ORAL SURGERY 1  Events that tend  Severity of

TOPIC: Management of Patients with Compromising to precipitate the angina

Medical Conditions angina
 Frequency &  Response to
duration medications or
CARDIOVASCULAR PROBLEMS:
diminished
Ischemic Heart Disease: activity
ANGINA PECTORIS DYSRHYTHMIAS
HEART ABNORMALITIES
*If the PATIENT’S ANGINA ARISE only during
MYOCARDIAL INFACTION THAT PREDISPOSE TO
INFECTIVE ENDOCARDITIS MODERATELY VIGOROUS EXERTION, RESPONDS
CEREBROVASCULAR CONGESTIVE HEART FAILURE READILY TO REST and ORAL NITROGLYCERIN
ACCIDENT (STROKE) (HYPERTROPHIC ADMINISTRATION and if NO RECENT INCREASE IN
CARDIOMYOPATHY)
SEVERITY. AMBULATORY ORAL PROCEDURES are
usually safe when performed with proper precautions.
ANGINA PECTORIS:
However,
 Angina from Greek word “a choking sensation”
If the PATIENTS ANGINAL EPISODES only occur with
 NARROWING OF MYOCARDIAL ARTERIES is one
MINIMAL EXERTION, if several DOSES OF
of the MOST common health problems that
NITROGLYCERIN are NEEDED TO RELIEVE CHEST
dentist encounters
DISCOMFORT, or if the patient has UNSTABLE ANGINA.
 Occurs primarily in MEND older than 40y.o. and
ELECTIVE SURGERY should be POSTPONED and patient
prevalent in POSTMENOPAUSAL WOMEN
can be referred to and ORAL MAXILLOFACIAL
 BASIC DISEASE PROCESS- is a progressive
SURGEEON if EMERGENCY SURGERY is necessary
narrowing or spasm of one or more of the
CORONARY ARTERIES that cant lead to a
INCREASED OXYGEN DEMAND during AMBULATORY
mismatch between MYOCARDIAL OXYGEN
ORAL SURGERY- is primarily the result of patient
DEMAND, AILITY OF THE CORONARY ARTERIES
anxiety
TO SUPPLY OXYGEN-CARRYING BLOOD.
ANGINA is a symptom of reversible ischemic heart
 LA for ANGINA is no more than 4ml LA solution
disease produced when:
with a 1:100,000 concentration of epinephrine
 Myocardial blood supply cannot be sufficiently
for a total adult dose of 0.04mg in any 30-min
increased to meet the increased oxygen
period.
requirement
The Introduction of BALLOON-TIPPED CATHETERS- Into
MYOCARDIUM becomes ISCHEMIC producing a heavy
the narrowed CORONARY ARTERIES for the purpose of
pressure or squeezing sensation in the patient
REESTABLISHING ADEQUATE BLOOD FLOW and
SUBSTERNAL REGION that can radiate into:
STENTING ARTERIES OPEN.
Left shoulder Mandibular
Region
Arm MYOCARDIAL INFARCTION:
STIMULATION OF VAGAL ACTIVITY commonly occurs w/  Occurs when ischemia is not relieved and
resulting causes MYOCARDIAL CELLULAR DYSFUNSTION
Nausea Bradycardia and DEATH
Sweating  Usually occurs when an area of CORONARY
ARTERY NARROWING has clot that blocks most
PREVENTIVE MEASURES begin with taking a careful of the blood flow.
history about px’s angina and should be questioned
about:
INFARCTED AREA OF MYOCARDIUM: becomes non- (If MORE THAN 6mos have elapsed and clearance is
functional, necrotic & is surrounded by an AREA of obtained, the MANAGEMENT of patient who has had MI
usually ISCHEMIC MYOCARDIUM that is PRONE to serve is SIMILAR to care of PATIENT WITH ANGINA:
as a NIDUS FOR DYSRHYTHMIAS. Anxiety-reduction Prophylactic Nitroglycerin
program (Administer only if directed by
(During early hours and weeks after an MI and if physician)
Supplemental Oxygen (can LA with epinephrine (Safe if
THROMBOLYTIC TREATMENT was unsuccessful, be consider but usually given in proper amounts)
treatment would consist of): unnecessary)
Limiting myocardial work Suppressing the production
requirements of dysrhythmias by irritable Patient who had CABG (Coronary Artery Bypass
foci in ischemic tissue Grafting) are treated similar to patient who have had
Increasing myocardial Surgical bypass of the MI. (Before MAJOR ELECTIVE SURGERY 3mos are
oxygen supply blocked vessels to promote
allowed to ELAPSE.)
revascularization
(If MAJOR SURGERY is necessary EARLIER than 3mos
after CABG patient physician should be consulted.)

