Patient with complex medical history: what would be a possible dental treatment plan?

Given the history, I'd prefer a hospital setting and dentures for low maintenance and ease of use... Possibly overdentures with attachments if possible

Insulin dependent diabetes? All meds? Medical consultation? Do you have hospital privileges? Take it in steps, do you want to take on this complex case?

refer to a specialist. If you have to ask these types of questions it's best to get this patient to a surgeon and prosthodontist who are familiar with the meds and medical condition. I agree with CRS, do you really want to take this on?

Bright Red Flags!!! Send this case to the oral surgeon who runs the service at the nearest major medical center. One she is all healed(3months or so) then you can make some dentures.

Ok first of all you should have a precise list of her medications. Before you start the extraction it will be best to make at least blood count so you can see decide about her general condition. If you thing that the patient is suffering from malnutrition it would be wise to check the protein status- albumins. As far as the diabetes is concerned you should check the glycated haemoglobin HbA1c and see how well controlled diabetes she has. If it is controlled dental implants are not contraindicated. If is poorly controlled she should first visit endocrinologist than after couple of mounts the blood glucose level is controlled you can proceed to extractions and any other prosthetic or implant treatment. As far as her Lime disease and spinal meningitis are concerned I assume that are not acute conditions because both require immediate treatment and neither extraction, prosthetic rehabilitation nor dental implants would be indicated at that time. After the acute phase and stabilisation of the condition there are no contraindications for dental treatment. Remember that dental implant placement is not emergency procedure! So you should take enough time to prepare your patient. I would do the extraction first and do conventional prosthetic treatment. After that you have time to observe the healing period and if everything goes fine I do not see any reason why not to insert implants if they are necessary. Do simple implant planing with minimum implants for maximum effect. The simplest and easiest way to maintain good oral hygiene around the implants if preferable in order to have a long term success. Good luck! Dime

I agree with Dime and after all the pre-implant procedures as outlined, may I suggest the placement of intra-mucosal snapfits for the maxilla and then perhaps normal implant supported mandibular full denture, if the patient can tolerate the maxillary procedure.

These cases can be challenging for the OMS. So, if you are not familiar with these conditions refer to an OMS for the surgery and keep the pros at dentures. The recurrent spinal meningitis indicates immune issues, lyme patients do not always heal well (I have had trouble with lyme patients), the insulin dependent diabetic can be managed. With a bad mouth and the other conditions, keep the treatment conservative. What is causing the recurrent spinal meningitis? The patient needs to see an infectious disease physician.