THE health and life expectancy in Guyana have been improving over the years. More people are surviving with chronic illness, many are on long-term medication and there are proportionally many more old people today than a few decades ago. But despite this, oral health care has not always been forthcoming for the patient with medical problems, and oral diseases are not always recognised. Indeed it is quite common that patients who visit the dentist also suffer from medical conditions for which due consideration must be given, but which is not usually the case.

No patient should suffer any deterioration of health as a consequence of dental treatment. It is therefore essential, within the practical limitations of the dental practice, the presence and significance of medical problems likely to affect oral care.

The prevalence of medical disorders that might affect dental treatment is higher in certain groups, particularly the elderly, the handicapped and the hospitalised. However, the presence of certain basic ailments should be investigated routinely.

Anaemia is the first to be considered. In this state, the haemoglobin (red pigment) of the blood is lacking. The haemoglobin, which is responsible for taking oxygen to the cells of the body, is measured in grams and the normal adult generally has ten to fifteen. One pint of blood contains just over one gram of haemoglobin. Whenever there is anaemia, the main danger exists if general anaesthesia is given. Symptoms include debility, weakness, pallor, breathlessness and swelling of the ankles.

Prolonged bleeding after a dental extraction is usually of a local cause but it is also one of the common signs of a bleeding disorder. The condition is usually caused by disorders of platelets (a type of blood cell), or of the clotting mechanism (such as haemophilia or patients on anticoagulants for stroke). Platelet defects give rise to purpura, characterised by superficial (capillary) bleeding in the skin or mucosa which is observed as one or more reddish spots. Coagulation disorders cause severe bleeding deep in the tissues and extensive haematoma formation after slight injury. Bleeding after surgery or trauma can also be prolonged and severe as to be a potential killer.

A bleeding disorder in a close relative is strongly suggestive of a blood-clotting defect. When occurring congenitally, most become apparent in childhood. However, some haemophiliacs escape recognition until adult life if they manage to avoid injury. Patients who have had dental extractions without trouble are most unlikely to have severe congenital bleeding disorders. Many diseases can result in prolonged bleeding after an extraction. Among the main ones, are high blood pressure, liver disease including cirrhosis, severe anaemia, malnutrition and HIV infection. A patient must never forget to tell the dentist if he or she has a bleeding problem since their well-being may be endangered by failing to disclose any disorder.

Cardiovascular diseases, particularly high blood pressure and ischaemic heart disease are the most common causes of death in many countries. There are millions of ambulant dental patients who have heart disease, treated or untreated. Drugs, procedures or just anxiety can aggravate heart disease or possibly even provoke cardiac arrest whereby the patient dies instantly. So even when one is under medication from one’s doctor for any condition, even a simple cold, and the dentist should be informed so that contraindicated drug therapy or procedures can be avoided.