Dentist's Guide to Medical Conditions, Medications and Complications (eBook)

Kanchan Ganda (Autor)

eBook Download: PDF

2013 | 2. Auflage
John Wiley & Sons (Verlag)
978-1-118-31390-9 (ISBN)

Infos

The second edition of Dentist's Guide to Medical Conditions, Medications and Complications continues to provide quick-access, clinical information on the dental treatment of patients with common systemic conditions and medical complications. Expanded in this second edition is information about patient medications. Ideal for general practitioners and students in advanced general dentistry programs, the book outlines protocols for treating patients with common conditions, presents essential drug interaction information, and guides the dental professional through prevention and management of in-office medical emergencies.

Kanchan Ganda, MD, is the Director of Medicine at Tufts Dental School and is responsible for the creation, implementation and co-ordination of teaching dental students. Additionally, she acts as Medical Consultant for all medically complex patients seen in the Tufts Dental Clinics. She also oversees the prevention and care of medical emergencies and personally lectures in continuing education courses to faculty and outside practitioners.

Inhalt

Dentist’s Guide to Medical Conditions, Medications, and Complications 3
Contents 9
Acknowledgments 14
Introduction: Integration of Medicine in Dentistry 16
I Patient Assessment 19
1 Routine History-Taking and Physical Examination 21
GENERAL OVERVIEW 21
Patient Interview Introduction 21
Patient Workup Sequential Pattern 21
Patient Interview Practical Points 21
Physical Examination Practical Points 22
History-Taking and Physical Examination: Broad Conclusions 22
HISTORY-TAKING DETAILS 22
Data Collection 23
Chief Complaint 23
Present History 23
Past History 23
Personal History 26
Family History 26
Review of Systems: Overview and Components 27
Review of Systems: Assessment Components 27
History-Taking Conclusion 30
PHYSICAL EXAMINATION: DETAILED DISCUSSION 30
Structure and Overview 30
PHYSICAL EXAMINATION: ASSESSMENT COMPONENTS 30
General Appearance 30
Vital Signs: Pulse, Respiration Rate, Blood Pressure, Height, and Weight 30
Examination of the Skin 32
Examination of the Head 32
Examination of the Ears 32
Examination of the Eyes 32
Examination of the Nose and Sinuses 34
Examination of the Mouth and Throat 34
Examination of the Neck: Lymph Glands, Thyroid, and Trachea 34
Examination of the Hands 36
Examination of the Back 36
Examination of the Lower Extremities 36
Examination of the Lungs or Pulmonary Examination 37
Examination of the Cardiovascular System 38
Examination of the Musculoskeletal System 39
Examination of the Cranial Nerves 41
2 History and Physical Assessment of the Medically Complex Dental 42
HISTORY AND PHYSICAL: INTRODUCTION 42
MEASURES ESTABLISHED WITH THE COMPLETE HEALTH HISTORY 42
Diabetes Assessment Example 43
Hypertension Assessment Example 43
Lanoxin (Digoxin) Assessment 43
Lanoxin (Digoxin) Mechanism of Action 44
Theophylline (Theo-Dur) Assessment 45
Over-the-Counter Drugs 45
Morphine and Codeine Cross-Reactivity 45
Corticosteroid History 45
Recreational Drugs 46
Oral Contraceptives 46
How Does the Patient Feel About Dentist Visits? 46
MEASURES ESTABLISHED WITH THE PHYSICAL EXAMINATION 46
TREATMENT PLAN ASSESSMENT 46
The Medical Consultation Case Note 50
Common Medical Abbreviations 50
II Pharmacology 51
3 Essentials in Pharmacology: Drug Metabolism, Cytochrome P450 Enzyme System, and Prescription Writing 53
DRUG METABOLISM OVERVIEW 53
CYTOCHROME ENZYME SYSTEM OVERVIEW 54
CYP System-Related Terminologies 55
Drug Transporters 55
CYP1A2 59
CYP2B6 60
CYP2C8 60
CYP2C9 60
CYP2C19 61
CYP2D6 61
CYP2E1 62
CYP3A4 62
PRESCRIPTION WRITING 64
Overview 64
Metric, Apothecary, Liquid Weight, and Household Measurement Systems 64
Prescription Abbreviations 65
Prescription Writing Regulations 65
Drug Enforcement Agency Number 65
DEA Drug Schedules 65
Pregnancy Drug Categories A–X 68
ELEMENTS OF PRESCRIPTION WRITING 69
Patient Specificity 69
Date 69
Patient’s Name, Date of Birth, and Address 70
Drug Name 70
No Substitution Box 70
Drug Strength 70
Drug Dose 70
Route of Administration 70
Duration of the Prescription 70
Total Amount of Drug Dispensed 71
Total Number of Refills 71
Drug Safety 71
Drug Regulations 71
Managed Care Guidelines 71
Convenience 71
Label Box Check Off and Drug Indication 71
4 Local Anesthetics Commonly Used in Dentistry: Assessment, Analysis, and Associated Dental Management Guidelines 72
LOCAL ANESTHETIC CLASSIFICATION AND PHARMACOTHERAPEUTICS 72
Classification of Amides with Epinephrine 72
Amide with Levonordefrin (NeoCobefrin) 72
Classification of Amides Without Epinephrine 72
Classification of Ester Local Anesthetics 72
Metabolism of Local Anesthetics 74
Factors Affecting Onset and Duration of Local Anesthetics 75
Local Anesthetics and Cross-Reactivity 76
Local Anesthetic Adjuncts 76
AMIDE AND ESTER LOCAL ANESTHETICS DETAILED DISCUSSION 76
Amide Local Anesthetics 76
Ester Local Anesthetics 79
Topical Benzocaine 79
Methemoglobinemia 80
LOCAL ANESTHETIC DENTAL ALERTS AND SUGGESTED DENTAL GUIDELINES 81
LOCAL ANESTHETIC COMPLICATIONS 83
Localized Complications 83
Generalized Complications 84
5 Pain Physiology, Analgesics, Opioid Dependency Maintenance Therapies, Multimodal Analgesia, and Pain Management Algorithms 85
ANATOMY AND PHYSIOLOGY OF PAIN 85
Introduction 85
Nociceptive Pain 85
Generation of Pain Impulse to Noxious Stimuli 86
Acute Pain Transmission 86
Acute Pain Perception 86
Acute Pain Modulation 87
Chronic Pain 87
Neuropathic Pain 87
Physical and Psychological Assessment of Pain 88
NONOPIOID ANALGESICS 89
Introduction 89
Acetaminophen (Tylenol) 89
IV Acetaminophen 92
Nonsteroidal Anti-Inflammatory Drugs (NSAIDS) 93
Aspirin 95
Ibuprofen and Naproxen 96
COX-2 Inhibitors 97
OPIOID ANALGESICS 98
Opioids Classification 99
Opioid Metabolism and the Liver 99
Opioid-Associated Effects and Side Effects 100
Opioid Antidote 100
FULL MORPHINE-LIKE OPIOID AGONISTS 100
Codeine 100
Morphine 102
Hydromorphone (Dilaudid) 103
Fentanyl 104
Oral Transmucosal Fentanyl Citrate 105
Oxycodone and Oxycodone + Acetaminophen (Percocet) 106
Hydrocodone and Hydrocodone + Acetaminophen (Vicodin) 108
Propoxyphene Dextropropoxyphene (Darvon) 109
Meperidine (Demerol) 109
Methadone 110
Oxymorphone (Opana) 111
PARTIAL OPIOID AGONISTS 111
Buprenorphine (Subutex) 111
Mixed Opioid Agonists-Antagonists 112
Pentazocine (Talwin) 112
NONNARCOTIC OPIATE AGONIST 112
Tramadol (Ultram) 112
OPIOID ALERTS AND SIGNIFICANT FACTS FOR DENTISTRY 113
ADJUVANTS 114
Corticosteroids 114
Benzodiazepines 115
Antihistamine H1 Blockers 115
Muscle Relaxants 115
Tricyclic Antidepressants (TCAs) 115
Bisphosphonates 116
MULTIMODAL ANALGESIA 116
Acute Multimodal Pain Management Algorithms in Opioid Na¨?ve and Opioid Dependent Patients 117
Chronic Pain Management Therapies 120
FDA SAFETY MEASURES FOR OPIOID MEDICATIONS 123
ANALGESICS SUMMARY 124
6 Odontogenic Infections, Antibiotics, and Infection Management 128
ODONTOGENIC INFECTION OVERVIEW AND MANAGEMENT FACTS 128
FACTORS ASSESSED PRIOR TO ANTIBIOTIC USE 128
ODONTOGENIC INFECTIONS: ORGANISMS AND DURATION OF INFECTION 129
Odontogenic Infection and Associated Antibiotic Management Protocol 129
Odontogenic Infection Types 130
Symptoms, Signs, Patient Immunity, and Vital Organ Status 130
ANTIBIOTIC PHARMACOTHERAPEUTIC CONSIDERATIONS AND FACTS FOR ODONTOGENIC INFECTIONS 135
Antibiotics and Dose-Selection Criteria 135
