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Dental management of patients with cardiovascular conditions

Potential problems with anticoagulant and antiplatelet drugs in patients undergoing dentoalveolar surgery ( including extractions): Many patients with caridiovascular disorder, including coronary heart disease, cerebrovascular disease, atrial filbrillation and venous thromboembolic disease, take antiplatelet and/ or anticoagulant drugs. The key issue with patients taking an anticoagulant or antiplatelet drug is the balance between the increases risk of bleeding fromm a wound if the drug is not stopped before surgery. The emphasis in the past has been on minimizing bleeding; however, a thromboembolic event is potentially much more serious( eg s stroke is catastrophic event, whereas bleeding from the mouth , although messy and troublesome, can be easily managed by local measure). Stroke is a catastrophic event, whereas bleeding from the mouth can be managed bu local measures. It is essential to ascertain if the patient is taking any anticoagulant or antiplatelet drugs and, if...
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Dental management of patient with coronary heart disease:

Apart from the potential problems with antiplatelet and coagulant drugs in patients with a history of coronary heart disease is to ensure that their current condition is stable and they are following their preventive and /or rehabilitation program. Defer elective dental treatment for 3 months after myocardial infarction, stent placement or coronary artery bypass surgery. If dental pain or infection occurs within the 3   month period following infarction, treat it as simply and expediently as possible. Defer elective dental treatment for 3 months after myocardial infarction, stent placement or coronary artery bypass surgery. Antibiotic prophylaxis for dental procedure is not required in patients with coronary stents, unless otherwise indicated . Patients with pacemakers and other implantable cardiac devices, and endocarditis is not a risk as the device is implanted within the muscle. A patient who is known to have episodes of angina should be instructed to bring their me...
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Dental management of patients with adrenal disorders

The adrenal glands produces steroid hormones from the cortex and catecholamines from medulla. When both adrenal glands have been destroyed or removed ( primary adrenal insufficiency), replacement of steroid hormones, particularly the glucocorticoids, is essential. Replacement of catecholamines is not need. Removal of one adrenal gland does not usually require steroid replacement therapy. The therapeutic use of corticosteroi ds is the most common cause of adrenal suppression. Corticosteroids are used in management of some inflammatory and immune disorders ( eg rheumatoid arthritis, severe dermatological conditions, severe asthma). Treatment with prednisolone or prednisone at dose greater than 10mg daily for more than 3 weeks can be sufficient to cause adrenal suppression. Dental issues It is important to ascertain if a patient is taking corticosteroids and, if so, their underlying condition and current drug regimen. Also check if they are taking biphosphonates to treat stero...
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Dental management of patients with bone and calcium disorders ( Including osteoporosis)

Osteoporosis is a common health problem. It is characterized by low bone mass and deterioration in the microarchitecture of bone ( bone quality) , leading to increased bone fragility and a consequent increase in fracture risk. About 50 % of women can expect to sustain fractures in their lifetime. Low trauma fractures can occur in 30 % of older men and one third of all hip fractures in the community occur in men. Drug therapy is aimed at improving bone strength further bone loss and/ or increasing bone mass. Osteopenia refers to bone mass that is lower than normal, but not low enough to be classified as osteoporosis. Other bone and calcium disorders include Paget disease of bone, malignancy involving bone, and hypercalcaemia. The bisphosphonates are one of the drug classes used to treat bone and calcium disorders; however, they have been related to osteonecrosis of the jaws. Dental issues : Bisphosphonate related to osteoporosis of the jaws Bisphosphonate related osteonecros...
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Antibacterial drugs used in dentistry

Beta lactams used in dentistry Penicillins The most common adverse effects of the penicillins are nausea, diarrhoea, rash, urticaria, pain and inflammation ( at the injection ( after prolonged treatment and / or with broad spectrum penicillins). * Narrow spectrum penicillins Narrow spectrum penicillins are active mainly against Gram positive organism, and they are inactivated by beta lactamases. Phenoxymethylpenicillin ( penicillin V ) is acid stable , so it can be given orally, although food impairs absorption. It is intrinsically less active than bensylpenicillin. Phenoxymethylpenicillin is the drug of choice in acute odontogenic infections due to its narrow ( and appropriate) spectrum of activity, with 85% of oral bacteria susceptible. Although susceptibility to amoxycillin is marginally higher ( 91%), it use should be reserved to prevent the development of resistance in infections caused by Streptococcus pneumoniae. Phenoxymethylpenicillin has fewer has fewer gastroin...
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Dental management of patients with psychological and psychiatric disorders

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- this is image in implant placement procedure, so memorable moment - Approximately 15 % of the population have a significant psychological disorder and approximately 2% have a major psychiatric disorder. If these are not managed, they can have serious individual and societal consequences. Pharmacological treatment is often used in the management of psychological and psychiatric disorders. Drugs commonly used in psychiatric disorders * antidepressants : + selective serotonin reuptake inhibitors ( SSRIs) : citalopram, escitalopram, fluoxetine, fluvoxamin, paroxetine, setraline. + tricyclic antidepressants ( TCAs) : amitriptyline, dothiepin, doxepin + monoamine oxidase inhibitors ( MAOIs) : moclobemid, phenelzine + serotonin and noradrenalin reuptake inhibitors ( SNRIs): venlafaxine, duloxethine + others : mirtazapine, reboxetine * Mood stabilisers ( used in bipolar disorder) : + carbamazepine, lamotrigine, lithium, sodim valproate. + first generation antipsychoti...
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Antibiotic prophylaxis

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- this image is the first time we went to Singapore for Australia dental council exam, so happy with two angels- Antibiotic prophylaxis is the administration of antibiotic before a dental procedure to minimize the risk of bacterial infection. It is only given when the risk of infection is high. Infection can occur at : * a distant site through the haematogenous route, usually the heart ( eg endocarditis ) * an oral surgical site There is a very small risk infection at a prosthetic joint site through the haematogenous route. Therefore antibiotic prophylaxis is not recommended before dental procedure in patients with prosthetic joints. If required, antibiotic prophylaxis should be given just before the . The aim is to achieve high plasma and tissue concentration is most likely. Prescribing antibiotics after the procedure is of no prophylactic value. PREVENTION OF ENDOCARDITIS Infective endocarditis is relatively uncommon illness with high morbidity and mortality. Th...
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