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Dental Management of the Medically Compromised Patient - E-Book

Dental Management of the Medically Compromised Patient - E-Book

James W. Little | Donald Falace | Craig Miller | Nelson L. Rhodus

(2012)

Additional Information

Book Details

Abstract

Learn how common medical conditions can affect the course of the dental treatment a patient receives. This updated, concise reference provides the information you need to provide appropriate dental care to any patient, regardless of existing medical conditions. Featuring vivid illustrations and well-organized tables in each chapter, this text gives you the in-depth details and the overall summaries you need to get to the root of your patients’ needs.

  • Organization of medical conditions provides a brief overview of the basic disease process, epidemiology, pathophysiology, signs and symptoms, laboratory findings, and currently accepted medical therapy of each disorder. This is followed by a detailed explanation and recommendations for specific dental management.
  • Coverage of dosages, side effects, and drug interactions with medications used in dentistry, including those used during pregnancy.
  • Chapters focusing on major health problems in the US and other nations include, ischemic hearth disease, smoking and tobacco use cessation, sleep-related breathing disorders, sexually transmitted diseases, diabetes mellitus, and psychiatric disorders.
  • Dental management summary table summarizes important factors for consideration in the dental management of medically compromised patients.
  • Appendix on the therapeutic management of common oral lesions provides a quick reference to the causative factors, clinical description, currently accepted therapeutic management, and patient education regarding common oral conditions.
  • Appendix on alternative and complementary drugs looks at herbal remedies, specifically efficacy, adverse effects/reactions, medical problems, drug interactions, and dental implications.
    • NEW! Chapter on drug and alcohol abuse discusses the effects of marijuana, cocaine, amphetamines/methamphetamine, and alcohol, along with considerations for both medical and dental management.
    • NEW! 2009 AAOS statement on Antibiotic Prophylaxis for Bacteremia in Patients with Joint Replacements provides recommendations to supplement practitioners in their clinical judgment regarding antibiotic prophylaxis for patients with a joint prosthesis.


    Table of Contents

    Section Title Page Action Price
    Front cover cover
    Inside front cover ifc1
    Front Matter i
    Evolve page ii
    Little and Falace's Dental Management of the Medically Compromised Patient, 8/e iii
    Copyright page iv
    Dedication v
    Foreword vii
    Preface ix
    New to This Edition ix
    Table of Contents xi
    Dental Management: A Summary DM1
    One Patient Evaluation and Risk Assessment 1
    1 Patient Evaluation and Risk Assessment 2
    Medical History 2
    Cardiovascular Disease 2
    Heart Failure. 2
    Heart Attack. 3
    Angina Pectoris. 3
    High Blood Pressure. 4
    Heart Murmur. 4
    Mitral Valve Prolapse. 4
    Rheumatic Fever. 4
    Congenital Heart Disease. 4
    Artificial Heart Valve. 4
    Arrhythmias. 4
    Coronary Artery Bypass Graft/Angioplasty/Stent. 5
    Hematologic Disorders 5
    Hemophilia or Inherited Bleeding Disorder. 5
    Blood Transfusion. 5
    Anemia. 5
    Leukemia/Lymphoma. 5
    Taking a “Blood Thinner”/Tendency to Bleed Longer Than Normal. 5
    Neurologic Disorders 5
    Stroke. 5
    Epilepsy, Seizures, and Convulsions. 5
    Behavioral Disorders/Psychiatric Treatment. 6
    Gastrointestinal Diseases 6
    Stomach or Intestinal Ulcers, Gastritis, and Colitis. 6
    Hepatitis, Liver Disease, Jaundice, and Cirrhosis. 6
    Respiratory Tract Disease 6
    Allergies or Hives. 6
    Asthma. 6
    Emphysema/Chronic Bronchitis. 6
    Tuberculosis. 6
    Sleep Apnea/Snoring. 7
    Musculoskeletal Disease 7
    Arthritis. 7
    Prosthetic Joints. 7
    Endocrine Disease 7
    Diabetes. 7
    Thyroid Disease. 7
    Genitourinary Tract Disease 7
    Kidney Failure. 7
    Sexually Transmitted Diseases. 7
    Other Conditions and Factors 7
    Tobacco and Alcohol Use. 7
    Drug Addiction and Substance Abuse. 8
    Tumors and Cancer. 8
    Radiation Therapy and Chemotherapy. 8
    Steroids. 8
    Operations or Hospitalizations. 8
    Pregnancy. 8
    Current Physician 8
    Drugs, Medicines, or Pills 8
    Functional Capacity 9
    Physical Examination 9
    General Appearance 9
    Skin and Nails. 9
    Face. 9
    Eyes. 10
    Ears. 11
    Neck. 11
    Vital Signs 11
    Pulse. 12
    Rate. 13
    Rhythm. 13
    Blood Pressure. 13
