Mandibular Arteriovenous Malformation (Vascular Lesion) in a 16-Year-Old Patient
Intraosseous arteriovenous malformations in jaws are rare congenital vascular abnormalities that the dentist may encounter. A vascular lesion or disease should be suspected when there is unexplained bleeding from the oral cavity. Diagnostic imaging is a valuable tool in diagnosing and localizing vascular lesions. An understanding of some of the salient clinical and radiographic features of arteriovenous malformations in jaws aids the clinician in correctly diagnosing this condition and avoids iatrogenic injuries, such as hasty tooth extraction, which may potentially cause severe bleeding and possibly death. The dentist sho...
Source: Dental Clinics of North America - April 20, 2023 Category: Dentistry Authors: Adeyinka Dayo, Temitope T. Omolehinwa Source Type: research

Clinical Decisions in Medically Complex Dental Patients, Part I
When confronted with a patient who has significant comorbid medical conditions, the dental practitioner often faces the questions: (Source: Dental Clinics of North America)
Source: Dental Clinics of North America - April 20, 2023 Category: Dentistry Authors: Mel Mupparapu, Andres Pinto Tags: Preface Source Type: research

Adolescent Patient with Cystic Fibrosis Presents with Suspected Ludwig Angina
A 15-year-old boy attended Emergency Department with a complaint of difficulty in breathing due to dental infection. A pulmonologist was consulted regarding the severity of the cystic fibrosis. The patient was admitted and intravenous (IV) fluids and antibiotics were given. The infected mandibular right first permanent molar tooth # 30 was extracted under IV ketamine dissociative anesthesia in the hospital setting. (Source: Dental Clinics of North America)
Source: Dental Clinics of North America - April 19, 2023 Category: Dentistry Authors: Jayakumar Jayaraman Source Type: research

Scaling and Root Planing in a Patient with Atherosclerosis, Arrhythmia, and Anticoagulation
Patients with cooccurring coronary artery disease and arrhythmias are frequently encountered by dental providers. Individuals with comorbid cardiovascular disease who require dual anticoagulant and antiplatelet therapy are a clinical challenge with regard to the need to balance the risks and benefits of intensive antithrombotic therapy. Modifications to dental care will need to be individualized considering the current disease state and medical management. Oral health promotion and good oral hygiene measures are recommended among this population. (Source: Dental Clinics of North America)
Source: Dental Clinics of North America - April 18, 2023 Category: Dentistry Authors: Kimberly A. Strauch, Miriam R. Robbins Source Type: research

Restorative Treatment in a Patient with Symptomatic Valvular and Structural Heart Disease
Heart failure (HF) and valve replacements are common conditions encountered by dental professionals. Identification and differentiation between acute versus chronic HF symptoms will be key to providing safe and effective dental care. Vasoactive agents should be used cautiously in individuals with advanced HF. People with underlying cardiac conditions that put them at an increased risk of developing infectious endocarditis require antibiotic prophylaxis before all dental procedures. Establishing and maintaining optimal oral health is necessary to minimize the risks of bacterial seeding from the oral cavity to the heart. (So...
Source: Dental Clinics of North America - April 18, 2023 Category: Dentistry Authors: Kimberly A. Strauch, Miriam R. Robbins Source Type: research

A Patient with Permanent Cardiac Pacemaker, History of Stroke Presents for an Extraction of Mandibular Molar Tooth
Poor oral health and/or dental disease are highly prevalent among stroke survivors. Muscle weakness and loss of dexterity can decrease the patient ’s ability to provide effective oral hygiene post-stroke. Modifications to dental treatment should be based on the degree of neurologic sequelae, including scheduling needs. Special considerations must be taken with individuals who have permanent cardiac pacemakers. (Source: Dental Clinics of North America)
Source: Dental Clinics of North America - April 18, 2023 Category: Dentistry Authors: Miriam R. Robbins, Kimberly A. Strauch Source Type: research

A Child with Tetralogy of Fallot Presents for Extraction of Mandibular Premolars
A 11-year-old boy was referred from an orthodontist for routine extraction of premolars. The patient ’s cardiac condition was thoroughly examined, and the premolars were extracted following antibiotic prophylaxis to prevent bacterial endocarditis. (Source: Dental Clinics of North America)
Source: Dental Clinics of North America - April 18, 2023 Category: Dentistry Authors: Jayakumar Jayaraman Source Type: research

An Initial Visit in a Patient with a History of Tuberculosis
As public health stewards, dental providers must be mindful of actual of potential infectious disease risks. Tuberculosis (TB) is a leading cause of death in adults worldwide and is spread via aerosolized droplets. Individuals at the greatest risk of contracting TB are those with impaired immunity or those who have a higher risk of being exposed to an infection due to environmental factors. Dental providers must be aware of the clinical and public health implications of treating people with active versus latent TB infections. (Source: Dental Clinics of North America)
Source: Dental Clinics of North America - April 18, 2023 Category: Dentistry Authors: Kimberly A. Strauch, Miriam R. Robbins Source Type: research

