TAILIEUCHUNG - Chapter 032. Oral Manifestations of Disease (Part 9)

Dental Care of Medically Complex Patients Routine dental care (., extraction, scaling and cleaning, tooth restoration, and root canal) is remarkably safe. The most common concerns regarding care of dental patients with medical disease are fear of excessive bleeding for patients on anticoagulants, infection of the heart valves and prosthetic devices from hematogenous seeding of oral flora, and cardiovascular complications resulting from vasopressors used with local anesthetics during dental treatment. Experience confirms that the risks of any of these complications are very low. Patients undergoing tooth extraction or alveolar and gingival surgery rarely experience uncontrolled bleeding when warfarin anticoagulation is. | Chapter 032. Oral Manifestations of Disease Part 9 Dental Care of Medically Complex Patients Routine dental care . extraction scaling and cleaning tooth restoration and root canal is remarkably safe. The most common concerns regarding care of dental patients with medical disease are fear of excessive bleeding for patients on anticoagulants infection of the heart valves and prosthetic devices from hematogenous seeding of oral flora and cardiovascular complications resulting from vasopressors used with local anesthetics during dental treatment. Experience confirms that the risks of any of these complications are very low. Patients undergoing tooth extraction or alveolar and gingival surgery rarely experience uncontrolled bleeding when warfarin anticoagulation is maintained within the therapeutic range currently recommended for prevention of venous thrombosis atrial fibrillation or mechanical heart valve. Embolic complications and death however have been reported during subtherapeutic anticoagulation. Therapeutic anticoagulation should be confirmed before and continued through the procedure. Likewise low-dose aspirin . 81-325 mg can be safely continued. Patients at high or moderate risk for bacterial endocarditis Chap. 118 should maintain optimal oral hygiene including flossing and have regular professional cleaning. Prophylactic antibiotics are recommended for all at-risk patients who undergo dental and oral procedures likely to cause significant bleeding and bacteremia. Should unexpected bleeding occur antibiotics given within 2 h following the procedure provide effective prophylaxis. Hematogenous bacterial seeding from oral infection can undoubtedly produce late prosthetic joint infection and therefore requires removal of the infected tissue . drainage extraction root canal and appropriate antibiotic therapy. However evidence that late prosthetic joint infection occurs following routine dental procedures is lacking. For this reason antibiotic prophylaxis .

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