Table 3.156.
Key considerations for dental management in traumatic injury to CNS (see text)
| Management modifications* | Comments/possible complications | |
|---|---|---|
| Risk assessment | 2 | Mobility; communication; consent; loss of cough and gag reflexes |
| Appropriate dental care | 3/4 | Defer elective treatment for 6 months; monitor blood pressure |
| Pain and anxiety control | ||
| – Local anaesthesia | 1 | Avoid epinephrine and electronic dental analgesia |
| – Conscious sedation | 1 | Avoid opiates |
| – General anaesthesia | 4 | Avoid barbiturates and muscle relaxants |
| Patient access and positioning | ||
| – Access to dental office | 1 | Impaired mobility |
| – Timing of treatment | 1 | Mid-morning; short visits |
| – Patient positioning | 1 | Upright position if possible |
| Treatment modification | ||
| – Preventive dentistry | 1 | Electric toothbrush |
| – Oral surgery | 1 | Poor oral hygiene |
| – Implantology | 1 | Only simple procedures |
| – Conservative/Endodontics | 1 | Only simple procedures |
| – Fixed prosthetics | 1 | Only simple procedures |
| – Removable prosthetics | 1 | Difficult to place |
| – Non-surgical periodontology | 1 | Poor oral hygiene |
| – Surgical periodontology | 1 | Only simple procedures |
| 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.