title: Dental treatment for high-risk patients with refractory heart failure: a retrospective observational comparison study.
abstract: OBJECTIVE
  Heart failure affects large population groups. The understanding of the etiology, pathophysiology, and treatment of heart failure has changed considerably within the last few years. The changes have significant implications for the medical management of the disease, as well as on the ability to provide proper dental treatment for these patients.
  
  
  METHODS
  A retrospective observational study of the outcome following dental treatment of 54 patients was performed: 32 with refractory heart failure stage D (study group) and 22 patients at risk for heart failure stages A to C (control group). Dental management of these patients concentrated on the prevention of iatrogenic, dental setting- induced, and precipitating factors of heart failure. To prevent deterioration of patients' medical condition, a comprehensive, tailored treatment including adequate anxiolysis, close monitoring, profound dental anesthesia, and close follow-up was used. A previously described three-step gradual level protocol (at home, waiting room, and dental chair) was adopted.
  
  
  RESULTS
  All the planned dental procedures were successfully completed. Six patients experienced respiratory distress during treatment, and five patients demonstrated arrhythmias during dental treatment. Only minute differences were found between the groups regarding blood pressure and heart rate.
  
  
  CONCLUSIONS
  Use of the suggested protocol facilitated the completion of planned dental treatments for all patients. Thus, providing essential dental treatment for severe heart failure patients with special attention to their medical problems and the use of medications and supporting means to prevent health-compromising situations is recommended.
authors: Department of Hospital Oral Medicine, Hebrew University-Hadassah School of Dental Medicine, Jerusalem, Israel. findler@inter.net.il
authors: Mordechai
authors: M
authors: Findler
authors: Sharon
authors: S
authors: Elad
authors: Eliezer
authors: E
authors: Kaufman
authors: Adi A
authors: AA
authors: Garfunkel
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000766:Anesthesia, Dental / Q000379:methods; D000772:Anesthesia, Local / Q000379:methods; D014151:Anti-Anxiety Agents / Q000627:therapeutic use; D001145:Arrhythmias, Cardiac / Q000209:etiology; D001794:Blood Pressure / Q000502:physiology; D002985:Clinical Protocols; D003190:Comprehensive Dental Care; D016854:Dental Anxiety / Q000517:prevention & control; D017742:Dental Care for Chronically Ill; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000188:drug therapy / Q000503:physiopathology* / Q000517:prevention & control; D006339:Heart Rate / Q000502:physiology; D006801:Humans; D007049:Iatrogenic Disease / Q000517:prevention & control; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic / Q000379:methods; D010347:Patient Care Planning; D011654:Pulmonary Edema / Q000209:etiology; D012131:Respiratory Insufficiency / Q000209:etiology; D012189:Retrospective Studies; D013318:Stroke Volume / Q000502:physiology; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000503:physiopathology
chemical_list: D014151:Anti-Anxiety Agents