Dental Management of Cardiovascular Diseases

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Questions and Answers

What is a possible risk for hypertensive patients in a dental setting?

Hypertensive attacks (correct)

Cardiac arrest

Stroke

All of the above

Which of the following is a type of Ischemic Heart Disease?

Vasculitis

Rheumatic Heart Disease

Atherosclerosis

Angina Pectoris (correct)

What is a crucial step in the dental management of patients with Ischemic Heart Disease?

Using a local anesthetic without a vasoconstrictor

Pre-treatment consultation with a physician (correct)

Avoiding dental treatment altogether

Administering oxygen during the procedure

Which of the following is a cardiovascular disease risk factor?

All of the above Signup and view all the answers

What is Myocardial Infarction?

A heart attack Signup and view all the answers

What is a possible oral health complication in patients with hypertension?

Xerostomia Signup and view all the answers

Why is it essential to evaluate the patient's blood pressure before dental treatment?

To prevent hypertensive attacks during the procedure Signup and view all the answers

What is a consideration in the dental management of patients with cardiovascular disease?

All of the above Signup and view all the answers

What is the management of a cardiac patient who requires complex surgery or needs a general anaesthetic and is unstable with dyspnoea on minimal exertion?

Manage in hospital Signup and view all the answers

A patient with a recent myocardial infarction (< 6 months post MI) requires a Type III dental procedure. What is the recommended management?

Contraindication – palliative therapy and hospitalization Signup and view all the answers

Which of the following is a characteristic of severe angina?

Daily episodes, unstable, and triggered by mild emotion or exertion Signup and view all the answers

What is the management of a patient who has had a myocardial infarction (> 1 year post MI) and requires a Type V dental procedure?

Consultation + hospitalization Signup and view all the answers

What is the primary factor in determining the dental management of a patient with ischemic heart disease?

How well the patient's heart is compensated Signup and view all the answers

A patient with a history of myocardial infarction (> 1 year post MI) and stable angina requires a Type II dental procedure. What is the recommended management?

Defer, consultation, and sedation Signup and view all the answers

What is the primary goal in managing a patient with ischemic heart disease in a dental practice?

To control stress and bleeding Signup and view all the answers

What is the classification of a dental procedure that involves a simple extraction, curettage, and gingivoplasty?

Type IV Signup and view all the answers

What is the primary cause of Ischaemic Heart Disease (IHD)?

Atherosclerosis Signup and view all the answers

What is the typical duration of an anginal attack in a dental clinic?

Few minutes Signup and view all the answers

What is the primary goal of managing a patient with a history of CVD and chest pain in a dental clinic?

Stop dental treatment Signup and view all the answers

What is the recommended dose of glyceryl trinitrate (GTN) for a patient with chest pain in a dental clinic?

0.5mg sublingually Signup and view all the answers

What is a sign that is suggestive of Myocardial Infarction (MI)?

Pain that persists after three doses of nitroglycerine Signup and view all the answers

What is the recommended oxygen flow rate for a patient with chest pain in a dental clinic?

5L/min Signup and view all the answers

What is a common risk factor for Ischaemic Heart Disease (IHD)?

Hypertension Signup and view all the answers

What is the recommended course of action if chest pain persists for 10 minutes in a dental clinic?

Continue oxygen at 10–15L/min, chew 300mg of aspirin, and insert an intravenous cannula Signup and view all the answers

Study Notes

Cardiovascular Diseases

Vascular diseases: Aneurism, Vasculitis, Atherosclerosis
Heart diseases: Carditis, Cardiomyopathy, Heart Failure, Valvar heart disease, Arrhythmia
Ischemic heart diseases: Angina Pectoris, Myocardial Infarction
Other cardiovascular diseases: Hypertension, Infective Endocarditis

Hypertension

Possible risks for hypertensive patients:
- Oral health events (mainly due to drugs)
- Hypertensive attacks
Management of hypertensive patients:
- Pre-treatment evaluation of blood pressure
- Proper history to evaluate patient risk
- Evaluate procedure risk
- Timing of appointment
- Control pain and anxiety
- Consider pre-treatment consultation

Dental Management of Patients with Cardiovascular Diseases

Patient evaluation:
- Consult physician if patient indicates persistently high blood pressure
Possible complications:
- Xerostomia
- Lichenoid drug reaction
- Gingival enlargement
- Oral ulceration
- Paraesthesia and disturbance in sensation
- Orthostatic hypotension
- Salivary gland swelling
Addressing complaints:
- Evaluate patient and procedure
- Control stress, attack, and bleeding
Categories of dental procedures:
- Type I: Examination, radiograph, impressions
- Type II: Simple operative procedure, prophylaxis, supra-gingival scaling, orthodontics
- Type III: Advanced operative procedure, scaling & root planning, endodontics
- Type IV: Simple extraction, curettage, gingivoplasty
- Type V: Multiple extractions, single impaction, flap surgery, single implant
- Type VI: Full arch/mouth extractions, major surgery

Angina and Myocardial Infarction (MI)

Classification of angina:
- Mild angina: Frequency up to 1/month, stable, onset following severe exertion or emotion
- Moderate angina: Frequency up to 1/week, stable, onset following moderate exertion or emotion
- Severe angina: Daily episodes, unstable, onset following mild exertion, emotion, or at rest
Dental management of MI patients:
- Time since last attack:
 - < 6 months: defer, consultation, and sedation
 - 6 months-1 year: defer, hospitalization
 - > 1 year: normal protocol, sedation
Risk management:
- Hypertensive attack: discontinue treatment, place patient in supine position, allow rest, and re-check BP

Ischemic Heart Disease (IHD)

Definition: Progressive myocardial ischaemia due to persistently reduced coronary blood flow
Signs and symptoms:
- Chest pain (retro-sternal, radiating to left shoulder & arm, back, neck, and jaw)
- Heavy, squeezing, crushing character
- Precipitating factors: exertion, emotion, cold, heavy meal
- Relieving factors: rest, sublingual nitrates (coronary vasodilator)
- Duration: few minutes
Management of patient with hx of CVD and chest pain:
- Stop dental treatment
- Place patient upright
- Give glyceryl trinitrate (GTN) 0.5mg sublingually
- Give oxygen 5L/min, monitor vital signs
- If pain persists, consider MI and summon medical help

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Description

This quiz covers the dental management of patients with cardiovascular diseases, including ischemic heart diseases, hypertension, heart failure, and more. It helps dental professionals understand the oral health implications of cardiovascular diseases.