Minimum Inhibitory Concentration 136
Antibiotic Half-Life 137
Therapeutic Window 137
Antibiotic Spectrum of Activity 137
Bactericidal and Bacteriostatic Activity 138
Protein Synthesis Inhibitors 139
Antibiotic Resistance Mechanism 139
Antibiotic Drug-Drug Interactions 140
Antibiotics and Allergy 140
Antibiotics and Intestinal Bacterial Flora 140
Antibiotics and Water/Fluid Consumption 140
Oral Antibiotics and Oral Contraceptives 140
Antibiotics and Breast-Feeding 141
ANTIBIOTICS USED IN DENTISTRY 141
Antibiotic Classification 141
PENICILLINS 143
Overview 143
Penicillin Types 143
Penicillin VK 144
Penicillin G 145
Amoxicillin 145
Amoxicillin-Clavulanic Acid (Augmentin) 146
Ampicillin 147
Dicloxacillin 148
CEPHALOSPORINS 148
Cephalosporins Spectrum of Activity and Overview 148
Cephalosporins Adverse Effects 149
Cephalosporins Drug Use 149
Cephalosporins Prescriptions 150
LINCOSAMIDE GROUP ANTIBIOTIC, CLINDAMYCIN 150
Clindamycin Spectrum of Activity and Overview 150
Clindamycin Drug Uptake 151
Clindamycin Adverse Effects 151
Clindamycin Drug Uses 151
MACROLIDES 152
Macrolides Overview and Spectrum of Activity 152
Drugs Interacting with Azithromycin, Erythromycin, and Clarithromycin 154
Macrolides Prescriptions 154
NITROIMIDAZOLES: METRONIDAZOLE (FLAGYL) 155
Metronidazole (Flagyl) Spectrum of Activity and Overview 155
Metronidazole Adverse Effects 156
Metronidazole and DDIs 156
Metronidazole Prescriptions 156
TETRACYCLINES 157
Tetracyclines Spectrum of Activity and Overview 157
Tetracyclines Dosing 158
GLYCOPEPTIDES: VANCOMYCIN (VANCOCIN) 159
Vancomycin Spectrum of Activity 159
Vancomycin Adverse Drug Reactions 159
Vancomycin DDIs 160
Vancomycin Dosing 160
GLYCYLCYCLINE 160
Tigecycline Facts 160
Tigecycline Side Effects 161
Tigecycline Pharmacology 161
Tigecycline Dose 161
Tigecycline Associated DDIs 161
FLUOROQUINOLONES 161
Fluoroquinolones Facts 161
Fluoroquinolones Side Effects 162
AMINOGLYCOSIDES 162
Aminoglycosides Facts 162
Aminoglycoside Side Effects 162
Aminoglycoside Members 163
DICHLOROACETIC ACID DERIVATIVES 163
Chloramphenicol 163
Chloramphenicol Side Effects 163
LIPOPEPTIDES 163
Daptomycin 163
OXZOLIDINONES 164
Linezolid 164
SULPHONAMIDES 164
Sulphonamide Members 165
Sulfonamides Side Effects 165
INFECTION MANAGEMENT PROTOCOLS 165
Universal Infection Coverage 165
Anaerobic Infection Coverage 166
Pseudomonal Infection Coverage 166
MRSA Infection Coverage 166
Non-MRSA Gram-Positive Cocci Infection Coverage 166
Gram-Negative Sepsis Coverage 166
Sinusitis Infection Coverage 166
Pharyngitis Infection Coverage 167
Human Bite Coverage 167
7 Antifungals Commonly Used in Dentistry: Assessment, Analysis, and Associated Dental Management Guidelines 168
POLYENE AND AZOLE ANTIFUNGALS: OVERVIEW, FACTS, AND PRESCRIPTIONS 168
Polyene Antifungals: Mechanism of Action 168
Polyene Drug Classifications 168
Azole Drugs Classification 168
Imidazole and Triazole Antifungals: Mechanism of Action and Facts 168
Topical and Oral Nystatin 169
Amphotericin B (Fungizone) 169
Clotrimazole (Mycelex) 170
Ketoconazole (Nizoral) 171
Fluconazole (Diflucan) 171
Itraconazole (Sporanox) 172
Antifungals and Pregnancy 172
8 Antivirals Commonly Used in Dentistry: Assessment, Analysis, and Associated Dental Management Guidelines 173
ACYCLOVIR, VALACYCLOVIR, AND FAMCICLOVIR OVERVIEW AND FACTS 173
Common Features 173
Acyclovir (Zovirax) and Valacyclovir (Valtrex) Mechanism of Action 173
Acyclovir (Zovirax) and Valacyclovir (Valtrex) Clearance 173
Acyclovir (Zovirax) and Valacyclovir (Valtrex) Drug Resistance and Side Effects 174
Acyclovir 174
Valacyclovir 174
Famciclovir (Famvir) 175
III Acute Care and Stress 177
9 Management of Medical Emergencies: Assessment, Analysis, and Associated Dental Management Guidelines 179
MEDICAL EMERGENCIES OVERVIEW, FACTS, AND TOOLS 179
Prevention of Medical Emergencies 179
Preparation or Training for Medical Emergencies 180
Common Medications Used During Medical Emergencies 181
Emergency Equipment and Adjuncts 182
The Basics of Support: Airway, Breathing, and Circulation (The ABCs) 183
CLASSIFICATION OF MEDICAL EMERGENCIES 183
Syncope Attack 183
Chest Pains 184
Respiratory Distress 184
Adverse Drug Reactions 184
Seizures 184
VASOVAGAL SYNCOPE 184
Vasovagal Syncope Predisposing Factors 184
Vasovagal Prodrome Stage 184
Vasovagal Syncope Stage Vital Signs 184
Vasovagal Postsyncope Stage 184
Vasovagal Syncope Treatment 185
Vasovagal Syncope and Suggested Additional Steps of Care 185
Steps to Interrupt a Vasovagal Syncope Attack 185
ORTHOSTATIC HYPOTENSION 185
Orthostatic Hypotension Predisposing Factors 185
Orthostatic Hypotension Prodrome Stage 186
Orthostatic Hypotension Syncope Stage Vital Signs 186
Orthostatic Hypotension Pretreatment Diagnosis 186
Orthostatic Hypotension Prevention Strategy 186
HYPERVENTILATION SYNDROME 186
Hyperventilation Syndrome Predisposing Factors 186
Hyperventilation Syndrome Pathophysiology and Clinical Features 186
Hyperventilation Syndrome Additional Clinical Features 187
Hyperventilation Syndrome Vital Signs 187
Hyperventilation Syndrome Treatment 187
HYPOGLYCEMIA 187
Hypoglycemia Predisposing Factors 187
Hypoglycemia Clinical Features 187
Hypoglycemia Mild Stage 188
Hypoglycemia Moderate Stage 188
Hypoglycemia Vital Signs 188
Hypoglycemia Treatment 188
Hypoglycemia: Additional Suggested Recovery Facts and Alerts 189
TRANSIENT ISCHEMIC ATTACKS (TIAS) 189
Transient Ischemic Attacks Predisposing Factors 189
Transient Ischemic Attacks Clinical Features 189
Transient Ischemic Attacks Vital Signs 189
Transient Ischemic Attacks Treatment 189
CEREBROVASCULAR ACCIDENT 190
Cerebrovascular Accident Predisposing Factors 190
Cerebrovascular Accident Clinical Features 190
Cerebrovascular Accident Vital Signs 190
Cerebrovascular Accident Treatment 190
CARDIAC ARREST OF UNKNOWN ORIGIN 190
Cardiac Arrest Predisposing Factors 191
Cardiac Arrest Clinical Features 191
Cardiac Arrest Unresponsive Patient Management 191
HYPERGLYCEMIA 192
Hyperglycemia Clinical Features 192
Hyperglycemia Vital Signs 192
Hyperglycemia Treatment 192
ACUTE ADRENAL INSUFFICIENCY 193
Acute Adrenal Insufficiency Etiology 193
Acute Adrenal Insufficiency Clinical Features 193
Acute Adrenal Insufficiency Vital Signs 193
Acute Adrenal Insufficiency Treatment 193
ANGINA PECTORIS 193
Angina Pectoris Clinical Features 193
Angina Pectoris Vital Signs 193
Angina Pectoris Treatment 194
Angina Treatment Alerts 194
Nitroglycerine and Erectile Dysfunction: Drug Combination Alert 195
MYOCARDIAL INFARCTION 195
Myocardial Infarction Risk Factors 195
Myocardial Infarction Clinical Features 195
Myocardial Infarction Vital Signs 195
Myocardial Infarction Medical Management 195
FOREIGN BODY OBSTRUCTION (FBO) 196
Foreign Body Obstruction Facts 196
Foreign Body Obstruction Treatment 196
ASTHMA 196
Asthma Types 196
Acute Asthma Clinical Features 196
Asthma Vital Signs 197
Asthma Treatment 197
ANAPHYLAXIS/ALLERGY 197
Anaphylaxis/Allergy Clinical Features 197
Anaphylaxis/Allergy Treatment 197
LOCAL ANESTHETIC OVERDOSE 198
Local Anesthetic Overdose Clinical Features 198
Local Anesthetic Overdose Vital Signs 198
Local Anesthetic Overdose Treatment 198
EPINEPHRINE OVERDOSE REACTION 198
Epinephrine Overdose Clinical Features 198
Epinephrine Overdose Reaction Vital Signs 198
Epinephrine Overdose Reaction Treatment 198
SEIZURES 199
Prodromal Phase 199
Seizure or Ictal Phase 199
Aura Phase 199
Tonic Phase 199
Clonic Phase 199
Flaccid Phase 200
Seizure Treatment 200
