The Dentist’s Quick Guide to Medical Conditions Mea A Weinberg, DMD, MSD, RPh Diplomate, American Board of Periodontology Clinical Professor Department of Periodontology and Implant Dentistry New York University College of Dentistry New York, NY, USA Stuart L Segelnick, DDS, MS Diplomate, American Board of Periodontology Diplomate, International Congress of Oral Implantologists Clinical Associate Professor Department of Periodontology and Implant Dentistry New York University College of Dentistry New York, NY, USA Section Chief of Periodontics Brookdale University Hospital and Medical Center Brooklyn, NY, USA Joseph S Insler, MD Fellow, Addiction Psychiatry Department of Psychiatry Boston University Boston, MA, USA with Samuel Kramer, DDS Clinical Assistant Professor Department of Endodontics New York University College of Dentistry New York, NY, USA www.ajlobby.com This edition first published 2015 © 2015 by John Wiley & Sons, Inc Editorial Offices 1606 Golden Aspen Drive, Suites 103 and 104, Ames, Iowa 50010, USA The Atrium, Southern Gate, Chichester, West Sussex, PO19 8SQ, UK 9600 Garsington Road, Oxford, OX4 2DQ, UK For details of our global editorial offices, for customer services and for information about how to apply for permission to reuse the copyright material in this book please see our website at www.wiley.com/wiley-blackwell Authorization to photocopy items for internal or personal use, or the internal or personal use of specific clients, is granted by Blackwell Publishing, provided that the base fee is paid directly to the Copyright Clearance Center, 222 Rosewood Drive, Danvers, MA 01923 For those organizations that have been granted a photocopy license by CCC, a separate system of payments has been arranged The fee codes for users of the Transactional Reporting Service are ISBN-13: 978-1-118-71011-1/2015 Designations used by companies to distinguish their products are often claimed as trademarks All brand names and product names used in this book are trade names, service marks, trademarks or registered trademarks of their respective owners The publisher is not associated with any product or vendor mentioned in this book The contents of this work are intended to further general scientific research, understanding, and discussion only and are not intended and should not be relied upon as recommending or promoting a specific method, diagnosis, or treatment by health science practitioners for any particular patient The publisher and the author make no representations or warranties with respect to the accuracy or completeness of the contents of this work and specifically disclaim all warranties, including without limitation any implied warranties of fitness for a particular purpose In view of ongoing research, equipment modifications, changes in governmental regulations, and the constant flow of information relating to the use of medicines, equipment, and devices, the reader is urged to review and evaluate the information provided in the package insert or instructions for each medicine, equipment, or device for, among other things, any changes in the instructions or indication of usage and for added warnings and precautions Readers should consult with a specialist where appropriate The fact that an organization or Website is referred to in this work as a citation and/or a potential source of further information does not mean that the author or the publisher endorses the information the organization or Website may provide or recommendations it may make Further, readers should be aware that Internet Websites listed in this work may have changed or disappeared between when this work was written and when it is read No warranty may be created or extended by any promotional statements for this work Neither the publisher nor the author shall be liable for any damages arising herefrom Library of Congress Cataloging-in-Publication Data Weinberg, Mea A., author The dentist’s quick guide to medical conditions / Mea A Weinberg, Stuart L Segelnick, Joseph S Insler p ; cm Includes bibliographical references and index ISBN 978-1-118-71011-1 (pbk.) I. Segelnick, Stuart L., author. II. Insler, Joseph S., author. III. Title [DNLM: 1. Signs and Symptoms. 