    Respiration. 14
    Temperature. 14
    Weight. 14
    Head and Neck Examination 14
    Clinical Laboratory Tests 14
    Physician Referral and Consultation 15
    Potential Issues/Questions of Concern 15
    Risk Assessment 16
    Treatment Modifications 16
    Stress and Anxiety Reduction 17
    Older Patients 17
    References 17
    Two Cardiovascular Disease 19
    2 Infective Endocarditis 20
    Epidemiology 20
    Etiology 22
    Pathophysiology and Complications 24
    Signs and Symptoms 25
    Laboratory Findings 26
    Medical Management 26
    Dental Management 27
    Antibiotic Prophylaxis 27
    Source and Frequency of Bacteremia 28
    Magnitude of Bacteremia 28
    Bleeding and Bacteremia 28
    Efficacy of Antibiotic Prophylaxis 29
    Risk of Bacterial Endocarditis Due to Dental Procedures 29
    Current American Heart Association Recommendations (2007) 29
    Patients Recommended to Receive Antibiotic Prophylaxis 30
    Dental Procedures for Which Antibiotic Prophylaxis Is Recommended 30
    Antibiotic Prophylaxis Regimens 31
    Special Situations 31
    Patients Already Taking Antibiotics. 31
    Patients Undergoing Cardiac Surgery. 32
    Prolonged Dental Appointment. 32
    Other Considerations 32
    Implementation of the Recommendations 32
    Nonvalvular Cardiovascular Devices 33
    Intravascular Catheters 34
    References 34
    3 Hypertension 37
    General Description 37
    Prevalence 37
    Etiology 39
    Pathophysiology and Complications 39
    Clinical Presentation 39
    Signs and Symptoms 39
    Laboratory Findings 40
    Medical Management 41
    Dental Management 43
    Medical Considerations 43
    Use of Vasoconstrictors. 47
    Treatment Planning Modifications 49
    Oral Manifestations. 49
    References 49
    4 Ischemic Heart Disease 51
    General Description 51
    Incidence and Prevalence 51
    Etiology 51
    Pathophysiology and Complications 52
    Clinical Presentation 54
    Symptoms 54
    Signs 56
    Laboratory Findings 56
    Medical Management 56
    Angina Pectoris 56
    Myocardial Infarction 60
    Dental Management 60
    Medical Considerations 60
    Angina Pectoris/Past History of Myocardial Infarction. 63
    Vasoconstrictors. 64
    Bleeding. 65
    Oral Manifestations 65
    References 65
    5 Cardiac Arrhythmias 67
    General Description 67
    Incidence and Prevalence 67
    Etiology 67
    Pathophysiology and Complications 68
    Supraventricular Arrhythmias 68
    Sinus Nodal Disturbances 68
    Disturbances of Atrial Rhythm 70
    Tachycardias Involving the AV Junction 70
    Heart Block 70
    Ventricular Arrhythmias 71
    Disorders of Repolarization 71
    Clinical Presentation 71
    Signs and Symptoms 71
    Laboratory Findings 71
    Medical Management 72
    Antiarrhythmic Drugs 72
    Implanted Permanent Pacemakers 72
    Implantable Cardioverter-Defibrillators 74
    Electromagnetic Interference. 74
    Radiofrequency Catheter Ablation 74
    Surgery 74
    Cardioversion and Defibrillation 75
    Dental Management 75
    Medical Considerations 75
    Stress and Anxiety Reduction. 77
    Use of Vasoconstrictors. 77
    Warfarin (Coumadin). 77
    Dabigatran (Pradaxa). 79
    Pacemakers/ICDs and Antibiotic Prophylaxis. 79
    Pacemakers/ICDs and Electromagnetic Interference. 79
    Digoxin Toxicity. 79
    Treatment Planning Considerations 79
    Oral Manifestations 79
    References 79
    6 Heart Failure (or Congestive Heart Failure) 81
    General Description 81
    Incidence and Prevalence 81
    Pathophysiology and Complications 83
    Clinical Presentation 84
    Signs and Symptoms 84
    Laboratory Findings 86
    Medical Management 86
    Dental Management 89
    Medical Considerations 89
    Treatment Planning Modifications 91
    Oral Manifestations 91
    References 91
    Three Pulmonary Disease 93
    7 Pulmonary Disease 94
    Chronic Obstructive Pulmonary Disease 94
    Epidemiology 94
    Etiology 94
    Pathophysiology and Complications 94
    Clinical Presentation 96
    Signs and Symptoms 96
    Laboratory Findings 96
    Medical Management 96
    Dental Management 98
    Prevention of Potential Problems 98
    Treatment Planning Modifications 100
    Oral Complications and Manifestations 100
    Asthma 100
    Definition 100
    Epidemiology 101
    Incidence and Prevalence 101
    Etiology 101
    Pathophysiology and Complications 103
    Clinical Presentation 103
    Signs and Symptoms 103
    Laboratory Findings 103
    Classification 104
    Medical Management 104
    Dental Management 105
    Prevention of Potential Problems 105
    Management of Potential Problems: Asthma Attack 107
    Treatment Planning Modifications 107
    Oral Complications and Manifestations 107
