A Practical Approach to Special Care in Dentistry E-Book
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- Herausgeber: John Wiley & Sons
- Kategorie: Fachliteratur
- Sprache: Englisch
A Practical Approach to Special Care in Dentistry Learn to treat dental patients with disabilities or who are medically compromised A Practical Approach to Special Care in Dentistry delivers a comprehensive and robust overview of special care dentistry reflecting the most common compromised clinical conditions dentists will regularly encounter. It discusses more than 50 topics based on real-world clinical cases focusing on two main areas: patients with disabilities and medically compromised patients. The book uses a problem-based learning approach and helps the reader to apply knowledge in a clinical case context. Each chapter contains a case report establishing the main risk factors relating to the provision of dental treatment. That is followed by a practical and realistic set of adaptations for the reader to follow to minimise the rate and severity of potential complications for their patient. The book also includes: * A thorough introduction to patients with disabilities, including physical disabilities, like cerebral palsy and epilepsy, and cognitive impairments, like Down's Syndrome * Comprehensive explorations of the treatment of medically compromised patients, like those with infectious diseases, endocrine diseases, hepatorenal disease, and cardiovascular disease * Practical discussions of other special patient situations, like those with allergies, antiresorptive and antiangiogenic drugs, terminal patients, underhoused patients, and pregnant or breastfeeding patients Perfect for general dentists, undergraduate students of odontology, and graduate students of special care dentistry, A Practical Approach to Special Care in Dentistry is also a must-read resource for dental specialists in special care dentistry, hospital odontology, geriatric odontology, oral surgery, and dental hygienists.
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Seitenzahl: 1172
Veröffentlichungsjahr: 2021
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Table of Contents
Cover
Title Page
Copyright Page
About the Authors
List of Contributors
Preface
1 Physical Disability
1.1 Cerebral Palsy
Section I: Clinical Scenario and Dental Considerations
Section II: Background Information and Guidelines
Recommended Reading
1.2 Epilepsy
Section I: Clinical Scenario and Dental Considerations
Section II: Background Information and Guidelines
Recommended Reading
1.3 Muscular Dystrophy
Section I: Clinical Scenario and Dental Considerations
Section II: Background Information and Guidelines
Recommended Reading
2 Cognitive Impairment
2.1 Attention Deficit and Hyperactivity Disorder (ADHD)
Section I: Clinical Scenario and Dental Considerations
Section II: Background Information and Guidelines
Recommended Reading
2.2 Autism Spectrum Disorders
Section I: Clinical Scenario and Dental Considerations
Section II: Background Information and Guidelines
Recommended Reading
2.3 Down Syndrome
Section I: Clinical Scenario and Dental Considerations
Section II: Background Information and Guidelines
Recommended Reading
3 Sensory Impairment
3.1 Visual Deficit
Section I: Clinical Scenario and Dental Considerations
Section II: Background Information and Guidelines
Recommended Reading
3.2 Auditory Deficit
Section I: Clinical Scenario and Dental Considerations
Section II: Background Information and Guidelines
Recommended Reading
4 Infectious Diseases
4.1 Tuberculosis
Section I: Clinical Scenario and Dental Considerations
Section II: Background Information and Guidelines
Recommended Reading
4.2 Human Immunodeficiency Virus (HIV) Infection/AIDS
Section I: Clinical Scenario and Dental Considerations
Section II: Background Information and Guidelines
Recommended Reading
4.3 Viral Hepatitis
Section I: Clinical Scenario and Dental Considerations
Section II: Background Information and Guidelines
Recommended Reading
5 Endocrine Diseases
5.1 Diabetes Mellitus
Section I: Clinical Scenario and Dental Considerations
Section II: Background Information and Guidelines
Recommended Reading
5.2 Hypothyroidism
Section I: Clinical Scenario and Dental Considerations
Section II: Background Information and Guidelines
Recommended Reading
5.3 Hyperthyroidism
Section I: Clinical Scenario and Dental Considerations
Section II: Background Information and Guidelines
Recommended Reading
6 Hepatorenal Diseases
6.1 Hepatic Cirrhosis
Section I: Clinical Scenario and Dental Considerations
Section II: Background Information and Guidelines
Recommended Reading
6.2 Chronic Kidney Disease (Dialysis)
Section I: Clinical Scenario and Dental Considerations
Section II: Background Information and Guidelines
Recommended Reading
7 Bone Diseases
7.1 Osteoporosis
Section I: Clinical Scenario and Dental Considerations
Section II: Background Information and Guidelines
Recommended Reading
7.2 Paget Disease
Section I: Clinical Scenario and Dental Considerations
Section II: Background Information and Guidelines
Recommended Reading
7.3 Rheumatoid Arthritis
Section I: Clinical Scenario and Dental Considerations
Section II: Background Information and Guidelines
Recommended Reading
8 Cardiovascular Diseases
8.1 Arterial Hypertension
Section I: Clinical Scenario and Dental Considerations
Section II: Background Information and Guidelines
Recommended Reading
8.2 Angina Pectoris
Section I: Clinical Scenario and Dental Considerations
Section II: Background Information and Guidelines
Recommended Reading
8.3 History of Myocardial Infarction
Section I: Clinical Scenario and Dental Considerations
Section II: Background Information and Guidelines
Recommended Reading
8.4 Carrier of Coronary Pacemaker
Section I: Clinical Scenario and Dental Management
Section II: Background Information and Guidelines
Recommended Reading
8.5 Carrier of Valvular Prosthesis
Section I: Clinical Scenario and Dental Considerations
Section II: Background Information and Guidelines
Recommended Reading
8.6 Carrier of Coronary Stent
Section I: Clinical Scenario and Dental Considerations
Section II: Background Information and Guidelines
Recommended Reading
9 Respiratory Disease
9.1 Chronic Obstructive Pulmonary Disease (COPD)
Section I: Clinical Scenario and Dental Considerations
Section II: Background Information and Guidelines
Recommended Reading
9.2 Asthma
Section I: Clinical Scenario and Dental Considerations
Section II: Background Information and Guidelines
Recommended Reading
10 Bleeding Disorders
10.1 Haemophilia
Section I: Clinical Scenario and Dental Considerations
Section II: Background Information and Guidelines
Recommended Reading
10.2 Treatment with Heparin
Section I: Clinical Scenario and Dental Considerations
Section II: Background Information and Guidelines
Recommended Reading
10.3 Treatment with Warfarin (Acenocoumarol)
Section I: Clinical Scenario and Dental Considerations
Section II: Background Information and Guidelines
Recommended Reading
10.4 Treatment with Direct Oral Anticoagulants
Section I: Clinical Scenario and Dental Considerations
Section II: Background Information and Guidelines
Recommended Reading
10.5 Treatment with Antiplatelets
Section I: Clinical Scenario and Dental Considerations
Section II: Background Information and Guidelines
Recommended Reading
11 Blood Dyscrasias
11.1 Thalassaemia
Section I: Clinical Scenario and Dental Considerations
Section II: Background Information and Guidelines
Recommended Reading
11.2 Sickle Cell Anaemia
Section I: Clinical Scenario and Dental Considerations
Section II: Background Information and Guidelines
Recommended Reading
11.3 Neutropenia
Section I: Clinical Scenario and Dental Considerations
Section II: Background Information and Guidelines
Recommended Reading
11.4 Thrombocytopenia
Section I: Clinical Scenario and Dental Considerations
