Oral Health Considerations & Antibiotic Prophylaxis

Podcast

Play an AI-generated podcast conversation about this lesson

Questions and Answers

What is the most prominent oral sign of tissue hypoxia due to valvular heart disease?

Frequent bleeding gums

Swelling of the gums

Halitosis

Cyanosis of lips and oral mucosa (correct)

Which of the following patients should receive antibiotic prophylaxis before dental procedures?

Patients with healthy heart valves

Patients who have had a routine dental cleaning

Patients with mitral valvular prolapse and regurgitation (correct)

Patients without a history of heart disease

Which dental procedure is NOT listed as requiring antibiotic prophylaxis?

Endodontic instrumentation

Routine dental check-up (correct)

Extraction of teeth

Implant placement

Which condition does NOT require antibiotic prophylaxis according to the guidelines?

Normal leukocyte count Signup and view all the answers

What should be performed on patients with a prior history of infective endocarditis when undergoing oral procedures?

Antibiotic prophylaxis Signup and view all the answers

Which of the following is a non-pharmacological lifestyle modification recommended for managing hypertension?

Regular exercise Signup and view all the answers

What oral manifestation may result from the use of anti-hypertensive drugs?

Gingival overgrowth Signup and view all the answers

Which risk factor is not associated with coronary artery disease (CAD)?

High intake of antioxidants Signup and view all the answers

Which symptom is clinically significant in diagnosing coronary artery disease?

Chest tightness Signup and view all the answers

Which of the following assessments is crucial before initiating dental care for patients with hypertension?

Presence of target organ disease Signup and view all the answers

What is the primary blood pressure reading that classifies hypertension?

Systolic blood pressure (SBP) /= 130 mm Hg or diastolic blood pressure (DBP) /= 90 mm Hg Signup and view all the answers

Which organ is NOT commonly damaged by long-standing hypertension?

Liver Signup and view all the answers

Which of the following is considered a symptom of hypertension?

Dizziness Signup and view all the answers

What characterizes white coat hypertension?

Elevated blood pressure only in clinical settings Signup and view all the answers

Which of the following factors does NOT increase the risk of hypertension?

High potassium intake Signup and view all the answers

What is the most common symptom seen in the morning hours for individuals with hypertension?

Headache Signup and view all the answers

What is the primary precipitating factor for angina pectoris?

Physical exertion Signup and view all the answers

Which characteristic feature is associated with angina pectoris?

Pain sometimes described as a sense of tightness Signup and view all the answers

Which of the following descriptions is NOT associated with the effects of hypertension on target organs?

Abdominal cramps Signup and view all the answers

What precautions should be taken during dental care for patients with a history of myocardial infarction?

Monitor oxygen saturation and vital signs Signup and view all the answers

What classification stage involves a systolic blood pressure (SBP) of 140-159 mm Hg and/or diastolic blood pressure (DBP) of 90-99 mm Hg?

Stage 1 Hypertension Signup and view all the answers

What is contraindicated in patients taking beta blockers during dental procedures?

Local anesthetics containing adrenaline Signup and view all the answers

Which statement correctly describes the clinical features of myocardial infarction?

Many patients may be symptomless prior to MI Signup and view all the answers

What oral adverse effect may occur in patients being treated for angina?

Ulcers Signup and view all the answers

What indicates that an anginal attack may be transitioning into a myocardial infarction?

The attack lasts longer than 30 minutes Signup and view all the answers

Which of the following is NOT recommended for dental procedures in patients with vascular stents within the first six weeks postoperatively?

Prophylactic antibiotics Signup and view all the answers

What is a common symptom of streptococcal oropharyngitis?

Red and edematous soft palate Signup and view all the answers

Which of the following is a recommended dental consideration for patients at high risk for infective endocarditis?

Prophylactic antibiotics prior to dental procedures Signup and view all the answers

What are the signs of rheumatic heart disease?

Murmur due to valvular damage Signup and view all the answers

Which condition can lead to heart failure due to structural problems of the heart?

Ischemic heart diseases Signup and view all the answers

What is a clinical feature of rheumatic fever?

Shortness of breath Signup and view all the answers

Which statement is true regarding general anesthesia for patients with rheumatic heart disease?

It should only be performed in a hospital setting Signup and view all the answers

What does biventricular failure refer to?

Failure of one side of the heart leading to failure of the other Signup and view all the answers

What type of precautions should be taken during dental procedures for patients with a history of rheumatic fever?

