The Dentist s Quick Guide to Medical Conditions

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5 The Dentist s Quick Guide to Medical Conditions Mea A. Weinberg, DMD, MSD, RPh Diplomate, American Board of Periodontology Clinical Professor Department of Periodontology and Implant Dentistry New York University College of Dentistry New York, NY, USA Stuart L. Segelnick, DDS, MS Diplomate, American Board of Periodontology Diplomate, International Congress of Oral Implantologists Clinical Associate Professor Department of Periodontology and Implant Dentistry New York University College of Dentistry New York, NY, USA Section Chief of Periodontics Brookdale University Hospital and Medical Center Brooklyn, NY, USA Joseph S. Insler, MD Fellow, Addiction Psychiatry Department of Psychiatry Boston University Boston, MA, USA with Samuel Kramer, DDS Clinical Assistant Professor Department of Endodontics New York University College of Dentistry New York, NY, USA

6 This edition first published by John Wiley & Sons, Inc. Editorial Offices 1606 Golden Aspen Drive, Suites 103 and 104, Ames, Iowa 50010, USA The Atrium, Southern Gate, Chichester, West Sussex, PO19 8SQ, UK 9600 Garsington Road, Oxford, OX4 2DQ, UK For details of our global editorial offices, for customer services and for information about how to apply for permission to reuse the copyright material in this book please see our website at Authorization to photocopy items for internal or personal use, or the internal or personal use of specific clients, is granted by Blackwell Publishing, provided that the base fee is paid directly to the Copyright Clearance Center, 222 Rosewood Drive, Danvers, MA For those organizations that have been granted a photocopy license by CCC, a separate system of payments has been arranged. The fee codes for users of the Transactional Reporting Service are ISBN-13: /2015. Designations used by companies to distinguish their products are often claimed as trademarks. All brand names and product names used in this book are trade names, service marks, trademarks or registered trademarks of their respective owners. The publisher is not associated with any product or vendor mentioned in this book. The contents of this work are intended to further general scientific research, understanding, and discussion only and are not intended and should not be relied upon as recommending or promoting a specific method, diagnosis, or treatment by health science practitioners for any particular patient. The publisher and the author make no representations or warranties with respect to the accuracy or completeness of the contents of this work and specifically disclaim all warranties, including without limitation any implied warranties of fitness for a particular purpose. In view of ongoing research, equipment modifications, changes in governmental regulations, and the constant flow of information relating to the use of medicines, equipment, and devices, the reader is urged to review and evaluate the information provided in the package insert or instructions for each medicine, equipment, or device for, among other things, any changes in the instructions or indication of usage and for added warnings and precautions. Readers should consult with a specialist where appropriate. The fact that an organization or Website is referred to in this work as a citation and/or a potential source of further information does not mean that the author or the publisher endorses the information the organization or Website may provide or recommendations it may make. Further, readers should be aware that Internet Websites listed in this work may have changed or disappeared between when this work was written and when it is read. No warranty may be created or extended by any promotional statements for this work. Neither the publisher nor the author shall be liable for any damages arising herefrom. Library of Congress Cataloging-in-Publication Data Weinberg, Mea A., author. The dentist s quick guide to medical conditions / Mea A. Weinberg, Stuart L. Segelnick, Joseph S. Insler. p. ; cm. Includes bibliographical references and index. ISBN (pbk.) I. Segelnick, Stuart L., author. II. Insler, Joseph S., author. III. Title. [DNLM: 1. Signs and Symptoms. 2. Dental Care. 3. Therapeutics. WB 143] RK dc A catalogue record for this book is available from the British Library. Wiley also publishes its books in a variety of electronic formats. Some content that appears in print may not be available in electronic books. Cover image: istockphoto / Squaredpixels / File # Set in 10/12.5pt Times by SPi Publisher Services, Pondicherry, India

7 Dedication We would like to dedicate this book to our family Dr. Mea Weinberg: Adam, Nina, & Nigel Dr. Stuart Segelnick: Tina & Noah Dr. Joseph Insler: Suzanne & Jacob Dr. Samuel Kramer: Cynthia & Harry for without their love and support this wonderful work would not be possible.

