Best Dental Hospital in Jaipur for Complete Oral Health Care

Why Your Medical History Changes Your Dental Treatment

In clinical medicine, it is now well recognized that systemic disease is associated with oral disease. Diabetics have poor blood sugar control when they have untreated gum disease. The oral bacteria that get into the bloodstream through the bleeding gums are linked to cardiac infections and atherosclerosis. On the other hand, systemic diseases affect the healing process, response to infection, and tolerance of dental treatment.

As a result of this two-way relationship, if the patient has uncontrolled diabetes or has severe heart disease, a dental extraction or implant surgery is not a routine procedure. It's a protocol that has a higher risk of complications, but can be done safely with the proper protocols   as long as the dental doctor in Jaipur treating them knows the protocols and can get medical backup if necessary.

Dentists and their patients in India often have undiagnosed diabetes or hypertension: An India-centric study published in PMC has revealed that a considerable number of the patients who visited dental clinics had diabetes and hypertension without being diagnosed. A lot of patients have high blood pressure or blood sugar, but don't know it and don't tell the dentist. If this happens in an independent clinic, then it goes unnoticed. In a hospital, it can be detected and treated before treatment starts.

Dental Care and Diabetes: What Changes and Why

Diabetes impacts dental treatment in two ways. First, diabetes or hyperglycemia, which is high blood sugar, badly affects the healing process of wounds. An extraction socket that takes 7-10 days to heal in a non-diabetic patient may take as long as 3-4 weeks or more in a patient with an HbA1c greater than 8%. The incidence of infection after the procedure is also significantly increased. If a diabetic patient requires a tooth extraction or dental implant and his blood sugar level is not in a safe range prior to treatment, his chance of having a wound that will not heal properly is real.

Second, diabetes and gum disease are a vicious circle. Uncontrolled Diabetes makes people more prone to gum disease because it weakens immunity and changes the gut flora. Inflammatory gum disease, in turn, raises blood sugar by causing inflammation in the body. Diabetic patient suffering from untreated periodontitis is in a vicious cycle where each disease exacerbates the other. The coordinated treatment by both the dentist and the physician who is treating diabetes is essential to break the cycle.

If you are diabetic, before any dental surgery: Your dental doctor should get your current HbA1c and it is best to get your fasting blood glucose level on the day of the surgery. A blood glucose level greater than 9% is generally too high for elective dental surgery, however, please discuss with your physician prior to elective dental procedure. Do not attend a dental appointment when fasting without discussing this with the dentist and how it will affect your diabetes medications for that day.

Oral Implants For Diabetic People.

Dental implants are safe to be inserted in diabetic patients, but there are criteria to consider. An HbA1c level of less than 7.5% to 8% is ideal for achieving good healing results. Surgical technique, antibiotic prophylaxis and a longer healing period are required before placement of the crown, then is prescribed in non-diabetic patients. Monitoring is more intense after surgery.

A best dental hospital in Jaipur for implants for diabetic patients should: Take the HbA1C level into consideration before appointment, consult with the patient's doctor if blood sugar is not at target, use antibiotic prophylaxis as a standard protocol, schedule a longer healing period, and provide a doctor if the patient's blood sugar becomes unstable on the day of surgery. If a clinic is not implanting in compliance with this protocol and is doing implants on diabetics, they're not doing the recognised standard of care.

Dental Care and Heart Disease: A Risk That Requires Protocol, Not Avoidance

Dental management for cardiac conditions is a well-defined clinical research; dental treatment is generally safe for patients with controlled heart disease, but requires a few modifications. Dental procedures cause stress and pain that causes the release of adrenaline, which increases heart rate and blood pressure. This physiological stress response poses clinical risk in the patient with ischaemic heart disease, uncontrolled hypertension or an arrhythmia.

The following are the important changes to be made in the dental situation for cardiac patients:

Blood pressure monitoring:  BP should be taken prior to and during longer procedures. Elective dental treatment is advised to be delayed for patients with BP >160/100 mmHg until the physician has reviewed and stabilised their BP.

