This document discusses the dental management of medically compromised patients. It provides guidance for treating patients with diabetes, including deferring surgery until diabetes is controlled, scheduling early appointments to avoid fatigue, and monitoring vitals during procedures. It also outlines protocols for patients with hypertension, angina, heart disease, respiratory disorders like asthma, liver and kidney disorders, and thyroid conditions. The document emphasizes the importance of medical consultation, using anxiety-reduction techniques, having emergency medications available, and taking precautions to minimize risks for these medically complex patients.

1. DENTAL
MANAGEMENT
OF THE MEDICALLY
COMPROMISED
PATIENTS
Dr Shweta_Parray_49DDCh_2017

2. Who are Medically
Compromised Patients?

8. Dental management:
1.Defer surgery until the diabetes is well
controlled; consult the patient’s
physician.
2. Schedule an early morning
appointment; avoid lengthy
appointments.
3. Use an anxiety-reduction protocol, but
avoid deep sedation techniques in
outpatients.

9. Dental management:
4. Monitor pulse, respiration, and blood
pressure before, during, and after
surgery.
5. Maintain verbal contact with the
patient during surgery.
6. Have the patient eat a normal
breakfast before surgery and take the
usual dose of insulin/hypoglycemic
agent

11. REGIMEN FOR HYPOGLYCAEMIA

13. HYPERTENSIVE DISEASES

16. ANGINA PECTORIS

17. DENTAL MANAGENT OF ANGINA:
1.Medical consultation
2. Reduction of stress & anxiety
CLONEZAPAM 1 MG (0+0+1) 10 Days
3. Local anesthesia
4. General anesthesia
5. Treatment procedures
MINIMAL INVASIVE
6. Drugs used in treatment
SUBLINGUAL TRINITRATES

18. MYOCARDIAL INFARCTION

19. CONGESTIVE HEART FAILURE

20. PROPHYLACTIC ANTIBIOTIC REGIMEN
FOR CARDIAC PT.

21. IF PATIENT IS ALLERGIC:
Adult --------- Clindamycin 600 mg OR
Azithromycin 500 mg OR
Cephazolin 1 gm
(1 hour before Orally)
( ½ ,,, ,,,, injection)
Child --------- Clindamycin 20 mg per Kg.
Azithromycin 15 mg per Kg.

22. 2. Under G.A
a)Adults----- 1gm Amoxicillin I.V at
induction.
OR 3gm Amoxicillin orally 4 hours
before induction followed by 3gm Amoxicillin
immediately after recovery.
OR 300mg Clindamycin I.M ½ hour
before induction.
OR 300mg Clindamycin I/V at induction

23. b) Children ------ (5–10 years)1/2 adult
(< 5 years) 1/4 adult
Use an anxiety-reduction protocol.
5. Have nitroglycerin available; use it prophylactically
if the physician advises.
6. Administer supplemental oxygen (optional).
7. Provide profound local anesthesia.

24. POST Myocardial Infarction

25. Infective Endocarditis

27. Diagnosis – Duke’s Criteria

29. Complications
1.Prolonged Bleeding – Failure of Haemostasis
2.Severe Internal Bleeding – Risk of Shock
3.High risk of Postoperative Infections.

32. •Emergency in MC Patients

33. Thankyou

34. RESPIRATORY DISORDERS

35. BRONCHIAL ASTHMA

36. Dental management
1. Medical consultation.
• Emotional stress factors can precipitate
an attack, nitrous oxide sedation is
suggested
• Morphine is contraindicated
• Bronchodilator inhaler should be
available

37. Dental management
1. Defer dental treatment until the asthma is well
controlled and the patient has no signs of a
respiratory tract infection.
2. Use an anxiety-reduction protocol, including nitrous
oxide, but avoid the use of respiratory depressants.
3. If the patient is or has been chronically taking
corticosteroids, provide prophylaxis for adrenal
insufficiency.
4. Keep a bronchodilator-containing inhaler easily
accessible.
5. Avoid the use of nonsteroidal anti-inflammatory drugs
(NSAIDs) in susceptible patients.

38. LIVER DISORDERS

39. Dental management

41. CHRONIC RENAL FAILURE

42. THYROID GLAND DISORDER

43. THANK YOU