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Paper text:
this fact is particularly evident when the patient seeking oral health care presents with systemic illness and/or disability . to provide optimal dental care for this medically compromised population ,
moreover , modifications of dental management due to compromising medical conditions are necessary to provide better and safer oral care for patients .
as the proportion of the elderly in the population continues to increase , due to advances in medical technology , greater access to medical facilities and better socio - economic conditions , which enable people to live longer , as evidenced by an increase in the life expectancy in many parts of the world , there will be more patients with medically compromised conditions .
in the united states , the number of people age 65 or older has increased more than 10-fold from 3 million ( 4% of the population ) in 1900 to 35 million ( 13% of the population ) in 2000 .
the size of the older population is estimated to double over the next 30 years , growing to 70 million by 2030 . as the 65 and older age group increases in size
these advances are also reflected in better oral health care in a number of patients since they still retain their natural teeth into the old age .
the national center for health statistics reported that 15% of the adult population age 65 and over have chronic medical conditions .
the most prevalent reported diseases are cardiovascular ailments , diabetes , hypertension , chronic bronchitis , and arthritis .
it is becoming an increasingly larger responsibility for the dentist and other oral health care professionals to identify patients with systemic diseases , compromising conditions , and disabilities that have an impact on , and can be impacted by , oral health treatment .
though this situation is easily stated , the ability to practice dentistry properly within the context of the larger health care system is a challenge for the dental practitioner .
the effective evaluation of the medical history is an integral aspect of the rationale for this challenge .
there is a paucity of data concerning the prevalence of medically compromised conditions in dental patients from india .
the aim of this study was to determine the prevalence of medically compromised conditions in dental patients .
the patient records from the o.p.d . of dental college and hospital of mathura city ( india )
starting from 1 january 2009 to 31 december 2010 were reviewed for the presence of medically compromised conditions .
two socioeconomic variables , i.e. , income level and occupation were also collected from patients records , and majority of patients belonged to low socioeconomic strata .
the medically compromised conditions were classified into 11 categories as follows : cardiovascular diseases , endocrine disorders , respiratory disorders , hematologic disorders , neurological disorders , infectious disorders , skeletal disorders , gastrointestinal disorders , renal disorders , drug allergy and liver disorders .
chi square (  ) was used to describe male to female ratio . a p value less than 0.05 was considered statistically significant .
out of 36,729 dental patients , a total of 375 patients were found to have of medically compromised conditions in the period of study .
the prevalence of medically compromised conditions in dental patients of our hospital in the present study was 1.02% .
the dental patients who were afflicted with medically compromised conditions with the mean agesd=50.0413.21 years .
there were 199 male patients ( 53.06% ) and 176 female patients ( 46.93% ) .
almost all categories elicited male predilection over female patients except in the cardiovascular and gastrointestinal diseases , but the difference here was statistically insignificant ( p>0.05 ) .
prevalence of medically compromised condition in dental patients mean age in years of medically compromised patients comparison of medically compromised conditions between genders in the present study , the most frequently encountered disease category was cardiovascular diseases ( 57.87% ) followed in descending order by endocrine disorders ( 35.73% ) , respiratory disorders ( 7.47% ) , hematologic disorders and neurological disorders ( 3.47% ) , infectious disorders ( 3.20% ) , skeletal disorders ( 1.87% ) , gastrointestinal disorders ( 1.60% ) , renal disorders and drug allergy ( 1.33% ) and liver disorders ( 0.53% ) , respectively .
however , in allergy category , most patients were allergic to penicillin followed by sulfa group .
as more and more patients with medically compromised conditions are seeking dental treatment , dentists should be prepared to handle such patients .
a thorough history taking and physical examination in every patient is important to identify patients with medically compromised conditions , but unaware of them .
for example , in the first 6 months after acute myocardial infarction , dental treatment should be reserved for emergency situation only or the avoidance of bruising maneuvers during dental treatment in patients with coagulation factor deficiency .
prescribing medications for medically compromised patients must be carried out with extra care to avoid interference with multiple medications patients are already prescribed and to prevent any undesirable drug interactions .
it would be beneficial to reduce stress in the dental setting when treating this type of patient , especially in hypertensive patients .
the category , which exhibited the highest mean age of 58.5713.12 , was the skeletal diseases category followed by the liver diseases category with a mean age of 56.5012.02 .
