Treating Medically Complex Patients with Dental Infections

A refresher on some of the conditions, pharmaceutical treatments, and host defenses that can complicate treatment:

Part 1- Determine the severity of the infection e.g. How is the patient feeling? How quickly did the infection start? Is there any trismus, dyspnea, dysphagia, malaise? If the infection arose quickly and/or shows signs listed above, the infection may be severe and immediate action or referral to an Oral Surgeon may be required.

Part 2- Determine Patient’s host Defense Mechanisms: There are many different metabolic diseases or dysfunctions that can contribute to more severe infections e.g. Uncontrolled diabetes type I or II, End Stage Renal Disease, Severe Alcoholism, and malnutrition. There are also Immune System-Suppressing Diseases that can lower white cell functioning and allow infections to spread faster e.g. HIV/AIDS, Leukemias and Lymphomas or other congenital or acquired immunologic diseases.

Part 3- Is the patient taking any Pharmaceuticals that decrease host defenses to infections? Certain drugs can lower white cell counts to low levels, with this the host defenses are severely compromised potentially allowing infections to run rampant. Patients commonly receive immunosuppressive drugs for things like 1. organ transplants, 2. cancer chemotherapeutics, and 3. autoimmune diseases. These drugs commonly fall under the the categories of Cyclosporine, Corticosteroids, Tacrolimus, and Azathioprine. Some of these drugs can affect the patient for years after ending therapy.

Summary:

Quick and efficient action for patients presenting with any of the conditions listed above are important. Reminder that if the patient has difficulty breathing, swallowing, opening, elevated temperature, severe malaise, need for General Anesthesia, or compromised host defenses, it may be time to refer to your neighborly Oral Surgeon.

Pharmaceutical Refresh: Other common names for drugs listed above for attention.

  1. Cyclosporine: Sandimmune, Neoral, Gengraf
  2. Tacrolimus: Envarsus XR, Astagraf XL, Protopic
  3. Azathioprine: Azasan

Reference:

Hupp, J. R., III, E. E., & Tucker, M. R. (2019). Contemporary Oral and maxillofacial surgery. Elsevier. 

The Author of this post does not assume any liability for any injury and/or damage to persons or property as a matter of products liability, malpractice, negligence, or otherwise, or from any use or operation of any methods, instructions or ideas contained. The foregoing parties will not be liable for any direct, special, indirect, incidental, consequential, or punitive damages as a result of the reader’s use of this information.

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s

%d bloggers like this: