Medically Compromised Patients

A patient on warfarin with stable INR 2.5 needs nonsurgical RCT with expected bleeding.

Patient on apixaban (DOAC) twice daily presents for emergency pulpotomy.

Poorly controlled diabetes (HbA1c 10.2%) with symptomatic apical abscess and facial swelling.

Stable angina patient uses nitroglycerin PRN; needs RCT.

Uncontrolled hypertension (190/110) arrives for elective endodontic therapy.

History of infective endocarditis presents for NSRCT with expected bleeding.

Patient with prosthetic hip joint asks for antibiotics before RCT.

Pregnant patient (2nd trimester) with SIP needs analgesia and LA.

Third-trimester pregnancy needs emergency pulpotomy; profound IANB difficult.

Lactating mother needs post-op pain control after RCT.

Patient taking nonselective β-blocker (propranolol) requires local anesthesia.

Hyperthyroid patient currently uncontrolled (TSH suppressed, symptoms) needs elective RCT.

Patient on oral bisphosphonate therapy (5 years) needs RCT on restorable molar.

Head-and-neck irradiated patient (60 Gy) with deep caries and pulpitis.

Chemotherapy patient with ANC 300/µL presents with acute apical abscess.

Post-liver transplant on tacrolimus/prednisone needs RCT.

Chronic kidney disease (eGFR 25) needs analgesic plan.

Hepatic cirrhosis (Child-Pugh B) requires anesthesia and analgesia.

HIV-positive patient with CD4 180, viral load detectable, symptomatic apical abscess.

Patient with von Willebrand disease requires NSRCT.

Sickle cell disease patient has SIP; office is hot and patient dehydrated.

Asthmatic with aspirin-exacerbated respiratory disease needs analgesia.

COPD patient with baseline O2 sat 91% requests nitrous oxide.

Patient reports cocaine use earlier the same day; needs emergency anesthesia.

Patient on MAOI for depression needs vasoconstrictor.

History of adrenal insufficiency on chronic steroids requires RCT.

Patient with severe OSA requests benzodiazepine plus opioid for the visit.

Active tuberculosis is suspected (cough, fever, weight loss); urgent dental pain.

Uncontrolled epilepsy (recent seizures) needs emergency pulpotomy.

Patient with severe allergy to esters; needs local anesthesia.

Warfarin patient requires antibiotics for spreading cellulitis; which to avoid?

Severe anxiety with history of panic disorder—LA planning.

Patient on dual antiplatelet therapy (aspirin + clopidogrel) post-stent needs RCT.

History of malignant hyperthermia in family—anesthetic choice.

Patient with thyroid storm history now euthyroid on levothyroxine; anesthetic plan.

Organ transplant recipient on cyclosporine has gingival overgrowth and necrotic molar.

Patient on denosumab for osteoporosis needs apical surgery.

Severe GERD patient with chronic NSAID use presents with SIP.

Patient with G6PD deficiency requires topical analgesic.

Patient on methadone maintenance with history of opioid use disorder has severe endodontic pain.

Mild hemophilia A patient requires nonsurgical RCT with expected bleeding.

Patient on dabigatran (DOAC) with eGFR 30 needs emergency pulpotomy.

Hemodialysis patient needs NSRCT. Best appointment timing?

Patient on high-dose chronic steroids for autoimmune disease—stress-dose for RCT?

Severe COPD with resting SpO₂ 90% requests nitrous oxide for anxiety.

Patient with myasthenia gravis on pyridostigmine needs endodontic emergency care.

Unstable angina (recent rest pain) presents with severe endodontic pain.

Patient on linezolid (MAOI-like) requires local anesthesia with vasoconstrictor.

Solid-organ transplant recipient on tacrolimus/cyclosporine needs antibiotics for spreading odontogenic infection.

Parkinson’s disease with tremor—best chairside strategy for RCT.

Severe anxiety on chronic benzodiazepines requests additional sedatives.

Patient with active COVID-19 symptoms and pulpal pain.

Hepatitis B surface antigen positive, high viral load—RCT needed.

Patient with uncontrolled hyperglycemia (random glucose 360 mg/dL) and facial cellulitis.

Sickle cell trait (not disease) presents with SIP.

Severe obstructive sleep apnea using CPAP asks for opioid post-op.

Patient with Addison’s disease (adrenal insufficiency) stabilized on hydrocortisone needs NSRCT.

G6PD deficiency needs topical anesthetic and analgesia.

Patient on clozapine (risk agranulocytosis) with acute apical abscess.

History of stroke 3 months ago on dual antiplatelet therapy; asymptomatic pulpitis.

Patient with pheochromocytoma (untreated) presents with severe dental pain.

Epilepsy well controlled; last seizure 2 years ago—needs RCT.

Patient on methotrexate for rheumatoid arthritis needs antibiotics.

Hyperparathyroidism with osteopenia—RCT planning.

Patient taking isotretinoin requests apical surgery for persistent lesion.

HIV-positive, CD4 520, undetectable viral load—SIP case.

Patient with hemophilia B (factor IX deficiency) requiring I&D for abscess.

History of malignant hyperthermia in patient—local anesthetics plan?

Hyperthyroid patient now controlled (euthyroid) on methimazole—use of epinephrine?

Pacemaker-dependent patient—use of ultrasonics/EM devices in endodontics?

Sarcoidosis patient on long-term prednisone—periapical surgery planned.

Alcohol use disorder with elevated AST/ALT—analgesic recommendation.

Patient with pheochromocytoma status-post resection, well controlled—LA plan.

Patient on warfarin (INR 2.3) and aspirin for mechanical valve—RCT with expected bleeding.

Organ transplant recipient on sirolimus—surgical endodontics needed.

Patient with von Willebrand disease (type 1) needs NSRCT.

Uncontrolled asthma (frequent exacerbations) with SIP needs urgent anesthesia.

Patient with bleeding gastric ulcer history—post-op analgesic after RCT.

Recent chemotherapy with ANC 800/µL and symptomatic apical abscess.

Patient with epilepsy on carbamazepine needs antibiotics for cellulitis.

Severe hemophilia A requires anesthesia for lower molar—plan for IANB?

Patient on lithium for bipolar disorder needs post-op analgesia.

HIV patient on ritonavir-boosted ART requests tramadol for pain.

Patient with thrombocytopenia (platelets 35,000/µL) needs emergency I&D.

Bleomycin-treated cancer survivor requests nitrous for anxiety.

Scleroderma with microstomia—best isolation strategy for RCT.

Patient with infective endocarditis history and true penicillin anaphylaxis needs prophylaxis.

Renal transplant recipient on tacrolimus presents with cellulitis—antibiotic choice caveat.

Hemodialysis patient with AV fistula—BP cuff/IV placement note.

Hyperthyroid crisis (thyroid storm) warning signs during visit.

Patient with latex anaphylaxis needs RCT.

Sickle cell disease—analgesic choice for acute endodontic pain.

Patient on MAOI (phenelzine) requires vasoconstrictor.

Decompensated cirrhosis—preferred post-op analgesic plan.

Patient with severe OSA on CPAP asks for benzodiazepine at bedtime after RCT.

vWD type 1 patient responsive to DDAVP—LA selection and hemostasis.