Traumatic Brain Injury
Injury to the brain may result from trauma such as an automobile accident or cranial surgery. Clinical manifestations of TBI can be extensive and include:
- altered mental status
- communication disorders
- emotional and psychiatric disorders
- related paralysis or paresthesia
These individuals may be receiving extensive medication regimens including anti-coagulants, psychotropic medications, and anti-hypertensives.
Spinal Cord Injury
The level at which the spinal cord is injured determines the extent of sensory and motor deficits. Individuals with higher spinal cord injury may have:
- impaired ventilation
- reduced gag and cough reflex
- difficulty controlling oral fluids
Individuals with higher spinal cord injury receiving dental treatment may require:
- special treatment areas (hospital)
- additional personnel
- attentive and rapid evacuation of fluids
- blood pressure monitoring
- other specific monitoring
Individuals with lower spinal cord injury usually require no special preparation for receiving dental care, other than barrier free access to treatment areas.
In general, patients with spinal cord injury experience a loss of bowel and bladder control. These patients should void and carry out their bowel program prior to the dental appointment.
When it is necessary to place the patient in the dental chair, proper wheelchair transfer technique is essential to prevent injury to patient or dental staff. A physical therapist can demonstrate the proper technique to the dental staff. In addition, paralyzed patients may develop ischemia in weight bearing areas causing decubitus ulcers. The dental staff should not leave the patient in the same position for extended periods.
People with spinal cord injuries may be receiving coumadin, aspirin, or persantine to prevent thrombosis. The patient’s physician must be consulted prior to treatment.
Appropriate blood tests may include:
- platelet count
- prothrombin time
- partial thromboplastin time
- bleeding time