Dental considerations in cardio vascular cases /certified fixed orthodontic courses by Indian dental academy

Dental considerations in
diseases of C.V.S

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INDIAN DENTAL ACADEMY
Leader in continuing dental education


Coronary heart disease [IHD]
• Disease of myocardium secondary to decreased or
inadequate blood supply.
• Impairment of blood supply –pain [Angina Pectoris]
• Death of myocardial tissue- myocardial infraction.
• Predisposing factors
• Age
• Sex- male > female
• Diabetes
• Hypertension
• Hypercholesterolemia
• Family H/O CHD


• Cigarate smoking
• Increased level of LDL cholesterol intake
• Obese patients


Angina pectoris
• Def: Thoracic pain usually substernal
precipitated by exercise, emotion or heavy meal
& relieved by VD drugs, rest
: result of moderate inadequacy of coronary
circulation
• They are 3 types:
• 1)Stable/classic angina
• 2)Variant / Prinzmetal angina-mainly due to
coronary insufficiency.
• 3)Unstable angina.

Clinical features/diagnosis
• 1)duration of pain :short duration of
discomfort for about 2-10 min.
Chest pain lasts for 30sec.
• 2)precipitation factors: exertion, cold
weather, diabetes
• 3)frequency: once/twice per week.
• 4)Relieving factors: nitro glycerine & rest


Dental therapy considerations
• Prevention – stress reduction protocol
• Length of appointment
• Supplemental oxygen: 3- 5 lit of oxygen/min
via nasal cannula or nasal hood
• Pain control during therapy: adequate local
anaesthesia with adrenaline with MPD of
0.04mg(4 ml).
• Psycho sedation if required
• Monitor vital signs.

Management on dental chair
•
•
•
•

Stop all procedures
Position
A.B.C
Oxygen supply & sub lingual nitroglycerine:
0.3-0.6mg
• Mech of action: it produces a decrease in
systemic vascular resistance through arterial /
venous dilation, so decreased venous returnless will be cardiac work load.

Myocardial Infarction (MI)


• Decreased blood supply to a region of
myocardium leads to cellular death &
necrosis.
• Characterized by severe & prolonged
substernal pain similar to, but more
intense & of longer duration than angina
pectoris.
• It radiates on to left arm 4 & 5th finger tips.
• In addition there is vomiting, facial pallor,
sweating, restlessness/apprehension
leading to sudden death.

Dental considerations
• H/o M.I: post pone invasive dental treatment for
at least 6 months.
• During recovery period collateral circulation
develops allowing the myocardium to heal &
decrease the size of residual infarct.
• Modification of anti coagulant/anti-platelet
therapy.
• B.T,C.T & prothrombin time should be done .


HYPERTENSION


• Def : Hypertension is a persistently raised
blood pressure resulting from increased
peripheral arteriolar resistance.
• Normal level for adult: 120/80 mm Hg
• Types : Primary [essential] hypertension
•
Secondary hypertension


Causes for hypertension
• PRIMARY/IDIOPATH
IC/ ESSENTIAL
HYPERTENSION
•
•
•
•

Aging
Obesity
Smoking
Diabetes

• SECONDARY
HYPERTENSION
•
•
•
•

Renal disease
Endocrine diseases
Cerebral diseases
Coarctation of aorta


Malignant hypertension
• Uncommon
• It can have an acute onset or can develop in pre
existing essential hypertension.
• Typically affects young adults & causes no
symptoms until complications develop.
• Chief complications is severe form
nephrosclerosis mainly & also facial palsy
occasionally.
• Death occurs in this due to deterioration in renal
function ,cardiac failure & cerebro vascular
accidents.

Clinical features
•
•
•
•
•
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Head ache
Palpitations
Fatigue
Restlessness
Irritability
Heart failure
Brain damage
Blood vessel diseases

Diagnosis
• By using sphygmomanometer:
• 2 methods: 1) Palpatory method
2) Auscultatory method


Treatment
• SYMPOTOMATIC
TREATMENT
• Life long treatment is
usually necessary.
• Reduction of weight
• Reduction of salt
intake.
• More exercise.

DEFINITIVE TREATMENT

• B-adrenoreceptor
blockers.
• Vasodilators
• ACE inhibitors
• Calcium channel
blockers.


