Cardiovasular Patient in Dentistry

7/30/2019 Cardiovasular Patient in Dentistry

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Cardiovascular patient in Dentistry

Iyad Abou RabiiDDS. OMFS. MRes. PhD


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WhoPatients with the following medical conditions may require either a modification in dental treatment plan:

High- and moderate-risk categories of endocarditis,

pathologic heart murmurs,

hypertension,

unstable angina pectoris,

recent myocardial infarction,

cardiac arrhythmias,

poorly managed congestive heart failure


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Main signs & symptoms of C.V.S diseases

Chest pain

Dysnea

cyanosis

palpitation

Syncope

Edema of ankles

Cold pale extremities

Clubbing fingers

Easy fatigue


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Angina pectoris

Myocardial infarction

Acute coronary insufficiency

Cardiac arrhythmia

Heart failure

Sudden death ( cardiac arrest, ventricular

fibrillation )

Asymptomatic ( silent )

presentation of heart diseases


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ANGINA PECTORIS

It is a myocardial ischemia resulting from imbalance

between coronary blood flow & oxygen demand

Angina is pain that starts in the chest. Sometimes it

spreads to your lower jaw.

Some people with angina take drugs called calciumchannel blockers. That can cause gingival overgrowth.


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1. People with stable angina can be treated like any

other patients, with a few differences. dentist should

have oxygen and nitroglycerin available during yourvisit and should consult with physician before the

appointment to evaluate condition.

2. People with unstable angina should not receive

elective dental care. Emergency dental care shouldbe performed under continuous heart monitoring.

DENTALMANAGEMENT OF ANGINA


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MYOCARDIAL INFARCTION

It results from occlusion of coronary artery by a thrombusso deficient coronary arterial blood supply to a region ofmyocardium that results in a cellular death & necrosis.

Dental management:

As angina pectoris except;

Drugs used in treatment.


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CONGESTIVE HEART FAILURE

It is the ability of heart to pump sufficient blood to meet themetabolic needs of the heart.

Dental management:

Same as angina except; 1.preoperative antibiotic.

2. Drugs used in treatment.

3. Dental management


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CONGESTIVE HEART FAILURE

The medications for this condition can usually cause dry mouth

and gingivitis.

People with more severe heart failure should not lie down in the

dental chair too far because the fluid build-up in their lungs may

affect breathing.

They should also take it slow when moving from a standing

position to the chair, and when standing up from the chair,

because they can become dizzy and light-headed easily.


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Stroke

If the patient have had a stroke in the past, then

as a dentist we should know if the patient

is taking anticoagulants (blood-thinning drugs).

So any procedure like extraction should be

carried out taking in to factor the bleeding and

clotting time . Usually the patient is asked to stopthe medication 5 days prior to the dental

appointment.


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High Blood Pressure (Hypertension)

dry mouth or an altered

sense of taste (dysgeusia). Others may make you

more likely to faint when you are raised from the relatively flat

position in the dentists chair to a sitting or standing position

quickly. This reaction is called orthostatic hypotension.

Some anti hypertensive drugs like Calcium channel blockers are

known to have produced Gingival Hyperplasia.


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High Blood Pressure (Hypertension)

The first time a patent visits the dental office after being

diagnosed with high blood pressure, dentist should take reading

of blood pressure two or three times.

This is to establish a baseline blood pressure. This way, the

dentist will know if the patients blood pressure changes in

response to treatment or a medicine.


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SPECIAL GUIDELINES FOR DENTISTS

with CVS

(A) The patient should the treating dentist a complete list of the names and

dosages of all the drugs you are taking for your heart condition (as well as any

other prescription or nonprescription drugs that you may be taking). This will help

the dentist in deciding on the best course of treatment .

(B) Any of the procedure should be carried out only after a written permissionfrom a certified cardiologist. Without certified consultation no treatment should be

tried.

(C) The dentist should record the address and contact of the treating cardiologist

of the patient in case there might be some need to talk to him/her.

(D) Any major surgical should only be carried out in the presence of a certifiedcardiologist.


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Prophylactic antibiotics

Cardiac Valves,

Previous Bacterial Endocarditis,

Complex Cyanotic Congenital Heart Disease,

Surgically Constructed Systemic Pulmonary Shunts or Conduits)

Moderate-Risk Patients (i.e., Rheumatic, Congenital, or Other

Acquired Valvular Heart Disease, Hypertrophic Cardiomyopathy,

and Mitral Valve Prolapse with Regurgitation and/or ThickenedLeaflets) Who are Undergoing Invasive Dental Procedures


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Thank you foryour attention!

Any Questions?


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Cardiovasular Patient in Dentistry