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The Effects of Physical Problems on Dental Treatment

1. Diabetes

Uncontrolled diabetes is frequently accompanied by multiple small oral

abscesses andd poor tissue tone. The disease should be brought under controll

  before prosthodontic treatment is innitiated. The decreased resistance to

infection exhibited by diabetic patients necessitates special care during

treatment and follow-up. Diabetic patient often display reduced salivary out-

  put. This significantly reduces patient’s ability to wear a prosthesis and

increases the likelihood of dental caries.

2. Arthritis

Arthritic changes in temporomandibular joint of a patient may produce

changes in occlusion. Arthritic changes also may create difficulties in the

determination and recording of jaw relations.

3. Paget Disease

Patients with paget disease may show enlargement of the maxillary

tuberosities. This can cause changes in the fit and occlusion of prosthesis. A

frequent recall program should be instituted for patients with Paget disease.

4. Acromegaly

A patient with acromegaly may have enlargement of the mandible.

Consequently, patients with acromegaly should be examined frequently to

evaluate the fit and function of removable prosthesis.

5. Parkinson Disease

Parkinson disease is characterized by rythmic contractions of the musculature,

including the muscles of mastication. The symptoms are sometimes so severe

that it is impossible for a patient to insert and remove a removable partialdenture, let alone practice the oral hygiene procedures necessary for the

maintenance of oral health. Impression procedures also may be compromised

 by the presence of excessive quantities of saliva.

6. Pemphigus Vulgaris

Pemphigus vulgaris is a disease that usually begins with formation of bullae in

the oral cavity with gradual extension to the skin. In acute phase, oral

discomfort and dryness of the mouth are common symptom. These symptoms

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may be erroneously linked to the presence of removable prosthesis.

Consequently, patients have been known to go from dentist to dentist for the

relief of pain, or the fabrication of new prosthesis. When the disease is

  brought under controlled with appropriate medication, patients can wear 

  prosthesis successfully. However, care must be taken to establish smooth,

 polished borders in the finished prosthesis.

7. Epilepsy

The construction of removable partial dentures is usually contraindicated if the

 patient has frequent, severe seizures that occur with little or no warning.

However, of the seizure are well controlled or if the patient has adequate

 premonition to permit removal of prosthesis, a removable partial dentures may

 be indicated.

All material used in the construction of removable partial dentures should be

radiopaque so that any parts of the prosthesis that is swallowed or aspirated

during a seizure can be located radiographically.

If the patient’s medication includes phenytoin, one must take particular care to

ensure that the removable partial denture does not irritate the gingival tissue,

otherwise, gingival hyperthrophy may result.

8. Cardiovascular

Patients with the following cardiovascular condition require medical

consultation before the initiation of the dental procedures :

a. Acute or recent myocardial infarction

 b. Unstable or recent onsent of angina pectoris

c. Congestive heart failure

d. Uncontrolled arrhytimiae. Uncontrolled hypertension

Prophylactic antibiotic therapy is always recommended if surgical procedures

are to be accomplished for patients with a congenital or rheumatic valvular 

heart disease, cardiac murmurs, or repaired coarctation of the aorta. There is

conflicting evidence regarding the need for prophylactic medication when

lesser degree of tissue trauma are anticipated, such as the placement of 

restorations and the making of impressions.

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9. Cancer

Oral complications caused by ionizing radiotion and chemotherapy such as

mucosal irritations, xerostomia, bacterial infections, and fungal infections may

complicate the construction and wear of removable partial dentures.

10. Transmissible Disease

HIV, hepatitis, influenza, tbc, and other transmissible disease pose a particular 

hazard for patients, dental auxiliaries, and dentists. It is imperative that dental

 personel take precautions to prevent contamination and disease transmission,

such as properly disinfected impression, and tools.

Evaluating the Effects of Drugs on Treatment

1. Anticoagulants

Postsurgical bleeding may be a problem for patients receiving anticoagulants.

Care must be taken to stop the ingestion of this medication before dental

treatment initiated.

2. Antihypertensive Agents

The most significant side effect of antihypertensive drugs is orthostatic

hypotension, which may result in syncope when a patient suddenly assumes an

upright position. Treatment for hypertension may also include the prescription

of antidiuretic agent which may contribute to a decrease of salive and

associated dry mouth.

3. Endocrine Therapy

A patient undergoing endocrine therapy may experience severe oral

discomfort related to dry mouth. If the patient is wearing a prosthesis, it could

 be mistakenly blamed for causing discomfort.4. Saliva-Inhibiting Drugs

Methanteline, atropine, and their derivatives are sometimes used to controll

excessive salivary secretion. These drugs are particularly useful when a

 practitioner is making impression. Saliva-inhibiting drugs are contraindicated

in patients with cardiac disease because of their vagolytic effects. These drugs

should be avoided in patients with prostatic hyperthrophy and glaucoma.