    Tuberculosis 108
    Definition 108
    Epidemiology 108
    Incidence and Prevalence 108
    Etiology 109
    Pathophysiology and Complications 109
    Clinical Presentation 110
    Signs and Symptoms 110
    Laboratory Findings 110
    Medical Management 112
    Dental Management 113
    Medical Considerations 113
    Patients with Clinically Active Sputum-Positive Tuberculosis. 113
    Patients with a Past History of Tuberculosis. 114
    Patients with a Positive Tuberculin Test. 114
    Patients with Signs or Symptoms Suggestive of TB. 114
    Adverse Effects of Drugs 114
    Treatment Planning Modifications 115
    Oral Complications and Manifestations 115
    Occupational Safety and Health Association 116
    References 116
    8 Smoking and Tobacco Use Cessation 119
    Systemic and Oral Effects of Smoking 119
    Scope of the Problem 119
    Benefits of Quitting 122
    Addiction to Nicotine 122
    Interventions for Smoking Cessation 123
    Initiating Smoking Cessation Therapy 123
    Patient Education Literature 124
    Counseling 124
    Nicotine Replacement Therapy 124
    Non–Nicotine Replacement Therapy Pharmacotherapy 126
    Reimbursement for Smoking Cessation Therapy 126
    References 126
    9 Sleep-Related Breathing Disorders 128
    Snoring and Obstructive Sleep Apnea 128
    General Description 128
    Epidemiology 128
    Etiology and Pathophysiology 128
    Complications and Outcomes 129
    Clinical Presentation 132
    Signs and Symptoms 132
    Laboratory Diagnosis 133
    Medical Management 134
    Behavioral Modification 135
    Positive Airway Pressure 135
    Oral Appliances 136
    Surgical Approaches 138
    References 140
    Four Gastrointestinal Disease 143
    10 Liver Disease 144
    Hepatitis 144
    Definition 144
    Epidemiology 144
    Pathophysiology 145
    Clinical Manifestations 145
    Diagnosis 146
    Treatment 147
    Hepatitis A 148
    Epidemiology 148
    Pathophysiology 148
    Clinical Manifestations 148
    Diagnosis 148
    Prevention 148
    Treatment 149
    Prognosis 149
    Hepatitis B 149
    Epidemiology 149
    Pathophysiology 149
    Clinical Manifestations 150
    Diagnosis 150
    Prevention 150
    Treatment 150
    Prognosis 151
    Hepatitis C 151
    Epidemiology 151
    Pathophysiology 151
    Clinical Manifestations 151
    Diagnosis 151
    Prevention 152
    Treatment 152
    Prognosis 152
    Hepatitis D 152
    Epidemiology 152
    Pathophysiology 152
    Clinical Manifestations 152
    Five Genitourinary Disease 185
    12 Chronic Kidney Disease and Dialysis 186
    Definition 186
    Epidemiology 186
    Incidence and Prevalence 186
    Etiology 187
    Pathophysiology and Complications 187
    Clinical Presentation 189
    Signs and Symptoms 190
    Laboratory Findings 190
    Medical Management 191
    Conservative Care 191
    Dialysis 191
    Dental Management 193
    Patient Under Conservative Care 193
    Medical Considerations. 193
    Oral Complications and Manifestations. 195
    Treatment Planning Modifications. 197
    Patient Receiving Dialysis 197
    Medical Considerations. 197
    Oral Complications and Manifestations. 198
    Patient with Renal Transplant 198
    References 199
    13 Sexually Transmitted Diseases 200
    Gonorrhea 200
    Definition 200
    Epidemiology 200
    Incidence and Prevalence 200
    Etiology 201
    Pathophysiology and Complications 201
    Clinical Presentation 202
    Signs and Symptoms 202
    Laboratory Findings 202
    Medical Management 202
    Syphilis 203
    Definition 203
    Epidemiology 203
    Incidence and Prevalence 203
    Etiology 203
    Pathophysiology 203
    Clinical Presentation 203
    Signs and Symptoms 203
    Primary Syphilis. 204
    Secondary Syphilis. 204
    Latent Syphilis. 205
    Tertiary (Late) Syphilis. 205
    Congenital Syphilis. 205
    Laboratory Findings 206
    Screening Serologic Tests for Syphilis: Nontreponemal Tests—VDRL and RPR. 206
    Confirmatory Serologic Tests for Syphilis: Treponemal Tests (FTA-ABS and MHA-TP). 206
    Medical Management 206
    Genital Herpes 207
    Definition 207
    Epidemiology 207
    Incidence and Prevalence 207
    Etiology 207
    Pathophysiology and Complications 207
    Clinical Presentation 208
    Signs and Symptoms 208
    Laboratory Findings 208
    Medical Management 208
    Infectious Mononucleosis 209
    Definition 209
    Epidemiology 209
    Incidence, Prevalence, and Etiology 209
    Pathophysiology 210
    Clinical Presentation 210
    Signs and Symptoms 210
    Laboratory Findings 210
    Medical Management 210
    Human Papillomavirus Infection 211
    Definition 211
    Epidemiology 211
    Incidence and Prevalence 211
    Etiology 211
    Pathophysiology 211
