DENTAL -CV PROBLEMS AND DENTAL PRACTICE DOWNLOAD

CARDIOVASCULAR PROBLEMS AND DENTAL PRACTICE : 

CARDIOVASCULAR PROBLEMS AND DENTAL PRACTICE DUBAI IN Dr.A.K.KAPOOR. M.B;B.S,MD(Med),DM(Card),F.Card(Germany)FCCP(USA) Chairman-GETWELL MEDICAL CENTRE. Co-ordinator-Cardiology Neurospinal Hospital Head of the Cardiovasclar Division-Neurospinal Hospital Visiting Consultant Cardiologist–Intenational Modern Hospital

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STORY OF A PATIENT R.D. is 55y The gentleman is a Diabetic with a strong family H/O CAD and DM. H/O Chest pain off and on. Went for Dental Extraction. Chest Pain since morning. Fortunately good sense prevailed and the ECG was done before touching the teeth. Had Acute SMI. Hospitalised , treated and after 3 months underwent Dental treatment with Cardiology cover.

CARDIOVASCULAR PROBLEMS AND DENTISTRY : 

CARDIOVASCULAR PROBLEMS AND DENTISTRY CONGESTIVE HEART FAILURE CARDIAC ARRHYTHMIAS CARDIOMYOPATHY HYPERTENSION VALVULAR HEART DISEASE CONGENITAL HEART DISEASE ENDOCARDITIS CARDIOACTIVE MEDICATIONS CORONARY ARTERY DISEASE

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The most fascinating disease for doctors-A doctor can do wonders, can revert life to death in ICU, OT,Clinic, Bedside or even on the roadside by Basic Life Supports. The Greatest Killer of Mankind 7.5 million deaths /year Maximum Health care force involved Best Results In the H/O Medicine The most Painful & the most Painless cause of Death The Most deceptive Disease CORONARY ARTERY DISEASE_THE DISEASE PROFILE

Some of the risk factors for heart disease include smoking,high blood pressure, high cholesterol, diabetes, and obesity. : 

Some of the risk factors for heart disease include smoking,high blood pressure, high cholesterol, diabetes, and obesity. UNHEALTHY GUMS-GINGIVITS-AN ASSOCIATION OR A RISK FACTOR

Coronary Artery Circulation : 

Coronary Artery Circulation 1.Left Main Coronary artery- Left Anterior Desc.Artery Left circumflex Artery. 2.Right Coronary Artery. kapoor

DENTAL TREATMENT AND : 

DENTAL TREATMENT AND Stable Angnia Unstable Angina/ACS MyocardialInfarction Cardiomyopathy

CORONARY PATIENTS:DOS & DONTS IN A DENTAL CLINIC : 

CORONARY PATIENTS:DOS & DONTS IN A DENTAL CLINIC Be-AWARE of HIGH RISK and should be able to act quickly and effectively in the case of an acute cardiovascular event. GOOD control of pain. REDUCE stress. Use or avoidance of a vasoconstrictor in dental anesthesia. Cautious use of the antiplatelet, anticoagulant and antihypertensive medication., ADRENALINE. During the first 6 months after AMI, dental treatment should be reserved for emergency situations destined to provide odontogenic pain relief: tooth extractions, the drainage of abscesses, and pulpectomies. Preferably carried out in the hospital setting in complicated cases.

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Professor E.H. Rompen, Department of Periodontology - Dental Surgery, C.H.U. Liège, Belgium. “We found that 91% of patients with cardiovascular disease suffered from moderate to severe PERIODONITIS, while this proportion was 66% in the non-cardiac patients.”

BP INSTRUMENT OR AN ORNAMENT : 

BP INSTRUMENT OR AN ORNAMENT So it would appear that blood pressure measuring equipment in many dentists' surgeries is more ornament than use. Rather than screening for hypertension, a more important consideration is that dentists consider measuring blood pressure in patients with a history of hypertension in order that safe patient management can be achieved. HYPERTENSION

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EPIDEMIOLOGY MORE THAN 25 TO 30% OF THE POPULATION HAS HYPERTENSION 50% OF THE HYPERTENSIVE ARE UNAWARE OF THEIR HYPERTENSION. 16% OF THE HPERTENIVE PATIENTS ARE ADEQUATELY CONTROLLED. 75 million Americans have high BP. Hypertension an Epidemic

Classification and Management of Blood Pressure for Adults : 

