Dental treatment for medicaly compromised

within a county jail system, I have treated thousands of inmates with acute and chronic dental problems. The typical correctional patient presents with grossly carious teeth which are either not restorable or the cost of restoration upon release is beyond their financial ability. Another common malady among the inmate population is advanced periodontal disease featuring loss of the alveolar bone that supports the teeth and causing advanced tooth mobility which requires extractions. Unfortunately, this population has not used preventive dentistry to their advantage.

Additionally, these patients have neglected their general health and have more medical problems than a comparable segment of the general population. When this trend is coupled with the acute oral problems which emerge due to poor oral health, dentists must consider the patient’s medical problem(s) and any corresponding prescribed medications before dental treatment can be initiated. This article will be a feature some of the most frequently occurring medical problems which I have seen among correctional patients, their impact on the ability to provide dental treatment, and their direct and indirect consequences upon oral health.


Hypertension is the most common chronic illness which afflicts the patients I treat. Although this disease afflicts 50% of patients 65 years of age and older, it is by no means restricted to the geriatric population. It is mandatory to take vital signs on all patients before the initiation of any dental treatment, especially treatment which is invasive. If blood pressure is elevated, a decision must be made whether to defer treatment especially for surgical procedures. The literature suggests treatment deferral at various cutoffs for systolic and diastolic blood pressure ranging from 160 to 180 and 100 to 110 respectively. I use the lower end of both ranges, e.g. 160/100 mm hg, as the point at which I will not proceed with oral surgery. Patients that have elevated blood pressure levels should be referred to the medical department for further evaluation and treatment to controlled levels before proceeding with dental treatment. Additionally, it is essential that vital signs are recorded before any surgical procedure for all patients, not just those know to have hypertension since epinephrine, an endogenous catecholamine, is added to local anesthetics to prolong anesthesia and aid in hemostasis. Epinephrine must be used cautiously in hypertensive and cardiac patients as it can raise the blood pressure.


While tooth decay is often the primary cause of a toothache, it's important for you to have a complete oral examination to determine the cause. Other causes of a toothache can include the following:

   Gum disease
   Grinding teeth (bruxism)
   Tooth trauma
   An abnormal bite
   Tooth eruption (in babies and school-age children)

TMJ/TMD (Temporomandibular Joint Disorder), sinus or ear infections, and tension in the facial muscles can cause discomfort that resembles a toothache, but often these health problems are accompanied by a headache.

Pain around the teeth and the jaws can be symptoms of heart disease such as angina. If your dentist suspects a medical illness could be the cause of your toothache, he or she may refer you to a physician.

If you have a toothache, you may have a cavity or advanced gum disease. The first sign of decay may be the pain you feel when you eat something sweet, very cold or very hot. If the pulp – the inside of the tooth that has tissue and nerves – has become irritated, this can cause pain in your tooth.