, FOREWORD
I
t is now 5 years since the sixth edition of Dental tions, control of blood-borne pathogens, and avoiding
Management of the Medically Compromised Patient was complications when providing dental treatment. Again,
published. The number of patients in this critically to appropriately meet this challenge, updated informa-
complex area of healthcare delivery continues to expand tion in a concise and understandable format is essential.
along with the scientific advances in diagnosis and treat- Because the majority of medically compromised
ment. The number of Americans over age 65, which now patients need and/or want oral healthcare, a working
approximates 14% of the population, is expected to knowledge of the multitude of medically complex condi-
increase to more than 20% within the next few decades. tions is critical for dental professionals. This information
Thus the pool for such patients seeking and needing will support and enable high standards for dental-oral
dental care grows. Furthermore, as longevity increases, healthcare delivery. This knowledge includes an under-
so do the number of diseases and conditions that disable standing of medical conditions and compromised states
individuals, converting them to compromised patients. and is necessary to help prevent, minimize, and alert cli-
Along with increasing longevity, other factors such as nicians to possible adverse side effects potentially associ-
obesity, new infections, and widespread use and abuse of ated with procedures and drugs used in dentistry. An
drugs, the rising number of medically compromised understanding will assist in formulating treatment plans
patients will continue to grow. As a consequence, an ever- that are safe and compatible with a patient’s medical
enlarging number of individuals with oral health prob- status.
lems will create demands and responsibilities on dental Care of the medically compromised patient often is
professionals regarding standards of care. Education and complicated, requiring specialists. However, occurrence
readily available resource material is essential to provid- of compromised patients is so common that practitioners
ing these services in an optimal and safe manner, and the and students must know how to recognize and prevent
thoroughly revised seventh edition fills this role problems associated with dental management, and to use
perfectly. consultations and referrals appropriately. This updated,
A multitude of diseases have an impact on oral health- revised, and expanded text recognizes and supplies this
care services. Some examples follow. Cancer is an age- type of information with practical and organized over-
related disease that afflicts more than 1.4 million new views of diagnosis and management. This is accomplished
patients each year in the United States. This in turn in 30 well-organized and revised chapters by comprehen-
accounts for almost 25% of all deaths, and is the second sively covering diseases and conditions that lead to com-
leading cause of death. Because of the ever-increasing promised states that affect a person’s well-being. The 30
number of new malignancies and the complications chapters, now in color, are presented in 9 logical parts
caused by aggressive therapy to increase survival rates, that enhance user-friendly utility. The material is sup-
dental services and information—for example, oral com- ported by summary tables for easy access to information,
plications of cancer treatments and rehabilitation—take figures and graphs to supplement text, and appendices
on significant importance. that allow the reader to recognize disease states, be aware
Other examples of conditions that commonly affect of potential complications, and select an approach to
dental-oral care are cardiovascular diseases, the number drug management. An appendix on alternative and com-
one killer of Americans, and diabetes, which affects an plementary medicine has also been added.
estimated 20 million Americans. The list goes on end- Although the main focus is on the management of
lessly. Again, this underscores the need for current, reli- medically compromised patients having dental proce-
able, and practical information to minimize or prevent dures, the text effectively includes a medical overview of
potential problems related to general health and ongoing each disease entity, including etiology, signs and symp-
oral-dental care. Knowledge of the pathophysiology of toms, pathophysiology, diagnoses, treatment, and prog-
the common medical diseases and conditions, along with nosis. Therefore it also serves as a mini-text on common
the potential risks of dental procedures and services, is medical diseases and conditions. Because tobacco use is
essential. the most common cause of preventable deaths in the
Interrelationships between oral and general health United States (more than 440,000 each year), a chapter
involve most organ systems. Some examples of medical- on this topic has been added. In its present format, it
dental interaction relate to hematologic, autoimmune, serves as both a quick reference and a somewhat in-depth
and infectious diseases that strike both the young and the resource for this critical interface of medicine and den-
elderly. These include blood dyscrasias, vesiculoerosive tistry. It will help ensure high standards of care and help
inflammatory diseases, and many bacterial, viral, and reduce the occurrence of adverse reactions by improving
fungal infections. Thus a very common problem calls knowledge and encouraging judgment in the manage-
upon recognition and management of oral manifesta- ment of at-risk patients.