10 Oral and Parenteral Conscious Sedation for Dentistry: Assessment, Analysis, and Associated Dental Management Guidelines 201
CONSCIOUS SEDATION OVERVIEW 201
SEDATION CLASSIFICATIONS 201
Anesthesiologist-Administered Deep Sedation 201
Intravenous (IV) Sedation or Deep Conscious Sedation 202
Inhalation Conscious Sedation 202
Oral Conscious Sedation 202
Inhalation and Oral Conscious Sedation: Additional Facts 202
PATIENT SELECTION AND INSTRUCTIONS FOR CONSCIOUS SEDATION 203
The American Society of Anesthesiology Status 203
Sedation and the Medically Compromised Patient 203
Conscious Sedation Contraindications 203
Conscious Sedation Patient Instructions 204
VITAL PARAMETERS AND CONSCIOUS SEDATION 204
Vital Parameters Timeline Protocol 204
Conscious Sedation Recovery Alerts 205
Conscious Sedation and the Aldrete Scoring System 205
Patient Assessment Alerts 205
COMPLICATIONS OF CONSCIOUS SEDATION 206
Respiratory Depression and Hypoventilation 206
Cardiac Complications and Hypotension 206
Inadequate Analgesia or Amnesia 207
CONSCIOUS SEDATION DRUGS CLASSIFICATION AND FACTS 207
Benzodiazepines Used for Conscious Sedation 207
Opioid Narcotics Used for Conscious Sedation 207
Barbiturates Used for Conscious Sedation 207
MIDAZOLAM (VERSED) 209
Midazolam (Versed) Dose 209
Intravenous Versed Pharmacology Facts 209
Intramuscular Midazolam (Versed) 209
Oral Midazolam (Versed) 209
IV Midazolam (Versed) Adverse Reactions 210
Midazolam (Versed) Lower Dose Alert 210
Midazolam (Versed) and Diazepam (Valium) Shared Properties 210
TRIAZOLAM (HALCION) 210
Halcion and DDIs 210
DIAZEPAM (VALIUM) 211
Diazepam (Valium) Facts and Pharmacology 211
IV Diazepam (Valium) Adverse Reactions 211
Oral Diazepam (Valium) 211
Oral Premedication Diazepam (Valium) Dosage 211
Diazepam Contraindications 212
LORAZEPAM (ATIVAN) 212
IV Lorazepam (Ativan) 212
Lorazepam (Ativan) Dosages 212
Lorazepam Contraindications 212
MORPHINE 213
Morphine (IV) Dose 213
HYDROMORPHONE (DILAUDID) 213
IV Hydromorphone Dose 213
PO (Oral) Hydromorphone Dose 213
FENTANYL (SUBLIMAZE) 213
Average Adult IV Fentanyl (Sublimaze) Dose 213
MEPERIDINE (DEMEROL) 213
Meperidine IV Dose 213
Intramuscular (IM) Meperidine (Demerol) 213
BARBITURATES 214
Pentobarbital (Nembutal) Dosages 214
Secobarbital (Seconal) Dosages 214
CONSCIOUS SEDATION OVERDOSE MANAGEMENT AND REVERSAL DRUGS 214
Conscious Sedation Reversal Drugs 214
FLUMAZENIL (ROMAZICON) 214
Flumazenil Seizure Alert 215
NALOXONE (NARCAN) 215
Naloxone Dose 215
IV Hematopoietic 217
11 Complete Blood Count: Assessment, Analysis, and Associated Dental Management Guidelines 219
HEMATOPOIETIC SYSTEM OVERVIEW 219
COMPLETE BLOOD COUNT COMPONENTS 219
The Red Blood Cell (RBC) 220
Hemoglobin (Hb) 220
Hematocrit (Hct) 220
Mean Corpuscular Volume (MCV) 220
Mean Corpuscular Hemoglobin (MCH) 221
Mean Corpuscular Hemoglobin Concentration (MCHC) 221
Red Cell Distribution Width (RDW) 221
Reticulocyte Count 221
WHITE BLOOD CELL (WBC) COUNT AND WBC DIFFERENTIAL FUNCTION 222
Neutrophils 222
Lymphocytes 222
Monocytes 222
Eosinophils 222
Basophils 222
White Blood Cell (WBC) Disorders 222
Immature WBCs 223
WBC Differential Patterns and Suggested Dental Guidelines 223
LEUKOPENIA AND ABSOLUTE NEUTROPHIL COUNT (ANC) 224
ANC Calculation Formula 224
Decreased Absolute Neutrophil Count (ANC) Classification 225
Severe Neutropenia and Infection Associated Symptoms and Signs 225
Severe Neutropenia (0–500 Neutrophils/mm3) Management Protocol 226
Mild (1,000–1,500 Neutrophils/mm3) or Moderate (500–1,000 Neutrophils/mm3) Neutropenia Management Protocol 226
12 Red Blood Cells Associated Disorder: Anemia: Assessment, Analysis, and Associated Dental Management Guidelines 227
NORMAL IRON METABOLISM 227
Iron Storage 228
Laboratory Tests 228
ANEMIA FACTS AND CLASSIFICATION 228
ANEMIA CLASSIFICATION BY ETIOLOGICAL FACTORS 229
Congenital/Hereditary/Hemolytic Anemia 229
Nutritional Anemia 229
Anemia of Chronic Disease/Malignancy-Related/Early Iron Deficiency/Acute Blood Loss/Chronic Renal Failure 230
Causes of Anemia of Chronic Disease 230
CONGENITAL/HEREDITARY ANEMIA 230
Overview 230
Complications Associated with Frequent Hemolysis 231
SICKLE-CELL ANEMIA 231
Sickle-Cell Anemia Major Manifestations 231
Sickle-Cell Anemia Medical Management 232
THALASSEMIA/COOLEY’S ANEMIA 232
Thalassemia Minor 232
Thalassemia Major 232
RBC Pattern 232
GLUCOSE-6-PHOSPHATE DEHYDROGENASE (G6PD) DEFICIENCY ANEMIA 232
Oxidant Drugs and Associated Hemolysis 232
Oxidant Drugs Contraindicated in the Medical Setting 233
G6PD CBC Pattern 233
HEREDITARY SPHEROCYTOSIS 233
Hereditary Spherocytosis RBC Pattern 233
IRON DEFICIENCY ANEMIA 233
Iron Deficiency Anemia Treatment 234
B12 DEFICIENCY ANEMIA 234
PERNICIOUS ANEMIA 235
The Schilling’s Test 235
FOLIC ACID DEFICIENCY ANEMIA 235
Folic Acid Deficiency Anemia Etiological Factors 235
Folic Acid Deficiency Anemia Treatment 235
DIAGNOSTIC CRITERIA FOR ALL TYPES OF ANEMIAS 235
Anemia Symptoms and Signs 235
Symptoms of Mild Anemia 236
Symptoms of Moderate-to-Severe Anemia 236
Symptoms of Severe Anemia 236
Anemia Signs 236
ANEMIA LABORATORY DIAGNOSIS AND TREATMENTS 236
Anemia Patterns 236
Anemia Treatments 237
SUGGESTED ANESTHETIC, ANALGESIC, ANTIBIOTIC, AND STRESS MANAGEMENT PROTOCOLS FOR ALL ANEMIAS 237
Mild Anemia: Hemoglobin Drop of 25% from Normal 237
Moderate Anemia: Hemoglobin Drop of 25–50% from Normal 237
Severe Anemia: Hemoglobin Drop of More than 50% from Normal 238
Suggested Local Anesthetic for G6PD Anemia 238
Suggested Analgesic Protocol for All Anemias Except G6PD Anemia 238
Suggested Analgesic Protocol for G6PD Anemia 238
Suggested Antibiotics Protocol for All Anemias 239
Anemia and Stress Management 239
13 Red Blood Cells Associated Disorder: Polycythemia: Assessment, Analysis, and Associated Dental Management Guidelines 240
POLYCYTHEMIA SYMPTOMS AND SIGNS 241
ABNORMAL LABORATORY VALUES ASSOCIATED WITH POLYCYTHEMIA 241
TREATMENT OF POLYCYTHEMIA 241
SUGGESTED DENTAL CONSIDERATIONS WITH POLYCYTHEMIA 242
14 Red Blood Cells Associated Disorder: Hemochromatosis: Assessment, Analysis, and Associated Dental Management Guidelines 243
HEMOCHROMATOSIS DIAGNOSIS 244
Additional Tests to Evaluate Affected Organ Systems 244
HEMOCHROMATOSIS MANAGEMENT 245
Hemochromatosis and Suggested Dental Considerations 245
V Hemostasis and Associated Bleeding 247
15 Primary and Secondary Hemostasis: Normal Mechanisms, Disease States, and Coagulation Tests: Assessment, Analysis, and Associated Dental Management 249
PRIMARY AND SECONDARY HEMOSTASIS: OVERVIEW, FACTS, AND ASSOCIATED DISEASE STATES 249
The Elements of Hemostasis 249
Physiology of Hemostasis 250
Elements Associated with Primary Hemostasis 250
Elements Associated with Secondary Hemostasis 250
Primary Hemostasis: Detailed Discussion 250
Secondary Hemostasis: Detailed Discussion 251
Clot Limitation 252
Clot Dissolution 252
Clotting Factor Facts 252
Clotting Factor Deficiency Causes 253
Coagulation Abnormalities Associated with Cirrhosis 253
Coagulation Abnormalities Encountered with Cirrhosis 254
CLOTTING FACTOR TESTS PT/INR AND PTT 256
Prothrombin Time (PT)/International Normalized Ratio (INR) 256
The International Normalized Ratio (INR) 256
The Partial Thromboplastin Time (PTT) 257
Global Coagulation Assessment Tests in Cirrhotics 257
Coagulopathy Management in Patients with Decompensated Cirrhosis 258
16 Platelet Disorders: Thrombocytopenia, Platelet Dysfunction, and Thrombocytosis: Assessment, Analysis, and Associated Dental Management Guidelines 261
THROMBOCYTOPENIA/PLATELET DEFICIENCY 261
Thrombocytopenia Causes 261
