Dental Management: High Risk Conditions Patient

High risk conditions patient in dental treatment include:

• Prosthetic valves
• Bacterial endocarditis history
• Single Ventricel states
• Great arteries' transposition
• Tetralogy of fallot

In dental care procedure, patient with these condition have potential problem such as:

• High risk of bacterial endocarditis secondary to dental treatment that resulting in significant bleeding. Patient that have had surgical repair to their heart could also have this risk.
• Patients that have been using long term anticoagulant therapy are at high risk of excessive bleeding.
• Patient with cyanosis may be prone to infection and have excessive bleeding.

Oral manifestation:

• No oral manifestation for prosthetic valves or history of previous bacterial endocarditis patient.
• Possible cyanotic appearance of oral mucosa for complex cyanotic congenital heart disease.
• Patient with heart problem also have possibility to get hematologic abnormalities. This condition could manifest as petechiae or ecchymosis in oral mucosa.

Prevention procedure

• Administration of prophylactic antibiotics before doing dental procedure that result in significant bleeding.
• Standard: oral amoxicillin
• Unable to take oral medications: IV or IM ampicillin
• allergic to penicillin: oral clindamycin
• Allergic to penicillin and unable to take oral medication: IV clindamycin

Treatment planning modification

• Administration of prophylactic antibiotics 1-3 hours before procedures likely to result in significant bleeding.
• Administration of second antibiotics if dental procedure take more than 4-6 hours or if multiple appointments occur on the same day.
• Patients that using anticoagulants medication may need to alter it doses depending on the level of anticoagulation and the extent of planned dental procedure.
• Take a break at least 9 days between dental treatment sessions so that penicillin-resistant organisms disapear from the oral flora. If treatment session must be done sooner than 9 days, select one of the alternative antibiotics for prophylaxis.

Dental Management Of The Medically Compromised Patient (Little, J.W.; et.al.)