MEDICAL HISTORY in complete denture.pptx

medical history

1. MEDICAL HISTORY BHAVIN MILIND PATIL JR1

2. INDEX DEFINITIONS MEDICAL HISTORY SYSTEMATIC FACTORS SYSTEMIC DISEASES AND ITS RELATION TO PROSTHETIC TREATMENT CONCLUSION REFERENCES

3. Diagnosis : the determination of the nature of a disease(GPT9) Boucher: A series of planned observations to determine and evaluate the existing conditions, which will lead to decision-making based on the conditions observed Winkler: The examination of the physical state and evaluation of mental Or psychological makeup and understanding the needs of each patient to ensure a predictable result.

4. Differential diagnosis : the process of identifying a condition by comparing the signs and symptoms of all pathologic processes that may produce similar signs and symptoms Patient history: the collected data about an individual, family, environmental factors (including medical and dental history), and any other information that may be useful in analyzing and diagnosing conditions or for instructional purpose.

5. Prognosis : Forecast of the probable outcome of treatment. Treatment plan: GPT: The sequence of procedures planned for treatment of a patient after diagnosis. Boucher: Treatment planning is the process of matching possible treatment options with patient needs and systematically arranging the treatment in order of priority but in keeping with a logical or technically necessary sequence.

6. Systemic Status No prosthodontic procedures should be planned until the systemic status of the patient is evaluated The dentist not only must be aware of the systemic factors but must also consider them in the treatment plan. Some systemic diseases have a direct relation to denture success even though no local manifestations are apparent. Many systemic diseases have local manifestations with no apparent systemic symptoms and others have both local and systemic reactions.

7. DEBILITATING DISEASES Patients with diseases debilitating in nature should be under medical control. Diabetes,, tuberculosis, and blood dyscrasias are examples. These patients require extra instructions in oral hygiene, eating habits, and tissue rest Since the supporting bone may be affected by the disease, frequent recall appointments should be arranged to keep the denture bases adapted and the occlusion corrected

8. MEDICAL HISTORY The complete health history should include: (1) the name of the patient’s physician, including the date and reason for the last appointment. (2) a record of the status of all major body systems. (3) a record of all medications the patient is currently taking and any change in that regime within the last six months,

9. (4) a record of any hospitalization. (5) a record of any complication that was a result of previous dental treatment. (6) a record of the patient’s opinion of his or her general health. (7) a space to update the health history when the patient is recalled

10. There are three basic techniques for obtaining patient information: direct interrogation by the dentist. a comprehensive questionnaire. combination of both .

11. POINTS TO LOOKOUT FOR: Particular attention should be paid to the patient’s medication regime. Patients often will not know the names of the drugs they are taking or why they are taking them. The dentist should request a list of all medications

12. Once an accurate list of medications has been obtained, it is the dentist’s responsibility to look up the unfamiliar ones. The medication list will act as a check on the patient’s health history, as any serious health problem usually requires some type of medication The dentist should be aware of the possible side effects of drugs and what consequences they may have on treatment outcome

13. EXAMPLES Xerostomia is a common side effect of antihypertensive drugs and antidepressants. These drugs can cause problems with complete denture retention and increased soreness due to the loss of protective lubrication. Diuretics can cause significant changes in tissue fluids which affect the retention and stability of complete dentures. Psychotropic drugs may cause uncontrollable tongue or facial movements

14. GENERAL OUTLOOK OF PATIENT The patient’s opinion of his or her general health is often very revealing in terms of mental outlook. Some patients who have serious health problems are happy, outgoing, and generally optimistic about life. This is a positive adaptive response and is indicative of a patient who will accept new complete dentures with minimal complaints. A depressive chronic complainer who feels that his or her health is slipping away may be unwilling to adjust to new dentures

15. SYSTEMATIC DISEASES Require specific instruction on denture/tissue care. Special follow-up appointments to observe response of soft tissue to the denture. Special considerations made according to the condition

16. CARDIOVASCULAR DISEASES: Patient under the anti-hypertensive drugs have postural hypoten sion. Other CVS diseases require medical consultation before dental treatment:- Acute or recent myocardial infarction Unstable angina pectoris Congestive heart failure Uncontrolled hypertension

17. PROBLEMS RELATED TO PROTHODONTICS Most of the problems are related to anaesthetics, vasoconstrictors, anti coagulants, etc Xerostomia from diuretic therapy Causes burning and itching of oral mucosa and sticking of food to prosthesis

18. Prophylactic antibiotics therapy is always r ecommended if patient is having history:- Congenital / rheumatic valvular heart diseases Cardiac murmurs Rheumatic fever Myocardial infarction

19. CEREBROVASCULAR DISEASES The vascular diseases that affect the CNS are usually of two types Ischemic stroke Hemorrhagic stroke Both types cause loss of cerebral function

20. PROBLEMS RELATED TO PROTHODONTICS Patients who have suffered from stroke posses problems in removable prosthesis Unilateral hypotonia favours prosthesis instability Loss of oral sensitivity favours formation of decubitus ulcers

21. Diabetes Mellitus

22. Absolute or relative lack of insulin Glucose accumulates in the blood ( hyperglycaemia ) and spills over into the urine ( glucosuria ), taking with it, osmotically, a large amount of water ( polyuria ). This leads to dehydration and thus thirst and the need to drink excessively ( polydipsia ). Characteristics weight loss, peripheral muscle wasting in type 1 diabetes- production of ketone bodies

23. Types T ype1 diabetes ( insulin-dependent (IDDM) or juvenile-onset diabetes ) most commonly diagnosed at about 12 years of age and commonly presents before the third decade antibodies directed against insulin and the pancreatic islets of Langerhans nausea, vomiting, or stomach pains. Type 2 diabetes   symptoms often take several years to develop insulin resistant and have diminished beta-cell function Gestational diabetes  (diabetes during pregnancy)

24. Dental aspects Infection Periodontal disease Oral Candidiasis Mucormycosis Dentoalveolar abscess swelling of the salivary glands ( sialosis ) Neuropathy ‘ Grinspan syndrome’ (diabetes, lichen planus and hypertension) Osteoporosis Residual alveolar Bone resorption Delayed wound healing Reduced secretion of saliva.