Anaesthetic choice: Epinephrine (adrenaline) used as a vasoconstrictor is the standard local anaesthetic used in dentistry; it lasts longer and causes less bleeding. In patients with heart disease, the dose of epinephrine should be restricted. For patients who have well managed hypertension and/or stable coronary disease, most guidelines suggest using one to two 1:100,000 concentrations of epinephrine per injection. Of course, the dentist needs to know the patient's cardiac history in detail.

Antibiotic prophylaxis: If a patient has certain cardiac problems such as a history of infective endocarditis, some congenital heart defects, or prosthetic heart valves, dentist care must be accompanied by antibiotics to prevent bacteria that may enter the bloodstream and seed the heart. Prior to any type of dental invasive procedure, this should be verified with the patient's cardiologist.

Medication review:  A large proportion of cardiac drugs have an interaction with anaesthetic used during a dental appointment or make the blood clump. Several antihypertensive drug classes are contraindicated with NSAIDs that are used for dental pain. This review must be done in the presence of a physician, not a drug reference book.

Cardiac patients should choose a Jaipur dental hospital within a multispeciality hospital for dental treatment as it will have a cardiologist in the same building

Patients on blood thinner (anticoagulant): The extraction issue

There is a huge population of patients taking anticoagulants or antiplatelet treatment in Jaipur such as warfarin, aspirin, clopidogrel, newer oral anticoagulants such as rivaroxaban or dabigatran. They are used to treat atrial fibrillation, DVT, prosthetic heart valves, stroke prevention, and CAD. They prevent blood clots from forming – this is imperative for the treatment of the condition they are working on, however it is a particular problem when any dental procedure which involves bleeding is planned.

In the past, patients taking warfarin were advised to discontinue the warfarin prior to dental extraction. It's now commonly known to be a dangerous suggestion, because abruptly stopping anti-clotting drugs can raise the chance of the issue for which they are used (stroke, cardiac clot)

Current guidelines call for:

• If the patient was taking aspirin only: keep aspirin and use local haemostatic measures
• INR monitoring should be considered within 24 hours of the procedure: If INR is in the therapeutic range (usually 2.0 – 3.0), do not withhold warfarin without specific instructions from the prescribing physician; If INR is outside of therapeutic range, continue warfarin treatment as usual
• For newer oral anticoagulants: see key guidance from the prescribing doctor as timing of last dose (before or after) the procedure is different for each drug

This must be done properly and needs direct communication with the physician prescribing the anti-coagulant. For warfarin users an INR test must be performed in-house on the day of the procedure. It needs to have a dental environment with the ability to manage surgical-site bleeding using appropriate haemostasis techniques. This is the norm in any best dental hospital in Jaipur that is a multispeciality hospital. It is much more difficult to do in a standalone clinic without the lab and the physician onsite.

Dental Care During Pregnancy.

Many people think that pregnancy makes a woman ineligible to get any dental care for 9 months. This is a myth that can have health implications. Most pregnant women get some degree of pregnancy gingivitis, which is caused by hormonal changes during pregnancy, especially increased levels of progesterone and oestrogen. If left untreated, it can lead to more severe gum disease; also, in the research literature, an untreated periodontitis in pregnancy is linked with poor outcomes in birth, such as premature delivery and low birth weight.

The right way to take care of your teeth when you are pregnant is not avoidance, it is selection. Routine check-ups, professional scale and clean and treatment for pain or infection are safe at any stage of pregnancy. The elective procedures are best performed during the second trimester (weeks 14–28) when organogenesis is complete, and the uterus is not large enough to cause discomfort when lying back. Dental X-rays with the use of a lead apron are safe at any age when clinically needed.

A dental hospital in Jaipur with a direct link to the obstetrics and gynaecology department provides a tremendous advantage to a pregnant woman who has to undergo dental treatment. When a question comes up regarding the suitability of a procedure or medication at a specific point during pregnancy, the answer is not a referral chain that takes days, but rather across the corridor with the obstetrician involved.

Elderly Patients: When Multiple Conditions Overlap

The dental management of elderly patients is often a challenge which involves several of the above at the same time: diabetes, hypertension, cardiac medication, anticoagulants, and often the use of multiple medications (polypharmacy) whose interactions are not always fully understood). In certain older patients there is cognitive decline which may also result in poorer home oral hygiene care, which can result in increased decay and periodontal disease, thus necessitating more frequent professional care.

