Dental care causes changes to the patient’s homeostasis. The results of the microbiologic, physical, and psychological stimuli caused by dental care may be altered by underlying medical conditions. Therefore, modifications necessary for providing safe and appropriate dental care are often determined by underlying medical conditions. A risk assessment needs to be performed to evaluate and determine what modifications should be implemented before, during, and after dental treatment. Different modifications may be necessary at each stage of treatment. For example, antibiotic prophylaxis or steroid replacement may be necessary before treatment,
or it may not be possible to place the patient in a supine position during dental procedures, or specific hemostatic agents may need to be employed after extractions.
In this book, many different medical conditions are discussed, and protocols for the modification of dental care are suggested. However, it is the responsibility of the oral health care provider to obtain all the pertinent information that may have an impact on the patient’s care.
Before initiating dental care, the risk to the patient must be assessed. It is helpful to focus on the following three questions (which will change according to severity of the underlying disease or condition):
1. What is the likelihood that the patient will experience an adverse event due to dental treatment?
2. What is the nature and severity of the potential adverse event?
3. What is the most appropriate setting in which to treat the patient?
Each of these questions can be subdivided into smaller entities, which will facilitate the assessment of the patient.
The four major concerns that must be addressed when assessing the likelihood of the patient to experience an adverse event are (1) possible impaired hemostasis, (2) possible susceptibility to infections, (3) drug actions and drug interactions, and (4) the patient’s ability to withstand the stress of the dental procedure.
The adverse event may be (1) minor and effectively dealt with at “chairside” (minor complications and adverse events are anticipated) or (2) major, in which case austere interventions may be necessary (major complications and adverse events are anticipated).
Finally, based on the type and severity of the medical condition, the likelihood of the patient’s experiencing an adverse event and the severity of that event will determine the most appropriate setting for the dental care. The patient can be treated as one of the following:
1. Outpatient in a general dental office 2. Outpatient in a dental office with more extended
resources for resuscitation 3. Patient in a short procedure unit in a hospital 4. Inpatient in an operating room
Most medically complex patients can be safely treated when the factors mentioned above have been addressed.
resources for resuscitation 3. Patient in a short procedure unit in a hospital 4. Inpatient in an operating room
Most medically complex patients can be safely treated when the factors mentioned above have been addressed.