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9 Contents Contributors Foreword Preface x xi xii 1 Gastrointestinal disorders 1 A. Peptic ulcer disease 1 B. Gastroesophageal reflux disease 4 C. Irritable bowel syndrome 6 D. Inflammatory bowel disease 7 a. Crohn s disease 7 b. Ulcerative colitis 10 E. Diverticular disease 11 F. Acute pancreatitis 12 G. Celiac sprue 13 H. Pseudomembranous colitis 13 2 Medical conditions of the respiratory system 17 A. Respiratory diseases 17 a. Asthma 17 b. Chronic obstructive pulmonary diseases 23 c. Pulmonary tuberculosis 24 d. Obstructive sleep apnea 27 3 Disorders of the urinary system 30 A. Acute renal injury and chronic kidney disease 30 B. Kidney dialysis 37 C. Kidney transplant 39 D. Polycystic kidney disease 42 E. Benign prostatic hypertrophy 42 4 Diseases of the endocrine system 46 A. Diabetes 46 B. Thyroid diseases 50 C. Adrenal gland disorders 53 vii

10 viii Contents 5 Disorders of the cardiovascular system 59 A. Hypertension 59 B. Angina Pectoris 68 Clinic 68 C. Myocardial infarction 70 D. Heart failure 73 E. Arrhythmias 75 F. Valvular heart disease 78 G. Epinephrine in cardiac patients 79 6 Pregnancy, lactation, and oral contraceptives 82 A. Pregnancy and lactation 82 B. Oral contraceptives 89 7 Disorders of the liver and gallbladder 93 A. Liver disease 93 a. Alcoholic liver disease and cirrhosis 98 b. Hepatitis 99 c. Liver transplant 103 B. Gallstones Diseases of the neurological system 109 A. Parkinson s disease 109 B. Multiple sclerosis 113 C. Seizures Psychiatric disorders 125 Introduction 125 A. Antipsychotics 126 a. Typical antipsychotics 127 b. Atypical antipsychotics 128 c. Anticholinergic medications 128 B. Antidepressants 132 a. Monoamine oxidase inhibitors 133 b. Tricyclics and tetracyclics 134 c. Selective serotonin reuptake inhibitors 135 d. Selective serotonin norepinephrine reuptake inhibitors (SNRIs) 136 e. Others 136 f. Summary: Dental interactions and side effects 136 C. Mood stabilizers 138 a. Lithium 139 b. Valproic acid (Depakote) 140 c. Lamotrigine (Lamictal) 140 d. Carbamazepine (Tegretol) 141 e. Oxcarbazepine (Trileptal) 141

11 Contents ix D. Alcohol and other drugs with addictive potential 142 a. Alcohol 142 b. Sedatives and hypnotics 143 c. Opioids 143 d. Cocaine Hematologic disorders and drugs that cause bleeding 149 A. Brief overview of the coagulation process 149 a. Thrombocytopenia 152 b. Thrombocytopathy 153 c. Antiplatelet medications 153 B. Bleeding disorders: Coagulation disorders 154 a. von Willebrand disease 154 b. Hemophilias 155 c. End-stage liver disease 156 d. Anticoagulation medications Blood dyscrasias 171 A. Red blood cell disorders 174 a. Anemia 174 b. Myeloproliferative disorders 181 B. White blood cell disorders 182 a. Leukemia 182 b. Lymphoma 186 c. Multiple myeloma Musculoskeletal and connective tissue disorders 193 A. Osteoporosis 193 B. Osteoarthritis 197 C. Rheumatoid arthritis 198 D. Gout 201 E. Fibromyalgia syndrome 203 F. Systemic lupus erythematosus 205 G. Sjögren s syndrome HIV and oral health care Radiation and chemotherapy 237 Appendices Appendix A Antibiotic prophylaxis of the dental patient 252 Appendix B Common dental drug interactions 255 Appendix C Summary of tables/boxes 266 Appendix D Interpretation of common laboratory values 270 Index 274