Classification and Management of Blood Pressure for Adults

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WHAT TO DO IN CASE OF A HIGH BLOOD PRESSURE First of all, eliminate a false high blood pressure False high blood pressure for several reasons: The size of the cuff. The conditions of measurement of the blood pressure are not good (period of stress, absence of rest before the measurement of arterial pressure). Ambulatory blood pressure monitoring for 24 hours. The absence of a high blood pressure during this examination, whereas there is a high blood pressure during the measurement in the physician’s office, defines an arterial hypertension called " white-coat hypertension ". WHITE COAT HYPERTENSION

EPINEPHRINE IN DENTISTRY : 

EPINEPHRINE IN DENTISTRY Epinephrine is widely used as an additive in local anesthetics . To improve the depth and duration of the anesthesia. To to reduce bleeding in the operative field. Epinephrine counteracts the anesthetic's localized vasodilator effects in subcutaneous and submucosal vessels, thereby reducing the risk of anesthetic toxicity by decreasing the rate of systemic absorption from the site of injection

ADRENALINE : 

ADRENALINE Through the direct action of epinephrine-greater probability of acute hypertensive crisis (dangerously high blood pressure), angina pectoris and myocardial infarction, as well as cardiac arrthymias. Brought about by the interaction of epinephrine and some antihypertensive medications-acute hypertensive or hypotensive crisis.

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Clinical studies have shown that epinephrine blood levels increase following its intraoral administration. The risk of this increase is dependent on characteristics of the patient. For example, hypertensive patients or those with other cardiovascular disease or patients taking other drugs that affect sympathetic nervous system function are at higher risk than patients without these conditions. Systemically absorbed epinephrine could also increase heart rate and exacerbate cardiac rhythm disturbances or myocardial ischemia.

2% Xylocaine® DENTAL with Adrenaline 1:80,000-Contraindications : 

2% Xylocaine® DENTAL with Adrenaline 1:80,000-Contraindications Patients with partial or complete heart block, due to the fact that local anaesthetics may depress myocardial conduction. Patients with advanced liver disease or severe renal dysfunction The elderly and patients in poor general condition. Patients on TRICYCLIC ANTIDEPRESSANTS Patients on BETA BLOCKERS.

INFECTIVE ENDOCARDITIS : 

INFECTIVE ENDOCARDITIS

Endocarditis Prophylaxis:Does It Make Sense? : 

Endocarditis Prophylaxis:Does It Make Sense? Cumulative risk of endocarditis resulting from bacteremia caused by daily activities is far greater than the risk of endocarditis resulting from a single dental procedure Scientists also found no compelling evidence that taking antibiotics before a dental procedure prevents IE in patients who are at risk of developing a heart infection. Their hearts already often are exposed to bacteria from the mouth that can enter their bloodstreams during basic daily activities such as brushing or flossing.

Endocarditis Prophylaxis:Does It Make Sense? : 

Endocarditis Prophylaxis:Does It Make Sense? All patients 1 in 14,000,000 • Patients with MVP with MR 1 in 1,096,824X13 • Patients with rheumatic disease 1 in 475,290X100 • Patients with prosthetic valve 1 in 114,069X125 • Patients with previous endocarditisx95058X150

DENTAL ASPECTS OF ENDOCARDITIS PROPHYLAXIS : 

DENTAL ASPECTS OF ENDOCARDITIS PROPHYLAXIS Procedures for Which Prophylaxis is Recommended : Dental ProceduresAll dental procedures that involve the manipulation of gingival tissue or the periapical region of teeth or perforation of the oral mucosa

EXCLUSIONS: : 

EXCLUSIONS: Excluded are: routine anesthetic injections through uninfected tissue, taking radiographs, placement of removable prosthodontic or orthodontic appliances, adjustment of orthodontic appliances, placement of orthodontic brackets, shedding of deciduous teeth, and bleeding from trauma to the lips or oral mucosa.

Guidelines From the American Heart Association : 

Guidelines From the American Heart Association Patients with: • Prosthetic heart valves • Previous infectious endocarditis • Cyanotic congenital heart disease • Congenital heart disease with indwelling shunts • Cardiac transplantation with valvular abnormalities

PREVENTION OF INFECTIVE ENDOCARDITIS-WALLET CARD : 

PREVENTION OF INFECTIVE ENDOCARDITIS-WALLET CARD Name: _________________________________________ needs protection from INFECTIVE (BACTERIAL) ENDOCARDITIS because of an existing heart condition. Diagnosis: ______________________________________ Prescribed by: __________________________________ Date: __________________________________________

Antibiotics before a dental visit are now recommended only for those heart Patients with artificial heart valves, heart transplant patients who develop cardiac valve problems, certain congenital heart disease, recipients of an artificial patch to repair a congenital defect within the past six months or patients with a history of IE. : 

