Medical Diseases

Leading cause of death in

the U.S.
Includes diseases of the
heart and blood vessels.
Disease Classification

❚ Anatomic System
❙ Diseases of pericardium, myocardium,
endocardium, heart valves and blood
vessels
❚ Etiologic System
❙ Diseases by causitive agent includes
infectious agents, atherosclerosis,
hypertension, immunologic mehanisms
and congenital anomalies
Congenital Heart Disease

❚ Embryonic defects
that occur during
1st nine weeks
❚ Accurate patient
history to
determine nature
of lesion and
degree of disability
❚ Medical consult
❚ May require
premed
Rheumatic Heart Disease

❚ Complications following rheumatic

fever - affects connective tissue
especially heart, its valves and the
joints of body
❚ Valves become chronically inflamed
❚ Patient may need premed
❚ Always consult physician to verify
necessity of premedication if patient
unsure
Infective Endocarditis

❚ Bacterial invasion of heart valve or

endocardium that occurs in
proximity to congenital or acquired
defects
❚ Bacteria usually Streptococcus
viridans that enters during dental
treatment and settles on valve
previously damaged
❚ Causes bacteremia-prognosis
Prevention of Infective
Endocarditis

❚ Antibiotic premedication

❚ Accurate medical history

❚ Patient following approved

prophylaxis regimen of antibiotic
Hypertension

❚ Results from increased load on the

heart because of high blood pressure

❚ Can lead to enlarged heart, then

heart failure

❚ Elevation of blood pressure is

symptom of hypertension
HYPERTENSION

❚ PRIMARY ❚ SECONDARY
(ESSENTIAL) Hypertension:
Hypertension: Specific causes can
Etiologic factors be identified-
unknown-could be increased blood
diet, obesity, pressure is
smoking,etc. secondary to major
❚ 90% of people disease - kidney
have this type disease,diabetes
❚ 10% of people
have this type
Ischemic Heart Disease

❚ Coronary Heart Disease

❚ Caused by reduction or arrest of
blood supply- usually because of
atherosclerosis of the vessel walls

❚ Angina pectoris, myocardial

infarction, congestive heart failure
Angina Pectoris

❚ Coronary arteries unable to supply

sufficient blood to myocardium
❚ Result is pain in chest, mild to severe
crushing pain which radiates from
heart to left arm
❚ Unstable angina -increased intensity
of attacks,serious sign of impending
myocardial infarction
❚ Patients should carry own
Myocardial Infarction

❚ Heart attack, coronary occlusion,

coronary thrombosis
❚ Results from sudden reduction of
coronary blood flow
❚ Area affected by zero blood flow is
said to be infarcted
❚ Need to know severity,residual
damage, and time elapsed since
attack
Congestive Heart Failure

❚ Occurs when ventricles fail to

maintain an adequate output of
blood for the needs of the body
❚ Assess degree of heart failure with
help of medical consult and patient
information
❚ Patient may not be able to breath if
lowered too far back
❚ Administration of O2 may be
Cardiovascular Conditions
Contraindicate Treatment

❚ ACUTE conditions
of

❙ Angina pectoris

❙ Congestive heart
failure

❙ Extreme
hypertension
Prevention of Infective
Endocarditis

❚ Identify high risk patients

❚ Prophylactic antibiotic coverage for
appointments
❚ Working with patient to improve and
maintain high level of oral health to
diminish frequency or severity of
bacteremia
❚ Bacteremia lasts only 15 minutes
after prophy
Oral Tissue
Characteristics

❚ Patient health history may not reveal

blood disorders

❚ Oral manifestations of blood

disorders are usually exaggerated
when there is plaque and local
irritating factors
Oral Findings of Blood
Disorder

❚ Gingival bleeding ❚ Acute or chronic

or history of infections in mouth
difficulty in that do not
controlling respond to
bleeding treatment
❚ Bruises easily ❚ Severe ulcerations
❚ Numerous gingival that do not
petechiae respond to
❚ Marked pallor of treatment
mucous ❚ Exaggerated
membranes gingival response
Normal Blood Composition