Cavities are dramatically increased by dry mouth (xerostomia), which is a side effect of over 400 commonly prescribed medications, especially among elderly patients, and is caused by insufficient saliva buffering. For a dental doctor treating elderly patients it is important to have a detailed history of medicines prescribed at each appointment and make appropriate changes to the treatment plan. There are so many medications with dental implications that it is not necessary but clinically important to have a physician available.

Why a Dental Department is Different to These Patients at the Hospital

The difference between a dental clinic in Jaipur and a hospital based dental department is not so much in the equipment used. Most of the contemporary stand alone dental clinics are outfitted with satisfactory dental chairs, rotary endodontic systems, and OPG X-ray. The difference is that when a situation outside of the scope of dentistry occurs, which is not uncommon in medically complex patients, but is a possibility in clinical practice.

What a hospital-based dental department provides that a standalone clinic cannot:

• Same-day blood tests: HbA1c, random blood glucose, INR: blood tests available to view in house prior to the procedure, not sent to an external laboratory and reported on the next day.
• Physician consultation: When a patient has a BP higher than the recommended treatment level, then the physician is two floors away and not across town.
• Anaesthetic backup: An anaesthetist is available on-site in the same building for patients who need dental treatment under sedation or general anaesthetic, such as complex implant surgery, paediatric dentistry or patients who are dental-phobic.
• Emergency response: cardiac event, allergy to local anaesthetic, vasovagal collapse during a procedure: in a standalone clinic, call an ambulance. In the hospital, it means opening a door.
• Cardiologist and physician proximity: for pre-procedure clearance and medication review; to facilitate same day consultation in the event of an intra-procedure issue.

Dental Care at Jaipur Vatika Hospital

The Advanced Dental and Maxillofacial Care department at Jaipur Vatika Hospital is designed to cater to the entire dental requirement, including that of the ones mentioned in this guide, the medically complex patients.

• For diabetic patients: same-visit HbA1c and blood glucose testing at the on-site NABL accredited laboratory; protocol based implant assessment with physician co-ordination; Pathways for wound monitoring following extraction.
• Cardiac and hypertensive patients: pre-procedure BP monitoring, cardiologist in the same building for pre-procedural clearance, anaesthetic dose management according to cardiac guidelines, antibiotic prophylaxis protocols.
• For patients taking anticoagulants: INR testing on the day of surgery for patients on warfarin; review of medication with doctor; haemostatic protocol for surgical procedures.
• For pregnant patients: direct coordination with Obstetrics and Gynaecology department under Dr. Rinku Barwar (MBBS, DGO); timing of procedures in the second trimester; safe anaesthetic and medication protocols.
• For elderly: Dr. Amit Ghasil (MRCP London, ex-NHS) will carry out a medication history review with the General Medicine team and will discuss the management of dry mouth with the patient, as well as modified treatment protocols for polypharmacy patients.

Dentists in Jaipur offer a complete dental facility, which includes preventive care, restorative care, painless rotary RCT, dental implants in Jaipur, maxillofacial surgery, laser and cosmetic dentistry services under the hospital infrastructure.

Conclusion

Generally, a self-contained clinic that has a dentist in Jaipur is a suitable place for a healthier person to get a routine check-up. For the vast and ever-growing patient base of diabetes, hypertension, cardiac disease, anticoagulant therapy or pregnancy, a premium dental hospital in Jaipur within a multispeciality hospital isn't a choice. It is the clinical "right" setting in which the unique risks they present to dental care can be addressed and not ignored.

Advanced Dental and Maxillofacial Care at Jaipur Vatika Hospital has all the dental services available with direct access to the hospital's General Medicine, Cardiology and Obstetrics departments and an in-house laboratory facility, which is NABL accredited for taking blood samples on the spot   on the Jaipur-Ajmer Expressway at Thikariya. For booking a consultation, shoot us an email on the JVH E-Consultation App or give us a call at +91-8209809753.