MH Considerations

Question 1

Give the possible MH contraindications in oral surgery

Answer 1

High BP
Angina
Recent MI
Cardiac defects
Liver disease
Kidney disease
Diabetes
Epilepsy
Haemophilia / VWB
Anticoagulant therapy
Antiplatelet therapy
Chemotherapy / radiotherapy
Bisphosphonates

Question 2

Why may high BP be a contraindication to tx?

Recommendations?

Answer 2

Risk of MI and More prone to bleeding

LA with no vasoconstrictor is recommended
Consider postpone if 160/100

Question 3

Why may angina be contraindication to tx? Recommendations?

Answer 3

Risk of angina attack or MI during tx

• enquire about frequency of angina
• controlled or uncontrolled
• ensure GTN spray on hand

Question 4

When may recent MI be a contraindication to tx? Recommendations?

Answer 4

Risk of another MI

• No extractions within 3 months of MI
• no GA within 6 months

Question 5

Why might cardiac defects be contraindication to tx? Recommendations

Answer 5

Cardiac defects such as valve replacement or previous endocarditis are at increased risk of bacteremia and IE

• liaise with patients cardiologist before any XLA
• reinforce OH

Question 6

Why is liver disease sometimes a contraindication to tx? Recommendations?

Answer 6

Impaired blood clotting
Immunosuppressed
Cross infection risk if hep B,C,D
Impaired first pass metabolism

• consider full blood screen
• check BNF for appropriate drug regime
• liaise with physician

Question 7

Why may kidney disease be contraindication to tx? Recommendations?

Answer 7

Immunocompromised
Bleeding - platelet dysfunction

• treat dialysis patient during day after dialysis so kidneys at optimum function
• reduce max LA doseage

Question 8

Why may diabetes impact dental tx? Recommendations?

Answer 8

Impaired wound healing - high blood sugar results in immunocompromised
- poorly controlled diabetes

Hypoglycaemia risk

• know hypoglycaemia medical emergencies
• blood glucose between 5-15mmol/L
• morning appts

Question 9

How may epilepsy influence dental tx?

Answer 9

Seizures due to stress of dental Tx

• know their type of seizures and management, and frequency
• issues with dentures / removeable pros
• IV sedation can be indicated due to anticonvulsant effects
• ensure pt eaten before extraction

Question 10

Considerations in patients with haemophilia / VWD?

Answer 10

What type?
- possible factor assay?

A =. Factor 8
B = Factor 7
VWB - VWB factor

Safe factor is 50-75% factor vIII

Question 11

Considerations of radiotherapy / chemotherapy in head and neck with tx? Recommendations?

Answer 11

Thrombocytopenia - bleeding
Neutropenia - infection
ORN risk

• platelets must be 50x10^9 / 5.0x10^10 (real standard form)
• avoid extractions
• atraumatic and aseptic if need
• ensure good oral hygiene

Question 12

Considerations of bisphosphonates? Recommendations?

Answer 12

MRONJ risk

• if on them for >5 years
• on concurrent glucocorticoids
• being treated for cancer
• previous MRONJ risk
• liaise with physician