2. Dental Care. 3. Therapeutics WB 143] RK61 617.6–dc23 2014027086 A catalogue record for this book is available from the British Library Wiley also publishes its books in a variety of electronic formats Some content that appears in print may not be available in electronic books Cover image: © iStockphoto / Squaredpixels / File # 23383041 Set in 10/12.5pt Times by SPi Publisher Services, Pondicherry, India 1 2015 www.ajlobby.com Dedication We would like to dedicate this book to our family Dr Mea Weinberg: Adam, Nina, & Nigel Dr Stuart Segelnick: Tina & Noah Dr Joseph Insler: Suzanne & Jacob Dr Samuel Kramer: Cynthia & Harry for without their love and support this wonderful work would not be possible www.ajlobby.com Contents Contributorsx Forewordxi Prefacexii Gastrointestinal disorders A Peptic ulcer disease B Gastroesophageal reflux disease C Irritable bowel syndrome D Inflammatory bowel disease a. Crohn’s disease b. Ulcerative colitis E Diverticular disease F Acute pancreatitis G Celiac sprue H Pseudomembranous colitis 1 7 10 11 12 13 13 Medical conditions of the respiratory system A Respiratory diseases a. Asthma b. Chronic obstructive pulmonary diseases c. Pulmonary tuberculosis d. Obstructive sleep apnea 17 Disorders of the urinary system A Acute renal injury and chronic kidney disease B Kidney dialysis C Kidney transplant D Polycystic kidney disease E Benign prostatic hypertrophy 30 Diseases of the endocrine system A Diabetes B Thyroid diseases C Adrenal gland disorders 46 17 17 23 24 27 30 37 39 42 42 46 50 53 vii www.ajlobby.com viii Contents Disorders of the cardiovascular system A Hypertension B Angina Pectoris Clinic C Myocardial infarction D Heart failure E Arrhythmias F Valvular heart disease G Epinephrine in cardiac patients 59 Pregnancy, lactation, and oral contraceptives A Pregnancy and lactation B Oral contraceptives 82 Disorders of the liver and gallbladder A Liver disease a. Alcoholic liver disease and cirrhosis b. Hepatitis c. Liver transplant B Gallstones 93 59 68 68 70 73 75 78 79 82 89 93 98 99 103 105 Diseases of the neurological system A Parkinson’s disease B Multiple sclerosis C Seizures 109 Psychiatric disorders Introduction A Antipsychotics a. Typical antipsychotics b. Atypical antipsychotics c. Anticholinergic medications B Antidepressants a. Monoamine oxidase inhibitors b. Tricyclics and tetracyclics c. Selective serotonin reuptake inhibitors d. Selective serotonin norepinephrine reuptake inhibitors (SNRIs) e. Others f. Summary: Dental interactions and side effects C Mood stabilizers a. Lithium b. Valproic acid (Depakote) c. Lamotrigine (Lamictal) d. Carbamazepine (Tegretol) e. Oxcarbazepine (Trileptal) 125 www.ajlobby.com 109 113 116 125 126 127 128 128 132 133 134 135 136 136 136 138 139 140 140 141 141 Contents ix D Alcohol and other drugs with addictive potential a. Alcohol b. Sedatives and hypnotics c. Opioids d. Cocaine 142 142 143 143 145 10 Hematologic disorders and drugs that cause bleeding A Brief overview of the coagulation process a. Thrombocytopenia b. Thrombocytopathy c. Antiplatelet medications B Bleeding disorders: Coagulation disorders a. von Willebrand disease b. Hemophilias c. End-stage liver disease d. Anticoagulation medications 149 11 Blood dyscrasias A Red blood cell disorders a. Anemia b. Myeloproliferative disorders B White blood cell disorders a. Leukemia b. Lymphoma c. Multiple myeloma 171 12 Musculoskeletal and connective tissue disorders A Osteoporosis B Osteoarthritis C Rheumatoid arthritis D Gout E Fibromyalgia syndrome F Systemic lupus erythematosus G Sjögren’s syndrome 193 13 HIV and oral health care 214 14 Radiation and chemotherapy 237 Appendices Appendix A Appendix B