Optimal Dental care for cardiac patients
Talk to your dentist, primary care physician, and Cardiologist. Give your dentist a complete list of names and dosages of all drugs you are taking for your heart disease. Give your dentist the name and phone number of your Cardiologist if they wish to or need to discuss your condition. Ask your dentist if oxygen and nitroglycerin are available during your dental visit in case of emergency. Talk to your dentist about pain management during and after dental procedures including anesthetics and sedation. Visit your hygienist every three months for regular dental cleaning. Brush at least two times per day.
Floss regularly. Some heart conditions may need antibiotic prophylaxis before some dental procedures. There are several heart conditions requiring different types of management by your hygienist and your dentist.
Endocarditis
Patients with endocarditis have a high risk of developing an infection of the inner lining of the heart. Unhealthy teeth are a source of bacteria that cause endocarditis. These patients must take special care to practice oral hygiene everyday. Antibiotic prophylaxis has to be discussed and decided by your cardiologist.
American Heart Association (AHA) revises per research and data almost every few years. All patients scheduled for valve surgery should and need to have excellent oral hygiene and see a dentist before surgery.
Angina
Dental dare varies depending on the type of angina. If you have stable angina, you could have normal dental care. If you have unstable angina you should postpone all elective dental treatment. Emergency dental treatment can be performed in a hospital with cardiac monitoring capabilities.
Heart attack
What treatment was done? CABG/bypass surgery, or were any stents placed? Best to wait for 6 months after a heart attack before undergoing any extensive dental treatment. You can get a regular dental cleaning.
Heart failure
Patients with heart failure including those presenting palpitations, asthenia or dispense can get emergency dental care in hospital setting. Oral manifestations from some of the Medications used in heart conditions treatment: Are you taking any anticoagulants like Warfarin, Coumadin – if so tell your dentist. These medications cause excessive bleeding during oral surgery procedures. Are you taking any antiplatelet medications like Clopidogrel (Plavix) – if so, let your dentist know about it. Never stop taking anticoagulants without talking to your cardiologist.
Are you taking any beta blockers or ACE inhibitors like captopril or Enalapril? They have oral manifestations like Lichenoid reactions, burning mouth syndrome, loss of taste sensation etc. Are you taking any calcium channel blockers?
These are known to cause gum overgrowth and bleeding. Are you using any diuretics like Furosemide? This has a side effect of xerostomia or also know as dry mouth.
Are you taking Digitalis? If so, anesthesia with vasoconstrictor like epinephrine should be limited to around 2 carpules.
Ideal dental appointment for heart disease patients
- Morning hours
- Shorter appointments
- Semisupine position with control of body movements
- Avoid fast and abrupt movements which can cause orthostatic hypotension.
Antibiotic prophylaxis per AHA
Some of the conditions antibiotic prophylaxis are given as follows:
- Prosthetic valve or valve repair
- Certain congenital heart conditions
- History of endocarditis
- Heart transplant
- Sometimes heart attack can mimic asthma attack
- It is very important to communicate with your healthcare provider all the details about your health and thus take appropriate steps towards customized dental treatment.