Table 3.14.

Key considerations for dental management in aortic valve disease (see text)

	Management modifications*	Comments/possible complications
Risk assessment	2	Infective endocarditis; antibiotic prophylaxis
Preventive dentistry and education		Thorough assessment; stabilisation essential to minimise risk of infective endocarditis
Pain and anxiety control
– Local anaesthesia	1	Aspirating syringe
– Conscious sedation	3/4
– General anaesthesia	3/4
Patient access and positioning
– Access to dental office	0
– Timing of treatment	1	Delay 6 months after cardiac surgery
– Patient positioning	0
Treatment modification
– Oral surgery	1	Monitor pulse and blood pressure
– Implantology	1
– Conservative/Endodontics	1
– Fixed prosthetics	1
– Removable prosthetics	0
– Non-surgical periodontology	1
– Surgical periodontology	1
Hazardous and contraindicated drugs	2	Some patients are treated with anticoagulants

^*0 = No special considerations. 1 = Caution advised. 2 = Specialised medical advice recommended in some cases. 3 = Specialised medical advice mandatory. 4 = Only to be performed in hospital environment. 5 = Should be avoided.