Special Needs Dental Management of the Class 3 Obese Patient

Abstract

Obesity, classified as a chronic disease by the World Health Organisation (WHO), is a worldwide public health problem. Obesity has links with numerous systemic diseases which may complicate dental management and as such, patients with obesity and concomitant medical comorbidities are commonly managed by Special Needs Dentistry specialist departments in Australia. The sparsity of available evidence on the dental status in this group is likely due to significant access issues experienced by the class 3 obese, who often weigh >140 kg and therefore are unable to be examined or treated in conventional dental chairs. “Bariatric” is a term used to refer to a specific branch of medicine dealing with causes, prevention, and treatment of obesity. It is used widely in the literature to refer to obese patients; however, dentistry for this cohort (“bariatric dentistry”) is less well defined and represents less frequently used terminology. This case report is of a 58-year-old female, with class 3 obesity, who presented in May 2018 for outpatient consult to the Special Needs Unit/Medically Complex Dental Clinic at Westmead Centre for Oral Health, Sydney, Australia, with a compromised and neglected dentition and requiring full dental clearance. The case highlights many of the significant access issues and considerations for safe and effective delivery of dental management. As we move into the future, dental professionals need to become more aware of the growing challenge obesity presents and understand how medical complexities influence dental management. Facilities need to be able to meet this growing need and the specific requirements for a functional and safe bariatric dental service; dependent on both appropriate infrastructure and training.

Waistline to the gumline: Relationship between obesity and periodontal disease‐biological and management considerations

“…Unfortunately, the social stigma associated with obesity, both by other individuals and self-imposed, contributes to mental health disorders. 103 Since the first report of obesity and biologic factors emerged in 1946, decades of research highlight the well-established bidirectional associations between obesity and multiple psychiatric disorders, including anxiety and depression. 104,105 Several common determinants, such as genetics, diet and exercise, neurotransmitters, and medications, are shared in a bidirectional link.…”

Manejo endodóntico actual del paciente con enfermedad cardiovascular

“…Y que su atención, de tratarse de una emergencia, debe limitarse al control del dolor o de la infección aguda. 9,34 Es necesario además conocer que el desarrollo de una crisis hipertensiva puede cursar con los siguientes síntomas; dolor de cabeza, disnea, nauseas, vómitos epistaxis y ansiedad pronunciada, por lo que el profesional debe contar con recursos necesarios para el traslado del paciente a una institución de salud en caso de presentarse durante la consulta endodóntica. 32 Es necesario destacar que el comienzo de la era moderna de la terapia antihipertensiva fue marcado por el lanzamiento al mercado de los diuréticos tiazídicos.…”

“…Los pacientes que toman anticoagulantes orales, pueden ser tratados de forma usual, pero considerando algún posible aumento en el sangrado, de haberlo. 34 Cuando se trata de un paciente controlado y se está frente a la necesidad de realizar una cirugía apical deberá hacerse previamente la interconsulta de rigor con el médico tratante, así como exámenes complementarios de laboratorio que incluyan contaje sanguíneo completo, esperando además tener un tiempo de sangrado no mayor a los 18 segundos, protrombina e índice internacional normalizado (INR) en un rango entre 2,5 y 3,5. 43…”

Oral Manifestations in Obesity and Bariatric Surgery: Narrative Review

“…Oral cavity contains soft tissue, hard tissue, and saliva. Tooth caries, periodontitis, and hyposalivation are the most prevalent manifestations in obese patients [3]. It should be con-sidered that patients may suffer from systemic diseases induced by obesity, as well [3].…”

“…Tooth caries, periodontitis, and hyposalivation are the most prevalent manifestations in obese patients [3]. It should be con-sidered that patients may suffer from systemic diseases induced by obesity, as well [3]. Bite force, time of chewing, and frequency of eating are some ignored causes of oral manifestations.…”