Table 3.27.
Key considerations in dental management in cardiac failure (see text)
| Management modifications* | Comments/possible complications | |
|---|---|---|
| Risk assessment | 3 | Arrhythmias; angina; vomiting; coughing; leucopenia; bleeding tendency; emergency protocol |
| Appropriate dental care | 3/4 | |
| Pain and anxiety control | ||
| – Local anaesthesia | 1 | Reduce epinephrine dose; epinephrine interacts with beta-blockers; avoid bupivacaine |
| – Conscious sedation | 3/4 | |
| – General anaesthesia | 5 | |
| Patient access and positioning | ||
| – Access to dental office | 0 | |
| – Timing of treatment | 1 | Late morning |
| – Patient positioning | 1 | Upright position |
| Treatment modification | Grade of cardiac failure; cardiac monitoring | |
| – Oral surgery | 3 | |
| – Implantology | 3 | |
| – Conservative/Endodontics | 1 | Avoid gingival retraction cords containing epinephrine |
| – Fixed prosthetics | 1 | |
| – Removable prosthetics | 1 | |
| – Non-surgical periodontology | 3 | |
| – Surgical periodontology | 3 | |
| Hazardous and contraindicated drugs | 1 | Avoid erythromycin, tetracycline, itraconazole, NSAIDs |
*
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.