IP Annals of Prosthodontics and Restorative Dentistry 2021;7(1):5–11

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IP Annals of Prosthodontics and Restorative Dentistry

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Review Article
A brief review in dental management of medically compromised patients

Dania Fatima1, *, Prashanti Wahengbam2 , Shagufta Verma2 , Apurva Agnihotri2 ,

Monika Sehrawat1
1 Dept. of Prosthodontics Crown Bridge and Implantology, Kalka Dental College and Hospital, Meerut, Uttar Pradesh, India
2 Bhojia Dental College and Hospital, Bhud, Baddi, Himachal Pradesh, India

ARTICLE INFO ABSTRACT

Article history: With advancement in the technology & medical science there has been also increase in the various diseases
Received 16-01-2021 & disorders due to lifestyle changes, dietary changes, etc. Due to increase in the aspect of dentistry, there is
Accepted 23-01-2021 a need to know about the medical condition of patients because many dental procedures may cause stress
Available online 26-02-2021 to the patient and their proper management is required in case if patient health status is not so good. Also,
in invasive dental procedures that involve implants, extractions or jaw surgeries also need a proper dental
as well medical management depending upon different conditions likewise there is a risk of bleeding that
Keywords: could be fatal in bleeding disorders, overdose of LA may precipitate the epileptic attack and many more.
COPD Chronic obstructive pulmonary Here in this article we are going to discuss briefly about dental management in medically compromised
disease (COPD)
patients, and also it’s the duty of dentist to have the knowledge of such conditions and he should know how
to manage those patients in his or her dental operatory.

© This is an open access article distributed under the terms of the Creative Commons Attribution
License (https://creativecommons.org/licenses/by/4.0/) which permits unrestricted use, distribution, and
reproduction in any medium, provided the original author and source are credited.

1. Introduction medical history.

We all know that in past few years the medical science

has done great inventions that are very beneficial in better
1.1. Definition of medically compromised patient
diagnosis and treatment of the diseases and same is in
the field of dentistry. But still the disease rate has also Person suffering with medical disorder and may get
been increased in today’s population either due to lifestyle compromised while treating other pathology. 1
changes like dietary changes, sedentary life or there may be
environmental changes or the use of much more chemicals, 2. Discussion
etc. The practice of dentistry today is far different from
past one or two decades also, not only in dental techniques The review focuses on a few medical problems that dentists
and procedures but also in the kinds of patients encountered might encounter in daily practice that need extra knowledge
day to day life. Many chronic disorders or their treatments and care to prevent complications causing otherwise
require alterations in the provision of dental management unnecessary morbidity and mortality. The diseases &
and failure to make appropriate treatment modifications may disorders include diabetes mellitus, cardiac abnormalities,
have serious clinical consequences. The key to successful bleeding disorders like hemophilia, renal system disorder,
dental management of a medically compromised patient is a neurological disorders like epilepsy, respiratory problems,
thorough evaluation of the patient medical condition or his infectious diseases like HIV or hepatitis and many more
disease including multiple drug interactions too.
* Corresponding author. The important points in managing the patient with
E-mail address: dr.dania@gmail.com (D. Fatima). medical problems is acquiring a thorough medical history

https://doi.org/10.18231/j.aprd.2021.002
2581-4796/© 2021 Innovative Publication, All rights reserved. 5
6 Fatima et al. / IP Annals of Prosthodontics and Restorative Dentistry 2021;7(1):5–11