Antibiotics before a dental visit are now recommended only for those heart Patients with artificial heart valves, heart transplant patients who develop cardiac valve problems, certain congenital heart disease, recipients of an artificial patch to repair a congenital defect within the past six months or patients with a history of IE. HIGH RISK: CLASS I Prosthetic heart valves Previous infective endocarditis Complex cyanotic congenital heart disease Transposition of great arteries Fallot’s tetralogy Gerbode’s defect Surgically constructed systemic pulmonary shunts or conduits Mitral valve prolapse with mitral regurgitation or thickened valve leaflets MODERATE RISK: CLASS II Acquired valvular heart disease eg: rheumatic heart disease Aortic stenosis Aortic regurgitation Mitral regurgitation Other structural cardiac defects eg: ventricular septal defect Bicuspid aortic valve Primum atrial sepal defect Patent Ductus Arteriosus Aortic root replacement Coarctation of aorta Atrial septal aneurysm/patent foramen ovale Ventricular septal defect Hypertrophic obstructive cardiomyopathy Subaortic membrane

WARFARIN AND DENTISTRY : 

WARFARIN AND DENTISTRY Warfarin (also known under the brand names Coumadin,is an anticoagulant. Warfarin decrease blood coagulation by inhibiting vitamin K epoxide reductase. Vitamin K antagonist.

Warfarin does not need to be stopped before primary care dental surgical procedures : 

Warfarin does not need to be stopped before primary care dental surgical procedures The risk of significant bleeding in patients on oral anticoagulants and with a stable INR in the therapeutic range 2-4, is low. The risk of thrombosis if anticoagulants are discontinued may be increased. Oral anticoagulants should not be discontinued in the majority of patients requiring out-patient dental treatment.

RISK STARTIFICATION : 

RISK STARTIFICATION High risk - mechanical mitral valve, ball-cage valve, venous thrombosis <3 months ago, hypercoagulable state, atrial fibrillation (AF) with a history of stroke, acute MI <3 months ago or recent stroke or TIA(<1 month ago). Intermediate risk - bileaflet tilting disc aortic valve with ≥2 stroke risk factors, chronic AF with >2 stroke risk factors, venous thromboembolism <6 months ago. Low risk - AF without stroke, cardiomyopathy without AF, venous thrombosis >6 months ago, bileaflet aortic valve and <2 stroke risk factors. Patients with prosthetic heart valves classed as high risk have a 9% to 22%

Recommendations: : 

Recommendations: In patients undergoing dental extractions, bleeding may be minimised by: a. The use of oxidised cellulose (‘Surgicel’) or collagen sponges and sutures b. 5% tranexamic acid mouthwashes used four times a day for 2 days .

ASPIRIN/PLAVIX & NSAIDS : 

Antiplatelet agent used to reduce the risk of stroke or heart attack in patients who have already had a heart attack or stroke, or have other circulatory problems due to narrowing and hardening of the arteries. ASPIRIN/PLAVIX & NSAIDS

Assessing the risk of thromboembolism versus potential bleeding : 

Assessing the risk of thromboembolism versus potential bleeding Is the surgery urgent or elective? Is the patient at high or low risk of thromboembolism if the drug is discontinued? Can the procedure be done safely without discontinuing the drug? What degree of risk are the patient and the provider willing to accept Finally, is the patient on a single antiplatelet drug or on combination therapy with another drug?

DENTAL MANAGEMENT : 

DENTAL MANAGEMENT

What is heart failure? : 

What is heart failure? Most people with heart failure have weakness on the left side of their heart, which is the side that pumps oxygen-rich blood to the body.

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Common symptoms of heart failure then include: • Long-lasting fatigue • Shortness of breath • Fluid buildup in the feet, ankles, and legs• Increased urination, especially at night• Chest pain • Rapid weight gain in one or two days• A dry, hacking cough that doesn't go away

DENTAL PROCEDURES IN CHF PATIENTS : 

DENTAL PROCEDURES IN CHF PATIENTS STABLE CHF OR CONTROLLED CHF MULTIPLE SHORT SITTINGS POSTURE DIURETERICS TO BE AVOIDED ON THE DAY

ACUTE PULMONARY OEDIMA-DENTIST APPROACH : 

ACUTE PULMONARY OEDIMA-DENTIST APPROACH Approach of the dental surgeon to acute lung edema After contacting the emergency service (telephone number 112), the patient is to be seated with the legs relaxed, and oxygen is to be administered by means of a mask or nasal catheter or cannula (4-6 liters/minute).

Sudden Cardiac Arrest : 

Sudden Cardiac Arrest A natural disaster hits, the power goes off and the lights go out. Ventricular fibrillation (V Fib) is the most common reason for sudden death in patients.