vii
FM-A04535.indd vii 6/6/2007 4:19:42
, viii DENTAL MANAGEMENT OF THE MEDICALLY COMPROMISED PATIENT
In summary, treating the medically compromised sive text as a reference for students and practitioners is
patient is a complex part of dentistry, requiring compe- evident.
tent practitioners with many attributes: sound technical
skills, insight into medicine, familiarity with pharmaco- Sol Silverman, Jr.
therapeutics, and the capability of analyzing findings Professor of Oral Medicine
from patient histories and signs and symptoms. There- University of California, San Francisco
fore the usefulness of this excellent updated, comprehen-
FM-A04535.indd viii 6/6/2007 4:19:42
, PREFACE
A
s the flow of new knowledge and changing con- ence describing the dental management of patients with
cepts in medicine and dentistry continues to selected medical problems. The more common medical
expand, the need for a seventh edition of Dental disorders that may be encountered in a dental practice
Management of the Medically Compromised Patient became continue to be the focus. This book is not a comprehen-
apparent. sive medical reference, but rather a book containing
A number of major changes have been made in the enough core information about each of the medical con-
seventh edition. The chapters have been reorganized and ditions covered to enable the reader to recognize the
placed under topic headings to streamline the text. For basis for various dental management recommendations.
example, the following chapters are placed under the Medical problems are organized to provide a brief
topic heading of Cardiovascular Disease—Chapter 2: overview of the basic disease process, epidemiology,
Infective Endocarditis Prophylaxis; Chapter 3: Hypertension; pathophysiology, signs and symptoms, laboratory find-
Chapter 4: Ischemic Heart Disease; Chapter 5: Cardiac ings, and currently accepted medical therapy of each dis-
Arrhythmias; and Chapter 6: Heart Failure. order. This is followed by a detailed explanation and
Three new chapters have been added—Chapter 8: recommendations for specific dental management. The
Smoking and Tobacco Use Cessation; Chapter 9: Tuberculosis; accumulation of evidence-based research over the years
and Chapter 10: Sleep-Related Breathing Disorders. Chap- has allowed us to make more specific dental management
ters that had previously been one combined chapter have guidelines that will benefit the audience of this text,
been split into two separate chapters for better readabil- which includes practicing dentists and dental hygienists,
ity. This includes Chapter 23: Disorders of Red Blood Cells dental graduate students in specialty or general practice
and Chapter 24: Disorders of White Blood Cells, and Chapter programs, and dental and dental hygiene students. In
28: Behavioral and Psychiatric Disorders (Anxiety, Delirium, particular, the text is intended to give the dental provider
and Eating Disorders), and Chapter 29: Psychiatric Disor- an understanding of how to ascertain the severity and
ders. A new appendix devoted to the use of alternative and stability of common medical disorders and make dental
complementary drugs in dentistry has been added— management decisions that afford the patient the utmost
Appendix E: Alternative and Complementary Drugs. health and safety.
Chapters 2 and 3 (Infective Endocarditis and Cardiac Continued emphasis has been placed on the medica-
Conditions Associated With Endocarditis) from the sixth tions used to treat the medical conditions covered in this
edition have been combined into one new chapter, seventh edition. Dosages, side effects, and drug interac-
Chapter 2: Infective Endocarditis Prophylaxis, which incor- tions with agents used in dentistry—including those used
porates the latest guidelines for the prevention of bacte- during pregnancy—are discussed in greater detail.
rial endocarditis from the American Heart Association. Emphasis also has been placed on having contemporary
Alzheimer’s disease now appears in Chapter 27: Neuro- equipment and diagnostic information to assess and
logic Disorders, and the use of bisphosphonates and its monitor patients with moderate to severe medical
complications are discussed in Chapter 26: Cancer and disease.
Oral Care of the Patient. Appendix C has been updated Our sincere thanks and appreciation are extended to
and now includes the sixth edition of the American those many individuals who have contributed their time
Academy of Oral Medicine’s Clinician’s Guide to Treatment and expertise to the writing and revision of this text.
of Common Oral Conditions.
All of the chapters have been updated where necessary, James W. Little
and many have been provided with new figures and tables. Donald A. Falace
The majority of the figures in the book are now in full Craig S. Miller
color.
