Dental Care and the Heart Patient

Oral health is a very important factor when we consider the quality of daily living. The same holds true for you, the heart patient, but, in addition, your oral health can be CRITICAL to your life. Heart patients and their families should be aware of the necessity for regular dental care and good oral health, and the precautions which must be taken while receiving such care.

Here are some guidelines to follow when seeing your dentist. Remember that you should have specific recommendations made for you by your doctor.

Coronary Artery Disease (Angina, Heart Attack, Bypass Surgery)

Patients with stable angina can safely undergo routine dental care during short appointments. Keep your nitroglycerine within reach and let your dentist or hygienist know if you are in distress.

Patients with unstable angina, who require hospitalization or frequent medication changes, should postpone dental treatment until their condition has been stabilized. In the case of an emergency, dental treatment can be performed under controlled conditions, preferably in a hospital dental clinic.

Patients who have had a recent heart attack should postpone dental treatment for 3-6 months after their attack. Emergency dental treatment can be done under controlled conditions, preferably in the hospital.

Hypertension (High Blood Pressure)

Elective dental care should be postponed until your blood pressure is under control. Emergency care can be done under carefully controlled circumstances in the hospital.

Congestive Heart Failure

Most patients with congestive heart failure have regular dental care, but those who are having difficulty should consult with their physician prior to dental treatment for specific instructions and/or seek care in a hospital setting.

Valvular Disease

Patients with valvular disease, prosthetic valves, most congenital cardiac malformations, surgically constructed systemic pulmonary shunts, indwelling arterial-venous sheaths and Hickman lines, hypertrophic cardiomyopathy and history of bacterial endocarditis MUST receive prophylactic antibiotics prior to dental treatment to prevent infection of the heart tissues. Ask your cardiologist about specific regimes.

It is very important that the level of bacteria in the mouth is kept to a minimum with sensible oral hygiene practices to reduce the risk of bacteria entering the blood through the oral route and infecting the heart tissues. Regular dental care, including routine check-up and cleaning appointments at standard intervals (3, 4 or 6 months as determined by your dentist) and good oral hygiene practices will significantly reduce your risk of bacterial infection from the oral route. Your dentist and hygienist can help you to determine which of the many products, tools and techniques available will best suit your individual lifestyle and pocket book needs.

Dental care can be expensive (OHIP will only cover the cost of the initial exam and extractions and remains largely your responsibility, but the cost of dental neglect can be even higher!

Anticoagulation Therapy

Patients who take Coumadin or Aspirin may risk prolonged bleeding after dental treatments, especially extractions. Consultation with your cardiologist or family doctor is necessary prior to dental treatment and may require interruption of your medication for a short period of time.

Heart Transplant

Patients with heart transplants follow an anti-rejection drug regime which includes cyclosporine, azathioprine, equine ATG, and prednisone. These drugs render the individual susceptible to infections and the oral cavity should be assessed prior to surgery and post operatively to prevent infection from the oral route. The need for prophylactic antibiotics for invasive dental procedures is mandatory and the specific regime will be decided upon by your cardiac surgeon/cardiologist.

Regular routine dental care is strongly recommended to maintain a healthy oral environment, reduce the bacterial levels in the mouth and thus reduce the risk of infection from the oral route (see Valvular Disease).

As a heart patient, neglecting your oral health can seriously jeopardize your overall health. All the most sophisticated treatments in the world can fail due to infection from the oral cavity. Prevention is the key. See your dentist regularly.

- Information provided by the University of Ottawa Heart Institute