Dental Management Considerations Research Articles

Expanding the phenotype in Pitt-Hopkins syndrome; description of new oral finding and dental management considerations

BackgroundPitt-Hopkins syndrome (PTHS) is a rare neurodevelopmental disorder with physical, cognitive, and behavioral characteristics that is caused by heterozygous mutations in the TCF4 gene. Patients with PTHS might present a unique challenge for oral healthcare professionals because of the associated comorbidities.Case reportHere we describe a new case of PTHS in a 13-year-old girl with particular emphasis on oro-dental findings and oral healthcare management. Observed oro-dental findings in our case included shallow palate, absence of lingual frenum, gingival enlargement, thick lips and relative microdontia. The patient was unable to tolerate dental care under local anesthesia. Therefore, comprehensive dental treatment was performed under general anesthesia after a careful pre-anesthetic cardio-respiratory, neurological, and hematological evaluation. The patient was closely monitored intra-operatively for breathing rhythm, O2 saturation, and signs of respiratory distress. The patient was observed for 24 h post-op for respiratory distress and was discharged then uneventfully.ConclusionDental treatment under general anesthesia in these patients might be complicated by the abnormal breathing rhythm, and close monitoring and follow up for signs of respiratory distress after general anesthesia is necessary. Recognition of oral and dental findings might help to expand the phenotype and better characterize rare syndromes.

Dental Management Considerations for Patients with Cardiovascular Disease-A Narrative Review.

Dental therapists encounter patients with various systemic diseases of which cardiovascular disease (CVD) patients form a significant segment. Relation between oral health and cardiac diseases has been well established. Common cardiac disorders encountered in a dental practice include arterial hypertension, heart failure, ischemic heart disease, cardiac arrhythmias, infective endocarditis, stroke, and cardiac pacemaker. Patients with CVDs pose a significant challenge to dental therapy. These patients need special considerations and an adequate understanding of the underlying cardiovascular condition to provide safe and effective dental treatment. Based on the cardiac condition, an appropriate modification in dental care is crucial. A multidisciplinary approach including the patient's cardiologist can potentially reduce complications and improve dental treatment results. This review aims at unfolding the risks associated with the dental management of a cardiac patient and outlines the measures to be undertaken for optimum dental treatment.

Apert Syndrome: Dental management considerations and objectives

BackgroundApert syndrome (AS) is a rare congenital disorder that correlates with many craniofacial features, like craniosynostosis, midfacial malformation, and symmetrical syndactyly of the hands and feet. AimThis paper describes the facial and oral manifestations in a 20-year-old female previously diagnosed with AS, discusses the complex dental treatment plan and treatments, including the use of a customized toothbrush handle to enhance the patient's brushing ability. ResultsA satisfactory outcome was provided, and the patients quality of life improved significantly due to this comprehensive multi-disciplinary care process. ConclusionsComprehensive examination, extensive medical history reviewed, parental and patient consent are needed to establish a comprehensive treatment plan regarding the special needs of these patients.

Dental management considerations in the elderly with acquired bleeding disorders

Background: Globally, the percentage of elder people is increasing every year and has been projected that by year 2050 one in six people in the world will be 65 years and older. With advancing age, there are increased changes in the hemostatic balance resulting in acquired bleeding disorders. It has become very common for such patients to seek oral healthcare in hospitals and clinics. Hence it is essential that Dentists are able to manage such patients with regards to ensuring patient safety and delivering high standards of care.Objective: Enable Dental professionals to recognize underlying hematological comorbidities, order and interpret appropriate lab investigations, identify drugs which might cause bleeding during dental treatment, planning and delivering required dental procedures especially invasive procedures such as dental extractions.Methods: Literature review searches were done PubMed, Wiley Online & Cochrane Library Databases using keywords.

Dentists' knowledge about medication-related osteonecrosis of the jaw and its management

