Is there a link between periodontal disease and cardiovascular disease?
Various researchers and government agencies continue to investigate the possible relationship between periodontal disease and cardiovascular disease. Some researchers speculate that bacteria in the mouth that are involved in the development of periodontal disease move into the bloodstream and cause inflammation in the blood vessels — changes that, in turn, contribute to heart disease and stroke.
Studies have been conducted that both support and refute the possible link between these two diseases. Irrespective of the possible link between periodontal disease and cardiovascular disease, maintaining optimal oral hygiene is an important component of your overall health. Brushing your teeth a minimum of twice daily and regular flossing can reduce the incidence of dental decay, gum inflammation, and oral infections such as abscess formation.
Oral Health and Heart Disease
Benico Barzilai, MD
Section Head, Clinical Cardiology
Robert and Suzanne Tomsich Department of
I have cardiovascular disease. What do I need to know and/or tell my dentist to ensure that my dental encounter will be safe?
First, make sure you give your dentist a complete list of the names and dosages of all the medications you are taking for your cardiovascular condition (as well as any other prescription and non-prescription drugs that you might be taking). This will help your dentist decide on the best treatment course for you, including medicine selection for dental procedures.
Second, make sure to give your dentist the name and phone number of your doctor(s) in case your dentist needs to speak to him or her about your care.
Third, if you are particularly nervous about undergoing a dental procedure because you believe your stress, worry, and fears could result in a worsening of your cardiovascular condition, talk with your dentist. Your dentist can provide you with information and work with you on strategies for controlling dental pain and easing your fears.
The following section provides some additional advice and information for patients with specific cardiovascular diseases. (The following list is not all-inclusive of cardiovascular conditions. Never hesitate to ask your dentist specific questions about your dental plan of care in light of your particular cardiovascular disease.)
Heart attacks (myocardial infarction) — Optimally wait a minimum of six months after a heart attack before undergoing any extensive dental treatments, including dental cleaning. Tell your dentist if you are taking anticoagulants (blood-thinning drugs). These medicines could result in excessive bleeding during some oral surgery procedures. Ask your dentist if oxygen and nitroglycerin are available in case a medical emergency should arise during your office visit. Do not stop any of your heart medications including aspirin, anticoagulants, and blood pressure medications without speaking to your cardiologist first. This is particularly important for those patients who are on blood thinners related to coronary stent placement.
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, resulting in chewing difficulties. If you do experience gum overgrowth, your dentist will give you detailed oral hygiene instructions and might ask you to make more frequent dental visits for cleanings. Infrequently, gum surgery might be required. (A gingivectomy is the name of the surgical procedure performed to remove excess gum tissue.) Excessive gum tissue is removed with a scalpel, electrosurgery unit, laser, or with diamond dental burs. If your dental procedure requires the use of anesthesia, ask your dentist if the anesthesia contains epinephrine. Epinephrine is a common additive in local anesthesia products. Use of epinephrine in some patients with hypertension or other cardiovascular conditions such as coronary artery disease might result in cardiovascular changes — including the rapid development of dangerously high blood pressure, angina, heart attack, and arrhythmias — and therefore should be used with caution.
Angina — Patients with angina treated with calcium channel blockers might experience gum overgrowth. In some cases, gum surgery might be required. Like patients with previous heart attacks, patients with angina should ask their dentists if oxygen and nitroglycerin are available in case a medical emergency should arise. While patients with stable angina can typically undergo many dental procedures, patients with accelerating or unstable angina should not undergo elective (non-essential) dental procedures, and instead have their hearts evaluated first at the hospital. In unstable angina patients, emergency dental care should be performed in a hospital equipped with cardiac monitoring capability.
Stroke — Tell your dentist if you are taking anticoagulants (blood-thinning medications). These medicines could result in excessive bleeding during some oral surgery procedures. If your stroke has resulted in an inability to produce an adequate amount of saliva, your dentist might recommend the use of artificial saliva. If your stroke has affected your face, tongue, or dominant hand and arm, your dentist might also recommend use of fluoride gels, modified brushing or flossing techniques, and strategies you can use to assist you in maintaining good oral hygiene.
Heart failure — Some medicines used to treat heart failure (such as diuretics) can cause dry mouth.
This information is provided by Cleveland Clinic and is not intended to replace
the medical advice of your doctor or health care provider.
Please consult your health care provider for advice about a specific medical condition.
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