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1. Monitor vital signs at every appointment because of cardiovascular and respiratory side effects.

2. Have the patient sit up slowly and remain seated for at least two minutes after being supine in order to minimize the risk of orthostatic hypotension.

3. Decreased saliva flow can put the patient at risk for dental caries, perio-dontal disease, and candidiasis.

4. Dental procedures may cause the patient anxiety or place stress on the heart. Assess cardiovascular patient for this risk.

5. Early morning and shorter appointments as well as methods for addressing anxiety levels in the patient can help to reduce the amount of stress that the patient is experiencing.

6. Vasoconstrictors should be used with caution and in low doses.

7. Calcium channel blockers have been associated with gingival hyper-plasia. Have the patient perform meticulous oral hygiene.

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