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Systemic contraindications
Brittle uncontrolled diabetes Stress of surgery Metabolic Perturbation (hypersecretion of counterregulator hormones like catecholamines, glucagons, cortisol and growth hormones that anatognised the effect of insulin
Greater incidence of Dry Socket Prone to develop infection (due to high glucose level of blood) Deposition of cholesterol in peripheral circulation atherosclerosis Alteration in calcium and phosphate metabolism bone demineralization, decrease trabeculation, decresased thickness of cortical bone jaw fracture and abnormal healing after extraction Bleeding tendency (renal anaemia + alteration in platelet aggregation) Mechanical damage + heparin anti-coagulation during dialysis ecchymosis + petechiae + haemorrhage Susceptible to infection (in kidney transplant paitnet due to immune suppressive therapy) Uncontrolled Tendency to bleed: intraoral bleeding peetechiae + ecchymosis + leukaemia and haematoma lymphoma Increased risk of infection (compromised lymphocyte function) Risk of developing osteonecrosis if jaw of patient treated with radiotherapy / IV bisphosphonate Anaemia: fatigue easily + not able to tolerate time consuming dental treatment Corticosteroid treatment secondary adrenal insufficiency Secondary malignancy Severe uncontrolled LA + Adr inducing cardiac arrhythmia / collapse cardiac disease Patient takes anticoagulants blood less likely to clot Stress + anxiety cardiac arrhythmia Recent MI Likelihood of reinfarction within 6 months Toxic goitre Precipitate thyroid crisis cardiac embarrassment and heart failure
Local contraindications
Teeth located in malignant tumour Vascular lesion (Arteriovenous malformations + Haemangiomas) Disseminated cells hasten metastatic potential Bleeds easily Dramatic bleeding
Severe bleeding disorder Polycythaemia Vera Patients on Anticoagulant Therapy Medication: Corticosteroid, immunosuppressive drug
Cirrhosis of liver
Postoperative infections Suppression output of adrenocorticotrophic hormone from anterior pituitary gland adrenal cortical atrophy (Give cortisone prep: 50-100mg cortisone orally 2 hours preoperatively; 100mg of hydrocortisone sodum succinate IV; 12 hours postoperatively, 50mg of cortisone orally) Coagulopathy + thrombocytopenia Abnormal results in PT / INR, PTT Increased susceptibility to infection Potential for bacteraemias occurring and spontaneous bacterial peritonitis Unpredictable hepatic metabolism of drugs administered Prolonged haemorrhage (Should receive prophylactic dose of Vitamin K before extraction) Danger of contracting endocarditis (roughened endocardium provides place for bacterial organisms to lodge, vegetate, interfere with valvular functions) Extraction of large numbers of chronically infected teeth ppt acute nephritis Delayed healing postoperative infection (Should undergo antisyphilitic treatment before extraction) Osteoradionecrosis Spread of bacteria to lower head and neck region
Local Complications
Radiotherapy Severe pericoronitis Acute maxillary sinusitis Acute gingival inflammation
Spread of bacteria