Cardiovascular Disease

There are cardiovascular diseases that can affect your oral health. They will also require changing your dental treatments and how you get dental care. There is research that shows a link between coronary artery disease and periodontal disease. There is also research that links strokes with periodontal disease. However, there is not enough research to show that periodontal disease actually causes coronary artery disease or strokes.

Periodontal disease will affect your general health. Over time, this will increase the risk for heart disease and strokes. Research shows that people with periodontal disease are more likely to get coronary artery disease then people with healthy mouths. Scientists have two possible explanations for this. First, bacteria that cause periodontal disease can release toxins into the bloodstream. They may travel through the bloodstream and help in the forming of fatty plaques in the arteries. The plaque deposits will block the blood flow and may lead to serious complications like blood clots. Second, bacteria will prompt the liver to produce high levels of protein. They will inflame the blood vessels and could lead the heart to an attack or a stroke. Symptoms of this periodontal disease are

consistent bad breath
red, swelling, or tender gums
bleeding gums after brushing
um that have already pulled away from your teeth
teeth that are loose
a change in the way your teeth come together when you bite

If you have symptoms of periodontal disease then you must see your dentist as soon as possible so that you can get treated immediately.

Will heart disease affect your dental treatment?

Patients with heart conditions are at a higher risk for endocarditis. It is an infection of the heart and it can be life threatening. It happens when the bacteria in the bloodstream attaches themselves to damaged heart valves or damaged heart tissues. People with certain heart conditions must take antibiotics before any dental treatment that involves bleeding.

In 2007, the American Heart Association updated its guidelines on using antibiotics prior to a dental treatment. The policy advises antibiotic use for lesser people. It is more lenient now although pre-treatment with antibiotics is still recommended especially for people who have had endocarditis before. Antibiotics are also recommended for people with artificial hearts, people who went through heart transplants and people who have developed heart valve problems.

Antibiotics prior to dental treatments are also recommended for people who have had heart conditions when they were born. Those involved may be

People with cyanotic heart disease, shunts and conduits
People with heart defects that were completely repaired with a prosthetic material or device. Antibiotics are advised for the first six months after the treatment
People who have gone through heart repair

Antibiotics before dental treatment are no longer advised for people with

mitral valve prolapse
acquired heart valve dysfunction like rheumatic heart disease
bicuspid valve disease
calcified aortic stenosis
congenital heart conditions like ventricular septal defect, atrial septal defect, and hypertrophic cardiomyopathy

The American Heart Association guidelines advise antibiotics before dental procedures that involve incisions or manipulation of the gum tissues near the root of the tooth. Antibiotics are not required in the following cases

routine anaesthetic injections on uninfected tissues
x-rays
when dentures are being placed
placing or adjusting orthodontic appliances like braces
placement of the bracket parts of the braces
the natural loss of baby teeth in children
bleeding from a trauma to the lips or the mouth

How will Myocardial Infraction affect dental treatment?

Myocardial infraction or a heart attack will feel like pain that begins in the chest and spreads to the lower jaw. You should wait for at least six months after a heart attack before you have any dental treatments. On your next appointment, your dentist must have oxygen and nitroglycerin available. Your dentist and your physician must discuss your condition before any of your dental treatments. Some of the medicines that you take will change the way your dentist treats you. For instance, if you are taking blood thinning drugs or anticoagulants then your blood is less likely to clot. Your dentist should know about the medicines that you take and how much of it you take.

How will hypertension affect dental treatment?

Drugs that treat hypertension can cause dry mouth or altered tasting. Other drugs can make you faint when you are raised from a moderately flat position in your dentist's chair. You may have gum overgrowth as a side effect when you take drugs that are meant to treat hypertension. Calcium channel blockers are one of the drugs that have this effect. These effects can begin as early as one month after you begin your drug therapy. Some people will end up with gums that are so large. They end up having difficulty chewing. In some cases, surgery is even needed to remove part of your gums.

People with high blood pressure should have it checked during their dental visits. Your dentist will decide whether it is alright for you to have a non-emergency dental treatment. This will depend on

your blood pressure
if your blood pressure is under control
your other medical conditions

On the first time you visit your dental office after being diagnosed with blood pressure, your dentist may have to take your blood pressure several times to establish a baseline blood pressure. In this way, the dentist will know if your blood pressure is changing in response to treatments and medications. Several people with high blood pressure are able to take anti-anxiety drugs like nitrous oxide or Valium during dental procedures. They may receive a local anaesthetic even if it contains epinephrine. You should talk to your dentist if you are concerned about these drugs.

