Table 3.21.

Key considerations for dental management in bedbound patients (see text)

	Management modifications*	Comments/possible complications
Risk assessment	2/4	ASA score
Pain and anxiety control
– Local anaesthesia	0
– Conscious sedation	2	Grade of cooperation; avoid drug synergy
– General anaesthesia	3–5	Depends on underlying disease
Patient access and positioning
– Access to dental office	2/4
– Timing of treatment	0
– Patient positioning	1
Treatment modification
– Oral surgery	2/4	Only simple, single procedures at home
– Implantology	5
– Conservative/Endodontics	1/5	Individualised evaluation
– Fixed prosthetics	5
– Removable prosthetics	1/5	Individualised evaluation
– Non-surgical periodontology	1/5	Individualised evaluation
– Surgical periodontology	5
Hazardous and contraindicated drugs	2	Antibiotic selection; some patients receive anticoagulants or corticosteroids

^*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.