Evidence of systemic diseases can be in the mouth and see adjacent structures (see Table: Oral findings in systemic diseases). A dentist should consult a physician if a systemic disease is suspected, when the patient certain drugs occupies (z. B. coumarin derivatives, bisphosphonates), and if it must be judged whether a general anesthesia or an extensive oral surgery be made in a patient can.
(See also IINTRODUCTION. The dental patient) evidence of systemic diseases can be found (see table: Oral findings in systemic diseases) in the mouth and adjacent structures. A dentist should consult a physician if a systemic disease is suspected, when the patient certain drugs occupies (z. B. coumarin derivatives, bisphosphonates), and if it must be judged whether a general anesthesia or an extensive oral surgery be made in a patient can. Patients with certain heart valve abnormalities need before certain dental treatments Prophylactic antibiotics to prevent bacterial endocarditis (see table: procedures that make endocarditis in high risk patients required and see Table: Recommended endocarditis during dental procedures or surgery of the airways *). Oral findings in systemic diseases, oral thrush manifestation Associated diseases (oral candidiasis) diabetes, AIDS, other causes of immunosuppression (eg. B. agranulocytosis, neutropenia, leukemia, immunoglobulin deficiency, disturbances of the leukocyte function), the use of antibiotics Atrophic glossitis (a smooth tongue caused by atrophy of the Fadenpapillen) iron deficiency Painful atrophy of the oral mucosa and the tongue surface, sometimes with aphthous ulcers Megaloblasteren anemia Magenta tongue Vitamin B12 deficiency dark pigmented areas (if it is not a feature of ethnic origin is) haemochromatosis, Addison’s disease, Peutz-Jeghers syndrome, melanoma (rare, but could occur on the palate), Smoker’s linear, grayish discoloration ( lead line) of the gingiva close to the adjacent teeth lead, silver or bismuth poisoning purple spots Kaposi’s sarcoma, AIDS Keratotic Lichenoid spots, sometimes reddish with painful mucosal graft-versus-host disease, if found in the oral cavity of an organ recipient discoloration of the teeth Congenital erythropoietic porphyria High, vaulted soft palate Marfan syndrome Notched incisors, arched or Maulbeermolaren. Congenital syphilis hairy leukoplakia (white, vertical folds at the lateral edge of the tongue) HIV infection, which is passed into AIDS red or reddish-purple accumulations of oral telangiectasia hereditary hemorrhagic telangiectasia (Rendu-Osler-Weber syndrome), multiple impacted supernumerary teeth and osteoma Gardner syndrome Granulomatous gingivitis, which looks like cobblestone Crohn’s disease Dental care of patients with systemic disease Certain diseases (and their treatment) predispose patients for dental problems, and poor dental care. Hematological diseases in patients with diseases that affect blood clotting (eg. As hemophilia, acute leukemia, thrombocytopenia), a general medical consultation is required before they undergo dental procedures that can cause bleeding (eg. As tooth extraction, mandibular -Leitungsanästhesie, teeth cleaning). Patients with hemophilia should be before, during and after tooth extraction and a restorative dental procedure with local anesthesia (z. B. fillings) coagulation factors are administered. Most hematologists prefer that patients with hemophilia, particularly those who have developed factor inhibitors obtained infiltrative local anesthetic rather than block for restorative dental procedures. Restorative procedures can be performed with a hematologist in a dental office after consultation. However, if the patient has an inhibitor to factor VIII, the intervention in a hospital should be performed under general anesthesia. Oral Surgery should be performed in the hospital with the assistance of a hematologist. All patients with bleeding disorders should live long exercise routine dental check-up appointments where dental cleanings, necessary fillings, topical fluoride application and preventive seals are performed extractions to vermeiden.Kardiovaskuläre disease after myocardial infarction dental procedures should be avoided if possible for 6 months, so that the damaged myocardium less electrically unstable behavior. Patients with lung or heart disease who require inhalation anesthetics before dental procedures should be hospitalized. is Endokarditisprophylaxe before dental treatment only in patients with prosthetic heart valves necessary or which is used to repair heart valves Former bacterial endocarditis Untreated, cyanotic congenital heart disease, prosthetic material, including palliative shunts and lines; completely treated congenital cardiac defects with prosthetic material or device used for 6 months after treatment; treated congenital heart disease with residual error at or adjacent to the operated