This medical Condition Consult is presented by the JCDA Oasis Team. The consult is also available through the JCDA Oasis Mobile
|Use vasoconstrictors with caution, due to increased risk for adverse outcomes1. Increased risk of cardiac arrhythmias in patients taking digitalis (e.g., digoxin).2. Increased risk of a hypertensive episode followed by bradycardia in patients taking nonselective beta-blockers (e.g., propranolol).3. Risk of complications increases with high doses of vasoconstrictors||Prescribe with caution
1. NSAIDs and ASA with Digoxin, Captopril, Propranolol: limit prescribing to 4 days or less.
2. Antibiotics (e.g., erythromycin, tetracycline) with Digoxin, Propranolol.
3. Barbiturates, benzodiazepines with Digoxin, Verapamil, Lovastatin.
|Recommended||Effects on Bleeding|
|1. Epinephrine-containing local anesthetic can be used with minimal risk if the dose is limited to 0.036 mg epinephrine (2 cartridges containing 1:100,000 epi) or 0.20 mg levonordefrin (2 cartridges containing 1:20,000 levo)2. AVOID the use of epinephrine-impregnated retraction cord and epinephrine 1:50,000 concentrations.||Increased risk, monitor patient
Low-dose ASA (75–325 mg/day), antiplatelet agents (e.g. clopidogrel), and oral anticoagulants (e.g., warfarin) can increase the risk of surgical and postoperative bleeding.
|Defer Elective Care||Scheduling of Visits|
|Delay routine dental treatment for 6 weeks if patient has had a revascularization procedure (i.e. coronary artery bypass graft or stent placement).||Short, morning appointments for stress and anxiety reduction.|
|General Treatment||Orthostatic Hypotension|
|1. Prior to dental treatment, ask the patient about unstable angina and exercise tolerance.2. Prescribe adequate analgesia during the appointments to minimize pain, discomfort, and anxiety.||1. Consider semisupine chair position for patients with cardiovascular disease.2. Discharge patient slowly to avoid orthostatic hypotension.|
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