Unstable angina - defer elective treatment. If care is necessary, consult physician.
Management may include IV use, sedation, EKG monitoring, pulse
... [Show More] oximeter,
oxygen, caution with vasoconstrictors, phophylactic nitroglycerin
Stable angina - reduce stress/anxiety with use of oral/inhalation sedation. Pts on
nonselective beta blockers - limit epi to <2 cartridges, avoid retraction cord, avoid
anticholinergics, provide LA of excellent quality for pain control.
Previous myocardial infarction
Patient may have some degree of heart failure, may have a pacemaker, may be
taking a nonselective beta blocker, may be taking aspirin or another platelet
aggregation inhibitor or warfarin (Coumadin).
Recent MI (<1 month) - major risk; defer elective dental care. If needed, consult
physician; management may include establishment of IV line, sedation, EKG, pulse
oximeter, oxygen, phophylactic nitroglycerin
Past MI (>1 month) - same precautions as stable angina plus manage excessive
bleeding due to medications. If patient is on Warfarin, INR should be <3.5 before
performance of invasive proceudres. If patient has a pacemaker or implanted
defibrillator, avoid use of electrosurgery and ultrasonic scalers (abx pre-med NOT
recommended)
Arrhythmias
High-risk arrhythmia - high-grade AV block, symptomatic ventricular arrhythmia,
supraventricular arrhythmia with uncontrolled ventricular rate. Limit dental tx to
urgent care only (tx of acute infection, bleeding or pain).
Many of the same precautions as stable/unstable angina and history of MI.
Patient may be taking digoxin for arrhythmia. Avoid use of epinephrine due to
increased risk of inducing arrhythmia. Be observant for signs of digoxin toxicity
(hypersalivation).
COPD
Treatment may aggravate and/or worsen the already compromised respiratory
function.
Avoid treating if upper respiratory infection is present
Use an upright chair position
Avoid use of bilateral local anesthesia (mandibular/palatal blocks)
Do NOT use rubber dam in patients with severe disease (hmmmm)
Use pulse oximetry to monitor oxygen
Use low-flow oxygen
Don't use nitrous-oxygen sedation in patients with severe emphysema
Low-dose diazepam is acceptable
Avoid barbiturates, narcotics, antihistamines and anticholinergics
Avoid macrolide antibiotics (erythromycin, clarithromycin) and ciprofloxacin for
patients who are taking theophylline
Outpatient general anesthesia is contraindicated
Asthma
Dental treatment may result in precipitation of acute asthma attack [Show Less]