❚ Three types of
❚ 55% plasma fluid formed elements
❙ Erythrocytes - RBC

❚ 45% formed
❙ Leukocytes - WBC
element
❙ Thrombocytes -
Platelets
Functions of Blood Cells

❚ RBC’s: sensitive,flexible and change

shape readily; contain hemoglobin-
carries O2 to cells
❚ WBC’s: motile so pass into
connective tissue; work in CT -
phagocytic and immunologic -
respond to invasion of
microorganisms
❚ Platelets: 1/4 size of RBC’s, active in
Anemia

❚ Reduction of hemoglobin
concentration-which carries O2,
hematocrit (fraction of blood
occupied by RBC’s)
❚ Causes of anemia -
❙ Blood loss:iron deficiency anemia
❙ Increased hemolysis(destruction of
RBC’s): sickle cell anemia
❙ Diminished production of RBC’s:
❘ nutritional iron deficiency
Characteristics of Anemia

❚ Pale and thin skin

❚ Weakness, ❚ Dimness of vision,
malaise, easily spots before eyes
fatigued
❚ Dyspnea on slight ❚ Brittle nails with
exertion, faintness loss of convexity
❚ Headache, vertigo,
tinnitus
Treatment Considerations

❚ Decreased ability of blood to carry

oxygen throughout body

❚ Fainting may occur more easily

❚ IV sedation must have supplemental

O2
Treatment Sickle Cell

❚ Hereditary
hemolytic form
❚ Occurs primarily in
blacks and
mediterranean
origin
❚ Concerned with SC
crisis-acute stage
❚ Do not treat if in
this stage
Treatment Sickle Cell

❚ Premed if not completely controlled

❚ Crisis seen in periods of unusual
stress or when patient does not
receive adequate oxygen supply
❚ When SC not controlled patient
susceptible to infection
❚ Perio disease may be present even
in children
Polycythemia

❚ An increase in number and

concentrations of RBC’s above
normal level
❚ Relative polycythemia- loss of
plasma without loss of RBC’s so
concentration of RBC’s increased
❙ caused by
dehydration,diarrhea,repeated
vomiting,sweating or fluid loss from
burns
Polycythemia

❚ Primary polycythemia - actual

increase in number of circulating
RBC’s and platelets viscosity of
blood increased,which affects
oxygen transport to tissues
❘ results from bone disorder
❚ Secondary polycythemia - increase
number of RBC’s
❘ causes are hypoxia(high altitudes and
diseases or tumors
Leukopenia

❚ Decrease in number of WBC’s

❚ Results when cell production can’t
keep pace with the turnover rate or
when accelerated rate of removal
occurs ( in certain diseases)
❚ Causes are typhoid fever,
influenza,malaria, measles, German
measles,chronic drug poisoning and
radiation
Leukocytosis

❚ Increase in number of circulating

WBC’s
❚ May be caused by inflammatory and
infectious states, trauma,exercise
❚ Most extreme cause is Leukemia
❙ Malignant proliferation of WBC’s in bone
marrow -results numerous immature
WBC’s
❙ Oral complications, more severe tissue
response
Hemorrhagic Disorders

❚ Diseases that have ❚ Types due to:

tendency
spontaneous ❙ abnormalities of
bleeding and/or blood capillaries
moderate to
excessive bleeding ❙ platelet dysfunction
after trauma or or deficiency
surgical procedure
❙ blood clotting
defects
Blood Capillary Disorder

