This document discusses the management of periodontal treatment for patients with cardiac diseases. It begins with an introduction noting the increased prevalence of medically compromised dental patients. It then covers the classification of patients based on American Society of Anesthesiologists guidelines. Several cardiac conditions are discussed, including hypertension, ischemic heart disease, congestive heart failure, and arrhythmias. Guidelines are provided for managing dental treatment for patients with these conditions, focusing on reducing stress and risk of infection. The document concludes that periodontal disease is a risk factor for cardiovascular disease, and treating periodontal disease can reduce this risk.

1. P E R I O D O N T A L
M A N A G E M E N T
I N P A T I E N T S
W I T H C A R D I A C
D I S E A S E S
Guided by
DR.P.ASHOK
HEAD OF THE DEPARTMENT
DEPARTMENT OF PERIODONTITIS
Presented by
J.SANTHOSH MOULI
INTERN

2. CONTENTS :
• Introduction
• Classification
• Pathophysiology
• Diseases
• Management
• Conclusion

3. INTRODUCTION

4. • A large number of patients seeking periodontal care has significant
medical conditions which may alter the treatment plan and therapy
provided
• As the age of the average dental patient increases in the coming years
it is predicted that a greater number of older and more medically
compromised patients will seek dental care
• Identification of potential systemic disorders is a pre-requisite to
assessing the impact of such conditions on periodontal care

5. C LASSIFIC ATION

6. • When all potential systemic conditions have been thoroughly evaluated,the patients
may be assigned a physical status classification based on guidelines of American
society of anesthesiologist
• The ASA physical state classification system:
• ASA 1:
• Patients are considered to be Normal and healthy
• ASA 2:
• Patients have mild to moderate systemic disease
• ASA 3:
• Patients have severe systemic disease that limits activity,but it is not incapacitating

7. • ASA 4:
• Patients have severe systemic disease that limits activity and is a constant threat to life
• Whenever possible,elective dental care should be postponed until such time as the
patients medical condition has improved to atleast an ASA III Classification
• ASA 5:
• Patients are moribund and are not expected to survive more than 24 hours with or
without an operation
• These patients are almost always hospitalized terminally I'll patients

8. • ASA 6:
• Clinically dead patients being maintained for harvesting of organs
• ASA-E:
• Emergency operation of any variety

9. PATHOPHYSIOLOGY

11. D I S E A S E S I N C L U D E S :
• Hypertension
• Ischemic heart disease
• Cardiac arrhythmia
• Congestive heart failure
• Valvular heart disease
• Hypertrophic cardiomyopathy

12. HOW TO MANAGE...???

13. H Y P E R T E N S I O N
• A condition in which the force of the blood artery walls is too high.
• Usually hypertension is defined as blood pressure above 140/90, and is
considered severe if the press is above 180 /120.

14. HYPERTENSION
• Patients with blood pressure less than 180/110 can receive any dental
treatment (but patient should be monitored during treatment if blood pressure
>160/100
• Patient with uncontrolled blood pressure 180/110 or more cannot be treated
• When treating hypertensive patients, the Clinician should not use a loca
anaesthetic Containing an epinephrine concentration greater than 1:100,000
• Chair position :avoid rapid position change
• Avoid use of retraction cords and topical hemostatic agent instead use
tatrahydrozoline or oxymetazoline

17. I S C H E M I C H E A R T D I S E A S E
• Also known as coronary artery disease
• Ischemic heart disease is a condition in which there is an inadequate
supply of blood and oxygen to the portion of the myocardium.
• Imbalance between myocardial oxygen supply and demand caused mainly
by atherosclerosis of coronary artery.
• It includes angina ,myocardial infarction, heart failure and arrhythmia

18. I S C H E M I C H E A R T D I S E A S E
• Short appointments and stress reduction protocol
• Supplemental oxygen via a nasal cannula
• Caution should be taken of la with solution
• Prophylactic antibiotic may need to be considered to
prevent infection
• In patients with pacemakers,electrocautery the use
of cavitron should be avoided
• Delay invasive treatment for 6 months

19. A patient who has an angina episode in the dental chair should receive the
following medical treatment:
• Discontinue the periodontal procedure.
• Administration one tablet (0.3 to 0.6 mg) of NTG sublingually.
• Reassure the patient and loosen restrictive garments.
• Administer oxygen with the patient in a reclined position.
• If the signs and symptoms subside within 3 minutes, complete the periodontal
procedure if possible, making sure that the patient is comfortable. Terminate
the procedure at the earliest convenient time

20. C O N G E S T I V E H E A R T
F A I L U R E
• Heart failure or congestive heart failure is a abnormal clinical condition
involving impaired cardiac pumping
• Definition: heart failure refers to the inability of the heart to pump sufficient
blood to meet the needs of the tissues for oxygen and nutrients
• The term heart failure indicates myocardial disease in which there is a
problem with contraction of the heart that may causes or may not cause
pulmonary or systemic congestion.