and to fully understand the significance of the disease for patients with significant COPD; in more severe
that may be endorsed by the patient & each identified cases, patients are given long acting agents and inhaled
medical condition can affect dental care in a unique manner. corticosteroids or short courses of systemic corticosteroids.
Knowing how to manage potential complications is also In the dental management of patients with COPD who
important and is presented below for few specific medical are receiving steroids, the dentist should consider the
conditions – use of additional supplementation before major surgery.
Sedatives, hypnotics, and narcotics that depress respiration
should be avoided. Patients may need to be kept in an
2.1. Diabetes mellitus upright sitting position in the dental chair to enable them
to better handle their commonly copious sputum/mucous.
DM is caused by an underproduction of insulin, a resistance Supplemental oxygen greater than their usual rate should
of insulin receptors in end organs to the effects of insulin, or not be administered to patients with severe COPD during
both. Diabetes is commonly divided into insulin-dependent surgery unless the physician advises it. 4
(type 1) and non–insulin-dependent (type 2) diabetes. Type
1 diabetes usually begins during childhood or adolescence. 2.2.1. Asthma
The main objective in managing the diabetic patient is It is the medical condition characterized by the narrowing &
to maintain the blood glucose at near normal levels swelling of airways of respiratory system making breathing
and to avoid acute or chronic complications especially difficult with cough production or wheezing sounds as
hypoglycemic attacks. Drugs like aspirin and steroids clinical symptoms.
should be avoided and Orofacial infections should be The most common causes of asthma exacerbations are
treated. Routine non-surgical procedure treatment is best pollens, spores, house dust, and insect, viral infections of
carried out just after breakfast and continuing with the respiratory tract or smoking. The medical management of
routine antidiabetic medication. For the surgical procedures asthma depends upon its severity either mild, moderate or
the desired blood glucose level is 120-180mg/dl and it severe with pharmacological agents like bronchodilators,
should be regularly monitored. Hyperglycemia may be anti-mucolytic agents, anticholinergics or corticosteroids.
harmful because of delayed wound healing or dysfunction. The supportive treatment of acute severe asthma includes
To avoid Hypoglycemia, IV infusion with glucose which supplemental oxygen, fluid and electrolyte maintenance,
should be measured regularly so that soluble insulin can be anxiety relief, and endotracheal intubation and, in extreme
added as required. 2 In case of moderate to severe dental situations, mechanical ventilation. 5 Dental procedures can
infection it is better to administer antibiotic to diabetic be done for asymptomatic or well-controlled asthmatic
patients prior to the dental extraction or surgery and also patients. A wheezing or poorly controlled patient should be
post op antibiotic medication for 3 to 5 days due to reappointed later. The sittings should be of short duration
compromised immune system in such patients. with as possible as in upright position with less duration of
sittings in supine positions.
The following steps should be taken to manage an acute
2.2. Pulmonary disease asthmatic attack in the dental office:

COPD Chronic obstructive pulmonary disease (COPD) is 1. Discontinue the dental procedure and allow the patient
a general term for pulmonary disorders characterized by to sit or lie down in a comfortable position
chronic airflow limitation from the lungs that is not fully 2. Keep the airway open and administer ~2-agonists with
reversible and it encompasses two main diseases that are inhaler or nebulizer
chronic bronchitis and emphysema. Most cases of COPD 3. Administer oxygen via face mask nasal hood, or
occur as a result of long-term exposure to lung irritants that cannula
damage the lungs and the airways. The primary cause of 4. If no improvement takes place and the patient
COPD is cigarette smoking & Other contributory factors is worsening, administer epinephrine subcutaneously
to COPD include recurrent respiratory tract infection, air (1:1000 solution, 0.01 mg/kg of body weight to a
pollution, cotton textile dust heredity and aging. The signs maximum dose of 0.3 mg), and summon medical
and symptoms of COPD include – assistance. 6
An ongoing cough or a cough that produces large
amounts of mucus often called smokers cough, Shortness of
breath, especially with physical activity, Wheezing, Chest
tightness. 2.3. Hemophilia
However, not everyone who has these symptoms has Bleeding disorders can be classified as coagulation factor
COPD. 3 Bronchodilators such as theophylline, inhaled beta deficiencies, platelet disorders, vascular disorders, and
agonists, or inhaled anticholinergics are usually prescribed fibrinolytic defects. Among these, hemophilia A that occurs
 Fatima et al. / IP Annals of Prosthodontics and Restorative Dentistry 2021;7(1):5–11 7

