Hospital dental practice in special patients

Abstract

Dental patients with special needs are people with different systemic diseases, multiple disorders or severe physical and/or mental disabilities. A Medline search was made, yielding a total of 29 articles that served as the basis for this study, which offers a brief description of the dental intervention protocols in medically compromised patients. Dental treatment in patients with special needs, whether presenting medical problems or disabilities, is sometimes complex. For this reason the hospital should be regarded as the ideal setting for the care of these individuals. Before starting any dental intervention, a correct patient evaluation is needed, based on a correct anamnesis, medical records and interconsultation reports, and with due assessment of the medical risks involved. The hospital setting offers the advantage of access to electronic medical records and to data referred to any complementary tests that may have been made, and we moreover have the possibility of performing treatments under general anesthesia. In this context, ambulatory major surgery is the best approach when considering general anesthesia in patients of this kind. Key words:Hospital dentistry, special patients, medically compromised patients.

Periodontal disease and the special needs patient

“…Access to oral health care may also be compromised by the willingness, confidence and ability of dental practitioners to provide care, referral to an appropriately equipped clinic, access to the mouth to perform the necessary procedures, management of the patients’ disability during treatment, appointment duration and financial considerations . Access to dental care may be further compromised in patients with complex medical conditions who require management in a hospital setting involving a multidisciplinary team approach or who are best treated under a general anesthetic . In addition, obtaining consent for treatment may be complicated by an inability to communicate and cooperate .…”

“…of the patients' disability during treatment, appointment duration and financial considerations (6,14). Access to dental care may be further compromised in patients with complex medical conditions who require management in a hospital setting involving a multidisciplinary team approach (65) or who are best treated under a general anesthetic (61). In addition, obtaining consent for treatment may be complicated by an inability to communicate and cooperate (6,13).…”

The patient at risk in dentistry: behavioral and medico legal recommendations

“…After analyzing the risk and deciding to undertake dental treatments in the private dental practice [16], the dentist has to communicate those risks to the patient during the compilation and signing of the informed consent form. The treatment options should also be envisaged, clarifying reasons for preferring one over another.…”

Di̇ş Heki̇mli̇ği̇ Açisindan Ri̇skli̇ Si̇stemi̇k Hastaliklar Ve Bu Hastaliklara Bağli Oluşabi̇lecek Aci̇l Durumlar: Bölüm 2 - Si̇stemi̇k Aci̇l Durumlar Ve Müdahaleleri̇

“…Bu şekilde 20-30 dakika arayla en fazla 3 doz epinefrin yapılabilir. Şiddetli kriz durumunda hava yolunun reaktivitesini azaltması için parenteral glukokortikoidler (500 mg hidrokortizon veya 125 mg metilprednisolone) uygulanabilir 8,[18][19][20] .…”

“…Bu disritmiler; bradikardi, ventriküler fibrilasyon/ventriküler taşikardi (VF/VT) veya asistoli şeklinde oluşabilir. Bu durumda ileri kardiyovasküler yaşam desteğine geçilmesi gerekebileceğinden mutlaka hazırda bir otomatik eksternal defibrilatör bulundurulmalıdır 4,8,19,26,27 . 10.…”