    Clinical Presentation 211
    Signs and Symptoms 211
    Laboratory Findings 212
    Medical Management 212
    Dental Management 213
    Medical Considerations 213
    Gonorrhea. 213
    Syphilis. 213
    Genital Herpes. 214
    Infectious Mononucleosis. 214
    Human Papillomavirus Infection. 214
    Patients with a History of Sexually Transmitted Disease 214
    Patients with Signs, Symptoms, or Oral Lesions Suggestive of a Sexually Transmitted Disease 214
    Treatment Planning Modifications 214
    Reporting to State Health Officials 214
    Oral Manifestations 214
    Gonorrhea. 214
    Syphilis. 215
    Genital Herpes. 215
    Infectious Mononucleosis. 215
    Human Papillomavirus Infection. 215
    References 216
    Six Endocrine and Metabolic Disease 218
    14 Diabetes Mellitus 219
    Background and Definitions 219
    Incidence and Prevalence 219
    Etiology 220
    Pathophysiology and Complications 221
    Clinical Presentation 224
    Signs and Symptoms 224
    Laboratory Findings 224
    Blood Glucose Determination. 224
    Oral Glucose Tolerance Test. 225
    Glycohemoglobin. 225
    Urinary Glucose and Acetone. 225
    Medical Management 225
    Pharmacologic Treatment of Type 1 Diabetes 227
    Insulin Regimens and Delivery. 228
    Treatment of Type 2 Diabetes 228
    Drug Treatment of Type 2 Diabetes. 230
    Oral Agents 230
    Insulin Sensitizers. 230
    Primary Action in Liver: Biguanides. 230
    Primary Action in Peripheral Tissues: Thiazolidinediones. 230
    Insulin Secretagogues. 230
    Glinides. 231
    Alpha-Glucosidase Inhibitors (AGIs). 231
    Fixed Combination Pills. 231
    Dipeptidyl Peptidase-4 Inhibitors. 231
    Injectable Agents 231
    Insulin. 231
    Incretin Mimetics. 231
    Amylinomimetics. 231
    Insulin Shock 231
    Mild Stage. 232
    Moderate Stage. 232
    Severe Stage. 232
    Dental Management 232
    Medical Considerations 232
    Local Anesthetics and Epinephrine 235
    Treatment Planning Modifications 235
    Oral Complications and Manifestations 236
    References 237
    15 Adrenal Insufficiency 240
    Background 240
    Mineralocorticoids 241
    Adrenal Androgens 242
    Definition 242
    Epidemiology 243
    Incidence and Prevalence 243
    Etiology 243
    Pathophysiology and Complications 243
    Clinical Presentation 244
    Signs and Symptoms 244
    Hypoadrenalism. 244
    Hyperadrenalism. 244
    Laboratory Findings 245
    Medical Management 245
    Primary Adrenal Insufficiency 245
    Secondary Adrenal Insufficiency 246
    Adrenal Crisis 246
    Dental Management 247
    Treatment Planning Modifications 249
    Oral Complications and Manifestations 249
    References 249
    16 Thyroid Diseases 251
    Thyroid Gland 251
    Location 251
    Enlargement and Nodules of the Thyroid Gland 251
    Function of the Thyroid Gland 253
    Epidemiology 253
    Incidence and Prevalence. 253
    Pathophysiology and Etiology 254
    Laboratory Tests 255
    Thyrotoxicosis (Hyperthyroidism) 255
    Etiology, Pathophysiology, and Complications 255
    Clinical Presentation 256
    Signs and Symptoms. 256
    Laboratory Findings. 258
    Medical Management 258
    Management of Thyrotoxic Crisis. 260
    Thyrotoxicosis Factitia. 260
    Other Causes of Thyrotoxicosis. 260
    Thyroiditis 260
    Definition 260
    Clinical Presentation—Hashimoto’s Thyroiditis 260
    Signs and Symptoms 260
    Laboratory Findings 260
    Medical Management 261
    Hypothyroidism 261
    Definition 261
    Clinical Presentation 262
    Signs and Symptoms 262
    Medical Management 262
    Thyroid Cancer 263
    Definition 263
    Etiology and Clinical Findings 263
    Diagnosis 264
    Treatment 265
    Prognosis 265
    Dental Management 265
    Clinical Examination 265
    Medical Considerations 265
    Thyrotoxicosis 265
    Hypothyroidism 266
    Thyroid Cancer 268
    Oral Complications and Manifestations 268
    Thyrotoxicosis 268
    Hypothyroidism 268
    Thyroiditis 268
    Radioactive Iodine 269
    Thyroid Disease and Lichen Planus 269
    References 269
    17 Pregnancy and Breast Feeding 271
    Overview of Pregnancy 271
    Physiology and Complications 271
    Dental Management 273
    Medical Considerations 273
    Preventive Program. 273
    Treatment Timing 274
    Dental Radiographs 274
    Drug Administration 276
    During Pregnancy. 276
    Local Anesthetics. 278
    Analgesics. 278
    Antibiotics. 278
    Antibiotics and Oral Contraceptives. 279
    Anxiolytics. 279
    During Breast Feeding. 279
    Treatment Planning Modifications 280
    Oral Complications and Manifestations 280
    References 281
    Seven Immunologic Disease 283
    18 AIDS, HIV Infection, and Related Conditions 284
    Definition 284
