44: Clients with Special Needs

SECTION 10 Clients with Special Needs


Quick Reference—Dental Hygiene Care Implications for Individuals with Cardiovascular Disease

Disease Implications for Dental Hygiene Care Dental Hygiene Actions
Rheumatic heart disease Special attention to oral self-care practices; self-inflicted bacteremias may occur when oral disease is present. Careful manipulation of soft tissues during instrumentation; ADA-accepted antibacterial mouth rinse to reduce transient bacteremia.
Infective endocarditis

Careful manipulation of soft tissue; antibacterial mouth rinse to reduce transient bacteremia. Valvular heart defects

If anticoagulant medication is being used and scaling procedures are planned, dosage of anticoagulant medication should be discussed with client’s cardiologist. Mitral valve prolapse Special attention to oral self-care practices because self-inflicted bacteremias may occur when oral disease is present. Careful manipulation of soft tissues during instrumentation to reduce transient bacteremia. Cardiac dysrhythmias and arrhythmias Electrical interference can cause unshielded pacemaker to malfunction. Use of electrical dental equipment is contraindicated. Hypertension Stress and anxiety about treatment may increase blood pressure. Use stress reduction strategies; if blood pressure is uncontrolled, dental hygiene care is contraindicated. Coronary (ischemic) heart disease Stress and anxiety about treatment may precipitate angina. None if person is under appropriate medical care. Keep client in upright position to decrease lung fluid.


Hypoglycemia Compared with Hyperglycemia

Signs and Symptoms Hypoglycemia (40-50 mg/dL) Hyperglycemia (400-600 mg/dL)
Onset Rapid (minutes) Slow (days/weeks)
Thirst Absent Increased
Nausea and vomiting Absent Frequent
Vision Double Dim
Respirations Normal Difficult, hyperventilation
Skin Moist, pale Hot, dry, flushed
Tremors Frequent Absent
Blood pressure Normal Hypotension

Features of Severe Diabetic Ketoacidosis

Features Possible Causes
Thirst Dehydration
Polyuria Hyperglycemia, osmotic dieresis
Fatigue Dehydration, protein loss
Weight loss Dehydration, protein loss, catabolism
Nausea, vomiting Ketones, gastric stasis, ileus
Abdominal pain Gastric stasis, ileus, electrolyte deficiency
Muscle cramps Potassium deficiency
Hyperventilation Acidemia
Dehydration Osmotic diuresis, vomiting
Tachycardia Dehydration
Hypotension Dehydration, acidemia
Warm, dry skin Acidemia (peripheral vasodilation)
Hypothermia Acidemia-induced peripheral vasodilation (when infection is present)
Impaired consciousness or coma Hyperosmolality
Ketotic breath Hyperketonemia (acetone)

Indicates speculated or unknown cause.

Oral Complications of Diabetes Mellitus

Clinical Signs and Symptoms Pathophysiology
Salivary and Oral Changes
Xerostomia Increased fluid loss
Bilateral, asymptomatic parotid gland swelling with increased salivary viscosity

Increased dental caries, especially in cervical region Secondary to xerostomia and salivary glucose levels Unexplained odontalgia and percussion sensitivity (acute pulpitis) Pulpal arteritis from microangiopathies Lingual erosion of anterior teeth Complications of anorexia nervosa and bulimia Periodontal Changes Periodontal disease Induction and accumulation of AGEs Tooth mobility   Rapidly progressive pocket formation Degenerative vascular changes Gingival bleeding Subgingival polyps Cause unknown Infection and Wound Healing Slow wound healing (including periapical lesions after endodontics) and increased susceptibility to infection Oral ulcers refractory to therapy, especially in association with a prosthesis Irritation fibromas Altered wound healing Increased incidence and prolonged healing of dry socket Tongue Changes Glossodynia Median rhomboid glossitis (glossal central papillary atrophy) Candida albicans Other Changes Opportunistic infections: Candida albicans and mucormycosis Acetone or diabetic breath (seen when the person is close to a diabetic coma) Ketoacidotic state Increased incidence of lichen planus (as high as 30%) Compromised immune system

AGE, Advanced glycation end product.

Although not a complication of diabetes per se, this pattern is seen when the person wants to maintain the weight-loss aspect of diabetes while ignoring or tolerating the hyperglycemic side effects. Client may not be taking proper insulin doses and may not be truthful when asked about this.

Periodontal disease is seen in up to 40% of diabetic patients. Adequate periodontal therapy may result in decreased insulin requirements.

Adapted from Lalla RV, D’Ambrosio JA: Dental management considerations for the patient with diabetes mellitus, J Am Dent Assoc 132:1425, 2001.


AIDS-Defining Conditions and Diagnostic Criteria

Condition Signs and Symptoms
Candidiasis Of the bronchi, trachea, lungs, or esophagus
Cervical cancer Invasive
Coccidioidomycosis Disseminated or extrapulmonary
Cryptococcosis Extrapulmonary
Cryptosporidiosis Chronic intestinal (>1 month duration)
Cytomegalovirus disease Other than liver, spleen, or nodes
Cytomegalovirus retinitis With loss of vision
Encephalopathy HIV-related
Herpes simplex Chronic ulcer(s) (>1 month duration), or bronchitis, pneumonitis, or esophagitis
Histoplasmosis Disseminated or extrapulmonary
Isosporiasis Chronic intestinal (>1 month duration)
Kaposi’s sarcoma Intraoral or extraoral

Mycobacterium avium complex or Mycobacterium kansasii Disseminated or extrapulmonary Mycobacterium tuberculosis Any site (pulmonary or extrapulmonary) Pneumocystis carinii Pneumonia
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Jan 1, 2015 | Posted by in Dental Hygiene | Comments Off on 44: Clients with Special Needs
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