Key Points
Signs and symptoms:
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Patients will recognise this for what it is
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Pain is transient, usually retro-sternal
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Pain may radiate to neck and arms Treatment:
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Allow patients to treat the attack themselves
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Normally safe to continue treatment if patient wishes
For myocardial infarction (MI):
Signs and symptoms:
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Prolonged severe retro-sternal chest pain suggests MI
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Patient may be cold, clammy, nauseous and frightened
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Pain is not relieved by GTN Treatment:
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Summon ambulance
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Give Aspirin to chew, plus GTN
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Oxygen is helpful
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Gain venous access if possible
Abstract
The provision of dental treatment under both local anaesthesia and sedation has an excellent safety record, although medical problems may occur. The high prevalence of cardiac disease in the population, particularly ischaemic heart disease, makes it the most common medical problem encountered in dental practice. Additionally, the increasing survival of children with congenital heart disease makes them a significant proportion of those attending for dental treatment. While most dental practitioners feel confident in performing cardio-pulmonary resuscitation, treating patients with co-existent cardio-vascular disease often causes concern over potential problems during treatment. This article aims to allay many of these fears by describing the commoner cardiac conditions and how they may affect dental treatment. It outlines prophylactic and remediable measures that may be taken to enable safe delivery of dental care.
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References
Chapman P J Medical emergencies in dental practice and choice of emergency drugs and equipment: a survey of Australian dentists. Aust Dent J 1997; 42: 103–108.
Peacock M E, Carson R E Frequency of self-reported medical conditions in periodontal patients. J Periodontol 1995; 66: 1004–1007.
Absi E G, Satterthwaite J Shepherd J P, Thomas D W The appropriateness of referral of medically compromised dental patients to hospital. Br J Oral Maxillofac Surg 1997; 35: 133–136.
Jainkittivong A, Yeh C K Guest G F, Cottone J A Evaluation of medical consultations in a predoctoral dental clinic. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1995; 80: 409–413.
Cintron G, Medina R Reyes A A, Lyman G Cardiovascular effects and safety of dental anaesthesia and dental interventions in patients with recent uncomplicated myocardial infarction. Arch Intern Med 1986; 146: 2203–2204.
McCarthy F M Safe treatment of the post heart attack patient. Compend Contin Educ Dent 1989; 10: 598–604.
Hansson L, Zanchetti A Carruthers S G Effects of intensive blood pressure lowering and low dose aspirin in patients with hypertension: principle results of the hypertension optimisation treatment (HOT) randomised trial. Lancet 1998; 351: 1755–1762.
Colhoun H M, Dong W Poulter N R Blood pressure screening, management and control in England 1994. J Hypertension 1998; 16: 747–753.
Brand H S, Abraham-Inpijn L Cardiovascular responses induced by dental treatment. Eur J Oral Sc 1996; 104: 245–252.
Lu D P, Lu G P Hypnosis and pharmacological sedation for medically compromised patients. Compend Contin Educ Dent 1996; 17: 32–40.
Campbell R L, Langston W G Ross G A A comparison of cardiac rate-pressure product and pressure-rate quotient with Holter monitoring in patients with hypertension and cardiovascular disease: a follow-up report. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1997; 84: 125–128.
Blinder D, Shemesh J Taicher S Electrocardiographic changes in cardiac patients undergoing dental extractions under local anaesthesia. J Oral Maxillofac Surg 1996; 54: 162–165.
Jowett N I Electrocardiographic monitoring. In: Cardiovascular Monitoring 1997 London: Whurr Publishers, pp: 35–61.
General anaesthesia, sedation and resuscitation in dentistry. Report of an expert working party. London: Department of Health, 1990.
Umino M, Ohwatari T Shimoyama K, Nagao M Unexpected atrial fibrillation during tooth extraction in a sedated elderly patient. Anaesthesia Progress 1994; 41: 77–80.
Miller C S, Leonelli F M and Latham E Selective interference with pacemaker activity by electrical dental devices. Oral Surg Oral Med Oral Pathol Oral Radiol & Endod 1998; 85: 33–36.
Tinker J H, Tarhan S Discontinuing anti-coagulant therapy in surgical patients with cardiac valve prostheses. J Am Med Ass 1978; 239: 738.
Purcell C A Dental management of the anti-coagulated patient. N Z Dent J 1997; 93: 87–92.
Weibert R T Oral anti-coagulation therapy in patients undergoing dental surgery. Clin Pharmacy 1992; 11: 857–864.
Ranstrom G, Sindet-Pedersen S Hall G, Blomback M, Alander U Prevention of post-surgical bleeding in oral surgery using tranexamic acid without dose modification of oral anticoagulants. J Oral Maxillofac Surg 1993; 51: 1211–1216.
Pemberton M N, Sloan P Ariyaratnam S, Thakker N S, Thornhill M H Derangement of warfarin anti-coagulation by miconazole oral gel. Br Dent J 1998; 184: 68–69.
Franco F, Saunders C P Roberts G J, Suwanprasit A Dental disease, caries related microflora and salivary IgA of children with severe congenital cardiac disease: an epidemiological and oral microbial survey. Pediatr Dent 1996; 18: 228–235.
Hallett K B, Radford D J Seow W K Oral health of children with congenital cardiac diseases: a controlled study. Pediatr Dent 1992; 4: 224–230.
Droz D, Koch L Lenain A, Michalski H Bacterial endocarditis: results of a survey in a children's hospital in France. Br Dent J 1997; 183: 101–105.
Saunders C P, Roberts G J Dental attitudes, knowledge and health practices of parents of children with congenital heart disease. Arch Dis Child 1997; 76: 539–540.
Cetta F, Warnes C A Adults with congenital heart disease: patient knowledge of endocarditis prophylaxis. Mayo Clin Proc 1995; 70: 50–54.
Goulet J P, Perusse R Turcotte J Y Contra-indications to vasoconstrictors in dentistry: Part III. Pharmacologic interactions. Oral Surg Oral Med Oral Pathol 1993; 74: 692–697.
Perusse R, Goulet J P Turcotte J Y Contra-indications to vasoconstrictors in dentistry: Part 1. Cardiovascular diseases. Oral Surg Oral Med Oral Pathol 1993; 74: 679–686.
Wright J M Oral manifestations of drug reactions. Dent Clin North Am 1984; 28: 529–543.
Seymour R A Calcium channel blockers and gingival overgrowth. Br Dent J 1991; 170: 376–379.
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Jowett, N., Cabot, L. Patients with cardiac disease: considerations for the dental practitioner. Br Dent J 189, 297–302 (2000). https://doi.org/10.1038/sj.bdj.4800750
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DOI: https://doi.org/10.1038/sj.bdj.4800750
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