Angina pectoris – commonly known as angina – is chest pain due to ischemia of the heart muscle, generally due to obstruction or spasm of the coronary arteries. The main cause of Angina pectoris is coronary artery disease, due to atherosclerosis of the arteries feeding the heart. The term derives from the Latin angina ("infection of the throat") from the Greek ἀγχόνη ankhonē ("strangling"), and the Latin pectus ("chest"), and can therefore be translated as "a strangling feeling in the chest".
There is a weak relationship between severity of pain and degree of oxygen deprivation in the heart muscle (i.e., there can be severe pain with little or no risk of a Myocardial infarction (commonly known as a heart attack), and a heart attack can occur without pain). In some cases Angina can be extremely serious and has been known to cause death. People that suffer from average to severe cases of Angina have an increased percentage of death before the age of 55, usually around 60%.
Worsening ("crescendo") angina attacks, sudden-onset angina at rest, and angina lasting more than 15 minutes are symptoms of unstable angina (usually grouped with similar conditions as the acute coronary syndrome). As these may herald myocardial infarction (a heart attack), they require urgent medical attention and are generally treated as a presumed heart attack.
Management of angina attack: Nitroglycerine tab .3-.4mg or sublingual spray.
If during implant surgery you have chest pain, we will stop all treatment give 100% oxygen at 6L/min.
Monitor vital signs. Emergency medical assistance on standby
If you are having a dental implant, we will reduce your stress by pre-medication of anxiolitics , we will avoid adrenaline, premedication with diazepam Lorazepam etc, pain control.
We will keep a check of your blood pressure. Greater than 180 S and 110 D no treatment
Myocardial infarction (MI) or acute myocardial infarction (AMI), is the medical term for an event commonly known as a heart attack. It happens when blood stops flowing properly to part of the heart and the heart muscle is injured due to not getting enough oxygen. Usually this is because one of the coronary arteries that supplies blood to the heart develops a blockage due to an unstable buildup of white blood cells, cholesterol and fat. The event is called "acute" if it is sudden and serious.
A person having an acute myocardial infarction usually has sudden chest pain that is felt behind the breast bone and sometimes travels to the left arm or the left side of the neck. Additionally, the person may have shortness of breath, sweating, nausea, vomiting, abnormal heartbeats, and anxiety. The anxiety is often described as a "sense of impending doom." Women experience fewer of these symptoms than men, but usually have shortness of breath, weakness, a feeling of indigestion, and fatigue. In many cases, in some estimates as high as 64 percent, the person does not have chest pain or other symptoms. These are called "silent" myocardial infarctions.
If you have had an MI in the past we will evaluate your medical condiionEvaluate dates of all episodes of MI
MI in past 6 months precludes any major dental treatment including implantology . We will consult with your physicians before any treatment.
We will follow a Stress Reduction protocol.
Heart failure (HF), often called congestive heart failure (CHF) or congestive cardiac failure (CCF) occurs when the heart is unable to provide sufficient pump action to maintain blood flow to meet the needs of the body. Heart failure can cause a number of symptoms including shortness of breath, leg swelling, and exercise intolerance. The condition is diagnosed by patient physical examination and confirmed with echocardiography. Blood tests help to determine the cause. Treatment depends on severity and cause of heart failure. In a chronic patient already in a stable situation, treatment commonly consists of lifestyle measures such as smoking cessation, light exercise, dietary changes, and medications. Sometimes, depending from etiology, it is treated with implanted devices (pacemakers or ventricular assist devices) and occasionally a heart transplant is required.
Common causes of heart failure include myocardial infarction and other forms of ischemic heart disease, hypertension, valvular heart disease, and cardiomyopathy. The term heart failure is sometimes incorrectly used for other cardiac-related illnesses, such as myocardial infarction (heart attack) or cardiac arrest, which can cause heart failure but are not equivalent to heart failure.
Heart failure is a common, costly, disabling, and potentially deadly condition. In developed countries, around 2% of adults suffer from heart failure, but in those over the age of 65, this increases to 6–10%.
New York Heart association 1 &11 do not require any special consideration, more severe cases we will do a pre op stress reduction protocol, availability of oxygen and emergency medical team available
Infective endocarditis is a form of endocarditis, or inflammation, of the inner tissue of the heart (such as its valves) caused by infectious agents. The agents are usually bacterial, but other organisms can also be responsible.
The valves of the heart do not receive any dedicated blood supply. As a result, defensive immune mechanisms (such as white blood cells) cannot directly reach the valves via the bloodstream. If an organism (such as bacteria) attaches to a valve surface and forms a vegetation, the host immune response is blunted. The lack of blood supply to the valves also has implications for treatment, since drugs also have difficulty reaching the infected valve.