Section II: Background Information and Guidelines
Recommended Reading
11.5 Leukaemias
Section I: Clinical Scenario and Dental Considerations
Section II: Background Information and Guidelines
Recommended Reading
11.6 Lymphoma
Section I: Clinical Scenario and Dental Considerations
Section II: Background Information and Guidelines
Recommended Reading
11.7 Bone Marrow Transplantation
Section I: Clinical Scenario and Dental Considerations
Section II: Background Information and Guidelines
Recommended Reading
12 Immunosuppression
12.1 Systemic Corticosteroids
Section I: Clinical Scenario and Dental Considerations
Section II: Background Information and Guidelines
Recommended Reading
12.2 Antineoplastic Agents (Chemotherapy)
Section I: Clinical Scenario and Dental Considerations
Section II: Background Information and Guidelines
Recommended Reading
12.3 Immunosuppressants (Solid Organ Transplantation)
Section I: Clinical Scenario and Dental Considerations
Section II: Background Information and Guidelines
References
Recommended Reading
13 Head and Neck Cancer
13.1 Surgery
Section I: Clinical Scenario and Dental Considerations
Section II: Background Information and Guidelines
Recommended Reading
13.2 Radiation Therapy
Section I: Clinical Scenario and Dental Considerations
Section II: Background Information and Guidelines
Recommended Reading
13.3 Oral Cancer Survivor
Section I: Clinical Scenario and Dental Considerations
Section II: Background Information and Guidelines
Recommended Reading
14 Neurological Disorders and Strokes
14.1 Alzheimer Disease
Section I: Clinical Scenario and Dental Considerations
Section II: Background Information and Guidelines
Recommended Reading
14.2 Parkinson Disease
Section I: Clinical Scenario and Dental Considerations
Section II: Background Information and Guidelines
Recommended Reading
14.3 Multiple Sclerosis
Section I: Clinical Scenario and Dental Considerations
Section II: Background Information and Guidelines
Recommended Reading
14.4 Motor Neuron Disease
Section I: Clinical Scenario and Dental Considerations
Section II: Background Information and Guidelines
Recommended Reading
14.5 Stroke
Section I: Clinical Scenario and Dental Considerations
Section II: Background Information and Guidelines
Recommended Reading
15 Psychiatric Disorders
15.1 Anxiety and Phobia
Section I: Clinical Scenario and Dental Considerations
Section II: Background Information and Guidelines
Recommended Reading
15.2 Depression
Section I: Clinical Scenario and Dental Considerations
Section II: Background Information and Guidelines
Recommended Reading
15.3 Schizophrenia
Section I: Clinical Scenario and Dental Considerations
Section II: Background Information and Guidelines
Recommended Reading
15.4 Recreational Drug Use
Section I: Clinical Scenario and Dental Considerations
Section II: Background Information and Guidelines
Recommended Reading
15.5 Alcoholism
Section I: Clinical Scenario and Dental Considerations
Section II: Background Information and Guidelines
Recommended Reading
16 Other Special Considerations
16.1 Allergies
Section I: Clinical Scenario and Dental Considerations
Section II: Background Information and Guidelines
Recommended Reading
16.2 Antiresorptive and Antiangiogenic Drugs
Section I: Clinical Scenario and Dental Considerations
Section II: Background Information and Guidelines
Recommended Reading
16.3 Pregnancy and Breastfeeding
Section I: Clinical Scenario and Dental Considerations
Section II: Background Information and Guidelines
Recommended Reading
16.4 Bariatric Patients
Section I: Clinical Scenario and Dental Considerations
Section II: Background Information and Guidelines
Recommended Reading
16.5 Homelessness
Section I: Clinical Scenario and Dental Considerations
Section II: Background Information and Guidelines
Recommended Reading
16.6 End of Life
Section I: Clinical Scenario and Dental Considerations
Section II: Background Information and Guidelines
Recommended Reading
Appendix A: Case Mix Model
Appendix B: Common Oral Manifestations of Systemic Diseases
Appendix C: American Society of Anesthesiologists (ASA) Physical Status Classification System
Appendix D: Glasgow Coma Scale (GCS)
Appendix E: WHO Three‐step Ladder for Pain Relief
Appendix F: Medical Conditions Associated with Increased Bleeding Risk
Appendix G: Classes of Drugs Associated with Increased Bleeding Risk
Appendix H: Bleeding Risk Associated with Dental Procedures
Appendix I: Topical Haemostatic Agents for Invasive Dental Procedures
Index
End User License Agreement
List of Tables
Chapter 1-1
Table 1.1.1 Considerations for dental management.
Table 1.1.2 Classification and characteristics of cerebral palsy.
Chapter 1-2
Table 1.2.1 Considerations for dental management.
Table 1.2.2 Management of epileptic seizure in the dental clinic.
Table 1.2.3 New classification of epilepsy.
Table 1.2.4 Clinical presentation of seizures.
Chapter 1-3
Table 1.3.1 Considerations for dental management.
Table 1.3.2 Classification and characteristics of muscular dystrophy.
Chapter 2-1
Table 2.1.1 Considerations for dental management.
Table 2.1.2 Medical management of attention deficit and hyperactivity disord...
Chapter 2-2
Table 2.2.1 Considerations for dental management.
Table 2.2.2 Common concurrent conditions in the autism spectrum disorders.
Chapter 2-3
Table 2.3.1 Considerations for dental management.
Table 2.3.2 Most common systemic conditions in Down syndrome.
Chapter 3-1
Table 3.1.1 Considerations for dental management.
Chapter 3-2
Table 3.2.1 Considerations for dental management.
Table 3.2.2 Auditory deficit classification.
Table 3.2.3 Auditory deficit aetiology.
Chapter 4-1
Table 4.1.1 Considerations for dental management.
Chapter 4-2
Table 4.2.1 Potential consequences of HIV disease.
Table 4.2.2 Main antiretroviral drugs with adverse orofacial effects
.
Table 4.2.3 Considerations for dental management.
Chapter 4-3
Table 4.3.1 Considerations for dental management.
Table 4.3.2 Prescription of drugs for patients with moderate to severe hepat...
Table 4.3.3 Characteristics of the most common types of viral hepatitis.
Chapter 5-1
Table 5.1.1 Considerations for dental management.
Table 5.1.2 Managing hypoglycaemia in the dental clinic
a
.
Table 5.1.3 Criteria for the diagnosis of diabetes (WHO).
Table 5.1.4 Types of insulin and their action profiles.
Chapter 5-2
Table 5.2.1 Considerations for dental management.
Table 5.2.2 Clinical manifestations of hypothyroidism.
Chapter 5-3
Table 5.3.1 Dental management considerations.
Table 5.3.2 Causes of hyperthyroidism.
Chapter 6-1
Table 6.1.1 Considerations for dental management.
Table 6.1.2 Child–Pugh classification of cirrhosis.
Chapter 6-2
Table 6.2.1 Oral findings in patients with chronic kidney disease undergoing...
Table 6.2.2 Considerations for dental management.
Table 6.2.3 Prescription of drugs for patients with chronic kidney disease.
Table 6.2.4 Clinical characteristics of chronic kidney disease.
Table 6.2.5 Classification of chronic kidney disease.
Chapter 7-1
Table 7.1.1 Classification of mandibular cortical bone in assessment of oste...
Table 7.1.2 Considerations for dental management.
Chapter 7-2
Table 7.2.1 Considerations for dental management.
Chapter 7-3
Table 7.3.1 Orofacial adverse effects of the most common biological disease‐...
Table 7.3.2 Dental management considerations.
Table 7.3.3 Extra‐articular manifestations of rheumatoid arthritis (excludin...
Chapter 8-1
Table 8.1.1 Examples of oral side‐effects of antihypertensive drugs.
Table 8.1.2 Considerations for dental management.
Table 8.1.3 Blood pressure categorisation in adults.
Table 8.1.4 Early diagnosis of target organ damage in hypertensive patients ...
Table 8.1.5 Main oral antihypertensive drugs.
Chapter 8-2
Table 8.2.1 Main oral adverse effects of antianginal drugs.
Table 8.2.2 Considerations for dental management.
Table 8.2.3 Protocol for the management of an angina pectoris attack (specif...