Appendix C Appendix D 252 255 266 270 Antibiotic prophylaxis of the dental patient Common dental drug interactions Summary of tables/boxes Interpretation of common laboratory values 149 152 153 153 154 154 155 156 157 174 174 181 182 182 186 187 193 197 198 201 203 205 208 Index274 www.ajlobby.com Contributors Cheryl A Barber, MPH, MS Senior Research Scientist Department of Basic Sciences HIV/AIDS Research Program New York University College of Dentistry New York, NY, USA Floyd L Dussetschleger, DDS Clinical Professor Cariology & Comprehensive Care New York University College of Dentistry New York, NY, USA David H Hershkowitz, DDS Clinical Assistant Professor; Associate Chairperson Cariology & Comprehensive Care New York University College of Dentistry New York, NY, USA Joseph S Insler, MD Fellow Addiction Psychiatry Department of Psychiatry Boston University Boston, MA, USA x www.ajlobby.com Foreword People are living longer According to “The State of Aging and Health in America 2013,” the increase in the number of Americans aged 65 years and older is unparalleled in the history of the USA Chronic conditions present a major modification in the principal causes of death for all age groups from infectious diseases and acute conditions to chronic diseases and degenerative illnesses Many Americans, including the older population, present with numerous chronic medical conditions Treatment of this section of the population makes up a good majority of the country’s healthcare allocation Dentists will be seeing more people with medical issues that will have to be treated differently than in a healthy individual The The Dentist’s Quick Handbook of Medical Updates is a must-have to help dentists navigate treatment for these patients The book is detailed yet easy to read The dental notes for each condition located by system are a handy quick reference that will help make precise treatment decisions Charles N Bertolami Professor and Herman Robert Fox Dean College of Dentistry New York University xi www.ajlobby.com Preface The Dentist’s Quick Guide to Medical Conditions is a manual designed to provide practicing dental clinicians with a comprehensive review of the latest information on treatment of dental patients with common medical disorders The information in this book is primarily concerned with the clinical practical aspects of different medical conditions, pharmacologic management, and dental management of these conditions The book is structured around the clinical synopsis of the medical condition, specific diagnostic/laboratory values that are important for the dentist to know, significant drug–drug and drug–disease interactions, and key dental notes needed to treat the medically complex dental patient Each chapter’s discussion of medical and pharmacological treatment relies heavily on the clinical experience of the authors and therefore addresses many of the problems that the dentist encounters in daily practice Most chapters contain easy-to-follow tables and bullets denoting important facts Features of The Dentist’s Quick Guide to Medical Conditions include the following •• At the end of each chapter are easy-to-follow dental notes on management of the medically complex patient •• Drug tables: many tables are provided that summarize the main medical/pharmacologic/dental features of the different medical conditions •• Many appendices: Appendix A, antibiotic prophylaxis of the dental patient; Appendix B, common dental drug interactions; Appendix C, summary guide to dental management of systemic diseases; Appendix D, interpretation of common laboratory values •• Comprehensive up-to-date references with each chapter The authors are deeply grateful for the opportunity to write this book, and hopefully it will meet the needs of the dentist in practice Mea A Weinberg Stuart L Segelnick Joseph S Insler I will have been a clinical instructor of endodontics at New York University College of Dentistry for