Lect 2 DIABETIC PATIENTS.pdf

MEDICALLY COMPROMISED PATIENTS MOHAMED ABDELHALEEM The issues Aims: Learning outcomes Medically compromised patients DIABETIC PATIENTS AIMS:  Aims: 1. To improve the dental management of patients with medical problems that may be e...

MEDICALLY COMPROMISED PATIENTS MOHAMED ABDELHALEEM The issues Aims: Learning outcomes Medically compromised patients DIABETIC PATIENTS AIMS:  Aims: 1. To improve the dental management of patients with medical problems that may be encountered in daily practice. 2. To enable learners to identify common medical emergencies and manage LEARNING OUTCOMES  Learning outcomes Following this course learners should be able to: 1. Recognize undiagnosed and diagnosed common medical disorders (. Recognise signs and symptoms of common medical emergencies ). 2. Know a variety of common medical disorders and their affect on oral health and the delivery of dental care 3. Understand how to assess medical risk involved in the delivery of dental care to medically compromised patients.  Learning outcomes ,cont 4. Know how to plan and deliver safe and effective dental care to patients with medical conditions and medically compromised patients so as to promote oral health and overall health, and minimize medico-legal risk. 5. Recognise, manage and provide basic and immediate life support for medical emergencies. 6. Understand drugs commonly taken for medical conditions, and have knowledge of how to prevent drug-interactions and adverse drug effects in dental practice MEDICALLY COMPROMISED PATIENTS  Patient assessment 1. The general condition of the patient 2. The need for medical consultation 3. Specific drug sensitivity 4. The need for premedications 5. The choice of anaesthesia 6. The need of oxygen 7. The need and quantity of vasoconstrictor 8. The technique to be employed 9. The operative time required 10. The pre and post operative consultation  Medically compromised patients include Patients with: – Endocrine diseases – Cardiovascular diseases – Respiratory diseases – Gastrointestinal disease – Liver diseases – Renal diseases – Blood diseases – Neurogenic diseases – Musculoskeletal diseases – Sexually transmitted diseases – Patients under corticosteroid, chemotheapeutic or immunosuppressive drugs Pregnant 11/22/23 ladies  Medical history A: Anemia B: Bleeding disorders C: Cardiorespiratory disorders D: Drug treatment and allergies E: Endocrine disorders F: Fits or Faints G: Gastrointestinal disorders  Medical history ,cont H: Hospital admissions and attendances I: Infections J: Jaundice and liver disorders K: Kidney disorders L: Likelihood of Pregnancy M: Mental state  Golden role No contraindication for any dental procedure if the patient is controlled Give premedication of the pt preoperatively except the anticoagulants and oral hypoglycemic DIABETIC PATIENTS Lecture contents: – Definition of diabetes mellitus – Types of diabetes mellitus – Clinical features – Diagnosis – Complications – General and dental management – Oral/Orofacial manifestations  Definition of diabetes It is a chronic mellitus hyperglycaemia long Types of diabetes 2 mellitus enough to cause microvascular 3 Clinical features complications.  Type 1 insulin dependent. Definition of diabetes 1 mellitus Type 2 noninsulin dependent. Types of diabetes 2 mellitus Type 3 gestational. 3 Clinical features  Early features:- - Confusion. Definition of diabetes mellitus - Weakness and weight loss. - Constipation. Types of diabetes 2 mellitus - Itching. - Polydypsia, polyphagia and 3 Clinical features polyuria.  Late features:- - Abdominal pain. - Coma. Definition of diabetes - Dehydration. mellitus - Hyperventilation. Types of diabetes 2 mellitus - Muscle wasting. - Nausea and vomitting. 3 Clinical features - Paraesthesia. - Renal failure. - Shock.  Diabetes can be confirmed by:- Fasting blood glucose 7.8 mmol/l - 140 mg/l. Diagnosis Random blood glucose >11.1 4 mmol/l. 200 mg/l with signs and symptoms. 5 Complications GTT ; at least 11.1 mmol/l in 2 hours General and dental 6 management A diagnosis of DM is made if any of the above test is positive with a second test positive in a different day. HbA1c 4 – 6% + 2  Acute complications:- 4 Diagnosis - Acute hypoglycamic 5 Complications coma. General and dental - Hyperglycaemic 6 management coma. - ketoacidosis  Chronic complications:- - atherosclerosis. 4 Diagnosis - Renal damage and failure. - Polyneuropathies. 5 Complications - Candidosis, staphylococcal General and dental infection and systemic 6 management mycosis. - Retinopathy and cataracts.  - For type 1 DM treatment by diet control and insulin. 4 Diagnosis - For type 2 DM treatment 5 Complications by diet alone or diet with oral hypoglycaemic. General and dental 6 management - Glycocylated Hb more than 6.1% is indicative for regimen.  Oral Hypoglycaemics:- 1- sulfonylureas (chlorpropamide and 4 Diagnosis glibenclamide). 5 Complications 2- bigunides (metformin). 3- glitazones General and dental 6 management (pioglitazone). 4- intestinal alpha- glusidase inhibitors.  It depends on: 4 Diagnosis Complications 1. The glycemic status 5 2. The type of General and dental 6 management anaesthesia (G.A/L.A) and operation  - The main hazard is hypoglycaemia. - Operation early morning, breakfast and medication 4 Diagnosis - Patient should tell the staff if the attack of hypoglycaemia start. - Conscious sedation is usually safe. 5 Complications - LA is safe. General and dental - Orthostatic hypotension. 6 management - Aspirin and steroids should be avoided. - Control of orofacial infection.  - Routine dental treatment or short minor surgical procedures under LA can carried out with no special 4 Diagnosis precautions apart from taking the meal. 5 Complications - The desired blood glucose is 120- 180 mg/dl(3-5mmol/l). General and dental - For major surgery the patients are 6 management given an infusion of glucose and insulin according to the plasma level  Oral features:- - Severe periodontits. 5 Complications - Severe dentoalveolar abscess and fascial spaces General and dental 6 management involvement. - Oral paraesthesia. 7 ORAL/OROFACIAL MANIFESTATIONS - Candidal infection. - Xerostomia and sialosis. - Grinspan’s syndrome. ANY QUESTIONS?