Advise for dentists regarding dental procedures in patients with long-QT syndrome.

1. Beta Blocker therapy should be continued as normal on day of dental treatment

2. Avoid drugs known to prolong QT interval

Contraindicated drugs in dentistry include:
Antibiotics: Erythromycin, azithromycin, clarithromycin, metronidazole
Antifungals: Fluconazole, itraconazole, ketoconazole

Check up-to-date web based lists
www.bnf.nice.org.uk
www.sads.org/living-with-sads/Drugs-to-Avoid
www.crediblemeds.org

3. Adrenaline is contraindicated

4. Bupivacaine can induce arrhythmias and is best avoided

5. Alleviate patient anxiety

Effective analgesia; use topical anaesthetic

Consider conscious sedation
• Nitrous oxide safe
• Midazolam safe
• Consider pre-medication with temazepam / diazepam

Quiet, calm environment

6. Check electrolytes prior to general anaesthetic

7. Patients with ICD

Electrosurgery can result in circuit damage, arrhythmia or burning
Modern ultrasonic scalers, apex locators and pulp testers may be used safely

8. Management of medical emergencies
CPR / BLS training essential
Manage medical emergencies in the usual manner, including the administration of adrenaline in the case of anaphylaxis
Access to an automated external defibrillator (AED) as torsades (ventricular tachycardia) can deteriorate to VF and cardiac arrest NB: dental practices should carry out a risk assessment in line with their regulatory body requirements to determine if an AED is required on the premises.