Chapter 29 The Medically and Physically Compromised Patient Copyright 2003, Elsevier Science (USA). All rights reserved. No part of this product may be reproduced or transmitted in any form or by any means, electronic or mechanical, including input into or storage in any information system, without permission in writing from the publisher. PowerPoint® presentation slides may be displayed and may be reproduced in print form for instructional purposes only, provided a proper copyright notice appears on the last page of each print-out. Produced in the United States of America ISBN 0-7216-9770-4 Copyright 2003, Elsevier Science (USA). All rights reserved. Introduction More individuals are living with some type of medical or physical disorder. Copyright 2003, Elsevier Science (USA). All rights reserved. The Rights of a Patient Americans with Disabilities Act American Dental Association • • • • Title Title Title Title I: Employment Discrimination II: Access for Disabled III: Public Accommodations IV: Telecommunication Services Copyright 2003, Elsevier Science (USA). All rights reserved. Role of the Dental Assistant Aid in providing treatment. Provide information to patient and family. Make patient comfortable. Help in reducing anxiety. Copyright 2003, Elsevier Science (USA). All rights reserved. The Aging Population Aging is the irreversible and inevitable changes that occur with time. Stages of the older population • Young/Old: People age 65 to 74 years old. • Old: People age 75 to 84 years old. • Old/Old: People age 85 years old or older. Copyright 2003, Elsevier Science (USA). All rights reserved. Dentally Related Aging Changes Xerostomia: Condition from certain disorders and medications that cause a decreased flow of saliva. Periodontal disease: An increasing problem in the older population. Tissues of older patients may be slower to heal. Dental decay: Increase in the form of coronal and root caries and recurrent decay around defective restorations Dark and brittle teeth: As a result of deposits of secondary dentin that have gradually reduced the size of the pulp chamber. Bone resorption: Loss of the alveolar ridge. Copyright 2003, Elsevier Science (USA). All rights reserved. The Medically Compromised Patient Patient Assessment • Category I: Healthy patient • Category II: Medical conditions requiring schedule changes • Category III: Medical conditions requiring significant modifications in dental treatment • Category IV: Medical conditions requiring major modifications in dental treatment • Category V: Serious medical conditions Copyright 2003, Elsevier Science (USA). All rights reserved. Neurologic Disorders Alzheimer’s disease: Brain disorder that is marked by deterioration of mental capacity. Disease progresses in three stages: • The early disease, or forgetfulness phase. • The intermediate disease, or confused phase. • The late disease, or dementia phase. Dental care management Copyright 2003, Elsevier Science (USA). All rights reserved. Neurologic Disorders- cont’d Seizure: An abrupt suspension of motor, sensory, and/or body function. Epilepsy • Petit mal: Type of seizure lasting no longer than 30 seconds. • Grand mal: These seizures have many causes and arise in all age groups. Dental care management Copyright 2003, Elsevier Science (USA). All rights reserved. Neurologic Disorders- cont’d Multiple Sclerosis: A debilitating and degenerative disorder of the central nervous system with a progressive weakening of the lower extremities, causing muscle weakness, unsteady gait, and paralysis. Dental care management Copyright 2003, Elsevier Science (USA). All rights reserved. Neurologic Disorders- cont’d Parkinson’s disease: A progressive disorder causing degeneration of the nerves in the brain. This degeneration will lead to tremors, weakness of muscles, and slowness of movement. Dental care management Copyright 2003, Elsevier Science (USA). All rights reserved. Neurologic Disorders- cont’d Cerebrovascular accident: A cerebrovascular accident or stroke is a minor to severe loss of the central nervous system function caused by a sudden vascular lesion of the brain, such as hemorrhage, embolism, thrombosis, or ruptured aneurysm. Dental care management Copyright 2003, Elsevier Science (USA). All rights reserved. Cardiovascular Disorders Heart disease is the leading cause of death in the United States. Manifestations of heart disease • Angina: Severe pain in the chest associated with an insufficient supply of blood to the heart • Myocardial Infarction: Heart attack Copyright 2003, Elsevier Science (USA). All rights reserved. Cardiovascular Disorders- cont’d Hypertension: Referred to as high blood pressure, is the result of the heart having to work harder as it pumps against resistance such as a blocked artery. Major factors associated with hypertension: • Stress • Age • Heredity • Smoking • Obesity Copyright 2003, Elsevier Science (USA). All rights reserved. Cardiovascular Disorders- cont’d Cardiac and Prosthetic Considerations: A patient with cardiac disease or a prosthetic replacement carries an increased risk of becoming infected from bacteria carried in the blood system. Endocarditis: Severe infection of the cardiac valves and supporting structures caused by blood-borne pathogens that gain entry to the bloodstream from such places as the mouth and gastrointestinal tract. Copyright 2003, Elsevier Science (USA). All rights reserved. Pulmonary Disorders Disorders that affect the lungs and are characterized by airway obstruction. • Bronchial asthma: Often arising from allergies characterized by an increased hypersensitivity to various stimuli, which results in bronchial edema and widespread narrowing of the bronchial airways. Dental care management Copyright 2003, Elsevier Science (USA). All rights reserved. Pulmonary Disorders- cont’d Chronic obstructive pulmonary disease: General term for pulmonary diseases characterized by blocked airflow during respiration. Bronchitis: Irreversible narrowing of the bronchial airways as a result of chronic inflammation. Emphysema: Irreversible enlargement of the size of the air spaces, resulting in labored breathing and an increased susceptibility to infection. Copyright 2003, Elsevier Science (USA). All rights reserved. Blood Disorders Disorders that involve the cellular elements of the body. • Leukemia: An excessive increase in white blood cells. • Hemophilia: Excessive bleeding caused by a congenital lack of a protein substance necessary for blood clotting to occur. Copyright 2003, Elsevier Science (USA). All rights reserved. Muscular Disorders Musculoskeletal system includes the bones, muscles, and joints. • Arthritis: Older patients are more likely to have chronic progressive arthritis with stiffening of joints. • Muscular Dystrophy: Involves the striated muscles in the body, causing progressive atrophy and weakness. Copyright 2003, Elsevier Science (USA). All rights reserved. Endocrine Disorders Glands located in many different regions of the body, all of which release hormones into the bloodstream which help regulate the metabolism in body cells. • Hyperthyroid: An overactive thyroid gland. • Hypothyroid: An underactive thyroid gland that produces fewer hormones. Copyright 2003, Elsevier Science (USA). All rights reserved. Endocrine Disorders- cont’d Diabetes Mellitus: Disease characterized by a sustained high blood glucose level resulting from an absolute or a relative lack of insulin. • Type I: Patient is insulin dependent. • Type II: Disease is controlled through diet and oral medications. Dental care management Copyright 2003, Elsevier Science (USA). All rights reserved. Psychiatric Disorders Types of disorders • Anxiety: Feeling of impending disaster. • Depression: Condition of general emotional rejection and withdrawal. • Schizophrenia: A disturbance in thinking and perception with delusions, hallucinations, and impaired reality testing. Copyright 2003, Elsevier Science (USA). All rights reserved. Behavioral Disorders Eating disorders • Anorexia nervosa: Condition is indicated when a person has an obsessive fasting (starving) condition. • Bulimia: Disorder in which a person eats an abnormal amount of calories at one time and then induces vomiting or uses laxatives. Substance related disorders • Drugs • Alcohol • Nicotine Copyright 2003, Elsevier Science (USA). All rights reserved. The Physically Compromised Patient The wheelchair-bound patient • Transferring the patient Seeing-impaired patient Hearing-impaired patient Copyright 2003, Elsevier Science (USA). All rights reserved.