Table 8.2.4 Classification of angina pectoris.
Chapter 8-3
Table 8.3.1 Main adverse oral effects of drugs administered prophylactically...
Table 8.3.2 Considerations for dental management.
Table 8.3.3 Clinical classification of myocardial infarction.
Chapter 8-4
Table 8.4.1 Main oral adverse effects of antiarrhythmic drugs.
Table 8.4.2 Considerations for dental management.
Table 8.4.3 Pacemaker coding system. (North American Society of Pacing and E...
Chapter 8-5
Table 8.5.1 Considerations for dental management.
Table 8.5.2 Antimicrobial prophylaxis for preventing infective endocarditis ...
Chapter 8-6
Table 8.6.1 Considerations for dental management.
Chapter 9-1
Table 9.1.1 Considerations for dental management.
Table 9.1.2 Types of respiratory failure.
Table 9.1.3 GOLD (Global Initiative for Chronic Obstructive Lung Disease) st...
Chapter 9-2
Table 9.2.1 Considerations for dental management.
Table 9.2.2 Asthma severity.
Table 9.2.3 Asthma attack severity and emergency management.
Table 9.2.4 Pharmacological management of asthma.
Chapter 10-1
Table 10.1.1 General dental management considerations.
Table 10.1.2 Blood coagulation factor defects in descending order of frequen...
Table 10.1.3 Severity of haemophilia (World Federation of Haemophilia 2012).
Table 10.1.4 Therapeutic approaches for patients with haemophilia.
Table 10.1.5 Risk factors for inhibitor development in haemophilia.
Table 10.1.6 General management of patients with inhibitors.
Chapter 10-2
Table 10.2.1 Unfractionated heparin and low molecular weight heparin – diffe...
Table 10.2.2 General dental management considerations.
Table 10.2.3 Comparison of the characteristics of unfractionated heparin and...
Table 10.2.4 Low molecular weight heparin (LMWH) medications.
Chapter 10-3
Table 10.3.1 Management of patients taking warfarin undergoing dental proced...
Table 10.3.2 Major–moderate drug interactions between warfarin and antibioti...
Table 10.3.3 General dental management considerations.
Table 10.3.4 Pharmacokinetics and pharmacodynamics of warfarin.
Table 10.3.5 Indications for oral anticoagulation and target INR.
Chapter 10-4
Table 10.4.1 Management of patients taking direct oral anticoagulants (DOAC...
Table 10.4.2 General dental management considerations.
Table 10.4.3 Direct oral anticoagulation medications
a
.
Table 10.4.4 Comparison of the characteristics of warfarin and direct oral a...
Chapter 10-5
Table 10.5.1 General dental management considerations.
Table 10.5.2 Antiplatelet medications: drug characteristics.
Table 10.5.3 Indications for antiplatelet therapy.
Chapter 11-1
Table 11.1.1 Facial features and oral manifestations of thalassaemia.
Table 11.1.2 Considerations for dental management considerations.
Table 11.1.3 Clinical presentation of thalassaemia.
Chapter 11-2
Table 11.2.1 Dental management considerations.
Chapter 11-3
Table 11.3.1 Dental management considerations.
Table 11.3.2 Classification of neutropenia.
Chapter 11-4
Table 11.4.1 Dental management considerations.
Table 11.4.2 Oral surgery management based on severity of thrombocytopenia.
Table 11.4.3 Drugs that may impair platelet function.
Chapter 11-5
Table 11.5.1 Principles of oral healthcare in leukaemia.
Table 11.5.2 Dental management considerations.
Table 11.5.3 Classification of leukaemia.
Chapter 11-6
Table 11.6.1 Dental management considerations.
Table 11.6.2 Features of different types of lymphomas.
Table 11.6.3 Risk factors associated with the development of lymphomas.
Table 11.6.4 Modified Ann Arbor staging system for lymphomas.
Chapter 11-7
Table 11.7.1 Dental management considerations.
Chapter 12-1
Table 12.1.1 Dental management considerations.
Table 12.1.2 Corticosteroid supplementation regimen for patients undergoing...
Table 12.1.3 Classification of glucocorticoids.
Table 12.1.4 Most common therapeutic indications for systemic corticosteroi...
Table 12.1.5 Most common adverse effects of systemic corticosteroids.
Chapter 12-2
Table 12.2.1 Guidelines for minimal haematological values for performance o...
Table 12.2.2 Dental treatment planning prior to chemotherapy.
Table 12.2.3 Acute oral side‐effects of chemotherapy and oral care manageme...
Table 12.2.4 Chronic oral side‐effects of chemotherapy (management as for a...
Table 12.2.5 Oral mucositis scales.
Table 12.2.6 General dental management considerations.
Table 12.2.7 Chemotherapeutic treatment intents.
Table 12.2.8 Drugs used in treatment of malignant disease.
Table 12.2.9 Adverse effects and toxicities of various chemotherapeutic age...
Chapter 12-3
Table 12.3.1 General dental management considerations.
Table 12.3.2 Risk assessment and modifications in relation to specific orga...
Table 12.3.3 Immunosuppressive agents used in organ transplantation and den...
Table 12.3.4 Types of transplants.
Table 12.3.5 Immunosuppressive regimens.
Table 12.3.6 Relative potency and side‐effects of immunosuppressant drugs.
Table 12.3.7 Transplanted organs, source and graft/patient survival.
Chapter 13-1
Table 13.1.1 Dental management considerations.
Table 13.1.2 TNM staging system for oral cancer.
Chapter 13-2
Table 13.2.1 Acute oral complications of radiation therapy in head and neck...
Table 13.2.2 Delayed oral complications of radiation therapy in head and ne...
Table 13.2.3 Dental management considerations.
Chapter 13-3
Table 13.3.1 Dental management considerations.
Table 13.3.2 Multidisciplinary approach for survivors of head and neck canc...
Chapter 14-1
Table 14.1.1 Dental management considerations.
Table 14.1.2 Alzheimer disease – potential risk factors.
Table 14.1.3 Alzheimer disease – clinical presentation.
Chapter 14-2
Table 14.2.1 Dental management considerations.
Table 14.2.2 Diagnostic criteria for Parkinson' disease (UK Parkinson's Dis...
Chapter 14-3
Table 14.3.1 Dental management considerations.
Table 14.3.2 McDonald criteria for the diagnosis of multiple sclerosis (201...
Table 14.3.3 Clinical subtypes of multiple sclerosis.
Table 14.3.4 Pharmacological treatment of multiple sclerosis.
Chapter 14-4
Table 14.4.1 Dental management considerations.
Table 14.4.2 Main types of motor neuron disease
Table 14.4.3 Clinical presentation of amyotrophic lateral sclerosis
Chapter 14-5
Table 14.5.1 Dental management considerations.
Table 14.5.2 Oral healthcare for patients who have had a stroke.
Table 14.5.3 Main types of stroke.
Table 14.5.4 Risk factors of stroke.
Chapter 15-1
Table 15.1.1 Considerations for dental management.
Table 15.1.2 Diagnosis for specific phobias according to the main classific...
Table 15.1.3 Continuum of depth of sedation, showing the impact on the resp...
Table 15.1.4 Summary of the pharmacological options for anxiety/phobia manag...
Table 15.1.5 Indicator of Sedation Need (IOSN).
Chapter 15-2
Table 15.2.1 Considerations for dental management.
Table 15.2.2 Major depressive disorder diagnostic criteria according to the...
Table 15.2.3 Symptoms of depression.
Table 15.2.4 Most common types of antidepressant drugs.
Chapter 15-3
Table 15.3.1 Considerations for dental management.
Table 15.3.2 Diagnostic criteria according to the American Psychiatric Asso...
Table 15.3.3 Clinical presentation of schizophrenia.
Table 15.3.4 Antipsychotic medications and their characteristics.
