• 대한치과의사협회지
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• 제48권7호
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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.

• 대한치과마취과학회지
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• 제8권1호
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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.

• 대한치과마취과학회지
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• 제11권2호
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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.

• 대한치과의사협회지
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• 제48권1호
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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.

• 대한치과의사협회지
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• 제48권1호
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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.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제26권1호
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• pp.85-92
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• 2000

Common dental procedures(dental extraction & minor operation) are potentially stress-inducing in many patients, especially medically compromised patients. The body's 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 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 Though the stress reduction protocol above was applied to the dental extraction in medically compromised patients with the advanced infected teeth, the final responsibility for the complications(syncope, bleeding & infection, etc.) in a patient rests with the dentist who ultimately treats him. For the prevention of postextraction complications & poor prognosis, the authors treated the advanced infected teeth with the pulp extirpation, opening drainage through the canal and complete occlusal reduction. The final extraction and wound closure were then done after $1{\sim}2$ weeks. The final prognosis was comfortable without common complications.

• 대한치과의사협회지
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• 제48권1호
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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.

• 대한장애인치과학회지
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• 제9권1호
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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.

• 대한치과마취과학회지
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• 제11권2호
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• pp.177-182
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• 2011

There are five principal causes for excessive bleeding in the immediate postextraction phase ; (1) Vascular wall alteration (wound infection, scurvy, chemicals, allergy) (2) Disorders of platelet function (genetic defect, drug-aspirin, autoimmune disease) (3) Thrombocytopenic purpuras (radiation, leukemia), (4) Inherited disorders of coagulation (hemophilia, Christmas disease, vitamin deficiency, anticoagulation drug-heparin, coumarin, aspirin, plavix). If the hemorrhage from postextraction wound is unusually aggressive, and then dehydration and airway problem are occurred, the socket must be packed with gelatine sponge(Gelfoam) that was moistened with thrombin and wound closure & pressure dressing are applied. The thrombin clots fibrinogen to produce rapid hemostasis. Gelatine sponges moistened with thrombin provide effective coagulation of hemorrhage from small veins and capillaries. But, in dental alveoli, gelatine sponges may absorb oral microorganisms and cause alveolar osteitis (infection). This is a case report of bleeding and infection control by the circumferential suture and iodoform gauze drainage on infected active bleeding extraction socket under sedation and local anesthesia in a 71-years-old male patient with anticoagulation drug.

• 대한치과보철학회지
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• 제47권3호
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• pp.295-300
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• 2009

연구목적: 현대의학의 발달로 고령 인구가 증가함에 따라 부분 무치악이나 완전 무치악 환자의 비율이 증가되고 있다. 고령 환자는 전신적 질환이 동반되는 경우가 흔하므로 보철 치료 시에도 전신적인 건강 상태 및 경제적 여건에 대한 고려가 필요하다. 고령의 환자나 전신적 질환자에 있어 임플란트 등의 치료보다 가철성 국소의치가 선호되고 실제로 많이 적용되고 있으나 기존의 금속-아크릴 국소의치는 많은 한계점을 가지고 있다. 전치부에 금속 클래스프가 위치하여 비심미적이고 미중합 레진에 의한 알레르기 반응이 있으며 지대치에 가해지는 응력이 크며, 파절 시 수리가 용이하지 않다. 또한 대부분의 경우 지대치에 주조 금관의 제작이 필요하며 이로 인해 추가적인 고가의 보철비용을 부담하여야 하고 제작과정이 복잡할 뿐 아니라 장기간의 치료와 여러 번의 내원이 필요하다. 반면, 최근 이용빈도가 증가하고 있는 Valplast$^{(R)}$ 탄성 국소의치는 Nylon 재질로 생체친화성이 높고 심미적이고 가벼우며 수리가 용이한 장점이 있다. 또 간단한 진료 과정과 짧은 제작기간 후 의치를 장착할 수 있다. 본 증례에서는 장기간의 치료기간과 다수의 내원이 어려운 전신 질환자 및 예후가 불량한 환자에서 Valplast$^{(R)}$ 탄성국소의치를 적용한 예를 보고하고자 한다. 결과 및 결론: 증례에서 환자들은 만성 질환, 암 등의 전신적, 소모성 질환을 앓고 있거나 개구 제한 또는 예후가 불량한 잔존 지대치 등 통상적인 보철치료가 힘든 경우였다. 이러한 환자들에게 기존의 금속-아크릴 국소의치는 신체적으로나 경제적인 이유로 적용이 어려워 대신 추가적인 보철물의 제작이 필요없고, 제작과정이 간단한 Valplast$^{(R)}$ 탄성 국소의치를 적용하였다. 환자들은 평균 1-2회의 주기적 체크를 했고 현재까지 동통이나 파절 등의 불편감이 없이 잘 사용하고 있다. 여러 증례에서 기존의 가철성 의치의 단점을 보완하는 탄성의치를 이용하여 만족한 결과를 얻었기에 보고하는 바이다.