Thrombocytopenia Symptoms and Signs 261
Thrombocytopenia Laboratory Tests 262
Thrombocytopenia Treatment (Except ITP) 262
Thrombocytopenia Dental Alerts 262
IDIOPATHIC THROMBOCYTOPENIC PURPURA (ITP) 262
Symptoms 262
Causes 262
Risk Factors 263
Complications 263
Tests and Diagnosis 263
Treatments and Drugs 264
Medications 264
Steroid Treatment Protocol 265
Suggested Dental Guidelines for ITP 265
PLATELET DYSFUNCTION 266
Drugs Associated with Platelet Dysfunction 266
Platelet Dysfunction and von Willebrand’s Disease (vWD) 266
Antiplatelet Drug Therapy 266
THROMBOCYTOSIS 267
Thrombocytosis-Associated Symptoms 267
Suggested Dental Guidelines for Thrombocytosis 267
17 Von Willebrand’s Disease: Assessment, Analysis, and Associated Dental Management Guidelines 268
TYPES OF VON WILLEBRAND’S DISEASE 268
Type 1 vWD 268
Type 2 vWD 269
Type 3 vWD 269
Symptoms and Signs of vWD 269
Diagnosis of vWD 269
VWD TREATMENT 270
Treatment of Type 1 and Type 2A vWD 270
Treatment of Type 2B and Type 3 vWD 270
Suggested Dental Guidelines for vWD 271
18 Coagulation Disorders: Common Clotting Factor Deficiency Disease States, Associated Systemic and/or Local Hemostasis Adjuncts, and Dental Management 272
HEMOPHILIA A AND HEMOPHILIA B: OVERVIEW, FACTS, AND MANAGEMENT 272
Hemophilia A and Hemophilia B 272
Hemophilia Severity Classification 272
Hemophilia A and B Treatment 273
DDAVP Dosing 273
Hemophilia A and B Clotting Factor Replacement Therapy 273
Factors VIII and IX Sources 274
Factor VIII Products for Hemophilia A 274
Factor IX Products for Hemophilia B 274
ANTIFIBRINOLYTIC DRUGS: EPSILON AMINOCAPROIC ACID (AMICAR) AND TRANEXAMIC ACID (CYKLOKAPRON) 275
Epsilon Aminocaproic Acid (Amicar) Oral (PO) and Mouthwash Prescriptions 275
Tranexamic Acid/Cyklokapron Oral (PO) and Mouthwash Prescriptions 275
LOCAL HEMOSTATIC AGENTS 276
Microfibrillar Collagen (Avitene or Helistat) 276
Gelfoam 277
Thrombostat 277
Fibrin Glues 277
Surgicel 277
Amicar or Cyklokapron Mouthwashes 277
Calcium Sulfate 277
Moist Tea Bag 277
SUGGESTED DENTAL GUIDELINES FOR HEMOPHILIAS A AND B 277
HEMOPHILIA INHIBITORS 278
Mixing Study 279
ADDITIONAL FACTOR DEFICIENCIES 279
Factor XII Deficiency 279
Factor XIII Deficiency 279
19 Anticoagulants: Assessment, Analysis, and Associated Dental Management Guidelines 280
ANTICOAGULATION THERAPY OVERVIEW 280
WARFARIN (COUMADIN) 280
Warfarin (Coumadin) Reversal 281
Conditions Associated with Increased Risk of Thrombosis 281
STANDARD/UNFRACTIONATED HEPARIN (UFH)/INTRAVENOUS HEPARIN AND LOW MOLECULAR WEIGHT HEPARINS (LMWHS) 282
Mechanism of Action of IV and Low Molecular Weight Heparins 282
LMWH Preparations 283
DDIs Associated with Heparin 283
Heparin Antidote 283
WARFARIN AND HEPARIN PROTOCOLS AND SUGGESTED DENTAL GUIDELINES 283
DDIs Associated with Warfarin (Coumadin) 285
NEWER ANTICOAGULANTS 286
Introduction 286
New Anticoagulants General Pharmacology 286
Rivaroxaban (Xarelto) 287
Apixaban (Eliquis) 288
Apixaban Pharmacokinetics 288
Apixaban DDIs 288
Edoxaban (Lixiana) 289
Conclusions and Dental Alerts 289
Discontinuation of Newer Anticoagulants for Surgery 289
Converting from or to the Newer Anticoagulants 290
Reversal 290
VI Cardiology and 291
20 Rheumatic Fever: Assessment, Analysis, and Associated Dental Management Guidelines 293
RHEUMATIC FEVER FACTS AND OVERVIEW 293
The Major and Minor Jones Criteria 293
Major Jones Criteria 293
Minor Jones Criteria 295
RHEUMATIC FEVER (RF) DIAGNOSIS 296
RF Treatment 296
21 Infective Endocarditis and Current Premedication Prophylaxis 297
INFECTIVE ENDOCARDITIS 297
Overview 297
Acute Bacterial Endocarditis (ABE) 297
Subacute Bacterial Endocarditis (SBE) 297
Infective Endocarditis Clinical Features 298
Infective Endocarditis Treatment 298
PREMEDICATION PROPHYLAXIS 298
Conditions That Require AHA Premedication Prophylaxis 298
Conditions That Do Not Require AHA Premedication Prophylaxis 300
PROSTHETIC CARDIAC VALVES 301
Bioprosthetic Valves 301
Mechanical Valves 301
JOINT PROSTHESIS 302
Joint Prosthesis Overview and Facts 302
Joint Prosthesis Premedication Antibiotic Selection Criteria 303
SUGGESTED DENTAL GUIDELINES IN THE PRESENCE OF PREMEDICATION PROPHYLAXIS 303
22 Hypertension and Target Organ Disease States: Assessment, Analysis, and Associated Dental Management Guidelines 306
AUTONOMIC NERVOUS SYSTEM 306
HYPERTENSION 307
Hypertension Classification 307
2003 VII JOINT NATIONAL COMMISSION’S HIGH BLOOD PRESSURE GUIDELINES 308
MAJOR RISK FACTORS FOR HYPERTENSION 309
Target Organ Damage/Clinical Cardiovascular Diseases 309
Blood Pressure Measurement Follow-Up Guidelines 309
Blood Pressure Monitoring and Hypertension-Related Facts 309
Postural/Orthostatic Hypotension 310
Hypertension Treatment 310
HYPERTENSION AND TARGET ORGAN DISEASE 314
ANTIHYPERTENSIVE MEDICATIONS 314
Peripheral Adrenergic Receptor Blockers 314
Centrally Acting Adrenergic Blockers 315
Peripheral-Nerve Acting Adrenergic Blockers 315
DIRECT RENIN INHIBITORS 315
Mineralocorticoid Receptor Antagonists 316
HYPERTENSION-ASSOCIATED SUGGESTED DENTAL GUIDELINES 316
Anesthetics and Hypertension 316
23 Cerebral Circulation Diseases TIAs and CVAs: Assessment, Analysis, and Associated Dental Management Guidelines 318
TRANSIENT ISCHEMIC ATTACKS (TIAS) 318
Acute TIA Attack Management 318
TIA-Associated Suggested Dental Management Guidelines 318
STROKE/CEREBROVASCULAR ACCIDENTS (CVA) 319
Acute CVA Attack Management 319
CVA-Associated Suggested Dental Management Guidelines 319
24 Coronary Circulation Diseases, Classic Angina, and Myocardial Infarction: Assessment, Analysis, and Associated Dental Management Guidelines 320
PREVENTION AND TREATMENT OF ANGINA 320
Stable Angina 320
Angina Treatment and Prevention: Short-Acting Drugs 320
Optimal Prevention Treatments 320
First-Line Anti-Anginal Drugs 321
Additional Anti-Anginal Drugs 321
UNSTABLE ANGINA 322
Initial Medical Management of Unstable Angina 323
Acute Angina Attack 324
Angina Pectoris–Associated Suggested Dental Guidelines 324
Prinzmetal’s Angina 325
MYOCARDIAL INFARCTION 325
Acute Myocardial Infarction Attack 325
Surgical Reperfusion Options Post MI 326
MI Management Post Acute-Phase Recovery 326
MI-Associated Complication: CHF and Cardiac Arrhythmias 326
Dental Disease and MI Link 326
MI-ASSOCIATED SUGGESTED DENTAL GUIDELINES 327
25 Congestive Heart Failure: Assessment, Analysis, and Associated Dental Management Guidelines 329
CONGESTIVE HEART FAILURE (CHF) SYMPTOMS AND SIGNS 329
CHF Symptoms 329
CHF Signs 329
CONGESTIVE HEART FAILURE MEDICAL MANAGEMENT 330
SYSTOLIC HEART FAILURE NEW TREATMENT GUIDELINES 330
Beta-Blockers and Angiotensin-Converting Enzyme Inhibitors (ACEI) 330
Mineralocorticoid Receptor Antagonists (MRA) 330
Diuretics 330
Ivabradine (Procoralan) 330
Digoxin 330
Hydralazine and Isosorbide Dinitrate 331
ADDITIONAL CHF DRUG FACTS OF DENTAL IMPORTANCE 331
Diuretics 331
Vasodilators 331
Lanoxin (Digoxin) 331
26 Cardiac Arrhythmias: Assessment, Analysis, and Associated Dental Management Guidelines 333
CARDIAC ARRHYTHMIAS OVERVIEW 333
Sinus Tachycardia 333
Atrial or Supraventricular Arrhythmias 333
Ventricular Arrhythmias 334
SUGGESTED DENTAL GUIDELINES FOR ARRHYTHMIAS 334
Suggested Dental Guidelines for Tachyarrhythmias 334
Bradycardia 334
Suggested Dental Guidelines for Patients with Bradycardia 335
27 Peripheral 336
SYMPTOMS OF PERIPHERAL CIRCULATION DISEASE 336
SIGNS OF PERIPHERAL CIRCULATION DISEASE 336
SUGGESTED DENTAL GUIDELINE 336
28 Renal Function Tests, Renal Disease, and Dialysis: Assessment, Analysis, and Associated Dental Management Guidelines 337