❚ Vascular fragility increased which

leads to petechial hemorrhages in
skin or mucous membranes, includes
gingiva

❚ May be caused by severe infections

such as typhoid, drug reaction,
scurvy
Platelet Deficiency and
Dysfunction

❚ Thrombocytopenia ❚ Platelet
Dysfunction
❙ Lowered number of
platelets due to ❙ Interferes with
decreased clotting mechanism
production in bone and leads to
marrow prolonged bleeding
time
❙ Leukemia or ❙ aspirin
vitamin B12 contraindicated
deficiency
Blood Clotting Defect

❚ Possible irregularity or disorder is

associated with each of the many
clotting factors
❚ Examples include Vitamin K
deficiency, liver disease, hereditary
disorders - Hemophilia A and B
Characteristics of
Hemophilia

❚ Congenital disorders of the blood

clotting mechanism
❚ Severity varies
❚ Hemophilia A and B inherited by
males
❚ Acceptable minimal surgical level of
the clotting factor is 30% - includes
subgingival scaling
Treatment of Hemophilia

❚ Must consult patient’s hematologist -

they may need clotting factor
replacement therapy before and
after appointment

❚ Susceptible to infection-may need

premed

❚ Avoid nerve blocks since positive

Prosthetic Joint
Replacement

❚ Replacement of hips, knees, and

elbows with prosthetic devices is
becoming common
❚ Common practice to premedicate to
prevent bacteremia
❚ Consultation with orthopedic surgeon
essential before proceeding with
appt
Pulmonary Diseases

❚ Abnormal condition of the

respiratory system, characterized by
cough, chest pain, shortness of
breath, sputum production, wheezing

❚ Diseases are Obstructive or

Restrictive
Obstructive

❚ Result of an obstacle in airway that

impedes the flow of air, especially
during expiration
❚ May be caused by bronchospasms,
edema, loss of lung elasticity or thick
bronchial secretions
❚ Asthma, bronchitis, emphysema
❚ Asthmatics frequently allergic to
aspirin
Restrictive

❚ Caused by conditions that limit lung

expansion by an actual reduction of
the volume of inspired air
❚ Increased work to breath and an
inefficient exchange of gases
❚ Examples include pulmonary fibrosis
or chest deformities
Treatment Considerations
for Pulmonary Diseases

❚ Supplemental
oxygen may be
necessary ❚ Not suitable for
nitrous oxide
❚ Chair position may usage
be important -
allow patient to
feel comfortable
❚ Asthmatics should
about breathing
have their own
medications
Diabetes Mellitus

❚ Three types of
❚ Genetically diabetic
heterogenous syndromes:
group of disorders
that are ❙ Type I - Insulin
characterized by Dependent
glucose intolerance ❙ Type II - Noninsulin-
dependent
❙ Type III -
Gestational
Diabetes Type I

❚ Insulin dependent

❚ Patient has natural insulin deficiency

❚ Patient depends on insulin for
survival
❚ Usually begins in childhood
❚ Abrupt onset of symptoms
Diabetes Type II

❚ Noninsulin dependent

❚ May or may not use insulin for

symptom control but do not need it
for survival
❚ Slow progression of disease
❚ Typically begins after 35 - 40 years
of age
❚ Obese type - weight control and diet
Diabetes Type III

❚ Gestational

❚ Begins or is noticed during

pregnancy
❚ Above average risk of perinatal
complications
❚ Glucose intolerance may not last
past pregnancy
Function of Insulin

❚ Hormone
❚ Facilitates conversion of glucose to
fat in adipose tissue
❚ Speeds the conversion of glucose to
glycogen in the liver and muscles
❚ Facilitates the transmission of
glucose into cells
❚ Speeds the oxidation of glucose
within the cells for energy
Effects of Decreased
Insulin

❚ In diabetes, insulin is decreased in

amount or function
❚ Less glucose is transmitted through
cell walls into the cells
❚ Glucose increases in the circulating
blood until a threshold is reached
when glucose spills over into urine
❚ Without glucose in the cells to use
for energy, the cells utilize fats
When cells utilize fats….

