2. Cardiovascular disease is a common medical condition
found in elderly and medically compromised patients. The
periodontist should identify new cases of these diseases
and must be able to provide adequate periodontal care to
patients. These disorders generally include Hypertension,
Ischemic heart disease, Congestive heart failure, Infective
endocarditis, Cerebrovascular accidents etc.
CVD can be identified by:
Taking detailed medical history & limited physical
examination
Identifying vital signs, including BP & pulse rate
Consultation with physician if needed
INTRODUCTION
3. It is defined as a systolic blood pressure of 90 mm Hg or
greater
HYPERTENSION
4. Stress free, calm & relaxing environment
Short & afternoon appointments
LA containing epinephrine conc. not greater than
1:100,000 should be used
Postural hypotension can be minimized by slow positional
changes in dental chair
Gingival retraction cord containing epinephrine should be
avoided
Aspirin may cause sodium & fluid retention & may be
contraindicated in severe hypertension
Guidelines To Do Periodontal
Treatment In Hypertensive Patient
5. Commonly manifested as angina pectoris & myocardial
infarction
Guidelines To Do Periodontal Treatment :
1. Physician should be consulted to obtain the formers
fitness to undergo periodontal therapy
2. Instruct the patient to bring their medications,
particularly if they are on nitroglycerin
3. Keep the visit short. Include smaller areas in the mouth
for each visit
4. Dental treatment is generally deferred for atleast 6
months following myocardial infarction because peak
mortality rate is during this time
5. Stress reduction protocol: it induces acute angina attacks
ISCHEMIC HEART DISEASE
6. Discontinue periodontal procedure
Administer one tablet (0.3-0.6 mg) of nitroglycerine
sublingually
Reassure the patient & loosen restrictive garments
Administer oxygen to the patient in reclined position
If the signs & symptoms cease within 3 min. complete
the periodontal procedure if possible, making sure that
the patient is comfortable. Terminate the procedure at
the earliest convenient time
If the anginal signs & symptoms do not resolve with this
treatment within 2-3 min, administer another dose of
nitroglycerin, monitor the patients vital signs , call the
patient’s physician, & be ready to accompany the patient
A Patient Who Has An Anginal Episode In dental
Chair Should Receive Following Emergency Medical
Treatment
7. A third nitroglycerin tablet may be given 3 min. after
the second. Chest pain that is not relieved by three
tablets of nitroglycerin indicates possible MI. The
patient should be transported to the nearest
emergency medical facility immediately
Pain that persists after 3 doses & last more than 15-20
min. or associated with diaphoresis, nausea vomiting
syncope or hypotension usually indicate MI. Immediate
transportation to a hospital & vital signs should be
monitered closely . Patient should continue to receive
oxygen along with administration of 5-10 mg of
morphine sulfate IV for pain & anxiety , if
cardiopulmonary arrest occurs while aid is arriving , the
dentist & staff should perform resuscitative measures
8. Cardiac arrhythmias need special attention during
periodontal therapy. Cardiac usually managed with
medications. However some are treated with implantable
pacemaker or automobile defibrillators.
Guidelines For Periodontal Treatment
Prior opinion from the patients physician allows
determination of cardiac status the type of pacemaker &
automatic defibrillator
Treatment should be done in controlled medical setting
with careful cardiac monitoring
In refractory arrhythmia patient’s use of LA with
vasoconstrictors may be contraindicated
Stabilizing the operating field with bite blocks or other
devices can prevent unexpected trauma
CARDIAC PACEMAKER & AUTOMATIC
DEFIBRILLATORS
9. It is a condition in which the pump function of heart is
unable to supply sufficient amount of oxygenated blood
to meet the body’s needs
Guidelines For Periodontal Treatment
Semi-recumbent or Upright position : The dental chair
should be adjusted to a comfortable level for the patient
instead of being placed in a supine position. However, it
should be adjusted at a comfortable position for the
patient, especially semi- recumbent or upright
Schedule stress free, short appointments. Profound local
anesthesia, possibly conscious sedation & use of
supplemental oxygen should be considered
CONGESTIVEHEART FAILURE
10. It is a disease in which microorganisms colonize the damaged
endocardium or heart valves. Organisms most commonly
encountered in IE are α-hemolytic streptococci along with it
nonstreptococcal organisms present in periodontal pocket including
Eikenella corrodens, Actinobacillus actinomycetemcomitans
Lactobacillus species increase risk of IE
Preventive Measures To Reduce Risk Of IE :
A careful medical history will disclose the susceptible patient
Consult patients physician
Oral hygeine should be practiced with methods that improve gingival
health yet minimizes bacteremia , In patients with gingival
inflamation , oral hygeine should be limite to procedures ( oral rinse
& gentle toothbrushing) to minimize bleeding , as gingival health
improves more oral hygiene may be initiated
INFECTIVE ENDOCARDITIS
11. Consult patients physician
Recommended prophylactic regimens should be practiced
with all susceptible patients
Pretreatment with chlorhexidine mouthrinses are
recommended before all procedures, including periodontal
probing, to reduce the presence of bacteria on mucosal
surfaces
When possible , allow 7 days between appointments . If
this is not possible, select an alternate antibiotic regimen
for appointments within 7 day time period
Teeth with severe periodontitis & poor prognosis may
require extraction
Sutures reabsorbing in short period of time like chromic
catgut are indicated
Guidelines For Periodontal Treatment
12.
13. It occurs as a result of ischemic changes or hemorrhagic phenomena
A sudden interruption of blood flow to the brain, deprives the
neuronal cells from oxygen & result in stroke . Hypertension &
atherosclerosis are predisposing factors to CVA and clinician should
be alert to evaluate them
Guidelines For Periodontal Treatment
Stroke patients usually needs oral anti coagulant therapy
No periodontal therapy should be performed for 6 months due to
risk of recurrence
Short appointments with minimizing stress
LA containing epinephrine conc. not greater than 1:100,000 should
be used
Light concious sedation may be used for anxious patients
Monitor blood pressure carefully
CEREBROVASCULAR ACCIDENTS