Normally, blood flows smoothly through these valves. If they have been damaged - from rheumatic fever, for example - the risk of bacterial attachment is increased.
We will consult your physician before any implant treatment
Mitral valve prolapse (aka primary form of myxomatous degeneration of the mitral valve aka floppy mitral valve syndrome) is a valvular heart disease characterized by the displacement of an abnormally thickened mitral valve leaflet into the left atrium during systole. There are various types of MVP, broadly classified as classic and non-classic. In its non-classic form, MVP carries a low risk of complications. In severe cases of classic MVP, complications include mitral regurgitation, infective endocarditis, congestive heart failure, and, in rare circumstances, cardiac arrest, usually resulting in sudden death.
The diagnosis of MVP depends upon echocardiography, which uses ultrasound to visualize the mitral valve. The prevalence of MVP is estimated at 2-3% of the population.
The condition was first described by John Brereton Barlow in 1966. In consequence, it may also be referred to as Barlow's Syndrome, and was subsequently termed mitral valve prolapse by J. Michael Criley.
Prophylactic antibiotics NOT recommended in: Mitral valve prolapse, Rhumaticheart ,Bisupidvalse disease, Aortic stenosis, congenital heart conditions. We will however, speak to your physician before starting any implant surgery.
Diabetes mellitus , or simply diabetes, is a group of metabolic diseases in which a person has high blood sugar, either because the pancreas does not produce enough insulin, or because cells do not respond to the insulin that is produced. This high blood sugar produces the classical symptoms of polyuria (frequent urination), polydipsia (increased thirst) and polyphagia (increased hunger).
There are three main types of diabetes mellitus (DM).
• Type 1 DM results from the body's failure to produce insulin, and currently requires the person to inject insulin or wear an insulin pump. This form was previously referred to as "insulin-dependent diabetes mellitus" (IDDM) or "juvenile diabetes".
• Type 2 DM results from insulin resistance, a condition in which cells fail to use insulin properly, sometimes combined with an absolute insulin deficiency. This form was previously referred to as non insulin-dependent diabetes mellitus (NIDDM) or "adult-onset diabetes".
• The third main form, gestational diabetes, occurs when pregnant women without a previous diagnosis of diabetes develop a high blood glucose level. It may precede development of type 2 DM.
Other forms of diabetes mellitus include congenital diabetes, which is due to genetic defects of insulin secretion, cystic fibrosis-related diabetes, steroid diabetes induced by high doses of glucocorticoids, and several forms of monogenic diabetes.
Untreated, diabetes can cause many complications. Acute complications include diabetic ketoacidosis and nonketotic hyperosmolar coma. Serious long-term complications include cardiovascular disease, chronic renal failure, and diabetic retinopathy (retinal damage). Adequate treatment of diabetes is thus important, as well as blood pressure control and lifestyle factors such as stopping smoking and maintaining a healthy body weight.
All forms of diabetes have been treatable since insulin became available in 1921, and type 2 diabetes may be controlled with medications. Insulin and some oral medications can cause hypoglycemia (low blood sugars), which can be dangerous if severe. Both types 1 and 2 are chronic conditions that cannot be cured. Pancreas transplants have been tried with limited success in type 1 DM;gastric bypass surgery has been successful in many with morbid obesity and type 2 DM. Gestational diabetes usually resolves after delivery.
We at the Implant Center and Rahman & Rahman Dental Surgeons have conducted a five year internationally funded clinical research on diabetes and its effects on dental implants. We are confident that the literature supports placing and restoring dental implants as long as your diabetes is under control.
No contraindications for diet and oral med controlled diabetes
Antibiotic coverage for insulin dependent patients, more failure reported.
Hypoglycemia serious complication. Stress reduction protocol must.
Must have good metabolic control, blood glucose levels less than 150 mg/dL with HbA1c 7.0
Uncontrolled diabetics should have procedures postponed.
Sedative techniques should be considered
Imbalance in production of thyroid hormones arises from dysfunction of the thyroid gland itself, the pituitary gland, which produces thyroid-stimulating hormone (TSH), or the hypothalamus, which regulates the pituitary gland via thyrotropin-releasing hormone (TRH). Concentrations of TSH increase with age, requiring age-corrected tests. Hypothyroidism affects between three and ten percent of adults, with incidence higher in women and the elderly.
Not a contraindication for dental implants but caution is needed.
Sensitive to CNS depressant drugs especially narcotics and sedative drugs.
