Hygiene Atlas

Atlas · Plate XVII · Patient Management and Special Needs · 06

Medically compromised patients

Medical conditions change timing and technique. Elective care in pregnancy fits best in the second trimester. Head and neck radiation patients need daily high-strength fluoride for life, dialysis patients are seen the day after dialysis, and a spinal injury at or above T6 risks autonomic dysreflexia. Prosthetic joints generally need no antibiotic premedication.

High-yield facts · 11

  1. Pregnancy: second trimester is best for elective care; avoid tetracyclines; radiographs as needed; no nitrous in the first trimester.T2S62
  2. Cancer chemotherapy: check counts; defer invasive care if absolute neutrophil count is under about 1,000-1,500/microliter or platelets under about 50,000. (verify thresholds)T2
  3. Head and neck radiation over about 60 Gy raises osteoradionecrosis risk; extractions and invasive care in the field need special planning.T2
  4. Radiation patients need daily high-fluoride (custom trays or 5,000 ppm paste) for life.T2
  5. Kidney dialysis: treat the day after dialysis; never take BP on the arm with the AV fistula.T2
  6. Organ transplant patients take immunosuppressants; cyclosporine causes gingival enlargement.T2
  7. Spinal cord injury at or above T6: risk of autonomic dysreflexia (sudden hypertension, often from a full bladder); stop, sit upright, find the trigger.T2
  8. HIV: oral signs include candidiasis, hairy leukoplakia, Kaposi sarcoma, linear gingival erythema and necrotizing periodontal disease.T5
  9. Patients with HIV cannot be refused care because of their status; standard precautions apply to all.S7
  10. Sickle cell disease, hemophilia and leukemia raise bleeding or infection concerns; consult the physician.T2
  11. Patients with prosthetic joints generally do not need antibiotic premedication.S4

Facts are written in our own words; each tag links to its source. Values marked "sources vary" differ between references, so check the one your program uses.