Oral Health and Heart Disease
Benico Barzilai, MD
Section Head, Clinical Cardiology
Robert and Suzanne Tomsich Department of
Is there a link between periodontal disease and cardiovascular disease?
Researchers and government agencies continue to investigate the possible relationship between periodontal disease and cardiovascular disease. Some studies have shown that bacteria in the mouth that are involved in the development of periodontal disease can move into the bloodstream and cause an elevation in C-reactive protein, a marker for inflammation in the blood vessels. These changes can, in turn, increase the risk of heart disease and stroke.
There is research to both support and refute the possible link between periodontal disease and cardiovascular disease, and more studies are needed to see how the two may be linked. Regardless of the relationship, maintaining optimal oral hygiene is an important component of your overall health.
What are the benefits of proper oral care?
You can reduce the chance of developing dental decay, gum inflammation and oral infections such as abscess formation by taking good care of your teeth and gums. Optimal dental care includes:
- Seeking professional dental care every six months
- Brushing your teeth a minimum of twice daily
- Regularly flossing your teeth
- Making sure dentures fit properly
If you have cardiovascular disease, what should you tell your dentist?
First, make sure you give your dentist a complete medical history and list of the names and dosages of all the drugs you are taking for your cardiovascular condition (as well as any other prescription or nonprescription drugs you might be taking). This will help your dentist determine the best treatment for you, including medication 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 make your cardiovascular condition worse, talk with your dentist. He or she can provide you with information and work with you on strategies to control dental pain and ease your fears.
What cardiovascular diseases require specific care?
The following list contains information about some of these conditions and the proper precautions you may need to take. Please note that this is not an all-inclusive list of conditions. If you have any questions or concerns about dental care and your particular cardiovascular condition, be sure to talk to your dentist.
If you have cardiovascular disease and need oral surgery, you should talk to your dentist or surgeon about plans for pain control during and after surgery, including the use of anesthetics and sedation.
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. Traditionally, many of these patients were advised to take antibiotics before having dental work; however, the American Heart Association revised their guidelines to state that only people who are at the highest risk of developing bacterial endocarditis will reasonably benefit from taking preventive antibiotics before certain procedures.
Your doctor can tell you if you fall into the high-risk group. All patients scheduled for valve surgery need to have excellent oral hygiene and see a dentist before surgery because unhealthy teeth are one source of bacteria that can cause endocarditis.
Heart attack (myocardial infarction)
It is best to wait a minimum of six months after a heart attack before undergoing any extensive dental treatments. You do not need to wait to have a dental cleaning. Ask your dentist if oxygen and nitroglycerin are available in case a medical emergency should arise during your office visit.
Anticoagulants and Antiplatelet Medications
Be sure to tell your dentist 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.
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, your dentist will give you detailed oral hygiene instructions and might ask you to make more frequent dental visits for cleanings. 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, laser or diamond dental burs.
Patients with angina who are treated with calcium cannel blockers might experience gum overgrowth. In some cases, gum surgery might be required (see description in the High Blood Pressure section, above). Like patients with a history of heart attack, patients with angina might want to make sure oxygen and nitroglycerin are available in the dentist’s office in case of a medical emergency. Although patients with stable angina can typically undergo many dental procedures, patients with accelerating or unstable angina should not undergo nonessential (elective) dental procedures. These patients should have their heart evaluated by their cardiologist before having such procedures. Patients with unstable angina should have emergency dental care performed in a hospital equipped with cardiac monitoring capability.
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, 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 the use of fluoride gels, modified brushing or flossing techniques and strategies to help you maintain good oral hygiene.