Table 3.43.
Key considerations for dental management in depression (see text)
| Management modifications* | Comments/possible complications | |
|---|---|---|
| Risk assessment | 2 | Recognition of depression |
| Appropriate dental care | 2 | Sympathetic handling; avoid elective dental care until disease is controlled |
| Pain and anxiety control | ||
| – Local anaesthesia | 1 | Reduce epinephrine dose |
| – Conscious sedation | 2 | Avoid benzodiazepines and opioids |
| – General anaesthesia | 3–5 | Respiratory depression |
| Patient access and positioning | ||
| – Access to dental office | 0 | |
| – Timing of treatment | 0 | |
| – Patient positioning | 1 | Postural hypotension |
| Treatment modification | ||
| – Oral surgery | 1 | |
| – Implantology | 1/5 | Xerostomia; neglected oral hygiene |
| – Conservative/Endodontics | 1 | |
| – Fixed prosthetics | 1 | Avoid gingival retraction cord with epinephrine |
| – Removable prosthetics | 0 | |
| – Non-surgical periodontology | 1 | |
| – Surgical periodontology | 1 | |
| Hazardous and contraindicated drugs | 1 | Avoid acetaminophen and erythromycin |
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.