Chapter 15-4
Table 15.4.1 Considerations for dental management.
Table 15.4.2 Protective and risk factors related to substance consumption.
Table 15.4.3 Recreational drugs, mode of action, examples and oral implicat...
Chapter 15-5
Table 15.5.1 Alcoholism‐related comordibities and orofacial manifestations.
Table 15.5.2 Considerations for dental management.
Table 15.5.3 Alcohol Use Disorders Identification Test (AUDIT), created by ...
Table 15.5.4 Clinical presentation of alcohol consumption.
Table 15.5.5 Classification of alcoholics according to demographics.
Table 15.5.6 Medication commonly used in alcohol dependence.
Chapter 16-1
Table 16.1.1 Allergens with particular relevance to dentistry.
Table 16.1.2 Basic series of allergens for analysing hypersensitivity to de...
Table 16.1.3 Considerations for dental management.
Table 16.1.4 Conditions that promote sensitisation and the development of a...
Chapter 16-2
Table 16.2.1 Recommended clinical protocol before starting antiresorptive t...
Table 16.2.2 Risk assessment of medication‐related osteonecrosis of the jaw...
Table 16.2.3 Drugs implicated in the development of medication‐related oste...
Table 16.2.4 Other drugs considered to be implicated in the development of ...
Table 16.2.5 Main risk factors for medication‐related osteonecrosis of the ...
Table 16.2.6 Staging and management of medication‐related osteonecrosis of ...
Chapter 16-3
Table 16.3.1 Considerations for dental management.
Table 16.3.2 Drugs prescribed during pregnancy and breastfeeding.
a
Table 16.3.3 Systemic disorders during pregnancy.
Chapter 16-4
Table 16.4.1 General dental management considerations.
Table 16.4.2 Airway assessment (L.E.M.O.N tool).
Table 16.4.3 World Health Organization classification of weight by body mas...
Table 16.4.4 Factors influencing the risk of obesity.
Table 16.4.5 STOP‐Bang questionnaire for sleep apnoea.
Table 16.4.6 Ethnicity‐specific obesity indices.
Chapter 16-5
Table 16.5.1 Barriers and enablers of oral healthcare in homelessness.
Table 16.5.2 General dental management considerations.
Table 16.5.3 Factors contributing to homelessness.
Table 16.5.4 Prevalent medical conditions associated with homelessness.
Chapter 16-6
Table 16.6.1 Dental management considerations.
List of Illustrations
Chapter 1-1
Figure 1.1.1 Patient with spastic cerebral palsy and preserved intellectual ...
Figure 1.1.2 Extensive caries upper central incisors.
Figure 1.1.3 (a) Severe malocclusion with anterior open bite. (b) Sialorrhoe...
Figure 1.1.4 Patients who present in wheelchairs may have treatment provided...
Figure 1.1.5 (a) Spastic cerebral palsy. (b) Hand deformity calls for adapti...
Chapter 1-2
Figure 1.2.1 Patient with uncontrolled epilepsy wearing a protective headgea...
Figure 1.2.2 Severe displacement of the maxillary central incisors following...
Figure 1.2.3 (a) Tooth extraction and removal of maxillary bone fragments. (...
Figure 1.2.4 (a) Sequelae of repeated facial injuries secondary to epileptic...
Figure 1.2.5 Severe gingival hyperplasia in a patient on phenytoin.
Figure 1.2.6 Electroencephalogram (EEG) showing epileptiform activity.
Figure 1.2.7 Magnetic resonance imaging (MRI) can identify structural change...
Chapter 1-3
Figure 1.3.1 Facial myopathy with severe open mouth.
Figure 1.3.2 Anterior open bite.
Figure 1.3.3 Lateral cephalogram showing a dolichocephalic growth pattern (r...
Figure 1.3.4 (a) Facial myopathy (hypotonia, dolichocephaly and open mouth)....
Figure 1.3.5 Diagnostic muscle biopsy showing random variation in fibre size...
Figure 1.3.6 Orthopaedic surgery to improve scoliosis.
Chapter 2-1
Figure 2.1.1 Dentition: generalised plaque, calculus and gingival inflammati...
Figure 2.1.2 Maxilla: caries in teeth #54, #53, #65, stained fissures in #16...
Figure 2.1.3 Mandible: caries in teeth #75, #84 and #85; calculus on the lin...
Figure 2.1.4 Right and left bitewing radiographs: mixed dentition; caries in...
Chapter 2-2
Figure 2.2.1 Oral examination was carried out with the help of pictograms.
Figure 2.2.2 (a) Fracture of the incisal edge of the crown of tooth #11. (b)...
Figure 2.2.3 Desensitisation with visual support may be helpful.
Figure 2.2.4 A visual timer may improve co‐operation.
Figure 2.2.5 (a) Fascination by an inanimate object. (b) Ritualistic behavio...
Chapter 2-3
Figure 2.3.1 (a) Irregular palate, with erythema of the denture bearing muco...
Figure 2.3.2 Cone beam computed tomography showing a bone defect in the uppe...
Figure 2.3.3 (a–d) Prosthodontic rehabilitation with a new upper dental pros...
Figure 2.3.4 (a) Lip fissures. (b) Dental agenesis, microdontia and macroglo...
Figure 2.3.5 Orthodontic therapy can be successfully performed in selected p...
Chapter 3-1
Figure 3.1.1 Thickened upper labial frenulum.
Figure 3.1.2 Cone beam computed tomography showing a considerable isolated c...
Figure 3.1.3 Orthodontic treatment for a patient with visual impairment.
Figure 3.1.4 Braille is a useful communication tool mainly for complete blin...
Figure 3.1.5 When the blind patient uses a guide dog, avoid interfering with...
Chapter 3-2
Figure 3.2.1 Bimaxillary compression resulting in a narrow, pointed/ogival a...
Figure 3.2.2 Sign language can be used to enhance communication.
Figure 3.2.3 Orthodontic treatment for a patient with craniofacial dysostosi...
Figure 3.2.4 An audiogram shows the quietest sounds a patient can just hear....
Figure 3.2.5 Cochlear implants in a child with congenital deafness.
Chapter 4-1
Figure 4.1.1 Orthopantomogram showing multiple caries and alveolar bone loss...
Figure 4.1.2 Primary tuberculosis manifesting as a non‐healing, tender ulcer...
Figure 4.1.3 Positive Mantoux test (also known as tuberculin PPD test for pu...
Figure 4.1.4 Chest x‐ray showing cavitary lesions typically associated with ...
Chapter 4-2
Figure 4.2.1 Oral HPV‐associated papillomatosis in AIDS.
Figure 4.2.2 (a–c) Lesions closely associated with HIV infection: oral candi...
Figure 4.2.3 Exfoliative cheilitis as an adverse oral effect of proteinase i...
Figure 4.2.4 Infection control in the dental clinic.
Figure 4.2.5 Pneumonia by
Pneumocystis carinii
as an AIDS‐defining condition...
Chapter 4-3
Figure 4.3.1 Orthopantomogram demonstrating unrestorable caries in #26.
Figure 4.3.2 Erosive lichen planus in an HCV‐infected patient.
Figure 4.3.3 Jaundice related to liver dysfunction.
Chapter 5-1
Figure 5.1.1 Panoramic radiography showing caries and a prior filling in too...
Figure 5.1.2 (a–c) Severe periodontal disease in a 37‐year‐old male with dia...
Figure 5.1.3 Xerostomia – depapillated, smooth dry dorsum of the tongue.
Figure 5.1.4 Continuous glucose monitoring system.
Chapter 5-2
Figure 5.2.1 Orthopantomogram: neglected mouth with unrestorable caries in t...
Figure 5.2.2 Macroglossia in a patient with hypothyroidism.
Figure 5.2.3 Goitre (enlarged thyroid gland).