Nelson L. Rhodus
The purpose of the book remains the same—to give
the dental provider an up-to-date, concise, factual refer-
ix
FM-A04535.indd ix 6/6/2007 4:19:42
I
t is now 5 years since the sixth edition of Dental tions, control of blood-borne pathogens, and avoiding
Management of the Medically Compromised Patient was complications when providing dental treatment. Again,
published. The number of patients in this critically to appropriately meet this challenge, updated informa-
complex area of healthcare delivery continues to expand tion in a concise and understandable format is essential.
along with the scientific advances in diagnosis and treat- Because the majority of medically compromised
ment. The number of Americans over age 65, which now patients need and/or want oral healthcare, a working
approximates 14% of the population, is expected to knowledge of the multitude of medically complex condi-
increase to more than 20% within the next few decades. tions is critical for dental professionals. This information
Thus the pool for such patients seeking and needing will support and enable high standards for dental-oral
dental care grows. Furthermore, as longevity increases, healthcare delivery. This knowledge includes an under-
so do the number of diseases and conditions that disable standing of medical conditions and compromised states
individuals, converting them to compromised patients. and is necessary to help prevent, minimize, and alert cli-
Along with increasing longevity, other factors such as nicians to possible adverse side effects potentially associ-
obesity, new infections, and widespread use and abuse of ated with procedures and drugs used in dentistry. An
drugs, the rising number of medically compromised understanding will assist in formulating treatment plans
patients will continue to grow. As a consequence, an ever- that are safe and compatible with a patient’s medical
enlarging number of individuals with oral health prob- status.
lems will create demands and responsibilities on dental Care of the medically compromised patient often is
professionals regarding standards of care. Education and complicated, requiring specialists. However, occurrence
readily available resource material is essential to provid- of compromised patients is so common that practitioners
ing these services in an optimal and safe manner, and the and students must know how to recognize and prevent
thoroughly revised seventh edition fills this role problems associated with dental management, and to use
perfectly. consultations and referrals appropriately. This updated,
A multitude of diseases have an impact on oral health- revised, and expanded text recognizes and supplies this
care services. Some examples follow. Cancer is an age- type of information with practical and organized over-
related disease that afflicts more than 1.4 million new views of diagnosis and management. This is accomplished
patients each year in the United States. This in turn in 30 well-organized and revised chapters by comprehen-
accounts for almost 25% of all deaths, and is the second sively covering diseases and conditions that lead to com-
leading cause of death. Because of the ever-increasing promised states that affect a person’s well-being. The 30
number of new malignancies and the complications chapters, now in color, are presented in 9 logical parts
caused by aggressive therapy to increase survival rates, that enhance user-friendly utility. The material is sup-
dental services and information—for example, oral com- ported by summary tables for easy access to information,
plications of cancer treatments and rehabilitation—take figures and graphs to supplement text, and appendices
on significant importance. that allow the reader to recognize disease states, be aware
Other examples of conditions that commonly affect of potential complications, and select an approach to
dental-oral care are cardiovascular diseases, the number drug management. An appendix on alternative and com-
one killer of Americans, and diabetes, which affects an plementary medicine has also been added.
estimated 20 million Americans. The list goes on end- Although the main focus is on the management of
lessly. Again, this underscores the need for current, reli- medically compromised patients having dental proce-
able, and practical information to minimize or prevent dures, the text effectively includes a medical overview of
potential problems related to general health and ongoing each disease entity, including etiology, signs and symp-
oral-dental care. Knowledge of the pathophysiology of toms, pathophysiology, diagnoses, treatment, and prog-
the common medical diseases and conditions, along with nosis. Therefore it also serves as a mini-text on common
the potential risks of dental procedures and services, is medical diseases and conditions. Because tobacco use is
essential. the most common cause of preventable deaths in the
Interrelationships between oral and general health United States (more than 440,000 each year), a chapter
involve most organ systems. Some examples of medical- on this topic has been added. In its present format, it
dental interaction relate to hematologic, autoimmune, serves as both a quick reference and a somewhat in-depth
and infectious diseases that strike both the young and the resource for this critical interface of medicine and den-
elderly. These include blood dyscrasias, vesiculoerosive tistry. It will help ensure high standards of care and help
inflammatory diseases, and many bacterial, viral, and reduce the occurrence of adverse reactions by improving
fungal infections. Thus a very common problem calls knowledge and encouraging judgment in the manage-
upon recognition and management of oral manifesta- ment of at-risk patients.