CABG usually have a history of ANGINA, MI, or BOTH

CEREBROVASCULAR ACCIDENT (STROKE):

 Always susceptible to further NEUROVASCULAR
ACCIDENTS
 Often prescribed ANTICOAGULANTS or
ANTIPLATELET MEDICATION depending the
cause of CVA
 Typically a result of an EMBOLUS from a
HISTORY OF ATRIAL FIBRILLATION, a
THROMBUS due to a HYPERCOAGULABLE STATE
(It is recommended that ELECTIVE MAJOR SURGICAL
or STENOTIC VESSELS
PROCEDURES be deferred until at least 6 months after
 Patient should be treated by a
an infarction)
NONPHARMACOLOGIC ANXIETY REDUCTION
PROTOCOL. If pharmacologic sedation is
(Patients who have had and MI typically take ASPIRIN or
necessary LOW CONCENTRATIONS of NITROUS
another ANTIPLATELET or ANTICOAGULANT to
OXIDE can be used.
DECREASE CORONARY THROMBOGENESIS)
(In the case of patient having an EMBOLIC or  The HEART begins to have an INCREASED END-
THROMBOTIC STROKE the patient is likely taking an DIASTOLIC VOLUME that in the case of the
ANTICOAGULANT as opposed to ischemic stroke normal myocardium INCREASES CONTRACTILITY
secondary to STENOTIC VESSELS in which case patient through the FRANK-STARLING MECHANISM
would be taking ANTIPLATELET MEDICATION).
Normal of Diseased Myocardium further dilates,
DYSRHYTHMIAS become a less efficient pump that eventually leads
 CARDIAC DYSRHYTHMIAS manifest as to:
UNCOORDINATED CONTRACTIONS of the  Pulmonary Edema
chambers of the heart, SECONDAY to the  Hepatic Dysfunction
conduction deficits initiated by either problems  Compromised Intestinal
with IMPLUSE INITIATION or IMPULSE Nutrient Absorption
PROPAGATION THE LOWERED CARDIAC OUTPUT causes: Generalized
weakness, Impaired Renal Clearance of excess fluid
DYSRHYTHMIAS may occur in patients as a RESULT of a leads to VACULAR OVERLOAD.
HISTORY OF CHRONIC ILLNESS such as: SYMPTOMS OF CHF:
Prior cardiac disease Metabolic Syndrome 1. Orthopnea
Open heart surgery Electrolyte Abnormalities  A respiratory disorder that
exhibits shortness of breath
Valvulopathy Idiopathically
when patient is at SUPINE
Thyroid disease
position
ATTRIAL FIBRILLATION is the MOST COMMON
 Usually occurs as a result of
dysrhythmias occur in patients OLDER THAN 50y.o. REDISTRIBUTION OF BLOOD
(Many advocate limiting the total amount of POOLED in the LOWER
epinephrine administration to 0.04mg) EXTREMITY (as when sleeping)
 Patient with this usually sleep
PACEMAKERS post NO CONTRAINDICATION for OS and with their upper body supported
no evidence shows the need for ANTIBIOTIC by several pillows
2. Paroxysmal Nocturnal Dyspnea
PROPHYLAXIS.
 Symptom of CHF that is similar
In patient with PACEMAKER, ELECTRICAL EQUIPMENT to orthopnea
or ELECTROCAUTERY and MICROWAVE should NOT be  The patient has RESPIRATORY
used near the patient) DIFFICULT 1 or 2 HRS AFTER
LYING DOWN
HEART ABNORMALITIES THAT PREDISPOSE TO  Occurs when POOLED BLOOD
and INSTERTITIAL FLUID
INFECTIVE ENDOCARDITIS:
REABSORBED into the
 The internal cardiac surface or endocardium
VASCULATURE FROM THE LEGS
can be predisposed to infection when and are REDISTRIBUTED
abnormalities of its surface allow pathologic CENTRALLY
bacteria to attach and multiply  Patient suddenly awake, feeling
short of breath, and are
CONGESTIVE HEART FAILURE (HYPERTROPHIC compelled to sit up and try to
catch their breath
CARDIOMYOPATHY) (CHF/HCM);
3. Ankle Edema
 Occurs when a DISEASED MYOCARDIUM is
Other symptoms of CHF:
unable to deliver CARDIAC OUTPUT demanded 4. Weight Gain
by the body or when demands are placed on a 5. Dyspnea on Exertion
NORMAL MYOCARDIUM
LOWER EXTREMITY EDEMA
 Appears as a swelling of the FOOT, ANKLE or
BOTH.
 Caused by an increase interstitial fluid.
EDEMA is detected by PRESSING a FINGER into the
swollen area for a few seconds, if an INDENTATION is
left after the finger is removed PEDAL EDEMA is
deemed to be PRESENT.
Many patients carry SYMPATHOMIMETIC AMINES such
as EPINEPHRINE, METAPROTERENOL in an AEROSOL
FORM that can be self-administered if WHEEZING
OCCURS.
For ACUTE BRONCHOSPASM: Inhaled B-ADRENERGIC
AGONISTS such as ALBUTEROL to promote immediate
BRONCHODILATION.

