Cardiovascular
Dental Management of Patients with Myocardial infarction (history)
Confirm time since myocardial infarction
Time since the MI determines whether elective care can proceed.
Emergency vs routine management
If EMERGENCY — what to do
- • Within 30 days of MI: urgent care only (analgesia, antibiotics, simple drainage) after cardiologist consultation, ideally in hospital.Ref: Fleisher LA et al. 2014 ACC/AHA Guideline on Perioperative Cardiovascular Evaluation for Noncardiac Surgery. Circulation 2014;130:e278–e333
- • Limit adrenaline to 0.04 mg (≈ 2 cartridges of 1:80,000–1:100,000), aspirate and inject slowly.Ref: Little JW, Miller CS et al. Dental Management of the Medically Compromised Patient, 10th ed., Elsevier 2023
- • If chest pain occurs: stop treatment, sit upright, GTN 400 µg sublingual, aspirin 300 mg chewed (if not allergic), oxygen, and call emergency services if not relieved within 5 min.Ref: Resuscitation Council UK. Medical emergencies and resuscitation — Standards for dental practice, 2020 (updated 2023)
If ROUTINE — what to do
- • Defer elective care for ≥ 30 days after MI and until stable without angina; major surgery is often deferred 6 months.Ref: Fleisher LA et al. 2014 ACC/AHA Guideline on Perioperative Cardiovascular Evaluation for Noncardiac Surgery. Circulation 2014;130:e278–e333
- • Short morning appointments, stress reduction, review antiplatelet/anticoagulant therapy.Ref: SDCEP. Management of Dental Patients Taking Anticoagulants or Antiplatelet Drugs, 2nd ed., 2022
Clinical precautions
- • Establish date of infarction
Information & tests to request
- • Days since myocardial infarction
At a glance by procedure
Initial assessment before lab results or timing details are entered.
| Procedure | Initial assessment |
|---|---|
| Examination / radiographs | MODIFY / CAUTION Confirm time since myocardial infarction |
| Supragingival scaling / polish | MODIFY / CAUTION Confirm time since myocardial infarction |
| Deep scaling / subgingival RSD (subgingival calculus) | MODIFY / CAUTION Confirm time since myocardial infarction |
| Root canal treatment | MODIFY / CAUTION Confirm time since myocardial infarction |
| Simple extraction (1–3 teeth) | MODIFY / CAUTION Confirm time since myocardial infarction |
| Surgical / bony extraction | MODIFY / CAUTION Confirm time since myocardial infarction |
| Implant placement | MODIFY / CAUTION Confirm time since myocardial infarction |
References
- AHA — Dental management of the cardiac patient
- Fleisher LA et al. 2014 ACC/AHA Guideline on Perioperative Cardiovascular Evaluation for Noncardiac Surgery. Circulation 2014;130:e278–e333
- Little JW, Miller CS et al. Dental Management of the Medically Compromised Patient, 10th ed., Elsevier 2023
- Resuscitation Council UK. Medical emergencies and resuscitation — Standards for dental practice, 2020 (updated 2023)
- SDCEP. Management of Dental Patients Taking Anticoagulants or Antiplatelet Drugs, 2nd ed., 2022
Related guides
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This guide supports — and does not replace — professional clinical judgment. Always consider the individual patient and consult the treating physician when indicated.