KIDNEY FUNCTION TESTS 337
Serum Creatinine (S.Cr) 337
Creatinine Clearance (CrCl) 337
Proteinuria 338
Blood Urea Nitrogen (BUN) 338
Glomerular Filtration Rate (GFR) 338
Renal Imaging 339
CHRONIC KIDNEY DISEASE 339
Chronic Kidney Disease Pathophysiology 339
DECREASED RENAL FUNCTION AND ASSOCIATED HEMATOLOGICAL CHANGES SIGNIFICANT IN DENTISTRY 342
HEMODIALYSIS AND PERITONEAL DIALYSIS 342
Dialysis Overview 342
Hemodialysis 342
Hemodialysis Accesses 343
Intravenous Catheter Access 343
Arteriovenous (AV) Fistula or Arteriovenous Synthetic Graft 343
Peritoneal Dialysis 344
ANESTHETICS, ANALGESICS, ANTIBIOTICS, AND KIDNEY DISEASE 344
VII Pulmonary Diseases 349
29 Pulmonary Function Tests and Sedation with Pulmonary Diseases: Assessment, Analysis, and Associated Dental Management Guidelines 351
THE DIAGNOSTIC TOOLS TO DETECT PULMONARY DISEASE 351
History and Physical Examination 351
Laboratory Tests 352
Restrictive lung disease can be due to: 353
GENERAL ANESTHESIA OR CONSCIOUS SEDATION CONSIDERATIONS WITH PULMONARY DISEASES 354
Conscious Sedation 354
Oxygen Plus Nitrous Oxide 354
30 Upper Airway Disease: Allergic Rhinitis, Sinusitis, and Streptococcal Pharyngitis: Assessment, Analysis, and Associated Dental Management Guidelines 355
ALLERGIC RHINITIS 355
Allergic Rhinitis Symptoms 355
Allergic Rhinitis Treatment 355
SINUSITIS 355
Sinusitis Symptoms 356
Sinusitis Treatment 356
STREPTOCOCCAL THROAT INFECTION/BACTERIAL PHARYNGITIS 356
Symptoms and Signs of Streptococcal Throat Infection 356
Streptococcal Pharyngitis Diagnosis 357
Streptococcal Pharyngitis Treatment 357
31 Asthma and Airway Emergencies: Assessment, Analysis, and Associated Dental Management Guidelines 359
ASTHMA 359
Extrinsic Asthma 359
Intrinsic Asthma 359
Asthma Symptoms and Signs 359
Asthma Classification per the US National Heart, Lung, and Blood Institute 360
Asthma Etiological Factors 360
ASTHMA DIAGNOSIS 360
ASTHMA TREATMENT 361
Immediate-Relief Medications 361
Medications for Long-Term Control and Prevention of Asthma Attacks 361
Asthma Emergency Treatment Drugs 361
Asthma Management 363
Additional Asthma Facts 364
ASTHMA-ASSOCIATED SUGGESTED DENTAL GUIDELINES 364
Local Anesthetics and Asthma 365
Analgesics and Asthma 365
Oral Antibiotics and Asthma 365
Acute Airway Emergencies 365
32 Chronic Bronchitis and 366
CHRONIC BRONCHITIS 366
Chronic Bronchitis Treatment 366
Chronic Bronchitis Suggested Dental Guidelines 366
SMOKING CESSATION 366
Smoking Cessation Facts 367
Local and National Smoking Cessation Efforts 367
Smoking Risks 368
Smoking Cessation Benefits 368
Smoking Cessation Steps 368
SMOKING CESSATION NONPRESCRIPTION MEDICATIONS 370
Nicotine Patches (Nicoderm CQR /Habitrol) 370
Nicotine Gum (Nicorette) 370
Nicotine Lozenge (Commit) 371
Nicotine Inhalers (Nicotrol) 371
Nicotine Nasal Spray (Nicotrol NS) 371
SMOKING CESSATION PRESCRIPTION MEDICATIONS 372
Varenicline (Chantix) 372
Bupropion (Zyban or Wellbutrin) 372
33 Emphysema: Assessment, Analysis, and Associated Dental Management Guidelines 374
EMPHYSEMA FACTS 374
EMPHYSEMA TREATMENT 374
EMPHYSEMA-ASSOCIATED SUGGESTED DENTAL GUIDELINES 375
34 Chronic Obstructive Pulmonary Disease: Assessment, Analysis, and Associated Dental Management Guidelines 376
COPD ETIOLOGY 376
COPD SYMPTOMS AND SIGNS 377
COPD DIAGNOSIS 377
COPD CLASSIFICATION 377
Mild COPD 377
Moderate COPD 377
Severe COPD 378
Very Severe COPD 378
COPD TREATMENT GOALS 378
COPD Staging, Tests, Symptoms, and Treatment 379
Chronic Obstructive Pulmonary Disease (COPD) Staging 380
COPD Dental Alerts and Suggested Dental Guidelines 382
35 Obstructive Sleep Apnea: Assessment, Analysis, and Associated Dental Management Guidelines 383
OBSTRUCTIVE SLEEP APNEA FACTS 383
OSA RISK FACTORS 383
OSA TREATMENT 383
OSA DENTAL ALERTS 384
36 Tuberculosis: Assessment, Analysis, and Associated Dental Management Guidelines 385
TUBERCULOSIS EPIDEMIOLOGY 385
RISK FACTORS 385
TRANSMISSION 385
SYMPTOMS AND SIGNS 385
DIAGNOSIS 386
WHEN TO INITIATE TB TREATMENT 386
TYPES/FORMS OF TB 386
Latent TB 387
Active TB/Pulmonary TB 387
Multidrug Resistant (MDR) and Extensively Drug-Resistant (XDR) TB 387
Latent TB Treatment 387
Active TB/Pulmonary TB Treatment Regimens 388
PRECAUTIONS 388
TREATMENT GUIDELINES: DETAILED DISCUSSION 388
Isoniazide (INH) Side Effects 389
Rifampin (RIF) Side Effects 390
Ethambutol (EMB) Side Effects 390
Pyrazinamide (PZA) Side Effects 390
DDIs Among Anti-TB Medications and AAAs Used in Dentistry 390
SUGGESTED DENTAL GUIDELINES FOR TUBERCULOSIS 390
VIII Clinical Pharmacology 393
37 Prescribed and Nonprescribed Medications: Assessment, Analysis, and Associated Dental Management Guidelines 395
PRESCRIBED MEDICATIONS 395
OVER-THE-COUNTER MEDICATIONS 395
Aspirin or NSAIDS 395
Nasal Decongestants, Cough or Cold Preparations, and Appetite Suppressants 396
Laxatives 396
DRUGS CAUSING OR ASSOCIATED WITH ALLERGIES 396
Acute Anaphylactic Reaction 396
Mild or Moderate Anaphylaxis Reaction Management 398
RECREATIONAL DRUGS 398
Uppers 399
Downers 399
HERBAL MEDICATIONS 399
IX Endocrinology 401
38 Introduction to Endocrinology and Diabetes: Assessment, Analysis, and Associated Dental Management Guidelines 403
INTRODUCTION TO ENDOCRINOLOGY 403
The Endocrine System: Facts and Function 403
Endocrine Hormone Categories 404
Homeostatic Feedback Mechanisms 404
Pituitary Gland 404
Patterns of Hormonal Interactions 405
Hormones and Growth 405
Hormones and Stress 405
Hormones and Behavior 406
DIABETES OVERVIEW, FACTS, AND TESTS 406
Diabetes Overview 406
The Pancreas 406
Gut and Glucose Homeostasis 407
Kidneys and Glucose Homeostasis 407
Type 1 Diabetes 408
Type 2 Diabetes 408
Diabetes Symptoms and Signs 408
Diabetes Diagnostic Tests 408
ACUTE MEDICAL EMERGENCIES ASSOCIATED WITH DIABETES 410
Hypoglycemia 410
Hyperglycemia 410
CHRONIC MEDICAL COMPLICATIONS OF DIABETES 410
Microvascular Disease 410
Retinopathy 410
Macrovascular Disease 412
Neuropathy 413
Skin or Mucus Membrane Infections 413
DIABETES MANAGEMENT 413
Type 1 Diabetes 413
Type 2 Diabetes 413
Medical Management 413
DIABETES DENTAL ALERTS AND SUGGESTED MANAGEMENT GUIDELINES 414
Suggested Modifications for Major Surgery in the Outpatient Setting 418
Management Protocol for a Type I Diabetic Undergoing Inpatient Major Surgery Under General Anesthesia 418
Management During Major Surgery Under General Anesthesia for Patients on Insulin Pumps 419
Management Guidelines for a Type 2 Diabetic Undergoing Major Surgery Under General Anesthesia 419
Blood Sugar Values and Suggested Dental Management Guidelines 419
39 Thyroid Gland Dysfunctions: Assessment, Analysis, and Associated Dental Management Guidelines 421
THE THYROID GLAND 421
Thyroid Hormones 421
HYPERTHYROIDISM 422
Etiology 422
Clinical Features 422
Vital Signs and Cardiac Findings 422
Diagnosis 422
Treatment Options 423
Treatment Option Selection Protocol 423
Facts and Suggested Dental Guidelines 423
HYPOTHYROIDISM 424
Etiology 424
Symptoms 424
Signs 424
Diagnosis 424
Treatment 425
DDIs with Levothyroxine/L-Thyroxine 425
Facts and Suggested Dental Guidelines 425
Hypothyroidism and Local Anesthetics 425
Hypothyroidism and Sedatives, Hypnotics, and Narcotics 425
40 Adrenal Gland Disease States: Assessment, Analysis, and Associated Dental Management Guidelines 426
ADRENAL GLAND ANATOMY, PHYSIOLOGY, AND HORMONES 426
Adrenal Gland Anatomy 426
Adrenal Cortex Hormones 426
Adrenal Medulla Production 428
CUSHING’S SYNDROME 428
Etiology 428
Symptoms and Signs 428
Treatment 429
Associated Dental Alerts 429
