1. Assess vital signs at every appointment because of cardiovascular side effects.

2. Make sure that the patient's drug is easily accessible in case of an angina attack.

3. Early morning and shorter appointments may be of benefit for anxious patients.

4. Antianxiety drugs, such as ben-zodiazepines or nitrous oxide can be prescribed if the anxiety associated with a dental appointment precipitates the patient's angina attack.

5. Talk with patient about frequency of angina attacks (disease control).

6. Stress from a dental procedure may adversely affect the patient's cardiovascular status. Assess patient risk.

7. 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.

8. A semisupine position may be necessary for patients with cardiovascular disease.

9. Vasoconstrictors should be used with caution and in low doses. Avoid epinephrine-containing gingival retraction cords.

10. Decreased saliva flow can put the patient at risk for dental caries, periodontal disease, and candidiasis.

11. Check the expiration date on the patient's prescription and the bottle in your emergency medicine kit in order to make sure that the drug is active. Opened bottles have a three-month shelf life or less depending on the expiration date listed on the bottle. The spray form has a three-year shelf life.

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