21. C A U S E S
• Coronary artery disease
• Heart attack
• Cardiomyopathy
• Congenital heart disease
• Diabetes
• High blood pressure
• Arrhythmia
• Kidney disease

22. C O N G E S T I V E H E A R T F A I L U R E
• Elective periodontal treatment to be delayed
• Appointments have to be brief
• Partially recling position
• If supine......orthopnea
• Periodontist should be alert during the
procedure

23. A R R H Y T H M I A S
• Arrhythmias are deviations from normal heartbeat pattern. They include
abnormalities of impulse formation, such as heart rate, rhythm, or site of
impulse origin and conduction disturbances, which disrupt the normal
sequence of atrial and ventricular activation.

24. • An abnormality of the cardiac rhythm is called a cardiac arrhythmia.
Arrhythmias may cause sudden death, syncope, heart failure, dizziness,
palpitations or no symptoms at all.
• There are two main types of arrhythmia:1. Bradycardia: the heart rate is
slow(< 60 b. p. m.) . 2. Tachycardia: the heart rate is fast (> 100 b.p.m.).

25. A R R H Y T H M I A S
• Patients with cardiac arrhythmias may require special precautions during
periodontal therapy .
• Arrhythmias are often associated with Ischemic heart disease, congestive
heart failure,increased sympathetic tone or such reversible conditions as
hypoxia or electrolyte imbalance .
• Many of these patients function with little risk of life threatening emergencies
Although symptoms such as dizziness,palpitations and syncope may be
noticed

26. • The use of LA with vasoconstrictors may be contraindicated in patients
with refractory arrhythmias and periodontal treatment may be
accomplished in a controlled medical setting with careful cardiac monitoring

27. INFECTIVE
ENDOCARDITIS

28. R I S K F A C T O R S F O R D E V E L O P I N G I N F E C T I V E
E N D O C A R D I T I S I N C L U D E S :
• Heart valve disease
• Previous heart valve surgery
• Congenital heart disease
• Intravenous drug use
• Previous history of Infective endocarditis

29. E N D O C A R D I T I S P R O P H Y L A X I S R E C O M M E N D E D F O R
P A T I E N T S W I T H H I G H A N D M O D E R A T E R I S K C A R D I A C
C O N D I T I O N S
• Dental extractions
• Periodontal procedures,including surgery,Scaling and root
planing,probing and recall maintaince
• Dental implant placement and reimplantation of avulsion teeth
• Endodontic instrumentation or surgery only beyond the apex
• Subgingival placement of antibiotic fibers or strips
• Initial placement of orthodontic bands but not brackets

30. • Intraligamentary local
anaesthetic injections
• Prophylactic cleaning of teeth or
implants where bleeding is
anticipated

31. E N D O C A R D I T I S P R O P H Y L A X I S N O T
R E C O M M E N D E D
• Restorative dentistry,operative and prosthodontic and including restoration of
decayed teeth and replacement of missing teeth with or without retraction cord
• Local anesthetic injections
• Intracanal Endodontic treatment,post placement and buildup
• Placement of rubber dams
• Post operative suture removal

32. • Placement of Removal prosthodontic or orthodontic appliances
• Taking oral impressions
• Fluoride treatments
• Orthodontic appliance adjustment
• Shedding of primary teeth

35. C O N C L U S I O N
. It has been proven that a link exist between periodotal disease
and
cardiovascular disease
. Periodotal disease is a risk factor for the further development of
cardiovascular disease
. The prevention and treatment of periodotal disease reduces the
risk of cardiovascular disease

36. W I L K I N S ' C L I N I C A L P R A C T I C E O F T H E D E N T A L H Y G I E N I S T
/ L I N D A D . B O Y D , L I S A F . M A L L O N E E , C H A R L O T T E J .
W Y C H E , 1 3 T H E D - @ D E N T A L L I B - E L S E V I E R ( 2 0 2 0 ) .
C A R R A N Z A ' S C L I N I C A L P E R I O D O N T O L O G Y T H I R D S O U T H A S I A
E D I T I O N .
H T T P S : / / W W W . A H A J O U R N A L S . O R G › A B S P R E V E N T I O N O F
I N F E C T I V E E N D O C A R D I T I S | C I R C U L A T I O N - A H A
J O U R N A S L C I R C U L A T I O N . 2 0 0 7 ; 1 1 6 : 1 7 3 6 – 1 7 5 4
B Y W W I L S O N · 2 0 0 7 · C I T E D B Y 2 7 3 6 — G U I D E L I N E S F R O M
T H E A M E R I C A N H E A R T A S S O C I A T I O N .
P E R I O D O T A L D I S E A S E A N D O V E R A L L H E A L T H ; A C L I N I C I A N
G U I D E E D I T O R R O B E R T J . G E N C O R A Y C . W I L L I A M S .
REFERENCES

37. T H A N K Y O U ! !