Antibiotics 1 hour before and 6 hours after the procedure Signup and view all the answers

Study Notes

Oral Health Considerations & Oral Manifestations

Valvular heart disease that compromises cardiac output produces signs of hypoxemia.
Cyanosis of lips and oral mucosa is the most prominent oral sign of tissue hypoxia.
Antibiotic prophylaxis should be administered to patients who have undergone mitral or aortic valve repair or replacement.
Antibiotic prophylaxis is also recommended for patients with a prior history of infective endocarditis, mitral or aortic regurgitation or stenosis, mitral valvular prolapse with valvular regurgitation, prosthetic heart valves, previous bacterial endocarditis, acquired valvular dysfunction, complex cyanotic congenital heart disease, and surgically constructed systemic pulmonary shunts.

Oral Procedures & The Need For Antibiotic Prophylaxis To Minimize Risk of Bacterial Endocarditis

Dental procedures that require antibiotic prophylaxis include extractions, periodontal procedures (surgery, subgingival placement of antibiotic fibers or strips, scaling & root planning), implant placement, tooth reimplantation, placement of orthodontic bands (not brackets), endodontic instrumentation, intra ligamentary injection, prophylactic cleaning of teeth where bleeding is anticipated, and other procedures in which significant bleeding is anticipated.

Rheumatic Heart Disease

A history of rheumatic fever during childhood or adolescence can act as a predisposing factor for RHD after several years.
Common signs of RHD include a murmur due to valvular damage and later enlargement of the heart.
Oral manifestations are most prominent during the acute phase and include pharyngitis, increased oral temperature, distended neck veins, and a bluish color of the skin.
Dental considerations include the prophylactic use of antibiotics for all dental procedures to prevent complications of infective endocarditis.
Amoxicillin prophylaxis is recommended 1 hour before and 6 hours after the initial dose.
Good oral hygiene measures like fluoride treatment, chlorhexidine rinses, and routine cleanings are also recommended to reduce harmful bacteremias.
Proper history should be taken to identify a history of rheumatic fever during childhood, and suspicious cases should be referred to a cardiologist for cardiac evaluation prior to dental procedures.
Clindamycin or erythromycin prophylaxis can be given during dental treatment if amoxicillin is contraindicated.
Elective dental treatment should be performed under the physician's consultation.

Heart Failure

Heart failure (HF) is a condition in which a problem with the structure or function of the heart impairs its ability to supply sufficient blood flow to meet the body's needs.
Common causes of HF include ischemic heart diseases, hypertension, and valvular diseases.
Biventricular failure occurs when failure of one side of the heart subsequently leads to failure of the other.

Hypertension

Hypertension is known as the "silent killer" of mankind.
Most sufferers (85%) are asymptomatic, making early diagnosis a problem.
Hypertension is defined as having a systolic blood pressure (SBP) of ≥ 130 mm Hg or a diastolic blood pressure (DBP) of ≥ 90 mm Hg, or as having to use antihypertensive medications.
The Seventh Joint National Committee Criteria (JNC VII) classifies hypertension for adults aged 18 years and older into the following stages:

Blood Pressure Classification SBP (mm Hg) DBP (mm Hg)

Normal < 120 < 80

Prehypertension 120-139 80-89

Stage 1 Hypertension 140-159 90-99

Stage 2 Hypertension ≥ 160 ≥ 100
Other risk factors for hypertension include lack of exercise, increased salt intake, family history, too little potassium, alcohol, smoking, stress, and age.
The common target organs damaged by long-standing hypertension are the brain, heart, kidneys, eyes, and peripheral arteries.
Symptoms of hypertension include headache (usually in the morning), dizziness, and epistaxis.
Symptoms due to affection of target organs include:
- Cardiovascular System (CVS): dyspnea on exertion, anginal chest pain, palpitations
- Kidneys: hematuria, nocturia, polyuria
- Central Nervous System (CNS): transient ischemic attacks (TIA or stroke), hypertensive encephalopathy (headache, vomiting, etc.), dizziness, tinnitus, and syncope
- Retina: blurred vision or sudden blindness
"White coat hypertension" is a phenomenon in which individuals present with persistently elevated BP in a clinical setting but present with non-elevated BP in an ambulatory setting.
Approximately 20% of mild hypertensive individuals may present with white coat hypertension.

Blood Pressure Classification	SBP (mm Hg)	DBP (mm Hg)
Normal	< 120	< 80
Prehypertension	120-139	80-89
Stage 1 Hypertension	140-159	90-99
Stage 2 Hypertension	≥ 160	≥ 100

Dental Management of Hypertension

Measure and record BP at the initial visit.
Assess the presence of hypertension.
Determine the presence of target organ disease.
Determine if dental treatment modifications are required.

