Transcript Chapter 29 The Medically and Physically Compromised Patient

Chapter 29
The Medically and Physically
Compromised Patient
Copyright 2003, Elsevier Science (USA).
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Produced in the United States of America
ISBN 0-7216-9770-4
Copyright 2003, Elsevier Science (USA). All rights reserved.
Introduction
More individuals are living with some type of
medical or physical disorder.
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The Rights of a Patient
 Americans with Disabilities Act
 American Dental Association
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Title
Title
Title
Title
I: Employment Discrimination
II: Access for Disabled
III: Public Accommodations
IV: Telecommunication Services
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Role of the Dental Assistant
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Aid in providing treatment.
Provide information to patient and family.
Make patient comfortable.
Help in reducing anxiety.
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The Aging Population
 Aging is the irreversible and inevitable
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changes that occur with time.
Stages of the older population
• Young/Old: People age 65 to 74 years old.
• Old: People age 75 to 84 years old.
• Old/Old: People age 85 years old or older.
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Dentally Related Aging Changes
 Xerostomia: Condition from certain disorders and
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medications that cause a decreased flow of saliva.
Periodontal disease: An increasing problem in the
older population. Tissues of older patients may be
slower to heal.
Dental decay: Increase in the form of coronal and
root caries and recurrent decay around defective
restorations
Dark and brittle teeth: As a result of deposits of
secondary dentin that have gradually reduced the size
of the pulp chamber.
Bone resorption: Loss of the alveolar ridge.
Copyright 2003, Elsevier Science (USA). All rights reserved.
The Medically Compromised Patient
 Patient Assessment
• Category I: Healthy patient
• Category II: Medical conditions requiring
schedule changes
• Category III: Medical conditions requiring
significant modifications in dental
treatment
• Category IV: Medical conditions requiring major
modifications in dental treatment
• Category V: Serious medical conditions
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Neurologic Disorders
 Alzheimer’s disease: Brain disorder that is
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marked by deterioration of mental capacity.
Disease progresses in three stages:
• The early disease, or forgetfulness phase.
• The intermediate disease, or confused phase.
• The late disease, or dementia phase.
Dental care management
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Neurologic Disorders- cont’d
 Seizure: An abrupt suspension of motor,
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sensory, and/or body function.
Epilepsy
• Petit mal: Type of seizure lasting no longer
than 30 seconds.
• Grand mal: These seizures have many
causes and arise in all age groups.
Dental care management
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Neurologic Disorders- cont’d
 Multiple Sclerosis: A debilitating and
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degenerative disorder of the central nervous
system with a progressive weakening of the
lower extremities, causing muscle weakness,
unsteady gait, and paralysis.
Dental care management
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Neurologic Disorders- cont’d
 Parkinson’s disease: A progressive disorder
causing degeneration of the nerves in the brain.
This degeneration will lead to tremors, weakness
of muscles, and slowness of movement.
 Dental care management
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Neurologic Disorders- cont’d
 Cerebrovascular accident: A cerebrovascular
accident or stroke is a minor to severe loss of the
central nervous system function caused by a
sudden vascular lesion of the brain, such as
hemorrhage, embolism, thrombosis, or ruptured
aneurysm.
 Dental care management
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Cardiovascular Disorders
 Heart disease is the leading cause of death in
the United States.
 Manifestations of heart disease
• Angina: Severe pain in the chest associated
with an insufficient supply of blood to the
heart
• Myocardial Infarction: Heart attack
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Cardiovascular Disorders- cont’d
 Hypertension: Referred to as high blood
pressure, is the result of the heart having to
work harder as it pumps against resistance such
as a blocked artery.
 Major factors associated with hypertension:
• Stress
• Age
• Heredity
• Smoking
• Obesity
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Cardiovascular Disorders- cont’d
 Cardiac and Prosthetic Considerations: A
patient with cardiac disease or a prosthetic
replacement carries an increased risk of
becoming infected from bacteria carried in the
blood system.
 Endocarditis: Severe infection of the cardiac
valves and supporting structures caused by
blood-borne pathogens that gain entry to the
bloodstream from such places as the mouth and
gastrointestinal tract.
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Pulmonary Disorders
 Disorders that affect the lungs and are
characterized by airway obstruction.
• Bronchial asthma: Often arising from
allergies characterized by an increased
hypersensitivity to various stimuli, which
results in bronchial edema and widespread
narrowing of the bronchial airways.
 Dental care management
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Pulmonary Disorders- cont’d
 Chronic obstructive pulmonary disease:
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General term for pulmonary diseases characterized
by blocked airflow during respiration.
Bronchitis: Irreversible narrowing of the
bronchial airways as a result of chronic
inflammation.
Emphysema: Irreversible enlargement of the size
of the air spaces, resulting in labored breathing
and an increased susceptibility to infection.
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Blood Disorders
 Disorders that involve the cellular elements of
the body.
• Leukemia: An excessive increase in white
blood cells.
• Hemophilia: Excessive bleeding caused by
a congenital lack of a protein substance
necessary for blood clotting to occur.
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Muscular Disorders
 Musculoskeletal system includes the bones,
muscles, and joints.
• Arthritis: Older patients are more likely to
have chronic progressive arthritis with
stiffening of joints.
• Muscular Dystrophy: Involves the striated
muscles in the body, causing progressive
atrophy and weakness.
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Endocrine Disorders
 Glands located in many different regions of the
body, all of which release hormones into the
bloodstream which help regulate the
metabolism in body cells.
• Hyperthyroid: An overactive thyroid gland.
• Hypothyroid: An underactive thyroid gland
that produces fewer hormones.
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Endocrine Disorders- cont’d
 Diabetes Mellitus: Disease characterized by a
sustained high blood glucose level resulting from
an absolute or a relative lack of insulin.
• Type I: Patient is insulin dependent.
• Type II: Disease is controlled through diet and
oral medications.
 Dental care management
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Psychiatric Disorders
 Types of disorders
• Anxiety: Feeling of impending disaster.
• Depression: Condition of general
emotional rejection and withdrawal.
• Schizophrenia: A disturbance in thinking
and perception with delusions,
hallucinations, and impaired reality testing.
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Behavioral Disorders
 Eating disorders
• Anorexia nervosa: Condition is indicated when a
person has an obsessive fasting (starving)
condition.
• Bulimia: Disorder in which a person eats an
abnormal amount of calories at one time and then
induces vomiting or uses laxatives.
 Substance related disorders
• Drugs
• Alcohol
• Nicotine
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The Physically Compromised Patient
 The wheelchair-bound patient
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• Transferring the patient
Seeing-impaired patient
Hearing-impaired patient
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