DENTAL MANAGEMENT OF MEDICALLY COMPROMISED PATIENT LEARNING OBJECTIVES Dental management of Cardiovascular disease & Hypertension Dental management of diabetes mellitus Dental management of asthma Dental management of chronic renal failure DR.S.KARTHIGA KANNAN PROFESSOR ORAL MEDICINE & RADIOLOGY CARDIAC DYSFUNCTION Cardiac dysfunction consists of numerous clinical entities. Problems of concerns to the Dental surgeon include: Types cadiac dysfunction 1. Coronary artery occlusive disease Angina pectoris Myocardial infarction. 2. Infective endocarditis. Risk factors A. Fixed: 1. Familial history. 2. Age. 3. Male. B. Modifiable: 1. Smoking. 2. Hypertension. 3. Lipid disorders. 4. Diabetes mellitus. 5. Obesity. General consideration: A. Short appointments B. Use of sedative agents Oral or IV diazepam (valium) C. Need for oxygen: 1. Breathing oxygen allows good tissue perfusion with decreased cardiac output and heart rate. 2. Myocardial oxygenation is improved, which makes ischemia less likely. D. Tri-nitroglycerine (TNG). Angina, triggered by situational anxiety - administer sublingual nitroglycerin just before injection of the LA agent. Relative contraindications of vasoconstrictors: 1. Severe uncontrolled hypertension. 2. Recent myocardial infarction ( 6 months). 3. Recent stroke ( 6 months). 4. Unstable angina. 5. Recent coronary artery bypass graft ( 6 months). 6. Refractory arrhythmia. DENTAL MANAGEMENT OF CARDIAC PATIENT Dental management of a patient with unstable angina pectoris or with recent Myocardial infarction Duration