ObjectivesTo assess the knowledge of dentists regarding medication-related osteonecrosis of the jaw (MRONJ). MethodsIn this cross-sectional study, 74 dentists from governmental hospitals in Riyadh (Dental University Hospital in King Saud University, Military Hospital, National Guard Hospital), Jeddah (King Abdulaziz University Hospital, Ministry of Health Hospital), and the Eastern region of Saudi Arabia (Ministry of Health Hospitals in Dammam and Al-Ahsa) completed a two-part questionnaire. The first part gathered demographic data, such as sex and specialty. The second part included questions about bisphosphonate drugs and their indications; the identification of patients at risk of MRONJ; other medications associated with jaw necrosis; as well as the definition of MRONJ and its clinical features, risk factors, and preventive methods. ResultsOf the participating dentists, 60.8% knew about MRONJ, but only 35.1% were able to define it correctly. Most (79.7%) had never encountered MRONJ patients. Only 18.9% knew of the relationship between the risk of MRONJ in osteoporotic patients and long-term (>4 years) use of oral bisphosphonates or intravenous zoledronate, while 68.9% were unaware, and others answered incorrectly. Most participants did not know of MRONJ-predisposing medications, and 59.5% cited radiotherapy as the cause. Most participants identified dentoalveolar surgery as a major local factor, and the mandible as a common anatomic location. ConclusionDentists at the surveyed institutions had poor knowledge of MRONJ, although their knowledge of preventive measures was good. There is an urgent need for the optimization of educational programs pertaining to MRONJ, and its related dental management considerations. Clinical significanceDentists in the surveyed institutions in Kingdom of Saudi Arabia have poor knowledge of MRONJ management; thus, greater effort should be taken to educate undergraduate and postgraduate students regarding this pathology.

Psoriasis: A review of systemic comorbidities and dental management considerations.

There is a growing body of evidence to substantiate that cutaneous psoriasis is associated with an increased risk for a multitude of systemic disorders. Although there is an extensive array of medical publications regarding psoriasis, the dental literature has almost exclusively been focused on erythema migrans and occasionally, with oral psoriatic mucositis, chronic periodontitis, and psoriatic arthritis of the temporomandibular joint. This report will review the diversity of systemic comorbidities, namely cardiovascular, neurologic, renal, liver, gastrointestinal, pulmonary, endocrine, ocular, arthritic (including temporomandibular joint), nail, cutaneous, and psychologic (including suicide) disorders; neoplasia; infection; dyslipidemia; vitamin D deficiency; substance abuse; higher mortality; and oral mucosal involvement. A discussion of the oral and maxillofacial relevance of these comorbidities is also provided. The author conducted a PubMed search from 1975 through August 2017 for articles on comorbidities associated with psoriasis. For select topics, some relevant case reports were examined. A search on PubMed yielded almost 44,000 articles on psoriasis and nearly 1,300 with the keywords psoriasis and comorbidities. Articles selected for discussion consisted mostly of recent systematic reviews and meta-analyses. Case reports were included when there was a restricted number of psoriatic patients with a particular comorbidity. When a patient presents with a history of psoriasis, the dental practitioner should expand the medical history process to ascertain possible correlated diseases. Information gleaned from this interview process may prompt the attending dental clinician to seek consultation with the patient's physician to gain greater insight to the severity of any prevailing comorbidities and engage in discussions for possible modifications in dental management. Knowledge of psoriatic comorbidities and their possible impact on dental care may improve clinical outcomes.

Dental management considerations for a patient taking dabigatran etexilate: a case report

Dabigatran is a direct thrombin inhibitor approved to help prevent thrombotic events in patients with atrial fibrillation. As a rather new drug approval, information on management of bleeding during dental surgery in patients taking dabigatran is sparse. In this case report, a 67-year old male with a positive history for atrial fibrillation, coronary artery disease, intermittent angina, hypertension, type 2 diabetes and normal renal function was taking dabigatran 150 mg, 2 times daily. He underwent 8 surgical extractions, alveoloplasty and tuberosity reduction. Per guidelines prescribed by van Ryn et al., the patient's dabigatran was held the night before surgery and resumed the day after. Adverse outcomes were not observed during the procedure or in the 7-month postoperative period. This case suggests that due to its short half-life, dabigatran can be temporarily discontinued 24 h prior to elective oral surgery with consent of the physician and restarted the following day resulting in minimal complications.

Dental management considerations for the patient with an acquired coagulopathy. Part 2: Coagulopathies from drugs.

Dental patients often give a medical history that suggests the possibility of a coagulopathy from drugs, with a corresponding risk for prolonged bleeding during and following an invasive procedure. Identification of patients who may be prone to oral bleeding requires specific medical history information and the proper use of laboratory tests. Some NSAIDs are reported to cause prolonged oral bleeding, but scientific evidence is lacking. Likewise, the risk of oral bleeding from anticoagulants such as warfarin is often over stated, and unnecessary adjustment of NSAID or warfarin dosage puts patients at risk for significant morbidity and mortality. Some commonly employed laboratory tests such as the prothrombin time provide helpful information when used in the appropriate setting, but others, such as the bleeding time test, provide little or no predictive value in the determination of patients at risk for oral bleeding. Dental management of patients with potential coagulopathies from medications requires an understanding of basic principles of coagulation. The vast majority of these patients can be managed in the community setting without risk and without alteration of anticoagulant drug regimes.

