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

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Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.

Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.

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  • 1. Dental considerations in diseases of C.V.S www.indiandentalacademy.com
  • 2. INDIAN DENTAL ACADEMY Leader in continuing dental education www.indiandentalacademy.com www.indiandentalacademy.com
  • 3. 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 www.indiandentalacademy.com
  • 4. • Cigarate smoking • Increased level of LDL cholesterol intake • Obese patients www.indiandentalacademy.com
  • 5. 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. www.indiandentalacademy.com
  • 6. 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 www.indiandentalacademy.com
  • 7. 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. www.indiandentalacademy.com
  • 8. 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. www.indiandentalacademy.com
  • 9. Myocardial Infarction (MI) www.indiandentalacademy.com
  • 10. • 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. www.indiandentalacademy.com
  • 11. 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 . www.indiandentalacademy.com
  • 12. HYPERTENSION www.indiandentalacademy.com
  • 13. • 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 www.indiandentalacademy.com
  • 14. Causes for hypertension • PRIMARY/IDIOPATH IC/ ESSENTIAL HYPERTENSION • • • • Aging Obesity Smoking Diabetes • SECONDARY HYPERTENSION • • • • Renal disease Endocrine diseases Cerebral diseases Coarctation of aorta www.indiandentalacademy.com
  • 15. 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. www.indiandentalacademy.com
  • 16. Clinical features • • • • • • • • Head ache Palpitations Fatigue Restlessness Irritability Heart failure Brain damage Blood vessel diseases www.indiandentalacademy.com
  • 17. Diagnosis • By using sphygmomanometer: • 2 methods: 1) Palpatory method 2) Auscultatory method www.indiandentalacademy.com
  • 18. 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. www.indiandentalacademy.com
  • 19. Dental considerations in hypertensive pts www.indiandentalacademy.com
  • 20. 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 www.indiandentalacademy.com
  • 21. • • Etiopathogenesis β- haemonytic streptococci group • • 1. 2. 3. 4. 5. Clinical features Major criteria Carditis Polyarthritis Chorea (sydenham’s, Chorea) Erythema marginatum Subcutaneous nodules. www.indiandentalacademy.com
  • 22. Minor criteria are 1. Clinical findings (arthralgia, fever) 2. Lab finding (elevated ESR, raised Creactive protein, leucocytosis) 3. Supportive evidence of throat infection. www.indiandentalacademy.com
  • 23. The major causes of death in RHD are cardiac failure, bacterial endocarditic and embolism. • Dental consideration www.indiandentalacademy.com
  • 24. 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. www.indiandentalacademy.com
  • 25. It has two types; • Acute bacterial endocarditis (ABE) • Sub acute bacterial endocarditis (SABE) www.indiandentalacademy.com
  • 26. 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 www.indiandentalacademy.com
  • 27. 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. www.indiandentalacademy.com
  • 28. 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 www.indiandentalacademy.com Subacute > 6 weeks alpha -strepto less virulent previously
  • 29. 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 www.indiandentalacademy.com
  • 30. 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 www.indiandentalacademy.com
  • 31. 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 www.indiandentalacademy.com
  • 32. www.indiandentalacademy.com Leader in continuing dental education www.indiandentalacademy.com

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