAL FLUOR FOCAL INFECTION TREATMENT TAKE CARE IN DENTISTRY FOR: BONY FRAGILITY, HEPATITS B INFECTION RISC (DUE TO HEMODIALYSIS), PEPTIC ULCERS, SENSITIVITY TO MYORELAXANTS.