Ebook Dental management of the medically compromised patient (9/E): Part 1

Part 1 book “Dental management of the medically compromised patient” has contents: Patient evaluation and risk assessment, infective endocarditis, ischemic heart disease, cardiac arrhythmias, pulmonary disease, sleep-related breathing disorders, gastrointestinal disease, liver disease,… and other contents.

Dental Management: A Summary, xiii

12 Chronic Kidney Disease and

Dialysis, 193

13 Sexually Transmitted Diseases, 210

Disease, 229

14 Diabetes Mellitus, 230

15 Adrenal Insufficiency, 255

16 Thyroid Diseases, 268

17 Women’s Health Issues, 288

18 AIDS, HIV Infection, and Related

22 Disorders of Red Blood Cells, 390

23 Disorders of White Blood Cells, 402

24 Acquired Bleeding and Hypercoagulable Disorders, 428

25 Congenital Bleeding and Hypercoagulable Disorders, 457

26 Cancer and Oral Care of Patients With Cancer, 480

and Psychiatric Disorders, 515

Medical Emergencies in the Dental Office, 597

B Guidelines for Infection Control in Dental Health Care Settings, 606

Oral Lesions, 623

D Drug Interactions of Significance in Dentistry, 639

Alternative Medicine of Potential Importance in Dentistry, 645 Index, 655

DENTAL

MANAGEMENT

Compromised Patient

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of the Medically Compromised Patient, 9th Edition,include the

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2015v1.0

Professor of Oral Diagnosis and Oral Medicine

Provost Distinguished Service Professor

Department of Oral Health Practice

Department of Microbiology, Immunology and Genetics

The University of Kentucky College of Dentistry and College of Medicine

Lexington, Kentucky

Morse Distinguished Professor and Director

Division of Oral Medicine, Oral Diagnosis and Oral Radiology

University of Minnesota

School of Dentistry and College of Medicine

Minneapolis, Minnesota

Library of Congress Cataloging-in-Publication Data

Names: Little, James W., 1934- author | Miller, Craig S., author | Rhodus,

Nelson L., author.

Title: Little and Falace’s dental management of the medically compromised

patient / James W Little, Craig S Miller, Nelson L Rhodus.

Description: Ninth edition | St Louis, Missouri : Elsevier, Inc., [2018] |

Preceded by Little and Falace’s dental management of the medically

compromised patient / James W Little … [et al.] 8th ed., c2013 |

Includes bibliographical references.

Identifiers: LCCN 2017025872 (print) | LCCN 2017027016 (ebook) | ISBN

9780323443951 (Ebook) | ISBN 9780323443555 (pbk : alk paper)

Subjects: | MESH: Dental Care | Dental Care for Chronically Ill | Oral Manifestations

Classification: LCC RK55.S53 (ebook) | LCC RK55.S53 (print) | NLM WU 29 | DDC

617.6–dc23

LC record available at https://lccn.loc.gov/2017025872

Printed in China

Last digit is the print number: 9 8 7 6 5 4 3 2 1

Senior Content Strategist: Jennifer Flynn-Briggs

Senior Content Development Specialist: Diane Chatman

Publishing Services Manager: Deepthi Unni

Project Manager: Manchu Mohan

Designer: Renee Duenow

LITTLE AND FALACE’S DENTAL MANAGEMENT OF

THE MEDICALLY COMPROMISED PATIENT, NINTH EDITION ISBN: 9780323443555

Copyright © 2018 by Elsevier, Inc All rights reserved.

Previous editions copyrighted 2013, 2008, 2002, 1997, 1993, 1988, 1984, and 1980.

No part of this publication may be reproduced or transmitted in any form or by any means, electronic

or mechanical, including photocopying, recording, or any information storage and retrieval system, without permission in writing from the publisher Details on how to seek permission, further

information about the Publisher’s permissions policies and our arrangements with organizations such

as the Copyright Clearance Center and the Copyright Licensing Agency, can be found at our website:

Practitioners and researchers must always rely on their own experience and knowledge in evaluating and using any information, methods, compounds, or experiments described herein In using such information or methods they should be mindful of their own safety and the safety of others, including parties for whom they have a professional responsibility.

With respect to any drug or pharmaceutical products identified, readers are advised to check the most current information provided (i) on procedures featured or (ii) by the manufacturer of each product to be administered, to verify the recommended dose or formula, the method and duration

of administration, and contraindications It is the responsibility of practitioners, relying on their own experience and knowledge of their patients, to make diagnoses, to determine dosages and the best treatment for each individual patient, and to take all appropriate safety precautions.

