Table 3.118.

Key considerations for dental management in myasthenia gravis (see text)

	Management modifications*	Comments/possible complications
Risk assessment	2	Myasthenic crisis; aspiration
Appropriate dental care	2/4	During a remission
Pain and anxiety control
– Local anaesthesia	2	Minimal doses; avoid ester type
– Conscious sedation	2/4	Avoid intravenous sedation
– General anaesthesia	3/4	Avoid drugs that aggravate MG
Patient access and positioning
– Access to dental office	0
– Timing of treatment	1	Early morning; 1–2h after medication intake
– Patient positioning	1	Upright position
Treatment modification
– Oral surgery	1
– Implantology	1
– Conservative/Endodontics	1
– Fixed prosthetics	1
– Removable prosthetics	1/5	Unstable prostheses
– Non-surgical periodontology	1
– Surgical periodontology	1
Hazardous and contraindicated drugs	2	Avoid aspirin, clindamycin and tetracyclines

^*0 = No special considerations. 1 = Caution advised. 2 = Specialised medical advice recommended in some cases. 3 = Specialised medical advice mandatory. 4 = Only to be performed in hospital environment. 5 = Should be avoided.