Patients with CHF who are under physician’s care are
usually following:
 LOW SODIUM DIET (to reduce fluid retention)
 RECEIVING DIURETICS (to reduce intravascular
volume(
 CARDIAC GLYCOSIDES (such as DIGOXIN to improve
cardiac efficiency)
ORAL SURGICAL MANAGEMENT OF PATIENT WITH ASTHMA
involves:
 Recognition of the role of anxiety in
BRONCHOSPASM INITIATION
 Potential Adrenal Suppression in patient receiving
systemic CORTICOSTEROID THERAPY
ELECTIVE ORAL SURGERY- Should be deferred if a
RESPIRATORY TRACT INFECTION or WHEEZING is present.

(If a major surgical procedure is planned. NITROUS OXIDE is

SAFE to administer to persons with asthma and especially
indicated for patient whose asthma is TRIGGERED BY
ANXIETY.)
The patient’s own inhaler should be available during surgery,
and drugs such as INJECTABLE EPINEPHRINE, THEOPHYLLINE
and INHALED BETA AGONISTS should kept in and
EMERGENCY
Use of NSAIDs should be AVOIDED because they often
PULMONARY PROBLEMS: precipitate asthma attacks in susceptible individuals.
ASTHMA:
 TRUE ASTHMA involves the EPISODIC
NARROWING of INFLAMED SMALL AIRWAYS,
which produces WHEEZING and DYSPNEA as a
result of: (Chemical, Infectious, Immunologic,
Emotional Stimulation, or a combination of
these).
PATIENTS WITH ASTHMA should be questioned about:
Precipitating Factors Medications Used
Frequency Response to Medication
Severity of Attacks