due to deficiency of clotting factor VIII, hemophilia B deposited in a highly vascularized area, which carries a
also known as Christmas disease due to the deficiency of risk of hematoma formation. 9 Extravasation of blood in
factor IX, hemophilia C or Rosenthal syndrome due to the oropharyngeal area by an inferior alveolar block or
the deficiency of factor XI and von Willebrand’s disease in the pterygoid plexus can produce gross swelling, pain,
are the commonly encountered congenital coagulation dysphasia, respiratory obstruction and risk of death from
defect disorders. 7 These hemophiliac patients can lead to asphyxia. 10,11 Anesthetic infiltration and intraligamentary
prolonged clotting time and excessive bleeding tendencies anesthesia are good alternatives to nerve block with a
that may be fatal. vasoconstrictor (when possible) in such patients. Non-
Management of hemophilia A among patients surgical endodontic therapy is preferred over extraction
undergoing dental surgery consists of increasing factor whenever possible in hemophiliac patient.
VIII levels, replacing factor VIII and inhibiting fibrinolysis
(table1Table 1). 8 2.4. Thyroid patients
The thyroid gland is an endocrine gland in the neck
Table 1: Presurgery treatment for hemophilia A
consisting of two connected lobes that secretes the thyroid
Condition Treatment and dose Potential hormones like thyroxine (T4) & triiodothyronine (T3).
complications
Thyroid hormones help with brain development and
Mild bleeding Dose: 15 U/kg Hemarthrosis, function, regulates the metabolic rate of the body. These
factor VIII every oropharyngeal or hormones also regulate the metabolism of fat, proteins
8–12 hours for 1–2 dental bleeding, and carbohydrates, Thyroid hormones are integral in the
days Target: 30% of epistaxis, hematuria
normal level regulation of many functions and aspects of the human
Major Dose: 50 U/kg Same potential body, such as temperature regulation, energy levels, weight
bleeding factor VIII every complications as for and many more. Patients with thyroid dysfunction may
8–12 hours for mild bleeding, as be classified as euthyroid, hypothyroid, or hyperthyroid
7–14 days Target: well as CNS depending on normal, decreased or hyper activity of
80% to 100% haemorrhage, the thyroid. Characteristics of hypothyroidism include
retroperitoneal
haemorrhage,
anemia, cardiomegaly, cold intolerance, constipation,
gastrointestinal cretinism (children), dry hair, elevated, creatine, goiter,
bleeding of normal hyperlipidemia, hypertelorism, hypotension, inverted
level T waves in electrocardiogram, lethargy, low-amplitude
QRS wave in electrocardiogram, myxedema, paresthesia,
*Adjunctive therapy Desmopressin, tranexamic acid psilonaminocaproic reduced cardiac output, reduced respiratory rate, seizures,
acid(for mild disease) bradycardia, weight gain, whereas the characteristics of
hyperthyroidism include abdominal pain, heart murmur,
Hemophilia B is managed by replacement therapy with diplopia, dysrhythmias, elevated alkaline phosphatase,
highly purified, virally inactivated factor IX concentrates. fatigue , fine hair, goiter, heat intolerance, hypercalcemia,
Prothrombin complex concentrates can also be used for increased appetite, increased cardiac output, increased
factor IX replacement. 8 pulse, nervousness, palpitations, proptosis, psychosis
Von Willebrand’s disease is not sex linked. For mild ,tachycardia, tremor, warm skin, weight loss. 12 The dental
conditions in von Willebrand’s disease, use of DDAVP may management in hypothyroid patients in untreated or poorly
be sufficient, but severe disease needs replacement with controlled cases include avoid surgical procedures, treat
factor VIII. 8 oral infection, avoid CNS depressants such as narcotics,
The management of patients with bleeding disorders barbiturates; in well controlled cases avoid oral infections,
depends on the severity of the condition and the implementation of normal procedures and management;
invasiveness of dental procedure. If the procedure has where in case of medical crisis i.e. rare include recognition
limited invasiveness and the patient has a mild bleeding and initial management of myxedematous coma, seek
disorder, then only slight or no modification will be medical aid, hydrocortisone 100 mg, CPR. 13 Dental
required but in patients with severe bleeding disorders, management in case of hyperthyroidism include avoid
main aim is to restore the hemostatic system of the the use of adrenaline and control the spread of infection.
patient to acceptable levels and maintain hemostasis by Treatment should be discontinued if signs or symptoms
local and adjunctive methods. The patient’s physician of a thyrotoxic crisis develop. Management of stress is
should be consulted before invasive treatment. In case important in such patients as stress, anxiety or surgery
of irreversible coagulopathies, replacement of missing can trigger the thyrotoxic crisis. Anti-thyroid drugs like as
factors is the need. In haemophiliac patient nerve block propylthiouracil has anti-vitamin K activity and can cause
injections are contraindicated as the anesthetic solution is hypoprothrombinemia and bleeding that poses a risk for
8 Fatima et al. / IP Annals of Prosthodontics and Restorative Dentistry 2021;7(1):5–11