12 Contributors Cheryl A. Barber, MPH, MS Senior Research Scientist Department of Basic Sciences HIV/AIDS Research Program New York University College of Dentistry New York, NY, USA Floyd L. Dussetschleger, DDS Clinical Professor Cariology & Comprehensive Care New York University College of Dentistry New York, NY, USA David H. Hershkowitz, DDS Clinical Assistant Professor; Associate Chairperson Cariology & Comprehensive Care New York University College of Dentistry New York, NY, USA Joseph S. Insler, MD Fellow Addiction Psychiatry Department of Psychiatry Boston University Boston, MA, USA x

13 Foreword People are living longer. According to The State of Aging and Health in America 2013, the increase in the number of Americans aged 65 years and older is unparalleled in the history of the USA. Chronic conditions present a major modification in the principal causes of death for all age groups from infectious diseases and acute conditions to chronic diseases and degenerative illnesses. Many Americans, including the older population, present with numerous chronic medical conditions. Treatment of this section of the population makes up a good majority of the country s healthcare allocation. Dentists will be seeing more people with medical issues that will have to be treated differently than in a healthy individual. The The Dentist s Quick Handbook of Medical Updates is a must-have to help dentists navigate treatment for these patients. The book is detailed yet easy to read. The dental notes for each condition located by system are a handy quick reference that will help make precise treatment decisions. Charles N. Bertolami Professor and Herman Robert Fox Dean College of Dentistry New York University xi

14 Preface The Dentist s Quick Guide to Medical Conditions is a manual designed to provide practicing dental clinicians with a comprehensive review of the latest information on treatment of dental patients with common medical disorders. The information in this book is primarily concerned with the clinical practical aspects of different medical conditions, pharmacologic management, and dental management of these conditions. The book is structured around the clinical synopsis of the medical condition, specific diagnostic/laboratory values that are important for the dentist to know, significant drug drug and drug disease interactions, and key dental notes needed to treat the medically complex dental patient. Each chapter s discussion of medical and pharmacological treatment relies heavily on the clinical experience of the authors and therefore addresses many of the problems that the dentist encounters in daily practice. Most chapters contain easy-to-follow tables and bullets denoting important facts. Features of The Dentist s Quick Guide to Medical Conditions include the following. At the end of each chapter are easy-to-follow dental notes on management of the medically complex patient. Drug tables: many tables are provided that summarize the main medical/pharmacologic/dental features of the different medical conditions. Many appendices: Appendix A, antibiotic prophylaxis of the dental patient; Appendix B, common dental drug interactions; Appendix C, summary guide to dental management of systemic diseases; Appendix D, interpretation of common laboratory values. Comprehensive up-to-date references with each chapter. The authors are deeply grateful for the opportunity to write this book, and hopefully it will meet the needs of the dentist in practice. Mea A. Weinberg Stuart L. Segelnick Joseph S. Insler I will have been a clinical instructor of endodontics at New York University College of Dentistry for almost 20 years at the time of this publication. One day it dawned upon me that the very students I was mentoring in the clinic had greater medical knowledge than myself. To mention a few instances, the students had knowledge of new medical tests for disease entities and their corresponding normal values, better disease diagnosis with probable treatment outcomes, and knowledge of newer pharmacologic agents including their xii

15 Preface xiii indications, contraindications, and side effects. Most of this information was not part of my original dental school program as medical advances had left me and albeit some older graduates deficient in the newer procedures. A graduate of the University of Buffalo Dental School (1979), I desired to update my medical knowledge; this was the inspiration for the first edition of this book. It is with great pride and humility that we bring this book into the medical literature. Samuel Kramer, DDS SUNY Buffalo 1979-DDS New York University College of Dentistry 1991-Certificate in Endodontics