PATIENTS WITH SEVERE ASTHMA require XANTHINE-

CHRONIC OBSTRUCTIVE PULMONARY DISEASE:
DERIVED BRONCHODILATORS such as THEOPHYLLINE as
 Pulmonary disease are usually grouped
well as INHALED CORTICOSTEROIDS. CROMOLYN may
together under the headings of either
be used to protect against acute attacks.
OBSTRUCTIVE (CHRONIC OBSTRUCTIVE
 PULMONARY DISEASE) COPD or RESTRICTIVE
PULMONARY DISEASE.
 In the past the term EMPHYSEMA and
BRONCHITIS were used to describe clinical
manifestations of COPD
 COPD has been recognized to be a spectrum of
pathologic pulmonary problems
 Usually caused by long-term exposure to
pathologic irritants SUCH AS tobacco smoke
that can cause METAPLASIA of PULMONARY
AIRWAY TISSUE
CLINICAL MANIFESTATIONS of COPD:
Airways are inflamed and Excessive
disrupted secretions
Lost their elastic Bronchospasm
properties
Become obstructed
because of mucosal
edema
PATIENTS WITH COPD FREQUENTLY become DYSPNEIC
during MILD to MODERATE EXERTION. They have a
CHRONIC COUGH that produces LARGE AMOUNT OF
THICK SECRETIONS, REESPIRTORY TRACT INFECTIOMS,
BARREL-SHAPED CHEST, PURSE THEIR LIPS TO BREATHE
and have AUDIBLE WHEEZING during BREATHING.
BRONCHODILATORS such as THEOPHYLLINE, INHALED
BETA AGONIST or INHALED ANTICHOLINERGICS are
usually prescribed for patient with SIGNIFANT COPD
In more severe cases patients are given LONG-ACTING
AGENTS and INHALED CORTICOSTEROIDS or SHORT
COURSES OF SYSTEMIC CORTICOSTEROIDS
MOST SEVER CASES is SUPPLEMENTAL PORTABLE
OXYGEN used.
DENTAL MANAGEMENT OF PATIENTS WITH COPD who
are receiving corticosteroids:
 Dentist should consider the use of additional
supplementation before major surgery:
 SEDATIVES, HYPNOTICS, NARCOTICS that
depress respirations should be avoided
 Patients need to be kept in UPRIGHT SITTING
POSITION in dental chair to enable them to
better handle their COMMONLY COPIOUS
PULMONARY SECRETIONS.
RENAL PROBLEMS
RENAL FAILURE:
 Patients with CHRONIC RENAL FAILURE require
PERIODIC RENAL DIALYSIS
CHONIC DIALYSIS TREATMENT: Typically requires the
presence of an ARTERIOVENOUS SHUNT
SHUNT- Allows EASY VASCULAR ACCESS and HEPARIN
ADMINISTRATION, PERMITTING BLOOD to move
through the DIALYSIS EQUIPMENT WITHOUT CLOTTING.
 Dentist should NEVER use the SHUNT for
VENOUS ACCESS except in LIFE-THREATHENING
EMERGENCY.
 ELECTIVE ORAL SURGERY is best undertaken the
day AFTER a DIALYSIS TREATMENT has been
performed.
 NEPHROTOXIC DRUGS such as NSAIDs should be
avoided in patient with seriously compromised
kidney
RENAL TRANSPLANTATION and TRANSPLANTATION of
OTHER ORGANS:
 Most of the patients also receive
IMMUNOSUPPRESSIVE AGENTS that may
cause otherwise SELF-LIMITING INFECTIONS to
become severe.
 CYCLOSPORINE: An immunosuppressive drug
administered after organ transplantation, may
cause GINGIVAL HYPERPLASIA
 HEPATIC DISORDERS:
 The patient with severe liver damage resulting
from INFECTIOUS DISEASE, ETHANOL ABUSE,
or VASCULAR or BILIARY CONGESTION
 The production of nearly all coagulation
factors as well as PROTEIN C and S may be
depressed in severe liver disease. Therefore
obtaining INR, PT or PARTIAL
THROMBOPLASTIN TIME may be useful before
surgery in patients with more severe liver
disease.
HYPERTENSION:
INR- International Normalized Ratio
ESSENTIAL HYPERTENSION- CHRONICALLY ELEVATED
PT- Prothrombin Time or Partial Thromboplastin Time
BLOOD PRESSURE for which the cause is unknown.
MILD or MODERATE HYPERTENSION:
PORTAL HYPERTENSION
 Systolic <200mmHg and Diastolic <110 mmHg)
 Caused by liver disease
 Usually not a problem in the performance of
 May also cause HYPERSPLENISM and the
ambulatory surgical care as long as the patient
SEQUESTERING of PLATELETS, causing a relative
is not having signs or symptoms of END-ORGAN
THROMBOCYTOPENIA
INVOLVEMENT secondary to the ELEVATED
THROMBOPOIETIN
BLOOD PRESSURE
 Produced in the liver

