Complications and treatment errors in periodontal therapy in medically compromised patients

Abstract

In 2019, worldwide life expectancy was estimated at approximately 72 years of age. This has improved dramatically over decades, and is mirrored in childhood survival rates. 1 As a consequence, the number of people presenting with long-term conditions is increasing rapidly, as it is closely related to aging. 2 Multimorbidity in this aging population is common and it has been rising in prevalence over recent years, with one in three adults living with more than one chronic disease. 3,4 Evidence on the prevalence of systemic diseases in patients presenting for periodontal care suggests that between 40% and 52% of patients have more than one systemic condition, and these estimates increase with age. [5][6][7] In addition, the type of medical problems patients present with can differ significantly depending upon the facility where periodontal care is provided. 8 Findings from a retrospective analysis demonstrated a lower prevalence of medically compromised patients with periodontitis who attended a private dental practice (28%) compared with those attending a dental school or hospital clinic (46% and 74%, respectively). 8 Differences between participants in terms of age, socioeconomic status, or health awareness could explain these findings. 8 The most frequently reported medical problems in the dental office are allergies to medications followed by cardiovascular diseases (including hypertension) and endocrine disorders (including diabetes mellitus). [5][6][7][8][9][10] As a direct consequence of medical comorbidities, a substantial number of patients will be taking multiple medications, which may also have an impact on their periodontal management.Radfar and Suresh 11 observed that of 1041 patients treated in their dental school, 360 (35%) were taking antihypertensives, 202 (19%) painkillers, 181 (17%) antidepressants, 107 (10%) antidyslipidemic agents, and 95 (9%) antiplatelet drugs. This highlights an additional consideration in terms of the potential pharmacologic interactions with anesthetics or other medications that we might need to prescribe for these patients after certain periodontal procedures.In addition to the systemic pathology inherent to age and polypharmacy, the increased survival of patients with certain congenital diseases with periodontal manifestations has created a growing demand for periodontal treatment. These congenital disorders includeThis is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

Complications and treatment errors in root coverage procedures

“…Root coverage procedures, like any periodontal surgery, may be affected by systemic diseases, medication intake, and bad habits, potentially resulting in impaired wound healing and complications 11 . Treatment errors and complications in periodontal therapy in a medically compromised patient will be discussed in Cho et al's 12 review in this volume.…”