3Considerations of systemic disease in OMFS Rheumatic fever and rheumatic heart disease …infective endocarditis (2g PC)Congenital heart disease … infective endocarditis , prolong bleeding time(thrombosis in small vessels)Surgical corrected cardiovascular lesions …anticoagulant prolong bleeding time , endocarditis
4Considerations of systemic disease in OMFS Artificial heart valves …anticoagulant prolong bleeding time , endocarditisPremedication : amoxicillin 2g , child 50mg/kgHeart transplant : suppression of immune, anticoagulant, high steroid , may need supplementation
5AHA Prevention of Infective Endocarditis guideline(2007) Conclusionsﾑ The major changes in the updated recommendations include the following: (1) The Committee concluded that only an extremely small number of cases of infective endocarditis might be prevented by antibiotic prophylaxis for dental procedures even if such prophylactic therapy were 100% effective. (2) Infective endocarditis prophylaxis for dental procedures is reasonable only for patients with underlying cardiac conditions associated with the highest risk of adverse outcome from infective endocarditis. (3) For patients with these underlying cardiac conditions, prophylaxis is reasonable for all dental procedures that involve manipulation of gingival tissue or the periapical region of teeth or perforation of the oral mucosa. (4) Prophylaxis is not recommended based solely on an increased lifetime risk of acquisition of infective endocarditis. (5) Administration of antibiotics solely to prevent endocarditis is not recommended for patients who undergo a genitourinary or gastrointestinal tract procedure. These changes are intended to define more clearly when infective endocarditis prophylaxis is or is not recommended and to provide more uniform and consistent global recommendations.
6Table 5. Regimens for a Dental Procedure Situation Agent Regimen: Single Dose 30 to 60 min Before ProcedureAdults ChildrenOral Amoxicillin g mg/kg Unable to take oral medicationAmpicillin g IM or IV mg/kg IM or IV Cefazolin or ceftriaxone g IM or IV 50 mg/kg IM or IVAllergic to penicillins or ampicillinﾑoral Cephalexin* OR Clindamycin OR Azithromycin or clarithromycin 2 g 600 mg 500 mg 50 mg/kg 20 mg/kg 15 mg/kg Allergic to penicillins or ampicillin and unable to take oral medication Cefazolin or ceftriaxone OR Clindamycin 1 g IM or IV 600 mg IM or IV 50 mg/kg IM or IV 20 mg/kg IM or IV IM indicates intramuscular; IV, intravenous. *Or other first- or second-generation oral cephalosporin in equivalent adult or pediatric dosage. Cephalosporins should not be used in an individual with a history of anaphylaxis, angioedema, or urticaria with penicillins or ampicillin.
7Considerations of systemic disease in OMFS Angina pectoris … stress and anxiety, MI, sudden death … nitroglycerinMyocardial infarction … arrest, congestive heart failure, bleeding for anticoagulant, pacemaker cause infective endocarditis , >6month saver, morning, short visit, diazapam for stress, anticoagulant cause bleeding, no electric if pacemaker
8Considerations of systemic disease in OMFS Arrythmia … stress, cardiac arrest, pacemaker /no electricCongestive heart failure … bleeding for thrombosis in vessels, CVA, short of breath,AIDS … infection, bleedingDM … infection, poor wound healing , avoid hypoglycemia
9Considerations of systemic disease in OMFS Hyperthyroidism … thyroid storm, avoid epinephrineHypothyroidism … hypothyroid coma , sensitive to narcotic, tranquilizerAnaphylaxis … vital sign , epinephrine (Bosmin) to tongueLeukemia … infection, bleeding, delayed healing
10Considerations of systemic disease in OMFS Radiation … mucositis , xerostomia , loss of taste, constricture of muscle , infection ( candida) sensitive of teeth , cervical caries , osteonecrosis , trismusChemotherapy … bleeding for bone marrow suppression , infection , anemia , leukopeniaOsteoporosis…Foxamax…BRONJ(bisphosphonte related osteonecrosis of jaws)
11Considerations of systemic disease in OMFS Chronic obstructive pulmonary disease (COPD) …upright position , avoid bilateral mandibular or palatal block, avoid rubber dam , low flow O2 , sedation with N2O+O2, if use steroid need supplementationOsteoarthritis … aspirin cause bleeding
12Considerations of systemic disease in OMFS Hypertension … hypertension crisis, CVA, use 1: epi , less than 3 cartridgesAsthma … avoid precipitating factors, bring inhaler, avoid aspirin, narcotic, NSAID, erythromycin (if take theophyllin) avoid sulfite-containing local , recent steroid need supplementation , stress free
13Considerations of systemic disease in OMFS HBV …contracted by dentist from infectious patient, most carrier are undetectable by history, all patients should be treated with strict aseptic approachAlcoholic liver disease … bleeding tendencies
14Considerations of systemic disease in OMFS Hemodialysis … bleeding , hypertension , anemia , nephrotoxic drugs , AV shunt infection ,hepatitisRenal transplant …steoid, infection due to immunosuppressivePregnancy and lactation … radiation , drug, stress harm to fetus, supine hypotension , drug transmit by breast
15Considerations of systemic disease in OMFS Rheumatoid arthritis (RA) … bleeding for aspirin and NSAID ,steroid usageStroke … aspirin , coumarin cause bleeding , short appointment, check BP , minimum epi. Avoid epi. CordAdrenal insufficiency … stress, delayed healing , infection , hypertension