vii
FM-A04535.indd vii 6/6/2007 4:19:42
, viii DENTAL MANAGEMENT OF THE MEDICALLY COMPROMISED PATIENT
In summary, treating the medically compromised sive text as a reference for students and practitioners is
patient is a complex part of dentistry, requiring compe- evident.
tent practitioners with many attributes: sound technical
skills, insight into medicine, familiarity with pharmaco- Sol Silverman, Jr.
therapeutics, and the capability of analyzing findings Professor of Oral Medicine
from patient histories and signs and symptoms. There- University of California, San Francisco
fore the usefulness of this excellent updated, comprehen-
FM-A04535.indd viii 6/6/2007 4:19:42
, PREFACE
A
s the flow of new knowledge and changing con- ence describing the dental management of patients with
cepts in medicine and dentistry continues to selected medical problems. The more common medical
expand, the need for a seventh edition of Dental disorders that may be encountered in a dental practice
Management of the Medically Compromised Patient became continue to be the focus. This book is not a comprehen-
apparent. sive medical reference, but rather a book containing
A number of major changes have been made in the enough core information about each of the medical con-
seventh edition. The chapters have been reorganized and ditions covered to enable the reader to recognize the
placed under topic headings to streamline the text. For basis for various dental management recommendations.
example, the following chapters are placed under the Medical problems are organized to provide a brief
topic heading of Cardiovascular Disease—Chapter 2: overview of the basic disease process, epidemiology,
Infective Endocarditis Prophylaxis; Chapter 3: Hypertension; pathophysiology, signs and symptoms, laboratory find-
Chapter 4: Ischemic Heart Disease; Chapter 5: Cardiac ings, and currently accepted medical therapy of each dis-
Arrhythmias; and Chapter 6: Heart Failure. order. This is followed by a detailed explanation and
Three new chapters have been added—Chapter 8: recommendations for specific dental management. The
Smoking and Tobacco Use Cessation; Chapter 9: Tuberculosis; accumulation of evidence-based research over the years
and Chapter 10: Sleep-Related Breathing Disorders. Chap- has allowed us to make more specific dental management
ters that had previously been one combined chapter have guidelines that will benefit the audience of this text,
been split into two separate chapters for better readabil- which includes practicing dentists and dental hygienists,
ity. This includes Chapter 23: Disorders of Red Blood Cells dental graduate students in specialty or general practice
and Chapter 24: Disorders of White Blood Cells, and Chapter programs, and dental and dental hygiene students. In
28: Behavioral and Psychiatric Disorders (Anxiety, Delirium, particular, the text is intended to give the dental provider
and Eating Disorders), and Chapter 29: Psychiatric Disor- an understanding of how to ascertain the severity and
ders. A new appendix devoted to the use of alternative and stability of common medical disorders and make dental
complementary drugs in dentistry has been added— management decisions that afford the patient the utmost
Appendix E: Alternative and Complementary Drugs. health and safety.
Chapters 2 and 3 (Infective Endocarditis and Cardiac Continued emphasis has been placed on the medica-
Conditions Associated With Endocarditis) from the sixth tions used to treat the medical conditions covered in this
edition have been combined into one new chapter, seventh edition. Dosages, side effects, and drug interac-
Chapter 2: Infective Endocarditis Prophylaxis, which incor- tions with agents used in dentistry—including those used
porates the latest guidelines for the prevention of bacte- during pregnancy—are discussed in greater detail.
rial endocarditis from the American Heart Association. Emphasis also has been placed on having contemporary
Alzheimer’s disease now appears in Chapter 27: Neuro- equipment and diagnostic information to assess and
logic Disorders, and the use of bisphosphonates and its monitor patients with moderate to severe medical
complications are discussed in Chapter 26: Cancer and disease.
Oral Care of the Patient. Appendix C has been updated Our sincere thanks and appreciation are extended to
and now includes the sixth edition of the American those many individuals who have contributed their time
Academy of Oral Medicine’s Clinician’s Guide to Treatment and expertise to the writing and revision of this text.
of Common Oral Conditions.
All of the chapters have been updated where necessary, James W. Little
and many have been provided with new figures and tables. Donald A. Falace
The majority of the figures in the book are now in full Craig S. Miller
color.
Nelson L. Rhodus
The purpose of the book remains the same—to give
the dental provider an up-to-date, concise, factual refer-
ix
FM-A04535.indd ix 6/6/2007 4:19:42
