Table 3.86.
Key considerations for dental management in primary immunodeficiencies (see text)
| Management modifications* | Comments/possible complications | |
|---|---|---|
| Risk assessment | 3 | Evaluate general health status, prognosis, drug intake, and appropriate location for dental treatment |
| Appropriate dental care | 3/4 | Delay elective dental care with gamma-globulin levels < 20 mg/100 mL; possibly antibiotic prophylaxis |
| Pain and anxiety control | ||
| – Local anaesthesia | 1 | Chlorhexidine rinse |
| – Conscious sedation | 1 | Pulmonary function |
| – General anaesthesia | 3/4 | |
| Patient access and positioning | ||
| – Access to dental office | 1 | |
| – Timing of treatment | 2 | |
| – Patient positioning | 1 | |
| Treatment modification | ||
| – Oral surgery | 3/4 | Immune globulin supplementation; chlorhexidine; antibiotic cover; possibly G-CSF |
| – Implantology | 3–5 | See oral surgery |
| – Conservative/Endodontics | 3 | |
| – Fixed prosthetics | 3 | |
| – Removable prosthetics | 3 | |
| – Non-surgical periodontology | 3–5 | |
| – Surgical periodontology | 3–5 | |
| Hazardous and contraindicated drugs | 2 | Antibiotic resistance |
*
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.