A Patient with a History of Right-Sided Stroke and Hemiplegia, in a Wheelchair, Presents with a Complaint of Upper Left Tooth Pain
Patients with a history of stroke often present with numerous neurologic deficits and varying degrees of disability. Ambulation problems requiring the use of a wheelchair can make accessing and receiving dental care difficult for these patients. Side effects from medications can compromise their oral health and complicate care. Possible dexterity limitations decrease their ability to maintain their oral health. Innovative care plans and adaptations may be needed to accommodate the needs of these patients but care generally can be provided safely and effectively in the outpatient dental setting. (Source: Dental Clinics of North America)
Source: Dental Clinics of North America - June 18, 2023 Category: Dentistry Authors: Miriam R. Robbins, Alicia Risner-Bauman Source Type: research
A Patient with Dementia Presents from a Nursing Home with a History of Decreased Oral Intake, Malodor, and Weight Loss
Individuals with dementia can present with varying challenges depending on their state of disease. The individuals caring for them may be faced with resistant behaviors when trying to provide adequate oral care. A poor oral condition can lead to decreased caloric and fluid intake causing multiple comorbidities to be exasperated due to the declining oral condition. Creating a management plan and an oral disease prevention plan are key to improving the overall health outcomes of these patients. (Source: Dental Clinics of North America)
Source: Dental Clinics of North America - June 18, 2023 Category: Dentistry Authors: Miriam R. Robbins, Alicia Risner-Bauman Source Type: research
A Patient Presents for Dental Extraction and Goes into Sickle Cell Crisis in the Dental Chair
Sickle Cell Disease is an inherited autosomal recessive hemoglobinopathy associated with multiorgan damage. This single gene disorder involves one DNA base pair alteration, producing HbS. The sickle-shaped cells form when deoxygenated in the capillaries. The resulting RBC stasis leads to ischemia and pain, and acute and chronic organ damage. Patients with SCD presenting to a dental office need careful examination to rule out any current infections, neurologic deficits, or other organ involvement before formulating a dental treatment plan to avoid prolonged and complicated procedures. Early intervention and dental anxiety m...
Source: Dental Clinics of North America - June 18, 2023 Category: Dentistry Authors: Walter W. Hong, Irene H. Kim, Adeyinka F. Dayo, Mel Mupparapu Source Type: research
A Patient Undergoing Treatment of Hematologic Malignancy Reports for Oral Evaluation
Oral lesions are commonly seen in patients with acute myeloid leukemia (AML) and may be the first clinical signs of disease. It is important for the dental provider to be able to recognize the oral manifestations of AML to allow for timely referral to a medical specialist. Patients with AML may receive treatment through chemotherapy, targeted drug therapies, or stem cell transplantation, which can involve oral complications and therefore necessitate case-specific patient education, dental evaluation, and treatment planning. (Source: Dental Clinics of North America)
Source: Dental Clinics of North America - June 18, 2023 Category: Dentistry Authors: Payam Mirfendereski, Katherine France Source Type: research
A Patient with Hypothyroidism in Need of Periodontal Connective Tissue Graft Surgery
Hypothyroidism is a condition characterized by thyroid hormone deficiency and can be caused by a variety of factors. Untreated or chronic hypothyroidism can present in adult patients as myxedema, which is characterized by symptoms including fatigue, generalized slower metabolism, weight gain, depressed mood, dry skin, and brittle hair. Hypothyroidism can have various oral manifestations, particularly in children, in whom it can delay the eruption of the dentition. Dental management of patients with hypothyroidism depends on the etiology and status of the disease and requires the consideration of other organ systems affecte...
Source: Dental Clinics of North America - June 18, 2023 Category: Dentistry Authors: Sara Aldosary, Payam Mirfendereski, Mel Mupparapu Source Type: research
Scaling and Root Planning in a Patient Taking Chronic Corticosteroid Therapy for Lupus Erythematosus
The dental provider should be aware of the oral manifestations of systemic lupus erythematosus (SLE). Patients with SLE may be on chronic oral corticosteroids, which can increase the risk for periodontitis and opportunistic oral infections in addition to inducing multiple systemic adverse effects. Disease complications such as lupus nephritis and comorbid antiphospholipid antibody syndrome can further impact dental decision-making including around medications to prescribe or hemostatic measures to employ during treatment. Patients with SLE on systemic corticosteroid therapy usually do not require steroid supplementation be...