To the fullest extent of the law, neither the Publisher nor the authors, contributors, or editors, assume any liability for any injury and/or damage to persons or property as a matter of products liability, negligence or otherwise, or from any use or operation of any methods, products,

instructions, or ideas contained in the material herein.

In 2014, we lost our dearest colleague:

Each of us in dentistry has been truly blessed by Dr Silverman:

As a professor of oral medicine at University of California, San Francisco (UCSF) School of Dentistry, for many years, Silverman headed one of UCSF’s oral medicine clinics and was an advocate for prevention and early detection of oral cancer as well as AIDS Silverman was a diplomat of the American Board of Oral Medicine, past president of the Board, and past President of the American Academy of Oral Medicine (AAOM) Dr Silverman was a consultant to the American Dental Association Council on Scientific Affairs and a national spokesperson for the Association He published more than 300 scientific articles, chapters in textbooks, and monographs He received the prestigious Margaret Hay Edwards medal from the American Association for Cancer Education for outstanding contributions UCSF Enumeration on October 16, 2006, yet practiced until his death

Deceased August 14, 2014, at 88 years of age.

Dr Selverio Silverman, Jr., gave back so much to oral medicine profession worldwide and encouraged others around the world and as well as his fellow oral medicine colleges and students at UCSF’s oral medicine clinics yearly, stressing each to become an active member in AAOM Filled with pride and love, Bud exchanged his family stories over the years with each of us “Bud” was a very well-rounded doctor and family man who was filled with pride and love of both his family and his profession

Oral medicine educators, doctors, students, and AAOM members should never tire

of challenging each other academically because change makes for evolving changes, and teaming up with each other professionally makes for the very best for oral medicine

worldwide Giving is better than receiving always.

Thanks, “Bud,” for giving each of us your very best

Dear friend, you shall always be missed.

Dr “Bud” Silverman, Jr., has written the Foreword for this textbook for the prior last five editions This book serves as a textbook as well as a must-have reference book for every dental office in the United States as well as throughout the world

Dr Sol Silverman, Jr., and Dr James W Little were best friends for the past 45+ years Their world was carved with the same great values, yet they practiced and taught oral medicine more than 3250 miles apart Jim and Bud were tethered via phone as they dedicated their lives to oral medicine through their teachings, research, and their own publications and textbooks Each authored oral medicine textbooks as well as massive publications Each had the total support and love of each of their own families, their own university workplace, and fellow members of the AAOM Bud and Jim shared their love of sports by playing tennis, golf, and pick-up basketball into their 80s They kept young by enjoying their daily playtime with their college kids and all their AAOM friends

“Bud” Silverman is missed daily by each of us involved with oral medicine

Dr James W Little

It has been said that dental offices of the past were often

located upstairs, on second floors, to screen out those

who were too infirm to undergo dental treatment Patients

able to climb the flight of stairs to the office were

con-sidered fit enough to treat

Largely because of modern medical care, people today

are living and working with medical conditions that in

the past might have been disabling or even unsurvivable

Statistics from 2012 show that roughly half of

noninsti-tutionalized U.S adults had one or more of 10 chronic

medical conditions (hypertension, coronary heart disease,

stroke, diabetes, cancer, arthritis, hepatitis, weak or failing

kidneys, current asthma, or chronic obstructive pulmonary

disease) Almost a quarter (24.3%) had one of these

conditions, 13.87% had two, and 11.7% had three or

more Approximately one fourth of U.S adults have more

than one chronic illness.1

As one might expect, the incidence of chronic illness

increases with age A total of 69.5% of U.S adults age

55 to 64 years had one or more of six chronic

condi-tions (arthritis, current asthma, cancer, cardiovascular

disease, chronic obstructive pulmonary disease, and

diabetes), 37.1% had two or more, and 14.4% had three

or more For ages 65 years and older, the percentages

increase to 85.6%, 56.0%, and 23.1%, respectively

Women were more affected than men in all age groups

(2008 data).2

Prescription medication is a mainstay of modern health

care, and all age groups use them A total of 14.1% of

children younger than age 12 years, 17.3% age 12 to 29

years, and almost 20% of adults age 20 to 59 years use

a prescription medication Of adults age 60 years and

older, roughly a quarter take one or two prescription

medications, and almost four of 10 people (36.7%) take

five or more prescription medications.3 Almost one quarter

of U.S adults older than 65 years have three or more

chronic illnesses, and more than one third take five or

more medications

Nowadays, many patients no longer have “a doctor.”