Patients are extremely sensitive to epinephrine leading to thyroid storm, which is a life threatening condition.
Moderate risk category for implants if patients are treated.
Adrenal gland disorders (or diseases) are conditions that interfere with the normal functioning of the adrenal glands. They are characterized by adrenal insufficiencies, where there are deficiencies in the availability of steroids that are produced by the adrenal glands. Adrenal Gland disorder is rather prevalent in small animals including rabbits, ferrets & guinea pigs. They may cause hyperfunction or hypofunction, and it may be congenital or acquired. Adrenal gland disorders are challenging to diagnose, but if left untreated, they are life threatening and can be very deadly.
There are two parts of the adrenal glands, the adrenal cortex and the adrenal medulla. The adrenal cortex produces cortisol, a hormone that regulates nearly every type of organ and tissue within the body. The adrenal cortex also produces aldosterone. It helps to maintain appropriate proportions of water and salts within the body. When the proportions are disrupted, it results in low blood pressure. Most patients with adrenal insufficiency may experience fatigue, poor appetites, dizziness, weight loss, and nausea.
The adrenal gland is a gland that produces hormones that affects your growth, development and stress, it also helps regulate kidney function.
Body unable to produce steroids during stressful situations. Refer patients for consultation and med increase.
Patient on regular maintenance of steroids (5mg prednisolone) is at high risk of adrenal suppression.
For simple implant cases double the doze, for advanced procedures, GA or IV sedation is recommended
Anemia also spelled anaemia and anæmia; from Greek: ἀναιμία anaimia, meaning lack of blood, from ἀν- an-, "not" + αἷμα haima, "blood") is a decrease in number of red blood cells (RBCs) or less than the normal quantity of hemoglobin in the blood. However, it can include decreased oxygen-binding ability of each hemoglobin molecule due to deformity or lack in numerical development as in some other types of hemoglobin deficiency. Because hemoglobin (found inside RBCs) normally carries oxygen from the lungs to the capillaries, anemia leads to hypoxia (lack of oxygen) in organs. Since all human cells depend on oxygen for survival, varying degrees of anemia can have a wide range of clinical consequences.
Anemia is the most common disorder of the blood. The several kinds of anemia are produced by a variety of underlying causes. It can be classified in a variety of ways, based on the morphology of RBCs, underlying etiologic mechanisms, and discernible clinical spectra, to mention a few. The three main classes include excessive blood loss (acutely such as a hemorrhage or chronically through low-volume loss), excessive blood cell destruction (hemolysis) or deficient red blood cell production (ineffective hematopoiesis).
Of the two major approaches to diagnosis, the "kinetic" approach involves evaluating production, destruction and loss, and the "morphologic" approach groups anemia by red blood cell size. The morphologic approach uses a quickly available and low-cost lab test as its starting point (the MCV), although this test can lack specificity and sensitivity in many diseases. On the other hand, focusing early on the question of production may allow the clinician to expose cases more rapidly where multiple causes of anemia coexist.
Both short and long term complications. Bone maturation and development impaired.
Decreased bone density. Abnormal bleeding. Increased discomfort post surgically. Prone to infections both acute and chronic.
Sickle cell anemia patients are contraindicated for implants.
Hematocrit: Percent of whole blood composed of erythrocytes
Men 40-50% Women 35-45%.
Hemoglobin: Men 13.5% to 18g/dL
Implants not contraindicated, antibiotics a must. Risk of bleeding high
White blood cells, or leukocytes (also spelled "leucocytes"), are cells of the immune system involved in defending the body against both infectious disease and foreign materials. Five different and diverse types of leukocytes exist, but they are all produced and derived from a multipotent cell in the bone marrow known as a hematopoietic stem cell. They live for about three to four days in the average human body. Leukocytes are found throughout the body, including the blood and lymphatic system.
The number of leukocytes in the blood is often an indicator of disease. There are normally approximately 7000 white blood cells per microliter of blood. They make up approximately 1% of the total blood volume in a healthy adult. An increase in the number of leukocytes over the upper limits is called leukocytosis, and a decrease below the lower limit is called leukopenia. The physical properties of leukocytes, such as volume, conductivity, and granularity, may change due to activation, the presence of immature cells, or the presence of malignant leukocytes in leukemia, and may be reported as Cell Population Data.
Infection most common complication. Contraindicated in leukemias. Delayed healing also a consequence.
