The Medically and Physically Compromised Patient Chapter 29 Copyright 2009 2006 by Saunders an imprint of Elsevier Inc All rights Chapter 29 Lesson 29 1 Copyright 2009 2006 by Saunders an imprint of Elsevier Inc All rights Learning Objectives Pronounce define and spell the Key Terms Describe the type of dental management a medically compromised patient would receive Describe the stages of aging in the older population Describe orally related conditions affecting the older patient Cont d Copyright 2009 2006 by Saunders an imprint of Elsevier Inc All rights Learning Objectives Cont d Describe the importance of the medical history in the medically compromised patient Describe the major medical disorders that can affect a patient s oral health Copyright 2009 2006 by Saunders an imprint of Elsevier Inc All rights The Rights of a Patient Americans with Disabilities Act Provides a clear strong enforceable standard addressing discrimination against people with disabilities American Dental Association Supports Title I employment discrimination Title II access for the disabled Title III public accommodations Title IV telecommunications services Copyright 2009 2006 by Saunders an imprint of Elsevier Inc All rights Role of the Dental Assistant Aid the dentist in providing treatment Act as a source of information to the patient and family Provide comfort to the patient Help reduce anxiety Copyright 2009 2006 by Saunders an imprint of Elsevier Inc All rights The Aging Population Aging is the irreversible and inevitable changes that occur with time Stages of the older population Young old People 65 to 74 years old better educated and more demanding of health services retain more of their natural teeth Old People 75 to 84 years old beginning to have multiple health problems have more fixed and removable prostheses Old old People 85 years old or older have fewer natural teeth believe that tooth loss is inevitable and have medical conditions reflected in their oral health Copyright 2009 2006 by Saunders an imprint of Elsevier Inc All rights Dentally Related Aging Changes Xerostomia is a condition resulting from certain disorders and medications that involves decreased flow of saliva Periodontal disease is an increasing problem in the older population The tissues of older patients may be slower to heal Dental decay increases in the form of coronal and root caries and recurrent decay around defective restorations Dark and brittle teeth result from deposition of secondary dentin that have gradually reduced the size of the pulp chamber Bone resorption results in loss of the alveolar ridge Copyright 2009 2006 by Saunders an imprint of Elsevier Inc All rights Fig 29 3 Periodontal conditions of an older patient Copyright 2009 2006 by Saunders an imprint of Elsevier Inc All rights Fig 29 4 Root caries of in an older patient Copyright 2009 2006 by Saunders an imprint of Elsevier Inc All rights Fig 29 5 Darkened teeth associated with secondary dentin and aging Copyright 2009 2006 by Saunders an imprint of Elsevier Inc All rights Fig 29 6 Bone resorption with loss of teeth and alveolar ridge Copyright 2009 2006 by Saunders an imprint of Elsevier Inc All rights The Medically Compromised Patient Patient Assessment Category I Healthy patient Category II Medical conditions requiring schedule changes Category III Medical conditions requiring significant modifications in dental treatment Category IV Medical conditions requiring major modifications in dental treatment Category V Serious medical conditions Copyright 2009 2006 by Saunders an imprint of Elsevier Inc All rights Neurologic Disorders Alzheimer disease is a brain disorder that is marked by deterioration of mental capacity The disease progresses in three stages Early disease or forgetfulness phase Intermediate disease or confused phase Late disease or dementia phase Treatment plan modifications Thorough dental examination in early stages Special attention to daily care of the mouth Alertness to signs of xerostomia Cont d Copyright 2009 2006 by Saunders an imprint of Elsevier Inc All rights Neurologic Disorders Cont d Seizures are an abrupt suspension of motor sensory and or body function Epilepsy Petit mal seizures usually last 5 to 10 seconds Grand mal seizures have many causes and arise in people in all age groups Treatment plan modifications Maintenance of oral hygiene Surgical reduction of gingival hyperplasia Questioning before any procedure with regard to eating stress pain and alcohol consumption Cont d Copyright 2009 2006 by Saunders an imprint of Elsevier Inc All rights Neurologic Disorders Multiple sclerosis is a debilitating and degenerative disorder of the central nervous system that involves progressive weakening of the lower extremities causing muscle weakness unsteady gait and paralysis Treatment plan modifications Adrenal suppressants to relax muscles Extra time for procedures if the patient is wheelchair bound Cont d Copyright 2009 2006 by Saunders an imprint of Elsevier Inc All rights Neurologic Disorders Cont d Stroke or cerebrovascular accident is a minor to severe loss of central nervous system function caused by a sudden vascular lesion of the brain such as hemorrhage embolism thrombosis or ruptured aneurysm Treatment plan modifications Midmorning scheduling with additional time set aside Modification of oral hygiene aids Copyright 2009 2006 by Saunders an imprint of Elsevier Inc All rights Cardiovascular Disorders Heart disease leading cause of death in the United States Angina severe pain in the chest associated with an insufficient supply of blood to the heart Myocardial infarction heart attack Treatment plan modifications Vital sign checks throughout the procedure Use of supplemental oxygen Use of prophylactic sublingual nitroglycerin Avoidance of epinephrine Cont d Copyright 2009 2006 by Saunders an imprint of Elsevier Inc All rights Cardiovascular Disorders Cont d Hypertension Referred to as high blood pressure it results when the heart must work harder as it pumps against resistance e g a blocked artery Major factors associated with hypertension Stress Age Heredity Smoking Obesity Cont d Copyright 2009 2006 by Saunders an imprint of Elsevier Inc All rights Cardiovascular Disorders Cont d Congestive heart failure is a condition where the heart cannot pump enough blood to the body s other organs This lack of circulation throughout the body can result from Narrowed arteries Interference with the heart muscle by scar tissue from