almost 20 years at the time of this publication One day it dawned upon me that the very students I was mentoring in the clinic had greater medical knowledge than myself To mention a few instances, the students had knowledge of new medical tests for disease entities and their corresponding normal values, better disease diagnosis with probable treatment outcomes, and knowledge of newer pharmacologic agents including their xii www.ajlobby.com 268 The dentist’s quick guide to medical conditions Chapter 9 Table 9.1 Table 9.2 Table 9.3 Table 9.4 Table 9.5 More commonly prescribed typical antipsychotics Commonly prescribed atypical antipsychotics Clinically available monamine oxidase inhibitors Common tricyclic antidepressants Common selective serotonin reuptake inhibitors Chapter 10 Table 10.1 Table 10.2 Table 10.3 Table 10.4 Table 10.5 Table 10.6 Common bleeding disorders and screening tests Classification of platelet disorders International normalized ratio (INR) guidelines for dental treatment Medications and products used in preventing oral bleeding events Medical/drug management of patients with bleeding disorders Dental management of the patient with bleeding disorders Chapter 11 Table 11.1 Table 11.2 Table 11.3 Table 11.4 CBC with differential Common causes of anemia Acute leukemia: Common oral complications and their management Dental management of WBC disorders Chapter 12 Table 12.1 Bisphosphonates Table 12.2 Staging criteria for ARONJ Table 12.3 Drugs used to treat rheumatoid arthritis (RA) and dental management Table 12.4 Dental drug–drug interactions with medications for gout Table 12.5 Dental drug–fibromyalgia drug interactions Table 12.6 Common medications for systemic lupus erythematosus (SLE) and their dental implications Table 12.7 Signs and symptoms of Sjörgren’s syndrome (SS) and its management Table 12.8 Drugs for Sjögren’s syndrome (SS) Chapter 13 Table 13.1 FDA antiretroviral drugs used in the treatment of HIV infection Table 13.2 Drug interactions with antiretroviral therapy—antiretroviral drug combinations to avoid Summary of tables/boxes 269 Table 13.3 Highly active antiretroviral therapy—drug classes Table 13.4 Medical assessment of HIV-infected patients Chapter 14 Table 14.1 Oral adverse effects after radiation to head and neck/chemotherapy Appendix D Interpretation of common laboratory values Therapeutic range “High” value “Low” value Hematocrit (HCT) 38–54% (men) 36–47% (women) High-altitude areas, chronic smoker, dehydration (false positive), polycythemia vera, erythropoietin (Epogen) Anemia, blood loss, nutritional deficiency (iron, vitamin B12, and folate), chemotherapy, cancer (bone marrow), kidney failure Hemoglobin (Hb) 14–18 g/dl (men) 12–16 g/dl (women) 12–14 g/dl (children) 14.5–24.5 g/dl (newborns) High-altitude areas, dehydration (false positive), chronic smoker, polycythemia vera, emphysema, erythropoietin (Epogen) Loss of blood (injury, surgery, ulcers, and cancer); chemotherapy; iron, vitamin B12, or folate deficiency; thalassemia; sickle cell anemia; bone marrow complications Dehydration, polycythemia vera, kidney cancer, kidney transplant, heart failure, chronic obstructive pulmonary disease (COPD), congenital heart disease, carbon monoxide poisoning, sleep apnea Anemia; bone marrow complications; bleeding; multiple myeloma; copper, folate, and vitamin B6 and B12 deficiency; leukemia; pregnancy; RBC destruction Reticulocytes 0–1% of RBCs Kidney disease producing erythropoietin, hemolytic anemia, erythroblastosis fetalis Bone marrow failure; liver disease (cirrhosis); vitamin B12, iron, or folate deficiency; kidney disease; radiation therapy Leukocytes, total Bacterial infection, smoking, inflammatory diseases (e.g., rheumatoid arthritis), leukemia, tissue damage, some drugs (e.g., albuterol, lithium, and corticosteroids) Some drugs (e.g., chemotherapeutics, clozapine, antibiotics, and diuretics), bone marrow problems, autoimmune diseases (e.g., systemic