Perio 7 lecture

2. PERIODONTAL TREATMENT OF
MEDICALLY COMPROMISED
PATIENTS

3.  Many patients seeking dental
care have significant medical
conditions .

4. CARDIOVASCULAR DISEASES
 The most prevalent category of
systemic disease
 Increasing with age
 Health histories

5. These condition include:
 Hypertension
 Angina Pectoris
 Myocardial infarction
 Previous cardiac bypass surgery
 Previous cerebrovascular accident
 Congestive heart failure
 Presence of cardiac pacemaker
 Infective endocarditis

6. HYPERTENSION
 The most common cardiovasculer
disease
 BP greater than 140mm-hg
 Prehypertension
 Hypertension is classified:
 Stage 1: systolic 140-159 diastolic 90-
99
 Stage 2: systolic greater than 160
diastolic greater than 100

7. CONT…
 Primary hypertension
 Secondary hypertension
 The early hypertension may be
asymptomatic
 The dental office play vital role for
detection of hypertension
 Two BP reading spaced at least 10
minute apart

8. CONT…
 Dental treatment for hypertension
patients is generally safe
 If patient receive antihypertensive ,
consultation with the phyisian is
must before treatment

9. CONT…
 For patient with BP 180/110 should
be limited to emergency care
 Analgesic , antibiotic
 Surgical procedure should be limited
 Should not use anesthetic agent
with Epinephrine

10. CONT…
 The clinician aware of side effect of
antihypertensive medication
 Postural hypotension is common
 Positional change of dental chair

11. ISCHEMIC HEART DISEASES
Disorder such as:
 Angina pectoris
 Myocardial infarction
 Stable or unstable angina

12. CONT…
 Patient with unstable angina , should
be treated for emergencies
 Patient with stable angina , can
undergo elective dental procedure

13. CONT…
 Anginal attacks should be instructed
with nitroglycerine
 Should kept in emergency office
 Calcium channel blockers and beta
blockers
 Local anesthetic without epinephrine

14. CONT…
 If patient become fatigued and
unconformable or sudden change of
heart rhythm
 Procedure should be stopped

15. CONT…
 If anginal episode occur emergency
medical treatment are:
1. Discontinue the procedure
2. Administer 1 Tab of nitroglycerin
3. Resure the patient
4. Administer Oxygen
5. If the signs cease within 3 min , complet
the periodontal procedure
6. If the signs does not resolve
7. A third nitroglycerine Tab given

16. CONT…
Myocardial infarction :
 Dental treatment should referred for at
east 6 month
 Treated same as stable angina
 Aortocoronary bypass, femoral artery
bypass, angioplasty, endartectomy
should consult with cardiologist

17. CONGESTIVE HEART FAILURE
 The pump function of heart is unable
to supply sufficient amount of O2
blood to meet body needs
 Patient with poorly or untreated CHF
not elective for periodontal procedure

18. CONT…
 CA channel blockers, diuretics, ACE
inhibitors, alpha blockers, and digoxin
has side effect that impact periodontal
therapy

19. CARDIAC PACEMAKERS
 Cardiac errhymias most often treated
with medication
 Also use pacemakers
 Consultation with the patient is
important
 Old pacemaker could be disrupted by
ultrasonic or electrocautery units
 Stabilization prevent unexpected
trauma during periodontal treatment

20. INFECTIVE ENDOCARDITIS
 The disease which microorganism
colonize the damage endocardium
 The incident is low
 Alpha hemolytic (streptococuss
viridans)
 A.a , capincytophga, Eikenella
corrodens, and lactobacilus
 Acute and sub acute

21. CONT…
 The practice of periodontics is
concerned with prevention of IE
 (AHA) recomanded:
 Scaling , antibiotic prophylaxis,

22. CEREBROVASCULAR ACCIDENT
 CVA or stroke result from ischemic
changes
 Hypertension and atherosclerosis are
predisposing factors
 Medical history
 Consultation with physician

23. CONT…
 The clinician modify oral hygiene
 Chlorohexiden rinses
The treatment guideline:
1. No periodontal therapy for 6 month
2. Periodontal therapy may preform after 6
month
3. Light conscious sedation
4. Oral anticoagulants
5. BP should be monitored

24. THANKS