Dental Clinics of North America

A 34-year-old male patient living with human immunodeficiency virus (HIV) presents to the dental clinic with a 1-week history of throbbing tooth pain. He was referred by an oral medicine specialist for evaluation and treatment. The patient presents with very low absolute neutrophil, platelet, and cluster of differentiation (CD) (also T-helper cell) 4+ cell counts, as well as a high HIV RNA/viral load. Determining factors for dental management before extraction of the offending teeth were the absolute neutrophil count and platelet counts...

A 26-year-old man living with HIV and depression presents with symptoms of tooth sensitivity. His laboratory studies are all within normal limits except for a high viral load. The patient does not require any special dental management protocol and should be treated like other patients, with his laboratory studies reviewed every 6 months to 1 year. HIV is now a chronic medical conditions, with most patients having stable disease if they are compliant with their medications. Universal infection control protocols should be followed for all patients regardless of their HIV status...

Intraosseous arteriovenous malformations in jaws are rare congenital vascular abnormalities that the dentist may encounter. A vascular lesion or disease should be suspected when there is unexplained bleeding from the oral cavity. Diagnostic imaging is a valuable tool in diagnosing and localizing vascular lesions. An understanding of some of the salient clinical and radiographic features of arteriovenous malformations in jaws aids the clinician in correctly diagnosing this condition and avoids iatrogenic injuries, such as hasty tooth extraction, which may potentially cause severe bleeding and possibly death...

A 7-year-old girl came to the Emergency Department following an avulsion of the maxillary central incisor. The tooth was replanted and splinted. The patient was referred to a hematologist for follow-up and maintenance of adequate levels of Factor VIII.

Von Willebrand disease is a platelet phase bleeding disorder, affecting platelet aggregation and adhesion. It can be inherited or acquired in origin. Patients with von Willebrand disease can be successfully treated in a dental setting. This article discusses the dental management of a 74-year-old white woman presenting with pain and gingival erythema in the maxillary anterior area. The article emphasizes the importance of consultation with the hematologist in treating patients with von Willebrand disease, and understanding that disease severity varies in patients...

The authors describe the management of a 57-year-old man with hemophilia A who presents for extractions and implant placements. The patient required a combination of extractions, scaling and root planning, and composite restorations. The authors describe the management protocol for this patient as well as general considerations in the management of patients with hemophilia A.

Mönckeberg medial arteriosclerosis is a condition characterized by the calcification of the tunica media layer of the blood vessels that are visible on plain radiography or sectional tomography. In dentistry, a properly acquired panoramic radiograph may show the condition incidentally. It is also known as medial arterial calcinosis and can be associated with diabetes mellitus or chronic kidney disease. This condition is different from the more common atherosclerosis where the tunica intima remains unaffected, and the diameter of the vessel lumen is preserved...

A young female patient presents to a dental clinic for treatment of swelling and pain. Clinical examination and testing are completed revealing concomitant, suspected vascular pathology of the head and neck area. An endodontic diagnosis is made, but an unusual clinical finding of a vascular entity, not typically considered by dentists, requires interdisciplinary assessment and management with vascular surgery before surgical intervention of the oral cavity.

Human papilloma virus (HPV)-attributable head and neck cancers (HNCs) are on the rise, impacting younger patients compared with HPV (-) HNC. Fortunately, HPV (+) HNCs are associated with favorable prognoses and tend to be radiosensitive. However, radiation therapy for the treatment of HNC is associated with acute and chronic normal tissue toxicity to salivary glands, muscles, bone, and the oral cavity and presents a treatment challenge. Thus, the prevention of normal tissue injury and optimization of oral health are key...

Patients planned for hematopoietic stem cell transplantation (HSCT) routinely undergo dental evaluation. Conditioning before HSCT engenders immunosuppression that may lead to flares of oral infections. Before transplantation, the dental provider should educate the patient on the oral complications of HSCT and identify and treat dental needs as appropriate to the patient's medical status. Dental evaluation and treatment must be performed in close coordination with the patient's oncology team.

