The Journal of the American Dental Association
HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
QUICK SEARCH:   [advanced]


     

J Am Dent Assoc, Vol 137, No 5, 630-637.
© 2006 American Dental Association
This Article
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Services
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Right arrow reprints & permissions
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Karp, J. M.
Right arrow Articles by Moss, A. J.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Karp, J. M.
Right arrow Articles by Moss, A. J.
Related Collections
Right arrow Infection Control

CLINICAL PRACTICE

JADA Continuing Education

Dental treatment of patients with long QT syndrome



Jeffrey M. Karp, DMD, MS and Arthur J. Moss, MD

Background. Long QT syndrome (LQTS) is associated with life-threatening cardiac arrhythmias causing syncope and sudden cardiac death, frequently precipitated by physical or psychological stress.

Types of Studies Reviewed. The authors did a literature review of data published in peer-reviewed medical and dental journals. They also extracted epidemiologic information, correlations between genetic mutations and disease onset and progression, and data regarding outcomes of therapy from published peer-reviewed studies and the cohort population belonging to the International Long QT Syndrome Registry.

Results. LQTS is diagnosed after an unexpected cardiac event or through QT interval prolongation on an electrocardiogram. Gene mutation identification in LQTS provides insight into respective proarrhythmogenic factors and indicated therapeutic regimens. ß-blockers are the initial treatment for two of the three major forms of LQTS. Patients refractory to ß-antiadrenergic therapy may benefit from one or more of the following: cardiac pacemakers, implanted cardioverter defibrillators and left cardiac sympathetic denervation.

Conclusions. Clinical studies are needed to investigate the safety of treating patients in an ambulatory setting.

Clinical Implications. Preventive measures are recommended, including evaluation by a cardiac specialist before any dental intervention, use of anxiolytic protocols, avoidance of drugs that prolong the QT interval, and provision of treatment in a setting in which medical emergencies can be managed expeditiously. Dental treatment in a hospital and use of a general anesthetic administered by anesthesiologists are recommended for procedures in which anxiety and adrenergic stimulation would not be suppressed sufficiently in an ambulatory environment.

Key Words: QT prolongation; long QT syndrome; torsades de pointes; syncope; dental procedures; stress




This article has been cited by other articles:


Home page
 Journal of the American Dental AssociationHome page
R. S. Brown
Long qt syndrome.
J Am Dent Assoc, August 1, 2006; 137(8): 1068 - 1069.
[Full Text] [PDF]


HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
Copyright©1995-2006 American Dental Association (ADA).
Reproduction or republication strictly prohibited without prior written permission of ADA.