Week 3 Mani: Medically Compromised Patients Flashcards
What paeds pts often have congenital heart defects?
70% of children with Trisomy 21 (downs syndrome) are affected
What are examples of congenital heart defects?
Acyanotic and cyanotic defects
What are acquired cardiac problems?
- Cardiac arrythmias
- Infection endocarditis
- Cardiomyopathies
What are medical implications regarding cardiac issues?
- Other medical conditions/syndromes
- Risk of bacterial endocarditis
- Bleeding tendency (if on anticoagulants)
- Possibility of oxygenation issues
- Potential blood pressure issues
What is dental management for cardiac conditions?
- Liaise with cardiologist
- Is AB cover needed?
- Prevention- good OH, routine reviews
- Reduce risk of endocarditis
- Administer LA with vasoconstrictor with caution
- Pulp therapy in primary teeth contraindicated
Most important considerations: Drug hx, AB prophylaxis, Bleeding disorders, No pulp therapy in primary teeth
Why is pulp therapy in primary teeth contraindicated for cardiac paeds pts?
Exo is recommended instead. Want to eliminate source in infection to prevent secondary infection.
What are classic features of congenital heart conditions?
- Dyspnoea
- Cyanosis
- Clubbing of fingers
What are oral features of cardiac conditions?
Developmental enamel defects (esp primary dentition)
Inc risk of dental caries- meds, compliance, diet
What dental procedures require AB prophylaxis?
- Exo
- Raising flap
- Biopsies
- Subgingival procedures (ortho bands, scaling teeth, irrigation of pockets)
- Intraligamentary injections
- Reimplantation of avulsed teeth
- Incision and drainage of abscess
- Placement of dental implants
- During diagnostic phase of RCT if likely that file will pass through apex
Describe primary haemostasis
- Injury to blood vessels
- Vascular spasm (slows blood loss)
- Platelet plug formation. Platelets release chemicals to attract more platelets to site of injury, forming clot
- Secondary haemostasis (coagulation cascade)
What are quantitative vs qualitative platelet disorders?
- Quantitative: reduced platelet numbers (leukaemia, HIV, liver disease, drug induced)
- Qualitative: altered platelet function (von-willebrand, drug induced)
How do do NSAID’s cause increased bleeding?
NSAIDs inhibit COX which blocks production of thromboxane A2, which results in reduced platelet aggregation
What are dental implications of haematological disorders?
- Failure of initial clot formation
- Oral petechiae and purpura
- Spontaneous gingival bleeding
- Prolonged excessive bleeding
- Other associated medical conditions e.g. liver disease or malignancy
How can platelet disorders be managed?
- Management of platelet levels
- Avoid exos
- Good surgical technique and local measures to control bleeding
- AVOID block injections
Why avoid block injections on paeds pts with haemotological disorder?
Accidental injury to vessel may cause excessive/inadvertent bleeding
What are reasons for coagulation mechanism disorders?
- Haemophilia A, B, C
- Von Willebrand’s disease
- Anticoagulation therapy
- Bone marrow suppression
- Renal failure
- Liver disease
- Vit K deficiency
Why can haemophilia bleeds be delayed?
Can be delayed by several hours bc primary haemostasis not impaired
How can haematological disorders be managed dentally?
- Liaise with haematologist
- May need to coordinate dental tx with med tx (may need hospital setting)
- Avoid oral surgery/invasive procedures in general dental setting where risk is greater
- Preventative
- Gentle techniques
- Avoid prescription drugs that would exacerbate bleeding e.g. NSAIDs
- Appropriate local measures to control bleeding
- LA (use vasoconstrictor and IAN block requires haematological prophylaxis)
What vit deficiency can sore tongue and oral mucosa indicate?
Vit B12 deficiency
What are oral manifestations of deficiency anaemia?
Angular cheilitis, atrophic glossitis, soreness of tongue, recurrent ulcerations