    Incidence and Prevalence 284
    Etiology 285
    Pathophysiology and Complications 286
    Clinical Presentation 289
    Signs and Symptoms 289
    Laboratory Findings 290
    Medical Management 290
    ART and HAART 291
    Chemoprophylaxis. 291
    Dental Management 293
    Treatment Planning Considerations 294
    Occupational Exposure to HIV 295
    Risk of Transmission From Health Care Personnel 295
    Oral Complications and Manifestations 295
    References 302
    19 Allergy 304
    Definition 304
    Epidemiology: Incidence and Prevalence 304
    Etiology 305
    Pathophysiology and Complications 306
    Humoral Immune System. 306
    Type I Hypersensitivity Reactions. 307
    Type II Hypersensitivity Reactions. 308
    Type III Hypersensitivity Reactions. 308
    Cellular Immune System. 308
    Type IV Hypersensitivity Reactions. 308
    Nonallergic Reactions. 309
    Medical Management 309
    Dental Management 310
    Medical Considerations 310
    Local Anesthetics. 310
    Penicillin. 312
    Analgesics. 313
    Rubber Products. 314
    Dental Materials and Products. 315
    Hereditary Angioedema. 315
    Other Conditions. 315
    Treatment Planning Modifications 315
    Oral Complications and Manifestations 315
    Hypersensitivity 315
    Type I Hypersensitivity. 315
    Type III Hypersensitivity. 315
    Type IV Hypersensitivity. 316
    Lichenoid Drug Eruptions. 317
    Management of Severe Type I Hypersensitivity Reactions 318
    Angioedema. 318
    Anaphylaxis. 318
    References 319
    20 Rheumatologic and Connective Tissue Disorders 320
    Categories of Musculoskeletal Diseases 320
    Anatomy 320
    Pathophysiology 320
    Rheumatoid Arthritis 321
    Definition 321
    Incidence and Prevalence 321
    Etiology 321
    Pathophysiology and Complications 322
    Clinical Presentation 322
    Signs and Symptoms 322
    Laboratory Findings 323
    Diagnosis 323
    Medical Management 324
    Combination Therapies 326
    Dental Management 326
    Medical Considerations 326
    Prosthetic Joints. 327
    Treatment Planning Modifications 329
    Oral Complications and Manifestations 329
    Osteoarthritis 330
    Definition 330
    Etiology 330
    Pathophysiology and Complications 330
    Clinical Presentation 330
    Signs and Symptoms 330
    Laboratory Findings 331
    Medical Management 331
    Dental Management 331
    Medical Considerations 331
    Treatment Planning Modifications 331
    Oral Complications and Manifestations 331
    Psoriatic Arthritis 332
    Definition 332
    Epidemiology 332
    Pathophysiology 332
    Diagnosis 332
    Medical Management 333
    Dental Management 333
    Treatment Planning Modifications 333
    Giant Cell Arteritis 333
    Definition 333
    Diagnosis and Dental Implications 334
    Treatment 334
    Giant Cell Arteritis Misdiagnosed as Temporomandibular Disorder. 334
    Systemic Lupus Erythematosus 334
    Definition 334
    Incidence and Prevalence 334
    Etiology 335
    Pathophysiology and Complications. 335
    Clinical Presentation 335
    Signs and Symptoms 335
    Laboratory Findings 336
    Medical Management 336
    Dental Management 336
    Medical Considerations 336
    Treatment Planning Considerations. 337
    Oral Complications and Manifestations 337
    Fibromyalgia 337
    Medical Management 338
    Dental Management 338
    Medical Considerations 338
    Treatment Planning Modifications 338
    Oral Complications and Manifestations. 338
    Lyme Disease 339
    Definition 339
    Incidence and Prevalence 339
    Pathophysiology and Complications 339
    Laboratory Findings 340
    Medical Management 340
    Dental Management 340
    Medical Considerations 340
    Sjögren Syndrome 340
    Definition 340
    Incidence and Prevalence 340
    Etiology 341
    Pathophysiology and Complications 341
    Clinical Presentation 341
    Signs and Symptoms 341
    Salivary Gland Dysfunction and Hyposalivation 341
    Diagnosis 342
    Laboratory Findings 342
    Sialometry. 342
    Imaging. 342
    Dental Management 342
    Medical Considerations. 342
    Moisture and Lubrication 342
    Oral Complications and Manifestations 343
    Prevention and Maintenance 344
    Lymphoma 344
    Acknowledgment 344
    References 344
    21 Organ and Bone Marrow Transplantation 347
    Definition 347
    Incidence and Prevalence 347
    Etiology 349
    Pathophysiology and Complications 349
    Clinical Presentation 349
    Signs and Symptoms 349
    Laboratory Findings 349
    Medical and Surgical Management 351
    Immunosuppression 351
    Surgical Procedure 351
    Heart Transplantation. 351
    Heart-Lung Transplantation. 351
    Liver Transplantation. 352
    Small Bowel Transplantation. 353
    Kidney Transplantation. 353