What are the symptoms of sudden cardiac arrest? : 

What are the symptoms of sudden cardiac arrest? Almost immediate loss of consciousness occurs, and the affected person will not be able to be aroused. The person will fall or slump over. No pulse will be able to be palpated, and there will be no signs of breathing.

CARDIOPULMONARY ARREST : 

CARDIOPULMONARY ARREST How is cardiopulmonary arrest diagnosed? The classical description of arrest includes the following: 1) absence of ventilation and cyanosis ("respiratory arrest"); 2) absence of a palpable pulse (pulse will disappear when systolic pressure < 60 mm Hg); 3) absence of heart sounds (heart sounds will disappear when systolic pressure < 50 mm Hg); 4) dilatation of the pupils.

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ARRYTHMIAS AND HEART Dr.A.K.KAPOOR. M.B;B.S,MD(Med),DM(Card),F.Card(Germany)FCCP(USA) Chairman-GETWELL MEDICAL CENTRE. Co-ordinator-Cardiology Canadian Specialist Hospital Head of the Cardiovasclar Division-Neurospinal Hospital Visiting Consultant –Welcare Hospital

VENTRICULAR TACHYCARDIA Bruguda syndrome : 

VENTRICULAR TACHYCARDIA Bruguda syndrome

CPRCardiopulmonary resuscitation (CPR) is a procedure to support and maintain breathing and circulation for a person who has stopped breathing (respiratory arrest) and/or whose heart has stopped (cardiac arrest). : 

CPRCardiopulmonary resuscitation (CPR) is a procedure to support and maintain breathing and circulation for a person who has stopped breathing (respiratory arrest) and/or whose heart has stopped (cardiac arrest). Cardiopulmonary resuscitation: The emergency substitution of heart and lung action to restore life to someone who appears dead. The two main components of conventional cardiopulmonary resuscitation (CPR) are chest compression to make the heart pump and mouth-to-mouth ventilation to breath for the victim

What is the treatment for sudden cardiac arrest?What Do I Do if I Witness Sudden Cardiac Arrest? : 

What is the treatment for sudden cardiac arrest?What Do I Do if I Witness Sudden Cardiac Arrest? Basic Life Support: A -- Establishment of an Airway. B -- Breathing support. C -- Circulation support. Advanced Life Support: D -- Diagnosis and Drugs. E -- Electrocardiography. F -- Fibrillation control. Prolonged Life Support: G -- Gauging a patient's response. H -- Hopeful measures for the brain I -- Intensive care.

C-----------P-------------R : 

C-----------P-------------R

Learn to Use an AED (Automated External Defibrillator) : 

Learn to Use an AED (Automated External Defibrillator) Each day about 600 people die in the US of sudden cardiac arrest. AEDs are not a substitute for CPR (cardiopulmonary resuscitation). Anyone trained to operate an AED must be trained in CPR, since early CPR is a critical step in resuscitation to help reestablish the circulation of blood and the delivery of oxygen to the body.

ANAPHYLACTIC SHOCK-BLUE OUT OF THE BOLT : 

ANAPHYLACTIC SHOCK-BLUE OUT OF THE BOLT A sudden, severe allergic reaction characterized by a sharp drop in blood pressure, urticaria, and breathing difficulties that is caused by exposure to a foreign substance

Emergency treatment : 

Emergency treatment Anaphylaxis is a life-threatening medical emergency because of rapid constriction of the airways. First aid measures for anaphylaxis include rescue breathing (part of CPR). The primary treatment for anaphylaxis is administration of epinephrine (adrenaline) . Antihistamines IM (such as chlorphenamine or diphenhydramine); Steroids, such as hydrocortisone or dexamethasone; IV Fluid administration. Pressor agents such as dopamine for hypotension. Oxygen. Intubation during transport to advanced medical care.

PREVENTIVE ASPECT:Healthy Dental Practices can Help to Prevent Heart Diseases : 

PREVENTIVE ASPECT:Healthy Dental Practices can Help to Prevent Heart Diseases Dentist detects heart problems

A CARDIAC PATIENT:RESPONSIBILITIES : 

A CARDIAC PATIENT:RESPONSIBILITIES As someone with heart disease, you have three responsibilities: Establish and maintain a healthy mouth. Practice good oral hygiene and visit your dentist regularly. Make sure your dentist knows you have a heart problem. Carefully follow your physician's and dentist's instructions when they prescribe special medications such as antibiotics. Ask your physician for an Infective Endocarditis Wallet Card and Anticoagulation card. Healthy lifestyle for healthy teeth and a healthy heart.

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THANK YOU SO MUCH