lupus erythematosus), liver or spleen disease, radiotherapy, viral infections Whole blood Complete blood count (CBC) Erythrocytes (RBCs) 4.5–6 × 104 (men) 4.3–5.5 × 104 (women) 5,000–10,000 cells/ mm3 The Dentist’s Quick Guide to Medical Conditions, First Edition Mea A Weinberg, Stuart L Segelnick, Joseph S Insler, with Samuel Kramer © 2015 John Wiley & Sons, Inc Published 2015 by John Wiley & Sons, Inc 270 Interpretation of common laboratory values 271 Therapeutic range “High” value Myelocytes 0; 0% of leukocytes Juvenile neutrophils 0–100; 0–1% of leukocytes Eosinophils, neutrophils, and basophils: chronic myeloid leukemia Band neutrophils 0–500; 0–5% of leukocytes Segmented neutrophils Lymphocytes 2500–6000; 40–60% of leukocytes Eosinophils 1000–4000; 20–40% of leukocytes Basophils Monocytes “Low” value 50–300; 0–5% of leukocytes 0–100; 0–1% of leukocytes 200–800; 4–8% of leukocytes Platelets 150,000–400,000 cells/mm3 Hemolytic anemia, iron-deficiency anemia, splenectomy, cancer, von Willebrand disease Chemotherapy/radiation, cancer of bone marrow RBC Measurements Mean corpuscular volume (MCV) 80–94 µm3 Pernicious anemia, alcoholism, vitamin B12 or folate deficiency Iron-deficiency anemia, blood loss, thalassemia, chronic disease Mean corpuscular hemoglobin (MCH) 27–32 pg Macrocytic anemia Chronic blood loss, microcytic anemia Sickle cell anemia Microcytic and macrocytic anemias Mean 33.4–35.5 g/dl corpuscular hemoglobin concentration Electrolytes Bicarbonate (carbon dioxide) (total) 18–30 mEq/l Metabolic alkalosis Metabolic acidosis (kidney disease, liver failure, diarrhea) Calcium (total) 9–11 mg/dl; 4.5–5.5 mEq/l Hyperparathyroidism (tumor), sarcoidosis, multiple myeloma, excessive vitamin D intake, Paget’s disease Hypothyroidism, osteomalacia Chloride 98–106 mEq/l Metabolic acidosis, renal tubular acidosis Addison’s disease, heart failure, syndrome of inappropriate diuretic hormone secretion (SIADH) (continued) 272 The dentist’s quick guide to medical conditions Therapeutic range “High” value “Low” value Magnesium 1.8–3.6 mg/dl; 1.5–3.0 mEq/l Addison’s disease, chronic Alcoholism, chronic diarrhea, renal failure, dehydration, hypoparathyroidism, ulcerative diabetic acidosis colitis, liver cirrhosis Phosphorus 3–4.5 mg/dl; Liver disease, renal fail1.8–2.3 mEq/l (adults) ure, hypoparathyroidism Hyperparathyroidism 4–6.5 mg/dl; 2.3– 3.8 mEq/l (children) Potassium 3.5–5.5 mEq/l Kidney failure, Addison’s disease, angiotensinconverting enzyme inhibitors (ACEIs; antihypertensive), diuretics, drug abusers, type diabetes Eating disorders (bulimia—vomiting), sweating, chronic diarrhea Sodium 135–147 mEq/l Cushing’s syndrome, hyperaldosteronism, increased fluid loss (vomiting, diarrhea), excessive dietary salt, NSAIDs, corticosteroids, laxatives, lithium, oral contraceptives Heart failure, burns, vomiting, dehydration, liver cirrhosis, syndrome of inappropriate diuretic hormone secretion (SIADH), diuretics Alkaline phosphatase 50–160 U/l Paget’s disease, biliary obstruction, osteoblastic bone tumors, hyperparathyroidism Protein deficiency Amylase 53–123 U/l Acute pancreatitis, pancreatic cancer, intestinal/bile duct blockage, perforated ulcer Toxemia of pregnancy creatine kinase (CK) or creatine phosphokinase (CPK) 38–174 U/l (males); Lipase 10–150 U/l ALT (SGPT) 0–30 U/l AST (SGOT) 0–40 U/l Enzymes Bowel obstruction, Crohn’s disease, celiac duodenal ulcer, pancreatic disease, cystic fibrosis 96–140 U/l (females) cancer Liver cirrhosis, hepatitis, infectious mononucleosis, acute myocardial infarction, alcoholism Normal results Recent myocardial infarction, liver disease, hepatitis, skeletal muscle trauma Normal results Interpretation of common laboratory values 273 Therapeutic range “High” value “Low” value Albumin 3.5–5.5 g/dl Dehydration, high protein diet Liver disease, kidney disease Bilirubin 0.1 mg/dl Cirrhosis, hepatitis, pancreatic cancer No concerns Total cholesterol (depends on age)