Figure 5.2.4 Grey‐scale ultrasound and colour Doppler sonogram showing multi...
Chapter 5-3
Figure 5.3.1 Mild goitre (anterior and lateral view).
Figure 5.3.2 Pitted hypoplastic enamel and staining present on buccal surfac...
Figure 5.3.3 Generalised moderate to severe tooth surface loss on the palata...
Figure 5.3.4 Orthopantomogram demonstrating patchy medullary radiolucency su...
Figure 5.3.5 Long cone periapical radiograph demonstrating periapical radiol...
Chapter 6-1
Figure 6.1.1 Orthopantomogram demonstrating a neglected mouth with multiple ...
Figure 6.1.2 Postoperative bleeding after dental extraction in liver cirrhos...
Figure 6.1.3 Grey‐scale ultrasound and colour Doppler sonogram showing a liv...
Chapter 6-2
Figure 6.2.1 Orthopantomogram demonstrating multiple carious teeth, missing ...
Figure 6.2.2 Brown tumour associated with secondary hyperparathyroidism in a...
Figure 6.2.3 Autosomal‐dominant polycystic kidney disease (ADPKD) may lead t...
Figure 6.2.4 A haemodialysis system including a blood circuit (with the vasc...
Chapter 7-1
Figure 7.1.1 Orthopantomogram findings suggestive of osteoporosis as well as...
Figure 7.1.2 Granular jawbone and severe cortex erosion in a female patient ...
Figure 7.1.3 Right‐sided femoral neck fracture (most are due to osteoporosis...
Figure 7.1.4 The gold‐standard method to assess bone mineral density (BMD) i...
Chapter 7-2
Figure 7.2.1 Enlargement of the left maxillary area.
Figure 7.2.2 Hypercementosis associated with Paget disease.
Chapter 7-3
Figure 7.3.1 Orthopantomogram showing conserved structure of the condylar pr...
Figure 7.3.2 Condylar process of a rheumatoid arthritis patient showing flat...
Figure 7.3.3 Methotrexate‐induced oral ulcer.
Figure 7.3.4 Stiff fingers and swollen joints in rheumatoid arthritis.
Chapter 8-1
Figure 8.1.1 Orthopantomogram demonstrating severe vertical bone loss in mes...
Figure 8.1.2 Angiotensin‐converting enzyme inhibitor (enalapril)‐induced fac...
Figure 8.1.3 (a,b) Calcium channel blocker (nifedipine)‐induced gingival hyp...
Figure 8.1.4 Ambulatory blood pressure monitoring record over a 24‐hour peri...
Chapter 8-2
Figure 8.2.1 Periapical dental radiograph showing chronic periapical periodo...
Figure 8.2.2 Gingival hyperplasia caused by nifedipine (a calcium channel bl...
Figure 8.2.3 Nicorandil (a potassium channel opener)‐induced oral ulcer.
Figure 8.2.4 Patient with unstable angina treated in a hospital setting with...
Figure 8.2.5 Stress echocardiography and Doppler echocardiography are establ...
Chapter 8-3
Figure 8.3.1 Orthopantomogram demonstrating loss of multiple teeth and deter...
Figure 8.3.2 Oral lichenoid drug reaction triggered by a beta‐blocker (nevib...
Figure 8.3.3 Myocardial perfusion single‐photon emission computed tomography...
Chapter 8-4
Figure 8.4.1 Orthopantomogram showing severe maxillary atrophy and radiograp...
Figure 8.4.2 Heart pacemaker (VVI) on chest x‐ray.
Figure 8.4.3 Implantable cardioverter‐defibrillator with 1 lead and 2 shock ...
Chapter 8-5
Figure 8.5.1 Periapical radiograph showing radiolucent lesion related to #36...
Figure 8.5.2 Exploratory surgery confirmed the radiological suggestion of ra...
Figure 8.5.3 Mechanical mitral valve prostheses.
Figure 8.5.4 Biological aortic valve prostheses.
Chapter 8-6
Figure 8.6.1 Orthopantomogram showing carotid stent.
Figure 8.6.2 Invasive coronary angiography remains the standard for the dete...
Chapter 9-1
Figure 9.1.1 Orthopantomogram of a patient with chronic obstructive pulmonar...
Figure 9.1.2 Inhaling smoke is a chronic work hazard for street hawkers.
Figure 9.1.3 Spirometry is the standard respiratory function test for case d...
Figure 9.1.4 Chest x‐ray of an elderly man with chronic obstructive pulmonar...
Chapter 9-2
Figure 9.2.1
Lignosus rhinocerus
.
Figure 9.2.2 Mandibular dentition: rampant caries and multiple retained root...
Figure 9.2.3 (a) Characteristic facial features of asthma. (b) Mouth‐breathi...
Figure 9.2.4 Spirometry is the recommended test to confirm asthma (see also ...
Chapter 10-1
Figure 10.1.1 Orthopantomogram showing extensive caries.
Figure 10.1.2 Spontaneous gingival bleeding.
Figure 10.1.3 Persistent bleeding from hyperplastic pulpitis (pulp polyp).
Figure 10.1.4 Infraorbital haematoma following infiltrative local anaesthesi...
Chapter 10-2
Figure 10.2.1 Multiple other decayed and defective heavily restored teeth.
Figure 10.2.2 (a) Periapical radiograph upper right quadrant showing fractur...
Chapter 10-3
Figure 10.3.1 Periapical radiograph of the #14 demonstrating extensive bone ...
Figure 10.3.2 International normalised ratio (INR) testing in the dental cli...
Figure 10.3.3 (a,b) Prolonged bleeding and bruising (haematoma) after dental...
Figure 10.3.4 Prolonged bleeding after dental extractions; haemostatic pack ...
Chapter 10-4
Figure 10.4.1 Periapical radiograph showing root canal treatment in tooth #2...
Figure 10.4.2 Exploratory surgery showing radicular fracture. Consequently, ...
Figure 10.4.3 Bruising (haematoma) following dental extractions.
Chapter 10-5
Figure 10.5.1 (a,b) Long cone periapical radiographs of lower anterior teeth...
Figure 10.5.2 Ecchymoses associated with dental implant surgery.
Figure 10.5.3 Most common types of antiplatelet drugs.
Chapter 11-1
Figure 11.1.1 Lateral view of the face showing malar prominence and anterior...
Figure 11.1.2 Mixed dentition with generalised crowding and pale gingivae.
Figure 11.1.3 Orthopantomogram demonstrating mixed dentition, thin mandibula...
Figure 11.1.4 (a,b) Facial features: frontal bossing, ‘chipmunk face’, class...
Chapter 11-2
Figure 11.2.1 Lower lip trauma lesion.
Figure 11.2.2 Fractured crowns #11 and #21, extruded tooth # 21, localised i...
Figure 11.2.3 Upper right and left periapical and upper occlusal radiographs...
Figure 11.2.4 Lower lip radiograph: no foreign body/tooth fragments.
Figure 11.2.5 Splinting of teeth #11–23 with wire and composite splint.
Chapter 11-3
Figure 11.3.1 Panoramic radiography showing tooth resorption of the mandibul...
Figure 11.3.2 (a,b) Recurrent oral ulceration in cyclic neutropenia.
Figure 11.3.3 Severe periodontal disease and early tooth loss related to chr...
Figure 11.3.4 Aggressive periodontitis in a teenager with DiGeorge syndrome ...
Chapter 11-4
Figure 11.4.1 (a) Dentition: inflamed, hyperplastic, bleeding gingivae; toot...
Figure 11.4.2 Spontaneous blood‐filled bullae (angina bullosa haemorrhagica)...
Chapter 11-5
Figure 11.5.1 Generalised dental plaque, calculus and staining.
Figure 11.5.2 (a,b) Right and left bitewing radiographs demonstrating extens...
