is when blood pressure is too high. Blood pressure is written as two numbers. The first (systolic) number represents the pressure in blood vessels when the heart contracts or beats. The second (diastolic) number represents the pressure in the vessels when the heart rests between beats
Avoid rapid position changes owing to possibility of antihypertensive drug-associated orthostatic hypotension
Local anesthetic with 1:100,000 epinephrine for 1 or 2 carpules at a given time has little clinical consequence in patients with blood pressure less than 180/110 mm Hg.
Avoid more than 2 weeks use of NSAIDs, because these agents may interfere with effectiveness of some antihypertensive medications.
Avoid the use of erythromycin and clarithromycin (not azithromycin) with calcium channel blockers, because the combination can enhance hypotension.
Excessive bleeding due to hypertension is possible but unlikely.
if the patient has Less than 180/110 mmHG
May Receive any Necessary Dental Treatment if More than 180/110mmHG Deferred any Dental treatments
is a disease in which the blood glucose, or blood sugar, levels are too high. Glucose comes from the foods has eaten. Insulin is a hormone that helps the glucose get into cells to give them energy. With type 1 diabetes, the body does not make insulin. With Type 2 insulin dose not inter the Cell
No issues
No issues if diabetes is well controlled and don’t has any Co-existing Diseases. dose of epinephrine should be limited to no more than two cartridges containing 1:100,000 epinephrine.
Avoid use of aspirin and other NSAIDs in patients taking sulfonylureas, because these can worsen hypoglycemia.
Prophylactic antibiotics generally are not required
Thrombocytopenia is a rare adverse effect associated with sulfonylureas.
If diabetes is not well controlled (i.e., fasting blood glucose less than 70 mg/dL or more than 200 mg/dL and co-exist with other Diseases present, and blood pressure more than 180/110 mm Hg , should be Provide Only Emergency Care
And Advise patients to take usual insulin dosage and normal meals before the treatments and make glucose source like orange juice Available
is a condition in which the airways narrow and swell and may produce extra mucus. This can make breathing difficult and trigger coughing, a whistling sound (wheezing) when breathe out and shortness of breath. For some people, asthma is a minor nuisance
Semisupine or upright chair position for treatment may be better tolerated.
May Elect to avoid solutions containing epinephrine or levonordefrin because of sulfite preservative.
No issues.
Avoid erythromycin, macrolide antibiotics, and ciprofloxacin in patients taking theophylline.
Instruct patient to bring current medication inhaler to every appointment; use prophylactically in moderate to severe disease. Avoid any smells may tigger the asthma attack , there is mentioned in Drugs.com says avoid any NSAIDs for asthma patients
(Overactive thyroid) Occurs when the thyroid gland produces too much of the hormone thyroxine. Hyperthyroidism can accelerate the body's metabolism, causing unintentional weight loss and a rapid or irregular heartbeat.
Avoid using epinephrine in local anesthetics in untreated or poorly controlled patients.
Aspirin and other NSAIDs can increase the amount of circulating T4, making control of thyroid disease more difficult. Use appropriately.
Crofloxacin should not be taken simultaneously with levothyroxine, because the antibiotic appears to decrease absorption of the thyroid hormone.
Excessive bleeding may occur in patients with untreated or poorly controlled disease owing to thrombocytopenia, which fortunately is not a common finding.
There is extra informations , refer to the Book for additional informations , Avoid Epinephrine even For gingival retraction cords, or to control bleeding
Is an underactive thyroid gland. Hypothyroidism means that the thyroid gland can't make enough thyroid hormone to keep the body running normally. People are hypothyroid if they have too little thyroid hormone in the blood.
No issues.
Avoid CNS depressants such as narcotics, barbiturates. and sedatives in patients with poorly controlled disease.
In patients with poorly controlled as well as well-controlled disease, treat acute infection aggressively using appropriate antibiotics and incision and drainage when indicated.
There is extra informations , refer to the Book for additional informations , but it's much less than Hyperthyroidism
the condition or period of being pregnant.
Patient may not be able to tolerate a supine chair position in third trimester.