Treatment of Hypertension

Non-Pharmacological Treatment & Lifestyle Modifications:
- Salt restriction
- Weight reduction
- Stop smoking
- Diet modifications: reduce intake of cholesterol and saturated fat, adequate intake of calcium and magnesium
- Limit alcohol intake
- Relaxation techniques such as yoga, psychotherapy, etc.
- Regular exercise

Oral Manifestations of Hypertension

There are no recognized oral manifestations of hypertension, but anti-hypertensive drugs can often cause side effects, such as:
- Xerostomia
- Gingival overgrowth
- Salivary gland swelling or pain
- Lichenoid drug reactions
- Erythema multiforme
- Taste sense alteration
- Paresthesia (tingling sensation)

Coronary (Ischemic) Artery Disease

Atherosclerosis is the most common cause of CAD.
Etiopathogenesis:
- Lipids (especially HDL)
- Hypertension
- Diabetes mellitus & glucose intolerance
- Cigarette smoking
- Lifestyle & dietary factors
- Exercise
- Obesity
- Vitamins
- Plasma fibrinogen
- Endothelial dysfunction
- Antioxidants
- Estrogen deficiency

Diagnosis of CAD

Based on clinical presentation such as chest tightness, jaw discomfort, left arm pain, dyspnea, epigastric distress.
Electrocardiogram (ECG).

Dental Aspects of CAD

Stress, anxiety, exertion, or pain can provoke angina.
Short, minimally stressful dental appointments are recommended.
Late morning appointments are preferred.
Excessive doses of LA containing adrenaline should be avoided in patients taking beta-blockers.

Acute Coronary Syndromes

Represent a continuous spectrum of disease ranging from unstable angina to myocardial infarction (MI).

Angina Pectoris

The name given to paroxysms of severe chest pain.
Clinical Features:
- Often affects individuals between 40 and 60 years of age, with men more commonly affected than women.
- Pain is often described as a sense of strangling, choking, tightness, heaviness, compression, or constriction of the chest.
- Pain may radiate to the jaw or left arm.
- Rarely, pain may be felt in the mandible, teeth, or other tissues.
Precipitating factors:
- Physical exertion, particularly in cold weather.
- Emotion (anger or anxiety), and stress caused by fear or pain.
Typically relieved by rest.

Dental Aspects of Angina Pectoris

Preoperative glyceryl trinitrate and oral sedation may be advised in some cases.
Dental care should be carried out with minimal anxiety and with monitoring oxygen saturation.
Monitor pulse and blood pressure.
Post angioplasty, elective dental care should be deferred for 6 months. Emergency dental care should be provided in a hospital setting.
Patients with bypass grafts:
- No antibiotic cover is needed against infective endocarditis.
- LA containing adrenaline is contraindicated as it may cause dysrhythmia.
Patients with vascular stents:
- No antibiotic cover is needed except during the first 6 weeks post-op for emergency dental care.
Drugs used in the treatment of angina can cause oral adverse effects like lichenoid reaction, gingival swelling, and ulcers.

Myocardial Infarction

Synonyms: coronary thrombosis or heart attack
Clinical Features:
- Clinical picture is variable.
- Symptomless in more than 50% of patients.
- May be preceded by angina often felt as indigestion-like pain.
- Any anginal attack lasting longer than 30 minutes is considered MI.
- Tachycardia and irregular pulse.
- Nausea, vomiting, sweating, restlessness, facial pallor.
- Breathlessness, cough.
- Loss of consciousness, shock, and even death.
- Many patients die within the first hour to a few days after the attack.
- Thus, MI is a medical emergency.

General Precautions during Dental Procedures

The dental clinic should have advanced cardiac life support or at least basic cardiac life support.
Use of a pulse oximeter to determine the level of oxygenation.
Sudden onset of sore throat (streptococcal oropharyngitis) should be treated as a medical emergency.

Symptoms/Clinical Features of Rheumatic Fever

Fever
Painful, tender, red, swollen joints
Pain in one joint that migrates to another one
Heart palpitations
Chest pain
Shortness of breath
Skin rashes
Fatigue
Small, painless nodules under the skin

Dental Considerations for Rheumatic Heart Disease

Dental extractions and local anesthesia should be carried out in consultation with a physician.
Prophylactic use of antibiotics prior to a dental procedure is now recommended ONLY for patients with the highest risk of adverse outcomes resulting from endocarditis.
Nitrous oxide can be used with the approval of a physician.
General anesthesia should be avoided, and if essential, should be given in a hospital setting.
Good oral hygiene measures, fluoride treatment, chlorhexidine rinses, and routine cleanings are recommended to reduce harmful bacteremias.

Studying That Suits You

Use AI to generate personalized quizzes and flashcards to suit your learning preferences.

Description

This quiz covers the critical oral health considerations related to valvular heart disease and the importance of antibiotic prophylaxis during dental procedures. It includes details on signs of hypoxia in the oral cavity and specific patient conditions that necessitate antibiotic treatment. Test your knowledge on these vital health connections and their implications for dental care.