Gerald S. Fine, D.D.S.

   Oral and Maxillofacial Surgery

Brookline Office
Tel: 617-731-6060

Our commitment is to provide you the highest standard of oral and maxillofacial surgery in a professional manner.

The Treatment Of The Medically Compromised Patient

This past week a very pleasant 68 year old female patient was referred to my office for the removal of a lower first bicuspid tooth which had fractured while she was having lunch with her friends. The patient was friendly, cooperative, and maintained an active life since her relatively recent retirement. Upon completion of her health record I noted she had a history of hypertension and arthritis and was taking Capoten and aspirin as her only two medications. The remainder of her history was unremarkable. Upon commenting to her about her excellent health she then said, "Other then my knee replacements, I'm perfect." My patient, who was absolutely clear minded and aware of everyday matters had failed to inform me of her bilateral knee replacements because they were performed five years earlier, and she had a totally, uneventful recovery. In addition, she also had never informed her general dentist of her surgery. My patient had received general dental treatment for the past five years without antibiotic prophylaxis. My patient was rescheduled for later that afternoon, premedicated, and uneventfully treated.

As the population ages, the dental community will be treating more elderly patients, many of whom will be medically compromised. The clinician should be aware of the elderly patient's dental needs as well as how the general medical health history may affect the treatment.

When evaluating the elderly patient, it should be kept in mind that older patients may have general visual, hearing, or memory impairments that require some adjustment on the part of the dental staff. Older patients may also seek to control the medical information they disclose in order to maintain autonomy. Given these potential health and attitudinal problems, the health history and physical evaluation require careful attention.

The dentist should remember that the prevalence of common medical problems such as cardiovascular disease (ischemic heart disease, hypertension, infective endocarditis), diabetes, and arthritis (prosthetic joints) increases with advancing age. When a patient reports a significant medical problem, a review of the system should be undertaken to establish the severity of the condition. Detailed records of any medications and why the drug is used should be noted. An appreciation of possible drug-related intraoral effects, drug sensitivity, and potential drug interactions is required for optimal patient care. The information contained in the health history should be updated before each appointment.

Although dental treatment for the elderly patient will require little modification for the elderly patient, the informed dentist must be aware of the patient's chronic medical problems, their management, and its implications.

‍Gerald S. Fine, D.D.S.
Practice limited to oral & maxillofacial surgery‍