A 15-year-old boy attended Emergency Department with a complaint of difficulty in breathing due to dental infection. A pulmonologist was consulted regarding the severity of the cystic fibrosis. The patient was admitted and intravenous (IV) fluids and antibiotics were given. The infected mandibular right first permanent molar tooth # 30 was extracted under IV ketamine dissociative anesthesia in the hospital setting.

A 13-year old male patient with uncontrolled asthma presents with a grossly decayed permanent first molar. Medical consultation was obtained from a pulmonologist to understand the type and severity of asthma, history of allergies, aggravating factors, and medications. The patient was treated in the dental setting with nitrous oxide and oral conscious sedation with benzodiazepine.

Early dental screening and treatment before and after solid organ transplantation are recommended infection prophylaxis measures. Dental treatment after transplantation should only be rendered after a discussion with the patient's health-care provider and/or transplant surgeon to determine the patient's stability for dental care. Potential sources of acute or chronic oral infections should be evaluated at every visit. Periodontal evaluation and through dental prophylaxis should be performed. Oral hygiene instruction including the importance of maintaining excellent oral health after transplant should be reviewed...

As public health stewards, dental providers must be mindful of actual of potential infectious disease risks. Tuberculosis (TB) is a leading cause of death in adults worldwide and is spread via aerosolized droplets. Individuals at the greatest risk of contracting TB are those with impaired immunity or those who have a higher risk of being exposed to an infection due to environmental factors. Dental providers must be aware of the clinical and public health implications of treating people with active versus latent TB infections...

Cardiovascular diseases are among the most common medical problems in the general population. Individuals with underlying cardiac conditions require special considerations with regard to appropriateness of dental treatment and precautions needed to deliver safe and effective care. Patients with unstable cardiac disease are at higher risk of developing complications during dental treatment. Similarly, comorbid conditions among patients with ischemic heart disease, such as chronic obstructive pulmonary disease, can further affect dental health and treatment, and they often require more individualized dental approaches...

With increasing rates of asthma in the general population, dental professionals need to be able to recognize the signs and symptoms of poorly controlled asthma and modify dental treatment accordingly. Prevention of an acute asthma exacerbation is key. Patients should be reminded to bring their rescue inhaler with them to every dental appointment. Patients who are using inhaled corticosteroids to manage their asthma are at greater risk of oral candidiasis, xerostomia, and caries. Regular dental visits and good oral hygiene are important among this population...

Patients with chronic obstructive pulmonary disease (COPD) have varying degrees of compromised airway function that can affect their ability to tolerate dental treatment. Thus, the delivery of dental care to individuals with COPD may need to be modified based on an understanding of the severity and control of the patient's disease, exacerbating factors, frequency of signs/symptoms, and disease management protocols. There is a strong association between aspiration of plaque organisms and pneumonia in individuals with COPD...

A 11-year-old boy was referred from an orthodontist for routine extraction of premolars. The patient's cardiac condition was thoroughly examined, and the premolars were extracted following antibiotic prophylaxis to prevent bacterial endocarditis.

Poor oral health and/or dental disease are highly prevalent among stroke survivors. Muscle weakness and loss of dexterity can decrease the patient's ability to provide effective oral hygiene post-stroke. Modifications to dental treatment should be based on the degree of neurologic sequelae, including scheduling needs. Special considerations must be taken with individuals who have permanent cardiac pacemakers.

An in-depth understanding of coronary artery disease will be critical to providing safe and effective dental care. Individuals with ischemic heart disease are at increased risk for anginal symptoms during dental care. Consultation with a cardiologist is advisable to ascertain cardiac stability for dental care if a patient has undergone recent coronary artery bypass graft surgery (less than 6 months ago). Judicious use of vasoactive agents during dental treatment is recommended. Antiplatelet and anticoagulant medications should be continued and local hemostatic measures used to control bleeding...