June 25, 2015

  1. Diabetics – Many diabetics unaware they are affected, look out for unexpected periodontal problems, well and moderately controlled same risk as ‘normal’, implant survival minimally affected (short term), be aware of hypoglycemia.
  1. HIV – 24% unaware they are infected, look for oral signs of HIV, do not focus on absolute CD4 counts, consider co-morbidities, treat as ‘normal’ with universal precautions, risk of seroconversion from needlestick is very low.
  1. Chemotherapy – Treat significant infection 10 days before therapy, encourage continued oral hygiene, beware of masked oral infections, crushed ice for mucositis, frequent change of soft toothbrush.
  1. Bisphosphonates / Anti-resorptive medications – Oral bisphosphonates low risk, maximise oral health, IV bisphosphonates / denosumab highest risk, pre treatment dental assessment vital, evidence on implant treatment is equivocal but risk appears low with oral bisphosphonates.
  1. Osteoradionecrosis – Pre-radiation dental plan and stabilisation imperative, radiation risk increases through life, avoid extractions in areas >60 grey, meticulous oral care to avoid extractions.
  1. Anticoagulants/antiplatelets – Most treatment safe with INR < 4, new anticoagulants treat like warfarin, local measures at extraction sites, no need to stop / adjust anti-platelet treatments, avoid Ibuprofen / NSAID’s.

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