Treatment planning modifications are needed. If it is due to some infection, treat that first
Chronic obstructive pulmonary disease (COPD) , also known as chronic obstructive lung disease (COLD), chronic obstructive airway disease (COAD), chronic airflow limitation (CAL), and chronic obstructive respiratory disease (CORD), is a lung disease defined by persistently poor airflow as a result of breakdown of lung tissue (known as emphysema) and dysfunction of the small airways. It typically worsens over time. Primary symptoms include: shortness of breath, cough, and sputum production.
COPD is most commonly caused by tobacco smoke, with a number of other factors playing a less common role. This triggers anti inflammatory response in the lung. COPD is often defined based on low airflow on lung function tests. In contrast to asthma, this limitation is rarely reversible and usually gets worse over time.
Management involves quitting smoking, vaccinations, rehabilitation, and often inhaled bronchodilators. Some people may benefit from long-term oxygen therapy or lung transplantation.
Worldwide, COPD ranked as the sixth leading cause of death in 1990. Mortality is expected to increase due to an increase in smoking rates and an aging population in many countries. COPD is the third leading cause of death in the U.S., and the economic burden of COPD in the U.S. in 2007 was $42.6 billion in health care costs and lost productivity.
Dental implants are not contraindicated in mild forms of COPD, but in advanced severe cases significant care must be taken.
Supplemental oxygen, supine position
Drugs that depress respiration such as sedatives, tranquilizers and narcotics should be discussed with the physician
Cirrhosis is a consequence of chronic liver disease characterized by replacement of liver tissue by fibrosis, scar tissue and regenerative nodules (lumps that occur as a result of a process in which damaged tissue is regenerated), leading to loss of liver function. Cirrhosis is most commonly caused by alcoholism, hepatitis B and hepatitis C, and fatty liver disease, but has many other possible causes. Some cases are idiopathic (i.e., of unknown cause).
Ascites (fluid retention in the abdominal cavity) is the most common complication of cirrhosis, and is associated with a poor quality of life, increased risk of infection, and a poor long-term outcome. Other potentially life-threatening complications are hepatic encephalopathy (confusion and coma) and bleeding from esophageal varices. Cirrhosis is generally irreversible, and treatment usually focuses on preventing progression and complications. In advanced stages of cirrhosis the only option is a liver transplant.
The word "cirrhosis" derives from Greek κιρρός [kirrhós] meaning yellowish, tawny (the orange-yellow colour of the diseased liver) + Eng. med. suff. -osis meaning an increase. While the clinical entity was known before, it was René Laennec who gave it the name "cirrhosis" in his 1819 work in which he also describes the stethoscope
Pts with no abnormal lab values for CBC, PT, PTT are at low risk. Elevated PT 1.5 times normal moderate risk. Pts above 1.5 times normal, thrombocytopenia, increased liver enzymes are at high risk, elective dental procedures are contraindicated
Osteoporosis ("porous bones", from Greek: οστούν/ostoun meaning "bone" and πόρος/poros meaning "pore") is a progressive bone disease that is characterised by a decrease in bone mass and density and that leads to an increased risk of fracture. In osteoporosis, the bone mineral density (BMD) is reduced, bone microarchitecture deteriorates, and the amount and variety of proteins in bone are altered. Osteoporosis is defined by the World Health Organization (WHO) as a bone mineral density of 2.5 standard deviations or more below the mean peak bone mass (average of young, healthy adults) as measured by dual-energy X-ray absorptiometry; the term "established osteoporosis" includes the presence of a fragility fracture. The disease may be classified as primary type 1, primary type 2, or secondary.
The form of osteoporosis most common in women after menopause is referred to as primary type 1 or postmenopausal osteoporosis. Primary type 2 osteoporosis or senile osteoporosis occurs after age 75 and is seen in both females and males at a ratio of 2:1. Secondary osteoporosis may arise at any age and affect men and women equally. This form results from chronic predisposing medical problems or disease, or prolonged use of medications such as glucocorticoids, when the disease is called steroid- or glucocorticoid-induced osteoporosis.
The risk of osteoporosis fractures can be reduced with lifestyle changes and in those with previous osteoporosis related fractures medications. Lifestyle change includes diet, exercise, and preventing falls. The utility of calcium and vitamin D is questionable in most. Bisphosphonates are useful in those with previous fractures from osteoporosis but are of minimal benefit in those who have osteoporosis but no previous fractures. Osteoporosis is a component of the frailty syndrome.
No contraindication. Make sure that rough surface implants are used with maximum bone implant contact.
