Question

Frank Castinelli is 55 years old, is slightly overweight, and has been coming to your practice for close to 10 years. He has a somewhat stressful job that takes up quite a bit of his time. His medications include: nitroglycerin sublingual tablets for angina, Ibuprofen for aches and pains, antacids for heartburn.

Mr. Castinelli comes in today for a schedule oral health maintenance examination and tells you that he suffered a heart attack and was diagnosed with hypertension approximately 4 months ago. He is now taking an angiotensin-converting enzyme (ACE inhibitor) to treat high blood pressure, simvastatin for high cholesterol, and an aspirin a day to prevent a second heart attach. Unfortunately, you find two cavities during you examination of Mr. Castinelli that need to be addressed.

1. Would you and the dentist recommend that Mr. Castinelli have his cavities filled within the next 2 weeks? Why or why not?

2. Can you use a local anesthetic with a vasoconstrictor in a patient with hypertension?

3. What would be an appropriate cardiac dose of a vasoconstrictor?

Answer 1

Frank cristallin Having Heart disease with Hypertension .Present finding was dental cavities.

1. Yes .we should notify the problem to patient and recommend for dentist visit.Because poor dental health increase the risk of bacterial infections in the blood stream ,which can affect the blood valves .Tooth loss pattern also connected to Coronary Artery disease.

Patient already suffering with heart attack if didn't take treatment for cavities increase the risk of consequent problem's of heart.

*** Patients suffering from cardi vascular disease are vulnerable to physiological and emotional stress.so better to inform their Care givers about present complaints.** If patient undergoing dental procedure need to inform dentist about his cardiac problem because due to stress and anesthesia during dental treatment Cardiac patient may collapse due to various cardiac emergencies.

2.Local anesthesia is have importance during dental procedure.we can't give comfortable to the patient with out anesthesia .

But Patient with the cardiac problem there is need to adjust local anaesthetic dose.Because Local anaesthetic and vaso constrictor EPINEPHRINE used widely ,normal dose also affect cardiac patient.

3.Appropriate cardiac dose of Vaso constrictor 0.04mg.

Normal condition dose was 0.2 mg.

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