hemorrhage and so patients taking PTU must be carefully the arteries of the heart. IHD include stable angina, unstable
evaluated before surgery or invasive dental treatment. 14 angina, myocardial infarction, and sudden cardiac death.
Dental management in IHD is given via table 2. 20
In case of patients taking anti-platelet or anti-coagulant
2.5. Cardiac problems therapy in case of MI or angina, there is the need to
monitor the CT, BT, PT, pTT/INR in case when there is
Hypertension is an important health problem due to its the requirement of surgical procedure or dental extractions.
high incidence and prevalence in the general population Also, the appointments should be of smaller duration with
and it is associated with increase in risk of suffering proper stress management.
cardiovascular disease like angina, myocardial infarction
and cerebrovascular events example stroke. The blood
2.6. Epilepsy
pressure values considered to be normal were established
by consensus as under 90 mmHg in the case of diastolic Dental environment can provoke seizures even in well-
pressure, and under 140 mmHg in the case of systolic controlled epileptics. Prophylactic anticonvulsants:
pressure 15 and National Committee on the Prevention, Carbamazepine, Phenobarbitone, Sodium Valproate,
Detection, Evaluation, and Treatment of High Blood Phenytoin, Lamotrigine, Vigabatrin and Gabapentin.
Pressure (JNC 7) introduced the term “pre-hypertension” The management of epileptic patient in dental operatory
in reference to people with a systolic blood pressure of includes –
120-139 mmHg or with a diastolic blood pressure of 80- Terminate dental procedure and place patient into a
89 mmHg. 16 A well control hypertensive patients does not supine position, Protect the patient during attack, Seizures
pose a risk in clinical practice, hypertensive patient is to secondary to LA overdose- until cerebral level of LA falls
be instructed to take his or her medication as usual on below seizure threshold, maintain adequate airway and
the day of dental treatment. Prior to dental treatment, the oxygen, IV anticonvulsants administration of diazepam 0.2
patient blood pressure should be recorded, and the treatment – 0.5mg / kg per dose IV, repeated at 3 – 5 min. (2)
should be postponed if the values are higher. Dental
visits should be in morning time with shorter durations. 2.7. Renal problems
Prescription of anxiolytic agents is required in anxious
patients like 5-10 mg of diazepam the night before and Kidney transplant dental treatment of transplant
1-2 hours before the appointment before dental treatment. patient requires close consultation between the dentist
A good local anesthetic technique should be performed, and the treating nephrologist. After transplant the
avoiding intravascular injection and using a maximum of immunosuppressants are given to the patient to prevent
two anesthetic cartridges (1.8mlx2) with vasoconstrictor. If organ rejection that include nowadays is a combination
more anesthesia is needed, it should be provided without of tacrolimus, mycophenolate and prednisolone. Instead
vasoconstrictor. Absorbable sutures are to be avoided with of this, some patients receive cyclosporine, sirolimus or
adrenaline. When the patient does not present good blood azathioprine.[22] Even after the kidney transplantation, the
pressure control, it is best to refer him to the physician. renal function is not fully restored and this may result in
In the case of emergency dental visits, treatment should hemorrhage and also in the rare occasion that the transplant
be conservative, with the use of analgesics and antibiotics. patient is administered coumarin anticoagulants as large no.
Surgery is to be avoided until adequate blood pressure of patients suffers from cardiovascular diseases too, that
control has been secured. 17 Certain NSAIDs, such as is why a recent INR should be required before any dental
ibuprofen, indomethacin or the naproxen, can interact with work that may involve bleeding & INR should be less than
antihypertensive drugs (beta-blockers, diuretics, ACEIs), 18 or equal to 2.5 and if more here should be a consultation
thus lowers antihypertensive action of drugs. Normally with the nephrologist so as to adjust the dose. 21
more than five days of treatment with both types of drugs Renal failure (on dialysis) dental management in
are required for interactions to occur; 19 as a result, NSAIDs patients with renal failure that are on dialysis need a close
should not be prescribed for longer than this five-day period. cooperation between medical and dental professionals in
In the case of a hypertensive emergency (>120/210 mmHg), order to improve the oral and general health of the patient.
furosemide should be administered (40 mg, via the oral Prior to any invasive dental treatment, a complete blood
route). If this proves insufficient to restore pressure control, count together with coagulation tests is the need. It is
captopril should be administered (25 mg via the oral or essential to eliminate any infection in the oral cavity as soon
sublingual route). If the blood pressure fails to decrease as possible with the consideration of antibiotic prophylaxis
within 30 minutes after these measures, the patient should when bleeding and/or a risk of septicemia is expected.
be referred to the nearest hospital. 20 B.P. should be monitored. Penicillins, clindamycin and
IHD ischemic heart diseases involves the reduction of cephalosporins can be administered at the usual doses,
blood flow to the heart muscle due to build-up of plaque in and are the antibiotics of choice although the dosing
 Fatima et al. / IP Annals of Prosthodontics and Restorative Dentistry 2021;7(1):5–11 9

