ORAL CONDITIONS IN PATIENTS

WITH SYSTEMIC ORIGIN

Hening Tuti Hendarti, drg.,MS.,Sp.PM
Kabupaten Merauke
Papua
 Safe dental treatment
planning needs medical
history information and risk
assesment, the challenges
of general practice dentist

Dentist should have the potential

to encounter different type of
medical emergencies, related to
the patients medical health,
adequacy of management and
stress tolerance
More patients seeking oral health care
have underlying medical conditions that
may alter oral health status, treatment
approaches and outcomes

Systemic health may alter the

healing response to an
effectiveness of surgical and
non surgical therapies, and
risk of precipitating a medical
emergency
 For Key Considerations

1. Impaired hemostasis
2. Susceptibility to infections
3. Drug actions / interactions
4. Ability tolerate the stress of dental care
 1. IMPAIRED HEMOSTATIS

May required support management by

hematologist
Bleeding risk assessment (inherited or
acquired)
Phases of hemostasis : vascular, platelet,
coagulation, metabolic / fibrinolytic
 Clinical appearance

Skin and mucosal petechial, ecchymoses

or purpura
SKIN AND MUCOSAL HEMATOMAS
SPONTANEOUS GINGIVAL HEMORCHAGE
HEMOSIDERIN STAINING OF CALCULUS ON TEETH
JAUNDICE OF SCLERA MUCOSA AND SKIN
SPIDER ANGIOMA SKIN STIGMATA OF SEVERE
LIVER DISEASE
 MEDICATION may ALTER HEMOSTASIS :

Anticoagulant medications
(Warfarin, heparin)
Antiplatelet agent
(Aspirin, ticlopidine)
 HERBAL SUPPLEMENTS can enhance
BLEEDING RISK

Green Tea
Garlic
Ginkobiloba
Ginseng
To Control Bleeding
Preassure
Local hemostatic materials :
( Epinephrine, surgical stent, bone wax)
Electrocautery
 2. Susceptibility to Infections

The oral cavity is host to numerous bacteria

and fungi
Potential raising of local infection and
distant hematogenous spread

Ex : Chronic periodontitis flossing, scalling

and root planning bacteremia (Steptocaccal
Viridians)
Gingivitis and Intraoral Herpetic
Infection in Leukemic patient
 Susceptibility to infection
Renal dialysis
 Susceptibility to infection

Systemic lupus erythematosus

 Susceptibility to infection

Diabetes Mellitus
 To prevent distant site
infection

Good oral and muscosal health

Good gingival and periodontal health
Good dental health
 3. Drug Interaction

patient with complex medical conditions

are likely to be on multiple medications for
management of their systemic disease.
( therapeutic and adverse)
Prescription medication
Vitamin and minerals
herbal supplements
PRECAUTION

Liver disease

Renal Reduce drug

impairment dosages
Young Extended
chiildren intervals
The very old Avoidance
certain drug
Pregnant patient first trimester
teratogenic nursing mothers systemic
medication in the breast milk

Serious adverse effects

Allergic reactions
Averdosage
Drugs interactions
Symptoms of allergy :
Skin rash, pruritis (itching), urticaria,
swealling of the lips, tongue and throat,
angiodema, shortness of breath, syncope
 4. ABILITY TO TOLERATE DENTAL
CARE

Physiological and psychological stress

Stress Catecholamines (epinephrine and nor

epinephrine) from andrenal medulla into
cardiovasculer system heart workload
 Physical or Physiological Stress
may relate to:

o Pain
o Time at day or length of appointment
o Dental chair position
o Local anasthetic with or without epinephrine

Psychological Stress
o Anxiety
o Fear
Conclusion :
For safe patient management dentist must
obtain
Medication use
Dietary supplement
Allergy history
Understanding of the actions and
interactions off all medications
For patient comfort :
Adequate pain control
Morning, short, afternoon appointments
Positional change / pillow support
Elevate back of dental chair
For Stress reduction :
Anxiolytic Premedication
Minimize waiting time
Vital sign
Sedation
Short treatment duration
THANKYOU