Dental significance of cardiovascular disease Flashcards
What is hypertenison?
Increased BP
What level of BP is hypertension?
140/90
What is also considered when diagnosing hypertension?
Overall cardiovascular risk (smoking, drinking, weight)
Describe aetiology of hypertension?
Poly-causal –> essentially a diagnosis of exclusion (looked at everything else that could be causing it cant find anything)
Environmental - obesity, salt intake, lack of exercise
Genetic
What is the most common cause of secondary hypertenison?
Renal artery stenosis
or
Endocrine causes line Conn’s or Cushing’s syndrome
Cushing’s syndrome vs Cushing’s disease?
disease = primary pituitary problem = excess circulating steroid
Disease is a type of syndrome
Effect of elevated BP?
Increase risk of coronary heart disease
Aortic aneurysm
Peripheral vascular disease
Cerebral circulation
therapeutic measures of hypertension?
weight reduction
Exercise
Decrease salt intake
Alcohol reduction
therapeutic measures that will reduce risk of cardiovascular disease but not BP?
Stop smoking
Reduce saturated fat
Increase intake of oily fish
What is a major risk factor if CVS disease that relates to dentistry?
Periodontal disease
Sources of blood-borne infections that could cause infective endocarditis?
Mouth = toothbrushing, chewing, gingival bleeding
Skin
GI tract
Pregnancy (delivery)
Is antibiotic prophylaxis routinely given against infective endocarditis?
NO
Complications of antihypertensive treatment
Orthostatic hypertension - light headed as they lie flat
Xerostomia
Gingival overgrowth
Drug interactions
Main drug that is often given to patients with CVS disease that has lots of drug interaction?
Warfarin
Considerations relevant of dental management of patients with significant CVS compromise?
Shorter appointments, in the morning
Effective LA
Conscious sedation - reduce stress
post-op analgesia
Why is there queries about giving CVS patients LA?
LA is a vasoconstrictor
How does endogenous adrenaline react when under stress?
Increase x20
How does the adrenaline in LA differ to endogenous?
May not be as effective, definitely not straight away
What are the recommendations for LA use in patients with CVS disease?
Patients with mild to moderate CVS disease can have LA containing adrenaline as usual.
Patients with severe CVS disease may be considered relative contraindication to VC use
What constitutes severe CVS disease?
Unstable angina, recent MI, severe high BP
Patients with ischaemic heart disease, specific considerations regarding dental treatment:
a) how long should elective treatment be postponed after acute MI?
b) how should you go about treating patient with unstable angina (e.g. angina at rest)
c)
a) 6 months
b) should not be treated in primary care
What do you need to ensure is compatible in patients with pacemakers or implanted defibrillators?
Diathermy
Electrosurgical units
Ultrasonic scalers
Anything electronic
How should dental treatment differ on a patient with cardiac surgery?
a) Effects of stent/angioplasty/valve replacement
b) immediate post-op period
a) procedures do not pose contraindications
b) avoid treatment as immature suture line susceptible to bacterial infection
Why are patients with unstable CVS disease better treated in secondary care?
They need to be carefully monitored suing equipment like BP, ECG
What should you do if a patient has angina attack?
GTN spray, 2 actuations every 3 mins
Should feel better after 2 sprays, if you have to repeat start thinking, could this be MI
100% oxygen at 15 litres/minute
If you think a patient may be having an MI, why give them aspirin to chew?
Anti-platelet effect
How should you manage patients taking anti-platelet drugs like aspirin?
No alteration to drug regime for treatment but do make sure haemostasis have been achieved (cellulose mesh)
How should you manage patents taking warfarin?
INR check on the day of the invasive procedure
If INR value above 4, warfarin should be altered.
If below 4 - no alteration just ensure haemostasis
Oral manifestations related to cardiovascualr disease and cause?
dry mouth gingival hyperplasia angiodemia lichenoid drug reactions due to the drugs they are taking
What drugs cause xerostomia?
Beta blockers
Diuretics
ACE inhibitors
Ca channel blockers
What drugs cause lichenoid drug reactions?
NSAIDs
Beta blockers
Diuretics
Statins
What drugs cause angiodema?
ACE inhibitors
Common adverse effects of calcium channel blockers?
Gingival overgrowth