Dental management considerations for the patient with an acquired coagulopathy. Part 1: Coagulopathies from systemic disease.

Current teaching suggests that many patients are at risk for prolonged bleeding during and following invasive dental procedures, due to an acquired coagulopathy from systemic disease and/or from medications. However, treatment standards for these patients often are the result of long-standing dogma with little or no scientific basis. The medical history is critical for the identification of patients potentially at risk for prolonged bleeding from dental treatment. Some time-honoured laboratory tests have little or no use in community dental practice. Loss of functioning hepatic, renal, or bone marrow tissue predisposes to acquired coagulopathies through different mechanisms, but the relationship to oral haemostasis is poorly understood. Given the lack of established, science-based standards, proper dental management requires an understanding of certain principles of pathophysiology for these medical conditions and a few standard laboratory tests. Making changes in anticoagulant drug regimens are often unwarranted and/or expensive, and can put patients at far greater risk for morbidity and mortality than the unlikely outcome of postoperative bleeding. It should be recognised that prolonged bleeding is a rare event following invasive dental procedures, and therefore the vast majority of patients with suspected acquired coagulopathies are best managed in the community practice setting.

Periodontal management of patients with cardiovascular diseases.

Periodontists are often called upon to provide periodontal therapy for patients with a variety of cardiovascular diseases. Safe and effective periodontal treatment requires a general understanding of the underlying cardiovascular diseases, their medical management, and necessary modifications to dental/periodontal therapy that may be required. In this informational paper more common cardiovascular disorders will be discussed and dental management considerations briefly described. This paper is intended for the use of periodontists and members of the dental profession.

Dental management considerations for the patient with diabetes mellitus

The prevalence of diabetes mellitus, or DM, in the United States is increasing steadily. The increasing longevity of the American population and more effective diagnostic protocols mean that the dental practitioner will be treating an increasing number of patients with the disease. The authors present relevant information about DM, including a recently revised nomenclature system, pathophysiology, complications, new diagnostic criteria, medical and dental management considerations, and associated oral conditions. There are many important medical and dental management issues that dentists should consider when treating patients with DM. The information presented in this report should help general dentists deliver optimum treatment to patients with DM.

PENGELOLAAN KELAINAN GIGI DAN MULUT PADA PASIEN KOMPROMIS MEDIK (PASIEN DENGAN PENYAKIT DARAH)

Oral pathosis were frequent signs or symptoms in patient with undiagnosed blood dyscrasias. The symptoms in the mouth often are the early sign of the disease, so that the patient will seek aid of the dentist first. Otherwise dentists are in the primary position to recognise oral manifestation of the systemic disease. The dentist should be able to detect patients with these diseases by history, clinical examination, and screening laboratory tests. In addition to the diagnostic role, the dentist has an increasingly important part to play during the management of patients with blood disorders. There are three major dental management considerations in the patient with hematologic disorders. As mentioned, patient with blood disorders are functionally immunosuppressed and are at risk for infection and abnormal bleeding. Sources of oral infection should be eliminated. Close cooperation between dentist and physician is mandatory in planning dental treatment.

Dental management considerations for institutionalized geriatric patients

The elderly in general and the residents of nursing home facilities in particular are increasingly frail, old, and dentate. Dentists should be prepared to manage the oral health needs of elderly clients who are afflicted with complex medical, functional, and dental disabilities. Proper dental management requires a commitment to provide treatment of quality despite myriad obstacles. From the outset of evaluation, there must be recognition of the likelihood of compromised self-care and the development of proactive strategies to address dependence in oral care.

Dental management considerations for the patient with post-traumatic stress disorder

Vietnam veterans with post-traumatic stress disorder are frequently encountered in the dental office. They are often anxious, hostile, depressed, withdrawn, or resistant to treatment. Their psychological set and relatively high incidence of alcohol and drug-related problems frequently require modification of their dental therapy. An attractive and biologically sound restoration of the orofacial structures may improve long-term rehabilitation by enhancing self-esteem and social interactions.

Dental Considerations in Management of Head and Neck Cancer

The successful management of patients with squamous cell cancer of the aerodigestive tract requires a multispecialty team. Cooperation among these individuals will ensure that the patient has the best possible chance for a favorable outcome. The role of the dentist as a member of this team is discussed.