Figure 11.5.3 Infiltration of gingival tissue with leukaemia cells in a pati...
Figure 11.5.4 Formation of blood cells (haematopoiesis).
Chapter 11-6
Figure 11.6.1 Extrusion of the lower right second molar and gingival ulcer w...
Figure 11.6.2 Orthopantomogram showing #47 radiolucent periapical lesion wit...
Figure 11.6.3 Radionuclide bone imaging showing mandibular invasion.
Figure 11.6.4 Mediastinal bulk defined from chest radiograph in Hodgkin lymp...
Figure 11.6.5 (a.b) Positron emission tomography/computed tomography (PET/CT...
Chapter 11-7
Figure 11.7.1 Back brace for support.
Figure 11.7.2 Mucosa – healing ulcer in the vestibule close to #26.
Figure 11.7.3 Floor of mouth – minimal saliva pooling; caries #44, #45 and #...
Figure 11.7.4 Periapical radiograph demonstrating caries in #44, #45 and #46...
Figure 11.7.5 Cone beam computed tomography images showing a changed bone de...
Figure 11.7.6 (a,b) Graft‐versus‐host disease.
Chapter 12-1
Figure 12.1.1 Malar rash (butterfly rash).
Figure 12.1.2 Orthopantomogram demonstrating generalised bone loss, retained...
Figure 12.1.3 Delayed wound healing and bacterial infection following tooth ...
Chapter 12-2
Figure 12.2.1 Long cone periapical radiograph #36 demonstrating associated p...
Figure 12.2.2 Acute mucositis secondary to the administration of 5‐fluoroura...
Figure 12.2.3 A child wearing a hood due to alopecia.
Figure 12.2.4 Chest radiograph showing a left single‐lumen central venous ca...
Chapter 12-3
Figure 12.3.1 Anterior view of the dentition showing generalised hard and so...
Figure 12.3.2 (a,b) Bite‐wing radiographs showing horizontal bone loss, subg...
Figure 12.3.3 Sirolimus‐induced oral ulceration.
Figure 12.3.4 Cyclosporine‐induced gingival hyperplasia.
Figure 12.3.5 Cutaneous chronic graft‐versus‐host disease following kidney t...
Chapter 13-1
Figure 13.1.1 Orthopantomogram showing segmental mandibulectomy reconstructe...
Figure 13.1.2 Surgical sequelae of a lower jaw carcinoma. Reconstruction of ...
Figure 13.1.3 The mobility of the residual tongue determines the functional ...
Figure 13.1.4 Lymphoscintigraphy for sentinel lymph node detection in patien...
Chapter 13-2
Figure 13.2.1 Periapical radiograph showing extensive cervical caries #33 an...
Figure 13.2.2 Hyposalivation and thick and sticky saliva are common acute co...
Figure 13.2.3 Rampant caries (‘radiation caries’) is a delayed complication ...
Figure 13.2.4 Clinical findings highly suggestive of osteoradionecrosis in a...
Chapter 13-3
Figure 13.3.1 (a–c) Implant‐supported prosthetic rehabilitation after surgic...
Figure 13.3.2 (a,b) Oral health status in a patient with nasopharyngeal carc...
Figure 13.3.3 (a,b) Maintenance care is mandatory for the long‐term success ...
Chapter 14-1
Figure 14.1.1 Anterior dentition: marginal gingivitis; #11 chipped incisal e...
Figure 14.1.2 Palatal aspect of the upper anterior teeth: palatal erosion an...
Figure 14.1.3 (a,b) Food packing posteriorly.
Figure 14.1.4 Co‐operation during radiological examination diminishes with a...
Chapter 14-2
Figure 14.2.1 Excessive drooling (sialorrhoea, hypersalivation).
Figure 14.2.2 Haematoma on the right side of the forehead due to a fall.
Figure 14.2.3 (a,b) Partially edentate, plaque‐induced gingivitis, moderate ...
Figure 14.2.4 Long cone periapical radiograph demonstrating extensive caries...
Figure 14.2.5 Advanced Parkinson disease showing mask‐like appearance, tremo...
Chapter 14-3
Figure 14.3.1 Partially edentate, extensive caries #13 and #23.
Figure 14.3.2 Upper right maxillary quadrant with extensive soft deposits an...
Figure 14.3.3 Long cone periapical radiograph of the upper right quadrant de...
Figure 14.3.4 Multiple sclerosis presenting with sustained contracture and m...
Chapter 14-4
Figure 14.4.1 Xerostomia, frothy saliva, tongue biting.
Figure 14.4.2 Heavily restored #17 and #18; food trapping interdentally.
Figure 14.4.3 Long cone periapical radiograph; 1 mm space between #17 and #1...
Figure 14.4.4 Fasciculations of the tongue.
Chapter 14-5
Figure 14.5.1 Partially edentate; plaque‐induced gingivitis; root caries fro...
Figure 14.5.2 Retained roots #17 and #15; root caries #24.
Figure 14.5.3 Xerostomia and healing ulcer left lateral border of the tongue...
Figure 14.5.4 Orthopantomogram demonstrating extensive interdental decay in ...
Figure 14.5.5 Acute ischaemic stroke (cerebellar infarction) confirmed by co...
Chapter 15-1
Figure 15.1.1 Scalloped tongue due to bruxism/tongue biting.
Figure 15.1.2 Poor oral health with associated gingivitis.
Figure 15.1.3 Lower incisors: calculus and lingual recession.
Figure 15.1.4 Multiple restorations; #25 caries; #24 disto‐occlusal defectiv...
Figure 15.1.5 The Modified Dental Anxiety Scale (MDAS).
Chapter 15-2
Figure 15.2.1 Partially edentate, deep overbite, multiple carious teeth.
Figure 15.2.2 Maxillary dentition: retained roots #17, #24 and #27; palatine...
Figure 15.2.3 Mandibular dentition: retained root #41; caries in #34, #32, #...
Figure 15.2.4 Full‐mouth periapical radiographs demonstrating multiple retai...
Chapter 15-3
Figure 15.3.1 Anterior dentition – gingival recession, xerostomia.
Figure 15.3.2 Maxillary dentition – retained root #14, extensive subgingival...
Figure 15.3.3 Orthopantomogram showing generalised bone loss, #46 perio‐endo...
Figure 15.3.4 Dental prosthesis heavily stained due to compulsive smoking an...
Figure 15.3.5 Tardive oral dyskinesia.
Chapter 15-4
Figure 15.4.1 (a) Anterior dentition demonstrating gaps in the lateral incis...
Figure 15.4.2 (a) Upper partial denture in situ. (b) Fractured upper partial...
Figure 15.4.3 Orthopantomogram demonstrating multiple carious teeth and gene...
Chapter 15-5
Figure 15.5.1 Angular cheilitis, dry lips/mouth, fissured tongue.
Figure 15.5.2 Partially edentate, xerostomia, gingival recession, poor oral ...
Figure 15.5.3 Lack of posterior occlusal support on the right side.
Figure 15.5.4 Full‐mouth periapical radiographs.
Chapter 16-1
Figure 16.1.1 Sudden lip swelling during dental treatment may become a medic...
Figure 16.1.2 Oral manifestations of allergic reactions (types I–IV).
Figure 16.1.3 Patch test to study hypersensitivity to dental materials.
Figure 16.1.4 Hypersensitivity reaction to amoxicillin‐clavulanate in an HIV...
Chapter 16-2
Figure 16.2.1 An area > 1 cm of exposed bone on the right lingual surface of...
Figure 16.2.2 Spontaneous bone exposure following periodontal treatment, sug...
Figure 16.2.3 Detail of an orthopantomogram showing bone sequestration in th...
Figure 16.2.4 Cone beam computed tomography demonstrating the extent of medi...
Chapter 16-3
Figure 16.3.1 Gingival hyperplasia and bleeding gums.
