ORAL CONDITIONS IN

PATIENTS WITH
SYSTEMIC ORIGIN
Hening Tuti Hendarti, drg.,MS.,Sp.PM(K)
 Safe dental treatment
planning needs medical
history information and risk
assesment, the challenges
of general practice dentist

Dentist should have the potential

to encounter different type of
medical emergencies, related to
the patient’s medical health,
adequacy of management and
stress tolerance
More patients seeking oral health care
have underlying medical conditions that
may alter oral health status, treatment
approaches and outcomes

Systemic health may alter the

healing response to an
effectiveness of surgical and
non surgical therapies, and
risk of precipitating a medical
emergency
Four Key Considerations

Impaired Susceptibility
hemostasis to infections

Ability tolerate
Drug actions /
the stress of
interactions
dental care
1. IMPAIRED HEMOSTATIS
 May required support
management by
hematologist
 Bleeding risk assessment
(inherited or acquired)
 Phases of hemostasis :
vascular, platelet,
coagulation, metabolic /
fibrinolytic
Clinical
appearance
Skin and mucosal petechial, ecchymoses or purpura
Skin and mucosal
hematomas
Spontaneous gingival
hemorrhage
Hemosiderin staining
of calculus on teeth
JAUNDICE OF SCLERA
MUCOSA AND SKIN
Spider angioma skin
stigmata of svere liver
disease
Medication may alter
hemostasis

Anticoagulant medications
• (Warfarin, heparin)

Antiplatelet agent
• (Aspirin, ticlopidine)
Herbal supplements can
enhance bleeding risk
Green Tea

Garlic

Ginkobiloba

Ginseng
To control bleeding

Pressure

Local hemostatic materials :

• ( Epinephrine, surgical stent, bone wax)

Electrocautery
2. Susceptibility to
infections
 The oral cavity is host to
numerous bacteria and fungi
 Potential raising of local
infection and distant
hematogenous spread
Ex : Chronic periodontitis
flossing, scaling and root
planingbacteremia
(Steptococcal Viridans)
GINGIVITIS AND INTRAORAL
HERPETIC INFECTION IN
LEUKEMIC PATIENT
  Chronic kidney disease
(ckd)
Susceptibility  Decrease leukocyte
to infection function and leukopenia
Advanced CKD

 Poor oral hygiene

 Periodontal disease → loss of teeth
 Dry mouth
 Uremic stomatitis
 Oral mal odor
 Metallic taste
 Enlargement of major salivary gland
 Pallor of oral mucosa
Susceptibility
to infection
 Systemic lupus
erythematosus
 Ulceration or
mucosal
inflammation,
atrophic area
surrounded by
keratinazed white
lesion,
xerostomia
Susceptibility  Diabetes Mellitus

to infection
Oral manifestation

Xerostomia, delayed wound healing,

burning mouth, enlarge parotid gland,
increase incidence and severity of
infection, gingivitis, periodontitis,
increasing dental caries.

DM + corticosteroid: antidiabetic
↓ and blood glucose ↑
To prevent distant site
infection

Good oral and muscosal health

Good gingival and periodontal

health

Good dental health

3. Drug interaction
Patient with complex medical
conditions are likely to be on
multiple medications for
management of their systemic
disease.
( therapeutic and adverse)
Prescription medication
Vitamin and minerals
herbal supplements
Antimicrobial

Metronidazole + alcohol: vomitting, nausea, headache

Tetracycline + iron supplement or antaside:

antibacterial ↓

Cyclosporin + itraconazol, fluconazol, ketoconazol,

amphotericine: nephrotoxicity ↑

Amoxiciline, erythromisin, tetracycline, metronidazile

+ oral contraceptive: contraceptive failure

Antibiotic/antifungi + warfarin: anticoagulan↑

Anti inflamasi

Aspirin + alcohol: damage to gastric mucosa ↑

Aspirin + antihypertensive drug:

antihypertensive drug↓
Aspirin + insulin: risk of hypoglicemia

Aspirin/NSAID + warfarin: risk of

hemorrhage↑
Dietary Supplement

Doxycycline/tetracycline + calcium:
antiinfective↓

Aspirin + Ginkobiloba: bleeding↑

Precaution
 Reduce drug
Liver disease
dosages
Renal impairment  Extended
Young children
intervals
The very old  Avoidance certain
drug
Pregnant patient – Serious adverse effects
first trimester – Allergic reactions
teratogenic, Overdosage → apnea,
nursing mothers – delirium
systemic Drugs interactions
medication in the
breast milk Xerostomia
Symptoms of allergy :
Skin rash, pruritis (itching), urticaria, swelling of the
lips, tongue and throat, angiodema, shortness of
breath, syncope, peripheral vasodilatasion,
tachycardi, loss of consciousnesse
ORAL CONSEQUENCES
OF SYSTEMIC DRUGS
 Erythema Multiforme: antimalaria, carbamasepine,
penisilin, clindamycin, codein, tetracycline,
salicylites.
 Lichenoid reaction: ACE inhibitors, allupurinol,
NSAID, tetracycline.
 Ulser: chemoterapeutic agent, erythromycine,
carbamazepine.
 Xerostomia: anti-depressant, anti histamin,
antihypertensive, anti retroviral
 Taste alteration: ACE
inhibitors, chlorhexidine,
metronidazole,
prednisone.
 Tooth discoloration:
chlorhexidine,
tetracycline.
 Gingival overgrowth:
calcium channel
blockers, cyclosporin,
phenytoin.
 Angioedema: ACE
inhibitors, H2 blockers,
4. ABILITY TO
TOLERATE DENTAL
CARE
 Physiological and psychological stress
 Stress

Catecholamines (epinephrine and nor

epinephrine) from andrenal medulla

cardiovasculer system

heart workload
PSYCHOLOGICAL OR
PHYSIOLOGICAL STRESS
MAY RELATE TO

PAIN TIME AT DAY

OR LENGTH
DENTAL
CHAIR
LOCAL
ANASTHETIC
OF POSITION WITH OR
APPOINTMENT WITHOUT
EPINEPHRINE

Psychology
stress

ANXIETY FEAR
Conclusion

For safe patient management dentist must obtain history

of :
 Medication use
Dietary supplement
Allergy or hypersensitivity
Understanding of the actions and interactions of all
medications
For patient comfort

Adequate pain control

Morning, short, afternoon appointments

Positional change / pillow support

Elevate back of dental chair

Anxiolytic Premedication

Minimize waiting time

For
stress
Vital sign
reductio
n
Sedation

Short treatment duration

THANKYOU 