special patient GI disease, kidney disease, and cancer

pre-cancer treatment planning and evaluation

•ok to treat if stage 1 or 2 and no evidence it has spread; consider increased frequency of recare

•Rule out/address oral disease- comprehensive dental exam

•Plan for pain management during treatment

•OHI, nutritional counseling for non-cariogenic diet recommendations, prophylaxis, remove irritants and sources of infection

oral health care during cancer treatment

dental treatment between cycles of chemotherapy/radiation therapy; no routine care during therapy

post-cancer treatment management

•will include management of long-term side effects of treatment

• side effects may include hyposalivation, trismus, jaw osteonecrosis, neuropathic pain, chemosensory changes

oral complications of cancer treatment

•Mucositis- breakdown of mucous membrane

•Bone marrow depression- infection, bleeding, anemia

•GI changes- diarrhea, malabsorption, altered nutritional status

•Cardiac and pulmonary dysfunction

40%

• _ of patients receiving chemotherapy for any malignancy will experience oral complications

peptic ulcer disease

• break in the GI mucosa from chronic acid or pepsin secretion and destruction cuased by the host response to helicobacter pylori (H. Pylori)

medical management of peptic uclers

•Proton pump inhibitors if not caused by H. pylori

•Gastric acid secretion inhibitors and antibiotics if caused by H. pylori

•Remove things that cause ulcers: NSAIDS, alcohol, aspirin, corticosteroids, food that aggravate ulcers, stress, smoking

•Surgery is only used to treat complications of peptic ulcer disease

dental considerations for peptic ulcers

•Medical history review and ID condition/meds

•Undiagnosed but symptoms are present- refer to physician

•Consider antibiotics used for treatment if prescribing antibiotics for dental care

•Consider patient comfort.  Severity of disease may dictate length of appointment. Do not treat if ongoing signs and symptoms are present in the presence of treatment

•Do not prescribe aspirin, aspirin-containing compounds, NSAIDS- choose acetaminophen (Tylenol)

•Some acid blocking drugs decrease metabolism of dental anesthetics- consider longer duration of action in these patients- may require dose adjustment

oral complications and manifestations of peptic ulcers

•Stress good oral hygiene and regular dental hygiene care

•Antibiotics may cause candidiasis- look for signs (median rhomboid glossitis)

•Lip may exhibit vascular malformations

•Enamel erosion – refer to physician if present with reflux

•Proton pump inhibitors may alter taste perception

•Mucosal ulcerations, pallor, gingival bleeding

•Medications may cause xerostomia

•Erythema multiforme

inflammatory bowel disease

Ulcerative colitis and Crohn disease are the two diseases that fall under the umbrella term of inflammatory bowel disease.

signs and symptoms of ulcerative colitis

•Attacks of diarrhea

•Rectal bleeding

•Abdominal cramps

•Dehydration

•Fatigue

•Weight loss

•Fever

•Arthritis

•Tender red bumps on the shin

•Large painful sores on the legs

signs and symptoms of crohn’s disease

•Recurrent or persistent diarrhea

•LR quad abdominal pain

•Anorexia

•Fever

•Weight loss

•Malaise

•Arthritis

•Uveitis

medical management of UC and IBD

•Antidiarrheal medications

•Immunosuppressive agents

•Antibiotics

•Biologic agents for severe disease

•Surgical resection to remove damaged parts of the colon

•Diet change

•Rest

•Nutritional supplements

•Corticosteroids when unresponsive to other treatments

dental considerations for UC or IBD

•MH review, ID signs/symptoms, medications- refer if signs and symptoms are present with no diagnosis

•Refer for medical consult if moderate or sever disease is present

•Consider higher risk for infection if taking biologics with steroids

•Schedule elective procedures during remission; treat only emergent conditions during acute exacerbations

•Be flexible with appointment scheduling and cancellations

•Steroids can suppress adrenal function and decrease ability to handle stress- incorporate stress reducing protocol and provide pain control to minimize stress

•Recommend Tylenol for pain control

•Thorough head and neck exam

•Refer to physician if fever is present

•Painful oral lesion erupt during flare ups

pseudomembranous colitis

•Overgrowth of C. difficile in colon- often fatal

•Causes diarrhea, abdominal pain, cramping, fever, dehydration, hypotension, peritonitis, toxic megacolon

•Managed with antibiotic that will eliminate toxin produced by C. diff.

•Elective dental care should be postponed until condition is resolved

•Use of antibiotics may result in candidiasis infection in mouth

stage 1 of chornic kidney disease

• normal or slightly elevated GFR

• no specific symptoms but kidney function can slowly decline

• 90%+

stage 2 chronic kidney disease

• slightly decreased GFR and mild loss of function

• very few/mild signs or symptoms

• 89-60%

stage 3 chronic kidney disease

• moderately decreased GFR

• moderate to severe loss of function

• 59-30%

• Generalized illness, fatigue, weakness, headaches, nausea, loss of appetite, weight loss. Anemia, leg cramps, insomnia, dark urine, nocturia.

stage 4 chronic kidney disease

• severely decreased GFR

• 29-15%

• kidney function is very low and treatment for kidney failure may be needed soon

• Generalized illness, fatigue, weakness, headaches, nausea, loss of appetite, weight loss. Anemia, leg cramps, insomnia, dark urine, nocturia.

stage 5 chronic kidney failure

• renal failure

• 15%

• kidneys can no longer keep up with removing waste products and extra water

• this is known as kidney failure

• no cure, but treatment options are available

• Generalized illness, fatigue, weakness, headaches, nausea, loss of appetite, weight loss. Anemia, leg cramps, insomnia, dark urine, nocturia.

GFR

• glomerular filtration rate

• how much flood passes through the kidneys each minute; indicates how well kidneys are working

medical management for prevention of kidney failure

• increase water intake

• smoking cessation

• control blood sugar

• healthy eating habits

• monitor blood pressure

• exercise

• limit salt intake

medical management for kidney disease

• DAAMN

• diuretics, ACEi/ARBS, aminoglycosides, metformin, NSAIDs

• kidney dialysis

treatment planning for patients receiving dialysis

•Prone to infection- consult with physician

•Consult with physician regarding control of bleeding

•Schedule based on dialysis schedule- day after dialysis

•Assess for cardiovascular conditions and take blood pressure on arm opposite of shunt

•Ensure patient is medically stable and able to tolerate care- medical consult

•Update medications and address oral side effects

•Tailor drug doses to align with dialysis activity- may alter dose based on dialysis schedule