What blood pressure reading requires deferring
dental treatment and directing patient to their primary
care provider or the ER?
180/110
What is the cause of 90% of hypertension diagnoses?
Unknown causes, usually primary hypertension.
When get a high blood pressure reading, what should you ask the patient?
What are your symptoms? Are you in any pain?
What dental instruments are contraindicated in patient with a pacemaker?
- Electrosurgery
- Ultrasonic scalers
- Battery operated curing lights
If patient has atrial fibrillation, what does this mean is going on in the heart?
Atrium not pumping correctly. Some blood inside will
be static. Static blood clots
What is the expected treatment/medical prescription for atrial fibrillation?
MD will prescribe anticoagulant (Coumadin or Warfarin) to avoid clotting in atrium
If patient is taking an anticoagulant, what must their INR be for minor oral surgery (single tooth extraction)?
Therapeutic range (2.0-3.5). Consider packing foam and suturing after EXT.
What is the ideal time span for an INR?
The day of surgery
What type of procedure can you perform if the INR is in the 2.0-3.5 range?
Simple EXT, e.g. perio involved tooth. NOT a boney
impacted #16
How many carpules of local anesthesia with 1:200,000 epi can be administered in a patient with hypertension?
2 carpules
What is the term for stenosis of the arteries that brings nutrients and oxygen to the heart itself so it can function?
Coronary artery disease
What is the term for and ultrasound of the heart to look at heart structure and check ejection fraction?
Echocardiogram
What is the term for an electrical picture of the heart?
Electrocardiogram (ECG/EKG)
What is the term for a balloon blown up in the vein to break up an
occlusion?
Angioplasty
What is the term for metal mesh holding a blood vessel open?
Stent
What is the term for the procedure whereby you bypass a part of a coronary artery that is blocked?
Bypass surgery
What are 3 questions to ask to assess patients risk for the
procedure you will perform?
- Severity of the patient’s disease
- Type of procedure planned
- How is patient right now
What risk level is basic dental operative considered?
Low cardio risk
Gauging a patient’s ability to perform normalphysical activity is gauging their what?
Functional capacity
The Metabolic Equivalents of Tasks (METs), which isna method to determine a person’s functional capacity, quantifies what?
The body’s use of oxygen
A MET is equivalent to what with respect to oxygen?
MET is a unit of oxygen consumption
1 MET = 3.5 mL of O2/kg of body wt/minute at rest
A patient is at risk of a perioperative cardiovascular event if they do not meet what MET level?
4-MET
What are some types of CV disease?
HTN Arrhythmia Ischemic heart disease/coronary artery disease Heart failure Infective endocarditis Cardiomyopathy Inflammatory heart disease
What are the limits for stage 1 hypertension?
140-159 sys or 90-99 dias
What are the limits of stage 2 hypertenion?
> 160 sys or >100 dias
If the patient has had a balloon angioplasty, how many days after the angioplasty must you wait before you perform head and neck surgery with aspirin?
More than 14 days
If the patient has a bare-metal stent placed, how many days after the placement should you wait before you perform head and neck surgery with aspirin?
More than 30-45 days
If the patient has had a drug-eluting stent placed, how long should you wait after the placement before you perform a head and neck surgery on that patient with aspiring?
More than 365 days
Can EPI be given to a pt with mild/stable angina or a past history or MI?
Yes, no more than 2 carpules (0.036 mg) at a time
If a patient has unstable angina or a recent MI, can they be given EPI?
Yes, nor more than 2 carpules (0.036mg ) at a time.Consider prophylactic nitroglycerin before procedure
What are some heart conditions that require prophylaxis prior to dental procedures?
- Prosthetic cardiac valve
- Previous infective endocarditis
- Congenital Heart Disease
- unrepaired cyanotic
- repaired cyanotic but w/in 6 months of repair -repaired cyanotic, but w/residual defects - Transplant that develops valvulopathy
If a patient requiring antibiotic prophylaxis for
cardiac reasons has bleeding from trauma to the lips or oral mucosa, is antibiotic prophylaxis indicated?
No
When is antibiotic prophylaxis indicated for dentistry?
All dental procedures involving manipulation of gingival tissue or periapical region of teeth or perforation of the oral mucosa
Does perforation of the oral mucosa include routine anesthetic injections through noninfected tissue?
No
In patients where antibiotic prophylaxis is indicated, how long before the procedure should the antibiotics be given?
30-60 minutes before the procedure
What is the prophylactic dosage for orally administered amoxicillin?
2 g adult
50 mg/kg child
What is the prophylactic dosage for IV or IM Ampicillin (unable to take oral amoxicillin)?
2 g adult
50 mg/kg child
What is the prophylactic dosage for IV or IM Cefazolin or Ceftriaxone (unable to takeoral amoxicillin)?
1 g adult
50 mg/kg child
If the patient is allergic to penicillin or ampicillin, what are alternatives for prophylaxis?
Cephalexin
Clindamycin
Azithromycin
Clarithromycin
What is the regimen for prophylaxis with cephalexin (penicillin or ampicillin allergy)?
2g adult
50mg/kg child
What is the regimen for prophylaxis for clindamycin (penicillin or ampicillin allergy)?
600 mg adult
20 mg/kg child
What is the prophylactic regimen for Azithromycin/Clarithromycin (penicillin orampicillin allergy)?
500 mg adult
15 mg/kg child
If the patient is allergic to penicillin or ampicillin and unable totake Cephalexin, Clindamycine, Azithromycin,
Clarithromycin orally, what is the alternative for prophylaxis?
Cefazolin or Ceftriaxone IV/IM
Clindamycin phosphate IV/IM
What is the prophylactic regimen for Cefazolin/Ceftriaxone IV or IM for prophylaxis (penicillin or ampicllin allergy and unable oral)?
1 g adult
50 mg/kg child
What is the prophylactic regimen for Clindamycin phosphate IV or IM for prophylaxis (penicillin or ampicillin allergy and unable oral)?
600 mg adult 20mg/kg child
What is an acronym for treating Acute Coronary Syndrome that incorporates IV?
A-airway B-breathing C-circulation O-oxygen M-monitor I- IV
What is an acronymn for treating Acute Coronary Syndrome that incorporates aspirin and nitroglycerine?
M-Morphine
O-Oxygen
N-Nitroglycerin
A-aspirin