Table 3.38.

Key considerations for dental management in Creutzfeldt–Jakob disease (see text)

	Management modifications*	Comments/possible complications
Risk assessment	2	Prions detected in dental tissue
Appropriate dental care	3/4	Evaluate risk group and record in notes and in referrals for surgery Standard infection control: single-use instruments; air and water supplies and suction device independent; concentrated bleach for cleaning
Pain and anxiety control
– Local anaesthesia	0
– Conscious sedation	0
– General anaesthesia	3/4
Patient access and positioning
– Access to dental office	0
– Timing of treatment	1	At the end of the working day
– Patient positioning	0
Treatment modification
– Oral surgery	2	Risk of the use of some grafts
– Implantology	2
– Conservative/Endodontics	1
– Fixed prosthetics	1
– Removable prosthetics	1
– Non-surgical periodontology	2
– Surgical periodontology	2	Risk of the use of some grafts
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.