Dental treatment under local anesthesia and sedation, is of great benefit, but medical problems may arise, especially in patients with cardiovascular disease (CVD). Cardiovascular disease is the leading cause of death worldwide, with more than three-quarters of deaths reported in low-and middle-income countries. In dentistry, clinical procedures in patients with cardiovascular disease should be carefully evaluated, including the use of local anesthesia and sedatives. Although there is a long history of safe use of local anesthetics (LA) in healthy patients and those with complex medical situations, prophylactic and corrective measures should be taken to ensure the safe delivery of dental care in patients with heart disease.

Assessment of the coastal degradation using the coastal sensitivity index (CSI) in the microtidal environment (Gulf of Gabes, Tunisia) shows that 78.6% of the coast is under low to moderate sensitivity. Moderate sensitivity class includes the sheltered zones and the stable sea cliffs. The highest sensitivity was recorded in sandy beaches (12.7%) where the drift actions amplify littoral fragility and flood risk.The coastal sensitivity index (CSI) is resulted from the combination of eight ranked variables: (a) geomorphology (b) coastal slope (c) hinterland topography (d) facies (e) shoreline exposure (f) shoreline changes (g) tide (h) sea-level trend. Fifty six morphodynamic cells are deduced from a strictmorphologic classification of the studied coast. Each specified cell presents a numerical pattern according to the ranked physical and structural variables. Once managed, the beaches with the highest sensitivity are immediately disturbed. Littoral disturbance is irreversible when the foredune unit is damaged but sustainable remediation of coastal areas must emphasize with the adequate planning for the environmental rehabilitation.

No abstract