Dental considerations in
hypertensive pts


Rheumatic Heart Diseases
Bacterial Endocarditis
• Def (RF) is a systemic, post-streptococcal,
non- Suppurative inflammatory disease
principally affecting the heart, joints,
central nervous system, skin and
subcutaneous tissue. The chronic stage of
(RF) involves all layers of the heart
(Pancarditis) causing major cardiac
sequelae referred to as rheumatic heart
disease

•
•

Etiopathogenesis
β- haemonytic streptococci group

•
•
1.
2.
3.
4.
5.

Clinical features
Major criteria
Carditis
Polyarthritis
Chorea (sydenham’s, Chorea)
Erythema marginatum
Subcutaneous nodules.

Minor criteria are
1. Clinical findings (arthralgia, fever)
2. Lab finding (elevated ESR, raised Creactive protein, leucocytosis)
3. Supportive evidence of throat infection.


The major causes of death in RHD are
cardiac failure, bacterial endocarditic and
embolism.
• Dental consideration


Bacterial Endocarditis (BE)
Definition ; serious infection of the valvular and
mural endocardium caused by different form of
bacterial (other than tubercle bacilli and nonbacterial microorganism) and is characterised
by typical infected and friable vegetations.


It has two types;
• Acute bacterial endocarditis (ABE)
• Sub acute bacterial endocarditis (SABE)


Acute Bacterial Endocarditis (ABE)
• Is the fulminant and destructive acute
infection of the endocardium by highly virulent
bacteria in previously normal heart and almost
invariably runs a rapidly fatal course in a
period of 2-6 weeks


Sub Acute Bacterial Endocarditis (SABE)
• Is less virulent bacteria in a previously
diseased heart and has a gradual downhill
course in a period of 6 weeks few months
and sometimes a years.


Features
Acute
1) Duration
< 6 weeks
2)Most
staph aureus
cocci
Organism
3)Virulence of highly virulent
orgnisms
4)Condition of previosly normal
damaged
valves

Subacute
> 6 weeks
alpha -strepto

less virulent
previously

Standardard regimens for antibiotic prophylaxis to minimise
risk of bacterial endocarditis after oral procedures
•

Patients category

•
•
•

Adults ,not allergic to

oral medications

non-oral medication

2.0gm amoxicilin 1hr before
procedure

2.0 gm ampicillin IM or IV within 30 min
before procedure

600mg clindamycin 1hr before
procedure or 2.0g cephalexin I hr

600mg clinamycin IV within 30 min before
before procedure

before procedure
or
500mg azithromycin or clarithromycin
1hr before procedure

or
1.0gm cefazolin IM or IV within30 min before
procedure

penicillin

•
•
•
•
•
•
•

Adults ,penicillin allergic

•
•
•

Children , not allergic to

•
•
•
•
•
•

Children ,penicillin allergic

50mg /kg amoxicillin 1hr before procedure

50 mg/kg ampicillin IM or IV within 30 min
before procedure

20 mg /kg clindamycin 1 hr before procedure
or
50 mg /kg cephalexin 1hr before procedure

20 mg /kg clindamycin within 30 min prior to procedure
or
25 mg/kg IM or IV cefazolin 30 min before procedure

penicillin

15 mg /kg azithromycin or clarithromycin
1 hr before procedure


Oral procedures requiring antibiotic
prophylaxis
• Extractions
• Periodontal procedures including surgery, subgingival
placements of antibiotic fiber or strips , scaling, and root
planning
• Placements of subgingival antibiotic fibers or strips
• Implant placement
• Tooth reimplantation
• Placement of orthodontic bands
• Endodontic instrumentation
• Intra ligamentary injections
• Prophylactic cleaning of teeth where bleeding is
anticipated

Oral procedures not requiring
prophylaxis
• Operative and prosthodontic procedures with or without
retraction cord
• Local anaesthetic injections (non intra ligamentary)
• Intracanal endodontic procedures ( including post placement
and buildup)
• Placement of removable prosthodontic or orthodontic
appliances
• Orthodontic appliance adjustment
• Impression taking
• Exfoliation of primary teeth
• Oral radiography
• Fluoride treatment
• Placement of rubber dams
• Post operative suture removal

Leader in continuing dental education


Dental considerations in cardio vascular cases /certified fixed orthodontic courses by Indian dental academy

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Dental considerations in cardio vascular cases /certified fixed orthodontic courses by Indian dental academy