❚ End products of fat metabolism

(ketones) accumulate in the blood

❚ Acidosis results

❚ Acidosis can result in diabetic coma

Insulin Complications

❚ Insulin reaction - ❚ Diabetic coma -

hypoglycemia ketoacidosis

❙ lowered blood ❙ Too little insulin

glucose with excess with excess ketones
insulin proportion in blood
❙ sudden onset ❙ gradual onset
Uncontrolled Diabetes

❚ Patient has symptoms known as

Classic Triad

❘ Excess urine - polyuria

❘ Excessive thirst - polydipsia

❘ Increased appetite - polyphagia

Uncontrolled Diabetes -
Other Symptoms

❚ Dehydration from fluid loss

❚ General
weakness,drowsiness,fatigue
❚ weight loss from inability to utilize
foods
❚ elevated blood glucose
❚ glucose in urine
❚ slow wound healing, persistent
infections
Infection and Diabetes

❚ More susceptible to infection

❚ Failure to treat an infection increases
severity of diabetic state and
intensifies the symptoms
❚ With infection present, insulin
requirements increase, infection
heals,insulin lowered
❚ Frequently seen infections-urinary
tract infections, skin, lungs and oral
Diabetes

❚ Diet therapy- eliminate concentrated

carbohydrates
❚ Appointment therapy:
❚ stress reduction critical- watch
stress level
❚ best appt is in morning 1 to 3 hours
after normal breakfast and
medication
Diabetes - Appointment
Considerations

❚ Antibiotic protection may be

indicated for a patient who has
history of slow healing from previous
scaling or any surgical procedure
❚ May need to recheck tissues one
week post-scaling appt for healing
response
❚ May want to postpone fluoride
application if scaling was difficulty
Diabetes - Progress of
Periodontal Disease

❚ Patients with insulin dependent

diabetes have a tendency to develop
perio disease - even at early age

❚ Diabetes doesn’t cause disease just

decreases resistance to bacteria
Reactive Hypoglycemia

❚ Low blood sugar, deficiency of sugar

in blood
❚ Types: most common following meal,
due to delayed insulin response in
some mild maturity onset diabetes
after carbo load
❚ alcohol induced,
❚ functional ( unknown causes)
Reactive Hypoglycemia

❚ Symptoms: lightheadedness,
palpitations, sweating,
hunger,nervousness
❚ Symptoms trigger a ripple effect of
fatigue, depression, consciousness,
convulsions, and coma
❚ Stress intensifies ripple
❚ Symptoms relieved by oral glucose
Hypothyroidism &
Hyperthyroidism

❚ Most patients will be sensitive to

temperature changes.

❚ Most people will have had the

disease but be under control due to
drugs or surgery.
Hypothyroidism &
Hyperthyroidism

❚ HYPO ❚ HYPER
❙ atrophy of gland ❙ enlarged gland
❙ less secretions from ❙ more secretions
thyroid from thyroid
❙ sluggish ❙ increases basal
❙ decreases basal metabolism
metabolism ❙ nervous
Corticosteroid Therapy

❚ Hormonal steroid
❚ Used in the management of a wide
variety of diseases including
arthritis, allergic diseases, and
pemphigus
❚ Corticosteroids depress the natural
defensive responses including
inflammation and alter connective
tissue response to injury
Corticosteroid Therapy

❚ In dentistry, use ❚ Treatment

corticoids for oral considerations:
ulcerations, ❙ arthritis patients
arthritis of TMJ may be on long
term treatment
❚ Usually applied
with CS
topically for ❙ dental treatment
suppression of causes stress-need
local inflammation to ascertain if
patient has
complications with
handling stress
Corticosteroid Therapy
Treatment Considerations

❚ Patient may have high BP, salt and

water retention
❚ Topical applications should be
avoided in patients suffering from
diabetes,hyper- tension,peptic
ulcer,TB or viral infections
❚ For those on long term therapy, early
signs of inflammation will be masked
and correct diagnosis may be missed
Allergic Reactions