ADDISON’S DISEASE 429
Etiology 429
Symptoms and Signs 430
Diagnosis 430
Dental Alerts and Suggested Guidelines 430
CORTICOSTEROID FACTS AND SUGGESTED DENTAL GUIDELINES 431
Alternate-Day Steroid Intake and Dentistry 432
Suggested Steroid Dose Guidelines for Stress-Associated Dentistry 432
Prednisone or Hydrocortisone Boost Protocol During Dental Emergency 433
41 Parathyroid Dysfunction Disease States: Assessment, Analysis, and Associated Dental Management Guidelines 435
PARATHYROID GLAND PHYSIOLOGY, FACTS, AND DYSFUNCTION OVERVIEW 435
Parathyroid Gland Physiology 435
Roles of the Gut, Parathyroid Glands, Vitamin D, and Kidney in Calcium Metabolism 436
Vitamin D Excess 438
BONE REMODELING PROCESS AND OSTEOPOROSIS 439
Bone Remodeling 439
Osteoporosis 441
ANTI-RESORPTIVE AGENTS 441
Classification 441
Anti-Resorptive Agent Uses 442
Anti-Resorptive Agent Side Effects 443
ANTI-RESORPTIVE AGENT–INDUCED OSTEONECROSIS OF THE JAW 443
Risk Factors Associated with ARONJ 444
Prevention Strategies 444
Identification Criteria 444
Radiographic, CT, and MRI Bone Findings Associated with Anti-Resorptive Agents 445
ARONJ Stages and Associated Treatments 447
Dental Alerts Associated with Anti-Resorptive Therapy 449
42 Growth Hormone Dysfunction and Endocrine Tissues of the Reproductive System 451
GROWTH HORMONE DYSFUNCTION 451
Hypothalamus-Pituitary Growth Hormone (GH/Somatotrophin) Axis 451
Acromegaly Facts 452
Acromegaly Treatment 452
Gigantism 453
ENDOCRINE TISSUES OF THE REPRODUCTIVE SYSTEM 453
The Gonads 453
X Seizure Disorders 455
43 Classic Seizures: Assessment, Analysis, and Associated Dental Management Guidelines 457
SEIZURE CLASSIFICATION, OVERVIEW, AND TREATMENT OPTIONS 457
Seizure Classification 457
General Introduction 457
Seizure Etiology 458
Seizure Diagnosis 458
Seizure Treatment 458
SEIZURE MEDICATIONS: OVERVIEW 458
Grand Mal Seizure Medications 458
Petit Mal Seizure Medications 459
SEIZURE MEDICATIONS: DETAILED DISCUSSION 459
Phenytoin Sodium (Dilantin) 459
Carbamazepine (Tegretol) 459
Phenobarbital (Barbita/Luminal) 460
Primidone (Mysolin) 460
Gabapentin (Neurontin) 460
Clonazepam (Klonopin) 461
Oxcarbazepine (Trileptal) 461
Valproic Acid (Depakene) 461
Ethosuximide (Zarontin) 461
Divalproex (Depakote) 461
Lamotrigene (Lamictal) 462
Topiramate (Topamax) 462
Zonisamide (Zonegran) 462
SEIZURE MEDICATIONS AND SUGGESTED DENTAL ALERTS 462
GRAND MAL SEIZURE 463
PETIT MAL SEIZURE 463
Etiology 463
Diagnosis 463
Treatment 463
XI Gastrointestinal Conditions and Diseases 465
44 Gastrointestinal Disease States and Associated Oral Cavity Lesions: Assessment, Analysis, and Associated Dental Management Guidelines 467
ANGULAR CHEILITIS 467
Predisposing Factors 467
Treatment 467
APHTHOUS ULCERS 467
Etiology 467
Treatment 468
PEUTZ-JEGHER’S SYNDROME 468
Etiology 468
Clinical Manifestations 468
Complications 468
ESOPHAGEAL CANCER 469
Risk Factors 469
GASTROESOPHAGEAL REFLUX DISEASE 469
Etiology 469
Clinical Features 469
Extra-Esophageal Manifestation of GERD 469
Complications 469
Treatment 469
Adjunct Treatment 470
PEPTIC ULCER DISEASE 470
Etiology 470
Classification 470
Symptoms 471
Diagnosis 471
Treatment 471
Complications 472
ESOPHAGITIS, GERD, AND PEPTIC ULCER SUGGESTED DENTAL ALERTS 472
PANCREATIC DISEASE: ACUTE PANCREATITIS 472
Clinical Features 473
Laboratory Tests 473
Diagnosis 473
Treatment 473
CELIAC SPRUE 473
Clinical Features 473
Diagnosis 474
Treatment 474
Suggested Dental Alerts 474
IRRITABLE BOWEL SYNDROME 474
Diagnosis 474
Medical Management 475
CLOSTRIDIUM DIFFICILE INFECTION 475
Facts 475
Symptoms and Signs 475
Diagnosis 475
Treatment 476
INFLAMMATORY BOWEL DISEASE 476
Epidemiology 476
CROHN’S DISEASE 476
Clinical Features 477
Diagnosis 477
Complications 477
Drug Therapy 477
ULCERATIVE COLITIS 478
Symptoms 478
Diagnosis and Medical Management 478
Medications and Treatment Alerts 479
CROHN’S DISEASE AND ULCERATIVE COLITIS SUGGESTED DENTAL GUIDELINES 480
DIVERTICULITIS 480
Suggested Dental Alerts 480
COLON CANCER 481
Facts 481
Diagnosis 481
Treatment 481
ADDITIONAL ALERTS AND SUGGESTED DENTAL GUIDELINES 481
XII Hepatology 483
45 Liver Function Tests, Hepatitis, and Cirrhosis: Assessment, Analysis, and Associated Dental Management Guidelines 485
LIVER FUNCTION TESTS 485
LIVER STATUS ASSESSMENT COMPONENTS 485
DETAILED DISCUSSION 485
Total Protein 485
Albumin 486
Globulin 486
Low Albumin and Normal LFT Profile 486
Prothrombin Time/International Normalized Ratio 486
ALT and AST 487
Bilirubin 487
Alkaline Phosphatase 488
Isolated Elevation of AP in an Asymptomatic Patient with Normal GGT 488
Gamma-Glutamyltransferase (GGT) 488
Other Specific Tests Diagnosing Causes of Liver Disease 489
LFTs and Coagulation Studies: Medical Case Note/Medical Record Lattice Recording 489
ACUTE VIRAL HEPATITIS: HEPATITIS A AND E 490
Acute and Chronic Viral Hepatitis Introduction 490
Hepatitis A and E: General Overview 490
Transmission 490
Symptoms and Signs 490
Infection Markers 490
Acute Viral Hepatitis LFT Profiles 491
Vaccinations 491
CHRONIC HEPATITIS: HEPATITIS B, C, AND D 491
Hepatitis B, C, and D: General Overview 491
Transmission 492
Symptoms and Signs 492
Hepatitis B: Detailed Discussion 492
Hepatitis B: Serological Markers 492
The Hepatitis B Antigen–Antibody Cycle Graph 492
Serological Markers Facts 492
The Hepatitis B Carrier Patient 494
The Carrier Patient and Dentistry 495
Hepatitis B Vaccine 495
Hepatitis B Post-Vaccination Testing 495
Combined Hepatitis A and B Vaccine 496
Hepatitis B Needle-Stick Exposure Rate 496
HEPATITIS C (HCV) 496
Hepatitis C: Detailed Discussion 496
Hepatocellular Carcinoma (HCC) Risk Factors 496
Hepatitis C Needle-Stick Exposure Rate 496
Hepatitis C Blood Tests 497
HCV Antibody Tests 497
Hepatitis C and Associated LFTs 498
Hepatitis C Treatment 499
ALCOHOLIC LIVER DISEASE 503
Alcoholic Liver Disease Facts 503
Alcoholic Hepatitis 503
Alcoholic Liver Disease Laboratory Tests 503
Alcoholic Liver Disease LFT Pattern 504
CIRRHOSIS OF THE LIVER 504
Cirrhosis Symptoms and Signs 504
Cirrhosis Complications 504
Cirrhosis and Associated LFTs 504
Hepatic Function Derangement in Cirrhosis 504
Cirrhosis Treatment 505
SUGGESTED DENTAL GUIDELINES WITH HEPATITIS OR CIRRHOSIS 505
BILIARY DISEASE 506
Primary Biliary Cirrhosis 506
Primary Biliary Cirrhosis Blood Test 506
Primary Sclerosing Cholangitis 506
XIII Postexposure Prevention and Prophylaxis 511
46 Needle-Stick Exposure Protocol and CDC Recommendations for Dental Health-Care Providers Infected with the Hepatitis B Virus 513
NEEDLE-STICK EXPOSURE OVERVIEW 513
Exposure Risks with Percutaneous and Mucocutaneous Exposures 513
ACCIDENT PREVENTION PROTOCOL 513
PERCUTANEOUS AND MUCOCUTANEOUS EXPOSURE PROTOCOL 514
EXPOSURE PROTOCOL 514
Postexposure Steps 514
Postexposure Tests: Protocol for the Source and the Provider/Healthcare Worker (HCW) 514
Tests for the Provider/HCW 515
Postexposure Medications 515
THE CDC OCCUPATIONAL POSTEXPOSURE PROPHYLAXIS GUIDELINES 516
PEP Therapy Side Effects 516
PEP Guidelines for Toxicity Monitoring and Transmission Protection 516
CDC RECOMMENDATIONS FOR DENTAL PROVIDERS INFECTED WITH THE HEPATITIS B VIRUS 516
Introduction 516
New CDC Recommendations for the Management of Infected HCWs and Students 517
Current HBV Therapies 517
Dental Procedures and HBV infection 518
HBV Vaccination and Screening 519
HCWs Conducting Category 1 EPP 519
XIV Infectious Diseases 521
47 Human Immunodeficiency Virus, Herpes Simplex and Zoster, Lyme Disease, MRSA Infection, and Sexually Transmitted Diseases 523
HUMAN IMMUNODEFICIENCY VIRUS 523
