Table 3.123.

Key considerations for dental management in Paget's disease (see text)

	Management modifications*	Comments/possible complications
Risk assessment	2	Increased heart disease; impaired sight and hearing; bleeding tendency; osteomyelitis Osteochemonecrosis due to bisphosphonates
Appropriate dental care	2	Penicillin prophylaxis; haemostatic measures
Pain and anxiety control
– Local anaesthesia	0
– Conscious sedation	0
– General anaesthesia	3/4	Heart disease; chest deformity; bleeding; infection
Patient access and positioning
– Access to dental office	0
– Timing of treatment	0
– Patient positioning	1	Kyphosis
Treatment modification
– Oral surgery	2/4	Hypercementosis; bleeding Osteochemonecrosis due to bisphosphonates
– Implantology	2/4	Hypercementosis; bleeding
– Conservative/Endodontics	1	Pulp calcification
– Fixed prosthetics	1
– Removable prosthetics	1/2	Prosthesis replacement
– Non-surgical periodontology	1	Bleeding tendency
– Surgical periodontology	2	Bleeding tendency
Imaging	1	Typical radiological features
Hazardous and contraindicated drugs	0

^*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.