Heart Disease and Dental Treatment
People with certain cardiovascular conditions need to take antibiotics before
dental treatment to reduce the risk of a condition called bacterial endocarditis.
This is a relatively uncommon infection of the heart valves, but it can
be life threatening. In 1997, the American Heart Association recommended
pre-treatment antibiotics for people who have had endocarditis in the
past and for those with:
- Artificial heart valves
- Certain types of complex congenital heart malformations
- Surgically constructed systemic-pulmonary shunts
- Acquired heart valve dysfunction (for example, rheumatic heart disease)
- Hypertrophic cardiomyopathy
- Mitral valve prolapse with valvular regurgitation (leakage) and/or
thickened leaflets
The American Heart Association guidelines recommend pre-treatment antibiotics
for the following dental procedures:
- Tooth extraction
- Implant placement
- Reimplantation of natural teeth
- Periodontal procedures (gum exams, cleanings, surgeries)
- Some types of endodontic
(root canal) procedures
- Initial placement of orthodontic bands (but not brackets)
- Intraligamentary local anesthetic injections
- Placement of antibiotic fibers or strips below the gumline
- Tooth or implant cleaning, if bleeding is anticipated
Oral Effects
A heart attack can sometimes be felt like a pain starting in the chest and radiating
to the lower jaw.
At the Dentist
You should wait at least six months after a heart attack to have dental treatment.
Your dentist should have oxygen and nitroglycerin available during your appointment,
and should talk with your physician about your condition.
Certain medications may change the way your dentist treats you. For
example, if you are taking anticoagulants, your blood is less likely
to clot. Always give your dentist a detailed list of your medications,
with dose information, to avoid drug interactions or complications.
High Blood Pressure (Hypertension)
Oral Effects
Some drugs that are prescribed to treat high blood pressure (anti-hypertensive
medications) cause dry
mouth or
an altered sense of taste (dysgeusia); Others may predispose you to fainting
when you are raised from the relatively flat position in the dentist's chair
to a sitting or standing position.
Gum overgrowth is a possible side effect of some anti-hypertensive medications,
such as calcium channel blockers. It can begin as soon as one month after
starting drug therapy. Some people's gums become so large they have difficulty
chewing. In some cases, surgery is required to reduce the gums.
At the Dentist
If you have high blood pressure, you should consider your dentist part of your
health care team. Your dentist should check your blood pressure at each visit.
Your dentist can decide whether it’s OK for you to have elective dental
treatment based on the severity of your hypertension, how well it is controlled,
and any other conditions you have (stroke, angina, kidney disease, etc.).
Your dentist may take your blood pressure two or three times at your first
appointment after a hypertension diagnosis. This is to establish a " baseline" blood
pressure, so the dentist will know if you have a reaction to treatment or medication.
Most people with hypertension can safely take anti-anxiety medication — such
as nitrous oxide or diazepam (Valium) — for dental procedures. They can
also safely receive local
anesthetics even if they contain epinephrine. If you have concerns about
these medications, talk to your dentist.
If you take calcium channel blockers and notice gum overgrowth (also called
gingival hyperplasia), your dentist will give you detailed oral hygiene instructions
and may ask you to visit more often for professional cleanings. If you stop
taking the drugs, your gums recede somewhat, but this may take several months
and they may not return to normal on their own. Gum
surgery may be necessary in some cases.
Make sure your dentist knows which drugs you are taking for your high blood
pressure. Take your medications as you normally do and eat properly before
dental visits.
Coronary Artery Bypass Graft (CABG)
Oral Effects
There are no oral effects of this procedure.
At the Dentist
For the first couple of weeks after surgery, you may experience severe pain when
reclining in the dental chair. This is a side effect of the surgery used to
perform the CABG. Work with your dentist to find a comfortable position in
the chair.
People who have had CABG generally do not require antibiotics before dental
treatment unless they require dental treatment within several weeks of graft
placement.
Angina
Oral Effects
An angina attack can sometimes be felt like a pain starting in the chest and
radiating to the lower jaw.
