Cardiovascular Diseases

Some cardiovascular diseases may affect your oral health. They also may require changes in your dental treatment and how you receive dental care. Some 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.

Periodontal disease can affect your overall health. Over time, it may increase the risk for heart disease and stroke. Several studies have shown that people with periodontal disease may be more likely to have coronary artery disease than people with healthy mouths.

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 block blood flow. They can lead to serious complications, such as blood clots.

The other explanation is that these bacteria cause the liver to make high levels of certain proteins. These proteins inflame the blood vessels. This inflammation eventually could lead to a heart attack or stroke.

Symptoms of periodontal disease include:

Persistent bad breath
Red, swollen or tender gums
Gums that bleed when you brush your teeth
Gums that have pulled away from the teeth
Loose teeth
A change in the way your teeth come together when you bite down

If you have symptoms of periodontal disease, see your dentist for treatment.

Patients with certain heart conditions have a higher risk of endocarditis. This is an infection of the heart. It can be life threatening. It happens when bacteria in the bloodstream attach to damaged heart valves or other damaged heart tissue.

People with certain heart conditions may need antibiotics before they have dental treatment that is likely to cause bleeding.

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:

Cyanotic heart disease that has not been repaired or was repaired incompletely. This includes people with shunts and conduits.
A heart defect that was completely repaired with a prosthetic material or device. In this case, antibiotics are advised only for the first six months after the procedure.
Any repaired heart defect that still has some defect at or next to the site of a prosthetic patch or device

Antibiotics before dental work no longer are advised for people with:

Acquired heart valve dysfunction (for example, rheumatic heart disease)
Mitral valve prolapse
Bicuspid valve disease
Calcified aortic stenosis
Congenital heart conditions, such as ventricular septal defect, atrial septal defect, and hypertrophic cardiomyopathy

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:

Routine anesthetic injections through noninfected tissue
X-rays
Placement of dentures
Placement or adjustment of removable orthodontic appliances
Placement of the bracket part of braces (not bands)
The natural loss of baby teeth in children
Bleeding from trauma to the lips or mouth

A heart attack can sometimes feel like pain that starts in the chest and spread to the lower jaw.

You should wait at least six months after a heart attack to have most dental treatments. Your dentist should have oxygen and nitroglycerin available during your appointment. Your dentist and physician should discuss your condition before dental treatment.

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. Let your dentist know the medicines you take, and their doses.

Some drugs that treat high blood pressure (anti-hypertensive medications) cause dry mouth or an altered sense of taste (dysgeusia). Others may make you more likely to faint when you are raised from the relatively flat position in the dentist's chair to a sitting or standing position.

Gum overgrowth is a possible side effect of some drugs that treat high blood pressure, such as 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.

If you have high blood pressure, your dentist should check your blood pressure at each visit. Your dentist can decide whether it's OK for you to have non-emergency dental treatment. It will depend on:

How high your blood pressure is
How well your blood pressure is controlled
Whether you have other medical conditions

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 (also called gingival hyperplasia). Your dentist will give you detailed oral hygiene instructions and may ask you to visit more often for professional cleanings. 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.

There are no oral effects of this procedure.

For the first couple of weeks after surgery, you may feel severe pain when reclining in the dental chair. This is a side effect of the surgery. Work with your dentist to find a comfortable position in the chair.

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.

Angina is pain that starts in the chest. Sometimes it spreads to your lower jaw.

Some people with angina take drugs called calcium channel blockers. These drugs can cause gum overgrowth (gingival hyperplasia). 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. Sometimes, people need gum surgery.

People with stable angina can be treated like any other patients, with a few differences. Your dentist should have oxygen and nitroglycerin available during your visit. Your dentist should talk to your physician before your appointment.

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. Talk to your dentist about ways to reduce stress during an appointment. Bring your medicines to the dentist's office. If you feel chest pain during your visit, tell your dentist.

People with high cholesterol have too much fat in their blood. There are no oral effects of high cholesterol.

Some drugs used to treat high cholesterol can make you feel faint after you get up from the dental chair. Also, this condition puts you at risk of hardening of the arteries. This can lead to a heart attack or stroke. Your dentist should know about your condition and the drugs you are taking. Some drugs taken for high cholesterol can cause problems when taken with certain drugs that a dentist may prescribe.

Stroke can cause many long-term effects. These include:

Paralysis
Difficulty speaking and swallowing
Increased or decreased sensitivity to pain
Blurred vision
Poor memory
Personality changes (anxiety, depression)

In some people, a stroke paralyzes one side of the body. If this happens to you, a family member or caregiver can help you with daily dental care. Special toothbrushes and floss holders also are available. If you wear dentures, they may need to be remade or 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.

Some stroke survivors take blood thinners. If you do take these drugs, talk to your dentist before having any major dental work done. Blood-thinning medicines make the blood less likely to clot. This could cause excessive bleeding during surgery. Usually, routine dental treatment is safe. Bring a copy of your most recent blood tests to your dentist at every visit.

Many medicines used to treat congestive heart failure (CHF) cause dry mouth. Dentists call dry mouth "xerostomia."

If you are being treated for CHF and have no complications, side effects or physical limitations, there are usually no special changes needed for the patient in dental treatment. However, the dentist may make some change, depending on the medicines you take and your overall health.

People with more severe heart failure should not lie down in the dental chair too far. The fluid build-up in their lungs may affect their breathing. They should also take it slow when changing position (standing to sitting, or lying down to sitting). These changes can make them dizzy and light-headed. Your dentist can confirm how serious your CHF is by talking with your physician or cardiologist. Some people with CHF should consider having 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.

There are no specific oral effects caused by having a pacemaker.

If you have a pacemaker, you should confirm that there are no interactions between electromagnetic devices in your dentist's office and your pacemaker. Certain machines that a dentist or dental hygienist may use could potentially interact and cause a problem with a pacemaker. Examples include machines used for ultrasound or electrosurgery. The chance of any interaction is very small. You or your dentist should be able to find out about interactions from your physician or from the pacemaker manufacturer. Talk with your physician about possible interactions before visiting the dental office. If there is a chance of interaction, your dentist can take precautions to prevent it.