Professional Documents
Culture Documents
CONTENTS
CARDIOVASCULAR PROBLEMS
HYPERTENSION ISCHEMIC HEART DISEASE STROKE CONGESTIVE HEART FAILURES DIABETES MELLITUS ADRENAL INSUFFICIENCY HYPERTHYROIDISM HYPOTHYROIDISM
ENDOCRINAL DISORDERS
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HEMATOLOGICAL PROBLEMS
HEREDITARY COAGULOPATHIES THERAPEUTIC ANTICOAGULATION ASTHMA COPD RENAL DIALYSIS RENAL TRANSPLANT HEPATIC DISORDERS SEIZURES ETHANOLISM
Pulmonary problems
RENAL PROBLEMS
NEUROLOGICAL DISORDERS
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CARDIOVASCULAR PROBLEMS
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HYPERTENSION
Chronically elevated blood pressure for which the
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whenever administration of epinephrine- containing local anesthetic surpasses 0.04mg during a single visit
Use of anxiety reduction protocol Avoid rapid posture changes in patients taking drugs
better controlled
Consider referral to oral and maxillofacial surgeon for
emergency problems
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Progressive narrowing or spasm of one or more of the coronary arteries Discrepancy between the myocardial oxygen demand and 5/1/12 the ability of the coronary arteries to supply oxygen-
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Angina is a symptom of ischemic heart disease The myocardium becomes ischemic, producing a
heavy pressure or squeezing sensation in the patients substernal region that can radiate into the shoulder and arm and into the mandibular region. nausea,sweating and bradycardia.
Stimulation of vagal activity commonly occurs with Preventive measures that will reduce the anginal
episode-
exertion, responds to oral nitroglycerin and no recent increase in severity- ambulatory oral surgery procedures are safe when performed with proper precautions.
If anginal episodes occur after minimal exertion,
several doses of nitroglycerin are needed, patient has unstable angina- elective surgery is deferred. oral surgery can safely proceed, increased oxygen demand result in patient anxiety.
is used.
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BEFORE APPOINTMENT
Hypnotic to promote sleep on night before surgery
(optional)
surgery(optional)
After surgery
Succinct instructions for postoperative care Patient information on expected postsurgical sequelae
premedicated nitroglycerin
q Profound anesthesia best means of limiting anxiety q Avoid excessive epinephrine administration by
with a 1:100,000 concentration of epinephrine for a total adult dose of 0.04mg in any 30-minute period. vital signs
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death
Eventually necrotic+ surrounded by an area of reversibly ischemic myocardium Prone to serve as a nidus for dysrrhythmias
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MANAGEMENTv Patients physician consultation v Elective major surgical procedures be deferred until at
decrease coronary thrombogenesis, this information should be sought because it can affect surgical decision making
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to deliver the cardiac output demanded by the body or when excessive demands are placed on a normal myocardium.
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nocturnal
dyspnea,
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surgeon
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ENDOCRINE
DISORDERS
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DIABETE S MELLIT
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physician
appointment
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appointments
Use an anxiety reduction protocol Monitor pulse, respiration and blood pressure before,
Maintain verbal contact with the patient during If patient can eat or drink before oral surgery and will
have difficulty eating after surgery, instruct patient 5/1/12 to skip any oral hypoglycemic medications that day
ADRENAL INSUFFICIENCY:-
insufficiency
corticosteroid levels in response to physiologic stress may cause them to become- hypotensive, syncopal, nauseated, feverish during complex, prolonged surgery
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MANAGEMENT-
after surgery
Instruct patient to double usual daily dose on the day
If the patient is not currently on steroids, but has received at least 20mg of hydrocortisone ( cortisol or equivalent) for more than 2 weeks within past year:
Use anxiety reduction protocol Monitor pulse and blood pressure before, during,
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hydrocortisone (or equivalent) the day before and the morning of surgery (or the dentist should administer 60mg of hydrocortisone or equivalent intramuscularly or intravenously before complex surgery.