Calcium channel blockers can cause gum overgrowth (gingival hyperplasia).
This condition can begin as soon as one month after starting drug therapy.
Some people's gums become so large they have difficulty chewing. In some cases,
surgery is required to reduce the gums.
At the Dentist
People with stable angina can be treated like any other patients, with a few
differences. Your dentist should have oxygen and nitroglycerin available during
your visit and should consult with your physician before the appointment to evaluate
your condition.
People with unstable angina should not receive elective dental care. Emergency
dental care should be performed under continuous heart monitoring.
If you are taking calcium channel blockers and have gum overgrowth, your
dentist can give you detailed oral hygiene instructions and may ask you to
visit more often for professional cleanings. If you stop taking the drugs,
your gums do recede somewhat, but this may take several months and they may
not return to normal on their own. Gum
surgery may be necessary in some cases.
Talk to your dentist about ways to reduce stress during an appointment. Stress
can trigger angina attacks, so bring your medications to the dentist's office.
If you feel chest pain during your visit, tell your dentist.
High Cholesterol (Hyperlipidemia)
Oral Effects
There are no oral effects of hyperlipidemia, which is an excess of fat (lipids)
in the blood.
At the Dentist
Some drugs used to treat hyperlipidemia can make you feel faint after getting
up from the dental chair. Also, having high cholesterol puts you at risk of atherosclerosis
(hardening of the arteries), which can lead to cardiovascular emergencies, such
as heart attack or stroke. Your dentist should be aware of your condition and
the drugs you are taking.
Stroke
Oral Effects
Stroke is a leading cause of long-term disabilities, which may include paralysis,
difficulty speaking and swallowing, increased or decreased sensitivity to pain,
blurred vision, poor memory and personality changes (anxiety, depression).
If your stroke caused paralysis of your dominant hand, a family member or
caregiver can help with daily dental care. Toothbrushes and floss holders with
modified handles are also available. If you wear dentures, your dentures may
need to be refashioned or realigned.
Paralysis of the face and tongue can reduce the ability of saliva to cleanse
your mouth, and can make you less aware of oral injuries or food particles
in your teeth. Rinsing may be difficult or impossible. Your dentist may suggest
that you use a fluoride gel or saliva substitute.
At the Dentist
If you take anticoagulant medication, you should talk to your dentist before
having any major dental work. Anticoagulants make the blood less likely to clot,
which could cause excessive bleeding during surgery. If you need surgery, your
dentist will take your medication use into consideration when deciding how to
treat you. Usually, routine dental treatment does not require any changes in
your medications. Because some of these medicines can thin your blood, bring
a copy of your most recent blood tests to your dentist as often as it is available.
Congestive Heart Failure
Oral Effects
Many medications used to treat congestive heart failure may cause dry mouth (xerostomia).
At the Dentist
If you are being treated for CHF and have no complications or side effects, there
are no special considerations for dental treatment.
People with more severe heart failure should not lie down in the dental chair
too far because the fluid build-up in their lungs may affect breathing. They
should also take it slow when moving from a standing position to the chair,
and when standing up from the chair, because they can become dizzy and light-headed
easily. Your dentist can confirm your level of CHF disease by contacting your
physician or cardiologist. Some patients with CHF that is class III or IV (using
the New York Heart Association functional classification system) should consider
dental treatment in a hospital setting.
Pacemaker Implantation
Oral Effects
There are no specific oral effects caused by pacemaker implantation. At the Dentist
If you have a pacemaker, you should confirm that there are no interactions between
electromagnetic devices in your dentist's office and your pacemaker. The chance
of any interaction is minimal, and you or your dentist should be able to find
out about interactions from your physician or the pacemaker manufacturer. Talk
with your physician about possible interactions before visiting the dental
office. If there is a chance of interaction, your dentist can take precautions
to prevent it.
You should avoid elective dental care within the first few weeks after receiving
your pacemaker. If you must receive dental care within that time, your dentist
and physician should decide if pre-treatment antibiotics are right for you.
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