SEVERE HYPERTENSION:
DECREASED PRODUCTION of THROMBOPOIETIN may
 Systolic >200mmHg and Diastolic >110mmHg
result in a TRUE THROMBOCYTOPENIA (Finding a
 ELECTIVE ORAL SURGERY should be postponed
PROLONGED BLEEDING TIME or LOW PLATELET COUNT
until the pressure is controlled
reveals this problem)

ENDOCRINE DISORDER
DIABETES MELLITUS
CARE of POORLY CONTROLLED HYPERTENSIVE
 Caused by UNDERPRODUCTION OF INSULIN
PATIENT:
 A resistance of insulin receptors in end organs
 Anxiety-reduction protocol
to effects of insulin, or both.
 Monitoring of vital signs
DIABETES is COMMONLY DIVIDED into:
(EPINEPHRINE-CONTAINING LA should be used
 Insulin-Dependent (TYPE 1)
cautiously after surgery)
 Non-Insulin Dependent (TYPE 2)
TYPE 1 DIABETES: MORNING AMOUNT of REGULAR INSULIN and a HALF
 Usually begin during CHILDHOOD or DOSE of NEUTRAL PROTAMINE HAGEDORN INSULIN of
ADOLESENCE HYPOGLYCEMIA.
 MAJOR PROBLEM: is an UNDERPRODUCTION OF
INSULIN, result in the INABILITY of the PATIENT SIGN OF HYPOGLYCEMIA:
TO USE GLUCOSE PROPERLY Hypotension Diaphoresis
 Must strike a balance with regard to CALORIC Hunger Tachycardia
INTAKE, EXERCISE, and INSULIN DOSE Drowsiness Mood Change
Nausea
ELECTRONIC GLUCOMETER: Determine SERUM
GLYCOSURIA: The serum glucose rises above the level
GLUCOSE with a drop of the patient’s blood.
at which the RENAL ABSORPTION of all GLUCOSE can
take place.
(PERSON with WELL-CONTROLLED DIABETES are NO
MORE SUSCEPTIBLE to infections than are PERSON
OSMOTIC EFFECT OF GLUCOSE SOLUTE RESULTS IN:
WITHOUT DIABETES, but they have more DIFFICULTY
POLYURIA POLYDYPSIA (frequent
consumption of liquids) CONTAINING INFECTIONS.
STIMULATING THIRST

TYPE 2 DIABETES:
 Produces insulin but in INSUFFICIENT AMOUNT
because of decreased insulin activity, insulin
receptor resistance or both
 Usually begins in ADULTHOOD
 Exacerbated by OBESITY (does not usually
require insulin therapy
 Treated by WEIGHT CONTROL, DIETARY
RESTRICTIONS, USE OF ORAL HYPOGLYCEMIA

INSULIN- required only if the patient is unable to

maintain acceptable serum glucose level using the usual
therapeutic measures.

