CVD - History taking and dental implications

Question 1

When gathering information, how do we address any existing conditions?

Answer 1

Any existing conditions:

• Can you tell me about any illnesses yiu have?
• Specifically have you been told you have high BP, diabetes, angina, a heart attack or vascular disease in your legs?
• Do you get chest pains?
• Do you ever get pains in your legs when you walk?

Question 2

How do we gather information regarding how severe those conditions are?

Answer 2

How severe those conditions are:

• Tell me more about your angina/PVD…
• How far do you walk before it comes on?
• Have you ever had pain come on at rest?
• How often do you use your GTN spray?
• Does your GTN always work?

Question 3

How do we gather information about other vascular risk factors?

Answer 3

What illnesses run in your family?

Do you have high cholesterol levels?

Are you a smoker?

Tell me about how active you are?

Tell me about your diet?

How much alcohol fo you drink in an average week?

Question 4

How to gather information regarding do they have any particular ideas, concerns or expectations about their dental treatment?

What are dental aspects we need to consider when treating patients with CVD?

Answer 4

• Is there anything you’re worried about regarding treatment here?

Dental Aspects:

• Don’t operate if symptoms suggest unstable angina, critical limb ischaemia or concerning hypertension - refer to GP
• Avoid any dental treatment until at least 4 weeks post MI - check with GP prior to treating

Question 5

What does ASA classification assess?

Answer 5

Globally assesses the degree of ‘sickness’ or ‘physical state’ prior to selecting anaesthetic or performing surgery

ASA I - normal, healthy patient - non-smoker, minimal alcohol use

ASA VI - brain dead whose organs are being removed for donor purposes

Question 6

What is JADA advice on treating patients with CVD?

Answer 6

• ensure any haemodynamic change does not exceed the CV reserve of patients
• short morning appointments
• give good LA
• avoid sedation
• excellent post-op analgesia

Question 7

Summarise drugs patients may be taking for CVD:

Answer 7

• statins
• drugs for diabetes
• antiplatelet meds or anticoagulants
• meds for hypertension
• meds for ischaemic heart disease
• meds for arrhythmias

Question 8

List some key examples of CVD drugs impacting on oral health:

Answer 8

• ACE inhibitors and oral lichen planus
• Nicorandil and chronic painful ulcers
• Calcium channel blockers and gingival hypertrophy