    Pancreas Transplantation. 355
    Bone Marrow Transplantation. 356
    Histocompatibility. 358
    Complications 358
    Immunosuppression 358
    Rejection 359
    Drug Side Effects 359
    Special Organ Complications 360
    Dental Management 361
    Pretransplant Medical Considerations 361
    Posttransplantation Medical Considerations 362
    Treatment Planning Considerations 364
    Pretransplantation Patients 364
    Posttransplant Patients 365
    Immediate Posttransplantation Period. 365
    Stable Posttransplantation Period. 365
    Risk of Infection. 366
    Viral Infections. 367
    Excessive Bleeding. 367
    Adverse Reaction to Stress. 367
    Hypertension. 367
    Chronic Rejection Period. 367
    Oral Complications and Manifestations 367
    References 368
    Eight Hematologic and Oncologic Disease 370
    22 Disorders of Red Blood Cells 371
    Anemia 371
    Definition 371
    Erythropoiesis 371
    Epidemiology 371
    Etiology 371
    Types of Anemia 372
    Iron Deficiency Anemia 372
    Folate Deficiency Anemia and Pernicious Anemia 372
    Hemolytic Anemia 373
    Hemolytic Anemia: Glucose-6-Phosphate Dehydrogenase Deficiency 373
    Sickle Cell Anemia 373
    Aplastic Anemia 375
    Renal Disease 375
    Organ Transplantation 375
    Clinical Presentation 375
    Signs and Symptoms 375
    Screening Laboratory Tests 376
    Medical Management 378
    Dental Management 378
    Medical Considerations 378
    Treatment Planning Modifications 380
    Oral Complications and Manifestations 381
    References 382
    23 Disorders of White Blood Cells 384
    Leukocytosis and Leukopenia 385
    Cyclic Neutropenia 385
    Leukemia and Lymphoma 385
    Leukemia 386
    Acute Myelogenous Leukemia 386
    Definition 386
    Epidemiology 386
    Etiology 386
    Pathophysiology and Complications 386
    Clinical Presentation 387
    Signs and Symptoms 387
    Laboratory Findings 387
    Acute Lymphoid Leukemia 387
    Definition 387
    Epidemiology 387
    Etiology 387
    Pathophysiology and Complications 388
    Clinical Presentation 388
    Signs and Symptoms 388
    Laboratory Findings 388
    Medical Management of Acute Leukemia 389
    Oral Manifestations of Acute Leukemia 390
    Chronic Myelogenous Leukemia 392
    Definition 392
    Epidemiology 392
    Etiology 392
    Pathophysiology and Complications 392
    Clinical Presentation 392
    Signs and Symptoms 392
    Laboratory Findings 392
    Medical Management 392
    Oral Manifestations 393
    Chronic Lymphocytic Leukemia 393
    Definition 393
    Epidemiology 393
    Etiology 393
    Pathophysiology and Complications 393
    Clinical Presentation 393
    Signs and Symptoms 393
    Laboratory Findings 394
    Medical Management 394
    Oral Manifestations 394
    Lymphomas 395
    Hodgkin Lymphoma 395
    Definition 395
    Epidemiology 395
    Etiology 395
    Pathophysiology and Complications 395
    Clinical Presentation 395
    Signs and Symptoms 395
    Laboratory Findings 396
    Medical Management 396
    Non-Hodgkin Lymphoma 397
    Definition 397
    Epidemiology 397
    Etiology 397
    Pathophysiology and Complications 397
    Clinical Presentation 397
    Signs and Symptoms 397
    Laboratory Findings 397
    Medical Management 397
    Oral Complications and Manifestations 398
    Burkitt Lymphoma 399
    Definition 399
    Epidemiology 399
    Etiology 399
    Pathophysiology and Complications 399
    Clinical Presentation 399
    Signs and Symptoms 399
    Laboratory Findings 400
    Medical Management 400
    Oral Complications and Manifestations 400
    Multiple Myeloma 400
    Definition 400
    Epidemiology 400
    Etiology 400
    Pathophysiology and Complications 401
    Clinical Presentation 401
    Signs and Symptoms 401
    Laboratory Findings 401
    Medical Management 401
    Oral Complications and Manifestations 402
    Dental Management 403
    Recognition of Disorders of White Blood Cells and Medical Considerations 403
    Treatment Planning Modifications 403
    Pretreatment Evaluation and Considerations. 403
    Oral Health Care and Oral Complications During Medical Therapy. 404
    Mucositis. 404
    Neutropenia and Infection. 404
    Bleeding. 405
    Graft-versus-Host Disease. 405
    Adverse Drug Effects. 406
    Growth and Development. 406
    Posttreatment Management. 406
    References 407
    24 Acquired Bleeding and Hypercoagulable Disorders 409
    Definition 409
    Epidemiology: Incidence and Prevalence 409
    Etiology 409
    Pathophysiology 411
    Vascular Phase. 411
    Platelet Phase. 412
    Coagulation Phase. 412
    Fibrinolytic Phase. 414
    Timing of Clinical Bleeding. 414
    Clinical Presentation 415
    Signs and Symptoms 415
