MH Considerations Flashcards
Give the possible MH contraindications in oral surgery
High BP
Angina
Recent MI
Cardiac defects
Liver disease
Kidney disease
Diabetes
Epilepsy
Haemophilia / VWB
Anticoagulant therapy
Antiplatelet therapy
Chemotherapy / radiotherapy
Bisphosphonates
Why may high BP be a contraindication to tx?
Recommendations?
Risk of MI and More prone to bleeding
LA with no vasoconstrictor is recommended
Consider postpone if 160/100
Why may angina be contraindication to tx? Recommendations?
Risk of angina attack or MI during tx
- enquire about frequency of angina
- controlled or uncontrolled
- ensure GTN spray on hand
When may recent MI be a contraindication to tx? Recommendations?
Risk of another MI
- No extractions within 3 months of MI
- no GA within 6 months
Why might cardiac defects be contraindication to tx? Recommendations
Cardiac defects such as valve replacement or previous endocarditis are at increased risk of bacteremia and IE
- liaise with patients cardiologist before any XLA
- reinforce OH
Why is liver disease sometimes a contraindication to tx? Recommendations?
Impaired blood clotting
Immunosuppressed
Cross infection risk if hep B,C,D
Impaired first pass metabolism
- consider full blood screen
- check BNF for appropriate drug regime
- liaise with physician
Why may kidney disease be contraindication to tx? Recommendations?
Immunocompromised
Bleeding - platelet dysfunction
- treat dialysis patient during day after dialysis so kidneys at optimum function
- reduce max LA doseage
Why may diabetes impact dental tx? Recommendations?
Impaired wound healing - high blood sugar results in immunocompromised
- poorly controlled diabetes
Hypoglycaemia risk
- know hypoglycaemia medical emergencies
- blood glucose between 5-15mmol/L
- morning appts
How may epilepsy influence dental tx?
Seizures due to stress of dental Tx
- know their type of seizures and management, and frequency
- issues with dentures / removeable pros
- IV sedation can be indicated due to anticonvulsant effects
- ensure pt eaten before extraction
Considerations in patients with haemophilia / VWD?
What type?
- possible factor assay?
A =. Factor 8
B = Factor 9
VWB - VWB factor
Safe factor is 50-75% factor vIII
Considerations of radiotherapy / chemotherapy in head and neck with tx? Recommendations?
Thrombocytopenia - bleeding
Neutropenia - infection
ORN risk
- platelets must be 50x10^9 / 5.0x10^10 (real standard form)
- avoid extractions
- atraumatic and aseptic if need
- ensure good oral hygiene
Considerations of bisphosphonates? Recommendations?
MRONJ risk
- if on them for >5 years
- on concurrent glucocorticoids
- being treated for cancer
- previous MRONJ risk
- liaise with physician
