Some people are at high risk of developing an infection of the inner lining of the heart (bacterial endocarditis). These patients must take special care to practice good oral hygiene every day. Many patients who are at the highest risk of developing bacterial endocarditis are advised to take preventive antibiotics before certain procedures. We will contact your doctor if you fall into the high-risk group. All patients scheduled for valve surgery need to have excellent oral hygiene and regular dental care before surgery because unhealthy teeth are one source of bacteria that can cause endocarditis.
All dental procedures that involve manipulation of gingival tissue or the periapical region of teeth, or perforation of the oral mucosa for which prophylaxis is reasonable in patients with cardiac conditions listed highest risk of adverse outcomes from endocarditis, including:
- Prosthetic cardiac valve or prosthetic material used in valve repair
- Previous endocarditis
- Congenital heart disease only in the following categories:
Heart attack (myocardial infarction)
- Unrepaired cyanotic congenital heart disease, including those with palliative shunts and conduits
- Completely repaired congenital heart disease with prosthetic material or device, whether placed by surgery or catheter intervention, during the first six months after the procedure
- Repaired congenital heart disease with residual defects at the site or adjacent to the site of a prosthetic patch or prosthetic device (which inhibit endothelialization)
- Cardiac transplantation recipients with cardiac valvular disease
- Prophylaxis is reasonable because endothelialization of prosthetic material occurs within six months after the procedure.
It is best to wait a minimum of six months after a heart attack before undergoing any extensive dental treatments. However if emergency treatment is required we are best trained and equipped to support during your treatment.
Anticoagulants and anti-platelet medications
Be sure to tell us if you are taking anticoagulants (blood-thinning drugs) such as Warfarin (Coumadin). These medications could result in excessive bleeding during some oral surgery procedures. Many patients with cardiovascular disease take an antiplatelet medication called clopidogrel (Plavix), particularly patients with drug-eluting stents. Never stop taking Plavix without talking to your cardiologist. Also, if you are on aspirin do not cease the medication.
High blood pressure (hypertension)
Some antihypertensive medicines can cause dry mouth or alter your sense of taste. Calcium channel blockers, in particular, may cause the gum tissue to swell and overgrow, causing problems with chewing. If you do experience gum overgrowth, we will provide you with a preventative programme to eliminate these issues. Although rare, gum surgery is sometimes needed. A procedure called a gingivectomy can be done to remove excess gum tissue. During this procedure, excessive gum tissue is removed with a scalpel, electrosurgery unit and laser or diamond dental burs. However, prevention is best.
Patients with angina who are treated with calcium channel blockers might also experience gum overgrowth. In some cases, gum surgery might be required. Patients with stable angina can typically undergo many dental procedures, patients with accelerating or unstable angina will require additional precautions. We may recommend you have further evaluation of your condition by your cardiologist before having such procedures.
Tell your dentist if you are taking anticoagulants (blood-thinning medications). These medications could cause excessive bleeding during some oral surgery procedures. If your stroke has resulted in an inability to produce an adequate amount of saliva, the use of artificial saliva may be required. If your stroke has affected your face, tongue or dominant hand and arm, we can provide you with numerous strategies to help you maintain good oral hygiene.
Dentistry for cardiac health in GSDC: taking care of your gums and your heart
Regardless of the root causes for cardiovascular diseases, at GSDC we believe that good nutrition and good oral hygiene help control bacterial inflammation in the mouth. Additionally, these good habits are essential to help lower risk factors and prevent heart disease. We help our patients understand that choosing a diet high in nutrients, removing oral bacteria meticulously on a daily basis and having regular periodic professional cleanings and dental check-ups will help reduce unnecessary risk factors that can lead to heart disease and stroke. We are dedicated to providing the highest level of dental care for optimum cardiac health.