Fig. 1:

interval should be prolonged. PCM is the drug of choice or CD4+ T lymphocyte percentage of total lymphocytes is
in analgesics and aspirin should be avoided due to its <14 or documentation of an AIDS-defining condition (see
antiplatelet activity. It is advisable to provide dental Box 18-1). Documentation of an AIDS-defining condition
treatment on non-dialysis days, to ensure the absence of supersedes a CD4+ T lymphocyte count of ≥200 cells/µ L
circulating heparin, which has a half-life of about four and a CD4+ T lymphocyte percentage of total lymphocytes
hours. Desmopressin has been proposed for the control of of ≥14.
severe bleeding in patients with renal failure, Tranexamic
acid in the form of a rinse or administered via the oral route Treatment of AIDS often is organized into three
at a dose of 10-15 mg/kg body weight a day distributed in major areas: (1) ART, (2) prophylaxis for opportunistic
2-3 doses, may also prove useful. 22 infections, and (3) treatment of HIV related Complications.
Medical history, head and neck examination, intraoral
soft tissue examination, and complete periodontal and
dental examinations should be performed on all new
2.8. Infectious diseases
patients before performing any dental procedures. As with
AIDS acquired immunodeficiency syndrome that is caused other immunosuppressed patients, such as cancer patients,
by retrovirus named as HIV (human immunodeficiency proper nutrition is important. Treating AIDS patients
virus). It can be transmitted during sexual intercourse who have painful oral lesions with appropriate analgesics
from an infected to an uninfected partner, when sharing or medicines for oral lesions is especially important as
equipment used to inject drugs, during pregnancy, labor immunosuppression is major factor for these oral lesions
and delivery, and through breastfeeding. Infection can also to occur. 23 A proper oral examination is of importance
occur during exposure to the blood of an infected patient via because many physicians do not perform thorough intraoral
needlestick or a splash to exposed mucous membranes. examinations at routine visits. It is the responsibility
CDC staging of HIV infection in adults (4) – of the dental practitioner to screen for oral cancer and
Stage 1: Laboratory confirmation of HIV infection, no intraoral lesions that may be indicative of HIV, oral
AIDS-defining conditions and CD4+ T lymphocyte count of disease, or oral/perioral signs of other systemic diseases.
≥500 cells/µ L or CD4+ T lymphocyte percentage of total The oral manifestations of AIDS include Candidiasis,
lymphocytes of ≥29. Angular chelitis, Histoplasmosis, Cryptococcosis linear
Stage 2: Laboratory confirmation of HIV infection, no gingival erythema, necrotizing ulcerative periodontitis,
AIDS-defining condition, and laboratory confirmation of necrotizing stomatitis, actinomycosis, herpes simplex, hairy
HIV infection and CD4+ T lymphocyte count of 200- leukoplakia, oral warts, kaposi’s sarcoma, facial palsy,
499 cells/µ L or CD4+ T lymphocyte percentage of total trigeminal neuropathy, recurrent thrombocytopenic purpura,
lymphocytes of 14-28. recurrent aphthous ulcers, salivary gland enlargement,
Stage 3: (AIDS): Laboratory confirmation of HIV xerostomia that may lead to dental caries, melanotic
infection and CD4+ T lymphocyte count is <200 cells/µ L pigmentation. 24 Thus, proper oral screening and their
10 Fatima et al. / IP Annals of Prosthodontics and Restorative Dentistry 2021;7(1):5–11