The usual local anesthetics with vasoconstrictors are safe to use, provided that care is taken not to exceed the recommended dose.
IF analgesics are required, consult with the physician. Acetaminophen(Paracetamol) is the drug of choice. It’s only analgesics safe for pregnant
If antibiotics are required, consult with the physician. Use those with FDA classification A or B, unless otherwise approved by the physician.
"B" Antibiotics like 1-penicillin 2-clindamycin
Avoid all drugs as possible. If drugs are needed, use FDA category A or B, only
is a Angina is a type of chest pain caused by reduced blood flow to the heart. myocardial infarction (MI), commonly known as a heart attack, occurs when blood flow decreases or stops to a part of the heart, causing damage to the heart muscle.
Ensure a comfortable chair position and avoid rapid position changes.
Avoid use of excessive amounts of epinephrine; limit to two carpules of 1:100,000 epinephrine within 30-45 minutes
Ensure adequate postoperative pain control.
No issues
If patient is taking aspirin or other antiplatelet medication, anticipate some excessive bleeding, but modification of drug regimen is not required.
Use stress reduction protocol , Continuous monitoring of blood pressure and pulse
And remember the retraction cord also has epinephrine
Angina is a type of chest pain caused by reduced blood flow to the heart. myocardial infarction (MI), commonly known as a heart attack, occurs when blood flow decreases or stops to a part of the heart, causing damage to the heart muscle.
Ensure a comfortable chair position and avoid rapid position changes.
avoid use of vasoconstrictor if possible. If vasoconstrictor is needed, avoid excessive amounts of epinephrine; limit to two carpules of 1:100,000 epinephrine within 30-45 minutes
Ensure adequate postoperative pain control.
No issues
If patient is taking aspirin or other antiplatelet medication, anticipate some excessive bleeding, but modification of drug regimen is not required.
Use stress reduction protocol , Continuous monitoring of blood pressure and pulse
Consider administering prophylactic nitroglycerin just before procedure.
Occurs when the heart muscle doesn't pump blood as well as it should. Certain conditions, such as narrowed arteries in the heart (coronary artery disease) or high blood pressure, gradually leave the heart too weak or stiff to fill and pump efficientl
Positioning usually is not a problem if the patient is under good medical management
Use of epinephrine (1:100,000) at a dose of no more than 2 carpules in local anesthetics generally causes no problems, it’s important to achieve and maintain excellent anesthesia to reduce stress
Usa with caution with NSAIDs, can exacerbate HF
There is no need for antibiotic prophylaxis unless the patient has a prosthetic heart valve or another cardiac condition (refer to AHA guidelines). But may be more susceptible to infection but its unusually
Heart failure patients are on Many medications you should aware of them and how To manage them and there interactions and in some of these Medications also my cause bleeding
It’s group of conditions that cause the heart to beat irregular, too slowly, or too quickly. There are several categories of arrhythmia, including: bradycardia, or a slow heartbeat. tachycardia, or a fast heartbeat. irregular heartbeat, also known as a flutter or fibrillation.
Ensure comfortable chair position and try to Raise chair slowly
Ensure profound local anesthesia. Up to two carpules containing 1:100,000 concentration it’s okay ,Avoid the use of epinephrine in retraction cord.
Provide good postoperative analgesia to minimize pain and associated stress.
For patients with pacemakers or ICDs, antibiotic prophylaxis to prevent bacterial endocarditis is not recommended. Some antibiotics (e.g., metronidazole, extended-spectrum penicillins) are known to increase the INR in patients on warfarin (Coumadin); caution in their use is advised.
Any patient with cardiac problems it better to not make him/her leave directly Make them seating in chair for while in upright position
This medication is used to treat blood clots (such as in deep vein thrombosis-DVT or pulmonary embolus-PE) and/or to prevent new clots from forming in your body. Preventing harmful blood clots helps to reduce the risk of a stroke or heart attack.
No issues
Avoid aspirin, aspirin-containing compounds, and other NSAIDs; acetaminophen with or without codeine is suggested for most patients.
Not indicated unless acute infection is present.
