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Human Diseases > Dental Significance of Cardiovascular Diseases > Flashcards

Dental Significance of Cardiovascular Diseases Flashcards

1
Q

What is hypertension?

A

Elevated blood pressure

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2
Q

What are used to listen to the Korotkoff sounds?

A

A sphygmomanometer and a stethoscope

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3
Q

What is the blood pressure when sounds appear in Korotkoff sounds?

A

Systolic

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4
Q

What is the blood pressure when sounds disappear in Korotkow sounds?

A

Diastolic

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5
Q

What is the normal blood pressure systolic/diastolic in mmHg?

A

120/80

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6
Q

What level of blood pressure constitutes hypertension in mmHg?

A

> 140/90

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7
Q

Apart from consistent blood pressure levels of >140mmHg/90mmHg, what else needs to be taken into account to diagnose hypertension?

A

Overall cardiovascular risk eg alcohol, obesity, smoking

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8
Q

The device used to measure blood pressure should be recommended by:

A

British Hypertension Society (BHS)

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9
Q

When will dental professionals need to measure blood pressure?

A

If doing intravenous sedation

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10
Q

What are the requirements of measuring blood pressure levels?

A

Patients should be sitting down
At least 2 measurements and average out the readings

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11
Q

What is the ‘white coat’ effect?

A

When someone sets foot in a doctor or dentist surgery, the blood pressure shoots through the roof. There is blood pressure variability between home and clinic.

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12
Q

If ‘white coat’ effect is suspected in a patient, what can be done?

A

Ambulatory BP monitoring (where BP is measured continuously for 24 hours)

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13
Q

How do we suspect ‘white coat’ effect?

A

If a patient repeatedly came in with a high blood pressure, but when contacting their GP about it, GP says their BP is normal during GP visit. This could mean that the patient has ‘white coat’ effect for the dentist.

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14
Q

__________ __________ is 90% of hypertension cases.

A

Essential hypertension

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15
Q

Essential hypertension is essentially a diagnosis of ___________. This is when all possible causes have been checked yet the main cause of hypertension still cannot be determined.

A

Exclusion

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16
Q

What can lead to essential hypertension?

A

Multiple genetic loci influence
Excessive salt intake
Obesity
Lack of exercise/sedentary lifestyle

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17
Q

What is the most common cause of secondary hypertension?

A

Renal artery stenosis

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18
Q

Renal artery stenosis is most often seen in (older/younger) patient with vascular disease.

A

Older

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19
Q

What are the endocrine causes of secondary hypertension?

A

Conn’s syndrome (primary hyperaldosteronism)
Cushing’s syndrome (hypercortisolism)

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20
Q

What can cause Cushing’s syndrome?

A

Excess steroids in the body either prescribed or due to an endogenous cause

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21
Q

What is Cushing’s disease?

A

A primary pituitary problem where the adrenocorticotrophic hormone is produced in excess, causing excess circulating steroids

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22
Q

What is the hypothalamopituitary adrenal axis?

A

Hypothalamus produces corticotrophin-releasing hormones
Pituitary produces adrenocorticotrophic hormone
Adrenal cortex produces cortisol
Via a negative feedback loop, if the cortisol goes down, the hormones at the top end of the chain will increase. If cortisol goes up, hormones at the top end of chain will decrease.

23
Q

Patients with an intrinsic renal disease such as glomerulonephritis could have ___________ ___________.

A

Secondary hypertension

24
Q

Hypertension is common and usually ___________ hence it is a silent killer potentially.

A

Asymptomatic

25
Q

What can an elevated BP increase the risk of?

A

Coronary heart disease
Left ventricular hypertrophy
Arrhythmias
Aortic aneurysm
Peripheral vascular disease eg arteriosclerosis
Cerebral infarction
Cerebral haemorrhage

26
Q

What are the 4 non-therapeutic measures for managing hypertension?

A

Weight reduction
Exercise
Decrease salt intake
Alcohol reduction

27
Q

What are some measures taken to reduce cardiovascular risk related to hypertension?

A

Stop smoking
Reduce saturated fat
Increase intake of oily fish

28
Q

What are the diseases that periodontitis is a risk factor of?

A

Peripheral macro-vascular disease
Diabetes
Atherosclerotic vascular disease

29
Q

Periodontal inflammation has a bi-directional relationship with what?

A

Diabetic control

30
Q

What are some sources of blood-borne infections/possible causes of bacteremia?

A

Toothbrushing
Chewing
Gingival bleeding
Skin lesions
Gastrointestinal or genital urinary tract manipulations
Pregnancy particularly birth delivery

31
Q

What are the complications of antihypertensive treatment?

