Medically Complex Dental Cases

Everyone deserves good dental health, and good dental health care. Getting it, however, can be difficult for some people. Illness or disease, and certain psychological conditions, can make it a challenge just getting to the dentist’s chair. They can also make the patient more susceptible to oral complications, and to compromised dental health. Such circumstances are broadly grouped as medically complex cases, which are a specialty of the Center for Dental Anesthesia in Alexandria.

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The link between oral health and general health is by now firmly established. “The oral cavity has been described as ‘the window to general health,’” wrote Dr. Shawn F. Kane, who notes that many health care professionals consider this obvious. “The oral cavity is also the intersection of dentistry and medicine, semi-independent professions that share the same common goal of improving the health and quality of life of patients.”[1]

Yet medically complex cases can be a serious obstacle to obtaining proper dental care. These cases include:

  • Cancer
  • Post-Traumatic Stress Disorder (PTSD)
  • Diabetes
  • Heart disease/high blood pressure
  • Kidney disease
  • Allergies
  • Epilepsy, tremors, and palsy

People contact the Center for Dental Anesthesia with all of these issues. This blog post describes how medically complex conditions impact oral health, and what can be done about it – with a special focus on cancer and post-traumatic stress disorder (PTSD).

There are an estimated 1.4 million new cases of cancer in the United States every year. Modern medicine can work miracles in cancer patients, but it comes with many side effects. Some of these are common knowledge: most of us know that chemotherapy and radiation treatment can lead to fatigue, nausea, and hair loss. Less well known are its effects on oral health.[2]

Chemotherapy side effects on oral health include:

  • Tooth decay and gum disease
  • Mouth sores
  • Mouth bleeding
  • Dry mouth (xerostomia)
  • Difficult swallowing
  • Malnutrition and dehydration.

Patients with medically
complex cases need one-
on-one attention and a
relaxing dental
environment. Dr. Mady is
pleased to provide safe
sedation dentistry to his
patients with additional
medical needs.

Patients and dentists alike should know about these side effects, as well as the emotional issues and other special needs the patient may have. Up to one-third of cancer patients receiving treatment develop some kind of oral complication that can make it hard for them to talk and eat. These issues can, in turn, further affect the patient’s health, as well as their social and psychological well-being.[3]

While most of these are transitory, and clear up when treatment ends, others may continue. Tooth decay in particular can become a significant issue.

Radiation therapy to the head and neck area can be especially harmful to oral health, with side effects that include:

  • Tooth decay and gum disease
  • Mouth sores
  • Breakdown of hard and soft tissues
  • Infection
  • Difficulty swallowing
  • Malnutrition and dehydration

Fortunately, the effects of cancer treatment on oral health can, in many cases, be minimized or even prevented with good dental hygiene before and during the treatment. Regular brushing and flossing, rinsing with anti-bacterial and baking soda solutions, drinking plenty of water, and eating bland foods, all can help. It’s also a good idea to see the dentist a month or so before radiation therapy begins, if possible. That way existing problems, like new cavities, can be addressed.[4]

The team at the Center for Dental Anesthesia can provide detailed suggestions.

Historically, Post-Traumatic Stress Disorder has been known as “shell shock” or “combat fatigue.” But the condition is not unique to military veterans; it can occur in anyone. PTSD is a reaction to experiencing or witnessing a traumatic event, such as violent crime or abuse, an automobile accident, a natural disaster, or war. This post uses the term “trauma survivor” in reference to people with PTSD. [5]

Not everyone who experiences a traumatic event will develop PTSD. Most, in fact, will not. But with a new generation of American servicemen and women engaged in foreign conflicts, Lisa Mayo, the dental hygiene program director at Concorde Career College in Texas, foresees an increase in reported cases. “Gone are the days when you saw PTSD on a medical history only once in a blue moon,” she cautions. “This disorder will begin presenting in your practices more frequently than ever before due to the military climate set in motion on 9/11.”[6]

A number of health issues are associated with PTSD, including sleep disorders and substance abuse, alcohol in particular. These issues frequently contribute to oral health problems in trauma survivors, such as periodontitis and bruxism.