Instead, a patient may see multiple doctors for his or

her various conditions, such as a cardiologist for

coro-nary artery disease, an endocrinologist for diabetes, a

rheumatologist for arthritis, an oncologist for cancer, a

psychiatrist for depression—the list can go on and on

This can make medical consultation challenging for the

dentist because each specialist focuses on his or her

own area and cannot be expected to be knowledgeable

about the details of dental diseases and treatments The

dentist cannot expect simply to request a “clearance”

from one of the patient’s physicians, who may not have a thorough understanding of what the proposed treatment entails

It is therefore essential that the dentist understand how patients’ dental diagnoses and planned treatment relate

to their medical diagnoses and treatment For example, some patients may take anticoagulants or have bleeding disorders that affect dental surgical options and require special considerations in treatment planning Medical treatments such as head and neck radiation therapy or antiosteoclast medications may impair healing after dental infections or dental surgical procedures, and failure to appreciate and take into account such relationships may put patients at risk for serious complications Some medical conditions, if unstable, may pose a risk of intraoperative medical emergency during dental treatment and may require modification of treatment planning and delivery Organ and hematopoietic transplant recipients are an increasingly large group of patients, and among their considerations is the potential for opportunistic infections and malignancies, which can occur in the oral cavity as well as elsewhere Certain medical problems may them-selves adversely affect dental health, such as a patient with physical or cognitive impairment that precludes effective dental hygiene or a patient whose illness or medication produces such profound xerostomia that caries cannot be controlled

Medications that a patient is taking may create the potential for interactions that must be considered when the dentist wishes to prescribe or administer a drug

In addition, therapeutic effects of medications, such as anticoagulation, or adverse effects, such as xerostomia

or mucosal reactions, may bear on dental management Advanced age, or renal, hepatic, or other diseases that alter drug uptake, metabolism, clearance, or response may require dosage adjustments Furthermore, each new drug creates the potential for known or as yet unknown drug interactions and side effects, and adverse effects

of older medications continue to be discovered with ongoing use

These are just a few examples of common conditions that can impact dental management Although the most complex and seriously ill patients may require specialists

to provide their dental care, no dentist will be able to avoid treating patients with medical problems altogether, and all dentists must be prepared for them This book, which has been thoroughly updated in the present edition, provides an excellent overview of pathophysiology and treatment of a broad range of common medical conditions

that will provide the dentist with understanding of the

interrelationships between patients’ dental and medical

care, as well as information on recommended

modifica-tions of treatment delivery Competency in this critical

and complex area of dentistry is essential to the safe

and effective provision of dental care to an increasingly

large part of our population Its importance cannot be

overstated

John C Robinson, MA, DDS, FAAOM

Santa Rosa, California

REFERENCES

1 Ward BW, Schiller JS, Goodman RA Multiple chronic

conditions among US adults: a 2012 update Prev Chronic

Dis 2014;11:130389.

2 CDC/National Center for Health Statistics National Health Interview Survey https://www.cdc.gov/nchs/

3 Gu Q, Dillon CF, Burt VL Prescription drug use

continues to increase: U.S prescription drug data for 2007-2008 NCHS data brief, no 42 Hyattsville, MD,

2010, National Center for Health Statistics.