On the first 2 postsurgical days, the dose should
be dropped to 40mg and dropped to 20mg for 3 days thereafter. The clinician can cease administration supplemental steroids 6 days after surgery.
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triiodothyronine (T3) and thyronine(T4), caused in graves disease, multinodular goiter or thyroid adenoma
with agents that block thyroid hormone synthesis and release or with thyroidectomy or both.
v Patients left untreated or incompletely treated can
MANAGEMENT-
and inspection, GLAND SHOULD NOT BE PALPATED because it may trigger a crisis
Patient with treated thyroid disease can safely undergo
HYPOTHROIDISM: Dentist play a role in initial recognition Early symptoms- fatigue, constipation, weight loss,
hoarseness, headaches, arthralgia, menstrual disturbances, edema, dry skin, brittle hair and fingernails therapy required
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HEMATOLOGIC PROBLEMS
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HEREDITARY COAGULOPATHIES:-
or von Willibrand disease-managed by the perioperative administration of factor replacement and by use of an antifibrinolytic agent, such as
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MANAGEMENT-
(prothrombin time, partial thromboplastin time, Ivy bleeding time, platelet count) and a hepatitis screen
implanted devices, such as prosthetic heart valves; with thrombogenic cardiovascular problems such as arterial fibrillation or post-MI; or with a need for extracorporeal blood flow, such as for hemodialysis properties, such as aspirin, as a secondary effect
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stopping the anticoagulant drug for several days drugs have been stopped for 5 days
5. Stop warfarin approximately 2 days before surgery 6. Check the PT daily and proceed with surgery on the
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safety of stopping heparin for the perioperative period heparin is stopped or reverse heparin with protamine
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PULMONARY PROBLEMS
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ASTHMA-
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such as, tobacco smoke, that cause metaplasia of pulmonary airway Airways are disrupted Lose their elastic properties Become obstructed because of mucosal edema, excessive secretions and bronchospasm
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MANAGEMENT
Bronchodilators like theophylline are
prescribed
Severe cases corticosteroids are given Only in most severe chronic cases-
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treatment is possible
Listen to chest bilaterally with stethoscope to determine
respiratory depressants
If patient is on chronic oxygen supplementation, continue
at prescribed flow rate. If patient is not on supplemental oxygen therapy, consult physician before administering oxygen
If patient chronically receives corticosteroid therapy,
RENAL PROBLEMS
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excretion. Modify the dose if such drugs are necessary antiinflammatory drugs
v Avoid use of nephrotoxic drugs, such as nonsteroidal v Defer dental care until the day after dialysis has
been given
v Consult physician concerning use of prophylactic
antibiotics
v Monitor blood pressure and heart rate 5/1/12
RENAL TRANSPLANT AND TRANSPLANT OF OTHER ORGANS:MANAGEMENTv Defer treatment until primary care physician or v Avoid use of nephrotoxic drugs. v Consider use of supplemental corticosteroids. v Monitor blood pressure.
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gingival hyperplasia. Emphasize importance of oral hygiene particularly for patients on immunosuppressive agents
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HEPATIC DISORDERS
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infectious disease, ethanol abuse or vascular or biliary congestion requires special consideration before oral surgery is performed
NEUROLOGIC DISORDERS
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about the frequency, type, duration and sequelae of seizures hypoglycemia, or traumatic brain damage or can be idiopathic.
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controlled
ETHANOLISM (ALCOHOLISM):-
Hepatic insufficiency Ethanol and medication interaction Withdrawal phenomena anxiety reduction protocol 5/1/12
phenomenon in the perioperative period if they hav acutely lowered their daily ethanol intake before seeking dental care.
Phenomenon exhibit- mild agitation, tremors,
seizure, diaphoresis.
Rarely, delirium tremens with hallucinations,
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disease or signs of ethanol withdrawal- should be treated in the hospital setting consultation before surgery are desirable
Liver function tests, a coagulation profile, medical In patients treated on an ambulatory basis, dose of
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drugs metabolize in the liver should be altered and patients should be monitored closely for signs of oversedation
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