Restorative Needs and Options in Medically Complex Patients
Citation
Rodriguez Maldonado, Dagmarie Liz. 2024. Restorative Needs and Options in Medically Complex Patients . Master's thesis, Harvard University School of Dental Medicine.Abstract
Introduction: An increase in the size of the U.S. population is accompanied by an increasingly aging population, with adults 65 and older experiencing the highest prevalence of edentulism. Studies indicate that 25% of persons aged 35 to 74 are edentulous and require a high amount of prosthetic care. These patterns demonstrate an increasing quantity of older patients with systemic medical conditions seeking oral care. Complete edentulism is associated with several comorbid conditions, where pre-treatment and peri-treatment oral health status are critical for a favorable long-term prognosis of prosthodontic treatment. It is essential to recognize that systemic diseases may affect or limit restorative treatment options, complicating treatment planning and implementation.Purpose: This study aims to explore the oral health needs among patients identified as medically complex. In addition, to determine the most prevalent systemic conditions among medically complex patients who are concurrently seeking dental care, evaluate the major restorative and periodontal treatments needed, and explore how these systemic conditions limit their restorative options.
Methods: An estimate of 80 e-records from the Medically Complex Clinic at Harvard Dental Center will be evaluated retrospectively using a statistical software package for analysis.
Result: Of the 62 patients treated at the Medical Complex Clinic of HSDM that were evaluated for this study, 47 were diagnosed with cancer. Twenty-four had at least one episode of osteoradionecrosis. We could observe that the MCC of HSDM receives a substantial number of cancer patient referrals.
Conclusion: Cancer is a treatment-limiting factor that severely affects a patient’s oral health. Cancer treatment can create immunosuppression, which affects patient's ability to fight infections. The recorded data allowed us to better understand the medically complex patients that are referred. With this information, existing protocols can be updated and adjusted to meet the needs of the patient pool. This may promote further brainstorming of preventive oral therapies that can be given concurrently with treating systemic conditions.
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