Banner.  Girl flossing


Cardiovascular Diseases

Some cardiovascular (heart and artery) diseases 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. Treatment of periodontal disease can reduce overall inflammation in the body. However, there is no evidence that it prevents heart disease, heart attack or stroke.

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

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 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:

  • 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 soon for treatment.

Heart Disease and Dental 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 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 conditions 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

Taking antibiotics before dental treatment is no longer 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 non-infected 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

Heart Attack (Myocardial Infarction)

Oral Effects
A heart attack can sometimes feel like pain that starts in the chest and spreads to the lower jaw. Other times it may be pain that starts in the jaw or in the left arm or shoulder.

At the Dentist
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. 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 deep scaling (cleaning) of your gums, gum surgery (periodontal surgery) or extractions.

High Blood Pressure (Hypertension)

Oral Effects
Some drugs that treat high blood pressure (anti-hypertensive medicines) cause dry mouth (xerostomia) 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 quickly. This reaction is called orthostatic hypotension.

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 overgrown gum tissue.

At the Dentist
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 safe