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 medication ( eg glyceryl trinitrate spray or tablets) when presenting for dental treatment. Dental treatment should be undertaken in short appointments. Use relaxation techniques and consider sedation. Ensure effective local anaesthesia- the use of vasoconstrictors with local anaesthetics is indicated in these patients.
Epidemiological studies have implicated periodontal disease as a risk factor for cardiovascular disease. However, it has not been proven whether pariodontal disease and cardiovascular diseases are concurrent manifestations of vascular disease, or whether treatment of periodontal disease results in improves cardiovascualar disease status. Further studies are needed but, regardless of this, improving periodontal health is important.
Dental management of patients with heart failure
Heart failure is usually a condition of elderly. It can be predominantly ventricular with with pulmonary congestion and dyspnoea, or predominantly right ventricular with elevated venous pressure, peripheral oedema and hepatic congestion. Usually both coexist in the classical syndrome of congestive or biventricular heart failure.
Dental issues
Dental treatment should only be undertaken if the patient's heart failure is stable and should be performed in short appointments. Patients with heart usually do not tolerate being placed in a horizontal position and should be placed with their head higher their heart. A useful guide is to determine the extent to which the patient needs to be propped up in bed at night; if they can only comfortably sleep with the aid of multiple pillows, they may not tolerate the dental chair being placed horrizontally.
Nonsteroid anti inflammatory drugs ( NSAIDs) should be avoided in patients with heart failure as they can worsen heart failure.
( Therapeutic Guidelines)

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