There are various heart conditions that need special precautions when it comes to caring for teeth and the mouth. If someone has suffered from a heart attack, high blood pressure, angina, stroke, or congestive hear failure, the situation should be discussed with the dentist or the physician prior to dental procedures.
Someone with heart disease should be responsible for maintaining a healthy mouth by practicing good oral hygiene and regularly visiting the dentist. It would be also important to follow the physician’s or the dentist’s instructions when they prescribe particular medications such as antibiotics.
Infective endocarditis is a relatively uncommon infection of the heart valves, although that can be life threatening. The infection occurs when bacteria or other micro-organisms enter the body and reach the heart. A very common way of bacteria entrance is through the mouth. To prevent infective endocarditis in patients with a weakened heart, antibiotics should be taken before doing certain dental treatments.
The American Heart Association recommends taking antibiotics before dental treatments for patients with:
- Previous history of infective endocarditis.
- Prosthetic (artificial) heart valves.
- Recipients of heart transplant who have cardiac valvular disease.
- Some congenital heart defects.
The American Heart Association also advises taking antibiotics before the following dental treatments:
- Tooth extraction.
- Endodontic procedures (root canals).
- Placement of implants.
- Tooth or implant cleaning, if bleeding is anticipated.
- Intraligamentary local anesthetic injections.
- Reimplantation of natural teeth after dental avulsion (a tooth that falls out completely after an accident).
- Periodontal procedures (gum exams, cleanings, and surgeries).
- Placement of orthodontic bands, but not brackets.
- Placement of antibiotic fibres or strips below the gum line.
High blood pressure
There are a few drugs that are prescribed to treat hypertension that cause xerostomia (dry mouth) or dysgeusia (altered sense of taste). Other medications may prompt to fainting when the patient is raised from the somewhat flat position in the dentist’s chair to a standing or sitting position.
Some anti-hypertensive drugs, such as calcium channel blockers, can cause gingival hyperplasia (overgrowth of the gums). Gingival hyperplasia can begin as soon as one month after someone starts taking the drug. Some people’s gums become so large they have difficulty chewing and surgery is required to make the correction. If the dentist detects that problem, the patient must follow detailed hygiene instructions and have more frequent cleanings.
Before someone with hypertension undergoes dental treatments, the dentist might need to take a blood pressure reading. Local anaesthetics can be safely received even if they contain epinephrine (adrenaline). Also, most people with high blood pressure can safely take anti-anxiety medication, such as nitrous oxide or diazepam (Valium), for dental procedures.
The symptoms of myocardial infarction (heart attack) can be described like a pain that starts in the chest and that radiates to the lower jaw.
Someone who’s had a heart attack should wait at least six months before having dental treatments. It’s important to give the dentist a detailed list of the drugs taken to prevent complications. For example, if a heart attack patient takes anticoagulants, the blood is less likely to clot and treatments like tooth extraction may need a temporary modification of the drug intake.
Just like a heart attack, an angina attack can be felt like pain that starts in the chest and radiates to the lower jaw.
Some drugs such as calcium channel blockers might cause gingival hyperplasia (overgrowth of the gums), which can start as soon as one month after someone starts taking the drug. Some people’s gums become so large they have difficulty eating and surgery is necessary to make the correction. If the dentist detects that problem, the patient must follow detailed hygiene instructions and have more frequent cleanings.
Patients with stable angina can be treated like any other patients and proceed with any dental treatment. But people who suffer from unstable angina should not receive elective dental procedures and concentrate only on emergency treatments.
It’s recommended to reduce stress during a dental appointment because stress can trigger angina attacks. It is also important to bring angina medications to the dentist’s office. Some ways to reduce stress are sleeping well the night before seeing your dentist and avoiding caffeine before the appointment.
Congestive heart failure
Many medications prescribed to treat congestive heart failure may cause xerostomia (dry mouth) or dysgeusia (altered sense of taste).
There are usually no special concerns in undergoing dental treatment for someone being treated for congestive heart failure if he or she has no complications or side effects.
People who have severe heart failure should consider dental treatments done in a hospital clinic. They should not stay lying down in the dental chair too far because the fluid build-up in their lungs may affect breathing. It’s also recommended to go slowly when moving from a standing position to the chair, and when standing up from the chair, because dizziness can come easily.
Coronary artery bypass surgery
Coronary artery bypass surgery (or heart bypass surgery) is a surgical procedure which consists of bypassing a narrowed or a blocked coronary artery by grafting another artery or vein taken from another area of the body.
If a patient who has had coronary artery bypass must get a dental treatment, he or she might experience severe pain when reclining in the dental chair. This is a side effect of the surgery. Taking antibiotics before dental treatment is usually not required unless surgery has been done several weeks before seeing the dentist.
A pacemaker is a medical device which uses electrical impulses to regulate the beating of the heart. The primary purpose of a pacemaker is to maintain an adequate heart rate, either because the heart’s native pacemaker is not fast enough, or there is a block in the heart’s electrical conduction system.
It’s very important to inform the dentist if a patient has a pacemaker because all dental electromagnetic devices should be avoided. More thorough dental treatments should be postponed several weeks after surgery. If an emergency dental procedure must be conducted, the dentist or the physician may prescribe pre-treatment antibiotics.
- Dental Care and Heart Disease – American Heart Association (www.americanheart.org).
- Heart Disease and Dental Treatment – Colgate (www.colgate.com).
The information above should be used as a reference only. Any medical decision should not be taken before consulting a health care professional.
The masculine gender may have been more used in the article, but without prejudice, to make reading easier.
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