Things to consider:
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Medical history form has to be updated
history of hypertension should be noted as he is taking medicine regularly for it
(amlodipine)
Lifestyle choices such as smoking and weight
gums bleeding could be medicine or could/poor oral hygiene/ stopping of smoking
due to thick layer, repercussions of long term smoking
whose responsible is it to update medical history?
responsibilities of the dentists and their duty of care in terms when combined with
general medical practitioner
risk factors for cardio vascular disease
how does cardio vascular disease affect dental treatment
smoking and how it increases risk of hypertension and cardiovascular disease
how the medication for cardiovascular disease affects your ability to do dental
treatment
angina/high blood pressure / cardiac arrest
chest pain when excursion
pick up on the fact that he had angina whilst watching tv which suggests that his
angina is p
valvular heart disease —>infective endocarditis
use of pace maker to stop
use of medicine can sometimes effect dental treatment in regards to using together as
they can interact badly
BNF- website
private dentists can prescribe anything
prescribing in dental practise (using the BNF)
https://bnf.nice.org.uk/dental-practitioners-formulary/
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list of sections of particular relevance to dentists
medical emergencies in dental practise
medical problems in dental practise
chapter 2 cardiovascular system, section 4 blood pressure, 4.1 hypertension e.g
antihypertensive drugs
sections for each drug (list)
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indications and dose
important safety info
contra- indications (condition that means it wouldn’t be safe to prescribe)
causations (prescribe but be careful)
interactions (some medicine can’t take together because they affect the metabolism of
the medicine)
side effects
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use of drug in specific patient populations
administration and monitoring
profession specific information
medicinal forms (different ways the medicine can be taken)
Diseases Hypertension- high blood pressure. Lifestyle adjustments are the standard first-line
treatment for hypertension, regular exercise.
valvular heart disease
infective endocarditis
Angina
Is chest pain caused by reduced blood flow to the heart muscles. It's not usually life
threatening, but it's a warning sign that you could be at risk of a heart attack or stroke.
There are 2 main types of angina you can be diagnosed with:
 stable angina (more common) – attacks have a trigger (such as stress or exercise)
and stop within a few minutes of resting
 unstable angina (more serious) – attacks are more unpredictable (they may not have
a trigger) and can continue despite resting
Some people develop unstable angina after having stable angina.
medicine given to:
 treat attacks when they happen (only taken when needed)
 prevent further attacks
 reduce the risk of heart attacks and strokes
If medicines aren't suitable or don't help, an operation to improve blood flow to the heart
muscles may be recommended.
Patients with angina treated with calcium channel blockers may have gum overgrowth. In
some cases, gum surgery may be needed.
Like patients with a previous heart attack, patients with angina may want to ask their
dentist if oxygen and nitroglycerin are available in case a medical emergency should arise.
While patients with stable angina (chest pain that occurs in a predictable pattern) can
undergo any dental procedure, patients with unstable angina (new chest pain or
unpredictable chest pain) should not undergo elective (nonessential) dental procedures,
and emergency dental care should be performed in a hospital or office equipped with
cardiac monitoring capability.
Amlodipine:
Calcium-channel blockers (less correctly called ‘calcium-antagonists’) interfere with the
inward displacement of calcium ions through the slow channels of active cell membranes.
They influence the myocardial cells, the cells within the specialised conducting system of the
heart, and the cells of vascular smooth muscle. Thus, myocardial contractility may be
reduced, the formation and propagation of electrical impulses within the heart may be
depressed, and coronary or systemic vascular tone may be diminished.
 For angina – dose: Initially 5 mg once daily; maximum 10 mg per day
 For Hypertension – dose: Initially 5 mg once daily; maximum 10 mg per day.