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3251 Riverport Lane St. Louis, Missouri 63043 Dental Management of the Medically Compromised Patient ISBN: 978-0-323-08028-6 Copyright © 2013 by Mosby, an imprint of Elsevier Inc. Copyright © 2008, 2002, 1997, 1993, 1988, 1984, 1980 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopy, recording, or any information storage and retrieval system, without permission in writing from the publisher. 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: www.elsevier.com/permissions. This book and the individual contributions contained in it are protected under copyright by the Publisher (other than as may be noted herein). Notices Knowledge and best practice in this field are constantly changing. As new research and experience broaden our understanding, changes in research methods, professional practices, or medical treatment may become necessary. 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. Library of Congress Cataloging-in-Publication Data Dental management of the medically compromised patient / James W. Little ... [et al.]. – 8th ed. p. ; cm. Includes bibliographical references and index. ISBN 978-0-323-08028-6 (pbk. : alk. paper) I. Little, James W., 1934- [DNLM: 1. Dental Care. 2. Dental Care for Chronically Ill. 3. Oral Manifestations. WU 29] 617.6–dc23 2011052299 Printed in China Last digit is the print number: 9 8 7 6 5 4 3 2 1 Vice President and Content Strategy Director: Linda Duncan Executive Content Strategist: John Dolan Senior Content Development Specialist: Courtney Sprehe Publishing Services Manager: Catherine Jackson Project Manager: Sara Alsup Design Direction: Teresa McBryan Cover Designer: Maggie Reid Text Designer: Maggie Reid Working together to grow libraries in developing countries www.elsevier.com | www.bookaid.org | www.sabre.org
iii James W. Little, DMD, MS Professor Emeritus University of Minnesota School of Dentistry Minneapolis, Minnesota; Naples, Florida Donald A. Falace, DMD, FDS RCSEd Professor Emeritus Oral Diagnosis and Oral Medicine University of Kentucky College of Dentistry Lexington, Kentucky Craig S. Miller, DMD, MS 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 Nelson L. Rhodus, DMD, MPH 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
vii F O R E W O R D It is now 4 years since the seventh edition of Dental Management of the Medically Compromised Patient was published. The number of patients in this critically complex area of healthcare delivery continues to expand along with the scientific advances in etiology, patho- physiology, diagnosis, and treatment. The number of Americans over age 65, which now exceeds 15% of the population, is expected to increase by more than 20% within the next few decades. Thus the pool for such patients seeking and needing dental care grows. Further- more, as longevity increases, so do the number of dis- eases and conditions that disable individuals, converting them to compromised patients. With increasing longevity, and other factors such as obesity, poor diets, suboptimal exercise, new infections, as well as widespread use and abuse of drugs, the rising number of medically compromised patients will continue to grow. As a consequence, an ever increasing number of individuals with oral health problems will create demands and responsibilities on dental professionals with regards to services and standards of care. Education and readily available resource materials are essential to providing these services in an optimal and safe manner, and the thoroughly revised and updated eighth edition fills this role perfectly. A multitude of diseases have an impact on oral health- care services. Some examples follow. Cancer is an age- related disease that afflicts more than 1.5 million new patients each year in the United States. This in turn accounts for almost 25% of all deaths, and overall, is the second leading cause of death; in those under 85 years of age, cancer is the leading cause of death. Because of the number of new malignancies and the complica- tions caused by aggressive therapy to increase survival rates, dental services and information—for example, oral complications of cancer treatments and rehabilitation— take on significant importance. Furthermore, this is a global problem with new cases of cancer exceeding 12 million each year. Other examples of conditions that commonly affect dental-oral care are cardiovascular diseases, the number one killer of Americans, and diabetes. In Part 2, six chapters thoroughly cover all aspects of cardiovascular disease of interest for dental professionals. Diabetes (see Part 6, Chapter 14) is an exploding global problem with a profound effect on Americans, affecting more than 25 million with diagnosed diabetes, and an additional 12 million with undiagnosed diabetes. Diabetes has a large impact on dental health and care. It is the leading cause of end-stage renal disease and blindness among adults, and a major cause of heart disease and stroke. Diabetes is associated with obesity, poor diet, suboptimal physical activity, and aging. Projections estimate a possible dou- bling, or even tripling, in the coming decades if current trends continue. The list of medical diseases goes on, and underscores the need for current, reliable, and practical information to minimize or prevent potential problems related to general health, and ongoing oral-dental care. Knowledge of the pathophysiology of common medical diseases and conditions, along with the potential risks associated with some dental procedures and services, is essential. Interrelationships between oral and general health involve most organ systems. Some examples of medical- dental interaction relate to hematologic, autoimmune, and infectious diseases that strike both the young and the elderly. These conditions include blood dyscrasias, vesiculobullous inflammatory diseases, and many bacte- rial, viral, and fungal infections. Thus a very common issue is the proper recognition and management of oral manifestations, control of blood-borne pathogens, and avoidance of complications when providing dental treat- ment. Again, to appropriately meet this challenge, updated information in a concise and understandable format is essential. Because the majority of medically compromised patients need and/or seek oral healthcare, a working knowledge of the multitude of medically complex condi- tions is critical for dental professionals. This information will support and enable high standards for dental-oral healthcare delivery. This knowledge includes an under- standing of medical conditions and compromised states and is necessary to help prevent, minimize, and alert clinicians to possible adverse side effects potentially associated with procedures and drugs used in dentistry. An understanding will assist in formulating treatment plans that are safe and compatible with a patient’s medical status. Care of the medically compromised patient often is complicated, and requires specialists. However, occur- rence of compromised patients is so common that prac- titioners and students must know how to recognize and prevent problems associated with dental management, and to use consultations and referrals appropriately. This updated, revised, and expanded text recognizes and supplies this type of information with practical and organized overviews of diagnosis and management. This is accomplished in 30 well-organized and revised chapters by comprehensively covering diseases and con- ditions that lead to compromised states that affect a person’s well-being. The 30 chapters, are presented in 9 logical parts that enhance user-friendly utility. The mate- rial is supported by summary tables for easy access to information, figures, and graphs to supplement text, and