Systemic contraindications preclude extraction because the patient’s systemic health is such that the ability to withstand the surgical insult may be compromised (see Chapter 1). One systemic contraindication is a group of conditions called severe uncontrolled metabolic diseases. Brittle diabetes ana end-stage renal disease with severe uremia are part or this group. Patients with mild diabetes or well-controlled severe diabetes can be treated as reasonably normal patients. It is only when the disease process becomes uncontrolled that the patient should not have a tooth removed.
Patients who have uncontrolled leukemias and lymphomas should not have teeth removed until the leukemias can be brought under control. The potential complications are infection as a result of nonfunctionlng white cells and excessive bleeding as a result of an Inadequate. number of platelets. Patients with any of a variety of severe uncontrolled cardiac diseases should also have their extractions deferred until the disease can be brought under control. Patients with severe myocardtal Ischernta,such as unstable angina pectoris, and patients who have had a recent myocardial infarction (MI) should not have a tooth extracted. Patients who have severe uncontrolled hypertension should also have extractions deferred,because persistent bleeding, acute myocardial insufficiency,and cerebrovascular accidents are more likely to occur as a result of stress caused by the extraction. Patients who have severe, uncontrolled cardiac dysrhythmias should have their extraction procedures deferred as well.
Pregnancy is a relative contraindication; patients who are in the first or last trimester should have their extractions deferred If possible. The latter part of the first trimester and the first month of the last trimester may be as safe as the middle trimester for a routine uncomplicated extraction, but more extensive surgical procedures should be deferred until after the child has been delivered.
Patients who have a severe bleeding diathesis, such as hemophilia, or severe platelet disorders should not have teeth extracted until the coagulopathy has been corrected. Most severe bleeding disorders can be controlled by the administration of coagulation factors or platelet transfusions. Close coordination with the patient’s hematologist can result In an uncompllicated recovery from the extraction procedure in most situations. similarly patients who take anticoagulant can have routine extraction performed when care is taken to manage the patient appropriately.
Finally, patient who take or have taken n variety of medications should have surgery performed with caution, Drug to watch for include corticosteroids, Immunesuppresives, and cancer chemotherapy agents.