Human Immunodeficiency Virus (HIV) Specifics 523
Modes of HIV Transmission 524
Epidemiology of HIV 524
HIV Natural History 525
AIDS-Defining Conditions (ADC) in the Symptomatic Stage 525
HIV and AIDS Criteria Summary 526
HIV/AIDS TESTS 527
DIAGNOSTIC TESTS 527
The Non-Rapid Diagnostic Tests 527
Opt-Out Testing 527
The First FDA-Approved OTC HIV Test Kit 528
The Rapid Diagnostic Tests 528
QUANTITATIVE TESTS 528
The Role of Quantitative Virology and Antiretroviral Therapy 529
HIV RNA or Viral Load 529
ORGAN ASSESSMENT TESTS WITH MEDICATION INTAKE 529
Highly Active Antiretroviral Therapy (HAART) 531
HAART-Associated Lipodystrophy Syndrome and Metabolic Abnormalities 531
Cumulative Side Effects of HIV/AIDS Medications 531
PROPHYLAXIS AND TREATMENT OF OPPORTUNISTIC INFECTIONS 532
Primary and Secondary Opportunistic Infections Prophylaxis 532
HIV/AIDS TREATMENT 532
2012 Recommendations of the IAS-USA for ART 533
Treatment Endpoints 535
PREGNANCY AND HIV/AIDS 535
Highly Active Antiretroviral Therapy (HAART) 537
ART: Fixed-Dose Combinations (FDC) 539
HIV/AIDS DENTAL ASPECTS AND SUGGESTED DENTAL GUIDELINES 539
Dental Guidelines 539
Drugs Contraindicated with HIV/AIDS Medications 540
HERPES SIMPLEX AND HERPES ZOSTER INFECTIONS 540
Herpes Simplex 540
Herpes Zoster 542
LYME DISEASE 543
Overview 543
Prevention and Precautions 544
Presenting Features 544
Stages 545
Diagnosis 545
Treatment 546
Dental Alerts 548
METHICILLIN-RESISTANT STAPHYLOCOCCUS AUREUS (MRSA) 548
Introduction 548
Classification 549
Terminology 549
Clinical Presentation 550
Treatment 550
Prevention Steps in the Dental Setting 551
Routine Dental Care 552
Acute Dental Care 553
MRSA Prevention Protocol and Dental Alerts 553
SEXUALLY TRANSMITTED DISEASES 554
Overview 554
Chlamydia 554
Genital Herpes 555
Gonorrhea 555
Syphilis 555
XV Oral Lesions and Dentistry 557
48 Therapeutic Management of Oral Lesions in the Immune-Competent and the Immune-Compromised Patient in the Dental Setting 559
OVERVIEW 559
COMMON ORAL LESIONS 566
DETAILED DISCUSSION OF COMMON VIRAL INFECTIONS 566
Herpes Simplex, Herpes Zoster, and Cytomegalovirus 566
VIRAL INFECTION TREATMENTS 567
VALACYCLOVIR HCL (VALTREX) 567
Facts 567
Prescriptions 567
ACYCLOVIR (ZOVIRAX) PRESCRIPTIONS 568
FAMCICLOVIR (FAMVIR) 569
Famciclovir Facts 569
Famciclovir Dosing 569
ORAL VIRAL LEUKOPLAKIA AND HAIRY LEUKOPLAKIA 570
HIV-GINGIVITIS 570
HIV-G General Guidelines of Care 570
HIV-PERIODONTITIS 571
HIV-P Treatment 571
HIV-P Recommended Antibiotic Therapy 571
HIV NECROTIZING STOMATITIS 572
HIV Necrotizing Stomatitis Treatment 572
ORAL AND ESOPHAGEAL CANDIDIASIS 572
ANTIFUNGAL DRUGS 573
Antifungal Drugs Classification 573
CLOTRIMAZOLE (MYCELEX) TROCHES 573
Clotrimazole (Mycelex) Troches Facts 573
Clotrimazole Prescription 573
NYSTATIN (MYCOSTATIN) 573
Nystatin (Mycostatin) Prescriptions 573
AMPHOTERICIN B 574
Facts 574
Prescriptions 574
FLUCONAZOLE (DIFLUCAN) 575
Fluconazole (Diflucan) Facts 575
Fluconazole (Diflucan) Prescriptions 575
ANGULAR CHEILITIS 575
Angular Cheilitis Facts 575
Angular Cheilitis Prescriptions 575
ORAL KAPOSI’S SARCOMA 576
ORAL WARTS 576
RECURRENT APHTHOUS ULCERS 576
Classification 576
Minor Aphthous Ulcerations 577
Herpetiform Ulcerations 577
Treatment Options and Prescriptions 577
Antibiotic Therapy Prescriptions 578
Anti-inflammatory Agents Prescriptions 578
Immune Modulators Prescriptions 578
Topical Anesthetics Prescription 579
Prescription of Other Agents for Recurrent Aphthous Ulcerations 579
XEROSTOMIA (DRY MOUTH) 579
Etiology 579
Manifestations 580
Treatment Options 580
Saliva Substitutes Detailed Discussion 580
Saliva Stimulants Detailed Discussion 581
Pilocarpine HCL (Salagen) Overview 581
Cevimeline (Evoxac) 581
XVI The Female Patient: Pregnancy, Lactation, and Contraception 583
49 Pregnancy, Lactation, and Contraception: Assessment and Associated Dental Management Guidelines 585
PREGNANCY, LACTATION, AND CONTRACEPTION 585
Pregnancy Overview 585
Pregnancy and Trimesters 585
Pregnancy-Associated Symptoms and Signs 586
Pregnancy Tests 586
PREGNANCY-ASSOCIATED CHANGES 587
Dietary Changes 587
Cardiovascular Changes 587
Gastrointestinal Changes 588
Oral Cavity Changes 588
TERATOGENIC DRUGS AND FDA DRUG CATEGORIES 589
Teratogenic Drugs Facts 589
FDA Drug Categories 590
DRUGS CONTRAINDICATED DURING PREGNANCY 590
Drugs Absolutely Contraindicated During Pregnancy 590
RADIATION AND PREGNANCY 590
Fetal Risks with Improper Radiation Exposure 591
GENERAL ANESTHESIA AND PREGNANCY 591
SUGGESTED GENERAL PRINCIPLES OF PREGNANT PATIENT CARE 591
SPECIFICS OF PREGNANT PATIENT CARE IN THE DENTAL SETTING 592
Trimester Dental Guidelines 596
Suggested Guidelines for Anesthetics, Analgesics, Antibiotics Use During Pregnancy 597
LACTATION/BREAST-FEEDING 597
Safe Local Anesthetics During Lactation 598
Safe Analgesics During Lactation 598
Safe Antibiotics During Lactation 600
Unsafe Antibiotics During Lactation 600
ORAL AND SYSTEMIC CONTRACEPTIVES 600
Hormonal Contraception 600
Commonly Available Contraceptives 600
Long-Acting Contraception Alerts 601
Antibiotic Use with Oral Contraceptives 601
XVII Rheumatology: Diseases of the Joints, Bones,and Muscles 605
50 Classic Rheumatic Diseases: Assessment and Associated Dental Management Guidelines 607
RHEUMATOLOGY OVERVIEW, FACTS, AND DISEASE CLASSIFICATION 607
Classification of Rheumatic Diseases 607
SYSTEMIC LUPUS ERYTHEMATOSUS 608
Overview 608
Eleven Criteria Associated with SLE 608
Symptoms and Signs 609
Treatment 609
Drug Precautions 609
SCLERODERMA 609
Forms of Scleroderma 609
Clinical Features 610
Diagnosis 610
Treatment 610
SJÖGREN’S SYNDROME 610
Introduction 610
Complications 611
Xerostomia-Associated Oral Side Effects and Dental Alerts 612
Prognosis 613
Treatment 613
Dry Mouth Therapy 613
Topical and Systemic Therapies 614
REITER’S SYNDROME 615
Characteristic Features 615
Treatment 615
BEHÇET’S SYNDROME 616
Clinical Features 616
Behçet’s Syndrome Treatment 616
TEMPORAL OR GIANT CELL ARTERITIS 616
Classic Features 616
Diagnostic Test 617
Treatment 617
RHEUMATOID ARTHRITIS 617
Clinical Features 617
Cervical Spine Involvement 617
Cervical Spine Involvement Diagnosis 617
Cervical Spine Involvement Treatment 617
Cricoaritenoid Arthritis 618
Rheumatoid Arthritis Blood Tests 618
Rheumatoid Arthritis Treatment 618
OSTEOARTHRITIS 618
Facts 618
ANKYLOSING SPONDILITIS 618
Clinical Features 618
Diagnosis 619
General Anesthesia 619
DIFFUSE IDIOPATHIC SKELETAL HYPEROSTOSIS OR FORESTIER DISEASE 619
Facts 619
GOUT 619
Facts 619
Symptoms and Signs 619
Clinical Features 619
Diagnosis 620
Treatment 620
Medications: Acute and Maintenance Drugs 620
ANTIRHEUMATIC MEDICATIONS 621
BIOLOGIC RESPONSE MODIFIERS 622
Classification 622
Common TNF Blockers 622
DMARDS 622
NSAIDS 625
Classification 625
Acetylated Salicylate: Aspirin 625
Nonacetyl Salicylates 625
Traditional NSAIDS 626
Cyclo-oxygenase (COX)-2 Inhibitors 626
SUGGESTED DENTAL GUIDELINES FOR RHEUMATIC DISEASES 627
DISEASES OF THE BONES: PAGET’S DISEASE 628
Pathophysiology 628
Symptoms and Signs 628
Common Symptoms 628
Diagnosis 629
Complications 629
Treatment 629
SUGGESTED DENTAL GUIDELINES FOR PAGET’S DISEASE 630
DISEASES AFFECTING MUSCLES: MALIGNANT HYPERTHERMIA 630
Pathophysiology 631
Causative Factors 631
Diagnostic Tests 631
Symptoms and Signs 631
Treatment 631
Suggested Safe Drugs for Use in Dentistry 632
DISEASES AFFECTING MUSCLES: POLYMYOSITIS AND DERMATOMYOSITIS 632
Polymyositis 632
Polymyositis Symptoms and Signs 632
Dermatomyositis Symptoms and Signs 633