Source: Dental Clinics of North America - June 18, 2023 Category: Dentistry Authors: Payam Mirfendereski, Rogan Magee, Katherine France Source Type: research
A Female Patient Recently Diagnosed with Sjogren Syndrome Presents to the Dental Office Seeking Upper and Lower Complete Dentures
Sjogren syndrome (SS) is a common autoimmune disease associated with the immune-mediated destruction of exocrine glands, primarily the salivary and lacrimal glands. As a result, patients have xerophthalmia and xerostomia (Sicca syndrome). The diagnosis of SS can be difficult due to its multifactorial nature and often insidious symptoms, and there is no one test for its diagnosis. The many oral manifestations in SS stemming from the xerostomia present challenges to the treating dentist. Dentists should be knowledgeable about SS and its palliative care to help improve their patients ’ quality of life. (Source: Dental Clinics of North America)
Source: Dental Clinics of North America - June 18, 2023 Category: Dentistry Authors: Irene H. Kim, Purvi C. Patel, Mel Mupparapu Source Type: research
A Patient Presenting for Dental Extraction After Completion of Chemotherapy
Acute myeloid leukemia (AML) presents several oral manifestations, including gingival hyperplasia, pale mucosa, poor wound healing, petechiae, ecchymoses, candidiasis, recurrent herpes infection, and ulcerations in the oral mucosa. Chemotherapy is the first-line treatment of AML. Common dental complications of chemotherapy include mucositis, infections secondary to profound bone marrow aplasia, and gingival bleeding. When treating patients with AML, preparing a comprehensive treatment plan is essential to help minimize their risks for developing these oral complications. (Source: Dental Clinics of North America)
Source: Dental Clinics of North America - June 18, 2023 Category: Dentistry Authors: Walter W. Hong, Irene H. Kim, Brad M. Hong, Sophia Oak, Mel Mupparapu Source Type: research
A 65-Year-Old Man with Recent History of Radiation Therapy to the Head and Neck Reporting for Treatment of a Non-restorable Tooth
Patients with a history of head and neck radiation involving or adjacent to tooth-bearing areas are at increased risk of developing osteonecrosis following dental procedures. The dental provider should thus aim to preserve the patient ’s dentition after radiation therapy. Root canal therapy with coronectomy may be an option for a nonrestorable tooth, whereas atraumatic extraction can be considered if retaining the tooth is impossible. When treating a patient with a history of head and neck radiation, it is recommended that the dental provider reviews the patient’s radiation records and consults with the patient’s rad...
Source: Dental Clinics of North America - June 18, 2023 Category: Dentistry Authors: Payam Mirfendereski, Jacob W. Trotter, Katherine France Source Type: research
A Diabetic Patient with Acute Osteomyelitis Presenting with Jaw Pain and Submandibular Swelling
This case scenario shows the value of applying relevant imaging and the selection of appropriate antibiotic via culture and sensitivity before prescribing especially when dealing with a patient with type 1 Diabetes Mellitus. When confronted with a diagnosis of acute osteomyelitis, it is always better to refer the patient to a hospital for admission where the management and any other intervention is easily accomplished. Admission to the hospital, culture and sensitivity, and appropriate intravenous antibiotics may have limited the progress of the infection and ultimately may have prevented the sequestration in this patient,...
Source: Dental Clinics of North America - June 18, 2023 Category: Dentistry Authors: Mel Mupparapu, Angela M. Barnes, Archana Mupparapu, Steven R. Singer Source Type: research
Patient with Crohn's Disease Presents for Pain in Relation to Maxillary Teeth
Crohn's disease has been associated with poor oral health and oral health–related quality of life. Myriad-specific and nonspecific oral lesions have been associated with Crohn's disease. Oral lesions in patients with Crohn's disease may be a source of referred pain, especially if mucosal ulcerations o r orofacial granulomatosis are involved. The dental provider can play an important role in evaluating for and/or managing oral lesions in patients with Crohn's disease and thereby improving patients’ oral health and quality of life. (Source: Dental Clinics of North America)
Source: Dental Clinics of North America - June 18, 2023 Category: Dentistry Authors: Payam Mirfendereski, Lauren Wilson, Katherine France Source Type: research
A Patient Diagnosed with Bulimia Reports to the Dental Office Seeking Cosmetic Dental Work
Bulimia nervosa (BN) is a serious psychiatric illness that typically occurs in adolescents and young adults. It is characterized by recurring episodes of consuming large amounts of food with an inappropriate compensatory behavior of purging to prevent weight gain. The purging behavior results in oral manifestations such as dental erosion, dental caries, sialadenosis, and oral mucosal trauma. Medical complications include electrolyte imbalances, esophageal rupture, and renal and cardiovascular failure. Treatment of BN involves psychosocial and psychopharmacologic approaches. Dentists are in a unique position to recognize pa...
Source: Dental Clinics of North America - June 18, 2023 Category: Dentistry Authors: Irene H. Kim, Walter W. Hong, Mel Mupparapu Source Type: research
Restorative Dental Treatment and Endodontic Surgery in a Pregnant Patient Receiving Corticosteroids
Corticosteroid therapy (CST) can be used to treat complicated pregnancy. Second trimester of pregnancy is the preferred period to perform dental treatments. The long-term use of CST may result in hyperglycemia, hypertension, immunosuppression, and adrenal suppression, which, theoretically, may cause adrenal crisis during surgical procedures. The risk of adrenal crisis at the dental clinic caused by exogenous CST depends on the dosage, duration of treatment, route of administration, frequency, time lapse since the last dose, and type of procedure performed. Current evidence found that patients on CST undergoing general dent...
Source: Dental Clinics of North America - June 18, 2023 Category: Dentistry Authors: Fatmah Alhendi Source Type: research
Clinical Decisions in Medically Complex Dental Patients, Part II
After completing many scenarios in Part I of the Clinical Decisions series, like allergic reactions, anaphylaxis, renal and hepatic disorders, cardiometabolic disorders, blood dyscrasias, cerebrovascular events, and stem cell transplantation, to name a few, it is only logical in Part II to move on to other frequently encountered medical disorders that dental patients present with. If a dental practitioner is not prepared to handle a medically complex scenario, a dental practice decision and patients ’ well-being are in jeopardy. (Source: Dental Clinics of North America)
Source: Dental Clinics of North America - June 18, 2023 Category: Dentistry Authors: Mel Mupparapu, Andres Pinto Tags: Preface Source Type: research
Clinical Decisions in Medically Complex Dental Patients, Part I
DENTAL CLINICS OF NORTH AMERICA (Source: Dental Clinics of North America)
Source: Dental Clinics of North America - May 26, 2023 Category: Dentistry Authors: Mel Mupparapu, Andres Pinto Source Type: research
