• The Journal of the Korean dental association
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• v.48 no.7
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• pp.538-546
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• 2010

Dental surgical procedures are potentially stress-inducing to not only patients but clinicians especially in case of medically compromised patients. The body response to dental stress involves the cardiovascular, respiratory and the endocrine system. To minimize the stress to the medically compromised patients, the stress reduction protocols should be established. The protocols include (1) Recognize the patient's degree of medical risk (2) Medical consultation before dental therapy (3) Schedule the patient's appointment in the morning (4) Monitor and record preoperative, perioperative and postoperative vital signs (5) Intra-venous sedation during surgical procedures (6) Adequate pain control during therapy (7) Short length of appointment time (8) Contact the patients on the same day. Two cases of Bisphosphonate-related osteonecrosis of the jaws were analyzed. There were 2 women, and the mean age was 70 years (range, 64~74 years). both are medically compromised, with steroids. Both patients were taking an oral bisphosphonate for several years. BRONJ is defined as an area of exposed bone of more than 8 weeks - duration in a patient taking a bisphosphonate for bone disease. Bisphosphonates have been widely prescribed over the last decade for a range of bone diseases, mainly intravenously for bone cancers and orally for osteoporosis. Although it is still controversial as to precisely how the bisphosphonates work, generally it is accepted that they prevent osteoclast action, with consequent cessation of osteoblast activity, so that the bone turnover is markedly reduced or ceased. The aim of this study is to informed the clinicians how to prepare and recognize in case of the BRONJ with medically compromised patients.

• Journal of The Korean Dental Society of Anesthesiology
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• v.8 no.1
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• pp.1-9
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• 2008

Common dental procedures (local anesthesia and dental treatment) are potentially stress-inducing in many patients, especially medically compromised patients. The body response to dental stress involves the cardiovascular system (an increase in cardiovascular workload), the respiratory organ and the endocrine system (change in metabolism). To minimize the stress to the medical risk patient, the stress reduction protocol was established. The obtained contents were as follows: (1) Recognize the patient's degree of medical risk (2) Complete medical consultation before dental therapy (3) Schedule the patient's appointment in the morning (4) Monitor and record preoperative, perioperative and postoperative vital signs (5) Use psychosedation during therapy (6) Use adequate pain control during therapy (7) Short length of appointment: do not exceed the patient's limits of tolerance (8) Follow up with postoperative pain/anxiety control (9) Telephone the higher medical risk patient later on the same day that treatment was given. This protocol is predicated on the belief that the prevention of or reduction of stress ought to begin before the start of an appointment, continue throughout treatment, and, if indicated, into the postoperative period. The authors used the stress reduction protocol in the care of local anesthesia infected teeth in medically compromised patients. The final prognosis was comfortable without any complications.

• The Journal of the Korean dental association
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• v.48 no.1
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• pp.38-44
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• 2010

Nowadays, medically compromised patients who could not receive dental treatments in the past are able to go through minor oral surgeries with adequate preoperative measures. Thorough understanding of the systemic disease and its complications is needed as well as the management them. Frequent complications of surgical procedures are bleeding, infection, delayed healing, systemic reactions by stress and they can be aggravated due to the patients' systemic conditions. Therefore, understanding of the systemic disease of patient visiting dental office and treatment modification according to the systemic status is needed. Also consultation to the medical doctor is imperative, through which perioperative risk and complications can be reduced. Among the high frequency complications of dental treatment of medically compromised patients, bleeding, infection, delayed healing, systemic reactions by stress will be discussed with the management of each one.

• The Journal of the Korean dental association
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• v.48 no.1
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• pp.27-37
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• 2010

Current trend of aging society suggests that many patients are at risk for various preoperative preparations and postoperative complications during and following invasive dental procedures, due to an acquired medically compromised conditions from systemic disease and/or from medications. The medical history is critical for the identification of patients potentially at risk for medically compromised and old aged patients' factors from dental treatment. The proper dental management requires an understanding of certain principles of pathophysiology for these medical conditions and some standard laboratory tests. Polypharmacy in old age, besides representing a risk in and of itself, points to the potential risk the underlying diseases that necessitated the drugs can present in the dental office. These diseases and medications can also present a risk to oral health. A sequence for categorizing drugs in a medication list is presented here to aid in the identification of potential risks in the dental treatment and management of patients with complex medical histories and drug regimens. Specific patient populations, such as pediatric, may have specific drugs or additional criteria that need to be considered. Practitioners must use the health history and the medication list in concert, using one to make sense of the other and utilizing all the information available from reviewing each one carefully in order to manage their increasingly complex patients safely and effectively.

• Journal of The Korean Dental Society of Anesthesiology
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• v.11 no.2
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• pp.164-171
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• 2011

Altered consciousness may be the first clinical sign of a serious medical problem that requires immediate and intensive therapy to maintain life. There are many causes of the loss of consciousness in the dental office setting, such as, vasodepressor syncope, drug administration or ingestion, orthostatic hypotension, epilepsy, hypoglycemic reaction, acute adrenal insufficiency, cerebrovascular accident, hyperglycemic reaction, acute myocardial infarction, acute allergic reaction and hyperventilation. This is a case report of syncope and coma during endodontic treatment of a maxillary third molar under local infiltration anesthesia in multiple medically compromised patient. The main cause was thought to be hypoglycemic reaction. The patient was transferred to the medical emergency room and cared properly by the emergency medical physicians. The prognosis was good.