Polymyositis and Dermatomyositis Diagnosis 633
Polymyositis and Dermatomyositis Complications 633
Polymyositis and Dermatomyositis Management 633
Polymyositis and Dermatomyositis Suggested Dental Alerts 633
DISEASES AFFECTING MUSCLES: PARKINSON’S DISEASE 634
Presentation 634
Diagnosis 634
Management 634
Suggested Dental Guidelines 635
DISEASES AFFECTING MUSCLES: MYASTHENIA GRAVIS 635
Symptoms and Signs 635
Diagnostic Tests 636
Treatment 636
Suggested Dental Guidelines 636
DISEASES AFFECTING MUSCLES: MULTIPLE SCLEROSIS 637
Multiple Sclerosis Types 637
Age of Onset 637
Symptoms and Signs 637
Diagnosis 638
Treatment 638
SUGGESTED DENTAL ASPECTS AND GUIDELINES FOR MULTIPLE SCLEROSIS 639
Multiple Sclerosis and Anesthetics 640
Multiple Sclerosis and Analgesics 640
Multiple Sclerosis and Antibiotics 641
XVIII Oncology: Head and Neck Cancers, Leukemias,Lymphomas, and Multiple Myeloma 643
51 Head and Neck Cancers and Associated Dental Management 645
ONCOLOGY OVERVIEW 645
HEAD AND NECK CANCER DETECTION AND THE DENTIST 645
NEOPLASMS OF THE ORAL CAVITY 646
NEOPLASMS OF THE NASAL CAVITY 646
HEAD AND NECK CANCER SYMPTOMS AND SIGNS 646
LYMPH NODES OF THE HEAD AND NECK 646
Lymph Nodes Surrounding the Base of the Skull 646
The Cervical Chain of Lymph Nodes 647
GENERAL CANCER RISK FACTORS AND PREVENTION 647
Smoking as a Cancer Factor 647
Alcohol as a Cancer Factor 648
Miscellaneous Risk Factors 648
CANCER PREVENTION 649
SCREENING TESTS FOR CANCER DETECTION AT SPECIFIC BODY SITES 649
CANCER MANAGEMENT 649
CANCER DIAGNOSTIC AIDS 649
CANCER STAGING 649
Broder’s Classification 649
The TNM Staging System 650
The TNM Stages 650
American Joint Committee on Cancer (AJCC) Stage Groupings 651
The Eastern Cooperative Oncology Group Scale 651
CANCER TREATMENT 651
Treatment Options and Goals 651
Treatment Principles 652
Treatment Response Definitions 652
Head and Neck Cancer Treatment Options 652
HEAD AND NECK CANCER TREATMENT 653
Surgery 653
Radiation Therapy 653
Chemotherapy 653
BONE MARROW TRANSPLANT 654
Bone Marrow Transplant Complications 654
IMPORTANT HEAD AND NECK CANCER FACTS 655
Localized and Systemic Complications Associated with Head and Neck Cancer Therapy 655
HEAD AND NECK CANCERS AND DENTISTRY 655
OSTEORADIONECROSIS 656
CHEMOTHERAPY-ASSOCIATED LOCALIZED AND SYSTEMIC SIDE EFFECTS 657
Myelosuppression 657
Fever and Oral Infections 657
Graft Versus Host Disease 657
Organ Damage 657
Neurotoxicity 657
Integument Involvement 658
Toothache 658
SUGGESTED DENTAL GUIDELINES FOR THE CHEMOTHERAPYAND/ OR RADIOTHERAPY-TREATED HEAD AND NECK CANCER PATIENT 658
ORAL LESIONS AND SIDE EFFECTS ASSOCIATED WITH CHEMOTHERAPY AND RADIOTHERAPY, AND SUGGESTED MANAGEMENT GUIDELINES 659
Mucositis 659
Xerostomia 662
Infections 663
Trismus 664
LEUKEMIA 664
Acute Leukemias Overview 664
Chronic Leukemias Overview 664
Prevalence 665
Symptoms and Signs 665
Diagnosis 665
Treatment Terminology 665
Leukemia Treatment 666
Treatment Protocols 666
ACUTE LYMPHOBLASTIC LEUKEMIA (ALL) TREATMENT PROTOCOL 666
Induction Chemotherapy 666
Consolidation Chemotherapy 666
Maintenance Chemotherapy 666
ACUTE MYELOID LEUKEMIA (AML) TREATMENT PROTOCOL 666
Remission Induction Therapy 667
Consolidation Therapy 667
Leukemia and Suggested Dental Guidelines 667
HODGKIN’S LYMPHOMA 667
Overview 667
Pathophysiology 667
Risk Factors 667
Symptoms and Signs 667
Diagnosis 668
Staging 668
Treatment 668
Suggested Dental Guidelines 668
NON-HODGKIN’S LYMPHOMA (NHL) 669
Pathophysiology 669
Etiology 669
Symptoms and Signs 669
Diagnosis 669
Staging 669
Treatment 669
NHL and Suggested Dental Guidelines 670
MULTIPLE MYELOMA 670
Normal Bone Cell Activity 670
Normal Immunoglobulin Production Cycle 670
Immunoglobulins 671
Malignant Plasma Cells Formation Cycle and Associated Pathophysiology 671
Multiple Myeloma Prevalence 671
Multiple Myeloma Clinical Features 672
Symptoms and Signs 672
Multiple Myeloma Types 674
Multiple Myeloma Diagnosis 674
Multiple Myeloma Treatment 675
Treatment Classification 675
Treatment Options 676
Multiple Myeloma Suggested Dental Guidelines 677
XIX Psychiatry 679
52 Psychiatric Conditions: Assessment of Disease States and Associated Dental Management Guidelines 681
ANXIETY DISORDERS 681
Anxiety Disorder Classification 681
Treatment of Anxiety Disorders 682
Anxiety Medications 682
Anxiety Disorders and Alcohol Abuse 682
Anxiety Disorders and Suggested Dental Alerts 683
MOOD DISORDERS: DEPRESSION 684
Major Depressive Episode Symptoms 684
Depression Disorder Classification 684
Bipolar Disorder/Manic-Depressive Psychosis 684
DEPRESSION AND SUGGESTED DENTAL ALERTS 689
DEMENTIA 690
Overview and Facts 690
Classification 691
ALZHEIMER’S DISEASE 691
AD Identifying Biomarkers 691
AD Classification 692
The Standardized Mini-Mental State Examination 692
AD Pharmacotherapy 692
FDA-Approved ChEIs for AD Management 693
Future Therapies: Gammagard for Alzheimer’s Patients 693
AD Medication Alerts 693
ALZHEIMER’S DISEASE SUGGESTED DENTAL GUIDELINES 694
SCHIZOPHRENIA 694
Symptoms 695
Diagnosis 695
Treatment 695
SCHIZOPHRENIA SUGGESTED DENTAL GUIDELINES 696
EATING DISORDERS 696
Eating Disorder Classification 696
Anorexia Nervosa 696
Bulimia 697
Binge Eating 697
Eating Disorders Treatment 697
EATING DISORDERS SUGGESTED DENTAL GUIDELINES 698
XX Transplants 701
53 Organ Transplants, Immunosuppressive Drugs, and Associated Dental Management Guidelines 703
ORGAN TRANSPLANTS OVERVIEW AND FACTS 703
Kidney Transplant Facts 703
Liver Transplant Facts 704
Cells Responsible for Prevention of Organ Rejection 704
TYPES OF IMMUNOSUPPRESSION 704
Induction Immunosuppression 704
Maintenance Immunosuppression 705
Anti-Rejection Immunosuppression 705
IMMUNOSUPPRESSANT DRUGS 705
AZATHIOPRINE (IMURAN) 705
Mechanism of Action 705
Side Effects 705
CYCLOSPORINE (SANDIMMUNE) 705
Mechanism of Action 706
Facts 706
Side Effects 706
Drug Interactions 706
TACROLIMUS (PROGRAF), FK506 706
Mechanism of Action 707
Side Effects 707
Drug Interactions 707
Suggested Dental Alert 707
PREDNISONE 707
Mechanism of Action 707
Side Effects 707
Suggested Dental Facts and Alerts 707
MYCOPHENOLATE MOFETIL (CELLCEPT) 708
Mechanism of Action 708
Side Effects 708
SIROLIMUS (RAPAMYCIN) 708
Mechanism of Action 708
Side Effects 708
OTHER MEDICATIONS 708
Antibiotics 709
Anti-Fungal Medications 709
Anti-Ulcer Medications 709
Antivirals 709
Diuretics 709
Statins 709
TRANSPLANTS AND CANCERS 709
Types of Cancers 709
Cancer Risk Factors 710
Prevention and Early Detection 711
SUGGESTED DENTAL GUIDELINES FOR ORGAN TRANSPLANT PATIENTS 711
XXI Common Laboratory Tests 713
54 Comprehensive Metabolic Panel and Common 715
THE COMPREHENSIVE METABOLIC PANEL COMPONENTS 715
COMMON HEMATOLOGICAL TESTS AND DENTISTRY 715
THE CMP AND DENTISTRY 716
Lattice Pattern Recordings: CBC, PT/INR, and CMP 716
Appendix: Suggested Reading 717
Index 761

Produkt-Details

• Erscheint lt. Verlag: 23.5.2013
• Sprache: englisch
• Themenwelt: Medizin / Pharmazie ► Gesundheitsfachberufe
• Themenwelt: Medizin / Pharmazie ► Medizinische Fachgebiete
• Themenwelt: Medizin / Pharmazie ► Zahnmedizin
• Schlagworte: Common • complications • Conditions • Dental • dentistry • dentists • Einführung i. d. Zahnmedizin • Einführung i. d. Zahnmedizin • Guide • highly accessible • Introductions to Dentistry • Oral Sciences & Technology • patients • protocols • Readers • Reference • Systemic • thorough • Treatment • wholepatient context • Wissenschaft u. Technologie der Mundheilkunde • Zahnmedizin
• ISBN-10: 1-118-31390-9 / 1118313909
• ISBN-13: 978-1-118-31390-9 / 9781118313909