SEVERE HYPERGLYCEMIA in PATIENT WITH TYPE 2

DIABETES rarely produces KERATOACIDOSIS but leads to
a HYPEROSMOLAR STATE with altered levels of
consciousness

SHORT-TERM, MILD TO MODERAETE HYPERGLYCEMIA:

Usually NOT a SIGNIFICANT PROBLEM for persons with
diabetes.
AMBULATORY ORAL SURGERY PROCEDURES should be
performed early in the day using an ANXIETY-
REDUCTION PROGRAM
(If IV SEDATION is not being used, patient should be
asked to eat a NORMAL MEAL and take the USUAL
  Result of an excess of circulating
TRIIODOTHYRONINE and THYROXINE which is
caused most frequently by GRAVES DISEASE, a
multinodular goiter, or a thyroid adenoma.
EARLY MANIFESTATIONS of EXCESSIVE THYROID
HORMONE PRODUCTION include:
Fine and Brittle Hair Palpitations
Hyperpigmentation of Skin Weight Loss
Excessive Sweating Emotional Lability
Tachycardia
THYROTOXIC PATIENTS: are usually treated with
agents that BLOCK THYROID HORMONE SYNTHESIS
and RELEASE with a THYROIDECTOMY or with both.

EARLY SYMPTOMS OF A THYROTOXIC CRISIS:

 Restlessness
 Nausea
 Abdominal Cramps
(Later sign and symptoms are HIGH FEVER, DIAPHORESIS,
ADRENAL INSUFFICIENCY: TACHYCARDIA, CARDIAC DECOMPENSATION.)
SYMPTOMS of PRIMARY ADRENAL INSUFFICIENCY:
Weakness Hyperpigmentation of skin
Weight Loss Mucous Membrane
Fatigue

MOST COMMON CAUSE OF ADRENAL INSUFFICIENCY: HYPOTHYROIDISM:

 Chronic Therapeutic Corticosteroid EARLY SYMPTOMS OF HYPOTHYROIDISM:
Administration (secondary adrenal insufficiency) Fatigue Arthralgia
Constipation Menstrual Disturbances
PATIENTS WHO REGULARLY TAKE CORICOSTEROIDS HAVE: Weight Gain Edema
Moon Faces (Moon-shaped face) Hoarseness Dry Skin
Buffalo (Back) Humps Headaches Brittle Hair & Fingernails
Thin, translucent skin (If the symptoms of hypothyroidism are MILD, NO
MODIFICATION of DENTAL THERAPY is required).
THE INABILITY TO INCREASE ENDOGENOUS CORTICOSTEROID
LEVELS in REPONSE TO PHYSIOLOGIC STRES MAY CAUSE THEM TO
BECOME: HEMATOLOGIC PROBLEMS:
HEREDITARY COAGULOPATHIES:
Hypotensive Feverish during complex
PROLONGED BLEEDING after EXO- May be the 1st
Syncopal Prolonged Surgery
Nauseated EVIDENCE that a BLEEDING DISORDER EXIST.

HYPERTHYROIDISM: THIS SHOULD ALERT THE DENTIST for a PRESURGICAL

THYROTOXICOSIS LABORATORY COAGULATION SCREENING or
 The thyroid gland problem of PRIMARY HEMATOLOGIST CONSULTATION:
SIGNIFICANCE in OS. Epistaxis (Nosebleed) Hematuria
Easy Bruising Heavy menstrual bleeding
and Spontaneous Bleeding
This is usually managed by PERIOPERATIVE
ADMINISTRATION of COAGULATION FACTOR
CONSENTRATES or DESMOPRESSIN and by the use of:
Antifibrinolytic Agent such as AMINOCAPROIC ACID
(AMICAR)
Platelet problems may be QUANTITATIVE or
QUALITATIVE.
3.5. WARFARIN has 2- to 3-day delay in the
onset of action.
(Stopped taking the WARFARIN 2-3 days BEFORE the
planned surgery if CESSATION OF THE MEDICATION is
necessary because of expected excessive surgical blood
loss).

