Medically Complex Dental Cases

By Zeyad Mady, DDS, FAGD

Everyone deserves good dental health, and good dental health care. Getting it, however, can be difficult for some people. Illness or disease, and certain psychological conditions, can make it a challenge just getting to the dentist’s chair. They can also make the patient more susceptible to oral complications, and to compromised dental health. Such circumstances are broadly grouped as medically complex cases.

The link between oral health and general health is by now firmly established. Yet medically complex cases can be a serious obstacle to obtaining proper dental care. These cases include:

Cancer

Post-Traumatic Stress Disorder (PTSD)

Diabetes

Heart disease/high blood pressure

Kidney disease

Allergies

Epilepsy, tremors, and palsy

Cancer

There are an estimated 1.4 million new cases of cancer in the United States every year and comes with many side effects. Most of us know that chemotherapy and radiation treatment can lead to fatigue, nausea, and hair loss. Less well known are its effects on oral health.

Chemotherapy and radiation therapy side effects on oral health include:

Tooth decay and gum disease

Mouth sores

Mouth bleeding

Breakdown of hard and soft tissues

Infection

Dry mouth (xerostomia)

Difficult swallowing

Malnutrition and dehydration.

Up to one-third of cancer patients develop some kind of oral complication that can make it hard for them to talk and eat. While most of these are transitory, and clear up when treatment ends, others may continue such as tooth decay.

Fortunately, the effects of cancer treatment on oral health can be minimized or prevented with good dental hygiene before and during the treatment. Regular brushing and flossing, rinsing with anti-bacterial and baking soda solutions, drinking plenty of water, and eating bland foods, all can help. It’s also advised to see the dentist a month or so before radiation therapy begins. That way existing problems, like new cavities, can be addressed.

PTSD

PTSD is a reaction to experiencing or witnessing a traumatic event, such as violent crime or abuse, an automobile accident, a natural disaster, or war. This post uses the term “trauma survivor” in reference to people with PTSD.

A number of health issues are associated with PTSD, including sleep disorders and substance abuse, alcohol in particular. These issues frequently contribute to oral health problems such as periodontitis and bruxism.

It is important that dentists establish a good relationship with trauma survivors. It can help make the patient more comfortable, determine whether any procedures are particularly difficult, and lead to better outcomes. The chairside manner of the dentist is critical, establishing a calm, neutral environment.

Other ways dentists can make treatment easier for trauma survivors include:

Give the patient as much control and choice about treatment as possible

Encourage questions, and discuss any concerns before treatment begins

Understand the patient may require a support person in the examination room

Allow for leeway; let the patient know the treatment can stop whenever necessary

When dental teams and other health care providers understand the issues associated with trauma survivors and cancer patients, they are more likely to have positive experiences and successful outcomes.