Figure 16.3.2 Pregnancy‐related mild gingivitis.
Figure 16.3.3 Pyogenic granuloma (gravidarum).
Chapter 16-4
Figure 16.4.1 Shoulder obstruction during attempt to undertake an orthopanto...
Figure 16.4.2 Orthopantomogram demonstrating caries on the distal aspect of ...
Figure 16.4.3 Dental chair unable to reposition.
Figure 16.4.4 Bariatric bench.
Figure 16.4.5 Wheelchair platform.
Chapter 16-5
Figure 16.5.1 Orthopantomogram demonstrating metal mesh on the left orbital ...
Figure 16.5.2 (a,b) Silver diamine fluoride may be beneficial for patients w...
Figure 16.5.3 Homeless man sleeps in a public space.
Chapter 16-6
Figure 16.6.1 (a,b) Xerostomia with collection of debris/secretions on the p...
Figure 16.6.2 (a,b) Supine panoramic radiography device.
Figure 16.6.3 Using damp gauze wrapped round a gloved finger to gently moist...
Figure 16.6.4 Portable dental unit.
Figure 16.6.5 Phases of care when approaching death.
Guide
Cover Page
A Practical Approach to Special Care in Dentistry
Copyright Page
About the Authors
List of Contributors
Preface
Table of Contents
Begin Reading
Appendix A Case Mix Model
Appendix B Common Oral Manifestations of Systemic Diseases
Appendix C American Society of Anesthesiologists (ASA) Physical Status Classification System
Appendix D Glasgow Coma Scale (GCS)
Appendix E WHO Three‐step Ladder for Pain Relief
Appendix F Medical Conditions Associated with Increased Bleeding Risk
Appendix G Classes of Drugs Associated with Increased Bleeding Risk
Appendix H Bleeding Risk Associated with Dental Procedures
Appendix I Topical Haemostatic Agents for Invasive Dental Procedures
Index
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A Practical Approach to Special Care in Dentistry
Edited by
Pedro Diz Dios, MD, DDS, PhD, EDiOM, FDSRCS (Edin)
Special Care Dentistry Unit, School of Medicine and Dentistry,
University of Santiago de Compostela & Galician Health Service (SERGAS),
Santiago de Compostela, Spain
Navdeep Kumar, BDS, FDSRCS (Eng), PhD, Cert RDP, Cert Surg & Pros Implantology
Royal National Ear, Nose and Throat & Eastman Dental Hospitals,
University College London Hospitals NHS Foundation Trust/University
College London, London, United Kingdom
Content Editors
Stephen Porter, BSc, MD, PhD, FDSRCS (Eng), FHEA
UCL Eastman Dental Institute
London, United Kingdom
Jacobo Limeres Posse, DDS, MSc, PhD
Special Care Dentistry Unit, School of Medicine and Dentistry, University of Santiago de Compostela
Santiago de Compostela, Spain
This edition first published 2022© 2022 John Wiley & Sons Ltd
All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, except as permitted by law. Advice on how to obtain permission to reuse material from this title is available at www.wiley.com/go/permissions.
The right of Pedro Diz Dios and Navdeep Kumar to be identified as the authors of this work has been asserted in accordance with law.
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Limit of Liability/Disclaimer of Warranty
The contents of this work are intended to further general scientific research, understanding, and discussion only and are not intended and should not be relied upon as recommending or promoting scientific method, diagnosis, or treatment by physicians for any particular patient. In view of ongoing research, equipment modifications, changes in governmental regulations, and the constant flow of information relating to the use of medicines, equipment, and devices, the reader is urged to review and evaluate the information provided in the package insert or instructions for each medicine, equipment, or device for, among other things, any changes in the instructions or indication of usage and for added warnings and precautions.While the publisher and authors have used their best efforts in preparing this work, they make no representations or warranties with respect to the accuracy or completeness of the contents of this work and specifically disclaim all warranties, including without limitation any implied warranties of merchantability or fitness for a particular purpose. No warranty may be created or extended by sales representatives, written sales materials or promotional statements for this work. The fact that an organization, website, or product is referred to in this work as a citation and/or potential source of further information does not mean that the publisher and authors endorse the information or services the organization, website, or product may provide or recommendations it may make. This work is sold with the understanding that the publisher is not engaged in rendering professional services. The advice and strategies contained herein may not be suitable for your situation. You should consult with a specialist where appropriate. Further, readers should be aware that websites listed in this work may have changed or disappeared between when this work was written and when it is read. Neither the publisher nor authors shall be liable for any loss of profit or any other commercial damages, including but not limited to special, incidental, consequential, or other damages.
Library of Congress Cataloging‐in‐Publication Data Applied for
[Hardback ISBN 9781119600046]
Cover Design: WileyCover Image: © Pedro Diz Dios
About the Authors
Dr Pedro Diz DiosMD, DDS, PhD, EDiOM, FDSRCS (Edin)Professor, Consultant and Head of the Special Needs Unit at the School of Medicine and Dentistry, Santiago de Compostela University (Spain). He is a member of the International Association of Disability & Oral Health (IADH) Curriculum Working Group and IADH Scientific Committee, and Honorary Visiting Professor at the UCL‐Eastman Dental Institute (UK). He has written and edited 10 books, over 40 book chapters and over 220 papers cited on MEDLINE. He is the Editor in Chief of Special Care Dentistry Journal, an Associate Editor of Oral Diseases Journal and of Medicina Oral Cirugía Oral Patología Bucal, and an Editorial Board Member of the Journal of Disability and Oral Health.
Dr Navdeep KumarBDS, FDSRCS (Eng), PhD, Cert RDP, Cert Surg & Pros ImplantologyConsultant in Special Care Dentistry, Honorary Senior Lecturer and Divisional Clinical Director RNENT & EDH, at the University College London Hospitals NHS Foundation Trust. Over the last 20 years Dr Navdeep Kumar has been committed to special care dentistry (SCD) and has acquired an extensive range of clinical, teaching and research experience in the area to ensure the delivery of high‐quality oral care for people with an impairment or disability. She has considerable expertise in the clinical management of the medically compromised patient and the management of oral complications of systemic diseases. She has an integral role in training others with an interest in SCD, examining in this field, and is actively involved in the promotion of oral care for this vulnerable cohort, contributing to the development of national and international guidelines and numerous publications in this area.
List of Contributors
Fatima Al SarrafBDS (Hons)‐NUI, MFDS (RCSI), KBAGD, MGDS (RCSI), MSC (SCD), FGDS (RCSI)Advanced General and Special Care Dentistry, Ministry Of Health Kuwait, Kuwait City, Kuwait
Sofia Bonvallet CommentzBSD, PgDip, MScUniversity of Valparaiso & Valparaiso San Antonio Health Service, Valparaiso, Chile
Lim Guang Xu DavidBDS, MSc, PGDip, ACLP, MFDS (RCS Ed)Tzu Chi Free Clinic, Buddhist Compassion Relief Tzu Chi Foundation, Geriatric and Special Needs Dentistry Clinic, National Dental Centre Singapore, Oral Health Therapy, Nanyang Polytechnic, Singapore
Javier Fernández FeijooMD, DDS, MSc, PhD, PCDSpecial Care Dentistry Unit, School of Medicine and Dentistry, University of Santiago de Compostela, EOXI Santiago de Compostela, Galician Health Service (SERGAS), Santiago de Compostela, Spain
Márcio Diniz FreitasDDS, MSc, FDS, PhD
Special Care Dentistry Unit. School of Medicine and Dentistry, University of Santiago de Compostela, Santiago de Compostela, Spain
Emma Vázquez GarcíaDDS, MSc, PhD, PCDEOXI Pontevedra‐Salnés, Galician Health Service (SERGAS), Pontevedra, Spain
María Consuelo Cousido GonzálezMD, PhD, BDS, BDM, PCDEOXI Coruña‐Cee, Galician Health Service (SERGAS), La Coruña, Spain
Jee‐Yun LeungBDSc (Hons), MSc (SCD), DSCD (RCS Eng)Adelaide Dental School, The University of Adelaide, Special Needs Unit, Adelaide Dental Hospital, SA Dental, Adelaide, Australia
Lucía Lago MéndezDDS, MSc, FDS, PhD, PCDEOXI Santiago de Compostela, Galician Health Service (SERGAS), Santiago de Compostela, Spain
Ricca Mae Roco‐BernardinoDMD, MSc (SCD)
The Medical City and Philippine Children's Medical Center, Metro Manila, Philippines
Preface
Special Care Dentistry (SCD) was previously defined by patient characteristics, such as their medical condition or behavioural issues. However, it has changed in recent decades to reflect the complexity of providing holistic oral care for patients with multiple comorbidities which may lead to physical and/or intellectual, sensory, mental or social impairment. Although it commonly relates to adults, in some countries it also includes the oral care of children with disabilities.