The need for a ninth edition of Dental Management of

the Medically Compromised Patient became apparent

because of the continued, ever-increasing flow of new

knowledge and changing concepts in medicine and

dentistry

The purpose of the book remains to give dental

provid-ers an up-to-date, concise, factual reference work

describ-ing the dental management of patients with medical

problems The more common medical disorders that may

be encountered in a dental practice continue to be the

focus This book is not a comprehensive medical reference

but rather a book containing enough core information

about each of the medical conditions covered to enable

readers to recognize the basis for various dental

manage-ment recommendations Medical problems are organized

to provide a brief overview of the basic disease process,

epidemiology, pathophysiology and complications, signs

and symptoms, laboratory and diagnostic findings, and

currently accepted medical therapy of each disorder

This is followed by a detailed explanation and

recom-mendations for specific dental management and oral

considerations

The accumulation of evidence-based research over the

years has allowed us to provide specific dental management

guidelines that should benefit those who read this text

This includes practicing dentists, practicing dental

hygien-ists, dental graduate students in specialty or general

practice programs, and dental and dental hygiene students

In particular, the text is intended to give dental providers

an understanding of how to identify a significant medical

issue, ascertain the severity and stability of the disorder,

and make dental management decisions that afford the

patient the utmost health and safety

An important feature of the book is access to the Evolve

Resources for the ninth edition These continue to be

available at https://evolve.elsevier.com and include Evolve

Student and Evolve Instructor Resources Instructions for

activating these resources are included Working with our

publisher, Elsevier, it is our goal to provide more

informa-tion online via Evolve each year This will allow dentists,

dental hygienists, and students easy access to current

information

The “Dental Management: A Summary” at the front

of the book is a very important resource because it is

specific and to the point and serves as a current overview

This resource provides readers with a quick reference

review with annotation of the corresponding chapter

We are extremely pleased to welcome three experts

who serve as contributing authors for this ninth edition:

Dr Alexander Ross Kerr, clinical professor, Oral and Maxillofacial Pathology, Radiology, and Medicine, New York University, College of Dentistry; Dr Eric T Stoopler, associate professor and director of the Postdoctoral Oral Medicine Program, School of Dental Medicine, University

of Pennsylvania, School of Dental Medicine; and Nathaniel Simon Treister, chief, Division or Oral Medicine and Dentistry, Brigham and Women’s Hospital and Dana-Farber Cancer Institute and assistant professor of Oral Medicine, Harvard School of Dental Medicine Each of these authors made important contributions to this edition and reinvigorated our knowledge base We are pleased and proud to have these authors as a part of our team

NEW TO THIS EDITION

A number of major changes have been made in this ninth edition Near the front of most chapters, a clear statement has been made in red type regarding the complications that may occur Chapter 1 presents the dental management and risk assessment process that is used as an important framework throughout the book The Eighth Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure was added and explained in Chapter 3 Chapter 17 has been expanded and renamed “Women’s Health Issues.” It includes in-depth discussions of osteoporosis, osteonecrosis, and drugs used during pregnancy and breastfeeding The

2012 report of the American Dental Association/American Academy of Orthopaedic Surgeons on dental management

of invasive dental procedures for patients with knee and hip replacements was added to Chapter 20 Chapter 21was completely rewritten with new tables and figures added In Chapters 28 and 29, we made the decision not

to use The American Psychiatric Association fifth edition

of Diagnostic and Statistical Manual of Mental Disorders

(DSM) that was published in 2013 The authors are aware

of the implications of applying the new fifth edition of the DSM We decided to postpone the application This was based on the need to see how well accepted it becomes Thus, in this ninth edition the fourth edition of the DSM

is used

All remaining chapters have been updated where necessary, and new dental considerations appear for steroid supplementation, antibiotic prophylaxis, and patients taking bisphosphonates Some chapters have been provided with new color figures, boxes, and tables Continued emphasis has been placed on the medications used to treat medical conditions Dosages, side effects, and drug

interactions with agents used in dentistry—including those

used during pregnancy and breastfeeding—are discussed

in detail Emphasis also has been placed on having

contemporary equipment and diagnostic information to

assess and monitor patients with moderate to severe

medical disease

Our sincere thanks and appreciation are extended to

those many individuals who have contributed their time

and expertise to the writing and revision of this text These include but are not limited to Brian Loehr, Jolynn Gower, Diane Chatman, and Kathy Falk as head of the Dental Division at Elsevier

James W Little Craig S Miller Nelson L Rhodus

Dental Management: A Summary, xiii

1 Patient Evaluation and Risk Assessment, 2

2 Infective Endocarditis, 19

3 Hypertension, 38

4 Ischemic Heart Disease, 53

5 Cardiac Arrhythmias, 70

6 Heart Failure (or Congestive Heart Failure), 86

7 Pulmonary Disease, 101

8 Smoking and Tobacco Use Cessation, 128

9 Sleep-Related Breathing Disorders, 138

10 Liver Disease, 151

11 Gastrointestinal Disease, 176

12 Chronic Kidney Disease and Dialysis, 193

13 Sexually Transmitted Diseases, 210

PART VII Immunologic Disease, 308

18 AIDS, HIV Infection, and Related Conditions, 309

19 Allergy, 330

20 Rheumatologic Disorders, 345

21 Organ Transplantation, 370

22 Disorders of Red Blood Cells, 390

23 Disorders of White Blood Cells, 402

24 Acquired Bleeding and Hypercoagulable Disorders, 428

25 Congenital Bleeding and Hypercoagulable Disorders, 457

26 Cancer and Oral Care of Patients With Cancer, 480

B Guidelines for Infection Control in Dental Health Care Settings, 606

C Therapeutic Management of Common Oral Lesions, 623

D Drug Interactions of Significance in Dentistry, 639

E Drugs Used in Complementary and Alternative Medicine of Potential Importance in Dentistry, 645