this reflects the character of these two categories , which are usually encountered in adult or elderly patients , while the neurological disorders category showed the lowest mean age of 31.2319.90 since some neurologic disorders are congenital abnormalities and can be present at birth or during childhood .
the present study demonstrated male preponderance in most of the categories , even in the generally accepted female predominance diseases such as endocrinal diseases .
this phenomenon may be attributable to the fact that males pay less attention to both general health and oral health than females .
the prevalence of medically compromised conditions in dental patients of our hospital in the present study was 1.02% .
rhodus et al . , reported that the prevalence of medical conditions in dental patients increased from 7.3% in 1976 to 24.6% in 1986 .
smeets et al . , revealed the prevalence of medically compromised patients from the survey of 29,424 dental patients from the netherlands to be 28.2% .
saengsirinavin et al . , disclosed the prevalence of medical conditions in thai dental patients to be 55.45% .
umino et al . , reported that one or more medically compromised conditions were encountered in 64.2% of elderly japanese dental patients .
the results revealed that the private office group had 27.6% medical problems , the academic dental center had 46.3% , while the hospital dental clinic showed the highest prevalence of 74.1% .
the reasons for this may be accounted for by the fact that the present study recruited patients across a wide age range in contrast to most previous studies , which focused exclusively on elderly patients since the prevalence of medically compromised conditions tends to increase with advancing age . in the present study ,
cardiovascular diseases were the most prevalent medically compromised conditions ( 57.87% ) in dental patients as in the studies by smeets et al .
, persson et al . , and jainkittivong et al . , ( 33.7% ) a number of previous studies reported that cardiovascular diseases were the most prevalent medically compromised conditions in dental patients .
the most frequent and serious cardiovascular emergencies that can manifest during dental treatment are chest pain ( as a symptom of underlying disease ) and acute lung edema . due to the high prevalence and seriousness of these problems ,
the dental surgeon must be aware of them and should be able to act quickly and effectively in the case of an acute cardiovascular event . in patients with a history of cardiovascular disease , attention must center on the control of pain , the reduction of stress and the use or avoidance of a vasoconstrictors in dental anesthesia . in turn
, caution is required in relation to the antiplatelet , anticoagulant and antihypertensive medication typically used by such patients .
endocrine disorders , the majority of which were diabetes mellitus , came second in the present study ( 35.73% ) .
the majority of people in developing countries such as india do not undergo routine medical check - ups . as a consequence , patients harboring asymptomatic medically compromised conditions such as hypertension , heart disease or diabetes mellitus
the major drawback of the present study is that it does not conduct the interview and physical examinations , so patients with undiagnosed medically compromised conditions may go undetected .
the other reason is that patients with infectious or sexually transmitted diseases such as aids may not give accurate medical history for fear that they may be denied dental treatments .
medically compromised patients need more in - depth evaluation , which indeed requires more knowledge of medicine .
this is an important issue that leads to reassessing whether medicine should be taught more in - depth in dental schools .
dental schools may have to expand subjects such as management of the medically compromised patients , pharmacology , and medical emergencies .
continuing education courses should emphasize these subjects as well . in dentistry , the curriculum may require modification toward a more medically oriented dental education .
dental educators should reassess their materials and methods of education to make sure that dental practitioners are equipped for the population 's requirements for dental care as medical needs change . knowing about systemic diseases and medications will help dental practitioners to be aware of life - threatening situations that may occur during dental treatment .
background : over the last few decades , oral health care has become a greater priority as people live longer with serious medical conditions and disabilities . as a result , they require more comprehensive dental treatment . 
 we are now , more than ever , at a turning point in history where dental care , or more broadly oral health care , is an integral part of medical care . 
 therefore , a need was felt to study the prevalence of medically compromised patients seeking dental treatments.materials and methods : the present study was a retrospective study conducted by reviewing the patient records starting from 1st january 2009 to 31st december 2010 for the presence of medically compromised conditions . 
 demographic data of the patients was also collected.results:the prevalence of medically compromised conditions in dental patients of our hospital in the present study was 1.02% . 
 the cardiovascular diseases accounted to be the most prevalent condition ( 57.87% ) followed by endocrine disorders ( 35.73%).conclusion : even though the prevalence of medically compromised conditions in dental patients is not high , dentists should bear in mind that some of the patients may harbor such conditions , which are contraindicated for certain dental procedures or medication or require special attention when treating these patients .