Table 3.123.
Key considerations for dental management in Paget's disease (see text)
| Management modifications* | Comments/possible complications | |
|---|---|---|
| Risk assessment | 2 |
|
| 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 |
|
| – 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.