QUANTITATIVE PLATELET DEFICIENCY:

 May be a CYCLIC PROBLEM
 Hematologist can HELP DETERMINE THE
PROPER TIMING OF ELECTIVE SURGERY
 Count must usually dip below 50,000/mm
before ABNORMAL POSTOPERATIVE BLEEDING
OCCURS
(If the platelet count is BETWEEN 20,000/mm and
50,000/mm if a concurrent qualitative platelet problem
exist)

QUALITATIVE PLATELET DISORDERS:

 Typically due to the administration of
ANTIPLATELET MEDICATIONS (such as ASPIRIN
or CLOPIDOGREL)
 Can be related to the LIVER or SPLENIC
DYSFUNCTION
 Platelet count >20,000/mm usually require
PRESURGICAL PLATELET TRANSFUSION or a
DELAY IN SURGERY.

THERAPEUTIC ANTICOAGULATION:
 Is administered to patients with
THROMBOGENIC IMPLANTED DEVICES such as
PROSTHETIC HEART VALVES; with
THROMBOGENIC CARDIOVASCULAR
PROBLEMS such as ATRIAL FIBRILLATION or MI.
 Patient may also take antiplatelet properties
such as ASPIRIN for secondary effect
 PROTAMINE SULFATE- reverses the effects of
heparin, can also be used if emergency oral
surgery cannot be deferred until HEPARIN is
naturally INACTIVATED.
 WARFARIN ADMINISTRATION is typically an INR
of 2-3 and, in some cases may be increased to
 NEUROLOGIC DISORDERS: 2. Patient need to be I more UPRIGHT
SEIZURE DISORDERS: POSITION or have TORSO turned slightly
HISTORY OF SEIZURES SHOULD BE QUESTIONED to the LEFT SIDE during surgery
ABOUT: TWO AREAS OF SURGICAL MANAGEMENT with the
Frequency Duration POTENTIAL FOR CREATING FETAL DAMAGE ARE:
Type Sequelae of Seizures 1. Dental Imaging
2. Drug Administration
SEIZURES CAN RESULT FROM:
Ethanol Withdrawal Hypoglycemia
High Fever Traumatic Brain Damage
Electrolyte Imbalance Can be Idiopathic

DRUGS THAT BELIEVED LEAST LIKELY TO HAVE A FETUS

WHEN USED IN MODERATE AMOUNTS:
Lidocaine Penicillin
Bupivacaine Cephalosporin
ETHANOLISM (ALCOHOLISM): Acetaminophen NSAIDs (such as ASPIRIN and
PRIMARY PROBLEMS ETHANOL ABUSER AHAVE IN ibuprofen)
RELATION TO DENTAL CARE ARE: Codeine
HEPATIC INSUFFICIENCY ELECTROLYTE
ABNORMALITIES
ETHANOL WITHDRAWAL
PHENOMENA
MEDICATION
INTERACTION

ETHANOL ABUSER may undergo withdrawal

phenomenon in the perioperative period. This
phenomenon may exhibit: (Mild Agitation, Severe
Hypertension) which can progress to:
Tremors Delirium Tremens with
hallucinations
Seizures Considerable Agitations
Diaphoresis or Rarely Circulatory Collapse

MANAGEMENT OF PATIENTS DURING & AFTER

PREGNANCY:
PREGNANCY:
1. Prevention of genetic damage to the
fetus is the PRIMARY CONCERN when
providing care for a pregnant patient.
POST PARTUM:
Avoiding drugs that are KNOWN to enter breast milk
and to be POTENTIALLY harmful to infant is PRUDENT.

(All the DRUGS COMMON IN ORAL SURGICAL CARE ARE

SAFE to use in MODERATE DOSES; the EXCEPTION ARE:
CORTECOSTEROIDS (Should not be used)
AMINOGLYCOSIDES (Should not be used)
TETRACYCLINES (Should not be used)