The risk for excessive bleeding after invasive dental procedures depends on the level of the patient’s INR
If patient INR between 3.0 to 3.5 Defer any dental treatment specially if it make him/her bleed and try with his/her doctor to reduce it below 3.0 - Test For Warfarin is PT
Is a Rare disorder in which the blood doesn't clot normally because it lacks sufficient blood-clotting proteins (clotting factors). If having hemophilia, it’s may bleed for a longer time after an injury than if your blood clotted normally.
Avoid block anesthetic injections in patients not on desmopressin, aminocaproic acid, and/or factor concentrates.
Avoid aspirin, aspirin-containing compounds, and other NSAIDs; acetaminophen with or without codeine is suggested for most patients.
Not indicated unless acute infection is present.
These patients are at great risk of bleeding from invasive dental procedures. Special precautions must be taken before invasive procedures. Patients with mild to moderate hemophilia can be managed using desmopressin and aminocaproic acid for many dental procedures. Factor VIII replacement is needed for patients with more severe hemophilia. Patients who are low responders for inhibitors (antibody response to factor VIII) will require higher doses of factor VIII. Patients who are high responders are most difficult to manage and will require activated factor VII, porcine factor VIII, steroids, or other special preparations such as prothrombin complex concentrates or activated prothrombin complex concentrations.
Hemophilia A&B Occurs only in Males , the Female is carriers , A = Factor 8 , B = Factor 9 - Test for Hemophlia is PTT
Is a blood disorder in which the blood does not clot properly. Blood contains many proteins that help the body stop bleeding. One of these proteins is called von Willebrand factor (VWF).
Avoid infiltration and block anesthetic injections in patients not on desmopressin, aminocaproic acid, and/or factor concentrates.
Avoid aspirin, aspirin-containing compounds, and other NSAIDs; acetaminophen with or without codeine is suggested for most patients.
Not indicated unless acute infection is present.
These patients may be at risk for bleeding from invasive dental procedures. Patients with type 2N and type 3 vWD are at greatest risk. Special precautions must be taken before invasive dental procedures and surgery. Most patients can be managed with desmopressin and aminocaproic acid. A few patients will require factor VIII with vWF
Sickle cell anemia is an inherited red blood cell disorder in which there aren't enough healthy red blood cells to carry oxygen throughout your body. Normally, the flexible, round red blood cells move easily through blood vessels. In sickle cell anemia, the red blood are shaped like sickles or crescent moons.
Consider using local anesthetic without epinephrine for routine dental care. For surgical procedures, use 1:100,000 epinephrine in local anesthetic. Avoid general anesthesia, particularly if the hemoglobin level is below 10 g/dL.
Avoid strong narcotics and high doses of salicylates. Use acetaminophen with or without small doses of codeine
Antibiotic prophylaxis is recommended for major surgical procedures.
No issues.
There is Multiple Types of Anemia this is one of them
Leukemia is a blood cancer caused by a rise in the number of white blood cells in the body.
Lymphoma is cancer that begins in infection-fighting cells of the immune system, called lymphocytes.
Mucositis is painful and requires management with bland mouth rinses, antihistamine solutions, and topical anesthetic gel such as Orabase.
No issues.
Antibiotic sensitivity testing should be done for oral infections , infections should be treated in a conservative manner with heat the indcated antibiotic and strong analgesics for pain , chlorhexidine rins may be helpful to Mucositis , consult physician regarding antibiotic
If the platelet count is less than 50,000/μL, platelet transfusion may be needed before certain invasive and surgical procedures. Confirm by medical consultation.
is a chronic inflammatory lung disease that causes obstructed airflow from the lungs. Symptoms include breathing difficulty, cough, mucus (sputum) production and wheezing.
Semisupine or upright chair position may be better for treatment
Local anesthesia can be used without change in technique. Avoid outpatient general anesthesia.
No issues.
Avoid erythromycin, macrolide antibiotics, and ciprofloxacin in patients taking theophylline. In patient who has received courses of antibiotics for upper respiratory infections, oral and lung flora may include antibiotic- resistant bacteria.
Is any disturbance of liver function that causes illness. The liver is responsible for many critical functions within the body and should it become diseased or injured, the loss of those functions can cause significant damage to the body. Liver disease is also referred to as hepatic disease.
