⚠️ No elective dental care.
- For emergency care, use analgesics and antibiotics as indicated.
- For invasive procedures, consult with patient’s cardiologist and be prepared to use continuous cardiac monitoring.
- Arrange for necessary medical attention.
- Have oxygen and nitroglycerin available.
- Use additional pain and anxiety control as indicated.
- Schedule late-morning or early-afternoon appointments.
- Schedule short appointments.
- Use local anesthetics judiciously.
- Use adjunct measures to reduce stress.
- No contraindication for using epinephrine.
- Be aware that chronic use of non-steroidal anti-inflammatory drugs may increase the risk of cardiovascular events in elderly patients with hypertension.
- Address patient’s anticoagulation therapy, if indicated.
⚠️ If the patient is also suffering from decompensated congestive heart failure (CHF), treat patient as if having unstable angina, until coronary stability has been verified by the patient’s physician.
| Drugs/ drug|
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- Medical Disorders
- Oral Health Care Considerations
- Laboratory Values
- Classifications and Definitions
- Adabag AS, et al. Sudden death after myocardial infarction. JAMA 2008;300:17:2022-2029.
- Chen TT, et al. Risk of Myocardial Infarction and Ischemic Stroke after Dental Treatments. JDR. 2019;98(2):157-163.
- Levy BI, et al. The many faces of myocardial ischaemia and angina. Cardiovasc Res. 2019 Aug 1;115(10):1460-1470.
- Schjerning Olsen A-M, et al. Duration of treatment with nonsteroidal anti-inflammatory drugs and impact on risk of death and recurrent myocardial infarction in patients with prior myocardial infarction: a nationwide cohort study. Circulation. 2011;123(20):2226-35.
- Skar D, et al. Dental procedures and risk of experiencing a second vascular event in a Medicare population. JADA. 2012;143(11):1190-8.
- Thygesen K, et al. Fourth universal definition of myocardial infarction (2018). J Am Coll Cardiol. 2018;72(18):2231–2264.
- Waks JW, et al. Risk Stratification for Sudden Cardiac Death After Myocardial Infarction. Annu Rev Med. 2018;69:147-164
- Coronary Heart Disease. National Heart, Lung, and Blood Institute. March 23, 2021.
- Cardiovascular Safety of Nonsteroidal Anti-inflammatory Drugs by Elgendy IY, et al. Medscape. The Heart.org. January 19, 2016.
- Framingham Risk Calculator
- Heart Diseases. Medline Plus. National Library of Medicine. May 19, 2021.
- What is cardiovascular disease. American Heart Association. May 31, 2017.