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hYPERTENTION AND DIABETES MILLITUS FOCUS ON MANAGMENT
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DEFENITION
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is abnormal elevation in arterial blood pressure that can be fatal if untreated.
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ETIOLOGY
hYPERTENTION
dIABETES MELLITUS
Primary (essential) idiopathic H.T
Most common 90% of cases (genetic)
associated with cardiovascular risk factors, smoking, obesity, lipid problems, and diabetes.
Secondary H.T(underlying cause )
intrinsic renal diseases, renovascular disease, Pheochromocytoma, Cushing’s syndrome, thyroid or parathyroid disease, heavy alcohol consumption, chronic corticosteroid therapy, chronic NSAIDS therapy,
or long-term oral contraceptive use can lead to secondary
hypertension. cured after treatment of the underlying cause
Due Date
mm/dd/yyyy
introduction
DM
BLOOD PRESSURE
Definition
IN
ADULT
NORMAL
Dental managment
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The systolic pressure is the force that the blood exerts on the artery walls as the heart contracts to pump the blood to the peripheral organs
- SYSTOLIC
- DIASTOLIC
- PULS PRESSURE
is the product of cardiac output and peripheral
resistance.
And is dependent on:
1-Heart
2-vasculature
3-ANS
4-Endocrine system
5-Kidneys
NORMAL IN ADULT
diastolic pressure is residual pressure exerted on the arteries as the heart relaxes
SYSTOLIC
120 -140 MM\HG
Diabetes mellitus is a chronic disease complex with metabolic and vascular
components.
The metabolic disorder of carbohydrate due to disturbance of the normal insulin mechanism (characterized by hyperglycemia )
Insulin
•Insulin is a hormone secreted by the B-cells of the pancreatic islets of langerhans, it promotes the entry of glucose into the body's cells.
Types of
diabetes mellitus
DIASTOLIC
80-90 MM\HG
PULSE PRESSURE
Type 2 DM insulin resistance, a condition in which cells fail to use insulin properly’ non insulin-dependent diabetes mellitus (NIDDM)’
•Type 1 DM : the body's failure to produce insulin,
"insulin-dependent diabetes mellitus" (IDDM)
The difference between diastolic AND systolic pressures
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.
•Potential drug interactions between the patient's antihypertensive medications and the drugs prescribed and oral adverse effects that might be caused by antihypertensive medications
Dental management
•During the course of treatment, the patient might experience an acute elevation in blood pressure that could lead to a serious outcome such as stroke or MI. This acute elevation in blood pressure could result from the release of endogenous catecholamines in response to stress and anxiety, from injection of exogenous catecholamines in the form of vasoconstrictors in the local anesthetic, or from absorption of a vasoconstrictor from the gingival retraction cord. .
Based on blood pressure measurements, the dental management is as follows:
Once it has been determined that the hypertensive patient can be safely treated, the following should be considered:
• Stress/anxiety reduction.
•Establishment of good rapport.
•Short, morning appointments.
•Consider premedication with sedative/anxiolytic like Diazepam 2-5 mg the night before surgery and/or 1 hour before surgery
Oral maifistation
No oral complications have been associated with hypertension itself.
Patients with malignant hypertension have been reported to occasionally develop facial palsy.
•Patients with severe hypertension have been reported to bleed excessively after surgical procedures or trauma.
•Patients who take antihypertensive drugs, especially diuretics, may report dry mouth.
•
Lichenoid reactions have been reported with thiazides, methyldopa, propranolol, andlabetalol
•ACE inhibitors may cause neutropenia, resulting in delayed healing or gingival bleeding, non-allergic angioedema and burning mouth.
•All calcium channel blockers may cause gingival hyperplasia
nitrous oxide/oxygen
•Slow position changes
•intraoperative blood pressure monitoring
•excellent local anesthesia
•Noradrenalin and levonordefrin should be avoided
•adrenalin is generally not advised in patients with uncontrolled or severe hypertension
•the adverse interactions between vasoconstrictors and the nonselective beta-blocking agents (such as propranolol
Insulin Shock
•Patients who are treated with insulin must closely adhere to their diet.
If they fail to eat in a normal manner but continue to take their regular insulin injections, they may experience a hypoglycemic reaction caused by an excess of insulin (insulin shock).
Detection of the Patient With Diabetes(DIABETIC PERSON)
•1- Detection by history:
•a. Are you diabetic?
•b. What medications are you taking?
•c. Are you being treated by a physician?
2_Establishment of severity of disease and degree of control:
•a. When were you first diagnosed as diabetic?
•b. What was the level of the last measurement of your blood glucose?
•c. What is the usual level of blood glucose for you?
•d. How are you being treated for your diabetes?
•e. How often do you have insulin reactions?
•f. How much insulin do you take with each injection, and how often do you receive injections
•g. Do you test your urine for glucose?
•h. When did you last visit your physician?
•i. Do you have any symptoms of diabetes at the present time?
ORAL MANIFESTATIONS:
•xerostomia ,bacterial ,viral, fungal, infections including candidiasis & more rare are mucormycosis ,poor wound healing , high caries incidence, gingivitis & periodontal disease ,periapical abscesses &burning mouth . lichen planus may also more in diabetic patient due to alter in immune system.
Dental Management of the Patient With Diabetes mellitus :
1- Non-insulin-dependent patient: If diabetes is well-controlled, all dental procedures can be performed without special precautions.
2. Insulin-dependent patient:
•If diabetes is well-controlled all dental procedures can be performed without special precautions,
- Morning appointments are usually best. - Patient advised to take usual insulin dosage and normal meals on day of dental appointment. information confirmed when patient comes for appointment.
- Advise patient to inform dentist or staff if symptoms of insulin reaction occur during dental visit.
- Glucose source (orange juice) should be available and given to the patient if symptoms of insulin reaction occur.
•If extensive surgery is needed: Consult with patient's physician concerning dietary needs during postoperative period.
•- Antibiotic prophylaxis can be considered for patients with brittle diabetes and
those taking high doses of insulin who also have chronic states of oral infection.
If not well-controlled (i.e. high fasting blood glucose ,high HbA1c or ANY complications of DM like Ml, renal disease,congestive heart failure, symptomatic angina, old cardiac arryhthmia, cerebrovascular accident, blood pressure >180/110 mm Hg):
•Provide appropriate emergency care .
•- Request referral for medical evaluation, management, and risk factor modification
•- If symptomatic, seek IMMEDIATE referral.
•- If asymptomatic, request routine referral
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