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. 

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