W3 - Medically Compromised Children - Mani Flashcards
(46 cards)
Cardiac medical implications to consider in compromised children (6)
- Risk of bacterial endocarditis (valve defects, birth defects)
- Bleeding tendency - anticoagulants?
- Possibility of oxygenation issues
- Blood pressure issues
- Other medical conditions
- Medications
Clinical features / presentations of cardiac patients (5)
Dyspnoea - shortness of breath
Cyanosis
Clubbing of fingers
Heart sounds (murmurs)
Altered heart rate
Oral features of cardiac patients (2)
No direct effects, HOWEVER indirect effects due to meds, routine, etc
-
Developmental defects of enamel
- Hypoplasia in primary teeth
- Increased risk of caries
Dental management of cardiac patients (5)
- Liase with cardiologist
- AB cover indicated?
- Reduce risk of bacterial endocarditis
- Prevention - good OH and frequent check ups
- Careful with LA w/ vasoconstrictor (not contraindicated)
DO NOT LEAVE ANY SOURCE OF INFECTION IN MOUTH IN CARDIAC PT
Exo rather than pulp therapy
Why is pulp therapy (pulpectomy, pulpotomy) contraindicated in primary teeth in cardiac patients
Do not leave any source of infection in mouth of child with congenital cardiac disorders
- They will have increased risk of bacterial endocarditis
Extract instead
Primary vs secondary haemostasis
Primary: platelet adhesion (thrombocytes)
Secondary: coagulation cascade (clotting factors)
Ultimate goal is for fibrinogen to form fibrin clot
Additional info:
Thrombocytopoenia / platelet disorder is associated with PRIMARY haemostasis
Von Willebrands and Hemophilia is associated with SECONDARY haemostasis
How are platelet disorders classified (2) examples?
Quantitative - reduced # (thrombocytopoenia)
- can be inherited (many; rare) or acquired (infections like HIV)
Qualitative - altered function
- can be inherited (von willebrand) or acquired (aspirin or NSAID)
How does Aspirin and NSAID affect haemostasis?
Inhibits COX which blocks production of thromboxane A2
- Leads to reduced platelet aggregation
What are 4 dental implications that can occur if you treat a pt with a platelet disorder or coagulation mechanism disorders?
Failure to clot
Excessive bleeding
Spontaneous gingival bleeding
Purpura / petechiae
Dental management of pts with platelet disorders (4)
Management platelet levels (only tx once safe)
Avoid block injections
Avoid exo
Good surgical technique + local measures to control bleeding
Why should you avoid block injections (IAN) in pts with platelet disorders?
Accidental injury to vessel could cause inadvertant/excessive bleeding
Examples of inherited (2) and acquired (5) coagulation mechanism disorders
Inherited
- Hemophilia A (factor 8 def) and B (factor 9 def)
- Von Willebrands
Acquired
- Anti-coagulation therapy (warfarin)
- Vit K deficiency
- Liver disease
- Renal failure
- Bone marrow suppresion
What clotting factors are associated with Haemophilia A, B, and Von Willebrands
Hemophilia A (factor 8 def)
Hemophilia B (factor 9 def)
Von willebrands (factor 8 def)
Why may delayed bleeding occur in pts with hemophilia or von willibrands
They still have primary haemostasis to stop bleeding (formation of platelet plug)
Fibrin clot will not develop however and thus they will bleed later
How to manage patients with coagulation disorders (hemophilia/ von willibrands) (5)
- Liase with haematologist
- Avoid oral surgery / invasive procedure in general dentist setting (consider hospital setting)
- Avoid prescribing NSAID / Aspirin
- Local measures to control bleeding
- Nerve block (IAN) requires haematologic prophylaxis
Oral manifestations of Deficiency anemia (Fe, B12, folate) (4)
Angular cheilitis
Atrophic glossitis
Soreness of tongue
Recurrent ulcerations
Cause of hemolytic anemia (2) and consideration
- Extrinsic factors (malaria
- Defects with hemoglobin (thalassemia, sickle cell)
REQUIRE AB PROPHYLAXIS
Oral features of immunocompromised pts (5)
Candidosis (could be angular cheilitis)
gingivitis / perio
Recurrent aphthous ulceration
Recurrent herpetic infections
Premature tooth exfoliation
Dental management of immunodeficient patients (3)
- Preventive care
- Antibacterial / antifungal / antivirals
- Extraction of pulpally involved teeth
Treatment of candidiasis in children (2 ways) younger than 2 years
Nystatin liquid 100 000 units/mL 1 mL topically (then swallowed), 4xday after feeding for 7-14 days (or 2-3 days after symptoms resolve)
OR
Miconazole 2% gel 1.25mL topically (then swallowed), 4xday after feeding for 7-14 days (continue tx for 7 days after symptoms resolve)
How to treat oral candidiasis in adults and children >2 years
3 ways
“favourite exam question .. oral manifestation and treatment of fungal disorders”
Miconazole 2% gel 2.5mL topically (then swallowed), 4xday after food for 7-14 days (continue tx for 7 days after symptoms resolve)
OR
Nystatin liquid 100 000 units/mL 1mL topically (then swallowed) 4xday after food, for 7-14 days (or 2-3 days after symptoms resolve)
OR
Amphotericin B 10mg lozenge, 4xday after food, for 7-14 days (continue tx for 2-3 days after symptoms resolve)
Oral complications of chemotherapy (5)
Mucositis
Infection (due to neutropenia)
Haemostasis problems
Hyposalivation
Affect development of teeth
Oral complications of radiotherapy (5)
Salivary gland atrophy
Demin / Caries
Altered tooth development
Microdontia
Osteoradionecrosis
Oral complications of Bone Marrow Transplant (for cancer pts)
Mucositis
Mucosal sloughing
Xerostomia
Loss of taste
Acidic saliva (low pH)
