Many periodontitis patients, seeking dental care, also have other diseases that may affect the course of their oral disease and the treatment that they receive. Therefore, proper diagnosis of these diseases and/or disorders is the key for treating their condition as a whole.
The training courses currently offered by Aula DENTAID cover the importance of medically compromised patients. Here we review some diseases that are important to consider:
- Diabetic patients: If during dental treatment, levels of insulin or oral antidiabetic agents are higher than physiologically needed, we are talking about a hypoglycaemic episode. What should we do? Never use insulin, but rather glucose PO (juice, sugar cubes) and glucosmon® IV: 1 vial (33–50% 20–50 ml).
After treatment, patients with poor glucose control or facing extensive oral surgical treatments should be prescribed antibiotic treatment. Lastly, the dose of insulin and diet should be adjusted depending on the oral intervention and whether or not the patient can eat.
- Hypertense patients: It is important to know if the patient is controlled and if he or she is taking the prescribed medication. If not, we must refer the patient. Also keep in mind that pain must be controlled with analgesics and adequate local anaesthesia, before, during and after the intervention.
Bear in mind that some blood pressure medications cause a more pronounced gag reflex and vomiting, side effects that must be treated.
- Patients being treated with oral anticoagulants: Before performing exodontias, the area should be irrigated with tranexamic acid. Then, post-extraction local compression should be performed for 20 minutes with a piece of gauze soaked in tranexamic acid, followed by suturing. NSAIDs and COX-2 should not be prescribed.
- Patients being treated with coumarin derivatives: Keep in mind that patients experiencing acute infectious processes and also taking anticoagulants should not undergo surgery. Additionally, post-operative INR tests should be conducted if patient is taking drugs that interact with coumarin derivatives, and local haemostatic measures should be employed: suturing and plugging
It is very important to consider these conditions and their implications when treating a patient with periodontitis, in order to prevent even greater complications. The key is performing a complete diagnosis of the patient and applying the best treatment based on the various existing diseases.