Caring for patients with both CVD and periodontitis requires careful evaluation, quantification and ongoing monitoring of existing periodontal inflammation. Consultation with a physician, in regards to the management of their CVD and the overall functional capacity of the patient is also recommended. A thorough medical history and physician consultation, if necessary, should be performed to assess the patient’s cardiovascular risk in association with dental procedures (Table 3).106 Patients should be triaged and care altered to account for their cardiovascular status (Table 4).106
American College of Cardiology Cardiac Risk Classification |
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Major Predictors |
Unstable coronary syndromes |
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Decompensated hear failure |
Significant arrhythmias |
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Severe Valvular disease |
Intermediate Predictors |
Mild angina pectoris (Canadian class I oe II) |
Previous MI by history or pathologic Qwaves |
Compensated or prior heart failure |
Diabetes mellitus (especially insulin-dependant type) |
Renal insufficiency |
Minor Predictors |
Advanced age |
Abnormal ECG (e.g. left ventricular hypertrophy, left bundle branch block, ST-T abnormalities) |
Rhythm other than sinus (e.g. atrial fibrillation) |
Low functional capacity (e.g. inability to climb one flight of stairs with a bag of groceries) |
History of stroke |
Uncontrolled systemic hypertension |
ECG, electrocardiogram; MI, myocardial infarction. |
Specific Management Protocols