Higher doses may be required to achieve adequate anesthesia in presence of alcoholic liver disease. Epinephrine (1:100,000, in a dose of no more than two carpules) in local anesthetics generally is not associated with any problems, but patients should be monitored closely.
Avoid Nonsteroidal antiinflammatory drugs (NSAIDs), including aspirin, and acetaminophen, as well as codeine and meperidine
Antibiotic prophylaxis is not recommended; however, patients who have severe liver disease may be more susceptible to infection. Avoid use of metronidazole and vancomycin
Try to avoid any medications because most of drugs metabolized in liver ,Refer to a good drug reference. severe liver disease consider treating in special care clinic or hospital
Refer to diseases involving the gastrointestinal tract, namely the oesophagus, stomach, small intestine, large intestine and rectum, and the accessory organs of digestion, the liver, gallbladder, and pancreas.
Chair position should be based on patient comfort relative to the GI disorder.
No issues.
Avoid use of aspirin and other NSAIDs in patients taking sulfonylureas, because these can worsen hypoglycemia.Avoid prescribing aspirin, aspirin-containing compounds, and other nonsteroidal antiinflammatory drugs (NSAIDs) for patients with a history of peptic ulcer disease or inflammatory bowel disease (IBD). Use acetaminophen-containing products or celecoxib (Celebrex) in combination with a proton pump inhibitor or misoprostol (Cytotec).
Selection of antibiotics for oral infections may be influenced by recent use of antibiotics for peptic ulcer disease; certain drugs can increase the risk of intestinal flareup in a patient with inflammatory bowel disease. Avoid long-term use of antibiotics, especially in elderly and debilitated persons, to minimize risk of pseudomembranous colitis. Monitor for signs or symptoms (diarrhea, GI distress) suggestive of pseudomembranous colitis or disease worsening. Contact patient’s physician if GI symptoms worsen while patient is on antibiotics, so that alternative therapies can be initiated.
End-stage renal disease, also called end-stage kidney disease, occurs when chronic kidney disease - the gradual loss of kidney function - reaches an advanced state. In end-stage renal disease, the kidneys are no longer able to work as they should to meet the body's needs.
If patient is on antihypertensive medication, assist person to regain His Balance in upright position before exiting dental chair.
In local anesthesia Dosage adjustment generally is not required.
Dosage adjustment likely when glomerular filtration rate (GFR) is <50. Avoid long-term use of nonsteroidal antiinflammatory drugs (NSAIDs) in chronic kidney disease (CKD). Avoid narcotics in CKD because these drugs can cause prolonged sedation and respiratory depression.
Dosage adjustments likely when GFR is <50. Aggressively manage orofacial infections with culture and sensitivity testing and antibiotics. Consider hospitalization for severe infection or major procedures. A loading dose may be required when infection and CKD are concurrent.
Avoid dental care on day of Hemodialysis (especially within first 6 hours afterward); best to treat on day after. Excessive bleeding may occur in the patient with untreated or poorly controlled CKD. Have topical anticoagulants available for use.
is a disease in which the blood glucose, or blood sugar, levels are too high. Glucose comes from the foods has eaten. Insulin is a hormone that helps the glucose get into cells to give them energy. With type 1 diabetes, the body does not Is an uncommon disorder that occurs when your body doesn't produce enough of certain hormones. In Addison's disease, your adrenal glands, located just above your kidneys, produce too little cortisol and, often, too little aldosterone. insulin. With Type 2 insulin dose not inter the Cell
Hypotension (e.g., from severe adrenal insufficiency) may dictate a supine position. Otherwise, normal chair position can be used.
Provide adequate operative and postoperative anesthesia; routine use of epinephrine (1:100,000) is appropriate. Consider using long-acting local anesthetics (e.g., bupivacaine) at the end of the procedure to provide longer postoperative pain control. General anesthesia increases glucocorticoid demand and could render an adrenal-insufficient patient susceptible to adrenal crisis; therefore use cautiously.
Provide good postoperative pain control to avoid adrenal crisis.
No issues.
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