site with prosthetic patches or prosthesis Fully treated congenital heart disease with prosthetic material or device treated (for 6 months after treatment) congenital heart disease with residual defects at or adjacent to the operated site with prosthetic patch or prosthesis valvulopathy after heart transplantation, the heart is better protected against weakly developed bacteremia that occur in chronic dental disease when dental treatment is performed with prophylactic measures, as if this does not occur. In patients who have a heart valve operation or correct a congenital heart defect right to necessary dental procedures should be completed before the operation. Although the benefits may not be very large, antibiotic prophylaxis for patients with hemodialysis shunts and for a period of two years after the onset of a replacement is sometimes recommended by larger joints (hip, knee, shoulder, elbow). The pathogens that cause infections in these places are, almost without exception dermal instead of oral origin. Adrenergic drugs such as adrenaline and levonordefrin (vasoconstrictor) are added to local anesthetics to prolong the duration of anesthesia. In several cardiovascular patients excessive amounts of these drugs arrhythmias, myocardial ischemia or hypertension cause. Pure anesthetic is used for operations of a maximum of <45 min, but with longer interventions or when a hemostatic effect is required (dental ampoules 1 2: 100,000 epinephrine) up to 0.04 mg epinephrine considered safe. Generally not a healthy patient should receive more than 0.2 mg epinephrine per session. Absolute contraindications for epinephrine (in each dose) are a unkontrolliebare hyperthyroidism: pheochromocytoma; Blood pressure 200 mmHg> systolic or> 115 mmHg diastolic; uncontrolled arrhythmias despite medical therapy and unstable angina pectoris, myocardial infarction or stroke within the last 6 months. Some electrical dental equipment such as electrosurgery, Pulpenprüfer or ultrasonic scaler, the function of pacemakers of the first generation beeinträchtigen.Krebs The extraction of a tooth in immediate vicinity of a carcinoma of the gingiva, palate or the antrum favors the invasion of the alveoli (alveolar) through the Tumor. Therefore, a tooth should be extracted only during the final treatment. In patients with leukemia or agranulocytosis, after extraction, despite the use of antibiotics infection auftreten.Immunsuppression patients with impaired immune defenses are prone to serious infections of mucosa and periodontal ligament by fungi, herpes and other viruses as well, less frequently, by bacteria. The infections can lead to bleeding, delayed wound healing, or sepsis. After several years of immunosuppression dysplastic or neoplastic oral lesions may develop. Patients with AIDS can Kaposi’s sarcoma, non-Hodgkin’s lymphoma, Haarzellenleukoplakie candidiasis, aphthous ulcers or a rapidly progressive form of periodontal disease, HIV-associated periodontal disease entwickeln.Endokrine diseases The dental treatment can be complicated by some endocrine diseases. For example, patients with hyperthyroidism develop tachycardia and excessive anxiety reactions as well as a hyperthyroid crisis when they get adrenaline. The insulin requirement in diabetics can be reduced by elimination of an oral infection; the insulin dose may need to be reduced when the food intake is limited due to pain after oral surgery. In diabetic hyperglycemia followed by polyuria can lead to dehydration, which in turn has a reduced salivation (xerostomia) result, which favors together with elevated glucose values ??in the saliva the development of caries. Patients on corticosteroid therapy and patients with adrenal insufficiency may require an additional dose of corticosteroids for larger dental procedures. Patients with Cushing’s syndrome or patients taking corticosteroids, may experience a loss of alveolar bone, delayed wound healing and increased permeability of capillaries aufweisen.Neurologische disease patients with seizure disorders who require dentures should be supplied with non-removable dentures, neither swallow nor aspirated can be. Patients who are not able to effectively use toothbrush or dental floss, morning and evening apply chlorhexidine 0.12% rinses. In many countries outside the US chlorhexidine is available with 0.2%. However, these higher strength has not proven to be effective for the health of the gingiva and can führen.Obstruktive to increased tooth staining sleep apnea patients with obstructive sleep apnea who can not tolerate treatment with a continuous positive airway pressure mask (CPAP) or bilevel positive airway pressure, are sometimes with an intra-oral device that extends the oropharynx treated. This treatment is not as effective as CPAP, but the acceptance of the treatment in patients höher.Drogen certain drugs such as corticosteroids, immunosuppressants