Table 3.140.
Key considerations for dental management in rheumatoid arthritis (see text)
| Management modifications* | Comments/possible complications | |
|---|---|---|
| Risk assessment | 1 | Atlanto-axial joint dislocation or fracture; drug related bleeding tendency |
| Appropriate dental care | 2 | Corticosteroid supplementation and possibly antibiotic cover |
| Pain and anxiety control | ||
| – Local anaesthesia | 0 | |
| – Conscious sedation | 0 | |
| – General anaesthesia | 3/4 | Protect the neck |
| Patient access and positioning | ||
| – Access to dental office | 0 | |
| – Timing of treatment | 1 | Afternoon; short |
| – Patient positioning | 1 | Upright; supplementary cushions |
| Treatment modification | ||
| – Preventive dentistry | 1 | Adapted toothbrushes |
| – Oral surgery | 1 | Bleeding tendency; infections |
| – Maxillofacial surgery | 4 | TMJ and orthognathic surgery |
| – Implantology | 2 | Possibly not recommended |
| – Conservative/Endodontics | 1 | Only single procedures |
| – Fixed prosthetics | 2 | Possibly not recommended |
| – Removable prosthetics | 0 | |
| – Non-surgical periodontology | 1 | Bleeding tendency |
| – Surgical periodontology | 1 | Bleeding tendency; infection |
| Hazardous and contraindicated drugs | 1 | Avoid NSAIDs which increase bleeding tendency |
*
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.