The implications and management of acute odontogenic infection in association with Down and Eisenmenger syndromes and schizophrenia in a rural setting

Abstract

Background: This report describes the case management of a 32 year old special needs patient with life-threatening odontogenic infection. The combination of schizophrenia, Down and Eisenmenger syndromes presented significant challenges to managing his oral health, particularly within the rural context. In this case, dental treatment was limited to a full dental clearance during a high risk general anaesthesia session. Method: A comprehensive work-up prior to general anaesthesia was an essential aspect of care. This included a full medical history and examination, communication between medical specialists, the dentist and family consultation. The anaesthetic procedure was undertaken using a careful regimen of drugs and monitoring to minimize the impact on his cardiovascular system. Techniques to minimize bleeding from extraction sites were also important. Results: Three weeks postsurgically the patient was reviewed and his family reported that he was interacting positively with them after years of surliness and conflict. This was attributed to a managed psychotropic medication regimen and improved dental condition, which has led to a sustained improvement in quality of life. Conclusions: The management of acute odontogenic infection for special needs patients in the rural setting requires a local interdisciplinary team approach, careful consideration of related pathophysiology and its potential impact on general anaesthesia, and close consultation with family and carers.

Síndrome de down e esquizofrenia: um relato de caso

“…Ainda sobre os outros estudos encontrados na busca, Cooper et al 9 publicaram uma compilação de sete casos da comorbidade de SD e esquizofrenia, onde os pacientes acometidos não se diferenciavam dos pacientes que apresentavam apenas SD no quesito funcionalidade, avaliado pela Adaptive Behavior Scale. Já Buttler et al 7 descrevem com detalhes um relato de caso de uma comorbidade de SD e esquizofrenia e as dificuldades do tratamento odontológico em um cenário rural.…”

“…Assim como o relato de Buttler et al 7 , nosso caso teve melhora dos sintomas psicóticos com baixa dose do antipsicótico, porém o de Buttler et al não relatou a presença de SEP ou sintomatologia residual, o que dificulta a comparação com o nosso caso. Os outros estudos levantados não abordam o tratamento medicamentoso e a sintomatologia residual 6,8,9 .…”

“…Existem poucos relatos na literatura médica e escasso material sobre SD e esquizofrenia comórbidas [6][7][8][9] , justi fi cando a necessidade de produção cientí fi ca sobre o tema.…”

Perioperative care of adults with Down syndrome: a narrative review

“…3 Autism has been reported to be almost ten times more common in children with DS than in the general population. 4 The characteristic facial features of DS patients, which include mid-face hypoplasia, macroglossia, micrognathia, high-arched palate, poor dentition, and small upper airway, [13][14][15] predispose these patients to obstructive sleep apnea (OSA); there is an 85% prevalence of OSA among DS adults, with a mean apnea-hypopnea index of 25. 3 Additionally, airway management can be difficult and these patients may have laryngotracheal or subglottic stenosis.…”

“…25 While rare, Eisenmenger syndrome is most commonly linked with the DS population. 13,27 Tetralogy of Fallot is the most common cyanotic CHD and may be associated with AVSD in DS. Surgical repair is typically undertaken between six and 12 months.…”