A

Orthostatic hypotension
Xerostomia
Gingival overgrowth
Lichenoid reactions
Potential drug interactions eg warfarin

32
Q

What are some considerations relevant to the dental management of patients with significant cardiovascular compromise?

A

Shorter appointments (morning)
Effective LA
Conscious sedation
Post-operative analgesia
LA: +/- vasocontrictor

33
Q

What is the recommendation for LA use in patients with CVS disease?

A

Patients with mild to moderate CVS disease can have LA-containing adrenaline

34
Q

What are some CVS diseases considered severe and may have contraindications to vasoconstrictors?

A

Unstable angina
Recent MI
Dysrhythmias
Severe hypertension
Severe heart failure

35
Q

What are some specific considerations regarding dental treatment for patients with ischaemic heart disease?

A

Acute MI: postpone elective treatment to 3-6 months later; refer to maxillofacial specialist for emergency treatment
Unstable angina: dental care in suitable facilities or postpone
Cardiac failure: dyspnoea when lying flat so do not lie flat

36
Q

What devices need to be avoided (and only used when it’s confirmed compatible and safe) in patients who have pacemakers and implanted defibrillators?

A

Diathermy
Electrosurgical units
Ultrasonic scalers

37
Q

For patients who just recently had coronary artery bypass graft (CABG)/stent/angioplasty or valve surgery/replacement, what should be avoided and why?

A

Avoid dental treatment during the immediate postoperative period because the suture line is still immature which could potentially lead to bacterial or any other kind of infection

38
Q

What do we need to look out for or ask in patients who recently had a cardiac surgery?

A

Still have chest pain?
Using GTN spray?
Taking warfarin or other anticoagulants?

39
Q

What needs to be monitored in high-risk cardiac patients eg unstable angina and recent MI where dental treatment is unavoidable/urgent?

A

Clinical signs and symptoms
BP
Pulse oximetry
ECG

40
Q

If it was angina, when would the patient start to feel a difference after using GTN spray?

A

2 actuations for 2-4 minutes

41
Q

If the patient does not feel a difference with the first 2 actuations of GTN spray and needs to repeat 2 actuations every 3 minutes, what disease could be suspected?

A

Myocardial infarction

42
Q

How much oxygen and how frequently do patients with chest pain deserve?

A

100% oxygen at 15 litres/minute (size CD oxygen cylinder)

43
Q

For patients with myocardial infarction, what can be given to manage them?

A

100% oxygen at 15 litres/minute
GTN spray sublingually
Aspirin 300mg (chewed)

44
Q

What are some oral manifestations related to CVS disease?

A

Dry mouth (thiazide diuretics for hypertension)
Lichenoid drug eruptions (beta blocker eg atenolol)
Gingival hyperplasia (calcium channel antagonists)
Angioedema
Nicorandil (potassium channel activator)

45
Q

What drug classes can cause xerostomia?

A

Beta-blockers
Diuretics
ACE inhibitiors
Calcium channel blockers

46
Q

What drug classes can cause lichenoid drug reactions?

A

NSAIDs
Beta-blockers
Diuretics
Oral hypoglycaemics
Statins
Antimalarials
Sulphonamides

47
Q

What do calcium channel blockers/antagonists do and what are some examples?

A

Lower blood pressure in hypertensive patients. Nifedipine, amlodipine, nicardipine, nimodipine, verapamil, diltiazem.

48
Q

How to manage gingival hyperplasia caused by calcium channel blockers?

A

Optimise oral hygiene
Carry out high-quality scaling
Recommend a change in medication
Gingivectomy (if gingival tissues remain massively inflamed)

49
Q

What is nicorandil and what is it used for?

A

Potassium channel activator
Vasodilator
For angina

50
Q

What drug could sometimes cause the unwanted effect of severe, persistent oral ulceration (cancer-like appearance)?

A

Nicorandil

51
Q

What should always be carried out for persistent oral ulcerations, even if the associated risks eg nicorandil are known, to confirm that it isn’t oral cancer?

A

Incisional biopsy

52
Q

What deficiency is present in angioedema?

A

C1 esterase inhibitor

53
Q

Angioedema is the swelling of the deeper layers of the skin, caused by a build-up of fluid. There’s usually been an exaggerated response to _______, which could include dental treatment. It can also be drug-related (_____ _________) or hereditary.

A

Trauma, ACE inhibitors

54
Q

How to manage angioedema?

A

Change ACE inhibitor to another drug
Closely monitor airways to prevent airway compromise
If tongue oedema, admit to hospital and intubate until swelling subsides

Human Diseases (24 decks)

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