    Laboratory Tests 417
    Screening Tests: 417
    Partial Thromboplastin Time. 417
    Prothrombin Time. 417
    Platelet Count. 417
    Thrombin Time. 417
    Diagnostic Tests Performed by the Hematologist. 418
    Platelet Disorders. 418
    Disorders of the Intrinsic Pathway. 418
    Disorders of the Extrinsic Pathway. 418
    Disorders of the Common Pathway. 419
    Degradation Products of Fibrin or Fibrinogen. 419
    Disorders with Normal Primary Screening Results. 419
    Medical Management 419
    Vascular Defects 420
    Platelet Disorders 420
    Disorders of Platelet Function. 420
    Coagulation Disorders 420
    Disseminated Intravascular Coagulation. 420
    Clinical Findings. 420
    Laboratory Diagnosis. 420
    Treatment. 421
    Fibrinolytic Disorders 421
    Fibrinolysis and Fibrinogenolysis. 421
    Thrombosis and Antithrombotic Therapy 421
    Anticoagulant Drugs 422
    Heparin. 422
    Synthetic Heparins. 422
    Direct Thrombin Inhibitors. 422
    Direct Factor Xa Inhibitors. 423
    Coumarin. 423
    Antiplatelet Drugs 424
    Preoperative Evaluation of Hemostasis 425
    Dental Management 425
    Patient Identification 425
    History and Symptoms 425
    Bleeding Problems in Relatives. 426
    Bleeding Problems After Operations and Tooth Extraction. 426
    Bleeding Problems After Trauma. 427
    Medications That May Cause Bleeding. 427
    Presence of Illness Potentially Associated with Bleeding Problems. 427
    Spontaneous Bleeding. 427
    Physical Examination 428
    Screening Laboratory Tests 428
    Surgical Procedures 428
    Medical Considerations 428
    Absence of Clinical or Historical Clues to Cause a Bleeding Problem. 428
    History or Clinical Findings, or Both, Suggestive of Possible Bleeding Problem in the Absence of Clues to Its Cause. 429
    Antiplatelet Therapy. 430
    Coumarin Therapy. 430
    Heparin Therapy. 433
    Direct Thrombin Inhibitors. 433
    Possible Liver Disease. 433
    Chronic Leukemia. 433
    Malabsorption Syndrome or Long-Term Antibiotic Therapy. 433
    End-Stage Renal Disease and Renal Dialysis. 433
    Vascular Wall Alteration. 433
    Management of the Patient with a Serious Bleeding Disorder 434
    Thrombocytopenia. 434
    Treatment Planning Modifications 434
    Oral Complications and Manifestations 434
    References 434
    25 Congenital Bleeding and Hypercoagulable Disorders 437
    Definition 437
    Epidemiology: Incidence and Prevalence 437
    Etiology 437
    Pathophysiology 438
    Clinical Presentation 438
    Signs and Symptoms 438
    Laboratory Tests 439
    Medical Management 440
    Vascular Defects 440
    Clinical Findings. 440
    Laboratory Tests. 441
    Treatment. 441
    Platelet Disorders 442
    von Willebrand Disease. 442
    Clinical Findings. 444
    Laboratory Tests. 444
    Treatment. 444
    Other Hereditary Platelet Function Disorders. 444
    Bernard-Soulier Syndrome. 445
    Nine Neurologic, Behavioral, and Psychiatric Disorders 493
    27 Neurologic Disorders 494
    Epilepsy 494
    Definition 494
    Epidemiology 494
    Etiology 495
    Pathophysiology and Complications 495
    Status Epilepticus. 495
    Clinical Presentation 496
    Signs and Symptoms 496
    Laboratory Findings 496
    Medical Management 496
    Dental Management 496
    Medical Considerations 496
    Seizure Management. 498
    Treatment Planning Considerations 499
    Oral Complications and Manifestations 500
    Stroke (Cerebrovascular Accident) 500
    Definition 500
    Epidemiology 500
    Incidence and Prevalence 500
    Etiology 501
    Pathophysiology and Complications 501
    Clinical Presentation 502
    Signs and Symptoms 502
    Laboratory Findings 502
    Medical Management 503
    Prevention 503
    Stroke Treatment 503
    Emerging and Experimental Therapies 503
    Dental Management 504
    Medical Considerations 504
    Treatment Planning Modifications 505
    Oral Complications and Manifestations 506
    Parkinson’s Disease 506
    Definition 506
    Epidemiology 506
    Incidence and Prevalence 506
    Etiology 507
    Pathophysiology and Complications 507
    Clinical Presentation 507
    Signs and Symptoms 507
    Laboratory Findings 508
    Medical Management 508
    Dental Management 510
    Medical Considerations 510
    Treatment Planning Modifications 511
    Oral Complications and Manifestations 511
    Dementia and Alzheimer’s Disease 511
    Definition 511
    Epidemiology 511
    Incidence and Prevalence 511
    Etiology 511
    Pathophysiology and Complications 512
    Clinical Presentation 512
    Signs and Symptoms 512
    Laboratory Findings 512
    Medical Management 513
    Dental Management 513
    Medical Considerations 513
    Dosage and Side Effects 514