As treatment begins, it is important that dentists establish a good relationship with trauma survivors, perhaps an even better relationship than with other patients. But trauma survivors are not likely to reveal the condition without prompting. Dentists should screen for it, and try to identify it, by including a question about PTSD on health history forms. Understanding from the outset that a patient is a trauma survivor can help make the patient more comfortable, determine whether any procedures are particularly difficult, and lead to better outcomes.[7]

The chairside manner of the dentist is critical. Establishing a calm, neutral environment is advised, but may not be enough. “The treatment phase can be challenging,” say authors Noel Kelsch and Marhya Kelsch. “Time in the chair may need to be adjusted, and the plan should incorporate flexible, short appointments.” A trauma survivor may once have been pinned down, for example; the dentist chair can mimic the experience and become an inadvertent trigger.[8]

Other ways dentists can make treatment easier for trauma survivors include:

  • Give the patient as much control and choice about treatment as possible
  • Encourage questions, and discuss any concerns before treatment begins
  • Understand the patient may require a support person in the examination room
  • Allow for leeway; let the patient know the treatment can stop whenever necessary[9]

When dental teams and other health care providers understand the issues associated with trauma survivors, patients are more likely to have positive experiences and successful outcomes. They will enjoy the benefits of good dental health, to which they are entitled.

Dental Success
Cancer and PTSD are only two of the medically complex cases that can adversely affect oral health. Prevention is always better than defensive health care, but unfortunately, it is not always possible to achieve.

The goal of any dental practitioner is the patient’s well-being and the success of the dental treatment. At the Center for Dental Anesthesia in Alexandria, our special needs dentistry addresses medically complex cases with one-on-one attention in a stress-free dental environment.

We also offer family and cosmetic dentistry.


End Notes
[1] Oral health and general health: See, for example,
Quote: “The Effects of Oral Health on Systemic Health,” by Shawn F. Kane, MD, FAAFP, FACSM.

[2]  Number of new cancer patients each year: “Oral Complications of Cancer Treatment: What the Dental Team Can Do,” cited hereafter as “Oral Complications.”

[3] “Oral Complications,” and “Dental and Oral Complications of Cancer Treatment – Facts,” cited hereafter as “Facts.”

[4] “Oral Complications” and “Facts.”

[5]  “What Is Posttraumatic Stress Disorder?” From the American Psychiatric Association website; no author credited.
“Trauma survivor” term is suggested by, and borrowed from, “Trauma Survivors in Medical and Dental Settings,” a Western Massachusetts Training Consortium pamphlet, available online at
Referred to hereafter as “Trauma Survivors.”

[6] “Shell Shocking Impacts From PTSD,” by Brittany Morgan Getz, RDH, Emily R. Holt, RDH, Samantha Harpenau, Rey Gabriel Carandang.
Quote: “Patients with Post-Traumatic Stress Disorder,” by Lisa Mayo, RDH, BSDH, MHA, .
The author cites the American Psychiatric Association handbook Diagnostic and Statistical Manual, Fifth Edition [DSM-5], for prevalence of PTSD among U.S. adults.

[7] “Identifying and Treating Patients with PTSD,” by Noel Kelsch RDH, RDHAP, AS, BS, and Marhya Kelsch LCSW, MSW, BSW, AA. Cited hereafter as “Identifying and Treating…”

[8] “Trauma Survivors.” Quote: “Identifying and Treating…” p. 5.

[9] Bullet points adapted from “Trauma Survivors.”


Additional Sources

Dental Treatment in Medically Complex Patients

Heart Disease and Your Oral Health

The Mouth and Heart Connection

Dental Care of Cancer Patients Before, During and After Treatment and

12 Facts You Can’t Ignore