Cardiovascular
Some cardiovascular diseases may affect your oral health. They also may require changes in your dental treatment and how you receive dental care. Recent research has linked periodontal disease with the risk of coronary artery disease and stroke. But there is not enough research to show whether periodontal disease causes these other conditions. If you have a one of these conditions, make sure that your dentist always has an up-to-date list of all the medicines you take. The list should be neatly written or typed. It should include prescription drugs, and over-the-counter medicines such as antacids. It also should include vitamins, herbal pills and other nutritional supplements. Your list should provide the name of each drug, the dosage, how often you take it and when your physician prescribed it. Put the date that you made the list at the top of the page. This will let the dentist know that it is a current list. Periodontal Disease and Cardiovascular Conditions Right now, scientists have two possible explanations for this association. One is that the bacteria that cause periodontal disease can release toxins into or travel through the bloodstream and help to form fatty plaques in the arteries. These plaque deposits can lead to serious problems, such as blood clots, which can block blood flow. The other explanation is that these bacteria cause the liver to make high levels of certain proteins, which inflame the blood vessels. Inflammation eventually could lead to a heart attack or stroke. Symptoms of periodontal disease include:
If you have symptoms of periodontal disease, see your dentist for treatment. Heart Disease and Dental Treatment People with certain heart conditions may need antibiotics before they have certain types of dental procedures. Make sure to inform your dentist of any heart issues. In 2007, the American Heart Association updated its guidelines on the use of antibiotics before dental treatments. The new policy advises antibiotics for fewer people than the old policy did. Pre-treatment with antibiotics is still recommended for people who have had endocarditis in the past. It is also recommended for people with artificial heart valves, and people who had heart transplants and later developed heart valve problems. Pre-treatment with antibiotics also is recommended for people with certain heart conditions that were present at birth:
Antibiotics before dental work no longer are advised for people with:
The American Heart Association guidelines recommend pre-treatment antibiotics for dental procedures that involve an incision or manipulation of the gums or the tissues around a tooth root. Antibiotics are not required for the following:
Myocardial Infarction (Heart Attack) Oral Effects At the Dentist Some medicines you take can change the way your dentist treats you. For example, if you are taking blood thinning drugs (anticoagulants), your blood is less likely to clot. You may need to stop taking your blood thinning medicines before some dental procedures. Do not stop taking any medicines until you have spoken to your physician. This is something your dentist will discuss with you and your physician. Let your dentist know the medicines you take, and their doses. You may need to take blood tests before some dental procedures, such as gum surgery (periodontal surgery) or extractions. High Blood Pressure (Hypertension) Oral Effects Gum overgrowth is a possible side effect of some drugs that treat high blood pressure. These include calcium channel blockers. It can begin as soon as one month after you start drug therapy. Some people's gums become so large that they have difficulty chewing. In some cases, surgery is needed to remove part of the gums. At the Dentist
The first time you visit the dental office after being diagnosed with high blood pressure, your dentist may take your blood pressure two or three times. This is to establish a "baseline" blood pressure. This way, the dentist will know if your blood pressure changes in response to treatment or a medicine. Most people with high blood pressure can safely take anti-anxiety drugs — 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 drugs, talk to your dentist. Some people taking calcium channel blockers may notice gum overgrowth (gingival hyperplasia). Your dentist will give you detailed oral hygiene instructions and may ask you to visit more often for professional cleanings. Remember that your daily tooth brushing and flossing at home is very important. If you stop taking the drugs, your gums recede somewhat. However, this may take several months. Some people's gums do not return to normal on their own. Gum surgery may be necessary. Make sure your dentist knows which drugs you are taking for your high blood pressure. Before a dental visit, take your medicines as you normally do. Coronary Artery Bypass Graft (CABG) Oral Effects At the Dentist Unless they need dental treatment within a few weeks after the surgery, people who have had CABG generally do not require antibiotics before a dental procedure. Oral Effects Some people with angina take drugs called calcium channel blockers. These drugs can cause gum overgrowth. This can happen as soon as one month after you start these drugs. Some people's gums become so large that they have problems chewing. People who have this problem will most likely need surgery on their gums (periodontal surgery). At the Dentist People with unstable angina should not receive non-emergency dental care. If you need emergency dental care, your heart should be continuously monitored. Stress can trigger angina attacks. If being in the dental chair increases your anxiety, speak with your dentist about ways to reduce this stress. If you feel any chest discomfort, tell your dentist or the dental staff right away. High Cholesterol (Hyperlipidemia) Oral Effects At the Dentist Oral Effects
In some people, a stroke paralyzes one side of the body. If this happens to you, a family member or caregiver may need to help you with activities of daily living, including your dental care. Special toothbrushes and floss holders also are available. If you wear dentures, they may need to be adjusted. If your face or tongue is paralyzed, you may not be able to rinse your mouth. You may also not realize when you have food left in your mouth. You may bite your lip or tongue and not realize it. To keep your teeth and gums healthy, your dentist may suggest that you use a fluoride gel or saliva substitute. At the Dentist Oral Effects At the Dentist If you have more severe heart failure, you should not lie down in the dental chair too far. The fluid build-up in your lungs may affect your breathing. You also should not sit up or lie down very quickly. These changes can make you dizzy and light-headed. Your dentist can confirm how serious your CHF is by talking with your physician or cardiologist. Some people with severe CHF may need to have their dental treatment in a hospital setting. This includes people whose disease is considered class III or IV under the New York Heart Association functional classification system. Oral Effects At the Dentist 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 you need to take antibiotics before treatment. |
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