Index, 655

Dental Management:

A Summary

This table presents several important factors to be considered in the dental management of medically

compromised patients Each medical condition is outlined according to potential problems related to

dental treatment, oral manifestations, prevention of problems, and complications potentially impacting

on dental treatment

This table has been designed for use by dentists, dental students, graduate students, dental hygienists,

and dental assistants as a convenient reference work for the dental management of patients who have

medical diseases discussed in this book

POTENTIAL MEDICAL PROBLEM RELATED

Infective Endocarditis (IE) Chapter 2 1.

teeth or perforation of the oral mucosa can

POTENTIAL MEDICAL PROBLEM RELATED

Hyperthyroidism (Thyrotoxicosis) Chapter 16 1.

sensitive to actions of epinephrine and other pressor amines; thus,

POTENTIAL MEDICAL PROBLEM RELATED

POTENTIAL MEDICAL PROBLEM RELATED

Thyroid Cancer Chapter 16 1

POTENTIAL MEDICAL PROBLEM RELATED

POTENTIAL MEDICAL PROBLEM RELATED

Sickle Cell Anemia Chapter 22 1

leading to possible acute crisis; codeine and acetaminophen

hypoxia at the termination of nitrous oxide

vasoconstrictor; for surgical procedures, use 1

POTENTIAL MEDICAL PROBLEM RELATED

Aplastic Anemia Chapter 22 1.

POTENTIAL MEDICAL PROBLEM RELATED

Multiple Myeloma Chapter 23 1.

with clotting factors, thereby inactivating the clotting factors (See

POTENTIAL MEDICAL PROBLEM RELATED

Bleeding Problem Suggested by Examination and History Findings But Lack of Clues to Underlying Cause Chapter 24 1.

POTENTIAL MEDICAL PROBLEM RELATED

Vascular Wall Alterations (Scurvy, Infection, Chemical, Allergic, Autoimmune, Other Agents or Factors) Chapter 24 1.

POTENTIAL MEDICAL PROBLEM RELATED

Anticoagulation with Coumarin Drugs (Warfarin) Chapter 24 1.

POTENTIAL MEDICAL PROBLEM RELATED

POTENTIAL MEDICAL PROBLEM RELATED

Disorders of Platelet Release Chapter 24 1.

Primary Fibrinogenolysis Chapter 24 1.

POTENTIAL MEDICAL PROBLEM RELATED

POTENTIAL MEDICAL PROBLEM RELATED

Congenital Disorders of Coagulation (Hemophilia) Chapter 25 1.

POTENTIAL MEDICAL PROBLEM RELATED

POTENTIAL MEDICAL PROBLEM RELATED

von Willebrand Disease Chapter 25 1.

POTENTIAL MEDICAL PROBLEM RELATED

POTENTIAL MEDICAL PROBLEM RELATED

to hypotension, bradycardia, severe

myopathy or cardiomyopathy); laxatives and diuretics

POTENTIAL MEDICAL PROBLEM RELATED

with elective and complex procedures delayed until effective medical management of depression

are common, and agents used by the dentist

(see later section on antipsychotic [neuroleptic]

or may develop as adverse effects of medications

POTENTIAL MEDICAL PROBLEM RELATED

Antidepressant Drugs Chapter 29 1.

taking to explore significant adverse effects associated with

POTENTIAL MEDICAL PROBLEM RELATED

Antimanic (Mood-Stabilizing) Drugs Chapter 29 1.

POTENTIAL MEDICAL PROBLEM RELATED

Antipsychotic (Neuroleptic) Drugs Chapter 29 1.

drug adverse effects are present: •

POTENTIAL MEDICAL PROBLEM RELATED

POTENTIAL MEDICAL PROBLEM RELATED

Drug and Alcohol Abuse Chapter 30 1.