There is a significant geographical variation in access to SCD related to lack of training, appropriate infrastructure and financial factors. Nevertheless, it is rapidly growing due to increased demand and is now acknowledged as an essential field of dentistry across the world. Dramatic improvements in medicine, mainly in areas related to early diagnosis and new therapeutic approaches, have resulted in increased life expectancy and the quality of life of chronically ill patients and individuals with severe disability. Hence, individuals requiring care are not limited to hospitalised patients and more commonly include those living in the community, either independently or with support.
As a consequence, it is essential that undergraduates, postgraduates and general dental practitioners acquire specific knowledge in the field of SCD, so that they can integrate this discipline into their daily practice. To enable this, we have created this book, which contains 61 topics based on clinical cases from across the world, reflecting the most common clinical conditions which may present in general dental practice. This scenario‐based approach enables the application of elements of problem‐based learning and structured clinical reasoning, allowing the reader to appreciate that patients rarely present with a single medical condition or risk factor, and that multiple factors must be taken into consideration when providing care.
Each case includes the application of a risk assessment framework of medical, social and dental risk factors. This allows the systematic consideration of appropriate modifications that should be implemented prior to commencement of dental treatment, thereby reducing complications and treatment planning errors.
Subsequently, the main oral findings and the specific considerations for dental management for each condition/disease are discussed. The ACCESS mnemonic is utilised to ensure that six domains which address different aspects of care are considered:
A
ccess
C
ommunication
C
onsent
E
ducation
S
urgery
S
pread of infection
Lastly, each chapter concludes with background information on each condition/disease, with updated medical content on their definition, aetiopathogenesis, clinical presentation, diagnosis, treatment and prognosis.
In 2006, under the guidance of Professor Crispian Scully, we published the book entitled Special Needs in Dentistry (Handbook of Oral Healthcare). A few years later, in December 2015, we received an email announcing that ‘The Special Care Dentistry book will be 10 years old next year! I am intent on producing something that focuses on the younger generations and that can be regularly updated’. The tragic and premature loss of Professor Scully deprived us of his academic guidance, editorial experience and enormous knowledge. We have therefore put all our efforts into this new publication, which launches today thanks to the contribution of a group of relevant collaborators. We hope it will serve as a tribute to our master, mentor and friend.
Pedro Diz Dios and Navdeep Kumar
1Physical Disability1.1 Cerebral Palsy
Section I: Clinical Scenario and Dental Considerations
Clinical Scenario
A 24‐year‐old patient attends your dental practice with acute pain from a lower right molar tooth. Two courses of antibiotics prescribed by the general medical practitioner have been ineffective. She attends alone and has used a private taxi that has been able to accommodate her wheelchair.
Medical History
Spastic cerebral palsy
Degenerative disc disease and spondylosis of the cervical spine
Adjustment disorder (presented after divorce; undergoing follow‐up by psychiatry)
Medications
Trihexyphenidyl hydrochloride
Baclofen
Bromazepam
Lormetazepam
Mirtazapine
Omeprazole
Dental History
Irregular dental attender – avoided attending as she is anxious that dental treatment will make her gag
No experience of local anaesthesia to enable dental treatment in the dental clinic setting
Previous dental treatment provided under general anaesthesia on 2 occasions, when she was a child
Good level of co‐operation
Brushes her teeth regularly herself, although she admits difficulty accessing the posterior teeth due to her gag reflex and involuntary movements
Social History
Lives alone and is not currently working
Divorced and does not have a good relationship with her ex‐husband's family; no children or close family
A caregiver visits every morning to help with basic activities of daily life
Wheelchair user (
Figure 1.1.1
)
Limited financial resources
Oral Examination
Involuntary movements of the jaw
Moderate sialorrhoea – saliva does not spill over the vermilion border
Pronounced gag reflex
Mouth in very poor condition, with numerous carious teeth and deposits of calculus (
Figure 1.1.2
)
Caries: #11, #15, #17, #21, #22, #25, #26, #27, #35, #37, #41, #42, #44, #45 and #48
Tenderness on palpation: #48; no associated swelling
Missing teeth: #36, #46 and #47
Radiological Examination
Orthopantomogram – artefacts due to the patient's movement
Supplemented by long‐cone periapical radiography anteriorly
Endodontic treatment of #11 and #21 (obturation satisfactory; no periapical radiolucent areas)
Extensive, deep and unrestorable caries in #15 and #48 (with pulpal involvement)
Restorable caries in #17, #22, #25, #26, #27, #35, #37, #41 and #44
Recurrent caries associated with the dental fillings in #16, #42 and #45
Missing teeth #36, #46 and #47
Figure 1.1.1 Patient with spastic cerebral palsy and preserved intellectual ability in the dental practice.
Figure 1.1.2 Extensive caries upper central incisors.
Structured Learning
The #48 is painful on palpation and you suspect periapical periodontitis. The patient's temperature is not elevated and there is no associated lymph node enlargement. What emergency management would you propose and why?
It is important to treat the dental infection urgently to reduce the risk of significant morbidity and life‐threatening sequelae, including Ludwig's angina
However, within the last 20 years, antimicrobial resistance has become a significant issue with prescribed antibiotics/dosages being ineffective
Hence it is important to remove the source of infection, establish drainage and prescribe analgesics
Further effective antibiotics may also enable successful dental intervention at a later date, namely effective local anaesthesia followed by removal of the infected pulpal contents or by extraction of the tooth
Drainage of an associated abscess should also be considered if swelling develops
The patient has received appropriate and high‐dose antibiotics and requests that you attempt to extract the tooth the same day. Although she has no previous experience with local anaesthesia, she appears to be co‐operative and has capacity. What would you discuss with her?
Extraction of #48 is the preferred treatment option as:
The use of rotary instrumentation for caries removal is associated with increased risk due to the posterior position of the tooth, uncontrolled movements and increased gag reflex
There is limited access to allow for endodontic treatment (e.g. due to difficulties accessing the posterior sections of the mouth)
The patient struggles to access her posterior teeth for cleaning
As this is an urgent procedure, the dental extraction can be attempted in the dental chair
Given her considerable dental treatment needs, this can be followed up by the provision of non‐urgent procedures (e.g. restorations) provided in a hospital setting under general anaesthesia
Prosthetic rehabilitation and subsequent follow‐up/treatment sessions should be performed in the dental clinic, if possible
What factors are considered important in assessing the risk of managing this patient?
Social
Lack of available escort
Transport difficulties when attending dental clinic/hospital
Limited financial means
Medical
Neck position compromised by the dental chair and by problems in the cervical spine; consider the option of treating the patient in her wheelchair
Risks associated with general anaesthesia may be increased in patients with cerebral palsy (hypothermia, hypotension)
