Dental considerations in
diseases of C.V.S

www.indiandentalacademy.com
INDIAN DENTAL ACADEMY
Leader in continuing dental education
www.indiandentalacademy.com

www.indiandentalacademy.com
Coronary heart disease [IHD]
• Disease of myocardium secondary to decreased or
inadequate blood supply.
• Impairment of bl...
• Cigarate smoking
• Increased level of LDL cholesterol intake
• Obese patients

www.indiandentalacademy.com
Angina pectoris
• Def: Thoracic pain usually substernal
precipitated by exercise, emotion or heavy meal
& relieved by VD d...
Clinical features/diagnosis
• 1)duration of pain :short duration of
discomfort for about 2-10 min.
Chest pain lasts for 30...
Dental therapy considerations
• Prevention – stress reduction protocol
• Length of appointment
• Supplemental oxygen: 3- 5...
Management on dental chair
•
•
•
•

Stop all procedures
Position
A.B.C
Oxygen supply & sub lingual nitroglycerine:
0.3-0.6...
Myocardial Infarction (MI)

www.indiandentalacademy.com
• Decreased blood supply to a region of
myocardium leads to cellular death &
necrosis.
• Characterized by severe & prolong...
Dental considerations
• H/o M.I: post pone invasive dental treatment for
at least 6 months.
• During recovery period colla...
HYPERTENSION

www.indiandentalacademy.com
• Def : Hypertension is a persistently raised
blood pressure resulting from increased
peripheral arteriolar resistance.
• ...
Causes for hypertension
• PRIMARY/IDIOPATH
IC/ ESSENTIAL
HYPERTENSION
•
•
•
•

Aging
Obesity
Smoking
Diabetes

• SECONDARY...
Malignant hypertension
• Uncommon
• It can have an acute onset or can develop in pre
existing essential hypertension.
• Ty...
Clinical features
•
•
•
•
•
•
•
•

Head ache
Palpitations
Fatigue
Restlessness
Irritability
Heart failure
Brain damage
Blo...
Diagnosis
• By using sphygmomanometer:
• 2 methods: 1) Palpatory method
2) Auscultatory method

www.indiandentalacademy.co...
Treatment
• SYMPOTOMATIC
TREATMENT
• Life long treatment is
usually necessary.
• Reduction of weight
• Reduction of salt
i...
Dental considerations in
hypertensive pts

www.indiandentalacademy.com
Rheumatic Heart Diseases
Bacterial Endocarditis
• Def (RF) is a systemic, post-streptococcal,
non- Suppurative inflammator...
•
•

Etiopathogenesis
β- haemonytic streptococci group

•
•
1.
2.
3.
4.
5.

Clinical features
Major criteria
Carditis
Poly...
Minor criteria are
1. Clinical findings (arthralgia, fever)
2. Lab finding (elevated ESR, raised Creactive protein, leucoc...
The major causes of death in RHD are
cardiac failure, bacterial endocarditic and
embolism.
• Dental consideration

www.ind...
Bacterial Endocarditis (BE)
Definition ; serious infection of the valvular and
mural endocardium caused by different form ...
It has two types;
• Acute bacterial endocarditis (ABE)
• Sub acute bacterial endocarditis (SABE)

www.indiandentalacademy....
Acute Bacterial Endocarditis (ABE)
• Is the fulminant and destructive acute
infection of the endocardium by highly virulen...
Sub Acute Bacterial Endocarditis (SABE)
• Is less virulent bacteria in a previously
diseased heart and has a gradual downh...
Features
Acute
1) Duration
< 6 weeks
2)Most
staph aureus
cocci
Organism
3)Virulence of highly virulent
orgnisms
4)Conditio...
Standardard regimens for antibiotic prophylaxis to minimise
risk of bacterial endocarditis after oral procedures
•

Patien...
Oral procedures requiring antibiotic
prophylaxis
• Extractions
• Periodontal procedures including surgery, subgingival
pla...
Oral procedures not requiring
prophylaxis
• Operative and prosthodontic procedures with or without
retraction cord
• Local...
www.indiandentalacademy.com
Leader in continuing dental education

www.indiandentalacademy.com
Upcoming SlideShare
Loading in …5
×

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

832 views

Published on

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.

Published in: Education, Health & Medicine
0 Comments
4 Likes
Statistics
Notes
  • Be the first to comment

No Downloads
Views
Total views
832
On SlideShare
0
From Embeds
0
Number of Embeds
13
Actions
Shares
0
Downloads
1
Comments
0
Likes
4
Embeds 0
No embeds

No notes for slide

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

  1. 1. Dental considerations in diseases of C.V.S www.indiandentalacademy.com
  2. 2. INDIAN DENTAL ACADEMY Leader in continuing dental education www.indiandentalacademy.com www.indiandentalacademy.com
  3. 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. 4. • Cigarate smoking • Increased level of LDL cholesterol intake • Obese patients www.indiandentalacademy.com
  5. 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. 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. 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. 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. 9. Myocardial Infarction (MI) www.indiandentalacademy.com
  10. 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. 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. 12. HYPERTENSION www.indiandentalacademy.com
  13. 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. 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. 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. 16. Clinical features • • • • • • • • Head ache Palpitations Fatigue Restlessness Irritability Heart failure Brain damage Blood vessel diseases www.indiandentalacademy.com
  17. 17. Diagnosis • By using sphygmomanometer: • 2 methods: 1) Palpatory method 2) Auscultatory method www.indiandentalacademy.com
  18. 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. 19. Dental considerations in hypertensive pts www.indiandentalacademy.com
  20. 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. 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. 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. 23. The major causes of death in RHD are cardiac failure, bacterial endocarditic and embolism. • Dental consideration www.indiandentalacademy.com
  24. 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. 25. It has two types; • Acute bacterial endocarditis (ABE) • Sub acute bacterial endocarditis (SABE) www.indiandentalacademy.com
  26. 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. 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. 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. 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. 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. 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. 32. www.indiandentalacademy.com Leader in continuing dental education www.indiandentalacademy.com

×