______________________ The Impact of Vascular and Cardiovascular Diseases on Oral Health, 4th Edition
disease. These include guidance on emergency cardiovascular care and infective endocarditis prophylaxis, as well as recom- mendations for the presurgical management of patients on oral anticoagulant or antiplatelet therapy. 2020 AMERICAN HEART ASSOCIATION GUIDELINES UPDATE FOR CARDIOPULMONARY RESUSCITATION AND EMERGENCY CARDIOVASCULAR CARE In 2020, the AHA published updated guidelines for cardio- pulmonary resuscitation and emergency cardiovascular care. The sequential assessments and actions that healthcare provid- ers should take when providing basic life support have been updated from the 2010 AHA algorithm. A detailed description of the adult basic life support algorithm is beyond the scope of this course, but the algorithm is available online on the American Heart Association website. Basic life support is fundamental to saving lives after cardiac arrest. As in previous guidelines, the AHA states that ide- ally all healthcare providers should have training in basic life support. Key aspects of adult basic life support include initial recognition of sudden cardiac arrest, heart attack, or stroke; activation of the emergency response system; early cardiopulmonary resuscitation; and rapid defibrillation with an automated external defibrillator. The development of automated external defibrillators has simplified defibrillation by providing reliable, safe, computer- ized devices that use voice and visual prompts and automatic analysis of the victim’s rhythm to deliver a shock. Automated external defibrillators inform the rescuer if a shock is needed and deliver a shock only when ventricular fibrillation (or rapid ventricular tachycardia) is present. 2021 AMERICAN HEART ASSOCIATION GUIDELINES FOR INFECTIVE ENDOCARDITIS Over the years, the AHA has made numerous recommenda- tions regarding the prevention of bacterial endocarditis. The association acknowledges the important role that oral health care plays in the prevention of infective endocarditis. Poor oral health care can cause gingivitis, which in turn can lead to periodontitis. The AHA recognizes the likelihood that community-acquired infective endocarditis is associated with periodontal diseases. The AHA recommends that a dentist thoroughly evaluate patients with infective endocarditis to identify and eliminate oral conditions that could lead to bacte- remia that could contribute to the risk for a recurrent incident of the heart infection. This evaluation is particularly important for patients who may require valve replacements. Healthcare providers should educate patients with infective endocarditis on the signs of infection and the need for antibiotic prophylaxis for certain dental, surgical, or invasive procedures.
According to the American Dental Association (ADA), infec- tive endocarditis prophylaxis for dental procedures should be recommended only for patients with underlying cardiac condi- tions associated with the highest risk of adverse outcome from infective endocarditis. These are patients with: • A prosthetic cardiac valve or prosthetic material used for cardiac valve repair • A history of infective endocarditis • A cardiac transplant that develops cardiac valvulopathy • Any of the following congenital (present from birth) heart conditions: ‒ Unrepaired cyanotic congenital heart disease, including palliative shunts and conduits ‒ A completely repaired congenital heart defect with prosthetic material or device, whether placed by surgery or by catheter intervention, during the first six months after the procedure ‒ Any repaired congenital heart defect with
residual defect at the site or adjacent to the site of a prosthetic patch or a prosthetic device (that inhibits endothelialization)
For patients with these underlying cardiac conditions, prophy- laxis is recommended for all dental procedures that involve manipulation of gingival tissue or the periapical region of teeth or perforation of the oral mucosa (Lockhart et al., 2021). GUIDELINES FOR MANAGEMENT OF PATIENTS ON ORAL ANTICOAGULANT OR ANTIPLATELET THERAPY UNDERGOING DENTAL SURGERY Physicians prescribe anticoagulant and antiplatelet medications to prevent and manage various cardiovascular diseases. Anti- coagulants, the most common of which is warfarin, prevent blood clot formation or expansion. Platelets, which help form the initial hemostatic plug at the vascular injury site, are a key contributor to arterial thrombosis that can lead to myocardial infarction and ischemic stroke. Common antiplatelet drugs include acetylsalicylic acid, clopidogrel, and dipyridamole (Wójcik et al., 2022). Cardiovascular patients taking anticoagulant medication have an altered hemostasis that can lead to complications when dental professionals perform procedures or surgeries that cause bleeding. Therefore, it is important that dental profession- als obtain a complete medical history, adhere to meticulous surgical techniques, be able to close wounds properly, and be knowledgeable of adjunctive hemostatic technique. Literature generally supports the continuation of anticoagulants during dental surgery in most cases (Wójcik et al., 2022). The initial consideration for patients on antiplatelet or anticoagulant
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