management is the duty of dentist, besides this before Antibiotic prophylaxis has been used in dentistry for
doing invasive procedure its better to consult with patient’s patients at risk of infective endocarditis or prosthetic
physician to know about the current viral load and CD4 joint infections. The most common antibiotics used
count of the patient. Also, dentist must follow the universal before surgeries are cephalosporins, such as cefazolin and
precautions for the prevention and if got exposed he should cefuroxime. Your doctor may prescribe vancomycin if
take chemo-prophylactic therapy. you are allergic to cephalosporins. For dental procedures,
Universal precautions are – amoxicillin or ampicillin, clindamycin or azithromycin or
Washing your hands often. cephalosporins can be given prior to the surgical procedure.
Using protective barriers such as gloves, gowns/aprons, ASA physical status classification American Society
masks for direct contact with blood and other body fluids. of Anaesthesiologists (ASA) Physical Status classification
Safe collection and disposal of needles and sharps system was initially created in 1941 by the American
(sharps boxes required for this). Society of Anaesthetists. The purpose of the grading system
Following the correct procedures for a needle–stick is to asses the degree of patient’s sickness prior providing
injury (the area should be washed out with soap and water, any treatment and this asa classification also implies for the
dispose the needle safely (in case you injure yourself again), dental treatment. The classification for the above is given
go & get assessed for PEP. below in the table 4 27
Covering all cuts and abrasions with waterproof
dressings.
Use of disposable instruments for examining and doing
procedures as far as possible.
Cleaning up spills of blood and other body fluids with
bleach. Use a separate mop for body fluid spillages and
dispose carefully of all equipment (cloths etc.) used to clean
up the spillage.
These universal precautions are not limited to HIV
infections, instead helpful in every contagious or
communicable infections like hepatitis B, C, and nowadays
also in case of covid-19 pandemic which is too contagious
that the whole world is suffering since more than a year.
PEP for HIV is – You must start PEP within 72 hours
after you were exposed to HIV. 25 The sooner you start it, Fig. 3:
the better it will be.
PEP by GOI (NACO) is given below 26
3. Conclusion
From the above overall discussion we can conclude that
how important it is to keep the knowledge of different
medical conditions and their medical management as well
as dental management in dental OPD. A minor stress can
precipitate an anginal attack or lack of taking proper medical
history may result in heavy bleeding that could be fatal for
patient’s life. Thus, every dentist must take proper medical
history and do general examination so that he could manage
such patients in a well-mannered way and thus can prevent
medical emergencies to a great extent.

4. Source of Funding
Fig. 2: No financial support was received for the work within this
manuscript.
Antibiotic prophylaxis Routine management, where
invasive dental treatment is provided without antibiotic 5. Conflict of Interest
prophylaxis, will be appropriate for the vast majority
The authors declare they have no conflict of interest.
of patients at increased risk of infective endocarditis.
 Fatima et al. / IP Annals of Prosthodontics and Restorative Dentistry 2021;7(1):5–11 11