    Testing New Alzheimer’s Drugs 514
    Treatment Planning Considerations 514
    Oral Complications and Manifestations 516
    Multiple Sclerosis 516
    Definition 516
    Epidemiology 517
    Incidence and Prevalence 517
    Etiology 517
    Pathophysiology and Complications 517
    Clinical Presentation 517
    Signs and Symptoms 517
    Laboratory Findings 518
    Medical Management 518
    Dental Management 519
    Medical Considerations 519
    Treatment Planning Modifications 519
    Oral Complications and Manifestations 519
    Cerebrospinal Fluid Shunts 519
    References 520
    28 Anxiety, Eating Disorders, and Behavioral Reactions to Illness 522
    Anxiety Disorders 522
    Definition 522
    Epidemiology: Incidence and Prevalence 523
    Etiology 523
    Clinical Presentation and Medical Management 524
    Phobias 525
    Panic Attack 525
    Generalized Anxiety Disorder 525
    Posttraumatic Stress Disorder 525
    Acute Stress Disorder 528
    Treatment of Anxiety Disorders 528
    Eating Disorders 529
    Definition 529
    Epidemiology: Incidence and Prevalence 529
    Etiology 530
    Clinical Presentation and Medical Management 531
    Drugs Used to Treat Anxiety Disorders 532
    Dental Management 533
    Patients’ Attitudes Toward Dentists 533
    Behavioral Reactions to Illness 533
    Patient Management 534
    Anxiety. 534
    Posttraumatic Stress Disorder. 534
    Stress-Related Disorders. 534
    Eating Disorders. 535
    Drug Interactions and Adverse Effects 537
    Treatment Planning Considerations 537
    Oral Complications and Manifestations 538
    References 538
    29 Psychiatric Disorders 540
    Mood Disorders 540
    Definition 540
    Epidemiology 540
    Incidence and Prevalence 540
    Etiology 541
    Clinical Presentation and Medical Management 541
    Depressive Disorders 541
    Bipolar Disorder 542
    Treatment of Mood Disorders 544
    Somatoform Disorders 545
    Definition 545
    Epidemiology 546
    Incidence and Prevalence 546
    Etiology 546
    Clinical Presentation and Medical Management 546
    Somatization Disorder 546
    Conversion Disorder 546
    Pain Disorder 546
    Hypochondriasis 547
    Factitious Disorder 547
    Treatment 547
    Schizophrenia 547
    Definition 547
    Epidemiology 548
    Etiology 548
    Clinical Presentation and Medical Management 548
    Drugs Used to Treat Psychiatric Disorders 550
    Antidepressant Medications (Excluding Those for Bipolar Depression) 550
    Tricyclic Antidepressants. 550
    Monoamine Oxidase Inhibitors. 550
    Second-Generation Antidepressant Drugs. 552
    Selective Serotonin Reuptake Inhibitors. 552
    Atypical or Nontricyclic Antidepressant Agents. 552
    Bipolar Depression Drugs. 552
    Mood-Stabilizing Drugs 552
    Lithium. 552
    Carbamazepine. 552
    Valproic Acid and Divalproex. 552
    Lamotrigine. 553
    Antipsychotic (Neuroleptic) Drugs. 553
    Dental Management 555
    Medical Considerations 555
    Depression. 555
    Bipolar Disorder. 556
    Somatoform Disorder. 557
    Schizophrenia. 557
    Suicidal Patient. 558
    Drug Interactions and Adverse Effects 559
    Tricyclic Antidepressants. 559
    Monoamine Oxidase Inhibitors. 559
    Antipsychotic Drugs. 559
    Treatment Planning Considerations 559
    Oral Complications and Manifestations 559
    References 560
    30 Drug and Alcohol Abuse 562
    Definitions 562
    Epidemiology 562
    Incidence and Prevalence 562
    Etiology 564
    Clinical Presentation and Medical Management 565
    Marijuana 565
    Opioids 566
    Cocaine 567
    Amphetamines 567
    Sedative-Hypnotics 568
    Alcohol 568
    Dental Management 569
    Medical Considerations (Box 30-1) 569
    Marijuana. 570
    Cocaine. 570
    Methamphetamine. 570
    Alcohol. 570
    Screening. 570
    Brief Intervention. 571
    Referral. 571
    Treatment. 571
    Treatment Planning Considerations (see Box 30-1) 572
    Oral Complications and Manifestations 573
    References 573
    Appendices 575
    Appendix A Guide to Management of Common Medical Emergencies in the Dental Office* 576
    General Considerations 576
    General Principles of Emergency Care 577
    Key Points 577
    Types of Emergencies and Their Treatment 577
    Unconsciousness 577
    Syncope and Psychogenic Shock 577
    Signs and Symptoms. 577
    Cause. 577
    Treatment 577
    Low Blood Pressure/Slow Pulse 577
    Treatment: Low Blood Pressure 577
    Treatment: Slow Pulse. 578
    Cardiac Arrest 578
    Index 631
    A 631
    B 634
    C 636
    D 639
    E 640
    F 641
    G 641
    H 642
    I 645
    J 646
    K 646
    L 646
    M 647
    N 649
    O 650
    P 651
    Q 653
    R 653
    S 654
    T 656
    U 658
    V 658
    W 659
    X 659
    Z 659