hyperglycemia

1. hyperglycemia It is difficult to be treated & you should send the patient to the hospital for medical treatment

2. Adrenal Insufficiency • For low dose (less than 20 mg /day) or • high dose for short duration ( less than • one month) no supplement of cortisone • is needed before dental treatment.

3. For higher doses (more than 20 mg • per day ) for long time you should • double or even triple the dose before • dental treatment after consultation • with their physician.

4. 3. For topical steroids, no need for steroid supplement, but you should be aware of topical steroids that kept under occlusive dressing for long time here you may end up with adrenal crises.

5. Management of Acute adrenal crisis 1- Terminate periodontal treatment. 2- Ask for medical assistance. 3- Monitor the patients vital signs. 4- Give oxygen. 5- Put him in supine position. 6- Give him 100 mg of hydrocortisone sodium succinate

6. Pregnancy 1 - It is safest to work during the 2nd trimester 2 - In the 3rd trimester you have to avoid supine position because of the supine hypotensive syndrome that may occur in a pregnant woman No radiographs or drugs can be given except in emergency.

7. Hemorrhagic disorders 1- Give the patient the missing factor if required after consultation with his physician. 2- Bleeding time and Prothrombin time monitoring. 3- For patients on anti coagulant therapy you should decrease the does after consultation with their physician

8. Infectious diseases (as an example AIDS) Patients with HIV positive should be treated under strict protective measures such as: wear double gloves & double masks, use disposable instruments and materials, avoid using of any dental machines that produce an aerosol into the atmosphere to prevent spread of the disease and follow a proper sterilization process after treatment.

9. Epilepsy • medical referral and consultation. • Be sure that the patient is under • medical control. • Treat the patient with minimal • stress and trauma. • Short and morning appointments.

10. Management of epileptic seizure hold the patient and laid him down on the ground, putting some cotton or gauze inside the patients mouth to prevent tongue trauma, remove any instruments trays or other dental instruments that may hit by patient vigorous movements and preventing patient from putting his leg or arm between different parts of dental unit.

11. Phenytoin induced gingival enlargement • reported in 3-84 % of patients using this anti epileptic medication. • more in younger patient . • severity was found to be related to the taken doses. • painless enlargement of the facial and oral interdental papillae and marginal gingiva.

12. 5. may developed to cover the crowns of the teeth. 6. firm, pale pink, resilient and fibrous in consistency. 7. tooth related lesion rarely occurs in edentulous patients. 8. can affect all the dentition but it is more sever in anterior regions.

13. Adalat and Cyclosporine-A induced gingival hyper plasia Adalat or Nifidipine is a beta blocker or calcium channel blocker. It is a medication used for cardiovascular disease like hypertension and coronary artery insufficiency, Cyclosporine is a potent immune suppressive drug used to prevent body rejection of a newly transmitted organ. It also used for other auto immune diseases.

14. These two medications also found to have a similar hyper plastic effect as Phenytoin on gingival tissues. They found that the prevalence of gingival hyper plasia caused by these drugs in Iraq is about 30-35 % of patient taking these medications. This percentage is slightly higher than the universal value which is about 20 % of patients taking these medications.