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The Link Between Oral Health and Heart Disease

"How can my oral health affect my heart condition?"
By: Michelle S. Segarra, DMD, MOHThe Link Between Oral Health and Heart Disease

In the last few years, much has been written about the connection between the mouth and the heart.

Periodontitis or disease of the gums and supporting structures of the teeth, has been linked to several systemic conditions such as diabetes, cardiovascular disease particularly myocardial infarct and stroke, respiratory diseases and pre-term, low birth-weight babies. Among these systemic diseases, diabetes seems to have the strongest evidence of a bi-directional relationship with periodontal disease. With regards to heart disease and periodontitis, recent systematic reviews showed that there is a small increased risk of coronary heart disease with periodontitis compared to other factors such as hyperlipidemia, obesity or smoking and that there is almost 20% increase in fatal heart attack in the presence of periodontal disease. 

Symptoms of Periodontal Disease

As periodontal disease is a risk factor for heart disease, it is important that we know if we have the disease. If you have these symptoms, it is advisable to consult the dentist as soon as possible.

  • Persistent bad breath
  • Red or swollen gums
  • Tender or bleeding gums
  • Painful chewing
  • Loose teeth
  • Sensitive teeth
  • Receding gums that make the teeth appear longer

Precautionary Measures Prior and During Dental Treatment

A.   Prophylactic or Preventive Antibiotics - Precautions for patient with heart disease are necessary as they are at higher risk for bacterial or infective endocarditis, a condition that develops when bacteria travel into the bloodstream and attach to damaged heart tissues. The judicious and careful use of antibiotics can help prevent the development of this life-threatening condition. The dentist prescribes to the patient an antibiotic that he/she has to take a few hours before the dental procedure.

Below is a summary of the 2007 American Heart Association Guidelines on the use of antibiotics for dental procedures:

1.   Patient selection - The use of prophylactic antibiotic is recommended for patients with the following conditions:

  • prosthetic cardiac valve or prosthetic material used for cardiac valve repair
  • a history of infective endocarditis
  • a cardiac transplant that develops cardiac valvulopathy
  • the following congenital (present from birth) heart disease
    • unrepaired cyanotic congenital heart disease, including palliative shunts and conduits
    • a completely repaired congenital heart defect with prosthetic material or device, whether placed by surgery or by catheter intervention, during the first six months after the procedure
    • any repaired congenital heart defect with residual defect at the site or adjacent to the site of a prosthetic patch or a prosthetic device (that inhibit endothelialization)

2.   When to give prophylactic antibiotics - Prophylaxis is recommended for all dental procedures that involve manipulation of the gums and alveolar bone or perforation of the soft structures of the mouth.

3.   What if the patient forgets to premedicate? - “If the dosage of antibiotic is inadvertently not administered before the procedure, the dosage may be administered up to two hours after the procedure.”

4.   Drug interactions - If the patient is already taking another antibiotic for a different condition, the guidelines advise that the dentist select an antibiotic from a different class

B.   Precautions DURING dental treatment - These are precautions that should be observed during treatment of patients with known heart conditions.

  • Myocardial infarction (Heart attack)
    • Wait at least six months after a heart attack. The clinic should be equipped with oxygen and nitroglycerin. The patient should always discuss with his medical physician first before undergoing dental treatment.
    • If the patient is taking an anti-coagulant or blood thinner, the risk of bleeding is increased as the blood is less likely to clot. The patient may need to stop taking the anti-coagulant before the dental procedure, under his physician’s supervision. The patient should inform his dentist of any medication he is currently taking.
    • In some situations, blood tests may be necessary such as during periodontal surgery of complicated extractions.
  • Hypertension (High Blood Pressure)
    • The dentist should monitor the patient’s blood pressure (how high, whether the hypertension is controlled, and if the patient has other medical conditions).
    • Most patients with high blood pressure can take anti-anxiety drugs but only with the strict supervision of the dentist and the medial physician.
    • People taking calcium-channel blockers to control their blood pressure may have increased gum growth (gingival hyperplasia).
  • Coronary Artery Bypass Graft (CABG)
    • The patient may experience severe chest pain when reclining in a dental chair if the surgery is still recent. The dentist should find the most comfortable position for the patient.
    • The use of prophylactic antibiotic is not necessary unless an emergency procedure is needed within a few weeks after the surgery.
    • The medical physician should be consulted if the dental procedure is to be done within six months after the graft.
  • Angina Pectoris
    • Patients with stable angina pectoris can be treated normally. However, oxygen and nitroglycerin should be readily available.
    • Do not give non-emergency dental treatment to patients with unstable angina pectoris.
    • Prevent any stress to the patient as stress can trigger angina.
  • Hyperlipedemia (High Cholesterol)
    • Consider medications taken by the patient as some medications for hyperlipedimia can cause hardening of the arteries which can lead to heart attack or stroke.
  • Stroke
    • Consider the patient’s use of anticoagulants or blood thinners as they can cause bleeding due to reduced ability to form blood clots.
    • The patient should get clearance from the medical physician before any medication is stopped. The dentist and the physician should thoroughly discuss the patients’ medical condition before any dental procedure is done.
    • Routine dental treatment is usually safe.
  • Congestive Heart Failure
    • Some medications for CHF may cause dry mouth.
    • Patients with severe heart failure should not be placed in a lying down, complete reclining position as the fluid build-up in the lungs can affect breathing.
    • As always, there should be good coordination between the dentist and the physician
  • Pacemakers
    • The dentist should not use any device that can cause interactions or interferences with the pacemaker.
    • As much as possible, non-emergency dental treatment should be avoided within a few weeks after pacemaker placement. 
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