The systemic management of cardiovascular risk patients in dentistry

Recently, dental patients with cardiovascular diseases, especially hypertensive and ischemic heart disease, have been increasing. Performing dental procedures on these patients could bring about the acute exacerbations of preexisting cardiac diseases. Anxiety, tension, pain, and discomfort during dental treatment and the catecholamines contained in local anesthetic solutions are thought to be causative factors. Consequently, it is important to decide whether the procedure concerned could safely be performed by dental staffs in the dental clinic. Systemic management in dental treatment includes the application of psychosedation, proper selection of the vasoconstrictor in the anesthetic solution, and control of blood pressure by vasodilating agents under continuous careful monitoring. By these means, the magnitude of hemodynamic fluctuation should be kept minimal. Management of hypertension, ischemic heart disease, and cardiomyopathies will be explained.