Dental care of handicapped and hospitalized patients
Delivery of dental services in a hospital 1788 RC Skinner 1790 first hospital dental clinic 1901 intern training program § Service options § Total oral healthcare (including prevention) § Acute therapies (extractions, no prevention) § Treatment of serious head&neck diseases
Delivery of dental services in a hospital
Primary preventive dentistry in a hospital setting § Specific ® essential to many patients § Routine ® desirable for all patients
Combined efforts of medical&dental professions.
Problems § Poor oral health concepts and practices § Psychical and physical problems § Infection-prone patients ® oral disease poses a serious health risk which patients? what to do?
Specialized care § Consultation with medical services § Individual factors § Guidelines for management (AHA, ADA) individual decisions
Use every possible prevention method!!!
Surveys § No satisfactory oral hygiene Carrilho - Int J Dent Hyg. 2011
§ Oral health needs and barriers to dental care in hospitalized children. Spec Care Dentist. 2007 Oct § Needs for dental treatment in handicapped children. Ann Univ Mariae 2003;58(2):1-6.
§ Handicapped & hospitalized patients have many dental needs Emery - Gen Dent 1980;28:54 § 80% of all patients required treatment, patients were unaware (caries, periodontal involvement, prophylaxis, dentures, missing teeth, extractions) Harvey – J hosp Dent Prct 1980;4:123-
2011-2015 1. 2. 3. 4. 5. 6. 7. 8. 9.
A population-based cost description study of oral treatment of hospitalized Western Australian children aged younger than 15 years. Alsharif AT, Kruger E, Tennant M. J Public Health Dent. 2015 Mar 3. Oral health status among long-term hospitalized adults: a cross sectional study. Bilder L, Yavnai N, Zini A. PeerJ. 2014 Jun 10;2 Prevalence of Oral Lesions in Hospitalized Patients with Infectious Diseases in Northern Brazil Karina Gemaque,1 Gustavo Giacomelli Nascimento,2 José Luiz Cintra Junqueira,1 Vera Cavalcanti de Araújo,1 and Cristiane Furuse3; Volume 2014 (2014), Article ID 586075 Status of oral health care in hospitalized children. Blevins JY. MCN Am J Matern Child Nurs. 2013 Mar;38(2):115-9. doi: 10.1097/NMC.0b013e318269daac. Edward KL, Felstead B, Mahoney AM. Hospitalized mental health patients and oral health. J Psychiatr Ment Health Nurs. 2012 Jun;19(5):419-25. Gurbuz O, Alatas G, Kurt E, Dogan F, Issever H. Periodontal health and treatment needs among hospitalized chronic psychiatric patients in Istanbul, Community Dent Health. 2011 Mar;28(1):69-74. Terezakis E, Needleman I, Kumar N, Moles D, Agudo E. The impact of hospitalization on oral health: a systematic review. J Clin Periodontol. 2011 Jul;38(7):628-36. Carrilho Neto A, De Paula Ramos S, Sant'ana AC, Passanezi E. Oral health status among hospitalized patients. Int J Dent Hyg. 2011 Feb;9(1):21-9. Sjogren, PetteriTI - Hospitalisation associated with a deterioration in oral health EvidenceBased Dentistry 12, 48 (2011)
Categories of patients § § § § § § § § § §
Head and neck cancer patients AIDS patients Renal failure patients Comatose patients Patients in need of prophylactic AB Paraplegics quadriplegics and amputees Post surgical patients Diabetes patients Psychiatric patients Organ transplant recipients
A, HEAD & NECK CANCER THE DISEASE CAN BE PREVENTED § Smoking/tobacco (intra oral cancer) § Exposure to the sun (lips and face cancer) § identification, patient targeted plans, medicated gum, four A’s (Ask, Advise, Assist, Arrange), second chance alert
IF CARCINOMA HAS DEVELOPED Establish healthy oral environment prior to initiation of carcinoma therapy
Bisphosphonate § Bisphosphonates are mainly used for the treatment of osteoporosis, but they are also used in the treatment of cancer. Cancer patients take them in higher doses. § Bisphosphonate-associated osteonecrosis can occur spontaneously, owing to dental disease or secondary to dental therapy.
Bisphosphonate / Cancer patients § Prior Bisphosphonat-Therapy (or in the first 3 month) all potential sources of oral infections should be treated (Any invasive dental procedure ideally to be completed prior to initiation of high-dose bisphosphonate therapy) § During Bisphosphonat-Therapy § All preventive procedures are important (good oral hygiene, regular dental visits, Clh, F) § Avoid extractions. Rootcanal treatment preferable and if coronally unrestorable can amputate to root level after root treatment and seal. § Nonurgent invasive dental procedures preferably to be delayed for 3–6 months following interruption of bisphosphonate therapy
Bisphosphonate § Stopping smoking, limiting alcohol intake, and maintaining good oral hygiene should be emphasised § Good-fitting dentures, prevent trauma § Conventional orthograde endodontics recommended rather than extraction where possible. § If tooth has to be extracted: conservative surgical technique with primary tissue closure; Prophylactic antibiotics
B, AIDS PATIENTS Acquired immune deficiency syndrome T4 cell decline ® immunosuppresion § Opportunistic infections (Pneumocystitis, Candida) § Cancers (Kaposi’s sarcoma, lymphoma) § Oral manifestation Role of dental practitioners: Diagnosis, monitoring, management
B, AIDS PATIENTS
B, AIDS PATIENTS
Oral manifestations § § § § §
Candidiasis (75%), HSV, CMV, VZ Antiviral agents Hairy leukoplakia (EBV, 83% is associated with AIDS) Topical anesthetics Aphtous ulcer Kaposi’s sarcoma (hard plate brown lesion) HIV gingivitis Scaling, root planning, AB, ClH
Because of immunosuppresion sources of oral infection should be eliminated
B, AIDS PATIENTS
Dental procedure § Infection control & immunsuppression § AB prophylaxis : Routine antibiotic prophylaxis is contraindicated. § There seem to be no significant differences § decision should be made on an individualized basis § If the absolute neutrophil count is