and chemotherapy drugs interfere with wound healing and defense reactions. If possible, any dental treatment should be carried out as long as these drugs are administered. Many medications cause dry mouth (xerostomia), which is a major health problem, especially in elderly patients. The causative drugs often have anticholinergic effects, and include certain antidepressants, antipsychotics, diuretics, antihypertensives, anxiolytics and sedative drugs, NSAIDs, antihistamines and opioid analgesics. Some chemotherapeutic agents (e.g., doxorubicin, 5-fluorouracil, bleomycin, dactinomycin, cytosine, arabinoside, methotrexate) cause stomatitis, which runs in patients with pre periodontal disease heavier. Before prescribing such drugs to dental prophylaxis treatment should be completed and the patient have received training on proper oral hygiene, including the use of dental floss. Drugs that affect blood clotting, must be prior to oral surgery may be reduced or discontinued. Patients taking aspirin, NSAIDs or clopidogrel should discontinue this medication 4 days before a dental procedure and can the therapy after the bleeding resume. Most patients taking an oral anticoagulant and have a stable prothrombin time <4, the drug must not settle before outpatient dental surgery (including extraction) because the risk of significant bleeding is very small and the risk of thrombosis increases when oral anticoagulants be temporarily stopped. In hemodialysis patients dental procedures on the day after dialysis should be performed when the heparin has subsided. Phenytoin, cyclosporin and calcium channel blockers, especially nifedipine, promote gingival hyperplasia. Gingival hyperplasia develops in about 50% of the patients taking phenytoin, and in 25% of patients taking cyclosporine or a calcium channel blocker. However hyperplasia is minimized with excellent oral hygiene and frequent cleanings by a dentist. Bisphosphonates may result after an extraction with an antiresorptive agent-induced osteonecrosis of the jaw (ONJ). ONJ occurs especially when the bisphosphonates are administered parenterally in order to treat bone cancer, and to a much lesser extent, when they are taken orally, to prevent osteoporosis (ONJ risk about 0.1%). A conscientious oral hygiene and regular dental care can help reduce the risk of ONJ, however, there is no validated methods to determine who has the risk of developing an induced by antiresorptive agents ONJ. Exposing the bisphosphonate treatment in individuals who are treated due to osteoporosis, the risk could not decrease and the rate of bone loss erhöhen.Strahlentherapie (Note: After the extraction of teeth from irradiated tissues [especially when the total dose amounted to> 65 Gy an ORN of the jaw occurs, especially in the lower jaw] usually on. This is a serious complication collapse in the extraction and often bone and soft tissue are repelled.) Therefore patients all necessary dental treatment before radiotherapy of head and neck region have completed, with enough time for the healing process. Teeth with questionable prognosis should be extracted. Required sealants and topical fluorides should be applied. After irradiation, an extraction possible, should be avoided and replaced by restorative measures and root canal treatment. Irradiation of head and neck frequently damages the salivary glands, which leads to permanent xerostomia, which favors the development of caries. Patients must therefore all their lives run a good oral hygiene. A fluoride and fluoride-containing mouthwash should be used daily. Rinsing with 0.12% chlorhexidine for 30 to 60 seconds, when it is tolerated, are performed in the morning and evening. The application of hyperviscosity lidocaine can put patients with sensitive oral tissues in a position to eat and clean your teeth with brushing and flossing. In the 3-, 4-, or 6-month intervals, a dentist must be sought, according to the findings of the recently completed study. Irradiated tissue beneath the prosthesis tends to atrophy; Therefore dentures should be checked regularly and corrected if symptoms occur. Early tooth decay can be treated with Kalziumphosphopeptiden and amorphous calcium phosphate, either applied by a dentist or prescribed to the patient for use at home. Patients who undergo radiation therapy may develop mouth sores, reduced sense of taste and a trismus due to fibrosis of the masticatory muscles. The trismus can be minimized by exercises like twenty times wide open and close the mouth, the 3 are carried out to 4 times daily. Extractions of teeth in irradiated bone should be avoided (because of possible ORN). Sometimes the root canal treatment has been completed and the tooth to the gum line ground to prevent bone atrophy. If an extraction is required after irradiation, 10-20 treatments in a hyperbaric O2 chamber pressure can attenuate or prevent Strahlenosteonekrose.