Cardiovascular patient in Dentistry

Iyad Abou Rabii DDS. OMFS. MRes. PhD

Who
Patients 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

Main signs & symptoms of C.V.S diseases

Chest pain

Dysnea

cyanosis

palpitation

Syncope

Edema of ankles

Cold pale extremities

Clubbing fingers

Easy fatigue

presentation of heart diseases

Angina pectoris Myocardial infarction

Acute coronary insufficiency

Cardiac arrhythmia Heart failure Sudden death ( cardiac arrest, ventricular fibrillation ) Asymptomatic ( silent )

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 calcium channel blockers. That can cause gingival overgrowth.

DENTAL MANAGEMENT OF ANGINA

1. People with stable angina can be treated like any other patients, with a few differences. dentist should have oxygen and nitroglycerin available during your visit 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 should be performed under continuous heart monitoring.

MYOCARDIAL INFARCTION

It results from occlusion of coronary artery by a thrombus so deficient coronary arterial blood supply to a region of myocardium that results in a cellular death & necrosis. Dental management: As angina pectoris except; Drugs used in treatment.

CONGESTIVE HEART FAILURE

It is the ability of heart to pump sufficient blood to meet the metabolic needs of the heart. Dental management: Same as angina except; 2. Drugs used in treatment. 3. Dental management 1.preoperative antibiotic.

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.

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 stop the medication 5 days prior to the dental appointment.

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.

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.

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 permission from 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 certified cardiologist.

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 Thickened Leaflets) Who are Undergoing Invasive Dental Procedures

Thank you for your attention! Any Questions?

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