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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.