By Gwen Grosso RDH, MS, and Renee Prajer RDH, MS
Coronary artery disease or ischemic heart disease refers to a decreased supply of oxygenated blood to the heart. This disease process is the etiologic agent for conditions such as angina pectoris, myocardial infarction and cardiac arrest.
Ischemia occurs as a result of a narrowing of the coronary arteries, commonly referred to as atherosclerosis. The arteries become partially or fully occluded with a lipid-like substance that decreases the flow of oxygenated blood.
Treatments for this condition are balloon angioplasty and coronary stenting. Balloon angioplasty involves inserting a catheter with a deflated balloon into a diseased artery. Once the balloon is in place, it is inflated to widen the artery therefore increasing the flow of oxygenated blood.
Coronary stents are stainless steel mesh tubes that are inserted into the artery after balloon angioplasty has been performed to provide support to the widened artery. Following coronary stent placement, the patient is maintained on antiplatlelet medication to prevent the risk of thrombosis.
When treating patients that have undergone coronary angioplasty and stenting it is necessary to consider the following:
• Date of stent placement?
• Is the patient currently on antiplatelet therapy?
Various research states that patients should be premedicated prior to dental treatment for six months following stent placement. However, specific guidelines regarding the need for premedication are inconclusive. The dental hygienist should be aware that consultation with the patient's physician is necessary to determine the need for premedication and possible alteration of prescribed antiplatelet medication.
• Redding, Spencer, D.D.S., M.ED, Roberts, Howard, D.M.D., Coronary Artery Stents: Review and Patient Management Recommendations, JADA, Vol. 131, June 2000
• Little J. et al: Dental Management of the Medically Compromised Patient, 2002, Mosby.
Gwen Grosso RDH, MS, is Assistant Professor and the Community Based Coordinator; Renee G. Prajer RDH, MS, is Assistant Professor and the Junior Clinic Coordinator; both from the University of New Haven, West Haven, CT.