References 17. Jr JK, Herman WW, Prisant LM. Joint National Committee on
Prevention, Detection, Evaluation, and Treatment of High Blood
1. Mustilwar RG, Shetti AN, Bhadange S, Mani A, Padmawar N, Pressure. New national guidelines on hypertension: A summary for
Vadvadgi V, et al. Management of medically compromised patients dentistry. J Am Dent Assoc. 2004;135(5):576–84.
in dentistry -A Review. Int J Scientific Res. 2018;7(4):64–7. 18. Pharmacological interactions of anti-inflammatory-analgesics in
2. Manihan AK, Singla K, Vyas D, Sareen K, Parmar E, Arora odontology. Med Oral Patol Oral Cir Bucal. 2009;14(2).
A, et al. Dental Management in Medically Compromised 19. Salort-Llorca C, Mínguez-Serra MP, Silvestre-Donat FJ. Interactions
Patients : An Overview. Int J Contemp Res Rev. 2020;11(8). between ibuprofen and antihypertensive drugs: Incidence and clinical
doi:10.15520/ijcrr.v11i08.832. relevance in dental practice. Med Oral Patol Oral Cir Bucal.
3. Rahman SS, Faruque M, Khan MHA, Hossain SA. Dental 2008;13(11):E717–21.
management of COPD patient. Bang Med J (Khulna). 2011;44:21– 20. Cruz-Pamplona M, Jimenez-Soriano Y, 1 MGSP. Dental
4. considerations in patients with heart disease. J Clin Exp Dent.
4. Little J, Miller C, Rhodus N, Falace D. Dental Management in 2011;3(2):c97–105.
Medically Compromised Patients: An Overview. In: 8th Edn. Elsevier; 21. Dental management of patients before and after renal transplantation.
2012. Stomatologija, Baltic Dent Maxillofac J. 2011;13:107–12.
5. Outpatient management of childhood asthma. Pediatr Ann. 22. Dental management in renal failure: Patients on dialysis. Med Oral
1993;22:579–81. Patol Oral Cir Bucal. 2008;13(7):E419–26.
6. Asthma. Medical Emergencies in the Dental Office. CV Mosby Co; 23. Dental Treatment Issues for Patients With HIV/AIDS. Inside Dent
1993. p. 194–207. Assisting. 2009;5(6).
7. Warnakulasuriya S. Burket’s oral medicine: diagnosis and treatment. 24. HIV/AIDS in Dental Care - A Case-Based Self-Study Module for
In: 10th Edn. New York: BC Decker; 2007. Dental Health Care Personnel. 2002;.
8. Gupta A, Epstein JB, Cabay RJ. Bleeding Disorders of Importance in 25. https://www.cdc.gov/hiv/basics/pep.html.
Dental Care and Related Patient Management. JCDA. 2007;73(1):77– 26. Revised guidelines for PEP for HIV. Govt. of India, MoHFW.; 2014.
83. 27. https://www.researchgate.net/profile/Satbir_Grover/publication/2930
9. Nazif M. Local anesthesia for patients with hemophilia. ASDC J Dent 98432/figure/fig1/AS:672198465441792@1537276011139/ASA-Ph
Child. 1970;37(1):79–84. ysical-Status-Classification-System-27_W640.jpg.
10. Archer WH, Zubrow HJ. Fatal hemorrhage following regional
anesthesia for operative dentistry in a hemophiliac. Oral Surg
Oral Med Oral Pathol. 1954;7(5):464–70. doi:10.1016/0030-
Author biography
4220(54)90003-1.
11. Leatherdale RAL. Respiratory obstruction in haemophilic patients. Br
Med J. 1960;1(5182):1316–20. Dania Fatima, Post Graduate 3rd Year Student
12. Fabuel LC, Soriano YJ, Pérez MGS. Dental management of patients
with endocrine disorders. J Clin Exp Dent. 2010;2(4):196–203.
13. little JW. Thyroid disorders. Part II: hypothyroidism and Prashanti Wahengbam, Post Graduate 3rd Year Student
thyroiditis. Oral Surg, Oral Med, Oral Pathol, Oral Radiol, Endod.
2006;102(2):148–53. Shagufta Verma, Post Graduate 3rd Year Student
14. Fabue LC, Soriano YJ, Pérez MGS. Oral manifestations of
thyroid disorders and its management. Indian J Endocrinol Metab. Apurva Agnihotri, Post Graduate 3rd Year Student
2010;2(4):e196–203.
15. Jr AGM. Medical management of the patient with cardiovascular Monika Sehrawat, Post Graduate 2nd Year Student
disease. Periodontol. 2000;2000:136–41. doi:10.1034/j.1600-
0757.2000.2230114.x..
16. Chobanian AV, Bakris GL, Black HR, Cushman WC, Green
LA, Jr JI, et al. The Seventh Report of the Joint National Cite this article: Fatima D, Wahengbam P, Verma S, Agnihotri A,
Committee on Prevention, Detection, Evaluation, and Treatment of Sehrawat M. A brief review in dental management of medically
High Blood Pressure: the JNC 7 report. JAMA. 2003;289(19):2560– compromised patients. IP Ann Prosthodont Restor Dent 2021;7(1):5-11.
72. doi:10.1001/jama.289.19.2560.