Table 3.150.
Key considerations for dental management in stroke (see text)
| Management modifications* | Comments/possible complications | |
|---|---|---|
| Risk assessment | 2 | Further strokes; anticoagulation; hypertension; loss of gag reflex; consent issues |
| Appropriate dental care | 3/4 | Deferred 6 months; no elective care in TIA; monitor blood pressure; monitor anticoagulation |
| Pain and anxiety control | ||
| – Local anaesthesia | 1 | Avoid epinephrine and electronic dental analgesia |
| – Conscious sedation | 1 | Avoid opiates |
| – General anaesthesia | 4 | Deferred 6 months; avoid barbiturates |
| Patient access and positioning | ||
| – Access to dental office | 1 | Impaired mobility |
| – Timing of treatment | 1 | Mid-morning; short visits |
| – Patient positioning | 1 | Upright position |
| Treatment modification | ||
| – Preventive dentistry | 1 | Electric toothbrush |
| – Oral surgery | 1 | Anticoagulation |
| – Implantology | 1 | Poor oral hygiene; anticoagulation |
| – Conservative/Endodontics | 1 | Only simple procedures |
| – Fixed prosthetics | 1 | Difficult to place |
| – Removable prosthetics | 1 | Anticoagulation |
| – Non-surgical periodontology | 1 | Anticoagulation; poor oral hygiene |
| – Surgical periodontology | 1 | Anticoagulation |
| Imaging | 1 | Carotid plaques |
| Hazardous and contraindicated drugs | 1 | Acetaminophen – drug of choice; avoid hypertensive drugs |
*
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.