Table 3.94.

Key considerations for dental management in ischaemic heart disease (see text)

	Management modifications*	Comments/possible complications
Risk assessment	2/3	Angina; MI; hypertension
Appropriate dental care	2/4	Evaluate type of IHD and dental intervention; sedation; preoperative glyceryl trinitrate
Pain and anxiety control
– Local anaesthesia	2	Avoid lidocaine and epinephrine
– Conscious sedation	3/4	Delay 6 months after MI and other conditions
– General anaesthesia	3/4	Delay 6 months after MI and other conditions; avoid barbiturates
Patient access and positioning
– Access to dental office	0
– Timing of treatment	1	Late morning or early afternoon
– Patient positioning	1	Upright position; orthostatic hypotension
Treatment modification
– Oral surgery	3
– Implantology	3
– Conservative/Endodontics	2
– Fixed prosthetics	2
– Removable prosthetics	2
– Non-surgical periodontology	3
– Surgical periodontology	3
Hazardous and contraindicated drugs	2	Some patients are on anticoagulants; avoid NSAID usage for more than 3 weeks; avoid antimicrobials which affect other drugs

^*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.