❚ Mild: Characterized by
swelling,redness, itching- delayed
❚ Severe: Characterized by respiratory
depression and circulatory system
involvement-anaphylaxis-abrupt &
immediate
❚ ANY allergies must be fully evaluated
before the start of treatment and
any drug administration
Mental Conditions

❚ Considerations for patients on

antianxiety, antipsychotic, or
antidepressants
❚ Usually under care of a physician
❚ May be taking multiple drugs for
management of their disorders
❚ Side effects might include
xerostomia and/or lack of mental
alertness
Epilepsy

❚ Find out type of seizure activity, its

frequency,drugs used to prevent
seizures.
❚ Minimize and/or reduce stress level
for patient.
❚ Gingiva may be enlarged from
medications.
Pharmacological
Considerations

❚ CENTRAL NERVOUS SYSTEM

DEPRESSANTS:
❙ Barbituates:effective sedative and
hypnotics - long acting barbs used fro
seizure disorders and mild anxiety
❙ Narcotics: pain control in terminal
disease
❙ Antianxiety:used in psychiatric
treatment
❙ Treatment considerations: If patient has
Pharmacological
Considerations

❚ CENTRAL NERVOUS SYSTEM

STIMULANTS:
❙ Include antihistamines, diet pills,
caffeine, cocaine
❙ Side effects include:
• xerstomia - dry mouth
• increase in vital signs
• nervousness, talkative
❙ Severe overstimulation can cause heart
failure
Cancer Patients

❚ Usually on anti-neoplastic
(chemotherapy) drugs- in
combination with surgery, and
radiotherapy-may cause oral
manifestations side effects
❘ oral ulcerations, mucosal sloughing, necrotic
lesions
❘ increased susceptibility to infections such as
candidiasis due to suppression of normal
defense mechanisms
❘ bleeding problems from suppression of
Cancer Patients

❚ Pre-medication may be necessary;

consult oncologist; immune system
compromised; will be susceptible to
infections
❚ Treatment problems
❙ When head and neck area radiated it
may cause necrosis of bone in jaws and
rampant caries
❙ Oncological treatment
❘ Before: prophy to decrease risk of infection
Liver Disease

❚ Caused by: ❚ Problems with

❙ hepatitis-drug treatment:
induced,alcoholic,vi ❙ serious bleeding
ral problems may
❙ cirrhosis- occur;may need
alcoholic,biliary replacement of
❙ infiltrations- clotting proteins
glycogen,fat ❙ Reduced capability
❙ biliary obstruction to metabolize
❙ severe vascular drugs-prolonged
blood levels of
diseases
drugs
Childbearing Age Females

❚ Oral contraceptives: usually mixture

of estrogen and progesterone
❚ Tissues may mimic effects of
pregnancy
❙ mild inflammation and edema
❙ loss of tissue tone
❙ spontaneous bleeding
❙ tenderness and ulcerations
Alcohol and Drug
Addiction Patients

❚ Higher than normal

incidence of liver
disease
❚ Increase of
valvular damage
❚ May need
premedication
❚ Low tolerance for
pain
Tuberculosis

❚ Contracted by inhalation of fresh

droplets containing tubercle bacilli
❚ Predisposing factors - any
debilitating or immunosuppressive
condition-eg. HIV,diabetes.chronic
lung disease, alcoholism
❚ Incubation period- up to 6 months
Tuberculosis

❚ Early symptoms: low grade fever,

loss of appetite, weight loss, tire
easily,slight cough
❚ Later symptoms: definite
temperature elevations, night
sweats, weakness and persistent
cough
❚ Re-infection TB: infection may
remain inactive and later produce a
Tuberculosis

❚ Clinical management:
❙ May have enlarged lymph nodes, ulcers
on palate
❙ Chemotherapy can control patients
contagious condition
❙ Consult physician to clarify if active- can
usually treat patient if they have been
on medication for 2-3 weeks
Hepatitis A