A Patient with Epilepsy Presenting for a Dental Hygiene Visit
All dentists should be trained in the diagnosis and management of seizures in a dental chair. Although epilepsy is a common etiological factor, there are other medical situations whereby seizures are manifested. Once a seizure is suspected and other causes of altered consciousness or involuntary motor movements are ruled out, proper management should commence immediately. The first step in management is to immediately remove/stop all provocative factors, like bright flashing lights, drill sounds, and such. Benzodiazepines remain as the first-line treatment for patients with continued seizures before activating emergency me...
Source: Dental Clinics of North America - April 18, 2023 Category: Dentistry Authors: Nikhil Mistry, Kenneth Kufta, Mel Mupparapu, Neeraj Panchal Source Type: research

Restorative Treatment in a Patient with Chronic Obstructive Pulmonary Disease, Ischemic Heart Disease, and Arrhythmia
Cardiovascular diseases are among the most common medical problems in the general population. Individuals with underlying cardiac conditions require special considerations with regard to appropriateness of dental treatment and precautions needed to deliver safe and effective care. Patients with unstable cardiac disease are at higher risk of developing complications during dental treatment. Similarly, comorbid conditions among patients with ischemic heart disease, such as chronic obstructive pulmonary disease, can further affect dental health and treatment, and they often require more individualized dental approaches. (Sour...
Source: Dental Clinics of North America - April 15, 2023 Category: Dentistry Authors: Kimberly A. Strauch, Miriam R. Robbins Source Type: research

A Patient with an Unknown Latex Allergy Presenting for Sealant Placement
Dentists should be trained to treat any allergic reaction in a dental office, and in this scenario, allergic reaction to latex-based product (rubber dam) is illustrated. Identification of signs and symptoms related to latex allergies is vital, and all dentists should be trained in the appropriate management of such a patient. The dental management of the scenario describes details of the diagnosis and management of latex-related allergies in a dental office for both adults and children. (Source: Dental Clinics of North America)
Source: Dental Clinics of North America - April 15, 2023 Category: Dentistry Authors: Nikhil Mistry, Mel Mupparapu, Neeraj Panchal Source Type: research

Treatment of a Mandibular Abscess in a Patient with Coronary Artery Disease and Intermittent Angina
An in-depth understanding of coronary artery disease will be critical to providing safe and effective dental care. Individuals with ischemic heart disease are at increased risk for anginal symptoms during dental care. Consultation with a cardiologist is advisable to ascertain cardiac stability for dental care if a patient has undergone recent coronary artery bypass graft surgery (less than 6  months ago). Judicious use of vasoactive agents during dental treatment is recommended. Antiplatelet and anticoagulant medications should be continued and local hemostatic measures used to control bleeding. (Source: Dental Clinics of North America)
Source: Dental Clinics of North America - April 12, 2023 Category: Dentistry Authors: Miriam R. Robbins, Kimberly A. Strauch Source Type: research

Crown Preparation in a Patient with Hypertension and Type 2 Diabetes Mellitus
Management of the diabetic dental patient should focus on the delivery of comprehensive dental care with an emphasis on maintaining periodontal health. Gingivitis, periodontitis, and associated bone loss independent of plaque accumulation are associated with poorly controlled diabetes. Periodontal status should be monitored carefully in patients with diabetes and underlying disease managed aggressively. Likewise, the dental team plays an important role in the identification of hypertension and managing dental-related side effects of anti-hypertensives. (Source: Dental Clinics of North America)
Source: Dental Clinics of North America - April 7, 2023 Category: Dentistry Authors: Miriam R. Robbins, Kimberly A. Strauch Source Type: research

A Patient with a History of Extrinsic Asthma Presents for Endodontic Therapy for the Upper Molar
With increasing rates of asthma in the general population, dental professionals need to be able to recognize the signs and symptoms of poorly controlled asthma and modify dental treatment accordingly. Prevention of an acute asthma exacerbation is key. Patients should be reminded to bring their rescue inhaler with them to every dental appointment. Patients who are using inhaled corticosteroids to manage their asthma are at greater risk of oral candidiasis, xerostomia, and caries. Regular dental visits and good oral hygiene are important among this population. (Source: Dental Clinics of North America)
Source: Dental Clinics of North America - April 7, 2023 Category: Dentistry Authors: Miriam R. Robbins, Kimberly A. Strauch Source Type: research

Patient Receiving Hematopoietic Stem Cell Transplantation Reports for Dental Clearance
Patients planned for hematopoietic stem cell transplantation (HSCT) routinely undergo dental evaluation. Conditioning before HSCT engenders immunosuppression that may lead to flares of oral infections. Before transplantation, the dental provider should educate the patient on the oral complications of HSCT and identify and treat dental needs as appropriate to the patient ’s medical status. Dental evaluation and treatment must be performed in close coordination with the patient’s oncology team. (Source: Dental Clinics of North America)
Source: Dental Clinics of North America - April 7, 2023 Category: Dentistry Authors: Payam Mirfendereski, Katherine France Source Type: research