(5) Diabetes mellitus. Diabetes is a systemic disease in which the body is
unable to utilize sugars in the diet because of the lack of insulin in the system. Diabetes
may be controlled by periodic injections of insulin, oral medication, or diet, depending on
its severity. Periodontal disease is often associated with uncontrolled diabetes. Special
consideration must be given in performing surgery or any dental treatment on diabetics
because of their tendency to bleed easily and their high susceptibility to infections. The
dental officer normally will not perform extractions on uncontrolled diabetics unless the
patient's physician assumes responsibility and supportive measures have been
(6) Hemophilia. Hemophilia is a rare hereditary condition appearing in males.
In hemophilia, there is profuse bleeding caused by an inadequate clotting mechanism
resulting in prolonged uncontrollable bleeding, even from the slightest cut. Any necessary
surgical procedures should be done only with the cooperation of the patient's physician to
minimize and to control bleeding.
(7) Pernicious anemia. Pernicious anemia is a severe form of anemia
characterized by lowering red blood cell count, weakness, and other forms of debilitation.
One frequent early symptom is a painful, fiery red inflammation of the tip and sides of the
tongues. The wearing of dentures or any other mild mechanical irritations cannot be
tolerated by some patients with pernicious anemia.
(8) Allergy and hypersensitivity. Patients may be allergic or hypersensitive to
any of a number of drugs or materials used in dentistry. The dental officer must take a
thorough history, so that he may avoid the use of drugs and materials to which the patient
may have an unfavorable reaction.
(9) Hyperthyroidism. Hyperthyroidism is a disease in which the thyroid gland
is abnormally active and produces marked systemic effects. Among these effects are
pronounced nervousness and emotional instability, cardiovascular changes, weakness,
and other symptoms. Extensive or painful oral operations or the use of agents containing
adrenalin is contraindicated in the active hyperthyroid cases. The patient's physician
normally will be consulted before an oral operation is performed on the patient. The
hyperthyroid patient on adequate medication can become a well-stabilized dental patient.
(10) Hepatitis B. Patients with active hepatitis, or who are carriers of the
Hepatitis B virus, can infect the dentist, staff, and other patients. To reduce risk to
everyone, strict barrier protection procedures must be enforced (masks, gloves, gowns,
and protective eyewear) along with strict aseptic techniques. Hepatitis is a very
debilitating disease and causes death in a small percentage of the cases. Therefore, it is
recommended that all dental personnel receive the heptavax vaccine to eliminate risk of
infection with the Hepatitis B virus.