Longer healing periods
Implant stabilization at time of placement
Patients on Bisphosponates should be told of surgical complications
Fibrous dysplasia is an abnormal bone growth where normal bone is replaced with fibrous bone tissue. Fibrous dysplasia causes abnormal growth or swelling of bone. Fibrous dysplasia can occur in any part of the skeleton but the bones of the skull, thigh, shin, ribs, upper arm and pelvis are most commonly affected. Fibrous dysplasia is very rare, and there is no known cure. Fibrous dysplasia is not a form of cancer.
Most lesions are monostotic, asymptomatic and identified incidentally and can be treated with clinical observation and patient education.
This disorder is usually diagnosed in childhood or early adulthood and can affect one or several bones. Males and females of any race are equally affected.
Contraindicated in areas of active bone involvement
Excision of bone involved is treatment of choice. After healing implants can be placed
Rheumatoid arthritis (RA) is an autoimmune disease that results in a chronic, systemic inflammatory disorder that may affect many tissues and organs, but principally attacks flexible (synovial) joints. It can be a disabling and painful condition, which can lead to substantial loss of functioning and mobility if not adequately treated.
The process involves an inflammatory response of the capsule around the joints (synovium) secondary to swelling (turgescence) of synovial cells, excess synovial fluid, and the development of fibrous tissue (pannus) in the synovium. The pathology of the disease process often leads to the destruction of articular cartilage and ankylosis (fusion) of the joints. RA can also produce diffuse inflammation in the lungs, the membrane around the heart (pericardium), the membranes of the lung (pleura), and white of the eye (sclera), and also nodular lesions, most common in subcutaneous tissue. Although the cause of RA is unknown, autoimmunity plays a big part, and RA is a systemic autoimmune disease. It is a clinical diagnosis made on the basis of symptoms, physical exam, radiographs (X-rays) and labs.
Treatments are pharmacological and non-pharmacological. Non-pharmacological treatment includes physical therapy, orthoses,occupational therapy and nutritional therapy but these don't stop the progression of joint destruction. Analgesia (painkillers) and anti-inflammatory drugs, including steroids, suppress symptoms, but don't stop the progression of joint destruction either. Disease-modifying antirheumatic drugs (DMARDs) slow or halt the progress of the disease. The newer biologics are DMARDs. The evidence for complementary and alternative medicine (CAM) treatments for RA related pain is weak, with the lack of high quality evidence leading to the conclusions that their use is currently not supported by the evidence nor proved to be of benefit.
About 0.6% of the United States adult population has RA, women two to three times as often as men. Onset is most frequent during middle age, but people of any age can be affected.
The name is based on the term "rheumatic fever", an illness which includes joint pain and is derived from the Greek word ῥεύμα-rheuma (nom.), ῥεύματος-rheumatos (gen.) ("flow, current"). The suffix -oid ("resembling") gives the translation as joint inflammation that resembles rheumatic fever. The first recognized description of RA was made in 1800 by Dr. Augustin Jacob Landré-Beauvais (1772–1840) of Paris.
Bisphosphonates (also called diphosphonates) are a class of drugs that prevent the loss of bone mass, used to treat osteoporosis and similar diseases. They are the most commonly prescribed drugs used to treat osteoporosis. They are called bisphosphonates because they have two phosphonate (PO
3) groups and are similar in structure to pyrophosphate.
Evidence shows that they reduce the risk of osteoporotic fracture in those who have had previous fractures.
Bone undergoes constant turnover and is kept in balance (homeostasis) by osteoblasts creating bone and osteoclasts destroying bone. Bisphosphonates inhibit the digestion of bone by encouraging osteoclasts to undergo apoptosis, or cell death, thereby slowing bone loss.
The uses of bisphosphonates include the prevention and treatment of osteoporosis, osteitis deformans ("Paget's disease of bone"), bone metastasis (with or without hypercalcaemia), multiple myeloma, primary hyperparathyroidism, osteogenesis imperfecta, and other conditions that feature bone fragility.
An anticoagulant is a substance that prevents coagulation (clotting) of blood. Such substances occur naturally in leeches and blood-sucking insects. A group of pharmaceuticals called anticoagulants can be used in vivo as a medication for thrombotic disorders. Some anticoagulants are used in medical equipment, such as test tubes, blood transfusion bags, and renal dialysis equipment. Natural anticoagulants: Heparin, Anti-thrombin III, Fibrin, Anti-thromboplastin, Heparan Sulphate, Protein C, Protein S etc.
Most of our patients are on ASPIRIN THERAPY which is an anticoagulant as well as a drug called PLAVIX
Under normal circumstances we do not stop Aspirin therapy, but if you are on Plavix we will talk to your physician and take your ANR levels before implant surgery.