Case report

1. DENTAL MANAGEMENT OF MEDICAL
COMPROMISED CASE REPORT
PRE BY: Hafsa Hiddig
Lecturer: Dr Sabir Takkar
Cousre: Dental management of medical
compromised patient

2. Case on Arrhythmias:
• A 75-year-old man came to EAU dental clinic
for extraction of mandibular molar tooth with
the complaint of pain and dizziness for the
past week.
• He denied any chest pain, shortness of breath,
hearing loss, or syncope.
• He had a medical history of hypertension,
diabetes, and glaucoma. His medications
included aspirin, amlodipine, carvedilol, and
timolol eye drops.

3. • His dose of carvedilol was increased from 6.25 to
12.5 mg last week by his primary physician. He
denied any tobacco habits.
• On clinic examination in the clinic, he was vitally
stable with no significant findings.
• Also his blood sugar level was normal.
• The monitory vital signs BP indicated 148/99 and
pulse was 94-100.
• How would they manage this patient?

4. Case Review
• This case describes the importance of medication
review in the elderly population.
• Elderly patients taking excessive atrioventricular
(AV) node-blocking agents can have symptoms of
dizziness and syncope with remarkable ECG
changes.
• The temporal association of the medication dose
increase and careful review of the medication list
are key to diagnose the etiology of dizziness and
AV block.

5. Case Study
Definition:
Cardiac arrhythmia: which refers to any variation in the
normal heartbeat, includes disturbances in rhythm, rate, or
the conduction pattern of the heart.
Causes of Arrhythmias:
Coronary artery disease.
Irritable tissue in the heart (due to genetic or acquired
causes).
High blood pressure.
Changes in the heart muscle (cardiomyopathy).
Valve disorders.

6. Supraventricular Arrhythmias
• Sinus Nodal Disturbances
• Sinus arrhythmia is characterized by phasic variation in
sinus cycle length.
• In the respiratory type, heart rate increases with
inhalation and decreases with exhalation.
• Non respiratory sinus arrhythmia is unrelated to
respiratory effort and is seen in digitalis intoxication.
• Sinus tachycardia. Tachycardia in an adult is defined as a
heart rate greater than 100 beats per minute, with
otherwise normal findings on the ECG.14 The rate usually
is between 100 and 180 beats per minute.

7. • This condition most often is
• physiologic response to
exercise,
anxiety, stress, or emotion.
• Pathophysiologic causes include
 fever,
hypotension,
 hypoxia, infection,
anemia
 heart failure.

8. • Sinus bradycardia: is defined as a heart rate less than 60
beats per minute, with an otherwise normal ECG tracing.
• It often coexists with a sinus arrhythmia.
• it is relatively common among well-conditioned athletes and
healthy young adults and decreases in prevalence with
advancing age.
• Pathophysiologic causes of bradycardia include
intracranial tumor,
increased intracranial pressure,
myxedema,
hypothermia, and
 gram-negative sepsis.

9. Signs and Symptoms of Cardiac Arrhythmias
• Signs
Slow heart rate (<60 beats/min)
Fast heart rate (>100 beats/min)
Irregular rhythm
• Symptoms
Palpitations, fatigue
Dizziness, syncope, angina
Congestive heart failure:
Shortness of breath

10. Dental Management of Arrhythmias
• Potential Medical Problem Related to Dental Care in
this case
The stress and anxiety of dental treatment or
amounts of epinephrine may induce life-
threatening arrhythmias in susceptible patients.
elevated the blood pressure due to amounts of
epinephrine because patient was taking a
nonselective beta blocker.
• Oral Manifestations
dry mouth, taste changes, and oral lesions may be
drug-related.
Excessive bleeding or bruising may occur as the result
of use of aspirin.

11. Prevention of Problems
 Determined the nature, severity, and appropriate
treatment of arrhythmia through history and
clinical findings.
 For intermediate- and low-risk arrhythmia
 Elective dental care was provided with the
following management considerations.
 Stress/anxiety reduction: provided oral sedative
premedication: inhalation Sedation Nitrous Oxide,
 assess pretreatment vital signs; avoided excessive
use of epinephrine (for taking a nonselective beta
blocker, limited epinephrine to ≤2 cartridges, and
provided local anesthesia of excellent quality and
postoperative pain control).

12. • Early and short morning appointment were treated.
• Every effort was made to keep procedure time down to a
minimum.
• 30mint before procedure Amoxicillin 2gr was take by orally
• The patient was allowed to attain comfortable position in
dental chair (trendelenburg).
• Body movement was controlled to avoid orthostatic
hypotension.
• Profound Local anaesthesia was injected to numbing area
and reduced anxiety

13. • Separated gum with caution
• Luxated the tooth with elevator
• Verbal communication was used to control patient
attention.
• Adopted forcep and removed the tooth
• Curettage was made and cleaning the socket with saline
• Suture was made to reduce bleeding because patient was
taking aspiring medication
• Then the clinician gave post-opera instruction
• After 6days the patient come back suture removal was made
and area was healed.

14. post-opera instruction
Keep tongue away from the socket.
Don't rinse for 24hrs after surgery.
For mild discomfort(pain) use ibuprofen.
Your diet should consist mainly soft and easy
swallowed food.

15. Conclusion
• Although this was medical compromising patient and
it was difficult to manage but finally he got his dental
care without any risk of the patient.
• Any indicated dental treatment may be provided as
long as arrhythmia is controlled and appropriate
management issues are considered.

16. Thank you all