• The Journal of the Korean dental association
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• v.48 no.1
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• pp.20-26
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• 2010

The fundamental goal of dental treatment is rehabilitation of oral health thus various dental treatment are done. Most of the dental procedures are not life threatening but patients who are medically compromised are exceptional. Fortunately systemic disease can be easily diagnosed by medical insurance(medicare) or annual medical check examination in Korea. Diseases which were fatal at the past are successfully treated nowadays and consequently the population of the elder increases. As the population of elder increases, patients who need medical care as well as dental patient with compromised medical condition increases. It is essential to find out if the patient has any systemic disease. Consultant to the appropriated physician of medically compromised patients? is demanded and also for a successful dental treatment, deep knowledge of the systemic disease is necessary.

• The Journal of Korean Academy of Prosthodontics
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• v.47 no.3
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• pp.295-300
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• 2009

Statement of problem: As the number of elders is growing with the advancement of medicine, partially or fully edentulous patients have increased. Medically compromised conditions are common in the older population so that it should be taken into account in prosthetic treatment planning as well as their economic conditions. In the older patients, removable prosthesis has been preferred to implant prosthesis. However, cast metal based removable partial dentures also has several limitations. Purpose: In this report, we present several cases of Valplast$^{(R)}$ flexible denture which were fabricated in patients who had medically compromised conditions or whose remaining teeth showed a relatively poor prognosis. Results & Conclusion: This article describes an alternative treatment for a partially edentulous patient with mouth opening limitation, after cancer surgery, compromised general condition and questionable remaining teeth. In these patients, Valplast$^{(R)}$ flexible denture was used because of its unique characteristics and the results were all satisfactory. Patients had 1-2 check-up and there were no postoperative pain or fracture of denture up to now.

• The Journal of the Korean dental association
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• v.42 no.11 s.426
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• pp.798-806
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• 2004

• The Journal of Korea Assosiation for Disability and Oral Health
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• v.9 no.1
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• pp.30-35
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• 2013

The four principles of treatment of odontogenic infection are as follows : (1) removal of the cause, (2) establishment of drainage, (3) institution of antibiotic therapy, and (4) provision of supportive care, including proper rest and nutrition. A separate incision is required to establish drainage, especially in the case of extensive fascial space infections. There are four principle causes for active bleeding in the immediate incision & drainage phase; (1) vascular wall alteration (infection, scurvy, chemicals), (2) disorder of platelet function, (3) thrombocytopenic purpuras, (4) disorders of coagulation (liver disease, anticoagulation drug). If the hemorrhage from incision & drainage site is aggressive, the site must be packed with proper wet gauze and wound closure & drainage dressing are applied. The specific causes of bleeding may be associated with hypoxia, changes in the pH of blood & chemical changes affecting vascular contractility and blood clotting. This is a case report of bleeding control by the circumferential suture & drainage on active bleeding incision & drainage site of temporal space abscess due to advanced odontogenic infection in a multiple medically compromised disabled patient.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.45 no.5
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• pp.260-266
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• 2019

Objectives: Dental implants shorter than 8 mm, called short dental implants (SDIs), have been considered to have a lower success rate than standard length implants. But recent studies have shown that SDIs have a comparable success rate, and implant diameter was more important for implant survival than implant length. Also, SDIs have many advantages, such as no need for sinus lifting or vertical bone grafting, which may limit use in medically compromised patients. Materials and Methods: In this study, 33 patients with 47 implants 7-mm long were examined over the last four years. All patients had special medical history and were categorized into 3 groups: systemic disorders, such as diabetes mellitus (controlled or uncontrolled), mental disability, and uncontrolled hypertension; oral cancer ablation with reconstruction, with or without radiotherapy; diverse osteomyelitis, such as osteoradionecrosis and bisphosphonate-related osteonecrosis of the jaw. Most of these patients have insufficient residual bone quality due to mandible atrophy or sinus pneumatization. Results: The implant diameters were 4.0 (n=38), 4.5 (n=8), and 5.0 mm (n=1). Among the 47 implants placed, 2 implants failed before the last followup. The survival rate of 7-mm SDIs was 95.74% from stage I surgery to the last follow-up. Survival rates did not differ according to implant diameter. The mean marginal bone loss (MBL) at 3 months, 1 and 2 years was significantly higher than at implant installation, and the MBL at 1 year was also significantly higher than at 3 months. MBL at 1 and 2 years did not differ significantly. Conclusion: Within the limitations of the present study, the results indicate that SDIs provide a reliable treatment, especially for medically compromised patients, to avoid sinus lifting or vertical bone grafting. Further, long-term follow-up is needed.