The oral cavity is considered to be the home where large number of bacteria resides. But if these bacteria get into the bloodstream, (which may happen during routine tooth cleaning which initiates slight bleeding) the bacteria can pose to be harmful. Streptococci, a bacteria found in abundance in oral cavity can cause deposition of unwanted clots on heart valves, leading to “infective endocarditis” – an infection of the inner lining of the heart. Although it is rare but when it occurs it can prove to be fatal.
CARDIAC DISEASES AFFECTING ORAL HEALTH
- High Blood Pressure (Hypertension): Anti – hypertensives can cause decreased salivary flow leading to dry mouth, altered sense of taste. Increased blood pressure may make you more likely to faint when you are raised from sitting or flat position in the dentist’s chair to stand quickly. Calcium Channel blockers also can cause gingival overgrowth.
- Myocardial Infarction (Heart Attack): 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 and radiates towards left shoulder or arm.
- Angina: The pain of Angina radiates towards the lower jaw. Calcium Channel blocker prescribed for angina can cause gingival overgrowth this much that they may possess difficulty in chewing.
- Stroke: It eventually causes paralysis which may possess difficulty in speaking and swallowing, altered sensitivity to pain, inability to maintain oral hygiene.
- RECOMMENDED DENTAL PROTOCOL TO BE FOLLOWED IN CARDIAC PATIENTS
- Physician / Cardiologist consent – It is mandatory for a physician /cardiologist consultation before initiating any dental surgical procedure in a cardiac disease patient.
- Procedural Timing – Patients who have suffered a heart attack or undergone a surgical procedure should wait minimum six months before undergoing any dental procedure and must inform the dentist about any current or past prescribed medication especially blood thinners.
- Stress reduction protocol – Increased stress (either by the means of pain or anxiousness, uncomfortable clinical set up) increases the workload on heart, which may make cardiac patients more vulnerable to the dental treatment.
- Caution with the use of vasoconstrictors – Very frequently used, Adrenaline in Local Anesthetic can cause an increase in heart rate. Therefore, if using, use in minimal concentration. Plus, double aspiration is mandatory before depositing to make sure about avoiding any vascular structure. The epinephrine present in gingival retraction cords do gets absorbed into the systemic circulation and can affect the cardiovascular system.A vasoconstrictor is an absolute contraindication in patients with uncontrolled hypertension and unstable angina.Avoid Long appointments as the patient is medically compromised
- Oral anticoagulants therapy– should not be discontinued in the majority of patients. If the risk of bleeding of the procedure is more anticoagulants should be stopped at least 12-16 hours prior treatment. Minimize the risk of bleeding through oxidized cellulose, bone wax or collagen sponges and sutures. Constantly monitor and maintain the blood pressure.
- STRESS REDUCTION PROTOCOL
- Short morning appointments
- A calm clinical set – up
- Excellent pain control during and after the procedure
- Relieving the patient of anxiety by answering all his/her concerns
- Preoperative sedation, if required
- Use of N2O-O2 analgesia
PRE – TREATMENT ANTIBIOTIC
Indicated in people having following heart diseases :
- Infective endocarditis in past
- Patient having artificial heart valves
- Patient with shunts
- Any repaired heart defect
WHAT TO DO IN CARDIAC EMERGENCY
A clinician should be always prepared for any sort of unfortunate medical emergency.
- Cardiopulmonary resuscitation – The airway, breathing and circulation (the ABCs of CPR) are to be addressed on the first basis.
- Oxygen administration – for almost all medical emergency
- Nitroglycerine – in case of acute angina or myocardial infarction
- Aspirin – in case of infarction
- Call Ambulance – it is important to seek proper medical assistance for definitive care.