People taking calcium channel blockers may notice a gum overgrowth. This is also known as hyperplasia. Your dentist will give you specific instructions on this. They may even ask you to visit the dental office more often for professional cleaning. If you stop taking these drugs then your gums may recede. However, this may take several months before they return to normal. Sometimes, people's gums don't even return to normal. In these cases, you may have to go through gum surgery.

You should make sure that your dentist knows which drugs you take for high blood pressure. Even before your dental visits, take your medications like you usually do.

How will a coronary artery bypass graft affect your dental treatments?

There are no oral effects after this procedure although you may feel a lot of pain when you recline on the dentist's chair. This is a side effect of the surgery and you may experience this for the first few months. You should work with your dentist to find a comfortable position on the chair. People who have had coronary bypass graft surgery do not require antibiotics before dental treatments unless they really need dental treatment within a few weeks after the operation.

How will angina affect your dental treatments?

Angina is a pain that starts at the chest and reaches up to your lower jaw. People with angina may take drugs called calcium channel blockers. These drugs can cause too much growth in your gums or gingival hyperplasia. It can happen as soon as a month right after you take the drugs. There are people whose gums may become so large that they have difficulty chewing. In some cases, gum surgery may be necessary.

People with angina are treated just like the other patients although with some slight differences. Your dentist must have oxygen and nitroglycerin available during your visits and you must talk to your physician prior to any dental appointment. People with angina must not receive non-emergency dental care but if dental care is really needed, your heart must be monitored continuously.

Stress could trigger an angina attack. You should talk to your dentist about ways to reduce stress during these appointments. Bring your medicines when you go to the dentist's office and if ever you feel any pain in your chest, simply notify them.

How will high cholesterol affect dental treatments?

People who have high cholesterol have too much fat in their blood. Some drugs that are used to treat high cholesterol could make you feel faint after getting up from the dental chair. This condition will put you at risk of hardening your arteries and can lead to a heart attack or a stroke. Your dentist should know about your condition, the drugs you take, and their respective dosages. There are drugs for high cholesterol that may conflict with drugs that a dentist prescribes so you should inform your dentist about all your medications.

How will a stroke affect your dental treatments?

A stroke can have many long term effects and they may include

paralysis
difficulty in speaking and in swallowing
an increase or a decrease in sensitivity to pain
blurred vision
poor memory
changes in personality like anxiety and depression

A stroke may paralyze one side of the body so if such misfortune happens to you, ask a family member, guardian, or a caregiver to help you with your daily dental care. There are special toothbrushes and flosses for this special situation. In addition, your dentures may have to be remade or adjusted.

If your face or if your tongue becomes paralyzed then you may not be able to clean your mouth properly. There are times where you forget that there is food in your mouth. You may bite your lip or bite your tongue and not even realize what you just did. In order to keep your teeth and your gums healthy, your dentist will suggest fluoride products or saliva substitutes.

There are stroke survivors that take blood thinners. If you are taking these drugs then you should talk to your dentist before you have any dental treatments. Blood thinning medications will make the blood less likely to clot and may cause excessive bleeding during a surgery. Normally, a routine dental appointment is safe but make sure to always bring your most recent blood test results on your appointments.

How can congestive heart failure affect your dental treatment?

A lot of medicines that are used to treat congestive heart failure or CHF cause dry mouth. Dentists usually refer to this as xerostomia. If you are being treated for CHF and there are no complications, physical limitations, or side effects then there aren't many changes needed for dental treatment. However, some changes may be made due to the medicines you take, their dosage, and your physical well-being.

People who have serious heart problems should not lie down in the dental chair too far because the fluid that builds up in their lungs may hamper their breathing. They should take it slow when they change their positions like when they stand from sitting down, when are lying down to sitting down, and so on. The changes may make the patient dizzy and light-headed. When your dentist talks to your physician or to your cardiologist, the seriousness of your congestive heart failure will be known. If you have serious CHF then you must consider getting your dental treatment in a hospital. If your disease is classified as a class III or a class IV under the New York Heart Association then have your dental treatment done at a hospital.

How can a pacemaker implantation affect your dental treatment?

If you have a pacemaker then you must confirm that there are no electromagnetic interactions between your dentist's tools and your pacemaker. There are some machines at your dentist's office that could potentially interact and cause problems with your pacemaker. Some examples will include the ultrasound and the electrosurgery. Even if the chance of interaction is very small, you should still be aware of it and take the necessary precautions. You, your dentist, and your physician should talk about the interactions that are possible with your dentist's equipment and the pacemaker. If there are any chances of interaction the necessary steps must be taken in order to prevent any accidents from occurring.

You must stay away from any elective dental care in the first few weeks upon receiving your pacemaker. If you have to receive dental care at that time then your dentist or your physician should decide if pre-treatment antibiotics are needed.