❚ Occurs most frequently in children

and young adults
❚ Most common transmission is
through close contact in unsanitary
conditions (fecal-oral route)
❚ Prevention by universal precautions
Hepatitis B

❚ Occurs at any age

❚ Very different disease process than
HepA
❚ Major source of HPB from patients
with acute infection and
symptomless chronic carriers
❚ Transmitted by blood, other bodily,
perinatal transmission
❚ Prevention through immunization
Hepatitis D - Delta

❚ Can only cause infection in presence

of HBV
❚ Occurs primarily in persons who
have multiple exposures of HBV
❚ Transmission same as HBV
❚ More severe than HBV
❚ Prevention is same as HBV
HIV

❚ Infected patients have variety of

symptoms since disease has 3
stages

❙ Asymptomatic

❙ AIDS related complex- ARC

❙ AIDS
HIV

❚ Damages immune ❚ Consult physician-

and neurological may need premed
system if abnormal white
❚ Transmission via cell, fungslT-cell
blood,semen,vagin and/or platelet
al count
secretions,breast ❚ Patient may have
milk opportunistic
❚ Patient highly diseases
susceptible to ❙ fungal-candidiasis
infection ❙ bacterial-
HIV

❚ Neoplasms-Kaposi’s
sarcoma,squamous cell carcinoma,
Non-Hodgkin’s lymphoma
❚ Neurological disturbances- facial
palsy
❚ Unknown etiological diseases-
recurrent apthous ulcers, delayed
wound healing, salivary gland
enlargement, xerostomia
Herpes Virus Diseases

❚ Varicella-zoster:

❙ Chicken pox - highly contagious; lesions

on trunk

❙ Shingles- painful, burning and itching

lesions that may be anywhere on the
body
Herpes Virus Disease

❚ Epstein-Barr virus:Infectious
Mononucleosis

❘ Characterized by fever, swollen lymph

nodes and sore throat

❘ Transmitted orally by direct contact and

droplets
Herpes Virus Diseases

❚ Cytomegalovirus: CMV- Salivary

gland viruses-
❘ Occurs congenitally,postnatally, or at any
age, ranges in severity from a slight
infection without complications through
disease manifested by fever, hepatitis,
pneumonitis, and in neonates- severe brain
damage resulting in stillbirth or perinatal
deaths
❘ 60-90% adults have experienced infection
❘ Transmitted by blood transfusion, graft
transplant,sexual transmission,respiratory
Herpes Simplex Virus

❚ Primary herpetic gingivostomatitis-

primary infection may be
asymptomatic or with symptoms-
usually painful lesions and flu-like
symptoms
❚ Herpes labialis (HSV-1) or genital
herpes (HSV-2)- cold sores,fever
blister, both cause genital and oral-
facial infections that can’t be
distinguished clinically
Herpes Virus Disease

❚ Herpes labialis:
❙ Usually triggered by stress, sunlight,
illness or trauma
❙ Healing may take 10 days
❙ Lesions are infectious and can be
spread to eye, nose and genitals
❙ Treat after lesion has burst and dried,
crusted appearance
Herpes Virus Disease

❚ Herpetic Whitlow: HSV infection of

fingers that results from the virus
entering through minor skin
abrasions
❚ May be recurrent lesion of HSV-1 or
HSV-2
❚ Transmission results from direct
contact with a vesicular lesion on
patient’s lip or saliva- lesions are
Herpes Virus Diseases

❚ Ocular herpes- HSV-1 or HSV-2 in the

eye

❚ Transmission by splashing saliva or

fluid from lesion into eye, extension
from facial lesion, or during birth
Herpes Virus Diseases

❚ Clinician with a
herpetic lesion -

❙ Herpetic Whitlow -
direct patient care
should be avoided
for duration
❙ Herpes Labialis-
careful isolation
with mask,care that
mask does not
become moist