25. Anemia Anaemia is defined as haemoglobin (Hb) level below the normal for the age, gender and ethnic background of the individual In adult females, below 11.5g/dl, and adult males below 13.5g/dl are the criteria of anaemia .

26. Dental aspect Sore mouth Ulceration Angular stomatitis Glossitis Burning mouth symptoms

27. DISEASES OF BONE & JOINTS osteosarcoma This occurs very frequently in TMJ Degenerative arthritis, increase with the age and women are affected more. Arthritis changes in fingers-Difficult to insert and clean the denture. Arthritis changes in TMJ - reduces the mouth opening and pain.

28. OSTEOMALACIA Bone mass reduced Deformation of load bearing bones Increased tendency of bone fracture

29. PROBLEMS RELATED TO PROSTHODONTIC TREATMENT Weakening of cortical and intertrabecular bone Tendency to develop pulpitis and multiple spontaneous abscesses Load induced deformation of mandible and maxilla

30. Hyperthyroidism Thyroid-stimulating autoantibodies against thyroid TSH receptor ( TRAbs ) and thyroid microsomal antibodies ( TMAbs ) Clinical features exophthalmos, eyelid lag and eyelid retraction , anorexia, vomiting or diarrhoea , weight loss, anxiety tremor, sweating and heat intolerance

31. Hypothyroidism weight gain, lassitude, dry skin, myxoedema, ischaemic heart disease, bradycardia, anaemia, hypotonia, cerebellar signs of ataxia, tremor, and dysmetria, polyneuropathy,

32. Gastrointestial diseases 35 Gastroesophageal reflux disease The gastroenteric disease is of major interest to the dentist is gastroesophageal reflux disease, which consists of the retrograde passage of gastric fluids from the stomach into the esophagus; the condition may or may not be associated with hiatal hernia and esophagitis.

33. Oral manifestations 36 gastroesophageal reflux can provoke serious dental damage, even in asymptomatic subjects. damage depends on exposure to acid gastric juices and affects mainly the areas of the mouth most exposed to the reflux (the lingual and occlusal surfaces of the maxillary premolars and anterior teeth).

34. Problems related to prosthetic treatment 37 Decreased vertical dimension requires extensive prosthetic treatment.

35. Diseases of the small intestine 38 Celiac disease Celiac disease originates from hypersensitivity to gliadin, a constituent protein of gluten, with consequent inflammation and destruction of the intestinal villi Oral disturbances are related to malabsorption of certain nutritional elements and consist of anemic pallor, glossitis, burning mouth, angular cheilitis, recurring aphthous ulcers, and enamel hypoplasia.

36. Hepatic Disease: Cirrhosis 39 Cirrhosis is outcome of extensive damage of the hepatic parenchyma, which induces fibrosis, nodular regeneration, and vascular rearrangement. Various diseases lead to hepatic cirrhosis. Among the most common causes are toxic substances (alcohol and drugs), infections (hepatitis B and C viruses), and chronic vascular engorgement (congestive heart failure).

37. Oral manifestations 40 The oral manifestations of hepatic disease are various: Increased cariogenicity (especially in alcoholics), increased tooth loss. and stimulated salivary flow. Increased formation of periodontal pockets and loss of tooth attachment, gingival hyperplasia is observed in patients receiving cyclosporine A after liver transplantation. Dental erosions as a result of frequent regurgitation of gastric fluids. Predisposition to oral cancer. Secondary manifestation hypoproteinemia, malabsorption of vitamins, anemia, and hemorrhagic diathesis.

38. Problems related to prosthetic treatment 41 • Disturbances of coagulation • Difficulty in wound healing • Disturbance of bone metabolism

39. SCLERODERMA: This collagen disease results in sclerosis of the skin and connective tissues. T he limitation in the size of the oral aperture and mandibular opening are common findings . Intraorally, the tongue become a serious functional complication.

40. NEOPLASTIC DISEASES – ORAL MANIFESTATIONS Leukemia – gingival bleeding, necrotic ulcers, oral infections, tooth loss, delayed healing Lymphoma- frequent infections, anemia , and drug effects of cytostatics , corticosteroids Agranulocytosis- severe ulceration in oral mucosa Thrombocytopenia- petechiae, ecchymosis, gingival bleeding

41. CHEMO AND RADIOTHERAPY Infections Ulcers and Mucositis Xerostomia Oral pain Fibrosis Trismus Prosthetic relation- advisable to postpone until oncologic treatment is complete.

42. SYNOPSIS Medical background of patient is an important factor in success of prosthetic treatments. Information about patient’s general health provides significant insight to the treatment outcome and possible complications. Patients History helps prepare for possible errors or complications during or after the prosthetic treatments.

43. REFRENCES Heartwell , 4 th edition Glossary of Prosthodontic terms Boucher 13 th edition Essentials of complete denture prosthodontics , Sheldon Winkler- 2 nd edition Prosthetic rehabilitation- Giulio Preti

44. Thank you