Treatments 2

The most common cardiovascular disease is ___

hypertension

Hypertension

abnormally high blood pressure

Can local anesthesia with epinephrine be used for patients with cardiovascular diseases?

no! cannot have epinephrine

Procedures for hypertension should be ___

short

under 30 minutes

You want to minimize pain of cardiovascular diseased patients with profound local anesthesia.. why?

to avoid an increase in endogenous epinephrine secretion

Why can you not use epinephrine in patients with hypertension?

potential for hemodynamic compromise

You want to limit the ___ of patients with hypertension... consider conscious sedation for those with ___

stress

anxiety

___ are typically used to treat hypertension... these may cause gingival overgrowth

Calcium channel blockers

ex: Nifedipine

Hypertensive Crisis

systolic > 180

diastolic > 120

send to physician, immediately

You need to delay treatment if diastolic is over ___ mmHg

109

Ischemic heart disorders include ___ and ___

angina pectoris

myocardial infarction

Ischemic

pertaining to a lack of blood flow

Angina pectoris

chest pain or discomfort that occurs when your heart muscle does not receive enough oxygen-rich blood

Myocardial infarction

universally known as a heart attack, occurs when blood flow to a part of the heart is blocked

much more severe angina

When a patient has unstable angina, you can only perform ___

emergency dental treatments

A patient with stable angina can undergo ___... but make sure to reduce ___!!!

elective dental procedures

stress

Patients with ischemic heart diseases should be instructed to bring their ___ to dental appointments

nitroglycerin

this should also be kept in the office medical emergency kit

For angina, you use nitroglycerin ___ before calling ER (if no resolution)

thrice

If the patient becomes fatigued or uncomfortable or has a sudden change in heart rhythm or rate during a periodontal procedure, the procedure should be ___

discontinued as soon as possible

For a patient who had a myocardial infarction, dental tx is usually deferred for at least ___

6 months

Why?

peak mortality rate occurs during this 6 month stretch

If someone is suffering from MI, send them to the ___

ER!!!!!!

___ is a condition in which the pump function of the heart is unable to supply sufficient amounts of oxygenated blood to meet the body's needs

Congestive Heart Failure

For a patient with poorly controlled or untreated CHF, it is not recommended to perform ___

any elective dental procedures

Why?

these individuals are at risk for sudden death, usually from ventricular arrhythmias

If a patient has controlled CHF, appointments should be kept ___, with emphasis on ...

short

stress reduction, profound local anesthesia, possibly conscious sedation, and use of supplemental oxygen

Pacemaker

a small, battery-operated medical device implanted under the skin in your chest

it continuously monitors your heart's natural rhythm and sends mild, painless electrical impulses to regulate it, ensuring your heart beats at a normal, healthy rate

What should you NOT use on patients with older pacemakers?

ultrasonic scalers

Ultrasonic Scalers

effective in removing plaque and calculus

Can ultrasonic scalers be used on newer pacemakers?

maybe... ask their physician

Infective Endocarditis

inflammation of the endocardium

usually caused by bacteria

___ is needed for IE ahead of dental appointments/procedures

Antibiotic prophylaxis

Prophylaxis can be given in form of:

amoxicillin

azithromycin

What is a cerebrovascular accident?

a stroke

No periodontal therapy, besides emergencies, should be performed for ___ after CVA

6 months

___ of those who suffered from a stroke must be monitored regularly

Blood pressure

Why?

recurrence rates for CVAs are high

Endocrine

a network of glands and organs that produce and release hormones directly into the bloodstream

What is the most prevalent endocrine condition?

diabetes

How do you track diabetes?

HbA1c

T/F: well controlled diabetics (HbA1c < 7%) usually respond to therapy in a manner similar to nondiabetics

true

T/F: poorly controlled patients often have a poor response to treatment, with more postoperative complications and

less favorable long-term results

true

Normal HbA1c for non-diabetics:

4-6%

HbA1c for good diabetes control:

under 7

HbA1c for moderate diabetes control:

7-8

HbA1c that implies that actions are suggested for improved diabetes control:

over 8

Periodontal infection can worsen ___ and should be managed aggressively

glycemic control

Periodontal disease and diabetes have a ___ relationship

bidirectional

= either may worsen the other

Patients with diabetes should be asked to bring their ___ to the dental office for each appointment

glucometer

may need to check blood sugar pre appointment

___ is a medical emergency

Hypoglycemia

(not enough insulin provided)

Hypoglycemia Symptoms

tremors, palpitations, anxiety, restlessness, sweating, and pallor

If hypoglycemia occurs during tx...

provide oral carbs

give carbs via IV if patient cannot take food or drink

Hemorrhagic Disorders

disorders characterized by a lack of clot-forming substances, leading to states of excessive bleeding

More invasive dental treatments for patients with bleeding disorders requires ___

prior physician consultation

Renal Diseases

affect the kidney

Drugs that are ___ or metabolized by the kidney should not be given

nephrotoxic

ex: NSAIDs, tetracycline, aminoglycoside antibiotics

Liver Diseases can cause ___ after dental treatments/procedures, especially periodontal treatments

excessive bleeding

liver is source of production of many coagulants

What is the main concern with bisphosphonates and antiresorptive agents, such as Denosumab, when using them?

MRONJ

Radiation therapy may cause ... in the mouth

mucositis, dermatitis, xerostomia, dysphagia, gustatory alteration, radiation caries

You may need to consider ___ before radiation therapy starts

possible extractions

Endocrine Disorders

___ of those who suffered from a stroke must be monitored regularly

angina pectoris

Angina