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Heart diseases have become increasingly common in society and are now visible in people of all ages. How do they affect the choices available for permanent teeth replacement? We have the answer.

When we are talking about patients with heart disease, it is important to realize that this actually includes a number of very different conditions, ranging from high blood pressure and patients who have suffered from angina or myocardial infarctions (heart attacks) to people with an erratic heart rhythm and those who have had valve reconstruction or pacemakers installed.

The ages of these patients vary widely, as can their need for permanent teeth replacement.

The severity of all of these diseases also differs, and thus a detailed history and consent from the patient’s physician (if deemed necessary) must be obtained before planning for permanent tooth replacement in heart disease patients [1].

Dental Implants In Heart Disease Patients

The first question that patients often ask is whether dental implants should be placed in people with heart disease. The answer to that is an unequivocal yes. There is absolutely no reason why patients who are receiving treatment for heart diseases or who have suffered serious cardiac incidents in the past should not be considered for dental implants [1].

The exact nature of their heart condition, however, will alter the process somewhat.

A number of cardiac patients are on anticoagulants or blood thinners which means that a test to determine the ability of the blood to form clots must be performed before a surgical procedure is undertaken [2].

The surgical procedure to place dental implants may be altered and done in a ‘flapless’ manner that minimizes bleeding and also helps reduce the post-operative healing time. There was a time when dentists were advised to stop the blood thinners a few days before the procedure, however, that is not the current protocol. The risk of suffering another cardiac incident is far greater than the risk of increased bleeding during a dental procedure because it can easily be managed by local hemostatic measures [3].

For patients who are on high blood pressure medication, it is advised that they continue their medication as advised by their physician and get a blood pressure reading during the treatment planning as well as on the day of the surgery [4]. For patients who fall within the normal range there is nothing additional that needs to be done and the treatment can proceed as normal. There is no additional risk of failure or long-term complication that needs to be worried about [5].

In the case of a patient who has suffered a heart attack, all non-essential dental treatment must be deferred by at least six months. This includes permanent tooth replacement through the use of dental implants or any other method [6]. Once the six months are up, patients are advised to get an all-clear from their physicians before getting dental implants placed.

After getting approval, myocardial infarction patients are treated as high-risk patients and all necessary precautions — like having emergency medication ready — must be taken during the implant surgery.  The same is true for patients who had an episode of angina or suffer from cardiac arrhythmia [7].

Dental implants are an excellent option for cardiac patients when it comes to permanent teeth replacement options because they allow the patients to have a healthy, unrestricted diet, require minimal maintenance and are less likely to have plaque build-up than other options [8].

All things considered, it is clear that dental implants are an excellent choice for patients with heart disease even though certain precautions have to be taken in treatment planning and during the procedure itself.

Dental crowns and bridges in heart disease patients

There is a tenuous link that has been established between the occurrence of gum disease and heart disease [9]. While this may suggest that heart disease patients are more likely to lose their teeth to gum disease, it does not in any way mean that their teeth are not strong enough to provide support for crowns and bridges.

Each tooth must be individually evaluated and if found healthy, can be used to help fabricate crowns and bridges without any hesitation.

The advantage of this treatment method to provide permanent tooth replacement in heart disease patients is that even those patients that have been ruled medically unfit or are reeling under medical expenses can get their dentition rehabilitated relatively quickly.

The same sort of precautions applies in this case as well, although, the lack of any surgical procedure makes the bar much lower for patients to clear. One of the things that dentists need to be careful about during the tooth preparation stage is the risk of infective endocarditis where bacterial contamination can cause a life-threatening contamination of artificial valves in the heart [10].

Antibiotic premedication is a must in such cases with the recommendation from the American Heart Association being the accepted protocol around the world.

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