MEDICAL CONDITIONS AND THEIR IMPACT ON DENTAL CARE

Transcription

1 MEDICAL CONDITIONS AND THEIR IMPACT ON DENTAL CARE Preface James R. Hupp xiii Ischemic Heart Disease: Dental Management Considerations 483 James R. Hupp Ischemic heart disease (IHD) is a common problem. Thus, most dental professionals who treat adults see patients with IHD on a daily basis. Fortunately, most patients are either too young to have clinical stigmata of IHD or have the disease well controlled. However, for those patients prone to angina or a myocardial infarction, dental care providers must be prepared to recognize and manage the risks so untoward events are prevented or their impact mitigated. This article presents information useful for assessing risks and planning the delivery of safe dental care to those with IHD. Valvular Heart Disease and Heart Failure: Dental Management Considerations 493 Gary Warburton and John F. Caccamese, Jr Approximately 5 million people are diagnosed with valvular heart disease in the United States each year. Many of these will present to the general dentist for routine dental care. The dentist must then understand the implications of this disease process to treat these patients safely and effectively. Of course patients with pathologic valve disease are managed in close consultation with their physicians. Even so, a dentist with knowledge of the disease process, as well as its diagnosis and treatment, has greater confidence when treating these patients. This article summarizes issues related to valvular heart disease and heart failure and provides guidance to dentists treating patients with such heart conditions. VOLUME 50 Æ NUMBER 4 Æ OCTOBER 2006 v

2 Dental Management of Patients with Obstructive Pulmonary Diseases 513 Wendy S. Hupp Many dental patients have obstructive pulmonary diseases, such as chronic bronchitis, emphysema, and bronchial asthma. These diseases have different etiologies but may have overlapping signs and symptoms. Diagnosis and treatment are becoming more sophisticated so that morbidity and mortality are improving. Most dental patients with these diseases can be treated safely with only minor adjustments to procedures. Cigarette smoking is a common risk factor that dental health care providers can address with a simple cessation program called the five A s. Management of the Dental Patient with Renal Disease 529 Kameron Raja and Domenick P. Coletti The kidneys are essential organs responsible for a multitude of bodily functions. One of the most important roles involves the regulation of intravascular volume and concentration of fluids in the body by producing urine. In addition, the kidneys are involved in regulation of blood pressure, detoxification of harmful substances, secretion of hormones, the control of acid/base balance and concentration of several electrolytes, and many other functions. This article provides the dental practitioner with a review of the renal system, associated pathology, and how one must alter their management to provide effective and safe treatment. Dental Management of Patients with Hypertension 547 J. Bruce Bavitz About 50 million people in the United States have hypertension. Many epidemiologists feel it is the number one public health problem in developed countries. Although asymptomatic early on, untreated hypertension leads to cardiovascular disease, strokes, renal failure, and blindness. Dentists no doubt treat patients with hypertension and its sequelae in their practice. This article summarizes the current thinking on the diagnosis and treatment of this condition, emphasizing dental implications. The article presents common oral and systemic side effects of antihypertensive medications, and discusses how dentists can help treat hypertension through the fabrication of devices useful in reducing obstructive sleep apnea. vi

3 Dental Management of Patients with End-Stage Liver Disease 563 F. John Firriolo This article presents a review of end-stage chronic liver disease (cirrhosis) with emphasis on the clinical presentation, diagnosis, and complications of cirrhosis, along with their medical and surgical management and prognosis. This article also discusses the evaluation and management of the dental patient with cirrhosis, including the implications decreased hepatic function has on drugs commonly used in dental treatment. Dental Management of Patients with Diabetes 591 Samuel J. McKenna Diabetes is a disease of metabolism resulting from impaired insulin secretion, varying degrees of insulin resistance, or both. Management of the diabetic dental patient must take into consideration the impact of dental disease and dental treatment on the management of diabetes as well as an appreciation for the comorbidities that accompany long-standing diabetes. Those comorbidities include obesity, hypertension, and dyslipidemia. Central to the management of diabetes is the intensive regulation of plasma glucose along with management of comorbidities comprising the metabolic syndrome. Management of the diabetic dental patient should focus on periodontal health and the delivery of comprehensive dental care with minimal disruption of metabolic homeostasis and recognition of diabetic comorbidities. Management of Dental Patients with Seizure Disorders 607 Robert B. Bryan and Steven M. Sullivan Dental practitioners from time to time must treat patients with epilepsy or similar seizure disorders. This article describes the various classifications for epilepsy, explains how such disorders are evaluated and diagnosed, discusses management methods, and addresses related issues for special populations, such as pregnant women and the elderly. In addition, the article offers information about what special steps dentists should take in treating such epileptic patients and others vulnerable to seizures and in preparing offices and staff for the possibility that a patient will have a seizure in the office. In general, a patient with severe, poorly controlled epilepsy should be treated in a hospital. Otherwise, a well-controlled patient should easily be treated in the office. vii

4 Dental Management of Patients with Stroke or Alzheimer s Disease 625 Debra Sacco and David E. Frost Dentists are caring for an older population with significant comorbidities. It is necessary to be familiar with a patient s medical history and medications and how they may affect the care provided. This article focuses on patients with history of stroke or Alzheimer s disease. HIV-Positive Patients: Dental Management Considerations 635 Nicholas G. Mosca and Alicia Rose Hathorn HIV infection in humans occurs primarily by mucosal infection during unprotected sexual activity or inoculation during intravenous drug use. HIV infection causes a progressive deterioration of protective cell-mediated immunity, specifically due the destruction of thymus-derived lymphocytes, called T cells, during viral replication. Highly active antiretroviral therapy (HAART) reduces HIV viral replication and improves immune function against opportunistic infections, but it does not offer a cure for disease. Dental professionals should be able to recognize those with HIV infection by identifying the oral manifestations of fungal, viral, and bacterial infections or neoplasms that occur with immunodeficiency. Dental care providers should understand the adverse effects of HAART and communicate the importance of good oral health in managing disease. Dental Management of Patients with Bone Marrow and Solid Organ Transplantation 659 Kim E. Goldman With advances in transplant science, an increasing number of people are undergoing and surviving hematopoietic stem cell and solid organ transplantation. Those transplant recipients are also living longer. This means that many dentists nowadays will occasionally treat patients who are anticipating a transplant or who have received a transplant. Dentists thus should be knowledgeable about issues related to this population. The dentist s role is important because transplant patients are especially vulnerable to infection, which can stem from poor oral and dental hygiene. This article provides dentists with an overview of transplant science and guidance for dentists treating transplant patients. viii

5 Pregnancy: Physiologic Changes and Considerations for Dental Patients 677 Tracy M. Dellinger and H. Mark Livingston Human gestation is a period of dynamic physiologic changes designed to support the developing fetus. Systems affected include the respiratory, gastrointestinal, circulatory, and musculoskeletal. These alterations influence the patient s general health and make her prone to develop complications unique to pregnancy. Such complications include pre-eclampsia, gestational diabetes, and pregnancy tumors. The fetus s development is also affected by its mother s health, social habits, and medication usage. To protect both the mother and unborn child, dental professionals may need to incorporate maternal counseling, treatment modifications, or changes to their customary medication repertoire. Index 699 ix